In a July 2023 piece, Towards a science of infectious disease negative externalities I outlined the first-principles review of public health that I commenced in early 2023 to identify the legitimate role for public health in society.
By May 2023, I was amazed to find that the founders of modern public health – the Sanitarians – had been vigorous opponents of quarantine. They found that quarantine always fails and can never work – even as it always causes harm. Quarantine was the problem they were fighting against, and sanitation was the solution. Based on this, Paul Frijters, Gigi Foster, Jay Bhattacharya and Ari R Joffe kindly joined me as co-authors of a working paper “The Failed History of Quarantines, and Its Implications for Public Health” that was published on the IZA website in mid-2024.
1. What did the Sanitarians find?
Let me summarise the Sanitarians’ findings. I’ll then talk about a global conference on abolition of quarantine that we urgently need.
Quarantine started as a “remedy” against plague in the 1350s on the basis of the false assumption that the plague is contagious. But plague is not contagious. It transmits through fleas and rats. Touching a plague-ridden person or even injecting pus (dead bacteria and white blood cells) from the patient’s buboes into one’s own body won’t spread the disease. Further, quarantine doesn’t reduce the spread of fleas and rats but could increase their spread, instead. Later, such misguided quarantine was extended to other non-contagious diseases like typhus, yellow fever and cholera. For nearly 450 years no one asked whether quarantine actually works. It took Dr. Charles McLean’s lifelong study (he lived from c.1766-c.1824) to confirm that none of these diseases are contagious, nor had quarantine ever worked. He also found that quarantine increased overall deaths, apart from increasing deaths from the disease for which it was established.
Additionally – and this is particularly relevant to us in the context of diseases like covid – Maclean pointed out that quarantine could never have worked even if these diseases had been contagious. He and the Sanitarians knew of a number of contagious diseases such as smallpox, measles, lues venerea, exanthemata and scarlet fever. But Maclean showed that it wouldn’t matter even if the plague and yellow fever were contagious, quarantine could never work. In his 1817 pamphlet he has a bold sub-heading: “Absurdity of the Quarantine Laws, even according to the Doctrine of Contagion”. In other words, quarantine is “absurd” even if the concerned disease is contagious.
Maclean explained why, in two parts. First, quarantine doesn’t work because of what we call human factors in the 2024 working paper cited above. Maclean pointed to practical problems with the laws: “the laws of quarantine are absurd” and that they are “inefficient for their object” (they can’t be practically implemented). He cited examples of fraud and corruption, and of people concealing their sickness, as reasons why quarantine was always breached. He questioned the delusions and “gratuitous assumptions” of quarantine officials who “suspected” ships of harboring disease. (Both type 1 and type 2 errors operate: ships with disease are missed from quarantine; ships without disease might get quarantined.)
Thus, quarantine, he showed, is necessarily porous. He compared quarantine to Milton’s poetic metaphor: “But these are false, or little else but dreams, conjectures, fancies, built on nothing firm”. Later, the first Chief Medical Officer of the UK, Sir John Simon (1816-1904) used similar terminology to call quarantine “paper plausibilities” and “an elaborate example of leakiness”. And Edwin Chadwick, the architect of modern public health, wrote that “quarantines [are] of as little avail as they would be against the east wind”.
The points that these empiricists were making is vitally important in today’s era when public health relies purely on models, ignoring all empirical facts. Unlike animal quarantine (which itself is challenging to implement), human quarantine is leaky. Human factors such as information gaps, incentive issues, ignorance, laziness, sleepiness, human error, deliberate breaches, and a lot more, make a dog’s breakfast of any attempt to reduce the spread of contagion. Even hospital-grade medical isolation under highly controlled conditions fails, with over 100,000 people dying each year in the USA from diseases that they acquired during a hospital visit. If professional isolation of the sick under controlled conditions in an advanced country like the USA is hard, it is harder by orders of magnitude to isolate the healthy under uncontrolled conditions, or in less developed countries.
