Why airport screening for Ebola won't work

During Thursday’s hearings on Ebola, Congressman Cory Gardner questioned the panel of five witnesses. Some important pieces of information were revealed. Let’s start with the numbers.

There are about 150 people a day flying to the United States from countries in West Africa most impacted by Ebola. All incoming flights connect through other countries. Ninety-four percent of these travelers will receive enhanced screening.

Curious about the 94% figure, I did some research and learned that enhanced screening will be implemented at the five international airports that “manage more than 94 percent of travelers from Liberia, Sierra Leone and Guinea….” The airports are JFK in NY (where half the travelers land), Washington Dulles outside of DC, O’Hare in Chicago, Hartsfield-Jackson in Atlanta, and Newark Airport in New Jersey.

Enhanced screening is scheduled to begin this weekend at JFK and will be rolled out at the other four airports next week. CDC staff will be train and assist customs agents and border patrol. The screening process is as follows:

  • Travelers fill out questionnaires and have their temperatures taken with a non-contact thermometer.
  • Customs agents assess travelers for any signs of illness and ask them questions, such as whether they’ve had any contact with an Ebola patient.
  • Any traveler that appears to be a risk will be moved to a quarantine area or may be taken directly to the hospital. (If in NY, it will be Bellevue Hospital.)
  • Travelers who do not appear to be a risk will be given a form to provide their contact information. They will also be asked to take their temperature every day. (I assume they will be given medical parameters and contact information should they spike a fever.)

These measures are better than nothing, but they are not good enough. Why should we have to set up elaborate screening mechanisms when it would be much simpler and more effective to ban flights from these countries? Or “temporarily suspend the 13,500 Visas” originating in countries overwhelmed by Ebola as has been proposed by five Republican congressional representatives.

And if I may add, since there’s no way of predicting the moment an infected person may become symptomatic, what happens when that occurs in transit on the airplane? We need not have such concerns if we banned these flights.

For now, we’re stuck with screening.

And it’s dreadfully flawed. Dangerously so. Here’s a snapshot of some of the things that can go wrong. And will go wrong. And already have gone wrong. Yahoo News reports:

…Lawrence Gostin, who teaches global health law at Georgetown Law School…said travelers with a fever can evade detection by taking over-the-counter medication.

People also could lie on questionnaires, said Dr. David Mabey…."They don't want to be delayed for hours," Mabey said. (snip)

Thomas Eric Duncan….said on a questionnaire that he had not been in contact with anyone infected with Ebola. Liberian officials said he was in contact with a woman who later died. A friend of his family said Duncan did not know the woman had Ebola.

Whether Duncan lied or was simply ignorant is something we may never know. Travelers’ lack of understanding about the disease and how it is spread is another problem when basing critical decisions on how they answer questions.

Plus, in addition to the flaw in taking people’s temperature noted in the excerpt above, I would add the following: 

  • In 13% of cases, fever is not always present during the initial phases of the illness.
  • If a person had something cold to drink for up to 20 minutes prior to having his temperature taken, it will lower the temperature reading.
  • Creating a cut-off temperature is arbitrary and does not take into account that everyone’s baseline temperature is not 98.6. If someone’s baseline is below that, a temperature of 99 can represent a fever.

It appears that non-contact thermometers (infrared temperature guns) will be used so the risk of cross infection should not be an issue.

To offer an overarching perspective: Screening is only as good as the degree to which it is adequate, thorough, performed by well trained personnel, carried out each and every time without error, and able to extract reliable information. As far as I can tell and as has been discussed thus far, there is little reason to feel confident about any of this.

If the CDC and medical professionals can’t get a handle on this problem, how in the world do we expect airport personnel to be on top of this? We’re now relying on individuals with no medical background (customs agents, border patrol, and DHS officials) to screen for a deadly infectious disease while also counting on them to appropriately respond to all manner of symptoms. As for CDC staff participating in screenings, there is no reason to have faith in the CDC. At all.

