Past the Virus - Containing Pandemics Throughout History 

The history of pandemics is rife with examples of how the past informs the way we respond to health crises today. In March 2020, the world went into lockdown, but similar measures have been used before, with effects that are not unlike those we are experiencing today under Covid-19. In this second episode of the Past the Virus series, Dr. Eugenia Tognotti, researcher and medical historian, dives into the history of curfews, lockdowns and other forms of movement restrictions as ways of containing the major viral outbreaks of humankind.

According to the historians of antiquity, one of the first measures implemented to fight a pandemic dates back to the Byzantine Emperor Justinian. He imposed isolation for both travelers and food coming to Constantinople from North Africa, hit by the terrible plague outbreak (541-542 A.D). 
 
Over the centuries and up to Covid-19, every pandemic has led to a limitation of rights and freedoms, although to varying degrees. The responses to public health emergencies have evolved and adapted throughout history. But it is really the bubonic plague of the 14th century that set a precedent in the elaboration of a coherent model, which was then perfected in the following centuries. Given the lack of medical efficacy at the time, the only way to keep the plague under control and to limit its spread was a complex and articulated system of quarantines (quarantine stations in isolated little islands, in mainland buildings or in ships at anchor for maritime travellers), cordons sanitaires, the isolation of the contaminated in lazarets, fumigation and disinfection, and the regulation of social categories at risk. Freedom of movement was only granted to those who obtained "a sanitary certification" from the authorities. In Venice, foreigners and passengers coming on ships needed to show a "certificate", to prove that they came from contagion-free places. In times of plague or cholera those who entered the cities were obliged to present a "health certificate" ("Patente di sanità") to the authorities. The idea is not too different from today’s EU Digital Green Certificate. These measures, although with some adaptations, were also put in place during the yellow fever epidemic in the US at the end of the 18^th century and the cholera outbreaks in Europe in the first half of the 19th century. 

Isolation, separation, and social control were key tactics during major epidemic emergencies. Through a reorganization of the urban space, the healthy and the sick were separated. Hospitals, lazarets and "isolated areas" became familiar territories for those who had come into contact with the infected, or who came from a contaminated place. The houses where plague cases broke out had to be seized and supervised by armed guards. No one could enter or leave, apart from priests, midwives and doctors, who generally entered homes covered in a large waterproof hooded tarpaulin, long sleeves, gloves and boots. During a cholera outbreak rooms and objects belonging to the sick had to be disinfected with chlorine fumigations - a practice that is not unlike our daily sanitizing habits in the time of Covid-19. The sanitary regulation of the Kingdom of the Two Sicilies, put in place to deal with the cholera pandemic of 1835-36, called for the closure of boarding schools, monasteries, convents, prisons and military lodgings. Convening in the streets was prohibited. The rules of safety and urban control were strengthened on inns, taverns and accommodation of any kind. A curfew was also introduced: no one could move around the city at night. If a person had to do so out of necessity, they were obliged to move about with a lit lantern. 
There was also an important social dimension at the cornerstone of emergency responses. Access to the city was only allowed for the wealthy - homeless people and prostitutes were considered to be carriers of disease. The poor thus had to be controlled.

Quarantines, sanitation and other protective measures were also implemented in Russia, Great Britain and the United States during the second cholera pandemic (1826-37). A rapid spread of an epidemic disease naturally required quick and firm action by the authorities, including prompt mobilization of the State's repressive police force. 

Who Were the Public Measures For? 

Over centuries of health crises, governments have had to enforce quarantine measures, social isolation and other non-pharmaceutical interventions (NPIs), as they were lacking vaccines and drugs. During the 1918 flu, schools, churches, theaters and spaces for public gatherings were closed. In Philadelphia, where the yellow fever hit, the city mostly shut down and quarantined the ill in their homes. A century later, the strategy against the spread of Covid-19 around the world also relied on NPIs: bans on social events and gatherings, a hiatus in national and international travel, school closures, remote working, the closure of theaters and restaurants, national and regional lockdowns and curfews.