ebola travel ban

Information about Airline Passengers Evaluated for Ebola

The Centers for Disease Control and Prevention (CDC) investigates serious contagious diseases on airplanes. If a sick person on a flight is reported to CDC and there is concern about Ebola, passengers are given a Travel Health Alert Notice and asked to complete a Passenger Locator Form so that we may contact them in the future if the sick person has Ebola. If a person with Ebola is identified after a flight and the person was showing symptoms during the flight, CDC will locate and notify passengers. CDC will connect these passengers with their health department so they can get information about any action or precautions they need to take.

This web page contains information about specific flights in which Travel Health Alert Notices related to Ebola were given to passengers. If you received one of these notices, it is because one or more passenger(s) on your airplane became sick during the flight with symptoms that could be caused by Ebola. This web page will help you find updated information about your possible exposure and recommended public health actions, if any, you need to take.

What you should do if you were given a Travel Health Alert Notice

Please scroll down to get information about your particular flight and find out if you need to take any action.

• Information on specific flights will be posted as soon as possible.
• Additional instructions and contact information will be posted as needed.
• If your flight information is not available, come back to this page at a later time.

*Note: Information will only be posted for those flights in which Travel Health Alert Notices were distributed. If you were on a flight in which CDC responded, you did not receive a Travel Health Alert Notice, and your flight is not listed, the ill traveler on your flight did not have a diagnosis of public health concern.

If you were on one of the flights listed below, remember that

• Spread of Ebola on a plane or in an airport is NOT likely. However, CDC is being extra careful to ensure your safety.
• Most sick people on planes do not have Ebola, even if they are traveling from a country where Ebola is spreading.
• If the person is found to have Ebola and CDC believes you were possibly exposed, a public health official will contact you.
• Take your temperature every morning and evening, and watch for symptoms of Ebola.
• Call a doctor if you get a fever* and other symptoms. *Fever: temperature of 100.4°F / 38°C or higher or feeling like you have a fever.
• Call in advance to tell the doctor about recent travel and symptoms before going to the office or emergency room. Advance notice will help the doctor provide care and protect other people who may be in the office.
• Tell the doctor you might have been exposed to Ebola on a plane.
• Do not go anywhere except to the doctor’s office or hospital. Limit your contact with other people when you go to the doctor. Do not use public transport to get to the medical facility.
• Bring the notice you received on the plane and give it to health care staff when you arrive.
• People exposed to Ebola cannot spread it to others unless they have fever or other symptoms of Ebola. Therefore, if you have no symptoms, you are not at risk of transmitting Ebola to others.
• For more information on Ebola, go to: Ebola (Ebola Virus Disease)

Flight information by date

No Travel Health Alert Notices have been distributed on flights in the past 30 days.

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

Why Airlines and the CDC Oppose Ebola Flight Bans

T he debate surrounding travel bans as a way to curb the spread of Ebola has intensified after Thursday’s congressional hearing , unleashing a flurry of impassioned arguments on both sides.

The stakes are high: those for a flight ban believe it’s a necessary protection against a deadly epidemic that has already reached American soil, but those against it say a ban would make the U.S. even more vulnerable to the virus.

Rep. Tim Murphy (R-Pa.), who ran the hearing, wants to prohibit all non-essential commercial travel from Guinea, Liberia and Sierra Leone, as well as institute a mandatory 21-day quarantine order for any American who has traveled to the stricken African nations. This quarantine would include a ban on domestic travel.

Murphy explained his position at the opening of Thursday’s hearing: “A determined, infected traveler can evade the screening by masking the fever with ibuprofen… Further, it is nearly impossible to perform contact tracing of all people on multiple international flights across the globe, when contact tracing and treatment just within the United States will strain public health resources.” Murphy is not alone; other lawmakers such as House Speaker John Boehner and Rep. Fred Upton (R-Mich.) agree.

The Centers for Disease Control and Prevention (CDC), however, maintains that these congressmen have it backwards. While they think a travel ban would secure the U.S. border from Ebola and shrink the potential spheres of contact, CDC director Tom Frieden says instituting a flight ban would forfeit what little control we currently have over the virus.

“Right now we know who’s coming in,” Frieden said at the hearing. “If we try to eliminate travel… we won’t be able to check them for fever when they leave, we won’t be able to check them for fever when they arrive, we won’t be able—as we do currently—to see a detailed history to see if they’ve been exposed.” The White House has sided with Frieden. White House press secretary Josh Earnest said Thursday that a travel ban is “not something we’re considering.”

Inside the Ebola Crisis: The Images that Moved them Most

Even if Republican lawmakers are correct that a travel ban could curb the spread of Ebola in the U.S., it would also curb the movement of American health workers to the West African countries that are already desperate for more aid.

“If we do things that unintentionally make it harder to get that response in, to get supplies in, that make it harder for those governments to manage, to get everything from economic activity to travel going, it’s going to become much harder to stop the outbreak at the source,” Frieden said this week. “If that were to happen, it would spread for more months and potentially to other countries, and that would increase rather than decrease the risk to Americans.”

There’s also a practical concern surrounding the bans. Thomas Eric Duncan, the first person to be diagnosed with Ebola in the United States and who later died from the disease, took three flights and flew on two airlines on his trip from Monrovia, Liberia to Dallas, TX, stopping in Belgium on the way. Prohibiting travel from West Africa to the United States quickly falls down the rabbit hole of connecting flights in Europe, especially since there currently aren’t any direct flights between the U.S. and the primary Ebola hot zones.

A spokesperson for Airlines for America, the industry trade organization for leading U.S. airlines, told TIME, “We agree with the White House that discussions of flight bans are not necessary and actually impede efforts to stop the disease in its tracks in West Africa.”

And if domestic or international travel bans were to be instituted, others familiar with the airline industry warn of unintended consequences. Greg Winton, founder of The Aviation Law Firm outside Washington, D.C., told TIME that mass flight restrictions “will have a huge impact financially, certainly on the whole economy, not just the aviation sector.”

But at this point Winton says anything is possible, citing the Federal Aviation Administration’s shut down of air travel following 9/11 as an extreme precedent. “As far as FAA aviation law, none of that really takes precedence over disease control at this point,” he said.

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Should We Ban Flights From Countries With Ebola Outbreaks?

By Vauhini Vara

Early last week, about as soon as the Centers for Disease Control and Prevention said that it had learned that a man in Texas had been infected with the Ebola virus after having travelled in Liberia, people started suggesting that maybe the U.S. should ban people from flying here from West Africa.

Atul Gawande wrote on Friday about the failure of communication at Texas Health Presbyterian , the hospital that treated the patient but discharged him, at first, with a diagnosis of gastroenteritis; he also outlined the well-established procedures that hospitals and public-health workers should use to contain an outbreak. But how can the U.S. keep infected people from arriving in here in the first place?

In this case, it’s hard to see how it could have been prevented. While in Liberia, the man had helped to carry a pregnant woman who was infected with Ebola to a taxi. But when he arrived at the airport in Monrovia, he didn’t have Ebola symptoms—which staffers had been trained to look for—and, when he filled out an airport-screening form, he answered no to questions about whether he had cared for an Ebola patient or touched the body of someone who had died in an area affected by Ebola. (Liberian authorities said that they would prosecute the man, who is Liberian, for lying on the form, but it’s unclear whether he knew the woman had Ebola; the Associated Press reported that “her illness at the time was believed to be pregnancy-related.”)

Those living and working in Ebola-stricken areas have grown to be well aware that it’s difficult to detect infection early on. But some in the U.S. were surprised—and concerned—when they considered the implications for travel: if it’s so difficult to know for sure whether someone has been infected with Ebola, some have argued , shouldn’t the U.S. be able to stop people who have been exposed to Ebola from arriving here on commercial flights? To be safe, what about blocking everyone who has spent time in Liberia, Sierra Leone, and Guinea?

Those who have questioned whether the existing controls are strong enough, such as Senator Ted Cruz , the Republican from Texas, have pointed out that several African countries have restricted or shut down air travel to countries with confirmed Ebola cases. Maybe the U.S. should simply stop airlines from traveling to those countries.

The fact is, U.S. airlines don’t fly to the countries with ongoing Ebola outbreaks. Delta used to fly to Monrovia, but stopped in August. Today, only Delta and United offer direct, nonstop service between the U.S. and West Africa, according to Airlines for America, a trade group for U.S. airlines—Delta to Lagos, Accra, and Dakar, and United to Lagos alone. The Ebola patient in Texas first flew from Monrovia to Brussels on a different airline, reportedly Brussels Airlines, then boarded a United flight to Washington, D.C., and another one to Dallas.

Airlines could suspend flights to the West African countries where they do fly, if they choose, but that wouldn’t necessarily keep passengers from Ebola-stricken countries from using other airlines to leave Liberia and later boarding their flights, as the Texas man did. To keep people who have been in West Africa from boarding U.S. carriers would be more difficult; typically, screenings are left to airport and public-health workers, with airlines getting involved only if a passenger is obviously ill and is seen as presenting a danger to crew members or other passengers.

So far, airlines are relying on the C.D.C. and the World Health Organization for guidance on how to respond. Jennifer Dohm, a United spokeswoman, told me in an e-mail, “We have not made any flight changes at this time, but are in regular communication with government agencies and health officials and will follow their recommendations that apply to our operation.” Health officials, in turn, have not recommended travel bans; in fact, the World Health Organization recommends the opposite— “no bans on international travel or trade.”

