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Macmillan Childrens Publishing Group

Until Proven Safe

The History and Future of Quarantine

Geoff Manaugh and Nicola Twilley; read by Kristen DiMercurio

Macmillan Audio

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PART I

ENCOUNTERING UNCERTAINTY


1


The Coming Quarantine


On March 6, 2020, a King County, Washington, health department van pulled up in front of an Econo Lodge motel outside Seattle. An employee clad in white coveralls hopped out, grabbed tools from the back of his van, and proceeded to paint the motel’s still-glowing sign pitch-black. The red and yellow colors of the chain’s familiar logo quickly disappeared, replaced by a matte-black rectangle that loomed over the street like a pirate flag. Ominous, deathly, its former welcoming light now extinguished, the motel had become a quarantine facility.

The lo-fi nature of the motel’s transformation was an unsettling indicator of just how improvised and ad hoc quarantine preparations seemed to be when a new infectious disease—known as COVID-19—first arrived in the United States. As this novel coronavirus spread exponentially and hospital beds filled up, public health officials realized that they had nowhere to put people who could not quarantine at home.

Instead, buildings such as this roadside motel—purchased by Washington State health officials for $4 million—were hastily retrofitted, becoming part of the nation’s emergency medical infrastructure overnight. In this case, the motel’s rooms were already equipped with independent HVAC units, doors that opened to the outside, and seamless, easy-clean floors. All it took to complete the transformation was a coat of black paint.

* * *

That same week, a friend of ours invited us to join an international preppers’ list hosted on the encrypted communication app Telegram. The purpose of the list was allegedly to help its members prepare themselves and their families for what appeared to be an imminent national lockdown; there were tips for securing enough toilet paper, advice on baking bread, and tales of making a first-time handgun purchase.

In the many thousands of messages hosted by the group, posted by often-anonymous users from around the world, we saw a sign of things to come in terms of public perception of the coronavirus pandemic. Some members wondered aloud about imaginary connections between COVID-19 and 5G wireless technology; others began formulating a muddled conspiracy theory in which the billionaire Bill Gates planned to use a future vaccine to inject electronic nanoparticles into human subjects against their will. If there was any doubt that global health authorities had lost control of the information war before the pandemic had even really started, this Telegram group quickly dispelled it.

More striking to us than the group’s embrace of misinformation and conspiracy theories was the profound, almost palpable fear of a coming quarantine. For members based in the United States—a country whose popular identity has been constructed around notions of freedom of movement and individual liberty—political fears of government overreach became fused with the morbid dread of a global plague. Every day, it seemed, the looming specter of quarantine crept closer, depicted as a dictatorship of doctors in which we would all be considered infectious until proven safe.

By this time, China was already several weeks into its own mass lockdown aimed at containing the novel coronavirus; tens of millions of people had been quarantined for potential exposure to COVID-19, entire cities forcibly isolated from the rest of the world. A popular view emerged in Western media during those early weeks that only an authoritarian government such as China’s could even attempt such a thing.

Skepticism about U.S. quarantine capabilities was, in fact, warranted: as cases of the virus began to grow in number, the nation’s permanent federal quarantine infrastructure consisted of just twenty inspection stations at international airports around the country and a brand-new, twenty-bed unit in Omaha, Nebraska. This, the nation’s only federal quarantine facility, barely opened in time for COVID-19: after a lengthy construction process, it became operational on January 29, 2020. Nevertheless, nightly news reports and incendiary social media posts only confirmed for many members of this Telegram group that mass quarantine was imminent. Convinced that the government exercise of such extraordinary powers was potentially illegal and certainly un-American, they readied themselves to resist.

Even Chinese authorities seemed caught off guard by the scale of COVID-19. The New York Times described efforts to isolate or quarantine people in the city of Wuhan—where the disease is believed to have originated—as a “mass roundup” marked by “chaos and disorganization.” Public health authorities were “haphazardly” gathering up “sick patients, in some cases separating them from their families.” Family members and close contacts of confirmed cases were also dispatched into centralized quarantine and observation facilities—primarily existing buildings, including stadiums, convention centers, and schools that had undergone emergency conversion into strange new types of frontline medical infrastructure.

