The Ebola Virus Disease (EVD) found it’s way into the United States in the form of Liberian man, Thomas Eric Duncan who was confirmed positive for the lethal virus on Sept. 30. Duncan reportedly lied on official paperwork in Liberia concerning his exposure to an Ebola patient and flew to Dallas, Texas via Brussels, Belgium and Dulles International in Washington DC.
Since that moment, there has been many on talk radio, cable news and US politicians who have called for a temporary ban on airline flights from at least Guinea, Sierra Leone and Liberia.
However, two of the most prominent public health officials in the United States say otherwise.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH) said the following in an interview on Fox News Sunday, “You isolate them, you can cause unrest in the country. It’s conceivable that governments could fall if you just isolate them completely.”
Centers for Disease Control and Prevention (CDC) director, Dr. Thomas Frieden echoed Fauci’s concerns saying, “If we don’t control the outbreak, there’s a real risk that it could spread to other countries in Africa and beyond. To do that, we need regular travel.”
I contacted several experts in public health, infectious diseases and virology to get their thoughts–What do you think is the right thing to do and why? The expert opinions were from both ends of the spectrum.
Columbia University Professor of Microbiology and Immunology, Vincent Racaniello, PhD said:
As the Ebola virus outbreak spirals out of control, the risk of importation of the virus into other countries increases. As of the beginning of September, one study concluded that the ‘probability of international spread outside the African region is small, but not negligible’ (http://currents.plos.org/outbreaks/article/assessing-the-international-spreading-risk-associated-with-the-2014-west-african-ebola-outbreak/). We have already had one importation into the US, where it was contained. There are many other countries that would not be able to detect and contain an Ebola virus infection. Therefore we face the scenario of seeing Ebola virus outbreaks in multiple countries, which would further increase the risk of spread. Therefore I believe that we should restrict travel out of Liberia, Sierra Leone, and Guinea, such that only individuals involved in providing assistance are permitted to leave.
The Dean of the School of Health Professions and Public Health at Mercyhurst University, David Dausey, PhD referred me to an opinion piece he wrote published in the Washington Post today and said, “My stance is that we should ban travel on commercial airlines until the outbreak is contained. I believe that we can use our military to transport aid and aid workers to the region.”
Associate Professor with the Department of Biostatistics, Environmental Health Sciences, and Epidemiology at Kent State University’s College of Public Health, Tara Smith, PhD had a different take on it:
A policy person would probably be better to respond than myself, but in general, I agree with Frieden. Stopping flights isn’t going to make us any safer–it’s just going to be more theater that will endanger more people than it’s supposed to be saving. We need to focus on stopping the epidemic in West Africa and doing anything that needs to be done to take care of that, including moving people and supplies in and out. If we can get that under control, then we minimize the risk of any infected travelers crossing into the US. Best to focus on the house on fire first, using Bill Foege’s words.
I don’t think the US should halt flights from any country because of Ebolavirus. That would be a radical – and I believe unprecedented – measure which would only worsen the course of the epidemic.Many people have been citing the precedent of the 2003 SARS epidemic, but to my knowledge we didn’t have any travel bans then. SARS is caused by a respiratory virus far more contagious than Ebolavirus, but even the most restrictive countries at the height of that epidemic only stipulated that people arriving with a fever had to be hospitalized and tested. They didn’t ban travel. In the US, the CDC screened travelers at airports and recommended delaying non-essential travel to a few specific destinations. Please confirm this with the CDC, but as I recall that was a recommendation, not a regulation. The WHO “travel restrictions” at the time were also recommendations, as the WHO does not have the authority to dictate national policies. A flight ban for Ebolavirus would be a really extreme move.
Besides being excessive, a flight ban would be completely counterproductive. The evidence for large-scale quarantine efficacy is spotty at best, and history suggests that people would just circumvent it. Ban flights to the US from Sierra Leone, and folks would simply find a route to another country before starting the US leg of their journey. Worse, by encouraging people to evade the direct routes, we’d completely lose the ability to track arrivals from the affected countries. Anyone flying in from anywhere could’ve originated in a country with Ebola. Meanwhile, we’d make it much harder for aid organizations and even governments to help those countries combat the epidemic. It’s already tough enough to transport people and supplies to these places. Additional barriers would effectively halt the response and make the whole situation much worse. Bear in mind that banning arriving flights is tantamount to banning departing ones, as no airline or cargo carrier is going to send air crews into a place they can’t get them back out of.