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Britain’s absurd quarantine failures Closing the borders to plague is an age-old response — which our government disregarded

Quarantine hotels have been around a lot longer than Covid. Credit: JAIME REINA/AFP via Getty Images

Quarantine hotels have been around a lot longer than Covid. Credit: JAIME REINA/AFP via Getty Images


July 28, 2021   6 mins

During the pandemic, the words “isolation” and “quarantine” have been somewhat elided. But it’s useful to distinguish between them: if you definitely have a disease and you’re kept apart from everyone else, you’re in isolation; if it’s uncertain whether you have a disease but you’re separated for a while just to be safe, you’re in quarantine. The crucial difference is the element of uncertainty in the latter — and it’s this uncertainty that obsesses the authors of a new book about quarantine.

Husband and wife Geoff Manaugh and Nicola Twilley did most of the research for Until Proven Safe before the Covid-19 pandemic struck. Perhaps they felt strangely lucky, then, as the world descended into the current age of lockdowns and self-isolation, their study of “the history and future of quarantine” taking on a sharp new relevance.

Reading the book, there’s a case to be made that the just-to-be-sure quarantining began in fourteenth-century Dubrovnik, where travellers from areas known to be infested with the Black Death weren’t allowed to enter the walled city until they’d spent a month on a nearby small island. Similar schemes were adopted for maritime visitors to Venice, where you can still visit the lazarettos — quarantine hospitals — that were built especially for this purpose. Even lacking the germ theory of disease, the powers-that-be in these ancient cities intuited that separating was a way of protecting.

In the modern era, with a much better understanding of germs, we sometimes quarantine humans when we don’t really believe it’s necessary: recall the famous photo of the Apollo 11 astronauts, having just returned from their successful moon landing, meeting Richard Nixon from behind a window in a sealed metal box. They were quarantined for three weeks just in case they’d brought back some unknown alien pathogen from the moon — even though it was strongly suspected that (as we now know) the surface of the moon was sterile, and no such pathogens existed.

We’ve been less strict when it comes to the animal kingdom, where we can see some of the most drastic consequences of not quarantining playing out. Think of the episode of The Simpsons where Bart sneaks his pet bullfrog into Australia, whereupon it promptly escapes, reproduces, and devastates all the crops in the country. Manaugh and Twilley remind the reader of the UK’s terrible foot-and-mouth disease crisis in 2001, which originated in pigs who had been fed illegally imported pork from Asia. They also describe how Florida’s citrus industry has been in decline for years due in large part to the insect pest known as the psyllid. Only extremely strict quarantine of incoming plants by the state of California has stopped something similar happening to its famous oranges.

And remember the “friendship tree” that Donald Trump and Emmanuel Macron planted on the White House lawn in 2018? Being from France, its roots were specially wrapped in plastic so as not to spread anything nasty to the US — and it was immediately dug up and sent for a two-year quarantine as soon as the cameras were switched off. (In a definitely-not-metaphorical development, it died before it was returned).

It might seem to be stretching the term, but we quarantine some non-living objects, too: containers of radioactive waste are “quarantined” deep underground until they’re no longer dangerous. That, as Manaugh and Twilley explain, might be a very long time — long enough that scientists have tried to develop universal signs and symbols to communicate with civilisations thousands of years in the future who might have languages very different from our own: “there is bad stuff here – it is dangerous”.

So, animal, vegetable, and mineral: we routinely quarantine them all. Until Proven Safe argues that quarantine is a fundamental part of how societies deal with uncertainty. The lazaretto, the quarantine greenhouse and the concreted-over mine facility full of radioactive waste are, as the authors put it, “what results when abstract arguments over risk are given architectural form” — our best attempts at seeking the certainty we so badly need in the face of terrifying, and sometimes existential, dangers.

But the book left me with one massive unanswered question. If quarantine is such a well-understood process, with such a long history, how come we fumbled it so badly during Covid-19?

