Aquarantine is a restriction on themovement of people, animals, and goods which is intended to prevent the spread ofdisease orpests. It is often used in connection to disease and illness, preventing the movement of those who may have been exposed to acommunicable disease, yet do not have a confirmedmedical diagnosis. It is distinct frommedical isolation, in which those confirmed to be infected with a communicable disease are isolated from the healthy population.
The concept of quarantine is known to have been practised through history in various places. Notable quarantines in modern history include the village ofEyam in 1665 during thebubonic plague outbreak in England;East Samoa during the1918 flu pandemic; theDiphtheria outbreak during the1925 serum run to Nome, the1972 Yugoslav smallpox outbreak, the SARS pandemic, the Ebola pandemic and extensive quarantines applied throughout the world.
Ethical and practical considerations need to be considered when applying quarantine to people. Practice differs from country to country; in some countries, quarantine is just one of many measures governed by legislation relating to the broader concept ofbiosecurity; for example,Australian biosecurity is governed by the single overarchingBiosecurity Act 2015.
The wordquarantine comes fromquarantena orquarantaine, meaning "forty days", used in theVenetian language in the 14th and 15th centuries and also in France. The word is designated in the period during which all ships were required to be isolated before passengers and crew could go ashore during theBlack Death plague.[1] Thequarantena followed thetrentino, or "thirty-day isolation" period, first imposed in 1377 in theRepublic of Ragusa,Dalmatia (modernDubrovnik in Croatia).[2][3][4][5]
Merriam-Webster gives various meanings to the noun form, including "a period of 40 days", several relating to ships, "a state of enforced isolation", and as "a restriction on themovement of people and goods which is intended to prevent the spread ofdisease orpests". The word is also used as a verb.[6]
Quarantine is distinct frommedical isolation, in which those confirmed to be infected with a communicable disease are isolated from the healthy population.[7]
Quarantine may be used interchangeably withcordon sanitaire, and although the terms are related,cordon sanitaire refers to the restriction of movement of people into or out of a defined geographic area, such as a community, in order to prevent an infection from spreading.[8]
The mandatory quarantine of special groups of patients, including those with leprosy, started early in Islamic history.[9] Ahadith going back to the Islamic prophet Muhammad advised individuals present in a region with a plague outbreak to remain in place, and advised healthy individuals to avoid traveling there.[10] The Persian Muslim polymathAvicenna argued for controlling "the spread of diseases" in his medical encyclopedia The Canon [Al-Qanun] of Medicine, published in 1025. He also recommended quarantine for patients with infectious diseases, especiallytuberculosis.[11][12][13] In the early 8th century the sixthUmayyad caliphAl-Walid Isegregated lepers from the general population, with some later sources crediting the caliph with opening ahospital. The separation of lepers from the general population was also practiced in the Moroccan city of Fez, where lepers were relocated to a cave system outside of the city. Dedicated leprosariums were built in the time of the Ottoman sultanMurad II in the 15th century, with some of the facilities operating for centuries.[14] Since the sixteenth century, the Ottoman Empire has isolated travellers coming from epidemic areas during the Bubonic plague. A quarantine involved isolating healthy travellers for a period of time so that it could be ascertained if they were sick or not.[15]
The word "quarantine" originates fromquarantena, the Venetian language form, meaning "forty days".[16][4] This is due to the 40-day isolation of ships and people practised as a measure of disease prevention related to theplague.[16] Between 1348 and 1359, theBlack Death wiped out an estimated 30% of Europe's population, and a significant percentage of Asia's population.[16] Such a disaster led governments to establish measures ofcontainment to handle recurrent epidemics.[16] A document from 1377 states that before entering the city-state ofRagusa inDalmatia (modernDubrovnik in Croatia), newcomers had to spend 30 days (atrentine) in a restricted place (originally nearby islands) waiting to see whether the symptoms of Black Death would develop.[16] In 1448 theVenetian Senate prolonged the waiting period to 40 days, thus giving birth to the term "quarantine".[2] The forty-day quarantine proved to be an effective formula for handling outbreaks of the plague. Dubrovnik was the first city in Europe to set up quarantine sites such as theLazzarettos of Dubrovnik where arriving ship personnel were held for up to 40 days.[17] According to current estimates, the bubonic plague had a 37-day period from infection to death; therefore, the European quarantines would have been highly successful in determining the health of crews from potential trading and supply ships.[18]
Other diseases lent themselves to the practice of quarantine before and after the devastation of the plague. Those affected byleprosy were historically isolated long-term from society.[19] Quarantine systems were enacted to prevent the spread ofsyphilis in Zurich in the 15th and 16th centuries,[20] the advent ofyellow fever in Spain at the beginning of the 19th century, and the arrival of Asiaticcholera in 1831.[21]
