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U.S. Ebola strategy assigns critical role to airport quarantine stations

A medical worker wears a protective suit inside

A medical worker wears a protective suit inside an isolation room equipped to handle people inflected with the Ebola virus at Bellevue Hospital Center in New York on Oct. 8, 2014. Photo Credit: EPA / Justin Lane

U.S. quarantine stations in several key airports will play a critical role in the nation's Ebola defense, officials say, even as some experts question whether the country's new detection strategy will identify anyone with the deadly infection.

Federal authorities from Homeland Security and the Centers for Disease Control and Prevention announced last week that officials at five airports will ask passengers from three West African countries -- Liberia, Sierra Leone and Guinea -- a series of health questions and then take their temperature.

Saturday, Kennedy Airport became the first facility to start the fever checks.

Passengers found to have a fever will be sent to a quarantine station, where medical personnel will conduct a more thorough exam.

Officers at the stations possess legal authority to detain travelers based on their health status.

"The government has very broad powers to patrol our borders," said Michael Dorf, a Cornell University Law School professor who is an expert on constitutional issues involving quarantine. "Some intrusions that are not permissible domestically are permissible in matters of protecting the borders."

 

Most traffic at 2 airports

Quarantine stations at four other major U.S. airports -- Newark Liberty International, Washington's Dulles International, Chicago's O'Hare International and Atlanta's Hartsfield-Jackson -- will be involved in the nation's Ebola defense later this week.

Kennedy Airport receives about 43 percent of travelers from the three West African countries, followed by Dulles, which receives about 22 percent.

All five stations are part of a network of 20, which ostensibly serves as a safety net to keep dangerous infections out of the United States. The stations are part of the CDC.

Ebola has been on the stations' list of pathogens for years along with exotic flu strains, plague, diphtheria and several others.

Quarantine officers, who by training may be medical doctors, nurses and even veterinarians, are empowered by law to examine airline passengers and travelers who exhibit signs of illness arriving at key seaports or land borders.

Although a spotlight has been trained on Ebola, station personnel in recent months have been on the lookout for several other highly acute infections that may be emerging in hot spots or even circumnavigating the globe:

Tuberculosis, which has become drug resistant and pervasive in some countries.

Measles, a highly transmissible respiratory infection that causes a pervasive skin rash and is now on an upswing in some industrialized countries, the result of parents shunning vaccination for their children.

MERS-CoV, or Middle Eastern Respiratory Syndrome-Coronavirus, a deadly airborne infection that emerged in the Arabian Peninsula in 2012. Two travelers were diagnosed in the U.S. in May.

 

'Epidemic of fear'

Some doctors wonder whether checking temperatures for Ebola serves more to calm Americans stricken by "an epidemic of fear" than acting as a genuine firewall against Ebola.

The virus, they emphasize, is relatively rare and not easily transmitted. What is unprecedented, experts say, is the scale of the current epidemic gripping three countries that lack hospitals, are strapped for medical personnel and devoid of public health infrastructures.

"When a person is really stricken with Ebola they are not ambulatory. These people are not getting on planes. They are really, really sick," said Dr. Bruce Hirsch, chief of infectious diseases at North Shore University Hospital in Manhasset.

"If a person has a fever, what does that mean? A fever can be caused by all kinds of things."

Hirsch added that Ebola can have a long incubation period, up to 21 days, and that some people who are infected may not exhibit fever until late in the disease. Thomas Duncan, the Liberian man who died in Dallas last week, traveled through airports in three countries -- Liberia, Belgium and the U.S. -- apparently exhibiting no overt signs of illness. Ebola is a hemorrhagic fever virus that causes excessive internal bleeding.

Dr. Thomas Frieden, director of the CDC, said one concern with checking the temperatures of West Africans is the pervasiveness of fevers in people from that region, primarily the result of malaria.

The mosquito-borne infection is not only common, but can cause spikes in body temperature that wax and wane for years.

Because malaria is so prevalent, Frieden said, quarantine officers are more likely to detect that condition than Ebola.

 

Patients isolated on LI

On Long Island, doctors at North Shore and Nassau University hospitals have recently put patients in isolation out of an abundance of caution, only to find they were afflicted with malaria. Malaria, nevertheless, is a serious life-threatening disease.

Frieden said the five quarantine stations participating in the beefed-up Ebola defense will receive additional staff members. But the risk of Ebola occurring outside Africa cannot decline to zero, Frieden added, until the viral disease is stamped out in the three affected countries.

He said shutting down all air travel from West Africa is not practical because it would hinder the inflow and outflow of medical personnel and supplies.

Hirsch said panic is moving in waves across this country, and added, "I am concerned about the epidemic of fear surrounding Ebola."

"Ebola has been stopped in Nigeria after 20 cases. Nigeria shut this down and we are in a better situation than Nigeria," Hirsch said, referring to the United States as a global leader in health care and having had only one imported case.

Dr. Bruce Farber, also a specialist in infectious diseases at North Shore, said fever checks are a strategic way to make Americans feel secure.

"I think the major purpose of that kind of policy is to allay some fears and for the public to believe the federal government is doing something. I would think its efficacy would be modest.

"Basically, it's better than nothing, but far from ideal," Farber said.

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