Until Proven Safe: The History and Future of Quarantine

by Nicola Twilley

Until Proven The History and Future of Quarantine

Genres: Nonfiction, History, Science, Medicine, Health, Audiobook, Medical

300 pages, Hardcover

First published July 20, 2021

About the author

Nicola Twilley is author of Frostbite: How Refrigeration Changed Our Food, Our Planet, and Ourselves (Penguin Press, June 2024), and co-host of the award-winning Gastropod podcast, which looks at food through the lens of history and science, and which is part of the Vox Media Podcast Network in partnership with Eater. Her first book, Until Proven Safe: The History and Future of Quarantine, was co-authored with Geoff Manaugh and was named one of the best books of 2021 by Time Magazine, NPR, the Guardian, and the Financial Times. She is a contributing writer at The New Yorker and the author of Edible Geography. She lives in Los Angeles.

Reviews

[Ula Tardigrade · Rating 4 out of 5]

Every crisis is an opportunity - it may be a cliché but it is certainly true in the case of this book. Global pandemic in 2020 made a seemingly obscure quarantine not only relevant but a hot topic.

Thankfully, it is not a case of a hastily written volume intended to grab the spotlight. The authors worked on it for many years, researching, traveling the world and interviewing numerous experts, and it isn’t focused on COVID-19 (but it covers recent developments). I have to admit that after last year I am experiencing a kind of COVID-fatigue, so I’ve found the parts dedicated to the history of quarantine and it’s aspects not directly related to human infectious diseases most interesting and enlightening. I especially loved the chapter devoted to space exploration - yes, there is such a thing as planetary quarantine!

The book is very well written and original. Recommended to anyone interested in the history of medicine, science and engineering.

Thanks to the publisher, Farrar, Straus and Giroux, and NetGalley for an advanced copy of this book.

[Alexandra · Rating 5 out of 5]

I like to imagine Nicola Twilley and Geoff Manaugh saying "No one would have believed..." like Richard Burton at the start of Jeff Wayne's War of the Worlds , when asked how they feel in 2021 about this book. They started it, as far as I can tell, many years before 2020... and then finished it while large portions of the world were getting the ideas of 'quarantine' and 'isolation' mixed up. (As the pair make clear, quarantine is when there is doubt about the infection status of a person or object.)

I came across this book because I am a massive fan of Gastropod, "food through the lens of science and history", co-hosted by Twilley. And as a fan of wide-ranging history in general, it seemed like a good bet that it would be right up my alley. The podcast did one episode using some of the ideas from the book - talking about the quarantining of cocoa plants, mostly, so as to prevent the spread of chocolate-destroying pests, which I am heartily in favour of.

As the name suggests, the book covers both the history and the future of quarantine - and, of course, the present. Many more people know, in 2021, the origins of the word - the 40 days people and cargo on ships were kept out of places like Venice, for fear of sickness. Manaugh and Twilley visit Venice and Dubrovnik and Malta, places where quarantining had a long history in architecture and laws, and occasionally in famous people getting grumpy about being stuck.

The middle section is about quarantine today. As an Australian this is a particularly real issue; we really don't want to bring yet more pests and diseases in if we can avoid it. There's a reason dogs don't get to be smuggled in, JOHNNY DEPP. It was fascinating to read about measures that are used around the world to try and stop invasive stuff - and how often, this is a stop-gap measure, because with ever-increasing world trade it's just so easy for teeny critters and seeds to travel. This section also looks at 'quarantining' radioactive waste - which is a bit of a stretch, since there's no real question about the stuff being dangerous; and the authors acknowledge that it is, indeed, about isolation, rather than quarantine; but their argument is that places doing this stuff are fascinating for 'quarantine tourists' because they showcase 'extreme engineering controls'. And this section also looks at the measures used around space travel: like I didn't know the first couple of sets of Apollo astronauts were required to quarantine for fear of moon diseases.

My one grumble about the book is a minor Australian one. In discussing Australian legislation from 1884, they call Australia "the newly unified continent" (p125). Australia didn't federate until 1901. My quick google suggests that there were, indeed, "Sanitary Conferences" at this time aiming to have a united policy across the colonies, so I guess in that sense the continent was unified?

