key: cord-0804794-1dga53u8
authors: Berger, Miles; Ghadimi, Kamrouz
title: Necessary Heroes and Ethos, from Fighting Nazis to COVID-19
date: 2020-07-15
journal: Anesthesiology
DOI: 10.1097/aln.0000000000003488
sha: 0bd3f5e1ca6e06a1fb235fb31a353d333c30aba0
doc_id: 804794
cord_uid: 1dga53u8

nan

The Nazi Wehrmacht (armed forces) were terrified of typhus, a rickettsial disease endemic in Poland at that time, because typhus epidemics could decimate an army's fighting strength. Although typhus presented clinically with purple rash, headache, fever, and delirium, it was diagnosed serologically at that time using the Weil-Felix test, 2 which was performed by mixing a patient's blood sample with Proteus bacteria. If the mixture clumped when heated, the patient had typhus. In a small makeshift laboratory behind his house, Dr. Matulewicz discovered that the Weil-Felix test would yield a false positive for typhus if a patient had first been injected with dead Proteus bacteria. 3 Since Drs. Lazowski and Matulewicz knew that documentation of typhus was sufficient to prevent the Nazis from deporting Polish citizens to forced labor camps in Germany, they created a mock epidemic of typhus by immunizing people with the killed Proteus strain OX19. To make the epidemic look authentic, they immunized more people in the winter than in the summer, so that reports to the authorities followed the natural epidemiologic pattern of typhus. This went on for nearly 2 yr of the war. Consequently, over 8,000 Polish citizens were spared from deportation to forced labor and concentration camps, likely saving thousands of lives.

Interestingly, at one point Drs. Lazowski and Matulewicz were betrayed by Nazi collaborators, who reported that they saw no ill people in the village. The Nazis sent a team of doctors to investigate, but the Polish resistance alerted Dr. Lazowski, who hastily arranged a group of peasants to act bed-ridden and pretend to have fevers and chills.

When the Nazi inspection team arrived, their doctors were so terrified of louse infestations that they did not even examine these patients. The Nazi inspectors simply peeked into the room to make sure someone was in the bed and quickly drew blood samples before leaving. These blood samples were then sent to a reference lab in Germany, because the Nazis suspected subterfuge by Drs. Lazowski and Matulewicz. Of course, the test results were "positive, " reflecting a biologic false positive from Proteus immunization. Thus, the ruse went undiscovered, likely sparing Drs. Lazowski and Matulewicz and their families from being sent to concentration camps or being summarily shot.

During World War II, these two doctors cleverly manipulated a laboratory test to create false positives in order to save lives. Today, there is concern about the exact converse. False negative nasopharyngeal polymerase chain reaction tests for SARS-CoV-2 may occur in roughly 30% of infected patients 4, 5 and could lead to the erroneous conclusion that patient isolation and appropriate personal protective equipment are not necessary, 6,7 potentially causing iatrogenic spread of SARS-CoV-2 (which happened workers. Yet perhaps the most important legacy of our front-line healthcare colleagues who have fallen and those of us who continue to battle the COVID-19 pandemic will be a reminder to current and future generations of this timeless ethos, that healthcare workers will risk personal danger to save the lives of our most vulnerable patients.

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The authors thank the virologist Dr. Donald Ganem (Professor Emeritus, University of