The word “quarantine” has been tossed about quite a bit during the current Ebola outbreak, with people in the U.S. who have been in close proximity to those infected with the disease being subjected voluntarily or forcibly to a 21-day quarantine. The definition and history of the forced isolation of sick persons may shed some light on benefit and controversy of the current practice.
Isolating the sick from the well seems obvious today, but humanity apparently needs constant reminders. One is in the Old Testament, which tells priests to isolate a sick person for seven days. If they’re still sick, isolate for another seven days. Kind of a shampoo-rinse-repeat-until-well-or-dead school of medicine.
Another reminder is plagues. The word quarantine comes from the Italian phrase “quaranta giorni,” which mean 40 days, and dates back to the Black Death of the 14th century. Ships entering the port of Venice were required to anchor offshore for 40 days to see if anyone on-board was infected. Did it work? Well, up to 200 million people died from the plague so even if it did, it wasn’t much of an impact.
As travel and trade increased, so did the spread of diseases. Leaders of European and Asian nations held conferences to establish rules for quarantines and lengths of isolation. The rules varied widely according to the diseases and how the nations felt about each other. About the only thing they could agree upon is the color of the flag a quarantined ship must fly. Yellow has been the dominant color and today’s flag is the “Lima” or yellow-and-black pattern.
In the U.S., quarantines were handled at a local level until the Public Health Service Act of 1944 gave the federal government quarantine authority for the first time. After the SARS epidemic of 2003, the number of official U.S. quarantine stations was expanded to 18, encompassing all major port-of-entry cities. In reference to the current Ebola outbreak, Dallas is one of them, Cleveland is not.
The length of a quarantine is as varied as the diseases it covers. For anthrax, the quarantine lasts until the potentially infected person’s clothes are removed and their body decontaminated in a shower. For Mary Mallon, whose spreading of the disease earned her the name Typhoid Mary, mandatory quarantine lasted 24 years until her death. Again, as we see in the Ebola crisis, the length of a government-enforced quarantine is as much a civil rights issue as it is a medical one.
That’s a little bit on quarantines. Now go wash your hands.