And just as it is naïve to trust travelers to answer questions accurately, it is equally absurd to rely on the honor system by asking them to monitor their temperatures while they’re here. We learned last week that we couldn’t even trust a physician to honor a mandatory three-week quarantine, but somehow we’re supposed to believe all these travelers are going to follow directions to the tee.

Oh, and by the way, if you think there’s an extra layer of screening taking place when travelers from West Africa make their connecting flights through Europe, think again. Europe is not implementing enhanced screening.

Figures.

And what of the remaining 6% of travelers from affected regions coming through other airports? These 2,000-3,000 people per year will undergo a less extensive screening whereby they will not have to fill out a contact sheet and their temperature will not be checked. Instead, a more limited assessment will apply:

  • Identify people from the affected areas in West Africa.
  • Ask them questions about their itinerary.
  • Be alert to signs of illness and coordinate with the CDC and public health, as needed.
  • Hand out fact sheets about Ebola with contact information should they develop symptoms.

In addition to the numerous flaws already cited in this piece, I might add that this protocol assumes travelers will be able to read the fact sheet, understand it, care about what it says, and follow through on directions.

And what will happen when a sick passenger vomits on one of these screeners? Are there teams of professionals standing ready with protective gear who will whisk away these stricken people in a sealed enclosure? 

I doubt it.

Feeling secure yet?

But getting back to the congressional hearings: After the initial round of questions by Gardner, he asked how many commercial flights from the United States travel to these affected countries every day. No one on the panel knew.

No one.

Ban commercial flights to and from these Ebola-stricken countries now and temporarily suspend visas. At least until this epidemic is under control in West Africa and we have our act together here. Neither of which is happening at this time.

One thousand people each week are flying from West African nations to the United States. It’s reasonable to assume that some of those people will be infected with Ebola and that some of them will get though the screening process. And all that separates those people from you and me is hope.

Hope that they monitor their symptoms. Hope that if they are symptomatic they have not exposed others. Hope that they recognize when to seek medical care immediately and that they seek such care. And hope that the care they receive is up to speed.

If you feel like you’re dodging bullets, you are. That’s what national security is like under Obama. And it’s exactly the way he wants it.

Hat tip: The Gateway Pundit

During Thursday’s hearings on Ebola, Congressman Cory Gardner questioned the panel of five witnesses. Some important pieces of information were revealed. Let’s start with the numbers.

There are about 150 people a day flying to the United States from countries in West Africa most impacted by Ebola. All incoming flights connect through other countries. Ninety-four percent of these travelers will receive enhanced screening.

Curious about the 94% figure, I did some research and learned that enhanced screening will be implemented at the five international airports that “manage more than 94 percent of travelers from Liberia, Sierra Leone and Guinea….” The airports are JFK in NY (where half the travelers land), Washington Dulles outside of DC, O’Hare in Chicago, Hartsfield-Jackson in Atlanta, and Newark Airport in New Jersey.

Enhanced screening is scheduled to begin this weekend at JFK and will be rolled out at the other four airports next week. CDC staff will be train and assist customs agents and border patrol. The screening process is as follows:

  • Travelers fill out questionnaires and have their temperatures taken with a non-contact thermometer.
  • Customs agents assess travelers for any signs of illness and ask them questions, such as whether they’ve had any contact with an Ebola patient.
  • Any traveler that appears to be a risk will be moved to a quarantine area or may be taken directly to the hospital. (If in NY, it will be Bellevue Hospital.)
  • Travelers who do not appear to be a risk will be given a form to provide their contact information. They will also be asked to take their temperature every day. (I assume they will be given medical parameters and contact information should they spike a fever.)

These measures are better than nothing, but they are not good enough. Why should we have to set up elaborate screening mechanisms when it would be much simpler and more effective to ban flights from these countries? Or “temporarily suspend the 13,500 Visas” originating in countries overwhelmed by Ebola as has been proposed by five Republican congressional representatives.

And if I may add, since there’s no way of predicting the moment an infected person may become symptomatic, what happens when that occurs in transit on the airplane? We need not have such concerns if we banned these flights.

For now, we’re stuck with screening.

