Powers of Quarantine

[Image: Liberian security forces implement “a quarantine of the West Point slum, stepping up the government’s fight to stop the outbreak and unnerving residents.” Photo by Abbas Dulleh/AP, via Al Jazeera America].

Of Forcible Blockades and Military Isolation

A neighborhood-scale quarantine was forcibly imposed on the slums of Monrovia, Liberia, yesterday to help prevent the spread of Ebola.

Using makeshift roadblocks—consisting, for the most part, of old furniture, wooden pallets, and barbed wire, as everyday objects were transformed into the raw materials of a police blockade—authorities have forcibly isolated the densely populated neighborhood of West Point from the rest of the city.

Unsurprisingly, however, poor communication, over-aggressive law enforcement tactics, and general misinformation about the nature—even the very existence—of Ebola has led to local resistance.

Al Jazeera reports, for example, that “police in the Liberian capital have fired live rounds and tear gas to disperse a stone-throwing crowd trying to break an Ebola quarantine imposed on their neighborhood.” But they were perhaps simply trying to defend themselves against a badly communicated onslaught of police wielding batons and machine guns, and they would be doing so whether Ebola was in the picture or not.

[Image: Neigborhood-scale quarantine; photo by Abbas Dulleh/AP, via Al Jazeera America].

Ubiquitous Quarantine

But this is only one of the most recent—and one of the more extreme—examples of the spatial practice of quarantine reappearing in the news in recent weeks. At the end of July, for example, the Chinese city of Yumen was partially quarantined due to an outbreak of bubonic plague, as parts of the city were “sealed off” from the neighborhoods around them; and the ongoing Ebola outbreak has led to involuntary quarantines being implemented at nearly every spatial level, from the individual to the city to entire international regions.

In the latter case, recall that just last week a cordon sanitaire was enforced in the international border regions of Guinea, Liberia, and Sierra Leone to stop people possibly infected with Ebola from crossing the borders. As the New York Times described this action, “The Ebola outbreak in West Africa is so out of control that governments there have revived a disease-fighting tactic not used in nearly a century: the ‘cordon sanitaire,’ in which a line is drawn around the infected area and no one is allowed out.”

This spatial technique for managing the spread of microbiological life has “the potential to become brutal and inhumane,” the paper adds. “Centuries ago, in their most extreme form, everyone within the boundaries was left to die or survive, until the outbreak ended.”

[Image: Enforcing quarantine; Photo by Abbas Dulleh/AP, via Al Jazeera America].

Resisting Quarantine

Yet resistance to quarantine is nearly as ubiquitous as attempts to implement it. The very notion of involuntary quarantine is important to emphasize here: this is something that must be spatially imposed on people who have not chosen to bring this condition upon themselves.

Read this dramatic description from the Times, for example, depicting the moment at which involuntary government quarantine is revealed:

Soldiers and police officers in riot gear blocked the roads. Even the waterfront was cordoned off, with the coast guard stopping residents from setting out in canoes. The entire neighborhood, a sprawling slum with tens of thousands of people, awoke Wednesday morning to find that it was under strict quarantine in the government’s halting fight against Ebola.

The reaction was swift and violent. Angry young men hurled rocks and stormed barbed-wire barricades, trying to break out. Soldiers repelled the surging crowd with live rounds, driving back hundreds of young men.

Involuntary quarantine can inspire this type of reaction at any scale. Consider the panic-stricken family who forcibly raided a hospital in Freetown, Sierra Leone, in order to free an Ebola-stricken relative who, they had come to believe, was being held against her will; she later died, but not before passing her infection on to others. Or consider the Nigerian nurse possibly exposed to Ebola while caring for patients who nonetheless “skipped quarantine,” either out of a desperate sense of self-preservation or due to sheer ignorance of the dangers of her actions.

“Don’t Touch The Walls!”

Somewhat incredibly, though, the deliberate breaking of quarantine can also occur not out of survivalist panic or concern for one’s own medical safety, but simply for the purpose of looting. Some of the descriptions here are jaw-dropping, with raiders actually breaking into Ebola wards to steal “property like tents, tarpaulins, buckets, hospital beds, mobile phones and shoes among other things,” literally all of which could bear traces of Ebola and thus spread the contagion elsewhere.

The New York Times had a particularly chilling example of why not to steal from Ebola wards when it ran this haunting sentence two weeks ago: “‘Don’t touch the walls!’ a Western medical technician yelled out. ‘Totally infected.'”

Yet, even in the West Point quarantine zone, misguided acts of theft are rampant: “Residents stormed through” the quarantine zone, we read, also in the New York Times, “running off with a generator and supplies like mattresses, some soaked with the blood of patients who were believed to have Ebola.”

In a situation where even the hospitals are considered to be “death traps,” where the walls themselves are “totally infected” with Ebola, the designation of involuntary and militarily enforced quarantine boundaries is taken to mean the designation of a kind of urban sacrifice zone, a place where patients can be fatally off-loaded and the disease tragically but successfully contained. From this point of view, getting out of the quarantine zone becomes a top priority.

Residents of West Point have even protested that “their community, they believed, was becoming a dumping ground for Ebola patients,” and that quarantine was simply a spatial excuse for putting victims all in one place, uninfected neighbors be damned. “In all,” we read, “residents tried to break through the barricade three times on Wednesday, Col. Prince Johnson, the army’s brigade commander, said Wednesday evening by phone. His soldiers had fired in the air, he said, but he would not comment on whether they had also fired into the crowd.”

[Image: A “quarantine house” in Pennsylvania; courtesy of the U.S. Library of Congress].

Powers of Quarantine

Who has the power to quarantine? Where does this power come from—especially in a Constitutional democracy like the United States—and where exactly are this power’s limits? Does it have any?

Nicola Twilley and I explored these questions last week for the New Yorker, looking at, among other things, the Constitutional implications of quarantine powers. As we point out in that piece, there is an ethically troubling overlap between the notion of the quarantined subject, spatially isolated often against his or her will, and the liminal figure of the “enemy combatant” who potentially never faces the prospect of a legal trial whilst being indefinitely detained.

In both cases, extrajudicial detention can occur on the ground of suspicion alone—presumed guilt or infection—rather than legal or medical certainty.

In fact, writing as a coauthor on two Congressional Research Reports from 2005, legal theorist Jennifer Elsea commented on both of these categories: of the combatant held by the state without rights or legal access to resistance, and the medical subject unable to protest his or her segregation due to being held in a state of involuntary quarantine.

As we see massive international quarantine zones enforced at gunpoint throughout West Africa, and as suspected Ebola cases pop up everywhere from Johannesburg to California, it is well worth discussing where these spatial powers come from, who controls them, and when and where quarantine has reached its limit.

The Return of Quarantine

Indeed, as Twilley and I suggested back in 2010 during the “Landscapes of Quarantine” design studio and exhibition at New York’s Storefront for Art and Architecture, quarantine is a decidedly pre-modern spatial practice that is nonetheless experiencing a contemporary comeback.

Confronted with widespread antibiotic resistance and increased global air travel that can bring diseases like Ebola to every global metropolis in a matter of hours, quarantine is part of “a 14th-century toolbox” that ironically looks perfectly at home in the 21st century.

[Image: Quarantine station, Pennsylvania; courtesy of the U.S. Library of Congress].

Given all these examples of resistance, confusion, and the violence often necessary to impose spatial isolation on people only suspected of bearing a disease, we suggest in the New Yorker essay that quarantine becomes something of a spatial fiction, always and permanently on the verge of collapse. Its premise is a fantasy; the imaginary boundaries it seeks to defend are legally loose and physically porous.

Nonetheless, for all its apparent instability, quarantine offers a necessary fiction of separation and control at a time when the boundaries between health and contagion have become so vertiginous and blurred.

(Note: Parts of this post were co-written with Nicola Twilley).

Isolation or Quarantine: An Interview with Dr. Georges Benjamin

[Image: An emergency hospital ward in Kansas during the 1918 flu].

Dr. Georges Benjamin is executive director of the American Public Health Association (APHA) and former Secretary of Maryland’s Department of Health and Mental Hygiene; there his responsibilities included updating the state’s quarantine laws in response to the threat of bio-terrorism. Dr. Benjamin is publisher of both the American Journal of Public Health and The Nation’s Health.

He is also co-editor, with Laura B. Sivitz and Kathleen Stratton, of the 2005 report Quarantine Stations at Ports of Entry: Protecting the Public’s Health. That report consists of more than 300 pages of policy guidelines for how the United States can operate, maintain, and even expand its network of national quarantine stations. The very idea of a national quarantine policy, let alone phrases like the international “Quarantine System,” can inspire, at the extreme, all manner of conspiracy-laden theories—including the specter of fully militarized, FEMA-administered concentration camps on U.S. soil. In reality, however, “today’s quarantine stations are not stations per se, but rather small groups of individuals located at major U.S. airports. Their core mission remains similar to that of old: mitigate the risks to residents of the United States posed by infectious diseases of public health significance originating abroad.”

A jurisdictional map of CDC quarantine stations is available online, complete with informational PDFs ready for download.

[Image: Map of the CDC’s U.S. quarantine stations].

As part of our ongoing series of quarantine-themed interviews, Nicola Twilley of Edible Geography and I spoke to Dr. Benjamin about the APHA’s policy recommendations for pandemic flu quarantine, about the role of eminent domain in the medically-motivated seizure of private property, and about the architectural challenge of designing dual-use facilities for public emergencies.

• • •

Edible Geography: I was interested to read the American Public Health Association’s flu policy recommendations from 2007—in particular, to see the APHA’s emphasis on mental health support for people held in quarantine. What led to that being included in your official guidelines?

Dr. Georges Benjamin: If people are going to be confined for some time within a facility, then you want to make sure that you’re identifying those people who are already being treated for mental health issues. You want to make sure they’re getting their therapy and their medications, and you want to deal with any issue that might occur when someone has to stay alone under that level of stress.

Remember that someone who is quarantined is different from someone who is isolated. Quarantined people aren’t sick; they’re people who may get sick. They’re people who have been exposed to a disease but who are not physically ill. In many cases of voluntary quarantine, people are being asked to stay at home by themselves, or to stay self-isolated, and we need to make sure that someone is paying attention to them. We want to identify people who are not able to handle being by themselves or being in a relatively confined space—even if it’s inside their own home.

We were also concerned about making sure people have the basic needs of life: food, water, access to medical care, and access to social services. You want to make sure that you’ve addressed whatever those needs might be. All of these things were part of our package for people who might be quarantined.

BLDGBLOG: Who were the specific constituencies that called for those guidelines, and did anyone try to push you in another direction?

Dr. Benjamin: These guidelines come from our members. A lot of these discussions started way back when we were talking about smallpox, rather than pandemic influenza. We were thinking seriously about the idea of having people stay at home and be isolated, if they’re ill, or quarantined should there be a terrorist attack.

No one actually has access to smallpox now, but we were going out and vaccinating people against a potential terrorist threat, anyway. So we started having these discussions around the idea of whether or not you really needed to reinstitute large-scale—primarily voluntary—quarantine. In addition, we were talking about the risk of a pandemic.

Then, as you know, Hurricane Katrina hit New Orleans. You had people there who, by virtue of the fact that they ended up in the Superdome, did not have all of the things they needed. Certainly a lot of that stuff had been planned for, but it hadn’t been done as robustly as it needed to have been—and, obviously, they had more people in there than they could take care of.

Our thinking, based on that experience in New Orleans, was: in an emergency situation, how do you make sure that people have what they need? And, quite frequently, the mental health needs of people are something that matters in every kind of large-scale public health emergency—whether that’s a tornado, a hurricane, the flu, or an event where large numbers of people have died. It’s one of those things that people don’t really think about ahead of time, unless you remind them to think about it.

Our recommendations don’t just apply, by the way, to the people who are confined; there are huge stresses on the people who are managing those events. The EMTs, the paramedics, and the public health personnel who are all actually managing things can be really challenged—and you have to pay attention to them, too.

[Image: Sample covers of the American Journal of Public Health; design by Kropf Design].

BLDGBLOG: The APHA has also written about who exactly should have the authority to make decisions about who goes into quarantine and why. Can you talk us through your policy on that issue?

Dr. Benjamin: First of all, we try to guide by the least restrictive policy possible—and, to the extent that someone can be voluntarily in quarantine, that’s our first principle. Voluntary quarantine and the least restrictive quarantine possible is what we think is the most important way to start.

