By Charles Nicolson

Examples of diseases caused by viruses in humans include smallpox, the common cold, various types of influenza, measles, mumps, hepatitis, Ebola, poliomyelitis, HIV(AIDS), SARS, and others.

To-date, none of these have been completely eradicated, although specific vaccines and treatments have been developed which greatly diminish the severity of infections which, in turn, reduce symptoms and disease-related damages accordingly.

Viral diseases infecting humans tend to become epidemic (widespread) and then expand further becoming pandemic (world-wide).

The most devastating, although thankfully short-lived lethal pandemic in modern times, was the 1918/19 flu pandemic also known as The Spanish Flu. This was a particularly deadly influenza pandemic caused by the H1N1 influenza A virus.

The origin of the name ‘Spanish Flu’ comes from when it spread out from France into Spain in November 1918 during the final stages of World War 1. Spain was not involved in the war, having remained neutral, Spanish newspapers were therefore not under censorship and were able to report on one of the deadliest pandemics in human history.

The first wave was a typical flu epidemic. Those most at risk were the infirm and elderly, while younger, healthier people mostly recovered. When a second wave began, the virus had mutated to a much more deadly form. October 1918 was the month having the highest fatality rate of the entire pandemic occurring during a period when the flu killed more people in 24 weeks than HIV/AIDS killed in 24 years.

Electron micrograph of a re-created 1918 influenza virus.

By the time a third wave started during 1919, the virus had become a pandemic reaching as far south as Australia. At the beginning of 1920 a more minor fourth wave occurred but only in isolated areas around the world where mortality rates were very low. The overall death toll is estimated to have been in the range of 17 million to 50 million, although possibly as high as 100 million, making it one of the deadliest pandemics in recorded human history.

During the relatively short three-to-four year period of the Spanish Flu, another viral disease which had begun at least a thousand years earlier, was continuing a slower but inexorable spreading into a pandemic which afflicted virtually every corner of the earth directly or indirectly – poliomyelitis.

Many people, the writer included, have vivid personal memories of poliomyelitis in South Africa during the late 1940s and early 1950s. Memories of injections every 4 hours, day and night comprising substantial quantities of yellow liquid penicillin – not pleasant memories, but overladen with gratitude for dedicated people like Jonas Salk whose name will be always remembered for pioneering and developing the first successful anti-polio vaccine.

Although no major polio epidemics were recorded before the 20th century, the disease has caused paralysis and death for much of human history. It was only in the 1900s that epidemics began to occur in Europe followed by increasingly widespread epidemics in the US. By 1910, polio epidemics became regular events throughout the developed world primarily in cities during the summer months. At its peak in the 1940s and 1950s, polio paralysed or killed over half a million people worldwide every year. There was no known cure or preventative vaccine.

The consequences of the disease frequently left polio victims marked for life and created vivid images of wheelchairs, crutches, leg braces, deformed limbs and breathing devices, particularly the iron lung. The original iron lung was powered by an electric motor attached to two vacuum cleaners and worked by changing the pressure inside the machine.

When the pressure was lowered, the chest cavity expanded, trying to fill this partial vacuum. When the pressure was raised, the chest cavity contracted. These induced expansions and contractions followed the physical movements of normal breathing.

Charles Image 3 Iron LungAn iron lung

The design of the iron lung was subsequently improved by using a bellows attached directly to the machine and the design modified to make production less expensive. During polio epidemics the iron lung saved many thousands of lives but the machine was large, cumbersome and very expensive.

In the 1930s, an iron lung cost about USD1 500, about the same price as a normal residential home in the US. However, patients could be encased in the metal chambers for months, years and sometimes for life, although, even with an iron lung, the fatality rate for patients with various forms of polio often exceeded 90%. These drawbacks led to the development of more modern positive-pressure ventilators and the use of positive-pressure ventilation by tracheostomy.

Polio changed not only the lives of those who survived it, but was also a significant factor in cultural changes. Polio started the emergence of grassroots fund-raising campaigns that would revolutionise philanthropy across a broad medical field including rehabilitation therapy and, through campaigns for the social and civil rights of the disabled, polio survivors helped to spur the modern disability rights movement.

Probably the most influential person involved was the American President, Theodore Roosevelt, who kept his own lower body polio paralysis hidden from the public. Roosevelt organised funding for the non-profit National Institute of Infant Paralysis as a project, now historically known as the ‘March of Dimes’, which encouraged every American to send dimes to the White House to support treating polio victims and researching a cure. In the process, he changed American philanthropy, which had previously relied mainly on donations from the wealthy.

In 1954, the March of Dimes organised a national field trial of 1.8 million schoolchildren, the largest medical study in history. The data was processed and on April 12, 1955, six years from when Salk began his research, the Salk polio vaccine was declared “safe and effective.” Church bells rang and newspapers across the world claimed “Victory Over Polio.”, Concurrently, a research group, headed by John Enders at the Boston Children’s Hospital, successfully cultivated the poliovirus in human tissue.

This significant breakthrough ultimately determined the development of improved polio vaccines. Enders and his colleagues, Thomas H. Weller and Frederick C. Robbins, were recognised and rewarded with a Nobel Prize in 1954.

With the success of the polio vaccine, Jonas Salk, at age 39, became one of the most celebrated scientists in the world. He refused a patent for his work, declaring that the vaccine belonged to the people and that to patent it could be likened to “patenting the Sun.”

Recently, Bill Gates explained why the Bill and Melinda Gates Foundation had endorsed the eradication of polio worldwide as a top priority. He joined the World Health Organisation, UNICEF, Rotary International and others to help finish the job started by the Salk vaccine, to minimise the menace of polio. An additional envisioned benefit would be freeing up resources that would no longer have to be spent on the disease itself.

The Bill and Melinda Gates Foundation has been involved in helping to fight infectious diseases such as Ebola and malaria and has now included those due to coronavirus infections. On February 5, 2020, the foundation announced it would provide USD100-million to improve detection, isolation and treatment efforts and accelerate the development of coronavirus vaccines.

It is certainly alarming to see how the coronavirus (Covid-19) spreads in ways similar to poliomyelitis. On October 24, 2019, World Polio Day, the World Health Organisation announced that there were only 94 cases of wild polio existing in the entire world. The success of the polio vaccine started a whole series of vaccines that minimised or even negated many of the effects of these types of infectious diseases during the second half of the 20th century.

In the continuing and highly publicised global war against the coronavirus, Covid-19, it is quite extraordinary and heartening to see how citizens and governments of the world are rising to the occasion and demonstrating what is possible when we all work together.