Until Proven Safe: Interview with Geoff Manaugh and Nicola Twilley

As part of UCHRI’s investigation into living through upheaval, Alison Annunziata spoke with Geoff Manaugh and Nicola Twilley, authors of Until Proven Safe: The History and Future of Quarantine, to discuss the logistics and anatomy of quarantine, its logic and demands, and potential ways to reconstruct attitudes towards safety, isolation, society-and-self to accommodate a global civil society now emerging from mandated lockdown. Collating a wealth of empirical instantiations of quarantine, from human-historical to animal to extraterrestrial, Until Proven Safe reflects on the instrument of quarantine and the social and political implications of transforming it from a ‘necessary evil,’ so to speak, into an architectural and civic design principle. Drafting a solution, they write, “[i]f architects considered the need for infection control, toilet facilities, electrical outlets, and other necessities when designing new stadiums, convention centers, and sports facilities, those buildings would be substantially cheaper and faster to flip in an emergency situation.” A future oriented in this way “need not be dystopian,” they write. “We have the technical and material know-how to remake our spaces of isolation—to take quarantine seriously, from the very beginning, as a spur toward design creativity.”

How would you detail the intellectual trajectory of quarantine from its earliest instantiation to now? If we were to anatomize an architecture of quarantine, what elements would arise consistently? 

NT: From the start, what struck us as interesting about the history of quarantine is the idea of uncertainty, of quarantine always being a very liminal space. The entire point of quarantine is to mitigate against uncertainty, and to create a space and a time in which you can arrive at certainty. Is something dangerous or is it safe? We don’t know, we want to de-risk the situation, and quarantine is the space in which we can do that. Quarantine is the tool that we can use essentially to have our cake and to eat it: to take the risk of trade and travel without the danger that those exchanges can bring disease with them.

GM: There is an interesting trajectory over the course of the history of quarantine. As a spatial practice, quarantine was originally dependent on islands and edges. It was something that took place outside of the city; beyond the bounds of the inhabited space where communities gathered. It required requisitioning an island and turning it into a quarantine station, or finding a distant peninsula and enacting quarantine there, or putting quarantine outside the city gates. But the architecture of quarantine eventually began to internalize that distance, and through technical engineering, and engineering controls like air handling systems and wastewater management, architects and health professionals were able to achieve the isolation of an island in architectural form. This peripheral practice, this thing that occurred outside the bounds of what people might see in everyday life, has now moved to the very center of things. Two of the main places that we visit in the book are the new federal quarantine facility in Omaha, Nebraska, and then also an animal disease research facility in Manhattan, Kansas, and each of these is right in the very heart of the country. In the case of the animal disease research facility, it is centered near the very creatures that would be most at risk of the diseases being studied there. It has been interesting to see how the architecture of quarantine replaces the geographic need for isolation in terms of mechanical or technical expertise. 

NT: Both of those facilities are replacements for islands. The federal quarantines used to be at places like Ellis Island and Angel Island, and now it is in Omaha. The laboratory for working with livestock diseases used to be Plum Island, and now it is in the middle of the agricultural heartland in Kansas. That is one trend we saw. There’s also a tension between community experience and the individual’s experience: at times, quarantine has been a very communal experience, and, at other times, it’s reflected demographic profiles. The class-based divisions within quarantine go back quite a long way. There have been different levels of the quarantine experience depending on your financial situation for as long as there has been quarantine. 

How does the architecture of quarantine map onto a technology of surveillance? What would you say to those who respond critically to the concept of quarantine, owing to its inherent racial and class discrimination?

