Behind armed guard and closed blinds, four members of a Dallas family linked to America's first diagnosed Ebola victim spent much of this week confined to a small apartment, waiting to find out if they too will be stricken. Food was left in boxes outside the front door, doctors and a haz-mat team the only visitors.
The forced quarantine, which will remain in place until the Ebola incubation period passes on Oct. 19, has put the four people who lived briefly with Thomas Eric Duncan on edge and made a spectacle of their plight. The family won a bit of a reprieve Friday, when it was moved to a larger, four-bedroom house in a secluded section of Dallas where the children would be free to go outside, but the confinement remained.
While the court-ordered seclusion may seem disciplinary, the intent is the opposite.
"These folks are not being punished," said James Hodge, a professor of public health law and ethics at Arizona State University. "The measures are not designed to punish in any way. They're designed to protect public health — as well as their own health."
The concept of quarantine — denying a few people's personal freedoms to ensure the survival of the wider community — dates back centuries, and for most of that time was a lot harsher and inhumane than the version used in Dallas. In recent years, outbreaks of other infectious diseases, most notably SARS in 2003, when 45,000 people in Toronto alone were quarantined at home, have led to a softened approach, with an emphasis on home confinement and careful attention to subjects' well-being.
"It's not uncommon for a health department to look at all the services needed and figure out how to assist the family," said Jack Herrmann, senior advisor and chief of public health programs for the National Association of County and City Health Officials.
In Dallas, the local Department of Health and Human Services, American Red Cross and Dallas Independent School District are teaming up to provide for the quarantined family's needs, a county spokeswoman said. "There is no charge to the family for medical services, food or homework assistance," she wrote in an email.
Hodge pointed out that any adults who suffer lost wages as a result of a quarantine are protected by the Americans with Disabilities Act, even if they don't turn out to have contracted a disease.
Polls have shown that Americans largely support the idea of quarantines. In many cases, they've submitted to them voluntarily. Other relatives of Duncan have agreed to stay at home without a court order.
Pioneered in 1300s Venice to stop the spread of the bubonic plague, quarantine (based on the Latin for "40 days") was used for centuries around the world before becoming part of the modern public health system. While the method was effective at stopping outbreaks of tuburculosis, smallpox, leprosy and cholera, it also led to unhumane deaths and was used to make outcasts of whole communities: immigrants, the poor, American Indians. The unfair use of quarantines was personified by the case of Mary Mellon, known as Typhoid Mary, who lived most of her life as an outcast.
Today, federal, state and local governments have the power to impose quarantines, although the federal government rarely steps in. "It remains one of the fundamentals of public health controls," Hodge said. "It's done maybe hundreds of times a year."
He added, "What is uncommon is that, to my knowledge, we've never had to use it for Ebola. And that's where it gets interesting."