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. 

What Do the Muppets and Goldilocks Have in Common With Today's Diversity and Inclusion Dilemmas?

Muppet Bert cleans up Cookie Monster’s crumbs, relishes routine, enjoys hobbies such as collecting paper clips, dresses neatly and provides reality checks to Ernie, his roomie. Muppet Ernie likes to experiment with fanciful ideas, creates mayhem, is a non-conformist and lives for new experiences. Which one finds it easier to be inclusive?

As Michele Gelfand, distinguished professor of Psychology at the University of Maryland explains in “Rule Breakers, Rule Makers”, culture is at the heart of Bert and Ernie’s differing behaviours:

Bert’s “Tight” Cultural Experience: Let’s imagine that Bert grew up in a place that for millennia suffered from economic uncertainty driven by frequent invasions, civil wars, weather-related catastrophes, food shortages, few natural resources, poverty, rampant disease and very crowded communities. With that kind of background, Bert’s ancestors, full of fear for their futures, would have naturally worked hard to bring order out of chaos. Their goal was to reduce risk to make life more predictable and safer. That required less personal freedoms, more coordination and lots of rules and regulations created by “strong” leaders.

Ernie’s “Loose” Cultural Experience: On the other hand, Ernie and his ancestors evolved from a more secure, peaceful geographical location relatively safe from chronic invasions, blessed with plentiful natural resources, less disease and only occasional weather-related disturbances.  Although Ernie and his ancestors did struggle to survive and adapted as the conditions dictated, they had less disruption to their lives than did Bert’s family. As well, they were blessed with fewer people and their country was a haven for a diversity of refugees seeking refuge from Bert-type countries. 

In summary, the vastly different environmental experiences of Bert and Ernie shaped the social norms they valued, in effect unconsciously programming their brains. The reasons were similarly practical - to navigate through choppy waters and to make progress – but, the different behavioural reactions are rather polar opposites due to the level of pain and suffering wrought by their respective environmental challenges. Is one set of behaviours better than the other?

General Stanley McChrystal weighs in on this conundrum from a leadership perspective as described in “Leaders, Myth and Reality”. After examining the stories of thirteen well-known leaders from a range of eras and fields, he concludes that “leadership is intensely contextual and always dependent upon particular circumstances that change from moment to moment and place to place.” The effectiveness of their style in particular was a function of place in time. An example was Winston Churchill – a great war-time Prime Minister (tight circumstances) but considered less of a fit in peace time (loose environment). Different behaviours and strategies were required.

 In effect there are trade-offs. Bert’s tight culture is better organized and more efficient than Ernie’s. People in Bert’s environment have a strong desire to avoid mistakes yet are skillful at impulse control according to Gelfand. But, Bert’s culture is less innovative and generally less tolerant of the rights of women, gays, disabled and homeless people, immigrants and others in the “out-group” than Ernie’s.

On the other hand, Ernie’s world is chaotic, not as efficient and people are more impulsive (less attentive to social norms). Unlike the extreme of Bert’s community, Ernie’s society is more inventive and risk-taking, more comfortable with ambiguity and disorder, and more welcoming of all different types of people.  

What would Goldilocks make of this? Not too much (constraint or freedom), not too little, just right. Economists speak of our tendency to migrate to the mean for finding the best-balanced solutions to our complex problems. Stanley McChrystal’s historical leadership research underlines that bending style/decision making to best fit the context is key. And, that adaptation to shifting circumstances is vital.

We’re in the midst of a recalibration of our social norms worldwide. Factors such as globalism, widening inequality, demographic disparities interfering with sustainable prosperity, the rule of law encompassing the rights of all and more are challenging us to seek the Goldilocks sweet spot over and over again.

Are You More Like an Orchid or a Dandelion in Your Working Environment?

Why do some kids from really tough backgrounds manage to rise above the fray and survive while others wilt? Do these kids show up in the workplace as grown adults who manage the stresses well while others don’t?

Researchers Thomas Boyce (University of British Columbia) and Bruce Ellis (University of Arizona) coined an orchid-dandelion hypothesis based on the Swedish term “dandelion children”. Such children seem to be able to grow up in almost any environment unscathed. Boyce and Ellis added the term “orchid children” who blossom under good care but wilt when the environment lacks caring support.  Parental behaviour matters. Then, does organizational/leadership care matter? We know it does for everyone, yet for some it may be that which makes or breaks their motivation, engagement, happiness and overall productivity.

But hold on. The orchid kids might just have “heightened attention” to a new or ambiguous situation as Elaine Aron (State University of New York) posits. Their response might appear as “anxious inaction” when in fact they are “pausing to read cues and await opportunity.” It is somewhat akin to people who consider themselves “diverger” learners, generating options and taking a 360 view first. This “highly sensitive” response might be an evolutionary one from way back to our hunter-gatherer days when caution was a matter of life or death.

Steven Pinker (Harvard University) in his seminal book How the Mind Works points out that our minds are “designed by natural selection to solve the kinds of problems our ancestors faced in their foraging way of life…understanding and out-maneuvering objects, animals, plants, and other people”. He contends that we are not especially well-adapted yet to the modern world. We have “complex genetic recipes” that are working ever so slowly to adapt well in a non-hunter-gatherer world. The aim as always is to problem-solve through complex issues with survival as a key outcome!

