History of quarantine in the United States

History Of Quarantine in the United States

In 1966, during the summer season the U.S.A. congress closed the debate and passed an approval of construction of a laboratory that would be used to confine the astronauts and their baggage that they shall have brought back from the moon. The congress approved the NASA's budget in 1966 and the laboratory was completed in 1967 September. This was a major step forward in the history of USA quarantine system. The center was named Lunar Receiving Laboratory (LRL) located at Lyndon B. Johnson Space Center; this project came up as a result of fear of back-contamination from the astronauts and the material they carried from the moon.

The process was quite simple, after they were recovered from the sea upon landing; the crews from the Apollo 11, 12 & 13 were taken direct from the helicopter to a waiting isolation vehicle at the aircraft carrier deck and flown straight to LRL for isolation.

This isolation of the astronauts was seen to be a preventive measure to any eventual danger or incidental contamination. It was not carried out upon confirmation of any assured back-contamination from the moon. As a matter of fact, in all the three Apollo cases of quarantine, no serious threats were detected and therefore the astronauts were released to continue with their daily lives. The moral behind the quarantine was and still is more important than the findings there after.

Definition

Therefore, quarantine is a voluntary or compelled isolation ordinarily to try control the spread of an infection or disease deemed lethal to the population. The disease may be considered contagious enough to the population and hence the need for isolation. The isolation periods range fro very short like in cases of anthrax attack where the victim can leave as soon as they get their contaminated clothes off and take a decontamination shower. Some may last longer than that as the laboratory results are awaited.

Quarantine has gone through such massive advancements until now there are quarantine ambulances, mobile dispensaries and hospitals and lockdowns.

Origin of the practice

The word quarantine originates from Italian word quarantena or quaranta dei or quaranta giorni which literally mean forty day period. This forty day period was historically observed when ships arrive on the dock of another country and there was suspicion that they came from an area with active plaque situation. These days were enough for the authority to confirm that none of those on the ships was infected by the plaque. Though even this method was not water tight since fleas, rat's cockroaches could still carry the plague into the new country where the quarantine was imposed, regardless of these the practice of quarantine continued.

The mass holding of people off the shore for forty days continued for quite a long time until the mid 20th Century when the antibiotics were discovered and instead of holding people off the dock, there were vaccinations offered to the visitors. This made mass quarantine a thing of the past.

Quarantine, as a matter of fact has been with the human race as early as during the Biblical times. In the Old Testament we find evidence of lepers being isolated from the rest in the society. The laws of the unclean in the society during the biblical times ware to protect the clean people from the lepers. The lepers were to be put together outside the camp and their clothes that remained torn and burnt.

This was the cruelest form of quarantine since lepers were considered cursed by God and unclean. This practice carried on to the New Testament period and there after.

History of quarantine in USA

Ideally, the quarantine law in America began during the colonial times in 1663 when there was smallpox outbreak, when New York established a law entrenching isolation of the smallpox infected persons.

By 1700s all the major cities and towns along the eastern coast of the U.S.A. had passed quarantine laws though the laws were only enforced when, the epidemic turned out to be very lethal to the population. For instance, in 1701 a Massachusetts law stipulates that all those infected by a plague, smallpox and any other type of contagious or transmittable diseases must then be isolated in spare separate rooms.

In 1738 New York faced its first biggest test in terms of quarantine application when it was hit by a threatening smallpox and yellow fever infection. The city council then decided to build a quarantine station on Bedloe's Island. This became the holding station for arriving ship crews suspected to be contagious. Philadelphia was not spared either in 1793 when it was hit by a yellow fever attack of the same magnitude, if not higher, as the New York one and consequently in 1799 they built an expansive station for isolation of the contagious patients. This was called Philadelphia Lazaretto quarantine hospital right in Tinicum Township, of Delaware County, Pennsylvania. By this time Philadelphia was still the capital city of the U.S.A.

The hospital occupied ten acres strip of land along Delaware River and the structure still stands to date. This was also the year that saw the colonial legislature pass the first United States quarantine enactments in February 23, 1799 and the federal officers were consequently required to help enforce the enactment. This marked one of the early, significant developments in the quarantine systems in the U.S.A.

