Analysis. Quarantines were historically employed to single out certain people and social groups, one among many devices used by those in power. China's quarantine of 56 million people to contain the coronavirus outbreak is a test of power.

The high-stakes quarantine of 56 million people, the largest in history

In terms of sanitation measures, “Made in Italy” has been a brand recognized since 1370. At that time, the custom of secluding goods and people suspected of infection for 40 days was first established in Venice, the origin of the word “quarantine” and of the practice which spread everywhere.

It was a measure that developed independently of the modern ideas about contagion introduced by Pasteur: whatever the vector of the disease was thought to be (whether harmful miasmas of different origins and natures or invisible living beings), isolation was experimented with in all its forms.

Ships would be stopped before entering port, or the sick would be transported to places outside the city (not hospitals for treatment, but lazarettos, simple living places). With the evolution of knowledge, quarantine became more and more scientific, but with continuing ties to political and economic considerations, often based on the nationalities of doctors and of those suspected of infection.

On the large ships arriving from the East, the major Italian ports—Naples, Brindisi, Genoa, Palermo—would scrutinize both goods and passengers, but the ”high class” passengers who had purchased a first- or second-class ticket were exempt. The others could end up segregated on the ships and their personal belongings thrown into the sea (an older alternative to autoclave sanitation, used in ports all over the world to eliminate everything that might be infected: mattresses, pillows, blankets, etc.).

Archival documents tell of the “confidential” interventions of ambassadors with port authorities to hurry the health inspections, which could slow down the movement of goods and people. While there was already talk of globalization as early as the 19th century, it should be stressed that health measures were often used to “globalize” the elites and their interests: in fact, quarantines were employed to single out certain people and social groups, one among many devices used by those in power.

All these issues are raised once again by what has been called the largest quarantine in history. The more than 56 million people isolated in China due to the latest coronavirus outbreak represent an enormous test of the power of the Chinese government over its citizens (conscious of it or not).

The economist Carlo Cipolla recounted how the 17th century epidemics around Florence represented a locus of great conflicts of interest: in the face of attempts to quarantine the villages of the Valdarno, there were some who were breaking open the city gates at night. Will the same thing happen in Wuhan? For now, the images are showing a ghost town, empty of people, but it’s difficult to predict the impact of the coercive measures.

Historically, we know that whenever the borders are closed, there are attempts to escape (with the risk of an “invisible” spread of the disease). Moreover, a quarantine not supported by adequate health care condemns those being isolated to a high risk of infection. Faced with this threat, the authorities have to walk a fine line to avoid either overestimating or underestimating the risks.

What is crucial, as we learned at our own expense around a century ago, is the circulation of information and an equal level of cooperation between all those involved. That was the lesson of the “Spanish flu” epidemic, which killed tens of millions of people around the world between 1918 and 1919 (a precise estimate is impossible to give, but the death toll was somewhere between 50 and 100 million).

The name of that pandemic arose from the fact that Spain, which was not involved in the First World War, did not have the same severe censorship measures that had been applied elsewhere. While the news broke out from Madrid, the contagion spread via the military and the great movements of people that the war caused. 

As the historian Eugenia Tognotti has shown, the virulence of the disease was compounded by the chaos, both nationally and internationally. Troops were moving to and from the front lines and were held in camps, soldiers went back to their homes on leave, prisoners of war were continuously moved, and a compounding factor was the secrecy demanded by the military authorities in order to avoid circulating information that might be useful to the enemy. Military healthcare officials were not quick to pass information on to the civilian health authorities. 

While the real numbers of those infected were being hidden by all the armies, governments even censored public displays of mourning so as not to upset the morale of the population, and medical certificates did not always contain truthful information.

Fortunately, so far, the Chinese coronavirus is not comparable to the terrible flu of 1918. However, cooperation is still the key to fighting a possible epidemic.

The decision to offer free access to publications and share the results of research is a good first step, but an international cooperation plan for the circulation and control of data must also be put into place, in order to actually enable supranational health authorities to make a correct assessment of the risks.

As in the past, this is a question of renouncing certain prerogatives of national sovereignty in exchange for greater global security. However, in the past, sovereignty was often renounced only by those who were already in a weak position: for instance, in Italy at the beginning of the 20th century, there were US doctors present to inspect those who wanted to emigrate. The hope now is that no such obstacles will arise, either on account of national pride or economic policy. In such matters, a mistake would be unforgivable and might lead to a tragic outcome.

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