Ebola quarantines are antiquated

OPI_Quarantine_CDC Global via Flickr commons_webI hold deep reverence for certain ancient medical practices. Traditional Chinese medicine cured me in just days of Pityriasis rosea, a rash that Western doctors told me I would have for months. And though I haven’t yet had cause to try it, I have gruesome faith, as did Napoleon’s surgeon Baron Dominique Larrey, in the ability of maggots to aid in wound healing. But this faith is not ubiquitous. I delight in the fact that I will not be subject to bloodletting to balance my humors, nor undergo trepanation for the treatment of migraines. These practices were abandoned because as science progressed, it was recognized that these “cures” did more harm than good. So why has one such historical practice, unfounded by science, returned to prominence in recent years?

Quarantine refers to the isolation of asymptomatic individuals who are suspected of incubating infection. The roots of quarantine trace back to efforts to control the Black Death in 14th-century Venice. Isolation was initially imposed for a period of 30 days, known as the trentino, but was later modified to 40 days—the quarantino. Quarantines of our time are based on the incubation period of the pathogen in question rather than the traditional and arbitrary 40 days.

The long history of quarantine belies both the extent and the efficiency of the practice. There has not been a continuous record of its use since it failed to contain the Black Death, which wiped out between 30–60 per cent of Europe in the mid-1300s. In an article written for the Canadian Medical Association Journal, Dr. Richard Schabas recalls a time when quarantine had fallen into disrepute based on the perception that it was ineffective in controlling and containing disease.

In the U.S., blanket quarantines like those currently in place in four states to control the spread of Ebola have not been used since the influenza pandemic of 1918. In that country too, quarantines fell out of favour by the mid-20th century due to their limited effectiveness and the increased availability of genuine treatments such as antibiotics.

The success of quarantine in containing any disease relies upon three essential conditions: the disease must be transmissible in its incubation period (prior to the symptomatic stage), or very early in the symptomatic stage; it must be possible to identify all individuals incubating infection; and infected individuals must all comply with the conditions of the quarantine.

None of these conditions are met in the case of Ebola. The disease is transmissible only when individuals are very ill or dead (the disease is spread through direct contact with body fluids of a late-stage Ebola patient). It is impossible to identify every individual who may be harbouring the disease, and, as we have witnessed through the quarantine-flouting actions of American nurse Kaci Hickox, not all individuals will comply with the preposterous restrictions.

There is virtually no threat of Ebola becoming a major health risk in Canada. In a recent interview with CBC’s Evan Solomon, Schabas insists that the fear of Ebola has been exaggerated—and elsewhere argues that quarantine is an archaic practice that is rooted in ignorance and panic.

Yet Canada has taken the drastic measure to close its borders to people from West African countries experiencing persistent and widespread outbreaks. Canada is joined by only Australia in responding to the disease with such draconian measures. This is not just useless—it is also dangerous. Mandatory quarantine for health care workers returning from West Africa can discourage volunteers from offering their much-needed services. Within those countries suffering under the outbreak, quarantines have proven to diminish trust in authority.

Our excess was prominent on the global stage just little more than a decade ago, when the contemporary scourge of quarantine was ushered in. Confining 30 000 people to their homes or in hospitals, Canada’s response to the SARS outbreak was the most disproportionate to risk, with almost 100 individuals quarantined for every confirmed case. In this case, too, quarantine proved useless as compliance was poor, and because SARS is not highly infectious during its incubation stage. Perhaps it’s time to recognize that quarantine should not have been revived from history’s dustbin.

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