Why Ebola air travel restrictions keep changing

In recent days, Ebola-related restrictions on travel keep changing, sometimes in ways that can be confusing to airline passengers and to the general public. There are two basic reasons why this is happening, the first being the changing nature of the Ebola outbreak, and the second because there are several kinds of independent decision makers when it comes to Ebola travel policies.

The changing face of Ebola
As of late October 2014, Ebola remains a serious epidemic, and according to the CDC, over 10,000 people have been infected with roughly 5,000 dead. The largest number of cases are in three west African countries, Liberia, Guinea, and Sierra Leone. There have been at least five other countries with one or more Ebola cases, and for two these countries, the US and Nigeria, the virus was carried there by an airline passenger.

US response
The response of US authorities has been varied, with the key responses including the following:

• Federal requirements that air travelers who fly directly from Liberia, Guinea, or Sierra Leone enter the US in to one of five airports, each of which has a screening program to evaluate travelers from those countries.
• Additional requirements from several states (including states containing at least four of the five entry airports) that include some form of quarantine for some or all travelers who have been exposed to Ebola.
• US military authorities have either quarantine or evaluation programs for military personnel who have provided support in efforts to address Ebola in west Africa.

Why is the US concerned?
Although there have only been a handful of Ebola cases in the US, there has been a very high level of interest and concern by the public and the US government in keeping Ebola from becoming a serious problem. This concern is likely based on the reality that there is a significant number of people who travel between the US and those countries most affected by Ebola, including thousands of medical professionals and military members who are directly involved with fighting the epidemic in west Afria; and citizens, residents, and visitors from Liberia, Guinea, and Sierra Leone.

Who makes Ebola decisions in the US
In the US, various units of government are able to make decisions independently of one another, and that can lead to multiple, overlapping, and sometimes contradictory policies. In the case of Ebola, a few of the independent decision makers include the following:

• The federal government can enforce policies involving things like air transportation, travel between US states, and border security.
• Individual states, including cities, counties, and smaller government units within the states, can enforce restrictions or quarantines on air travelers that go beyond federal requirements.
• Military organizations, in addition to having access to its own air transportation system, can impose restrictions on members of the armed forces that may go far beyond those imposed by either the states or by federal governments.

In addition to units of government, individual travelers can make decisions that can easily circumvent the restrictions of the federal or state governments, largely because federal and state governments often have to rely on information provided by air travelers and have no way to independently verify a traveler's claims about their travel history.

So far, no individual air traveler has has caused someone in the US to contract Ebola due to deliberately avoiding the current screening and restriction programs or because of a failure of one of those programs. Should that happen, or should there be a sharp increase in the number of Ebola cases in the US, it is very likely that one or more government organizations may change air transportation rules in significant and unpredictable ways.

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Background information
AskThePilot.com on air travel bans
Air travel bans to control epidemics
Background information on Ebola
Background information on SARS

Why an air travel ban for Ebola may not help

In the days after the first Ebola fatality in the US in early October 2014, from a person who contracted the disease in Liberia and later flew to Dallas, TX, there have been concerns in some circles, most notably in the political arena and throughout social media, that there should be some kind of travel ban put into effect to keep other infected persons from traveling to the US. These concerns were due in part to the fact that two of the medical personnel who were involved with the treatment of the Ebola patient in Dallas also contracted Ebola.

US government passenger screening
In mid-October 2014, the US government implemented a screening process to check travelers flying to the US from Liberia, Sierra Leone, and Guinea for either Ebola-like symptoms, or exposure to the Ebola virus. This was done to manage the risk the US population faced from travelers who may be infected with the Ebola virus and who knowingly or unknowingly fly to the US.

The screening program was in effect for five US airports that accounted for about 95% of the travelers to come to the US directly from those countries. This program lessened the effect of a risk, specifically making it less likely that someone exposed to or infected by Ebola would also expose the general population to that disease.

While this screening program provided some protection from arriving passengers who may have been exposed to Ebola, it did not go as far as an outright ban of travel by people from that region, a ban which could potentially have eliminated the risk or made it much less likely to occur.

