What happens in communities during large-scale quarantines

Early in the pandemic, many nurses in Wuhan, China, cut their hair short or shaved their heads in an effort to reduce transmission of the COVID-19 virus. At the same time, groups of volunteers supported Wuhan residents sequestered in their homes under quarantine for weeks on end, risking their own health to bring food and supplies to those in need.

In a recent paper in Asian Bioethics Review, Duke researchers explored "reciprocity"—the practice of doing something for others because there's a mutual benefit—during quarantine and how it was negotiated by healthcare workers, volunteers and citizens amid the lockdown in Wuhan in early 2020.

Global health researchers Yanping Ni, Morris Fabbri, Chi Zhang and Kearsley Stewart looked at the topic beyond previous debates about quarantine reciprocity at the state level, analyzing two Wuhan case studies: one that involved nurses who were asked by their hospital administration to shave their heads in the belief that it would reduce infection spread, and a second about citizen-to-citizen mutual aid societies that provided essential supplies to neighbors to fill gaps left by the state. They also tracked social media channels on the Chinese platforms Douyin and Sina Weibo, to understand how individuals defined and responded to ethical and legal obligations in the wake of COVID-19.

"The basic question of our research was, in our modern era shaped by the 2003 SARS outbreak and the 2014-2016 Ebola pandemic in West Africa, what are the new ethics of quarantine?" says co-author Stewart, professor of the practice at Duke University, with joint appointments in the Duke Global Health Institute and Cultural Anthropology.

She adds, "Is it justified to enforce quarantine? Will it effectively reduce transmission? What are the obligations of the state to the citizens it confines in quarantine? But beyond those classic quarantine questions, the scope and scale of COVID-19 has created new obligations that we need to examine, not just from an efficacy standpoint, but in terms of the impact on our social relationships in the community—between people."

What Stewart and her co-authors discovered is that prevailing quarantine principles didn't hold up at the start of the COVID-19 pandemic, and that previous infectious disease outbreak responses, and the ethical issues surrounding them, needed to adapt to the virtual age to be effective.

In their paper, they offer ideas to strengthen and clarify reciprocal obligations for the state, hospital administrators, and citizens as the globe prepares for the next wave of COVID-19 circulating.

"One of the arguments we make is that quarantine ethics are now going to be a foundational part of public health discussions about policy going forward," Stewart says.

Their paper urges leaders to provide stressed frontline health care workers with adequate logistical and psychological support. For example, when leaders in Wuhan required female nurses to cut their hair, but not male health care workers, it highlighted the gendered and inequitable sacrifice imposed on women . They also studied the surprisingly widespread online solidarity and material generosity that quickly emerged when Wuhan citizens created mutual aid societies to help fellow citizens.

According to Chi Zhang, MSc-GH '20, our research "explored how smartphones and Internet connections facilitate people who want to assist their community." Zhang continues, "based on our evidence, we implore local governments to reconsider their attitudes towards social media rather than simply suppressing them."

"For the state, this may mean ceding elements of surveillance and control over people's abilities to access and use information," says Stewart.

A state that encourages ethical conduct among its citizens in a pandemic can build public trust and supportive capacity that will endure beyond the second wave of COVID-19 that certainly awaits us all, they concluded.

Stewart says the research impacted her personally as she watched U.S. leadership decisions and ensuing citizen behaviors.

"It was a lesson in humility to see the risks Chinese citizens took on behalf of others, to help strangers," she says.

She also points out that the research would not have been possible without the interdisciplinary team she was able to assemble at Duke, which included Yanping Ni, a masters student in the Asian Pacific Studies Program at Duke, who is conducting a larger study of the mutual aid societies that emerged during the Wuhan quarantine; Morris Fabbri, a master's student in Bioethics and Science Policy at Duke who was Stewart's teaching assistant this year in her ethics course and had written his master's thesis with Stewart on quarantine and HIV in Cuba; and Chi Zhang, a Duke student who had taken Stewart's ethics and qualitative methods classes and applied those skills to his focus on the social media aspect of the team's research.

"This paper reflects what can happen when an interdisciplinary, multilingual team works together to address an urgent research question of global importance. The resources at the Global Health Institute made this happen. It all just fell in my lap and I am really grateful to have been able to pull the team together so effectively," she says.