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| Ebola Patient’s Journey Shows How Global Travel Is Open to the Spread of Disease | Ebola Patient’s Journey Shows How Global Travel Is Open to the Spread of Disease |
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| MONROVIA, Liberia — The arrival in the United States of a Liberian man infected with the Ebola virus shows how difficult it is to control or restrict the disease from spreading, and how porous current procedures are in a world of globalized air travel. | MONROVIA, Liberia — The arrival in the United States of a Liberian man infected with the Ebola virus shows how difficult it is to control or restrict the disease from spreading, and how porous current procedures are in a world of globalized air travel. |
| Liberian officials said on Thursday that they planned to prosecute the passenger, Thomas E. Duncan, for lying on an airport questionnaire about not having contact with a person infected with Ebola before his travel — a pivotal part of the country’s screening process. | Liberian officials said on Thursday that they planned to prosecute the passenger, Thomas E. Duncan, for lying on an airport questionnaire about not having contact with a person infected with Ebola before his travel — a pivotal part of the country’s screening process. |
| “He lied on his form,” said Binyah Kesselly, chairman of the Liberia Airport Authority. “If he had answered truthfully,” he added, Mr. Duncan would not have been allowed to leave the country. | “He lied on his form,” said Binyah Kesselly, chairman of the Liberia Airport Authority. “If he had answered truthfully,” he added, Mr. Duncan would not have been allowed to leave the country. |
| Mr. Duncan took three planes as he flew from Monrovia, the Liberian capital, to Dallas last month, connecting in Brussels and Washington. | Mr. Duncan took three planes as he flew from Monrovia, the Liberian capital, to Dallas last month, connecting in Brussels and Washington. |
| His journey illustrates just how easily the disease can travel and how thin the procedures are, relying heavily on the honesty of travelers and the diligence of airport workers. Some experts say that the system, given its inherent weaknesses, could quickly be overwhelmed by the rapidly spreading disease. | His journey illustrates just how easily the disease can travel and how thin the procedures are, relying heavily on the honesty of travelers and the diligence of airport workers. Some experts say that the system, given its inherent weaknesses, could quickly be overwhelmed by the rapidly spreading disease. |
| Mr. Duncan’s temperature was taken by an airport worker in Monrovia who had been trained by the United States Centers for Disease Control and Prevention, registering a non-feverish 97.3, the agency’s director, Dr. Thomas R. Frieden, said Thursday. | Mr. Duncan’s temperature was taken by an airport worker in Monrovia who had been trained by the United States Centers for Disease Control and Prevention, registering a non-feverish 97.3, the agency’s director, Dr. Thomas R. Frieden, said Thursday. |
| But Mr. Duncan did not acknowledge during that screening that he had helped carry a woman stricken with the symptoms of Ebola to and from a hospital just days before, Liberian officials said. That woman died, as did her brother, who helped carry her with Mr. Duncan. | But Mr. Duncan did not acknowledge during that screening that he had helped carry a woman stricken with the symptoms of Ebola to and from a hospital just days before, Liberian officials said. That woman died, as did her brother, who helped carry her with Mr. Duncan. |
| The Obama administration has not changed procedures on air travel in light of the Dallas case, beyond stressing its existing guidance to airlines and border agents to be on the lookout for sick passengers. | The Obama administration has not changed procedures on air travel in light of the Dallas case, beyond stressing its existing guidance to airlines and border agents to be on the lookout for sick passengers. |
| Customs agents at airports, for instance, conduct “passive surveillance” for overt signs of illnesses, including visual observation and questioning of entering passengers at all American ports of entry. There are “screening procedures in place at our border,” Josh Earnest, the White House press secretary, told reporters on Wednesday. “There is nothing about this case that we know so far that would indicate any weakness or any flaws in that system right now.” | Customs agents at airports, for instance, conduct “passive surveillance” for overt signs of illnesses, including visual observation and questioning of entering passengers at all American ports of entry. There are “screening procedures in place at our border,” Josh Earnest, the White House press secretary, told reporters on Wednesday. “There is nothing about this case that we know so far that would indicate any weakness or any flaws in that system right now.” |
