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The forgotten link between Candy Land and polio and why it still matters

The history of the classic board game holds an important lesson about disease.

Photo credits: Amazon (left), Bror Brandt (right)

Candy Land was created for kids in the hospital with polio.

Candy Land has been adored by preschoolers, tolerated by older siblings, and dreaded by adults for generations. The simplicity of its play makes it perfect for young children, and the colorful candy-themed game has endured as an activity the whole family can do together.

Even for the grown-ups who find it mind-numbing to play, there's some sweet nostalgia in traversing the Peppermint Forest and avoiding the Molasses Swamp that tugs at us from our own childhoods. There are few things as innocent and innocuous as a game of Candy Land, but many of us may not know the dark reality behind how and why the game was invented in the first place.

candy landCandy Land has been a family favorite for decades, but it was originally created for kids with polio.m.media-amazon.com

Candy Land was invented by retired schoolteacher Eleanor Abbott while she recovered from polio in 1948. She was convalescing in a San Diego hospital surrounded by children being treated for the disease and saw how isolating and lonely it was for them. The game, which could be played alone and provided a fantasy world for sick children to escape to, become so popular among the hospital's young patients that Abbott's friends encouraged her to pitch it to game manufacturer Milton Bradley. The post-World-War-II timing turned out to be fortuitous.

“There was a huge market—it was parents who had kids and money to spend on them,” Christopher Bensch, Chief Curator at the National Toy Hall of Fame, told PBS. “A number of social and economic factors were coming together for [games] that were released in the [post-war era] that has kept them as evergreen classics." Candy Land soon became Milton Bradley's best-selling game.

Since the game doesn't require any reading or writing to play, children as young as 3 years old could enjoy it when they were feeling sad or homesick in the polio ward. As the polio epidemic ramped up in the early 1950s, the game gained even more popularity as parents often kept their kids indoors during polio outbreaks in their communities.

The polio vaccine changed the game—both for the disease and for Candy Land. Jonas Salk’s inactivated polio vaccine (IPV) was licensed in the spring of 1955 and a widespread vaccine campaign was launched. By 1961, polio cases had dropped from 58,000 to only 161. The disease was considered eradicated from the Americas in 1994, and, as of 2022, the only countries in the world to have any recorded cases were Pakistan and Afghanistan.

graph of polio cases from 1988 to 2021Vaccine GIF by World Health OrganizationGiphy

In the 70 years since the polio vaccine came out, Candy Land's connection to the disease has been lost, and it's now just a classic in the family board game cabinet. The fact that polio has so successfully been controlled and nearly eliminated makes it easy to forget that it used to be a devastating public health threat that spurred the need for the game in the first place. Children are routinely vaccinated for polio, keeping the disease at bay, but anti-vaccine messaging and fear threatens to impact the vaccination rates that have led to that success. Vaccination rates took a hit during the COVID-19 pandemic, and with the appointment of one of the most popular vaccine skeptics as the U.S. Secretary of Health and Human Services, public health specialists are concerned.

There is no cure for polio, so the vaccine is by far our best weapon against it. According to infectious disease experts, it's not impossible for polio to make a comeback. “It’s pockets of the unimmunized that can bring diseases back," Patsy Stinchfield, former president of the National Foundation for Infectious Diseases, told Scientific American. "If you have a community of people geographically close to each other and they all choose not to vaccinate, that community immunity is going to drop quickly. And if a person who has polio or is shedding polio enters that community, the spread will be much more rapid.”

Without herd immunity, vulnerable people such as babies who are too young to be vaccinated and people with compromised immune systems are at risk in addition to the unvaccinated. And since up to 70% of polio cases are asymptomatic, there can be a lot more disease circulating than it appears when symptomatic disease is detected. No one wants the serious outcomes that can come with polio, such as paralysis, the inability to breathe without assistance, or death, especially when outbreaks are entirely preventable through vaccine-induced community immunity.

The fact that kids have been able to enjoy Candy Land for decades without thinking about polio at all is a testament to vaccine effectiveness, but it's also a reminder of how easy it is to take that carefreeness for granted.

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74-yr-old Dr. Fauci treating Ebola patients in 2015 exemplifies his genuine leadership

Dr. Eric Ding/Twitter

Nearly a decade after the average American retires from their careers and choose to live a more leisurely life, Dr. Anthony Fauci was battling a deadly disease outbreak. And he wasn't just acting as the head of the National Institute of Allergy and Infectious Diseases (which was his actual job), or sitting at a desk crunching numbers and making models. He was suiting up to treat an a patient with Ebola—a disease with a mortality rate of around 50%—for two hours a day, even though he didn't have to.

