Quarantine

Connie Nugent MLS

There’s something happening here
What it is ain’t exactly clear…

Corresponding author: Connie Nugent
Contact Information: Connie.Nugent1@gmail.com
DOI: 10.12746/swrccc.v8i35.735

When musician Stephen Stills wrote these lyrics in 1966, he was no doubt unaware of coronaviruses, but the words are appropriate for the beginning of the COVID-19 pandemic late in 2019; it really wasn’t clear what was happening. It’s just a virus. We’ve had viral outbreaks before. As the statistics soon revealed, however, the situation became clear—this coronavirus was here to stay. As more and more people succumbed worldwide and the death toll mounted, responsible leaders proposed a “stay at home” protocol, hoping that social isolation would slow the spread of the virus.

Being quarantined due to infectious disease is not a new concept; in Leviticus 13, the Lord speaks to Moses regarding the presence of a “leprous” disease:

The priest shall confine the diseased person for seven days. The priest shall examine him on the seventh day, and if he sees that that the disease…has not spread in the skin, then the priest shall confine him seven days more.1

The priest checks the person with the skin affliction every seven days; if the disease is not resolved, the person continues to be quarantined. “He shall remain unclean as long as he has the disease…he shall live alone; his dwelling shall be outside the city.”1 It was the priest’s responsibility to consider possible contamination and to protect the health of the community.

Similarly, medieval Islamic physicians quarantined patients in bimaristans, “houses [or place] of the sick” that doubled as teaching hospitals. Umayyad Caliph Al-Walid ibn Abd al-Malik built a bimaristan in ca707 CE to treat ailments from blindness to leprosy, quarantining those with infectious diseases.2 The Islamic prophet Mohammad stated, “If you hear of an outbreak in a land, do not enter it; but if a plague outbreaks in a place while you are in it, do not leave that place.”3

The height of the bubonic plague pandemic occurred in the 14th century in Europe and Great Britain; to protect its city, the Venetian State Council mandated a 40-day quarantena for all ships and their crews, passengers, and cargo, hence the origin of the word “quarantine.”4 Other maritime ports also established lazarets, or quarantine stations, named after the beggar Lazarus, the patron saint of lepers.4

The plague recurred periodically, especially in the 1600s. In an attempt to reduce fatalities and to protect surrounding areas, the villagers in Eyam in central England voluntarily quarantined themselves in 1666. Rector William Mompesson persuaded his parishioners that no one was to enter or leave the village, and that the Earl of Devonshire, who lived nearby, would provide food and supplies if the quarantine held fast. “It’s remarkable how effective the isolation was in this instance,” commented Dr. Michael Sweet of the University of Derby.5 Though nearly a third of the villagers died, apparently very few broke the cordon sanitaire, thereby saving unknown hundreds of lives in the surrounding towns. “Plague stones” that marked the boundary of the village are still visible today. Mike Gilbert, the current rector of Eyam, has read Mompesson’s letters and admires his fortitude in the face of death. “He was scared but he did it all the same…I suspect fear stalked [the villagers] every day of their lives at the time.”5

During the 18th and 19th centuries, people worldwide were routinely quarantined during outbreaks of cholera, smallpox, yellow fever, etc. One notorious case of extensive isolation was that of Mary Mallon, an asymptomatic carrier of typhoid in the early 1900s. Families in New York for whom she had worked as a cook became ill with typhoid fever; health officials tracked the outbreak to Mallon, who was uncooperative. She wasn’t sick, she pointed out, so how could she have infected others? Eventually released from confinement, she began working again under an assumed name. Typhoid fever followed. She was once again apprehended, and “Typhoid Mary” spent the last 23 years of her life under quarantine on North Brother Island.6

Typhoid Mary Newspaper Image. Wikimedia Commons

Paranoia strikes deep
Into your life it will creep

It isn’t paranoia if something really is out to get you. People frightened of COVID-19 did—and do–stay home. This coronavirus devastated Italy early; officials mandated social isolation for weeks, closing bars, restaurants, schools, most businesses. Other European countries soon followed that lead, except for Sweden, whose leaders depended on achieving “herd immunity” through natural exposure. Most countries around the globe closed their borders. The United States lagged behind in requiring domestic social isolation; health officials recommended that persons having to leave home should practice social distancing with face coverings, although many political leaders eschewed that advice. It’s only science.