GM: On one level, the act of quarantining, even in the origins of the practice, was about putting people into a centralized facility where they could be seen and managed and controlled and administered. It was about putting people into particular buildings, or particular wards of buildings, and having their goods separated in a way that could be surveilled. Quarantine is about the control of movement and the spatial isolation of a targeted population—that is the logic of quarantine. But one of the things that is so interesting with COVID-19 and with the encroachment of big data, so to speak, into quarantine, is that we are so easily tracked now. We are giving off data streams that can be used to diagnose potential illness in a way that I do not think we, as a society, are grasping the implications of. In the book, we look at how smart homes are being turned into diagnostic devices so that your house itself can determine if you have a cough, or if you have a fever: your house, through the networked appliances within it, can begin to diagnose these things. This is about being watched or tracked in a new way. This also touches on issues of class in the sense that, ironically, wealthier consumers are surrounding themselves with these sensors and these technologies. But all this stuff trickles down and will get embedded into everyday society in a way that I think that we are not really prepared for. The present-day luxuries of the rich who are opting into an infinite quarantine scenario—I think it is going to have lasting effects for people who didn’t opt in.

NT: One of the things that is so interesting in the book is how the bureaucratic structures, checkpoints, and passports that arise to manage movement in and out of quarantine end up being the bureaucratic structures that shape our lives and our movement in general. In one chapter of the book we profile an interesting individual who founded the Disinfected Mail Study Circle, framing him as a sort of a postal archaeologist of quarantine. We use him as our guide to track how infrastructures for managing quarantine have ended up shaping borders, geopolitics, and all of the paraphernalia around that. Early health passports that are the ancestor of today’s passports were a way to actually avoid quarantine, for example—a way to say “I’m not coming from a risky place, so you don’t have to put me in quarantine.” The British, when they were trying to avoid the burden of quarantine, in order to maximize their colonial, global capitalist empire, bypassed the physical structure of quarantine with a whole system of documentation, tracking, and early contact tracing to be able to move beyond holding people in a particular space into a kind of distributed quarantine whereby you are surveilled instead. Surveillance and quarantine  are very much tied together throughout history, and, as you study that history, the shocking thing is to realize how frequently emergency temporary methods have hardened into the infrastructure that shapes our movement today.

How do you weigh quarantine as a governmental response against quarantine as a technology? 

GM: Our book makes the criticism that quarantine is a very easily abused power; it is subject to biases, discrimination, and unequal application. We see it all the time, even in terms of the assumption of racial danger: that COVID-19 came from China, therefore all people of Asiatic descent need to be distrusted or kept in their houses; or the quarantining of San Francisco’s Chinatown during the bubonic plague of the early 20th century. You see the same kinds of things happen where whole neighborhoods are cut off for political and not epidemiological reasons.

 NT: One of the things we tried to do is to say that these are not new concerns. The technology might be new, but the concerns are as old as quarantine itself. You can see how new technologies (health passports, for example) have been misused in the past. We need to use that to learn how to make today’s technology less prone to abuse. If there is one message to take away from the book (other than the fact that we will continue to need quarantine), it is that quarantine has always been abused and in remarkably predictable ways. 

GM: This relates to the important distinction between isolation and quarantine. Isolation occurs if you actually know someone is sick; they’re isolated, not quarantined. Quarantine is when you suspect someone of illness or of having the capacity to spread a disease. Suspicion, then, becomes the term that we are really talking about here—and suspicion can be weaponized, it can be abused, it can be taken advantage of, it can be invented. One can just pretend to be suspicious of people and use that to justify quarantine. There are a lot of political and even philosophical risks in the idea of quarantine, precisely because it is based in uncertainty—quarantine is about what we don’t know and what we’re suspicious of. 

NT: One of the scholars we interviewed mentioned that, on a legal level, what makes quarantine so unique and so fraught is that, while under the Anglo-American legal system you are innocent until proven guilty, in terms of quarantine, you are dangerous until proven safe. It is an inversion of the way that we think about culpability. 

What in the book emerges as a lesson for how to more wisely use quarantine? 

