Quarantine

==Ethical and practical considerations==
The quarantining of people often raises questions of [[civil rights]], especially in cases of long confinement or segregation from society, such as that of [[Mary Mallon]] (also known as Typhoid Mary), a [[typhoid fever]] [[Asymptomatic carrier|carrier]] who was arrested and quarantined in 1907 and later spent the last 23 years and 7 months of her life in medical isolation at Riverside Hospital on [[North and South Brother Islands, New York City#North Brother Island|North Brother Island]].<ref>[http://broadstreetonline.org/2015/02/typhoid-mary-and-the-publics-right-to-health/ "Typhoid Mary and the Public's Right to Health,"] ''Broad Street Magazine,'' 16 February 2015, 12:37 pm</ref><ref>[http://time.com/3474945/politics-quarantines-typhoid-mary-ebola/ Mary Beth Keane, "The History of Quarantine Is the History of Discrimination,"] 6 October 2014 ''Time Magazine,'', accessed 5 February 2020</ref>

===The United Nations and the Siracusa Principles===
Guidance on when and how human rights can be restricted to prevent the spread of infectious disease is found in the [[Siracusa Principles]], a non-binding document developed by the [[Siracusa International Institute for Criminal Justice and Human Rights]] and adopted by the [[United Nations Economic and Social Council]] in 1984.<ref>[http://www.unhcr.org/refworld/docid/4672bc122.html United Nations Economic and Social Council UN Sub-Commission on Prevention of Discrimination and Protection of Minorities, "The Siracusa Principles on the limitation and derogation provisions in the International Covenant on Civil and Political Rights," Section I.A.12 UN Doc. E/CN.4/1985/4, Annex. Geneva, Switzerland: UNHCR; 1985.] ''www.unhcr.org'', accessed 5 February 2020</ref> The Siracusa Principles state that restrictions on human rights under the [[International Covenant on Civil and Political Rights]] must meet standards of legality, [[evidence-based practice|evidence-based necessity]], proportionality, and gradualism, noting that public health can be used as grounds for limiting certain rights if the state needs to take measures 'aimed at preventing disease or injury or providing care for the sick and injured.' Limitations on rights (such as quarantine) must be 'strictly necessary,' meaning that they must:
* respond to a pressing public or social need (health)
* [[Proportionality (law)|proportionately]] pursue a legitimate aim (prevent the spread of infectious disease)
* be the [[least restrictive means]] required for achieving the purpose of the limitation
* be provided for and carried out in accordance with the law
* be neither arbitrary nor discriminatory
* only limit rights that are within the jurisdiction of the state seeking to impose the limitation.<ref>{{Cite journal |pmc = 4463097|year = 2013|last1 = Todrys|first1 = K. W.|title = Failing Siracusa: Governments' obligations to find the least restrictive options for tuberculosis control|journal = Public Health Action|volume = 3|issue = 1|pages = 7–10|last2 = Howe|first2 = E.|last3 = Amon|first3 = J. J.|pmid = 26392987|doi = 10.5588/pha.12.0094}}</ref>

In addition, when quarantine is imposed, public health ethics specify that:
* all restrictive actions must be well-supported by data and [[scientific evidence]]
* all information must be made available to the public
* all actions must be explained clearly to those whose rights are restricted and to the public
* all actions must be subject to regular review and reconsideration.

Finally, the state is ethically obligated to guarantee that:
* infected people will not be threatened or abused
* [[basic needs]] such as food, water, medical care, and preventive care will be provided
* communication with loved ones and with caretakers will be permitted
* constraints on freedom will be applied equally, regardless of social considerations
* patients will be compensated fairly for economic and material losses, including salary.<ref>M. Pabst Battin, Leslie P. Francis, Jay A. Jacobson, ''The Patient as Victim and Vector: Ethics and Infectious Disease,'' Oxford University Press, 2009. {{ISBN|019533583X}}</ref>