In the section about the future, Twilley and Manaugh do look at COVID responses, comparing them to medieval responses in terms of government use of power, and even deploy Foucault as a way of examining government (over)reach. We're discussing these questions a lot at the moment, of course, and it was interesting to see it all in this context. And what was completely terrifying was to discover that there's a "data-aggregation and modelling firm with close ties to the US defense industry" (p328) called Palantir. Palantir. The seeing-stones of Tolkien's Middle Earth. Wikipedia notes that "beings of great power could manipulate the stones to see virtually any part of the world". And someone at this company thought this was a good name for this company.

I think, given our situation at the moment, one of the last points made in the book is particularly pertinent: "Ironically, if quarantine does work... it will almost always be perceived as an overreaction" (p349).

Well written, well researched, broad ranging and examining difficult issues with compassion and clarity. This is a great history of quarantine and I thoroughly recommend it. Exactly WHEN you want to read it will depend on your experience of 2020 and 2021, I suspect.

[Katie · Rating 3 out of 5]

This nonfiction book about the global history of quarantine started before COVID and ended during, putting the authors in the unusual position of unwillingly experiencing what they were writing about (and in the enviable position of striking book gold--probably increasing sales dramatically because their chosen topic became uncomfortably close reality to the entire world at once).

"Lazarettos" were quarantine facilities constructed centuries ago, some of which were abandoned and decayed, but more than one of which became outdoor shopping/dining malls in later centuries. These facilities look like prisons because they ARE prisons, with the exception of open, outdoor courtyards for obvious reasons.

Did you know certain animals have been found to be smarter about this than we are? Bees, bats and spiders have all been shown to have a "social distancing" instinct, where when they contract something communicable, they somehow know to steer clear of their hive or nest until it clears up. They are not punching each others' lights out for wearing or not wearing masks.

The book envisions a (tiresome theme) digital future where, rather than a physical lazaretto building our sick would be forced into, Alexa or Siri automatically locks our doors, stranding us within our homes when it detects a rise in our body temperature or hears too much coughing.

I found this book mostly interesting but with some dull parts, like a whole long chapter on disinfecting mail I could've lived without, and skimmed through.

[Jessica Haider · Rating 4 out of 5]

Thanks to very recent history, we are all now familiar with quarantine, at least on some level. Sure, it means more than being locked away with your dwindling supply of Charmin and a year's worth of PopTarts.

In this well-researched book, Nicola Twilley takes us through the history of quarantine, from how it was discovered that it was necessary to how it works. We learn about quarantine's uses throughout history and how technology may help quarantines in the future.

I found this all very fascinating and recommend this book to any science nerds like myself or anyone interested in popular science.

I received a copy of this book in exchange for an honest review.

[Camille McCarthy · Rating 4 out of 5]

I thought this topic was timely and the authors did a good job of demonstrating all the different circumstances when we rely on quarantine - not just for human disease, but for invasive species, plant disease, unknown extraterrestrial matter, and nuclear waste. However, I thought maybe they made their subject too broad, as some of the takeaways may have been diluted with so much information. I wish they had belabored the points about public trust in institutions more, and how the US's lack of universal health care was an absolute disaster. I appreciated learning about the fangcang in China, where people went if they had been exposed or had mild infections and which prevented people from infecting others in their households. I would have liked to hear more about how architecture can make places like airports less likely to spread infections.
The historical parts were also very interesting - I enjoyed learning about the lazarettos and how quarantine was seen as a religious act in some ways, and I never knew the astronauts who went to the moon were quarantined for three weeks after. The nuclear waste chapter reminded me of "Want Not," a fiction book where one of the characters is working on signage for the nuclear waste structure.
The chapters on invasives and plant diseases was honestly a lot more frightening than the part about human diseases.
I think they could have also gone into more detail on what it means to take responsibility of care for people when you've restricted their freedom of movement - other countries, such as China and South Korea, gave their citizens actual food and other supplies when they were shut in due to illness, whereas in the US, we got almost nothing - one-time payments late into the pandemic, protections that expired after a few months, some extra unemployment money that again didn't last even though the worst of the pandemic hadn't even hit by that point, and now, free at-home tests that are again very limited. They could have also spent more time talking about how little was done to help the homeless, who were unable to self-isolate in their homes since they had none, or how many people were unable to pay rent and thus faced the threat of eviction, and how that also played a huge role - apparently evictions led to 10000 excess deaths in the US at some point last year. It's clear we have a lot to do in order to be prepared, not just for the next disease but for the next wave of covid, which will likely be here soon after I write this review.
For me, the book highlighted the enormous house of cards we live in as a result of global capitalism and how precarious the situation is. From lack of affordable health care to depending on monocultures for most of our food, to spending billions on space travel which may bring back disastrous organisms while many people on earth starve, to all the money and effort spent trying to plan for storing nuclear waste for 10000 years when we could be focusing on switching to renewables, I'm just amazed something like the covid pandemic didn't happen sooner.