Technically, quarantine differs from social isolation. During quarantine, people who are contagious are isolated from others; a stay-at-home mandate isolates everyone irrespective of whether they are ill. Nevertheless, the term “quarantine fatigue” began to be used to describe the claustrophobic feelings people experienced after months of lockdown.

What is the effect of continuous social isolation?

I felt a cleaving in my mind–
As if my brain had split–
I tried to match it–seam by seam–
But could not make them fit.
The thought behind I strove to join
Unto the thought before–
But sequence raveled out of reach
Like balls–upon a floor.7

Harvard Medical School epidemiologist Julia Marcus points out, “Quarantine fatigue is real. In addition to the economic hardship it causes, isolation can severely damage psychological well-being, especially for people who were already depressed or anxious before the crisis started.”8 She does warn that “the choice between staying home indefinitely and returning to business as usual now is a false one.”8 As the United States learns to live with the pandemic, people can differentiate between low-risk and high-risk activities, following the recommendations of health care professionals. Dr. Marcus offers suggestions to mitigate risk: (1) redesign indoor and outdoor space to reduce crowding, increase ventilation, and promote physical distancing; (2) health experts should recognize people’s need for human contact; (3) the public needs to accept that some people will choose to participate in high-risk activities, and that shaming them will not work.8

Behavioral health therapist Jane Pernotto Ehrman agrees that quarantine fatigue is “overwhelming, and part of the fatigue is the uncertainty, unpredictability, and the unknowns in all of this…It’s like we’re in the middle of the ocean. The ocean is COVID-19, and we’re not seeing land anywhere. It’s that feeling of helplessness.”9 The situation is almost surrealistic. Belgian painter René Magritte’s 1928 painting The Lovers could be interpreted as capturing the feeling of disorientation produced by quarantine fatigue caused by social isolation.

René Magritte. The Lovers I. 1928. Australian National Gallery.

Magritte’s surrealistic paintings portray ordinary objects placed in disturbing situations, juxtaposing reality with fantasy. In this painting, a man and a woman stand close together, in a clearly affectionate pose. The background is a verdant landscape in soothing shades of green and blue. They could be taking seriously the advice of healthcare officials with regard to COVID-19; their face coverings are literally that—shrouds that cover their faces. The painting seems to suggest that regardless of the personal feelings of the couple, fate may have other plans for them.

Stop, children, what’s that sound
Everybody look what’s going down

If months of quarantine feel surrealistic to adults, imagine the toll social isolation takes on children. Having to stay inside the house day after day after day grows old, but public health demands that the spread of the coronavirus be checked. After some weeks of being housebound, a couple took their young kids on a family hike in the woods. “The kids were so happy to be outside they almost cried,” the mother reported.10

Lydia Denworth writes in The Atlantic, “Time with other children is a crucial piece of growing up. Relationships with peers are how kids learn about cooperation, trust, and loyalty, as well as how to not just receive support from their parents, but also give it to others…millions of children are missing out on friendship.”11 She is particularly concerned with the reopening of schools; more waves of infection could continue to disrupt on-campus learning with peers. In her article in the Wall Street Journal, Andrea Petersen agrees, “Children gain critical life skills from spending time with their peers.”12 She describes what children learn by age: preschoolers learn how to regulate emotions and behavior, how to negotiate and cooperate with others; children in elementary school learn how to manage conflict, how to handle winning and losing, and how to see the perspective of others; teenagers learn how to give and receive social support, how to manage issues of intimacy and boundary setting.12 Both authors propose engaging in low-risk in person gatherings without social distancing, perhaps outdoor playdates with a close friend.

