Healthcare

What Happens If an Ebola Case Lands at JFK?

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Last Saturday, New York’s John F. Kennedy International Airport started conducting the U.S. Centers for Disease Control’s enhanced Ebola screening. JFK became the first out of five U.S. airports, including Washington-Dulles, Newark Liberty, Chicago-O’Hare, and Hartsfield-Jackson Atlanta international airports, to begin the special screening exercise. The discovery that Amber Vinson — the second Texas nurse who contracted Ebola — was allowed to board a commercial airliner from Ohio to Texas while running a fever begs an obvious question for New Yorkers: What happens if an infected passenger arrives at JFK?

If a person starts showing Ebola-like symptoms as a flight nears JFK, the pilot, according to the CDC’s Ebola Guidance for Airlines, will first notify the agency that there is an ill traveler on board. Then cabin crew members are trained to act quickly, separating the sick passenger from others and handling him or her with disposable waterproof gloves, while wearing surgical masks, protective aprons, and goggles.

Other Passengers
If the infected passenger becomes symptomatic while en route to the U.S., other passengers on the plane are at risk of contracting the virus. Once a contagious case is confirmed upon arrival at JFK, the CDC is required to reach out to the airline for the flight manifest to determine the radius of exposure — the at-risk area surrounding the passenger — a strategy the CDC has used in the past to assess exposure to infectious diseases like measles, rubella, or tuberculosis. (Although the agency’s contact investigations information has not yet been updated to be more Ebola-specific, it would appear that this is the same protocol the CDC would use to track passengers in danger of exposure to Ebola.)

Passengers, or “contacts,” whose assigned seats fell within a certain radius around the patient will be contacted by the CDC once they’ve disembarked. The zone of exposure can be up to 40 or 50 seats outward from the Ebola patient, according to the CDC’s website.

But Dr. Frank Rhame, an infectious-diseases physician at Abbott Northwestern Hospital in Minneapolis, is not convinced that the CDC’s estimation of who is likely to be infected aboard a plane is accurate.

“This management scheme is of dubious relevance to Ebola,” Rhame says, explaining that it typically has been used for airborne and droplet-spread pathogens. Ebola, on the other hand, is a virulent pathogen that can only be transmitted through direct contact with the body fluids of an infected person. There is no evidence to suggest that it can be spread through the air, hence weakening the argument that infectious aerosols in sneezes and coughs are contagious.

“Sometimes the more highly exposed folks are investigated first — that may be the rationale” behind the attention given by the CDC to the plane’s seating chart, Rhame adds. But, “If one of the nearby exposed persons is found to have suffered a transmission, they can expand the scope of the investigation,” he says.

The CDC did not respond to several calls and emails from the Voice seeking clarification of its protocol.

There are exceptions, however, to the 40-to-50-passenger radius. The infected traveler’s companions will also be deemed exposed and will be contacted by the CDC. More official protocols grant the CDC leeway to flex its authority while tracking down and containing infected persons and suspected cases:

Under 42 Code of Federal Regulations parts 70 and 71,CDC is authorized to detain, medically examine, and release persons arriving into the United States and traveling between states who are suspected of carrying these communicable diseases…. When alerted about an ill passenger or crew member by the pilot of a plane or captain of a ship, CDC may detain passengers and crew as necessary to investigate whether the cause of the illness on board is a communicable disease.

State, local, and tribal authorities also have the legal latitude to enforce the implementation of isolation and quarantine within their borders.

Exposed passengers and crew members will be monitored closely for 21 days (the incubation period of the Ebola virus).

Patient Zero
What becomes of the infected patient? The infected person will most likely be transferred from JFK to one of the four New York City hospitals that have been designated as Ebola treatment centers (there are eight overall in New York state). There, he or she will be quarantined.

Jennifer Bender, a spokeswoman for the NYC Health and Hospitals Corporation, says the city’s four Ebola treatment centers — Manhattan’s Bellevue, Mount Sinai, and New York Presbyterian hospitals, and Montefiore Medical Center in the Bronx — will be able to receive transfers from other city hospitals “after consultation with [the New York City Department of Health and Mental Hygiene].”

After arriving at one of the Ebola treatment centers, the passenger’s fate rests on a cocktail of blood transfusions, experimental drugs, rehydration therapies, and quality medical care.

According to the CDC, nearly 50 percent of travelers from the three affected West African nations — Guinea, Sierra Leone, and Liberia — arrived in the U.S. through JFK in the year ending July 2014.

Email the author: icnwoye@villagevoice.com
Follow on Twitter: @irenecnwoye

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