There are several reasons for this. For one thing, as Gawande points out, travel bans don’t really work: “Even if travel could be reduced by eighty per cent—itself a feat— models predict that new transmissions would be delayed only a few weeks.” For another, they make it even more difficult to address the public-health crisis: “If you try to shut down air travel and sea travel, you risk affecting to a huge extent the economy, people’s livelihoods, and their ability to get around without stopping the virus from traveling,” Gregory Hartl, a W.H.O. spokesman, said , according to the Washington Post . “You can’t ship goods in. Sometimes these goods are basic staples people need to survive.”

Some have protested that the U.S. and its airlines still ought to close themselves off from people travelling from Liberia, Sierra Leone, and Guinea to protect American citizens, whatever the potential enforcement difficulties or the harm to those abroad—if not by banning travel from certain countries altogether then by banning certain passengers from getting on planes. On the Web site of the National Review , Mark Krikorian wrote , “You can hear the objections now: It would be xenophobic, it might stigmatize West Africans, those countries will object to our State Department that they’re being discriminated against.”

These objections, it should be noted, are legitimate. But, on Thursday, Tom Frieden, the director of the C.D.C., offered another line of reasoning. Robert Ray of Al Jazeera America asked him whether the U.S. could require more rigorous screenings, in the U.S., of passengers arriving from West Africa. “Do you think that there should be something put in place for international travelers, specifically people coming in from West Africa, when they land here in the U.S. that perhaps their fever—their temperature should be taken right away because what if, what if, like I said, some desperate person over there knows that they have been exposed and they can afford a plane ticket and they know if they land here in the U.S., they can get that proper care, no matter what?” Ray asked .

In response, Frieden explained that such measures would make it harder to send aid workers into those places because of the difficulty of bringing them home afterward. “They're not going to be able to come out if they go in,” he said. “And because of that, it will enable the disease to spread more widely there and ultimately potentially spread more to other countries in Africa and become more of a risk to us here, so that the best way to protect ourselves is not to try to seal off these countries but to provide the kind of services that are needed so that the disease is contained there and to identify anyone who may come out.” There may be situations in which the U.S. could benefit from keeping out of other countries’ affairs; this, public-health officials seem to agree, is not one of them.

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A boy's temperature is taken using an infrared digital laser thermometer at the Nnamdi Azikiwe International Airport in Abuja, Nigeria, in mid-August.

Why U.S. Is Reluctant to Issue Travel Ban on Ebola-Stricken West Africa

U.S. officials are reluctant to ban travel from Liberia, Sierra Leone, and Guinea.

It seems so obvious: To keep Ebola out of the United States, simply keep anyone who has the deadly disease from getting in.

Some prominent Obama administration critics have made that argument this week, calling for a travel ban into the U.S. from the West African nations of Liberia, Sierra Leone, and Guinea, where more than 3,400 have died of the virus and thousands more are infected . There's a growing social media chorus calling for a ban, too. (Related: As Ebola's Spread Continues, Key Questions and Answers)

By cutting off travel from the Ebola zone, the thinking goes, someone like Thomas Duncan— the Liberian diagnosed with Ebola in Dallas last week and died Wednesday morning in a Dallas hospital—would never have made it into the United States. Ebola is not detectable (or contagious) until the patient develops symptoms such as fever and vomiting, so Duncan's illness could not have been diagnosed until after he arrived in the U.S.

The U.S. government does appear ready to increase screening of air passengers arriving in the United States from several West African nations by taking their temperatures, a federal official told CNN on Wednesday. And yet the Obama administration has steadfastly rejected the idea of an outright ban on travel to and from West Africa.

Thomas Frieden , director of the U.S. Centers for Disease Control and Prevention, has been asked repeatedly about a travel ban in near-daily briefings with the press over the past week. Each time, he has insisted it won't work.

Frieden, who is heading the government's Ebola response, has gone as far as to say that a travel ban could hurt Americans in the long run, by limiting the ability of relief workers and supplies to get into West Africa's Ebola zone.

"Until the disease is controlled in Africa, we can't get the disease to zero here," Frieden said at a Tuesday news conference. (Related: "Every Newly Emerging Disease Like Ebola Begins With a Mystery." )

Public health experts generally back the administration's actions, and most oppose a travel ban, at least for the moment. But they say the issue is more nuanced than Frieden has made it out to be. A travel ban would have kept Duncan from bringing Ebola to the U.S., they say, and could keep out some future infected travelers.

"It is a question, I think, on which people can honestly disagree," said Stephen S. Morse , professor of epidemiology at Columbia University's Mailman School of Public Health. "There are good arguments to be made on both sides. It's partly a philosophical choice."

Politics and Perception

Six African countries have already banned or suspended flights from Liberia, Guinea, and Sierra Leone, and others have instituted other travel restrictions. (Related: " Doctors and Nurses Risk Everything to Fight Ebola in West Africa .")

And since late August, the U.S. State Department has urged Americans to avoid all non-essential travel to Liberia, Sierra Leone, and Guinea.

But Congressman Alan Grayson , a Florida Democrat, wants the U.S government to go further. Grayson said he would propose legislation calling for a ban if the administration continues to avoid one.

"It will prevent infected travelers in whom Ebola is asymptomatic and undetectable from traveling to the United States and then exposing Americans to the disease after they become symptomatic," he said by e-mail.

It takes anywhere from 2 to 21 days for someone who has been exposed to the Ebola virus to show symptoms. People who are not symptomatic are not contagious, and Duncan did not have symptoms while he was traveling and so could not pass the virus on to fellow passengers. No one who came into contact with Duncan has yet become ill, though several family members and contacts are under observation until the 21 days have elapsed.

A number of high-profile Republican politicians, including Texas Senator Ted Cruz and Kentucky Senator Rand Paul, have said that more needs to be done to keep Ebola victims from arriving on U.S. soil. But they've stopped short of demanding a full ban.

Wendy Parmet , director of the Program on Health Policy and Law at Northeastern University School of Law, in Boston, said that travel bans are appealing because they make people feel safe. But she argued that safety could be an illusion.

"It gives us the false assurance that we can ignore the problems that are happening in Africa," she said. "At the end of the day, we can't. And our own safety depends on our getting it right there, not on building the walls."

Turkish medics in hazmat gear move a patient suspected of being infected with the Ebola virus. After traveling from Ivory Coast to Turkey in late September, the patient is being transferred to a hospital in Istanbul.

Would a Ban Matter?

Many public health experts who oppose the travel ban argue that it's simply not practical. That includes Columbia University's Morse, who describes himself as a "fence-sitter" on the issue but doesn't support a travel ban right now because people with financial means can travel to an intermediate country before entering the United States. West Africa's many porous borders make such travel even easier, he said.

It wouldn't make sense to ban people who fly out of Senegal—where, like the United States, there has been only one case of Ebola, Morse said. But if one person with Ebola made it there, others could, too.

A ban could also encourage people to lie about where they have been, Morse said: "One of the real concerns is that if you outlaw [travel], it will discourage people from coming forth with the truth."

Frieden, for his part, has focused his opposition to a travel ban on the hardship it would present for fighting the epidemic in Africa.

"If we do something that impedes our ability to stop the outbreak in West Africa, it could spread further there," he said Tuesday.

On Sunday, Frieden also cited the example of Senegal, which has restricted flights from the affected countries. The restrictions delayed the arrival of investigators looking for people who had come into contact with the country's one Ebola patient.

Plus, international volunteers who go into West Africa to help treat Ebola patients need to know that they can get back out, Frieden said.

At SIM , an international mission that has led Ebola treatment centers and seen two of its American missionaries recover from the virus, travel restrictions might make volunteers think twice, said George Salloum, who leads the agency's Ebola crisis response team.

"Anything you do to restrict movement of people back and forth or keeping them from getting back to work, it could have an impact on the flow of people willing to serve overseas," he said.

Screening at Airports—and Beyond

Those on both sides of the travel ban debate appear to support aggressive airport screening, to ensure that sick people won't be able to get on a plane and potentially infect fellow passengers.

President Obama on Monday announced plans to step up airport screening in the United States and in West Africa, evaluating travelers for signs of illness, better informing airport personnel on how to spot Ebola, and handing out fact sheets to incoming passengers from affected countries.

He did not reveal specifics about what he would change and did not mention a travel ban.

Frieden said Tuesday that he would announce more details in a few days. Among measures being considered, he said, are temperature checks and questionnaires given to passengers arriving in the United States. On Wednesday morning, CNN reported that temperature checks will begin this weekend or next week on passengers whose travel itineraries include the affected West African nations.

Frieden said that 77 people have been blocked from leaving the affected countries since this summer, when officials began questioning travelers and screening their temperatures at airports in Guinea, Liberia, and Sierra Leone. None of them tested positive for Ebola, he said, adding that they most likely had malaria, a mosquito-borne disease that shares early symptoms with Ebola.

A temperature check could have stopped Patrick Sawyer , a Liberian-born American citizen who flew from Liberia to Nigeria in late July while sick with Ebola, from spreading the disease.

Sawyer directly or indirectly infected 20 people in Nigeria, eight of whom died, as did Sawyer himself. It's unclear whether he knew he had Ebola when he left Liberia. A travel ban likely would not have stopped Sawyer from entering because he was a U.S. citizen, though an effective temperature scan would have.

