From plague to coronavirus: How quarantine as a public health strategy evolved over centuries
Quarantining has been a major method in our fight against contagious epidemics that don’t have any cure. Here is a look at how the method has evolved from ancient times when it was used in the fight against leprosy and the plague to this day when it is employed widely in the fight against the novel coronavirus.
Quarantining has been a major strategy in the fight against the novel coronavirus, which by now has affected over 100,000 people across the globe. Authorities have isolated millions from the rest of the population, the latest being the 16 million people told to stay home in Northern Italy on Sunday.
So, how did the concept of quarantining began? How effective is it? And why is it often controversial?
History of the quarantine
The earliest documented reference to quarantining was related to leprosy in the Old and New Testaments. Under the Catholic Church, leper colonies were set up in the Middle Ages to isolate the patients from the rest of the population.
The modern concept of quarantining began in the 14th century when the plague ravaged Europe. The term itself traces its origin back to this time.
In 1377, in the seaport in Ragusa (which is modern-day Dubrovnik, in Croatia), authorities issued a mandatory isolation period of 30 days for ships coming from plague-affected areas. It was called “trentina” – derived from the Italian word for 30 (trenta).
Later, the duration was extended to 40 days. The Italian word for 40 was quaranta, and thus originated the word quarantine.
Not surgical history, but a topical issue. Quarantine comes from the Italian quaranta giorni, meaning 40 days. This was the length of time chosen to isolate ships at anchor before landing if plague was suspected. The concept was first introduced in 1377 in Dubrovnik, Croatia. pic.twitter.com/Db3NKwZ3ri— Legends Of Surgery (@SurgeryLegends) March 8, 2020
“It is not known why 40 days was chosen as the length of isolation time needed to avoid contamination, but it may have derived from Hippocrates theories regarding acute illnesses,” says Eugenia Tognotti, a professor of the history of medicine and human sciences at the University of Sassari.
“Another theory is that the number of days was connected to the Pythagorean theory of numbers. The number 4 had a particular significance. Forty days was the period of the biblical travail of Jesus in the desert.”
While the practice was effective against the plague – which was transmitted from person to person through the air via infectious droplets or flea bites – it was ineffective against cholera, which spread through contaminated water or food.
But this was a time when there was no antibiotics and diagnostic testing against these diseases. Furthermore, people also had no knowledge of pathogens behind them – which developed only in the 19th and 20th centuries. So, authorities continued it as a major practice to tackle any public health emergency.
But quarantines – which involved isolation and suspension of personal liberties – was misused and abused for political-economic reasons during this period.
And that had repercussions.
“Social and political tensions created an explosive mixture, culminating in popular rebellions and uprisings, a phenomenon that affected numerous European countries. In the Italian states, in which revolutionary groups had taken the cause of unification and republicanism, cholera epidemics provided a justification (i.e., the enforcement of sanitary measures) for increasing police power,” writes Tognotti.
But as scientists identified the pathogens that were behind each of these epidemics, a turning point in the history of quarantines happened. Different public health strategies began to be adopted against different diseases like cholera, plague, and yellow fever.
In 1903, at the 11th Sanitary Conference, held in Paris, world nations adopted restructured international regulations for quarantines.
The use of quarantining, among other things, proved effective in containing the 2003 pandemic of severe acute respiratory syndrome in just over 3 months.
The practice was also highly effective in fighting Ebola and forms of contagious flu, against which we don’t have any pharmaceutical defence.
But quarantines often mean separation from families and loved ones, and a feeling of being a pariah in one’s own community, leading to mental anguish. They also mean sacrificing individual rights for collective interest in emergencies. So, the method continues to face criticism.
For instance, when medics returning from Ebola-affected West Africa were placed under a 21-day quarantine in the US, even the UN Secretary-General came up with a statement against the practice.
Recently, the quarantining practices in China have also raised concerns among the international community, because of the authoritarian nature of the imposition.
“Similar to other effective health measures, quarantine is not a panacea, and has its limits,” say authors of a research paper in the Journal of Infection.
“However, good quality evidence overall suggests that the basic concept of quarantine is still fully valid and that the implementation of correct quarantine procedures must be tailored according to single health, social and geographical conditions,” they add.