In a transit lounge of the airport where Liberian Thomas Earl Duncan touched down in Dallas carrying the Ebola virus last month, the House Homeland Security Committee heard today why administration officials are not angling for a travel ban from West African countries that comprise the epicenter of the outbreak.
Dr. Toby Merlin, director of the Division of Preparedness and Emerging Infection at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, argued that restricting travelers from Liberia, Guinea and Sierra Leone would make the problem worse.
“We feel that that would cause the disease to grow in that area and just spill over into other countries and then spill over more into the U.S.,” Merlin said. “And the real opportunity now is to put out that disease there. And every travel restriction that’s been placed on travel into that area has interfered with people who are trying to help not being able to get there — now either travel restrictions or reduction in air travel.”
“And it’s not just the U.S. Military, you know, it’s people from Europe, it’s people from China, it’s people from Cuba, who are trying to get there to help. And it would make doing what we need to do harder. And that’s why we ask the American people’s understanding of that.”
Rep. Joe Barton (R-Texas) noted that “you don’t have to have commercial flights to send flights into a country.”
“If we were really treating this as a public health issue, why — why would we not immediately stop these flights? And then, on a case-by-case basis, send equipment and people as necessary and, on a case-by-case basis, allow people to come out?” Barton asked.
“Why do we have to have commercial flights that, under the best of screening procedures that you’ve talked about, you’re almost guaranteed mathematically to miss some people? So with due respect, I don’t accept that answer, we can’t stop flights simply because we need to get people in.”
Merlin replied that “our experience has been that when there are interruptions in air travel, it impedes the public health response.”
“And although there might be workarounds, like military transport, that’s difficult and it’s — and right now, time is of the essence in what we do,” he said.
Health workers, including Ebola survivor Dr. Kent Brantly, have complained that the response from the U.S. and other countries was far too slow to begin with. The first case occurred in Guinea last December and spread to the capital of Liberia by June.
Dr. Kathryn Brinsfield, acting assistant secretary and chief medical officer in the Office of Health Affairs at the Department of Homeland Security, said they have to “defer to our colleagues at State” when it comes to discussion of flight restrictions.
“Who makes the decision?” Barton pressed. “Is it the president or the secretary of State or the Homeland Security or — who makes that decision?”
“I would defer to the interagency process that’s ongoing under the — under the president on this one,” Brinsfield replied. “I would say that there are many different actions that you’ve discussed here, one related to visas, one related to flights landing. Those are different authorities.”
Acting Assistant Commissioner John Wagner of Customs and Border Protection suggested “it’s a question more for the airlines and the airport authorities on what business they choose to do or not do.”
“I would have to defer on them on what business decisions they make and where to fly to and which airlines they go to,” Wagner said.
Rep. Filemon Vela (D-Texas) said he was “trying to understand, get at — what’s the scientific explanation for the response that a travel ban would actually make things worse?”
“We are very afraid that things that are done that impede travel will delay the interventions that — that prevent the progression of the disease. And if the disease progresses to the point that it can’t be stopped, it’s going to spill over into other countries and create a greater threat for the U.S.,” Merlin replied.
“So, we feel that, understandably, the notion of stopping travelers now might prevent a traveler from arriving in the U.S., that we know we can prevent an outbreak from that. But the greater risk is that, by delaying stopping the epidemic in Guinea, Sierra Leon and Liberia, you create a much larger epidemic that is impossible to control,” the CDC official continued. “The disease becomes endemic in Africa, and that we’re dealing with this for the foreseeable future, that we can’t stop it. What we want to do is stop it right now when we — with — with our — we know how to do it, and we just need to get the resources there to do it. And we don’t want to do things that would impede that.”
Rep. Eddie Bernice Johnson (D-Texas), a nurse by trade, asked about the screening procedures the administration is now implementing at five airports, which includes a questionnaire and having a temperature reading taken.
“Can it not be assumed that someone comes here from Liberia, that they’ve been in contact [with Ebola]?” Johnson asked.
“No, our questions about contact really have to do not with being around in an area that’s infected, but really particularly whether someone has had contact, exposure to body fluids. Have they had a splash of body fluids? Have they with their unprotected hands touched body fluids — have they — of a known person who was known to have Ebola? Have they been for an extended period of time around someone who was known to have Ebola?” Merlin replied.
“One of the things that we know about the disease in places like Liberia is it’s actually patchy. There are places where there is a lot of disease and there’s a place — there are places where there is very little disease. And our strategy out there, you know, is to actually prevent it from becoming spread all over the place,” he continued. “So, I don’t think it is — we would not say in our public health language that everyone from those countries have had — people from those countries have had contact with the disease.”
Wagner said CBP agents would depend on “how the people answer the questions and what they’re saying” to determine “any follow-up questions we would ask.”
“And, of course, Mr. Duncan did not reveal that he had been in contact with the Ebola virus in Liberia,” chairman McCaul asked. “Is that correct?”
“He did not truthfully answer the questions on the exit screening when he was asked whether he had an exposure, and it turned out subsequently that he had a known exposure,” Merlin replied.
Later the CDC official added, “There’s no way to ask Mr. Duncan.”
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