The extraordinary history (and likely busy future) of quarantine


By Jennifer Szalai


Quarantine can be lifesaving; it can also be dangerous, an exercise of extraordinary power in the name of disease control, a presumption of guilt instead of innocence.


In “Until Proven Safe,” a new book about quarantine’s past and future, Geoff Manaugh and Nicola Twilley do an impressively judicious job of explaining exactly why fears of quarantine are understandable and historically justified, while also showing how in coming years “we will almost certainly find ourselves more dependent on quarantine, not less.” Quarantine has to do with risk and uncertainty, and its logic is simple: “There might be something dangerous inside you — something contagious — on the verge of breaking free.”


While medical advances have made some diseases more diagnosable and less deadly, newfound knowledge can also accentuate the depths of our ignorance. The more we know, the more we know how much we don’t know — not to mention that modern life, with escalating numbers of people and goods churning their way around the world, has increased the opportunities for contagion.


Quarantine is distinct from isolation, even if the terms are often used interchangeably. Someone is isolated when they are known to be sick; someone is quarantined when they might be but we cannot be sure. Manaugh, an architecture and technology blogger, and Twilley, co-host of a podcast about the science and history of food, bring an impressively wide range of interests to bear on a subject that involves not only infectious disease but also — in their ambitious yet seamless narration — politics, agriculture, surveillance and even outer space.


The authors begin by tracing the history of quarantine through its geography. The first known mandatory quarantine provisions date back to 1377 in Dubrovnik, a city on the Adriatic coast, where visitors were told to spend a month in a nearby town or islet before they would be deemed admissible. The Black Death was sweeping across the continent. Venice, with its constellation of tiny islands separated by lagoons, became the site of the first permanent lazzaretto, or quarantine hospital; the word quarantine itself comes from the Italian word quarantena, short for quaranta giorni, or “40 days.”


Quarantine was often miserable for those subjected to it; conditions could be squalid and even cruel. (As Byron recalled in his poem “Farewell to Malta”: “Adieu, thou damned’st quarantine, / That gave me fever, and the spleen!”) But this book suggests that quarantine doesn’t have to be such a degrading experience. If anything, for quarantine to be a truly effective measure for public health, it has to be done with compassion and respect — or else people will understandably do everything they can to avoid it, possibly worsening the very problem quarantine was designed to solve.


A chapter on Kaci Hickox — the volunteer nurse who was forcibly kept in an isolation tent in 2014 after arriving in New Jersey from Sierra Leone, where she had treated Ebola patients — is unexpectedly poignant; at the time, most Americans didn’t seem to understand why Hickox, who had exhibited no symptoms and tested negative for Ebola upon her arrival, resisted quarantine. “Better safe than sorry,” seemed to be the prevailing argument for why Hickox should abide by New Jersey governor Chris Christie’s orders to isolate herself, even though medical experts repeatedly insisted those orders were scientifically unsound.


What becomes clear in “Until Proven Safe” is that it’s a lot easier to tell someone else to just shut up and submit to quarantine than to do it yourself. Any exercise of such formidable power also opens up the possibility of abuse. The book includes historical examples of disease control measures getting mapped onto existing prejudices. In 1900, a cordon sanitaire in San Francisco’s Chinatown zigzagged around white-owned businesses; during World War I, under the auspices of protecting men who might be called to fight overseas, local American officials were empowered to quarantine young women “reasonably suspected” of having a sexually transmitted disease.


More recently, in 1991, an “HIV prison camp” to detain asylum-seekers was set up by the Attorney General William Barr — the same William Barr, the authors helpfully remind us, who “refused to quarantine himself following a potential exposure to the coronavirus in October 2020.”


Manaugh and Twilley began their research into the subject years ago, and they acknowledge a certain irony to finishing a book about quarantine while living under lockdown for COVID-19. Quarantine infrastructures tend to be tailored to the previous epidemic, instead of anticipating whatever is to come. A shiny new federal quarantine facility in Omaha — the first constructed in the United States in more than a century — was finished in January 2020, just in time to receive 15 American passengers from the coronavirus-infested Diamond Princess cruise ship. This National Quarantine Unit has a grand total of 20 beds. It offers a “boutique experience” ideally suited to managing one or two patients at a time after they have had potential exposure to, say, Ebola. The facility can’t do much to help contain a raging pandemic. As Manaugh and Twilley point out, the first American evacuation flight out of Wuhan alone carried 195 passengers.


“Until Proven Safe” includes chapters on pests and agricultural blight, including forecasts of an impending “chocpocalypse.” (The cacao plant is especially disease-prone.) Another chapter, on space travel, recalls that astronauts were quarantined in retrofitted Airstreams after lunar missions for fear of contaminating Earth with extraterrestrial life and sparking a “celestial pandemic.”


But it’s when Manaugh and Twilley describe their visit to a nuclear waste facility that quarantine takes on dimensions that feel simultaneously urgent and fantastical. How do you sequester radioactive material that can stay deadly for thousands of years? And if you manage to figure that out, how do you get curious people not to open it millenniums from now? If you think that establishing trust is hard in the moment, imagine what it would take to build trust with future generations.


“A message has to survive, be found and be understood,” one geophysicist tells the authors. “It also has to be believed — that’s the hardest part.”