Simply giving people the facts about a disease process and keeping them well-educated and well-informed long before you’re going to need to take any action is the best policy. We, as an association, along with our colleagues in the federal agencies, have been trying to talk to the public about what the risks are for various diseases. How do you catch a disease—and how do you not catch it? How you protect yourself? How do you protect your loved ones? Usually, armed with this information, most people will follow the basic recommendations.

However, to the extent that you have to have compulsory quarantine—because you have someone who is continuing to put people at risk—then that is imposed, in the United States, by public health authorities. They have powers, mostly at the state and local level: those powers give them the authority to incentivize people not to put others—or themselves—at risk. In some cases, they can do that by having the police authorities act; in other cases, they have to go to court first. It depends on the individual jurisdiction.

In most cases, federal authorities’ powers end at the borders of the nation and then at the borders of each state. They can deal with issues across state lines, in some cases, and, of course, at our national borders and at ports of entry; but most of these quarantine authorities rest at the state and local health officer level.

BLDGBLOG: Has any of that legislation been revised in light of SARS, H1N1, or even the anthrax attacks?

Dr. Benjamin: There has been a national effort to modernize our public health laws. A lot of them were written years and years ago.

For instance, I was a state health official in Maryland from 1995 to 1999, and I was the secretary of health in Maryland from 1999 to 2002. During that time we began a process, which we finished when I was secretary, to update and modernize our laws. We had started talking about it before 9/11, but after 9/11 and the anthrax attacks , we realized that biological terrorism was a significant risk, and we really worked to strengthen the public health laws.

To give you an example of the kinds of changes and updates we made: we worked to put in some additional patient protections. The law at that time gave the health secretary enormous police powers to hold and to quarantine individuals—but there were no rights or rules for those individuals, or regulations about what they needed to receive while they were in confinement. The assumption was, of course, that they would get reasonable support and care—but we felt it was very important to guarantee that.

So we worked with several members of our advocacy community to strengthen the authority that the health officer had, and to make the authorities that I had at the time, as secretary of health, much clearer. But, on the same token, we were writing in protections. We guaranteed people due process. We guaranteed that, if we had to forcibly confine someone, then they would get medical care, social services, and social supports that they actually need. We put that in writing.

Other states around the nation have begun doing the same thing. There have been some public health law centers set up through various foundations, and they have also been working very hard to strengthen the various laws. There was a model public health law—I think it was produced with a grant from the Centers for Disease Control and several of the public health groups working with them. That law was then shared with all of the states and their elected officials, and it was used as a template through which states could look at their own laws and see how they matched up to the model.

Some states simply took the model and implemented it, exactly as it was written; some took pieces of it out; others took it and said, no, compared to the law we currently have, ours is better and we like ours. Either way, it served as a useful catalyst for people to begin looking at their own public health laws—not only in terms of the authorities that the public health officer had around isolation and quarantine, but also about reportable diseases, which diseases ought to be reported, and how, and who should do the reporting. There were also things that we added around patient protections, citizen protections, and due process. And there were sections that meant to clarify existing law, based on case law in the state, or nationally.

That work has been going on since late 2001, and it continues to this day in a variety of formats.

[Images: Hong Kong’s entire Metro Park Hotel was put under quarantine for seven days after an H1N1-positive Mexican tourist stayed there in May 2009; “psychologists were on standby,” we read. All photos courtesy of the China Post].

BLDGBLOG: In terms of these public health laws, where can quarantine occur? It was interesting during the SARS outbreak in Toronto, for instance, to see that hotel rooms were simply repurposed as temporary quarantine facilities.

Dr. Benjamin: Quarantine can occur anywhere—that’s the short answer.

Remember that quarantine is basically telling someone who has been exposed to a disease, even if they haven’t come down with that disease, to stay away from others, and to stay somewhere that we can observe them and see if they get sick. Functionally, that can occur anywhere—as long as you have the support that you need, and as long as you’re not kept somewhere where other people will be at risk. For someone who’s quarantined, a hospital is probably not a good place for them, because there are sick people in that hospital and, in any case, the hospital will usually need those beds.

Let’s say I travel to England for a business meeting, and there’s a big infectious disease outbreak. They’re not quite sure what it is, but I could theoretically have been exposed. They don’t want me to travel back home because they don’t want me on an airplane; I could expose people on that airplane. So they ask me to stay in my hotel room, and to get room service. That’s probably a perfectly reasonable request—as long as you know that, in everybody who’s had this disease, it shows up within 48-72 hours. It might be very inconvenient, but, in the interest of public health, somebody could ask me to do that. Now, there are issues around the air circulation in the hotel, and whether or not that’s appropriate—but let’s just assume that it is. From the APHA perspective, that request would be fine, particularly if you have somebody who can call and check on you a couple times a day and make sure that you’re not getting sick in the hotel room.

Now let’s say this happens at a wedding party taking place at a small hotel. For all practical purposes, if everybody at that hotel had been at the wedding, it would be reasonable to ask everybody to stay at that hotel—and, actually, they wouldn’t even have to stay in their rooms. They could be out and amongst each other, as long as they were fully informed about the symptoms that you get when you start to come down with whatever this disease process is. If those symptoms start to show, those people would then self-isolate, call public health authorities, and tell them, “I’m in my room, and I’ve got a cough and a fever, and I didn’t have that yesterday.”

If it turns out that this disease process is something mild, and we know you can take care of it there in the hotel room, then we’d probably just say, OK, isolate yourself in the hotel room. Before, you were able to get up and walk around the hotel—no big deal—but now you have to stay in your room. We’ll have the concierge send up your meals, and we’ll give you some Tylenol for your temperature. If it was something like H1N1—or some other viral illness that we knew is susceptible to antiviral agents—then we may very well give you antiviral agents, too. Of course, we’d also have the hotel doctor come up and see you. However, we would still ask you to stay in your room. That’s a voluntary isolation, now, within a quarantine facility, because you’ve been separated from everybody else.

The people who run the hotel, on the other hand, could say that they really don’t want this sick person staying in the hotel, for whatever reason. We’d then actually ask you to come out of the hotel; we’d come pick you up; and we’d take you to someplace else where people are being held and provided with medical care. At that point, you’re in isolation. It could be a hospital; it could be another facility. It could be a hotel; it could be a home. It could be anyplace where they’ve designated that as an isolation point. Again, in most cases it would be voluntary.

So it depends—these examples show that quarantine could take place anywhere, in a variety of forms.

[Images: (left) Reporter Will Weissert, quarantined in China, receives his lunch sealed in a plastic bag; (right) Weissert’s wife receives a medical check-up in the hotel room].

BLDGBLOG: Things like eminent domain and the government seizure of private property—these legal issues surely play a role in quarantine guidelines?

Dr. Benjamin: You’re right—and we’ve had long discussions about those issues.

For example, let’s say we have to isolate people due to a very severe disease process. In most cases, when people are sick enough, they need to, and are willing to, go to a hospital—but one of the challenges we’ve found is that hospitals don’t want to be known as the “X-disease hospital”: the SARS hospital, the swine flu hospital, the smallpox hospital. There’s some history there—in the United States, it began with places that became known as tuberculosis sanatoriums. If the public begins to shun a place because they’re afraid of catching a disease that has somehow been associated with that hospital, then it takes that hospital out of business—even if you only have one or two cases.

We saw this during the anthrax attacks at hospitals where somebody had been exposed, in whatever way, to anthrax. Even though we know anthrax is not a contagious disease, we had patients who were very concerned—at OBGYN services, in particular. Pregnant women just wouldn’t go to that hospital. As it turns out, we only had a very few cases of anthrax, but the press got onto this, and they publicized the fact that a person with anthrax had been at this particular hospital. Then that hospital had patients who were concerned about going there. So, of course, what we had to do was get on TV ourselves and say: “No, no, you don’t need to worry about that. It’s not contagious. That’s not how you get anthrax. You can still go there; you can still deliver your baby there.” But reassuring the public is sometimes very difficult. In many cases, it’s more about fear than anything else.

The other piece of this is that, if you have a disease outbreak that is so widespread that you have lots of sick people, then it’s unlikely that you’ll have only one hospital impacted. One of the fallacies of people worrying about their hospital being the SARS hospital, or their hospital being the smallpox hospital, or the flu hospital, is that, in most cases, those diseases are so infectious that lots of cases are already in the hospital environment. They’re in the ER, in the outpatient clinics, etc. One hospital might have an intensive care unit, and the very sick patients may end up in that unit—but the other hospitals in the area will end up taking care of the outpatients. The likelihood of only one hospital being the hospital with a particular disease process, and being stigmatized because of that, is very low.

There are exceptions, of course: let’s say you’ve got a research hospital and it has a novel therapy, and the only way to get that novel therapy is by going there—well, that hospital is going to end up with a disproportionate number of those patients. That’s one of the communication issues that hospital is going to have to manage with the public.

Now, to your question, many of the public health laws do have statutes that allow for the taking of stuff. In Maryland, for example, the state can confiscate your facility—and it’s not just your facility: it could be your pharmaceuticals; it could be your box of syringes. If the state declares an emergency, and it has the authority of the law and it goes through the proper procedures, then, yes, it can confiscate things.

But what we did in Maryland was we clarified a few things: firstly, that you would be compensated. We thought that was very important to put in. We also wanted to make sure that it requires extraordinary efforts to make it happen. In Maryland, for instance, a disaster has to be declared by the governor, and there’s a legal process that one has to go through in order to confiscate someone’s stuff.

A lot of the plans in the U.S. for where we’ll put sick people raise some interesting issues. For example, some of these plans say that if we need to expand bed-space beyond the hospitals, then we need to use schools, gymnasiums—anyplace where you have a wide-open ward. Of course, there’s a big debate going on about whether those are the best places for these folks—and the reason for that debate is that they’re not built as health facilities. You couldn’t put your sickest people there. You might be able to quarantine people there—people who are well enough to get up and wash their hands and go to the bathroom, etc.—and you might be able to put people there who are moderately ill, but you couldn’t put very sick people there. It’s simply not set up as an intensive care unit.

The other thing to remember is that, even though you’ve got a disease outbreak going through your community, you still have the other, baseline disease processes. There are still heart attacks and strokes and people with seizures and kids with fever unrelated to the flu or unrelated to the infectious disease going on. You still need beds for people at ICUs for heart attacks, and you still have to treat cancer. The management challenge is to make sure that local providers don’t set up a process, of either isolation or quarantine, that deprives them of the resources they need to maintain their ongoing health system.

Edible Geography: Where are the gaps, as you see it, in public preparations for quarantine?

Dr. Benjamin: There are a couple of things I can think of right away. There’s the public education aspect that we and our colleagues are continuing to work on—there’s always more that could be done there.

The other thing is that we need buildings and facilities that have multiple uses. When you build hospital emergency rooms, for example—and it’s been fascinating watching this shift occur—we’ve gone from a situation where people had individual rooms in the ER to open-bed concepts. But what you need is flexibility. You need facilities flexible enough to accommodate multiple purposes.

You remember I talked about a gym being utilized as a potential quarantine spot? Well, some of the issues that get in the way of that are that there are not enough electrical outlets. You can’t bring up walls to partition the place in a way that easily allows you to isolate one group and quarantine another. There also isn’t the plumbing, and there probably aren’t enough bathrooms. You’ve put a lot of people together who may have a disease—and now you have a problem, because not everybody can wash their hands. We’re all using hand sanitizers today, and they’re wonderful, and they work; but, frankly, good old soap and hot water is the best thing to use.

Then again, most elementary schools were designed for little people, and now you’re about to put a bunch of adults in there; they might not have as many soap dispensers as you need, or the bathrooms are too large, or the toilets are too low, or there aren’t enough sinks. Or, again, maybe the sinks aren’t in the right place: they’re not by the bedside where infection-control needs to occur.

Building an environment that thinks about these other potential uses is extremely important, for places like hotels or gyms or the other big spaces that might be used to hold a bunch of people. And, by the way, quarantine is only one need for those things: as part of our overall public health preparedness, we have to look at putting people up because of a hurricane, or floods, or a tornado, or a big infectious outbreak.

The single-center principle means that a place needs to be flexible enough for large numbers of people, and in which you can have adequate infection-control, adequate toilet facilities, and adequate food facilities so that everyone can eat.

