(Update: Nurse in Spain who treated missionary with Ebola evacuated to Madrid now confirmed to have first transmitted case outside Africa)
Recently, Ebola arrived in the United States when a man named Thomas Duncan stepped off a plane from Liberia. In the short time he has been in this country, he had direct or indirect contact with up to 100 people. Although every effort has been made to contain this case, it brings up the question as to whether a travel ban of flights from West Africa would have a protective effect for U.S. citizens.
The Director of the Center for Disease Control, Dr. Tom Frieden, has stated that ““If we take actions that seem like they may work, they may be the kind of solution to a complex problem that is quick, simple and wrong,”. His reasoning is that isolation of countries that have been ravaged by the epidemic would amount to cruel and unusual punishment. He also implies that needed help for these countries would somehow be hindered by restricting air travel from them. He says that the only way to ensure Americans are safe from the virus is to care for people in the Ebola-ravaged countries of Sierra Leone, Guinea and Liberia who have it.
His statements are well-meaning but go against sound logic. The restriction of air travel FROM Ebola-ridden nations and the active transport of aid TO them are not mutually exclusive. I applaud our efforts to send the best care to Guinea, Liberia, and Sierra Leone. However, a travel ban will decrease the chances of more Ebola cases here. A healthier U.S. means more resources sent elsewhere.
10,000 travelers from West Africa arrive in the U.S. every three months through the hubs of Houston, New York, and Atlanta. Although those entering the country are questioned regarding symptoms and even have their temperature taken, it is simple to bypass these “safeguards”. If you doubt me, put some ice water in your mouth before placing a thermometer in your mouth.
Mr. Duncan was less than forthcoming regarding his exposure to Ebola. While many consider this reprehensible, I can understand why he felt compelled to lie to the authorities in order to escape the epidemic zone. Why wouldn’t others wanting to leave these countries be tempted to do the same?
We have a sophisticated system to deal with infectious disease, but it only works when guidelines are followed. Human error played a part in Mr. Duncan’s story when a health worker failed to communicate his travel history to the physician (note: this allegation is now in dispute). This is a red flag that failed to be hoisted up the flagpole. The fact is: Mistakes are made and they can happen again.
Dr. Frieden states: “The best way to protect ourselves is not to try to seal off these countries but to provide the kinds of services that are needed so that the disease is contained there. The only way to get to zero risk is to stop it there.” While it must be stopped there, how is exposing the United States to more potential Ebola victims a “zero risk” situation?
It has been suggested that the decision to restrict air travel should come from President Obama himself. Although this restriction is logical, it is difficult for a politician to wage the battle between individual freedoms and public safety. It makes logical sense, therefore, that the recommendation must come from those that lead our major health institutions. Dr. Frieden and his colleagues must come to the conclusion that will assure our continued good health while expending resources to heal those abroad. The restriction of air travel, even temporarily, is the quick, simple and RIGHT decision here.
Joe Alton, M.D., aka the Disaster Doctor
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