A quarantine is a restriction on the movement of people and goods which is intended to prevent the spread of disease or pests. It is often used in connection to disease and illness, preventing the movement of those who may have been exposed to a communicable disease, but do not have a confirmed medical diagnosis. The term is often used synonymously with medical isolation, in which those confirmed to be infected with a communicable disease are isolated from the healthy population.
Quarantine may be used interchangeably with cordon sanitaire, and although the terms are related, cordon sanitaire refers to the restriction of movement of people into or out of a defined geographic area, such as a community, in order to prevent an infection from spreading.
The word quarantine comes from a seventeenth-century Venetian variant of the Italian quaranta giorni, meaning forty days, the period that all ships were required to be isolated before passengers and crew could go ashore during the Black Death plague epidemic. Quarantine can be applied to humans, but also to animals of various kinds, and both as part of border control as well as within a country.
The quarantining of people often raises questions of civil rights, especially in cases of long confinement or segregation from society, such as that of Mary Mallon (also known as Typhoid Mary), a typhoid fever carrier who was arrested and quarantined in 1907 and later spent the last 24 years and 7 months of her life in medical isolation at Riverside Hospital on North Brother Island.
Quarantine periods can be very short, such as in the case of a suspected anthrax attack, in which people are allowed to leave as soon as they shed their potentially contaminated garments and undergo a decontamination shower. For example, an article entitled "Daily News workers quarantined" describes a brief quarantine that lasted until people could be showered in a decontamination tent. (Kelly Nankervis, Daily News).
The February/March 2003 issue of HazMat Magazine suggests that people be "locked in a room until proper decon could be performed", in the event of "suspect anthrax".
Standard-Times senior correspondent Steve Urbon (14 February 2003) describes such temporary quarantine powers:
Civil rights activists in some cases have objected to people being rounded up, stripped and showered against their will. But Capt. Chmiel said local health authorities have "certain powers to quarantine people".
The purpose of such quarantine-for-decontamination is to prevent the spread of contamination, and to contain the contamination such that others are not put at risk from a person fleeing a scene where contamination is suspect. It can also be used to limit exposure, as well as eliminate a vector.
New developments for quarantine include new concepts in quarantine vehicles such as the ambulance bus, mobile hospitals, and lockdown/invacuation (inverse evacuation) procedures, as well as docking stations for an ambulance bus to dock to a facility under lockdown.
One of the earliest mentions of isolation is found in the Biblical book of Leviticus, written in the seventh century BC or perhaps earlier, which describes how infected people were separated to prevent spread of disease under the Mosaic Law:
"If the shiny spot on the skin is white but does not appear to be more than skin deep and the hair in it has not turned white, the priest is to isolate the affected person for seven days. On the seventh day the priest is to examine them, and if he sees that the sore is unchanged and has not spread in the skin, he is to isolate them for another seven days."
The word "quarantine" originates from the Venetian dialect form of the Italian quaranta giorni, meaning 'forty days'. This is due to the 40-day isolation of ships and people before entering the city-state of Ragusa (modern Dubrovnik, Croatia). This was practiced as a measure of disease prevention related to the Black Death. Between 1348 and 1359, the Black Death wiped out an estimated 30% of Europe's population, and a significant percentage of Asia's population. The original document from 1377, which is kept in the Archives of Dubrovnik, states that before entering the city, newcomers had to spend 30 days (a trentine) in a restricted place (originally nearby islands) waiting to see whether the symptoms of Black Death would develop. In 1448, the Venetian Senate prolonged the waiting period to 40 days, thus giving birth to the term quarantine. The forty-day quarantine proved to be an effective formula for handling outbreaks of the plague. According to current estimates, the bubonic plague had a 37-day period from infection to death; therefore, the European quarantines would have been highly successful in determining the health of crews from potential trading and supply ships.
Other diseases lent themselves to the practice of quarantine before and after the devastation of the plague. Those afflicted with leprosy were historically isolated from society, as were the attempts to check the spread of syphilis in northern Europe after 1492, the advent of yellow fever in Spain at the beginning of the 19th century, and the arrival of Asiatic cholera in 1831.