Bruce Feiler describes a destabilizing event like a pandemic as having three distinct emotional phases: the long goodbye, the messy middle, and the new beginning.13 At the outset of the COVID-19 pandemic, people said goodbye to “normal life” as quarantine set in. Feiler proposes that accepting disquieting emotions is a healthy way to cope with the grief of losing the security of normal life. The United States seems to be in the messy middle stage now—disorienting and disheartening. Feiler suggests, “…meaningful breakthroughs [can] occur during periods of disconnection.”13 Therapist Jane Ehrman echoes that sentiment, as she understands that people are now facing difficult circumstances, but that focusing on the future in positive ways can address worrying.9

Feiler’s third phase—the new beginning—hasn’t happened yet, at least in the United States. Ehrman states, “A common wish is for things to “go back to normal,” but “Normal is going back to the illusion of life rather than living with the truth…all [we] can do is take the wisdom and insight from what happened and move forward.”9 As Feiler optimistically points out, “A transition is the slow effortful process of turning the cacophony of a lifequake into the melody of everyday life…unsettled states are healing periods that take the wounded parts of our lives and begin to repair them.”13



REFERENCES

Song Lyrics: “For What It’s Worth.” Buffalo Springfield. 1967. Lyrics written by Stephen Stills. © Warner Chappell Music, Inc., Royalty Network, Warner Chappell Music Inc.

  1. Coogan MD, ed. The new Oxford annotated Bible; new revised standard version with the Apocrypha. 4th ed. Oxford: Oxford University Press, 2010.

  2. Edriss H, Rosales B, Nugent C, et al. Islamic medicine in the middle ages. Am J Med Sci 2017;354(3):223–229.

  3. Considine C. Can the power of prayer alone stop a pandemic like the coronavirus? Even the prophet Muhammad thought otherwise. Newsweek. March 17, 2020. https://www.newsweek.com/prophet-prayer-muhammad-covid-19-coronavirus-1492798

  4. Mayer J. The origin of the word ‘quarantine.’ Science Diction. Sept. 4, 2018. https://www.sciencefriday.com/articles/the-origin-of-the-word-quarantine/

  5. McKenna D. Eyam plague: the village of the damned. BBC News. Nov. 5, 2016. https://www.bbc.com/news/uk-england-350640715.

  6. Dominguez C. Typhoid Mary and the public’s right to health. Broadstreet Mag. Feb. 16, 2015. http://broadstreetonline.org/2015/02/typhoid-mary-and-the-publics-right-to-health/

  7. Dickinson, E. I felt a cleaving in my mind. In Matthiessen FO, ed. The Oxford Book of American Verse. New York: Oxford University Press, 1950.

  8. Marcus J. Quarantine fatigue is real. The Atlantic. May 11, 2020. https://www.theatlantic.com/ideas/archive/2020/05/quarantine-fatigue-real-and-shaming-people-wont-help/611482/

  9. Are you experiencing coronavirus fatigue? Cleveland Clinic. May 14. 2020. https://health.clevelandclinic.org/are-you-experiencing-coronavirus-quarantine-fatigue/

  10. Personal correspondence with the author.

  11. Denworth L. What happens when kids don’t see their peers for months. The Atlantic. June 24, 2020. https://www.theatlantic.com/ideas/archive/2020/05/quarantine-fatigue-real-and-shaming-people-wont-help/611482/

  12. Petersen A. The toll that isolation takes on kids during the coronavirus era. The Wall Street Journal. June 15, 2020. https://www.wsj.com/articles/the-toll-that-isolation-takes-on-kids-during-the-coronavirus-era-11592236617

  13. Feiler B. Learning to conquer life’s crises. The Wall Street Journal. July 11, 2020.



Keywords: quarantine, social isolation, COVID-19, surrealism, René Magritte, Typhoid Mary
Article citation: Nugent C. Quarantine. The Southwest Respiratory and Critical Care Chronicles 2020;8(35):68–71
From: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
Submitted: 7/10/2020
Accepted: 7/12/2020
Conflicts of interest: none
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.