And it Begins...

Barely two months ago, we were told that the odds of Ebola spreading to the U.S. were rather slim.  Remember this little "it won"t happen here" moment from late July, courtesy of the CDC?

The deadly outbreak of Ebola virus in West Africa is unlikely to spread outside of that region and into the United States, the Centers for Disease Control and Prevention said Monday (July 28).

“No Ebola cases have been reported in the United States and the likelihood of this outbreak spreading outside of West Africa is very low," CDC spokesperson Stephan Monroe, Ph.D., the deputy director at the National Center for Emerging and Zoonotic Infectious Diseases, said in a teleconference. "I want to underscore that Ebola poses little risk to the U.S. general population."

Barely seven weeks later, Patient Zero, a Liberian named Thomas Eric Duncan arrived at the Dallas-Fort Worth Airport from his homeland, completing a 28-hour journey that took him through Brussels and Dulles Airport outside Washington, before the final leg of his flight to Texas.  

By some accounts, Mr. Duncan (who lived in Liberia for the past two years) decided to travel to the U.S. because he had been exposed to the deadly illness and was seeking better medical care.  Before leaving Liberia, Duncan had been in close contact with a pregnant woman who died from the disease.  

Four days after arriving in the United States, Duncan was at a Dallas hospital emergency room, complaining of symptoms consistent with Ebola.  Despite reporting his travel from Africa to at least one hospital staffer, Duncan was sent home with antibiotics.  Two days later, he returned in an ambulance, was diagnosed with the deadly disease and placed in isolation.  

At this point, medical investigators haven't released a full accounting of Duncan's activities during his travels from Liberia and after his arrival in Texas.  According to The New York Times, state health officials estimate that at least 100 people in the Dallas area may have come in contact with Duncan--directly or indirectly--since he came to Dallas on 20 September.  Among those potentially exposed are students at four elementary schools near the apartment complex where Duncan was staying with family members.  So far, only a handful of the individuals being monitored by health officials have been placed in isolation, including three emergency medical technicians who took Duncan back to the hospital on 28 September.  As of this writing, none of those individuals are displaying symptoms of ebola. 

Readers will note that the narrative surrounding Mr. Duncan has grown more complex, almost by the hour.  Early reporting seemed to suggest he flew non-stop from Monrovia to Dallas, with no mention of his stops in Belgium and at Dulles.  Of course, anyone on the internet can quickly discover there are no direct flights from Liberia to Dallas; why was the "connecting" information omitted from preliminary media accounts?  Was it sloppy journalism, or were government officials trying to figure out what Duncan did in Brussels and Virginia while waiting for his next flight.  

There's also the timing of his travels.  Various press accounts indicate that Mr. Duncan worked as a driver for the local FedEx agent in Monrovia; his residence was a rented room in a local home--owned by the father of the young woman who died from Ebola, the same woman that Duncan helped transport to a local hospital and back home, after the staff told them they had no more room for patients suffering from the disease.  Duncan's contact with the woman came on 15 September, just four days before he left for the United States.

But that assumes he had no contact with his landlord's daughter prior to that date.  That would mean the young woman--who was well along in her pregnancy--almost never visited her parents' home, or dropped by only when Mr. Duncan was out of the house.  Potentially, he might have been exposed to the disease earlier than the reported date.  Claims that he wasn't showing symptoms are based on Duncan's visits to the Dallas hospital, and whatever he has told U.S. officials.  So far, no one in the media has managed (read: bothered) to track down people that sat near Duncan on the plane, or encountered him at the airports in Brussels and the U.S.

Some are also wondering how Mr. Duncan paid for a one-way ticket (that cost at least $3400) on his meager pay, just three days before departing.  His former employer hasn't disclosed how much Duncan earned, but the average annual income in Liberia is only $436.  In other words, Mr. Duncan paid almost ten times what a typical Liberian earns in a year for his ticket to America.  He must be a very thrifty person, or has friends who were willing to shell out some serious bucks--by Liberian standards--on very short notice.   And no one has divulged when Duncan obtained his visa to enter the United States.  

Meanwhile, the government of Liberia has announced plans to prosecute Mr. Duncan, assuming he survives Ebola and they can somehow secure his extradition.  Before flying to the U.S., Duncan was required to fill out a questionnaire, which asks departing passengers if they had cared for an Ebola patient, or touched the body of someone who died in an area where the disease has been confirmed.  Duncan answered "no" to all of the questions on the form.

Of course, all of this could have been prevented if the Obama Administration had acted prudently, and suspended air travel between the U.S. and Liberia.  Supporters of the president argue that such steps are ineffective, since passengers can fly out on carriers still serving affected nations, and connect with an American or European carrier, and travel on to the U.S.  But the supposed futility of that measure hasn't stopped several European airlines (including British Airways and Air France) from halting flights to and from Monrovia.  

It's also worth noting that Mr. Obama quietly scrapped new reporting and quarantine regulations proposed by the Bush Administration in 2005.  Those measures required airlines to keep track of sick passengers and report that information to the CDC.  The expanded regulations also allowed the Centers for Disease Control to detain passengers suspected of carrying certain infectious diseases, including Ebola.  Under pressure from the airline industry and the ACLU, Team Obama decided not to implement the new rules.       

Just four years later, Ebola has arrived on our shores, the same week that the former hospital at Ellis Island was reopened to the public.  Immigration activists often point to the iconic immigration depot as a symbol of America's willingness to take in people from around the world, and give them the opportunity for a better life.  

But they often ignore the rules imposed at Ellis Island; everyone coming into America was given a rigorous health screening and those who tested positive for an infectious illnesses were placed in quarantine and some were sent back home.  In fact, many of the sick immigrants never made it to Ellis Island; New York state health inspectors met arriving ships in the outer harbor and passengers with contagious diseases were transferred to quarantine facilities in Richmond County.  One researcher estimates that over 400 immigrants died in quarantine between 1909 and 1911.  

Once upon a time, the U.S. demanded "good health and moral character" of those entering the country.  More than a century later, the rules are vastly different and we are paying the price for our mistakes.  And the price will likely be tallied in human lives.    
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ADDENDUM:  FlightAware.com (and other sites) have also traced the travels of the United jets that Duncan flew on during portions of his trip.  From Brussels to Dulles, Duncan traveled on a Boeing 777 (registration number: N771UA), and an Airbus A320 (registration number: N482UA) for the final leg of his journey from Washington, D.C., to Texas.  

Over the six-day period following Duncan's arrival in Dallas, both aircraft were constantly in the skies, as you might expect.  The six day period represents the length of time that Ebola can live on a surface, such as an arm rest, seatback table, or lavatory fixture.  United has announced that no special cleaning measures have been used on either aircraft, even after they determined that Duncan had traveled on two of their jets.  

Between 20-26 September, the 777 flew to three different countries (England, Germany and Brazil); during that same period, the A320 served a number of domestic locations, including Denver, Jackson Hole, Wyoming; Orlando, San Francisco, Los Angeles, Houston, Newark, Las Vegas, Seattle and Orange County, California.  Admittedly, the odds of contracting Ebola from an expose surface are decidedly low, but there are literally scores of passengers who shared the areas where Duncan sat, and used the same facilities.  

H/T:  Gotnews.com