China has resorted to mass quarantining in response to the coronavirus epidemic, while towns in Italy with high infection rates have been cordoned off and holidaymakers in Tenerife are confined to their rooms. The rest of us can only watch and try not to panic. But this is far from the first time that freedom of movement has been curtailed because of fears of a pandemic.
The modern notion of quarantine dates back to the 15th century, when Venice was grappling with one of the recurrent outbreaks of the Black Death, which had devastated Asia and Europe in the 14th century and continued to reappear for the next 500 years. The idea of isolating potential carriers, usually sailors arriving on ships from Asia, where the plague originated, was common in the 14th century, but it wasn’t until 1448 that the Venetian authorities decreed the period of isolation to check for symptoms should be 40 (quaranta in Italian) days.
Isolating carriers of disease, however, predates the Black Death by thousands of years. The book of Leviticus in the Old Testament has an entire chapter devoted to dealing with people suspected of having leprosy, with instructions to “shut up” those thought to be at risk and get a priest to check on them every seven days to see if the disease has taken hold. The Greek physician Hippocrates, who first defined epidemics, also stressed the need to isolate sufferers.
Urbanisation and the regulation of public health in the late 18th and 19th centuries slowly led to systematic quarantining. During the 1793 yellow fever epidemic in Philadelphia, it was left to other towns in the US to quarantine the city by banning its residents and goods from entering. But repeated outbreaks of yellow fever, cholera and smallpox in the 19th century eventually led to the federal government taking responsibility for quarantine.
The influenza epidemic of 1918-20 (the so-called “Spanish flu”) was so widespread that in some places it was not the sick who were quarantined, but the healthy – a policy now called “protective sequestration”. In 1918, Gunnison in Colorado barricaded all roads into the town and told people arriving by train they would be arrested and quarantined. The policy worked: no one in the town died of Spanish flu.
Quarantine raises human rights issues, with individual freedom having to be balanced against public health. The UN stresses the need for proportionality and evidence-based action in accordance with the Siracusa principles established in 1984, but in the last resort the World Health Organization says “interference with freedom of movement when instituting quarantine or isolation for a communicable disease may be necessary for the public good, and could be considered legitimate under international human rights law”.
Now with coronavirus, is it 1918 all over again? That is the terrifying question.