I’m not an epidemiologist and I have no greater understanding about the spread of ebola than what I’ve read from others.
So I am limiting the scope of my commentary on the spread of the disease and travel. (Relatedly, I found this Wired piece from August on the extent to which disease spreads on planes interesting.)
One of the hot topics under discussion is the idea of an ebola travel ban, stopping anyone ‘from West Africa’ from entering the United States. I’ve seen lots of discussion of this in my Facebook feed, including a couple of links to a Whitehouse.gov petition with over 35,000 signatures.
Have the FAA ban all incoming and outgoing flights to ebola-stricken countries until the ebola outbreak is contained
While there are certainly capabilities to limit entry into the United States by certain persons, it strikes me that the whole idea is far more complicated than broadly understood or discussed.
- There’s no such thing, for instance, as a Monrovia – New York flight. There are very limited flights from West and Central Africa direct to the U.S. (these include the six times weekly United Lagos-Houston flight and the three times weekly Arik Air Lagos – New York JFK flight, Delta’s Dakar – New York JFK and Accra – JFK flights and South African’s Dakar – Washington Dulles flight). Most travel from the affected region would be via Europe..
- So we’re not just banning a certain set of flights, a policy would presumably be banning specific passengers enroute from Europe. And that’s harder.
You can stop people on entry into the U.S. But if they are infected with Ebola, they may have infected many others on the flights they took to the U.S. So the policy would keep them out, but not the people they infected.
You can stop people from boarding flights into the U.S. in the first place, but since it’s specific people on specific flights from Europe, this gets harder to do than it might seem at first blush.
The Department of Homeland Security generally knows the flight plans of each arriving passenger. They know everyone on an arriving aircraft, since airlines flying to the US have to provide their manifests in advance.
And DHS then cross-references against their PNR (reservation) database. So if passengers are traveling to the US on a single ticket, the US government knows where they have come from. It should be possible to decide that passengers on an itinerary originating in West Africa are ineligible for entry to the U.S, and thus should be denied boarding. And that passengers should not be permitted to purchase itineraries to the U.S. originating in West Africa going forward. (Existing tickets would have to be refunded.)
If a passenger, though, purchased a ticket say Monrovia – Brussels, and then a separate ticket Brussels to Washington DC, New York, or Chicago then the US government may not to know that the passenger originated in Liberia.
Another approach would be to bar passengers with West African passports from entering the U.S. But that could include people who haven’t been in Africa for months or longer. In other words, they would be banning Europe-originating passengers.
And it would not help keep out, say, Europeans who have been in West Africa.
It seems there are travel limitations that the US could put in place, but it is not obvious that the US could keep all of those people it intends to avoid entering into the US from doing so, and such a policy would likely keep out people who such an approach doesn’t intend to bar.
How would a West Africa travel ban even work?
- You can join the 40,000+ people who see these deals and analysis every day — sign up to receive posts by email (just one e-mail per day) or subscribe to the RSS feed. It’s free. You can also follow me on Twitter for the latest deals. Don’t miss out!
It was stated early on that EBOLA would be hitting our shores quicker then we would like, and it has. Placing a ban on travel from west africa would be the wrong thing to do, didn’t we learn anything from the HIV/AIDS pandemic? SARS is the perfect example on how to take care of a global health issue…
My DXB – JFK flight EK201 (Seat 2K A380 award Tckt) yesterday was met at the plane door by CBP officers checking passports. I passed & sailed away for a close connection on AA 2 DCA so don’t know if people were stopped. At departure in DXB a guy in front of me at First/Biz gate was escorted to a different elevator. Thanks to Global Entry & Pre-CK I made connection.
BTW I entered Australia just like Global Entry what a pleasure after being airside for PR 48 hours. #RTW14
Agreed that there is no perfect way to shut it down. But do we choose not to do it because it’s not perfect? If it helps protect us and our children, as a temporary measure, shouldn’t we at least consider it? As we send troops and help build field hospitals in Africa, aren’t we trying to contain it there, at least part of it?
From September 5, 2010 until August 31, 2014, Delta Airlines flew JFK to Monrovia via Accra (a few times weekly.) Just an FYI.
As far as a travel ban from the 3 countries, it can be done in 2 ways:
1) International cooperation to quarantine all 3 countries. Ivory Coast and Guinea-Bissau already closed its borders with those 3 countries. No ebola outbreak in either country. Europe, USA, and the international community need to cooperate in order to close down all commercial airports and only open flights for medical/health teams.
2) Airlines themselves suspend flights. Several airlines including British Airways, Kenya Airways, Emirates, & Delta. Delta suspended all its Monrovia flights back in August 31st, 2014. If you go to wikipedia and lookup the airports of Freetown, Monrovia, and Conakry, you’ll see ALL airlines suspended their flights with the exception of Royal Air Maroc, Brussels Airlines (star alliance), and Air France (skyteam).