The will-they-won’t-they history of the UK Government’s decisions about border quarantine is recounted in a long document by the Home Affairs Select Committee from August 2020. As the disease began to spread outside of China in February last year, our government put in place some relatively light measures: those who had been in Wuhan, Iran or some parts of South Korea were asked nicely to stay at home after arrival at a UK airport, even if asymptomatic; those who had been in Northern Italy or a few other locations where cases had been found did “not need to undertake any special measures” unless they had symptoms. Even though there was to be no UK lazaretto, at least there was a gesture towards keeping incoming high-risk guests apart from the population at large.

Then, on 13 March, this advice was completely dropped. As the outbreak began to spread into Europe, our government decided to remove some of its advice for border quarantines. As a Select Committee report five months later put it: “The decision to lift all Covid-19-related guidance for international arrivals on 13 March, just as other countries were expanding their border measures, is inexplicable.”

It would be 10 days until the first lockdown began in the UK — ten days in which thousands of people with Covid-19 entered the country and wouldn’t have had to isolate at home (as everyone would, when lockdown later came in), and certainly wouldn’t have to be tested as they arrived at the border. Even after lockdown began, there wasn’t the slightest question of us instituting a mandatory quarantine, despite other countries at the same time requiring incoming travellers, few though there were by this time, to stay locked in a hotel or other special facility for periods of as many as 21 days (that being, at one point, the length of the mandatory quarantine in Hong Kong). Incredibly, the UK only began a mandatory hotel-based quarantine on 15 February 2021 — and only for some countries — more than a full year since the first Covid case arrived on our shores.

Calling the decision inexplicable is understandable. But let’s try to explain it. Perhaps some thought that, since border measures like quarantine wouldn’t stop all cases, they weren’t worth instituting. This all-or-nothing argument has certainly been made in other contexts — for masks or even vaccines — and it betrays a magic-bullet mentality: defeating a contagious disease takes a lot of different measures, none of which will ever be 100% effective. Manaugh and Twilley note the irony that if a quarantine works — if it stops disease transmission — then it will in retrospect be seen as an overreaction.

Was quarantine thought to be a bit too disruptive, a bit too difficult, to institute? Perhaps, though of course we did eventually end up instituting it, and if the story of vaccines has shown us anything, it’s that we can move mountains to get something done if we feel we really have to.

Were some scientific advisers, and perhaps politicians, unable to decouple the idea of border quarantine (or indeed travel bans) from politically-unpalatable views in their minds? The authors of Until Proven Safe do note the political angle: treating foreigners, immigrants, or refugees as if they were carriers of disease (or were a disease themselves) has been the preserve of authoritarian, racist, populist leaders. Could an innate aversion to being like those bad people have skewed the experts’ judgement?

There is some evidence for this, with Sage fretting early in the pandemic that border measures would need to be “draconian” to hold back the spread — a choice of words that clearly indicated disapproval. In fact, those measures may have been the proverbial stitch in time that would’ve saved, well, a lot of lives — and to draw comparison between actions taken during a pandemic emergency and those in “normal” times is irrational in any case.

Or maybe there’s an even more disturbing explanation: that quarantines weren’t instituted because, at the start of the crisis, the UK’s scientific advisers thought it would be a good thing if as many people as possible caught the disease. The idea that a strong quarantine system could render the “herd immunity” plan unnecessary doesn’t seem to have occurred, even though it did to policymakers in Hong Kong, New Zealand and elsewhere.

In any case, few of the lessons from history described in Until Proven Safe were applied during the history we’ve just lived through. The simple idea that “keeping people in quarantine, even if you’re not sure they’re infected, helps to hold back a contagious disease” seems to have been lost in the morass of counter-intuitive thinking that swirled around the start of the pandemic.

Maybe we can learn the lessons for next time: what of the future of quarantine? Manaugh and Twilley say that it might not look like quarantine at all. They discuss DARPA’s Prometheus project, where the idea is to develop a way of predicting whether someone, once infected with a disease, will be contagious. One of the nastiest things about Covid is, of course, that people can still spread the disease before seeing any symptoms — if they get symptoms at all. Such a system could help us pinpoint the people who need to be isolated — and would, to return to the theme, help reduce a big source of uncertainty.