Venice took the lead in measures to check the spread of plague, having appointed three guardians of public health in the first years of the Black Death (1348).[22] The next record of preventive measures comes fromReggio/Modena in 1374. Venice founded the firstlazaret (on a small island adjoining the city) in 1403. In 1467Genoa followed the example of Venice, and in 1476 the old leper hospital ofMarseille was converted into a plague hospital. The great lazaret of Marseille, perhaps the most complete of its kind, was founded in 1526 on the island ofPomègues. The practise at all the Mediterranean lazarets did not differ from the English procedure in the Levantine and North African trade. On the arrival of cholera in 1831 some new lazarets were set up at western ports; notably, a very extensive establishment nearBordeaux. Afterwards, they were used for other purposes.[citation needed]
Epidemics of yellow fever ravaged urban communities in North America throughout the late-eighteenth and early-nineteenth centuries, the best-known examples being the1793 Philadelphia yellow fever epidemic[23] and outbreaks in Georgia (1856) and Florida (1888).[24] Cholera and smallpox epidemics continued throughout the nineteenth century, and plague epidemics affected Honolulu[25] and San Francisco from 1899 until 1901.[26] State governments generally relied on thecordon sanitaire as a geographic quarantine measure to control the movement of people into and out of affected communities. During the1918 influenza pandemic, some communities institutedprotective sequestration (sometimes referred to as "reverse quarantine") to keep the infected from introducing influenza into healthy populations.[27] Additionally, the nature of the influenza virus that caused the 1918 pandemic gave rise to a public awareness of the dichotomy between "crowd" and "home" diseases. Simply quarantining the sick in isolation was ineffective in halting the spread of the disease, and new quarantine standards that extended regulations to public spaces became increasingly more common.[28] Most Western countries implemented a range of containment strategies, including isolation, surveillance, and the closure of schools, churches, theatres, and public events.[29]
Isolating a village inRomania whose inhabitants believe that doctors poison those suspected of cholera (1911)
People were prevented from entering theAshanti Empire atborder checkpoints if they exhibited symptoms of smallpox. Those who discovered symptoms of the disease after entering Ashanti were quarantined in remote villages.[30] In the 1830s, both theOttoman Empire andEgypt established new quarantine systems. In 1831, Mehmet Ali of Egypt founded the Quarantine Board in Alexandria. In 1838, the Ottoman government installed the Supreme Council of Health, including the Quarantine Administration, in Istanbul. These two institutions set up permanent quarantines throughout the eastern Mediterranean, based on the western Mediterranean quarantine model.[31] For example, at the port ofİzmir, all ships and their cargo would be inspected and those suspected of carrying the plague would be towed to separate docks and their personnel housed in separate buildings for a determined period of time. InThessaly, along the Greek-Turkish border, all travellers entering and exiting the Ottoman Empire would be quarantined for 9–15 days. Upon appearance of the plague, the quarantine stations would be militarised and theOttoman army would be involved in border control anddisease monitoring.[32]
Since 1852, several conferences were held involving European powers, with a view to uniform action in keeping out infection from the East and preventing its spread within Europe. All but that of 1897 were concerned withcholera. No result came of those at Paris (1852), Constantinople (1866), Vienna (1874), and Rome (1885), but each of the subsequent ones doctrine of constructive infection of a ship as coming from a scheduled port, and an approximation to the principles advocated by the United Kingdom for many years. The principal countries which retained the old system at the time were Spain, Portugal, Turkey, Greece, and Russia (theBritish possessions at the time, Gibraltar, Malta, and Cyprus, being under the same influence). The aim of each international sanitary convention had been to bind the governments to a uniform minimum of preventive action, with further restrictions permissible to individual countries. The minimum specified by international conventions was very nearly the same as the British practice, which had been in turn adapted to continental opinion in the matter of the importation of rags.[citation needed]
The Venice convention of 30 January 1892 dealt with cholera by theSuez Canal route; that of Dresden of 15 April 1893, with cholera within European countries; that of Paris of 3 April 1894, with cholera by the pilgrim traffic; and that of Venice, on 19 March 1897, was in connection with the outbreak of plague in the East, and the conference met to settle on an international basis the steps to be taken to prevent, if possible, its spread into Europe. An additional convention was signed in Paris on 3 December 1903.[33]
A multilateral international sanitary convention was concluded at Paris on 17 January 1912.[34] This convention was most comprehensive and was designated to replace all previous conventions on that matter. It was signed by 40 countries, and consisted of 160 articles. Ratifications by 16 of the signatories were exchanged in Paris on 7 October 1920. Another multilateral convention was signed in Paris on 21 June 1926, to replace that of 1912. It was signed by 58 countries worldwide, and consisted of 172 articles.[35]
In Latin America, a series of regional sanitary conventions were concluded. Such a convention was concluded in Rio de Janeiro on 12 June 1904. A sanitary convention between the governments of Argentina, Brazil, Paraguay, and Uruguay was concluded in Montevideo on 21 April 1914.[36] The convention covers cases ofAsiatic cholera,oriental plague andyellow fever. It was ratified by the Uruguayan government on 13 October 1914, by the Paraguayan government on 27 September 1917 and by the Brazilian government on 18 January 1921.