Venice took the lead in measures to check the spread of plague, having appointed three guardians of public health in the first years of the Black Death (1348). The next record of preventive measures comes from Reggio in Modena in 1374. The first lazaret was founded by Venice in 1403, on a small island adjoining the city. In 1467, Genoa followed the example of Venice, and in 1476 the old leper hospital of Marseille was converted into a plague hospital. The great lazaret of Marseille, perhaps the most complete of its kind, was founded in 1526 on the island of Pomègues. The practice at all the Mediterranean lazarets was not different from the English procedure in the Levantine and North African trade. On the arrival of cholera in 1831 some new lazarets were set up at western ports, notably a very extensive establishment near Bordeaux, afterwards turned to another use.
The involuntary hospital quarantine of special groups of patients, including those with leprosy, started early in Islamic history. In 1307 the sixth Umayyad caliph built the first hospital in Damascus and issued an order to isolate those infected with leprosy from other patients in the hospital. The practice of involuntary quarantine of leprosy in general hospitals continued until the year 1431 when the Ottomans built a leprosy hospital in Edirne. Incidents of quarantine occurred throughout the Muslim world, with evidence of voluntary community quarantine in some of these reported incidents. The first documented involuntary community quarantine was established by the Ottoman quarantine reform in 1838.
Epidemics of yellow fever ravaged urban communities in North America throughout the late eighteenth and early nineteenth centuries, the best-known examples being the 1793 Philadelphia yellow fever epidemic and outbreaks in Georgia (1856) and Florida (1888). Cholera and smallpox epidemics continued throughout the nineteenth century, and plague epidemics affected Honolulu and San Francisco from 1899 until 1901. State governments generally relied on the cordon sanitaire as a geographic quarantine measure to control the movement of people into and out of affected communities. During the 1918 influenza pandemic, some communities instituted protective sequestration (sometimes referred to as "reverse quarantine") to keep the infected from introducing influenza into healthy populations.
Since 1852 several conferences were held involving European powers, with a view to uniform action in keeping out infection from the East and preventing its spread within Europe. All but that of 1897 were concerned with cholera. No result came of those at Paris (1852), Constantinople (1866), Vienna (1874), and Rome (1885), but each of the subsequent ones doctrine of constructive infection of a ship as coming from a scheduled port, and an approximation to the principles advocated by Great Britain for many years. The principal countries which retained the old system at the time were Spain, Portugal, Turkey, Greece and Russia (the British possessions at the time, Gibraltar, Malta and Cyprus, being under the same influence). The aim of each international sanitary convention had been to bind the governments to a uniform minimum of preventive action, with further restrictions permissible to individual countries. The minimum specified by international conventions was very nearly the same as the British practice, which had been in turn adapted to continental opinion in the matter of the importation of rags.
The Venice convention of 30 January 1892 dealt with cholera by the Suez Canal route; that of Dresden of 15 April 1893, with cholera within European countries; that of Paris of 3 April 1894, with cholera by the pilgrim traffic; and that of Venice, on 19 March 1897, was in connection with the outbreak of plague in the East, and the conference met to settle on an international basis the steps to be taken to prevent, if possible, its spread into Europe. An additional convention was signed in Paris on 3 December 1903.
A multilateral international sanitary convention was concluded at Paris on 17 January 1912. This convention was most comprehensive and was designated to replace all previous conventions on that matter. It was signed by 40 countries, and consisted of 160 articles. Ratifications by 16 of the signatories were exchanged in Paris on 7 October 1920. Another multilateral convention was signed in Paris on 21 June 1926, to replace that of 1912. It was signed by 58 countries worldwide, and consisted of 172 articles.
In Latin America, a series of regional sanitary conventions were concluded. Such a convention was concluded in Rio de Janeiro on 12 June 1904. A sanitary convention between the governments of Argentina, Brazil, Paraguay and Uruguay was concluded in Montevideo on 21 April 1914. The convention covers cases of Asiatic cholera, oriental plague and yellow fever. It was ratified by the Uruguayan government on 13 October 1914, by the Paraguayan government on 27 September 1917 and by the Brazilian government on 18 January 1921.
