Quarantine: is this measure from the depths of time magical thinking?

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The images are impressive: ghost towns deserted by their millions of inhabitants, masked men, convoys of people taken to containment centres, closed borders. The Chinese coronavirus has triggered a fever of anxiety, if not panic. A fever fought with the most ancestral means, forced isolation. This is how contagious disease is treated in the 21st century, with methods dating back to the Middle Ages if not the Old Testament. Methods of dubious effectiveness, which would be more a matter of magical thinking than of scientific rationality.

Deserted streets, abandoned café terraces, car-free expressways, a city of more than ten million inhabitants that has become a ghost town. No more children in the public gardens, no one in the streets lined with shops with their curtains down. A strange atmosphere, where man has disappeared.

The video published by ABC News on its Twitter account speaks for itself: faced with the coronavirus and the risk of an epidemic, if not a pandemic, that it represents, the Chinese government is employing major means: locking up its population. The 11 million inhabitants of Wuhan are in the second week of isolation. A confinement extended to fifteen other cities: 45 million Chinese are locked up at home. This is the largest quarantine in the history of mankind.

Forties, a word that was thought to have been lost in the dungeons of history and is now coming back into the open, on the front page of all the world's media. A containment measure that goes back a long, long way in time, the vestige of an ancestral form of health risk management, whose effectiveness in our 21st century world is widely debated.

A long history

The idea of confining patients with a contagious disease dates back to the Old Testament, when leprosy was mentioned. Leprosy is a disfiguring, frightening, and therefore thought to be contagious disease. Isolating the patients was then the best method, after prayer, to prevent it. It was especially in the fourteenth century that the first measures to confine ships coming from areas infected by the Black Death appeared. Historians trace the first episode of forced isolation at the port of Ragusa in Croatia in 1377. Ships coming from areas with high plague rates had to stay at sea for 30 days before docking. Any person on board who was in good health at the end of the waiting period was presumed to be unlikely to spread the infection and was allowed to go ashore.

However, it was in Venice, from 1423 onwards, that the systematic organisation of containment measures of thirty and then forty days and the word "quarantine" derived from "quaranta" appeared. It must be said that the Serenissima suffered sixty-three plague epidemics from the year 600 to 1500. The town, particularly exposed by the importance of its trade with the East, had the Lazzaretto Nuovo built to receive ships and their crews from ports suspected of being infested by the plague.

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At about the same time, the concept of quarantine was extended to that of cordon sanitaire, which consists of blocking access to a town or area to protect it from the entry of infected patients. Thus, in the Luberon at the beginning of the 18th century, a 27-kilometre long "plague wall" was installed. A method that will last since we see, in 1821, the French state sent 30,000 soldiers to block the Spanish border to prevent the entry of an epidemic of yellow fever. This method was repeated ten years later against the cholera epidemic that struck Western Europe.

More recently, the crew of Neil Armstrong's lunar mission was quarantined as soon as they returned to Earth.

Relative effectiveness

These imposed quarantines are appreciated by the people as long as they are not the ones concerned. In reality, these forced confinements are relatively effective. At the end of the 19th century, when the major international health conferences appeared, it was realized that the system was ineffective because there were always people who managed to escape and, as Patrick Zylberman, health historian and professor emeritus at the Ecole des hautes études en santé publique, thought  , it may be counterproductive. Indeed, locking up people who may be infected or who have an asymptomatic condition with healthy people only aggravates the situation and the risks of propagation. Quarantine would then produce a highly explosive culture broth.

Quarantining its population inevitably poses risks for a government. Violence, riots and rebellion often accompany these measures. This was the case recently, in 2014 in Liberia in Africa, where the capital Monrovia was isolated to stop the Ebola epidemic. Violent clashes between the panic-stricken population and the police resulted in many deaths.

In China too, where the population is one of the most docile in the world, confinements organized in the provinces of Shanghai and Nanjing during the SARS epidemic led to riots, as the enclosed population lacked sanitary or food supplies.

Quarantine is part of the arsenal of French prefects. They've never used it, as yet.

  • READ: Yellow flag. History of quarantine, from the Plague to Ebola by Sofiane Bouhdiba, L'Harmattan, 2016

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