Germ City
A century after the 1918 flu pandemic killed tens of thousands of New Yorkers, contagious diseases continue to shape our city.
On February 19th, 1881 — during one of the coldest winters on record — a headline in The New York Times spoke of an “Unusual Prevalence of Contagious Diseases” that year.
In just a few short months, the city had been afflicted with 550 deaths from diptheria, 88 deaths from smallpox, 508 deaths from scarlet fever, 76 deaths from measles plus dozens of cases of typhus fever and whooping cough.
By March, prominent politicians and doctors had had enough. A public meeting was called at Cooper Union, where they accused city officials of not providing essential services and creating “the dirtiest city in the universe” due to neglect that was akin to murder.
It was in that brutal winter that Harper’s Weekly published this etching, titled “A Warning Light.”
At the time, the Statue of Liberty was still under construction. New Yorkers could only imagine what her face would look like. Here, a beacon of hope becomes a symbol of fear. Lady Liberty’s skeletal face admonishes immigrants as they arrive: “New York: Leave All Hope Ye That Enter,” the supposed inscription on the gates of Hell.
As one of the biggest, most densely populated and heavily-travelled cities in the world, New York has always been a city embattled by contagious disease. As a result, the city also boasts one of the world’s finest public health departments to counter these microbial attacks.
Over the next few months, in collaboration with the Museum of the City of New York and the New York Academy of Medicine, WNYC will examine the intersection of infectious disease and urban life, past and present.
Did New York City Botch the 1918 Flu Epidemic? The Debate Still Rages
By Jim O'Grady
September 13, 2018
The 1918 trip around the world taken by the influenza virus as it moved from body to body on the wings of sneeze and cough left a trail of 50 to 100 million bodies. In the United States, the pandemic took more people in a single year than AIDS has killed in 40 years.
In the light of those numbers, 33,000 flu deaths in New York City has long been considered a relative if very macabre success. The city's death rate from the disease — 4.5 per thousand — was lowest among large cities on the east coast, and on the low end nationwide. By comparison, Boston's death rate was 6.5 and Philadelphia's was a whopping 7.3.
High marks for crisis management have historically been given to Royal S. Copeland, the president of what was then called the city's Board of Health. He's generally seen to have stumbled at first by underplaying the seriousness of the outbreak. "There is no cause for alarm," he told the public even as violently ill passengers were being removed to hospitals from ocean liners and naval vessels at anchor in the harbor. But, ultimately, it was Copeland's innovations that are credited with helping to slow the virus.
A clever public information campaign spread health tips through newsreels at theaters; posters reading "Spit Spreads Death" were hung all over town; and Boy Scouts accosted people heedlessly coughing in public with cards that read, "Stop! You're in violation of the sanitary code." Hundreds of nurses were told not to wait for patients to arrive at hospitals but go to tenement-packed slums and bring healing, along with the application of selective quarantine, to the infected, their family, and neighbors.
And crucially, Copeland took advice from a brilliant health official named S. Josephine Baker on the question of whether to close the schools. She strongly supported keeping school doors open so children could be monitored and treated early if they showed signs of infection.
Was it enough?
John Barry, author of The Great Influenza, a definitive history of the plague, said, no. "In most disasters, people come together and help each other," he told WNYC. "That was not the case in 1918 in most places. I think a lot of that was because of the politics of it and the public health response, or lack thereof."
Barry criticized Copeland in particular for not imposing a widespread program of isolation and quarantine, and said the city's low death rate from influenza might have resulted from natural immunization among part of the population when a milder form of the virus moved through the city several months before the lethal strain showed up. In other words, luck.
But Copeland has his defenders, among them Allan Kraut, professor of history at American University, and Jessica Cole, a planner at the city's Department of Health and Mental Hygiene. We interviewed both, along with James Colgrove, professor of public health at Columbia University. They discussed how the disease was handled a century ago — as well as lessons we might apply when doing battle with future pandemics.
New Exhibit Shows You All The Ways NYC Was And Is Covered In Germs
September 14, 2018
If you’re that person who won’t touch a subway pole, or refuses to go bowling, you will find yourself both vindicated and triggered by the new Germ City exhibit. The Museum of the City of New York marks the 100th anniversary of the 1918 Spanish flu pandemic with an exhibit that reminds New Yorkers that what makes us great also makes us vulnerable: germs love a bustling, crowded, international city, too. And we’ve been in a protracted battle against contagious-disease carrying microbes since long before we built subways or bowling alleys.
