An Italian quarantine historian talks Covid-19 - and lessons we can draw from the past

Eugenia Tognotti is an expert in quarantine, and a professor of the history of medicine and human sciences at the University of Sassari, in Sardinia, Italy. We recently asked her a few questions about how the epidemics of the past can help us understand today’s crisis.

What’s the earliest known historical example of quarantine?

According to the historians of antiquity, one of the first laws for quarantine goes back to the Byzantine Emperor Justinian. He imposed isolation for travelers and food coming to Constantinople from North Africa, which was hit by the terrible plague epidemic of 541-542 A.D. But an organized institutional response to disease control began during the plague epidemic of 1347–1352, known as the “Black Death”.

Emperor Justinian, San Vitale (Ravenna), 6th century

Later, quarantine became the core of a complex and articulated system, adapted by the early-modern states forced to confront strategies for combating plague. It included isolation, sanitary cordons, bills of health issued to ships on departure from port, and disinfection.

The infected individuals — or those suspected of being infected — had to be isolated in suitable sites far from populated areas. A rigid “prophylaxis of separation” between healthy and infected people was initially implemented through temporary, makeshift camps, established to isolate the population during the emergency.

After the first phase, Lazarettos replaced the temporary structures for isolation. The first was opened by the Republic of Venice in 1423 on the small island of ‘S. Maria di Nazareth’. It became to be known as “Nazarethum” or “Lazarethum” because of the assonance with the biblical character Lazarus, who suffered from leprosy.

In 1467 Genoa followed the Venetian system; and in 1476 the old leper hospital of Marseilles was converted into a plague hospital. The Mediterranean Lazarettos were first located at a suitable distance from the inhabited centre in order to restrict the possibility of contamination, without being so far away that they would have prevented an easy transportation of the sick.

Is there anything different or unique about the current lockdown, compared to other examples of quarantine you’ve studied?

I believe that what is striking and unique in the current lockdown, compared to other examples of quarantine in the past, is the lack of rebellions and riots and the general acceptance by populations of the strict quarantine rules even if this implies a heavy limitation of personal freedoms. Social tensions are very low and limited. But it is difficult to compare with the past, given the completely different historical and cultural context.

During the 1918 Spanish Influenza pandemic — which caused the death of millions of people around the world — the censorship imposed by the belligerent countries prevented anxiety and anguish from finding a voice in the newspapers.

Today the enormous amount of information (images, stories, data), spread through the media, allows a level of freedom so high that it necessarily calls into question our individual responsibility.

Border Control
The control of travelers from cholera-affected countries, arriving by land at the France–Italy border during the cholera epidemic of 1865–1866

You’ve written a book about Italy’s experience of the ‘Spanish’ flu. Is it possible to make comparisons with the ongoing situation in Bergamo? Does reading the news today remind you of looking at the historical sources from 100 years ago?

In fact, one thing is especially reminiscent of the Spanish flu (in which church ceremonies and public funerals were prohibited). The dramatic images of police trucks, lined up, transporting from the town of Bergamo dozens of corpses of coronavirus victims to other locations, because the cemetery of that city was not big enough to deal with all the dead.

During the research for my book, I found in the State Archives some previously censored letters from emigrants’ family members, which described the tremendous trauma and the socio-cultural impact caused by the inhibition of burial rituals. The same thing is happening today to relatives of the deceased, who are immediately transported elsewhere without any farewell ceremony.

Some people are worried about the lockdown leading to a permanent erosion of civil liberties, or to enormous social changes. Historically, were there any pandemics which caused permanent changes to society and politics? Or do things usually go back to normal after the pandemic ends?

In Italy there have been some protests about perceived restrictions of the freedoms guaranteed by the Italian constitution of 1947 — in which, however, the protection of health and the collective good prevails.

In the mid-nineteenth century, cholera epidemics provided a health justification for strengthening police power in the small Italian states where revolutionary groups were promoting the cause of unification and republicanism. In some European countries, the suspension of personal freedom in the name of the collective good has offered the opportunity to use special laws and arrest political opposition.

Historically, social and political tensions have created an explosive mix, causing popular uprisings — a phenomenon that has affected many countries, including Austria, France and Italy. But there are no examples of abrupt changes in political regimes.

The great pandemics have, however, left traces in public health policies and have produced great advances in medical and scientific knowledge. Many scholars speak of cholera as a “teacher”: it improved sanitation, and a vaccine (first developed in 1892) emerged as a new method to prevent this dreaded disease.