Early Thursday, Michal Ruprecht arrived at Uganda’s Entebbe International Airport around 2 AM for a flight. When he reached the airline counter, he mentioned his destination was Michigan.
He recalls the agent giving him a double take, questioning whether he was indeed going to Michigan. Ruprecht, a medical student and freelance reporter, was returning home after a month of reporting in Uganda for NPR.
The agent presented a memo from U.S. Customs and Border Protection, informing Ruprecht that he must fly into Washington Dulles International Airport (IAD). “At first, I was in denial,” he says, unsure if it was real.
Ruprecht was among the first passengers caught up in a newly announced policy stating that all Americans who have traveled through Uganda, South Sudan, or the Democratic Republic of Congo (DRC) within the last 21 days must arrive at IAD. Subsequently, it was declared that two more U.S. airports—Hartsfield-Jackson Atlanta International and George Bush Intercontinental in Houston—would start similar screening in the coming days.
The DRC and Uganda are experiencing a serious Ebola outbreak, with the World Health Organization identifying it as a public health emergency of international concern on May 17. So far, there are reported to be 800 suspected cases and over 180 possible fatalities.
The U.S. has implemented travel restrictions for those recently in these countries, directing U.S. citizens to specific entry points and reserving the right to deny entry to most others.
In Uganda, Ruprecht hurriedly rebooked his flights. After a 20-hour journey, upon arriving at Dulles, he was flagged for additional screening.
CDC officials took him to a makeshift clinic constructed with tarps that resembled a campsite. A CDC official measured his temperature with a handheld thermometer and remarked that it was slightly high. “I was definitely nervous,” he admits. Subsequent checks were normal, and they moved on to questioning.
Ruprecht confirmed he had no Ebola symptoms and hadn’t engaged in high-risk activities in Uganda. The entire process lasted about 5 to 10 minutes and felt somewhat anticlimactic.
In previous Ebola outbreaks, travelers received thermometers and guidelines for follow-up, which Ruprecht did not receive. Nevertheless, he caught his connecting flight back to Michigan.
The following afternoon, he received a text message from the CDC outlining Ebola symptoms and advising him to contact his local health department and isolate if he felt unwell.
States will monitor
Once the CDC conducts initial assessments at airports, they will inform state health departments about the travelers’ whereabouts. According to Dr. Laurie Forlano, Virginia’s state epidemiologist, some travelers will be monitored daily based on their exposure risk, and the state is ready for this process, having successfully managed similar situations before.
However, Forlano admits, initial responses often include some level of chaos. Virginia is already addressing other health issues, such as a measles outbreak and hantavirus monitoring.
According to Dr. Jeanne Marrazzo, a public health expert, the nation’s public health system is not operating at full capacity. In the past five years, many local and state public health resources have been cut, leading to concerns about preparedness.
Travel bans work with accompanying measures
Currently, only U.S. citizens and nationals traveling from Ebola-affected countries can guarantee entry at select airports in Virginia, Houston, or Atlanta. Those with green cards might gain entry, whereas others face restrictions according to the CDC’s recent Title 42 Order.
During the earlier Ebola epidemic from 2014 to 2016, U.S. officials chose not to impose such strict travel bans, allowing travelers in under specific monitoring conditions, which Dr. Marty Cetron of the CDC emphasized were key to effective management.
He pointed out that travel bans do not work in isolation. When restrictions are put in place, individuals often seek alternatives to travel anyway. Public health messaging and education were crucial during the past outbreaks, as compliance increased when travelers understood the health goals.
Cetron argues that while screenings at U.S. entry points provide some level of safety, they are not sufficient alone to ensure safety. Focus must also be on addressing the root cause of outbreaks where they begin.
The CDC currently has several staff members deployed in East-Central Africa, as Dr. Satish Pillai discussed regarding the agency’s ongoing Ebola response efforts. In the past, the U.S. took a leadership role in Ebola epidemics, sending thousands of personnel to assist in the affected regions.
