Why do we still need quarantine?

Why do we still need quarantine?

In the past, the ancient practice of quarantine was often the only tool in the fight against infectious diseases like leprosy and bubonic plague. Even in today’s world of vaccines and antibiotics, quarantine still has a role as evidenced by the emergence of the coronavirus in January 2020.

During the Black Death, one of the main methods used to try and prevent the disease from spreading between cities, ships were isolated before passengers and crew could go ashore. They were secluded for 40 days, as it could take 37 days to die from the plague – only the lucky living would leave, while the infected would have died during quarantine. In fact, the word quarantine comes from the Italian quaranta giorni, meaning “40 days”.

Since the Black Death, according to medical historian Eugenia Tognotti, quarantine then became 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.”

Caption:

The lazaretto at Livorno, Tuscany, Italy by P. Lapi.

Credit:

Source: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

In the early years of the plague, Venice took the lead in establishing quarantine stations for maritime travellers. These stations were ships permanently at anchor, isolated islands, or segregated buildings. The stations became known as lazarettos, as those emerging had metaphorically risen from the dead – as the biblical Lazarus did, having been restored to life by one of Christ’s miracles.

Caption:

Plague apparatus from a lazaretto in Venice; a machine for disinfecting letters and papers.

Credit:

Source: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

The possessions of those who left the lazarettos were disinfected to prevent the risk of the infection spreading. Special kinds of apparatus, like the device pictured above, were used to treat items like coins, letters, and clothing.

Caption:

A medical officer examining a ship's crew for bubonic plague on arrival in the Thames. Watercolour drawing by F. de Haanen, 1905, after C.E. Eldred, C. E. Eldred.

Credit:

Source: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

The bubonic plague wiped out an estimated third of Europe’s population during the 14th century. Recurring outbreaks continued across the world until the 19th century, and ships’ crews were regularly inspected on arrival at ports. A medical inspector would look for signs of plague by examining passengers’ tongues and feeling for bubonic swellings under their armpits. If there was evidence of disease, then ships would be quarantined as necessary. By the turn of the 20th century, the practice of quarantining ships and men was seen as a “thing of the past.” A few years late, with the onset of the 1918 influenza pandemic, quarantine inspections would quickly resume.

Caption:

Two lepers receiving food through a wall. Etching by Gaitt after A. Decamps., Alexandre-Gabriel Decamps.

Credit:

Source: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

While the word quarantine originated in the 14th century, the practice of isolating infected patients goes much further back. As long ago as biblical times, people affected with leprosy were segregated from society.

Caption:

Cholera Hospital, Oxford: near the Oxford Canals. Line engraving by J. Fisher after T. Taylor junior., Thomas Taylor.

Credit:

Source: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

Symptoms of ‘strangers’ disease’, also known as yellow fever, include black vomit and yellowing of the skin. Now it is known to be spread by mosquitoes, but in the 19th century it was believed that travellers and immigrants were the cause. This period also saw the arrival of Asiatic cholera, which led to the further use of quarantine as a method of preventing the spread of disease across the globe.

Caption:

A yellow quarantine flag, signalling yellow fever, by E. Schwarz, 1920/1950

Credit:

Source: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

On board ships and in ports flags were used to signal the presence of disease. The Yellow Jack, flown to denote yellow fever, also became a colloquial name for the disease itself. It is still used today to indicate a ship under quarantine measures. For example, a cruise ship that docked in St Lucia in the Caribbean was quarantined in May 2019 after a case of measles was confirmed.

Caption:

Public information notice, featuring a diphtheria quarantine card, Pennsylvania. Photograph, 1910/1930

Credit:

Source: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

In the early 19th century diphtheria became one of the major causes of death. Its transmission was fuelled by increasingly crowded living conditions, which led to people being isolated in their homes or communities.

Caption:

Pruriginous Impetigo following Varicella. Chromolithograph., E. Burgess

Credit:

Source: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

The widespread use of antibiotics and vaccination rendered isolation through official quarantining largely redundant in the 20th century. However, quarantine is still practised with infectious diseases like chicken pox or measles, where it is recommended that people stay at home.

Caption:

Newly emerging infectious diseases: patients in hospital. Relief print by Eric Avery, 2000., Eric Avery

Credit:

Source: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

While the killer plague that led to the coining of the word ‘quarantine’ is no longer a threat to global populations, newly emerging infectious diseases such as Ebola continue to pose threats to human health on a mass scale. In the absence of effective treatments, quarantine remains an important tool in preventing deaths.