Quarantine

fears and paranoia regarding that particular virus. So in this episode, we're going to talk about another closely related topic here, and that is quarantine, because that inevitably that's that's a lot of what we're talking about when we're talking about it, bou, because quarantine is necessary to protect those that are treating

the illness. Yeah, and also is one of those things that kind of plays into the whole Hollywood sensationalized idea of what a quarantine is, whether or not you're drawing that from your from each you know, when when the government comes into like quarantine the house and because it's scary, right, people in suits and they've wrapped the house and in

the in this giant plastic bubble. Yeah, or if you're even thinking about the movie Outbreak again, it's the it's the men in suits, you know, it's sort of like the storm They look like Stormtroopers, except for definitely not as you know, hard schoold. Yeah. I mean, on one hand, it's it's very much the idea that you have you have become something alien because you were infected or may have been infected, And I look like something alien now because I'm in this dehumanizing suit. Like it's a very

dehumanizing level to it. And then on another level, and we were talking about this an email just the other day, there's a dramatic sense to this too. There's the old saying you don't bring a cannon on the stage unless you're gonna fire it. And I feel, essentially the cases you do not introduce quarantine into a TV show, movie, novel, book, comic book, et cetera, unless somebody is going to break quarantine.

So it gives us this kind of skewed fictional idea about what quarantine is, how quarantine works, to what degree quarantine is effective or or is ineffective. I mean, we just have a very unreal vision of what it is. Yeah, And I was also thinking about Dr Alan Jamison. He is a retired doctor who was working with Medical Teams International to treat ebola patients, and he recently returned home to Tennessee in the United States, and he quarantined himself.

I think he did this not because he had any symptoms of ebola, but I think he understood that this topic right now is so supercharged and so emotionally just laden with fire works, with people getting angry. That he was like, whoa, whoa, guys, before you start, you know, congregating around my house, which works and fire I'm just gonna I'm gonna lay low twenty one days, just to make sure, so don't anybody get crazy. So I thought that was a smart move on his part, because he

is isolating himself. His family's dropping off food on his porch. It's a great excuse to to get out of social commitments, you know. And so I'd love to go to that baby shower, but I just got back. I really am. I'm not sick, there's nothing wrong with me, but just to be on the safe side, I can't go. I'm going to quarantine myself. Yeah, yeah, I'm gonna The next time I get an evite for a baby shower. I'm

gonna put that in my no reply. Sorry. In quarantine self quarantine, sorry, So why would you quarantine someone or why would a community quarantine itself? Um, Viral strains like tuberculosis might be a reason. Bioterrorism has been thrown around as well, the idea that you might use one of these viral strains in warfare and try to contain it. Yeah, I mean, and in this at this level of the scenario, it plays that exactly like it does in the movies.

There's something there's something either unknown that is potentially communicable or or it is very much danger. It can something that can spread and potentially become a major outbreak. So you want to contain it. You want to keep it from jumping to new individuals. And when we talk about outbreak, epidemic, pandemic, let's give a little bit more definition to that. Um.

This is actually from web MD. Uh. They say that with an outbreak, we're talking about a disease outbreak that happens when a disease occurs in greater numbers than expected in a community or region during a season. So the flu would be a good example of this. Yeah, and then an epidemic. And epidemic is when an infectious disease spreads rapidly too many more people. And this may be just within the same region, it may involve several countries that it's it can it can, it can vary in

size and still be an epidemic. And then finally you have the idea of the pandemic. And in a pandemic, you're dealing with a global situation. And in examples of this would be AIDS, HIV and various strains of influenza. Yeah, and just to go by to epidemic Stars is a

good example that. Yeah. So I like to think of these also in terms of of Beatlemania, right, I mean, you have a very regional outbreak of enthusiasm over a particular musical act, and then it it grows and it becomes popular in other areas and it eventually reaches a point at which it's a global phenomenon. Okay, And it's the same thing with any kind and essentially it's just a this in this case is a viral idea of viral taste. Music as virus um celebrity as virus that spreads.