Reasons a ban may be impractical
While the idea of a ban on travel to and from the three most affected African countries, may appear to be a prudent step to take to keep the epidemic from spreading to America, there are a number of reasons that it may not be effective, and in fact may make it harder to control the Ebola epidemic in the most heavily impacted countries. A few of those reasons include the following:

• No US airline provides direct service to Liberia, Sierra Leone, or Guinea, and the US government has no legal authority ban flights to the affected countries by non-US airlines.

• US citizens and permanent residents are allowed to travel to Liberia, Sierra Leone, and Guinea without prior approval from the US government.

• Banning international travel to or from Liberia, Sierra Leone, and Guinea would have done nothing to address domestic flights taken by those already in the US who were recently in one of those three countries.

• Several thousand US residents who are or may soon be traveling between those three countries and the US are medical professionals, civil servants, military personnel, and others who are or will be part of ongoing efforts to control the Ebola epidemic.

While the US at present has no outright travel bans in place, the changing nature of the Ebola epidemic may lead to some kind of travel ban in the future. For additional details on the kinds of travel bans that could be put into place, as well as why enforcing such bans may be difficult, visit AirSafe.com's Air travel bans to control epidemics page.

Background information
AskThePilot.com on air travel bans
Air travel bans to control epidemics
Background information on Ebola
Background information on SARS

About 800 Frontier passengers may have been exposed to Ebola virus

CDC Expands Passenger Notification
A nurse who had treated the first US Ebola patient was exposed to the Ebola virus and later contracted the disease. Before she was hospitalized, she had taken the following two airline flights in early October 2014 on Frontier Airlines:

• October 10th: Fight 1142 from Dallas, TX (DFW) to Cleveland, OH.
• October 13th: Flight 1143 from Cleveland to DFW.

Several days ago, it was revealed that this passenger had a fever while on the return flight, and may have put others on the aircraft at risk. The CDC and the airline started working together to contact passengers who were on flight 1143 from October 13th in order to interview them and to provide any necessary advice or information.

On Thursday October 16th, the CDC also revealed that they were looking for passengers who were on the earlier flight on October 10th. This is because the infected nurse, who was hospitalized one day after the October 13th flight, may have been exhibiting Ebola symptoms during the earlier October 10th flight.

What should those passengers do?
If you were on either of these Frontier Airlines flights, the CDC suggests that you contact them at the following numbers:

• 800-CDC-INFO (800-232-4636)
• 800-232-6348 (TTY)
• 1-404-404-639-3311 (main switchboard)

Were the airplanes contaminated?
It is unclear if the airplanes used on those flights were contaminated with the Ebola virus. According to an October 15th article from the Denver Post, the plane used for flight 1143 was cleaned using procedures that were consistent with CDC guidelines after the October 13th flight, and and again after flying on five additional flights on October 14th.

After Frontier was notified about the infected passenger on October 15th, the aircraft was removed from service. The aircraft has since been cleaned two more times, had its environmental filters changed, and had seat covers and carpets in the vicinity of the infected passenger replaced. The two flight crew and four cabin crew members were placed on paid leave for 21 days. The article did not mention the taken for the aircraft and crew used for flight 1142 on October 10th.

Passengers on other flights may be at risk
While the CDC is only actively seeking out passengers on flights 1142 and 1143, according to another Denver Post from October 16th, Frontier Airlines attempting to contact the roughly 800 passengers who were on the following five flights from October 14th and suggesting that they contact the CDC:

• Flight 2042, DFW-CLE, departed 7:50 am CDT
• Flight 1104, CLE-FLL departed 12:13 pm EDT
• Flight 1105 FLL-CLE departed 3:43 pm EDT
• Flight 1101 CLE-ATL departed 7:14 pm EDT
• Flight 1100 ATL-CLE departed 9:57 pm EDT

Related resources
October 15th Denver Post article
October 16th Denver Post article
Ebola and airline travel issues

Evolving issues with Ebola and air travel

The recent news that a nurse, Amber Joy Vinson, who was both infected by the Ebola virus and showing Ebola-related symptoms, was on an airline flight with 132 other passengers (and at least five crew members) was disturbing for a couple of reasons. The primary concern was that this nurse, who had a low-grade fever but no other Ebola-related symptoms, put all the passengers and crew on that plane at risk of being infected by the Ebola virus.

