How do West African airports screen passengers for Ebola? Is it effective?
Liberia, Sierra Leone and Guinea are the three West African countries hardest hit by the Ebola epidemic, and according to the Centers for Disease Control and Prevention, "relatively few of the approximately 350 million travelers who enter the United States each year come from these countries."
All air travelers leaving those countries are screened for Ebola by responding to a travel health questionnaire, being watched for symptoms and having their body temperature checked, according to a White House fact sheet. If their temperatures are 101.5 degrees Fahrenheit (38.6 degrees Celsius) or higher, passengers are taken aside for further screening to determine whether they need to be isolated.
According to CDC Director Thomas Frieden, that screening has stopped 77 people from boarding airplanes, including 17 potential passengers in September. But many of those travelers had malaria, he said.
There are several potential weaknesses in the airport screening system:
Passengers could lie about their contact with Ebola.
Passengers infected with Ebola might not yet be showing symptoms or know they are infected.
Symptomatic passengers could lower their temperatures by taking ibuprofen or any common analgesic.
Airport personnel might not be properly trained to spot the disease.
When virologist Heinz Feldmann returned from three weeks of work in Liberia in September, he told Science magazine that airport screeners took travelers' temperatures three times before they entered the airport in Monrovia, the capital, but that "the people that do this kind of work, they don't really know how to use the devices."
"They are writing down temperatures of 32¿¿C, which everybody should know is impossible for a living person," Feldmann said. "All the checks they do are completely useless because they are done by people who are not well trained or overwhelmed by the number of passengers. It is just a disaster, and it needs to be fixed."
Do travelers from West Africa have any reasons to avoid the Ebola dragnet?
"It is highly unlikely that someone would acknowledge having a fever, or simply feeling unwell," Kim Beer, a resident of Sierra Leone's capital, Freetown, who has been working to get medical supplies into the country, told the Los Angeles Times in an email. "Not only will they probably not get on the flight — they may even be taken to/required to go to a 'holding facility,' where they would have to stay for days until it is confirmed that it is not caused by Ebola. That is just about the last place one would want to go."
Sheka Forna, a dual citizen of Sierra Leone and Britain who manages a communications firm in Freetown, said, "You'd be confined to wards with people with full-blown disease," possibly raising the risk a traveler would then catch Ebola if not already infected.
Additionally, hospital care in the U.S. or other countries might offer a better chance for survival than overwhelmed facilities in West Africa, giving potential Ebola patients an incentive to get past screeners to get to the U.S.
What happens if an Ebola-infected traveler begins showing symptoms on a plane? Could he or she transmit the virus to other passengers?
The risk of contracting Ebola simply by flying in the same plane as an infected person is very low, according to the World Health Organization and the Centers for Disease Control and Prevention.
Ebola is spread through contact with bodily fluids including blood, diarrhea and vomit, rather than by air, as influenza or tuberculosis is. Someone who has Ebola is not infectious if he or she isn't showing symptoms. But Tom Skinner, a spokesman for the CDC in Atlanta, cautioned that "we can never say never" about the possibility that Ebola could spread through close-range coughing or sneezing from someone who is highly infected.
U.S. airlines, and airlines flying to and from the U.S., are allowed to prevent passengers with possible Ebola symptoms from boarding. If a passenger starts showing symptoms en route, pilots are required by law to notify the CDC before landing, at which point isolation procedures can begin.
The Assn. of Flight Attendants has warned its 60,000 members on 19 airlines to be on the lookout for passengers exhibiting symptoms of Ebola, saying that "all bodily fluids should be treated as if they are known to be contagious."
The CDC recommends airline employees try to keep the ill passenger separate from other travelers. Workers also should put on gloves, a surgical mask, goggles and a protective apron while providing aid, the CDC says.
After a potential Ebola patient has been on a flight, the CDC recommends disinfecting lavatory surfaces, the sick traveler's seat and those surrounding it, and any areas obviously contaminated by bodily fluids. Cloth contaminated by bodily fluids should be discarded.
Airline cabins are typically not cleaned after every flight. Instead, industry experts say, cleaning crews come through cabins overnight to vacuum the carpets and wipe down lavatories and tray tables.
What can U.S. airports and border officials do to prevent Ebola from spreading?
Very little that may actually be useful, according to Dr. Art Reingold, professor and head of epidemiology at UC Berkeley.
When travelers arrive in the U.S., Customs and Border Protection personnel are supposed to watch for "general overt signs of illness," and divert ailing passengers to be screened by medical personnel. They also hand out fact sheets about Ebola to travelers from countries affected by the virus. But U.S. border officials don't do automatic temperature checks as in West African countries.
President Obama said Monday that officials are "working on protocols to do additional passenger screening both at the source and here in the United States," but offered no further details. Frieden also mentioned screening on Tuesday.
In the U.S., "temperature and questionnaires [for incoming travelers' histories] are certainly things we are looking at," Frieden said.
U.S. Sen. Jerry Moran (R-Kan.), who is the ranking member of the Senate Appropriations health subcommittee, backed suggestions for stronger screenings at U.S. airports for passengers arriving from Liberia, Sierra Leone and Guinea.
"These enhanced screening techniques could include temperature checks, asking passengers if they have come in contact with Ebola patients, and a secondary round of screenings from Customs and Border Protection at every U.S. airport stop along their travel itinerary," Moran said in a letter to Frieden on Monday.
But according to Reingold, arriving travelers "can lie to people at [John F. Kennedy International Airport in New York] the same way they can lie to people in Africa."
Additionally, the odds that screeners would catch many passengers who had developed fevers while flying that they didn't have when departing would not seem to justify the inevitable expense and inconvenience of exit screening, Reingold said.
"It's a completely unproven benefit and of unknown cost and inconvenience," Reingold said.
Ebola's incubation period lasts up to 21 days, and some air travelers may not show signs of infection until well after they have gotten off a flight.
Why not shut down -- or limit -- air travel from West African countries until the Ebola epidemic is over?
CDC chief Frieden notes that banning air travel outright could make the outbreak worse in West Africa by hampering the international medical response. He cited Senegal's decision to stop flights, which hindered African Union health workers' ability to get into Liberia.
"Their ability to get there was delayed by about a week because their flight was canceled and they were stuck in a neighboring country," Frieden said at a recent news conference. "So that neighboring country … Senegal, had taken that action in order to protect themselves, stopping all flights, but that action ended up making it harder to stop the outbreak in Liberia and elsewhere and potentially increased the risk" to Senegal.
If the United States made a similar move, Frieden said, it could put itself at greater risk by allowing the outbreak in West Africa to get worse.
The World Health Organization's Emergency Committee opposes general travel and trade bans. After a meeting in September, the panel said flight cancellations and other travel restrictions were causing "detrimental economic consequences" in West Africa, in addition to hindering relief, "risking further international spread of the disease."
Berkeley's Reingold said a travel ban would be a "huge mistake."
Treating Ebola in West Africa -- and reinforcing medical infrastructure there -- "means sending large numbers of people ... and people need to come back," he said.
"Not only would it impede an [already inadequate] response in the countries," Reingold said, but "it would basically create even more dreadful circumstances in terms of economic harm, which would only make the damage there worse."
"These are already among the world's poorest countries, whose economies are already teetering on the brink," Reingold said. With a travel ban, "you're basically relegating them to the trash heap."
Staff writers David Willman, Michael Muskal and Hugo Martin contributed to this report.