We’re now in the third week since Chinese authorities locked down the city of Wuhan and, soon thereafter, surrounding areas in the province of Hubei. All told, more than 50 million people are now caught up in the largest quarantine in human history.
The goal of the lockdown is to stop the spread of the Wuhan coronavirus, a new strain of contagious illness that appears to have emerged from the city’s livestock market. But in the time since the lockdown began, the death toll and number of infections has continued to soar in China.
Meanwhile, the rest of the world is scrambling to avoid an epidemic like the one China now faces. To do that, governments, including our own, are also resorting to quarantines, separating those who may have been exposed to the virus from the general population.
So, in an age when scientists can edit genomes and engineer our own cells to fight diseases like cancer, why are we relying on a practice that originated in 14th-century Italy?
Well, because history has proven that it works.
Dr. Prescott Prescribes
We humans are creatures of selective memory. Especially when it appeals to our sense of romanticism.
So, when we hear of elderly spouses who die within a week of one another, we’re more prone to remember — and ascribe it to a broken heart. Meanwhile, we overlook the fact that people in their 80s or 90s could pass away within a short time of one another simply because of their age and health.
We also tend to forget all the wives (and occasional husbands) who live for years beyond their spouses’ deaths.
That said, in rare cases, grief alone appears capable of causing coronary events. The most notable example is known, aptly, as broken-heart syndrome. (It’s also called Takotsubo syndrome, but that’s less evocative, at least in English.)
Although not well understood, doctors hypothesize the condition is brought about by a rush of stress hormones after a traumatic event, causing a temporary weakening of the heart muscle. While the syndrome can strike any heart, most victims are women, and most are middle-age or older.
Thousands of cases have been reported. But fatalities appear to be extremely uncommon.
A Journal of the American Medical Association study compared 30,000 people age 60 to 89 whose partners had just died with 83,000 people the same age whose partners hadn’t. While researchers found the bereaved had an increased chance of coronary event in the month after partners’ deaths, the difference was tiny: 0.16 percent risk of heart attack or stroke versus 0.08 percent.
Venice and the plague
As a center of shipping and world commerce in the Middle Ages, Venice suffered multiple bouts of bubonic plague. Officials tried measures like ship inspectors and requiring documentation to ensure the vessels were plague-free, but these approaches failed to prevent disease-causing bacteria from reaching the city and starting new outbreaks.
Finally, Venice hit upon a strategy that worked. Before ships could come ashore, they had to sit at anchor off the coast of Venice for 40 days before landing.
The 40-day period was crucial, as it provided more than enough time for the disease to incubate. If no one aboard developed symptoms in this time, it demonstrated the vessel wasn’t carrying the plague — and the ship could come ashore.
The practice proved effective at preventing communicable disease. In fact, the term quarantine derives from the Italian words for “40 days,” or “quaranta giorni.”
A blunt instrument
Since Venice, governments around the world have used quarantines to help prevent the spread of communicable diseases such as cholera, influenza, yellow fever and, more recently, the respiratory illness SARS. Still, the practice has proven controversial.
In a quarantine, you sweep up a group of people who may have been exposed to an illness and keep them apart from non-exposed individuals. The point is to separate and restrict the movement of people to give the virus time to incubate, so that you don’t have a lot of asymptomatic carriers spreading disease among the general population.
By their very nature, quarantines are blunt instruments. To protect the general population, they impinge on the liberty of many people, most of whom will ultimately turn out not to have the disease.
Unsurprisingly, this approach results in much criticism and pressure to make exceptions. However, the only effective quarantines are ones that don’t yield to these forces.
That means that if the current quarantine of a cruise ship off the coast of Japan is going to work, every single passenger needs to stay on board for a full 14 days. Even the extremely wealthy, well-connected people who raise a ruckus.
Too much, too late?
When someone does develop a communicable disease like the new coronavirus, isolation is another important public health tool. This means keeping sick people apart from everyone else to help stop the disease from spreading.
In Venice, when someone contracted the plague, he or she was sent to a special hospital, or “lazaretto,” located on an island in the Venetian Lagoon. In Wuhan, Chinese authorities are now taking similar steps, creating makeshift mass shelters to isolate those with coronavirus.
Whether these measures prove effective with the current health crisis remains to be seen.
As many as 5 million people may have left Wuhan after the beginning of the outbreak but before the lockdown. They may already have spread the virus far and wide.
If so, it won’t mean that quarantines and isolation don’t work. It will only mean that locking down 50 million people almost a month after the first reported infection was too much, too late.