The secondary concern is that passengers on other flights may have also been exposed to the Ebola virus. The October 13th Frontier Airlines flight, which was flight number 1143, departed from Cleveland and flew to the Dallas DFW airport. This airport is a major hub airport for American as well a popular airport for international flights. It is likely that many of the passengers on that Frontier flight were changing planes in Dallas, may have exposed thousands of other passengers to the Ebola virus.

Nurse Vinson was not reckless or unaware of the risk of her flying. She had been directly involved with treating an Ebola patient in Dallas, and had been monitoring her health status for signs of an Ebola infection. She realized that she had a fever, which is a symptom of Ebola infection, and had contacted the Centers for Disease Control for advice on wether she should fly.

At the time, her fever was low enough to allow her to fly, and the CDC gave her permission to take that flight. Since then, the CDC has admitted that their decision was not the right one, and have changed their policy on travel by health workers who have been exposed to the Ebola virus.

Recent interviews
Below are several recent Ebola-related interviews and articles by Todd Curtis of AirSafe.com

• 17 October 2014: CJOB Winnipeg, Canada radio interview
• 17 October 2014: Newsmax television interview
• 15 October 2014: WFAA television Dallas, TX
• 15 October 2014: CTV television Canada
• 9 October 2014: CJOB radio with host Charles Adler
• 9 October 2014: Article: US airport screening procedures

Additional resources
Background information on Ebola
Passenger with Ebola flies to Dallas
Patrick Smith of AskThePilot.com on air travel and Ebola

Update on the location of flight MH370

On 8 October 2014, the Australian Transport Safety Bureau (ATSB) released an update detailing their best estimate of the current location of Malaysia Airlines Flight MH370. The location of this 777, which went missing on 8 March 2014 with 227 passengers and 12 crew members who were on board, is unknown, and in the seven months since the aircraft went missing, no trace of the aircraft, its passengers, or its cargo have been found.

In spite of this lack of direct, physical evidence, information from other sources, including radar data and signals sent from the aircraft to an INMARSAT satellite, were used to estimate both the duration of flight for the aircraft, and its approximate position when the aircraft presumably ran out of fuel over the southern Indian Ocean.

After an initial underwater search was ended last May, the ATSB, along with support from other nations, has spent considerable time producing more detailed maps of the seafloor in the vicinity of the proposed search areas, and refining the estimate of the likely location of the aircraft. The recent ATSB analysis, which included simulations of various end of flight scenarios, came to the following conclusions

• The last satellite communication occurred very near the estimated time of fuel exhaustion.
• The ATSB, Boeing, and Malaysia Airlines have been working on various end of flight scenarios.
• In a scenario involving fuel exhaustion with no control inputs, the aircraft entered a descending, spiraling low bank angle left turn and entered the water in a relatively short distance after the last engine flameout.
• The results of the new analyses support the search area defined in an earlier ATSB report from June 2014.

While the government of Malaysia has the overall responsibility for the search for the aircraft, the government of Australia, at the request of the Malaysian government, is leading the search for missing Malaysia Airlines Flight MH370

Related resources
ATSB flight path update from 8 October 2014
ATSB definition of underwater search area
AirSafe.com flight MH370 page

Photo: ATSB

New Ebola screening measures likely not effective

On October 8th, 2014 the US Centers for Disease Control (CDC), along with US Customs and Border Protection (CBP), announced a series of new screening measures at selected US airports. These measures, which will focus on travelers arriving from the west African nations of Liberia, Guinea, and Sierra Leone, the three nations most affected by the latest Ebola outbreak.

These new screening measures will be at five airports: New York's JFK and Newark airports, Washington Dulles, Chicago O'Hare, and Atlanta. The first airport to begin screening will be JFK on October 11th, and the enhanced entry screening at the other four airports by the end of the following week.

Why these five airports? While the CDC admits that no procedure will completely eliminate the risk of an Ebola outbreak in the US, These new screening measures will be at five airports: New York's JFK and Newark airports, Washington Dulles, Chicago O'Hare, and Atlanta. According to the CDC, these five airports represent the US entry point for the first airport to begin screening will be JFK on October 11th, and the enhanced entry screening at the other four airports by the end of the following week.