@Bill n DC, that is quite common for EK’s DXB-JFK flight. I’ve flown EK201 and EK203 several times from 2008-2013 and I’d say that occurred 60% of the time.
As for my previous comment, obviously nothing is perfect but I think the 2 options I provided is feasible. The US certainly can’t do it alone and cooperation from the international community is needed.
You left out another category of pax that makes this policy unworkable: US citizens. A substantial number of the people travelling to the US from affected countries are Americans. Would they be banned from entering the country?
I absolutely love this, “Have the FAA ban all incoming and outgoing flights to ebola-stricken countries until the ebola outbreak is contained”.
Exactly what definition of “ebola-stricken” would they like to use? Someone has Ebola? It’s spreading despite containment attempts? Its spread repeatedly? Sounds to me like the US qualifies.
Fine by me (a Canadian), but I think the average American might not like all international flights to/from the US being cancelled.
And what about cancelling all flights to/from Texas? And lets not forget that we now have to fence in and secure that state’s long border.
Seriously, the risk of catching Ebola is primarily when the infected folks are very, very sick – when they are likely in a health care facility. Which is why we mostly see health care workers getting infected. (They are the genuine heroes in this tragedy.)
I find the hysteria around Ebola bizarre. More people die from diarrhea each day than have died from Ebola in the entire history of the disease. More Americans die from the flu each year than all victims of Ebola worldwide ever. This is a manufactured crisis on an epic scale. Unless the victims start reanimating, a la zombie apocalypse, this will have no effect on my life (or my travels)!
Although obviously not an ideal measure, bans will certainly be put in place when we get the inevitable outbreak in a major US or European center – human fallibility makes this almost a guarantee. The ineptness shown so far in the medical responses in some of these cases outside of Africa is astounding and truly worrisome.
Containment can only be achieved at the origin of the problem. People cannot be allowed to leave if they come from an affected area unless they pass though quarantine first. Any measures outside of Africa are all too late and wishful thinking.
Believe it or not, the West African countries are very cooperative. I believe they would assist in setting up a quarantine on their own soil to be overseen by the airlines. West African citizens wishing to come to the U.S. would first check into a designated hotel and simply have a nice 21-day vacation before continuing their travel. American citizens would travel the the U.S. and check into a designated facility for 21-days before going on their merry way.
It’s really easy. It bothers me when leftists act like this is something incredibly hard. It’s not hard.
Just because a solution only covers 70% of the problem (or whatever) doesn’t mean we should do nothing. It still mitigates risk. Also, your argument about people who get infected on the plane doesn’t work. Someone may travel here and infect no one on the plane, only showing symptoms a week after arriving.
Yeah, a travel ban is silly. Have we learned nothing from 911? We tried to close our borders and now have more undocumented workers, with more political savvy and power, within our borders than ever. People will travel. If you would like them to do it legally and be easily trackable, keep it legal. If you would like to encourage them to go underground, then make it illegal. I personally don’t see the win from pretending to quarantine entire nations. That can’t happen.
I have award travel booked to Southern Africa via West Africa in the next few months. I have no intention of changing my travel plans. 🙂
@ColRebSez Who will pay for 3 weeks at this hotel? Who will pay for their food? What if someone in this quarantine shows up positive, now you have an entire hotel of travelers who are now exposed?
This is a completely overhyped issue. We should be FLOODING West Africa with aid, and we should be checking people for signs of distress when arriving at our shores, but nothing more. This is a risk we take when we are part of the world community. You cannot live in fear, or fear will take away your ability to live.
They should close the borders until Ebola is contained. It was just mentioned that ISIS could infect themselves in Africa and travel to the US to infect the masses.
I am in South Africa as I write this. South Africa initiated a “ban” on all travelers entering the country who 1) have a passport stamp from an “ebola hotspot” 2) have an “ebola hotspot” passport. The ONLY exceptions are for South African nationals who have been in an ebola hotspot (teachers, missionaries) who wish to return to South Africa. They may do SK; however, they are my at the airport by a small team, must undergo health exam, and are escorted directly to their residence wehere they must remain in housecquarantine, so to speak, at their own expense.
In our case coming from USA via Heathrow (BA), we were given a mandatory health questionaire to complete before arrival. At immigration our passports were screened closely, and we were verbally questioned about our past and future plans. We received the same treatment when we crossed borders (via car) into Swaziland, and back into South Africa.
Personally I think these are reasonable measures. Not only that, but the costs of evacuation and treatment/ quarantine are very high– and who is going to pay? The trip/ travel insurance companies are no longer underwriting to any of the Ebola hotspots.
@Michael I was watching the news last week and that idea came to my mind lol.
Personally I think time is key. They really should have temporarily suspended flights from the ebola stricken countries while they could a month or two ago (the time when Patrick Sawyer was able to fly to Lagos, Nigeria should have been a warning sign.)