But anyone who’s had a visit to the pub cancelled because of the UK’s “pingdemic” should know that technological solutions are wont to go awry; we can predict endless angry debate over the rate of false-positives and false-negatives from a Prometheus-like system should it ever come to be used. Far from putting all our eggs in technology’s basket, we should be open to the central point of Until Proven Safe: although the low-tech idea of setting possibly-contagious people apart could be made more effective, more equitable, and more humane — we wouldn’t have a history so full of quarantine if it didn’t really work.


Stuart Ritchie is a psychologist and a Lecturer in the Social, Genetic and Developmental Psychiatry Centre at King’s College London

StuartJRitchie

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J Bryant
J Bryant
3 years ago

That’s a great article. Thanks.
My own guess is most western countries didn’t close their borders early (and keep them closed) because they were afraid of being accused of racism.

L Walker
L Walker
3 years ago
Reply to  J Bryant

You’re exactly right.

Dr Stephen Nightingale
Dr Stephen Nightingale
3 years ago
Reply to  J Bryant

Much more likely that they are in hock to the Airline and “hospitality” lobbies.

Marcus Scott
Marcus Scott
3 years ago

Not this again.
Regarding the quarantine in 14th Century Croatia, did the rats and fleas also agree to go into isolation for a month on arrival?
COVID-19 arrived in the UK some time in Q4, 2019. By the time any form of isolation was being talked about anywhere in the world it had made its way into our healthcare system and care homes where it found the people it was going to kill. Closing the borders in late March would not have changed that.
How many British residents would have been trapped outside the country when the border closure was announced? The PM would have had to announce, “as from right this minute the borders are closed. Any aircraft or ferries on route must return to their point of departure. All returning residents are to remain where they are until further notice.”
How many people is that trapped in countries across the world? Half a million? I don’t know but a lot. It would have taken months, maybe years, to offer them all places in quarantine hotels. Their situations would have become desperate after only a few days stuck in countries that did not want them. Imagine, let’s say, 10,000 Brits stuck in Ireland. Many of them becoming increasingly agitated at the ferry ports and airports. At some point the Irish government would have said, “we are not going to have a scene at any of our ports that looks like something out of War of the Worlds. We are loading your citizens on ferries and sending them your way Boris. Alert the Royal Navy as if you want to stop them you will need to board or sink the ferries.”
So, no preparation time for the border closures. No, “in 48 hours”. It is “right now”. No provision in place for the 10,000 trucks coming through Dover carrying vital supplies. The public takes about five minutes to wake up to the fact our imported food supply is cut off and then what happens? About five minutes after that every food retail outlet in the country has been stripped bare. Better get the army on our streets to protect the supermarkets in advance of the announcement. I mean by that “better get the Chinese army on our streets” because the UK’s army is too small for that task.
Australia and New Zealand. Countries with which I am very familiar. Australia is a total disaster and New Zealand will soon follow. The politics are impossible. Jacinda and Morrison are facing a decision to reopen the borders which is a decision to allow people to die and a decision they cannot make. There have been repeated failures of the quarantine system in both countries. The UK border is orders of magnitude more complex than Australia’s. How long until there is a quarantine failure or football VIPs demand to be allowed in without quarantining? Another small matter, what will we do with aircraft crew? Are they all to spend ten days in managed isolation after each return flight? No. Doesn’t work.
Anyone advocating border closures better make clear how long these closures should have gone on for. NB: “as long as it takes” is not an acceptable answer.
While this is going on we have a first wave of deaths in April and May that is identical to the one we had.
What is the point?

Last edited 3 years ago by Marcus Scott
Jonathan Ellman
Jonathan Ellman
3 years ago
Reply to  Marcus Scott

Some good points. However, without closing borders, quarantining probably made the situation worse by ensuring the next wave would be more severe. True, Oz, NZ and China will have to open up at some point and it could be a political disaster for whoever chooses when. But if they’ve got their population mostly vaccinated, it may not be so bad. They will continue to test and quarantine incomers. The UK quarantined returnees from Wuhan in January/Feb 2020. Little did they know …
Btw, C19 arrived in the UK in Q1 2020.

