PA Survivors Network Information and Inspiration for All Polio Survivors and Their Families Serving the Keystone State and Beyond www.papolionetwork.org June 2020 Our Mission: To Be in Service Providing Information to Polio Survivors, Post Polio Support Groups, Survivor's Families and their Caregivers.

With so much polio history front and center in our news, we found ourselves more and more curious about the “unsung” heroes of the eradication efforts. This month, we’re bringing you Part Two of our series: The Unsung Heroes of Polio Eradication. Like Dr(s) David Bodian and Isabelle Morgan, whose stories we told in our May issue, Dr. Alex Karanek, PhD and Dr. Julius Youngner ScD are less known but were truly instrumental in the creation and improvement of ’s famous . “At the Guelph Little Theatre (in Guelf, Ontario) you will frequently encounter a very affable gentleman, with a lovely British accent, making himself useful in any number of ways. He might be designing a soundscape (piecing together the music and sound effects that enhance a production), memorizing his lines and learning his blocking (he has an affinity for Shakespeare), or he might be just helping to slap on a coat of paint somewhere. His name? Alex Kanarek. As a young man, Alex lived in the United Kingdom and played a significant role in the eradication of the polio virus. After a long and fruitful career as a scientist, Alex now lives in Ontario and volunteers at Guelph Little Theatre. On the face of it, here’s a great guy and a lovely human being who likes few things better than to sit down at the Albion over a pint and share stories about that play he did. When one reads an article from the CBC News, you discover that he’s made a place for himself in history like few others.” (1) . We’ve heard stories about Dr. Julius Youngner, but never truly read and learned about him. His significant contributions to the effort behind the Salk Vaccine are well documented. What’s new is the discovery that as a child, he was often very ill with viral . As a young man, drafted into the US Army he was (unknowingly) assigned to the top secret, historically significant research team that was named the “ Project”. His incredible life experiences led to his passion to learning about viruses. There were multiple interviews prior to his death in 2017. His wisdom and experience has a direct application to what the world is experiencing today.

There will be “unsung” heroes in the COVID19 journey. Only time will tell how long it takes their stories to be told. We are happy to bring you our first Q & A with Primary Care Physician Dr. Marny Eulberg, MD. We asked you to send us questions for her, and that you did! This month, she addresses the ability (or lack thereof) to breathe in a face mask along with the potential side effect of “brain fog” with the use of Melatonin. How many Neurons am I Losing as I age? We have a Bruno Byte Tidbit from Dr. Richard L. Bruno, HD, PhD that can help answer that question.

How Many Neurons Am I Losing As I Age? A Bruno Byte “Tidbit” From Dr. Richard L. Bruno, HD, PhD Director, International Centre for Polio Education Question: My leg muscle weakness seems to be increasing faster as I get older. I read that polio survivors lose 7% of muscle strength each year. How do I stop losing strength? Answer: PPS symptoms on their own don't increase more quickly as you get older, but, two things do happen over time: 1) Everyone over the age of 60 loses 1% of their motor neurons each year, not 1% of their muscle strength. A study by Dr. Alan McComas of untreated polio survivors (untreated meaning that they did not slow down, use braces, crutches or wheelchairs) found that they lost as much as 14% of their remaining MOTOR NEURONS (7% each year) over the two years of his study. 2) Some polio survivors will ignore muscle weakness for years and so do get weaker over time. One of our Post-Polio Institute studies found that polio survivors who applied our “conserve to preserve” protocol closer to the beginning of their symptoms had less muscle weakness, fatigue and pain after treatment than those who waited to be treated.

Bottom Line: Treating PPS sooner is better than later because symptoms will increase if you don't treat them. Some polio survivors will ignore PPS symptoms until they "need" an assistive device. Unfortunately by then it's too late because the motor neurons have died a natural or unnatural death.