But but of course it's based on. That idea is based on a very real model of how infectious agents spread through a species, right Beatles music spreading throughout a community. The world great, but not so much with with the virus UM. Now we could go like, I don't know for days about the history of quarantines, because it's a really rich history. Imagine every single country has has um, you know, some sort of protocol in place or history

with quarantine. So we won't go way deep in there, but just to give everybody an idea of the practice of quarantining in earnest This began in the fourteenth century and according to the Centers for Disease Control, what was happening is that there was this effort to protect coastal cities from plague epidemics. So ships arriving in Venice, which would have been the seat of power at that time, from infected ports, were required to sit at anchor for

forty days before landing. This practice, called quarantine, was derived from the Italian words quaranta. Quaranta means forty and journey means days. So that's how we got the term in the first place. During that same time, UM, since you know, the plague was a fact of life for hundreds of years in Europe and UM, in Asia and the Middle East, finding sick people and quarantine quarantine them was actually a job. Yeah, and uh, what happened is that not many people really

wanted to volunteer for it. So what you would have is usually older women without any other means of income, who would search dead bodies or really sick people and um, they would look for these plague victims and then they would announce to local officials where they had found them in the families, and they get a few pence for each body, or for turning in a family that was

harboring one of the bodies. Yeah, it's and this is interesting to note because it's easy to forget, especially looking at the Western and the United States model of quarantine. The quarantine is largely self reporting. It's more of an honor system. I just came from somewhere. I think I might be sick. Yes, quarantine me because I want treatment if there's something wrong with me, and maybe a distant second,

I don't want to get anyone else sick either. But essentially there's gonna there's gonna be some self interest there. You go back to this older model and there is more of a sense of please don't board me up in my house. Uh, let me be sick on my

own land or die in peace. And and one of the problems is that you you see, uh, there's a lot of space between those two attitudes, and you find various points on that on that line elsewhere in the world right now, as we discussed in our Bola episode, one of the problems that you have, you have locals who are going to be distrustive of outsiders who are

coming in and saying, hey, let me treat you. Let why don't you come into our tent and let us treat you for your problems, and then telling you how to care for your dad, etcetera. Yeah, And then I think this example is like a really good sort of like how people might get paranoid because again they're trying to hold onto their family. And so you've got this person, this this older lady going around. She's the plague hunter,

and you don't want her stopping by her home. But at the same time, this was a way to try to prevent further transmission. So you see our our modern quarantine practices, especially here in the state's kind of evolved over time. And in between state and local authorities UM made. They made the sporadic attempts to impose quarantine requirements over time, generally in response to what's going on in the world

and what's coming in and crossing the border. UM. Continued outbreaks of yellow fever finally prompted Congress to pass federal quarantine legislation in eighteen seventy eight. UM outbreaks of cholera from passengerships arriving from Europe forced US some reinterpretations of this law in e and this provided the federal government with more authority in imposing those quarantine requirements, so much so that during World War One, thirty thousand prostitutes were

rounded up. UM. Not because they were, you know, dealing in prostitution. UM, it was because they were known to be hookers. In the United States wanted their soldiers to be venearial disease free. Oh good luck with that, Yeah, all right, exactly. Uh So that again wasn't an attempt to try to uh, you know, quash any sort of

transmission here. Then, moving a little a little further on the timeline, Public Health Service Act of nineteen four established the federal government's quarantine authority for the first time, and this act gave US Public Health Service responsibility for preventing the introduction, transmission, and spread of communal diseases from foreign countries into the United States. Now this is now originally part of the Treasury Department Quarantine and Public Health Service

or phs UM. The parent organization became part of the Federal Security Agency in nineteen thirty nine, and in nineteen PHS and Quarantine joined the Department of Health, Education, and Welfare UH and the quarantine was then transferred to the agency that we now know as the Centers for Disease Control and Prevention in sixty seven, and the VDC remained a part of the Department of Health, Education, and Welfare until nineteen eighty, when the department was reorganized into the

