Protective sequestration
Encyclopedia
Protective sequestration is a public health
term that refers to measures taken to protect a small, defined, and still-healthy population from an epidemic
(or pandemic
) before the infection
reaches that population.
Given the extraordinary nature of these measures, they should be considered, if at all, only under exceptional circumstances: (1) implementation is feasible, (2) the measures can be enforced, and voluntary compliance of the sequestered population is highly likely, and (3) the sequestered population and/or the work they perform merits this effort and justifies the use of these measures. The term “protective sequestration” was coined by Howard Markel
and his colleagues, in their paper that described the successes and failures of several communities in the United States in their attempts to shield themselves from the 1918-1920 so-called “Spanish Influenza” pandemic during the second wave of that pandemic (September-December 1918).
The term “protective sequestration” avoids the use of the word “quarantine,” which, in public health, refers to the voluntary or enforced detention of a person who, because of actual or possible contact with a person carrying an infectious agent, may have acquired that agent and be capable of passing it along to others. The duration of the quarantine period is determined by the incubation period of the infection, i.e., the time between acquisition of the infectious agent and the development of signs or symptoms of the illness caused by that agent.
During the 1918-20 influenza
pandemic, factors that contributed to the rare successes of protective sequestration were the following. First, the community leader(s) recognized the danger posed by the pandemic before it reached the community and implemented protective measures early (before neighboring communities did). Second, taking advantage of the community’s remoteness or natural barriers that were generally, but not always, present, the community leadership established and enforced a cordon around the outer perimeter of the community. Third, anyone seeking entry into the community was placed in quarantine for the incubation period of the infection and released into the community only after they were shown to be free of infection. Furthermore, the leadership established a system whereby supplies were delivered and received in a way that eliminated human-to-human contact with those delivering the supplies. Fourth, families were kept together so that life within the protected zone was as normal as possible. Schools remained in session and places of worship remained open, people continued to work, and entertainment remained available. Fifth, “protective sequestration” measures remained in effect for the duration of the risk.
An advantage of protective sequestration is that it shields selected people from infection and possibly buys them time for the development and distribution of drugs or vaccine. A disadvantage, apart from its elitism and social and economic cost, is that those sequestered have no opportunity to develop naturally-acquired immunity to the infectious agent through contact with it, and, therefore, they remain susceptible to the agent during subsequent waves of the epidemic or pandemic.
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
term that refers to measures taken to protect a small, defined, and still-healthy population from an epidemic
Epidemic
In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience...
(or pandemic
Pandemic
A pandemic is an epidemic of infectious disease that is spreading through human populations across a large region; for instance multiple continents, or even worldwide. A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a pandemic...
) before the infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
reaches that population.
Given the extraordinary nature of these measures, they should be considered, if at all, only under exceptional circumstances: (1) implementation is feasible, (2) the measures can be enforced, and voluntary compliance of the sequestered population is highly likely, and (3) the sequestered population and/or the work they perform merits this effort and justifies the use of these measures. The term “protective sequestration” was coined by Howard Markel
Howard Markel
Howard Markel is an American medical historian, and a distinguished professor and Director of the Center for the History of Medicine at the University of Michigan. He is frequently asked to comment on medical issues in the news....
and his colleagues, in their paper that described the successes and failures of several communities in the United States in their attempts to shield themselves from the 1918-1920 so-called “Spanish Influenza” pandemic during the second wave of that pandemic (September-December 1918).
The term “protective sequestration” avoids the use of the word “quarantine,” which, in public health, refers to the voluntary or enforced detention of a person who, because of actual or possible contact with a person carrying an infectious agent, may have acquired that agent and be capable of passing it along to others. The duration of the quarantine period is determined by the incubation period of the infection, i.e., the time between acquisition of the infectious agent and the development of signs or symptoms of the illness caused by that agent.
During the 1918-20 influenza
Influenza
Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae , that affects birds and mammals...
pandemic, factors that contributed to the rare successes of protective sequestration were the following. First, the community leader(s) recognized the danger posed by the pandemic before it reached the community and implemented protective measures early (before neighboring communities did). Second, taking advantage of the community’s remoteness or natural barriers that were generally, but not always, present, the community leadership established and enforced a cordon around the outer perimeter of the community. Third, anyone seeking entry into the community was placed in quarantine for the incubation period of the infection and released into the community only after they were shown to be free of infection. Furthermore, the leadership established a system whereby supplies were delivered and received in a way that eliminated human-to-human contact with those delivering the supplies. Fourth, families were kept together so that life within the protected zone was as normal as possible. Schools remained in session and places of worship remained open, people continued to work, and entertainment remained available. Fifth, “protective sequestration” measures remained in effect for the duration of the risk.
An advantage of protective sequestration is that it shields selected people from infection and possibly buys them time for the development and distribution of drugs or vaccine. A disadvantage, apart from its elitism and social and economic cost, is that those sequestered have no opportunity to develop naturally-acquired immunity to the infectious agent through contact with it, and, therefore, they remain susceptible to the agent during subsequent waves of the epidemic or pandemic.