“His clothes shall be torn and his head bared, and he shall cover his mustache and cry ‘Unclean! Unclean!’ … and he shall dwell alone; his dwelling shall be outside the camp.”
These orders for quarantine, drawn from Leviticus, in the Old Testament, are a little more dramatic than the directive issued last week by California’s governor, Gavin Newsom (“I as the state public health officer and director of the California Department of Public Health order all individuals living in the state of California to stay home”), which has been followed by plenty of other elected leaders. But the basic idea—separating people to avoid mass infection—is the same. Indeed, the idea of separating the sick from the well is so old that it predates our scientific understanding of the causes of disease.
The word quarantine comes from Italian. During the days of the Black Death—which spread through Europe in the 1300s—people suspected of harboring the disease were confined for a proscribed quaranta giorni, or 40 days, often on a boat or an island surrounded by guards. This was usually a death sentence, since few treatments for pandemic diseases were available then. Entire ethnic groups were forced into permanent exile. They faced death not just from disease but from angry mobs that blamed them for the spreading maladies.
The delicate balance between authority and freedom, between prudence and panic, has been one of the most vexing issues in both modern and historic quarantines, and how much freedom people are willing to give up is a key factor (though not the only one) in determining whether isolation programs actually slow or stop the spread of disease, according to Eugenia Tognotti, a historian at Italy’s University of Sassari, in Sardinia, who studies quarantines. “The risk of mortality pushes the social acceptance of extreme measures,” Tognotti wrote in an email interview. “But it also leads to fear—of the paralysis of economic activities, the penalization of social classes, and the abolition of individual freedoms.”
Tognotti has been studying quarantines for more than a decade, but until now, she had never actually been under forced isolation herself. What Tognotti has seen, she said, is a “general and amazing acceptance of social distancing measures—in many cases, people are demanding more severe measures than what local authorities have initially asked for.”
Cooperative community sacrifice—with an emphasis on the word sacrifice, since some people are literally sentencing themselves as they agree not to take actions that would spread sickness to others—is probably the most noble and moving thing about quarantines. In the mid-17th century, as plague once again swept across Europe, the tiny village of Eyam, in Derbyshire, England, was faced with a choice. The mining town had experienced huge economic growth by establishing commercial links to London, 160 miles away. But trade also brought sickness, and by 1665, dozens of townsfolk were dying. The local priest, William Mompesson, arrived at a Leviticus-like decision: The village had to break all contact with the outside world. Mompesson convinced residents not to leave town for any reason. A stone at the village’s edge was designated as a safe site for outsiders to leave donations and supplies.
The villagers understood, according to historic account, that what they were doing was for the greater good, not to save themselves. More than two-thirds of Eyam’s population of 265 died, but the plague was contained. Today, Eyam—also known as “Plague Village”—is a tourist attraction. Among the most sobering sights are the stones in the town’s cemetery, which mark the passing of entire families that died during the village’s year off the medieval grid.
Sacrifice is never easy. It also can be grossly unfair. In the 19th and 20th centuries, quarantines targeted immigrants, the poor, prostitutes, and laborers. In the 1980s, Cuba immediately imposed strict isolation measures on people who were infected with HIV—the majority being gay men or soldiers returning from Africa. As new drugs helped the AIDS crisis to wane in the early 2000s, Cuba ended up with one of the lowest death rates from the disease in the Western Hemisphere.
Whether imposed or voluntary, effective quarantines require compliance. As this article was being written, Facebook feeds around the world were filled with outraged posts about everyone from celebrities to college kids on spring break who still insisted on gathering in crowds, despite official advice (and sometimes orders) not to do so. Counter-posts were written by people who saw quarantine and isolation orders as infringements on their civil liberties that must be ignored at any cost.
