Ebola: Epidemiologist: Stop the flights now

[grahamhgreen]

http://www.washingtonpost.com/posteverything/wp/2014/10/06/epidemiologist-stop-the-flights-now/

By
David Dausey, a Yale-trained epidemiologist who works on controlling pandemics, is dean of the School of Health Professions and Public Health at Mercyhurst University in Erie, Pennsylvania.

The incubation period for Ebola is up to 21 days, so a person could get on a plane the day he or she is exposed and spend three weeks in the United States before exhibiting symptoms. Then he or she could potentially infect any number of people here before the disease is properly diagnosed, and they are isolated or quarantined.

Top U.S. government health officials have spoken strongly against creating a travel ban (though members of Congress increasingly disagree). They say restricting flights will also restrict aid to affected countries and will increase the amount of ongoing unrest. But commercial airlines are not the only ways for the United States to send aid and aid workers. The United States has the most advanced military in the entire world; we can transport people and supplies without commercial carriers.

The Ebola outbreak in West Africa has been compared to a war zone. The disease is now being viewed as a national security threat on par with nuclear weapons. The United States has committed nearly 4,000 troops to impacted countries. It’s time to take security precautions that align with the gravity of the threat. That means doing whatever it takes to keep infected people from coming here.

[rocktivity]

1. The travel ban would be for commercial flights -- of course we should send in aid

And if the case of the nurse who got sick after caring for a since deceased Ebola patient in Spain is any indication, maybe it's time to start sending in the kind of aid that will allow all infected and contagious people to be treated there.


rocktivity

[dixiegrrrrl]

4. As long as you have access to travel

those who can are going to want to land in a country that has good health care.
And lie away their symptoms if that is necessary.
human nature.

[Fred Sanders]

10. It is illogical fear, the ones that can afford the tickets also need visas and are least at risk.

How many folks can afford to suddenly leave their country with their families and stay in another country for a month? (Not to mention folks from most countries in Africa are not nearly as free to travel to Western countries as we are to African countries.)

A lot less folks in Sierra Leone can afford such a trip than folks America, I can tell you that.

Irrational.

[LisaL]

12. Tell it to Mr.Duncan.

[PADemD]

14. Travel to the United States from West Africa

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.

http://www.nytimes.com/2014/10/02/us/man-in-us-with-ebola-had-been-screened-to-fly-but-system-is-spotty.html?_r=0

[NanceGreggs]

62. If one is going to ...

... "want to land in a country that has good health care," the US, sadly, would not be at the top of their list.

[Skidmore]

2. Restricting travel I would think would be desirable.

I think the big objection is that it would impact trade/money/business. When I was a young woman, there were travel bans made for areas with cholera and other diseases. When the flu gets out of hand at schools in this country, sometimes they are closed for a few days to allow children to recover and reduce the transmission of the virus. I do think that it would not hurt to have travel restrictions for awhle to see if this cannot be contained or slowed down.

[MohRokTah]

3. There are no direct flights from the affected areas.

So unless we shut down all flights into the US, it's a bullshit argument.

Nigeria is no longer affected and is the only nation that was affected with direct flights to the US.

[Fred Sanders]

5. Agreed. No direct flights to America so the whole premise of the panicky article is lost.

This fact about flights is noted as an edit at the link, but not in the posted OP....there is nothing to ban, folks.

[LisaL]

6. We can stop issuing VISAs.

[Fred Sanders]

7. That is another issue, we probably already are on the basis of health questions and checks.

[LisaL]

8. Unfortunately those questions appear to be not worth the paper they are

written on. People lie. And then lie some more.
They are not going to tell you they were exposed to Ebola because they know full well they won't be able to get on the plane.

[Fred Sanders]

9. Flights to connecting countries are already being restricted, British Airways for one.

British Airways and some other airlines have suspended flights from those affected countries, and overall traffic to and from the affected areas has dropped.

http://www.cbsnews.com/news/u-s-health-officials-in-opposition-to-ebola-travel-ban/

[Tarheel_Dem]

66. Thanks for trying.

[snagglepuss]

87. There is a 21 day incubation. The fact that there are no direct flights is

meaningless.

