In closing off Wuhan, a city of more than 11 million people, China is deploying a centuries-old public health tactic to prevent the spread of infectious disease — this time, a mysterious respiratory infection caused by a coronavirus.
Experts said the stunning scale of the shutdown, isolating a major urban transit hub larger than New York City, was without precedent.
“It’s an unbelievable undertaking,” said Dr. Howard Markel, a professor of the history of medicine at the University of Michigan, adding that he had never heard of so many people being cordoned off as a disease-prevention measure.
Still, “people are going to get out,” he said. “It’s going to be leaky.”
By limiting the movements of millions of people in an attempt to protect public health, China is engaging in a balancing act with a long and complicated history fraught with social, political and ethical concerns.
James G. Hodge Jr., director of the Center for Public Health Law and Policy at Arizona State University, said the shutdown would almost certainly lead to human rights violations and would be patently unconstitutional in the United States.
“It could very easily backfire,” he said, adding that the restrictions could prevent healthy people from fleeing the city, perhaps exposing them to greater risk of infection. “In general, this is risky business.”
To combat the spread of the virus, which first appeared at the end of December and has killed at least 17 people and sickened more than 500, the Chinese government said it would cancel planes and trains leaving Wuhan beginning Thursday, and suspend buses, subways and ferries within it.
The practice of isolating people and goods to halt the spread of disease dates at least to the 14th century, when ships arriving in Venice during the plague epidemic were required to anchor off the coast for 40 days. The isolation period gave rise to the term quarantine, from the Italian quaranta giorni, meaning 40 days, according to the Centers for Disease Control and Prevention.
Professor Hodge said quarantines could be effective if they selectively isolate only those who have been infected or are suspected of infection. The response in Wuhan, with the establishment of a “cordon sanitaire”-type boundary, goes much further than that.
“Quarantine would be saying ‘You can’t leave your own home, can’t go to school, work or church,’” he said. But the Chinese authorities “have drawn a line around this city and said, ‘No one in and no one out.’ That type of thing is obviously an excessive response.”
In recent years, governments have imposed other large-scale measures to prevent the spread of infectious diseases.
Sierra Leone, a country of about seven million people, said “everybody” was expected to stay indoors for three days in September 2014, as 7,000 teams of health and community workers went door to door to find hidden Ebola patients.
Earlier that year, Liberian officials placed West Point, a sprawling slum in Monrovia where 60,000 to 120,000 people were crammed into shacks, under an Ebola quarantine. The order led to deadly clashes with soldiers and may have helped to spread the disease, experts said, forcing people to crowd together for basic humanitarian aid.
During the SARS outbreak of 2003, Canadian health officials asked anyone in Ontario who had even one symptom of the respiratory infection to stay home for a few days out of fear that the disease might spread during the Easter holiday weekend.
In Beijing, at least 4,000 residents who had been exposed to the virus were kept in isolation, and 300 college students who had had contact with infected people were sequestered in a military camp for two weeks.
Historians have noted that quarantines have often targeted marginalized populations.
During the plague epidemic of the 14th century, European city-states posted armed guards on roads and access points to keep out merchants, people with leprosy and minority groups such as Jews, according to Eugenia Tognotti, a researcher in Italy who has written on the history of quarantine.
And during a wave of cholera outbreaks in Europe in the 1830s, Naples restricted the movement of prostitutes and beggars, who were thought to be carriers of the contagion, she wrote.
Russian Jews brought typhus fever into the Lower East Side of Manhattan in 1892, Dr. Markel said. It was not only infected people who were rounded up and quarantined on an island off the Bronx, however, but also their neighbors and others whom they had simply greeted on the street.
“That’s the darker side of quarantine — its misuse as a social tool rather than its scientific use as a medical tool,” Dr. Markel said.