The Encyclopedia of Polio and Post-Polio Sequelae contains all of Dr. Richard Bruno’s articles, monographs, commentaries and “Bruno Bytes” https://www.papolionetwork.org/encyclopedia.html Are you looking for a specific topic? The Encyclopedia Index (By Subject) is available by clicking HERE 2 Dr. Alex Kanarek, PhD “As a young man, Alex lived in the United Kingdom and played a significant role in the eradication of the polio virus. Alex earned his PhD in from the University of Cambridge. In 1954, at the age of 24, he was hired by the Burroughs Wellcome company to develop an effective and efficient method of mass producing the .” (1)(3) “Sixty years after he helped mass produce the polio vaccine in England, a Rockwood, Ont. man is celebrating news from the World Health Organization that the disease could soon be a thing of the past.” (2) Dr. Alex Kanarek, PhD In February, 2018, Alex Kanarek “came across a WHO statement that said we are ‘closer to polio eradication than ever before’.” As a result, he wrote the following message: “The WHO announced that polio is (soon to be) eradicated from the world, just like smallpox. Why it means a lot to me is that in 1958, the British government started vaccinations against polio with vaccine manufactured by two British companies, Glaxo and Burroughs Wellcome. I was a member of the Wellcome team that developed and produced that vaccine. That year I moved into a brand new laboratory to take charge of the chemical processing that ensured that the polio viruses were completely killed and made safe for the vaccine. For me, that was the most important job I had in the whole of my career. We changed over to the sugar-lump live vaccine in 1961, but in those three years I made enough vaccine to prevent polio in about 3 million kids. Nothing I have done since can match that in terms of my direct effect on children's health.” (4) Kanarek's story began in 1954, when he was hired by Burroughs Wellcome to find a way to produce enough polio vaccine to vaccinate all the children in the United Kingdom. American medical researcher Jonas Salk had just announced that his vaccine against polio worked, but no one knew how to make the vaccine on a large scale. It soon became obvious that the methods that we were using were not going to be adequate," Kanarek told CBC News. "Until then, people had been working with test tubes and little bottles, you see what I mean? We were now talking about 100 litres (26+ gallon) tanks." What needed to happen, Kanarek said, is that the process of manufacturing needed to be industrialized, and it fell to him and his small team of scientists and technicians to sort out what that would look like. "We were learning on the job," he said. "Every day we had another problem to solve, and that was the exciting part.“ (2) 3 Continued . . . Unsung Heroes – Alex Kanarek (continued . . .) “The live polio virus used for the vaccine came from Connaught Laboratories in Toronto, Kanarek said, and while that formula was shared with British laboratories, scientists were left on their own to develop the actual vaccine. ‘There was a lot of trade secrets in it,’ Kanarek said. He was hired by Burroughs, Wellcome Laboratory and got to work with two other scientists and six laboratory assistants to develop a safe and effective inactivated vaccine. ‘We split the job into three parts,’ Kanarek said. ‘Grow the virus, process it to make vaccine and test it.’ He was in charge of processing the vaccine. ‘What I had to do was take … (a blood bottle), I had hundreds of these, and I would put 500 ml of virus in a bottle, I would add chemicals, I would warm it up and I would take samples to see how … the virus was being killed and we would test those samples for live virus, residual virus and we would test them when they were all gone for how it would immunize,’ he said. It took three years before the three scientists found a vaccine that would produce the antibodies that would kill the polio virus. In the end, Kanarek helped to design a three-story building on the Burroughs Wellcome campus in Beckenham, just south of London, where the polio vaccine was produced. When the building opened in 1958, a local newspaper ran this photo of Kanarek and one of his technicians standing beside one of the stainless-steal mixing tanks he designed. When the reporters left the building, Kanarek said the real work began. They closed the doors, fired up the system and started producing the vaccine.” (3) “In those tanks I processed 138 lots successfully of polio virus, he said.” “138 lots were grown and … purified, inactivated and used to make vaccine. Out of that we made three million doses of vaccine.” Kanarek said there were two elements the scientists needed to be sure of when creating the vaccine. “One, that we had finally killed the stuff and secondly, that it was still capable of producing immunity in children.” “He said that they had a process that worked for killing polio, so as long as the conditions were consistent the virus would always be killed. ‘Then came the critical thing, which was the testing,’ he said. We had trials in Britain and in Northern Ireland and I suppose the really gratifying part was the results of the trials came back and the kids had antibodies. And then the government gave us the license to manufacture.”