[Barack_America]

17. Apparently we need to ban all flights from Brussels.

Yeah right.

I think it's United who is operating this flight. I suppose they could be asked to suspend it. I have to assume there aren't many Liberian visas being granted these days.

I have to say though, I'm pretty dismayed to see how few DUers have any empathy for those dying in West Africa. Few seem to have any concern what these national quarantines would do to those countries.

[grahamhgreen]

74. Well, we could take the 3 billion we spend eac week on war and provide aid...

[FSogol]

86. The West African Nation of Brussels.

[cwydro]

24. Yup. nt

[apples and oranges]

34. Other countries will also need to ban the affected countries,

at least temporarily.

[MohRokTah]

35. Ain't gonna happen. eom

[pnwmom]

38. Why couldn't customs halt non-citizens at the border whose flights originated in Liberia?

[uppityperson]

41. do you mean ban anyone from Liberia? And what would you do with the others on any plane

anyone from Liberia was on? And what about people in connecting airports? Or just all Liberians?

[pnwmom]

43. If travelers were banned from Liberia, then there wouldn't be anyone else on the plane with them

because Liberians wouldn't be there.

But I didn't say we should ban anyone from Liberia. I was responding to someone else.

[uppityperson]

51. You said you wanted customs to ban all non-citizens at the border whose flights originated in Liberi

How are those non-citizens whose flights originated in Liberia to get to our customs if not by a plane? What Flights are there that are not by aircraft?
wtf

[MohRokTah]

44. Great, make customs a breeding ground for Ebola. eom

[pnwmom]

46. I didn't say they should stay in customs. And I'm responding to the idea that a travel ban

would be unworkable because there are no direct flights from Liberia. That's a weak answer because it's easy enough to determine where a passenger began his travel.

[MohRokTah]

50. The idea is foolishness on its face. eom

[grahamhgreen]

75. You sure?

http://www.delta.com/content/dam/delta-www/pdfs/route-maps/africa-route-map.pdf

[MohRokTah]

77. Yep. eom

[Marrah_G]

90. None of those go to the effected area.

Check a map of Africa.

[grahamhgreen]

96. Lagos was affected...

[Marrah_G]

98. The cluster stemming from the Liberian-American man was quickly contained

All the people in the cluster have either recovered or died. 20 cases, 8 deaths.

[progressoid]

11. And, let's build a big fence around Africa.

[Warren DeMontague]

15. Actually, most of the rest of Africa has closed their borders to the 3 main affected countries

And for the most part, it has worked.

You bet your bippy that after Patrick Sawyer flew into Lagos and ended up infecting 20 others, Nigeria isnt screwing around anymore with letting people in.

[MohRokTah]

36. So our healtchare system is in the same shape as Mauritania?

Seriously?

[pnwmom]

48. Um . . . Dallas? You think that's a good example of handling it well? nt

[MohRokTah]

52. YES!

One infection. Twelve days after showing symptoms, no more infections.

It's the epitome of success!

[LisaL]

56. Only 9 days since actually admitted to the hospital.

The day he was vomiting all over the place.
Duncan himself developed symptoms 9 days after contact.
So, don't count your chickens before they hatch.

[MohRokTah]

57. Odds are, at least one of the four he was in close contact with would show symptoms.

So far, no symptoms.

Our culture of washing our hands consistently alone accounts for a lower infection level than West Africa.

[Warren DeMontague]

60. It's only been 8 days since Duncan was put into isolation.

He very well could have exposed others up to that point. It's a little early to say "no more infections". The jury is still out.

As it is, I have confidence in our HC system to contain any further importations to a small number of potential secondary cases, but I still wouldn't want the people I care about to be those secondary cases. And any further clusters of ebola cases are going to wreak all kinds of havoc- schools closed, buildings shut down, etc.

It's totally fucking inane to continue to allow travelers- visa holders- from those 3 countries until this blows over. There is no good reason for it, and a shitload of reasons against it. That doesn't mean we can't provide humanitarian aid and try to stop it there, it just means that for the time being we're not letting people in from L/SL/G.