Among these were so-called fever buildings and fangcang hospitals. Fangcang—a name that in Chinese is a homophone for “Noah’s ark”—were large temporary hospitals, often retrofitted sports and exhibition centers, to which people with mild or asymptomatic cases of COVID-19 could be sent, to isolate them from the community while supplying them with food, shelter, and social activities. Fever buildings were their dark cousins: entire housing complexes in which so many inhabitants had contracted the virus that authorities simply put a cordon around the entire structure. Large signs affixed outside warned healthy people to stay away. When converted facilities were not sufficient for the detention of tens of thousands of people suspected of exposure to COVID-19, however, China’s famously efficient construction industry clicked into gear. In one case, a sprawling thousand-bed hospital made from modular architectural units was assembled in only ten days by workers continually checked for symptoms of coronavirus infection.

For the historically minded, these sights resonated with medical efforts of the past; the implementation of quarantine and isolation has always been a stimulus for creatively rethinking the built environment. For centuries, pandemic disease has inspired people to find new uses for old buildings or to invent new structures altogether. In sixteenth-century England, following ordinances proclaimed by King Henry VIII, the houses of people in quarantine had to be marked with long white poles attached to the exterior walls, like the quills of a porcupine, with clumps of straw or hay attached to the ends. These functioned as highly visible warning signs as well as inconvenient physical obstacles, encouraging pedestrians and carriages to avoid certain streets altogether.

In Venice, Italy, toward the end of the 1500s, the houses of the quarantined were also marked and labeled with prominent warning signs, including wooden crosses, then boarded up and locked from without to prevent potentially infected inhabitants from breaking free. Commentators at the time described feelings of horror as they gazed upon thousands of homes forcibly shuttered around the city, many of them with people still inside.

Families stuck behind the bright yellow plastic barriers that snaked through Wuhan, cutting neighborhoods off from one another, must have felt similarly trapped. For apprehensive members of our Telegram group, the scale and rapidity of this official Chinese response was not inspiring; it was frightening. Were mass roundups, quarantine camps, and forced hospitalizations on their way to the United States?

The group’s mood grew darker as news emerged from beyond China’s major population centers. Linking to stories both reported and conspiratorial, members noted that Chinese villagers had begun using heavy construction equipment and agricultural machines to block roads into and out of town, enforcing their own makeshift lockdowns. Reuters described these as “vigilante” quarantines, thrown together with caution tape and cinder blocks, more Mad Max than World Health Organization (WHO). Commuters, stranded in their cars, were forced to sleep behind the wheel, alone, with neither food nor access to their homes and families. As human mobility ground to a halt, even the circulation of money and mail was affected: the People’s Bank of China instituted fourteen-day quarantines for banknotes from virus-stricken areas, while China Post announced it would quarantine envelopes and packages, delivering them only once transportation corridors could be reopened.

Then, just a couple of days after the Seattle Econo Lodge sign was painted black, the global dam seemed to break. Cases of COVID-19 began popping up everywhere, in South Korea, Iran, and Israel, in London and New York City.

Italy announced plans to lock down the entire region of Lombardy, in the country’s wealthy north. In U.S. media, this was all but confirmation that, for whole swaths of the country, from the Pacific Northwest to Texas, the clock was ticking. “Italy has been plunged into chaos,” The Guardian wrote, describing the country’s attempt to quarantine sixteen million people overnight. TV footage of commuters sprinting through railway stations, attempting to catch the last trains out of town, desperate to reunite with their families, captured an anxiety bordering on terror. We would later learn that as many as thirty thousand students boarded trains, hoping to return to their families in Italy’s south before the lockdown began. Upon arrival, these students were greeted by police-assisted teams of epidemiologists who ordered them directly into quarantine. “We know your name,” the police said to each student, according to Dr. Luigi Bertinato, the lead scientific advisor to Italy’s national COVID-19 response team. “We know where you live. We will check on you.”

