Ebola is a very dangerous virus, no doubt—and cases may continue to crop up in the United States, but from what I know about how Ebola virus spreads, I think US cases will be rare, despite the media hysteria about it. The biggest threats to US health are things that are easily controlled and roundly ignored. Consider that one in every four men in the US will die of cardiovascular disease—that’s a real American epidemic! And hundreds—sometimes thousands—of Americans (mostly the very young and old) die each winter because of the common flu.
I could go on about so many other health issues that Americans should be concerned about, but fears about air travel and spread of Ebola virus loom large for many of you. For expert insight, I spoke with Monika K. Shah, MD, a specialist in infectious diseases and international health from Weill Cornell Medical College and Memorial Sloan Kettering Cancer Center in New York City.
“There’s a lot of fear right now, and I understand why,” said Dr. Shah, who is one of the clinicians at Memorial Sloan Kettering’s Travel Clinic, which provides pretravel counseling and vaccinations. “But rather than fear, we should allow science and facts to guide us,” she said.
Despite what you may have heard, Ebola is not an airborne illness. Airborne illnesses are those caused by particles that are so small and light (less than 10 micrometers, like those of the flu virus) that they waft into the atmosphere and stay active for minutes to hours. Ebola, which is made up of heavier particles, is transmitted only when the blood or other body fluids of infected people make direct contact with broken skin (cuts and scratches) or mucous membranes (of the eyes, nose, mouth and genital and anal orifices) of other people, said Dr. Shah. Some scientists believe that the virus can potentially be aerosolized, though. This means that droplets from infected phlegm from an uncovered sneeze, for example, can fly up to three feet before gravity pulls them to the ground. But explosive sneezing or coughing is not a symptom of Ebola.
And people can’t transmit the infection until symptoms—fever, severe headache, muscle pain, diarrhea, vomiting, stomach pain and unexplained bleeding or bruising—appear, said Dr. Shah, because that is when and how the virus sheds. It does not shed or cause infection of others if the infected person has no symptoms, Dr. Shah emphasized. The virus has a 21-day incubation period, meaning that someone who is exposed but does not develop symptoms within 21 days of exposure is clear of the possibility of being infected.
None of this is to say that Ebola isn’t highly contagious, as it clearly is. But just how it can be caught, and when, do matter if you want to be armed with the facts. Although politicians are calling for strict quarantines of people who travel to the United States from West Africa or who have had contact with Ebola patients, Dr. Shah says that this is overkill. The Infectious Diseases Society of America and Centers for Disease Control and Prevention (CDC) agree. They recommend that people entering the country from West Africa be monitored for 21 days. Monitoring involves having a health-care worker take a person’s temperature twice daily and check for symptoms. Health-care and relief workers are instructed to monitor themselves. No symptoms after 21 days? All’s well…live and let live.
If you, personally, believe that all travelers to the United States who have been in West Africa should be quarantined, that’s your prerogative, but know that none of the five cases of Ebola virus that occurred in the United States between September 30 and November 17, 2014, have resulted in infection of a member of the public at large. Four of those infected contacts were health-care workers who were in close contact with either symptomatic Ebola patients in West Africa or the fellow who became symptomatic four days after returning to Texas from a visit to Liberia.
Some people fear getting on a plane—any plane to anywhere—because of the Ebola crisis. And some panic that they will ipso facto be booted from a flight if they happen to have a cold, stomach upset or a low-grade fever on the day they must board a flight. Here’s the reality…
Pilots and flight attendants are trained to spot and question passengers who appear to be ill. The first thing they will do is ask whether you’ve traveled to West Africa. If so, the crew member will detain you and contact the CDC, which will handle the situation from there. If not, the airline crew will follow a standard procedure, which I will summarize after giving you this one other important piece of advice…
Importantly, while waiting in line at security, boarding or customs, do not let a wry sense of humor get away with you by jesting about having Ebola or any other serious infection. (Don’t jest about security threats, either!) I worked in airport security many years ago, and it has long been the policy to detain anyone who jokes about these issues. Airport personnel are required to take your jest very seriously.
Although airlines are within legal rights to bar sick passengers from boarding planes, being ill with a cold or stomach virus, for example, won’t necessarily get you booted from a flight even today. Airplane personnel are required, according to the CDC and aviation control guidelines, to take precautions, such as seating you away from other passengers, if possible. They are also required to monitor sick passengers to make sure that they cover their mouths when coughing, use tissues to dispose of phlegm, get those tissues into the garbage ASAP and maintain hand hygiene.
Airplane personnel are also required by the CDC to wash their own hands frequently, use hand sanitizers, and wear gloves and masks if dealing with seriously sick passengers who end up on a flight (for instance, passengers who become sick during a flight). If you are really concerned about inflight infection of any kind, there is nothing to stop you from adopting these practices, too, on the off-chance that you do see a flight attendant in mask and gloves.
Also, airplane crews are required to report to the cleaning crews whether a sick passenger was on board. Cleaning crews are specially trained in how to sanitize planes in such circumstances and are required to take those measures.
Of course, there’s no guarantee that all of these guidelines are always being scrupulously followed. However, outbreaks of Ebola have been occurring in West Africa for at least the past 50 years without having an impact on the rest of Africa or international travel. At best, the idea of Ebola has at least gotten people to more seriously think about infection control in public places—and gotten international officials to finally decide to take decisive action against Ebola epidemics in their countries of origin to better prevent spread of Ebola elsewhere.
As for travel to and from West Africa, the CDC has issued a high alert urging US residents to avoid nonessential travel to this area of the world. In addition to concerns about Ebola, people who do travel to West Africa (and any other undeveloped countries) should concern themselves with precautions against other, far more common serious illnesses, said Dr. Shah. These include cholera, malaria, typhoid fever and dengue fever to name a few. Precautions include…
• Getting available vaccinations against the diseases known to be afoot in the countries you plan to visit.
• Getting and taking prophylactic medications, prescribed by your doctor, that help prevent travel-related infections.
• Washing hands and using hand-sanitizer gels and lotions frequently.
• Eating well-cooked food and drinking only boiled or purified water.
So do not let media hysteria and spin about Ebola paralyze you. Dr. Shah especially reminded me that, unlike in West Africa where certain social customs and lack of health care and sanitation promote spread of Ebola and other deadly diseases, America and other developed countries do have the health-care infrastructure and social norms to contain Ebola virus cases and prevent epidemic spread.