[grahamhgreen]

76. Are you an epidemiologist? Maybe we should consider what he's saying?

[XemaSab]

13. Allow private flights

End commercial airline flights.

The economy of the region is already in the crapper, so why should they be allowed to infect 6 billion more people? Because free trade?

[Warren DeMontague]

16. But that would be "mean"!

Who cares if sick people inevitably get on planes and kill countless others all over the globe, the important thing is not to make anyone feel bad.

[jeff47]

19. Why stop there?

Africans could get on boats and reach places from which they could fly to the US.

Clearly, the only safe solution is to incinerate the entire continent. Otherwise someone with ebola will appear in your bedroom tonight.

Alternatively, you could stop the insane paranoia and realize ebola isn't actually that communicable. An infected family member only passes it on to 1 in 7 family members in the same household. In Africa.

[LisaL]

21. Marthalene Williams is said to have infected her brother (dead), her neighbor (dead), her parents,

and Mr.Duncan. And some others. Way more than 1 in 7.

[jeff47]

25. Golly, if only there was some sort of math we could use to actually measure probability

We could call it "statistics". We could look over the tens of thousands of cases of Ebola that have been recorded, and get an idea of what the average really is instead of citing individual cases that help us run around with our hair on fire.

Naaaaaah. Much better to freak out. So when should we start setting fire to Liberia?

[LisaL]

29. But the official numbers coming out of Africa are most likely vastly

lower than the actual numbers.
Ever thought of that?

[jeff47]

31. Yes, Doctors without Borders are nothing but liars.

[LisaL]

33. Do you believe CDC?

The official numbers are highly under-reported.


"The range of estimated cases -- from 550,000 to 1.4 million -- is wide because experts suspect the current count is highly under-reported. The official death toll from Ebola in West Africa has climbed to more than 2,800 in six months, with 5,800 cases confirmed as of Monday, the World Health Organization said."

http://www.cnn.com/2014/09/23/world/africa/ebola-outbreak/

[Warren DeMontague]

23. Again, one guy flying into Lagos infected 20+ people, and they barely stopped it there.

To say "well we can't ensure no one could possibly get through, 100%, so let's not do anything" is a false dichotomy, and bad logic. Why have temperature screenings and questionnaires at the airport, even, then? I mean, apparently if a measure can't be 100% foolproof, it shouldn't be done at all.

Why has the rest of Africa closed their borders to these countries? In case you haven't noticed, with the exception of one guy in Senegal, land border closings have WORKED. Ebola has gotten out more effectively by airplane, and there's a reason for that.

The sky will not fall if recreational visa-holders from 3 West African countries are inconvenienced by not being allowed to vacation in the US until this is cleared up. The argument that it impedes humanitarian aid is bs. There are other ways to get aid in without allowing visa holders out.

[jeff47]

30. That's nice. You do realize there's this thing called "statistics" right?

And we have tens of thousands of ebola cases to study, not just one guy, right?

To say "well we can't ensure no one could possibly get through, 100%, so let's not do anything" is a false dichotomy

I'm not.

I'm saying treating this as the next black death is stupid. Because in a place with terrible sanitation, lousy healthcare and funeral practices that greatly help to spread the disease, the transmission rate is 1 in 7 family members.

Ebola is a serious disease. It demands a serious response that actually uses all of our knowledge, under the guidance of people who have dedicated their entire lives to responding to such diseases. Instead of flippant bullshit spouted by TV news anchors who can't spell "virus" if you spot them the "vir".

Why has the rest of Africa closed their borders to these countries?

They haven't. Only some have.

Ebola has gotten out more effectively by airplane, and there's a reason for that.

It's called "long travel time" and "incubation period". Africa doesn't have a great land travel network. It takes a while to go from one country to another by land.

So, should we extinguish your hair, or do you want to panic some more first?

[LisaL]

42. Do you undesrtand that statistics are meaningless when the official numbers are way off?

[Warren DeMontague]

61. I'm not panicking, thanks.

Maybe you shouldn't panic at the horrifying and untenable thought that some of the 10,000 Liberian US visa holders might not be able to Vacation in Manhattan or Minnesota until next summer, oh heavens no.

