Learning a pandemic lesson: Here's one habit we now avoid like the plague
Marking the homes of sick is one public health practice we have left in the past
This column is an instalment in our series Apocalypse Then, in which cultural historian Ainsley Hawthorn examines the issues of COVID-19 through the lens of the past.
Though our responses to pandemics have been surprisingly consistent across time, we've left one long-standing public health measure in the past: the practice of marking the homes of the sick.
Household quarantine signs were introduced to England during the reign of Henry VIII.
In 1517, an unidentified disease infiltrated Windsor Castle. The royal court often retreated to the countryside during epidemics to escape the stifling, crowded conditions of urban London, and for contagion to breach the walls of the rural Windsor stronghold must have been a sobering reality check for King Henry VIII and his court.
Death even penetrated the royal bedchamber itself; some of the pages who slept in Henry's room with him died. To avoid becoming infected, the king stopped taking audiences and dismissed his entire court, with the exception of three personal attendants, a musician and, of course, his physician.
Henry blamed the outbreak at Windsor on St. George's Chapel, a church on the castle grounds that was a popular destination for pilgrims, and wrote to the College of St. George, which ran the chapel, demanding solutions.
Singling out the sick
The king was, of course, famous for leaving the bodies of those who displeased him in his wake, so the canons of the college quickly drew up a comprehensive set of measures to keep the contagion in check.
In addition to banning visitors from overnighting at St. George's, the new rules established a system of quarantine for castle residents. Anyone who showed symptoms of infection would be required to isolate themselves in their quarters, which would be marked by a wisp of hay or straw hung on a long pole outside.
One person from each stricken household would be permitted to leave for food and provisions, but, while outside the home, they would be required to carry a four-foot-long white rod upright in their hand so that others would know to keep their distance.
The materials chosen to single out the sick — wooden rods and bits of hay — would have been readily available and easy to recognize. Even a royal residence like Windsor Castle was home to people of all social classes, and many inhabitants would have been illiterate.
The measures implemented at Windsor were later expanded to London and Oxford, and, in 1543, the wisps of hay used to designate sick-houses were upgraded to blue crosses of St. Anthony, headless crosses that resemble the letter T.
These crosses were painted on a placard with the words "Lord Have Mercy Upon Our Souls" emblazoned above or below. In times of plague, civic leaders ordered them by the hundreds to have on hand to nail to the doorposts of affected homes.
A book published in 1564 provides a vivid description of London during a plague outbreak: "The daily jangling and ringing of the bells, the coming in of the minister to every house and in the communion, the reading of the homily of death, the digging up of graves, the sparring of windows, and the blazing forth of the blue crosses do make my heart tremble and quake."
When the Great Plague struck the city in 1665, authorities instituted even more stringent measures to control the spread of illness.
Two watchmen were assigned to each infected household, now marked with a red cross in place of blue. One stood guard by day, the other by night, to ensure that no one came in or out. Residents were no longer allowed to leave for supplies — anything they needed was to be brought to them by the guards.
Not putting up with shutting up
This shutting-up of households was controversial at the time, and the sealing of the first household in the neighbourhood of St. Giles incited a riot. Public feeling early in the epidemic was that it was a death sentence to lock people up with their ailing relatives. The crowd at St. Giles eventually broke down the door of that first home to release the people inside.
An anonymous writer rejected the practice in the strongest possible terms: "This shutting-up would breed a plague if there were none: infection may have killed its thousands, but shutting up hath killed its ten thousands."
The author was as concerned with the toll quarantine would take on the mind as on the body. Like us, he worried that isolation would cause some people to contract "a melancholy" that would lead to a decline in their health.
Household quarantine, in any case, wasn't destined to last. The quarantine regulations that had been enacted in April 1665 were abandoned by September, when more than 7,000 Londoners were dying each week and there were no longer enough watchmen to go around.
The practice of marking sick-houses, though, didn't end with the plague. Quarantine signs were posted on the homes of scarlet fever, typhoid and measles patients through the 1940s, including in Canada.
LISTEN | Ainsley Hawthorn and Andrew Hawthorn break down something that has fortunately gone out of pandemic fashion:
Why have public health authorities taken a different approach during the COVID pandemic, often refusing to name even the communities where cases are located?
One reason is respect for medical privacy. Our modern health-care system is founded on the principle that no one has a right to a person's private medical information apart from the patient, their guardians, and their medical providers.
Quarantine notices advertise an individual's health status to the public at large, which not only breaches patient privacy but creates a risk of harassment and discrimination.
Publishing the locations of known COVID-19 cases would also instil a false sense of security.
We know now that many diseases can be transmitted even before a person begins to show symptoms, and, with COVID-19, up to 30 per cent of infections are asymptomatic from start to finish. From a public health perspective, it's better to encourage people to take precautions everywhere than to give them the impression that all cases have been identified and are effectively contained.
While household quarantine remains a key feature of today's pandemic response, quarantine signs are probably best relegated to history.