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Plague.  Yellow fever.  Cholera.  Diphtheria.   Diseases which evoke images of death and despair.  
Though less likely to transmit a fatal illness, would you open your door to someone with hepatitis, strep throat, or methacillin-resistant staph?  What about a person suffering from vomiting, diarrhea, a cough, or lice, or a fever?  Are you immune to measles, polio, and whooping cough – and would you even recognize these conditions?  How will you know if someone is going to come down with influenza in the next day or two?

Before antibiotics, before anti-virals, before immune globulin, societies used quarantines to protect their populations.  As early as the Middle Ages quarantines were imposed on potentially infected ships to reduce the risk of plague spreading to port cities. 

What will you do if someone shows up, seeking shelter?  Can you trust a child who appears healthy to be free of disease?  Does loving your neighbor as yourself require you to put your entire family at risk? 

In times of scarcity, when the marvels of modern medicine are unavailable, medical quarantine offers a possible solution.  The term quarantine applies specifically to apparently well people who may have been exposed to a contagious disease, and therefore may (or may not) become ill.  (For an obviously ill person, isolation procedures should be enacted, a topic for a future article.)

Almost every transmissible disease has an incubation period during which the person is infected but not yet showing signs of disease.  Quite often, a person can be contagious for one to several days before exhibiting symptoms.  Blood borne infections in asymptomatic individuals can sometimes be transmitted months or years before the infected person becomes symptomatic (as in HIV), hence the need for universal precautions.

In recent years the Haitian orphans provide an example of how the U.S. treats potentially contagious immigrants.  Though not quarantined in the usual sense, per the CDC even the apparently healthy children were all examined for:  bacterial and protozoal diarrhea, hepatitis A and E, typhoid fever, dengue fever, malaria, leptospirosis, tuberculosis, syphilis, intestinal parasites, Giardia spp., and Cryptosporidium.  They also had their immunization status checked and updated for diphtheria, pertussis, tetanus, measles, rubella, polio, hepatitis A and B, Haemophilus influenzae type b, meningocococcus, pneumococcus, and varicella (chicken pox).

Lacking the means to do any of this, what constitutes a reasonable approach to strangers seeking help?

For the purposes of this article, I’ll assume those seeking to join your group are not suffering from any apparent signs of infection including fever, chills, vomiting, diarrhea, cough, runny nose, peculiar behavior, or visible rash.  Again, lack of apparent infection does not guarantee health.  Certain illnesses such as chicken pox and influenza are often highly contagious even before symptoms have developed.  With other microbes, such as strep and typhoid, occasionally a person will develop a carrier state where they are able to transmit an infection but are not themselves infected.  In other cases an infection may be subclinical, that is, too mild to detect, as in the case of a toddler with infectious mononucleosis. 

The above reasons are the basis for quarantining apparently healthy individuals, isolating them from your established, (hopefully) healthy group, until sufficient time has passed to convince you that the well-appearing newcomers are, indeed, most likely healthy.  Even then, this cannot assure that an asymptomatic carrier is not in your presence, but the risk decreases as evidence of prolonged wellness accumulates.     

Quarantine measures depend on potential routes of transmission:  airborne, droplet-borne, direct contact, vector-borne (mosquitoes, fleas), fomite-borne (doorknobs, clothing, equipment, toys, or other inanimate object), food-borne, and feces-borne.  Blood-borne infections should not be an issue without exposure to blood or other body fluids.  (Warning: don’t have sex with strangers.) 

Ideally the quarantine area will be a separate building from your own living quarters, such as an outbuilding, garage, empty house, or barn.   If you choose to offer a room within your home, choose one vented to the outside, without ductwork connecting to the rest of the house.  Make sure the room has a negative pressure by leaving a window cracked, so the air flows into the room from the remainder of the house rather than vice versa.  If you allow newcomers within your home, have them fold their arms across their chests as you lead them to the quarantine room, to prevent potential contamination of walls, doorknobs, and other surfaces. 

Food utensils must be kept entirely separate.  Do not offer to wash dishes nor remove waste.  When offering food, do not touch a potentially contaminated dish with your own utensils.  If this occurs, either leave them with the quarantined population, or sterilize them (by boiling or with a 10% bleach solution.)
A 5-gallon bucket with attached toilet seat and sturdy disposable bags is adequate for waste disposal, preferably with an adequate supply of sturdy disposable plastic bags until the quarantine is lifted.