Now that it has spread here in the US, not really sure what else could be done.
@JoelFreak – I’d say the gov’t would pay for that 21 day “ponderosa” or “holiday” quarantined in a hotel. That would be a LOT cheaper than treating thousands of ebola patients in the USA.
@Caros, some people were even saying ISIS paid Duncan to fly to the USA (I doubt it though.)
I hope something is done soon. It is just common sense to ban travel from those countries, even if it keeps out just 1 infected person from coming here.
Well, here’s step 1: Have US Consulates in the affected countries stop issuing tourist visas.
This is not brain surgery, it’s public health. And quarantine is one of the most effective public health measures around, esp. when you don’t have an antibiotic that will stop the disease. Ebola, a virus, isn’t affected by antibiotics.
I just got back from SOUTH Africa (and botswana, zimbabwe and zambia) and non of my co-workers want to hang out with me!… americans are so un-informed.
The level of ignorance demonstrated, and uninformed rationale applied, by some of the comments shatter my assumption that this blog was trafficked by quite a knowledgeable readership. It wouldn’t be off base to suggest the readers here are at least college educated, mostly white collar workers, good many self employed and successful.
The methods applied by South Africa are nothing but theater, much like TSA security at airports, but the authorities want to cater/pander to those of the ilk clamoring for travel bans as the solution to spread of Ebola because it is far easier to do so than explain what actually works. The countries that have closed borders have actually raised the risk of experiencing a catastrophic epidemic within their own borders because the stigmatization and persecution of potentially infected only pushes them underground and into places ill-equipped to deal with the disease and reduce likelihood of transmission. How the world has successful dealt to an extent with the HIV/AIDS pandemic and how Nigeria and others have dealt with Ebola is instructive, fight the behaviors and modalities for disease transmission, hint it is not air travel.
In this episode alone, Nigeria has had 1 or 2 transmissions in the City of Lagos, which has a bigger population than Liberia and living conditions that would seem to be ripe for an Ebola outbreak. But guess what, they haven’t had the apocalypse, and why is that? It is because they implemented both clinical and behavioral interventions that deal with Ebola spread identified many decades ago in the DRC, former Zaire.
Health workers and people caring or burying infected people are your key transmitters, focus on them and the disease kills itself.
Being on a plane for 8-12 hrs isn’t going to see Ebola become an epidemic, limiting access and potentially encouraging people to avoid seeking help, now that is a sure fire way of having a nice outbreak. Hysteria that has people ignoring evidence and acting irrationally is another sure fire way of creating conditions that will encourage an outbreak. I should also add that hubris is also another factor that will promote an outbreak, and I think it is the key factor in the Dallas transmissions, there is a general air of superiority in US-based health care facilities that, like many children of today, believing that being told and believing you are the best makes you complacent and unable to assess whether you are truly are capable. Most hospitals have no business trying to treat Ebola beyond the initial care, they just don’t have the rigor nor the mentality to do so, but to have said this before would have people up in arms/panic. The same issue comes up when discussing health outcomes and when anyone mentions that our healthcare system is broken, the usual retort is well such and such comes here and pays for the care therefore we are the best and nothing needs to change.
To end my rant, focusing on travel bans is a waste of intellectual energy and real resources, it will not have the effect of that is being blindly attached to it. Rather diver the resources that would be spent implementing and enforcing such bans on equipping and supporting those fighting the disease in the afflicted countries and training up healthcare workers who treat anyone infected here and those that would first see any potential patients. Finally, educate people who may, or have, traveled to these areas on monitoring their situation and when to seek help appropriately so that they do not became an unwitting transmitter.
I cannot believe someone just mentioned that ISIS will use suicide Ebola patients, we should then be fencing off every McDonald’s in the US.
@Kimmie a I was under the distinct impression that illegal immigration into South Africa is a pretty big thing. I find it difficult to believe that someone who wants to enter South Africa’s long borders will fail to find a way. I just don’t see a travel ban as anything except a distraction and potentially a dangerous one if it pushes people underground.
@Top Gunner Good post. You summarize my thoughts well. I too have been shocked by the comments on this & similar stories.
The arguments here leave me speechless for their poor logic.
Look, it should be obvious to anybody that, other things being equal, it’s easier to prevent an outbreak in the US if we have policies in place that would allow fewer people to come into the US who are infected with Ebola. This isn’t hard, right? Even if we are able to contain the outbreak regardless of the number of infected people who come in, the number of people who will be infected in the US will go down proportionately to the number of people we let in.
So why would we not adopt policies that reduce the number of people we let in?
The only argument is if, somehow, putting such policies in place “backfires”, that is, actually somehow increases the number of infected people who get in, or otherwise increases the number of people in the US who are nonetheless infected.
And I don’t see a serious argument to that effect.