Continued . . .

4 Unsung Heroes – Alex Kanarek (continued . . .) Kanarek said they produced 3 million doses of polio vaccine over the next three or four years - 3 million doses that protected children from a deadly disease. "That was a wonderful achievement, not just for me, of course, but for the whole team that did that job," he said. (2) But then, in 1961, another American researcher - Albert Sabin - created a new vaccine, one that was much easier to produce and administer. Burroughs Wellcome phased out its production of the Salk vaccine and started producing the new Sabin one instead. Kanarek was still working for the company, but had moved on to other viruses and vaccines. So, when he thinks about polio, it's the early days that he remembers. "What I remember most is that we were young, we were so enthusiastic," he said. "We were right at the beginning of this enormous achievement, which now – 60+ years later - it's just something everybody expects. "We have vaccines against all these different virus diseases and they work and they're safe, but back then we were right at the beginning of it and that was very exciting.“ (2) Sources: 1. https://guelphlittletheatre.com/alex- kanarek/#:~:text=Alex%20Kanarek.,mass%20producing%20the%20polio%20v accine 2. https://www.cbc.ca/news/canada/kitchener-waterloo/polio-vaccine- rockwood-scientist- 1.4565757?adbsc=social_20180310_2196681&adbid=10156256944389837&a dbpl=fb&adbpr=78976274836 3. https://www.wellingtonadvertiser.com/rockwood-man-had-lead-role-in- development-of-polio-vaccine-in-england-60-years-ago/ 4. Alex Kararek, February 2018

With Gratitude to the Public Broadcasting System, we appreciate the 30 days of free access (May, 2020 newsletter) we had to be able to watch The Polio Crusade.

It is available for purchase from both PBS and Amazon.

5 Unsung Heroes (continued . . .)

Dr. Julius Youngner Julius Youngner was born in 1920 in , where his father was a businessman. As a child, he was sick quite often and when he was seven, Youngner was nearly killed by lobar pneumonia. All of this left him with a lifelong interest in infectious disease. (1)(2) Youngner graduated Evander Childs High School, when he was 15 years old, and received a B.A. in English from in 1939. After completing a Sc.D. (Doctor of Science) degree in microbiology at the he stayed on as a faculty member. He was drafted into basic U.S. Army infantry training. Dr. Julius Youngner Upon completion, he screened and assigned to a top secret project. The Army assigned him to their top-secret unit in Oak Ridge, Tenn., to examine the toxicity of uranium salts through classified research at University of Rochester School of Medicine. The effects of inhaled uranium salts on human tissue was important to the war effort, as it related to purification of uranium for nuclear research and weapons. Youngner never knew the research was related to weapons until the end of the war. (He thought nuclear energy would be used for planes or submarines for transportation). He had no idea he was working on what would be known as “The Manhattan Project” (the government’s clandestine program to develop an atomic bomb). (1)(2)(3) A commissioned officer in the Public Health Service at the Cancer Institute (National Institutes of Health), Julius Youngner discovered his interest in virus research. When he moved to Pittsburgh in 1949, he thought he’d be in the city for two years. He wanted to work on viruses and took a position in a lab directed by Dr. Jonas E. Salk, developing a vaccine for polio. “The Fifth Avenue lab where he and the original five-person team worked was located below a ward of polio patients who couldn’t breathe on their own. Machines, ‘iron lungs’ did it for them, said Youngner. ‘They had these machines that drove the in and out of breathing,’ he said. ‘I mean it just kept them alive.’ The ward was enormously loud. The machines created a terrible din and drove home the reality of the disease, Youngner said. ‘We had motivation right there in the building,’ he said. ‘Everybody Dr. Julius Youngner, part of the was very serious about what we were doing. I polio vaccine research team, works never worked so hard in my life. I worked seven in one of Pitt’s labs. Courtesy of days a week’.” (4) University Library Systems 6 Unsung Heroes – Julius Youngner (continued . . .) His contributions to Salk’s vaccine were critical to its success. (3) The most prominent was a rapid color test he designed to measure the amount of poliovirus in living tissue culture. He also developed techniques for trypsinization - a method that used the enzyme trypsin to harvest the polio virus in large quantities. This technique enabled vaccine-makers to produce material to make vaccines for everyone.(3) The Salk vaccine is based upon formalin inactivated wild type virus. The key to effective inactivation depended upon a color test developed by Youngner, which allowed formalin induced viral protein degradation to be accurately plotted. From Youngner's work, formalin application for six days was projected to produce only "one live virus particle in 100 million doses of vaccine." (1) By 1954, the first virus trials had immunized 800,000 children against polio. After his work on the polio vaccine, Youngner made major advancements in the fields of virology and immunology. Together with Pitt colleagues, he explored the antiviral activities of the immune protein interferon and identified what is now known as interferon gamma. Interferon is now used in many cancer therapies. He was an American Distinguished Service Professor in the School of Medicine and Department of Microbiology & Molecular Genetics at University of Pittsburgh. (1) A historical photo of He received numerous honors and awards, Dr Julius Youngner, a key member including the Polio Plus Achievement Award from of the University of Pittsburgh Rotary International in 2001. team that developed a polio He earned an honorary doctor of public service vaccine with Dr. Jonas E. Salk,. from Pitt in 2005, the Chancellors Medal in 2014, Photo Source: University of and the department of microbiology and molecular Pittsburgh genetics established an annual lecture series in his honor in 2015. (3) Dr. Julius Youngner died in 2017 at the age of 96.