If we build places that do those kinds of things, then they’ll meet all the needs for isolation, all the needs for quarantine, and all the needs for housing people in an emergency.

[Images: Shuhei Endo’s “tennis dome/emergency center” (left), photographed by Kenichi Amano, next to the New Orleans Superdome, post-Katrina].

BLDGBLOG: That actually reminds me of some stadiums in Japan that were built both as sports stadiums and as earthquake-disaster centers. There’s food and water stockpiled in the basement, the entryways are sized for emergency vehicles, and so on. How would you recommend this sort of architectural adaptation, on a policy level?

Dr. Benjamin: We wouldn’t have much trouble convincing the presidents of universities today, who are already challenged with a disease process big enough to affect the whole student body. In the United States right now, with H1N1, the number of sick kids is big enough that they’re having to manage those kids on campus. For a disease process in which people are going to be sick for five or seven days, it’s unrealistic to send them home once they’ve shown up on campus. Colleges are having to deal with accommodating them right now. You can bet that, at least on college campuses in the United States, they would be very sensitive to this idea of dual-use facilities, because there’s an operational need for it.

The second thing is, if I was trying to do this, I would be working directly with architects and engineers, convincing them of the need to do it and then letting them sell it. They can say how best to do this, in a way that does not obstruct the primary purpose of the facility. We don’t want to interrupt anyone’s football games, but at the moment, everyone says, yes, we can put people here but it’s only going to happen once or twice in my lifetime, when the truth is that, if you design it that way, then you could use it much more frequently for that purpose. You could get dual-use out of it. Getting the people who design these places to tell us how to do it, in an appropriate and cost-efficient manner, and then having them make the case to the owners and users, so that they know that this is value added to their facility: that’s how I would get this message across.

Then I would talk to elected city and state officials about ways they could leverage tax-payer dollars to get these dual-use facilities built. Let’s say I’m in city government and I have someone coming up to me wanting the city to put up tax-payer dollars to support the building of a football stadium or a basketball stadium or a new school. If I get this additional bonus—this dual-use that helps my emergency-preparedness—I’m more likely to want to use taxpayer dollars to support it. Increasingly, as you know, private sector guys are coming to the government and asking for fiscal support to build these facilities. If tax-payers are going to be paying for things, then the city or the community needs to get something out of it.

I can tell you that a lot of work had to be done to fix and clean the New Orleans Superdome—but if you had built it so that it could be much more functional in an emergency situation then you would have had less damage. And from an image perspective, a dual-use sports facility now has much more of a public value.

That’s my personal view, not the Association’s view; but I think it’s an effective argument.

• • •

This autumn in New York City, Edible Geography and BLDGBLOG have teamed up to lead an 8-week design studio focusing on the spatial implications of quarantine; you can read more about it here. For our studio participants, we have been assembling a coursepack full of original content and interviews—but we decided that we should make this material available to everyone so that even those people who are not in New York City, and not enrolled in the quarantine studio, can follow along, offer commentary, and even be inspired to pursue projects of their own.

For other interviews in our quarantine series, check out Extraordinary Engineering Controls: An Interview with Jonathan Richmond, On the Other Side of Arrival: An Interview with David Barnes, The Last Town on Earth: An Interview with Thomas Mullen, and Biology at the Border: An Interview with Alison Bashford.

More interviews are forthcoming.

Extraordinary Engineering Controls: An Interview with Jonathan Richmond

[Image: A mobile biosafety containment apparatus in a simulated medivac exercise, via the CDC].

Jonathan Richmond is director of Jonathan Richmond and Associates, Inc., a private biosafety consulting firm based in Atlanta, Georgia. He founded the company after nearly 35 years with the Centers for Disease Control.

The firm has a particular expertise in “facility design” for biosecure environments, with a strong emphasis on international biosafety education efforts. Richmond has worked on projects with NASA, the National Academy of Sciences, and the World Health Organization Biosafety Program, to name a few, and he has participated in supervisory visits to the remote bioweapons labs of the former Soviet Union.

As part of our ongoing series of quarantine-themed interviews, Nicola Twilley of Edible Geography and I spoke to Richmond about his firm’s work, about the technical specifics of biosafety, about the difference between biosecurity and quarantine, and about his own professional history.

• • •

BLDGBLOG: First of all, what exactly is biosafety? How is the term most commonly defined?

Jonathan Richmond: Biosafety is focused on issues related to microorganisms that cause diseases of humans or animals—and, if not the microorganisms themselves, the toxins that those organisms might produce. Achieving biosafety relies on a combination of the facility in which you’re going to work—that is, the engineering controls; the personal protective equipment that you’re able to wear; the medical surveillance programs that you’re involved with; whether you can be immunized against the disease agent, and so on—and then the practices and the procedures that you follow while you’re doing the work. The latter, ultimately, is perhaps the most important and most critical thing.

BLDGBLOG: Can you explain the difference between quarantine and biosafety?

Richmond: Quarantine is typically defined, or set up, when you have somebody who is already ill and you want to keep them from spreading their disease to other people. Our containment recommendations usually involve a range of biosafety practices, including quarantine. Some examples of that, of course, are all of the plans right now for the H1N1 swine flu. If you look at any of the websites that are talking about the precautions or procedures in college settings, for example, one of the things they emphasize is hand-washing—which is a practice or procedure that you can do to prevent the spread of a bug—but most go on to suggest that, if you are ill, then you should stay in your room. That’s a form of self-imposed quarantine.

We saw quarantine go into effect on a very large scale with the SARS virus outbreaks, primarily in SE Asia and Canada: there was an absolute need to isolate the people so that they did not spread the disease further.

Edible Geography: There seem to be different levels of biosafety. Someone staying in their dorm room is not biosecure, for instance; it’s just a form of social isolation.

Richmond: Yes, but that’s typically what one would do: keep the person isolated, either at home or, in the case of SARS, in hotel rooms, because they didn’t have appropriate isolation units in the hospitals.

It depends, I suppose, on the extent of a disease outbreak: how many people are actually infected? In a normal hospital setting, if you have only a single case, that person would be set up in what’s called an isolation area or isolation room. But as you get overwhelmed with cases, public health takes on other aspects, including trying to keep people quarantined in their own homes.

This was the standard set-up back at the turn of the last century. People would get various diseases going through the community, and public health people would go around and put a quarantine sign on your house. You were unable to have visitors; you weren’t supposed to go out. That’s basically the way things were contained.

[Images: Biosafe labs and research facilities].

BLDGBLOG: Beyond these social and behavioral safeguards, what about the actual design of biosafe spaces?

Richmond: We look at four different levels of biocontainment.

Level one is basically no containment. Level one is for working with microorganisms that aren’t known to cause human illness. This is the kind of laboratory that, for example, you might see in a high school, or in an introductory course at the college level—even a lab that’s doing E. coli studies at your local sewer plant. It’s not much of anything at all, except simple behavioral guidelines—like don’t stick things in your mouth!

Level two is for working with microorganisms that are generally circulating in the community. Those are things that may cause illness; they’re probably the childhood diseases that everyone experienced early on, or that you’ve already been vaccinated against. In these particular laboratories, there’s a lot of emphasis on such things as hand-washing, wearing gowns, and wearing gloves. The facility itself is relatively simple; it’s more like a hospital laboratory. In the scope of things, this is where 90% or more of microbiological work is done. These labs are throughout the country and around the world.

With level three laboratories you begin to see some extraordinary engineering controls. These laboratories are the ones that are designed to work with microorganisms spread by the aerosol route. Level two are for ones that are spread by contact. At level three, you would see the engineering controls that give you things like directional-inward airflow. You would be looking for special filtration on exhaust air that’s leaving the labs. People would work inside biological safety cabinets, which are designed to protect the worker, to protect the product that you’re working on, and, indeed, to protect the environment – the micro-environment of the lab or the external environment. Those are really quite sophisticated in their design and in their operation. There is where a lot of work on, for instance, tuberculosis takes place in this country. A fair number of the organisms that are being considered as potential agents for bioterrorism are worked with at level three.

Then the level four laboratories are super-containment labs. They’re called maximum containment labs. These are labs where people would ordinarily wear a positive pressure suit while working—so they would have air supplied to them. The diseases they’re working with are the ones for which we really don’t have any vaccines and that, for the most part, we really don’t have any method to cure you if you get ill. These are the really dangerous pathogens—things like Ebola viruses, Marburg viruses, smallpox, etc.. At level four, you have bladder gaskets around the doors and you take chemical showers when you come out so that your suit gets decontaminated—and then you take that off, and you take a regular shower (which you generally would do at level three, also).

A lot of attention is also paid to the liquids at level three and four—collecting these and decontaminating them, either through chemical means or through heat treatment. Anything that comes out of a level three or four lab has to be decontaminated. Small objects—things like the used clothing, small animal carcasses, and used laboratory equipment—would be run through steam autoclaves. That will sterilize things. But the large volumes of liquid effluent that you might get, say, from showers, would be collected in a very large tank, typically directly underneath the laboratory, and then heat treated or chemically treated with chlorine. Heat treatment means that you take it up to very high temperatures for certain designated periods of time before you can then cool it down and release it into a sanitary sewer.

BLDGBLOG: I’d love to hear about two or three specific projects that you’ve worked on in the past. How did those projects foreground questions of biosafety or quarantine in an interesting or perhaps unexpected way?

Richmond: I used to work at CDC, and CDC is the only place in the United States—indeed, it’s one of only two places in the world—where you can work with smallpox virus. Smallpox was eradicated back in the 1970s and, at that time, a lot of work was done to make sure that any smallpox still held in laboratories was either destroyed or sent to CDC.

But the other laboratory where smallpox can be worked on is at an institute called Vector, out in Russia. It’s in Siberia. I had an opportunity to visit that particular laboratory a number of years ago, to see how our Russian colleagues had their containment system set up. This was so we would could compare it to how we have things set up in the U.S.

I was one of the very few Americans who were ever allowed inside that containment facility; it was an honor to go there and it was extraordinarily interesting.

[Images: From artist Luke Jerram’s extraordinary Glass Microbiology project].

Edible Geography: What differences did you notice in their set-up?

Richmond: The Vector labs, like so many things in Russia, are built on a much larger scale than in the U.S. Buildings seem to be bigger there, and the general way they do things—things are just bigger.

At the time I was there—and this would have been in the mid to late 90s—the control systems for things like airflow, which is so critical in these labs, was basically handled on a laptop computer in the U.S. Over there, however, it was all controlled by this big bank of flashing lights, and they had two or three people who simply sat there all day long and watched the flashing lights, making sure that they continued flashing. Their technology was not as far advanced.

Also, the suits they wore were of a slightly different design—but they accomplished the same thing. I actually thought it was a pretty good suit.

I’ve also had a chance, in the past, to work with NASA, as they began to think about sending people to Mars. If you remember, back when we sent people to the Moon, there was a concern that the astronauts might bring something back from outer space. Although they built some pretty robust facilities for it, the way they handled it was not quite the way we would do it today. In fact, I had a chance to visit the NASA facility where all of the moon rocks are stored. I was able to get inside the laboratory and fiddle around with some moon rocks.

But the work for the future was looking at new issues. It started with a straightforward question: what happens if we bring samples back from Mars? In that case, there was a dual concern. On the one hand, if the samples that came back happened to have an infectious agent in them, then we wanted to make sure we could protect the workers—and that’s pretty much the same way you would protect the workers in a level four facility.

But the other thing that NASA wanted to be very sure of was that we did not contaminate the samples with normal earth microorganisms. Because then you could say: oh, look, we found life on Mars! When, in reality, it was something that had been introduced once the sample got back.

So we got to talk about design concepts where you would have the same biosafety technology that we have here, such as negative air pressure, to prevent any organisms from escaping the facility. On the other hand, we would normally use positive air pressure to keep bugs out of a system, say, in a facility where you’re developing of vaccines or drugs. So we had to come up with a dual system that would allow for both positive and negative air pressure at the same time.

[Image: The returning Apollo astronauts relax inside their Airstream trailer/quarantine station, and their highly regulated route back from the moon].

Edible Geography: How did you manage that?

Richmond: The concept designs that we developed used cabinets. Biological safety cabinets come in three basic formats: class one, two, and three. The class three cabinets are hermetically sealed devices; your arms go into the cabinet in these big gloves that are sealed to the cabinet itself. What the designers came up with was that, since the cabinet is normally operated under negative pressure, they put a second layer around the cabinet, and that would be under positive air pressure. You could do it other ways, obviously, but that was the one we came up with.

