Come Thursday, travelers arriving at Dulles International Airport from three West African nations hit hard by the Ebola virus will be met by Customs and Border Protection agents who will whisk them away to special screening rooms.
There, they will be evaluated for signs of illness, questioned about their travel and asked whether they’ve had contact with anyone with Ebola or anyone exposed to the virus. They’ll have their temperature taken. And, if they show no symptoms, they will be sent on their way — but not before leaving their contact information for possible follow-up. If they have a fever, they will be referred for additional screening, the most suspicious cases sent by ambulance to a nearby hospital for further evaluation. A positive Ebola test will trigger a system of alerts that will go to state, federal and local officials.
Welcome to the new normal for travelers arriving from Guinea, Liberia and Sierra Leone at five of the nation’s busiest international airports. The enhanced screening, set to also begin at Atlanta’s Hartsfield-Jackson, Newark’s Liberty International and Chicago’s O’Hare airports Thursday, is another effort to assure an anxious public that steps are being taken to prevent an outbreak of the deadly disease here.
The enhanced screening started Saturday at New York’s John F. Kennedy International Airport. Along with new strategies announced by the Centers for Disease Control and Prevention to increase training and reduce the number of people who come in contact with an infected patient, authorities hope the screenings will prevent a repeat of what happened in Dallas, where the first person diagnosed with Ebola in the United States died a week ago.
Thomas Eric Duncan, who traveled from Liberia late last month, passed through Brussels and Dulles before arriving in Dallas. He fell ill with Ebola four days after he landed in Texas. Since then, a nurse who treated Duncan has fallen ill with the disease, and dozens of others who had contact with him remain under observation.
“We’re learning from Dallas, we’re learning from Kennedy Airport in New York,” said David Goodfriend, director of the Loudoun County Department of Health. “This is something we take very seriously.”
Given that the Washington area is home to a major international airport and the nation’s capital, health officials say, it is more prepared to deal with the virus but also at higher risk that someone who lives here or passes through may be infected. “I think as long as there’s this kind of outbreak in any part of the world, it’s possible,” said Joshua M. Sharfstein, Maryland’s secretary of Health and Mental Hygiene.
The CDC already has a full-time office at Dulles, so the proximity to international travelers enables it to react quickly.
Christopher Paolino, a spokesman for the Metropolitan Washington Airports Authority, which manages Dulles and Reagan National airports, said the airport’s quarantine areas are intended to be used as short-term facilities until CDC officials can determine whether a traveler should be released or sent to a hospital for further tests.
According to Goodfriend, if CDC officials determine that a person should be hospitalized, that person likely will be transported by MWAA’s fire and rescue service or another nearby agency to a hospital in the area. Goodfriend added that CDC officials would notify the receiving hospital as well as local health officials about the possible infection.
Two laboratories in the region — Maryland’s Public Health Laboratory and the Virginia Division of Consolidated Laboratory Services — are equipped to test for the Ebola virus. That number is expected to grow with other certified laboratories in the area set to receive test kits from the CDC. At a briefing for regional leaders last week, Joxel Garcia, director of the D.C. Department of Public Health, said it takes roughly six hours for test results to be completed. Those results are then forwarded to the CDC for confirmation.
Paolino said travelers suspected of having Ebola will be taken to the nearest available hospital — a practice that has been questioned by some officials who believe treatment should be consolidated at a small number of hospitals.
“I have no doubt in my mind that [the National Institutes of Health] has the ability to care [for Ebola patients], but are all hospitals that well prepared?”asked Montgomery County Council member Roger Berliner (D-Potomac-Bethesda). “I find it peculiar that we don’t have hospitals specialize.”
Health officials have said that all U.S. hospitals should be prepared to care for those with the virus.
“We need to have every hospital ready, because we’re not going to know they have Ebola when they walk in,” said David Trump, chief deputy commissioner with the Virginia Department of Health.
CDC officials said they are now considering whether to designate certain hospitals as specialized treatment centers for Ebola, but some experts believe doing so would increase the risk for patients and caregivers.
Julie Fischer, an associate research professor of health policy at George Washington University, said transporting patients to far-flung facilities presents a major hurdle to centralizing Ebola treatment. Getting an Ebola patient from Louisiana to the Nebraska Medical Center, which has successfully treated Ebola patients, for example, would require using a biosafety-equipped airplane, and there are only two or three, at most, in the United States. Moving patients creates risks, too, she said.
“The drawback in transporting of patients is in the difficult logistics,” Fischer said.
At the Inova Health System, the largest in Northern Virginia and one that could be called upon to treat a patient with Ebola, officials said on the system’s Web site that they are upgrading action plans and increasing the number of drills designed to prepare staff for dealing with the disease. Officials with the system, which operates five hospitals with more than 1,700 licensed beds, added that their efforts, including the type of personal protective equipment that personnel wear, will go “above and beyond what the [Centers for Disease Control and Prevention] recommend.”
Health officials at several D.C.-area hospitals have already tested their readiness for dealing with a suspected case of Ebola.
This month, Howard University and George Washington University hospitals and Shady Grove Adventist Hospital in Rockville, announced that they had admitted patients with symptoms and travel histories associated with Ebola. All proved to be false alarms. An American doctor who was exposed to the virus was evaluated at the National Institutes of Health hospital in Bethesda but did not test positive for the virus and was released. On Tuesday, officials at a Richmond-area hospital said they admitted a woman who was suspected of having Ebola. It, too, was a false alarm.
Jill Holdsworth, president of the D.C. chapter of the Association for Professionals in Infection Control and Epidemiology (APIC), said that among the lessons she’s heard hospitals here and across the country are understanding: the importance of creating an Ebola cart, with all the necessary supplies should they need to treat a patient who might be infected.
“That was one thing no one really had, because we had never had to deal with something like this,” she said. “Now people don’t have to ask for certain types of gowns and gloves, because they are in a central place.”
At JFK, 91 people were flagged after enhanced screening began there. Five others were stopped for additional screening, but none was found to have a fever or Ebola. After JFK, Dulles handles the second highest number of travelers from the impacted countries.
There are no direct flights to the United States from the three countries most affected by Ebola. Federal officials said that in the past two months, an estimated 36,000 people have flown out of the three West African nations, with about 9,000 bound for the United States — an average of 150 a day. The five airports where passengers will receive additional screening handle 94 percent of traffic from the affected region.
Public health officials here and across the country have successfully managed other major outbreaks, including H1N1 in 2009 and Severe Acute Respiratory Syndrome (SARS) but concede that they face new challenges with possible cases of Ebola.
And news this week that the nurse who treated Duncan contracted the virus despite wearing protective clothing prompted officials with the Centers for Disease Control and Prevention to revisit how they treat and manage the disease. CDC Director Thomas Frieden said Tuesday that the CDC will deploy specialized Ebola teams “within hours” to any hospital with a confirmed Ebola case.
While some have expressed doubts that the enhanced screening can shield Americans, Goodfriend said he thinks it offers at least one way to stop possible infections before people move into the larger community.
Ashley Halsey III and Todd Frankel contributed to this report.