New airport screenings announced as Ebola fears spread across U.S.

The Baltimore Sun
5 major U.S. airports will begin screening international passengers for Ebola.

Federal officials announced Wednesday that they plan to screen international passengers for Ebola at five major U.S. airports, while hospitals around the country continue to isolate patients showing Ebola-like symptoms.

At least four Baltimore-area hospitals recently segregated patients with travel histories and other possible indications of Ebola, though the virus was ruled out in each case. Other cases were suspected and ruled out at two Washington-area hospitals last week.

Meanwhile, the first U.S. patient diagnosed with the virus died Wednesday in Dallas. The Liberian national had flown to Texas through Washington Dulles International Airport.

Maryland's top infectious disease expert said he expects more scares to come. While the risk of exposure is remote for those who haven't recently traveled to Africa, experts said heightened surveillance for potential Ebola cases is warranted given the virus' high mortality rate.

"You don't want this done lightly," Maryland state epidemiologist Dr. David Blythe said. "It's a tricky situation, but we do want to hear about those types of situations."

University of Maryland Medical Center officials confirmed they recently isolated at least one patient suspected to have Ebola. And at Franklin Square Medical Center in Rosedale, a spokeswoman said a patient was isolated late last month because of symptoms that suggested a number of infectious diseases, including Ebola. In both cases, the virus was ruled out.

Five patients have been isolated and cleared at Sinai Hospital in Baltimore, LifeBridge Health officials said. And at Johns Hopkins Hospital, several isolated patients have been examined for Ebola, which wasn't found, said Trish Perl, senior epidemiologist for Johns Hopkins Medicine.

Health officials emphasized that patients are frequently isolated for a variety of infectious diseases, such as tuberculosis, and that segregating patients based on a suspicion of Ebola does not necessarily warrant public health concern.

Perl said she was screened three times while visiting the Congo this week for Ebola-related work, but not upon her return to the U.S.

The airline industry also is on high alert.

On Tuesday night, an international passenger from London who presented symptoms of illness while being questioned by customs agents at Baltimore-Washington International Thurgood Marshall Airport drew the immediate attention of paramedics.

They began an assessment for communicable diseases, including Ebola, with the help of consultants from the Centers for Disease Control and Prevention, said Jonathan Dean, an airport spokesman.

Earlier this week, a sick man who had traveled to Kenya in August was removed from a flight in Orlando, Fla. — the plane was bound for BWI — to be examined after the crew expressed concerns.

Neither the passenger at BWI nor the man in Orlando were deemed to be carrying the virus.

The new screenings of passengers from West Africa will be introduced in coming days at Washington Dulles; O'Hare International in Chicago; Kennedy International in New York; Hartsfield-Jackson International in Atlanta; and Newark Liberty International.

The new measures are similar to those introduced in several Ebola-stricken countries by CDC teams in recent months. They include temperature screenings to flag feverish passengers and questionnaires asking about recent contact with sick people.

"We continue to have a lot of confidence in the screening measures that are already in place," Josh Earnest, a White House spokesman, said Wednesday. "What we're doing is essentially adding another layer of security."

But airport screenings have been shown to be ineffective at stopping the spread of diseases like the flu, said Dr. Donald Milton, a professor at the Maryland Institute for Applied Environmental Health at the University of Maryland, College Park. Moreover, Ebola has a 21-day incubation period, so patients may not exhibit symptoms for weeks after arriving here, he said.

But the strategy could help root out cases when they develop because the CDC is expected to give travelers packets of information on the virus and symptoms, he said.

"You can screen all you want, trying to keep people with a fever out, but that's not going to do much," Milton said. "You would really have to quarantine people at the airport for days," which he said would be impractical.

Last month, Thomas Eric Duncan became the first person to be diagnosed with Ebola in the United States after passing through such screenings in Monrovia, Liberia. He didn't have a fever at the time and allegedly lied on a questionnaire, failing to disclose contact he had with a pregnant woman who later died of the virus, according to Liberian officials.

Officials in Dallas announced Duncan's death Wednesday.

Perl, the Hopkins epidemiologist, said it's difficult to predict how effective the travel monitoring will be, but it should help prevent the spread of Ebola and encourage more prompt care for any Ebola patients.

"I hope this is going to be reassuring to people," Perl said. "This is about doing what's right."

The new screenings will focus on passengers arriving from countries at the center of the outbreak in West Africa, namely Liberia, Sierra Leone and Guinea, federal officials said.

The Coast Guard also announced it would screen individuals coming into the United States via ship from Ebola hot spots.

Officials have said that outright travel bans could undercut the already reeling economies in affected countries and impede a needed influx of health workers overseas.

Since August, when CDC screenings were implemented in West Africa, about 36,000 people have boarded flights from there. Screening measures led to 77 travelers being prevented from boarding. Most turned out to have malaria, and none had Ebola.

Of 7,942 confirmed, probable and suspected cases of Ebola since it emerged in March, 3,439 patients have died. The outbreak is the worst on record.

Dean, BWI's spokesman, said the Anne Arundel County airport does not have any direct flights to or from West Africa. He said he didn't know how many passengers who begin their travels in West Africa arrive in Baltimore as their final destination.

Dean said BWI personnel "have the skills, the training and the proper equipment to evaluate and treat sick passengers."

Steve Sapp, a spokesman for U.S. Customs and Border Protection in Baltimore, said customs agents are not medical professionals but are constantly looking for "any tell-tale signs" of ill travelers who should be isolated.

"We will continue to do what we are doing now, which is to identify travelers on arriving flights who are coming from Ebola-affected regions and notify CDC. If the CDC is also doing the same thing, targeting those airplanes, they'll notify us as well," Sapp said.

More than 70 percent of flights at BWI are operated by Southwest and its subsidiary AirTran, which only operate a few international flights to the Caribbean. Still, the airline is closely monitoring the situation and keeping its employees apprised of all current CDC guidelines for dealing with and reporting illness on flights, said Brandy King, a spokeswoman.

In suspected Ebola cases, doctors investigate a patient's potential exposure, including any connections to Liberia, Sierra Leone and Guinea.

In each case so far in Maryland, doctors have been able to rule out Ebola before a blood test was warranted, said Blythe, the state epidemiologist.

"I do expect we'll have situations where we will do testing," he said. "I'll be happy if we don't, but I would expect that we will."

In the case of Duncan, the patient who died, health officials found as many as 100 people came in direct or indirect contact with him before narrowing down the group to those who warranted closer surveillance.

If Maryland officials find Ebola is likely in a case, officials may begin tracing the patient's contacts even before blood test results are in, Blythe said.

Publicizing potential Ebola cases could discourage some patients from seeking care, warned Dr. Albert Wu, a professor at Johns Hopkins Bloomberg School of Public Health.

At Texas Health Presbyterian Hospital in Dallas, the emergency department saw a dramatic decline in patient volume after Duncan's case was announced.

"I don't see an obligation to be transparent about this," Wu said. "The personal risk to any individual who might be considering going to an emergency room in the U.S. today is very, very small."

Tribune Newspapers and Reuters contributed to this article.

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