Quarantine is a restriction on the movement of people and goods which is intended to prevent the spread of disease or pests. It is often used in connection to disease and illness, preventing the movement of those who may have been exposed to a communicable disease, but do not have a confirmed medical diagnosis. The term is often used synonymously with medical isolation, in which those confirmed to be infected with a communicable disease are isolated from the healthy population.
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Quarantine may be used interchangeably with cordon 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.
The word quarantine comes from a seventeenth-century Venetian variant of the Italian quaranta giorni, meaning "forty days", the period that all ships were required to be isolated before passengers and crew could go ashore during the Black Death plague epidemic. The quarantine can be applied to humans, but also to animals of various kinds, and both as part of border control as well as within a country.
History
An early mention of isolation occurs in the Biblical book of Leviticus, written in the seventh century BC or perhaps earlier, which describes the procedure for separating out infected people to prevent the spread of disease under the Mosaic Law:
"If the shiny spot on the skin is white but does not appear to be more than skin deep and the hair in it has not turned white, the priest is to isolate the affected person for seven days. On the seventh day the priest is to examine him, and if he sees that the sore is unchanged and has not spread in the skin, he is to isolate him for another seven days."
Islamic world
The involuntary hospital quarantine of special groups of patients, including those with leprosy, started early in Islamic history. Between 706 and 707 AD, the first hospital in Damascus was built and an order was issued to isolate those infected with leprosy from the other patients in the hospital. The practice of involuntary quarantine of leprosy in general hospitals continued until the year 1431 when the Ottomans built a leprosy hospital in Edirne. The first documented involuntary community quarantine was established by the Ottoman quarantine reform in 1838.
Middle Ages and Renaissance
The word "quarantine" originates from the Venetian dialect form of the Italian quaranta giorni, meaning "forty days". This is due to the 40-day isolation of ships and people practised as a measure of disease prevention related to the plague. Between 1348 and 1359, the Black Death wiped out an estimated 30% of Europe's population, and a significant percentage of Asia's population. Such a disaster led governments to establish measures of containment to handle recurrent epidemics. A document from 1377 states that before entering the city-state of Ragusa (modern Dubrovnik in Croatia), newcomers had to spend 30 days (a trentine) in a restricted place (originally nearby islands) waiting to see whether the symptoms of Black Death would develop. In 1448 the Venetian Senate prolonged the waiting period to 40 days, thus giving birth to the term "quarantine".The forty-day quarantine proved to be an effective formula for handling outbreaks of the plague. 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.
Modern history
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Epidemics of yellow fever ravaged urban communities in North America throughout the late-eighteenth and early-nineteenth centuries, the best-known examples being the 1793 Philadelphia yellow fever epidemic and outbreaks in Georgia (1856) and Florida (1888). Cholera and smallpox epidemics continued throughout the nineteenth century, and plague epidemics affected Honolulu and San Francisco from 1899 until 1901. State governments generally relied on the cordon sanitaire as a geographic quarantine measure to control the movement of people into and out of affected communities. During the 1918 influenza pandemic, some communities instituted protective sequestration (sometimes referred to as "reverse quarantine") - social distancing measures taken to protect a small, defined, and still-healthy population from an epidemic (or pandemic) before the infection reaches that population.
In the 21st century, people suspected of carrying infectious diseases have been quarantined, as in the cases of Andrew Speaker (multi-drug-resistant tuberculosis, 2007) and Kaci Hickox (Ebola, 2014). Moving infected patients to isolation wards and home-based self-quarantine of people potentially exposed was the main way the Western African Ebola virus epidemic was ended in 2016; health experts criticized international travel restrictions imposed during the epidemic as ineffective due to difficulty of enforcement and counterproductive as they slowed down aid efforts. The People's Republic of China has employed mass quarantines - firstly of the city of Wuhan and subsequently of all of Hubei province (population 55.5 million) - in the 2019–20 coronavirus outbreak. After a few weeks, the Italian government imposed lockdowns across the country (more than 60 million people) to stop the coronavirus outbreak. During the 2019–20 coronavirus pandemic, India quarantined itself from the world for a period of one month.
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Exercises
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