Infrastructure for containing infectious disease did once exist in the United States, in an era before the advent of antibiotics. Isolation hospitals and sanatoriums were part of a decades-long experiment in quarantine construction, which could be repeated, in some form, in the coming weeks and months.
As the novel coronavirus spread through Wuhan, China, earlier this year, Chinese authorities worked to construct emergency facilities where patients could live, receive care, and socialize with one another without the risk of infecting more people. The American medical system no longer includes spaces of that kind. Some preparations are being made to house patients in facilities beyond the hospital or the home; in California, for instance, Governor Gavin Newsom released an executive order allowing the state to take over hotels and medical facilities to house coronavirus patients. But most of those spaces, as my colleague James Hamblin notes, have been “hastily adapted” and have very limited capacities.
Beyond the practical advantage of providing contained spaces for contagious people, quarantine infrastructure changed “hygienic norms,” Graham Mooney, a professor of the history of public health at Johns Hopkins University, told me. The existence of isolation hospitals and sanatoriums, he observes, created a new expectation of civic duty for people with infectious diseases. “These aren’t just questions about disease, they’re also questions about social responsibility and citizenship and protecting your local community,” Mooney said. “The notion that [going into isolation] is something you should do, and the facilities were available to do it, meant that how people viewed disease and illness and what they should do under epidemic conditions was altered.”
This social pressure only worked, though, to the extent that patients could afford to leave normal life behind, and ail in isolation from their communities.