[uppityperson]

45. Did you know T Duncan came to the usa to get married to his long time love?

[LisaL]

47. Did you know that is not what his visa was?

He came in on a tourist visa, not fiancée visa.

[uppityperson]

54. I did not know there was a fiancee visa. Amazing, the things I am learning on du.

He came to get married, not simply vacation.

[LisaL]

59. He must have forgotten to mention this on his visa application.

Imagine that.

[Warren DeMontague]

63. Sort of how he forgot to mention that 4 days before getting on that airplane in Monrovia he was

in close personal contact with someone with ebola.

[uppityperson]

64. Wow, another dUer who knows him personally. I am impressed and hope your

quarantine passes easily and healthily.

[Warren DeMontague]

68. Did you miss the part about how the Liberian government plans to prosecute him for lying under oath

On the Airport exit screening form?

You gonna give that snark to President Sirleaf, too? She's pissed as shit with the guy.

[uppityperson]

70. Good luck with the quarantine.

[Warren DeMontague]

71. Right.

Thought so.

[KamaAina]

89. Not sure why they'd want to extradite him.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=5611895

[Warren DeMontague]

91. Given his condition, it may be moot.

But certainly what they want to discourage is the inevitable free-for-all of newly infected ebola patients "forgetting" to tell the truth on the forms.

[Warren DeMontague]

49. Did you know there's no way in hell he didn't realize he was lying on that form when he said

he hadn't been exposed to anyone with ebola?

[uppityperson]

53. No, I do not know that. I do know you did not answer my question

[Warren DeMontague]

55. So that means it doesn't matter that he lied on the form about being exposed to ebola?

Because he claims he was coming over to get married?

He also claimed he hadn't been exposed to ebola, and that was a legal document- which is why Liberia might prosecute him if he ever returns. I don't know, when someone lies once it becomes a bit harder to believe other stuff they say.

Are you suggesting we should let people into the US with ebola if they're coming to get married?

[uppityperson]

67. You fail at trying to put words in my mouth. He came to get married, not just on vacation. You still

did not answer my question. Did you know he came here to get married?

Simple question.

[Warren DeMontague]

69. I dont care.

Nor does it matter.

The person he ostensibly came to marry, he put her life in danger with his behavior. Not a particularly noble start to a marriage.

[uppityperson]

72. You still did not answer whether or not you knew that. Simple question yet you

refuse to answer. Odd.

[Warren DeMontague]

73. I knew it as soon as it became claimed in the media.

Did you know he lied on the form at the airport? Why dont you feel like answering that question?

[uppityperson]

80. It seems incredible that he would not know, that even her family refused to acknowledge it

What is going on in regards to their disbelief in micro organisms and passing it on due to how they treat their dead seems incredible to us here.

[Tanuki]

58. Did you know that marriage by proxy is an option in the state of Texas?

http://www.ehow.com/about_6520540_marriage-proxy-texas_.html

[uppityperson]

65. Interesting. They don't even have to be Texas residents. Think of how that'd be is TX had marriage

equality.

[AwakeAtLast]

20. You mean Republicans' Katrina

President Obama has had his Surgeon General recommendation blocked, and they have cut funding (because, you know, Republicans).

[AtheistCrusader]

28. Precisely. "Obama's Katrina"? Must be one of those 'special' calendars.

[former9thward]

39. The Surgeon General vote has been blocked by Harry Reid.

He refuses to allow a vote.

[JI7]

22. so now Ebola is Obama's Fault ?

[cwydro]

26. Most likely too late ya know?

Like closing the barn door after the horse is out?

We need to shut that disease down over there. So we need the flights.

I suppose they could only allow military and medical flights.

But, people will get out. Trust me on that one.

[SheilaT]

27. This tends to make it sound as if

someone with Ebola who is asymptomatic can infect others. That's just not true. The danger period is when the person develops symptoms and hasn't been isolated.

