A quarantine is a restriction on the movement of people, animals, 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, yet do not have a confirmed medical diagnosis. It is distinct from medical isolation, in which those confirmed to be infected with a communicable disease are separated, or isolated, from the healthy population.
The concept of quarantine is known to have been practiced around the world throughout history. Notable quarantines in modern history include the village of Eyam in 1665 during the bubonic plague outbreak in England; East Samoa during the 1918 flu pandemic; the Diphtheria outbreak during the 1925 serum run to Nome, the 1972 Yugoslav smallpox outbreak, the 2002–2004 SARS outbreak, the 2013–2016 Western African Ebola epidemic, and extensive quarantines applied throughout the world during the COVID-19 pandemic.
Ethical and practical considerations must be considered in the application of quarantine to people. Practice differs from country to country, as different countries vest the authority to quarantine their citizens and other persons under a variety of scenarios at different levels of government, with wide variation in quarantine enforcement mechanisms.
In some countries, quarantine is just one of many measures governed by legislation relating to the broader concept of biosecurity. For example, Australian biosecurity is mostly governed by the single overarching Biosecurity Act 2015. However, that is not the only Australian law touching on quarantine; Section 107 of the Constitution preserves states' broad residual legislative powers, including public health powers, and Section 51(ix) gives the Commonwealth power to legislate with respect to quarantine—that power is generally concurrent rather than exclusive. As a result, both the Commonwealth and the states can enact quarantine laws, with Commonwealth law prevailing in cases of inconsistency.
Etymology and terminology The word quarantine comes from quarantena or quarantaine, meaning "forty days", used in the Venetian 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 the Black Death plague. The quarantena followed the trentino, or "thirty-day isolation" period, first imposed in 1377 in the Republic of Ragusa, Dalmatia (modern Dubrovnik in Croatia).
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 the movement of people and goods which is intended to prevent the spread of disease or pests". The word is also used as a verb.
Quarantine is distinct from medical isolation, in which those confirmed to be infected with a communicable disease are isolated from the healthy population.Quarantine and Isolation Centers for Disease Control and Prevention, Quarantine and Isolation, accessed 5 February 2020
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.
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 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."Bible: The Old Testament- Leviticus, Numbers & Deuteronomy www.sparknotes.com, ...the Israelites' punishment for certain infractions is to isolate or expel the offending individual from the camp... ...Since uncleanness bars a person from approaching the sacred religious items, physical impurity places one farthest from the center of Israel... accessed 14 March 2020
Medieval
The mandatory quarantine of special groups of patients, including those with leprosy, started early in Islamic history. A hadith 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 travelling there.
in 1025, Persian Muslim polymath Ibn Sina (Avicenna) proposed a systematic and scientific formalization of quarantine in his medical encyclopedia, The Canon of Medicine. He established the clinical necessity of isolation to prevent "the spread of diseases," fundamentally shifting the practice from a traditional custom to a rigorous medical protocol. He also recommended quarantine for patients with infectious diseases, especially tuberculosis. In the early 8th century the sixth Umayyad caliph Al-Walid I segregated lepers from the general population, with some later sources crediting the caliph with opening a hospital. 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 sultan Murad II in the 15th century, with some of the facilities operating for centuries. 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.
The word "quarantine" originates from quarantena, the Venetian language form, 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 in Dalmatia (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 Journal of Sociologic Medicine – Volume 17 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 the Lazzarettos of Dubrovnik where arriving ship personnel were held for up to 40 days. 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.Susan Scott and Christopher Duncan, Biology of Plagues: Evidence from Historical Populations, Cambridge, United Kingdom: Cambridge University Press, 2001
Other diseases lent themselves to the practice of quarantine before and after the devastation of the plague. Those affected by leprosy were historically isolated long-term from society. Quarantine systems were enacted to prevent the spread of syphilis in Zurich in the 15th and 16th centuries, the advent of yellow fever in Spain at the beginning of the 19th century, and the arrival of Asiatic cholera in 1831.
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). The next record of preventive measures comes from Reggio/Modena in 1374. Venice founded the first lazaret (on a small island adjoining the city) in 1403. In 1467 Genoa followed the example of Venice, and in 1476 the old leper hospital of Marseille 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 of Pomègues. 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 near Bordeaux. Afterwards, they were used for other purposes.
Modern history
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).Arnebeck, Bob. "A Short History of Yellow Fever in the US". January 30, 2008; From Benjamin Rush, Yellow Fever and the Birth of Modern Medicine. bobarnebeck.com, accessed 3 February 2020 Cholera and smallpox epidemics continued throughout the nineteenth century, and plague epidemics affected HonoluluThe Disastrous Cordon Sanitaire Used on Honolulu's Chinatown in 1900 www.slate.com, accessed 3 February 2020 and San Francisco from 1899 until 1901.Mark Skubik, "Public Health Politics and the San Francisco Plague Epidemic of 1900–1904," Doctoral Thesis, San Jose State University, 2002 www.skubik.com, accessed 5 February 2020 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") to keep the infected from introducing influenza into healthy populations.Peter Oliver Okin, "The Yellow Flag of Quarantine: An Analysis of the Historical and Prospective Impacts of Socio-Legal Controls Over Contagion," Doctoral dissertation, University of South Florida, January 2012; p. 232, scholarcommons.usf.edu, accessed 5 February 2020 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. Most Western countries implemented a range of containment strategies, including isolation, surveillance, and the closure of schools, churches, theatres, and public events.