===Psychological impact===
[[File:Bell System Flu Quarantine.png|thumb|High tech communication brings cheer and encouragement]]
Quarantine can have adverse psychological effects on the quarantined, including [[post-traumatic stress]], confusion, and anger. According to a "Rapid Review" published in [[The Lancet]] in response to the [[COVID-19 pandemic]], "Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable."<ref>{{cite journal|doi=10.1016/S0140-6736(20)30460-8|title=The psychological impact of quarantine and how to reduce it: Rapid review of the evidence|year=2020|last1=Brooks|first1=Samantha K.|last2=Webster|first2=Rebecca K.|last3=Smith|first3=Louise E.|last4=Woodland|first4=Lisa|last5=Wessely|first5=Simon|last6=Greenberg|first6=Neil|last7=Rubin|first7=Gideon James|journal=The Lancet|volume=395|issue=10227|pages=912–920|pmid=32112714|pmc=7158942|doi-access=free}}</ref> Although youngsters appear to be less vulnerable to [[COVID-19]], the side effects of the pandemic can be devastating. Quarantine from the pandemic led to an increase the prevalence of violence in the family, depression, anxiety, and post-traumatic stress disorder. Children and adolescents may be highly exposed to biopsychosocial stressors generated by the pandemic and once population's containment measures to reduce virus spread are required, they could be potentially affected by the disruption in daily life routine as a result of social isolation and their unseasoned ability to conceive and comprehend the short- and long-term consequences of this outbreak.<ref>{{cite journal |last1=Spinelli |first1=Maria |last2=Lionetti |first2=Francesca |last3=Pastore |first3=Massimiliano |last4=Fasolo |first4=Mirco |title=Parents' Stress and Children's Psychological Problems in Families Facing the COVID-19 Outbreak in Italy |journal=Frontiers in Psychology |date=3 July 2020 |volume=11 |page=1713 |doi=10.3389/fpsyg.2020.01713 |pmc=7350926 |pmid=32719646 |doi-access=free }}</ref><ref>{{cite journal |last1=Banerjee |first1=Debanjan |last2=Rai |first2=Mayank |title=Social isolation in Covid-19: The impact of loneliness |journal=The International Journal of Social Psychiatry |date=September 2020 |volume=66 |issue=6 |pages=525–527 |doi=10.1177/0020764020922269 |pmid=32349580 |pmc=7405628 }}</ref>

===Short-term quarantines, e.g. for decontamination===
Quarantine periods can be very short, such as in the case of a suspected [[anthrax]] attack, in which people are allowed to leave as soon as they shed their potentially contaminated garments and undergo a [[decontamination]] shower. For example, an article entitled "Daily News workers quarantined" describes a brief quarantine that lasted until people could be showered in a decontamination tent.<ref>{{cite news| url = https://www.ourmidland.com/news/article/Anthrax-scare-temporarily-closes-Midland-Daily-7020034.php| title = Kelly Nankervis: Anthrax scare temporarily closes Midland Daily News| newspaper = Midland Daily News| date = 26 April 2005}} ''Daily News/ www.ourmidland.com''</ref>

The February–March 2003 issue of ''HazMat Magazine'' suggests that people be "locked in a room until proper decon could be performed", in the event of "suspect anthrax".{{citation needed|date=November 2018}}

''[[The Standard-Times (New Bedford)|Standard-Times]]'' senior correspondent Steve Urbon (14 February 2003) describes such temporary quarantine powers:
{{blockquote|Civil rights activists in some cases have objected to people being rounded up, stripped and showered against their will. But Capt. Chmiel said local health authorities have "certain powers to quarantine people".<ref>{{cite journal|last1=Tognotti|first1=E.|title=Lessons from the history of quarantine, from plague to influenza A.|journal=Emerging Infectious Diseases|volume=19|issue=2|pages=254–259|doi=10.3201/eid1902.120312|pmid=23343512|pmc=3559034|year=2013}}</ref><ref>{{cite book|last1=Qureshi|first1=Adnan|title=Ebola Virus Disease: From Origin to Outbreak|date=2016|publisher=Academic Press|location=London|isbn=978-0-12-804230-4|page=62}}</ref>}}

The purpose of such quarantine-for-decontamination is to prevent the spread of contamination and to contain the contamination such that others are not put at risk from a person fleeing a scene where contamination is suspect. It can also be used to limit exposure, as well as eliminate a [[Vector (epidemiology)|vector]].<ref>{{Citation |last1=National Academies of Sciences |first1=Engineering |title=Implementing Quarantine to Reduce or Stop the Spread of a Contagious Disease |date=2020-07-14 |work=Evidence-Based Practice for Public Health Emergency Preparedness and Response |url=https://www.ncbi.nlm.nih.gov/books/NBK563999/ |access-date=2024-04-10 |publisher=National Academies Press (US) |language=en |last2=Division |first2=Health and Medicine |last3=Practice |first3=Board on Population Health and Public Health |last4=Policy |first4=Board on Health Sciences |last5=Response |first5=Committee on Evidence-Based Practices for Public Health Emergency Preparedness and |last6=Downey |first6=Autumn |last7=Brown |first7=Lisa |last8=Calonge |first8=Ned}}</ref>

New developments for quarantine include new concepts in quarantine vehicles such as the [[ambulance bus]], mobile hospitals, and lockdown/invacuation (inverse evacuation) procedures, as well as docking stations for an ambulance bus to dock to a facility under lockdown.<ref>{{cite journal |last1=Zhang |first1=Min-Xia |last2=Yan |first2=Hong-Fan |last3=Wu |first3=Jia-Yu |last4=Zheng |first4=Yu-Jun |title=Quarantine Vehicle Scheduling for Transferring High-Risk Individuals in Epidemic Areas |journal=International Journal of Environmental Research and Public Health |date=27 March 2020 |volume=17 |issue=7 |pages=2275 |doi=10.3390/ijerph17072275 |pmc=7177222 |pmid=32230995 |doi-access=free }}</ref>