This design challenge then got extended by a project that we worked on through the National Academy of Sciences. They were thinking ahead to the point where the question became: How would we protect the astronauts if they went to Mars? How could we set up a laboratory there? That was very interesting, to learn about the geology and the geography of Mars, and to learn about some of the issues that we would have to deal with there.

For example, one of the biggest problems is the dust that just covers the surface of Mars. Regolith, they call it. If you’re running any kind of air-filtration system, it would very quickly clog if you had a dust storm going on.

Finally, I also had the opportunity to build a level three biocontainment laboratory in Africa—and that posed some very interesting questions. For the most part, in these developing countries, you don’t have all the things that we might expect to have, like running water or a reliable source of electricity. So the question there was: How do you design around those limitations?

Edible Geography: When you were working with NASA and the National Academy of Sciences, did concerns with quarantine also run the other way—in other words, quarantining materials from earth that we send to Mars, so as not to contaminate Mars?

Richmond: Yes. In fact, there’s a very interesting position in NASA; it’s called the Planetary Protection Officer. The person I met at the time who was Planetary Protection Officer was probably a combination of an engineer and a biologist—I don’t know what specific background he had. But that person oversees, and provides certain controls on, what is sent out from earth and what is returned to earth.

There are different criteria for this. For example, if a rocket is just going to go out, and there’s no intent for it to land anywhere—if it’s just going to send back information—then there’s less concern for what’s called “forward contamination.” But if we were to land that rocket on Mars, on an asteroid, or anywhere else, then there are things that we need to set up in order to sterilize a spacecraft before it can go.

Then, if it comes back, there are even more concerns. We spent a lot of time talking about how we could bring a rocket back from Mars. For instance, could it land on earth? Would they have to eject a capsule and parachute it down into the desert somewhere? How exactly could we do this? There was a lot of thought given to that.

The whole issue of quarantining samples, and bringing them back, also came up when the European Space Program wanted very much to be part of any Mars sample-return mission. In that case, if we can safely transport a sample from a containment lab somewhere in the U.S. to another lab in Europe, then could we also transport a subset of that sample to another country—say, to England—so that they could work on it over there?

We actually have developed some very robust mechanisms for the transport of infectious materials, globally, so I think the application of those same kinds of technologies to NASA sample-return missions would help assure us that we aren’t contaminating something that we’re shipping—or it wouldn’t break open and contaminate the world. The Andromeda Strain, you know.

BLDGBLOG: Is there a regulatory body that determines international standards of astronomical quarantine? For instance, what if China were to bring back a sample from Mars, but scientists in the U.S. thought it should be quarantined? How would this be regulated or enforced?

Richmond: Whether there’s such an agency or not, I don’t know. But I’ve been doing a lot of work in China recently, and in southeast Asia, and they are very concerned about biocontainment. They have pretty much adopted the same standards that we have in the U.S. The CDC’s book on biocontainment has actually been translated into at least seven languages, and it has pretty much become the accepted standard around the world.

So I think if you started to play around with something that you were bringing back from outer space… It’s such a small community of people, and they all have the same concerns. I am not terribly worried about the possibility of disagreement there.

[Image: Biosafety cabinet and suited worker].

BLDGBLOG: I’m very interested in your own career trajectory, and in the nature of the private company that you’ve founded. Could you talk about the market niche—private biosafety consulting—that you stepped into with this?

Richmond: It was a pretty logical next step, when I left CDC after about 35 years of biosafety work, because I just have a wealth of knowledge and I didn’t want to let it all disappear. I’ve done a lot of publishing, and I’ve got a lot of stuff out there; but there’s a lot more to it that just comes from experience.

So we set up a very small company just to provide these services—either working with architects and engineers in the design phase, or even in the commissioning phases, or auditing the labs once their built, to make sure that they’re actually functioning the way they were intended.

We also do a lot of teaching for the people who work in the labs, and for the people who support the labs, to make sure that they understand how to work safely. It’s been very interesting to be out and about.

When I was at CDC, I also had lots of international travel experience. That means I’ve been able to work with ministers of health in different countries, or to work with them through different agencies.

Shortly after I retired, I spent three months at the World Health Organization working with them on developing their biosafety program. I was there about two weeks—maybe three weeks—when they said, listen, we have a SARS laboratory-acquired infection in China. We want you to go and investigate it. That was really neat, to be on the ground, doing that kind of work.

Edible Geography: So in that case, you were investigating a biosafety failure?

Richmond: Yes—we were looking to understand how it occurred. Was there one thing—or two things, or six things, or a convergence of things—that allowed for this to happen?

That’s actually something that we often do in the field. Every institution that has experienced a laboratory-acquired infection spends a lot of time trying to determine what went wrong so that we can spread the word. Was it a failure of equipment? Was it a failure of procedure? What exactly happened?

This, incidentally, is the model that was established by Arnold Wedum, who is considered to be the father of biosafety. Back in the 1940s, Wedum was a physician at Fort Detrick, Maryland; at that time they were studying offensive biological warfare. He had a small team of people and, any time something went wrong, they would spend a lot of time trying to figure out what happened. What was it that allowed for an agent to escape from the tube or from the centrifuge? That work continues today, following the same guidance document, in order to figure out what’s going on.

Edible Geography: How did you first get started in this field?

Richmond: Years and years ago, when I first started, I was at a place called the Plum Island Animal Disease Center. That’s located just off the tip of Long Island. We did a lot of what if? scenarios there—not just about Plum Island itself. For example, we were once talking about foot-and-mouth virus: how do you contain it? And how do you eradicate it?

It was an incident like that that got me out of the lab as a full-time virology researcher and into the field of biological safety. We had a breach of the containment at Plum Island back in the 1970s, and the director came to me and he said, “Richmond, we need a biosafety officer—would you like to be that?” And I said, “What’s that?” [laughs] Because the term biosafety officer really had not been coined until 1976 or thereabouts, at the Asilomar Conference in California, where the first recombinant DNA research was presented as scientific fact. The scientists there got quite concerned—almost frightened, I suppose—not knowing what this research was going to be lead to. They called for a moratorium on this type of work until the director of the National Institutes of Health could assure them that it was safe. It took about a year of research at NIH before they came up with the guidance document about biosafety levels.

But, in this document, it said that if you’re going to do this type of work then you need to have a biosafety officer. That’s how we got things started.

[Image: The H5N1 “bird flu” virus].

BLDGBLOG: As far as your current work goes, who, for the most part, is your clientele? In other words, are you working mostly for private firms or for state-affiliated clients?

Richmond: It’s some of everything. We’ve done a lot of work in Brazil. Brazil has built a very robust biosafety program over the last dozen years. I’ve done perhaps 20% of my work in southeast Asia—a lot of work in Singapore and China. In Singapore it’s all quasi-governmental, because of the nature of their dictatorship. And in China—who knows what it is. [laughter] But most of the work I’ve done there has been with CDC China—the equivalent of the CDC in Atlanta.

I also work with private industry—companies that say, hey, we’re doing this kind of work and we need someone from the outside to come by and take a look, to make sure we’re meeting the standards. Back in 1996, a program started at CDC that, by its very nature, fell into my lap. That was to look at what has been called the “Select Agent Program,” which is a bunch of microorganisms that have the potential for being used in biowarfare. Laboratories that are working with these agents have to be registered with the CDC or with the Department of Agriculture—or with both, depending upon the agent. In order to get that registration, or to keep that registration, they have to be inspected by CDC or USDA roughly once every three years. There’s a growing concern that some of these labs are not going to pass the inspection. So they contact me to do a pre-CDC inspection—we just help them to clear up the things that might stand in the way of getting, or not getting, their approval. That’s the kind of work that we do.

The stuff I like to do the most, though, is teaching. Getting out there and teaching people what we call the principles of biosafety—and, how, once they’ve learned those, they can get out and start teaching them to other people in turn.

To give you an example: in the mid-90s we did a program in Brazil called a “Course for Multipliers.” We had one representative from each of the seven federal laboratories, and one from each of the twenty-three state laboratories, and we gave them all a week of training. We gave them materials—Powerpoint presentations and books, all translated into Portuguese. Over the next three years, they went on to train 4,000 more people. That’s why I say that they have taken to this big time.

We’ve also done training in China, and we’ve been working with Pakistani and Indian folks, first of all to get biosafety associations started there but also to do some training. The Pakistanis have since started a biosafety association; the Indians are planning to, but they haven’t actually done so yet.

Edible Geography: Finally, what issues, innovations, or trends for biosafety do you see looking into the future?

Richmond: That’s an interesting question. A few years ago, the United States set out to build more containment laboratories. This actually started before 9/11, as we tried to get more hospitals to have their TB work done at level three, rather than at level two. But, then, of course, after 9/11, a lot of money got pumped into the system, and there have been a whole bunch of labs built since then, both level three and level four.

However, I also think we’re going to see more international growth of the field. I have a project I’ve been working on for the last five or six years now, trying to see if we can establish a standard for biosafety professionals that would be recognized globally. The World Health Organization recognizes 196 different countries, and probably only 20 of them have what you would consider a reasonable biosafety program.

I think we’re going to see this gradually grow. Our concept of the world is shrinking all the time, in terms of how quickly we can move and how quickly agents can move around. And these little bugs don’t carry passports and they don’t honor borders, and we have to be vigilant. We have to take a look at whatever’s coming down the pike next. The avian flu and, now, the H1N1—and who knows what it will be next year. But there’s more and more international cooperation on this kind of stuff, and I think it’s wonderful.

• • •

This autumn in New York City, Edible Geography and BLDGBLOG have teamed up to lead an 8-week design studio focusing on the spatial implications of quarantine; you can read more about it here. For our studio participants, we have been assembling a coursepack full of original content and interviews—but we decided that we should make this material available to everyone so that even those people who are not in New York City, and not enrolled in the quarantine studio, can follow along, offer commentary, and even be inspired to pursue projects of their own.

For other interviews in our quarantine series, check out Isolation or Quarantine: An Interview with Dr. Georges Benjamin, On the Other Side of Arrival: An Interview with David Barnes, The Last Town on Earth: An Interview with Thomas Mullen and Biology at the Border: An Interview with Alison Bashford.

Many more interviews are forthcoming.

On the Other Side of Arrival: An Interview with David Barnes

[Image: A ruined dock at the Philadelphia Lazaretto; photo by David Barnes].

David Barnes is associate professor of the History and Sociology of Science at the University of Pennsylvania, where he focuses on medicine and public health. His most recent research project involves the Philadelphia Lazaretto, a 19th-century quarantine station located on an island in the Delaware River.

As part of our ongoing series of quarantine-themed interviews, Nicola Twilley of Edible Geography and I spoke to Barnes about the origins and history of the now-abandoned Lazaretto, including ongoing attempts to preserve the site today. In the process, our conversation covers the legal nature of Colonial-era quarantine, the cultural impact of epidemic disease, and the psychological effects of involuntary medical isolation,

[Image: The Philadelphia Lazaretto, via Wikipedia].

• • •

BLDGBLOG: How did you first get into the study of quarantine, and specifically of the Philadelphia Lazaretto?

David Barnes: The history of quarantine was actually not my idea of a burning historiographical problem. In fact, I was working on two completely different projects when I first saw the Lazaretto—but the sight of it just really stuck in my mind. I decided to read everything that had been written about the history of this place—but I soon found that essentially nothing had been written, in a city where it seems like half the buildings in Center City have two or three books written about their history. This is the oldest surviving quarantine facility in the Western hemisphere, and the seventh oldest in the world—and almost nothing has been written about its history.

BLDGBLOG: Why do you think it’s been so overlooked?

Barnes: I don’t really know. I don’t have a good answer for that, even though I’ve asked myself that question many times. It’s possible that it’s just an accident, and the right person at the right time simply hasn’t come along. On the other hand, I wouldn’t say that the history of quarantine is a large, robust subfield of the history of medicine. Generally, historians have written about specific diseases or specific outbreaks; in many of those works, quarantine figures only fairly marginally.

[Image: Philadelphia’s abandoned Lazaretto as it now stands, photographed by David Barnes].

Edible Geography: Can you describe the Philadelphia Lazaretto, and tell us something of what you have found out about it?