Still, airport screening is hardly foolproof. Duncan may have lied when answering questions about whether he had been exposed to anyone with Ebola. Or he may not have realized that helping a pregnant neighbor to the hospital in Liberia exposed him to the virus, Frieden said.

Beyond airports, hospitals are an important second line of defense against Ebola, said Jill Holdsworth, an infection control practitioner at Inova Mount Vernon Hospital in Alexandria, Virginia.

Duncan's symptoms were missed as Ebola the first time he went to Texas Presbyterian Hospital in Dallas, although he apparently indicated that he had recently arrived from Liberia. Several hospital workers and the ambulance drivers who took Duncan back to Texas Presbyterian two days later may have been exposed because of that mistake.

"As soon as a patient walks in, if they present with a fever, you should ask them about recent travel history," said Holdsworth, who is also a spokesperson for the 15,000-member Association for Professionals in Infection Control and Epidemiology . "If they say yes, they immediately get taken to a room until we can figure out what's going on. That's what every hospital has to be doing."

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David Pecker returns to witness stand in Trump's hush money trial

Ebola: here's why travel bans could make americans less safe.

Ebola is spreading rapidly in West Africa, and the first cases of people in the United States who have the deadly virus have been reported. Now, Americans are getting increasingly jittery about importing the deadly disease, new polls show.

In a recent Washington Post and ABC news poll, 67 percent of those surveyed said they supported a travel ban from the affected countries.

But despite broad popular support for such restrictions, travel bans would actually increase the risk of the disease spreading to other countries, including the United States, experts say.

Here's why: A travel ban would reduce the number of medical workers who enter the countries, which could worsen the outbreak there, said Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center in Nashville, Tennessee. The countries of Guinea, Liberia and Sierra Leone already had fragile health infrastructures, and many of their doctors and nurses have died from the disease, he said.

Further depriving those nations of U.S. medical workers would thus mean more Ebola cases there. And an increase in the number of cases anywhere in the world means there is an increase in the risk that someone with Ebola could come to the United States, said Dr. Amesh Adalja, an infectious disease specialist and a representative of the Infectious Disease Society of America.

Travel bans would also severely impact a targeted country's economy, leading to food and water shortages and political destabilization, Adalja said.

People may flee the affected countries and cross, undetected, into neighboring nations such as Mali or the Ivory Coast, Adalja said. (On Thursday, Oct. 23, Mali confirmed its first case of Ebola, in a 2-year-old girl who had crossed the border from Guinea.)

"What a travel ban does is it squeezes people to use other modes of transportation," Adalja told Live Science.

And people fleeing from Liberia, Guinea or Sierra Leone who were banned from flying to the United States could instead fly to other countries in Africa, which would mean the United States would then either have to ban travel from even more countries, or cast a much wider net in monitoring than it currently does, he said.

Right now, American airports funnel the approximately 150 passengers a day from Guinea, Liberia and Sierra Leone through five main ports of entry. Those coming from Ebola-ravaged countries must check in with public health authorities, take their temperatures for 21 days (the incubation period for the virus) and be on the alert for symptoms.

Under this system, public health officials can keep tabs on every person who comes down with the disease, and get them isolated and into a designated care facility before they are highly infectious. But this effort would be difficult to scale up if many more African countries had outbreaks flaring, Adalja said.

An endemic disease?

People in the United States may not want to risk American lives at home simply to help the humanitarian effort in Africa. But if the outbreak in Africa gets large enough, there's a risk that Ebola could become an endemic disease in the region, meaning there will always be cases present in some populations there, said Dr. Howard Markel, a pediatrician and the director of the Center for the History of Medicine at the University of Michigan.

That possibility was also highlighted earlier this month in a news conference held by the Centers for Disease Control and Prevention. [ The 9 Deadliest Viruses on Earth ]

"It could spread to other countries in Africa and be an ongoing risk that we would have to deal with for months or for years," Dr. Thomas Frieden, the director of the CDC, said. "It's really important that we stop the outbreak. And to do that, we need regular travel. We need countries not completely isolated from the world."

The outbreak in West Africa is now the worst Ebola outbreak in history , with nearly 10,000 cases and almost 5,000 reported deaths as of Oct. 22, according to the CDC.

Future use?

The Obama administration hasn't ruled out the possibility of a travel ban if the situation continues to worsen. In September, a CDC report projected that up to 1.4 million people could be stricken by Ebola in Guinea, Sierra Leone and Liberia if relief efforts aren't dramatically scaled up . At that point, a travel ban could be potentially useful, although even then it still may not make sense, Markel said.

So far, Ebola has stricken fewer than about 10,000 individuals in countries with millions of people, and only two of the thousands of passengers who have traveled recently to the United States from West Africa have tested positive for the disease after they arrived here, Markel said.

" Don't use a bazooka when a BB gun will do," Markel said. "A travel ban is a bazooka."

The risk to Americans is ultimately tied to the size of the outbreak in West Africa, all the experts said, so the best way to keep people in the United States safe is to stamp the disease out at the source.

"Until the outbreak is gone, everybody is going to be at risk," Adalja said.

Follow Tia Ghose on Twitter and Google+ . Follow Live Science @livescience , Facebook & Google+ . Originally published on Live Science .

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Copyright 2014 LiveScience , a TechMediaNetwork company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Poll: broad support in u.s. for ebola travel ban.

Scott Hensley

A passenger wearing a face mask arrives at Los Angeles International Airport Friday. Federal officials now require people traveling from West Africa to enter the U.S. at one of five airports equipped to screen them for signs of Ebola. Mark Ralston /AFP/Getty Images hide caption

A passenger wearing a face mask arrives at Los Angeles International Airport Friday. Federal officials now require people traveling from West Africa to enter the U.S. at one of five airports equipped to screen them for signs of Ebola.

How do Americans feel about Ebola and the U.S. response to the outbreak so far?

NPR and our partners at Truven Health Analytics asked more than 3,000 adults in a poll conducted online and by phone (mobile and landline) Oct. 1-15.

Nearly everyone — 97 percent — knew about the Ebola outbreak in West Africa, and a slim majority of those people, or 53 percent, believe the U.S. government has taken a leadership role in response.

A majority of Americans are worried about Ebola. Fifty-six percent of people are either "very concerned" or "somewhat concerned" about the spread of the Ebola virus to this country.

The level of worry "is a little lower than I would have guessed given the media play over the last several weeks," Dr. Michael Taylor , Truven's chief medical officer, tells Shots. He says there's no reason for panic. "The big concern is that if it can't be managed in Africa it's going to spread," he says.

People were split pretty evenly on whether the U.S. response has been adequate: 49 percent said yes; 51 percent said no.

About three-quarters of people aware of the Ebola outbreak say the U.S. should take steps such as banning travel to and from the affected part of Africa.

Shots - Health News

Quick facts about ebola.

Things got a little more complicated when we asked whether U.S. citizens who become infected with Ebola while performing humanitarian work should be brought back to this country for treatment.

Ebola In The United States: What Happened When

Overall, 40 percent of people oppose that idea; 60 percent are in favor. But sentiment varied quite a bit by age, education and income. There is support for bringing people back for treatment among nearly three-quarters of people who are 65 or older, have at least a college degree or whose annual household income is $100,000 or more. Among people under 35, there is an even split on whether infected people should be brought to the U.S. for treatment.

While the poll questions were in the field, Thomas Eric Duncan became the first person to die from Ebola in the U.S. and less than a week later Nina Pham, a nurse who helped care for Duncan, became the first person to become infected with Ebola in this country.

We asked while events were unfolding how Americans see the country's preparedness? A slim majority — 51 percent — believe the U.S. health care system has the resources and trained personnel to deal with Ebola here.

The poll's margin for error is plus or minus 1.8 percentage points. The full results, including the text of the questions, can be found here .

• NPR-Truven Health Analytics Health Poll

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• v.187(3); 2015 Feb 17

Unsanctioned travel restrictions related to Ebola unravel the global social contract

We are currently facing the worst Ebola outbreak since the virus was isolated. On Oct. 28, 2014, Australia became the first country among high-income nations to institute a restriction on travel from the three West African countries at the centre of the outbreak: Guinea, Liberia and Sierra Leone. 1 Canada followed suit on Oct. 31 by similarly refusing visas to residents of, and recent travellers to, these countries. 2 Days later, the World Health Organization (WHO) demanded justification for these measures because they are not consistent with the spirit of the revised International Health Regulations of 2005. 3 The disregard by Australia and Canada of the treaty harms the global social contract and our ability to respond collectively to future epidemics.

By the end of November 2014, a total of 15 935 confirmed, suspected or probable cases of Ebola and 5689 deaths from the disease had been recorded. 4 Guinea, Liberia and Sierra Leone have been the hardest hit, but cases have also been documented in Mali, Nigeria, Senegal, Spain and the United States, with a separate controlled outbreak in the Democratic Republic of Congo. 4

The revised International Health Regulations provide a mechanism to coordinate global action during public health emergencies of this magnitude. The origins of the treaty can be traced to the International Sanitary Conferences of 1851, which yielded a set of conventions outlining policies for quarantine to halt the spread of cholera, plague and yellow fever. This collective action eventually impelled the formation, in 1948, of WHO itself. 5 Among the first undertakings of the newly created WHO was the consolidation of the conventions into a single piece of legislation known as the International Sanitary Regulations. 6 Over the next few decades, the regulations were renamed the International Health Regulations. Minor modifications were made to reflect the changing epidemiology of infectious diseases that posed a global threat, although the focus remained largely disease specific. 5 In 1995, the decision-making body of WHO convened to address limitations in the vision and scope of the regulations. A set of revisions entered into force in 2007. 7 They required that the 196 signatories of the International Health Regulations establish minimum core capacities in health care to facilitate timely recognition and response to public health emergencies (biologic, chemical or radionuclear) that could have a global impact.

