Diseased People Crossing Borders

Scanners in some major airports are recording body temperatures for embarking passengers. And at those airports, if you have a fever, you are not getting onto the aircraft you think you are booked on. We’re implementing that procedure on passengers arriving from West African countries with high Ebola rates. One response. Another, which seems to have found traction with some of our more conservative members of Congress, is to ban flights to and from areas with widespread infection. It works sort of, but the social and political fallout are significant. But Ebola is scary, deadly, and while the past outbreaks have been sufficiently contained to allow the virus to extinguish itself, with cutbacks in medical funding (like at our own National Institutes of Health), we simply diagnosed latest the outbreak well beyond where it would have normally been flashing on our medical radar.

There are a couple of observations about the Ebola virus. People who have not developed clear symptoms – starting with that escalating fever – do not seem to transmit the disease. And takes somewhere between two and twenty-one days from the time of infectious contact (and it does take contact with the virus itself) to the onset of the disease itself. So a traveler without symptoms is not contagious until those symptoms become real. Most medical professionals believe that notwithstanding our initial diagnostic missteps, this Ebola outbreak isn’t going to become an epidemic here in the United States. New treatments are developing and likely to be effective, and some are already in use. Not particularly comforting for the thousands of seriously infected persons (and the families of the thousands lost already) in West Africa.

But this does seem to raise questions of how our own Centers for Disease Control and our border guardians are prepared to deal with travelers with infectious diseases in a world where global interaction is deep and constant. If a traveler is pulled out of an immigration line with “symptoms,” as inspectors keep their eyes open, focusing even more on those who have either described ailments in their landing or debarkation cards or are coming from areas where disease outbreaks are clear, their first line of defense is quarantine.

The word “quarantine” itself has an interesting etymology. It derives from Latin for “forty,” and is based on the practice of Renaissance-era Venice where foreign vessels were often required to sit off-shore for 40 days to insure that any onboard diseases would have run their course. Our quarantines are not so simplistically determined, but we have been applying the concept for a long time. Citing concerns over small pox and yellow fever, New York City initiated the quarantine movement in 1738, designating Bedloe Island (later the home of the Statue of Liberty; the pre-statue island is pictured above) as an isolation center. Various cities have since imposed similar sanctions, but it was not until 1878 that Congress pulled the quarantine obligations from states and cities into the federal government. However, it took until 1921 to move the last local quarantine center to federal control.

Budget cuts in the 1970s dropped the number of CDC quarantine centers from fifty-five to a mere eight, and by 1995, that number had dropped to seven. With the 1996 Olympics, Atlanta added one more. However, in response to the SARS (severe acute respiratory syndrome) epidemic sweeping the globe, between 2004 and 2007, the CDC elevated the number of federal quarantine centers to the present-day twenty. These facilities are quite well-constructed with secure isolation rooms and treatment/diagnosis procedures staffed with highly experienced personnel.

In a paranoid, volatile and dangerous world, just knowing how we deal with cross-border infectious diseases would seem to be important to assuaging concern and eliminating panic. Yes, we would have known more earlier if the Sequester (even with some cuts restored) had left a bigger federal medical operating budget, but we have what we have. And while too many have died in West Africa by reason of a failure to recognize the extent of the outbreak soon enough – something our NIH/CDC would not have missed in more financially-solvent times – there is much less to fear here in the United States over the Ebola outbreak. So far anyway, and there doesn’t seem to be much of a reason for us to worry too much about a local Ebola epidemic.

I’m Peter Dekom, and I thought you might want to know how our back-up systems are working to keep us from being exposed to epidemic risks.