Barnes: Sure. The first law relating to quarantine in Pennsylvania was signed by William Penn in 1700, in response to an epidemic of yellow fever in 1699 in Philadelphia. Philadelphia was founded by William Penn and his gang in 1682, of course—so yellow fever wasn’t far behind. But quarantine itself was not a systematic policy until later in the eighteenth century.

Sometime around 1743, the Pennsylvania colonial government bought an island at the mouth of the Schuylkill River, where the Schuylkill meets the Delaware near Fort Mifflin (which was also built around the same time). It was called by various names: Fishers Island and Province Island, and then later it became known as State Island. It’s just northeast of where the airport is today.

I should say that I’ve developed a little bit of a pedantic pet peeve about the word quarantine, because people use quarantine to refer to what I call isolation. Whenever there is the threat of swine flu or whatever other contagious disease, there are always various policies or proposals to isolate patients or isolate the households of patients or infected people—in other words, impose some form of voluntary or mandatory house arrest or hospitalization somewhere. To me, that’s not quarantine, that’s isolation. Quarantine, in the strict sense, refers to trying to prevent a disease from entering a community from the outside: basically, the interception and detention of vessels, vehicles, cargo, people, or whatever, for a period of time. That’s what quarantine is to me.

Anyway, in the 1740s, Fishers Island/Province Island was bought by the colonial government of Pennsylvania, and structures were built for the accommodation of vessels, passengers, cargo, and patients. Those structures are occasionally referred to as the Lazaretto, though it’s usually referred to as the Marine Hospital. Occasionally you’ll see it referred to as the Pest House, or just Province Island.

Quarantine was enforced on a sporadic basis at that location for the rest of the eighteenth century. As the city grew, the inhabited part of the city got closer and closer to the island. What was a pretty remote location in 1740 was not that far away at all from the city by the 1790s, and it was not at all hard for people in the city to have contact with people at the marine hospital. So you have friends and relatives trying to make contact with people undergoing quarantine; you have merchants trying to pick up their cargo from ships undergoing quarantine; you have people passing messages back and forth… It was just not very hard for Philadelphians to get there and to have contact with people under quarantine, even though it was against the law.

Then comes 1793. There was a devastating epidemic of yellow fever that year, the likes of which had not been seen before. The best estimate is that ten percent of the city’s population died in two months. A huge percentage of the population fled. Basically, anyone who had anywhere to go, left, including many of the doctors. It was a calamity.

By then, the United States was an independent nation, and its capital was Philadelphia. The Federal Government was sitting here, the Supreme Court, the President—they were all there in Philadelphia. They mostly hightailed it out of town, too, and the national government was brought to a standstill.

The scenes of devastation that are written about in letters and surviving testimony are absolutely heart-wrenching. It was terrifying, it was gruesome—but it was also heroic, poignant, and inspiring, because some people didn’t leave. Some people selflessly volunteered to tend to the sick, and to help keep the city going in the midst of an emergency. Dr. Benjamin Rush—a titan of American medicine—stayed, and he cared for patients from before sunrise to long after sundown. Of course, he also bled them profusely and gave them huge doses of what was, essentially, mercury—he was a controversial figure because of his treatment methods.

Others, including a community of free blacks in Philadelphia, led by Richard Allen and Absalom Jones, organized groups to take patients to Bush Hill, the emergency hospital that was set up in the city, and to provide clothing, food, and care for the sick people and their families. It was believed by many that black people were immune to yellow fever; the idea was that, because blacks were native to tropical climates, they were immune to tropical diseases. But, of course, that was not the case, and many blacks did die in that epidemic.

So there are stories of heroism, and stories of tremendous suffering. The reason I’m going on at length about 1793 is that I have come to believe that this experience was nationally formative. I think there was sort of a 9/11 effect, for lack of a better term, that took place after a catastrophe like that. There were many other yellow fever epidemics, in many other port cities, but 1793 in Philadelphia was, in a sense, like Ground Zero. It was something that nobody believed could happen; it was in the capital; it was just unimaginable.

The yellow fever went away with the first frost, as cooler temperatures arrived—but what is perhaps most terrifying of all was that it came back. It didn’t come back in 1794 or in 1795, but it came back especially severely in 1797, 1798, and 1799. A deep trauma, I think, was inflicted by those recurring epidemics. Clearly, quarantine at the Marine Hospital was not protecting the city against disease.

[Image: A painting of the Philadelphia Lazaretto, “probably by Frank Taylor, noted Philadelphia illustrator, ca. 1900,” Barnes notes].

BLDGBLOG: It’s interesting that the Marine Hospital was not a bio-secure facility in any modern sense; it was simply geographically isolated enough to function as a site of quarantine. Its medical usefulness was undone by urban sprawl.

Barnes: Exactly. The reason the hospital was there in the first place was because it was on the river. Ships could anchor there conveniently. Most importantly, though, it was far away from the city. It’s not as though the air on Province Island was especially healthful or clean—it was just the distance from downtown Philadelphia.

However, by the 1790s, it was clearly not working. Many people believed it was simply too easy for those undergoing quarantine to have contact with people from the city. There are countless stories of violations of the quarantine laws—people leaving ships or people coming on board the ships.

The Board of Health of Philadelphia was established in response to the 1793 yellow fever epidemic. It started meeting in 1794, and it quickly determined that the city needed a better quarantine facility—one that was farther away and that had much more rigorous enforcement.

[Image: An aerial view of the Philadelphia Lazaretto, ca. 1929].

BLDGBLOG: Did that come with any constitutional issues, as to whether or not the Board of Health was violating the rights of the people it held in quarantine? How much of that sort of discourse was there at the time?

Barnes: There wasn’t much discourse about infringement of liberties, at least in the way we would see it today. However, the Board of Health was always politically controversial. There were controversies about the division of powers between the state and the city authorities, and there were always arguments about the extent of the Board of Health’s power.

Complaints by individual people who were enduring the unpleasant experience of quarantine usually did not take the form of complaints about their rights being violated. Rather, it was that they had other things to do. It’s boring; they need to be somewhere else; it’s interfering with their business; it’s interfering with their lives and it’s taking too long. Those sorts of more mundane, less philosophical complaints predominate.

On the other hand, there are constant complaints about the way that this authority was used—that the Board of Health was overdoing it, or overreaching, or interfering excessively with commerce. In fact, “interfering excessively with commerce” is the number one complaint I’ve found.

In any case, in 1799 the Board of Health chose and bought a new location on Tinicum Island, which is the site of the Lazaretto that I’m studying—the one that is still intact today. That site was roughly twelve to fourteen miles from the city proper. It was much more remote, and nobody lived nearby. The new Lazaretto they built there was a state-of-the-art facility—there was nothing like it anywhere else in North America and possibly even the world. They opened it in 1801, and it operated continuously until 1895.

Edible Geography: What does “state-of-the-art” mean for a Lazaretto at that time? What design rubric or template were they using?

Barnes: That’s a really good question. One of the main things was its size. It’s a ten-acre site, and the main building is huge. Today, it still looks like a very large, very stately building. It’s even, I would say, beautiful.

In terms of outbuildings, there was a separate two-story house for the Lazaretto physician, and another separate two-story home for the Quarantine Master. There were bargemen’s quarters and a watch-house right on the edge of the river. There was a United States Customs Facility right next door with a large warehouse for the storage of cargo undergoing quarantine. There were also smaller outbuildings like a kitchen and a barn, or carriage house.

Interestingly, the main gate to the Lazaretto site still survives—it’s a gorgeous, ornate, wrought-iron gate that’s a little bit overgrown with vines now. That was where all transactions with the outside world took place. You had to get written permission from the Board of Health before approaching the gate of the Lazaretto. In other words, all relatives and friends visiting those who were undergoing quarantine, or visiting those who lived and worked at the Lazaretto, had to get permission simply to approach the gate.

Then there was another hospital that was sometimes called the Dutch hospital, or the smallpox hospital. It was a fairly decent-sized, two-story building, built in 1804-5 on the northwestern corner of the property. It does not survive today.

Basically, it was a very expansive facility. It had the ability to house a large number of patients and to provide for the daily needs of the crew and passengers undergoing quarantine. I certainly don’t think it operated any differently, medically-speaking, from other hospitals or quarantine hospitals of the time. It was fairly well-staffed with full-time employees, at least during the quarantine season. The quarantine season varied. For most of the nineteenth century, the season was, by law, June 1st to October 1st—but the Board of Health could declare an early start or a late finish to quarantine. In really bad years, where there were lots of epidemics, or reports of epidemics, in various geographic regions, the quarantine season could last all year.

I think it’s really the size and extent—the staffing and capacity—of the Lazaretto that made it state-of-the-art at the time.

[Image: Photo by David Barnes].

BLDGBLOG: How exactly would one preserve the Lazaretto today—would you be preserving only the buildings themselves, or could you somehow preserve, even recreate, the experience of quarantine? Further, at what stage of its life would the Lazaretto be most usefully preserved—as it was built in 1801, or as it was closed down in 1895?

Barnes: All excellent questions. I’ll take your last one first.

The site did change over time, but it didn’t change all that much. The grounds certainly changed—gardens and ornamental hedges were planted. The most detailed surviving description of the site that I’ve been able to find is from a newspaper article in 1879. It’s a very, very detailed description of the buildings and grounds. We also have a gorgeous watercolor, but it’s undated; the best guess of the archivists and curators who have studied it is that it’s from the middle of the nineteenth century. That doesn’t tell us much, but you can make some educated guesses based on the way the people are dressed in it. We also do have some photographs from the 1880s and onwards.

Interestingly, the site and the buildings later went through several incarnations. It became the summer home of the Philadelphia Athletic Club—so it was a summer resort retreat for the wealthy elite of Philadelphia. The Philadelphia Athletics baseball team, which are today the Oakland A’s, played at the Lazaretto. They played on the northern half of the grounds. There are even some depictions of it laid out as a baseball field. Then, beginning around 1920, it was the first seaplane base in North America—an aviation training school for seaplane pilots. That’s what it was for most of the twentieth century.

As far as preservation goes, I can’t tell you how many hours I’ve spent thinking about this. My own fantasy is of a great historic site and museum. The site has unparalleled historical significance. Various people have called it Philadelphia’s Ellis Island—but, in some ways, I think it’s more significant than Ellis Island. Ellis Island has tremendous historical significance because of the volume of human cargo that passed through there. The sheer number of people who passed through Ellis Island is huge, as is the number of Americans today who can trace their ancestry back through the inspection station there. But Philadelphia’s Lazaretto is a century older—as well as completely different. It was the quintessential nineteenth century institution. To me, it’s a no-brainer that this would be a destination.

Having said that, it costs money to preserve and save historic sites. It costs a lot of money to restore the buildings and the grounds, and to maintain them. And museums, with a few exceptions, are not doing all that well; they don’t generally tend to pay their own way. It’s not a no-brainer financially, by any means.

The latest proposal I’ve heard is that the outbuildings could be dedicated to historical interpretation, and the main building itself would be dedicated to commercial office space. It’s all still up in the air.

[Images: Out-buildings on the grounds of the Philadelphia Lazaretto, photographed by David Barnes].

Edible Geography: Your work suggests that quarantine is quite an overlooked dimension of everyday life in the early United States—as well as something of a forgotten chapter in the immigrant arrival experience. Why is that?

Barnes: Well, it was an unpleasant fact of life—that’s really the best way that I can put it. In one of the papers I’m writing about this, I call it “a most unloved institution.” Really, nobody liked quarantine at all. Merchants, of course, hated it—their cargo spoiled, time is money in business, and this was a huge delay, a waste of time, and an obstacle to commerce.

Everybody on board a ship couldn’t wait to get to their destination. Whether they were immigrants, as many of them were, or they were engaged in commerce—or simply visiting—everyone was desperate to arrive. They’re so close to getting there—but then they’re detained. They can write letters—but they can’t get off the ship unless they’re very sick and have to be taken to the hospital. Many refer to complete and utter boredom, and to impatience—sometimes even to fear of getting sick. After all, you’re trapped on board a filthy ship with filthy people who have been confined together for weeks at a time. They are, in a sense, imprisoned on this vessel. All they can do is write letters and complain.

The paradox for me, historically, has been: how did quarantine survive so long, even into the twentieth century, when everybody hated it so much? Crews and captains hated it, passengers hated it, and doctors denounced it. Many doctors, throughout most of the nineteenth century, said quarantine was completely worthless, and that we should be devoting our attention to cleaning up our cities instead, because it was sanitation that would prevent epidemics. Other doctors didn’t go quite so far, but they did complain that quarantine was enforced arbitrarily and needlessly aggressively.