From the outset, one of the core tenets of the International Health Regulations has been an emphasis on avoiding “unnecessary interference with international traffic and trade.” 7 Practically, this means that individual nation-states are not at liberty to impose travel restrictions in the absence of a WHO recommendation or scientific evidence. Australia and Canada are among about 30 jurisdictions that have imposed some form of restriction against travellers from the countries currently experiencing the worst of the Ebola outbreaks. 8 As the only two high-income countries on the list, their actions have the greatest potential to degrade the International Health Regulations and, more generally, global cooperation during infectious disease outbreaks.

The travel restrictions imposed by Australia and Canada might be justified if they were supported by expert consensus or evidence, but they are not. Researchers in Canada have recently used Ebola surveillance data coupled with international air transport data to show that only two or three travellers with Ebola might depart the affected countries per month. 9 This finding supports the use of public health strategies such as airport exit screening, but it calls into question the use of specific restrictions on travel. Furthermore, of the handful of people with Ebola contracted or treated in the United States to date, all save two have been successfully managed with the supportive care resources available in North America. In one case, the outcome could have probably been prevented had a proper travel history been taken and appropriate management instituted at first presentation. In the second, the patient was transported to the United States in an already critical condition after nine days of having symptoms. Contrasted with the devastation from the disease seen in West Africa, where a case-fatality rate of 60%–70% has been observed, 4,10 it becomes painfully apparent that the risk of dying from Ebola virus disease is highest where there are systemic failures such as an absent health care infrastructure, lack of necessary equipment and a shortage of trained personnel. 11

The Ebola outbreak has highlighted a need to re-evaluate the purpose of international treaties and how they are put into use under WHO. Despite the substantial normative authority of WHO, the organization faces challenges in generating collective agreements between its signatories. 12 Among the greatest challenges is balancing the competing goals of global cooperation and state autonomy. 13 In 1994, the United Nations Development Programme drafted its annual Human Development Report and included a chapter titled “New Dimensions of Human Security” 14 that explicitly linked human security and health concerns. 15 Regrettably, the very concept of global health security builds a “threat protection mentality” that risks emphasizing national sovereignty over global solidarity. 15 This thinking has been apparent in the discourse around the current Ebola epidemic.

The particular defiance by Australia and Canada sets an example that may prompt low-income countries to reconsider what binds them to the global community — a community that is supposed to share obligations through treaties such as the International Health Regulations. The revised regulations mandated the establishment and maintenance of an infrastructure for disease surveillance as a core capacity that countries must develop. Surveillance has the potential of serving the global community, but perhaps at the expense of low-income countries. Low-income countries may question what they have to gain from sharing surveillance data and reporting outbreaks transparently when other signatories to the International Health Regulations are not maintaining their commitments to the same treaty. 15 The financial repercussions of sharing data obtained through surveillance, which may result in trade or travel restrictions, will disproportionately affect already vulnerable economies. 16,17 Canada itself experienced such effects during the outbreak of severe acute respiratory syndrome (SARS) in 2002/03; as a result of a WHO-imposed travel ban, it suffered direct and indirect losses estimated at $2 billion. 18 At that time, concerns were raised that earlier reporting and greater transparency about the outbreak in China might have lessened the international reach of the outbreak; however, the economic devastation that might result from trade and travel advisories, or even simply from fear and stigma, was a major disincentive to report. 19 Underreporting is also a concern in the current Ebola outbreak, 20 particularly in the aftermath of the travel restrictions.

Other priority capacities outlined in the International Health Regulations include enhancing public health response, preparedness, human resources and laboratory services, 21 because development of these capacities in all nation-states has the greatest potential to thwart the impact of emerging infectious diseases on a global scale. 16 The target for establishing these capacities was 2012 — a deadline that was missed by the global community with little attention — and required several governments to pursue extensions through WHO. 22 Without the establishment of an adequate health system infrastructure in low-income nations, the global response to outbreaks will be, at best, a perpetuation of interstate reliance, 23 with a focus on charity at the expense of capacity-building. Furthermore, a global response to public health emergencies, and the necessary commitment of resources, may be invoked long after a low-income country’s threshold for containment, and its ability to protect its citizens, has been exceeded.

Despite coming into force in 2007, the revised International Health Regulations do not describe specific penalties for noncompliant member states. 17 The mechanism for dispute settlement is rooted in negotiation and mediation. Without a means of enforcement, the consequences of noncompliance are merely a “tarnished international image, … economic and social disruption, and public outrage.” 5 Since Canada and Australia instituted unsanctioned travel restrictions, one can see that high-income countries have sufficient political capital to be noncompliant with relative impunity.

The Ebola outbreak has created an imperative to revisit the International Health Regulations and consider how they represent a global social contract. The treaty should supersede shortsighted interests of individual states. Individual nation-states must consider how their actions might contribute to the unravelling of global partnerships that were created to promote the public’s health. It is clear that the Ebola outbreak is a cause for panic — moral panic — over how we wish to conduct ourselves in a global community.

• Canada and Australia are among 30 countries to have instituted restrictions on travel from the three West African countries most affected by Ebola virus disease.
• The restrictions defy the revised International Health Regulations’ emphasis on avoiding unnecessary interference with international traffic and trade during infectious disease outbreaks and are not supported by evidence.
• This disregard harms the global social contract and degrades our ability to respond appropriately to future epidemics.

Competing interests: None declared.

This article has been peer reviewed.

See references, www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.141488/-/DC1

The Ripple Effects of a Travel Ban Could Make The Ebola Problem Even Worse

Calls for an Ebola travel ban have gotten a lot louder. And they are not just coming from the lunatic fringe. Prominent Republican leaders, like House Speaker John Boehner , are now among those proposing to block travel from Guinea, Liberia, and Sierra Leone—the three countries where Ebola has already killed thousands.

Are these calls for closing the borders the product of political opportunism? Xenophobia? In some cases they are. But some of them represent good faith attempts to protect public health, both here and abroad. The editors of the National Review   have endorsed a travel ban, for example. In their editorial, they went out of their way to stress the importance of helping the victims of Ebola in West Africa, by making exceptions for aid workers and such. But they’d stop others from going to those countries, and handle returning visitors on a case-by-case basis. 

These are not crazy arguments. But most public health experts remain opposed to such a sweeping travel ban, because they believe the potential downsides are a lot bigger than the potential upsides. These experts make some pretty compelling arguments of their own.

One is that a travel ban would affect the flow of personnel and supplies into the countries where the epidemic continues to spread. Experts, along with non-profits like Doctors Without Borders, say that they’d have a much harder time getting volunteers into the countries if those volunteers knew they could not easily return. Even with an explicit exception for aid workers, they say, the extra burden and uncertainty of having to get special clearance would dampen enthusiasm. Meanwhile, a U.S. travel ban would almost certainly cause other highly developed countries to follow, dramatically reducing the demand for flights and other transportation options to West Africa. Agencies already struggling to get supplies into the area would struggle even more.

Lots of people wonder, couldn’t the U.S. government just arrange other transportation—maybe a modern-day version of the 1948 Berlin airlift? I’ve put that question to a number of officials and experts and the answer I keep hearing is “no.” In the real world, they say, making these arrangements would be difficult and solutions would be inadequate. It’s not as if assistance is this highly organized campaign, with all the necessary aid workers and their supplies lined up at Dover Air Force base, just waiting for C-17s to take them across the Atlantic. The flow of people and wares into West Africa is a constantly changing, unpredictable blob that’s heavily dependent on freely available commercial transportation. Replacing that would take resources and time, the latter of which the region really doesn’t have.

Here’s Lawrence Gostin , director of the O’Neill Institute for National and Global Health Law at Georgetown University:

It isn’t remotely realistic that we could charter flights that were cost effective and would coordinate with all the relief efforts that are ongoing and will ramp up. And advocates for a ban are assuming it would only be the US and US aid workers. But the US launching a travel ban would cascade around the world virtually sealing a whole region off. Not only would aid workers be impeded but also essential medicines, food, and humanitarian supplies. Ultimately it would cripple those countries. 

A travel ban would also hurt the region economically. And while it might seem frivolous to worry about dollars (or other currencies) when it comes to matters of life and death, the issues are inextricably linked. The more the people of these countries face deprivation, whether its lack of jobs or lack of food, the more they will push to leave. It’s not at all far-fetched to imagine huge refugee flows out of these countries—the kind that even tight border controls couldn't fully stop. That would increase the chances that Ebola ends up in other African nations, including those with large urban centers and strong ties to global networks. Think of Ebola taking hold in the slums of Lagos or Nairobi, and how quickly it would jump from there to the rest of the continent and then beyond. It’s just one more example of how a travel ban, quite apart from its devastating effect on the region, could actually result in more cases eventually showing up on American shores.