Sanitary conventions were also concluded between European states. A Soviet-Latvian sanitary convention was signed on 24 June 1922, for which ratifications were exchanged on 18 October 1923. A bilateral sanitary convention was concluded between the governments of Latvia and Poland on 7 July 1922, for which ratifications were exchanged on 7 April 1925. Another was concluded between the governments of Germany and Poland in Dresden on 18 December 1922, and entered into effect on 15 February 1923. Another one was signed between the governments of Poland and Romania on 20 December 1922. Ratifications were exchanged on 11 July 1923. The Polish government also concluded such a convention with the Soviet government on 7 February 1923, for which ratifications were exchanged on 8 January 1924. A sanitary convention was also concluded between the governments of Poland and Czechoslovakia on 5 September 1925, for which ratifications were exchanged on 22 October 1926. A convention was signed between the governments of Germany and Latvia on 9 July 1926, for which ratifications were exchanged on 6 July 1927.
One of the first points to be dealt with in 1897 was to settle the incubation period for this disease, and the period to be adopted for administrative purposes. It was admitted that the incubation period was, as a rule, a comparatively short one, namely, of some three or four days. After much discussion ten days was accepted by a very large majority. The principle of disease notification was unanimously adopted. Each government had to notify to other governments on the existence of plague within their several jurisdictions, and at the same time state the measures of prevention which are being carried out to prevent its diffusion. The area deemed to be infected was limited to the actual district or village where the disease prevailed, and no locality was deemed to be infected merely because of the importation into it of a few cases of plague while there has been no diffusion of the malady. As regards the precautions to be taken on land frontiers, it was decided that during the prevalence of plague every country had the inherent right to close its land frontiers against traffic. As regards the Red Sea, it was decided after discussion that a healthy vessel could pass through the Suez Canal, and continue its voyage in the Mediterranean during the period of incubation of the disease the prevention of which is in question. It was also agreed that vessels passing through the Canal in quarantine might, subject to the use of the electric light, coal in quarantine at Port Said by night as well as by day, and that passengers might embark in quarantine at that port. Infected vessels, if these carry a doctor and are provided with a disinfecting stove, have a right to navigate the Canal, in quarantine, subject only to the landing of those who were suffering from plague.
Guidance on when and how human rights can be restricted to prevent the spread of infectious disease is found in The Siracusa Principles, a non-binding document developed by the Siracusa International Institute for Criminal Justice and Human Rights and adopted by the United Nations Economic and Social Council in 1984. The Siracusa Principles state that restrictions on human rights under the International Covenant on Civil and Political Rights must meet standards of legality, evidence-based necessity, proportionality, and gradualism, noting that public health can be used as grounds for limiting certain rights if the state needs to take measures ‘aimed at preventing disease or injury or providing care for the sick and injured.’ Limitations on rights (such as quarantine) must be ‘strictly necessary,’ meaning that they must:
In addition, when quarantine is imposed, public health ethics specify that:
Finally, the state is ethically obligated to offer certain guarantees:
Plain yellow, green, and even black flags have been used to symbolize disease in both ships and ports, with the color yellow having a longer historical precedent, as a color of marking for houses of infection, previous to its use as a maritime marking color for disease. The present flag used for the purpose is the "Lima" (L) flag, which is a mixture of yellow and black flags previously used. It is sometimes called the "yellow jack" but this was also a name for yellow fever, which probably derives its common name from the flag, not the color of the victims (cholera ships also used a yellow flag). The plain yellow flag ("Quebec" or Q in international maritime signal flags) probably derives its letter symbol for its initial use in quarantine, but this flag in modern times indicates the opposite—a ship that declares itself free of quarantinable disease, and requests boarding and routine port inspection.
Australia has perhaps the world's strictest quarantine standards. Quarantine in northern Australia is important because of its proximity to South-east Asia and the Pacific, which have many pests and diseases not present in Australia. For this reason, the region from Cairns to Broome—including the Torres Strait—is the focus for many important quarantine activities that protect all Australians. As Australia has been geographically isolated from other major continents for millions of years, there is an endemically unique ecosystem free of several severe pests and diseases that are present in many parts of the world. If other products are brought inside along with pests and diseases, it would damage the ecosystem seriously and add millions of costs in the local agricultural businesses.