As to the experience of quarantine itself, I have only scattered bits of testimony. One of the letters I’ve found was from a Philadelphia-based merchant in 1804; I think his name was John Reynolds. I’ve found several letters that he wrote to his mother and sister in Philadelphia from the Lazaretto, where he was undergoing quarantine.

In each letter he says, “I hope to be liberated from here in a few more days.” And in the next letter, written five days later: “I cannot wait to escape from this place of my captivity.” He’s impatient. He’s not complaining that his rights have been violated; he’s just desperate to get out of there.

In one letter to his sister, he says, “It has been so long since I’ve been on shore. It has been so long since I have been home. I am dying to see some of those Pennsylvania beauties. You must introduce me to some as soon as I arrive.” This was in a letter to his sister.

It gets lonely where you’re trapped in this sort of sardine can!

Edible Geography: On average, how long were people held there?

Barnes: There is no general rule. The length of time varied from a day to two weeks, or even more. On occasion, vessels were detained for 30 days.

What’s interesting about the enforcement of quarantine is that there were three objects of detention: the vessel, the cargo, and the people on board. They were often treated very differently. I have lots of examples of vessels detained, and their cargo allowed to go on, but the people were kept on board. I have many other examples of the people being allowed to go, but the cargo being considered very dangerous and having to be cleansed and purified, usually by means of fumigation or with some kind of disinfectant spray.

Really, though, I think at the heart of quarantine is the idea of the cleansing power of time. The passage of time alone will make certain things better. If there is something dangerous in the vessel or in the cargo, it will declare itself within a period of time—or it will simply burn itself out. It can’t last indefinitely. Further, everybody knew from experience that things were fine after the first frost, so you would never detain any vessel, cargo, or people longer than the first frost.

[Image: Painting of the Lazaretto attributed to T. Barnea (undated); 
courtesy of the Atwater Kent Museum of Philadelphia].

BLDGBLOG: There’s an interesting point to be made here vis-à-vis long-haul travel to extremely distant destinations. If a place took long enough to get to, in an era of wind-powered ships, quarantine wasn’t often necessary; any disease on board would already have burned itself out, as you say, by the time of arrival. But when steam-powered ships came along, and, then airplanes, people could arrive before a disease cycle came to its natural end—so quarantine stations became necessary. In other words, an entire class of architectural structures comes into existence because of the lengths of certain journeys or the types of transportation involved.

Barnes: That’s fascinating. Time is crucial in quarantine—and there is always a negotiation about how long is long enough. There was a tug of war, for instance, between the Lazaretto physician, who was the leading authority on the site, and the Board of Health, whose dictates that physician was required to obey. But you also had to factor in news reports of epidemics on various Caribbean islands, and you had to factor in the testimony of the captain and crew about what the health status of their port of origin—whether there were any illnesses there, what broke out during the journey, and if anyone had died. But is the captain reliable, or is he known to be a liar? And you also had to inspect the passengers and the crew physically. All of these were factors in the quarantine decision.

Time will always be a critical element of that calculus.

• • •

This autumn in New York City, Edible Geography and BLDGBLOG have teamed up to lead an 8-week design studio focusing on the spatial implications of quarantine; you can read more about it here. For our studio participants, we have been assembling a coursepack full of original content and interviews—but we decided that we should make this material available to everyone so that even those people who are not in New York City, and not enrolled in the quarantine studio, can follow along, offer commentary, and even be inspired to pursue projects of their own.

For other interviews in our quarantine series, check out Isolation or Quarantine: An Interview with Dr. Georges Benjamin, Extraordinary Engineering Controls: An Interview with Jonathan Richmond, The Last Town on Earth: An Interview with Thomas Mullen, and Biology at the Border: An Interview with Alison Bashford.

Many more interviews are forthcoming.

The Last Town on Earth: An Interview with Thomas Mullen

Thomas Mullen is the author of The Last Town on Earth, a novel set in a voluntarily quarantined village in the remote forests of the Pacific Northwest during the Spanish Flu pandemic of 1918.

From the book’s description:

The year is 1918. America is fighting a war on foreign soil that has divided the nation. Meanwhile, rumors of the spread of the deadliest epidemic ever are causing panic on the home front. The uninfected town of Commonwealth, Washington, votes to quarantine itself, and two young friends are asked to guard the town entrance and keep strangers out.
One day, a starving, cold—and seemingly ill—soldier comes out of the woods begging for sanctuary, and the two guards are confronted with an agonizing moral dilemma.

The Last Town on Earth was named the Best Debut Novel of 2006 by U.S.A. Today – who describe it as “an absorbing depiction of a utopian town that attempts to keep the 1918 flu epidemic at bay” – and it won the James Fenimore Cooper Prize for Excellence in Historical Fiction.

As part of our ongoing series of quarantine-themed interviews, Nicola Twilley of Edible Geography and I spoke to Mullen about his novel, about the historical research that informed it, and about the moral implications of mass quarantine.

• • •

Edible Geography: What sort of research went into writing the novel?

Thomas Mullen: The impetus for the book was an article that I read many years ago about an AIDS virologist who had studied the 1918 flu earlier in his career. It also mentioned, parenthetically, that there had been healthy towns in the Rocky Mountain states and in the Pacific Northwest that were so terrified by stories about how contagious the flu was, and how fatal it was, that they decided their best recourse for staying healthy was to block off all the roads leading into town and to post armed guards to prevent anyone from coming in. That just blew me away—it was amazing to read that this had happened—and I thought it would be a very dramatic first scene.

I was hooked by the moral dilemma of quarantine: what happens if, one day, you and your buddy are standing guard over your town and you’re presented with a lost traveler? He’s freezing, and he’s starving, and he’s begging for your aid. He needs food and shelter, or he might die. What do you do? Do you bring this person in? Do you try to be charitable, even if you know he might be carrying this awful virus that you don’t really understand? Again, it was 1918 and their understanding of the virus was certainly worse than ours is today. Or do you tell you the person: “Hey, I’m sorry, but I need to think of my friends and family and my town. I don’t know what you might be carrying, and you’re just going to have to die in the woods.”

That’s what made me want to write the book. I sat down and I read a few books about the 1918 flu—although I couldn’t find many. It had become this overshadowed chapter in history. That’s starting to change now; with the new concern about avian flu and H1N1, there’s been much more discussion of the 1918 epidemic. But, back when I started my research, it was hard to find much information.

I tried to find out about these towns that had done this—these sort of reverse-quarantines. That’s just a phrase that I invented; I don’t know if there’s a real phrase for it. Normally, quarantine is when something or someone is ill and they’re quarantined off so that they don’t spread their germs to the rest of us. But in this situation, the town that closes itself off is healthy. I called that reverse-quarantine.

I couldn’t really find anything out about these towns. In fact, when I was about three-quarters done with the rough draft, a historian named John Barry wrote what is now the definitive history of the 1918 flu, called The Great Influenza. I got that book and I read it—and it’s about 600 pages long, but he only gives about half a page to this phenomenon of Western towns that had closed themselves off. He says that it worked for some and it didn’t work for others—and that’s it.

[Image: Historical quarantine marker].

Edible Geography: Was reverse-quarantine a common phenomenon and just under-reported, or was it actually fairly rare?

Mullen: It doesn’t sound like it was very common. After all, if it only got about half-a-page in a 600-page book… It’s just something I could not find reference to very often.

They were probably small towns that were already fairly isolated, and therefore might not have left such a good paper trail for historians to write about. It must have been fairly unusual in the first place, because the flu spread very, very quickly, so usually it was too late. By the time you were thinking that maybe you should close the borders, people were already getting sick in your town—so you missed the opportunity.

Meanwhile, because our nation was at war, there was censorship of the press. Newspapers didn’t want to report bad news. People didn’t often know what was happening until it was too late. Instead, newspapers would have a little pick-me-up story about how some soldiers in a nearby army base had a bad case of the flu… but they’re feeling much better now. Meanwhile, people are looking out their windows and seeing hearses! If there had been a free press, and if the government had not been distracted by a war and had shared information about it sooner, it’s possible that more towns would have tried quarantine. But for most people, by the time they realized what was happening, it was too late.

I think the reason why the towns that did this were in the Rocky Mountains and in the Pacific Northwest was that they were inland and fairly isolated. The flu had started, most epidemiologists believe at this point, in army bases, and then it had traveled along the rail lines, from army base to army base; and from port to port—meaning cities like Philadelphia and Boston and New Orleans and San Francisco—and it gradually trickled inland. Some of the mountain states were the last to get infected – and they were the ones where, finally, the story was out. They were the ones who knew what was happening, so some of them were able to make this decision.

Ultimately, though, because I’m a novelist—I write fiction, and I can make things up—I decided, okay, maybe it’s better that I don’t know exactly what happened in these towns. Maybe that frees me up a bit. I did as much research as I could into how the epidemic worked, how the disease itself worked, and what the political environment was like at that time in America—what these characters were doing and what they were thinking about. But, as for what had actually befallen towns that tried this, I was sort of unconstrained by historical fact—which, I think, was a good thing.

BLDGBLOG: That raises the question of your own interest, as a novelist, in the idea of quarantine. What are the narrative possibilities of quarantine that drew you to it, as a plot device?

Mullen: As a novelist, you need there to be some stress, because that creates the tension between the characters. It leads them to act – sometimes in inappropriate or regrettable ways.

One of the things that I was really interested in doing with this book was studying the way in which people act differently from the way they would like to think they act, under stress. We have this idea of ourselves as good people, and we have moral guidelines that we like to believe we follow, but when we feel threatened and we feel that our family is in danger, we tend to bend some of those rules. Whether that means shooting a stranger who’s trying to come into your town, or whether that means shutting out your neighbor because you think they might have a cold – things like that.

I was interested in looking at the stresses that these people would be under. First of all, externally, they feel they’re safe in their little town—but the world around them is dangerous, with everyone being ill. Also, in those political times, there were things happening that the utopians in my little mill town didn’t agree with; they’re very anti-war and anti-capitalist. They feel at odds with the world, and they’re closing themselves off from a world that they disagree with in many ways. But when the disease does get into the town, they’re at odds with each other: some are sick, some are healthy. New stresses are introduced; they start running out of food and out of things that they need to maintain their quarantine.

[Images: The town of Jerome, Arizona, during the 1918 flu outbreak; note the face masks. Courtesy of the Jerome Historical Society, via the Sharlot Hall Museum].

Edible Geography: Much of your book is focused on the moral dilemmas associated with implementing and enforcing quarantine. What drew you to that?

Mullen: That was something that I didn’t seek out to do, but, as I was writing the story, it came naturally. You have these utopian idealists and political activists who are anti-war and pro-union, and they’re early suffragists. Some of them support the quarantine because they want to stay healthy; they want to protect their families. But some of them, because their political beliefs are so strong, realize that, hey, I have these beliefs because I want to make the world a better place. I don’t want to just make my town a better place. And what are the moral implications of turning our back on a world that is suffering? Isn’t it our obligation to do something that would improve the world? Some people feel that the best way to make a better world is to focus on yourself, and on your own community, and to hope the world will emulate it. Others—more activist—think they need to get out there. I’m interested in that conflict.

And, of course, that line is itself blurred—because they all support the quarantine initially. Even those who opposed it refused to leave. So, theoretically, everyone in the town in chapter one is cool with the idea. But, as time goes on, some people are thinking, god, I’m bored, I want to get out of here; or we learn that they’ve been secretly sneaking out to visit women or buy booze. So even the people who had initially agreed with it came to feel that it had been imposed on them. They change their minds—but it’s too late.

BLDGBLOG: In a way, you illustrate the fundamental impossibility of a total quarantine: there’s always something getting in or getting out, usually due to human weakness or error.

Mullen: I can’t remember if that’s something that I always intended—that I was going to have these people sneaking out—or if that was something that came up halfway. But it just seemed right to me. The whole dilemma of utopian politics, in general, is: can we really make the world a perfect place? I think there is enough human frailty and vice out there that something will always sabotage it.

Medically speaking, I know that quarantine can work, but, with something on the scale of a whole town, I can’t help but wonder: would it really work? It didn’t in the book because it was this slapdash affair; you’ve got randomly chosen people standing guard. But I think if it were to happen now, with a city or a state, you’d have National Guard or police or army officers standing guard, and I don’t think they would bend quite the way my characters would bend. But then you have the other problem—where it becomes a police state—and people aren’t allowed to come and go. It might work to keep the disease out, and people might thank them for that, but they might also feel like their rights were being violated. It gets really complicated.

