Hyderabad: At a time when more than half of the world population has been forcibly put in a de facto quarantine in a bid to contain the spread of coronavirus disease which has affected millions and claimed thousands of lives, let’s take a look at the origins, purpose and the expanse of this practise or mechanism being touted as the only way to combat COVID-19 until a vaccine is developed.
In the list of diseases that may require quarantine, issued by the Centers for Disease Control and Prevention, the Severe Acute Respiratory Syndrome that can go on to become pandemic has been recently added to the existing ones — cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever and viral hemorrhagic fever. It shows that quarantine is a medically accepted mode to reduce community transmission.
Quarantine is considered to be the oldest mechanism to reduce the rapid spread of contagious diseases. Since ancient times, societies have practised isolation, and imposed a ban on travel or transport and resorted to maritime quarantine of persons.
From ‘Trentino’ to quarantine
The first law on medical isolation was passed by the Great Council in 1377 when the plague was rapidly ruining European countries. Detention for medical reasons was justified and disobedience made a punishable offence. The law prescribed isolation for 30 days, called a ‘trentino’. Subsequently, many countries adopted similar laws to protect people. When the duration of isolation was enhanced to 40 days, the name also changed to ‘quarantine’ by adopting the Latin 'quadraginta', which referred to 40-day detention placed on ships.
Quarantine has since been treated as the cornerstone of a coordinated disease-control strategy, including isolation, sanitary cordons, bills of health issued to ships, fumigation, disinfection, and regulation of groups of persons who were believed to be responsible for spreading the infection.
Some early examples
Bubonic plague in Venice (1370)
The so-called Black Death killed 20 million Europeans in the 14th century. So Venice, a major trade port, grew nervous. If a ship was suspected of harbouring plague, it had to wait 40 days before any passengers or goods could come ashore. Venice built a hospital/quarantine centre on an island off its coast, where sailors from plague-infested ships were sent either to get better or, more likely, to die. This 40-day waiting period became known as quarantinario, from the Italian word for 40.
Yellow fever in Philadelphia (1793)
Almost 5,000 people died over the course of two years, about a tenth of the city's population. Thousands fled for the countryside, and at the height of the epidemic, when nearly 100 people were dying every day, the city government collapsed. The best-known cure at the time was to "bleed" patients of infected blood and give them wine — and a popular theory on stopping the disease was to quarantine sailors at the Lazaretto, a hospital outside the city. But the disease is spread through mosquitoes, so quarantine was not as effective as the cold snap that eventually killed the infected insects.
Typhus in New York (1892)
In 1892, a boat carrying many Russian Jewish immigrants arrived at Ellis Island. Passengers in steerage class had developed such bad cases of body lice that the harbour inspector declared he had "never seen a more bedraggled group," according to medical historian Howard Markel. Lice led to typhus, but by the time that disease was discovered, the passengers had spread out to boarding houses and family homes across New York's Lower East Side. At least 70 were rounded up and quarantined in tents on North Brother Island in the East River.
Bubonic plague in San Francisco (1900)
City authorities strung rope and barbed wire around a 12-square-block section of Chinatown (after allowing all Caucasian residents to leave). The cause: fear of bubonic plague, after a Chinese immigrant was found dead in a hotel basement. The quarantine was lifted after a few days, but not before countless Chinese labourers had lost their jobs.
Typhoid in New York City (1907)
A woman named Mary Mallon, better known as "Typhoid Mary” was an Irish-born cook who carried the bacteria that causes typhoid fever, a form of salmonella that can cause fever, diarrhoea and death. But Mallon herself was immune to the disease. When authorities figured out that her work as a cook had caused the city's typhoid outbreak, she was sent to North Brother Island for a three-year quarantine. She promised never to cook for others again. But she broke her word. When apprehended in 1915, she was sent back to the island for the rest of her life — 23 more years.
Venereal disease in the United States (1917)
With World War I raging, the U.S. military became concerned about the number of young men ineligible for the draft because of sexually transmitted diseases like syphilis and gonorrhoea. They also noticed an uptick in "camp girls," prostitutes and other women hanging around U.S. training grounds and military recruitment centres. A federal order allowed for the incarceration of prostitutes and camp girls until they were deemed STD-free via mandatory testing.
Flu epidemic in Europe and the U.S. (1917-1919)
This global pandemic, which killed an estimated 50 million, prompted quarantine and isolation, as well as school cancellations in Europe and a ban on public gatherings in parts of the U.S.
SARS in Canada (2003)
Though the Severe Acute Respiratory Syndrome (SARS) pandemic of 2003 led to quarantines in many different countries, Canada's response was the most disproportionate to the risk. According to the U.S. National Institutes of Health, Canada quarantined almost 100 people for every confirmed SARS case in the country. Though Toronto only had 250 probable cases, about 30,000 people were confined in hospitals and their homes. A comparable number were quarantined in Beijing, which had 2,500 cases.
Bubonic plague in China (2014)
China took a page from San Francisco's turn-of-the-century playbook when it faced a single case of the bubonic plague. A man died of the disease after feeding a dead, plague-infected marmot to his dog in the north-western city of Yemen. Over 150 people who had contact with the man were placed in quarantine; several districts of the city were sealed off, isolating thousands. After two days, the quarantine was lifted; no other cases were reported.
Ebola in Liberia and Sierra Leone (2014)
In Liberia, the neighbourhood of West Point was cordoned off for 10 days in August after residents raided a centre for suspected patients. Patients fled into the densely populated slum, prompting the government's decision to isolate the neighbourhood for 21 days, the incubation period for the disease. Protests ended the quarantine after 10 days. In neighbouring Sierra Leone, a three-day quarantine in September asked everyone to stay at home while health workers went door to door, looking for the sick and delivering bars of soap. Doctors Without Borders, the medical organization that played an important role in the fight against Ebola, said, "It has been our experience that lockdowns and quarantines do not help control Ebola, as they end up driving people underground and jeopardizing the trust between people and health providers."
Quarantine in India
In India, the Epidemic Diseases Act, 1897, a law of colonial vintage, empowers the state to take special measures, including inspection of passengers, segregation of people and other special steps for the better prevention of the spread of dangerous diseases.
It was amended in 1956 to confer powers upon the Central government to prescribe regulations or impose restrictions in the whole or any parts of India to control and prevent the outbreak of hazardous diseases.
Quarantine is not an alien concept or strange action and it has been invoked several times during the bizarre situations caused by cholera, smallpox, plague and other diseases in India.