[Ben · Rating 4 out of 5]

Much like Twilley's podcast, this book is wide ranging and always interesting. The last couple chapters were the weakest. I'm not sure what nuclear waste storage has to do with quarantine—it is still fun to read about, but not really on topic. The discussion of digital surveillance, contact tracing and quarantine is also very weak—mostly speculative and not based on actual reporting. The book would have benefitted if the authors had reported from South Korea, China, or possibly the US developers of contract-tracing apps.

> Later, the practice of slashing mail with chisels and awls, which often left it in shreds, was made obsolete by a device called a rastel (from the Latin rastellus, or “rake”), which resembles the love child of a waffle iron and a medieval torture device. Letters were placed between hinged, spiked plates and punctured pre-fumigation

> for a century, from 1770, Austro-Hungarian authorities maintained a thousand-mile quarantine corridor along their imperial frontier, all the way from the shores of the Adriatic to the Transylvanian mountains. This epidemiological boundary was not simply a line but a buffer zone, thirty miles wide in many places, cutting a broad swath through modern-day Serbia, Bosnia, and Croatia. Inside this belt, every peasant was also a soldier, responsible for manning the sanitary cordon for at least one week in every eight, and more during an outbreak—up to a total of six months’ active service each year. A chain of two thousand lookout posts was constructed, each no more than a musket-shot’s distance from the next, and soldiers were instructed to fire on any unauthorized traffic. Nineteen crossing posts offered disinfection services, open-air parlatorios for distanced conversation across the divide, and supervised quarantine for travelers—twenty-one days when no outbreak was suspected, and forty-eight when the presence of plague was confirmed in the region

> When Napoleon sent sixty thousand French soldiers to Haiti to quash a slave rebellion in 1801, 80 percent of them died within two years, jaundiced, feverish, and vomiting a noxious substance that resembled spent coffee grounds. Defeated, Napoleon sold off the rest of his North American possessions to the United States in the Louisiana Purchase. Meanwhile, what was left of the imperial fleet sailed back to French and Italian ports in 1804, bringing yellow fever with them

> The use of these kinds of canaries in the coal mine of public health is expensive but effective. In Australia, which is the only continent free of the Varroa mite, sentinel beehives are stationed near ports, to alert biosecurity officials to any accidental introduction. In California, 139 flocks of sentinel chickens stand guard in chicken coops around the state; if the white leghorns are bitten by mosquitoes infected by West Nile or St. Louis encephalitis, they will develop antibodies that alert local public health agencies to the presence of the disease.

[Kristin · Rating 4 out of 5]

This is a comprehensive and fascinating look at all aspects of quarantine: its history, effects, and future as it pertains to not only pandemics but space contamination, nuclear waste, and bioterrorism. It covers how quarantine was handled during all the major pandemics from the Bubonic Plague to Covid-19. If you like nonfiction on this topic, this one could be for you!

[Maddie · Rating 4 out of 5]

This was super interesting! The authors were nearly finished with the book at the start of the pandemic and I thought they did a really good job of using covid as a modern context for the reader without making this a book solely about the covid pandemic. They also discuss uses of quarantine I don’t typically think about like space travel and plant disease.

[Maria · Rating 2 out of 5]

Thank goodness I am finally done with this book. It took me forever to get through, and I considered abandoning it many times. However I decided to stick with it, because despite being mostly boring it does also contain snippets of interesting and useful information. I read it because I heard Nicola Twilley talking about quarantining cocoa trees on a podcast. Turns out she presents the information in a much more engaging manner in that medium than in the form of a book. Unless this is a topic you are deeply interested in I would skip this one.