GM: One of the most interesting stories came from a woman named Kaci Hickox, who was vilified in the American media for resisting a quarantine order that she was given after doing Ebola hospital work in Africa for Doctors Without Borders. Through her subsequent lawsuit against New Jersey governor Chris Christie, she pushed for a quarantine Bill of Rights, according to which you would have certain guarantees from the authority who is quarantining you. This is echoed by the head of the quarantine division at the CDC, a man named Martin Cetron, who was independently pursuing his own very similar branch of advocacy, trying to make sure that if the government requires you to be quarantined, then they will make up for certain losses that quarantine entails. So there’s an assumption of a duty of care. Quarantine authorities tend not to think of quarantine as an actual lived experience. They look at it simply as a tool. But it is something you have to go through. That means that we have to think about where people are, whether they can afford to stay there, what they do all day, whether or not they have underlying medical conditions that they may not be able to treat while in quarantine. All of the things that we saw with COVID-19, where people were no longer going to the doctor for even extreme medical conditions (they couldn’t because it was too dangerous and the doctor was not seeing patients in-person), or families that couldn’t afford to stay home and be locked down, so they were working anyway. That is where you again get into the class-based aspects of quarantine. If you were a working family, without cash reserves to fund lockdown, you had to continue working in a way that endangered you, your family, your extended family. If you think about quarantine, not just as a building or a power but as an experience, then you really need to reimagine how it will be implemented, where it will be implemented, and even challenge when you think it is appropriate to call on its power, knowing how disruptive it will be to people’s lives.

NT: There is also a larger conceptual issue at the heart of quarantine which has to do with communicating uncertainty. One of the threads that comes out in our book is that science, as a whole, is often perhaps more black-and-white than it should be. Quarantine, by its very definition, sits in a place of uncertainty, and has lessons for us as to how we communicate the uncertainty around public health, infectious diseases, and medical understanding in general. People obviously want certainty; certainty is a much more comfortable place to be. And, in the absence of good communication around uncertainty, people will take up positions that seem certain, and yet which are not correct. Learning to live with uncertainty is perhaps something that contributes to the idea of learning to quarantine better.

Can you talk more about the fantasy of quarantine, a method you have qualified as “flawed and leaky”? In a way, Edgar Allan Poe’s short story, “Masque of the Red Death,” which you cite in the book, gestures towards the impossibility of impermeability; that we all live in a “monster zone” despite whatever safety measures we may put into place. 

NT: The leakiness of quarantine was actually a revelation to me. One of the people who speaks about this most insightfully is Marty Cetron at the CDC. In speaking with him, it became clear to us that quarantine is inevitably leaky, but, despite that, it still works. Nothing is watertight. Wishing for watertight biocontainment is just a fantasy. This idea that we can make ourselves safe through isolation is never going to be absolute, but that is how quarantine is communicated to people. I do think that’s the flaw. If quarantine was relayed as a way to buy time and to slow the spread, not as a watertight buffer, then maybe we would have a slightly more nuanced appreciation of it.

GM: Quarantine promises a world of total control, with a definitive outcome—and, as Nicky said, that is a communication error. Quarantine cannot do that; it is just a brute force way of spatially separating things. It is a really clunky tool. I think society is trying to make it more precise than it is and more targeted—more of a guarantee. But quarantine is such a strange, imprecise world of uncertainty that to instrumentalize it in that regard is misleading.  It can backfire because it does not guarantee a positive outcome. It might target people, it might sweep up people who never had this disease, and it might get people who have the disease and they still die. Those missteps can make quarantine appear more fruitless than it is. Quarantine is a straightforward and logical approach to an unknown ailment: in a group of three people, if one of them was just exposed to something, and that thing might later be transmitted to the other two, it actually makes logical sense that you just want to spend some time apart. Quarantine is such a simple approach to potential disease transmission that it is interesting how quickly it ramifies and builds, and becomes architecture, geopolitics, philosophy, and constitutional governance. At its heart, quarantine is just a rational spatial approach for trying to maintain safety. The vision of a totally safe society that has been achieved through quarantine overestimates its ability. 

I wonder if the solution is not to double down on quarantine, but to expand our perspective and reorient our relationship to feeling “safe”?

GM: Something that Nicky brought to the book was the conceptual flip of quarantine, especially during the maritime era of European history, wherein the European subject—who was always perceived as safe, always had the privilege of travel, who never thought of themself as a danger to the world but was, instead, always responding to the the danger of the ethnic other—suddenly became a vector of possible contagion. Through quarantine, the perceived safety of being European and being white and being middle class was inverted. Suddenly, Europeans had to deal with this notion of “we are the dangerous ones.” This can make people resistant to quarantine. It requires recognizing that you, yourself, can be dangerous, a threat. I think there are people who cannot philosophically, religiously, or politically accept that.  