Second, Dr Charles Maclean pointed out that even as quarantine never works, it imposes a huge cost on society. He conducted the first cost-benefit analysis of quarantine to demonstrate this, and (separately) assessed that quarantine kills around a million people each year, worldwide.
He concluded that quarantine must be abolished. In a pamphlet published in c.1821-24 entitled, Obligations of Governments to Abolish the Laws of Quarantine, he wrote: “Governments are not only warranted, but required to abolish the Laws of Quarantine, upon two grounds, either of which is separately sufficient, and both irresistible. 1. Pestilential contagion being proved to have no existence, laws to prevent its spreading can have no object. 2. In pestilences, whatever be their cause, the Quarantine Laws are, in point of fact, invariably found to increase sickness and mortality.” [Note again, his words: “whatever be their cause”, i.e. regardless of whether the disease is contagious or otherwise.]
In place of quarantine, Maclean advocated city-wide sanitation. He was not the originator of the idea but supported “aqueducts, common sewers, neatness in house”, opposed “crouding”, wanted stagnant water to be cleared, and wanted “more commodious and airy forms of the houses” for the poor.
His work finally did get some traction – but after his death. A young doctor, Dr Southwood Smith, and through him a young lawyer, Edwin Chadwick, took up his ideas into the political field and succeeded in getting the reforms (sanitation) which we now take for granted. We must not forget that for nearly five hundred years before Maclean, doctors believed in the quackery of quarantine instead of addressing human waste in the streets, and stagnant water. Medieval cities were cesspits of filth but the idea of sanitation never dawned upon them, so sure were they about the effectiveness of quarantine.
It was Dr Smith who mainly drafted (along with Chadwick) the 1849 Report on Quarantine of the General Board of Health, which thoroughly condemned quarantine and demanded its abolition: “The principal ground on which we have objected to the continuance of quarantine is that the fundamental principle on which it is based is fallacious, and that the only means of preventing the origin and spread of epidemic disease is the adoption of sanitary measures. … [W]e therefore accompany the proposal to abolish quarantine with the recommendation to substitute for it a plan of sanitary regulation.” Note carefully: their primary recommendation was the abolition of quarantine, only then was sanitation to be considered. Sanitation was a secondary recommendation.
This was the first detailed government inquiry into quarantine and it should have opened the door for abolition of quarantine. However, vested interests of the quarantine machine were too powerful to overcome.
Many important voices of that era also demanded an end to quarantine. In a 1851 lecture, Dr John Snow (1813-1858), celebrated for his studies on clean water, said: “With regard to preventive measures, I entirely agree with the Registrar-General, that ‘internal sanitary arrangements, and not quarantine or sanitary lines, are the safeguards of nations. For I believe that quarantine would often be evaded, and is altogether unnecessary”.
In a 1863 book, Florence Nightingale (1820-1910), the most famous nurse in human history, wrote: “according to quarantine laws, a live goose may be safely introduced from a plague country; but if it happens to be eaten on the voyage, its feathers cannot be admitted without danger to the entire community. There is no end to the absurdities connected with this doctrine.”
And so on. But they all failed. Maclean’s scientific findings and the strong recommendations against quarantine of the Sanitarians were buried by the quarantine establishment which continued to impose quarantine even for non-contagious disease like cholera at least till 1892 (in Hamburg) and for the plague at Heathrow airport even in 1994 to “protect” England against the Indian plague. The quarantine establishment also expanded its quackery into diseases that even medieval doctors had never visualized as likely candidates, such as the Spanish flu. Dr Donald Henderson, the man who eradicated smallpox, explained in detail why diseases which can spread asymptomatically can’t be controlled by quarantine, but no one cared for his warnings.
