A burial team from the Liberian Red Cross carries the body of an Ebola victim from his... Read More
While enhanced screening announced yesterday for New York’s John F. Kennedy and four other U.S. airports will help stem the disease’s spread, it’s an imperfect defense against a complex public health emergency, said Lawrence Gostin, a professor of global health law at Georgetown University in Washington.
The reliability of screening arriving passengers rests largely on travelers being honest about whether they have come in contact with others infected with Ebola. And tricks such as taking Tylenol before landing to help ensure they can pass a fever test
when going through Customs have been used by passengers before, such as during the 2003 SARS virus outbreak.
“If the goal is 100 percent effectiveness in terms of keeping Ebola patients out of the country, this won’t work,” Anish Jha, a professor at the Harvard School of Public Health in Boston, said in an interview. The increased screening “is a step in the right direction but it’s hardly foolproof.”
Health officials have vowed to stop any spread in the U.S. of the virus, which has a fatality rate of about 50 percent and is transmitted by direct contact with a sick person’s blood or other bodily fluids. Passengers whose travel originated in Liberia, Sierra Leone and Guinea will be visually assessed upon arrival to the U.S., have their temperatures taken and asked if they had any contact with people infected with Ebola.
The screenings will begin this weekend at JFK and will expand next week to Washington Dulles, Newark Liberty, Chicago O’Hare and Atlanta Hartsfield, the U.S. government said yesterday.
Innocent People
The screening probably wouldn’t have prevented the Sept. 20 entry into Dallas of Thomas Eric Duncan, the Liberian man who became the first case of Ebola diagnosed in the U.S. Duncan died from the disease yesterday at Texas Health Presbyterian Hospital in Dallas, where he had been isolated since Sept. 28, receiving an experimental medicine, kidney dialysis and other treatment.Even if health officials took stricter measures, it would have done little good, Jha said. There’s no blood test for Ebola until people exhibit symptoms, which usually takes seven to 10 days, he said.
Early signs of the disease are a fever and flu-like symptoms.
There’s also a risk of ensnaring innocent people, Gostin said.
“There will still be many false positives,” Gostin said. “Most patients with a fever will have influenza, malaria, tuberculosis or another disease.”
Swine Flu
Airport screening is likely to yield few results, while costing millions, said Mark Gendreau, who was part of a Federal Aviation Administration-sponsored study last year on reducing the threat from infectious diseases in airports.Chinese officials once tracked the transmission of the swine flu, or H1N1, to an airline passenger who lied to an airport screener. Meantime, previous attempts to screen for severe acute respiratory syndrome, or SARS, on airlines have turned up a tiny number of positive cases relative to their cost, Gendreau said.
“It’s incredibly expensive and incredibly ineffective,” said Gendreau, who is now vice chairman of emergency services at Lahey Hospital & Medical Center in Burlington, Massachusetts.
West Africa
The White House said that fighting the disease in West Africa is still the primary strategy in keeping the virus from spreading to the U.S.“Preventing passengers exhibiting symptoms of Ebola from boarding in the first place is the most effecting screening measure,” Josh Earnest, a White House spokesman, told reporters yesterday.
Passengers leaving Monrovia, Liberia, on international flights must wash their hands twice with chlorinated water before boarding, get their temperatures taken at a security gate and fill out a form indicating if they had contact with someone who had the disease. Duncan failed to disclose that he had that contact, according to the Liberian government, which said on a Twitter account before he died that it would charge him with making a false declaration.
40,000 Visitors
Ebola has killed more than 3,800 people in West Africa, prompting the U.S. to send as many as 4,000 military personnel to the region to build treatment centers and train health-care workers. President Barack Obama has committed to spend as much as $1 billion.The U.S. still must address visitors from West Africa, including more than 40,000 in the past six months alone, according to Thomas Frieden, director of the Centers for Disease Control and Prevention.
U.S. agents have the ability to track passengers’ full itinerary, even if they travel from Africa to Europe on separate tickets before coming to the U.S., according to Homeland Security Deputy Secretary Alejandro Mayorkas.
Fewer than 150 people per day, or less that 1 percent of travelers to the U.S., come from the three countries affected by yesterday’s announcement, said Jean Medina, a spokeswoman for Airlines for America, a Washington-based trade group.
SARS Outbreak
Only two U.S. airlines, United and Delta Air Lines Inc., offer Africa nonstop service, and neither flies to any of the countries in the Ebola-outbreak zone. Delta halted flights to Monrovia in August.The five airports with the new screenings accounted for 94 percent of travelers from the affected region.
Frieden said that the reaction to the 2003 outbreak of severe acute respiratory syndrome virus, or SARS, cost the world economy $40 billion, not because of the disease but because of the reaction to it.
“If we don’t ensure that we focus on what works, we may have that same kind of overreaction,” he said.
An analysis of border screening for SARS, which unlike Ebola can be transmitted through the air, found that border screening played a “relatively minor role” in reducing the disease spread. In Australia, 1.84 million people arrived in the months of 2003 when that nation tested for fevers and, of those, 794 were referred for screening. None of these people was confirmed to have SARS, according to a study by researchers from the Australian Department of Health and Aging.
Even if the procedures at airports don’t find any cases of Ebola, they can serve an important symbolic service, Gostin said.
“There is intense political pressure to be seen doing something,” he said.
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