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Postgradmedj-2020-138370.Full.Pdf Postgrad Med J: first published as 10.1136/postgradmedj-2020-138370 on 9 September 2020. Downloaded from Ethics and law Learning from the past in the COVID-19 era: rediscovery of quarantine, previous pandemics, origin of hospitals and national healthcare systems, and ethics in medicine Pier Paolo Bassareo ,1 Maria Rosaria Melis,2 Silvia Marras,2 Giuseppe Calcaterra3 1Department of Cardiology, ABSTRACT The first description of human coronavirus was University College Dublin, After the dramatic coronavirus outbreak at the end of published by the Scottish virologist June Hart Dublin, Ireland 2Department of Biomedical 2019 in Wuhan, Hubei province, China, on Almeida in The British Medical Journal in 1965, Sciences, University of Cagliari, 11 March 2020, a pandemic was declared by the WHO. while working in St Thomas’s Hospital Medical Cagliari, Italy Most countries worldwide imposed a quarantine or School (London). Since the spokes around the viral 3 Department of Cardiology, lockdown to their citizens, in an attempt to prevent edge reminded researchers of a crown, the virus was University of Palermo, Palermo, Italy uncontrolled infection from spreading. Historically, named corona (crown in Latin) in a subsequent quarantine is the 40-day period of forced isolation to paper published in Nature (1968).4 Correspondence to prevent the spread of an infectious disease. In this Since 11 March 2020, SARS-CoV-2 has changed Pier Paolo Bassareo, educational paper, a historical overview from the sacred our daily life, behaviour and maybe the whole human University College Dublin, temples of ancient Greece—the cradle of medicine—to history. SARS-CoV-2 has spread throughout our Mater Misericordiae modern hospitals, along with the conceive of healthcare nightmares with the same strength as it has had in University Hospital, Dublin breaking into our lives. D07 R2WY, Ireland; systems, is provided. A few foods for thought as to the [email protected] conflict between ethics in medicine and shortage of Quarantine, spread, isolation, lockdown, cocoon- personnel and financial resources in the coronavirus ing, masking, social distancing, hand hygiene, blood Received 30 May 2020 disease 2019 era are offered as well. tests, vaccine, immunity: all these words are now part Accepted 7 June 2020 of our daily speeches, pervading the most subcon- scious of our thoughts. Our healthcare system is now facing huge chal- One day Albert Einstein gave his students the same lenges with the spread this virus, and so it is getting final exam the year before. His assistant shyly a favourable occasion to review the history of the noticed the mistake. Einstein replied: “You are previous infections which the human being had to right, these are the same questions as last year – face in the past, with the ultimate aim of educating but the answers have changed” young doctors to learn from those events. In daily conversations, people often use the term http://pmj.bmj.com/ ‘quarantine’ to refer to separating sick people with a contagious disease from the healthy ones in various ways. Quarantine or lockdown is a forced segrega- INTRODUCTION tion to prevent a communicable disease from In December 2019, a series of pneumonia cases of spreading.5 unknown origin were reported in Wuhan, Hubei The term ‘quarantine’ comes from the Italian word province, China. ‘ ’ quarantena , which means a period of 40 days (in on September 26, 2021 by guest. Protected copyright. On 12 January 2020, after ascertaining the viral Italian, 40 is ‘quaranta’; the latter derives from the origin of the disease, the WHO recognised ā ā a coronavirus responsible for the disease and named Latin word quadr gint ). During the 14th century, 40 it as the 2019 novel coronavirus (2019-nCoV). days was the length of strict isolation required for Again, based on its genetic similarity to already ships suspected of carrying an infectious or contagious known coronaviruses, the International Committee illness before their passengers and crew were allowed on Taxonomy of Viruses renamed the previously to land. This practice was usual in Venice in the 1300s, ‘ ’ termed 2019-nCoV as severe acute respiratory syn- in an effort to stave off plague ( black death ). It 67 ©Author(s)(ortheir drome coronavirus 2 (SARS-CoV-2). Conversely, entered English language in the early 1600s. ‘ ’ employer(s)) 2020. No the first coronavirus or coronavirus 1 was responsi- An early mention of isolation dates back to the 7th commercial re-use. See ble for SARS epidemic in 2003.1 century B.C. or maybe earlier in the Leviticus, the third rights and permissions. book of the Old Testament in the Bible. In that book, Published by BMJ. On 30 January 2020, the WHO released a public health emergency of international concern. On the procedure of