The Australian Quarantine and Inspection Service is responsible for border-inspection of any products which are brought into Australia, and assess the potential risks the products might harm Australian environment. Visitors are required to fill in the information card truthfully before arriving in Australia, and declare what food and any products made of wood and other natural materials they have processed. If the visitor fails to do so, usually a quarantine infringement fine of 220 Australian dollars is to be paid, and if not, the visitor may face criminal convictions or fined up to 100,000 Australian dollars and 10 years imprisonment.
There are three quarantine Acts of Parliament in Canada: Quarantine Act (humans) and Health of Animals Act (animals) and Plant Protection Act (vegetations). The first legislation is enforced by the Canada Border Services Agency after a complete rewrite in 2005. The second and third legislations are enforced by the Canadian Food Inspection Agency. If a health emergency exists, the Governor in Council can prohibit importation of anything that it deems necessary under the Quarantine Act.
Under the Quarantine Act, all travelers must submit to screening and if they believe they might have come into contact with communicable diseases or vectors, they must disclose their whereabouts to a Border Services Officer. If the officer has reasonable grounds to believe that the traveller is or might have been infected with a communicable disease or refused to provide answers, a quarantine officer (QO) must be called and the person is to be isolated. If a person refuses to be isolated, any peace officer may arrest without warrant.
A QO who has reasonable grounds to believe that the traveler has or might have a communicable disease or is infested with vectors, after the medical examination of a traveler, can order him/her into treatment or measures to prevent the person from spreading the disease. QO can detain any traveler who refuses to comply with his/her orders or undergo health assessments as required by law.
Under the Health of Animals Act and Plant Protection Act, inspectors can prohibit access to an infected area, dispose or treat any infected or suspected to be infected animals or plants. The Minister can order for compensation to be given if animals/plants were destroyed pursuant to these acts.
Each province also enacts its own quarantine/environmental health legislation.
Under the Prevention and Control of Disease Ordinance (HK Laws. Chap 599), a health officer may seize articles they believe to be infectious or containing infectious agents. All travellers, if requested, must submit themselves to a health officer. Failure to do so is against the law and is subject to arrest and prosecution.
The law allows for a health officer who have reasonable grounds to detain, isolate, quarantine anyone or anything believed to be infected and to restrict any articles from leaving a designated quarantine area. He/she may also order the Civil Aviation Department to prohibit the landing or leaving, embarking or disembarking of an aircraft. This power also extends to land, sea or air crossings.
To reduce the risk of introducing rabies from continental Europe, the United Kingdom used to require that dogs, and most other animals introduced to the country, spend six months in quarantine at an HM Customs and Excise pound; this policy was abolished in 2000 in favour of a scheme generally known as Pet Passports, where animals can avoid quarantine if they have documentation showing they are up to date on their appropriate vaccinations.
The plague had disappeared from England for more than thirty years before the practice of quarantine against it was definitely established by the Quarantine Act 1710 (9 Ann.) The first act was called for due to fears that the plague might be imported from Poland and the Baltic states. The second act of 1721 was due to the prevalence of plague at Marseille and other places in Provence, France. It was renewed in 1733 after a new outbreak in continental Europe, and again in 1743, due to an epidemic in Messina. In 1752 a rigorous quarantine clause was introduced into an act regulating trade with the Levant, and various arbitrary orders were issued during the next twenty years to meet the supposed danger of infection from the Baltic states. Although no plague cases ever came to England during that period, the restrictions on traffic became more stringent, and in 1788 a very strict Quarantine Act was passed, with provisions affecting cargoes in particular. The act was revised in 1801 and 1805, and in 1823–24 an elaborate inquiry was followed by an act making quarantine only at discretion of the privy council, which recognized yellow fever or other highly infectious diseases as calling for quarantine, along with plague. The threat of cholera in 1831 was the last occasion in England of the use of quarantine restrictions. Cholera affected every country in Europe despite all efforts to keep it out. When cholera returned to England in 1849, 1853 and 1865–66, no attempt was made to seal the ports. In 1847 the privy council ordered all arrivals with a clean bill of health from the Black Sea and the Levant to be admitted, provided there had been no case of plague during the voyage, and afterwards the practice of quarantine was discontinued.
