One of the worst consequences of war is the spread of epidemic diseases. The influenza pandemic known as the Spanish flu broke out in the aftermath of World War I and killed about 50 million people. However, as we know from the COVID-19 pandemic, infectious diseases can spread like wildfire also in peacetime. With the global health emergency officially over since 5 May 2023, it is time too look at our experiences with Coronavirus from a historical perspective.

I have been researching a typhus epidemic in German-occupied Warsaw since 2017, but it wasn’t until March 2020 that this rather obscure topic on the fringes of history of medicine and Holocaust studies suddenly became relevant. Lockdown, quarantine and disinfection were all familiar terms in Warsaw during World War II and – even though we hardly ever learn anything from the past – I think that lessons from a typhus outbreak could shed some new light on our recent experiences with COVID-19 and inform our responses to future epidemic threats.

Epidemic louse-borne typhus

Typhus is a highly contagious disease, caused by the bacterium Rickettsia prowazekii which is transmitted in the faeces of the human body louse. Symptoms of typhus include a sudden onset of high fever of up to 40 degrees Celsius, the appearance of a characteristic dark-red rash as well as stupor and hallucinations. Mortality ranges from 10 to 40% and death is often caused by complications, such as pneumonia and encephalitis. Historically, small-scale natural outbreaks occurred among lice-infested populations in temperate climate zones, usually in winter, when people washed and changed their clothes less often.

Large-scale epidemics with hundreds of thousands of deaths typically broke out as a result of war-induced mass displacement. For example, Napoleon’s Grande Armée was decimated by typhus in 1812, while during World War I epidemics of typhus broke out in prisoner-of-war and refugee camps in Serbia, Poland and Austria. Between 1917 and 1923 typhus killed between 3 and 5 million people in European Russia alone.

Typhus in German-occupied Warsaw

On the eve of World War II, typhus remained endemic in Eastern Poland but was relatively rare in Warsaw. However, sanitary conditions in the Polish capital rapidly deteriorated in September 1939. German bombardment cut off the city’s water supply, damaged many hospitals and destroyed 12% of all residential buildings. The ensuing public health crisis was augmented by the arrival of 90,000 destitute Jewish refugees who escaped from persecution in smaller towns or were expelled overnight from areas that were annexed to Nazi Germany.

Makeshift refugee shelters were opened in schools, synagogues and private flats, often inside huge tenement houses which were located in the densely populated Jewish district of Warsaw. These refugee hostels did not receive any material help from the German occupational authorities and, as a result, were extremely overcrowded and often lacked heating, running water and basic sanitary appliances. Unsurprisingly, it was precisely these shelters that became breeding grounds of a typhus epidemic that broke out in Warsaw in late 1939.

Almost two thousand people contracted typhus and around two hundred fifty of them died. The vast majority of the victims were Jews, and even though the epidemic was contained in the summer months, the Nazis used the fear of typhus to justify isolating Warsaw’s entire Jewish population behind the ghetto wall in November 1940. This relatively small-scale outbreak of typhus was followed by a much larger epidemic in the spring of 1941. This calamity was a direct result of overcrowding, deprivation and starvation inside the Warsaw ghetto. The second epidemic killed at least 2,500 people.

Typhus, known as Fleckfieber (“spotted fever”) in German, was denounced by Nazi doctors as Judenfieber (“Jewish fever”) because of its allegedly high incidence and low mortality among the Jews who were racialised as subhuman parasites infecting the more susceptible “Aryans” with lethal pathogens. German public health administration in Warsaw, headed by Dr Kurt Schrempf (1903-1964), responded to the outbreak of typhus with a series of measures which were supposed to contain the epidemic and prevent its spread to German soldiers.

German measures to fight typhus

Whenever a suspected typhus case was reported, Dr Schrempf ordered the sick to be transported to the hospital, while those who were in direct contact with them were to be placed in a special quarantine station. All the other residents of the building in which the sick was living had to undergo mandatory delousing in public baths. Meanwhile, all their clothes and furniture were disinfected with poisonous gasses. The entire building as well as two adjacent houses were then locked for up to three weeks with nobody allowed to enter or exit.

Repeated “lockdowns” of this kind could mean loss of income or even death from starvation. The residents were also affected by theft and destruction of property which frequently occurred during the disinfection of quarantined buildings. What is more, healthy individuals often got sick while queuing naked in the cold and waiting for mandatory delousing in overstrained public baths. The dire consequences of reporting a suspected typhus case and the extreme overcrowding in the underfunded Jewish hospital in Warsaw warded off many people from seeking medical assistance until it was often too late.

German-imposed methods of fighting typhus were perceived by the Jews of Warsaw as essentially anti-Semitic, unnecessarily draconian and counter-productive. It is therefore hardly surprising that these measures were circumvented whenever possible. Polish policemen who guarded sealed-off buildings accepted bribes to allow access in and out. Corrupt and unprofessional disinfection squads quickly evolved into protection rackets that for a prescribed sum of money abstained from the obligatory disinfection of typhus-affected buildings. Wealthy individuals acquired the necessary “delousing certificates” by paying the less fortunate ones to go instead of them to the dreaded public baths.

German anti-typhus methods were heavily criticised by Jewish physicians and scientists, for whom German public health was personified in the figure of the sadistic Dr Schrempf who threatened Jewish doctors with a gun for any perceived disobedience. Nazi administrators were obviously more interested in preventing typhus from incapacitating the German army than in eradicating the actual causes of the epidemic.

On the other hand, it should be remembered that neither an efficient vaccine nor antibiotic treatment were available to the Germans in 1940, and therefore enforcement of draconian public health measures was probably necessary to contain the spread of this highly contagious and lethal disease. In fact, German methods of fighting typhus did not differ much from similar regulations that were in force in pre-war Poland and were eventually successful in containing the epidemic in the summer of 1940.

Lessons from the typhus epidemic

What can we learn from the typhus epidemic in German-occupied Warsaw? This historical precedent warns us what could happen if radical public health measures that paralyse the economic life of entire population groups are not offset by adequate material aid and welfare provisions.

The Jews of Warsaw objected to the public health measures to contain typhus not because of an anti-scientific mindset but because of the inhumane attitude of the German medical administration. Their trust in the effectiveness of these measures was further undermined by widespread corruption which allowed many people to flout anti-typhus rules with impunity.

While the epidemiology of typhus is rather different from that of COVID-19, and the fate of Jews in wartime Poland can hardly be compared with anything that currently takes place in the world, we could perhaps ask ourselves: to what extent was opposition to COVID-19 restrictions determined by socioeconomic rather than ideological concerns of those who are most affected by the lockdown?

Although the first outbreak of typhus in German-occupied Warsaw was eventually contained, the Nazis used the fear of typhus to justify the imprisonment of 400,000 Jews inside a closed ghetto. History of medicine teaches us that minorities are not only disproportionately affected by public health crises but often are also scapegoated for the spread of lethal diseases.

Perhaps understandably, most countries responded to the outbreak of the COVID-19 pandemic by immediately sealing off their borders. One can only hope, however, that the threat of epidemic diseases will not be used in the future to permanently restrict immigration and to deny refugees their right to seek asylum.

What are your thoughts on the lockdown?