[Image: A sick ward for those infected with the 1918 Spanish flu].

Edible Geography: Why do you think there has been such a historical silence about the epidemic?

Mullen: My partly cynical answer is that we Americans just don’t know our history very well!

I did a panel once with two other writers who both had novels set during World War I, and they were both British. They talked about how World War I is a big deal in the UK: how everybody knows about it; you see plaques everywhere listing the dead; and there were some towns where, in one night, the entire population of young men died, because they had this idea that men in the same town could enlist together and fight in the same regiment. This meant that you got to enlist with your friends, and you got to fight with your friends, which was great for morale—but what it also meant it that you died with your friends. There were literally towns where all the young men died on the same day, in one of those major battles.

It was a profound experience for so much of Europe, where they fought the war for years on their home soil. For America, on the other hand, we were only involved militarily for about year. We declared war earlier on, but it took a while just to get an army together, because we didn’t even have a standing army. And, of course, it wasn’t fought on our own soil. So the flu took place during the war, and the war itself is just not very well-taught or well-understood here.

But, also, in terms of why do people know about the war and not the flu, can it be that history textbooks can only handle one big subject at once? They’re writing about the war and they just didn’t think they needed to mention the flu? A disease doesn’t have the geopolitical themes that you get to play with when you’re teaching about a war or a politician or a movement; it was this horrible thing that just happened.

Also, I wonder how much of it was simply the fact that the people who lived through it just wanted to build a wall around those memories; they didn’t have our mindset, where we need to come to terms with our past and expose our scars in order to find closure. I think the survivors, to some degree, probably felt that it’s over – and it was horrible – but the last thing to do was to talk about it.

At this point, it’s enough generations away that there’s very little memory of it left – people only remember being told about it. Another horrible thing about the flu was that it killed so many adults and it left so many orphans. A lot of the survivors were very young children, who really don’t remember it for themselves.

But it was interesting to me that so many of the great literary lions in the early 20th century were people who lived through this when they were teenagers or young adults—Hemingway, Faulkner, Fitzgerald, Dos Passos, Steinbeck—and none of them wrote about it. It now seems like of course you would write about this.

• • •

This autumn in New York City, Edible Geography and BLDGBLOG have teamed up to lead an 8-week design studio focusing on the spatial implications of quarantine; you can read more about it here. For our studio participants, we have been assembling a coursepack full of original content and interviews—but we decided that we should make this material available to everyone so that even those people who are not in New York City, and not enrolled in the quarantine studio, can follow along, offer commentary, and even be inspired to pursue projects of their own.

For other interviews in our quarantine series, check out Isolation or Quarantine: An Interview with Dr. Georges Benjamin, Extraordinary Engineering Controls: An Interview with Jonathan Richmond, On the Other Side of Arrival: An Interview with David Barnes, and Biology at the Border: An Interview with Alison Bashford.

Many more interviews are forthcoming.

The Plague

What does a town under quarantine—walled off against the world, shutting its doors against commerce—feel like? What if those doors have been forcibly shut, against the citizens’ will? What is it like to be medically captive in a city? At the very least, how does one pass the time?

Nearly two years ago, while living and working in San Francisco, I would often spend my lunch breaks down at Stacey’s, an amazing bookstore that sadly went out of business this past spring. One of the books that I gravitated toward—and eventually purchased—was The Plague by Albert Camus.

Camus’s novel—about a quarantined city in North Africa called Oran, where the bubonic plague has erupted, originating in rats that have come crawling out into the streets to die en masse—seems to illustrate quite well the proposition that fiction is an extraordinarily effective medium through which to describe architectural and urban experiences. One of Camus’s characters, for instance, surveys the quarantined city laid out before him: “At that moment he had a preternaturally vivid awareness of the town stretched out below, a victim world secluded and apart, and of the groans of agony stifled in its darkness.”

Quarantine, Camus suggests, can have the effect of heightening the sensorial impact of certain urban details: “For in the heat and stillness, and for the troubled hearts of our townsfolk, anything, even the least sound, had a heightened significance. The varying aspects of the sky, the very smells rising from the soil that mark each change of season, were taken notice of for the first time.” The city has become amplified, so to speak, by its isolation. We even read that a “new paper has been launched: the Plague Chronicle,” as if all of these newly noticed details, and the alterations in daily routine that revealed them, were too numerous—and far too extraordinary—not to catalog.

But the city looms, stripped of vitality, anemic, its purpose gone; it is urbanism as depicted by Giorgio de Chirico.

The silent city was no more than an assemblage of huge, inert cubes, between which only the mute effigies of great men, carapaced in bronze, with their blank stone or metal faces, conjured up a sorry semblance of what the man had been. In lifeless squares and avenues these tawdry idols lorded it under the lowering sky; stolid monsters that might have personified the rule of immobility imposed on us, or, anyhow, its final aspect, that of a defunct city in which plague, stone, and darkness had effectively silenced every voice.

I won’t review the book here; it is worth reading, even if it’s emotionally imperfect, so to speak (and often a bit boring), but its literary merits are not what I’m concerned with. I’m concerned with its descriptions of space.

I thought, then, especially in light of the quarantine studio that kicks off in NYC this autumn, I would simply excerpt some of Camus’s more memorable thoughts on quarantine.

For instance, he writes, describing this strange state of medical siege-urbanism:

At first the fact of being cut off from the outside world was accepted with a more or less good grace, much as people would have put up with any other temporary inconvenience that interfered with only a few of their habits. But, now they had abruptly become aware that they were undergoing a sort of incarceration under that blue dome of sky, already beginning to sizzle in the fires of summer, they had a vague sensation that their whole lives were threatened by the present turn of events, this feeling of being locked in like criminals prompted them sometimes to foolhardy acts.

Oran, Camus continues, its city gates closed against foreign visitors, its citizens often sitting there, listless in the desert heat, “assumed a novel appearance.”

You saw more pedestrians, and in the slack hours numbers of people, reduced to idleness because shops and a good many offices were closed, crowded the streets and cafés. For the present they were not unemployed; merely on holiday. So it was that on fine days, toward three in the afternoon, Oran brought to mind a city where public rejoicings are in progress, shops are shut, and traffic is stopped to give a merry-making populace the freedom of the streets.

What is there to do in quarantine? Not much, it seems:

So now he drifted aimlessly from café to café. In the mornings he would sit on the terrace of one of them and read a newspaper in the hope of finding some indication that the epidemic was on the wane. He would gaze at the faces of the passers-by, often turning away disgustedly from their look of unrelieved gloom, and after reading for the nth time the shopsigns on the other side of the street, the advertisements of popular drinks that were no longer procurable, would rise and walk again at random in the yellow streets. Thus he killed time till nightfall, moving about the town and stopping now and again at a café or restaurant.

This level of ennui—”You could see them at street corners, in cafes or friends’ houses, listless, indifferent, and looking so bored that, because of them, the whole town seemed like a railway waiting-room”—unsurprisingly soon breeds violence (and, with it, glimpses of a new constitutional order):

It was incidents of this sort that compelled the authorities to declare martial law and enforce the regulations deriving from it. Two looters were shot, but we may doubt if this made much impression on the others; with so many deaths taking place every day, these two executions went unheeded—a mere drop in the ocean. Actually scenes of this kind continued to take place fairly often, without the authorities’ making even a show of intervening. The only regulation that seemed to have some effect on the populace was the establishment of a curfew hour. From eleven onwards, plunged in complete darkness, Oran seemed a huge necropolis.

For all of these descriptions, however, the question remains: what is the effect of quarantine on a city’s populace? Can public policy reach down into the emotions of a resident and predict how he or she might react? And how is urbanism itself transformed by states of temporary—but enforced—isolation?

For that, a much larger conversation about quarantine and the city must ensue.

Landscapes of Quarantine Studio: Participant Update

[Image: Quarantine facility and hospital ward on Swinburne Island, in the NYC archipelago].

It’s been an extremely eventful month since Edible Geography and BLDGBLOG teamed up to announce “Landscapes of Quarantine,” an eight-week, intensive, independent design studio to be hosted this fall in New York City; its brief is to create original and thought-provoking design projects that explore the spatial implications of quarantine. The results of the studio will then be the subject of an exhibition at Storefront for Art and Architecture in spring 2010.

The practice of quarantine extends far beyond questions of epidemic control and pest containment strategies to touch on urban planning, geopolitics, international trade, ethics, immigration, and more. In the early twentieth century, for example, “quarantine lines in Africa offered a clear and politically useful demarcation for new ‘international’ borders between Sudan and Egypt,” as historian Alison Bashford points out in her book Medicine at the Border.

From Boccaccio’s Decameron and disinfected mail protocols to bio-secure airlocks, plant smuggling, and Matt Leacock’s Pandemic boardgame, quarantine is a fertile territory for architects and designers to explore.

You can read more about the studio here.

Over the past few weeks, we have been blown away by the quality (and even quantity) of applicants interested in the studio. Indeed, narrowing the pool down to a manageable group of participants has been a very tricky process. We have been concerned all along with achieving a usefully diverse mix of backgrounds, media, and individual strategies of approach, while holding numbers low enough that the studio can still function as a weekly discussion group.

[Image: U.S. “Federal and State Isolation and Quarantine Authority,” updated January 18, 2005].

We are now excited to announce a truly amazing list of participants:

Joe Alterio — Illustrator, Animator, and Comic Book Artist (http://joealterio.com/)

Joe Alterio is an illustrator, animator, comic creator, and artist, interested in narrative structure, collective creativity, and the physical manifestations of story-telling. Joe has been at the forefront on using new technology to push forward the graphic narrative medium, from his early 2004 mobile comic The Basic Virus to his most recent work with Robots and Monsters. Alterio’s work has appeared in the Boston Globe, Rolling Stone, Boing Boing, Drawn!, The BLDGBLOG Book, and many other publications.

[Image: Joe Alterio, from Robots and Monsters].

Elizabeth Ellsworth and Jamie Kruse – Artists, smudge studio (http://smudgestudio.org/)

Elizabeth Ellsworth and Jamie Kruse are co-directors of smudge studio, a collaborative, non-profit media arts studio based in Brooklyn. Ellsworth is Associate Provost of Curriculum and Learning and Professor of Media Studies at The New School. Her recent book, Places of Learning: Media, Architecture, Pedagogy is about the aesthetics of mediated learning environments. Kruse is an artist, independent scholar, and freelance graphic designer.

Scott Geiger — Writer, Architecture Research Office (http://www.aro.net/)

Scott Geiger is the recipient of a Pushcart Prize for fiction. A contributor to magazines such as The Believer and Conjunctions, Geiger also writes for Architecture Research Office, a 2009 Finalist for the National Design Award for Architecture. As a Cleveland native, schemes to rescue America’s postindustrial cities stalk his work.

Yen Ha and Michi Yanagishita — Architects, Front Studio (http://www.frontstudio.com/) and “ladies who lunch” (http://lunchstudio.blogspot.com/)

Yen Ha and Michi Yanagishita are principals of Front Studio Architects, named one of the “world’s 50 hottest young architectural practices” by Wallpaper magazine. Their work has been featured internationally in Icon, AD: Cities of Dispersal, and the New York Times, and it was recently featured in the London Yields exhibition at the Building Centre in London. The Invisible Gate, their competition entry in the 2005 Gdansk International Outdoor Art Gallery, is currently under construction.

[Image: Front Studio, Farmadelphia].

Katie Holten — Artist (http://www.katieholten.com/)

Katie Holten has exhibited widely in Europe and the United States, and, in 2003, she represented Ireland at the Venice Biennale. She currently has a solo exhibition at The Bronx Museum of the Arts and a public artwork installed in the Bronx, called the Tree Museum. Holten was born in Dublin, Ireland, and is now based in New York City.

Jeffrey Inaba — Architect, INABA Projects (http://www.inabaprojects.com/), Director, C-LAB (http://c-lab.columbia.edu/), and Editor, Volume Magazine (http://volumeproject.org/)

Jeffrey Inaba is the Director of C-Lab, an architecture, policy and communications think tank at Columbia University‘s GSAPP, and he is Features Editor of Volume Magazine. With Rem Koolhaas, Inaba co-directed the Harvard Project on the City, a research program investigating contemporary urbanism and planning worldwide. Before starting INABA, he was a principal of AMO, the research consultancy founded by Koolhaas. Inaba has also taught at UCLA, Harvard, and SCI-Arc, and he lectures worldwide.

