The Coronavirus Outbreak: Part Two – Self-Isolation and Quarantine

The village of Eyam in Derbyshire, central England, was unlucky to discover that the pandemic, then raging 150 miles (226 kilometers) to the south in London, had arrived on its doorstep.  

The pandemic was the plague – the year was 1665. The disease had reached Eyam through the delivery of flea-ridden cloth from London to the local tailor, who would then made clothes for the villagers. The fleas carried the plague bacterium and the recipient of the cloth was the first to die.

Within three months another 41 villagers had perished. By spring 1666 a newly appointed rector proposed that, for the sake of other plague-free towns in the Peak District region, the village should self-isolate. A local Earl offered to guarantee food for the town (supplied on a rock at the edge of the village, paid with coins immersed in vinegar – see location below). In June 1666 the villagers reluctantly agreed. Over the summer the plague returned with a vengeance and there were five or six deaths each day. Eventually one third of the population died. But the nearby towns stayed plague free.

Some of the villagers must have left in the dark of night. We know the rector sent his own children away to stay in a neighboring town, rather than subject them to this deadly experiment, in which his own wife was to die.  

Unlike Eyam, the residents of Wuhan (pop. ~11 million) were not asked if they agreed to be isolated along with the coronavirus. All public transportation was ordered to be suspended on January 23, and on January 24, across Hubei province, city-by-city, self-isolation had been imposed.

The authorities had lost a critical month trying to suppress information about the new virus rather than chase down each new infection. By the time that isolation was in place, the virus had slipped beyond Wuhan, carried by thousands of residents scattering for the lunar New Year, or escaping before the cordon was tightened.  

In Eyam, we can trace how the disease spread from household to household. The villagers knew to avoid contact with other households, so the Sunday church service was held outdoors. However, it seems that children, cooped up for months, clamored to go and play with their friends, to the point that their parents gave up the struggle. One Eyam family lost all six children in the space of a few days. One can imagine identical situations in Wuhan today. Children may not be at greatest risk from the coronavirus but can still be the most likely to infect their grandparents. 

Wuhan residents have been told to hunker down in a state of self- and social-isolation. As yet, there is no demonstrable impact on new cases of the coronavirus in the city, by which to show the citizens the merit of their confinement, although that relentless exponential increase should eventually diminish.  

Confinement Studies

In 2016 the “Threat Reduction Agency” of the U.S. Department of Defense did a study of communities that had avoided the 1918-19 Spanish flu pandemic, to see what could be learned. These included remote communities in northern Vermont and deep into the Rocky Mountains, as well as two shuttered colleges where all the students had been sent home (and no one was allowed to arrive or depart).

Self-isolation and the rigorous implementation of quarantine can be effective remedies. Some communities in Alaska indulged in “protective sequestration” placing armed guards to prevent anyone approaching their village. Other nearby communities, without precautions, were almost wiped out by the pandemic.

Quarantine in the Venetian dialect means “forty days” – the time before the sailors on a suspect ship were allowed onshore. We now know the time from first symptoms to death in the bubonic plague is 37 days, so this choice of time period was enlightened (and clearly based on actual experience).

Tuning Quarantine

So, first – the quarantine period needs to be “tuned” to the disease.

American Samoa implemented a seven-day quarantine in 1919 while the island of Tasmania had a five-day quarantine. Both worked. There were no flu deaths in American Samoa even after the quarantine was relaxed in 1920, while the main island of Samoa had lost one-fifth of its population to the influenza outbreak.

In 1918, the 6,000 residents on the U.S. naval base on Yerba Buena island in San Francisco Bay were required to remain on station. New arrivals were subject to quarantine and eight-hourly throat sprays and had to stand at least 20 feet (6.1 meters) away from other people. Again, the measures held back the virus.  

The world is now rediscovering the power of quarantine. The critical period for the new coronavirus has been set at 14 days. The U.S. ban on entry to anyone who has been in China in the last two weeks is, in effect, achieving an unsupervised quarantine. Visitors from China will need to find some intermediary country, like Panama, in which to spend two weeks before moving on to the U.S. American citizens will be expected to serve quarantine through confinement in the U.S.    

In Europe, local nationals that have returned from Wuhan on special flights, are required to quarantine, but not visitors from elsewhere in China, who are only asked to self-report. Four flights a day continue to arrive from China to London.  

In pandemic modeling, we always knew that flights would speed up the transmission of a new virus around the world. What we might not have appreciated is that flights can also be stopped, staunching the disease vector when there is no easy alternative mode of travel. However, as at present, there has been no attempt to prohibit flights from Chinese airlines, probably because they offer the only escape for foreigners still in China. This could become a dangerous flaw in the protections, like building a flood wall only halfway around the town. 

As the outbreak moves into additional countries, so more flights will have to be stopped while the quarantine requirements are extended.    

In It for the Long Haul

At this time the principal aim of governments is to encourage self-protection, discourage panic and avoid mentioning the long haul ahead. The provincial administration will tell the inhabitants of Wuhan that schools and factories will be closed a few more days, but the reality is that Wuhan’s schools will remain closed for months. Airlines like to say they have suspended flights to China until late February, but there is no reasonable prospect they will be back for at least six months.

In the U.K. for example, the government will assure people the defenses are all in place, reminding people how SARs was defeated, but the U.K. has little excess intensive care capacity in which to treat tens of thousands of cases of viral pneumonia.

If the coronavirus got out of control in the U.K. one might eventually see many of the measures being taken in Wuhan: closing public transport, colleges, schools, sports fixtures, concerts, cinemas, theatres, shopping malls, travel and weddings. Just as in China, a pandemic would be worse in cities like London or New York, dependent on public transport, and with high-density accommodation and workplaces, than in rural areas (or even sprawling Los Angeles), where people live apart and rely on their own transportation.

There are studies on how to reduce your risk of contracting a coronavirus on a flight. Perhaps the riskiest place to be is on a cruise ship, both high density and confined.

Pandemics eventually pass. Netflix will flourish even if the theaters, cinemas and restaurants close. Walking holidays can substitute for dense beach resorts. Some retail, restaurant and holiday businesses will fail through lack of customers, and colleges will be unable to recruit next year’s intake of Chinese students.

Insurers will be hit by a perfect storm of event cancellation, non-damage business interruption, life and health covers and travel insurance. Yet for many businesses there is no damage done and we can expect a post-pandemic boom. The challenge, for all of us, is to survive to see it.