From the Experts

What We Can Learn from Response to Typhoid Mary

Once the germ was discovered and researchers discovered its origin was not related to dirt, looking through microscopes replaced sanitation and other systemic approaches to public health. Street cleaning and garbage removal stopped and focus shifted to individuals who carry germs. Citizens were encouraged to avoid germs, self-isolate, and vaccinate. 

Typhoid fever is a bacterial infection that causes GI distress. Historically, it struck cities that sent untreated water through pipes. This highlighted the need for cities to provide clean water. Once the water systems were in place, typhoid fever did not disappear completely. Healthy persons, who either recovered from the disease or never exhibited any symptoms, continued to carry the bacteria and transmit it to others.

Mary Mallon, or Typhoid Mary, a chef in New York in the 1900s, was stuck in isolation for over 25 years for carrying typhoid and endangering other people. Mary was not sick, however, managed to transmit the bacteria through the food she cooked. She was identified as a carrier after an epidemiologist traced a series of typhoid fever outbreaks in 9 families that previously employed her. 

Once tracked down, Typhoid Mary was removed from society and placed in an isolation cottage. Officials believed this was the best way to protect the health of the public. Mary’s data was gathered during her long stay and she was determined to be an intermittent carrier, meaning sometimes she tested positive, and sometimes she did not.

Mary interpreted this treatment to mean that the doctors did not know what they were doing. When she was able to leave isolation for a short period of time, she continued infecting people with her cooking. The one question nobody asked was, how could Mary stop transmitting the disease to others? Her life may have benefited from education in areas of proper sanitation or finding a career with less direct customer contact. 

Looking back, it’s known that 100% isolation is not a realistic approach to controlling an epidemic. New York State began governing the behavior of carriers, finding them jobs outside of the food industry, and even subsidizing their income in special circumstances. Restriction of certain activities was deemed sufficient. Carriers were no longer removed from society because their economic contribution to their family was acknowledged. Ultimately, the New York State Health Department forbade people sick with infectious diseases from handling food. Cooks needed to prove they were free from infectious diseases before gaining employment. 

Additionally, the government kept records of people who were infected with typhoid and monitored them post-recovery to keep data of healthy typhoid carriers. The healthy carriers were required to have satisfactory home environments and carry out the rules of public health. Many behaved in the public’s best interest, unlike Mary Mallon, who did not listen to medical advice and continued to cook food, proving there are multiple determinants of disease outcomes.

Typhoid is a bacteria and COVID-19 is a virus. Both are infectious. Even though Typhoid Mary’s experience began in 1907 and COVID-19 didn’t appear until 2019, many lessons can be learned from Mary.

Key takeaways:

  • Testing is critical 
  • Education is necessary  
  • Clean environments are the safest environments 
  • Asymptomatic people can be carriers of disease 
  • Wash hands 
  • Do not touch the face
  • Treat others with respect and empathy
  • Mentally prepare for the new normal
  • Social norms change
  • Restriction of certain activities work
  • Quarantine and isolation work
  • Buildings need to be reconstructed to promote health
  • Government surveillance works
  • Government intervention is necessary
  • Economic subsidies are necessary
  • Learning new skill or trade-in the new normal might be necessary