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All of Italy is on lockdown. Experts expect to see more quarantines across the globe. We’ll talk with experts on quarantines and public health emergencies.
Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University Medical Center. She's researched quarantines for the past 10 years, and teaches courses on global health diplomacy, global health security and emerging infectious diseases in the School of Foreign Service. (@RebeccaKatz5)
Howard Markel, professor and director of the Center for the History of Medicine at the University of Michigan. Author of "When Germs Travel: Six Major Epidemics That Have Invaded America Since 1900 and the Fears They Have Unleashed." (@HowardMarkel)
On the social impact of mass quarantines
Rebecca Katz: “We are in the middle of March right now. We're about 10 weeks into this outbreak. And there's a lot of evidence that we are collecting, and there's a lot of analysis that's going to be done simultaneously and also for years to come. But I think that it's important to think about how we define success of a quarantine. Quarantine, by definition, is curtailing individual rights. You are impacting population movement. And not all societies are OK with that.
"And I think what the Chinese were able to do — first of all, it's important to remember that it is completely unprecedented. We have never seen anything at that scale. That being said, when we think about quarantine and what is effective, it’s not just spread of the disease, but also the health and well-being of the population that is having their movement curtailed.
"And the mental health of the populations having their movement curtailed. And are we providing for food, and water, and communication and any other medical needs that they may have? And so ... I think we have to be really careful when we talk about these types of measures. That we’re not just focused on the spread of disease, but also on the population that’s impacted.”
On why we haven’t seen large-scale quarantines in generations
Rebecca Katz: “Bill Gates has said this. This is our hundred-year threat. We are facing a respiratory virus that is easily transmissible, that has a case fatality rate, that even though we're still trying to better understand it, still seems to be about 10 times more deadly than seasonal influenza. So this is a true public health threat.
"And it is a threat to which we don't currently have any medical countermeasures, which means that we have to be thinking about what's in the tool box for non-pharmaceutical interventions. And social distancing is one of the tools in the tool box. In fact, it’s one of the few tools in the tool box. And in fact, it's been a tool since biblical times. So we are in uncharted waters here.
"And I think what people should remember is that our public health communities haven't had to make these types of decisions at this type of scale in, again, approximately 100 years. I mean, we've had other threats, there are other threats that thankfully haven't been as challenging as this — or have had other parameters that we were able to manage. But this is bringing us into a new world. And it means that there's not a massive evidence base that we can be drawing on for all these decisions.
"So it means that decision-makers are going to be operating with a bit of uncertainty. And making the best judgments they can based off of the information that we have about the virus, about the evidence base, about our populations. But like I said, we're going to be studying this for a long time to come.”
On lessons to be learned from the 1918 global flu pandemic
Howard Markel: “A very effective lesson. In that we were asked in Michigan by the CDC to collaborate, oh, gosh, more than 13 years ago at looking at major American cities and how they responded to the threat of flu in 1918. You know, the menu of what are called non-pharmaceutical interventions was quite limited. You had quarantine and isolation.
"And by the way, the word quarantine now is being used so vastly differently by so many people that the originators in Venice in 1350 wouldn’t know what we were talking about. You had quarantine and isolation. You had public gathering bans, whether they were theatrical events, or bars, or dances, or vaudeville shows, or sporting events. And school closures.
"And we took 43 cities, because we had excellent data from the Census Department about week by week, the number of cases of influenza, and pneumonia and the number of deaths. And we could compare those in a statistical manner. And we found that cities had acted early because these containment measures or these mitigation strategies only work if you manage them, or you drop them or you trigger them before the virus has a chance to spread and circulate throughout the community.”