[Taylor Atkinson · Rating 4 out of 5]

Given how divisive and politicized the pandemic response was, I felt rather apprehensive about this read. Much to my relief, it steers clear of politics and stays focused simply on the history of quarantine. Here are several things that I learned that piqued my interest:

- For a long as humans have been gathering in large groups and then spreading illness, I expected the history of quarantine to stretch back thousands of years. And probably, in some small ways, it does. I think it's easy to perceive our ancient ancestors as unsophisticated or incompetent, which they weren't, so I think it's very likely people figured out the value of, at scale, staying away from sick people. Where this history picks up, though, is when quarantine becomes a combination of institutions and policies, especially ones that communities and countries tried to learn about and improve upon from each other. That history goes back only a handful of centuries.

- The modern (last several decades) policy failings of countries, as measured by their pandemic response practices and simulations, left me utterly astounded.

- The history I loved the most was the niche collection of mail, correspondence, and belongings that received special treatments or marks to indicate they passed through quarantine procedures. The captures moments of humanity, never delivered to their original addressee, gives us the delicate and the mundane, the tender and the evocative. In one example, modern day collectors are able to pin down when an item was mailed several hundred years ago thanks to meticulous record keeping at the time on which quarantine stamps were used and by which inspectors. Fascinating.

Award for the kindest human in this history goes to the natural philosopher who spent his life traveling and living in quarantine conditions to study and report the effects of different policies, conditions, and building designs and how they effected patients and communities.

[Katie · Rating 4 out of 5]

I was surprised to learn that this second book, on the history of quarantine, was in the works before covid. There was an intro that focused on covid and a few references to modern resistance to pandemic mitigation efforts, but this wasn't a large part of the book. The bulk of the book was about the origins of quarantine practices and the ethics of using quarantine to control disease spread today. There's also a significant digression about interesting cases where we try to isolate things for other reasons - specifically nuclear waste disposal and space travel. These sections initially felt off-topic, but they raised some really thought-provoking questions about the limits of and uses for quarantine. This book definitely read like narrative nonfiction, but was kept engaging through many anecdotes rather than one overarching story. Historical pandemics are recounted with personal perspectives and larger narrative arcs. The authors also intersperse information with fascinating stories about their travels learning about quarantine. I love when authors use their research experience to make potentially dry information feel immediate and alive.This review was originally posted on Doing Dewey

[pugs · Rating 4 out of 5]

a book years in the making, coincidentally forcing itself into forewarned disaster, proving one of its points, this is probably the only book with mentions of covid that i'm willing to read between now and in the near future, as so many others will be unsubstantial cash grabs. the authors traveled around the world before and after the pandemic, and it's fascinating to see just how much we rely on quarantine internationally, and... interplanetary measures. from religious connotations, to history of treating people during plagues, to safeguarding plants, inspection, the multi-multi-multi-layered, sanitized facilities, and how surveillance capitalism will affect the future of quarantine. worth reading and not a dry read, either.

[Mandy · Rating 5 out of 5]

Such an interesting book – a detailed and excellently researched history of quarantine, past, present and future, form the earliest recorded formal quarantine in 1377 to speculation about what quarantine might look like in the future. Scholarly but accessible, the book is full of fascinating and compelling stories and people, and I can’t imagine anyone NOT being absorbed by it. A really great read.

[Randi · Rating 5 out of 5]

Incredibly interesting look at all aspects of quarantine. It read like a binge-worthy podcast, each chapter like its own episode with topics ranging from physical quarantine to agricultural quarantine to the idea of being together, but apart. I usually gravitate toward books that help explain our current experiences, and while it references COVID-19 quite often, I loved that it spanned such a wide history. Absolutely worth your time to read.

[Elizabeth Layman · Rating 4 out of 5]

I first came across this book because I heard about it on a food science/history podcast called Gastropod, which is co-hosted by one of the authors, Twilley. The section of this book that described the quarantine process around agriculture/food was especially interesting to me, a food lover who has personally relinquished fruit at the border of California! I also loved the section on quarantining nuclear waste, as well as the section on quarantining moon/martian matter (and earth matter when traveling to space). So why did this book take me so long to finish? It's chockfull of amazing information, which I absorbed slowly. And honestly, when I first cracked this book open early this year, I had to close it again almost immediately; I guess reading about the beginning of the COVID-19 pandemic just felt a little traumatic, too soon. I cannot even imagine the authors writing this book in lockdown--how eerily perfect!