After the passing of the first Quarantine Act (1710) the protective practices in England were haphazard and arbitrary. In 1721 two vessels carrying cotton goods from Cyprus, then affected by the plague, were ordered to be burned with their cargoes, the owners receiving an indemnity. By the clause in the Levant Trade Act of 1752, ships arriving in the United Kingdom with a "foul bill" (i.e. coming from a country where plague existed) had to return to the lazarets of Malta, Venice, Messina, Livorno, Genoa or Marseille, to complete a quarantine or to have their cargoes opened and aired. Since 1741 Stangate Creek (on the Medway) had been the quarantine station but it was available only for vessels with clean bills of health. In 1755 lazarets in the form of floating hulks were established in England for the first time, the cleansing of cargo (particularly by exposure to dews) having been done previously on the ship's deck. No medical inspections were conducted, but control was the responsibility of the Officers of Royal Customs and quarantine. In 1780, when plague was in Poland, even vessels with grain from the Baltic had to spend forty days in quarantine, and unpack and air their cargoes, but due to complaints mainly from Edinburgh and Leith, an exception was made for grain after that date. About 1788 an order of the council required every ship liable to quarantine to hoist a yellow flag in the daytime and show a light at the main topmast head at night, in case of meeting any vessel at sea, or upon arriving within four leagues of the coast of Great Britain or Ireland.
After 1800, ships from plague-affected countries (or with foul bills) were permitted to complete their quarantine in the Medway instead of at a Mediterranean port on the way, and an extensive lazaret was built on Chetney Hill near Chatham (although it was later demolished). The use of floating hulks as lazarets continued as before. In 1800 two ships with hides from Mogador in Morocco were ordered to be sunk with their cargoes at the Nore, the owners receiving an indemnity. Animal hides were suspected of harboring infections, along with a long list of other items, and these had to be exposed on the ship's deck for twenty-one days or less (six days for each installment of the cargo), and then transported to the lazaret, where they were opened and aired for another forty days. The whole detention of the vessel was from sixty to sixty-five days, including the time for reshipment of her cargo. Pilots had to pass fifteen days on board a convalescent ship. From 1846 onwards the quarantine establishments in the United Kingdom were gradually reduced, while the last vestige of the British quarantine law was removed by the Public Health Act of 1896, which repealed the Quarantine Act of 1825 (with dependent clauses of other acts), and transferred from the privy council to the Local Government Board the powers to deal with ships arriving infected with yellow fever or plague. The powers to deal with cholera ships had been already transferred by the Public Health Act 1875.
British regulations of 9 November 1896 applied to yellow fever, plague and cholera. Officers of the Customs, as well as of Royal Coast Guard and the Board of Trade (for signalling), were empowered to take the initial steps. They certified in writing the master of a supposedly infected ship, and detained the vessel provisionally for not more than twelve hours, giving notice meanwhile to the port sanitary authority. The medical officer of the port boarded the ship and examined every person in it. Every person found infected was taken to a hospital and quarantined under the orders of the medical officer, and the vessel remained under his orders. Every person suspected could be detained on board for 48 hours or removed to the hospital for a similar period. All others were free to land upon giving the addresses of their destinations to be sent to the respective local authorities, so that the dispersed passengers and crew could be kept individually under observation for a few days. The ship was then disinfected, dead bodies buried at sea, infected clothing, bedding, etc., destroyed or disinfected, and bilge-water and water-ballast pumped out at a suitable distance before the ship entered a dock or basin. Mail was subject to no detention. A stricken ship within 3 miles of the shore had to fly a yellow and black flag at the main mast from sunrise to sunset.
Quarantine law began in Colonial America in 1663, when in an attempt to curb an outbreak of smallpox, the city of New York established a quarantine. In the 1730s, the city built a quarantine station on the Bedloe's Island. The Philadelphia Lazaretto was the first quarantine hospital in the United States, built in 1799, in Tinicum Township, Delaware County, Pennsylvania. There are similar national landmarks such as Swinburne Island and Angel Island. The Pest House in Concord, Massachusetts was used as early as 1752 to quarantine those suffering from cholera, tuberculosis and smallpox.
In early June of 1832, during the cholera epidemic in New York, Governor Enos Throop called a special session of the Legislature for June 21, to pass a Public Health Act by both Houses of the State Legislature. It included to a strict quarantine along the Upper and Lower New York-Canadian frontier. In addition, New York City Mayor Walter Browne established a quarantine against all peoples and products of Europe and Asia, which prohibited ships from approaching closer than 300 yards to the city, and all vehicles were ordered to stop 1.5 miles away.