Sanitary conventions were also concluded between European states. A Soviet-Latvian sanitary convention was signed on 24 June 1922, for which ratifications were exchanged on 18 October 1923.[37] A bilateral sanitary convention was concluded between the governments of Latvia and Poland on 7 July 1922, for which ratifications were exchanged on 7 April 1925.[38] Another was concluded between the governments of Germany and Poland in Dresden on 18 December 1922, and entered into effect on 15 February 1923.[39] Another one was signed between the governments of Poland and Romania on 20 December 1922. Ratifications were exchanged on 11 July 1923.[40] The Polish government also concluded such a convention with the Soviet government on 7 February 1923, for which ratifications were exchanged on 8 January 1924.[41] A sanitary convention was also concluded between the governments of Poland and Czechoslovakia on 5 September 1925, for which ratifications were exchanged on 22 October 1926.[42] A convention was signed between the governments of Germany and Latvia on 9 July 1926, for which ratifications were exchanged on 6 July 1927.[43]
In 1897, theincubation period for this disease was determined and this was to be adopted for administrative purposes. The incubation period was comparatively short, some three or four days. After much discussion ten days was accepted by a majority. The principle ofdisease notification was unanimously adopted. Each government had to notify other governments of the existence of plague within their jurisdictions and state the measures of prevention being carried out to prevent its spread. The area declared infected was limited to the district or village where the disease prevailed, and no locality was deemed to be infected because of the importation into it of a few cases of plague while there has been no spread. It was decided during the prevalence of plague, every country had the right to close its land borders to traffic. At theRed Sea, it was decided after discussion a healthy vessel could pass through the Suez Canal and continue its voyage in the Mediterranean during the incubation period of the disease and that vessels passing through the Canal in quarantine might, subject to the use of the electric light, coal up in quarantine at Port Said by night or by day, and that passengers might embark in quarantine at that port. Infected vessels, if these carry a doctor and a disinfecting stove, have a right to navigate the Canal in quarantine and subject only to the landing of those who have plague.[citation needed]
In the 20th and 21st centuries, people suspected of carrying infectious diseases have been quarantined, as in the cases ofAndrew Speaker (multi-drug-resistant tuberculosis, 2007) andKaci Hickox (Ebola, 2014). During the1957–58 influenza pandemic and the1968 flu pandemic, several countries implemented measures to control spread of the disease. In addition, theWorld Health Organization applied a global influenza surveillance network.[44]
During the1994 plague in India, many people were quarantined. Vessels and aircraft carrying passengers were fumigated.[45][46]
In theSARS epidemic, thousands of Chinese people were quarantined and checkpoints to take temperatures were set up.[47]
Moving infected patients toisolation wards and home-based self-quarantine of people potentially exposed was the main way theWestern African Ebola virus epidemic was ended in 2016; members of the 8thWHO Emergency Committee criticised international travel restrictions imposed during the epidemic as ineffective due to difficulty of enforcement, and counterproductive as they slowed down aid efforts.[48]
ThePeople's Republic of China has employed mass quarantines – firstly of the city ofWuhan and subsequently of all of theHubei province (population 55.5 million) – in thecoronavirus disease 2019 pandemic. After a few weeks, the Italian government imposedlockdowns for the entire country (more than 60 million people) in an attempt to stop thespread of the disease there.India quarantined itself from the world for a period of one month.[49][50] Most governments around the world restricted or advised against all non-essential travel to and from countries and areas affected by the outbreak.[51] By late 2020, the virus had already spread within communities in large parts of the world, with many not knowing where or how they were infected.[52]
Thesignal flag "Quebec", also called the "Yellow Jack", is a simple yellow flag that was historically used to signal quarantine (it stands forQ), but in modern use indicates the opposite, as a signal of a ship free of disease that requests boarding and inspection.
Plain yellow, green, and even black flags have been used to symbolise disease in both ships and ports, with the colour yellow having a longer historical precedent, as a colour of marking for houses of infection, previous to its use as a maritime marking colour for disease. The former flag used for the purpose was the "Lima" (L) flag, which is a mixture of yellow and black flags previously used. It is sometimes called the "yellow jack" but this was also a name foryellow fever, which probably derives its common name from the flag, not the colour of the victims (cholera ships also used a yellow flag).[16] The plainyellow flag ("Quebec" orQ ininternational maritime signal flags) probably derives its letter symbol for its initial use inquarantine, but this flag in modern times indicates the opposite—a ship that 'requests freepratique', i.e. that declares itself free of quarantinable disease, and requests boarding and routine port inspection.[53]
Ships in quarantine today would fly either the Q flag alone, meaning "My vessel is 'healthy' and I request free pratique", or the double Q flag (QQ), meaning "I require health clearance".[54]
The quarantining of people often raises questions ofcivil rights, especially in cases of long confinement or segregation from society, such as that ofMary Mallon (also known as Typhoid Mary), atyphoid fevercarrier who was arrested and quarantined in 1907 and later spent the last 23 years and 7 months of her life in medical isolation at Riverside Hospital onNorth Brother Island.[55][56]
High tech communication brings cheer and encouragement