Marcus Scott
Marcus Scott
3 years ago

An error on my part, I meant Q4 2019. Although the first cases were not identified until January 2020 it looks increasingly likely that some cases arrived in last 2019.
Australia is now engaged in a game of “pass the parcel of blame.” The NSW Premier has been seen as having had a “good COVID” unlike the Premier of Victoria. State governments are responsible for the quarantine hotels and when these have failed the Premiers have been desperate to maintain an image of control and the notion that these breakouts are only about a border failure and not that the virus might be ever present. The state politicians blame the public for lack of compliance and now, somehow, the failure of the quarantine system is not the main issue, that is the Federal government’s slow vaccine rollout. The Federal government may well fairly be blamed re the vaccine but that doesn’t take away the fact that the quarantine failed.
My main point re Australia is that there have been two major failures of border controls in winter 2020 and winter 2021. The UK would have had, probably, much more significant failures if a strict border control policy had been put in place due to the complexity of our borders. Lucky Jacinda can manage ALL incoming arrivals through a single airport. Leaving aside a handful of people on yachts. The vast majority of imports into Australia and New Zealand come in on giant container ships each with a crew of about 20. No trucks, obviously.

Last edited 3 years ago by Marcus Scott
Galeti Tavas
Galeti Tavas
3 years ago
Reply to  Marcus Scott

“”The Masque of the Red Death” by American writer E A Poe, first published in 1842. The story follows Prince Prospero’s attempts to avoid a dangerous plague, known as the Red Death, by hiding in his abbey. He, along with many other wealthy nobles, hosts a masquarade ball in seven rooms of the abbey, each decorated with a different color. In the midst of their revelry, a mysterious figure disguised as a Red Death victim enters and makes his way through each of the rooms. Prospero dies after confronting this stranger, whose “costume” proves to contain nothing tangible inside it (it is empty); the guests also die in turn.”

Did any read this story – We were given it after a tour of Medieval Italy….It has kept popping up in my thoughts, the wealthy of the region hide in the castle like Abby till the plague will pass, safe inside with great stocks of food and wine, but a guest at the costume Ball…. I think of AUS and NZ

I think keep the borders open to citizens arriving, and to much else – hiding is not usually the way to win.

Marcus Scott
Marcus Scott
3 years ago
Reply to  Galeti Tavas

Do you think that worked for the wealthy? I suspect the wealthy were much more easily able to flee the cities fo the country (some things never change) and isolating in a country house would have a chance of success. If you managed to avoid Bubonic Plague you were in good shape because it is not as if you could get it and develop immunity to it and be less vulnerable next time around You just needed to avoid it altogether.

Brendan O'Leary
Brendan O'Leary
3 years ago
Reply to  Marcus Scott

Did you mean Q4, 2019?

Marcus Scott
Marcus Scott
3 years ago

I did. Thanks for pointing that out. I must have one of my concubines or one of the eunuchs that guard them proof read my postings in future. They complain it is not part of the job role.

Alan Thorpe
Alan Thorpe
3 years ago
Reply to  Marcus Scott

Proving that facts matter. Another factor is that if we had closed our borders completely many would have starved to death.

Laura Creighton
Laura Creighton
3 years ago

“We wouldn’t have a history of quarantine if it didn’t really work”? come again? Human history is replete with examples of things that people have done out of a fervant hope that they would work, out of profound fear of the unknown, out of a deep desire to be seen to be doing something, regardless of whether it works or not, and out of a desire not to be out of step with the consensus. Add in those people whose chief joy in life is controlling other people, and forcing them to do things they do not wish to do, or not do things they do wish to, and those people who will go along with measures that are clearly not working in order to not undermine faith in the authorities.
We’ve quartantined people for non-infectious and barely infectious diseases such as multiple sclerosis and leprosy, for ethnicity, and for practicing witchcraft. We’ve treated diseases with faith healing, positive thinking, and casting the spirits that cause disease into a goat and then driving the goat out of the village. The human capacity to continue doing things that have no effect ‘because this is how we have always done things’ seems limitless.
However, the reason I believe that things changed on March 13th was that on March 11 Donald Trump shut the borders with 26 European states but not with all of Europe. A good many people thought that it was more important to disagree with whatever Trump was saying and doing even if a quarantine could be shown to be beneficial.

