IRA FLATOW: This is Science Friday. I’m Ira Flatow. You’re always surprised to turn up an “I didn’t know that” story that has a surprising connection to how you’re living your life now. Well, that’s the case of our next story about the Warsaw ghetto.

80 years ago, this fall, the Warsaw ghetto was created, where nearly half a million Jews were housed before they were scheduled to be shipped to concentration camps. And, even as people were starving to death, they were dealt a deadly typhus outbreak. And now, almost 100 years later, researchers are learning about how public health interventions turned this typhus epidemic around, under nearly impossible circumstances.

Sci-Fri Producer, Kathleen Davis, has more about this story. Hi, Kathleen.

KATHLEEN DAVIS: Hey, Ira.

IRA FLATOW: Why are researchers, so many years later now, still looking through this point of history through a public health lens?

KATHLEEN DAVIS: Well, it’s a really fascinating story. So, as you mentioned, almost half a million Jews were imprisoned in the Warsaw ghetto. And, for the better part of 1941, there was this really terrible typhus outbreak there. You know what typhus is, I would assume.

IRA FLATOW: Yeah, it’s spread by lice.

KATHLEEN DAVIS: Yeah, and it can be really deadly. So typhus was rampant there. But, when the winter rolled around, a second wave was expected. But it never came.

IRA FLATOW: An expected second wave. Sounds kind of familiar.

KATHLEEN DAVIS: Right, well researchers have found evidence that special public health measures that were enacted, under these really impossible circumstances, worked. And the community was able to get a handle on typhus to keep away the second wave. And there might be some lessons for us here, too, because as I’m sure you have not forgotten, we are going through a pandemic right now.

IRA FLATOW: OK, tell us the rest of that story.

KATHLEEN DAVIS: I talked to Dr. Lewi Stone. He is a professor of theoretical biology at Tel Aviv University. He’s based in Melbourne, Australia. He’s one of the main researchers behind this study.

And, in my conversation with him, he started off by explaining what it was like to live in the Warsaw ghetto.

LEWI STONE (INTERVIEW RECORDING): Let’s put it this way. It was an area of 3.4 kilometers squared. Within that area, there was close to half a million people, 450,000 people. So you can imagine that’s like Central Park with half a million people. On top of that, there’s this huge problem that they were being starved out by the Nazis. And, on top of that, there was this huge typhus epidemic that was developing early 1941 and which is what my paper is about.

KATHLEEN DAVIS: And so you say that the typhus outbreak became a big problem at the early part of the year. How badly did it hit this community?

LEWI STONE (INTERVIEW RECORDING): So there were two phases. The first phase with starvation. So, initially, when the ghetto was opened in late 1941 and early 1941, almost zero food supplies. Every person had 200 calories per day. And that was it, if they were lucky. And the goal was to starve the population out, initially. And refugees came in in January, February because they continually concentrated people into the Warsaw ghetto.

And, with that, some typhus came in and ignited the epidemic. Now the two things worked together– starvation and typhus. They seemed to feed off each other and enhance each other. And, within a month or two, there was something like 5,000 people per month dying.

So the typhus itself built up. And, by October, it reached a peak. One could say that, in a year, about 100,000 people contracted typhus. That was the estimate of the time, which in 3.4 kilometers squared is quite a lot of disease going around.

KATHLEEN DAVIS: And so the Warsaw ghetto was hit hard, as you say, in the better part of 1941. And then what happened when winter rolled around?

LEWI STONE (INTERVIEW RECORDING): OK, the curious thing was winter– everyone was expecting the epidemic to get even worse than it was. And it was already very bad. But, strangely, in late October, November, the epidemic started to die out, in short. This was hardly noticed because the people were too busy just trying to survive. And we don’t have the modern surveillance that we have today.

I was sitting on this data set for quite some time. And I had to ask myself, why was the epidemic dying away just when winter was beginning? It’s very unusual because typhus, especially, accelerates in the winter. So that was the big question that initiated this study.

KATHLEEN DAVIS: And so, in this study, you found that public health interventions were taking place within this community. Can you walk us through what kind of interventions you found?

LEWI STONE (INTERVIEW RECORDING): So it turns out the Warsaw ghetto had a large number of really professional doctors and specialists from the Warsaw hospital. All the good scientists were dumped into the ghetto. We even find, in the ghetto, that there was a Nobel Prize nominee, Ludwig Hirschfeld, very famous bacteriologist and scientist. So there were these amazing doctors.

They had few resources. There were major limitations. But what they could do they did. And, number one, they ran very serious educational programs. So there’d be lecture courses and seminars open to the public on epidemiology, on sanitation, on hygiene. These lectures were drawing maybe 900 people, at a single shot. That was one thing.

