August 14, 2014 • 28 mins
Sure, we've all seen medical quarantines against infectious disease in the movies, but how do they work in real life? Find out in this episode of Stuff to Blow Your Mind.
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Speaker 1 (00:03):
Welcome to Stuff to Blow your Mind from how stuff
Works dot com. Hey, welcome to Stuff to Blow your Mind.
My name is Robert Lamb and I'm truly Douglas. And
the episode that we just put out Tuesday was of
course on its bowlow where we talked about about the
virus itself, about how it spreads, about how we can
(00:25):
attempt to treat it, and how it plays into the
current sort of global climate bega that global ideas and
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,
(00:48):
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
(01:10):
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
(01:33):
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
(01:54):
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,
(02:17):
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
(02:38):
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
(02:59):
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
(03:19):
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
(03:41):
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
(04:06):
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
(04:27):
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
(04:47):
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
(05:10):
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.
(05:32):
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,
(05:56):
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
(06:17):
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
(06:38):
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,
(06:58):
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
(07:20):
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
(07:40):
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
(08:02):
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
(08:23):
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,
(08:44):
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,
(09:06):
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
(09:27):
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
(09:48):
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
(10:10):
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
(10:30):
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
(10:53):
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,
(11:16):
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.
(11:38):
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.
(12:01):
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
(12:22):
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
(12:43):
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,
(13:05):
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
(13:27):
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
(13:47):
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
(14:09):
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
(14:31):
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
(14:54):
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
(15:17):
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.
(15:40):
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
(16:00):
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.
(16:22):
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,
(16:43):
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
(17:03):
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,
(17:25):
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
(17:46):
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
(18:06):
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,
(18:31):
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,
(18:51):
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
(19:12):
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
(19:36):
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
(19:58):
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
(20:21):
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
(20:45):
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
(21:07):
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
(21:28):
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
(21:50):
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
(22:14):
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
(22:39):
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
(22:59):
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,
(23:22):
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
(23:42):
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
(24:05):
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,
(24:28):
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
(24:49):
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
(25:10):
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
(25:30):
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
(25:52):
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,
(26:16):
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,
(26:37):
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,
(26:58):
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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(27:20):
It's all there. Stuff to Blow your Mind dot com.
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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
(27:41):
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
at how staff works dot com. For more on this
(28:07):
and thousands of other topics, visit how staff works dot com.
Welcome to Stuff to Blow your Mind from how stuff
Works dot com. Hey, welcome to Stuff to Blow your Mind.
My name is Robert Lamb and I'm truly Douglas. And
the episode that we just put out Tuesday was of
course on its bowlow where we talked about about the
virus itself, about how it spreads, about how we can
(00:25):
attempt to treat it, and how it plays into the
current sort of global climate bega that global ideas and
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,
(00:48):
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
(01:10):
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
(01:33):
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
(01:54):
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,
(02:17):
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
(02:38):
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
(02:59):
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
(03:19):
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
(03:41):
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
(04:06):
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
(04:27):
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
(04:47):
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
(05:10):
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.
(05:32):
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,
(05:56):
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
(06:17):
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
(06:38):
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,
(06:58):
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
(07:20):
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
(07:40):
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
(08:02):
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
(08:23):
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,
(08:44):
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,
(09:06):
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
(09:27):
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
(09:48):
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
(10:10):
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
(10:30):
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
(10:53):
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,
(11:16):
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.
(11:38):
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.
(12:01):
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
(12:22):
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
(12:43):
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,
(13:05):
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
(13:27):
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
(13:47):
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
(14:09):
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
(14:31):
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
(14:54):
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
(15:17):
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.
(15:40):
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
(16:00):
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.
(16:22):
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,
(16:43):
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
(17:03):
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,
(17:25):
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
(17:46):
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
(18:06):
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,
(18:31):
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,
(18:51):
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
(19:12):
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
(19:36):
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
(19:58):
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
(20:21):
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
(20:45):
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
(21:07):
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
(21:28):
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
(21:50):
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
(22:14):
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
(22:39):
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
(22:59):
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,
(23:22):
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
(23:42):
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
(24:05):
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,
(24:28):
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
(24:49):
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
(25:10):
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
(25:30):
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
(25:52):
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,
(26:16):
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,
(26:37):
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,
(26:58):
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
stuff that we've done. You want to check out our
podcast episodes, all of them that we've ever made, you
can find them at that website. You can find our videos,
you can find our blog, post pictures of what we
look like. Uh, links to our various social media accounts.
(27:20):
It's all there. Stuff to Blow your Mind dot com.
Be sure to check out mind Stuff Show on YouTube.
If you're a YouTube user, your YouTube fanatic, go there, subscribe,
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
(27:41):
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
at how staff works dot com. For more on this
(28:07):
and thousands of other topics, visit how staff works dot com.
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