And even then you still must come in direct contact with body fluids: blood, vomit, sweat, semen.

[former9thward]

40. Tell that to the NBC camera man who was infected.

He had no contact. Tell that to doctors who have treated patients in HazMat suits who have been infected.

[SheilaT]

81. I'm going to guess that the cameraman did have contact

and there's something he's not saying.

As for the doctors in the Hazmat suits, the protocol for putting them on and taking them off is, as I understand it, very strict. Here's a quote from Dr. Billy Fischer of the University of North Carolina School of Medicine. He was on the Diane Rehm show on July 31 this year he said:

" So when you put on all of this equipment, it can get as hot as about 115, 116 degrees on an average temperature day inside your suit. And then you work for as long as you can before you start being -- coming very dehydrated and then you have to exit. But you have to take off your equipment in exactly the same way every single time. So Doctors Without Borders, MSF, has established these rules, these routines that really provide a safe way of removing these clothes, which have potentially infectious bodily fluids on them." (My italics)

Keep in mind these doctors over in Africa are not working in lovely, air-conditioned, western style hospitals. No, they're out there in conditions that can kindly be called primitive, and it's no wonder that a good number of the local health care workers have been infected. Keep in mind that while it's not easy to get Ebola, once even a few Ebola virus particles get in you, they multiply exceedingly well, far beyond your body's ability to overcome them. So once again, it's not easy to get infected in the first place, but once you do, oh boy.

The full transcript of that show is worth reading: http://thedianerehmshow.org/shows/2014-07-31/understanding-deadly-ebola-virus/transcript

As for the cameraman, I just looked at a USA Today article about him and it says, "Although Mukpo isn't sure how he was infected, he told his father that it's possible he was exposed when he was spray washing a car in which someone had died to disinfect it. That can expose people to Ebola, if blood or other fluids splash up and get into a person's eyes." So yes, he had contact. Not directly with a human with symptomatic Ebola, but he was in a situation where there was virus present. And he wound up having contact. I'm guessing that if he'd simply worn eye protection he'd have been okay.

So we are back to the fact that it is not airborne. It's not that easy to get. Despite the three doctors and the cameraman.

[quadrature]

32. how many deaths are acceptable?

100K
1Mil
?

before travel restrictions are appropriate?

[greytdemocrat]

78. Please...

That hurts some people's feelings here.

[Vinca]

79. So flights from affected areas would be stopped, but flights from everywhere else wouldn't?

Sounds like a GOP plan. Only they would be so stupid to think an African person might not fly to a European or Asian hub and catch another flight.

[grahamhgreen]

97. It's one epidemiologists view. Likely knows more than I do.

[Vinca]

99. But apparently doesn't know much about the routing of airplanes around the world.

[librechik]

82. just make a 21 day waiting period before flights mandatory.

no need to close the airports if all the passengers are symptom-free.

[LisaL]

84. Where are they going to wait?

If back in the home country, the waiting period is useless as they can get infected during the waiting period.

[rocktivity]

92. But if they go symptomatic within those 21 days they'll still on their home turf

As an alternative to a complete travel ban, it's not much, but it would make the difference between few infected people and a few dozen infected people entering other countries.


rocktivity

[LisaL]

93. That makes no sense. Duncan was infected about 4 days before he got on the plane.

If they stay home, and get infected during these 21 days, it's not going to stop the infected people from coming into the US.

[rocktivity]

94. But we'd have fewer people going symptomatic elsewhere

within that 21-day waiting period, because they wouldn't be allowed to get on a plane in the first place. No, it wouldn't stop everyone, but it would stop some -- which, in the absence of a travel ban, it better than nothing.


rocktivity

[LisaL]

95. You just postpon the travel by 21 days.

During which they can get infected. They might have been safer if you didn't make them wait 21 days.

[muriel_volestrangler]

83. Banning flights to other countries isn't up to the US; only the UN could make such a decision

So Congress better start lobbying the United Nations, if that's what they want. It would be almost worth it to see Republicans having to ask the UN nicely.

[Fred Sanders]

88. Well said. Banning flights is more than the simple thing some minds think is so simple.