Adelaide's Ghost - How the COVID-19 pandemic has shed light on my family's experience with a diphtheria epidemic 90 years ago

Today's commonly shared COVID-19 experience is a crucible for better understanding others, even family members

By Linda Pickard

Updated May 12, 2020


One Microcosm of an Epidemic’s Effects

Every April, we were reminded by my mother that it was the month of “Adelaide’s birthday”. Sometime in the early 1930's, my eight-year-old aunt Adelaide passed away from diphtheria in a Liverpool hospital. My five-year-old also sick mother in a nearby bed survived. The trauma affected her entire life sometimes positively but more so negatively. 

Over 91 years, depression, paranoia and social behaviour that swung erratically between caring and insensitivity characterized my mother’s life. Critical decisions made by my maternal grandmother and the U.K. government at the time, significantly altered the trajectory of her life. Instead of experiencing a joyful childhood followed by a relatively happy adult journey, she became a victim of what we now call post-traumatic syndrome. It never departed.

Lodged deeply in her psyche was the belief her mother expressed to her that “the good one died”. Her five-year-old fast developing brain stored the guilt, the shame and the lack of sensitivity to her feelings. In today’s context, this “moral injury” mirrors what some soldiers returning from war experience. Health workers may also suffer from the loss of a colleague or certain patients. Perhaps for my mother, there were significant others around bringing comfort and solace. Her despair was likely too strong to take in such healing messages.

The key to improving my aunt’s chance of survival was a vaccine which was available at the time. She did not receive it. Why my mother survived without a vaccine may be due to a variety of factors. One such factor may have been her body’s ability to build its army of antibodies to fight the virus. That she lived into her 91^st year despite her mental anguish may reflect the mystery of a strong constitution.

Some History

Similar to COVID-19, diphtheria, at one time, was a worldwide epidemic mainly affecting industrialized countries. Running rampant in the 1920's and 1930's, it was known as “the strangling ‘angel ‘of children”. It made breathing difficult.  In Canada during 1924, there were nine thousand cases of diphtheria. It was the number one cause of death in children under 14. Then as now, the diphtheria bacterium (not virus) is transmitted through close contact with an infected individual usually through respiratory secretions spread through the air.  How governments responded to this crisis literally affected who would live and who would die. Herein is the source of my mother’s lifetime of sorrow.

Science and Advocacy

Like many diseases for which thankfully we have vaccines, diphtheria has a long history dating back to the 1600's. Advances in its mitigation accelerated in the early twentieth century through the collaborative efforts of scientists worldwide. Pioneering work in a number of countries paved the way for a vaccine. For example, the United Kingdom and France developed an antitoxin for diphtheria. In Canada, the University of Toronto established in 1914 an anti-toxin laboratory (Connaught Laboratories) under the able leadership of Dr. John G. Fitzgerald, a tireless advocate for public health safety and well-being. 

A team of scientists at the Connaught Laboratories forged ahead in “Slaying the Dragon” with clinical trials across Canada. Approximately 36 thousand children participated in carefully controlled studies between 1926 and 1929. These trials proved that a diphtheria toxoid reduced incidence of the disease by about 90% if given in three doses. By the 1930's a vaccine was available for children in Canada, perfect timing for my mother and her older sister. But its safety was not to be for them.

Deadly Travel

My maternal grandmother despite coming to Canada on her own as a 17-year-old to seek a better life yearned for her homeland – Liverpool, the later home of the Beatles. Periodically, to satisfy her discontent, she would gather her children, book passage on a ship and head to Liverpool for a visit. In about 1931, she unwittingly took them smack dab into a raging diphtheria epidemic. Both my mother at age five and her 8-year-old sister became infected with the diphtheria bacterium. One lived, one died.

My aunt, who was born in 1933 at the height of the depression to “replace the lost child”, recently told me that the cost of vaccinating her sisters was about $5.00 each. As my grandmother relayed to my aunt, she could not afford the cost of vaccinating her children. But there is more to the story whether or not cost stood in her way. Had my mother’s mother remained in Canada, Adelaide might have lived because of what we now call the “herd effect”.  That is, there are enough children inoculated to prevent the spread of the disease to those who have not been vaccinated.

