Coronavirus update- Lessons from the Black Death: Quarantines work, but come at a cost
Covid-19 update: There’s evidence that quarantine helped to shorten the first influenza pandemic of the 21st century: the 2009 influenza H1N1 outbreak, mainly by preventing more people from getting it.Updated: Mar 30, 2020 07:20 IST
To beat the Covid-19 pandemic, India has imposed a tight curfew on its 1.3 billion people. Lockdowns elsewhere seem unprecedented. Yet quarantine as a medical strategy is centuries old. Evidence shows it works, but imposes long-term costs, according to a wide variety of literature reviewed by HT.
From the time of the Black Death in the mid-1300s and the first outbreaks of cholera in recorded history to the 1918 influenza pandemic, quarantines have always been a form of public-health response to pandemics as far back in history as one could go.
There’s evidence that quarantine helped to shorten the first influenza pandemic of the 21st century: the 2009 influenza H1N1 outbreak, mainly by preventing more people from getting it.
Italy had, at the time of going to print, 9,134 Covid-19 deaths. Italians have historically paid a high price to pandemics. Earliest forms of quarantine were, not surprisingly, born in Italy.
Quarantine comes from the Italian “quaranta,” denoting “obligatory means of separating persons”, according to the US Centres for Disease Control.
The Back Death or the Great Bubonic Plague emerged first in Italy. It was the most devastating plague in history, decimating nearly 200 million, according to medical historian Cohen’s book mentioned above.
The plague was thought to have broken out first among sailors arriving in Sicily. The contagion spread like wildfire in Florence, Venice and Genoa. That’s when organised quarantine first took shape.
“The epidemic had abated but not disappeared; outbreaks of pneumonic and septicemic plague occurred in different cities during the next 350 years,” according to a research article, “Lessons from the History of Quarantine”, by Eugenia Tognotti, professor of the history of medicine in Italy’s University of Sassari.
According to the author, the first instance of an organised quarantine as a state-led strategy was “first introduced in 1377 in Dubrovnik on Croatia’s Dalmatian Coast”.
“City-states prevented strangers from entering their cities, particularly, merchants and minority groups, such as Jews and persons with leprosy.” At the time, 40 days of isolation was thought necessary.
Yellow fever in ports of France, Spain and Italy by the turn of the 18th century forced governments to use quarantine again. The initial response to the first waves of cholera outbreaks was essentially physical separation.
With medical advances, some believed that quarantines would no longer be necessary until the catastrophic 1918 influenza pandemic struck the human race in three waves between 1918 and 1919. Quarantine was back.
The emergence of the SARS in 2003 brought massive lockdowns in the early 21st century. SARS set off in Guangdong Province, China. Likewise, MERS too necessitated quarantine measures.
There’s strong evidence to show quarantine works to stop the spread of communicable diseases. Hubei is proof enough, experts say. Mass quarantine resulted in a sharp fall in Covid-19 cases there from an average 1,693 cases a day in early February to 36 cases on March 8.
The social and economic costs can be devastating. Lockdowns hurt livelihood, push nations into deep poverty and can leave governments under massive piles of debt. It can also have lasting psychological impacts.
‘The Lancet’ published evidence from five studies that compared “psychological outcomes for people quarantined with those not quarantined”. Those quarantined were found “likely” to report exhaustion, detachment from others, insomnia, poor concentration, etc. WHO recommends that the extent of quarantine should not exceed the level of threat to public health.
As technologies keep us virtually connected, home quarantines are no longer the dreary confinement they historically used to be.