NT: The book argues that quarantine needs to be rethought and redesigned in a way that is tied up with issues of risk and consequence. This is something that actually became clear for us when we were talking with Dr. Mike Jacobs who runs the high level isolation unit in London at the Royal Free Hospital. He acknowledged that the expense and complexity of the infrastructure needed to keep one or two people entirely isolated may look ridiculous, but you have to think not just about risk, but also about consequence. Putting the two together in that situation—which was a low risk but high consequence situation—gave us a framework with which to think differently about infectious diseases and how we go about containing them. I think risk and consequence are very hard things for people to evaluate on their own as part of their everyday thinking. People are notoriously bad at thinking about risk and consequence, which is why you can be scared of flying and still smoke twenty cigarettes a day. These are calculations that I would go as far as to say we are fundamentally unsuited, as humans, to making, yet they are tied up in how we respond to infectious diseases, and whether our response is proportionate or not.

What conventions do we forgo to obey the fastidious logic of quarantine, and is it worth it? 

GM: We saw some of the negotiations of social conventions on a human scale when COVID-19 first hit. People were really uncomfortable in public, and sometimes laughing almost in a comedic-film way about having to do new things like wearing a mask or standing six feet apart. Senators of a certain political party insisted on continuing to shake hands, and insisted on not wearing masks, as if to say “I’m not going to give up this convention. This is what real men do.” The changing of social norms under the guise of preventing disease transmission was held very negatively in certain spheres. Even now, after being vaccinated, people who are not ready to go back to pre-COVID rituals insist on wearing a mask even though they are not at real medical risk. It is interesting to note what we get used to and what we are willing to give up.

NT: Other animals, non-human animals, have been using space and architecture for a lot longer than us. Quarantine and designing for the health of the community is just one aspect of how you might use space, but there are other priorities. Untangling how other social species that live together in structures have weighed those opportunity costs and benefits and come up with a spatial response is fascinating in terms of what we could learn. It also gives us a way to have a discussion about the principles of quarantine and public health that is not as fraught. Because you are not talking about people or groups of people, we can examine the fundamentals and the principles in a slightly different context and gain new insights.

In the section of the book dedicated to the non-human [Part III: ANIMAL, VEGETABLE, MINERAL, ALIEN], you detail a variety of quarantine mechanisms from the point of view of various species, wherein a balancing act between wellbeing and safety dictates the quarantine’s outcome. In lockdown, we forfeited a lot in this balancing act, and these social sacrifices were never part of the conversation. Is there a way for quarantine, whether structurally or design-wise, to relieve us of this sacrifice and burden of balance? As per the book’s example of gorillas in the Congo, who choose not to isolate or abandon their young at the risk of group infection, is there a future version of quarantine that allows us to protect social contracts while shielding the community from disease? 

NT: That is actually not an impossible dream. The initial quarantine hospitals, the lazarettos of the Adriatic Mediterranean, were seen as communal, public spaces that were part of a city going through something together, defending itself against a disease together, maintaining order in a time of total chaos. The lazaretto was a structure that promised order and some semblance of structure. It was designed deliberately in this way. Architecturally, even in terms of its distance from the city itself, the idea was still to be in sight, still to be connected, not banished. There is a potential to design quarantine so that we do not have to make some of the sacrifices that were asked of people during the COVID-19 quarantines.