Who should be quarantined?  The answer could be anyone outside your group who wishes to join you.  Of course, this will depend on several factors, including known epidemics, length of time since societal breakdown, potential resources of newcomers, etc.  Even a few days of separation are better than none at all.  People from unvaccinated populations may pose a greater threat than those likely to have had standard immunizations.  No matter how long you wait, you may not know if an asymptomatic carrier is in your midst. 

How long to impose a quarantine?  Many latent viral infections will manifest themselves within a period of 3-5 days, and most within 10-14.  A three-week period of wellness assures against most transmissible infections, though such a prolonged period may impose hardship on both host and guest.  Certain viruses such as infectious mononucleosis and hepatitis A sometimes have an incubation period of 6 weeks before symptoms occur.  Anyone over the age of 30, however, is presumed to have had mono whether they’ve ever exhibited symptoms or not.  A table at Wikipedia, culled from other sources, lists incubation periods of common illnesses.

Most illnesses are not truly airborne, but rather spread via droplet contamination of surfaces including hands, doorknobs, utensils, and tools  (TB, anthrax, and influenza may be either airborne or droplet-borne.)  It is not likely you will become infected by standing across the room from a person as long as you keep your hands to yourself.  If you do touch something, do not, repeat, do not touch your face until you have washed your hands adequately.  The mucus membranes of the eyes, nose, and mouth are the primary entry points for most contagious diseases. 

If your newcomers still appear well at the end of whatever quarantine period you’ve chosen, don’t neglect to do a rudimentary physical exam.  Check their hair for nits (lice eggs) and their skin for rashes.  Ask about known infections, including sexually transmitted diseases.  Keep your ears open for a cough, or wheezing, or abnormal behavior.

This brings us, perhaps, to the point of turning someone away.  Before you even start down the road of quarantine, you should have a plan in place.  Will you turn away a child?  A slow-moving grandmother?  A hard-working adult?  Will your decision be influenced by the potential contribution of the newcomer?  Would you welcome a carpenter with lice?  What about a gourmet cook with herpes?  Or a doctor with shingles?

If I were a layman considering a post-Armageddon scenario, I would update my immunizations now, beginning with those protective against diphtheria, hepatitis A and B, tetanus, pertussis (whooping cough), polio, measles, mumps, rubella, meningitis, chicken pox, pneumonia, and influenza.  Although other illness such as yellow fever, typhoid, and Japanese encephalitis are rare in the United States, immunizations are available.  See the American Academy of Family Physicians recommendations for a list of vaccines and associated costs. 

Note: Family quarantine will be addressed in detail in my upcoming book, Armageddon Medicine.

Learning to help yourself is a process, but an easy place to start is with my book, 101 Ways to Save Money on Health Care, which includes dozens of sections on treating yourself affordably.  Available for under $10 online, the book offers practical advice on treating: respiratory infections, pink eye, sore throats, nausea, diarrhea, heartburn, urinary infections, allergies, arthritis, acne, hemorrhoids, dermatitis, skin infection, lacerations, lice, carpal tunnel syndrome, warts, mental illness, asthma, COPD, depression, diabetes, enlarged prostate, high blood pressure, high cholesterol, and much more.

Dr. Koelker has recently started a new medical blog on surviving 2012 and TEOTWAWKI at www.armageddonmedicine.net.  She welcomes your questions, comments, and critiques.

With the rising number of people aware of the need to prep for survival in the coming times there are so many needs that must be addressed. When putting together a survival group, people draw from a diverse group of people and try to match talents and skills of the members so that they may cover a very large array of needs. There are so many steps one can take to prepare for or understand certain skills which could prove useful should their network be lacking of certain skills. One of the ones nearest to me is medical care!

So you don’t have a nurse, paramedic or doctor in your network of partners. What do you do when someone is faced with ailments typically treated by someone’s physician? When there is no one to give advice or prescribe medications, what are your options for hope of surviving even the simplest of things? We all have within us the capacity to adapt and handle certain emergent situations and there are field guides and how to books and manuals that can come in very handy as a reference on how to treat many different ailments. In many article I’ve read on the subject it seems there is something I have not read enough of!

I have been a patient of the healthcare industry and I’ve worked in administration. I am trained in emergency medicine but for years I have not graced the establishments as a patient! Years ago I was opened to the wonderful world of preventative medicine! I took to it quite quickly as I began to expand my knowledge in how the things we do and ingest affect our health. I’ve had bad experiences with doctors who are so eager to prescribe that they don’t often take enough time to really fix the problem as many medicines simply mask the symptoms.