Nevertheless, some of us, according to the orchid-dandelion view are more highly sensitive than others to the social environment and the stresses related to it. For example, we know that introverts easily become overloaded in social environments whereas extroverts generally thrive on the social stimuli.

Ernest Hartman from Tufts University prefers to characterize the differences as “boundaries” in the way we operate in the world. Some of us are thick-skinned, others thin-skinned. We “keep out” or “let in” stimuli according to our tolerance for handling the “energy of feelings”.  In his Boundary Questionnaire (BQ) Hartman has found that women score thinner than men. But if we look at this through an evolutionary lens, both are adaptive skills for survival.

In the workplace, therefore, we can conclude that both are strengths that only manifest if leaders and the infrastructure of the organization support the different tolerances for social stimuli. You can’t go wrong if you are a high emotionally intelligent leader. Walk in the shoes of others. Lend a helping hand. Unconditionally support. Take obstacles out of the way that impede getting the job done. Magical!  

Take a read break

I’ve been an avid reader forever probably because my mother is. As a young child, I couldn’t help notice she perpetually had her nose in books. To this day she is the same. For comfort and a break from the stresses of life, books were and are her escape. Is there something in this for any of us whether leaders, managers or members of the vital teams that power all organizations?

Various research sources indicate that vast and deep reading helps us to connect disparate ideas thereby adding to the creative journey. For example, I’ve been told that when I am in front of groups as a facilitator-teacher, I seem to effortlessly pull out stories and all manner of peripheral and supporting information on the fly, depending on the direction of the class discussion. I don't even know what I know until a trigger comment from someone. Then, I have to watch that I don't lose my audience by deviating too long from where we were on the agenda! At the least reading broadens my thinking and helps me “entertain”.

But there is a real benefit to reading that it often overlooked – its stress-reducing power. According to John Coleman’s August 15, 2012 HBR blog, “For those who want to lead, read”, six minutes of reading can reduce stress by 68%.

Now that’s an attractor in today’s far too fast-paced work environments! But it all depends on what one is reading, doesn’t it? Heavy duty reports don’t qualify.

So all you managers out there, take out your novel and set an example that reading breaks - fiction or non-fiction - contribute to productivity not the other way around. Water cooler gatherings have finally gained respectability as they help social cohesion, innovation, employee engagement and well-being. Now it's time to put read breaks of any kind in that same category.

Want to motivate your team? Build high performance? Don't skip one important detail.

Every time I read the latest statistics from Gallup and McKinsey or whomever on employee engagement my eyes glaze over. I used to write the information down for reference when doing talks or teaching. I don’t anymore because it’s the same old, same old. Lots of people in most organizations are not engaged. The further down the organization, the worse it gets. I always get an earful when working with front line employees (yes, I know, there is always another side to their stories). The beat goes on.

But, here and there, employees are inspired to do their best. Take the paramedics that attended to my husband this month when he had a dizzy spell, fell off a stool. In the moment, they did what they had to do and eventually took my husband to hospital emergency for further checking. In the end, it was a case of low blood pressure from his meds.

What I found most unusual was the extent to which the senior paramedic checked in with me between other ambulance trips on my husband’s status. It was then that we talked about his job. This was a motivated guy who had recently finished a year of advanced training. I still shake my head at his degree of interaction with our family. I’m not used to this caring customer service in general!

Annual surveys of the best organizations to work for show that there are many great companies young and old. Southwest Airlines is a perennial winner. Newer tech companies due to their start-up mentality often get the nod. Small is helpful as a rule because of the family-like atmosphere. The more complicated and big the tougher it is for leaders to keep the culture engaging and exciting.

If you are in a big, complex organization and want to motivate your team what can you do? Certainly “leading by values” is a good way. Herb Kelleher, Southwest’s founder, makes a point of mentioning values such as “leaning toward the customer” (his insistence) as a must. Founders do set the tone. But when the organization is older with thousands of employees and the newness of a company’s reason for existence has long receded in memory, how do you keep the founder’s spirit going?

One factor always pops up by various authors on the subject – purpose (why am I here to do what?). That’s the first one mentioned by Jim Kouzes and Barry Posner in their new book “The Leadership Challenge: How to Make Extraordinary Things Happen in Organizations”.  People are motivated by what is rewarding not what is rewarded. Knowing why they come to work every day – purpose – speaks to the rewarding part.

The best place to re-engage is at the team level. That’s where the real work gets done. The paramedics know they want to save lives whenever possible. Every leader/manager has more control over a team than the whole organization. Motivate a team and the infectiousness begins to rub off elsewhere as peers talk. Southwest’s fundamental success is due to teamwork.

Yes, there is much more to great teamwork than being pumped up by its purpose. Every day, every hour relating matters as the journey unfolds. Infrastructure to support team success matters. However, without a clear team purpose, the tasks at hand have no context for action.  

Don’t skip purpose – having the team openly determine the why of being together.