This debate isn’t new. In 1907, as typhoid raged across New York City, Mary Mallon, an Irish immigrant and cook for wealthy families (she was renowned for her peach ice cream) passed the disease on to dozens of others (the exact number of contacts and direct infections she was responsible for is in dispute). Mallon was sent to New York’s main quarantine center, North Brother Island, a landmass that’s now used as a wildlife sanctuary. It’s situated in the East River between the Bronx and Queens, and is adjacent to Rikers Island (still home to one of the country’s most notorious prisons). She spent three years there and was released only after promising not to work in jobs that would require public interaction. Cooking was specifically banned.
But Mallon, who was an asymptomatic typhoid carrier, changed her name and kept working. This led to a backlash that was both personal (nicknamed “Typhoid Mary,” she’s become the historic symbol for quarantine noncompliance) and racist (since Irish immigrants were seen as being more likely to be infected and more willing to spread infection). Mallon was eventually sent back to North Brother Island, where she lived in isolation until her death in 1938.
Even as Mallon was preparing infected ice cream, the nature of quarantine was about to shift, thanks to the development of powerful drugs that were able to cure many previously fatal diseases. In the US, the quarantine centers that had once been standard at every international border and airport were mostly closed by the 1990s. The country’s 55 quarantine stations were reduced to seven. The number of government employees working on quarantines was reduced from more than 500 to 90.
At the same time, the ability of people to travel around the world quickly was creating warnings of global pandemics that today seem prescient. SARS, along with outbreaks of plague and Ebola, have led to calls for harsher and swifter quarantines. These calls have always been “part of the experience of human society,” Tognotti said. To be most successful, quarantines can require “centralized power and strength of arms,” she said, pointing to China’s now-successful-looking efforts to contain coronavirus. Speed is also critical. Examples from the 1918 flu epidemic across the globe—from St. Louis and San Francisco to as far as Tasmania—illustrate that quick and broad action led to vastly fewer deaths than in places where measures were less rapid and less severe.
One such set of orders was issued in October 1918, by the governor of the Isle of Man, which sits in the Irish Sea off the coasts of Britain and Ireland. Residents were given seven commands, including “avoid crowded places” and “keep out of doors as much as possible.” Strict isolation, the edict said, “should be enforced in every affected case.”
For those under isolation—including most of us in the United States now, it seems—the challenge lies in following another of the Isle of Man governor’s commands: “Don’t be scared.” Beyond that, we all have to find ways to be productive. It isn’t known what the residents of Eyam did—presumably, they were people of faith and likely prayed for themselves and the world. But non-secular activities can also make isolation productive.
My kids are driving me crazy, but I also know that this is a time we’ll always remember—when a crisis forced us to pull together as a family, as a nation, as a world. It’s a time that calls on us to experience the weirdness and transcendence of learning to help one another from a distance of 6 feet. When I asked Tognotti how she was doing, her email reply indicated fatigue and frustration. “I’m very tired,” she wrote, and she pointed me toward the text for an essay that she was writing, asking me to quote from that.
“Italians enjoy life,” she wrote. “This means big families, long dinners, lunches, big hugs, kisses and close contact.” Changing ancestral behaviors in a few days is difficult, she said. “However, I am confident that Italy will make it out of this dark hour—and with the data we are accumulating and the lessons we learn, we will be able to better manage similar emergencies when this one is history.”
Further reading
How to Properly Care for a Sick Person at Home (and Not Get Sick Yourself)
by Ellen Airhart and Christina Colizza
If you’re taking care of an ill person at home, you should prep your space with a “hot zone” to keep the virus as contained as possible.
How to Work From Home With Kids
by Christine Cyr Clisset
Working from home with kids isn’t easy. But these 5 strategies can make it more manageable.
The Best Cloth and KN95 Face Masks for Kids and Toddlers
by Christina Szalinski
The best kids mask to safeguard against COVID-19 is the most protective one they’ll keep on. We have four to recommend that fit a range of ages and are high-performing and breathable.
You’re at Home. The News Is Intense. Make Time for Self-Care.
by Ingrid Skjong
Whether you’re self-quarantined or social distancing, you may be spending more time than ever at home. Here’s how to care for your mind and body.