The Immigrant Inspection Station on Ellis Island, built in 1892, is often mistakenly assumed to have been a quarantine station, however its marine hospital (Ellis Island Immigrant Hospital) only qualified as a contagious disease facility to handle less virulent diseases like measles, trachoma and less advanced stages of tuberculosis and diphtheria; those afflicted with smallpox, yellow fever, cholera, leprosy or typhoid fever, could neither be received nor treated there.
Mary Mallon was quarantined in 1907 under the Greater New York Charter, Sections 1169-1170, which permitted the New York City Board of Health to “remove to a proper place…any person sick with any contagious, pestilential or infectious disease.”
During the 1918 flu pandemic, people were also quarantined. Most commonly suspect cases of infectious diseases are requested to voluntarily quarantine themselves, and Federal and local quarantine statutes only have been uncommonly invoked since then, including for a suspected smallpox case in 1963.
The 1944 Public Health Service Act “to apprehend, detain, and examine certain infected persons who are peculiarly likely to cause the interstate spread of disease” clearly established the federal government's quarantine authority for the first time. It gave the United States Public Health Service responsibility for preventing the introduction, transmission and spread of communicable diseases from foreign countries into the United States, and expanded quarantine authority to include incoming aircraft. The act states that “...any individual reasonably believed to be infected with a communicable disease in a qualifying stage and...if found to be infected, may be detained for such time and in such manner as may be reasonably necessary.”
Communicable diseases for which apprehension, detention, or conditional release of people are authorized must be specified in Executive Orders of the President. Executive Order 13295 (Revised List of Quarantinable Communicable Diseases, April 4, 2003) and its amendments (executive orders 13375 and 13674) specify the following infectious diseases:
On January 19, 2017, the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) published the Final Rule for Control of Communicable Diseases: Interstate and Foreign. This Final Rule enhances HHS/CDC’s ability to prevent the introduction, transmission, and spread of communicable diseases into the United States and interstate by clarifying and providing greater transparency regarding its response capabilities and practices. This regulation became effective on March 21, 2017. It specifies that:
The new rules:
The Division of Global Migration and Quarantine (DGMQ) of the US Center for Disease Control (CDC) operates small quarantine facilities at a number of US ports of entry. As of 2014, these included one land crossing (in El Paso, Texas) and 19 international airports.
Besides the port of entry where it is located, each station is also responsible for quarantining potentially infected travelers entering through any ports of entry in its assigned region. These facilities are fairly small; each one is operated by a few staff members and capable of accommodating 1-2 travelers for a short observation period. Cost estimates for setting up a temporary larger facility, capable of accommodating 100 to 200 travelers for several weeks, have been published by the Airport Cooperative Research Program (ACRP) in 2008 of the Transportation Research Board.
The United States puts immediate quarantines on imported products if a contagious disease is identified and can be traced back to a certain shipment or product. All imports will also be quarantined if the disease appears in other countries. According to Title 42 U.S.C. §§264 and 266, these statutes provide the Secretary of Health and Human Services peacetime and wartime authority to control the movement of people into and within the United States to prevent the spread of communicable disease.
U.S. President John F. Kennedy euphemistically referred to the U.S. Navy's interdiction of shipping en route to Cuba during the Cuban Missile Crisis as a "quarantine" rather than a blockade, because a quarantine is a legal act in peacetime, whereas a blockade is defined as an act of aggression under the U.N. Charter.
The Spanish term for quaratine, la cuarantina, refers also to the period of postpartum confinement in which a new mother and her baby are sheltered from the outside world.
In fact, until this recent situation, the CDC hadn't issued such an order since 1963, when it quarantined a woman for smallpox exposure. Even during the SARS epidemic in 2003, officials relied mostly on voluntary isolation and quarantine. And the last large-scale quarantine in the U.S. took place during the Spanish flu epidemic of 1918–19. ...
Both antivirus and anti-spyware programs either quarantine or remove the malicious file. A quarantined file is temporarily disabled, usually by moving it to a sandboxed directory. An administrator may restore it.
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