“I just became persuaded after studying it ... that you’ll end up burning up a lot of resources and still get overtaken by the biological spread.” — Michael Leavitt, HHS Secretary under President Bush

Such an expansion of the epidemic would probably make the calls for a travel ban even louder. But the list of affected countries would grow quickly, and include international travel hubs throughout Asia and Europe. The ensuing complications are one reason that the Bush Administration, which did extensive research on travel restrictions during the avian flu outbreak, decided against a ban. Michael Leavitt , who as Secretary of Health and Human Services in the Bush Administration led the research effort, walked me through some of the logic.

It’s such an appealing idea, it sounds so easy. But it’s when you get to the second layer of activity and then the third and fourth it gets complicated. For example, imagine a Liberian citizen goes to Spain and in Spain he manifests symptoms and people in Spain get it. Do you now expand the travel ban to include Spain? Somebody from Spain goes to the U.K. and now it’s there, so do you include the U.K.? Now somebody who gets it there turns out to be a U.S. citizen and wants to come home to get treated. Do you let the citizen in?

Those complications alone wouldn’t have stopped the Bush Administration from imposing a ban. But officials also became convinced the ban just wouldn’t be very effective. People determined to evade travel restrictions, particularly family members, would find ways to do so. Models predicted that a ban might delay transmission to the U.S., not stop it altogether. Avian flu was airborne, so it's not quite the same situation. But models of Ebola's spread have come to similar conclusions. “I was honestly intrigued by the idea that, for periods of time, you could stop this,” Leavitt said. “I just became persuaded after studying it, and working through what you’d actually be undertaking, that you’ll end up burning up a lot of resources and still get overtaken by the biological spread anyway.”

There’s also a danger that restrictions would push transit into the shadows and underground, making it more difficult to keep track of who was where. “If [a ban] could be carried out, it might be effective in the narrow sense of preventing the entry of persons from those countries,” says Melinda Moore , a physician and public health expert who used to work at CDC and now focuses on these issues at the RAND Corporation. “But then again, it might drive people underground to game the system and circumvent ‘detection,’ to the detriment of everyone.”

Are these arguments ultimately persuasive? I think so, in part because I trust the medical experts who keep saying that the U.S. simply isn’t prone to a very large outbreak. It’s easy to forget, with the nonstop coverage on cable television, but only two people have contracted the disease here. Both were nurses exposed to a very sick patient at a time, and in an environment, when the public health system was seeing these cases for the first time. Everybody, from officials at the CDC to workers on the front lines, has learned from recent mistakes.

Most ( though not all ) experts I know agree. The data and research suggest that there are bound to be more cases here but there are not bound to be many more cases here—and that the top, overriding priority for U.S. policymakers should be doing everything possible to fight Ebola at the source, lest it spread and become a chronic, lingering menace to public health not just abroad but also here. Says Moore, “The best way to protect Americans, which is the objective of this potential policy, is to go all-out to curtail the epidemic in Africa while also ramping up hospital preparedness here in the USA.”

But reasonable people can hold different views  and I, for one, would like to see officials think through a travel ban and how it might work in practice. One reason the proposal is tough to evaluate is that it’s not clear precisely what it would entail and what is actually possible. For example, could Customs and Border Patrol actually screen for and keep out all travelers to the region? Could the U.S. military create an ongoing airlift? If so, how quickly? As Moore explains,

Potential new policies, such as the proposed travel bans, should be examined from various perspectives before decisions are made.  What is the objective? How would it be carried out? How feasible is it? How timely could it be? How effective could it be in the best case scenario and how effective is it likely to be in practice? What are potential unintended negative consequences, and how likely are they?  How acceptable is the policy/intervention to those involved?  Are there alternative approaches that could achieve the same ends but with a better profile in terms of effectiveness, feasibility, acceptability, etc?

That last point, about "alternatives," is important. Officials should also think through restrictions that fall short of a ban. Visitors from the three affected countries are already subject to tougher airport screenings , with monitoring and even quarantines possible at the discretion of officials on the scene. Perhaps, as a rule, all visitors from West Africa should be subject to three weeks of monitoring and loose travel restrictions within the U.S. That approach would seem to have some appeal. It wouldn’t be the kind of deprivation or hardship that would discourage aid workers, or prod people into evading controls. But it would allow public health authorities to keep close tabs on anybody at even moderate risk of getting Ebola and, upon becoming symptomatic, transmitting it.

Such a solution would essentially treat visitors from the region the way we now treat health care workers who have come in contact with Ebola patients. It wouldn’t be perfect, but it might help without hurting, and perhaps ease public anxiety—which, in a situation like this, can be an important public health measure all on its own.

Battle Over Ebola Travel Ban: Health Officials Call It a Big Mistake

There are reasons the U.S. hasn't enacted a travel ban on countries where Ebola has broken out: It wouldn't work and could actually make things worse, health officials say.

Still, that's done little to quell the calls for a ban.

On Friday, Texas Gov. Rick Perry became the latest politician to call for one for anyone seeking to enter the United States from affected areas of West Africa. Two days earlier, House Speaker John Boehner called on President Barack Obama to issue a temporary travel ban on Ebola-afflicted countries "as doubts about the security of our air travel grow." His request came after a second U.S. nurse was diagnosed with Ebola after treating a Liberian man who died of the disease in Dallas , and after she flew from Dallas to Cleveland and back.

A Washington Post-ABC News Poll said that 67 percent of Americans support restricting entry to the U.S. to travelers who have been in Ebola-affected countries.

Other countries — most recently including Jamaica, Guyana, Trinidad and Tobago, Colombia, and St.Lucia — have already taken steps to ban travelers from Liberia, Guinea and Sierra Leone or restrict entry until after a 21-day quarantine. Nigeria, Senegal and Democratic Republic of Congo are also on some of the banned lists.

By the numbers: Ebola in perspective

While the Centers for Disease Control and Prevention says it remains open to all effective options that will make Americans safer, "we can't have anything happening right now that slows our ability to stop the epidemic," CDC spokesman Tom Skinner said.

"When some commercial flights stop going into those countries, our people are delayed going in, our people are delayed going out," Skinner said. "When we stop commercial flights in and out of the country, it does not enhance our ability to stop the epidemic."

But maybe those types of logistics are best left to military logistics experts, said David Dausey, a doctor and the dean of the School of Health Professions and Public Health at Mercyhurst University in Erie, Pa. The Ebola crisis now demands a mobilization akin to a war, he said. "We should be handling this with the same sense of urgency."

There is no need to entirely close the borders of the affected countries, he said, but their airports should be temporarily closed to commercial flights, and foreign military should act fast to fill the gap for aid efforts with the same speed as if they were responding to a natural disaster.

No Ebola epidemic in US without 'mutation': CDC

While the U.S. has pledged aid and military help, White House Press Secretary Josh Earnest on Thursday made clear the president is not considering a travel ban. "Currently, when individuals do travel from West Africa to the United States they are screened prior to departure in West Africa. They are screened again once they enter this country, and they are subjected to heightened screening if they have traveled in these three West African countries in the last three weeks or so," Earnest said, referring to the five airports with extra screenings that see 94 percent of travelers from those countries.

"Now, if we were to put in place a travel ban or a visa ban, it would provide a direct incentive for individuals seeking to travel to the United States to go underground and to seek to evade this screening and to not be candid about their travel history in order to enter the country," he said. "And that means it would be much harder for us to keep tabs on these individuals and make sure that they get the screening that's needed to protect them and to protect, more importantly, the American public."

Many health experts agree that a ban isn’t necessary.

"You're not preventing the movement of the population anyway," said Harvard epidemologist John Brownstein. "Many of these countries have very porous borders."

And there's no evidence that travel bans have any lasting effect, he said. Brownstein co-authored a study that found that the airport closures in the eastern U.S. after 9/11 did delay the onset of flu that year, but only by two weeks.

"Ultimately these pathogens find their way around the globe," said Brownstein.

A ban on travel could also hurt the local economies in Africa.

Nigeria saw a big decline in air travel over the summer. In August, ticket sales from the United States to Nigeria were down 31 percent over the same time a year earlier, according to information for all airlines collected by the Airlines Reporting Corp. financial group. By September, when Nigeria's situation had improved, the decline was only 20 percent. The country hopes to get a final Ebola clearance from the World Health Organization within days.

Tourism to the three worst-afflicted countries is limited even in healthy times — they represent less than 0.5 percent of all international travel to Africa, said Sandra Carvao, spokeswoman for the United Nations World Tourism Organization.

Even so, the economic impact of a travel ban "would be tremendous," said Robert Brunner, a vice president for Arik Air, the largest airline in West Africa. "These are countries that are fragile to start with, and it wouldn't take much to tip them when things get harder than they are. …

"And if you're banning air travel, would there also be a call to ban ship travel? Any port of call is banned as well?" Brunner asked, referring to potential ways around a travel ban.

If you're going to start isolating people who don't even show symptoms, he said, "Where does it stop?"