Department of Health and Human Services. And so today the Division of Global Migration and Wuarantine is part of CDC's National Center for Emerging and Zoonotic Infectious Diseases and it's headquartered right here in Atlanta. That's right. And just uh, you know, a reminder of zoonotic um is just referring to diseases that are transferred between animals and humans, Alright,

So when can the government quarantine its own citizens. Well, here in the US, under forty two Code of Federal Regulations, Parts seventy and seventy one, the CDC is authorized to detain, medically examined and released persons arriving into the US and traveling between states who are suspected of carrying a communicable disease. And there's there's quite a list of these. Yeah. The list includes diphtheria, infectious tuberculosis, yellow fever, hemorrhagic fevers, stars,

and any kind of new strain of influenza with pandemic potential. Yeah. And the last large scale isolation and quarantine was last enforced during the influenza pandemic in ninety eighteen, nineteen nineteen.

That's also known as the Spanish Blue Yeah, and that really underscores again what we said about quarantining becoming more of an honor system situation here in the United States, because beyond that that situation, the only other account that we have is that the CDC issued an order in in nineteen sixty three to quarantine a single woman for smallpox exposure. So yeah, it's largely an artos system at

this point. That the CDC is not running around pulling et shenanigans on anyone and wrapping houses and holding people against their will. No, And I think the last sort of kerfuffle about this happened in two thousand and seven when Andrew Speaker, Atlanta native, was placed under federal quarantine because officials learned that with tuberculosis. He had boarded two trans atlantic flights because he was he had a destination wedding and he knew he had tuberculosis. But well, you know,

when you got a wedding, I forgot about this case. Yeah. Yeah, people were pretty upset about it. Um, so you know, and he apologized and he said he didn't realize what a bad idea that was. Well, you can get a card for that now the Hallmark, I'm sorry, I potentially exposed. Yeah, they're they're so funny too. I love those illustrations. Um. But yeah, you know, officials found out they detained him

in Montreal. Um, Now, if you were to break a quarantine, if you were put under if he had from the get go, then put under quarantine and he broke it, that would be a criminal misdemeanor. And in two thousand and nine, a twenty seven year old man in Arizona diagnosed with the same thing touberculosis, was then quarantine and prison hospital ward for ten months because he knew he had it, he failed to take his medicine, and he endangered others by going out and entertaining friends without wearing

a mask. So again, as you say, this is not like people are going to enter your house and a has matt suit. Largely it's self reporting. Now, these laws can vary from states to state, and they can be really specific or abroad. Um. In some states, local health authorities implements state law, and tribes also have police power authority to take actions that would promote the health and well being of fair community. So, yes, there's a federal level to it, but there is very much a state

level to it. Again giving you this idea that probably the has matt suit people are not going to show up just because the government is going to lock everybody down. So what happens when medical professionals suit up, Well, we've had some insight into that lately with the Ebola outbreak and um, if you look at Dr William Fisher's interview with Time magazine, he shows what it's like suiting up

in the field. He has helped and guinea, And what he's saying is that, again you want to minimize your exposure to blood, to vomit, to diarrhea, to any other fluids. So they are all required to wear personal protection equipment, which starts with a base layer of scrubs that you then put a big thick layer of boots on, and we're talking like the wash kind of boots that go

up to your knees. Then they put on an impermeable tai BAC suit that is incredibly hot, right, because again this is trying to minimize that the any sort of air flow that might come in trapping your own stinky fetid smell, right, And then you have two pairs of gloves. Then you place the impermeable hood over your head, neck and shoulders, a respirator covering your nose and mouth, and finally goggles. Everything is sealed. There is no speck of

skin that is visible. So it's basically a full body prophylactic. Yeah, and I've seen it flippantly referred to as a as a space suit as well, which isn't really like that bar off the mark. You're essentially throwing up as many barriers as possible between you and the pathogen. Yeah. Also I read I don't know if this was from the Ion nine article about all the the odd quarantine things,