All quarantine attempts for contagious diseases have also failed. I have collated extensive evidence to show that quarantines for the Spanish flu, Ebola, SARS, and Swine flu (and of course covid) all failed, even as they caused massive harm. A couple of minor exceptions were observed during Spanish flu in far-flung under-developed islands, but such exceptions don’t disprove the rule.
In all such cases, isolation of the sick is the appropriate remedy.
2. A global conference for abolition of quarantine
Nearly 175 years after the 1849 Report on Quarantine, we are stuck with quarantine, despite irrefragable evidence against it, evidence that is beyond any possibility of refutation not just for non-contagious but for contagious diseases.
The ongoing devastation caused by covid lockdowns is the latest manifestation of the deadly nature of quarantine.
So what’s stopping the medical world from abolishing quarantine? Vested interests, primarily. And lazy, shoddy thinking. Even the best doctors recommend some form of quarantine (a fine-tuned, sweet spot, called “focused protection”). But there is clear evidence that this is also a bad idea. Focused protection is porous because of human factors and worthless measures like masks and Perspex partitions that give people a false sense of security. All the while, harms to the elderly who are imprisoned, keep mounting. By all means let’s isolate the sick (even more strongly than we do so at present), but let’s not stop the normal life and movement of the healthy (the “asymptomatic”).
To rid doctors from their quarantine fixation, we need a major medical conference. On 29 July 2024 I called for “A global conference for abolition of quarantine” in my Times of India blog. I then wrote emails and communicated on social media with doctors whom I hold in high esteem, requesting them to take the lead on this. I even drafted a declaration for the conference to consider.
I also invited some of them to join me as co-authors for a textbook on quarantine which would prove to medical students and to the general public, that human quarantine is deadly quackery. The textbook could be based on my manuscript on quarantine of around 175,000 words. At present, there is no textbook on quarantine. Doctors absorb a wide range of unscientific, largely false opinions from snippets they come across in their readings.
But no luck. Not a single doctor has expressed interest (to date) in taking this forward.
3. Next steps
The fact that no one has come forward doesn’t deter me from doing what I must. I will continue my review of public health which has by now exposed a number of other shortcomings: e.g. the poor quality isolation of the sick, ideological dabbling by public health in matters about which the typical doctor has no training, the need to understand human irrationality and medical panic, and so on. I expect my review to take another two to three years, with over ten books likely to be generated.
But of the many reforms needed in public health, none is more urgent than the abolition of quarantine. So, who’s going to do it? Why is there no Charles Maclean, Southwood Smith or John Snow today? What’s so difficult about leading a global movement for the abolition of quarantine?
Two reasons, maybe:
First, to most doctors, quarantine represents unlimited, unaccountable power. Ending quarantine will mean loss of power, wealth, prestige, national awards, governorships. Dr Charles Maclean stood for the truth, regardless of the (huge) personal cost of his efforts. Such devotion to the truth is extremely rare, perhaps found in someone only once every few centuries.
Second, it is possible that today’s good doctors are past their “use by” date. They are stuck in old beliefs and paradigms, perhaps informed by worthless mathematical models, unwilling to review their beliefs from first principles. In 1950, Max Plank wrote: “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it”. We know that Charles Maclean and Southwood Smith were in their early 30s and Edwin Chadwick was in his mid-20s when they took upon themselves the task of reforming public health. They had the energy which older people don’t. They also had nothing to lose, such as professorships. They had an open life ahead of them. We might need to wait for young doctors to rise to the occasion.
Regardless of whether younger or older doctors arise, one thing is clear: ridding the world of deadly, killer lockdowns will never happen unless a major fight is taken to the medical establishment which is smitten by this quackery. First, the entire medical profession has to be educated. Then it has to demand change. Finally, the general public will need to be educated.
As an economist one can only do one’s part. Economists can provide the theory of quarantine failure, evidence of its failure, and proofs of harm. Economists can even conduct a cost-benefit analysis of quarantines. But economists can’t stop lockdowns. Only the medical profession can.