When you walk into the exhibit, there are a few items that are so big, they’re impossible to miss: Jordan Eagles’s "Blood Mirror," a large sculpture that contains blood donated by gay, bisexual and transgender men; an “iron lung” which looks like a human-sized submarine, used to assist the breathing of polio victims and a full protective suit like the one used to protect Bellevue Hospital’s staff and reduce the spread of disease during the Ebola outbreak.
It’s worth the trip to the museum just to see the original film copy of "Clean Up: We Care About New York," a terrifying PSA (that we've revisited before) made by none other than David Lynch. WARNING: rats.
Together the artifacts tell the story of contagious disease thematically rather than by disease, examining how we contain, investigate, and care for people regardless of whether they have contracted smallpox, yellow fever, diphtheria, cholera, influenza, polio, HIV, ebola or any of the diseases New York has battled over the years. The diseases may have changed over time, but the concerns stay the same. How do you contain disease, and fear, when there’s an outbreak?
"Germ City" opens Friday, September 14th, at the Museum of the City of New York, and runs until April 28th, 2019.
How SARS Changed the Face of Air Travel
September 20, 2018
Two weeks ago, Emirates Airline flight 203 from Dubai was quarantined by the Centers for Disease Control and Prevention at JFK airport. Two days later, two more flights were quarantined at Philadelphia Airport. In all three cases, dozens of passengers complained of flu-like symptoms. But in the end, only a handful were sent to the hospital and those cases were ultimately dismissed as nothing more than the common cold and seasonal flu.
What explains the fact that so many passengers initially reported feeling sick?
Dr. Amesh Adalja, a senior scholar at the John Hopkins Center for Health Security, said it's common for people to feel ill (even though they're perfectly healthy) when they're surrounded by those who are.
"Sometimes the symptoms themselves become contagious," he said. "Fear is contagious, and I guess that's what ends up happening."
The question that follows is: Did public-health officials overreact? Did the pilot on that flight from Dubai make the correct call in contacting local authorities before the plane landed?
"I do believe that what that pilot did on the Emirates flight was right," said Dr. Adalja.
He also believes the CDC's response is necessary to advert future pandemics. Quarantining an airplane allows officials to evaluate the health of passengers before they return to their communities.
"It's much easier when they have a postcard with everyone's name and information on it," said Dr. Adalja, "so that they can contact them if something epidemiologically significant was on board."
In these most recent cases, public health officials were concerned about a potential outbreak of MERS, or Middle East respiratory syndrome, atypical influenza and other novel respiratory infections that can potentially spread during air travel.
In 2003, an outbreak of another deadly virus, SARS, or severe acute respiratory syndrome, spread throughout Asia. Over 8,000 people worldwide contracted the illness. It killed nearly 1 in 10 of those infected. In the United States, only 8 people were confirmed to have been infected by SARS.
New York City narrowly averted an outbreak that year when an infectious disease specialist from Singapore, Dr. Hoe Nam Leong, unknowingly contracted the illness from a patient and then visited the city for a conference.
"I went to New York with my wife, who was pregnant then, and my mother-in-law," Dr. Leong recalled in a recent interview.
At each step in the trip, he risked spreading the disease to others: The shuttle bus to the hotel, their walk through Chinatown, dining out at a restaurant.
It was only toward the end of their first day in the city that Dr. Leong began to show symptoms.
"I realized that something wasn’t quite right," he said, although at that point he still hadn't realized the seriousness of his condition. "I had chills. I knew I was sick."
He visited a hospital the following day, where doctors were unable to diagnose him.
Dr. Leong and his family decided to cut their trip short and boarded a flight back home. Hours later, Singapore's Ministry of Health contacted the airline once his colleagues became aware of the situation. He was quarantined on the plane mid-flight and pulled off during a stopover in Frankfurt, Germany by health workers dressed in full-body protective suits.
"They took everyone off the plane. First the passengers, followed by the staff, and they came to get me," said Dr. Leong. "Then I started realizing that we might be at the brink of a new epidemic."
Dr. Leong was Singapore’s "Patient #3," and his story exposed many of the cracks in the global public-health system meant to prevent the spread infectious disease.
"Everyone has a role to play," he said.
Firstly, the hospital he works for in Singapore should have been more cautious in how doctors came into contact with patients. Secondly, once in New York, he should have been flagged by the doctors who treated him. And, as a specialist in infectious disease, he himself should have known not to fly.
"I honestly feel stupid," he said. "I shouldn’t have boarded that plane."
To prevent future outbreaks, the World Health Organization implemented international health regulations and increased disease surveillance to make it easier to identify sick passengers.
Additional reporting by Danny Lewis.