Quarantine can have adverse psychological effects on the quarantined, includingpost-traumatic stress, confusion, and anger. According to a "Rapid Review" published inThe Lancet in response to theCOVID-19 pandemic, "Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable."[60] Although youngsters appear to be less vulnerable toCOVID-19, the side effects of the pandemic can be devastating. Quarantine from the pandemic led to an increase the prevalence of violence in the family, depression, anxiety, and post-traumatic stress disorder. Children and adolescents may be highly exposed to biopsychosocial stressors generated by the pandemic and once population's containment measures to reduce virus spread are required, they could be potentially affected by the disruption in daily life routine as a result of social isolation and their unseasoned ability to conceive and comprehend the short- and long-term consequences of this outbreak.[61][62]
Quarantine periods can be very short, such as in the case of a suspectedanthrax attack, in which people are allowed to leave as soon as they shed their potentially contaminated garments and undergo adecontamination shower. For example, an article entitled "Daily News workers quarantined" describes a brief quarantine that lasted until people could be showered in a decontamination tent.[63]
The February–March 2003 issue ofHazMat Magazine suggests that people be "locked in a room until proper decon could be performed", in the event of "suspect anthrax".[citation needed]
Standard-Times senior correspondent Steve Urbon (14 February 2003) describes such temporary quarantine powers:
Civil rights activists in some cases have objected to people being rounded up, stripped and showered against their will. But Capt. Chmiel said local health authorities have "certain powers to quarantine people".[64][65]
The purpose of such quarantine-for-decontamination is to prevent the spread of contamination and to contain the contamination such that others are not put at risk from a person fleeing a scene where contamination is suspect. It can also be used to limit exposure, as well as eliminate avector.[66]
New developments for quarantine include new concepts in quarantine vehicles such as theambulance bus, mobile hospitals, and lockdown/invacuation (inverse evacuation) procedures, as well as docking stations for an ambulance bus to dock to a facility under lockdown.[67]
Standard quarantine practices in different countries
Biosecurity in Australia is governed by theBiosecurity Act 2015. TheDepartment of Agriculture, Water and the Environment (DAWE) is responsible for border inspection of products brought into Australia, and assesses the risks the products might harm Australian environment. No person, goods, and vessels are permitted into Australia without clearance from DAFF. Visitors are required to fill in the information card on arriving in Australia. Besides other risk factors, visitors are required to declare what food and products made of wood and other natural materials they have. Visitors who fail to do so may be subject to a fine of A$444, or may face criminal prosecution and be fined up to A$444,000 or imprisonment of up to 10 years.[68]
Australia has very strict quarantine standards. Quarantine in northern Australia is especially important because of its proximity to South-East Asia and the Pacific, which have many pests and diseases not present in Australia. For this reason, the region from Cairns to Broome—including theTorres Strait—is the focus for quarantine activities that protect all Australians.[69] As Australia has been geographically isolated from other major continents for millions of years, there is an endemically unique ecosystem free of several severe pests and diseases that are present in many parts of the world.[70] If other products are brought inside along with pests and diseases, it would damage the ecosystem seriously and add millions of costs in the local agricultural businesses.[71]
There are three quarantineActs of Parliament in Canada:Quarantine Act (humans),Health of Animals Act (animals), andPlant Protection Act (vegetations). The first legislation is enforced by theCanada Border Services Agency after a complete rewrite in 2005. The second and third legislations are enforced by theCanadian Food Inspection Agency. If a health emergency exists, the Governor in Council can prohibit importation of anything that it deems necessary under theQuarantine Act.
Under theQuarantine Act, all travellers must submit to screening and if they believe they might have come into contact withcommunicable diseases orvectors, they must disclose their whereabouts to aBorder Services Officer. If the officer has reasonable grounds to believe that the traveller is or might have been infected with a communicable disease or refused to provide answers, a quarantine officer (QO) must be called and the person is to be isolated. If a person refuses to be isolated, anypeace officer may arrest without warrant.
A QO who has reasonable grounds to believe that the traveller has or might have a communicable disease or is infested with vectors, after the medical examination of a traveller, can order him/her into treatment or measures to prevent the person from spreading the disease. QO can detain any traveller who refuses to comply with his/her orders or undergo health assessments as required by law.
Under theHealth of Animals Act andPlant Protection Act, inspectors can prohibit access to an infected area, dispose or treat any infected or suspected to be infected animals or plants. The Minister can order for compensation to be given if animals/plants were destroyed pursuant to these acts.
Each province also enacts its own quarantine/environmental health legislation.
Under thePrevention and Control of Disease Ordinance (HK Laws. Chap 599), a health officer may seize articles they believe to be infectious or containing infectious agents. All travellers, if requested, must submit themselves to a health officer. Failure to do so is against the law and is subject to arrest and prosecution.
The law allows for health officers who have reasonable grounds to detain, isolate, quarantine anyone or anything believed to be infected, and to restrict any articles from leaving a designated quarantine area. He/she may also order the Civil Aviation Department to prohibit the landing or leaving, embarking or disembarking of an aircraft. This power also extends to land, sea or air crossings.
Under the same ordinance, any police officer, health officer, member of theCivil Aid Service, or member of theAuxiliary Medical Service can arrest a person who obstructs or escapes from detention.