Ed Keller — Architect and Filmmaker, AUM Studio (http://www.aumstudio.org/)

Ed Keller is a designer, professor, writer, “media architect,” and former professional rock climber. He is co-founder with Carla Leitao of AUM Studio, an architecture and new media firm based in New York and Lisbon. Keller is an Associate Professor at Parsons School of Design, and he has taught at Columbia’s GSAPP, SCI-Arc, Pratt, the University of Pennsylvania, and more. Keller’s work has been featured in ANY, AD, Wired, Metropolis, Assemblage, among others.

Mimi Lien — Set Designer (http://www.mimilien.com/)

Mimi Lien is a designer of sets and environments for theater, dance, and opera. After studying architecture at Yale University, she began making paintings, installations, objects, and designs for performance. Her work has been seen at The Joyce and The Kitchen, and she is a recipient of a 2007-2009 NEA/TCG Career Development Program award.

[Image: Mimi Lien, from a set design for Samuel Beckett’s Endgame].

Richard Mosse — Photographer (http://www.richardmosse.com/)

Richard Mosse is an Irish photographer based in New York. He travels extensively with the assistance of a Leonore Annenberg Fellowship in the Performing and Visual Arts. Recent forays have taken him to Gaza, the Yukon Territories, and Iraq. Mosse has a forthcoming solo show at Jack Shainman Gallery, opening on November 19th, and new video work will be exhibited at Barcelona’s Ca L’Arenas, in a year-long exhibition cycle, investigating war and its representations.

[Image: Richard Mosse, ruined swimming pool at the palace of Uday Hussein, Jebel Makhoul, Iraq].

Daniel Perlin — Sound Designer, Perlin Studios (http://danielperlin.net/)

Daniel Perlin is a New York-based artist and sound designer. Perlin operates across media, creating video, objects, installations and performances. His work has been heard at Chelsea Art Museum, the Whitney Biennial 2006, D’Amelio Terras, TN Probe Tokyo, Temporary Contemporary Gallery, the Centre Pompidou, and BCA (Beijing), as well as in such films as Kelly Reichardt’s Old Joy, Errol Morris’s Fog Of War and Phil Morrison’s Junebug.

Thomas Pollman — Architect, NYC Office of Emergency Management (http://www.nyc.gov/oem and http://www.thomaspollman.com/)

Thomas Pollman is an architect and amateur cartographer based in New York City. He currently works in the Geographic Information Systems Division at the NYC Office of Emergency Management, where he works to enhance situational awareness for first responders through the deployment of geospatial technologies. Pollman is a registered architect in the State of New York.

Kevin Slavin — Urban Games Designer, Area/Code (http://areacodeinc.com/)

Kevin Slavin is managing director and co-founder of Area/Code. Working with media companies, museums, brands, and foundations around the world, Area/Code focuses on games with computers in them. Their work frequently extends game systems into the real world—and the other way around. Prior to founding Area/Code, Slavin was an artist and an advertising executive.

Brian Slocum — Architect, Polshek Partnership Architects (http://www.polshek.com/)

Brian Slocum is the recipient of a 2008 grant from the New York State Council on the Arts for ad hoc infrastructures, a design research project focusing on the deployment of scaffolding and alternatives for its spatial exploitation. Slocum was a contributor to Pamphlet Architecture #23 and is currently an Associate at Polshek Partnership Architects.

Amanda Spielman — Graphic Designer, Graphomanic (http://www.graphomanic.net/) and SpotCo (http://www.spotnyc.com/)

Amanda Spielman is a graphic designer at SpotCo, a New York-based design studio and ad agency that specializes in creating artwork for Broadway theater. Previously, she spent seven years in editorial design. Her work has appeared in The Design Entrepreneur, Fingerprint, Graphis, STEP, SPD, and metropolismag.com. Spielman graduated from the MFA Design program at the School of Visual Arts, and holds a BA from Vassar College.

[Image: Amanda Spielman, Island of New Ephemera].

Lebbeus Woods — Architect, Author, and Educator (http://lebbeuswoods.wordpress.com/ and http://lebbeuswoods.net/)

Lebbeus Woods is an architect and educator. He is co-founder of RIEA.ch, an institute devoted to the advancement of experimental architectural thought and practice, and author of Pamphlet Architecture #6 and #15, among countless other articles and books. His works are held in private and public collections worldwide, including the Museum of Modern Art and the Austrian Museum of Applied Arts, Vienna. Woods has received the Progressive Architecture Award for Design Research, the American Institute of Architects Award for Design, and the Chrysler Award for Innovation in Design. He is currently Professor of Architecture at The Cooper Union in New York City.

[Image: Lebbeus Woods, from a film treatment for Underground Berlin].

It’s hard to overstate how honored we are to work with practitioners of this caliber; we look forward to eight solid weeks of inspiring conversations and even more interesting work.

Expect frequent updates throughout the fall – in particular, during the week of October 5th, when we will begin to publish, both on Edible Geography and on BLDGBLOG, a series of original interviews with quarantine historians, public health policy experts, biosafety consultants, and more, placing quarantine into its unpredictably extensive context.

By making the studio discussions and our own research material public, we hope that anyone who has been inspired by the studio brief – and by the subject matter of quarantine – will be inspired to pursue their own projects, outside the necessarily limited walls of the studio.

Landscapes of Quarantine: Call for Applications

[Image: President Nixon addresses quarantined astronauts from the Apollo program; via NASA].

I’m incredibly excited to announce not only that BLDGBLOG will be living in New York City this fall, but that my wife and I will be hosting a design studio there called Landscapes of Quarantine – the results of which will be the subject of a public exhibition at Storefront for Art and Architecture in early 2010.

Meeting one evening a week this autumn in Manhattan, from October 6 to December 5, 2009, up to 14 studio participants will discuss the spatial implications of quarantine, each developing an individual design project in response to the studio theme.

Quarantine is both an ancient spatial practice and a state of monitored isolation, dating back at least to the Black Death – if not to Christ’s 40 days in the desert – yet it has re-emerged today as an issue of urgent biological, political, and even architectural importance in an era of global tourism and flu pandemics.

[Image: “Fear of Flu” by Mike Licht].

Quarantine touches on serious constitutional issues associated with involuntary medical isolation, as well as on questions of governmental authority, regional jurisdiction, and the limits of inter-state cooperation. Quarantine is as much a matter of national security, public safety, and agricultural biodiversity as it is an entry point into discussions of race, purity, and unacknowledged discrimination.

Quarantine is also a plot device increasingly seen in novels and films – from the aptly named Quarantine and Albert Camus’s The Plague to I Am Legend and The Last Town on Earth – even as it has become a source of arcane technical debate within plans for Martian exploration and Antarctic drilling rights.

The design implications of quarantine stretch from the ballast water of ships to the way we shape our cities, from the clothes in travelers’ suitcases to stray seeds stuck in the boot treads of hikers. Quarantine affects the pets we keep, the programs we download, and the machines we use in food-processing warehouses, worldwide.

Quarantine is about managing perimeters, controlling influence, and stopping contamination.

[Image: Cages for the laboratory testing of rats and mice by Innovive].

So how do we treat quarantine as a design problem?

Whether we design something to demonstrate that the very notion of quarantine might not be possible; whether we produce actionable plans for quarantine units, ready for implementation by the World Health Organization in hot zones around the world; whether we create quarantine-themed graphic novels, barrier-based urban games, or a series of ironic public health posters to be mounted around the city, how can we design for quarantine?

Quarantine also offers fertile territory for investigation through cartography and cultural documentation. After all, if we mapped the contents and locations of quarantine facilities worldwide, designed infographics to analyze the spread of invasive species, or recorded the oral histories of the quarantined, what sorts of issues might we uncover?

Bringing these very different techniques, media, and approaches together in the confines of a dedicated design studio will give participants an exciting opportunity to explore the overlooked spatial implications of quarantine.

[Image: A poster for Quarantine, directed by John Erick Dowdle].

We have already confirmed a fantastic list of participants, whose backgrounds include architecture, photography, illustration, games design, sound, landscape, food, and more; we are now opening the studio to a general call for interested participants.

The brief – which you can download here as a PDF or that you read as a JPG on Flickr – explains more; but potential applicants will be working with a truly stellar group as they meet once a week this fall and produce work eligible for inclusion in the “Landscapes of Quarantine” exhibition to be held at Storefront for Art and Architecture in early 2010.

If you are interested, please download the brief – which includes all necessary application info – and contact us at futureplural @ gmail by September 19, 2009.

[Image: Australian quarantine signage].

For ease of reference, I have decided to include the studio brief in full below:

Landscapes of Quarantine is an independent, multi-disciplinary design studio, based in New York City, consisting of eight Tuesday evening workshops, from October 6 to December 5, 2009, in which up to 14 participants will gather to discuss the spatial implications of quarantine. Quarantine is an ancient spatial practice characterized by a state of enforced immobility, decontamination, and sequestration; yet it is increasingly relevant—and difficult to monitor—in an era of global trade, bio-engineering, and mass tourism.

Studio participants will explore a wide variety of spatial and historical examples, including airport quarantine facilities, Level 5 biohazard wards, invasive species, agricultural regulations, swine-flu infected tourists confined to their hotel rooms, lawsuits over citizens’ rights to resist involuntary quarantine, horror films, World Health Organization plans for controlling the spread of pandemics, lunar soil samples, and more.

During the studio, participants will develop individual design projects in response to the problem of quarantine, with guidance and inspiration provided by readings, screenings, group discussions, and an evolving line-up of guest speakers and critics. These projects will then be eligible for inclusion in “Landscapes of Quarantine,” an exhibition hosted by the internationally renowned Storefront for Art and Architecture in early 2010.

By the end of the studio, each participant will have produced a complete design project. This could range from the speculative (plug-in biosecurity rooms for the American suburbs) to the documentary (recording the items and animals detained for quarantine on the U.S./Mexico border), and from the fantastical (plans for extra-planetary quarantine facilities) to the instructional (a field guide to invasive species control).

Landscapes of Quarantine is looking for applicants who are intrigued by the spatial possibilities and contingencies of quarantine, and who already possess the technical skills necessary to produce an exhibition-quality final design project or installation in their chosen medium. We hope to hear from people at all stages of their careers—from graduate school to retirees—and from a wide variety of design backgrounds. We are particularly excited to announce that we have already confirmed a select group of talented participants from fields as diverse as architecture, illustration, gaming, photography, and sound design.

The studio is both unaffiliated and independent (there is no college credit), and it is also free (though applicants will be responsible for all costs associated with producing their final project). We will be reviewing applications on a rolling basis until Friday, September 18, 2009, or until all studio positions have been filled. To learn more, and to submit an application, please email futureplural @ gmail with the information listed below.

1) Name
2) Email address
3) Telephone number(s)
Please indicate the best time to reach you
4) Mailing address
5) Education
• University/college name and country
• Dates attended
• Degree
6) Current affiliations and/or employment
7) 50-word (maximum) bio
8) Publications and/or personal blog
9) Portfolio
Attach a PDF of no more than 8 pages, or supply a link to online work
10) 300-word (maximum) statement of interest in the topic of quarantine
11) Candidate’s declaration
By submitting your application, you declare the following:
• I certify that the work submitted is entirely my own and/or my role is clearly stated
• I declare that all the statements I have provided are correct
• I agree that, if accepted into the studio, I will participate fully, attend all studio meetings unless previously discussed with the studio directors, and produce a finished final design project
12) Email addresses for two references

Landscapes of Quarantine is produced and organized by Future Plural, a project-based, independent design lab launching in October 2009 from a temporary base in New York City. Future Plural is Geoff Manaugh (BLDGBLOG) and Nicola Twilley (Edible Geography).

Finally, a major motivation behind starting Future Plural and hosting the Landscapes of Quarantine studio is to found a new institution without permanent location, dependence on grants, or academic affiliation. After all, as bloggers, why can’t we create our own groups, faculties, cultural spaces, and more? By bringing people together, on a project-by-project basis, to explore ideas and issues in a cross-disciplinary environment, we hope to demonstrate that, even in a time of recession, there is a broadly shared enthusiasm for creating something new.