GM: In addition to that, even though this maybe sidesteps the moral urgency of the question, there are technical solutions to quarantine that I think make it less expensive, easier, and also more likely to be adopted voluntarily. In the book, we talk about dual-use architecture: the idea that you can take a motel and rapidly turn it into a quarantine facility, or you can take a high school gymnasium, a college dormitory, or your own private house and just put it into a kind of quarantine mode. It is basically disaster architecture: you see it in Japan, which has incredibly good earthquake preparedness built into its everyday infrastructure. Or, tornado shelters in airports. You see the tornado shelter and it does not ring any alarm bells. You recognize that if there is a tornado, there is a safe room. Similarly, if there was just a quarantine facility that was easily transformable from what we have, whether it is a convention center like the Javits Center in New York City, or whatever it might be, this makes it much cheaper the next time around. It is a larger upfront investment in terms of making that architecture happen, but I think that, when there is the next pandemic, it will be infinitely easier and cheaper to quarantine. It will not be quite as scary because you will recognize that this is something built into the everyday environment. It will not look like a disaster film; it will be just as easy as checking into a different hotel room. This would make quarantine much less alarming. 

NT: I think it comes back to what Geoff brought up about the idea of experience design. Designing for an experience means thinking about where, when, and how. It also means thinking about the emotional importance of that experience. One of the most interesting aspects of quarantine is that it can be something that reinforces community bonds. We should reframe it as what it is: an act for the public good. How can that aspect of the experience be made experiential, rather than just conceptual? How can it be made to feel that way? We spoke to a boredom researcher for the book and her point was that experiences need to be meaningful, in order to not be boring. Quarantine has a meaning, we just haven’t done a very good job of designing an experience that makes it meaningful.

If domestic, commercial, and public spaces have a quarantine agenda, what are the political implications of an architecture with these preparatory elements?

GM: There are always political risks. You might find a new regime in power that is enthusiastic about using the capacity to isolate for nefarious purposes. That is a very real risk; however, it also exceeds the practice of quarantine and touches on much larger issues of democratic erosion and the competence of the people we elect. Those are different risks. They can exist in the same space as quarantine, but they are not identical to quarantine. If we have really good hospital wards for separating people with respiratory illnesses from cancer patients, is there political risk here? Or is that just medical treatment? I think that quarantine has a strange ability to get tied up in larger political questions, but, at heart, it’s just an idea that we can be separated from one another for safety’s sake, for a brief period of time. Dual-use architecture, seen one way, might present a political risk precisely because it makes it easier to quarantine; by having emergency infrastructure prepared and ready, the fear of things like FEMA camps, or the idea that we are all going to get put into a Department of Homeland Security tent city, might actually increase. But those same fears could be mitigated because quarantine might simply be enacted in your own home. I would step back from saying that these political fears invalidate the whole pursuit of quarantine as a medical response. I think architects and designers of domestic spaces should be thinking medically. Trying to get that kind of interdisciplinary collaboration I think is really important for quarantine moving forward.

NT: In the book, we are really clear that the ability to detain on suspicion is always subject to abuse. That is why it is so important to build in a legal framework around that, with due process and a way of protecting the rights of the individual in that situation. You can never have the right to detain on suspicion without risk of abuse, but you can really minimize that risk by making sure you have the right legal framework in place. That is how we handle a lot of issues of possible discrimination, by making sure there is legal recourse. We say this in the book: you cannot have public health without a public. If the institutions and legal frameworks that guarantee freedoms are broken, or certain norms of society have been eroded such that you cannot trust anything, then it is not just quarantine that is broken. Everything is broken. 

GM: If you just look at other existing powers in society, such as police investigatory powers, there are small things that help protect us from the police state: the need for a warrant, or the Fourth Amendment, which protects against invasive entry into a home. But the most basic police investigatory powers, if seen in a different political context without those same protections—like Cuba, Belarus, or China—would be politically and constitutionally alarming. That’s why you build in stopgaps; you build in the need for search warrants. As with quarantine, if there are systems in place to protect us from abuse (and that is a huge if), then protection should be the goal. What sort of political and constitutional frameworks can we develop around quarantine so that these are not risks? So that, if there is a quarantine facility on the outskirts of town, you do not need to be worried that you are going to end up there for politically motivated reasons?

NT: Our larger argument is to have these conversations now. Build both the protections and the facilities ahead of time so that you are not trying to do this on the fly. Do so now, ahead of the next pandemic, so that we have a chance of actually both being as fair and humane as possible, and achieving the benefits that quarantine can bring.