Typhus epidemic in the ghetto – one of the most interesting medical stories

On 24th July, the results of research conducted by Lewi Stone, a professor of biomathematics at Tel Aviv University and RMIT University in Melbourne, and his team – including Stephan Lehnstaedt from Touro College Berlin – on the typhus epidemic in the Warsaw Ghetto in 1941 were published in the Science Advances journal. The scientist tells us about the fight that ghetto doctors had to put up to stop the disease and the factors that contributed to the victory over it

13 August 2020

You specialise in using mathematical modelling in the epidemiology of infectious diseases. How quickly does typhus spread compared to Covid-19?

Typhus is less contagious, but more deadly disease. Covid-19 kills about 1% of people infected, whereas the mortality rate of typhus is 20%. Typhus spreads very quickly.

Social distancing and following hygiene procedures are essential weapons in the fight against all infectious diseases. Was this even possible in the densely populated Warsaw Ghetto?

We have not focused on social distancing in our scientific article. Only a small part of it is dedicated to that issue. The media picked it up, and I don’t want to dwell on it. From the diaries written in the Warsaw Ghetto we can learn that people avoided the ghetto tram knowing that human lice carry typhus and that crowds should be avoided, if possible. They tried not to touch other people, stay away from them, and avoid crowded streets. Of course, it was very difficult in the ghetto. The rich stayed at home in self-isolation, they did not leave – that’s what we know from the ghetto-related literature.

The Germans locked about 800 doctors and nurses in the ghetto. How many people in this group were involved in the fight against the typhus epidemic?

Everyone. It was the most highly skilled medical staff in Poland, including excellent epidemiologists, e.g. Nobel Prize nominee Ludwik Hirszfeld (bacteriologist, immunologist, creator of seroanthropology, who treated patients with epidemic typhus in the ghetto and used vaccine smuggled from Lviv; in 1942, he managed to escape to the so-called Aryan side – editor’s note ). Typhus was a ghetto plague, so all doctors and nurses were involved in the fight against it. Many accounts have been preserved. Jakub Penson (co-founder of Polish nephrology, doctor in the Jewish Hospital in Warsaw – since 1941 in the ghetto, where he conducted research on epidemic typhus; he managed to escape in 1942 – editor’s note) was my hero. Doctors helped as much as they could, but it should also be said that some were corrupt. There was large-scale corruption affecting all aspects of life in the ghetto.

What does “superhuman medicine” mean to you – an expression created by Adina Blady-Szwajger, paediatrician in the Bersohn and Bauman Children’s Hospital located within the Warsaw Ghetto?

To me it means that doctors made superhuman effort to save lives 24 hours a day, seven days a week.

In his diaries, Emanuel Ringelblum also noted a significant slowdown in the typhus epidemic in the ghetto in November 1941. Was it only due to social distancing, or were there any other factors that contributed to this?

I quoted Ringeblum in my article. Doctors in the ghetto were astonished that the epidemic began to slow down. They couldn’t explain it. The epidemic did not go away naturally. And not because of social distancing. I suppose there were several factors involved, and education was one of them. Hundreds of lectures and seminars on typhus were organised in the ghetto.  The documents show that even as many as 900 people took part in them. An underground medical university was set up. The Ghetto population was educated on hygiene and how to behave to face the epidemic. People tried to change their clothes every day. They did what they could. In July, August and September 1941, the administration in the ghetto changed. The Germans were no longer interested in starving the Ghetto residents, they wanted to use them for work. Then, food supplies in the ghetto improved and the amount of food more than doubled. More community kitchens were established. This certainly contributed to a more effective fight against the epidemic. Typhus did not disappear on its own, external factors were involved, such as waste collection which was resumed after several months. The sanitary situation in the shelters for displaced persons improved to some extent.

If the ghetto residents had done absolutely nothing to stop the typhus epidemic, what toll could this disease have taken? What was the worst-case scenario?

As many as 75% of people, i.e. approx. 300,000, could have died. Meanwhile, 100,000 people died of hunger and diseases.

What kind of scientific tools did you use in your research?

The same ones that I use in my research on the spread of Covid-19 and other pandemics – mathematical modelling. I’ve been doing this for years.

Why did you become interested in the typhus epidemic in the Warsaw Ghetto?

I have already studied, for instance, the Spanish flu and the epidemic of measles in the UK before and after vaccination. But when I read about the typhus epidemic in the Warsaw Ghetto and saw the data, I knew how unusual it was. It started to slow down at the end of October – when it should have gained momentum. It’s one of the most interesting medical stories to me.

Interview conducted by Anna Kilian

Photo RMIT University