but read somewhere. No, it was actually in the Time magazine that uh, the astronauts from the moon landing the person that they when they came back, they were quarantined. And I guess that's sort of like, well, you never know. Well, yeah, I mean at the time, what else are you gonna do? Uh. One of the important things and will continue to bear this out to give in mind, is that the quarantine and uh and and has mat and just the effective

handling of these situations. It's not it's not just about oh, here's the suit. It's not just about here is the room and here's what's in the room. It's about, Okay, who's who's cleaning the suits, how are the suits handled after they're used, how are they provided, who's uh, who's who's managing the people that are cleaning it, what's you know, the various training regimes that are involved in and how the the the equipment is handled, and just the overall

sanitation and management of the whole process. And so there are a lot of moving parts there that have to be they have to be in working order for a proper quarantine situation to take place. Yeah, and we'll look at that a little bit closer here when we talk about transporting someone who has a deadly virus. But I wanted to mention that at airports, and particularly right now,

this is very active. CDC operates quarantine stations across the US and the airports and um officers are trained to spot symptoms of a virus, in this case, ebola, and anyone who departs from a flight from an affected country and appears to have symptoms would be tested and if they test positive, they would be rushed to a hospital in quarantine. So there are officials who are trained in

this and they're on the lookout for it. There are twenty US quarantine stations located at ports of entry and land border crossings where international travelers arrive, and they are staffed with quarantine, medical and public health officers from the CDC.

And indeed, most notably to the news right now, we do have one in Atlanta, which we acquired when we had the Olympics here and probably a lot of you have seen the imagery and the news of the jet that the retrofitted jet that was used to transport to US citizens who were were over in West Africa and

who contracted ebola. And this thing is amazing to me, Yeah, because you have it's almost like a container within a container within the airplane, and it's I feel like people were drawn to it as much because it's almost a comforting image because you see in this plane a lot of money thrown at a single individual to to keep to you know, in the name of treating their illness, but also in the name of preventing their illness from

reaching anyone else. But it also ends up sort of playing into that pari paranoia because it's because you look at you look at the tremendous precautions that were taken to protect us from what's going on here. So can at times be you can almost oversell it a little bit um in terms of just a public perception of what's going on. It's like an eighteen million dollar ziplock job. Really if you look at it, the plane is large enough to accommodate a medical crew and it's outfitted with

a modular aero medical biological containment system. So we're talking about this tent like plastic structure. Now, when we talk about the patients, um, you know, he or heart. There they are on the gurney and then they are tented

and plastic and then they're put in another tent. And should there be any sort of um instance in which there's a hole in that plastic or anything that would cause a puncture in it, then what would happen is that the air would actually rush in from the inside as opposed the as opposed to the air from the inside of of that tent going out. And the reason for this is that they actually have negative pressure within

the tent, so that that happens. Yeah, you just want to limit the airflows as much as possible, I mean, basically cut it off when it comes to breathing the sick individuals air. Because and remember that the next time you were on on a flight somewhere, you're essentially cramming into this small, confined space with everyone, and you have

this agreement. Hey, everyone, we're going to all watch you know, the movie Quarantine on our individual screens, but we were going to breathe each other's air for the entire duration of this flight. Yeah, in this case, just imagine every single person individually tempted so that no pathogens could could cross into the cabin area. All right, So how effective is quarantining Well, in a large part it comes back to what I said earlier about there being a lot

of moving parts. I mean, the quarantine is more than just the suit or the room. It's to what degree can you actually instigate a quarantine? Do you have the for instance, if you're going to use a quarantine um in another country, do you have the means to carry it out, you have the personnel to carry it out? And then do you have the trust of the individuals involved in it? Because if we've we've discussed quarantine is large to become an honor system situation here in the

United States. But in cases where where an individual is not trusting of the quarantine situation, if they can break quarantine, well, than that throws a monkey wrench into the whole thing. Yeah, here's a couple of examples. One is from Dr Howard Markle, who is the director of the University of Michigan Medical

