Why One Public Health Expert Thinks Airport Ebola Screening Won't Work
Centers for Disease Control and Prevention Director Tom Frieden has said his organization will soon be implementing new health screening procedures at U.S. airports. It's part of an ongoing effort to control the spread of Ebola.
"We'll be strengthening our screening procedures both at the source and at entry," Frieden said at a news conference yesterday. His comments echoed calls for stepped-up screening by President Obama and Texas Gov. Rick Perry.
What will these screenings entail? And will they make Americans safer?
It's difficult to say, because the CDC hasn't released many details yet. Larry Gostin, a professor of global health law at Georgetown University, says the new requirements will likely mirror procedures already used in some West African airports: travel history, looking for signs for illness, and a temperature reading.
When it comes to the likelihood of these interventions benefiting public health, Gostin is skeptical.
"Fever screening can be unobtrusive, but let's not have the false impression that this is a tried-and-true method and it's going to keep Ebola out of the United States," he says. "It's just not the case."
In fact, there's little evidence that fever screenings for arriving passengers do much to prevent the spread of Ebola or other diseases.
Consider the case of Ebola patient Thomas Eric Duncan, who traveled to the U.S. from Liberia and is now in critical condition in a Dallas hospital. He would not have been detected either in Africa or the U.S. because he was not exhibiting any signs of the virus.
Or consider the case of Australia and the 2003 SARS outbreak. The country's airports screened more than 1.8 million incoming passengers for the airborne virus and found 794 with elevated temperatures. They held those travelers for additional testing, but no one turned out to have SARS.
Singapore and Canada saw similar results: millions of passengers screened, and few if any SARS cases detected. Meanwhile, thousands of people saw their travel plans disrupted and in some cases were quarantined for a week or longer.
Plus, Gostin says, many people know how to game the system. During the SARS outbreak, Gostin was on a flight to Beijing when the airline flight attendants began handing out Tylenol to first-class passengers. They were encouraged to take the medicine, to be sure they passed fever screenings.
And he worries that false positives could divert money and manpower away from actual Ebola cases.
"Just the other day, at Newark airport, someone came in with vertigo." He claims that high-level officials spent hours dealing with that one false alarm: "It's kind of not what you want."
Given this lack of evidence, why are new entry screenings being implemented? Gostin says it might have to do with an age-old tradition: The public gets scared and demands that the government protect them.
"And governments, even if they know better, will sometimes reply to that political outcry," Gostin says. "They're under a lot of pressure to do something [to] make the public feel reassured, even if it really doesn't make them safer."
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Transcript
RACHEL MARTIN, HOST:
Travel to and from West Africa is getting more complicated because of the Ebola outbreak. The Centers for Disease Control and Prevention says some 36,000 airline passengers traveling from West Africa have been screened for signs of Ebola over the past two months. Although, at a press conference yesterday, the head of the CDC said screenings haven't revealed any new cases of Ebola. Even so, Thomas Frieden said passengers flying into the U.S. from West Africa will start to get screened on this side of their trip as well.
(SOUNDBITE OF PRESS CONFERENCE)
THOMAS FRIEDEN: We're not, today, providing the steps that we plan to take. But I can assure you that we will be taking additional steps. And we will be making those public in the coming days once we can work out the details.
MARTIN: NPR's Anders Kelto has been speaking with public health experts about the issue, and he joins us now. Welcome to the program.
ANDERS KELTO, BYLINE: Thanks, Rachel.
MARTIN: So first off, President Obama has said travel bans to West Africa are not being considered. Do public health experts agree that that would be a bad idea, limiting travel?
KELTO: Yeah, there's pretty much uniform agreement on that. Restricting travel to those countries affected by Ebola would hurt their economies, which are already very debilitated. It could even destabilize those governments. And it would prevent an influx of health workers, which are badly needed right now. All of that could fuel the epidemic, lead to more cases and actually put us and the rest of the world even more at risk. And then there's a huge set of practical challenges. I mean, how do you prevent people who have travelled to that part of the world from making it to the U.S.? - and all of this for a disease that experts say is very, very unlikely to turn into an epidemic here in the states.
MARTIN: The three countries most affected by Ebola right now are conducting exit screenings. And you recently returned from Sierra Leone. You went through this. What is an exit screening like?
KELTO: Well, when we got to the airport, we had to go through multiple checkpoints. We had our temperatures taken. We had to wash our hands in this chlorine water. And we had to complete a questionnaire confirming that we had not had any direct contact with anyone with Ebola. And according to Dr. Frieden from the CDC, officials have prevented 77 people from boarding flights out of West Africa because they were running fevers. But none of them so far have turned out to have had Ebola.
MARTIN: So this is happening on both sides now because the discussion is now focused on entry screening. How would something like that work in theory?
KELTO: Yeah, well, that's what Dr. Frieden says will be happening, or we'll find out more about exactly what will be happening this week. So it's unclear exactly how this will work. But the experts that I spoke with said that the most likely scenario is that people will be giving a questionnaire. You know, they'll have to explain where they've been and whether or not they've had contact with anyone who might have Ebola - and having your temperature taken. I spoke with Larry Gostin from Georgetown University, who's a public health expert there. And taking temperatures isn't necessarily effective.
LARRY GOSTIN: Fever screening is, you know - it can be unobtrusive, and it's not terribly expensive or difficult. But let's not have the false impression that, you know, this is a tried and true method and it's going to keep Ebola out of the United States. It's just not the case.
KELTO: So for example, if you look at Thomas Eric Duncan, the man in Dallas who arrived from Liberia and then got sick with Ebola, he wouldn't have been stopped by the screening method. In fact, there's very little evidence that this type of screening works. So let me give you some numbers. In 2003, during the SARS epidemic, Australia began doing entry screening on international passengers. So they screened over 1.8 million people. And they did not detect a single case of SARS. And SARS is an airborne disease, and it's much more contagious than Ebola. They did quarantine 794 people and give them additional screening, but none of them turned out to have SARS.
MARTIN: So if there's so little evidence that this actually makes a difference, why is the U.S. considering it?
KELTO: Well, we'll have to wait and see what the CDC says. But Larry Gostin from Georgetown, who I spoke with, said it may have to do with a long-standing tradition, both in the U.S. and elsewhere, of basically, scared people demanding action from their leaders.
GOSTIN: They insist to their government, do something - doesn't matter what it is. Show us that you're doing something. Tell us that we have no risk. And governments, even if they know better, will sometimes respond to that political outcry. They're under a lot of pressure to do something, make the public feel reassured, even if it really doesn't make them safer.
KELTO: So according to Gostin, that may be what we're seeing here.
MARTIN: NPR's Anders Kelto. Thanks so much, Anders.
KELTO: Thank you, Rachel. Transcript provided by NPR, Copyright NPR.
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