Quarantine: Eternal Wisdom for Disease Prevention July 10, 2007 Mary Mallon was a personal chef preparing meals for families, often even traveling with those families to their country retreats and cooking for them during their vacations. She didn’t stay long with each family, but her well-developed culinary skills ensured her a new position each time she moved on. When Mallon left a household, she would sometimes leave behind more than just memories of delicious meals, however. Multiple members of her clients’ families reported being stricken with terrible headaches, nausea, dangerously high fevers, dreadful coughs, skin rashes, and constipation or, conversely, diarrhea. Three of those ailing did not recover. Investigating health authorities determined the cause of the deaths to be typhoid fever and traced its roots to the New York–area cook. They told her she was an asymptomatic carrier of the infectious disease caused by Salmonella typhi. The pathogen was multiplying within her, but she displayed no outward symptoms of the illness. She may have passed on the disease to unsuspecting victims through infected fecal matter by preparing food without properly washing her hands. But Mallon, not well educated, had a hard time believing she could be a threat to others when she never became ill herself. After health authorities tracked her down, they detained her at Riverside Hospital in New York, confining her to prevent the spread of the disease. Although she remained unconvinced that she needed to be quarantined, Mallon was eventually released with the stipulation that she never cook for others again. A few years later, authorities were investigating a disease outbreak in a local hospital. To their surprise, the new cook for the institution was none other than Mallon, who was infecting others while working under an alias in the only occupation she knew well. That was a hundred years ago. Recently Andrew Speaker has been in the headlines. Like Mallon, he is a carrier of a contagious disease and didn’t want to be quarantined, claiming not to believe he was a threat to others. But unlike Mary, who remained in the New York area, Speaker traveled around the globe after learning of his condition. He traveled to Paris on a commercial flight, continued on to Greece for his wedding, and then honeymooned in Europe. According to the Centers for Disease Control (CDC), representatives met him in Rome to discuss his options. But instead of checking in to a local hospital as recommended, Speaker and his bride fled to Prague, where they caught a flight to Montreal before crossing the border and entering the United States. Officials isolated the health fugitive, eventually transferring him to a Denver hospital for treatment. The CDC has contacted nearly all of the U.S. airline passengers who traveled with Speaker, but there is no way to know how many others were unknowingly exposed. The problems associated with exposure to communicable diseases have plagued humankind since ancient times. Thousands of years before Antonie van Leeuwenhoek first observed bacteria with his early-17th-century microscopes, some knew the principle of isolating ill patients to prevent the spread of disease. It may come as a surprise that quarantine and sanitary precautions for disease prevention are found in the Old Testament and are just as valid today as they were then (see Leviticus 13, 14 and 15; Deuteronomy 23; and Numbers 19). From biblical times until the 19th century, group travel meant ships, caravans or other time-consuming methods. The current meaning of the word quarantine grew from the Italian quaranta giorni, Italian for “40 days,” as 14th-century Venetians kept ships from plague-stricken areas waiting at anchor outside the port for an arbitrary 40 days. Today’s rapid worldwide air travel, coupled with the sheer numbers of travelers, means the potential for spreading disease far and wide in a short period of time is enormous. Mary Mallon (now known as Typhoid Mary), while living and working around the New York area during the early 20th century, likely infected fewer than 50 people. A century later, Andrew Speaker, jetting around the world in the silver incubation tubes we use for modern air transportation, may have exposed thousands to multidrug-resistant tuberculosis (MDR-TB) during his two-week gallivant. The media attention lavished upon Speaker’s apparent disregard for the welfare of others (including his own wife) should be a reminder to each of us to be more conscious and more cautious about isolating our own contagions. Do you send your children to day care or school with fevers, coughs and sore throats? What about exposing your coworkers to your cold? So you have a trip planned, but you have the flu—do you just take some drugs to lessen the symptoms and get on the plane anyway? Of course, the more serious the disease, the greater the potential for harm to others, and the greater the need for the timeless principle of quarantine. Although modern science has made almost unimaginable progress in preventing and dealing with illness, we would be wise to heed this pearl of ancient wisdom. ALICE ABLER RELATED ARTICLESPreparing for the Next Pandemic |
