The Birth of Quarantine: Venice’s Revolutionary Response to the Black Death
Quarantine, from the Italian “quaranta” meaning 40, was adopted as an obligatory means of separating persons, animals, and goods that may have been exposed to a contagious disease. Since the fourteenth century, quarantine has been the cornerstone of a coordinated disease-control strategy, including isolation, sanitary cordons, bills of health issued to ships, fumigation, disinfection, and regulation of groups of persons who were believed to be responsible for spreading the infection.
The word quarantine was first used in Venice, Italy in 1127 with regards to leprosy and was widely used in response to the Black Death, although it was not until 300 years later that the UK properly began to impose quarantine in response to plague. This ancient system became humanity’s first organized defense against the invisible enemy of infectious disease. The 30-day period stipulated in the 1377 quarantine order was known in Italian as a trentino, but doctors and officials also had the authority to impose shorter or longer stays.
Medieval Panic: When Fear Spread Faster Than Disease
A historical perspective of quarantine can contribute to a better understanding of its applications and can help trace the long roots of stigma and prejudice from the time of the Black Death and early outbreaks of cholera to the 1918 influenza pandemic. During the medieval period, quarantine measures often triggered mass hysteria as communities struggled to understand what they couldn’t see or explain scientifically.
The implementation of these early quarantine measures created social divisions and sparked widespread panic. People feared being trapped in designated areas, cut off from family members, and left without adequate supplies. Communities often turned against each other, with blame being assigned to foreigners, travelers, or minority groups who were seen as carriers of disease.
The Lazaretto System: Islands of Survival and Desperation
The term derives from the Biblical story of beggar Lazarus, who was raised from the dead out of the tomb by Jesus Christ. Following that, another lazaret was built on a small island in the lagoon in front of Venice in 1403. In 1467, the maritime Republic of Genoa followed the example of Venice, and in 1476, the old leper hospital in Marseille was turned into a black death hospital.
The great lazaret of Marseille, perhaps the most complete of its kind, was built in 1526 on the island of Pomègues. These isolation facilities became symbols of both hope and despair. While they prevented disease spread, they also concentrated suffering in confined spaces. The psychological impact on quarantined individuals was profound, with many experiencing extreme anxiety about their uncertain fate.
1918 Spanish Flu: The Great Quarantine Test
No one expected that within a few years, nations would again be forced to implement emergency measures in response to a tremendous health challenge, the 1918 influenza pandemic, which struck the world in 3 waves during 1918–1919. This pandemic caught the world completely off guard, despite previous experience with infectious diseases.
Health authorities in major cities of the Western world implemented a range of disease-containment strategies, including the closure of schools, churches, and theaters and the suspension of public gatherings. The United States lost 675,000 people to the Spanish flu in 1918-more casualties than World War I, World War II, the Korean War and the Vietnam War combined. The scale of death created unprecedented panic as communities watched neighbors and family members succumb rapidly.
Public Officials’ Dangerous Denials
Routinely, as influenza approached a city or town – one could watch it march from place to place – local officials initially told the public not to worry, that public health officials would prevent the disease from striking them. When influenza first appeared, officials routinely insisted at first it was only ordinary influenza, not the Spanish flu. As the epidemic exploded, officials almost daily assured the public that the worst was over.
Chicago’s public health commissioner said he’d do “nothing to interfere with the morale of the community…. It is our duty to keep the people from fear. Worry kills more people than the epidemic.” That idea – “Fear kills more than the disease” – became a mantra nationally and in city after city. This misguided approach often made quarantine enforcement more difficult and reduced public trust in health measures.
Australia’s Quarantine Success Story
Influenza entered Australia for the first time in January 1919 after a strict maritime quarantine had shielded the country through 1918. Australia also managed to avoid the first two waves with a quarantine. This remarkable achievement demonstrated how effective quarantine could be when properly implemented and maintained.
In the Pacific, American Samoa and the French colony of New Caledonia succeeded in preventing even a single death from influenza through effective quarantines. However, the outbreak was delayed into 1926 for American Samoa and 1921 for New Caledonia as the quarantine period ended. These successes came at the cost of extreme isolation and social disruption that lasted for years.
The Cholera Pandemics: Learning Through International Cooperation
It was the first of seven cholera pandemics over the next 150 years. Russia, Europe, the British Empire, Africa and even Japan were involved and millions died. The first of seven cholera pandemics over the next 150 years, this wave of the small intestine infection originated in Russia, where one million people died. Spreading through feces-infected water and food, the bacterium was passed along to British soldiers who brought it to India where millions more died.