Indeed, I’d argue that if there’s a policy that will “backfire”, it’s allowing everybody to come in, even under the proviso that they can’t, say, have fevers. Obviously, it’s easy enough to suppress a low grade fever by aspirin or Tylenol, so that’s hardly an impediment. And making it clear to people from infected regions that the US will do nothing effective to keep them out, and will treat them with the same level of care we afford our own citizens, is a perfect incentive for anyone in fear they have the disease to come here if they can manage to do so.
As for the case of Nigeria, it’s clear how they’ve handled the situation: by banning all travelers from infected areas, so that their system won’t be overrun. They know they’ve been lucky to control any outbreak, and have taken these steps to reduce the chances of one in the future.
Why this is something we can’t do is just beyond me.
The truth about the current outbreak of Ebola is that no one — and certainly no one at the CDC — seems to have a good handle on the true risks it imposes in various settings. The CDC got horribly wrong something it was absolutely key that it get right: what precautions, and what manner of communication of those cautions, would suffice to prevent Ebola from being contracted by health care workers. Only arrogance in its most extreme, deadly form would allow one to believe that, despite the egregious call by the CDC on this matter, we know everything we need to know about controlling Ebola on our our shores or elsewhere.
Until we know more, and with a justified confidence, we must take an abundance of caution. And that includes reducing to a minimum the number of infected people who come to our country.
My hyperbole might have not helped get the message across. Nigeria had 20 infections and 8 deaths (almost all health workers) from it’s brush with Ebola, with potentially 900 people at-risk. The index patient had arrived in Nigeria by air from Liberia, but it wasn’t the passengers that got stricken if I recall correctly. Nigeria’s reaction was to initially ban all flights from afflicted countries, however, once they began screening procedures for fever those flights resumed, a much bigger volume than the US would face from that part of the world. The result has not been new cases of ebola, but actually no new transmissions.
An example of of why relying on border closure is potentially risky, in Senegal they were lucky to find an infected person who had crossed in from neighboring Guinea. Their closure pushed the person away from what would be an effective screening point.
Let us also not overstate the case that someone is really trying to travel to the US to get treatment for Ebola. It would take some incredible insight to recognize you have Ebola and still have the capacity and time to book a flight to the US and make it without exhibiting symptoms. Though i guess someone will put up that perfect scenario ignoring incubation periods and the actual effects of the disease.
Since the US and Spain now have more new cases of Ebola than the three hotspots, the rest of the world should put a travel ban on flights originating from them?
Forgot to add, I think the world and health officials have a good handle on what to do and what not to do regarding Ebola. There have been outbreaks before like in Uganda that were successfully contained, Nigeria and Senegal should be declared Ebola-free very soon. As long as the appropriate procedures are followed by healthcare workers and the greater public is educated and addressed, without complacency at key administrative levels, Ebola is manageable.
Unfortunately this current outbreak happened and quickly overwhelmed countries that have weak health systems and decimated what capacity they had. In the case of the US and Spain, it was a little too much confidence/arrogance by hospitals/CDC and cost-cutting with poor decision making in Spain. Spain tried to use a hospital shut down due to budget cuts to deal with their cases, including throwing together an isolation unit.
It’s simple. Everyone has a COUNTRY OF ORIGIN so people from the countries where Ebola is a problem should not be allowed in the U.S., at least until the epidemic gets under control. It’s possible and it’s just common sense.
It works cos the politicians can claim to be taking steps to stop it. Just like TSA bogus security that the masses believe in
As I understand it, the airlines are responsible to make sure you have permission to enter the country when you board. If a person shows up and doesn’t have permission, I believe they are fined. That’s why they check your docs!
I see no major procedural hurdle to the USA “suspending” all visas from the 3 high-risk West African countries. We could then issue a new type of “emergency visa” with whatever strings we wanted to attach (probably individual review of the circumstancs of travel). We could also require all other travelers who have been to the affected countries in the past 21 days to seek pre-clearance to enter the USA. If they don’t comply, they face heavy fines and/or jail.
I suspect these policies would be 99% effective in regulating travel. All we need is the desire to do it. I’m not 100% sure it’s necessary, but I’m sure one more case in the USA originating in West Africa will do it for us.
As physicist & evolutionary theorist Greg Cochran comments:
“It’s nonsense. As I pointed out, if r < 1.0 in US conditions, the number of cases is linearly proportional to the number of infected visitors. You don't have to stop every single one: stopping 75% of them decreases the US end of the problem by 75%. Is this too subtle for people to understand?
I guarantee that most of those alternate routes through other countries are going to disappear, because they too are going to ban travelers from the hot zone.
Greatly reducing the flow of infected people from the hot zone to the US is trivially easy. Anyone who says otherwise is addled.
It is also easy as pie to block that flow without materially interfering with medical effort in the hot zone."