COMMENTARY

Polio: The Unwanted Sequel

Allan M. Block, MD

Disclosures

August 16, 2022

Dr Allan Block

Summer, since 1975, is traditionally a time for the BIG blockbusters to hit theaters. Some are new, others are sequels in successful franchises. Some anticipated, some not as much.

And, in summer 2022, we have the least-wanted sequel in modern history – Polio II: The Return.

Of course, this sequel isn't in the theaters (unless the concessions staff isn't washing their hands), definitely isn't funny, and could potentially cost a lot more money than the latest Marvel Cinematic Universe flick.

Personally and professionally, I'm in the middle generation of the disease. I'm young enough that I never had to worry about catching it or having afflicted classmates. But, as a doctor, I'm old enough to still see the consequences. Like most neurologists, I have a handful of patients who had childhood polio, and still deal with the chronic weakness (and consequent pain and orthopedic issues it brings). Signing off on braces and other mobility aids for them is still commonplace.

One of my attendings in residency was the renowned Parkinson's disease expert Abraham Lieberman. On rounds it was impossible not to notice his marked limp, a consequence of childhood polio, and he'd tell us what it was like, being a 6-year-old boy and dealing with the disease. You learn as much from hearing firsthand experiences as you do from textbooks.

And now the virus is showing up again. A few victims, a lot of virions circulating in wastewater, but it shouldn't be there at all.

We aren't in the era when schoolchildren died or were crippled by it. Elementary school kids today don't see classmates catch polio and never return to school, or see their grieving parents.

To take 1 year: More than 3,000 American children died of polio in 1952, and more than 21,000 were left with lifelong paralysis – many of them still among us.

When you think of an iron lung, you think of polio.

Those were the casualties in a war to save future generations from this, along with smallpox and other horrors.

But today, that war is mostly forgotten. And now scientific evidence is drowned out by whatever's on Facebook and the hard-earned miracle of vaccination is ignored in favor of a nonmedical "social influencer" on YouTube.

So polio is back. The majority of the population likely has nothing to worry about. But there may be segments that are hit hard, and when they are they will never accept the obvious reasons why. It will be part of a cover-up, or a conspiracy, or whatever the guy on Parler told them it was.

As doctors, we're in the middle. We have to give patients the best recommendations we can, based on learning, evidence, and experience, but at the same time have to recognize their autonomy. I'm not following someone around to make sure they get vaccinated, or take the medication I prescribed.

But we're also the ones who can be held legally responsible for bad outcomes, regardless of the actual facts of the matter. On the flip side, you don't hear about someone suing a Facebook "influencer" for doling out inaccurate, potentially fatal, medical advice.

So cracks appear in herd immunity, and leaks will happen.

A few generations of neurologists, including mine, have completed training without considering polio in a differential diagnosis. It would, of course, get bandied about in grand rounds or at the conference table, but none of us really took it seriously. To us residents it was more of historical note. "Gone with the Wind" and the "Wizard of Oz" both came out in 1939, and while we all knew of them, none of us were going to be watching them at the theaters.

Unlike them, though, polio is trying make it back to prime time. It's a sequel nobody wanted.

But here it is.

Block has a solo neurology practice in Scottsdale, Arizona.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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