A Historic Quarantine

The basic argument for quarantining is that in emergency scenarios, individual rights must be sacrificed for the collective interest. In the U.S., the constitutional basis for quarantining is somewhere between tenuous and nonexistent, depending on which legal expert you ask. A massive imposition like China’s would be unconstitutional, according to James Hodge, a health-law professor at Arizona State, who noted the likelihood of human-rights violation in such a scenario. Another skeptic, the Georgetown University legal scholar Alexandra Phelan, likened China’s response to a “sledgehammer.”

In theory, a sledgehammer sounds good and decisive. But responding to an emerging epidemic requires precision closer to brain surgery. Shutting everything down may help contain the virus—but also may help spread it by keeping people concentrated in crowded cities. This can create other health issues related to scarcity of resources and intensify panic. Quarantines can actually prevent treatment and detection if they are seen as punishments for reporting symptoms. If people do not trust that doctors and health officials have their best interest at heart—or if people believe them to be acting on a political imperative from above—they are much more likely to play down or ride out symptoms. If this happens, it takes longer for everyone to have a sense of the scale and scope of the outbreak, and to understand how it spreads.

This effect is especially possible in authoritarian states, but crises invite unusual exercises of state power anywhere. The Centers for Disease Control and Prevention quietly expanded its authority to detain people without due process in 2018, despite the concerns of some legal and human-rights advocates. In 2014, before he was president, Donald Trump called for extreme isolationism during the Ebola outbreak, including shutting down all flights between affected countries. The Obama administration, meanwhile, monitored some 10,000 Americans for 21 days and caught zero cases of Ebola. A health-care worker who had been in Liberia was kept in quarantine in Connecticut despite testing negative, sparking a lawsuit from Yale’s Global Health Justice Partnership and the American Civil Liberties Union, which argued that Ebola quarantines violated individual rights and undermined efforts in West Africa.

Read: The CDC’s new quarantine rule could violate civil liberties

Whether or not the new virus in China spreads globally to a significant degree, it will raise serious questions about global preparedness for pandemics, and what constitutes a strong response. Last year, the Johns Hopkins Center for Health Security modeled what might happen if a coronavirus outbreak reached the U.S., and found it could kill 65 million people. Among the lessons of the model was that no country can be prepared on its own. A coordinated global response is key to understanding such an outbreak—how it spreads, how to detect and treat the disease, and how to prevent further spread. There are early signs that this is happening. Scientists have praised Chinese colleagues for rapidly sharing the genome of the virus with the rest of the world. This week, scientists at the National Institutes of Health reported that they are already working on a vaccine prototype, which could be available within three months. Scientists at Johns Hopkins have started a crowdsourced site for genomic information and a map of cases.

This is all contingent on people being transparent and honest, and having reason to believe what they hear. People who trust the information they’re getting are more likely to actually take the actions needed—and to believe that things like staying at home during an outbreak are both safe and necessary. Any state that sows distrust in science and journalism, and lacks a solid foundation of trustworthiness, places itself and the world at risk.  

James Hamblin, MD, is a staff writer at The Atlantic. He hosts the video series If Our Bodies Could Talk and is the author of a book by the same title. | More