“There Must Be No Deserters”: COVID-19 and the Ethics of Mass Quarantine

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“There must be no deserters, or they will be nailed to the pillar of historical shame forever,” declared Sun Chunlan, the Vice Premier of the People’s Republic of China (Wuhan Rounds Up,” 2020). On January 23, 2020, Chunlan instituted a mass quarantine order in Wuhan, China—the epicenter of the COVID-19 outbreak (Secon et al., 2020). This extreme order was intended to control the spread of the novel coronavirus disease, but it had already spread to the surrounding area. Within days, all public access to the Hubei province was cut off and draconian restrictions were enforced. To prevent cross-infection within the community, citizens who had been infected or exposed were forced into hospitals and makeshift shelters to be quarantined. Citizens have been required to stay in their homes, depriving them of adequate access to food, fuel, or medication (Buckley et al., 2020). As of April 5, 2020, there are 56 million Chinese citizens who are still languishing in isolation.

Many public health experts and policy makers worldwide question the ethics and effectiveness of these severe mass quarantines. These experts worry that Chinese officials warned the world and the citizens of Wuhan about the virus far too late for the quarantines to be effective. Roughly five million people left the city before the government established impermeable boundaries around the area, which contributed to what is now 1,273,794 confirmed cases (and counting) of COVID-19 worldwide (JHU Coronavirus Resource Center, 2020). Given that the virus has spread worldwide despite their mitigating efforts, the Chinese government’s extreme restrictions on their people appears superfluous and cruel.

Moreover, policy makers object to mass quarantines like Wuhan’s because their ethical costs exceed their practical benefits. More exactly, mass quarantines can violate individuals’ civil liberties and may constitute an over-reach of state power as they bar civilians—both the sick, the healthy, and the recovered—from leaving their homes. Notably, bioethicists at the Hastings Center take that argument further as they contend that mass quarantines disproportionately deprive those of lower socioeconomic status of their autonomy and power. Pandemics can reinforce and augment existing power dynamics, as individuals of lower socioeconomic status are less likely to have savings and more likely to lose their employment in times of crisis. Some believe if the benefits and burdens of quarantine cannot be shared proportionately by all affected parties, they cannot be ethical (Lei and Qiu, 2020).

Be that as it may, there are many who argue that mass quarantines are both practically and morally necessary. Proponents of mass quarantine, like Thomas R. Frieden, the former director to the Centers for Disease Control and Prevention, contend that governments should enforce isolation policies when faced with pandemics. As he explains, “anything that is done that increases social distancing can help decrease the spread of the virus” (Buckley et al., 2020). Likewise, Polly Price, a professor of law and global health at Emory University, points to the precedent of Jacobson v. Massachusetts in support of mass quarantines. The ruling in this court case granted the federal government the power to enforce mass quarantine as a self-defense measure when disease threatens the safety and wellbeing of American citizens (Price, 2020). Similarly, we can see Wuhan’s mass quarantine as a self-defense measure that secured the safety of its citizens who may have otherwise been infected.

Scholars that favor mass quarantine also argue that governments not only have the power to protect their citizens from pandemics with mass quarantines, but they also have a responsibility to do so. In fact, many would argue that the mass quarantines in Wuhan and the Hubei province allowed the global community more time to mobilize public health infrastructures to respond to COVID-19 (Begley, 2020). Most physicians and bioethicists who advocate for mass quarantines also believe that the broader health benefits experienced by many outweigh the temporary restriction of rights experienced by the few individuals who must be isolated (Giubilini et al., 2017). While mass quarantines certainly come with sacrifices, it is more important that they be used to protect the health of many others.

In the face of the COVID-19 pandemic, mass quarantines are being tried in various forms with varying degrees of severity and success. In recent weeks, we have watched China’s new case numbers (supposedly) reduce to zero, which many attribute to their draconian approach. In the U.S., many counties and states have tried weaker restrictions with their “shelter-in-place” and “stay-at-home” orders as case numbers rapidly increase. These orders have raised serious questions about what obligations governments have to their citizens and how it can meet them without violating citizens’ civil liberties during these challenging and uncertain times. Until researchers create an effective vaccine, find a cure, or better understand the pathology of COVID-19, policy makers and public health officials must continue to examine the ethics of mass quarantine and isolation policies.

 Discussion Questions:

• What values are in conflict over Wuhan and the Hubei’s mass quarantine order? What is worrisome about this order?
• Are there any circumstances under which mass quarantine would be morally permissible or required?
• How should governments weigh violations of individual liberties against protecting the health and well-being of others during a health crisis?
• Are there ethical limits to how long mass quarantines can or should be in effect? 

Further Information: 

Buckley, Chris, Zhong, Raymond, Grady, Denise, and Roni Caryn Rabin. “As Coronavirus Fears Intensify, Effectiveness of Quarantines Is Questioned.” The New York Times, January 26, 2020. Available at: https://www.nytimes.com/2020/01/26/world/asia/coronavirus-wuhan-china-hubei.html

Giubilini, Alberto, Douglas, Thomas, Maslen, Hannah, and Julian Savelscu. “Quarantine, isolation and the duty of easy rescue in public health.” Developing World Bioethics, September 18, 2017. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6001516/#

“Coronavirus COVID-19 Global Cases the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University.” Johns Hopkins University & Medicine Coronavirus Resource Center, April 3, 2020. Available at: https://coronavirus.jhu.edu/map.html

Lei, Ruipeng, and Renzong Qui. “Report from China: Ethical Questions on the Response to the Coronavirus.” The Hastings Center, January 31, 2020. Available at: https://www.thehastingscenter.org/report-from-china-ethical-questions-on-the-response-to-the-coronavirus/

Price, Polly. “A Coronavirus Quarantine in America Could Be a Giant Legal Mess.” The Atlantic, February 16, 2020. Available at: https://www.theatlantic.com/ideas/archive/2020/02/coronavirus-quarantine-america-could-be-giant-legal-mess/606595/

Secon, Holly, Woodward, Aylin, and Dave Mosher “A comprehensive timeline of the new coronavirus pandemic, from China's first COVID-19 case to the present.” Business Insider, April 1, 2020. Available at: https://www.businessinsider.com/coronavirus-pandemic-timeline-history-major-events-2020-3

“Wuhan Rounds Up the Infected as Death Toll in China Jumps.” The New York Times, February 6, 2020. Available at: https://www.nytimes.com/2020/02/06/world/asia/coronavirus-china.html#link-3cb0be85

Authors:

Sophie Schott & Alicia Armijo
The Ethics Project
University of Texas at Austin
April 7, 2020

https://liberalarts.utexas.edu/ethicsproject/

Image Credit: Jason M.C., Hans / CC BY-SA 4.0

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