Why did he do it? Because he wanted to show his staff that he wouldn't ask them to do anything he wasn't willing to do himself. He also told Science, "I do believe that one gets unique insights into disease when you actually physically interact with patients."

That is what genuine, trusted leadership looks like, and is one of hundreds of examples of why Dr. Fauci has been one of the most well-respected experts in infectious disease in the world for decades.

Dr. Fauci has served the United States under six presidents, from Ronald Reagan to Donald Trump. In 2008, he was awarded the Presidential Medal of Freedom by President George W. Bush for his work on the HIV/AIDS epidemic.

In his remarks praising Dr. Fauci, Bush pointed out that Fauci still quoted the wisdom he received at the Jesuit high school he attended (where he had won a full scholarship)—"Precision of thought, economy of expression," then added, "And now you know why he never ran for public office."

Dr. Anthony Fauci Receives The Presidential Medal Of Freedomwww.youtube.com

It was a joke, but that statement basically sums up Dr. Fauci's career. Meticulous attention to the science. Saying what needs to be said, nothing more and nothing less. And always rising above the partisan political fray. Dr. Fauci has faithfully served under both Republicans and Democrats, earning a reputation on the international stage for his professionalism and expertise.

Anyone trying to discredit the 79-year-old scientist has literally decades of highly respected work to contend with, no matter what kinds of inconsistencies they claim to have gotten from Dr. Fauci. Information during a novel virus outbreak is naturally going to change frequently, as doctors and scientists have to learn about what the virus is and isn't, what works on it and what doesn't, how it spreads and how we might limit the spread, in real time. That kind of uncertainty—which is the nature of a novel virus pandemic—opens the door to silly political accusations of "flip flopping" from people who either don't understand how science works or who want to use people's ignorance for their own gain. And Dr. Fauci has always been clear that information is evolving and that no one is an expert in this particular virus, because it's brand new.

No human being is perfect, of course, but there are certain individuals at the top of every field whose work speaks for itself, who maintain a level of integrity that is beyond reproach, and who manage to avoid the pitfalls of politics. People who have worked with Dr. Fauci have shared their experiences with him, and it's hard to find one from a non-political source that isn't glowing in its assessment.



The Lincoln Project, a Republican group working to oust Trump from the White House in November, even shared an ad that shows how Dr. Fauci's reputation has been stellar for decades.

We've become so accustomed to attacks on people in politics that it almost seems normal, but there's nothing normal about attempts to discredit a lifelong public servant and medical expert like Dr. Fauci. Unless you've voluntarily donned a hazmat suit to treat a patient with a disease that has a high likelihood of killing you, and unless you have decades of experience in infectious disease research, you've got no room to criticize Dr. Fauci or his work. The gentleman is as close to above reproach as they come, and we need his precision of thought and honest truth-telling now more than ever.

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No, the CDC did not drop its COVID-19 death count to 37,000. In fact, it didn't 'revise' it at all.

Photo by Dimitri Karastelev on Unsplash

I'm losing count of how many times in the past few days I've seen someone post something along the lines of this tweet:

"The CDC has actually ADMITTED that they overcounted COVID-19 deaths!"

"Look at the numbers—they're right there on the CDC website plain as day!"

"See, it's all overblown! We did this whole shutdown thing and tanked the economy for nothing!"

First of all, no, the CDC did not revise anything. Let's dive into these numbers because they actually are a bit confusing when you don't read the whole page (and frankly, some parts are a little confusing even if you do—get it together, CDC).

There are different methods of counting COVID-19 deaths, and the CDC's website includes numbers for two very different methods. We have:

1) The official CDC death count, which you can find on the CDC's home page. This count comes directly from public health departments in each state and territory daily. As of the writing of this article, that count stands at 68,279.

2) The Provisional Death Count, which is where that ~37,000 number comes from. This count comes from the National Vital Statistics System—the system that processes and logs death certificates. The notable thing about the Provisional Death Count is that it's not up-to-date. The CDC site itself states that the numbers on the Provisional Death chart lag weeks behind other counts:

"It is important to note that it can take several weeks for death records to be submitted to National Center for Health Statistics (NCHS), processed, coded, and tabulated. Therefore, the data shown on this page may be incomplete, and will likely not include all deaths that occurred during a given time period, especially for the more recent time periods. Death counts for earlier weeks are continually revised and may increase or decrease as new and updated death certificate data are received from the states by NCHS. COVID-19 death counts shown here may differ from other published sources, as data currently are lagged by an average of 1–2 weeks."