On mitigation strategies and whether they work today
Howard Markel: “We're always well behind the eightball when we're on the heels of a microbe. And, you know, if they're concealed were actually giving it a head start. But history is littered with public health officials who either acted too early and then everybody gets angry about that, because these are incredibly disruptive to human society, and economics and so on. Or they acted too late and then people get sick and or die. So hitting that sweet spot, you really have to be the Babe Ruth of public health to knock that one out of the park. It's very difficult. And, you know, some of us would argue it's better to act early than later if it's really a deadly virus. But we don't have all that information yet. ... I mean, I have the easiest job in the world as a historian of quarantine. Because I evaluate this stuff 100 years after the fact.”
From The Reading List
The New York Times: "Coronavirus School Closings: Don’t Wait Until It’s Too Late" — "My research on the long history of epidemics has taught me that when it comes to outbreaks of contagious respiratory infections, closing schools can help prevent many thousands of illnesses and deaths.
"Schools are community gathering places where large numbers of people are in proximity to one another and respiratory infections can easily spread among young people and adults alike. Shutting them down can be a key part of slowing the spread of easily transmissible viruses so that hospitals are not overrun with sick people, and it can help to buy time to allow for the development of antiviral medications, medical treatments or a vaccine.
"But policymakers working to stop the spread of the coronavirus that causes Covid-19 should remember a key part of this historically informed equation: We can’t wait until it’s too late."
The Atlantic: "Italy’s Coronavirus Response Is a Warning From the Future" — "Italians woke up on Sunday morning, and it was already the future. Overnight, the government announced the most dramatic measures yet taken by a democracy to try to prevent the spread of the coronavirus. Other Western countries are watching closely, worried they may soon have to follow Italy’s lead.
"Rome placed severe travel restrictions on the entire Lombardy region surrounding Milan—the country’s economic, fashion, and media capital—and on 14 other provinces across the wealthy north, including Venice and parts of the Emilia Romagna region.
"In this area of 16 million people, the coronavirus’s European epicenter, where the number of cases has been rising rapidly, Italy banned all public gatherings—no weddings, funerals, concerts, sporting events, discos, bingo games, video arcades, or Mass—until April 3. While trains and planes are still operational, and running on time, the government is forbidding people from leaving unless absolutely necessary."
The Wall Street Journal: "Italy Bolsters Quarantine Checks After Initial Lockdown Confusion" — "Italy began more forcefully implementing a lockdown of almost 17 million people living across its north, including the cities of Milan and Venice, as the country tries to arrest the spread of the coronavirus.
"Police on Monday stopped people at northern train stations and airports, asking them to produce a written form explaining why their trip was necessary. Police were also doing spot checks in Milan.
"Violent revolts erupted in many prisons around Italy on Sunday and Monday, after the government curbed visits by relatives in an effort to staunch the spread of the epidemic. The increased enforcement of the region-wide quarantine that was instituted Sunday comes as total infections in Italy reached 7,375, nearing the number of cases in South Korea, which is behind only China in its infection tally."
The Weather Channel: "I Have Coronavirus: Quarantined Patient Details Life Aboard Diamond Princess and in Isolation Units" — "For 15 days, the cruise aboard the Diamond Princess was everything Carl Goldman and his wife, Jeri Seratti-Goldman, had hoped it would be.
"Then the couple from California were told a passenger from a previous cruise had tested positive for a new virus that was infecting thousands of people in China. The captain doubled the ship's speed and returned to port in Yokohama, Japan, on Feb. 3, a day earlier than planned.
"There, Carl and Jeri — and the 3,700 other people aboard the Diamond Princess — learned they would be quarantined for 14 days."
The New York Times: "How to Self-Quarantine" — "Stay home unless you must see a doctor. No work, school or shopping. If you must come out of your room, wear a mask. And don’t share towels.
"If you are among the thousands of Americans now self-quarantined because of possible infection with the coronavirus, these are a few of the new house rules, courtesy of your local health officials and the Centers for Disease Control and Prevention.
"Self-quarantine and self-isolation are different. The first measure is for the large numbers of healthy people who may fall sick following possible exposure. The second is for people who are ill with the coronavirus — they are a danger to their family and visitors, and must be watched carefully in case they deteriorate."
This program aired on March 10, 2020.
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