This is in no way intended to persuade someone to ignore the advice of their doctors and go without the care they have been receiving. They are simply helpful suggestions that I have followed for many years with great success myself and my children. The healthcare industry serves a great purpose to society and I am very fond of the emergency medical service. However, if your ailment comes from within and is not a result of an accident etc., there is a large possibility you can get to know your own body and keep yourself in such great health as to survive much longer without the care of physicians.

Here are a couple of the things I live by that have kept myself and my girls in pristine health even when others around us are sick and flus, colds and bugs are spreading among others! My not work for everyone and you really have to work on knowing yourself and your body for these techniques to work at all. The better you know your body the quicker you know if you’ve been infected with a bug or virus and the quickest action you take in preventing it from taking control of your system the better chance you have to keep from being sick at all!

Apple Cider Vinegar
I’m sure many people are thinking “yuck” right about now! However, this is one of the greatest defenses I can offer you for keeping what is going around from taking grip of your health! I am very aware of my body and I know quite quickly when something is not right. Yes I know I am not a doctor, and cannot diagnose myself with a sickness, but I have common sense enough to know when others around me are sick. When I start with a single symptom I am likely to be getting it soon!

Strep throat for example! I went from no symptoms to a fever and sore throat within hours one day and I knew I had been exposed to it. I was pretty sure what was going on. I immediately started taking straight vinegar as often as I could handle it. It burned quite a bit going down my sore and irritated throat. I did not treat the fever at that point because I knew that was simply my body reacting to the infection that was trying to take over my body. Well, I’ve had strep throat before and been to the doctor, so I know it is not uncommon to have the discomfort and symptoms for a week or more. However, being aware enough and by taking immediate action, I was over any and all symptoms with vinegar alone within 48 hours of the initial symptoms.

Common Colds and Flus
Germs are always in the air especially when we are in public places and when you live with a large number of people it can spread and re-spread in-between them and sometimes you can even get it again after being well for a week or more because others are getting it at different times! I have found that mixing the vinegar with honey to taste and drinking with hot water as a tea can prevent any germs from setting in! Years ago I finally got my daughters to do this by coming up with my special “honey cocoa”! It had no cocoa but the name put them at ease as they hated the vinegar alone. It became a ritual during the cold seasons especially. May not work for everyone but I cannot tell you how long it has been since myself or my children and had a cold or the flu and we do not get any immunizations for the flu! While germs and viruses are being passed even in our own homes we manage to escape untouched by the ailments! I’ve not managed to convince too many people of it but when you are in a WTSHTF situation and cannot get to a doctor, preventing a sickness from taking place gives you far better chances than having a sickness get so bad that you need antibiotics when there are none!

Local Honey
For those that suffer from allergies like pollen and other things that they typically seek treatment for or end up with drainage and are miserable there might be hope! There have been many articles in various magazines and web sites about this. The Google search engine is your friend! You will find many more uses than I will list here! If you take a tablespoon of local honey everyday it almost serves as an immunization to the allergies typically present in the local environment that the honey came from. This is thanks to the wonderful bees and cross pollination! I don’t know how many people it will work for but I do know it has worked for many people that have tried it including myself. You do have to be disciplined enough to do it each day and it doesn’t take effect overnight. It may take weeks or months before you can be in your environment that typically gives you allergic fits before you feel you can breathe easy and avoid the drainage and sometimes resulting sicknesses from all of it!

There are many more ways to stay on top of your own health and prevent many sicknesses from ever taking residence in your body. I will not list them all as I feel the above are the two most critical factors in my being able to maintain the health of myself and my daughters. However, there is a world of information out there and I would advise anyone to read books, articles and everything they can get their hands on about natural healing. I will say one thing I am doing myself, taking herbology classes! I am a novice practitioner of this already. I use herbs, essential oils and natural remedies as often as possible, as I am not a fan of pharmaceuticals. I don’t recommend anyone stop taking their medications. I am simply suggesting it may prove useful in the days ahead, if you no longer have access to medications, and you need to rely on Mother Nature! Even if you choose not to do or learn these things I would definitely advise that you take the time and effort to compile reference books on the subjects and have them in a safe waterproof place. One day they may be more valuable to you then you know!

One other little helpful bit of information that I would like to share even for now is the importance of getting water! I’m sure everyone has read of the greater success one will have if they conquer their addictions to anything before that time comes. Many people are hooked on sodas and drink very little water. Lack of water can cause quite a few ailments that people attribute to sickness but can be curtailed by staying hydrated. Just a couple I have read about; fatigue, headaches, nausea, and hunger pain, the list goes on and on. Definitely another topic worthy of research!

Good luck to all of you. Get to know yourself, because no one can possibly know your body better than you do yourself!