What such footage also showed is that, when faced with an imminent quarantine order, large portions of a targeted population are almost guaranteed to flee, sometimes carrying the disease with them, seemingly invalidating the purpose of the intended lockdown in the process. Several weeks earlier, as many as five million people had fled Wuhan in anticipation of lockdown measures; many of those five million went straight to crowded megacities, such as Beijing or Shanghai, or flew halfway around the world to destinations in Europe and North America, potentially seeding further outbreaks when they arrived. Quarantines are often compromised before they even begin: their threat alone can drive a disease underground, making its spread harder to track, let alone control.

Indeed, when the Trump administration abruptly announced an impending closure of the U.S. border to European arrivals in mid-March, it precipitated a reverse-rush of travelers back into the United States. Tens of thousands of people, afraid of being cut off from their homes and families for an indefinite period of time in the middle of a global pandemic, spent thousands of dollars apiece on emergency return tickets, sometimes canceling nonrefundable hotel reservations and other travel plans at enormous personal expense.

Writing in The Washington Post about her own experience, Cheryl Benard, a former health analyst for the RAND Corporation, described flying home to Washington, D.C., on a one-way flight from Vienna as “a case study in how to spread a pandemic.” Benard found herself standing in a packed international-arrivals hall at Dulles airport for hours, with no space between travelers—let alone between long lines of people known to be infected with COVID-19. “When I asked a security guard about the other lines,” Benard wrote, “he told me they were for people with a confirmed corona diagnosis. There was no separation for this group—no plastic sheets, not even a bit of distance. When your line snaked to the left, you were inches away from the infected.”

To the horror of our Telegram group, the Italian government suspended parts of the country’s constitution, enabling the expansion of quarantine orders to include the entire nation. Macabre details began to surface as the lockdown intensified. Among the eeriest of these was the story of Luca Franzese, a Neapolitan forced to quarantine at home with the corpse of his own sister, who had died of COVID-19. With local funeral homes refusing to take her body out of fear of contagion, Franzese found himself living alongside her remains for two horrific days. “Franzese posted an emotional appeal to his followers on Facebook,” The Washington Post reported, “urging them to take the virus seriously as he stood in the same room where his sister lay dead in the background. ‘We are ruined,’ he said. ‘Italy has abandoned us.’”

Equally chilling reports emerged of elderly and vulnerable populations locked at home without adequate food or medication, and women and children trapped indoors with only their abusers for company. “Many women under lockdown for #COVID19 face violence where they should be safest: in their own homes,” António Guterres, the secretary-general of the United Nations, tweeted in early April. “Today I appeal for peace in homes around the world.”

Meanwhile, with Chinese authorities reporting that their own outbreak seemed to be under control, Asians of all ethnicities living in Australia, Europe, and the United States found themselves shunned by their fellow citizens, banned from entering businesses, and accused of importing the coronavirus. These racist attacks ranged from verbal abuse—President Donald J. Trump insisted on referring to COVID-19 as the “Chinese virus,” and, later, “kung flu”—to physical attacks. In Midland, Texas, a Burmese American father and his sons were stabbed while shopping at a Sam’s Club; their attacker explained that he thought they were Chinese and that he was trying to stop them from spreading coronavirus in the community.

By late March, restaurants, cinemas, gyms, and schools across the United States began to close. Panic-shopping and toilet-paper hoarding kicked into high gear; fights broke out in supermarkets and big-box stores, requiring police intervention, with security guards forced to separate families battling over Clorox and Cottonelle. In Tennessee, a young man stockpiling hand sanitizer had his storage unit raided by police, his antibacterial hoard confiscated and donated to a needy public. Luxury quarantine schemes began to appear online, advertising accommodation in the California desert for people rich enough to escape an infected world. Even listings on mainstream travel websites, such as Travelocity and Airbnb, were hastily rewritten to entice people looking for a comfortable place to quarantine, now emphasizing a destination’s cleanliness and distance from its neighbors. Unusual new phrases—“social distancing,” “managed isolation”—became ubiquitous, describing efforts to avoid other people.