separating infected from healthy peo- To cite: Bassareo PP, Melis 11 February 2020, the WHO formally named the ple to prevent leprosy from spreading, according to MR, Marras S, et al. disease as COVID-19. Mosaic Law was described, (if the shiny spot on the Postgrad Med J Epub ahead of print: [please include Day On 11 March 2020, the WHO formally recognised skin is white but does not appear to be more than skin Month Year]. doi:10.1136/ the global spread of COVID-19 as a pandemic: deep and the hair in it has not turned white, the priest is postgradmedj-2020- the second in this century and the first to be caused to isolate the affected person for seven days. On the 138370 by a coronavirus.23 seventh day the priest is to examine him, and if he sees Bassareo PP, et al. Postgrad Med J 2020;0:1–6. doi:10.1136/postgradmedj-2020-138370 1 Postgrad Med J: first published as 10.1136/postgradmedj-2020-138370 on 9 September 2020. Downloaded from Ethics and law 30 days; and (4) whoever did not accomplish with the above ‘ ’ Box 1 Origin of the term lazaret stated regulations would be finedandsubjectedtoisolation for 30. ► All merchants, sailors and goods coming from ‘suspicious lands’ In 1397, the Great Council of Ragusa released a new decree could not enter Ragusa, unless they have spent a month on (De ordinibus contra eos qui veniunt de locis pestiferis anno 1397 quarantine on uninhabited islands of Mrkan, Bobara and Supetar in factis), which specified again the 30-day duration of quarantine front of the city. A few wooden shelters (wooden so that they could and determined the place. Penalties were imposed for those be burned if needed) were built on them because of the breaking rules, and three healthcare officers (called kacamorti) unfavourable weather. This sort of simple dwelling was called were appointed to supervise the compliance with quarantine lazaret (Italian: lazzaretto). The term derives from the Biblical story provisions. The penalties for not complying with the provided of beggar Lazarus, who was raised from the dead out of the tomb regulations were represented by a money fine or prison sentence by Jesus Christ. Following that, another lazaret was built on a small or severe corporal punishment. The penalties were applied only island in the lagoon in front of Venice in 1403. In 1467, the to common people but not to aristocracy. In addition, the impor- maritime Republic of Genoa followed the example of Venice, and in tation of goods from the countryside for the entire duration of the 1476, the old leper hospital in Marseille was turned into a black epidemic was forbidden.13 In 1448, the Venetian Senate, the main death hospital. The great lazaret of Marseille, perhaps the most deliberative and legislative body of the Republic of Venice, pro- complete of its kind, was built in 1526 on the island of Pomègues. longed the waiting period to 40 days, thus giving birth to the term The procedures in the lazarets in the Mediterranean sea did not ‘quarantine’.14 Over the next 80 years, similar edicts were pub- differ a lot from those of the British Empire in the Levantine and lished in Marseilles, Venice, Pisa and Genoa.15 North African trade. As soon as cholera arrived (1831), a few new Since disease was considered as a divine punishment for sin- lazarets were built, especially near the harbour of Bordeaux ners, the biblical 40-day period of purification had crossed over In the human history, similar isolation centres were built for those into health practices and the term ‘quarantine’ had great symbolic with leprosy (leprosarium) or tuberculosis (tubercolosarium). and religious significance to medieval Christians. In the sacred scripture, when God flooded the Earth, it rained over 40 days and 40 nights; Moses stayed on Mt. Sinai for 40 days; Jesus fasted and was tempted by the devil in the desert for 40 days; after child- birth, a new mother was expected to rest for 40 days.6 that the sore is unchanged and has not spread in the skin, he is to On the basis of a 14th-century tale by the Genoese Gabriele isolate him for another seven days).8 de’ Mussi, the devasting black death came over Italy carried by However, nowhere in these forerunner reports was the term Genoese sailors who sailed from Caffa/Kaffa (now Feodosija, ‘quarantine’ used. After arriving in Southern Europe in 1347, Ukraine) to their home city (1346/1350). In fact, in 1345, the plague spread rapidly and reached England, Germany and Tartar forces captained by Jani Beg Khan had laid a military Russia by 1350.6 Over these years, one-third of the European operation in which his forces surrounded Caffa, in an attempt population passed away. The dramatic impact of the epidemic led to cut off essential supplies, with the aim of compelling the governments to put in place extreme infection control measures.
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