Following an outbreak of varied epidemics in Caribbean, Mediterranean and several other tropical regions in 1808, the Boston Board of health ordered that from May to October of each year any vessels from the aforementioned regions shall be held up off the bay till they complete 25 days period since they left their respective ports. This was followed by the quarantine enforced by New York in 1832 after cholera killed close to 30,000 people in Britain. Ships were held at 300 yards radius off the dock if the captain knew there were cases of cholera aboard. Unfortunately, the infection slipped through the barrier and killed close to 3,500 resident of the City before it subsided in September.

Following heavy outbreaks of cholera and other infections in Europe, Egypt, Turkey etc., the New York City introduces a new Quarantine Act in 1863 that entrenches a quarantine office under a health officer with the legal mandate to quarantine any ship coming into the New York City for as long as the officer finds necessary and can as well order cargo removal and fumigation of ships. This was soon brought to test in 1866 when cholera riddled steamer "Virginia" docked in New York from Liverpool with 35 passengers and 2 crew members already dead. The New York health officer ordered for a quick quarantine and medical attention. This saved the day by only six hundred or thereabouts dying as compared to thousands that died in the previous epidemic.

Barely ten years down the line there arose the need to address the quarantine issue at a national level and the first national quarantine act came into effect in April 29, 1878 which mandated the federal officers to execute the State and the municipal quarantine rule and the following year, the U.S.A. Congress instituted the National Board of Health amidst fears of yellow fever attack. The board was to supplement the state efforts in enacting quarantine regulations though it was short lived since it was dissolved in 1883 after failing to carry out its mandate and running short of funding.

The 1890s ushered in the epoch of bacteriology. This was after an extensive scientific research following the numerous epidemic cases in the U.S. It was already determined, through scientific research, the life cycles of the various germs and hence the health officers could determine the length of the quarantine based on this information. In deed in 1892, President Benjamin Harrison, through his surgeon general announced that no foreign ships will be allowed to dock in the U.S. until and unless the ship has undergone a twenty days or more quarantine hold up and passed by the state authorities.

The subsequent year, the U.S. Congress passed the National Quarantine Act which created a national quarantine structure yet still allowing for the state managed quarantine. The act also stipulated the process and procedures of inspecting the foreign ships, immigrants, cargoes etc. As the marine Hospital Service do now at the federal level.

With turn of the century, there came more concrete actions and development concerning quarantine the U.S.A. In 1902 the Pan American Bureau was formed and was among the first organization formed in the 20th Century. The purpose of the bureau was to heighten the quarantine issue to the national level and consequently the control of diseases to the world stage. Barely a year later, New York City Department of Health established a quarantine facility on the North Brother Island in Riverside Hospital. The facility was aimed at offering TB patients an area for quarantine. This became the famous quarantine site for Mary Mallon, widely known as Typhoid Mary, am Irish woman who was quarantined here for 26 years from 1907 to 1938 when she died in isolation for being a healthy carrier of Typhoid fever and infecting several other people in her course of work as a cook. She is said to have refused to stop being a cook and this led to infection of people in a New York maternity hospital consequently she was re-arrested by the health officers and taken back to quarantine in 1915 till her death in 1938. This sparked a lot of human rights issues concerning quarantine as never before.

The typhoid pandemic in New York went hand in hand with the poliomyelitis pandemic that began in 1916. The health officers began to separate parents from their children in chagrin of many. This saw the wealthier families provide isolation rooms and treatment for their children right at home. However, in November of the same year when the pandemic subsided, it was after well above 2,300 lives claimed by the pandemic, a vast majority being the young.

It was not long until the world war brought with it another challenge of prostitution and consequent spread of venereal diseases. Between 1917 and 1919 the American authorities kept in quarantine to the tune of 30,000 prostitutes as an attempt to curb this menace. The quarantine was passed by the U.S.A. congress hence had all the support of the legal arm. This was another incarceration in the American history that sparked a lot of revolt and repulsion from human rights propagators. The most memorable incidence is when Allan Brandt referred to this incarceration as "the most concerted attack on civil liberties in the name of public health in American history."

Later on in 1944 the Public Health Service Act was well scripted and passed for implementation and saw the establishment of quarantine authority in the federal government. This authority was mandated with the control of all the U.S.A. quarantine facilities and stations from 1921. In the succeeding year, the mayor of Baltimore passed another rather bizarre quarantine instruction for all the patients who resented being given penicillin treatment, though this did not affect many people since many patients willingly accepted the treatment. In 1949 a similar quarantine situation is experienced when Seattle introduced the locked ward system for the Tuberculosis patients who obstinately resented treatment. Incidentally 88% of them were alcoholics.

