The Washington Post
By Mark Berman and Brady Dennis
October 6 at 7:53 PM
President Obama said Monday the U.S. government would increase passenger screenings in both the United States and Africa to detect the Ebola virus, though he resisted calls to impose a total travel ban on those traveling from the three West African countries most affected by the outbreak.
Neither the president nor White House officials elaborated on what those new screenings would entail. At the moment, passengers leaving the three nations riven by the virus — Liberia, Guinea and Sierra Leone — are screened for symptoms at the airport.
“The ability of people who are infected who could carry that across borders is something that we have to take extremely seriously,” Obama said Monday afternoon after a meeting with top advisers to discuss Ebola.
The range of new screening possibilities under consideration include everything from taking the temperature of travelers from impacted countries upon their arrival at major U.S. airports to conducting more stringent travel histories for international travelers arriving in the U.S., said a federal official familiar with the discussions, who asked to remain anonymous because plans have not been finalized.
Obama emphasized that the country was prepared to contain Ebola, saying that he felt the odds of an epidemic in the U.S. “are extraordinarily low.”
“In recent months we’ve had thousands of travelers arriving here from West Africa, and so far only one case of Ebola has been diagnosed in the United States, and that’s the patient in Dallas,” he said.
Obama spoke as Thomas Duncan, as a Liberian man stricken with Ebola, remained in critical condition in a Texas hospital. And his remarks came shortly after a nurse in Spain became the first known person to contract the virus outside of Africa.
This woman contracted the virus after caring for a priest who had been flown from Sierra Leone to Spain last month for treatment, Ana Mato, the Spanish health minister, said at a news conference Monday. The nurse’s condition was stable on Monday, and officials were trying to determine exactly how she contracted the illness, Muto said.
During his remarks Monday, the president was sharply critical of other countries that he said have not acted aggressively enough in response to the epidemic, which has killed more than 3,400 people and infected more than twice that number.
“Countries that think that they can sit on the sidelines and just let the United States do it, that will result in a less effective response, a less speedy response, and that means that people die,” he said.
Several Republicans on Monday called for heightened screenings or complete travel bans, with Texas Gov. Rick Perry (R) called for “enhanced screening procedures.” Sen. Ted Cruz (R) wrote a letter to the Federal Aviation Administration pointing out that the busy holiday season is looming and asked if the agency is planning on limiting or suspending air travel to the countries where Ebola is prevalent.
Perry and Cruz, both potential 2016 presidential candidates, hail from Texas, where last week Duncan became the first person diagnosed with Ebola in the U.S. The state is also home to international airports in Dallas, Houston, Austin and San Antonio that saw more than 55 million travelers in 2012, according to the Department of Transportation.
This issue has also come up in several key midterm contests in states that are home to some of the country’s busiest airports. Thom Tillis, the Republican nominee for Senate in the crucial battleground state of North Carolina, last week called for U.S. officials to ban travel from Liberia, Sierra Leone and Guinea. In Michigan, Republican Senate nominee Terri Lynn Land has also called for a travel ban.
North Carolina is home to Charlotte Douglas International Airport, which saw more than 20 million passengers in 2012. Detroit Metropolitan Airport in Michigan saw nearly 16 million passengers the same year.
U.S. airlines said Monday they would meet with federal authorities to discuss what would provide another layer of protection for their passengers. The trade group Airlines for America, which represents most of the major U.S. carriers, said “members that fly to affected countries remain in steady contact with government agencies and health officials, and have procedures in place to monitor and quickly respond to potential health concerns.”
Still, despite the furor, there does not appear to be a guaranteed way to prevent Ebola victims from flying into the U.S. There are, however, time-tested means by which the U.S. weathered two earlier global health scares: The swine flu pandemic in 2009 and the outbreak of severe SARS in 2002 and 2003.
Procedures developed during SARS and swine flu pandemic require flight crews to radio ahead whenever a passenger falls ill. In some cases, a heart attack, for example, the call would be made so that an ambulance could meet the aircraft. But with symptoms specified by the CDC, airlines are required to notify the federal disease control agency before the flight lands.
There are no direct flights by U.S. carriers from the three hard-hit nations: Sierra Leone, Guinea and Liberia, and fewer than half a dozen flights from anywhere in West Africa.The vast majority of travelers from Africa to the U.S. fly through hub cities in Europe. For example, Duncan flew from his native country to Brussels, where he boarded a flight to Dulles International Airport, changed planes and continued on to Dallas.