Galeti Tavas
Galeti Tavas
3 years ago

I do not care for the way you used isolation before modern science, it is not germane to this, especially the religious examples. Also leprosy is very contagious with enough exposure, close living to an infected person will give it to you – the saintlike young missionaries from the USA Midwest who staffed the newly created Leper colonies in the 1930s all were going to come down with it – it was a death sentence they signed up to serve for life – never being able to ever leave once serving there….to avoid taking it home with them.

When the WHO was established in the early 1900s by an amazing American Doctor he did sanitation and mosquito control with astounding results all over the globe, and organized the global spanning Leper colonies to replace the hell holes which till then were used. He was no Dr Tedros….

Edward De Beukelaer
Edward De Beukelaer
3 years ago

This is nice theoretical chatting if covid would spread like a some viruses do: just from one person to another , exponentially… but it does not. Transmission from a covid ill person (not positive test: sick person) to another healthy person is about 8-15% depending on the study (for people living together: there are many cases of one covid ill person in a household when none of the other in the household became ill or positive, i know of a typical case like this: 10 days with elderly mother and brothers…).
Covid will appear ‘out of nowhere’ to affect the people that have a particular sensitivity to that variant (just like flue does, it has appeared on boats in the middle of the ocean, after weeks on board with a full negatively tested crew). In 50% of cases (again not positive tests but ill people) it is impossible to establish where they picked up the infection. The full picture of how covid transmits is unknow. (Of course not many want to admit this) All the models are fanciful theories (we like them). For each new wave of a new covid variant, about 10% of the population will be affected: to do with individual susceptibility.
Quarantine will make very little difference in the case of covid. Lockdowns have no evidence of making any difference on the covid graphs (they may be effective for other infections). When is this publication going to look at the real world data!!!!!!!!!!!!!!!!!!!!!!
note: the comparison of viral infections with the way pests spread is such a stupid thing to do that this article is not worth reading. Simplifications is what has brought us in the covid regulations-mess we are in….
Covid is a pandemic which has cause some mortality (less than TB and many many other illnesses few people talk about) The main problems are caused by the reactions of the governments and fanciful scientists… it is a sad state.

Hardee Hodges
Hardee Hodges
3 years ago

Consider the obvious. Trump was roundly thumped over his China travel ban, so much so that he failed to act on EU travel as Italy became a center. But the US has many entry points compared to the UK. So politics trumps science.

Peter Francis
Peter Francis
3 years ago

Thanks to Stuart Ritchie for a good article. Minor quibble: in dictionary definitions, “isolation” is a more generic term and “quarantine” is a form of isolation with a specific purpose, i.e. to prevent spread of disease or pests.
If you want to use the pair of words in a particular way, that’s your privilege, but if the difference between isolation and quarantine is uncertainty, then nuclear waste is presumably isolated, rather than (as the article states) quarantined: it has a known level of radiation with a known half-life.

Last edited 3 years ago by Peter Francis
Jonathan Ellman
Jonathan Ellman
3 years ago

We live in a time of political limbo; a democratic veneer disguises the contempt politicians feel for the people they want to rule over and control. There were two clear choices at the beginning of the pandemic: A full on China style lockdown with closed borders or a policy of shielding the vulnerable and attaining herd immunity. The government chose the latter. The public forced the government to change to the former. If the public had made the choice, the borders would have been closed and the lockdown would have been stricter. The public knew better.
The government’s competence and authority has gone as a result. This is a political failing more than a scientific one. And again we have two choices: to continue this path towards totalitarianism like China or to increase direct democratic participation in politics.

Last edited 3 years ago by Jonathan Ellman
Galeti Tavas
Galeti Tavas
3 years ago

“A full on China style lockdown”

A What???? They locked down Wuhan to internal travel in or out, but let half a million international departures to seed the world..

Chain had no problem, no lockdown, 4 deaths per million, to the Western over 2000. They had show lockdowns, but basically this is a disease of Westerners, the Chinese kept the production going, they kept the huge national holidays where all travel home and hundreds of millions on the road…..

Jonathan Ellman
Jonathan Ellman
3 years ago
Reply to  Galeti Tavas

Yes, but China’s borders remain closed and this is about the UK.