Here's a real-world example of what this looks like:

This is a screenshot of the Provisional Death Count as of April 16, 2020 (which you can access at this CDC link). As you can see, the COVID death count for the week of 4/11/20 was 3,542.

And here is the Provisional Death Count as of the writing of this article, which you can view in real time at this CDC link. As you can see, the week of 4/11/20 has been updated from 3,542 deaths to 12,628—a nearly four-fold increase since the April 16 publication.

When the numbers were published on 4/16/20, there were still 9,086 death certificates that hadn't been processed yet from the week prior—that's what they mean by a lag. Three weeks later, the numbers are very different.

So that 37,000 total (well, 39,000 right now) will change as the death certificates get processed. The Provisional Death Count simply isn't accurate yet. And the lag means it will never be an up-to-date count, so it's not a reliable source for current death numbers.

The problem is that people have been sharing the not-up-to-date Provisional Death Count link as a way to make it sound like the COVID-19 death numbers are actually smaller. They are not.

It's worth noting that all COVID-19 death counts include both lab-confirmed and "presumed" COVID-19 deaths. This has also been a source of confusion, not to mention conspiracy. But "presumed" doesn't mean just a wild guess.

Test results for coronavirus have a high false negative rate—from 5% to 30%—according to Dr. Alan Wells, professor of pathology at University of Pittsburgh. So relying solely on positive lab test results for COVID deaths would miss thousands. At this point, doctors and medical examiners can generally recognize clear COVID symptoms in a critically ill or deceased patient, and if a patient meets the clinical, epidemiological, or vital records criteria for the COVID being the cause of death, that's considered "presumed."

Each state has different requirements for coding COVID-19 deaths, and it's generally a very small percentage that are counted as "presumed."

Adding to the confusion on this front, Dr. Birx, from the White House Coronavirus Task Force, said that the U.S. was taking a "liberal" approach to counting COVID-19 deaths, and ""The intent is, right now, that . . . if someone dies with COVID-19, we are counting that as a COVID-19 death."

People unfortunately did not take that statement in the context of underlying conditions, which is what Dr. Birx was talking about. Here's what she actually said:

"There are other countries that if you had a pre-existing condition and let's say the virus caused you to go to the ICU and then have a heart or kidney problem -- some countries are recording that as a heart issue or a kidney issue and not a COVID-19 death. Right now ... if someone dies with COVID-19 we are counting that as a COVID-19 death."

If a person has a heart condition and they get sick with COVID-19 and die, COVID is counted as a cause of their death, even if they died of a heart attack—the reasonable assumption being that the disease led the patient's weakened heart to give in. Dr. Birx did not mean that a gunshot victim or a fatal car accident victim would be certified as a COVID-19 death just because they tested positive for the disease. That would be silly, not to mention illegal.

Read more on how COVID-19 deaths are counted from a forensic pathologist here.

You can also see an email from the Louisiana Health Department specifying how doctors are to log coronavirus deaths here:

So, no, COVID-19 death counts have not been revised downward, nor are they artificially inflated. In fact, it's more likely that they've been undercounted than overcounted, since only deaths that had been confirmed by tests were being counted for at least the first month of the outbreak in the U.S.

More importantly, read the fine print on a website before you make any assumptions about what you're seeing. Health data tracking can be a confusing to dive into under normal circumstances, much less during a novel virus pandemic where we're all learning as we go.

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A doctor in the heart of Italy's outbreak shares what life is like in the hospital now

Photo by JC Gellidon on Unsplash

Those of us living in countries like the U.S., where coronavirus has arrived but not quite exploded exponentially, seem a bit conflicted about what our individual responses should be.

Ideally, we'd simply heed the advice of medical experts at the CDC and WHO instead of politicians who have a vested interest in over-or under-hyping a potential pandemic. But in a heated election season, that appears to be a tall order.

Everyone agrees that we shouldn't panic (no one responsible would ever tell people to panic), but what does that mean exactly? Is stocking up on food and toilet paper a sign of panic, or a smart precaution? What's the sweet spot between alarmism and aloofness?