Why these five airports? According to the CDC, these five airports receive over 94 percent of travelers from the Ebola-affected nations of Guinea, Liberia, and Sierra Leone. From August 2013 to July 2014, with JFK alone accounting for almost half the arrivals

What are the new procedures? Travelers from these three countries, who would have already gone through exit screening protocols in the affected West African countries, will face the following process:

• Travelers from Guinea, Liberia, and Sierra Leone will be escorted by CBP to an area of the airport set aside for screening.
• They will be observed them for signs of illness and asked a series of health and Ebola exposure questions.
• They will also have their temperature taken by a non-contact thermometer.
• If the travelers have fever, symptoms or if the health questionnaire reveals possible Ebola exposure, they will be evaluated by a CDC quarantine station public health officer, and if necessary referred to the appropriate public health authority.
• Travelers from these countries who are not Ebola-like symptoms exhibiting symptoms and who have no known history of exposure will receive health information for self-monitoring and will be allowed to enter the country.

How effective has exit screening been?
According to the CDC, since exit screening began about two months ago in Liberia, Guinea, and Sierra Leone, 36,000 people were screened and 77 people were kept from boarding a flight.

None of these 77 passengers were diagnosed with Ebola. However, at least one passenger who was infected with Ebola, but who was apparently not exhibiting any Ebola symptoms, was able to depart Liberia on September 19th, and flew to the US through Washington Dulles airport and then onward to Dallas, TX. This passenger, Thomas Eric Duncan later fell ill and died from Ebola.

How effective will this new entry screening process be?
In order for this screening process to identify passengers who are infected with Ebola, passengers must either be being both able and willing to provide accurate information on their Ebola exposure, or the passenger has to be exhibiting a fever or other symptom associated with Ebola.

Perhaps most importantly, in order to be even screened by this procedure, a passenger must be on a flight that comes directly from one of the three affected countries, and they must enter into one of the five airports that are part of the new screening program.

This means the roughly 6% of passengers who fly directly from the affected countries into another airport are not screened at all. However, there is a potentially much larger pool of passengers who will not be screened or who will not be identified by the proposed screening process, including passengers in the following categories:

• Not flying directly from the three targeted countries, for example having a layover of one or more days before flying onward to the US.
• Persons exposed to Ebola, who are not showing any symptoms, and who are either not aware of their exposure or who are not truthful about their exposure.
• Either exposed to or infected by the Ebola virus, and possibly even showing Ebola-related symptoms, but who are not flying from the three targeted countries.
• Entering the US by sea or through a land border.

Why make the effort if it will not be 100% effective?
The goal of these new procedures is the find and treat any passenger infected with Ebola upon arrival in the US. Clearly, these new procedures were not designed to screen every passenger entering the US, or even every passenger who is from a country that has had one or more reported Ebola cases (which include Nigeria, Senegal, and Spain).

Like many risk-reduction procedures, they will reduce the likelihood of that an Ebola-infected passenger will enter the US. However, given that passengers who are not exhibiting symptoms can easily escape notice, and that many categories of people entering the US will not be screened at all, it is quite likely that these new CDC and CBP procedures will at best be only somewhat effective and preventing an infected person from entering the US.

On October 9th, Todd Curtis of AirSafe.com and CJOB radio's Charles Adler discussed Ebola airline travel issues and risks airline passengers may face.

Additional information
AirSafe.com Ebola overview
How one Ebola-infected passenger made it to the US
CDC fact sheet on new screening procedures

Airline passenger infected with Ebola arrives in US

On September 30, 2014, the US Centers for Disease Control and Prevention (CDC) announced that the first case of Ebola to be diagnosed in the US involved an airline passenger, Thomas Eric Duncan, who had flown from Monrovia, Liberia to Dallas, Texas after stopovers in Brussels, Belgium and at Washington Dulles Airport in the US. The passenger, who departed from Liberia on September 19th and arrived in Dallas the next day, did not display any symptoms while he was traveling, and fell ill four days after he arrived.

Duncan is currently being treated in a Dallas-area hospital, but several key questions remained unanswered, such as how this passenger, who was infected while he was traveling in Liberia, was able able to travel to the US by flying on two airlines and passing through three airports without being detected.

For more information on this the information about this particular passenger, and to find out if you may have been on a flight taken by this passenger, you can visit the AirSafe.com page on Thomas Duncan.

More about Ebola
For more about Ebola, including links to CDC information for travelers, airline crews, airport crews, and others who may be exposed to people infected with Ebola, visit ebola.airsafe.com.