To reduce the risk of introducingrabies from continental Europe, the United Kingdom used to require that dogs, and most other animals introduced to the country, spend six months in quarantine at anHM Customs and Excise pound; this policy was abolished in 2000 in favour of a scheme generally known asPet Passports, where animals can avoid quarantine if they have documentation showing they are up to date on their appropriatevaccinations.[72]
The plague had disappeared from England for more than thirty years before the practice of quarantine against it was definitely established by theQuarantine Act 1710 (9 Ann. c. 2).[73] The first act was called for due to fears that the plague might be imported from Poland and theBalticregion. A second act of Parliament, theQuarantine Act 1721 (8 Geo. 1. c. 10), was due to the prevalence of plague atMarseille and other places inProvence, France. It was renewed in 1733 after a new outbreak incontinental Europe, and again in 1743, due to an epidemic inMessina. A rigorous quarantine clause was introduced into theLevant Trade Act 1752, an act regulating trade withthe Levant, and various arbitrary orders were issued during the next twenty years to meet the supposed danger of infection from the Baltic region. Although no plague cases ever came to England during that period, the restrictions on traffic became more stringent, and in 1788 a very strictQuarantine and Customs Act 1788 (28 Geo. 3. c. 34) was passed, with provisions affecting cargoes in particular. The act was revised in 1801 and 1805, and in 1823–24 an elaborate inquiry was followed by an act of Parliament[which?] making quarantine only at discretion of theprivy council, which recognised yellow fever or other highly infectious diseases as calling for quarantine, along with plague. The threat of cholera in 1831 was the last occasion in England of the use of quarantine restrictions. Cholera affected every country in Europe, despite all efforts to keep it out. When cholera returned to England in 1849, 1853 and 1865–66, no attempt was made to seal the ports. In 1847 the privy council ordered all arrivals with a cleanbill of health from theBlack Sea and the Levant to be admitted, provided there had been no case of plague during the voyage, and afterwards the practice of quarantine was discontinued.[74]
After the passing of the Quarantine Act 1710 the protective practices in England were haphazard and arbitrary. In 1721 two vessels carrying cotton goods from Cyprus, then affected by the plague, were ordered to be burned with their cargoes, the owners receiving anindemnity. By the clause in theLevant Trade Act 1752, ships arriving in the United Kingdom with a "foul bill" (i.e. coming from a country where plague existed) had to return to thelazarets of Malta, Venice, Messina, Livorno, Genoa, or Marseille, to complete a quarantine or to have their cargoes opened and aired. Since 1741Stangate Creek (on theMedway) had been the quarantine station but it was available only for vessels with clean bills of health. In 1755 lazarets in the form offloating hulks were established in England for the first time, the cleansing of cargo (particularly by exposure todews) having been done previously on the ship's deck. No medical inspections were conducted, but control was the responsibility of the Officers ofRoyal Customs and quarantine. In 1780, when plague was in Poland, even vessels with grain from the Baltic region had to spend forty days in quarantine, and unpack and air their cargoes, but due to complaints mainly fromEdinburgh andLeith, an exception was made for grain after that date. About 1788 an order of the council required every ship liable to quarantine to hoist ayellow flag in the daytime and show a light at the main topmast head at night, in case of meeting any vessel at sea, or upon arriving within fourleagues of the coast ofGreat Britain orIreland, theChannel Islands, or theIsle of Man.[74]
After 1800, ships from plague-affected countries (or with foul bills) were permitted to complete their quarantine in the Medway instead of at a Mediterranean port on the way, and an extensive lazaret was built onChetney Hill nearChatham (although it was later demolished). The use of floating hulks as lazarets continued as before. In 1800 two ships withhides fromMogador in Morocco were ordered to be sunk with their cargoes at theNore, the owners receiving an indemnity. Animal hides were suspected of harbouring infections, along with a long list of other items, and these had to be exposed on the ship's deck for twenty-one days or less (six days for each instalment of the cargo), and then transported to the lazaret, where they were opened and aired for another forty days. The whole detention of the vessel was from sixty to sixty-five days, including the time for reshipment of her cargo. Pilots had to pass fifteen days on board a convalescent ship. From 1846 onwards the quarantine establishments in the United Kingdom were gradually reduced, while the last vestige of the British quarantine law was removed by thePublic Health Act 1896, which repealed theQuarantine Act 1825 (with dependent clauses of other acts), and transferred from the privy council to theLocal Government Board the powers to deal with ships arriving infected with yellow fever or plague. The powers to deal with cholera ships had been already transferred by thePublic Health Act 1875.[74]
British regulations of 9 November 1896 applied toyellow fever,plague andcholera. Officers ofHer Majesty's Customs, as well as ofHer Majesty's Coastguard and theBoard of Trade (for signalling), were empowered to take the initial steps. They certified in writing the master of a supposedly infected ship, and detained the vessel provisionally for not more than twelve hours, giving notice meanwhile to theport sanitary authority. The medical officer of the port boarded the ship and examined every person in it. Every person found infected was taken to a hospital and quarantined under the orders of the medical officer, and the vessel remained under his orders. Every person suspected could be detained on board for 48 hours or removed to the hospital for a similar period. All others were free to land upon giving the addresses of their destinations to be sent to the respective local authorities, so that the dispersed passengers and crew could be kept individually under observation for a few days. The ship was then disinfected, dead bodies buried at sea, infected clothing, bedding, etc., destroyed or disinfected, andbilge-water andwater-ballast pumped out at a suitable distance before the ship entered a dock or basin. Mail was subject to no detention. A stricken ship within 3 miles of the shore had to fly a yellow and black flag at the main mast from sunrise to sunset.[74]
In the United States, authority to quarantine people with infectious diseases is split between the state and federal governments. States (andtribal governments recognised by the federal government)[75] have primary authority to quarantine people within their boundaries. Federal jurisdiction only applies to people moving across state or national borders, or people on federal property.[76]
Individuals must apply for a travel permit if they are under a Federal quarantine, isolation, orconditional release order.