When numbers are still low where you live, it's easy to say, "Eh, this isn't that big of a deal." But the reality is even if you yourself are not at high risk of dying from the virus, millions of people are. And unlike the flu, there's no vaccine for this. Measures that might seem "extreme" or "panic-driven" are designed to keep spread of the virus to a minimum.

And an ICU physician working in the heart of the outbreak in Italy, Dr. Daniele Macchini, has eloquently explained why limiting the spread is vital.

On February 27, Italy had 650 confirmed cases of COVID-19. Less than two weeks later, they have more than 10,000. The entire country is on lockdown and hospitals are over capacity—a massive contrast to the calm that preceded the storm in the Bergamo hospital where Dr. Macchini works.

Dr. Macchini posted a description on Facebook of what the hospital was like on March 6 vs. what it was like a week before. Below is a condensed translation of his post (which is written in Italian and can be read in its entirety here).

"After much thought about whether and what to write about what is happening to us, I felt that silence was not responsible.

I will therefore try to convey to people far from our reality what we are living in Bergamo in these days of Covid-19 pandemic. I understand the need not to create panic, but when the message of the dangerousness of what is happening does not reach people, I shudder.

I myself watched with some amazement the reorganization of the entire hospital in the past week, when our current enemy was still in the shadows: the wards slowly "emptied", elective activities were interrupted, intensive care were freed up to create as many beds as possible.

All this rapid transformation brought an atmosphere of silence and surreal emptiness to the corridors of the hospital that we did not yet understand, waiting for a war that was yet to begin and that many (including me) were not so sure would ever come with such ferocity.

I still remember my night call a week ago when I was waiting for the results of a swab. When I think about it, my anxiety over one possible case seems almost ridiculous and unjustified, now that I've seen what's happening. Well, the situation now is dramatic to say the least.

The war has literally exploded and battles are uninterrupted day and night. But now that need for beds has arrived in all its drama. One after the other the departments that had been emptied fill up at an impressive pace. The boards with the names of the patients, of different colours depending on the operating unit, are now all red and instead of surgery you see the diagnosis, which is always the damned same: bilateral interstitial pneumonia.

Now, explain to me which flu virus causes such a rapid drama. And while there are still people who boast of not being afraid by ignoring directions, protesting because their normal routine is"temporarily" put in crisis, the epidemiological disaster is taking place.

And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us. Cases are multiplying, they arrive at a rate of 15-20 admissions per day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the E.R. is collapsing.

Reasons for the access always the same: fever and breathing difficulties, fever and cough, respiratory failure. Radiology reports always the same: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All to be hospitalized.

Someone already to be intubated and go to intensive care. For others it's too late... Every ventilator becomes like gold: those in operating theatres that have now suspended their non-urgent activity become intensive care places that did not exist before.

The staff is exhausted. I saw the tiredness on faces that didn't know what it was despite the already exhausting workloads they had. I saw a solidarity of all of us, who never failed to go to our internist colleagues to ask "what can I do for you now?"

Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we can't save everyone, and the vital parameters of several patients at the same time reveal an already marked destiny.

There are no more shifts, no more hours. Social life is suspended for us. We no longer see our families for fear of infecting them. Some of us have already become infected despite the protocols.

Some of our colleagues who are infected also have infected relatives and some of their relatives are already struggling between life and death. So be patient, you can't go to the theatre, museums or the gym. Try to have pity on the myriad of old people you could exterminate.

We just try to make ourselves useful. You should do the same: we influence the life and death of a few dozen people. You with yours, many more. Please share this message. We must spread the word to prevent what is happening here from happening all over Italy."

Macchini was speaking to his countrymen, but those of us who live in nations with numbers like Italy had two weeks ago should take note. It's not just a matter of our own personal risk of critical illness; it's also about the capacities of our hospitals and the availability of medical personnel. (I live five hours from Seattle, and a nurse friend here told me yesterday that facilities are offering up to $5000 a week for nurses to go work in Seattle right now to help manage the outbreak there. Things are getting real, real quick.)

Italy had 650 cases less than two weeks ago. As of the writing of this article, the U.S. has 755. If we don't take extreme measures—which many will call mistakenly call "panic"—to keep spread to a minimum, we may soon be facing the same dire straits Dr. Macchini describes in Italy.

Let's all agree to hunker down at home as much as possible, wash our hands religiously, avoid crowded spaces, stop hoarding medical equipment, and ask that our government be proactive with testing and truthful and transparent about the numbers. And let's do all of the above without calling any of it "panic." At this point, it's not panic, but practicality.



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