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    Ebola, travel, and the fear of flying

    It’s been more than six weeks since Ebola crossed the Atlantic. On Sept. 30, the Centers for Disease Control and Prevention confirmed the first case to be diagnosed on US soil. The patient, a man who had traveled from Liberia to Dallas did not fall ill until four days after his return. A tragic situation that ended with his death, his case and those of two infected nurses who cared for him have instilled fear in many people and caused concern about the safety of travel. The pressing question many travelers have is: Should I worry about catching Ebola? According to Dr. Marty Cetron, director of the CDC’s Division of Global Migration and Quarantine, for the great majority of us, the answer is a resounding no.

    Ebola is not in the air. It can be transmitted only by direct contact with the bodily fluids of a contagious patient. And for a patient to be contagious, the expert consensus is that the patient needs to be symptomatic (demonstrated by fever, diarrhea, vomiting, or other symptoms). Cetron cited the risk of contracting Ebola during routine air travel as “minimal.” He elaborated that “to the best of our knowledge, based on scientific evidence, there is no asymptomatic transmission.” This point is critical, as it means that even if someone has caught Ebola, if they’re without symptoms, they’re incapable of transmitting the disease, even if they sat right on your lap.

    Most cases are detected before patients have a chance to board planes from West Africa because of intensive screening protocols. Cetron has great confidence in this screening system, which has proven effective.

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    “Most people who are symptomatic with Ebola have been identified at the source. The exit screening [from affected African countries] is extremely effective,” Cetron said. “If someone is symptomatic, it’s very probable they’ll be identified.”

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    There is still public concern about the hypothetical scenario whereby a patient becomes symptomatic during the course of their travel. Cetron does not feel this is likely. “It’s extremely unlikely that a patient will become symptomatic and contagious in transit,” he said. However in the rare instance where a patient could begin to manifest symptoms en route, the reality is they still are unlikely to transmit disease to their seatmates. This is because early in the disease, patients are only minimally contagious.

    Cetron explained that “at the first onset of fever, the viral load is typically very low. So low, in fact, that patients often test negative and need to have the test repeated in 72 hours.” In short, when patients are minimally ill, they’re minimally contagious; when they’re moderately ill, they’re moderately contagious.

    Ebola has, however, spread in Guinea, Liberia, and Sierra Leone (and there are sporadic cases reported in other countries). The fact that this outbreak has killed almost 5,000 people (a figure the CDC believes is an underestimateattributable to underreporting) strikes a chord of fear in many. It’s important to emphasize that in those West African regions, the degree of medical support, education, and conditions on the ground are very different from those in our own country and medical system.

    The CDC has implemented guidelines for travelers returning from Ebola-stricken countries or those who have otherwise been exposed to the virus. The policy categorizes patients into one of four categories: high risk of exposure, some risk, low risk, or no risk. Even shaking hands with an Ebola patient lands you in the low-risk group. And while the management of patients in these groups varies from monitoring of vital signs to placing those who are symptomatic in quarantine, most public health experts agree that blanket quarantine of everyone coming back from West Africa is unnecessary.

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    Recent polls have indicated that the majority of Americans support some form of quarantine. With individual states owning the latitude to impose quarantines on individuals, even those who wouldn’t be quarantined under federal guidelines, the heat is on anyone arriving from West Africa.

    Despite the recommendation to postpone nonessential travel to high-transmission countries, Cetron supports ongoing aid to battle Ebola in West Africa, saying “there is an essential humanitarian response that must continue.”

    He added: “The epidemic of disease is often followed by an epidemic of fear. And an epidemic of stigma. The vaccine for fear is education.”

    Brian Irwin is a family and travel physician in New Hampshire.