If a passenger books travel on a single ticket — Liberia to Brussels to the U.S. — tracking by the U.S. Customs and Boarder Protection will reveal the travel originated in Liberia. But any passenger who buys two tickets — Liberia to Brussels, and then Brussels to the U.S. — won’t show up the same way in the Customs data scan.
Airport officials, meanwhile, emphasized Monday that the CDC remains the lead agency for any response to the Ebola outbreak. The CDC maintains full-time offices at Dulles and other major U.S. destinations for international flights and there are quarantine stations at major airports across the country.
A spokesman for the Metropolitan Washington Airports Authority, which manages Reagan National and Dulles International airports, said that while there have been no formal discussions, there have been informal conversations regarding procedures in the event a passenger suspected of having Ebola moves through Dulles.
“As this has developed it’s on the forefront of people’s minds,” said Christopher Paolino, a spokesman for the airport authority. “Everyone wants to make sure we are prepared.”
The Federal Aviation Administration has the power to restrict flights by U.S. carriers and, working with the CDC and the White House, could revoke the right of specified foreign carriers to land in the U.S.
“While the FAA has the authority to direct flight operations in United States airspace, any decision to restrict flights between the United States and other countries due to public health and disease concerns would be an interagency decision,” the FAA said in a statement. “The World Health Organization and the CDC have not recommended general travel restrictions to or from the countries affected by Ebola.”
The White House said it was not thinking about banning travelers from West Africa, despite the uneasiness that followed Duncan’s diagnosis and the warnings that other Ebola cases are expected in the U.S.
“A travel ban is something that we’re not currently considering,” White House press secretary Josh Earnest told reporters Monday. He cited the “multi-layered” screening system currently in place as well as guidance given to flight crews and Customs and Border Patrol officers.
In a sign of how seriously the president is taking the Ebola outbreak, Obama convened virtually all of his top aides — from Lisa Monaco, Obama’s homeland security and counterterrorism adviser, who is leading the inter-agency coordination effort, to Katie Fallon, the White House director for legislative affairs — to discuss the administration’s response to the outbreak.
Public health officials have resisted a complete travel ban, which they warn would further impact the economies of these countries, hinder the ability to deliver desperately needed food and supplies and even limit the ability of doctors, nurses and humanitarian workers to travel into these areas.
Thomas Frieden, director of the Centers for Disease Control and Prevention, said Sunday that the agency has increased exit screenings at airports in the Ebola-riddled countries, using a combination of thermometers, questionnaires and “visual inspection” of travelers.
This screening had stopped 77 people from boarding planes, including 17 last month, he said.
However, this system is not foolproof, as is evidenced by Duncan’s diagnosis in the U.S. It relies upon a person filling out a questionnaire honestly and correctly, even though they may not know they had contact with a person with Ebola. A person who has contracted the disease but has not become symptomatic would not have a fever or any visible signs of illness, which means the thermometer and visual check would not help.
Duncan had his temperature taken by a person trained by the CDC using a thermometer approved by the Food and Drug Administration, Frieden said last week. He had no fever and did not display any symptoms until four or five days later.
The hospital treating Duncan, Texas Health Presbyterian Hospital Dallas, said Monday that over the weekend he had begun receiving an experimental treatment for the deadly disease. Known as brincidofovir, the drug is produced by Chimerix, a North Carolina-based biotech firm that describes itself as a developer of “novel, oral antivirals in areas of high unmet medical need.”
Brincidofovir is an antiviral drug developed to treat a range of viruses, including those in the herpes family and adenovirus, which accounts for some acute respiratory infections in children. The company, which also has sought to use the drug as a treatment against smallpox, said it also received permission to offer the drug to Ebola patients from the FDA, which must sign off on the experimental use of unapproved drugs. There currently are no approved treatments or vaccines for Ebola.
Duncan, who remained in critical but stable condition Monday, joins a handful of other Ebola patients who have received experimental drugs during the course of the current outbreak. Two U.S. missionaries infected this summer while working in West Africa were given doses of another unapproved drug, known as ZMapp. But the very limited supplies of that drug were soon exhausted; the San Diego-based company behind it is trying to produce more as quickly as possible. Another experimental medicine by a Canadian company, Tekmira, has been used on another American doctor who was flown to Nebraska from West Africa for treatment.
No one else that had contact with Duncan has showed any symptoms of Ebola, authorities said Monday.
Ashley Halsey III, Lori Aratani, Juliet Eilperin, Elahe Izadi and Sean Sullivan contributed to this report.
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