When an individual who is moving between U.S. states is "reasonably believed to be infected" with a quarantinable communicable disease in a "qualifying stage", the CDC may apprehend or examine that individual for potential infection.
This includes new regulatory authority permitting the CDC Director to prohibit the importation of animals or products that pose a threat to public health.
The rules:
Do not authorise compulsory medical testing, vaccination, or medical treatment without priorinformed consent.
Require CDC to advise individuals subject tomedical examinations that they will be conducted by an authorised health worker and with prior informed consent.
Include strongdue process protections for individuals subject to public health orders, including a right to counsel forindigent individuals.
Limit to 72 hours the amount of time that an individual may be apprehended pending the issuance of a federal order for isolation, quarantine, or conditional release.
Besides theport of entry where it is located, each station is also responsible for quarantining potentially infected travellers entering through any ports of entry in its assigned region. These facilities are fairly small; each one is operated by a few staff members and capable of accommodating 1–2 travellers for a short observation period.[82] Cost estimates for setting up a temporary larger facility, capable of accommodating 100 to 200 travellers for several weeks, have been published by the Airport Cooperative Research Program (ACRP) in 2008 of theTransportation Research Board.[82]
The United States puts immediate quarantines on imported products if a contagious disease is identified and can be traced back to a certain shipment or product. All imports will also be quarantined if the disease appears in other countries.[citation needed] According to Title42 U.S.C. §§264 and 266Archived 24 September 2015 at theWayback Machine, these statutes provide theSecretary of Health and Human Services peacetime and wartime authority to control the movement of people into and within the United States to prevent the spread of communicable disease.
The quarantine hospital building (lazaretto) at the historic Columbia River Quarantine Station near Knappton, Washington
In early June 1832, during the cholera epidemic in New York, GovernorEnos Throop called a special session of the Legislature for 21 June, to pass a Public Health Act by both Houses of the State Legislature. It included to a strict quarantine along the Upper and Lower New York-Canadian frontier. In addition, New York City Mayor Walter Browne established a quarantine against all peoples and products of Europe and Asia, which prohibited ships from approaching closer than 300 yards to the city, and all vehicles were ordered to stop 1.5 miles away.[85]
The Immigrant Inspection Station onEllis Island, built in 1892, is often mistakenly assumed to have been a quarantine station, however its marine hospital (Ellis Island Immigrant Hospital) only qualified as a contagious disease facility to handle less virulent diseases like measles,trachoma and less advanced stages of tuberculosis and diphtheria; those affected by smallpox, yellow fever, cholera, leprosy or typhoid fever, could neither be received nor treated there.[86][87]
Mary Mallon was quarantined in 1907 under the Greater New York Charter, Sections 1169–1170,[88] which permitted theNew York City Board of Health to "remove to a proper place...any person sick with any contagious, pestilential or infectious disease."[89]
During the1918 flu pandemic, people were also quarantined. Most commonly suspect cases of infectious diseases are requested to voluntarily quarantine themselves, and Federal and local quarantine statutes only have been uncommonly invoked since then, including for a suspectedsmallpox case in 1963.[90]
The 1944Public Health Service Act "to apprehend, detain, and examine certain infected persons who are peculiarly likely to cause the interstate spread of disease" clearly established thefederal government's quarantine authority for the first time. It gave theUnited States Public Health Service responsibility for preventing the introduction, transmission and spread of communicable diseases from foreign countries into the United States, and expanded quarantine authority to include incoming aircraft.[7] The act states that "...any individual reasonably believed to be infected with a communicable disease in a qualifying stage and...if found to be infected, may be detained for such time and in such manner as may be reasonably necessary."[91]
No federal quarantine orders were issued from 1963 until 2020, as American citizens were evacuated from China during theCOVID-19 pandemic.[92]
Eyam was a village in Britain that imposed acordon sanitaire on itself to stop the spread of the bubonic plague to other communities in 1665. The plague ran its course over 14 months and one account states that it killed at least 260 villagers.[94] The church in Eyam has a record of 273 individuals who were victims of the plague.[95]
Quarantine of the convict shipSurry on the North Shore of Sydney Harbour in 1814, the first quarantine in Australia
On 28 July 1814, the convict shipSurry arrived in Sydney Harbour from England. Forty-six people had died oftyphoid during the voyage, including 36 convicts, and the ship was placed in quarantine on the North Shore. Convicts were landed, and a camp was established in the immediate vicinity of what is nowJeffrey Street inKirribilli. This was the first site in Australia to be used for quarantine purposes.[96]
Mary Mallon was a cook who was found to be a carrier ofSalmonella enterica subsp. enterica, the cause oftyphoid fever, and was forcibly isolated from 1907 to 1910. At least 53 cases of the infection were traced to her, and three deaths. Subsequently, she spent a further 23 years in isolation prior to her death in 1938. The presence of the bacteria in her gallbladder was confirmed on autopsy.[97]
During the1918 flu pandemic, the thenGovernor ofAmerican Samoa,John Martin Poyer, imposed a fullprotective sequestration of the islands from all incoming ships, successfully preventing influenza from infecting the population and thus achieving zero deaths within the territory.[27] In contrast, the neighbouringNew Zealand-controlledWestern Samoa was among the hardest hit, with a 90% infection rate and over 20% of its adults dying from the disease. This failure by the New Zealand government to prevent and contain the Spanish Flu subsequently rekindledSamoan anti-colonial sentiments that led to its eventual independence.[98]
In 1942, duringWorld War II, British forces tested out their biological weapons program onGruinard Island and infected it withanthrax. Subsequently, a quarantine order was placed on the island. The quarantine was lifted in 1990,[99] when the island was declared safe, and a flock of sheep was released onto the island.