Here where we live in Los Angeles, temporary lines of colored tape appeared everywhere, marking safe places to sit or stand in public. The interiors of grocery stores were rearranged so that customers could maintain distance as they bulk-bought pasta. We found ourselves living under a stay-at-home order, marveling at the terrible irony of finishing a book about quarantine while in a state of medical lockdown.

Of course, none of these public health guidelines would have amounted to much if no one had been willing to enforce them. Sometimes, these efforts provided a surreal kind of comic relief: in late March, as the country entered its second week of lockdown, Italians circulated supercuts of their mayors berating them for leaving home. “Where are you going with these incontinent dogs?” yelled Massimiliano Presciutti, the mayor of the picturesque Umbrian hill town of Gualdo Tadino, in a video posted to Facebook. “People are dying, don’t you get it?” Dog walking was one of the few activities for which Italians were allowed to go outside, a loophole that quickly resulted in an underground pet-rental economy and some seriously pooped pooches.

As economic and social disruption from the coronavirus grew, The Washington Post warned that “under all kinds of political systems, governments are turning to increasingly stringent measures—and deploying their armed forces to back them up.” They were not referring to just official armed forces. In a Rio de Janeiro favela known as the City of God, gangs began imposing their own quarantine restrictions, ordering people to stay at home if they thought they or their families had been exposed. Brazil’s president, Jair Bolsonaro—who would later test positive for the coronavirus—infamously refused to mount a national response to COVID-19, rejecting all scientific guidance around masks, economic shutdowns, and quarantines. Everyday Brazilians were left to fend for themselves.

In Japan, so-called virus vigilantes took quarantine into their own hands, dumping thumbtacks on the street to pop the tires of potentially infected cyclists attempting to bike through neighborhoods where they didn’t belong, and scouring cities for cars with out-of-town registration details. The ominous, increasingly sci-fi outlines of a looming dystopia, in which individual liberties were subsumed by medico-political constraints, continued to emerge. China—then Italy, Spain, and France, to name but three—began buzzing law enforcement drones over the heads of residents ignoring lockdown orders. Drone-mounted speakers blared demands that people immediately turn around and go home. Food-delivery robots went from high-tech curiosity to pragmatic logistical infrastructure almost overnight, in the process offering a glimpse of the fully automated quarantines likely to come in the near future. In India, doctors began stamping mandatory stay-at-home orders directly onto people’s forearms with indelible ink; for some commenters in our group, this was uncomfortably close to the Nazi use of tattoos to mark concentration camp detainees in World War II.

When an op-ed came out in The Washington Post soon thereafter demanding that Trump institute widespread spatial controls on the movements of American citizens—imploring, “Mr. President, lock us up!”—many members of our Telegram group felt not just betrayed but endangered. They seemed less fearful of the disease, we noted, than of the tactics that might be used to protect them from it, a response that would become only more common—and more life-threatening—as the long, terrible year of 2020 dragged on.

It should have come as no surprise by then that cases of the coronavirus would rapidly multiply throughout the United States. For all that they had seen unfold over the past few weeks in China—a lengthy head start during which they could have distributed personal protective equipment (PPE) and built a robust coronavirus-testing infrastructure—U.S. authorities were shockingly unprepared. In fact, an attempt to designate six major ports of entry as “sentinel cities,” using enhanced surveillance to provide early warning of the disease’s movements, failed almost immediately because tests produced and distributed by the Centers for Disease Control and Prevention (CDC) proved unreliable.

In the absence of any coherent direction from the Trump administration came public reliance on misinformation and widespread distrust of official guidance from the WHO or the CDC. Some of our Telegram list members claimed that, in Iran, families were being welded inside their own homes; the only proof of this brute-force quarantine was grainy, unsourced footage depicting someone using an acetylene torch at night (supposedly somewhere in Tehran). Other members insisted that, in China, married couples had begun committing suicide together, leaping to their deaths from apartment windows, driven mad by hunger and isolation. In these cases, too, unverified smartphone video clips lacking dates or geographic context were the only evidence. In one unfortunate instance, an image taken from a recent science fiction film was misidentified as a scene of authoritarian quarantine taking place on a highway somewhere outside Moscow.


Copyright © 2021 by Geoff Manaugh and Nicola Twilley