Quantifying “Quarantine“

In Aphorism #23, Hippocrates states that acute illnesses reach a peak by 14 days. That is precisely the length of time that we are being asked to stay in quarantine when we develop COVID-19 symptoms. The word, quarantine, however, means 40 days.

You may ask where Hippocrates got the idea of 14 days. A set number of days for a disease originates in the Pythagorean theory of numbers and is based on the doctrine of critical days and decisive time points determining the course of illness.

Pythagoras associated the number “4” with the concept of wholeness and completion. He considered the four-point tetrad to be the origin of all things. This was fundamental to nature, he believed, as witnessed by the four phases of the moon: quarter, half, three-quarter and full; four seasons: spring, summer, autumn, and winter; four directions: north, south, east, and west; and, four ages of man: gold, silver, bronze, and iron.

Pythagoras considered the divinity to be a tetrad because the magic number 10 is composed of four parts: 1+2+3+4. Pythagoreans believed that that the number 10 was a perfect number because it encompassed odd and even e.g. good and evil. “10” was magic; “4” stood for wholeness, so 10X4 held powerful symbolic meaning. Hence the word, quarantine. God could make a person whole again in 40 days.

An article in the very well respected British Medical Journal of 1929 explains that Pythagorean theory was the basis of the 40 days required by Mosaic law to ensure purification after exposure to leprosy. It may also explain the 40-day duration of the great flood at the time of Noah, the 40 days Moses spent on Mount Sinai, the 40 days Jesus wandered in the desert, and the 40 days of the season of Lent. The Romans used the word quarentena for a period of 40 days set aside either for an official purpose, or for a penance or for a service, the magic of 40 extending beyond health and wholeness.

In the European Middle Ages, God being perceived as more powerful and more efficient than in classic times, the time of quarantine for illness was reduced to 30 days, and was accordingly called trentino.

The practice of trentino was first applied during the bubonic plague or “black death” that shot through Asia, Europe, and Africa in the 14th century killing approximately 50 million people, from 25% to 60% of the existing population. In 1377, in the Venetian-controlled port city of what is now Dubrovnik, Croatia was the first to require that all ships arriving from plague-affected areas isolate themselves for 30 days. No one from the port was allowed to visit the ships during the trentino; if they did, they too would be quarantined for 30 days. Over the next 80 years, Marseilles, Pisa, and other cities adopted the same policy of trentino to deal with subsequent epidemics. Within a century, however, in most of the world, the isolation period for contagious disease was extended from 30 to 40 days. Pythagoras prevailed.

Quarantine remains a controversial practice – today is no exception - because it raises political, ethical, and socioeconomic concerns and pits public interest against individual rights.

One profound problem is that, when citizens do not trust their government, quarantines can be perceived as masking an evil purpose. During the 14th century bubonic plague, outsiders, e.g. Jews and Gypsies, were prevented from entering most cities. A sanitary cordon was imposed by armed guards to keep undesirables out. Attempted entry was punishable by death. The ghettos imposed by the Nazi regime on Jews in Eastern Europe during the Second World War had as their stated rationale the prevention of typhus, rumored to be spread by Jews. It was called the Jewish disease. When the people in the ghettos became too weak to work for the war effort (from starvation not from typhus) they were transported to the death camps.

Even when not intended, quarantine measures almost always disproportionately affect ethnic, economically disadvantaged and marginalized groups. During the SARS epidemic of 2003 in China, police cordoned off buildings, organized roadside checkpoints, and, on occasion, installed web cameras in private homes. Control was strictest among the lower social strata. Village-level governments were empowered to isolate workers from SARS-affected areas. Public health officials in some areas resorted to repressive police measures, using extremely severe punishments, including the death penalty, against violators of quarantine. It is impossible to get accurate information about the response of the Chinese government to the COVID-19 crisis. On the other hand, it is quite possible that, here again, the most disadvantaged suffered most.”

In a globalized world, fear, panic, and conspiracy theories, augmented by the chorus of global media, can spread far and fast.

“In the face of new challenges posed in the twenty-first century by the increasing risk for the emergence and rapid spread of infectious diseases, quarantine and other public health tools remain central to public health preparedness. But these measures, by their nature, require vigilant attention to avoid causing prejudice and intolerance. Public trust must be gained through regular, transparent, and comprehensive communications that balance the risks and benefits of public health interventions.” – Tognotti, 2013

The Decameron by Giovanni Boccacio was written at the time of the Black Death. It is a book of 100 stories, ranging from the tragic to the bawdy, told by 10 young women and men staying at a deserted villa, isolating themselves from plague-ridden Florence. To pass the time, each member of the party tells a tale. Here is an excerpt (borrowed from Hecker & Babington, The Epidemics of the Middle Ages, 1859):

“Thus it was that one citizen fled from another, a neighbor from his neighbors, a relation from his relations; and in the end, so completely had terror extinguished every kindlier feeling, that the brother forsook the brother, the sister the sister, the wife her husband; and at last, even the parent his own offspring, and abandoned them, unvisited and unsoothed, to their fate. When the evil had become universal, the hearts of all the inhabitants were closed to feelings of humanity. They fled from the sick and all that belonged to them, hoping by these means to save themselves.”

This is far worse than what is happening now in the 21st century, but, for many, the quarantine has lasted too long, far longer than Hippocrates’ 14 days. It is now approaching 14 months. If it is any comfort, the bubonic plague lasted from 1337 to 1351, 14 years.

The authors, Bob Seeman and Neil Seeman, are co-founders of RIWI Corp., a global data analytics company. Neil Seeman is Chief Executive Officer of RIWI Corp. and a Senior Fellow at Massey College in Toronto.