While the threat of an Ebola outbreak in the United States is very slim, it is possible a few cases could arrive through our airports and create pockets of concern. The Ascel Bio National Infectious Disease Forecast Center has updated their air travel forecast targeting the most likely US cities to see the Ebola virus.
Nigeria just confirmed eight cases of Ebola and admitted to “not being aggressive enough” with their response. The capital Lagos, is the largest African city with a population of 21 million. The patients are located in Lagos and could create disruption if the spread is not contained. The country is under close scrutiny for signs of additional cases beyond the initial contacts of the American-Liberian and his nurse, both of whom have died.
Eighteen countries have direct flights from Liberia, Guinea, Sierra Leone and Nigeria:
- Cote d’Ivoire
- Equatorial Guinea
- South Africa
- United Arab Emirates
- United States
Prior to Nigeria the only ports of entry to the United States were New York City and Atlanta. “With Nigeria, it is a whole other story,” wrote Jim Wilson, MD, faculty at the University of Nevada, Reno and Director of the Ascel Bio National Infectious Disease Forecast Center. “From the viewpoint of connectivity to the US, Liberia was the only direct, non-stop air connection with two US international Ports of Entry: New York City and Atlanta. With Nigeria, it is a whole other story, with a 16-fold increase in air traffic volume and a seasonal peak in traffic that is now, in August.
Ports of entry for the United States are now:
- New York City
- Puerto Rico
Please note this does not include connecting flights once visitors enter the US. Regions with significant immigrant populations that have cultural ties to the four African countries with Ebola cases include:
- New York / New Jersey / Pennsylvania area
- Washington DC / Virginia / Maryland / West Virginia area
- Minneapolis/St. Paul/Bloomington area
According to Wilson, “The US is, right now, facing tremendous exposure and a substantive increase of translocation risk should 1) transmission proceed unchecked in Nigeria, and 2) airport based travel restrictions prove ineffective.”
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What Physicians Should Do
Wilson suggested the following guidelines for physicians:
- Medical facilities that are aware of the potential appearance of Ebola and are prepared for its arrival fare better than facilities that are caught by surprise or are unprepared. The difference could cost the healthcare provider and staff their lives, as well as expose the community they serve to unnecessary risk.
- Seek education regarding Ebola virus disease clinical and isolation ward management from a highly credible source such as the US Centers for Disease Control and Prevention [http://www.cdc.gov/vhf/ebola/]. Avoid using mass media outlets or sources of information that do not have direct experience with this pathogen. Fight anxiety and rumor with logic and knowledge.
- Ensure that your local hospital, in coordination with local public health officials, has begun the dialog regarding exposure risk identification, suspect patient management, and infection control. Ensure that education from highly credible sources is utilized aggressively. Consider tabletop exercises or bedside scenario walkthroughs to reinforce teamwork and infection control protocols.
- Ask a travel history of your patients, especially if you work in the above-mentioned areas of the US.
- If you identify a returning traveler from any of the countries experiencing an Ebola epidemic, assess the patient for evidence of illness. Contact your local infectious disease specialist or public health official if you have concerns about any patient with a positive travel history.
Other Disease A Major Concern
John Hunt, M.D. an infectious disease expert and allergy and immunologist physician who works with Trusted Angels Foundation, a medical organization operating in Liberia is concerned about other infectious disease which begins to rise this time of year. He spoke with the country director this morning about conditions there. “Joe is very concerned about the treatable diseases that are now killing more people than usual. Malaria and typhoid (big killers) go untreated as the health care workers have stopped coming to work and the hospitals are closed. “
He continues, “Food prices are rising in Liberia. I pray the government will not impose price controls, because then we will start seeing panic as supplies disappear. This is a tough situation.”
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