International prophylaxis against cholera, plague, and yellow fever began to be considered separately. In light of the newer knowledge, a restructuring of the international regulations was approved in 1903 by the 11th Sanitary Conference, at which the famed convention of 184 articles was signed. These international efforts marked the beginning of coordinated global health responses, though they came with significant political and economic tensions.
The False Sense of Victory
In 1911, the eleventh edition of Encyclopedia Britannica emphasized that “the old sanitary preventive system of detention of ships and men” was “a thing of the past.” At the time, the battle against infectious diseases seemed about to be won, and the old health practices would only be remembered as an archaic scientific fallacy.
This overconfidence proved catastrophic when the 1918 pandemic struck. The scientific community had become complacent, believing that modern medicine had conquered the threat of pandemic disease. When quarantine measures were suddenly needed again, many countries found themselves unprepared for both the logistical challenges and the public resistance that followed.
America’s Struggle with Federal Quarantine Authority
In the USA, the process of developing national quarantine policy required many years. Originally, as to many other matters, the single federal states were responsible for handling the influx of infectious illnesses. However, repeated outbreaks of yellow fever induced the Congress to release the National Quarantine Act in 1878, thus creating the premises for federal involvement. In 1892, a cholera outbreak led officials giving the federal government more authority to impose the requirements.
By 1921, the quarantine system was totally nationalised. This centralization came after decades of inconsistent and often contradictory state-level responses that had proven inadequate during major outbreaks. The struggle between federal and state authority created confusion and resentment among populations caught between competing jurisdictions.
Modern Quarantine: The COVID-19 Mental Health Crisis
In the first year of the COVID-19 pandemic, global prevalence of anxiety and depression increased by a massive 25%, according to a scientific brief released by the World Health Organization (WHO). The COVID-19 pandemic has led to acute changes in daily routines and lifestyles worldwide, with the social consequences being detrimental to mental health. For instance, there has been an estimated additional 76.2 million cases of anxiety disorders globally, an increase of 25.6%, and it is unlikely that mental health will recover to pre-pandemic levels for some time.
A prolonged period of quarantine was also correlated with higher risks of anxiety symptoms. Intuitively, contact history with COVID-positive patients or objects may lead to more anxiety symptoms. Unlike historical pandemics, modern quarantine measures had the advantage of digital communication, yet still produced unprecedented psychological distress.
The Vulnerable Populations: Who Suffers Most
The brief shows that the pandemic has affected the mental health of young people and that they are disproportionally at risk of suicidal and self-harming behaviours. It also indicates that women have been more severely impacted than men and that people with pre-existing physical health conditions, such as asthma, cancer and heart disease, were more likely to develop symptoms of mental disorders.
Young adults are especially likely to have faced high levels of psychological distress since the COVID-19 outbreak began: 58% of Americans ages 18 to 29 fall into this category. Women are much more likely than men to have experienced high psychological distress (48% vs. 32%), as are people in lower-income households (53%) when compared with those in middle-income (38%) or upper-income (30%) households. These patterns reveal how quarantine measures can exacerbate existing social inequalities.
The Long-Term Psychological Scars
A study of hospital staff who might have come into contact with SARS found that immediately after the quarantine period (9 days) ended, having been quarantined was the factor most predictive of symptoms of acute stress disorder. In the same study, quarantined staff were significantly more likely to report exhaustion, detachment from others, anxiety when dealing with febrile patients, irritability, insomnia, poor concentration and indecisiveness, deteriorating work performance, and reluctance to work or consideration of resignation. In another study, the effect of being quarantined was a predictor of post-traumatic stress symptoms in hospital employees even 3 years later.
This Review suggests that quarantine is often associated with a negative psychological effect. During the period of quarantine this negative psychological effect is unsurprising, yet the evidence that a psychological effect of quarantine can still be detected months or years later is more troubling and suggests the need to ensure that effective mitigation measures are put in place as part of the quarantine planning process.
Quarantine’s Enduring Power: From Medieval Times to Today
In the new millennium, the centuries-old strategy of quarantine is becoming a powerful component of the public health response to emerging and reemerging infectious diseases. During the 2003 pandemic of severe acute respiratory syndrome, the use of quarantine, border controls, contact tracing, and surveillance proved effective in containing the global threat in just over 3 months.
States and territories can use isolation and quarantine to keep people from spreading infectious diseases – as they did in the COVID-19 pandemic. It’s easier to do this in the early stages of an emergency if a jurisdiction has a plan in place. The challenge remains balancing public health protection with individual psychological wellbeing and civil liberties. Throughout history, quarantine has proven its effectiveness at saving lives while simultaneously demonstrating its capacity to create lasting trauma and social disruption. The key lesson from centuries of experience is that successful quarantine requires not just medical expertise, but also compassionate implementation that addresses the human cost of isolation.