A quarantine is a temporary “time-out” for people, animals or things to stop germs from spreading. It includes separating exposed well persons from those who are ill, providing care and essential services to all while protecting their “due process” rights, and restricting their movement to ensure that they do not spread the disease to others. Quarantine has been used throughout history, beginning in colonial America during the smallpox outbreak, and it is reflected in many national landmarks including Bedloe’s Island, the Philadelphia Lazaretto, and the Columbia River Quarantine Station.
Although it is an important tool for controlling infectious diseases, it is not always feasible or effective. It is a blunt instrument and has limitations that must be carefully considered when deciding when to use it. During early stages of the SARS and Ebola outbreaks, the causative agent of the disease was unknown, and it was difficult to predict the duration of communicability, mode of transmission and incubation period. Using the precautionary principle, public health officials placed large numbers of people in quarantine in these situations.
The use of quarantine in these circumstances is associated with significant psychological and financial harms for people who are confined to isolation. There is moderate COE that adherence to quarantine measures can be improved through various implementation strategies such as risk communication and messaging and access to employment leave. However, most studies on these outcomes are of low quality, cross-sectional in design, conducted months after the intervention, and use a range of subjective rather than objective measures.