In the midst of the Covid-19 pandemic, historians and epidemiologists are seeking lessons in past transmissible disease outbreaks, and have found one that almost defies belief in the Warsaw Ghetto of Nazi-occupied Poland in World War II. Facing extreme crowding, borderline starvation, and appalling sanitation, those trapped in the ghetto managed to control the spread of typhus, saving perhaps 100,000 lives. A new study of how this was achieved provides a stark contrast to the world’s current efforts under what should be much easier circumstances.

After conquering Poland, the Nazis confined more than 450,000 Jews to the Warsaw Ghetto, an area around 3.4 square kilometers (1.3 square miles). By comparison, Manhattan has less than four times the population, but is 17 times the size. Even the most overcrowded refugee camps today offer more space per person.

“The Warsaw Ghetto presented the perfect breeding ground for bacteria to spread typhus and it ripped through the mainly Jewish population there like a wildfire,” said Professor Lewi Stone of Australia’s RMIT University in a statement. 

Indeed, around 30,000 people in the ghetto did die from typhus, while around three times as many survived. Nevertheless, the epidemic was halted well before it had infected most of the population. Even more astoundingly, the infection rate fell off just as it would be expected to spike in the face of the harsh winter of 1941-42.

“Many thought it was a miracle,” said Stone, who has combined with researchers from around the world to study typhus' spread. In Science Advances, he has demonstrated how science, particularly the efforts of Jewish doctors, caused the halt. Although the diseases are different, the typhus outbreak was defeated by the same techniques epidemiologists are advocating today: sanitation programs, self-isolation, and physical distancing.

Crucially, those imprisoned in the ghetto heeded the doctors' advice.

Stone was able to reach these conclusions because doctors in the ghetto made great efforts to record what was occurring. These have previously provided some of the most influential information we have on the effects of starvation, but the light they shed on the typhus outbreak has not previously been studied using modern epidemiological and statistical techniques.

“I spent many, many hours in libraries around the world seeking rare documents or publications to find details about the interventions employed and the actual size of the epidemic itself,” Stone said. He found reports of hundreds of public lectures on the importance of how personal hygiene, self-isolating when sick, and physical distancing would stop the spread of typhus, as well as an underground medical university set up to train medical students on infection control.

Typhus also raged through towns in the Ukraine where Jews were also imprisoned, and in one of these, Shargorod, it was stopped once soap manufacturing began and cleaning services implemented, supporting Stone's claim.

Stone and co-authors point out the Nazis used the threat of typhus to Germans as the original justification to herd Jews into the ghetto, and subsequently to ship the inhabitants to death camps. “This exemplifies humanity’s ability to turn upon itself, based on racially guided epidemiological principles, merely because of the appearance of a bacterium,” they write. In the face of a pandemic that has disproportionately killed ethnic minorities, we can't assume such horrors have passed.