Isolation, Quarantine, and the Compression of Time

Isolation and quarantine: Although the two words seem interchangeable to many people, in public-health circles they are not; the principal difference between them is who they affect, and why.

Isolation refers to secluding a sick patient to keep him or her from spreading the disease or to keep a patient with a weakened immune system from becoming further infected. Patients can be isolated in special rooms either in a hospital or, if their condition allows, in their own homes.

Quarantine, on the other hand, refers to secluding healthy or “well” people who have come into contact with a sick person. The goal of both isolation and quarantine is to keep all potentially infected, and therefore infectious, people away from those who are not infected. If action is taken fast enough, the isolation and/or quarantine strategies can help to contain the spread of a disease.

The Exponential Growth of International Travel 

One of the major differences between the world of the early 20th century – when the 1918-19 global influenza pandemic claimed the lives of an estimated 50 million people throughout the world – and today’s world has been the development and growth of rapid international travel. American troops waiting for deployment to Europe in 1918 were sequestered for several weeks in U.S. military bases on the east coast of the United States, then transported to Europe on relatively slow-moving troop ships. Even for those embarked on the speedy new ocean liner Queen Elizabeth, the trip took at least six days. Today the same trip takes only six hours – by air.

During the same several decades when travel time was being compressed from a few days to only a few hours, the number of international travelers was increasing exponentially. Except for the troops, only the rich and super-rich, plus a few scholars and students (many of whom “worked their way” overseas), could afford to and were able to travel abroad in the first two decades of the 20th century. Today, hundreds of thousands of people, from almost every country on the planet, cross the oceans every day in huge passenger aircraft that soar over the world ocean at speeds previously undreamed of. The Delta flight from Atlanta, Georgia, to Mumbai, India – to cite but one example – takes only 17 hours. Theoretically, in fact, it is now possible for any person anywhere in the world to travel to any other place in the world in less than 24 hours.

Diseases Also Travel Faster 

The lethal corollary of these advances is that when people can travel that fast, the diseases they carry with them are traveling at the same speed. Add to that the fact that, according to the World Health Organization (WHO), a person who has been infected can infect others even before he or she displays visible symptoms. In 1918, an infected person would in all probability have exhibited such symptoms long before arriving at his or her destination.

Using modern transportation, though, a traveler can be in Mexico City today, in Germany for a meeting the following day, and off to China the day after that. The net effect is that an infected person may complete such a three- or four-day itinerary well before starting to show any symptoms.

In dealing with the current Swine Flu/H1N1 influenza outbreak both WHO and the U.S. Centers for Disease Control and Prevention (CDC) – working in close cooperation with other national and international public health agencies – have relied primarily on a mixture of travel warnings and restrictions to at least partially cope with the rapidly rising number of confirmed cases reported in one country after another in all corners of the world.

The Belated “Race Against Time” 

In many cases the principal response from these agencies was the issuance of recommendations to the general public to avoid unnecessary travel to areas known to have already been affected. Of course, by the time those recommendations were issued the disease was already past the point of being contained by travel restrictions.

On an international scale, restrictions on travel to an affected country can be viewed as either isolation or quarantine, depending on the direction and duration of the restriction. The global nature of business, educational, and recreational travel makes restrictions on travel extremely difficult both to put in place and to enforce. WHO issued the following statement in regards to the present H1N1 2009 outbreak, in fact:  “Limiting travel and imposing travel restrictions would have very little effect on stopping the virus from spreading, but would be highly disruptive to the global community.”

Another major difference between today’s travel conditions and those prevalent in the early 1900s is the current availability of instantaneous international communications. Epidemiologists can now use the internet to share information in the blink of an eye that a century ago would have been globally “disseminated” no faster than the speed of ships. The rapid growth in communications capabilities allows quicker warnings, therefore – and, possibly, a more rapid understanding of an outbreak, but not its actual prevention.

For that reason alone, and even though “closing borders” might seem to many to be an obvious (and politically tempting) response to the outbreak of an infectious and potentially deadly disease – that option is not backed either by science or by the everyday facts of daily life in the 21st century.

Joseph Cahill
Joseph Cahill

Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.



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