How to stop Ebola in America: Ban air travel from West Africa

A health worker takes a passenger's temperature with an infrared digital laser thermometer at the Felix Houphouet Boigny international airport in Abidjan August 13, 2014. Ivory Coast on Monday banned air travellers from Guinea, Liberia and Sierra Leone, the three countries worst-hit by the Ebola outbreak, and ordered its flagship carrier Air Cote d'Ivoire to cease flights to and from them. Ivory Coast has not registered any cases but is seen as vulnerable given its shared borders with Guinea and Liberia. REUTERS/Luc Gnago

In an effort to stop Ebola from spreading within the United States, five airports have begun additional screenings for travelers from West Africa.

These screenings include using no-touch thermometers to take the temperatures of passengers arriving from Liberia, Sierra Leone, and Guinea – the three countries which have been the most affected by the deadly Ebola outbreak. The passengers who have a fever will be interviewed to help officials determine whether or not they have been exposed to Ebola. If so, quarantine units are in place at each of the airports in order to isolate those who may be infected. But despite these efforts, this will not stop an Ebola outbreak in the U.S.

Why airport screenings won’t stop Ebola

While additional screenings at U.S. airports may impede the spread of Ebola, they will not stop it. Here’s why: Screening passengers via temperature checks and interviews will not catch asymptomatic carriers of Ebola. As we know, Thomas Eric Duncan did not have a fever when he left Liberia, nor when he arrived in the U.S. It wasn’t until a week later that he developed symptoms, including a fever of 103.

Airport officials in Liberia claim that Duncan lied on his health questionnaire about his exposure to Ebola. Whether he lied or not, passengers who wish to avoid quarantine or receive treatment in Africa (where both are inadequate and limited), may also lie. In addition, if these screenings had begun before Duncan arrived in the U.S., would this have stopped him from entering the country? No – because as previously mentioned, Duncan was not experiencing any Ebola symptoms until after he arrived. American officials have even admitted that the new screening procedures would not have caught Duncan. So, the real question is, how do we plan to stop the next asymptomatic carrier of Ebola?

Since Duncan’s death, two Texas health care workers involved in his treatment have been diagnosed with Ebola. Regardless of what the CDC alleged was a “protocol breach,” the U.S. has officially encountered its first and second person-to-person transmissions of the Ebola virus – events unavoidable regardless of airport screenings.

Now, only time will tell how many more people Duncan or these health care workers may have infected. There are currently 123 other people -- including health care workers who treated Duncan as well as the Liberian national’s  own contacts – who are currently being monitored by the CDC. As we move forward, trying to control the spread of Ebola after another asymptomatic carrier has flown to the U.S. and infected many others would be extremely difficult. Evidently, we need to implement more than just “additional airport screenings.”

Screenings at airports have failed in the past. The U.S. is currently using measures that have been used in the past to fight the spread of SARS and the bird flu. But according to a Canadian study during the 2003 SARS pandemic, airport screenings did not detect a single case. It was also noted that air passengers took over-the-counter painkillers to reduce their temperatures – so even if a person did have symptoms, it was undetectable. This could very likely happen with Ebola and passengers who have an undetectable fever. Screenings at airports are not guaranteed to be effective.

Refusing to issue a travel ban puts the U.S. in danger

Despite the CDC’s efforts to warn and educate people about the Ebola virus and its symptoms, sick people are still trying to board planes to the U.S. During the month of September, African countries reported turning away 77 people who displayed possible signs of Ebola. As the Ebola outbreak gets worse in West Africa, it will be more difficult to keep those infected with Ebola – especially asymptomatic carriers – from trying to board flights to the U.S.

Ban air travel from West Africa

The best way to keep Ebola from spreading within the U.S. is to close the borders and ban air travel from West Africa. The epidemic is currently present in Liberia, Sierra Leone and Guinea. There have also been smaller outbreaks in Nigeria and Senegal, which have reportedly been contained. The U.S. and West Africa are simply connected by air travel. All it takes is one person – one asymptomatic carrier – who is unaware or untruthful about their exposure to Ebola to initiate an explosive outbreak here in the U.S.  Most infectious diseases within the U.S. were introduced by foreign countries. It is hard to predict which country the next disease may come from, making it impossible to ban air travel in an attempt to protect our country. With Ebola, we know the source

Solution for those opposing an air travel ban

Government officials and the CDC currently have no plans to ban air travel because they say it would be counterproductive in that it would limit aid and health care workers traveling to and from the affected countries – which would make the outbreak overseas worse. While these efforts are certainly key to controlling the outbreak in West Africa, this does not protect Americans. In a recent survey, 58 percent of Americans said they support an air travel ban from countries affected by Ebola. So, how can we work to control the outbreak overseas and protect Americans? Here’s the solution: 1) Establish departure and return air travel for health care workers delivering relief to the affected areas - provided by either the government or the military.  2) Ban all other incoming air travel from the affected areas.

I am not trying to instill fear and panic - my job as a physician is to educate, contain and treat. As a physician in America, we should put more focus on protecting Americans and minimizing our risk of exposure, while continuing our efforts to gain control of the outbreak overseas. While the CDC claims to have the resources necessary to control an outbreak in the U.S., prevention should come first. Therefore, until there is a vaccine, the outbreak in West Africa is controlled, and the Ebola virus is fully understood, we need to ban air travel if we want to keep Ebola out of this country.