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One of the Ebola remedies that's gaining traction is to isolate West Africa — the hot zone — and close America off to travelers from the region. Yesterday, the calls for a travel ban escalated at a congressional hearing on the epidemic, making it seem like a political eventuality. "It needs to be solved in Africa, but until then, we should not be letting these people in, period," said Fred Upton, member of the House Energy and Commerce oversight and investigations subcommittee. The fear of spread is understandable, especially as an Ebola outbreak appears poised to grow closer to home . America recently recorded its first Ebola death with the passing of a Liberian visitor Thomas Duncan, and the CDC announced the first-ever cases of Ebola transmission to two of Duncan's nurses . As Ebola panic peaks, conspiracy theories are spreading fast. So now is the time when we need to check our irrational reactions to this horrible crisis and avoid policies that will divert scarce resources from actual remedies. And we know from past experience that airport screening and travel bans are more about quelling the public's fears and political expediency than offering any real boost to public health security.

Airport screening is political theater

In October, the US government announced a new airport screening regime for incoming travelers from West Africa. Passengers arriving from Sierra Leone, Guinea and Liberia to five US airports will now be questioned about potential Ebola exposure and have their temperatures checked. Exit screening has already been underway in West Africa since the summer, and famously failed in the case of Duncan. He flew to Dallas with Ebola incubating in his body, and did not disclose the fact that he had close contact with a dying Ebola patient days before his trip. A Canadian study showed that airport screening during the 2003 SARS pandemic didn't detect a single case. This failure shouldn't be a surprise. We know from past outbreaks that these techniques don't work. Entry and exit screening was used during the 2003 SARS pandemic. A Canadian study of the public-health response following the outbreak found that airport screening was a waste of money and human resources: it didn't detect a single case of the disease. This screening was "inefficient and ineffective," the authors of the assessment concluded, noting that the Canadian public health agency should seriously rethink using it again in the future. Another study found that those clunky and costly thermal scanners used to detect fever in airports were similarly useless when it came to singling out sick people who are trying to enter a country. So spending extra money to identify feverish people at airports — especially those with Ebola who can be undetectable for days until they are symptomatic — is an expensive and ineffectual exercise.

Closing borders would be a disaster

Taking airline panic one step further, US lawmakers are now pushing to close off West Africa to the rest of the world. Allow Ebola to fester over there, and keep people safe over here. In opposing this idea, public health experts unanimously agree: sealing borders will not stop Ebola spread and will only exacerbate the crisis in West Africa — and heighten the risk of a global pandemic. There are three reasons why it's a crazy idea. The first is that it just won't work to stop the virus. The weeks following 9/11, when people stopped getting on planes, provided influenza researchers with a natural experiment in what a travel ban might do to viral spread. They found it didn't stop influenza from moving, it only delayed flu season by a couple of weeks. What's more, the researchers didn't measure whether this delay actually reduced flu cases or saved lives. But a look at the CDC data shows that flu deaths actually massively spiked during the 2001-2002 flu season, rising from about 3,900 the year before to more than 13,000 post-9/11. Writing in the Washington Post , Laurie Garrett — senior fellow for global health at the Council on Foreign Relations — pointed out: "Many nations have banned flights from other countries in recent years in hopes of blocking the entry of viruses, including SARS and H1N1 'swine flu,'" she added. "None of the bans were effective, and the viruses gained entry to populations regardless of what radical measures were taken to keep them out." In CDC Director Tom Freiden's words , "Even when governments restrict travel and trade, people in affected countries still find a way to move and it is even harder to track them systematically." In other words, determined people will find a way to cross borders anyway, but unlike at airports, we can't track their movements. 90 percent of any outbreak's economic costs "come from irrational and disorganized efforts of the public to avoid infection." The second reason a travel ban won't work is that it would actually make stopping the outbreak in West Africa more difficult. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said , "To completely seal off and don't let planes in or out of the West African countries involved, then you could paradoxically make things much worse in the sense that you can't get supplies in, you can't get help in, you can't get the kinds of things in there that we need to contain the epidemic." Some have suggested a half-measure: close borders allowing exceptions for doctors, aid workers, and medical supplies only. The problem with this idea is that responses to humanitarian crises are not well-organized affairs. They're chaos. A bureaucratic regime that systematically screens who can go in and out of affected countries would only slow down or make impossible the much-needed relief. Plus, many aid workers — like reserve staff for Doctors Without Borders — would be responsible for booking their own tickets to get to the affected region. How would they do this then? And how long would it take to get them over there? The third reason closing borders is nuts is that it will devastate the economies of West Africa and further destroy the limited health systems there. The World Bank already estimates this outbreak could cost West African economies up to $33 billion. That's a lot for any country, but especially when you're talking about some of the world's poorest. World Health Organization director Margaret Chan reminded us that 90 percent of any outbreak's economic costs "come from irrational and disorganized efforts of the public to avoid infection."

The best way to protect Americans is by protecting West Africans

We live in a world where many crises are predictable. We don't know when the next one will strike, or where, but we know it will eventually come. In the health field, we even know approximately what it will look like. Every few years, for example, we seem to get another global pandemic that spreads across borders as if they don't exist. In 2002 it was SARS, then in 2009 it was Swine Flu. Today it's Ebola. In five year's time it will be something else. If we know these health crises are coming, why is it that we never seem ready? It's true that we can't prepare for every kind of outbreak in every place at every time; having a large standing army of white coated doctors at the ready would just be too expensive. But there is no reason we can't use the lessons learned from past outbreaks to make better choices in this time of Ebola. We also need to stop diverting precious resources on policies and procedures that do nothing to help the public. Instead of using airport screening and entertaining plans to seal borders, the government should focus its attention and resources on West Africa where the outbreak is out of control and where real action could actually be helpful in protecting America's health security. Because we know this for sure: the longer Ebola rages on in West Africa, the more people get the disease there, the more of a chance it has of spreading elsewhere. Three people in the US have been stricken by Ebola; more than 8,000 have in West Africa. The best way to avoid more cases in America is by protecting West Africans.

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Ebola: Here's Why Travel Bans Could Make Americans Less Safe

Ebola is spreading rapidly in West Africa, and the first cases of people in the United States who have the deadly virus have been reported. Now, Americans are getting increasingly jittery about importing the deadly disease, new polls show.

In a recent Washington Post and ABC news poll, 67 percent of those surveyed said they supported a travel ban from the affected countries.

But despite broad popular support for such restrictions, travel bans would actually increase the risk of the disease spreading to other countries, including the United States, experts say.

Here's why: A travel ban would reduce the number of medical workers who enter the countries, which could worsen the outbreak there, said Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center in Nashville, Tennessee. The countries of Guinea, Liberia and Sierra Leone already had fragile health infrastructures, and many of their doctors and nurses have died from the disease, he said.

Further depriving those nations of U.S. medical workers would thus mean more Ebola cases there. And an increase in the number of cases anywhere in the world means there is an increase in the risk that someone with Ebola could come to the United States, said Dr. Amesh Adalja, an infectious disease specialist and a representative of the Infectious Disease Society of America.

Travel bans would also severely impact a targeted country's economy, leading to food and water shortages and political destabilization, Adalja said.

People may flee the affected countries and cross, undetected, into neighboring nations such as Mali or the Ivory Coast, Adalja said. (On Thursday, Oct. 23, Mali confirmed its first case of Ebola, in a 2-year-old girl who had crossed the border from Guinea.)

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"What a travel ban does is it squeezes people to use other modes of transportation," Adalja told Live Science.

And people fleeing from Liberia, Guinea or Sierra Leone who were banned from flying to the United States could instead fly to other countries in Africa, which would mean the United States would then either have to ban travel from even more countries, or cast a much wider net in monitoring than it currently does, he said.

Right now, American airports funnel the approximately 150 passengers a day from Guinea, Liberia and Sierra Leone through five main ports of entry. Those coming from Ebola-ravaged countries must check in with public health authorities, take their temperatures for 21 days (the incubation period for the virus) and be on the alert for symptoms. 

Under this system, public health officials can keep tabs on every person who comes down with the disease, and get them isolated and into a designated care facility before they are highly infectious. But this effort would be difficult to scale up if many more African countries had outbreaks flaring, Adalja said.

An endemic disease?

People in the United States may not want to risk American lives at home simply to help the humanitarian effort in Africa. But if the outbreak in Africa gets large enough, there's a risk that Ebola could become an endemic disease in the region, meaning there will always be cases present in some populations there, said Dr. Howard Markel, a pediatrician and the director of the Center for the History of Medicine at the University of Michigan.

That possibility was also highlighted earlier this month in a news conference held by the Centers for Disease Control and Prevention. [ The 9 Deadliest Viruses on Earth ]

"It could spread to other countries in Africa and be an ongoing risk that we would have to deal with for months or for years," Dr. Thomas Frieden, the director of the CDC, said. "It's really important that we stop the outbreak. And to do that, we need regular travel. We need countries not completely isolated from the world."

The outbreak in West Africa is now the worst Ebola outbreak in history , with nearly 10,000 cases and almost 5,000 reported deaths as of Oct. 22, according to the CDC.

Future use?

The Obama administration hasn't ruled out the possibility of a travel ban if the situation continues to worsen. In September, a CDC report projected that up to 1.4 million people could be stricken by Ebola in Guinea, Sierra Leone and Liberia if relief efforts aren't dramatically scaled up . At that point, a travel ban could be potentially useful, although even then it still may not make sense, Markel said.

So far, Ebola has stricken fewer than about 10,000 individuals in countries with millions of people, and only two of the thousands of passengers who have traveled recently to the United States from West Africa have tested positive for the disease after they arrived here, Markel said.

" Don't use a bazooka when a BB gun will do," Markel said. "A travel ban is a bazooka."