Now, as well as lecturing about it, they tried to instill it into the population that they have to keep hygiene practices and sanitation. And so this was enforced in many different ways, as much as it could be. And people were shown how to get rid of lice. People were shown how to isolate and keep at a distance.

Now, there wasn’t social distancing, or face masks, as we know it. But people knew that this was a disease that you would catch by contact. So, every diary you read, people are trying to keep away from each other or avoid getting on the streets because they know this is a disease you catch in contact.

KATHLEEN DAVIS: So, while you were doing this research, you mentioned a little earlier that there were diary entries that you had found. What other types of evidence did you come across that proved that these interventions were happening at the time?

LEWI STONE (INTERVIEW RECORDING): OK, so we have the records of the ghetto itself– the famous Ringelblum Archives, which has many, many documents that were kept. And, before the Warsaw ghetto was completely destroyed, they buried these records in milk cans underground. And they were dug up after the war.

So we have many, many records of what went on. We also have survivors’ records. There are many of them. And we also have the records at the trials, where some of the key epidemiologists gave testimonies. So all of these give us a picture of what happened.

Now, I don’t want to give the complete wrong impression. We can’t be sure that these interventions necessarily curtailed the epidemic. But it’s the only sensible thing that we could come to. I think that one of the big contributions of our paper was that we built a model, a mathematical model, of the epidemic.

And it seemed the only possible way to explain this curtailing of the epidemic with that there must have been some intervention of some type that caused it to go down because what the model told us was, under natural conditions, it was impossible to fit the data with an epidemic model.

The only way you could do it is if, say, 70% of the population got infected. But we know that 70% of the population didn’t get infected. So something really had to dampen the epidemic in November 1941.

At the same time, we know that there was this huge effort. I mean, there were only two things on people’s minds in the lead up to November. One was food and two was how to get rid of this epidemic. So there was a huge, huge effort to try and do anything to get rid of it.

KATHLEEN DAVIS: So, despite the success for the Warsaw ghetto beating typhus, I want to be clear that this story probably doesn’t end happily for a lot of the people who lived here, is that right?

LEWI STONE (INTERVIEW RECORDING): Yeah, very few of the people, in fact. So we can say that, of the 450,000, maybe 100,000 people died during 1941 and early 1942. And then some 260,000 people were then shuttled off to the death camps, to Treblinka, in a matter of five or six weeks. So it’s a huge destruction and genocide.

KATHLEEN DAVIS: What we’re living through right now, with the COVID-19 pandemic, obviously is not directly comparable to what was happening in the Warsaw ghetto with typhus. But it does seem like there might be lessons that can be learned, in terms of how successful it seems they were at harnessing public health interventions. Do you think that there are takeaways here for us, in this modern time?

LEWI STONE (INTERVIEW RECORDING): As you said, COVID is a very different disease. COVID is a virus. Typhus is a bacteria. But, having worked with epidemics for decades, we always go back to previous pandemics or epidemics and try and get lessons on how to handle the next one.

So, yes, definitely intervention measures were helpful and always will be helpful in epidemics. I mean, these are things we learn from epidemic and pandemic after epidemic. There’s no doubting about it.

KATHLEEN DAVIS: And another thing that sticks out to me about this situation is that these people were living in impossible circumstances, but they were still listening to their epidemiologists and to their public health experts. I would imagine that plays a role in this, as well.

LEWI STONE (INTERVIEW RECORDING): Exactly, I mean, they had immense respect for their doctors and medical system. And I think it’s really outstanding that, even under this barbaric and diabolical regime of the Nazis, it was possible to run such a humane and highly professional health system, which probably has no equal in history of medicine, under such extreme situations.

So the ghetto really did build itself an amazing medical system. And the people appreciated it. Unfortunately, due to lack of resources, there weren’t many medicines and equipment. But the doctors, they would be going to people’s homes, chasing up patients, and working 24/7.

KATHLEEN DAVIS: That’s so amazing. We have, unfortunately, run out of time. But I would love to thank you for joining us today, Dr. Stone. Thank you so much.

LEWI STONE (INTERVIEW RECORDING): Thank you very much. Thank you.

KATHLEEN DAVIS: Dr. Lewi Stone, a professor of theoretical biology at Tel Aviv University. He is based in Melbourne, Australia.

IRA FLATOW: Sci-Fri Producer, Kathleen Davis, wow, that was really powerful, Kathleen.

KATHLEEN DAVIS: Yeah, it’s a really informative story. I think that learning about how people in the past dealt with disease, especially under really terrible circumstances, it can really help us think about our modern situations a little bit differently.

IRA FLATOW: Thanks, Kathleen.

KATHLEEN DAVIS: Thank you.

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