7 Unsung Heroes – Julius Youngner (continued . . . .) Words Of Wisdom and Experience from Personal Interviews with Dr. Julius Youngner.

Q: What did you think of the work of Albert B. Sabin, MD, that led to the development of the oral vaccine? A: Without Dr. Sabin's vaccine, polio would have never been eradicated because of the expense of the [Salk] vaccine and the fact that you needed needle and syringe. Multiple injections with needle and syringe made it not practical for global eradication. Dropping drops in babies' mouths was the way to go, and Dr. Sabin did it. (5) Q: How does it feel to have played such a significant role in eradicating this disease in the United States? A: Exhilarating -- and that doesn't even describe it, because I've been on a high ever since. (5) Dr. Julius Youngner, right, with Dr. Jonas Salk in an undated photo. Photo Q: Before the emergence of HIV, there was a point Credit: University of Pittsburgh where it was thought that all infectious diseases had been defeated. Do you think we'll ever be able to actually defeat infectious disease entirely? A: I really don't think so. Nature is the worst bioterrorist. There will always be new threats. Look at how AIDS appeared in the '80s. SARS came out of nowhere. In 2004, it disappeared, for the time being. Avian influenza in Asia is knocking on our doors. This could be the next pandemic, and nature knows how to do it. (5) Q: Can you tell me a little bit about the experience of doing research as a part of the polio team? A: “Well, it was very exciting. Especially since we knew very early on that we were probably going to be successful, because it was successful in monkeys — the vaccine immunized the monkeys, so they didn’t get polio when we challenged them.” (6) Q: How did you first get involved in Polio research? A: “I was a commissioned officer at the Cancer Institute in Bethesda, [Maryland], and I wanted to work with viruses and , but there was no lab space for me to do that. So, they said go anywhere you want, that way you can do what you want, and then come back and you will have a lab. Jonas Salk and I had a joint acquaintance in Ann Arbor, [Michigan], and when he found out I was looking for a position, he called me and said that you can work on cell culture and viruses, but I would like you to first work on polio. And I said, that’s no problem. The rest is history.