[Maddie Woda · Rating 5 out of 5]

Smart, well-researched, nuanced, and obviously prescient. Love that the authors are married.

[Joni Baboci · Rating 3 out of 5]

A review of quarantine around the world with a philosophical edge. It's an interesting book that starts in Venice/Dubrovnik and ends in potential future surveillance-tech quarantine covering most bases.

[Katie · Rating 4 out of 5]

A history book about a very pressing current subject. Explores many different kinds of quarantine and looks at what makes them effective and what doesn't (spoiler, it's people).

[Francis Pellow · Rating 4 out of 5]

very interesting. particularly enjoyed the chapters about agricultural quarantine and interplanetary quarantine.

[Ben Brooks · Rating 5 out of 5]

Fantastic! Pairs really well with The Sixth Extinction. This is as much about humanity as it is about disease.

[Kari · Rating 5 out of 5]

This was so interesting and highly readable. There were many things that made me gasp out loud. A book-length New Yorker article but one you’d send to your mom (my mom) after

[Shayla Poindexter · Rating 5 out of 5]

I was pleasantly surprised when this book took on the topics of quarantine of radioactive materials and quarantine of spacecraft and astronauts. Also me 😲😲when there was a reference to andromeda strain! 🦠 🧫

[Brook · Rating 4 out of 5]

Absolutely fascinating. But also detailed, so not of the Mary Roach "casual, fun read" variety.

And it shows that Trump ain't nothing new.

[Ericka Clou · Rating 4 out of 5]

A little all over the place but important and related topics about hazardous biologics and other materials.

[Kelly · Rating 2 out of 5]

Perhaps I went into this book with the incorrect mindset, because I thought it was a nonfiction history book, but I was very disappointed. Any history book that quotes historians instead of historical sources and doesn't even bother to explain how the historians they cite came to those conclusions should be viewed with cynicism in my opinion. It takes a truly talented historian to discuss the history of something across so much time and geographical distance while remaining detailed and accurate, and these authors were not up to the task. Even if the very first section they present out of date and inaccurate information on the black plague. The story of Mongols catapulting plague ridden bodies over the walls during the siege of Caffa was either too salacious to leave out or the authors simply didn't bother to engage with the newest academic literature when writing. Either way: disappointing.

[Ben · Rating 4 out of 5]

This was a very good book on pandemics and the future of things like COVID-19. What we have in years ahead.

I found it very interesting.

Proves how you can't be selfish during a pandemic.

Didn't love the little history bits (I am not a fan of just history for the sake of history), but I really enjoyed the majority of the book, as it mostly was written about current times and the future.

4.6/5

[Elaina · Rating 3 out of 5]

I wouldn't necessarily say this book as a whole was interesting, but the author did make interesting choices when it came to what to include. We begin with a history of quarantine and how that translated to the modern day and the COVID-19 pandemic. You may be asking, "what do you mean 'begin with', isn't that what this book is about?"

And therein lies the problem. I was expecting this to be a comprehensive history of quarantine, but the history only takes up about half of the book. The other half is dedicated to topics which are tangetially related to quarantine (sickness in plants and how to prevent the spread of disease, the disposal of nuclear waste, the cautions taken when it comes to space travel to prevent contaminating other planetary bodies).

I enjoyed the discussion of isolation versus quarantine, though it is a little pedantic. Words have meaning and it's important to recognize those meanings, but it's also important to recognize that both isolation and quarantine would likely impact people in a similar way. Both isolation and quarantine lead to disconnection from others, and I imagine the last thing someone wants to hear when discussing their disconnection would be "well actually, you weren't quarantined, you were isolated".

Another discussion I enjoyed was that of the precautions taken when it comes to not contaminating other planetary bodies with terrestrial bacterium, but I don't necessarily think that discussion belonged in this specific book. I think that discussion would fit better in a book about space travel/exploration. Sure, the astronauts quarantined, but I don't think we need to discuss every possible application of the word "quarantine" in a book about the history of quarantine.