Music Credits: "The Summit" by Blue Dot Sessions
Photos: The Strange History of NYC's Swinburne and Hoffman Islands
November 28, 2018
We have this vision of immigrants arriving by ship, seeing the Statue of Liberty and landing at Ellis Island to start their new American lives. But thousands of people never made it that far. Instead, they were detained at Swinburne and Hoffman Islands, two tiny islands in our harbor that were used as quarantine islands from the 1870s until the 1920s.
According to Professor James Colgrove at the Mailman School of Public Health at Columbia University, ships coming into New York harbor would be stopped before Ellis Island. He says:
As the ship steamed into lower harbor, a tugboat would have pulled up alongside the boat and a doctor or a few doctors would have boarded the boat and all the passengers would have been asked to line up on deck. And the doctors would go down the line and give everybody a very quick once over... This was really looking for just the most visibly ill people. You might be looking for kids who were covered with measles spots, somebody with smallpox. Someone who was obviously very ill. The doctor might have popped a thermometer into somebody’s mouth if they weren't sure. But basically this was just a very quick once over. And if you were unfortunate enough to be showing symptoms—if you were extremely flushed, if you were vomiting, if you had some kind of visible sign of disease—they would have then pulled you off the boat.
Immigrants who arrived visibly ill would be taken by tugboat to Swinburne and Hoffman Islands, just south of where the Verrazano-Narrows Bridge is today, about a mile off of Staten Island’s South Beach.
The story of how Swinburne and Hoffman came to exist is a bizarre chapter in New York’s history. Before the islands existed, many immigrants who arrived with potentially contagious diseases were detained at the Marine Hospital, a compound of buildings on Staten Island known as “The Quarantine.”
Back then, New Yorkers were dying from all sorts of maladies we rarely hear about today: smallpox, diphtheria, cholera. Much less was known about contagious diseases and in the 1850s, and there were frequent outbreaks; when they occurred on Staten Island, locals blamed The Quarantine, particularly after a bad outbreak of Yellow Fever that hit.
Professor Colgrove explains, "Yellow fever was one of the most frightening diseases because it spread in really inexplicable ways. We understand now that it's spread through mosquitoes, but disease in general struck very much at random which is what made it so frightening."
On the night of September 1st, 1858, a few dozen men broke down the brick walls surrounding The Quarantine. They entered the compound with matches and straw and set almost every building on fire. There were no fatalities because the staff and patients had been given advance warning to evacuate the premises. Given that Staten Islanders had been trying to get rid of this place for decades, no one was all that surprised the night The Quarantine burned down. The mob returned the following day to burn down more.
In the years following the fire, no one could agree where to put the immigrants who arrived sick. The city eventually agreed to build two islands from landfill on a shoal in the Narrows: these were Swinburne and Hoffman.
The conditions were horrific, and there was often overcrowding. In 1901, authorities held over 7800 people on Hoffman alone. But detailed records have disappeared, and the number of people who made it off alive or died on the islands is not known.
In the 1920s when open immigration was drastically reduced, they were no longer needed as quarantine islands. The NY Times declared them "ghost isles" in 1949, noting they were "orphaned amid relics of a more auspicious past." Since then, Swinburne and Hoffman have been used for many unusual purposes: a place to quarantine sick parrots; a training base for the Merchant Marines, and in the 1960s, a film crew was arrested for shooting pornographic films on the islands.
There’s not much left to see over there anymore—after years of being subjected to everything from vandals to arson, the most destructive force was Superstorm Sandy. All that remains today is an old dock off of Hoffman and some crumbling brick walls and a smoke stack, possibly from a crematorium, on Swinburne Island.
The islands are now owned by the National Park Service, and while visitors are not welcome, several tour companies offer boat rides that stop nearby so people can see the wildlife. Today Swinburne and Hoffman have become sanctuaries for herons, gulls and seals.
See more photos over at Gothamist.
On The Media Presents: Plague of Suspicion
December 14, 2018
It’s been 100 years since one of the greatest natural disasters... well, ever. The 1918-1919 flu pandemic (usually and mistakenly called the “Spanish flu”) infected roughly a third of the world’s population and killed somewhere in the order of 50-100 million people, leaving no corner of the world untouched. It came just as the world was beginning its recovery from the other global catastrophe of the time -- the First World War. The pandemic is sometimes referred to as the “Forgotten Plague” because the extent of the devastation wasn’t realized at the time, and has been missing from most history books since.
On this week’s episode of “On The Media”, we look back at what happened and ask: could it happen again?
Germ City is a collaboration with the Museum of the City of New York and the New York Academy of Medicine. WNYC’s health coverage is supported in part by the Robert Wood Johnson Foundation, Jane and Gerald Katcher and the Katcher Family Foundation, Science Sandbox, an initiative of the Simons Foundation, and the Alfred P. Sloan Foundation.