Between 24 July 1969 and 9 February 1971, the astronauts ofApollo 11,Apollo 12, andApollo 14, were quarantined (in each case for a total of 21 days) after returning to Earth, initially where they were recovered, and then were transferred to theLunar Receiving Laboratory, to prevent possibleinterplanetary contamination by microorganisms from theMoon. All lunar samples were also held in thebiosecure environment of the Lunar Receiving Laboratory for initial assay.[100]
In 2014,Kaci Hickox, aDoctors Without Borders nurse from Maine, legally battled 21-day quarantines imposed by the states of New Jersey and Maine after returning home from treatingEbola patients inSierra Leone.[101] "Hickox was sequestered in a medical tent for days because New Jersey announced new Ebola regulations the day she arrived. She eventually was allowed to travel to Maine, where the state sought to impose a 'voluntary quarantine' before trying and failing to create a buffer between her and others. A state judge rejected attempts to restrict her movements, saying she posed no threat as long as she wasn't demonstrating any symptoms of Ebola. Hickox said health care professionals like those at the U.S. Centers for Disease Control and Prevention – not politicians like New Jersey Gov. Chris Christie and Maine Gov.Paul LePage – should be in charge of making decisions that are grounded in science, not fear."[102]
A road sign at an exit onInterstate 91 inVermont, photographed in November 2020.
During theCOVID-19 pandemic, multiple governmental actors enacted quarantines in an effort to curb the rapid spread of the virus. Quarantine-like restrictions on movement includedcurfews and restrictions variously described asstay-at-home orders, shelter-in-place orders, shutdowns orlockdowns.[103]
On 26 March 2020, 1.7 billion people worldwide were under some form oflockdown,[104] which increased to 2.6 billion people two days later—around a third of theworld's population.[105][106]
In Hubei, the origin of the epidemic, acordon sanitaire wasimposed on Wuhan and other major cities in China, affecting around 500 million people, which is unprecedented in scale in human history,[107] to limit the rate of spread of the disease. The 'lockdown' of Wuhan, and subsequently a wider-scale 'lockdown' throughout Hubei province, began on 23 January 2020. At this stage, the spread of the virus in mainland China was running at approximately 50% growth in cases per day. On 8 February, the daily rate of spread fell below 10%.[108]
As the outbreak spread there, beginning 22 February 2020, acordon sanitaire was imposed on a group of at least 10 different municipalities inNorthern Italy, effectively quarantining more than 50,000 people.[109][110] This followed a second day when the declared detected cases leapt enormously (the period from 21 to 23 February saw daily increases of 567%, 295% and 90% respectively). A week later the rate of increase of cases in Italy was significantly reduced (the period from 29 February to 4 March saw daily increases of 27%, 50%, 20%, 23%, and 23%).
