483: Quarantine

A Thousand Things to Talk About

If it were a matter of public safety, would you quarantine yourself away from human contact?

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Full episode script

Quarantine can be a very effective method of controlling disease transmission, and it can also be a nightmare for individual and human rights. There’s quarantine procedures referenced in the Bible and plenty of other ancient texts. Many medical historians point to the 14th century as the birth of the modern quarantine, when the plague started decimating the population of many European city-states.

In the late 1600s and early 1700s, yellow fever and smallpox outbreaks led to quarantine procedures being established in a number of countries. Many of these procedures were built with public health in mind… and also had disproportionate impacts on underrepresented groups. Jewish individuals were often forced into quarantine zones in these early modern years of the practice.

That discriminatory history of the quarantine practice isn’t only in the history books, either. During the recent ebola outbreak, a number of HIV advocates pointed out the similarities between the quarantine restrictions put on individuals who had been exposed to ebola and the 1980’s quarantines that worsened the AIDS crisis.

There are standards established for quarantine that respects both human rights to movement and association as well as the public health necessity of disallowing contact with others. The UN lays these out in the The Siracusa principles. As Fiona Lander wrote in PLOS blogs, In order for a restriction like compulsory quarantine to accord with the Siracusa principles:

It must be provided for, and carried out, in accordance with the law;

It must be in the interest of a legitimate objective of general interest;

It must be strictly necessary to achieve the objective, in a democratic society;

There should be no less restrictive/intrusive means through which the same objective can be achieved;

The restriction must be based on scientific evidence, and not imposed arbitrarily or in a discriminatory way.

It is also vital that such restrictions be of limited duration, and subject to appeal and/or review.

And even when it is completely necessary, this quarantine can have a very real impact. Typhoid Mary was involuntarily quarantined — multiple times in her life and eventually permanently – because she didn’t comply with the order to not cook food and ended up causing multiple outbreaks of the disease. In The Atlantic, Michele Hirsch shared their experience of medical quarantine. Quote:

And don’t—not for a moment, even as you deal with a disease and, on top of it, the awful feeling of being a biohazard—don’t even consider letting someone give you a hug.

This script may vary from the actual episode transcript.