The risk to Americans is ultimately tied to the size of the outbreak in West Africa, all the experts said, so the best way to keep people in the United States safe is to stamp the disease out at the source.

"Until the outbreak is gone, everybody is going to be at risk," Adalja said.

Follow Tia Ghose on Twitter   and Google+ .   Follow Live Science @livescience , Facebook & Google+ . Originally published on Live Science .

Tia is the managing editor and was previously a senior writer for Live Science. Her work has appeared in Scientific American, Wired.com and other outlets. She holds a master's degree in bioengineering from the University of Washington, a graduate certificate in science writing from UC Santa Cruz and a bachelor's degree in mechanical engineering from the University of Texas at Austin. Tia was part of a team at the Milwaukee Journal Sentinel that published the Empty Cradles series on preterm births, which won multiple awards, including the 2012 Casey Medal for Meritorious Journalism.

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Effectiveness of Ebola travel ban questioned

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WASHINGTON (AP) — A ban on travel from West Africa might seem like a simple and smart response to the frightening Ebola outbreak there. It’s become a central demand of Republicans on Capitol Hill and some Democrats, and is popular with the public. But health experts are nearly unanimous in saying it’s a bad idea that could backfire.

The experts’ key objection is that a travel ban could prevent needed medical supplies, food and health care workers from reaching Liberia, Sierra Leone and Guinea, the nations where the epidemic is at its peak. Without that aid, the deadly virus might spread to wider areas of Africa, making it even more of a threat to the U.S. and the world, experts say.

In addition, preventing people from the affected countries from traveling to the U.S. could be difficult to enforce and might generate counterproductive results, such as people lying about their travel history or attempting to evade screening.

The U.S. has not instituted a travel ban in response to a disease outbreak in recent history. The experts insist now is not the time to start, especially given that the disease is still extremely contained in the U.S. and the only people who have caught it here are two health care workers who cared for a sick patient who later died.

“If we know anything in global health it’s that you can’t wrap a whole region in cellophane and expect to keep out a rapidly moving infectious disease. It doesn’t work that way,” said Lawrence Gostin, a professor and global health expert at Georgetown University Law Center. “Ultimately people will flee one way or another, and the more infection there is and the more people there are, the more they flee and the more unsafe we are.”

Officials with the Centers for Disease Control and Prevention and the National Institutes of Health voiced similar objections at a congressional hearing this past week. So did President Barack Obama after meeting with administration officials coordinating the response.

Obama said he didn’t have a “philosophical objection” to a travel ban but that he was told by experts that it would be less effective than the steps the administration has instituted, including temperature screening and monitoring at the five airports accounting for 94 percent of the arrivals from the three impacted nations. There are 100 to 150 arrivals daily to the U.S. from that region.

Still, with little more than two weeks from midterm elections and control of the Senate at stake, the administration is facing mounting pressure on Capitol Hill to impose travel restrictions. Numerous Republicans have demanded a ban, as have a handful of Democrats, including at least two endangered incumbent senators, Kay Hagan of North Carolina and Mark Pryor of Arkansas.

“A temporary travel ban is a prudent step the president can take to protect the American people, and I believe he should do so immediately,” Hagan said Friday.

Republican House Speaker John Boehner also favors a travel ban, and his spokesman, Kevin Smith, said the speaker hasn’t ruled out bringing the House back into session to address the Ebola issue. Obama “has the authority to put a travel ban into effect right now,” Smith said.

Lawmakers have proposed banning all visitors from Liberia, Sierra Leone and Guinea, or at least temporarily denying visas to nationals of those countries. They’ve suggested quarantining U.S. citizens arriving here from those nations for at least 21 days, Ebola’s incubation period, and limiting travel to West Africa to essential personnel and workers ferrying supplies. Related steps that have been proposed by Pryor and others include strengthening existing quarantine centers, getting health officials to assist with screenings at airports and ensuring that information collected at airports on travelers from hot zones is shared with state officials.

Experts say some of those limited steps make sense but question the legality, ethics and effectiveness of large-scale quarantines. Although it would be theoretically possible to get supplies and medical personnel to West Africa even while shutting down commercial air travel, in practice it would turn into a logistical nightmare, they say. They cite expenses and difficulties in chartering private aircraft or enlisting the military’s assistance to transport thousands of personnel and huge amounts of supplies from around the world that is now moving freely on scheduled air travel.

Screening measures now in place allow arrivals from West Africa to be tracked; if those people go underground, attempt to enter via the Southern Border or by other means, it becomes that much harder to keep tabs on them.

Another difficulty arises because there are no direct flights to the U.S. from the impacted nations, raising the question of where to draw the line. Should flights from Paris, Amsterdam, London or Munich be banned if it turns out there is a passenger from Monrovia, Liberia, on them? Or should the other passengers just be screened? What if Ebola breaks out on European soil — should the travel ban be extended?

Among the travel ban skeptics is former President George W. Bush’s top health official, who coordinated the government’s response to bird flu in 2005 and 2006. At the time, it was feared that the H5N1 flu strain, capable of jumping from birds to humans, could become the catalyst for a global pandemic.

A travel ban “is intuitively attractive, and seems so simple,” said Mike Leavitt, who led the Health and Human Services Department from 2005-2009. “We studied it intensely in preparation for H5N1. I became persuaded that there are lots of problems with it.”

Associated Press writers Charles Babington, Ricardo Alonso-Zaldivar and Jim Kuhnhenn contributed to this report.

Watch CBS News

Obama fans Ebola travel ban fever

By Major Garrett

October 17, 2014 / 6:00 AM EDT / CBS News

President Obama is struggling with the politics and policy of an Ebola travel ban.

After canceling his second day of travel to focus on the epidemic, Mr. Obama addressed increasing calls for a travel ban from the Oval Office, his team of health care and homeland security advisers huddled around, looking pensive and exhausted.

"I don't have a philosophical objection, necessarily, to a travel ban if that is the thing that is going to keep the American people safe," Mr. Obama said Thursday before listing all the reasons he has resisted one so far.

"If we institute a travel ban instead of the protocols that we've put in place now, history shows that there is a likelihood of increased avoidance," he said. "People do not readily disclose their information. They may engage in something called broken travel - essentially breaking up their trip so they can hide the fact that they have been to one of these countries where there is a disease in place. As a result we may end up getting less information about who has the disease, they are less likely to get treated properly, screened properly, quarantined properly and as a consequence we could end up having more cases rather than less."

Those comments amplified what White House Press Secretary Josh Earnest and Dr. Tom Frieden of the Centers for Disease Control and Prevention have been saying before Congress, inquisitive White House reporters and numerous cable network anchors. For the first time, Mr. Obama confronted the policy question head-on. But no sooner had the president listed all the scientific reasons not to impose a travel ban, he appeared to undercut the argument and opened the door to imposing one later.

"Now, I continue to push and ask our experts whether, in fact, we are doing what's adequate in order to protect the American people," he said. "If they come back to me and they say there's some additional things we need to do, I assure you we will do it. But it is important in these circumstances for us to look at the history of how these infectious diseases are best dealt with. And it is currently the judgment of all those who have been involved that a flat-out travel ban is not the best way to go."

As with every policy question that becomes part of a heated political season - more on that in a moment - parsing of presidential words can prove illuminating and potentially predictive. Mr. Obama said it was possible experts could come to a different conclusion. How was left intentionally vague. He also opened up some distance between his current position and the scientific advice being given - "the judgment of those who have been involved." Other advisers could become involved. Also, something less than a "flat-out travel ban" could be recommended and approved.

To underscore the point that the travel ban debate is far from over, Mr. Obama concluded with this:

"I am asking these questions and if in fact it turns out that I am getting different answers then I will share that with the American people. We will not hesitate to do what is necessary in order to maximize the chances that we avoid an outbreak here in the United States."

The president was, in fact, less emphatic than his press secretary only hours early at the Thursday White House briefing.

"If we're trying to protect the American public, we should not put in place a travel ban," Earnest said.

According to The Hill newspaper, dozens of lawmakers support banning travel to the United States from the so-called Ebola "hot zone" - Liberia, Sierra Leone and Guinea. By the newspaper's tally , 56 members of the House (50 Republicans and six Democrats) and 11 senators (10 Republicans and one Democrat) support the travel ban. GOP candidates have pressed the issue in Senate races in Iowa, North Carolina, South Dakota and Georgia. In North Carolina, embattled Senate Democrat Kay Hagan said a travel ban "may be one tool we can use" without fully endorsing it. There have also been calls for a ban on travel visas . The White House also opposes that move.

Jamaica, St. Lucia and Colombia issued travel bans on passengers from West Africa this week. A computer model created by Northeastern University physicist Alexi Vespignani attempts to calculate the risks of global travel in the age of Ebola and suggests a travel ban would be of marginal help since air travel is so common and symptoms of the virus can take two to 21 days to develop. The survey was and its various computer models and predictions were dissected in Forbes .

Lawmakers tussled over the issue Thursday during a House hearing on Ebola preparedness and prevention.

"The current airline passenger screening at five U.S. airports through temperature-taking and self-reporting is troubling," said Rep. Tim Murphy, R-Pennsylvania. "Both CDC (Centers for Disease Control and Prevention) and NIH (National Institutes of Health) tell us that the Ebola patients are only contagious when having a fever, but we know this may not be totally accurate. A determined infected traveler can evade the screening by masking the fever with ibuprofen, or avoiding the five airports. Further, it is nearly impossible to perform contact-tracing of all people on multiple international flights across the globe."

