Ebola Outbreak Kills an American, Highlights Need for Improved Travel Screening

A 25-year-old man who in March was diagnosed with tuberculosis was arrested some 15 miles outside of Bakersfield, California, after vacating a motel room in which he was ordered to remain while receiving treatment.

Half a world away, The World Health Organization has confirmed more than 800 Ebola cases in three West African nations. Thus far, one American has died and two more are gravely ill.

Appearing Tuesday, July 29 on CNN to address the concern that Ebola’s emergence outside of West Africa may be but one airline flight away, Dr. Marty Cetron, director of the CDC’s Global Migration and Quarantine Division, indicated that preparation, recognition and containment is “more important than speculating on propababilites of disease moving around by plane”.

The CDC describes the risk of Ebola showing up in the United States as “remote”. The American widow of a top official in the Liberian Ministry of Finance, whose spouse collapsed and later died, sees it differently. Decontee Sawyer told a Minnesota news station that the outbreak “is as close as the front door”.

The contrasts are stark: On the one hand, long-accepted efforts to contain the spread of TB have allowed for the arrest and forcible quarantine of an uncooperative patient in California. On the other hand, the CDC has done little more than issue an advisory to U.S. doctors regarding the West African outbreak. Notably missing from the CDC’s response is the means by which the agency is working to prevent Ebola’s emergence here on the home front.

Perhaps fear of public panic has shuttered what are, in fact, more proactive containment efforts behind the CDC’s closed doors. Whatever the case may be, the public face of the CDC on the heels of several domestic near-misses would appear to be oddly passive. Impacted nations in West Africa have begun to shut down borders and to screen prospective airline passengers, yet prevention efforts within the U.S. are at best low key. The CDC’s efforts to assure reporters that North Americans have little to fear may signal reassurance to some, but may also play like a case of institutional hubris: “It won’t happen here.” and “Our medical system is too sophisticated to have it go far if it does.”.

Anyone who has sought timely treatment from the Veteran’s Administration or shown up at a suburban emergency room, as I did earlier this year, without so much as an available wheelchair or gurney might beg to differ with the notion that the U.S. health care system is in any way, shape or form prepared for a natural disaster on the order of Hurricane Katrina, let alone global pandemic. But we live in a society in which saying that we’re safe often passes for the real thing, thanks to a coping mechanism known as the “normalcy bias“.

Call it denial or call it overconfidence, our vulnerabilities tend to remain unchallenged until the unthinkable occurs. Ebola notwithstanding, we remain at risk of “medical terrorism” — that is, terrorists’ use of infectious people as biological weapons. As efforts to board airliners with conventional explosives fail, it is not beyond the scope of possibility that terrorists will board seriously ill passengers on international fights as an alternative.

Isn’t it time we walked the walk of public safety, not merely talk the talk?

In view of the gaping security hole we have tolerated all these years as we focus on shoe and even cell phone bombers — and now with the impetus of the Ebola outbreak at our backs — might it be appropriate to implement a brief health screening, executed in tandem with the screening procedures international travelers are already accustomed to?

Step 1: Check for fever. There are non-invasive means of doing so, and as a timesaver this could be done while passing baggage through scanners.

Step 2: Using multilingual pamphlets as an aid, ask prospective international travelers six questions:

1) Have you or someone you are traveling with recently come into contact with an individual hospitalized for a communicable illness?

2) Have you or someone you have recently come into contact with experienced nausea or diarrhea, not related to a previously diagnosed medical condition?

3) Are you presently experiencing body aches not related to physical exertion or a previously diagnosed medical condition?

4) In the past 72 hours have you experienced unusually severe or persistent headaches, not related to a known condition such as a migraine?

5) In the past 72 hours have you developed a sudden, persistent or severe cough, not related to a previously-diagnosed condition?

6) Have you experienced rapid or severe irritation of the throat or skin within the past 72 hours, not related to a previously-diagnosed medical condition?

Thanks to technology, public health officials could be made available over Skype to address any questions that may arise out of such screening. Alternately, nurse practitioners could be employed by the Transportation and Security Administration (TSA) to evaluate travelers who are flagged for fever and/or for answering “Yes” to two or more questions indicated above. To be clear, these efforts would not reveal the cause or seriousness of such symptoms. Even so, with cancer patients, the very young, the very old and the immuno-compromised vulnerable even to ordinary communicable illnesses, a greater emphasis on infectious disease prevention can only help, not harm, society. In the broader view, moreover, efforts to normalize screening measures could perform a valuable public service. It could help drive home a universally-relevant message — that it is best to stay home while ill — and thus prime the public to take proper precautions and/or heed public health warnings in the event of a genuine pandemic threat.

Ebola in West Africa may indeed come and go, leaving the developed world largely untouched. But tragedies like this are opportunities, too. The Ebola outbreak highlights the need for authorities to make international travel by airline and cruise ship safer. Far from triggering panic, routine screening efforts are likely to become accepted in due time. In this way, should an even greater pandemic threat emerge, there will already be people and procedures in place to identify and curtail the spread of infectious diseases at international travel hubs — all without raising undo alarm. If public health officials are at all concerned that new or intrusive efforts to step up prevention will only provoke needless panic, a desensitizing strategy in which such screenings become the norm, not the exception, would go a long way toward putting to rest much of the debate: Do we act now or do we wait?

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