World unprepared for people trying to flee Ebola hot zone

Thomas E. Duncan, the man confirmed to be the first Ebola case in the United States, was preparing to leave Liberia for Dallas two weeks ago. He was determined to have no fever and allowed to board his flight, American officials say.
Since the deadly Ebola virus began spreading rapidly through West Africa, the Centers for Disease Control and Prevention has been pushing the authorities in the worst-hit countries, including Liberia, Sierra Leone and Guinea, to implement just that type of screening for departing passengers.
In early August, the C.D.C. sent medical workers to the region to train local government officials and airport workers in Ebola screening, according to Dr. Nicole Cohen, an infectious disease specialist with the agency’s Division of Migration and Quarantine. As part of that process, the agency advises that airport workers ask travelers if they have been exposed to Ebola in the last 21 days, have had a fever, and have had any symptoms including severe headache, muscle ache, abdominal pain, unusual bruising or bleeding, vomiting and diarrhea. The screener is expected to use a hand-held non-contact temperature monitor, a few inches from the travelers’ forehead, to check for fever.
But the system has its limits, relying on the traveler to reveal whether he or she has been exposed. And it leaves it to local officials to conduct the screening as they see fit, Dr. Cohen said. It is unclear how consistently or effectively those screenings are conducted across West Africa, and Dr. Cohen said she did not know how many potential travelers had been caught by screeners — if any.
“Our expectation is that people who are sick or people who are exposed should be getting the message they shouldn’t be traveling.” Airlines have not taken any specific steps to deal with Ebola, representatives
from several carriers said. They follow general guidelines issues by the C.D.C. and the World Health Organization. They have also informed their flight attendants about the hazards of Ebola, its symptoms and how the disease is spread. Delta has increased the supplies of gloves and sanitizers on board. But beyond taking simple precautions, airlines said they were not responsible for screening passengers.
The number of those passengers from West Africa is large. According to Airlines for America, the trade association of American carriers, more than 10,000 people flew to the United States from Sierra Leone from April 2013 to March 2014, and more than 17,000 flew from Liberia in the same period. Those figures include only passengers who flew on itineraries involving an American carrier.
The Dallas patient, Mr. Duncan, flew from Brussels to Dulles International Airport near Washington on Sept. 20 on United 951, and then on to Dallas-Fort Worth on Flight 822, the airline confirmed. It appears likely he got to Brussels from Liberia on Brussels Airways, a United code-share partner in the Star alliance.
United, in a statement, said it had been informed by the C.D.C. that its passenger was the one now hospitalized in Dallas. The airline repeated a statement from the director of the C.D.C. that there was “zero risk of transmission” to other passengers on the flight, because the man was not symptomatic at the time and thus could not have been contagious. But as a precaution, the airline said, it was “providing information about the flights United believes the patient took.”
Historically, the airlines have been most concerned with passengers who are so sick that they might force a flight to divert. Airlines are authorized to stop sick passengers from getting on planes, but are not required to do so. Under Department of Transportation rules, United States and foreign carriers flying to this country cannot exclude a passenger simply because the traveler has a communicable disease, but can do so if the disease poses “a direct threat.” Guidance issued by the department says that if the disease is serious and easily communicable, that constitutes such a threat. It cites SARS and active tuberculosis as examples.
The C.D.C. also offers advice to airline cabin crews in dealing with sick passengers. For gastrointestinal diseases like Ebola, it recommends seating the traveler close to a lavatory and restricting the use of that lavatory only to ill travelers; providing a plastic bag to dispose of used airsickness bags; and encouraging sick travelers to wash their hands and use alcohol-based hand cleaners.
If a passenger gets sick on board, the cockpit crew is supposed to radio ahead so the plane can be met by emergency medical service personnel and someone who can evaluate the passenger. The center asks Customs and Border Protection, which stamps passports, to watch for ill travelers and notify the C.D.C. if it finds them.
“They are our eyes and ears,” said Christine Pearson, a spokeswoman at the agency’s headquarters in Atlanta.
A spokeswoman for Airlines for America said that carriers that flew to West Africa “remain in steady contact with government agencies and health officials, and have procedures in place to monitor and quickly respond to potential health concerns.” The spokeswoman, Victoria Day, said the group’s members “are being provided regular development updates from the Centers for Disease Control on worldwide health precautions.”
The World Health Organization does not ban travel to countries with Ebola outbreaks, and there are no travel restrictions or closures of border entry points. Delta stopped flying to Liberia on Aug. 31. The airline used to fly from there three times a week to John F. Kennedy International Airport in New York with a stop in Accra, Ghana. The airline said that ending service had nothing to do with
Ebola and was the result of low ridership. Delta still has a daily flight to Accra, and another to Dakar, Senegal, from Kennedy. From Atlanta, Delta has a daily flight to Lagos, Nigeria. American Airlines does not fly to West Africa. United has a flight between Houston and Lagos.

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