And it’s dreadfully flawed. Dangerously so. Here’s a snapshot of some of the things that can go wrong. And will go wrong. And already have gone wrong. Yahoo News reports:

…Lawrence Gostin, who teaches global health law at Georgetown Law School…said travelers with a fever can evade detection by taking over-the-counter medication.

People also could lie on questionnaires, said Dr. David Mabey…."They don't want to be delayed for hours," Mabey said. (snip)

Thomas Eric Duncan….said on a questionnaire that he had not been in contact with anyone infected with Ebola. Liberian officials said he was in contact with a woman who later died. A friend of his family said Duncan did not know the woman had Ebola.

Whether Duncan lied or was simply ignorant is something we may never know. Travelers’ lack of understanding about the disease and how it is spread is another problem when basing critical decisions on how they answer questions.

Plus, in addition to the flaw in taking people’s temperature noted in the excerpt above, I would add the following: 

  • In 13% of cases, fever is not always present during the initial phases of the illness.
  • If a person had something cold to drink for up to 20 minutes prior to having his temperature taken, it will lower the temperature reading.
  • Creating a cut-off temperature is arbitrary and does not take into account that everyone’s baseline temperature is not 98.6. If someone’s baseline is below that, a temperature of 99 can represent a fever.

It appears that non-contact thermometers (infrared temperature guns) will be used so the risk of cross infection should not be an issue.

To offer an overarching perspective: Screening is only as good as the degree to which it is adequate, thorough, performed by well trained personnel, carried out each and every time without error, and able to extract reliable information. As far as I can tell and as has been discussed thus far, there is little reason to feel confident about any of this.

If the CDC and medical professionals can’t get a handle on this problem, how in the world do we expect airport personnel to be on top of this? We’re now relying on individuals with no medical background (customs agents, border patrol, and DHS officials) to screen for a deadly infectious disease while also counting on them to appropriately respond to all manner of symptoms. As for CDC staff participating in screenings, there is no reason to have faith in the CDC. At all.

And just as it is naïve to trust travelers to answer questions accurately, it is equally absurd to rely on the honor system by asking them to monitor their temperatures while they’re here. We learned last week that we couldn’t even trust a physician to honor a mandatory three-week quarantine, but somehow we’re supposed to believe all these travelers are going to follow directions to the tee.

Oh, and by the way, if you think there’s an extra layer of screening taking place when travelers from West Africa make their connecting flights through Europe, think again. Europe is not implementing enhanced screening.

Figures.

And what of the remaining 6% of travelers from affected regions coming through other airports? These 2,000-3,000 people per year will undergo a less extensive screening whereby they will not have to fill out a contact sheet and their temperature will not be checked. Instead, a more limited assessment will apply:

  • Identify people from the affected areas in West Africa.
  • Ask them questions about their itinerary.
  • Be alert to signs of illness and coordinate with the CDC and public health, as needed.
  • Hand out fact sheets about Ebola with contact information should they develop symptoms.

In addition to the numerous flaws already cited in this piece, I might add that this protocol assumes travelers will be able to read the fact sheet, understand it, care about what it says, and follow through on directions.

And what will happen when a sick passenger vomits on one of these screeners? Are there teams of professionals standing ready with protective gear who will whisk away these stricken people in a sealed enclosure? 

I doubt it.

Feeling secure yet?

But getting back to the congressional hearings: After the initial round of questions by Gardner, he asked how many commercial flights from the United States travel to these affected countries every day. No one on the panel knew.

No one.

Ban commercial flights to and from these Ebola-stricken countries now and temporarily suspend visas. At least until this epidemic is under control in West Africa and we have our act together here. Neither of which is happening at this time.

One thousand people each week are flying from West African nations to the United States. It’s reasonable to assume that some of those people will be infected with Ebola and that some of them will get though the screening process. And all that separates those people from you and me is hope.

Hope that they monitor their symptoms. Hope that if they are symptomatic they have not exposed others. Hope that they recognize when to seek medical care immediately and that they seek such care. And hope that the care they receive is up to speed.

If you feel like you’re dodging bullets, you are. That’s what national security is like under Obama. And it’s exactly the way he wants it.

Hat tip: The Gateway Pundit