(CNN) – While Chinese authorities warn that the coronavirus outbreak is accelerating, putting millions of people in more than a dozen Chinese cities under heavy travel restrictions may seem like a good idea.
But historically a massive quarantine is an aggressive response that is far from perfect. In the past it has had political, financial and social consequences.
The closure of Wuhan, a city of more than 11 million people where the virus originated, is “completely incredible,” Howard Markel, professor and director of the Center for the History of Medicine at the University of Michigan, told CNN.
“I had never seen an entire city with 11.4 million people cordoned off like this,” said Markel. “I thought I had seen everything.”
Lawrence Gostin, a professor of world health law at Georgetown University and director of the World Health Law Center of the World Health Organization, said the measure was “unprecedented” and, he thought, “very reckless” .
“Nothing has ever been tried on this scale,” he told CNN. “There is very little evidence of its effectiveness. And I think there are good reasons to think that it could be counterproductive, from a public, social and human rights perspective. ”
No quarantine works perfectly
Quarantines date back to Italy in the 1300s, when the bubonic plague devastated Europe. In Venice, sailors and ships from infected ports had to wait 40 days before docking at a practice called “quaranta giorni” or “40 days.”
People criticize quarantines because in practice a virus or bacterium “invariably releases,” Markel said, as do people. “Every quarantine, people go out,” he said. “They just do it, especially in one of this magnitude.”
Large-scale quarantines such as Wuhan’s are generally avoided today, while the medical community focuses on providing treatment, medications and vaccines to prevent them completely, according to Markel.
Quarantines “can calm things for a while,” he said, “but they are not the best in the long term.”
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They can also lead to logistical problems. Only the word “quarantine” can cause panic or hysteria, Markel said. Anyone concerned with a common cold will go to hospitals, exhausting already precious resources. Wuhan officials have already recognized that local hospitals were struggling to accommodate people seeking medical attention.
There are also implications for human rights when Wuhan and more than a dozen other Chinese cities are confined, Gostin said. “I don’t think a massive quarantine of 30 million people can be enforced without violating human rights.”
Gostin also questioned the effectiveness of the approach, pointing to smaller quarantines during the 2014 Ebola outbreak in West Africa. “It fueled public violence, there was … mistrust in public health authorities, people did not come to receive treatment and it was thought that it actually delayed the response to the outbreak considerably,” he said.
There are major financial and social consequences
But outside the field of public health, quarantines can present broader social problems. Perhaps the most obvious is the economic impact.
Quarantines “are often very costly from an economic and financial point of view,” said Alexandre White, an assistant professor of sociology and history of medicine at Johns Hopkins University.
The flow of trade in and out of the quarantined area stops, and the goods in the process of shipping could go wrong, depending on how long it lasts.
“As the quarantine is extended, the economic and social difficulties in the community under quarantine will expand, which will require the delivery of food and services and also hamper local economic activity,” he said.
These economic impacts are a large part of why quarantines are considered a “less desirable course of action,” White said.
Residents wear masks to buy vegetables at a market in Wuhan.
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Then there are the social consequences, White said, particularly for marginalized members of a community. Historically, he said, the aggressive control needed in a quarantine can link the disease to marginalized people and potentially fuel existing anxieties about race and class.
White pointed to an outbreak of bubonic plague in Cape Town in 1901 that led to a racially segregated quarantine camp, which he said was later used as a model for racial segregation during apartheid.
Markel told CNN that there was “a long history of misuse of quarantine as a social separator, rather than a public health one.”
“There is a risk of stigmatization,” he said, “that marginalized groups are justly worried and afraid.”
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Trust and cooperation are key
There is still a lot that is unknown about the coronavirus outbreak and how the Chinese authorities are responding.
But, in general, public trust and cooperation is the most important thing for officials in a public health crisis, Gostin said.
Without it, people will not undergo the tests and will not share the names of the people they have been in contact with, a vital part of the strategy to prevent the spread of the disease.
“People are afraid, they take shelter… You can’t go to social clubs, you can’t see friends. A blockade of 30 million people, that really turns their lives around. ”
Gostin believes that the best way to address a situation like Wuhan’s is “an increase in the public health response,” he said. It should be easier for people to get to the hospital and there should be mobile clinics that meet people in their homes to provide them with tests and treatments.
Governments that implement a quarantine should still want public cooperation, Markel said. The Government must give many explanations and maintain constant communication.
“Obtaining acceptance from people who are protecting themselves is essential,” he said, “and it is always better than ordering people to do things.”
Amanda Sealy and Elizabeth Cohen of CNN contributed to this report.
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