Continued . . . 8 Unsung Heroes – Julius Youngner (continued . . . .) So, when it came time for me to go back and work on cell culture and viruses, I stayed on the reserves and worked in Pittsburgh because I knew we were on the way to getting a major vaccine against a major disease. And here I still am.” (6) Q: How long was the time from the onset of the polio project until the results were able to be published? A: “We had immunized monkeys by 1951 and then we went to volunteer school children. Then in 1954, they started the big field trial with around 800,000 children in 12 states — that’s a kind of field trial that will never be seen again. It was done double-blind. On April 12, 1955, there was a big announcement made in Ann Arbor, Michigan, where the trial headquarters were and they made the big announcement that the vaccine was successful and it just went around the world like lightning because people were so afraid of polio and the incidence was increasing, especially in upper age groups.” (6) Q: How would the trial have been different if it had been conducted today (2016) ? A: “Today, it would have taken us 12 years to do what we did in four and a half years because of all the regulations now - there’s the institutional review board, the FDA, the animal care organization, the federal government. We didn’t even work with laminar flow hoods for safety, and we did mouth-pipetting, which you can’t do anymore. So, it would have taken us much longer if we were starting out now. “It would have been safer for us, and it would have had approval from many different groups before we could go ahead with each stage. We didn’t have to wait for formal approval by Institutional Review Boards for protocols and what we were going to do … And, with the animal care regulations now, our cages for the monkeys would have never passed muster … But, that’s why we did it so fast. That is an amazing thing for the world to recognize — this was done in very short time.” (6) Q: In the early 1900s, polio was a major epidemic, especially in New York, where 6,000 people died — many of them children — and 21,000 were left temporarily or permanently paralyzed by the epidemic, according to the New York Times. Do you think fear made finding volunteers an easy task? A: “Absolutely. And not only that, in 1952, when we started doing the human trials in Pittsburgh, this was the height of polio incidence — there were 52,000 cases of paralytic polio in the United States. We also had an incentive because in the building we working in, on the third floor, there were all people in iron lungs and to go up there and see these people in the iron lungs, which were artificial breathing devices, gave us an incentive to work hard. (6)

Continued . . .

9 Unsung Heroes – Julius Youngner (continued . . . .) Q: In regard to grants, how is the process different now than it was 50 years ago? A: “Well, in those days, the [National Institutes of Health] was not funded the way it is now. The whole development of the polio vaccine was done with only private money provided by what was then called the National Institute for Infantile Paralysis, which is now the March of Dimes, so there was not one penny of federal money. Actually, it gave an incentive and showed the government what can be done when you can spend money on research.” Q: In your mind, what is the next up-and-coming research discovery? A: “They are working on the Zika virus and that’s taking a lot of people’s energy. But, when they conquer Zika virus and have a vaccine, there will be something else because nature knows how to fill niches — there is always something new nature can do her tricks with. We never had ebola before, we never had Zika before … so, there is always going to be something new to threaten us and make research essential to solve the problem.” (6) Q: Will we ever be able to predict what will threaten us next? A: “No, I don’t think so … you can’t predict where it’s going to come from. Who would have predicted Zika virus? They didn’t even know the name, but it was circulating in Africa somewhere, from some animal and into humans. Then, it broke into populations that had never experienced it before in the Western Hemisphere and Asia, and it spread very easily.” (6) Q: How has the focus of research evolved over time? A: “I don’t think the focus has changed because in infectious diseases there are lots of problems that have to be solved. For instance, antibiotic resistance - that’s a problem that is really hard to solve … it is staying ahead of scientific technology. And now, a new disease like Zika, comes into the developed world and is carried by mosquitos, which we have plenty of in this country, and they found out a lot of things about Zika that they never knew - it can be transmitted sexually, by saliva. I mean, it’s really a very unique disease.” (6) Sources: (1) https://en.wikipedia.org/wiki/Julius_Youngner (2) This Week in Virology:373 www.papolionetwork.org/polio-history-videos (3) https://archive.triblive.com/local/pittsburgh-allegheny/julius-youngner-pitt-polio-pioneer-dies- at-96/ (4) https://www.wesa.fm/post/how-pittsburgh-made-polio-vaccine-helped-beat-disease-terrified- nation#stream/0 (5) https://amednews.com/article/20050411/health/304119969/4/ (6) https://pittnews.com/article/111964/top-stories/julius-youngner-polio-vaccine-research-team/

