The Washington PostDemocracy Dies in Darkness

From the Black Death to today, why quarantine is so unsettling

British expat David Young at home in Málaga, Spain, on June 21. Tens of thousands of British citizens overseas haven’t been able to visit friends and family in the U.K. because of quarantine requirements during the coronavirus pandemic. (Photo by Jorge Guerrero/AFP via Getty Images)

In March, my daughter called me in a panic. One of her college friends had tested positive for the coronavirus and had been sent to isolate in a designated building. My daughter and four other friends had recently tested negative, she told me, but they had spent time with the infected friend, so they were all at risk. For the next 10 days, each was quarantined in an individual hotel room at a local Hampton Inn. My daughter tried to concentrate on her Zoom classes, but she was at times overtaken by uncertainty and dread. I was as unsettled as she was.

Our apprehension derived from the nature of quarantine, which, in practical terms, is different from isolation. In their lively and engaging book, “Until Proven Safe: The History and Future of Quarantine,” Geoff Manaugh and Nicola Twilley explain: “If you know that you are infected with a communicable disease, and if you have been told to stay at home or in a hospital to avoid spreading that disease, then you have not been quarantined: you have been isolated.” Quarantine, in contrast, “emerges from a state of suspicion: it is about potential infection and possible risk.” It’s that inherent uncertainty that makes the concept of quarantine both disquieting and intriguing.

In their book, Manaugh and Twilley deliver a big-picture history of medical quarantine, its uses, successes and failures, from the Black Death through the present day. They also explore aspects of quarantine beyond the medical sphere: how it’s used to protect plants, animals, minerals and even our planet. And they enlighten us to their discoveries as they take us along on their journey of reporting and researching the book. As a result, “Until Proven Safe” reads like a vivid travel documentary informed by history, politics and science, deftly cutting back and forth among locations and time periods, and carrying us to where we are now. Although the authors started their examination of quarantine years before the coronavirus pandemic, their book serves as an insightful history of the present.

Manaugh, an author and magazine writer, and Twilley, a podcast co-host and New Yorker contributor, take us to some of the earliest quarantine stations in Europe. Calling themselves “quarantine tourists,” they trace the footsteps of “philanthropist, vegetarian, and prison-reform advocate” John Howard, who, in 1785, set out to inspect the condition of people placed in Mediterranean lazarettos, or quarantine hospitals. To experience quarantine himself, Howard got himself on an infected ship, arriving several months later at the Venetian island of Lazzaretto Nuovo, where, because of his exposure, he was briefly quarantined in a “very dirty room, full of vermin.” (Good thing he wasn’t there two centuries earlier: During the 1576 plague outbreak, this lazaretto, meant to house about 100 people, held more than 10,000, “waiting amid the mosquitoes and humidity for the dreadful signs of disease to emerge.”) Howard came through his quarantine unscathed. The authors write that he “helped to identify essential elements of a well-run quarantine facility, from ample ventilation and carefully designed circulation to communal religious services and compassionate care” — elements sometimes absent from contemporary quarantines.

In London, philatelist Denis Vandervelde enlightens the authors to the centuries-old practice of disinfecting mail in times of widespread disease. In earlier times, potentially contaminated letters and parcels were placed for a week in wooden coffins with spices and herbs, while others were treated with vinegar and smoke, or grilled on a wire grate. I couldn’t help but recall how my local library, in mid-2020, quarantined books before making them available in a no-contact pickup process.

The power to enforce quarantines naturally comes with the power to corrupt, and often, that has meant legitimizing bias and racism. In the late 1800s, John Cumpston, director of the Australian Department of Health, laid out the objectives of a national quarantine policy: to create “a white Australia” through protection from disease and from “certain races of aliens whose uncleanly customs and absolute lack of sanitary conscience form a standing menace to the health of any community.”

In 1900, San Francisco authorities sealed off “the entire [Chinatown] district with rope, fence posts, and barbed wire,” after a Chinese lumber salesman died of plague. Many San Franciscans wanted to reclaim the Chinatown area and redevelop it, and the Chinese residents feared that the quarantine was the first step in possibly imprisoning them all and burning down their houses in the name of public health. Ultimately, a judge ruled that the Board of Health had applied the quarantine with “ ‘an evil eye and an unequal hand’ and had ‘boldly directed [it] against [Asians] as a class’ in direct contradiction of the equal protections guaranteed by the Constitution.”

Misogyny and misogynoir permeated some quarantine policies, such as the 1917 “American Plan,” a federal public health initiative to protect soldiers that later was expanded to states and municipalities. Women thought likely to spread sexually transmitted infections were detained, quarantined and examined without consent: Some were turned in by their husbands after arguments; one, for dining alone. In Kansas, a third of the women detained were Black, even though only 3 percent of the population was Black. When asked why men were not included, Gardener M. Byington, a Michigan health official, offered the fatuous explanation that “a female can spread Venereal Disease a great deal more rapidly, and usually, it is easier to hospitalize a female than a male owing to the fact that the latter is a wage earner.”

Martin Cetron, director of the Centers for Disease Control and Prevention’s division of global migration and quarantine, told the authors, “Every major global epidemic of disease is followed by an epidemic of fear and an epidemic of stigma.” As a sobering example of the perverse use of quarantine, the United States denied noncitizens with HIV/AIDS entry to the country for 22 years, until 2010.

The authors also explore the role of quarantine in protecting the global food supply. They visit an animal-disease research center in Manhattan, Kan., and a greenhouse in London at the International Cocoa Quarantine Center, where they view cacao plants quarantined for several years to ensure disease-free future shipments, in this way “safeguarding the world’s chocolate supply.” The greenhouse, Manaugh and Twilley write, is “a rare example of true quarantine in the universe of nonhuman biosecurity.”

With quarantines and lockdowns again on the rise as the delta variant spreads unchecked among those yet to be vaccinated, we might do well to consider what the CDC’s Cetron has called “modern quarantine,” which weighs both the rights of individuals and the need to protect public health. A delicate trade-off exists. If government officials demand that people give up their rights in the interests of public health, the authorities must provide a promise of care: at the very least the basics of food and shelter, testing and treatment, and communication and transparency. As Cetron puts it: “There’s no control without care. It’s not health security versus human rights — it’s a carefully negotiated balance between them.”

Until Proven Safe

The History and Future of Quarantine

By Geoff Manaugh and Nicola Twilley

396 pp. $28