Ebola infected air travellers 'can avoid screening with a lie'

2014-10-03 12:12
File: AFP

File: AFP

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New York - People who contract Ebola in West Africa can get through airport screenings and onto a plane with a lie and a lot of ibuprofen, according to healthcare experts, who believe more must be done to identify infected travellers.

At the very least, they said, travellers arriving from Ebola-stricken countries should be screened for fever, which is currently done on departure from Liberia, Guinea and Sierra Leone, but such safeguards are not foolproof.

"The fever-screening instruments run low and aren't that accurate," said infection control specialist Sean Kaufman, president of Behavioural-Based Improvement Solutions, a biosafety company based in Atlanta.

"And people can take ibuprofen to reduce their fever enough to pass screening, and why wouldn't they? If it will get them on a plane so they can come to the US and get effective treatment after they’re exposed to Ebola, wouldn't you do that to save your life?"

On Thursday, Liberia said the first Ebola patient to be diagnosed in the US had lied on a questionnaire at the Monrovia airport about his exposure to an Ebola patient. He flew to Brussels and then Dulles airport outside Washington, DC, before landing in Dallas on 20 September.

No symptoms

The traveller, Thomas Eric Duncan, had no symptoms when he left Liberia, and fever scans there had shown a normal body temperature of 97.3 degrees Fahrenheit, US health officials said. He therefore could not have been identified through examination as carrying the Ebola virus.

His arrival and hospitalisation in Dallas have underscored how much US authorities are relying on their counterparts in West African countries to screen passengers and contain the worst Ebola outbreak on record.

Part of the screening burden rests on connecting airports.

For example, Kaufman flew from Monrovia to Casablanca to London to Atlanta. He was fever-screened in Monrovia and Casablanca, but not London's Heathrow, he said, and not when he arrived in Atlanta.

"At Heathrow, there were no questions about where I had come from," he said. "I offered the information to the official in Atlanta, and he said, ‘Thank you. Be safe.'"

In August, experts from the US Centres for Disease Control and Prevention (CDC) began teaching airport workers inMonrovia and other cities in the Ebola zone to conduct screenings, CDC medical worker Tai Chen said in an interview.

Honour system

Ebola cases and deaths have been reported in Guinea, Liberia, Sierra Leone, Nigeria and Senegal. The World Health Organisation has put the death toll at 3 338 out of 7 178 cases since March.

The CDC also worked with Liberian authorities to develop the questionnaire that was completed by Duncan: before travellers enter Roberts International Airport in Monrovia they are asked if they have had contact with anyone showing symptoms of Ebola.

There are at least two other screening points before a passenger is allowed to board a plane, with trained airport personnel asking about exposure to Ebola in the previous 21 days and any symptoms including fever, severe headache, bleeding, vomiting, diarrhea, and abdominal pain.

This process relies on an honour system, Chen said.

Officials at the CDC and the Department of Homeland Security would not say if they are considering using hand-held fever detectors on passengers arriving at US airports. But Homeland Security spokesperson Marsha Catron said the agency “will not hesitate to execute additional safety measures should it become necessary”.

CDC Director Dr Thomas Frieden cautioned  that a more restrictive approach to travel could make the Ebola outbreak harder to contain.

"The approach of isolating a country is going to make it harder to get help into that country," he said.

Fever detection

Virologist Heinz Feldmann of the National Institute of Allergy and Infectious Diseases has studied Ebola for years and helped develop an experimental Ebola vaccine. He told Science magazine in September that airport screeners in Monrovia, where he spent three weeks, “don’t really know how to use the devices”.

He said he saw screeners record temperatures of 32°C, which is so low it "is impossible for a living person".

Feldmann said in an email that according to his colleagues who have returned from Liberia in the last few days procedures for taking temperatures and doing clinical checks have improved.

Since August, major US airports that receive international flights have displayed signs alerting passengers to the presence of Ebola in West Africa, and telling them to be on the lookout for symptoms, said Customs and Border Protection spokeswoman Jennifer Evanitsky.

On Wednesday, customs personnel began distributing information prepared by the CDC describing Ebola symptoms and noting, “You were given this card because you arrived to the US from a country with Ebola.” It tells travellers that if they were exposed to Ebola overseas, “call your doctor even if you do not have symptoms.”

Read more on:    who  |  liberia  |  senegal  |  us  |  guinea  |  sierra leone  |  nigeria  |  west africa  |  health  |  ebola

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