International Quarantine: A Measure To Halt Disease Spread

Abstract

New challenges of 21st century such as rapid globalization, increased trades and hyper mobility of people; can spread infectious disease faster than ever before. Vigilant practice is vital to slow down the chain of transmission and quarantine is one among them. Quarantine is a measure used by the global health agencies to prevent the further spread of disease during an outbreak. Quarantine is usually done by restraining or separating human being and other living organism; who came into contact with contagious pathologies either actually or potentially.

Background

Historically the term ‘quarantine,’ signifies forty days separation of suspected human being, goods and others from the healthy person and community; but now a day’s due to changes in contributory factors of disease emergence, there are variable time interventions for various transmissible diseases based on the incubation period of particular disease and these diseases has capacity to spread speedily from one country to another country.

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Quarantine is considered as one of the oldest, simplest and valuable health measures to halt the disease progress. It helps to safeguard the public health from contagious diseases of various origins. The word quarantine emerges from Italian variant Quaranta giorni which means 40 days (forty days compulsory confinement before entering to other nation)

Evolution of quarantine

• 1377- During Black Death at Dubrovnik (place known for origin of Quarantine) person had to spend thirty days (Trentine) in a restricted area
• 1431- At Edirne self quarantine was done to control the leprosy cases in general hospitals
• 1492- Quarantine measures were directed towards the prevention of plague epidemics in coastal cities at Venice
• 1878- Following an outbreak of yellow fever at Mississippi valley local and state government pass quarantine legislation
• 1892- Quarantine laws had been changed after cholera outbreak at Europe
• 1944- Public health service act (PHS) was initiated by U.S government to prevent the transmission of infectious diseases
• 1967- Centers for disease control and prevention take up the responsibility of quarantine
• 1980- CDC restructured with establishment of 55 quarantine station
• 2003- System of quarantine station has been expanded after the outbreak of SARS epidemic at Foshan
• 2009- Outbreak of influenza H1N1 at Mexico; pandemic surveillance and quarantine has been applied
• 2014- Home based quarantine and Intercontinental travel control was imposed following outbreak of Ebola epidemics at western Africa
• 2019-2020- Mass quarantine and lockdown has been applied to all over the globe to stop the corona virus outbreak, which was first noted at Wuhan city

Types of quarantine

Control measures at community level are considered as essential way to reduce the contact between sick person and susceptible person. Following four kind of quarantine can be beneficial to cut down the disease transmission:-

• i) Mandatory quarantine- lockdown of cities and discontinuation of travel to infected area by legal order; which eventually leads people to stay at their homes
• ii) Voluntary quarantine- person who exhibit symptoms of being infected; willingly follows restriction of activities
• iii) Self quarantine- avoid needless contact with family as well as friends or maintain social distancing
• iv) Sequestering- limiting the face to face contact of healthy population and the length of quarantine was determined by incubation of particular infectious agent

Contributory factors of disease spread

Globally; Individual’s health can be determined by various factors such as rapid globalization, changes in environment, availability of health services, nutritional status of the population etc. following are the major contributory factors for disease spread:-

1. Earlier mobility of people was localized to state or nation. People started travel to long distance and become hyper migrated due to which infectious diseases are spreading faster than ever before. COVID-19 took only 6 days to spread around the globe. Future diseases are expected to take hardly few hours to infect numerous countries worldwide
2. Unexpected level of goods trades throughout the globe increases the opportunities for disease transmission
3. Environmental Deterioration happening at greatest speed which leads to climate changes. Travellers come across unexpected and significant changes in temperature, humidity and other factors; that eventually cause increased risk for transmittable diseases.

Qurantinable diseases

Various national as well as international agencies are working to get better surveillance and reporting of emergencies of international concern; such agencies identified many infectious diseases in the past decades. Following diseases need constant monitoring and supervision at every level:-

• i) Always notifiable diseases- several diseases such as Smallpox, Poliomyelitis, Human influenza, SARS always need to be notify irrespective of its time and place of origin.
• ii) Potentially notifiable diseases- biological and chemical events, cholera, hemorrhagic fever, yellow fever, plague needs attention when they characterize potential risk or situation.
• iii) Public health emergencies of international concern (PHEIC) - diseases that started spreading into many countries and require international response to control the outbreak of such diseases. i.e. Swine influenza(2009), polio virus(2014), Ebola(2016), Zika virus(2016), Nipha virus (2018), Corona virus(2019)

Quarantine Measures to halt disease spread

Due to insufficient knowledge about disease facts and floating rumours community members can easily get panic and anxious. Quarantine measures can be helpful in prevention of community transmission and can halt the disease progress to become pandemic:-

• Hold-up public gathering
• shutting down of public places i.e. Schools, colleges, cinema, malls
• Maintain social distancing by staying at home
• Restriction on mobility into or out of infected area (Cordon sanitaire)
• Avoid unnecessary visiting to health facility
• Regular monitoring of suspected and infected person’s Health status

Impacts of quarantine

Although quarantine is very good measure to control disease transmission but it may result in psychological distress, uncertainty and feeling of helplessness due to social distancing. The persons who required quarantine need to monitor regularly and should be well equipped with clear picture of the situation.

Conclusion

Future epidemics are still undecided. Traditional public health tool such as quarantine can be useful to control communicable disease outbreak and people’s anxiety globally. All the countries should be prepared for the upcoming epidemics and build up strong health care system to minimize the disease.