Over the last few weeks, the subject of quarantines for healthcare workers returning from Ebola affected regions has raised passions across the developed world.

I’ve talked before about why I think they’re an ineffective tool for the current outbreak.

That said quarantines are sometimes useful. Historically, they were one of the earliest techniques communities were able to leverage in order to contain an outbreak. Before we had the powers of modern medicine, we only had a rudimentary understanding of how diseases spread.

Historical quarantines were also implemented in problematic ways. They often stigmatized patients by equating disease with crime and there were many cases where the basic needs of patients were ignored.

As time went on however, quarantines were no longer seen as a panacea as they have gradually given way to more targeted approaches to fighting dangerous diseases.

To give more context to the current debate over Ebola quarantines, below is a list of some of the most notable uses of quarantines throughout history and their repercussions:

Leprosy (Lyons, 583)

One of the earliest examples of medical quarantines were “leper colonies.” Leprosy is a disease that can cause skin inflammation and disfiguration. The disease pops up in the historical record as far back as the Ancient Greeks and is referenced many times in the Christian Bible. The city of Lyons in 583 instituted a mandatory quarantine for Leprosy patients. It proved ineffective at managing the outbreak. Despite this failure, many European cities followed suit and by the year 1200, there were over 19,000 “leper colonies” across the continent. It was only in the 1900, with the advent of modern antibiotics, that finally brought the disease was brought under control.

Black Death (Venice, 1348’s)

Venice put into practice the first institutionalized system of quarantines in 1348. That year was estimated to be one of the peak years of the disease that wiped out between 30-60% of the European continent’s population. The Venice city council mandated ships must stay outside the lagoon for up to 40 days if there was a suspected cause of plague on board. The limited understanding of how plague was spread meant that, despite their best efforts, Venice was still hit hard with the disease.

Yellow fever in Philadelphia (1793)

1 in 10 people lost their lives in the city of brotherly love between 1793 and 1795. The disease was treated at that time by removing patients from the city and subjecting them to ineffective treatments such as “bleeding.” We know now that yellow fever is transmitted through blood-to-blood contact, with mosquitoes usually acting as a catalyst. The lack of understanding of the transmission of the disease, and no effort to keep mosquitoes away from the infected, led to the failure of the quarantine in stoping the fever.

Smallpox (Sydney 1881-82)

The initial case of Smallpox that was thought to have caused the outbreak in Australian was brought by the steamship Brisbane, in the spring of 1881. After the disease popped up on several places on the Australian mainland, the government rounded up hundreds of people and interred them at the North Head quarantine station. While this intervention was successful in containing a wider outbreak in Sydney, it’s implementation caused public outrage. Patients and their families were often treated with outright contempt by staff at the center and were denied access to basic need such as clean towels, linens and medical supplies.

Cholera (New York City, 1832)

There was a huge Cholera outbreak in Britain and parts of Europe in the early 1830’s. In response, the city of New York issued a decree that ships cannot approach the dock if there is a suspected Cholera patient onboard. The policy proved to be too unwieldy to be effective and the disease was able to slip through. It ended up taking the lives of 3,500 of New York’s 250,000 population before it was finally brought under control.

Venereal disease in the United States (1917)

With the outbreak of WWI, the US army began one of the largest recruitments drives in the country’s history. Officials were disturbed by the number of recruits who had to be turned away because of a growing number of Sexually Transmitted Infections(STIs) like gonorrhea and syphilis. The US government turned its attention to the groups of “camp girls” that had begun to pop up around training centers and recruitment facilities. Over the course of the war, over 30,000 women were rounded up, with many kept in detention long after they had tested negative. There is no evidence to show this intervention helped bring STI transmissions under control.

Flu epidemic (Europe and US, 1917-1919)

1917-1919 saw a massive uptick in the number of flu cases across the US and Europe, infecting more than 500 million people around the world. Officials leveraged more lenient measures such as school cancellations and bans on public assembly, as well as home quarantines for infected people. The flu can be spread very easily, and many of these methods did little more than slow down the spread of the virus.

AIDS in the United States (1985)

The US never implemented & an HIV/AIDS quarantine but polling throughout the early years of the continuing epidemic showed there was widespread public support for one. The NY Times reported on December 20^th, 1985 that 51% of the American public supported quarantines for AIDS affected individuals. Thankfully, this never occurred. Public health experts now believe it would have added to the already high levels of stigmatization among patients and further hampered treatment efforts.

SARS (China, 2003)

China was the epicenter of the SARS outbreak in 2003. The nation employed a brutal but effective means of keeping the epidemic under control. The population was subjected to mass quarantines, where even the suspicion of contact with an infected person was enough to keep groups of people isolated. Conditions in isolation units varied widely, but in cases caused panic and discontent. The WHO declared the outbreak over by the end of 2003, mostly due to mass isolation efforts. This is the sole example on this list of quarantines working as they should.

What’s clear when looking at the history of infectious diseases is that there is no one-size-fits-all cure for dealing with an outbreak. It’s important that we make science-based decisions and not succumb to panic. For some diseases, a mandatory quarantine may be good policy, for others, it is not.

The WHO, Doctors Without Borders, and other major NGO’s dealing with the outbreak in West Africa have all been united in their denunciation of calls for quarantines in developed countries.

What’s important today is that we keep the flow of health workers heading to Ebola affected countries steady. Right now, this is in jeopardy. Already Doctors Without Borders has reported a staffing crisis because health workers are concerned they will be quarantined when they return home.

The only way to keep everyone safe from Ebola is to stop it at its source. & 

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