| In an interview, Dr. Frieden defended the existing screening process at airports in the United States, saying the costs of a more comprehensive process would not be worth the potential benefits. | In an interview, Dr. Frieden defended the existing screening process at airports in the United States, saying the costs of a more comprehensive process would not be worth the potential benefits. |
| “Like any intervention, there are upsides and downsides,” Dr. Frieden said. There are a lot of downsides. You slow travel. You end up costing people money.” | “Like any intervention, there are upsides and downsides,” Dr. Frieden said. There are a lot of downsides. You slow travel. You end up costing people money.” |
| The best way to keep the virus out of the United States is to eradicate it at its source — in Africa, he said. But in the meantime, he noted, the risk of another infected person coming to the United States is “not zero.” | The best way to keep the virus out of the United States is to eradicate it at its source — in Africa, he said. But in the meantime, he noted, the risk of another infected person coming to the United States is “not zero.” |
| “Whatever we do, we are not going to get to zero risk in the U.S. until the outbreak is over in Africa,” Dr. Frieden said. “People may be uncomfortable with it, but we tell it like it is.” | “Whatever we do, we are not going to get to zero risk in the U.S. until the outbreak is over in Africa,” Dr. Frieden said. “People may be uncomfortable with it, but we tell it like it is.” |
| Liberia had no screening at its airports before July 26, adding measures only after an American-Liberian man, who was visibly sick and vomited during his flight, took the disease to Nigeria, resulting in 20 infections and eight deaths. | Liberia had no screening at its airports before July 26, adding measures only after an American-Liberian man, who was visibly sick and vomited during his flight, took the disease to Nigeria, resulting in 20 infections and eight deaths. |
| Now, Liberia says passengers’ temperatures are taken twice by scanning their foreheads with infrared thermometers, stopping anyone with a fever over 99.5 degrees, in addition to the required health questionnaire. Officials acknowledged that the controls rely in part on the honesty of travelers, but they argued that until symptoms are evident, there were few other options. | Now, Liberia says passengers’ temperatures are taken twice by scanning their foreheads with infrared thermometers, stopping anyone with a fever over 99.5 degrees, in addition to the required health questionnaire. Officials acknowledged that the controls rely in part on the honesty of travelers, but they argued that until symptoms are evident, there were few other options. |
| “There is nothing else we could do short of quarantining people who want to travel 21 days before their departure,” Mr. Kesselly said, referring to the maximum incubation period for Ebola. | “There is nothing else we could do short of quarantining people who want to travel 21 days before their departure,” Mr. Kesselly said, referring to the maximum incubation period for Ebola. |
| But of the 9,624 passengers who have flown out of Monrovia on commercial aircraft under the new guidelines, only two have been flagged for additional screening. | But of the 9,624 passengers who have flown out of Monrovia on commercial aircraft under the new guidelines, only two have been flagged for additional screening. |
| Some health experts in the United States said that number seemed suspiciously low, saying that it was "highly unlikely” or “not possible” that such a minuscule percentage of travelers would have fevers, even if unrelated to Ebola. | Some health experts in the United States said that number seemed suspiciously low, saying that it was "highly unlikely” or “not possible” that such a minuscule percentage of travelers would have fevers, even if unrelated to Ebola. |
| Another health expert said it was plausible that airport workers were taking passengers’ temperatures and reading the numbers correctly, but questioned the accuracy of the devices and pointed out that such methods had not necessarily worked in the past. | Another health expert said it was plausible that airport workers were taking passengers’ temperatures and reading the numbers correctly, but questioned the accuracy of the devices and pointed out that such methods had not necessarily worked in the past. |
| During the SARS epidemic, for instance, thermal scans of more than seven million passengers leaving Canada, Singapore, China, Hong Kong and Taiwan detected no cases of the disease, one study found. | During the SARS epidemic, for instance, thermal scans of more than seven million passengers leaving Canada, Singapore, China, Hong Kong and Taiwan detected no cases of the disease, one study found. |
