Geography of Quarantines

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With quarantines becoming or are already a possibility for millions as the COVID-19 virus spreads globally, we can turn to research by geographers and others to see how effective past quarantines have been in mitigating viral diseases while also balancing economic and physical needs. There are also tools that can help us to potentially make quarantines more effective. 

In 2015, the MERS, or Middle East Respiratory Syndrome, was spreading globally and particularly in South Korea. In that country, the government’s response was initially to downplay or minimize potential harm to the public, suggesting it was a limited threat. Additionally, when the government did respond, public health in different cities was outsourced to private companies. One study evaluating this response found that quarantine measures, while potentially effective in limiting the spread, demonstrated that harsher quarantine methods resulted because the government initially downplayed the scenario. Furthermore, outsourcing some of the crisis care and management led to exacerbated drastic measures which could have been avoided if the state took more direct measures and took direct responsibility rather than outsourcing care.[1] In fact, the World Health Organization (WHO) also highlighted that crowded emergency rooms and the fact patients either had to or wanted to doctor shop, that is visit different facilities before getting care, likely contributed to the widespread outbreak and the harsh quarantine that followed.[2]

The Geography and Timing of Quarantines

One problem for quarantines is estimating when and where they are need. It has been found with other infectious diseases that the incubation period between infection and onset of symptoms can vary greatly. Cholera, for instance, has a relatively quick manifestation in the population, making it easier to target for action, whereas Ebola, and similarly COVID-19, can have long incubation periods as much as 21 days. This means that the spread of these longer incubation period infections tends to be far less predictable, where people are likely to have traveled to many places between the time of infection and onset of symptoms. Thus, quarantines could be ineffective in completely stopping the spread of a disease since it is often likely someone who is infected has moved from an affected area and spread infection, although quarantines of an entire area could help slow the progress of infection.[3]


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This animated graph shows how quarantines and social distancing actions can slow down transmission rates to allow medical services to keep up with demand and lower mortality rates of a disease.

Using Geospatial Apps to Help with Quarantines

While quarantines can have negative connotations in the context of government enforced policy, there have been developments in geographic tools that allow individuals to become self-aware that people near them have become infected. One recent mobile application developed in China as a response to COVID-19 enabled users to receive in near real-time information if people around them had been reported to be infected or if places a given person had been recently to had people who became infected. This allowed users to self-isolate even before restrictive measures were in place, assisting any wider quarantine efforts.[4] 

Screenshots from a mobile application developed in China as a response to COVID-19 enabled users to receive in near real-time information if people around them had been reported to be infected or if places a given person had been recently to had people who became infected. Image: Boulos & Geraghty, 2020
Screenshots from a mobile application developed in China as a response to COVID-19 enabled users to receive in near real-time information if people around them had been reported to be infected or if places a given person had been recently to had people who became infected. Image: Boulos & Geraghty, 2020

Using spatiotemporal monitoring may also be used in conjunction with strict quarantines. For instance, during the outbreaks of foot and mouth disease (FMD), it was found there was a strong spatiotemporal correlation to where outbreaks occurred. Officials who can understand and use these data can better target areas for quarantine as seasonal, migration, and time variables all influence how given diseases spread.[5] Such analyses could make quarantines more sensible rather than overly harsh.

What research of previous outbreaks have shown is that governments may not respond adequately to major outbreaks, as they are often initially reluctant to mobilize against an outbreak and then may be forced into drastic measures in part to address the lack of initial response. There are factors that also limit what can be done, including incubation periods that might not always make it easy to monitor an outbreak, resulting in quarantines not being completely effective. Nevertheless, new tools, including those deployed against COVID-19, show that individuals and governments can better prepare using spatial analysis in targeting when and where to quarantine. 

Researchers found that the travel quarantine of Wuhan reduced international case importations by 80% until mid February. Source:  Chinazzi et al., 2020. .[6]

References

[1]    For more on how South Korea responded to MERS and what may have exacerbated measures and outcomes, see:  Lim SH and Sziarto K (2020) When the illiberal and the neoliberal meet around infectious diseases: an examination of the MERS response in South Korea. Territory, Politics, Governance 8(1): 60–76. DOI: 10.1080/21622671.2019.1700825.

[2]    For more on the WHO evaluation of South Korea’s response to MERS in 2015, see:  Lim SH and Sziarto K (2020) When the illiberal and the neoliberal meet around infectious diseases: an examination of the MERS response in South Korea. Territory, Politics, Governance 8(1): 60–76. DOI: 10.1080/21622671.2019.1700825.

[3]    For more on the predictability of infection based on different incubation periods for diseases, see:  Kahn R, Peak CM, Fernández-Gracia J, et al. (2020) Incubation periods impact the spatial predictability of cholera and Ebola outbreaks in Sierra Leone. Proceedings of the National Academy of Sciences 117(9): 5067–5073. DOI: 10.1073/pnas.1913052117.

[4]    For more on the application that enabled near real-time information on people’s locations in relation to the COVID-19 outbreak, see:  Boulos, M. N. K and Geraghty, E. 2020. Geographical tracking and mapping of coronavirus disease COVID-19 / severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic and associated events around the world: how 21st century GIS technologies are supporting the global fight against outbreaks and epidemics. International Journal of Health Geographics 19 (in press). 

[5]    For more on combining quarantines with spatiotemporal analysis for FMD disease, see:  Chen J, Wang J, Wang M, et al. (2020) Retrospect and Risk Analysis of Foot-and-Mouth Disease in China Based on Integrated Surveillance and Spatial Analysis Tools. Frontiers in Veterinary Science6: 511. DOI: 10.3389/fvets.2019.00511.

[6]  Chinazzi, M., Davis, J. T., Ajelli, M., Gioannini, C., Litvinova, M., Merler, S., … & Viboud, C. (2020). The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak. Science. DOI: 10.1126/science.aba9757

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