What made the difference given that many countries around the world were joining the “Slaying the Dragon” movement? In Britain, a number of barriers intervened - government reluctance, concern about efficacy, lack of effective organization in the U.K. and what we now call “anti-vaxxers”. People opposed to experimenting on animals vocalized their resistance to a vaccine too. Local governments in the U.K. at the town level did their best to provide protection against the diphtheria epidemic. They struggled for funding in the absence of a coordinated country approach to vaccinating children. It was not until World War II that the British became serious about the widespread availability of a diphtheria vaccine followed by many others for children. Finally there was “buy-in”!

Nevertheless, diphtheria outbreaks still occur. Nations experiencing social disruption and conflict and reluctance to vaccinate are key reasons for the fluctuating number of global cases up to the present time. Constant vigilance is a must.  

  

Lessons for COVID-19

The COVID-19 journey combines lessons learned from past experiences and new ones we are creating in search of good solutions.

Universal health care and government support

Let’s count our blessings now for the level of government support and public health interventions that are leading us in “slaying” COVID-19. Heroes long forgotten in our collective memories such as Tommy Douglas (Keifer Sutherland’s grandfather) along with many advocates brought us universal health care, a necessary tool for fighting on the front lines. 

Innovation

Courageous and curious infectious disease researchers such as John Fitzgerald’s team and many that followed him nationally and globally to this day shed more and more light on the nature and prevention of infectious diseases. Collaboration abounds across the world and within nations.

Bill Gates and other wealthy funders through their respective foundations have worked together for years with the World Health Organization (WHO) along with numerous local health organizations globally to increase vaccination rates and improve the living circumstances of the most vulnerable. Science and leadership are our saviours for which I am most grateful.

Safety, connection and kindness - precious gifts of COVID-19

My mother suffered from a lifelong distrust of hospitals, doctors and fear of sickness. Whenever I or my two sisters became ill, she would sit by our bedsides for hours ensuring herself that we were going to be OK. She sought the best medical support available for us even for our teeth! But, for her ailments, she was a difficult patient often embarrassing us with her rude antics when in the presence of anyone in the medical profession. We were mystified. A second near death experience (sepsis after childbirth) likely explained much of her behaviour.

Everywhere she saw “the enemy”. It became a family “dragon” we were neither able to slay nor understand. How could her family as we were lucky recipients of the prosperous decades in the late twentieth and twenty-first  centuries? Despite periodic psychiatric counselling, the world to my mother was not a safe and kind place. 

Nevertheless, she managed to create a number of positives in her life. As an avid reader with wide-ranging interests, she could always contribute well-thought out views in any conversation. She worked part-time over many years to add to the family income, something that gave her purpose and enhanced her well-being. Mid-life the call to upgrading her education beckoned. Having only a grade 11 education as a foundation, she managed to gain entry to the University of Toronto’s continuing education program for older adults, graduating with a Bachelor’s degree in political science. 

Later, when she and I embarked on a road trip from Toronto to Los Angeles, the unhappy mother I knew turned into an enthusiastic, happy and curious traveler, content to sight-see and meet interesting people at our rest stops. Ironically, her passion for politics was well-served. Our road trip coincided with the immediate after-math of Barack Obama’s election as President of the United States in 2008. We gained first hand insights into the thoughts of Americans at each stop of the way. She was in her element! 

It is clearer now, thanks to COVID-19. Safety, connection, kindness and purpose were the drivers of my mother’s periodic happiness. These are the same qualities that are surfacing more in our collective struggle to win the battle over COVID-19. All cultures yearn for these not just during a crisis but always. But, will they fade post-COVID-19 by the pull back to tribalism and ‘us’ versus ‘them’?

The way forward

COVID-19 is a global transformational experience. For example, it is helping me better understand my mother, and, by association – others. That means then that going back to the same-old, same-old is not possible. The path forward will be different not only for me but for many. Will we be more divided? Less divided?

We know from a vast amount of behavioural science research that a more prosperous, fairer world has a greater probability of coming into being with inclusiveness. It will not be easy to make that happen. The virus has rattled us, making us more protective and more wary of others not like ourselves, not part of our "in" groups. We innovate less from that stance, often finding less satisfaction.  It will require considerable effort by each one of us to opt instead for a higher level of “inclusive fitness”. One that embraces not rejects the simplicity and reward of the diversity bonus. We are simulating that world mindset currently through our shared COVID-19 immersion. It is life-changing. For that reason we might find working with our differences for the greater good easier than before the pandemic.

Linda Pickard, Ph.D. is an award-winning educator and designer of leadership development experiences. She is also an executive coach and specialist in the neuroscience of diversity and inclusion. She is currently working on a new book on the latter topic with a colleague.