10 Q & A with Primary Care Physician Dr. Marny Eulberg, MD Question: Dr. Eulberg, I find that wearing a mask makes breathing hard. I started to faint Friday at work. Is it the carbon dioxide I am rebreathing? What other options are there? Answer: Different masks make a difference in the control of respiratory infections (including COVID-19) in different ways. They affect the wearers ability to breathe differently as well based on the purpose and the materials the masks are made of. The COVID-19 virus is only about 1 micron in size, which is 100 times smaller than the width of a human hair. (There is an interesting video on YouTube if you Google “What is the size of the COVID virus?”). So-o-o if the goal of the mask is keeping the virus particles that are in the air from coming through the mask material and into your nose and mouth then the openings in the fabric of the mask must be smaller than 1 micron. That means very, very little air can come in and out! The challenge is finding a balance between limiting the amount of respiratory droplets that can be dispersed out into the environment by a contagious person, decreasing (if possible) the virus particles breathed in by a person wearing a mask, and breathability. At this time, we believe the primary purpose of wearing a mask is to keep the wearer from spreading germs to others—the mask can trap many of the much larger bacteria and reduce the distance that small viral particles travel when the wearer talks, coughs, or sneezes. For example, when wearing a mask an infectious person may now only spew respiratory droplets a distance of 1-2 feet instead of 6-10 feet. No mask, except those with hoses that circulate filtered air into a hood can keep the wearer from breathing in ANY viral particles. A mask’s effectiveness at serving as a filter to limit the spread of virus from an infected person is based on the materials the mask is made of and the number of layers in the mask. More layers or more dense materials increase the filtering capacity, but also decrease the ability of air to move in and out of the mask and thus the breathability. The easiest mask to breathe through is one with only two layers of a loosely woven fabric, but that also is the least protective. More effective is a mask made with four layers of material including at least one layer of a non woven material, such as that found in surgical drape material or fusible interfacing.

11 Question: Dr. Eulberg, probably because of all the world health issues that we are bombarded with constantly I have not been sleeping well so I decided to try Melatonin, 3mg at bed time. I have used it a few times and it does help me sleep, but the following day I feel like I'm functioning in a slight fog. I know that polio survivors have had some degree of brain involvement with the initial polio and I'm wondering if that is causing my foggy feeling. Answer: Since you report the brain fog beginning after starting to take the melatonin, my first thought would be that the slight brain fog is a side-effect of the melatonin and not related to some brain involvement from your prior polio. On days that you don’t take the melatonin do you have slight brain fog the next day? Or if you haven’t taken the melatonin for a couple nights, how do you feel in the morning? Although melatonin is generally safe, all chemicals, even if they are safe enough to be sold over the counter can still have undesirable side effects. You also have to decide whether the benefit of sleeping well is greater than the downside of slight brain fog the next day. Do you have a question for Dr. Eulberg? Email us at: [email protected] Dr. Eulberg shared a lot of helpful information for Polio Survivors in our May, 2020 Interview.

COVID-19 and Polio. Experiences that are sadly similar. As the world fights yet another virus, there are many stories about the polio epidemics being published all over the US an Abroad. A few weeks ago, we published this quote on numerous Facebook pages. The responses were moving and truly emotional. "I was taken by ambulance, far from my home . . .and placed in an isolation ward. THAT was where I discovered that the pit of fear has no bottom. I was never so alone in my life. I wanted desperately to be hugged, but the nurses seemed afraid to touch us. They did only what was necessary. As a result, for way too long, I lived out of touch with the rest of the world. My only steady companion was the swishing sound of a nearby respirator. When I finally did get to see my mother, she was dressed like a mummy . . . certainly not like a Mom. She was not allowed to cross a certain mark on the floor. She could not touch me and I could not hold on to her.“ This quote was taken from We Never Walk Alone, a story that we published in May 2020 about a 9 year old in 1944. This and many other moving stories are in the Survivor Connections section of our website. https://www.papolionetwork.org/survivor-connections.html 12 Stay well, and we quote the now famous line: “We’re all in this together”

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