The system of locked ward quickly spread to other cities. This type of detention was to re-appear in the 1990s when New York City detained well above 200 people who were obstinate towards taking voluntary treatment of TB. This was a control measure in combating a multi-drug resistant TB. The patients were confined to the highly secured and controlled wards of the hospital for approximately six months.

1967 saw a major change in the manner of handling quarantine issues when the U.S.A. Department of Health, Education and Welfare handed over the duty of quarantine to National Communicable Disease Center which later cam e to be known as Centers for Disease Control and Prevention (CDC) till date. This gave CDC the capacity to carry out research as it conducted the quarantine so as to help prevent future occurrence of the pandemic as well as control the spread at the moment.

The USA has made great strides in the control of most infections that hitherto led to quarantine. The remaining concern was an eventual need for quarantine in the near or far future. In 2001, in the experience of the 9/11 terrorist attacks, the U.S.A. health authorities drafted an act which came to be known as the Model State Emergency health Act. This was after the CDC advised and requested for such an Act. The Act in a nutshell mandates the state and authorizes it to quarantine an individual in the occurrence of a bioterrorist attack using a fatal microorganism like smallpox and anthrax etc. By July 2002 this legislation had gotten an approval in nineteen states and had consequently been introduced and implemented in seventeen states therefore.

The most recent of the outbreaks or outbreak scares was in 2003 case of Severe Acute Respiratory Syndrome (SARS). This was experienced in Asia and Canada being the closest to us. Health officials in the affected areas approved of quarantine and isolation as a means to mitigating the pandemic. In April of the same year, President George W. Bush adds SARS to the list of the diseases that can warrant use of quarantine as a means and process of mitigation.

At the moment, the Division of Global Migration and Quarantine which is a branch of the CDC is directly concerned with any matters relating to quarantine in the U.S.A. It manages the eight national facilities for quarantine in Chicago, Honolulu, New York, Los Angeles, Miami, Seattle, Atlanta and San Francisco. It is worth noting that selected city health officials have the authority to quarantine or if need be isolate patients or potential victims to a deadly infection.

In the list of the infections or diseases that can warrant isolation or quarantine in the U.S.A. are cholera, Marburg viruses, and viral hemorrhagic fevers such as the Ebola, diphtheria, plague, infectious tuberculosis, smallpox, SARS and yellow fever. These may be rare in the health situation of the U.S. citizens as at now due to the advanced medical care and hygiene conditions but they are not totally ruled out.

Shortcomings of quarantine

The real essence of quarantine or isolation is to help stop the spread of a disease or infection that has been detected. However, in the noble process of doing so there are fundamental disadvantages that come with it.

In the period that one is in isolation, the individual loses the basic human rights like movement, association religion, access to information and so on and so forth. At times the protection of these basic rights in the isolation units is way below even the protection of the same in the correction departments. For instance the right to willingly and voluntarily participate in a research is usually deprived. Prisoners will have the choice to participate in a biomedical research or not, yet those in isolation cannot make that choice. The level of the research conducted among the prisoners will of necessity be approved and controlled by Department of Health and Human Service. The department will ensure that no prisoner is coerced into participation in any research, which is not the case in the quarantine facilities since those in isolation are the experimental pieces by default.

The second issue is that quarantine produces the desired results and show effectiveness in very limited or few selected circumstances. As Richard Schabas stipulates, there are three rep requisite conditions for a quarantine to effectively work. i). Patients must have indicative symptoms of a communicable disease that cam possibly be spread at its early phase. This however is not possible to detect or obviously see in many diseases. ii). In order for a quarantine to work effectively in a region, there must be identification of practically all the individuals with the infection. This is not possible since one cannot restrict the movement of a whole street or all office workers of a given block. iii). Voluntary compliance is of great necessity for a quarantine to work with efficiency. This was seen in Canada during the SARS pandemic when the citizens refused to comply with the government requirements for quarantine. Richard further notes that the screening and restrictions at the airport cannot be effective since the importation of the infections happens when the carriers cross over when the infection is still at the incubation stages.