Louisa Jordan died from typhus fever at Kraguevatz in Serbia on March 16, 1915. The name of the new COVID-19 hospital in Glasgow commemorates her.
A nurse, she was born in Glasgow and had gone to Serbia to nurse wounded soldiers. A typhus fever epidemic started there at the beginning of 1915 and she took charge of a typhus ward. The epidemic lasted several months. It killed more than 170,000, including 126 Serbian doctors and five American Red Cross doctors. Typhus is transmitted by lice infected with the causative bacterium, Rickettsia prowazekii, a name memorialising Howard Ricketts and Stanislaus von Prowazek. Both contracted lethal infections when researching the disease.
Although typhus is caused by a bacterium, not a virus, and so is treatable with antibiotics, similarities with COVID-19 are uncanny. Cough and a fever are symptoms common to both. Both infect the cells lining small blood vessels, accounting for the severity of illness in many cases. And for both the mortality increases steadily with age, although in the pre-antibiotic era typhus was more lethal, killing about 1-2% of young children and more than 50% of the elderly. With modern treatment, the mortality rate is still greater than for COVID-19, with a rash and a universal headache and other effects on the brain distinguishing typhus from the modern disease; but a feature suggesting neurological effects of the latter is the occurrence of “happy hypoxia”, when patients are not breathing rapidly in spite of life-threateningly low levels of oxygen in the blood.
The rickettsiae are excreted in louse faeces and the commonest transmission route is by scratching through them. But just as with COVID-19, nurses and doctors get infected by breathing in the organism, although it is dried louse faeces for typhus and respiratory exhalations for COVID-19. And, as with COVID-19 today, once there was big political pressure to develop an effective vaccine.
In WW2 typhus had become a problem on the eastern front for the Germans. The one available to them had been developed by Rudolf Wiegl in Poland. It was made by infecting lice through the insect’s rectums, harvesting their intestines, and chemically killing the rickettsiae in them. For obvious reasons supplies were limited. Weigl’s laboratory was in Lwow, then in Poland. After occupation by the Germans, his activities had another benefit. Raising lice needed lots of louse feeders, people who had little cages strapped to their legs containing the lice. The Gestapo avoided them like the plague. Jewish lives were saved, including that of Stefan Banach, one of the stars of the Lwow school of mathematics, which met daily at the Scottish Cafe in Lwow, with their discussions and conjectures being recorded in a work called the Scottish Book. The other star, and a contributor to the Scottish Book, was Stanislaw Ulam, who left for Harvard in 1936 and became the co-inventor of the hydrogen bomb.
Ludwik Fleck was Jewish. He was a bacteriologist and worked with Weigl. He was put into the Lwow ghetto, where he made an experimental vaccine from the urine of people who had recovered from typhus. He was sent to Auschwitz, and was eventually transferred to the SS Institute of Virus and Typhus research at Buchenwald, where he continued to make his urine vaccine (that worked) for friends and a useless rabbit lung vaccine for the SS. A very useful by-product for the lab staff, all prisoners, was rabbit stew.
But Fleck was not only a bacteriologist. In 1935 he had published “Genesis and Development of a Scientific Fact”, a brilliant pioneering account of how science works, telling us why there is no such thing as “the science”. Solutions to a problem are deeply influenced by the training, experiences and assumptions of researchers. They are addressed by what he called a “thought collective.”
At its centre are experts practicing “journal science”, which is provisional, raw, and cautious. Then there are general experts practicing “handbook science”, nearly always a little out of date, with contradictions being resolved by negotiation. Together they form what he called the “esoteric circle”. Outermost is the “exoteric circle”, educated amateurs whose understanding comes from provisional esoteric knowledge, but owing to simplification it appears more secure, more rounded, and more certain. It shapes public opinion, and reacts back onto the experts.
SAGE, the most important scientific committee advising the UK government about COVID-19, seems to be almost entirely composed of experts in the outer ring of the esoteric circle. Only four of its 54 declared members have a virological background, and it is reasonable to assume that the specialism of three of them, influenza, influences their views.
Past pandemic planning focused on that virus, correctly, because we have had four since the beginning of the twentieth century ( a benign one in 1977 may well have been a laboratory escape), and we don’t expect other organisms with pandemic potential like cholera, diphtheria, or plague to take off in the UK. But the more we study COVID-19 the more the differences with influenza become evident. However, public pronouncements still take their cue from that virus, like the need to avoid a second wave that will swamp the NHS.
The 1918-19 flu pandemic was malignant as a killer. Its second wave was much nastier than the first. But it is the only one in which this has happened world-wide since; we don’t even know what kind of virus caused the much milder first wave, because influenza virus wasn’t discovered until 1933. And the notion that even if COVID-19 is put under a reasonable degree of control it will persist for years comes from influenza, which does that in spite of vaccines and antivirals, unlike SARS, which was eradicated in 2003 from humans without either, despite being related to COVID-19 and having an initial R0 number of 2.7 (the same as COVID-19).
It’s time to move on, resile from using influenza as a useful model, and focus on coronaviruses.
Featured image of Boris Johnson, Patrick Vallance and Chris Whitty at Downing St, May 11, by Pippa Fowles, courtesy of No 10 Downing St, CC BY-NC-ND 2.0