Real quarantine

When we lived in Christchurch, we'd tour occasionally out to Quail Island. Quail Island had been home to New Zealand's leper colony, and also served more generally for quarantine. Here's a bit of that history.

Although most migrants arrived fit and well, the authorities implemented disease prevention measures at the major ports. Before anyone disembarked, officials checked the health of the government migrants and the condition of the ship, and heard complaints. Ships with sick people aboard had to raise the yellow flag and go into quarantine, a dismal introduction to the New World for people who had already been cooped up for three to five uncomfortable months at sea.

Construction started before the island’s sale could be completed, so the government built cheaply and simply. In February 1875 the Rakaia (which had lost 11 passengers and still had 100 mumps cases aboard) became the first ship to use Quail Island. It would not be the last, but with migration tapering off in the late 1870s and steam taking over from the mid-1880s, the need to quarantine people declined sharply. From 1881 livestock were also detained here, most famously the dogs and ponies used by Antarctic explorers. Between 1901 and 1929 the Shackleton, Scott and Byrd expeditions all used Quail Island.

But sickness still drove people here. In 1918 victims of the influenza epidemic were sent here as Canterbury struggled to meet the crisis. Between 1906 and 1925 there was also a small leper colony. Just a few minutes’ walk from the barracks you will find the walls, concrete foundations and drain channels from the leper colony that sat on its own isolated terraces. Another few minutes’ walk away a solitary grave lies behind a neatly painted white picket fence. It belongs to the only leper to die here, 20-year-old Ivan Skelton, who was visiting relatives at Westport in 1918 when he was diagnosed with the ancient curse. Shipped off to Quail Island, he died five years later, far from his family.

I was increasingly aghast with the lack of quarantine or health checks as folks came in ahead of the border closure, then again with the rather informal nature of quarantine for residents returning from places where Covid was rife. The country had ample empty hotels.

I wonder how much of the total lockdown could have been avoided had we collectively not forgotten how to run proper case tracking, followed up by quarantine.

It does have a long history. Here's Lyman Stone's excellent summary. Read the whole thing. A few snips:

Before we get into what centralized quarantine might look like today, it’s worth walking through the history of this strategy. In Leviticus 13 and 14, Moses gave the people of Israel instructions on how to deal with outbreaks of infectious diseases (in this case, a skin condition; widely translated as leprosy, it is actually very unlikely that the disease described was true “leprosy.”). The instructions are a Bronze Age version of “test and quarantine.” Detailed diagnostic criteria are listed for experts to use to provide a diagnosis. Any cases that meet a very low standard for a “possible positive” were then isolated from the rest of the community in a secure location until they completed a certain window of time without symptoms.

This is textbook “centralized quarantine.” Infected people didn’t shelter in place, and isolation was not limited to highly infectious people. The instruction of God Almighty through His prophets to the people of God when they confronted a contagious disease was very simple: Isolate large numbers of people who might be infectious at a safe distance from the community.

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Detailed study of medieval cemeteries in Scandinavia has yielded an answer. Leprosy was driven to extinction in many Danish cities before 1400. It persisted longer in rural areas. The cities where leprosy declined share a common trait: lazar houses. They established “leprosaria” where infected people were isolated. This resulted in a dramatic decline of infection in the wider population.

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It is also, as it turns out, extremely beatable. There are numerous cases of bubonic plague being successfully controlled without modern pharmaceuticals, but the best-documented case is the city of Ferrara from 1629 to1631. Strikingly, the scientific paper about Ferrara’s successful management of bubonic plague was accepted for publication in December 2019, and just officially published last month.

From 1629 to 1631, a terrible wave of plague killed tens of thousands in every city in northern Italy. Except for Ferrara, where there were fewer than a dozen plague deaths. This was not due to luck: Several towns around the region’s official borders were hit hard, suffering thousands of deaths. But Ferrara, alone in the center of northern Italy, stood resilient and relatively plague-free.

Among the city’s strategies: Strict travel restrictions limited who could come to the city; trade goods were repackaged before being locally sold. Movement was limited, and most city gates were sealed. Mostly, these strategies worked. But not entirely. In August 1630, several cases broke out in the city. This should have been the end for Ferrara: Once you’ve got a few bubonic plague cases, it tends to spread. But the city’s officials deployed all options they had on hand: All those who were sick were put in centralized quarantine in the now-empty leper colonies. So were their close contacts, business partners, families, and others. Their houses were sealed up while they were away, and after a safe period of time scrubbed with a kind of medieval bleach.

There were a few other scares, which demonstrate how extreme the measures were. A postal worker got sick: He and everyone on his route were put into quarantine. A school child showed some symptoms: School was canceled for two months. If this all sounds surprisingly modern for 400 years ago, don’t be surprised: “Plague protocols” were written for many cities around the world. Unfortunately, they were often ignored. Ferrara is unique, not for having written rules, but for actually following those rules. Politicians in Ferrara shelled out a huge amount of money from their budget to pay for food for quarantined people, have doctors check on the poor, and generally keep their city safe. They succeeded.

As we come down into level 2, and desperately would like to stay there, it's worth considering proper quarantine for cases as they come up.

The question is why Americans didn’t leap to this response. Why did we, rather than using existing legal authorities and time-tested procedures, instead choose to lock down all of society, despite no precedent for such a response, and little evidence it would work? Why did we, instead of deploying a simple, easy-to-understand, low-tech solution that any local government could have implemented, focus on a futuristic testing-and-trace regime that is never going to be fully deployable? The legal authority for quarantine is very clearly codified in law, the historic basis for its effectiveness is obvious, and it was even used as a strategy against the 1918 influenza pandemic, polio, and against recent novel influenzas.

It's a good question here too. I disagree that there's anything futuristic about testing and tracing - but there is something silly about seeing it as a way of avoiding quarantine. I'd thought that testing was just a more accurate version of the older medical diagnosis, allowing for a narrower set of people to be quarantined. And contact tracing is needed for any kind of quarantine anyway. Wouldn't it rather be a strong complement to everything else, and a substitute for the broader and far more costly lockdowns?