On 8 March 2020, a much wider region of Northern Italy was placed under quarantine restrictions, involving around 16 million people.[111] On the next day, the quarantine was extended to the whole of Italy, effective on 10 March 2020, placing roughly 60 million people under quarantine.[112]
A team of Chinese experts, together with some 31 tonnes of supplies, arrived in Rome on 13 March 2020 to help Italy fight the virus.[113]
On 22 March 2020, Russia sent nine Ilyushin 76 planes with expert virologists, epidemiologists, medical equipment, and pharmaceuticals in a humanitarian aid operation that Italian media dubbed "From Russia With Love".[114][115]
Eventually the lockdown was extended until 3 May, although starting from 14 April stationery shops, bookshops, and children clothing's shops were allowed to open.[116]
On 26 April 2020, the so-called "Phase 2" was announced, to start from 4 May. Movements across regions were still forbidden, while movements between municipalities were allowed only to visit relatives or for work and health reasons.[117] Moreover, closed factories could re-open, but schools, bars, restaurants, and barbers were still closed.[118]
As cases of the virus spread to and took hold in more European countries, many followed the earlier examples of China and Italy and began instituting policies of lockdown. Notable among these wereIreland (where schools were closed in mid March for the rest of the month, and limits were set on sizes of meetings),[121]Spain (where alockdown was announced on 14 March),[122]Czech Republic,Norway,Denmark,Iceland,Poland,Turkey, andFrance, while theUnited Kingdom noticeably lagged behind in adopting such measures.[123]
As of 18 March 2020, more than 250 million people were in lockdown across Europe.[124]
In the immediate context of the start of the pandemic in Wuhan, countries neighbouring or close to China adopted a cautious approach. For example, Sri Lanka, Macau, Hong Kong, Vietnam, Japan, and South Korea had all imposed some degree of lockdown by 19 February.[125] As countries across the world reported escalating case numbers and deaths, more and more countries began to announce travel restrictions and lockdowns.[125] Africa and Latin America were relatively delayed in the spread of the virus, but even on these continents, countries began to impose travel bans and lockdowns. Brazil and Mexico began lockdowns in late February and much of the rest of Latin America followed suit in early March.[125] Much of Africa was on lockdown by the start of April.[125] Kenya, for example, blocked certain international flights and subsequently placed a ban on 'global' meetings.[126]
Self-quarantine (orself-isolation) is a popular term that emerged during theCOVID-19 pandemic, which spread to most countries in 2020. Citizens able to do so were encouraged to stay home to limit the spread of thedisease. Health specialists advise that self-quarantine lasts 14 days. Two weeks gives the necessary time for them to determine whether or not they will become ill and become contagious to others.[131][132]
U.S. PresidentJohn F. Kennedy euphemistically referred to the U.S. Navy's interdiction of shipping en route to Cuba during theCuban Missile Crisis as a "quarantine" rather than ablockade, because a quarantine is a legal act in peacetime, whereas a blockade is defined as an act of aggression under theU.N. Charter.[133]
In computer science, "quarantining" describes putting files infected bycomputer viruses into a special directory, so as to eliminate the threat they pose, without irreversibly deleting them.[134]
The Spanish term for quarantine,(la) cuarentena, refers also to the period ofpostpartum confinement in which a new mother and her baby are sheltered from the outside world.[135]
Infection control – Medical discipline for preventing nosocomial or healthcare-associated infectionPages displaying short descriptions of redirect targets
^The 19 airports with quarantine facilities are in Anchorage, Atlanta, Boston, Chicago, Dallas/Ft. Worth, Detroit, Honolulu, Houston, Los Angeles, Miami, Minneapolis, New York City (JFK), Newark, Philadelphia, San Diego, San Francisco, San Juan, Seattle, and Washington, D.C. (Dulles).
^Dunlop D, Colin G, Şehsuvaroǧlu BN (24 April 2012). "Bīmāristān". In Bearman P, Bianquis T, Bosworth C, van Donzel E, Heinrichs W (eds.).Encyclopaedia of Islam, Second Edition.doi:10.1163/1573-3912_islam_COM_0123.
^Susan Scott and Christopher Duncan,Biology of Plagues: Evidence from Historical Populations, Cambridge, United Kingdom: Cambridge University Press, 2001
^Hamed-Troyansky V (2021). "Ottoman and Egyptian Quarantines and European Debates on Plague in the 1830s–1840s".Past and Present (253):235–270.doi:10.1093/pastj/gtaa017.
^Andrew Robarts. Nukhet Varlik (ed.).Plague and Contagion in the Islamic Mediterranean. Arc Humanities Press. pp. 236–7.
^Yanzong Huang, "The SARS Epidemic and its Aftermath in China: A Political Persecutive",Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary, Washington (DC): National Academies Press (US), 2004.
^M. Pabst Battin, Leslie P. Francis, Jay A. Jacobson,The Patient as Victim and Vector: Ethics and Infectious Disease, Oxford University Press, 2009.ISBN019533583X
^Stuart A (1710).Quarantine Act 1710 [9 Ann. Chapter II A.D. 1710]. The Statutes at Large : from Magna Charta, to the End of the Last Parliament, 1761. Vol. IV. London, Great Britain: Mark Baskett, Henry Woodfall, and William Strahan. pp. 420–421.OCLC228755149 – via Internet Archive.
^"Get In That Bubble, Boy! When can the government quarantine its citizens?".Slate magazine. 1 June 2007. Retrieved30 September 2011.In fact, until this recent situation, the CDC hadn't issued such an order since 1963, when it quarantined a woman for smallpox exposure. Even during the SARS epidemic in 2003, officials relied mostly on voluntary isolation and quarantine. And the last large-scale quarantine in the U.S. took place during the Spanish flu epidemic of 1918–19. ...
Howard Markel (1999).Quarantine!: East European Jewish Immigrants and the New York City Epidemics of 1892. Johns Hopkins University Press.ISBN978-0-8018-6180-2.
Frati P (2000). "Quarantine, trade and health policies in Ragusa-Dubrovnik until the age of George Armmenius-Baglivi".Medicina Nei Secoli.12 (1):103–27.PMID11624707.