Schools Center for the History of Medicine. He looked to the past to see how effective quarantining was, and specifically he looked at the Spanish flu pandemic in the US and nineteen eighteen, and you look at a bunch of cities, and he found that cities that early on adopted what he calls old fashioned non pharmaceutical interventions like school closures, social distancing in the community, and workplace in quarantine and layered multiple interventions at once for a long period of time,

fared so much better than other cities who did not um embrace any of these sort of closures. Uh. And when they finally did, they did it slower rates and so they had higher infections. So it's not just about quarantining is but these other layers of distancing the person from the pathogen. Indeed, quarantine is just one tool in

the overall toolbox of managing infectious diseases. Now, if you look at Syria Leone, which now has more cases of the Abola virus in any other country in the regions um, the quarantine isn't strictly enforced, and neighbors still continue to stop buy grooving families who have been affected by a Bola And we talked more about this in the in the podcast episode an Evil specifically, but as our listener Jessica pointed out in the listener email that we read

the community bond is very important in Sierra Leon in a place like that, and so it's very hard to stop people from um getting together and grieving for one another, or you know, even shutting down that part of their lives that is so integral to day to day survival.

And then you should think about how these developing nations they lacked the public health resources needed to really enforce this in the first place, in the distrust of government and medical professionals and so on and so forth, and you can kind of see how this isn't really coming together as it could. So we have an example of how quarantine is done in the US. We have we've talked about the ways that we have an attempted quarantine in the past throughout history. But do we have another

international example of quarantining in action. Yeah, and this is extreme. This comes um Um from China, and this was just in July of this year two thousand and fourteen, in which authorities lifted a nine day quarantine of one and fifty one individuals from the city of human which was instituted after a thirty eight year old man died of the bubonic plague infection. So here's the other thing about it that's not so crazy. It's that entry and exit

points were also sealed off, trapping nearly thirty thousand residents. Now, no other cases had developed. But we have to contrast this to something that happened in the United States during the same timeframe. Health officials quickly treated and released four Colorado patients who had been hospitalized and diagnosed with the more lethal and more contagious pneumonic plague. And that's the respiratory form of the disease. And you can see how

that would be more contagious because it's airborne. And still no other cases have been reported here in the the US of the pneumonic plague. So when you look at that, when you come to say, well, what in the world is going on? Is that an overreaction from China? Is that an under reaction from the United States? And some health professionals would tell you, look, we have more information now, we have better testing, We know how diseases act, so we are able to treat those people and send them

on their way. There wasn't a need to like shut down, you know, a large swath of the United States and not let anybody leave it. Right. So, so the argument would be that the Chinese approach was maybe a little archaic because it didn't match up with our our current understanding of how these illnesses work and how we can treat them. It could be archaic, but it could also be on the part of Chinese officials of hey, we have a one of the largest populations in the world,

and therefore we need to be stricter. Okay. In the argument could be made that the Chinese simply responded with the model of of of treatment that worked best for that particular situation. Indeed, indeed, and it's kind of you know, I would say that snor probably is scary for nine days, that there's entry points and exit points that you cannot access, and you could sort of wonder what's going on if

you're in that community. Um that being said, you know, both both worked, so you can't can't blame you decide, all right, So there you go, quarantine in a nutshell, what it is, how it works, where it came from, to what degree it's effective or ineffective. Again, be sure to listen to that Hibola episode that aired just before this one if you haven't had a chance to yet, because that directly ties into everything we're talking about here, and you know, we're looking to possibly do some more

content on infectious diseases in the future. For for my part, I always find them interesting. And so if there are particular diseases, uh, viruses, pathogens, what have you that you think are highly interesting that you would like us to cover, let us know and uh and will come see are looking into them as always. You can find us at stuff to Blow your Mind dot com. You have a question about what we do. You want to see the

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follow us, comment on our videos. We try to engage the viewers there as much as humanly possible and uh yeah, check that out. Yeah, And if you have some thoughts percolating on quarantine, if you've ever pen and fall in one let us know. Um. Also make sure you check out I O nine's article ten of the Craziest things that you Never knew about quarantines and check out the one on typhoid mary Is. It's pretty interesting. Um. All right, send your swirling thoughts to us at below the mind

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