| Global health officials have said the hazards of air travel are low, since infected passengers are not contagious during the incubation period. | Global health officials have said the hazards of air travel are low, since infected passengers are not contagious during the incubation period. |
| But as the epidemic expands, these policies need to be reassessed, argued J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies. | But as the epidemic expands, these policies need to be reassessed, argued J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies. |
| “Those procedures were developed when the threat was more manageable,” he said. “The threat is becoming more magnified now.” | “Those procedures were developed when the threat was more manageable,” he said. “The threat is becoming more magnified now.” |
| Screening passengers at the point of embarkation will always have weaknesses, said Alexander Garza, the chief medical officer at the Department of Homeland Security from August 2009 until April 2013. | Screening passengers at the point of embarkation will always have weaknesses, said Alexander Garza, the chief medical officer at the Department of Homeland Security from August 2009 until April 2013. |
| Government officials and airport workers ask, “Do you have a fever or any of these signs or symptoms, or have you been around anyone with Ebola for 21 days?” | Government officials and airport workers ask, “Do you have a fever or any of these signs or symptoms, or have you been around anyone with Ebola for 21 days?” |
| But “how honest are people going to be?” asked Mr. Garza. “Unfortunately, there’s no simple test for that.” | But “how honest are people going to be?” asked Mr. Garza. “Unfortunately, there’s no simple test for that.” |
| Emily Veltus, who volunteered for Doctors Without Borders in Sierra Leone, flew home to the United States in late August. She said that her temperature was checked at the departure airport and that she had to fill out forms with questions about whether she had been in contact with sick people or dead bodies. | |
| “My own opinion is that temperature checks do very little,” Ms. Veltus wrote in an email. “It might have a small added value, but people could just take medicine to reduce their fever.” | “My own opinion is that temperature checks do very little,” Ms. Veltus wrote in an email. “It might have a small added value, but people could just take medicine to reduce their fever.” |
| Still, in Monrovia, the new screening protocol appeared to be a big improvement in weeding out the visibly sick. | Still, in Monrovia, the new screening protocol appeared to be a big improvement in weeding out the visibly sick. |
| Ashley Gilbertson, a photographer working in Liberia, described the absence of precautions at the end of June, three months after the start of the epidemic in Liberia. | Ashley Gilbertson, a photographer working in Liberia, described the absence of precautions at the end of June, three months after the start of the epidemic in Liberia. |
| “I had gotten really sick,” he said. “I had five different symptoms of Ebola.” | “I had gotten really sick,” he said. “I had five different symptoms of Ebola.” |
| He said he repeatedly sought treatment in Monrovia, but no one would test him for Ebola, even after he urged them to. When he got to the airport in Monrovia, no one took his temperature or asked him any questions about his health. | He said he repeatedly sought treatment in Monrovia, but no one would test him for Ebola, even after he urged them to. When he got to the airport in Monrovia, no one took his temperature or asked him any questions about his health. |
| “There was absolutely no screening process, and I looked like hell,” he said. “They just stamped me and let me leave.” | “There was absolutely no screening process, and I looked like hell,” he said. “They just stamped me and let me leave.” |
| Once he landed at Kennedy International Airport in New York, he said, he was asked no questions. “I got a welcome home,” he said. “It was a little bit alarming.” | Once he landed at Kennedy International Airport in New York, he said, he was asked no questions. “I got a welcome home,” he said. “It was a little bit alarming.” |
| Before his symptoms subsided, he said he continued seeking medical help, asking again to be tested at a clinic in Manhattan. | Before his symptoms subsided, he said he continued seeking medical help, asking again to be tested at a clinic in Manhattan. |
| “There were a ton of doctors crowded around a computer, Googling Ebola,” he said. Finally, he recalled, they said, “We can’t test for this,” and gave him a Post-it with a number for the C.D.C. | “There were a ton of doctors crowded around a computer, Googling Ebola,” he said. Finally, he recalled, they said, “We can’t test for this,” and gave him a Post-it with a number for the C.D.C. |
| “Call this if you get sicker,” he said they told him. “It was a 1-800 number. It wasn’t even an emergency line.” | “Call this if you get sicker,” he said they told him. “It was a 1-800 number. It wasn’t even an emergency line.” |