The book is written pretty well and it more or less kept my attention through the whole thing. I do think the "future of quarantine" discussion was terrifying just from a "we are constantly being watched by all of our tech". At the same time, this is an important to talk about when discussing a culture of care; what freedoms are we willing to sacrifice in order to help stop the spread of potentially fatal illnesses? The book loses some stars because the discussion is all over the place and brings in a lot of only tangentially related topics, but it may still be worth a read if you're interested in learning more about quarantine.

[Derek Lee · Rating 5 out of 5]

Starting a book on what must have felt like the subject of a bygone age and the fodder of zombie movies must have made Spring 2020 be an even more terrifying experience than for the rest of us. Ironically, the COVID pandemic is also when I discovered Nicola Twilly’s wonderful podcast about the science and history of food, Gastropod. And it’s because of the 2021 podcast episode about quarantining chocolate plants in London during the press junket for Until Proven Safe that I decided to read it.

I must applaud Nicola and her husband, Geoff, for sticking with this book. Looking back in 2023, on one hand the timing might of this book might have seemed to be an incredible stroke of luck. On the other hand, quarantine fatigue and too much reference to current events hurts the long term appeal and longevity of the book.

Which is such a shame, because Until Proven Safe, if published in say, 2019 instead of 2021, would have been a fun mixture of historical stories, with a foreboding undercurrent. It could have been like how for me, when visiting Hong Kong for the first time in 2018, I was struck by the poignant realization of how close we came to the brink during the 2003 SARS outbreak. The dozen bronze busts in honor of healthcare professionals who died in the line of duty combatting it, sitting in the middle of a quiet park in the center of one of the world’s most interconnected cities.

I hope more people read Until Proven Safe. It really is an interesting read, and there’s enough content about the historical quarantine and isolation stories to fill a book, without having to touch upon the COVID-19 pandemic. Maybe give it a few more years if you’re still fatigued today. But if you wait too long, we’ll find ourselves back in the midst of another one that we’re not prepared for.

[Lukas Lee · Rating 5 out of 5]

Well-written, well-researched, well-formatted, and impeccably timed! The authors provide a detailed history of quarantine across the globe, dating back to the 14th century, as well as outlining current quarantine examples for not only humans, but also plants and animals, nuclear waste, and even space rocks. They also provide examples and recommendations for what quarantine may look like in the future as technology advances, along with the potential benefits and dangers of such advancements.

“The future of quarantine is certainly a question of technology—of testing, tracking, surveillance, containment, and control. It is a question of ventilation systems, plumbing networks, and extreme forms of waste disposal and burial. But it is also a question of civility, of a politics and culture of collaboration that allow for awareness of shared responsibility in the face of an unknown disease. The ability to respond to such uncertainty—and to prioritize the collective good by temporarily separating ourselves—requires cooperation and self-sacrifice, mutual trust and humility, from political leaders and citizens alike.”

“The future of quarantine lies not only in technology, but also in us: we will never have public health if we do not think of ourselves as a public.”

“Quarantine exists not just to protect ourselves but to ensure the safety of others—of loved ones and strangers both. In the end, it demands nothing more of us than that we take the appropriate space and time; that we simply pause, before venturing out again, until proven safe.”

[Yibbie · Rating 2 out of 5]

Let’s see, 400+ pages and I feel that I’ve watched a documentary rather than read a history. The travelogue format of the early chapters certainly didn’t make it feel like a scholarly work of deep historical investigation. The author’s exploits in putting on PPE, watching concerts, and jumping fences are interesting tidbits, but not really that historically relevant. After that, there are more interesting bits that are more historic or scientifically relevant, but they are all drawn out and mixed with a chronicle of the author’s experience of learning each fact. “I” or “We” features a lot in the narrative for a history book.
In the final chapters, as she delves into a dystopian future of technological quarantine ‘for our own good’, the safety at all cost mentality really came through. I guess if you talk to enough ‘experts’ in the then theoretical field of quarantining they will make you think it’s the best thing since sliced bread. As they promote it, they forget the personal and national damage that broad quarantines can and do inflict. Granted, Covid hadn’t played out completely as they published this book, but only the good side of quarantine is mentioned for modern times. They seem to forget the stories from history of nations struggling to balance economic, personal, and social needs against the risks of infection.
So, if you are vaguely interested in some random facts about quarantines past and present, it might be for you. If you are interested in gaining a full historical understanding of quarantines this might annoy you with all the digressions.