Murphy pressed Frieden during the hearing, recounting a recent conversation on a travel ban that raised issues not related to public health.

Murphy: "Dr. Frieden, when we spoke on the phone the other day, you remained opposed to travel restrictions, because in your words, you said cutting commercial ties would hurt these fledgling democracies. Now is this the opinion of CDC? Is this your opinion or did someone also advise you, someone within the administration, someone in any other agencies, where did this opinion come from that that's of high importance? Frieden: "My sole concern is to protect Americans. We can do that by continuing to take the steps we are taking here as well as to -- Murphy: "Did someone advise you on that, someone outside of yourself? Somebody else advise you that that's the position, we need to protect fledgling democracies? Frieden: "My recollection of that conversation is that that discussion was in the context of our ability to stop the epidemic at the source.

Rep. Fred Upton, R-Michigan, asked Frieden about federal powers to impose a travel ban to protect public safety and protect against the spread of contagious diseases.

Upton: "The administration, as I understand it, as I've looked at the legal language, does the president -- does have the legal authority to impose a travel ban because of health reasons, including Ebola; is that not correct? Frieden: "I don't have the legal expertise to answer that question.

According to Executive Order 13295 the federal government can take steps to apprehend, detain and conditionally release any individual suspected of carrying or possibly introducing specified "communicable diseases."

The order lists the diseases: Cholera; Diphtheria; Infectious Tuberculosis; Plague; Smallpox; Yellow Fever; and Viral Hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named).

The executive order was drafted amid the SARS epidemic but an Oct. 9 Congressional Research Service report outlined federal and state powers - including a travel ban and the use of a "Do Not Board" list.

"The Secretary is also authorized to bar the entry of persons from foreign countries where the "existence of any communicable disease" poses a "serious danger" of entering the United States such that "a suspension of the right to introduce such persons and property is required in the interest of public health."

The report described the Do Not Board list as follows:

"The public health Do Not Board (DNB) list was developed by DHS and the CDC, and made operational in June 2007. The DNB list enables domestic and international health officials to request that persons with communicable diseases who meet specific criteria and pose a serious threat to the public be restricted from boarding commercial aircraft departing from or arriving in the United States.The list provides a tool for management of emerging public health threats when local public health efforts are not sufficient to keep certain contagious individuals from boarding commercial flights."

A September 2008 CDC report revealed 42 requests were made to put travelers on the Do Not Board list. Each had suspected or confirmed pulmonary tuberculosis. The CDC placed 33 travelers on the list.

Rep. Henry Waxman, D-California, defended existing policy and argued a travel ban would make matters worse at the source of the epidemic and here. Waxman questioned Frieden and Anthony Fauci, head of the NIH's Institute of Allergy and Infectious Diseases.

Waxman: "What you're saying is that we want to monitor people before they leave those countries to see whether they have this infection, and we want to monitor them when they come into these countries to see whether they have this infection. Is that what you're proposing to do? Frieden: "That's what we're actually doing. We're able to screen on entry. We're able to get detailed locating information. We're able to determine the risk level. "If people were to come in by -- for example, going overland to another country, and then entering without our knowing that they were from these three countries, we would actually lose that information. Currently, we have detailed locating information. We're taking detailed histories, and we're sharing information with state and local health departments, so that they can do the follow-up they decide to do. Waxman: "Dr. Fauci, do you agree with Dr. Frieden on this point? Fauci: "I do. It's certainly understandable how someone might come to a conclusion that the best approach would be to just seal off the border from those countries. But we're dealing with something now that we know what we're dealing with. If you have the possibility of doing all of those lines that you showed, that's a big web of things that we don't know what we're dealing with.

For many Americans, there is an unnerving sense the government has not always known what it's dealing with when it comes to understanding and containing Ebola risks. What is clear is the White House has no interest in a travel ban, despite calls from Congress and the campaign trail for just that.

Major Garrett is CBS News' chief Washington correspondent. He's also the host of "The Takeout," a weekly multi-platform interview show on politics, policy and pop culture.

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Joel Breman, Who Helped Stop an Ebola Outbreak in Africa, Dies at 87

Part of a team flown in to fight the deadly virus in 1976, Dr. Breman also worked to stamp out tropical diseases like smallpox, malaria and Guinea worm.

By Adam Nossiter

Dr. Joel Breman, a specialist in infectious diseases who was a member of the original team that helped combat the Ebola virus in 1976, died on April 6 at his home in Chevy Chase, Md. He was 87.

His death was confirmed by his son, Matthew, who said his father died of complications from kidney cancer.

“We were scared out of our wits,” Dr. Breman, recollecting his pioneer mission, told a National Institutes of Health newsletter in 2014, as a new and even deadlier Ebola outbreak raged that year.

Nearly 40 years earlier, his team of five had just landed in the interior of what is now the Democratic Republic of Congo, at a remote Roman Catholic mission hospital. They were up against a viral infection that had no name, whose origin was unknown, and that was accompanied by high fever and bleeding that led to a painful and quick death.

Dr. Breman, dispatched by the Centers for Disease Control and Prevention, had only what he described to the N.I.H. as “the most basic protective equipment” against the disease, in contrast to the full-body spacesuit-like gear that was standard in the later outbreak. He and others on the team, laboring in intense heat and bitten by sand flies, “developed rashes and didn’t know if we would catch the virus too,” he said.

But he calmly began deploying the techniques he had honed on earlier missions to Africa, on anti-smallpox initiatives in Guinea and Burkina Faso. He interviewed patients and witnesses, traveling from village to village and going from house to house. He and his colleagues, he recalled, soon determined that the infection was “spread by close contact with infected body fluids,” and that it had been propagated at a rural hospital that was using unsterilized needles.

Over a long career, much of it spent at the Centers for Disease Control, the World Health Organization and the National Institutes for Health, Dr. Breman worked to stamp out deadly tropical diseases like smallpox, malaria and Guinea worm. But that initial Ebola outbreak, he told an interviewer in 2009 , “was the scariest epidemic of my entire medical career and possibly of the last century.”

Compared with the later outbreak in West Africa, which lasted more than two years, the Congo (then Zaire) epidemic was quickly contained. There were fewer than 300 deaths, in marked contrast to the more than 11,000 from 2014 to 2016. The relative success in 1976 was partly because of Dr. Breman’s efforts to analyze, contain and isolate this frightening new virus.

“He was my mentor, and he was the leader of the team,” said Dr. Peter Piot, a former director of the London School of Hygiene and Tropical Medicine and himself a pioneering Ebola and AIDS researcher.

“He already had great experience of outbreak investigations and fieldwork,” Dr. Piot continued. “He was a combination of walking encyclopedia and accumulated experience. He had an incredible commitment to solve problems for people, reaching out to people and listening to them.”

Dr. Breman would spend a half-hour or more simply chatting with village notables, about their families and other matters, before getting down to questions about the disease, Dr. Piot said. “He made the connection between human understanding and interaction, and data analysis. He had the human factor.”

Dr. Piot had special praise for Dr. Breman’s demeanor: “He remained calm. This was a pretty stressful time. Lots of people died. He was very patient with me.”

Dr. Breman spent two months in Congo, becoming chief of surveillance, epidemiology and control for the mission. He was then sent by the C.D.C. to help run the World Health Organization’s smallpox program in Geneva.

By 1980, with smallpox effectively eradicated — “one of the greatest triumphs in the history of medicine,” he called it in a Story Corps interview with his son — Dr. Breman began what he called “a new career” running the disease control center’s anti-malaria program.

At a memorial tribute on April 9, Dr. Rick Steketee, a fellow member of the American Society of Tropical Medicine and Hygiene, said that in the years that followed, and through new postings, Dr. Breman “wrote book chapters that guide the medicine and public health practice around the world and edited textbooks that influenced the practice of infectious disease control and elimination, especially in low-resource countries.” Dr. Breman was president of the society in 2020.

Joel Gordon Breman was born on Dec. 1, 1936, in Chicago to Herman Breman, a painting contractor, and Irene (Grant) Breman. When Joel was 7, the family moved to Los Angeles, where his father painted movie sets and his mother bought and sold furniture and property.

Dr. Breman attended Hamilton High School in Los Angeles. He received a B.A. in political science from the University of California, Los Angeles, in 1958 and a medical degree from the University of Southern California in 1965. He was awarded a degree from the London School of Hygiene and Tropical Medicine in 1971.

His first assignment overseas was in Guinea, from 1967 to 1969, when the C.D.C. assigned him to run its smallpox eradication program. That mission fueled a lifelong passion for Africa, Matthew Breman said. Numerous scientific trips there followed, often as a consultant to the World Health Organization.

Dr. Breman held a number of senior positions at the National Institutes of Health, from which he retired in 2010 as a senior scientist emeritus.

In addition to his son, he is survived by his wife, Vicki; his daughter, Johanna Tzur; and six grandchildren.

“My dad loved helping others and thought it was important to help everyone,” Matthew Breman said. “I think that’s one of the reasons he went into medicine.”

Adam Nossiter has been bureau chief in Kabul, Paris, West Africa and New Orleans, and is now a Domestic Correspondent on the Obituaries desk. More about Adam Nossiter