Published: Oct 17, 2014
As Ebola continues to dominate the headlines, one hotly debated question is whether the U.S. should ban travelers from the West Africa nations where the disease is raging, as a preventive measure.
Members of Congress from both sides of the aisle support this idea. "To ensure that our country does not acquire any new cases of the virus, I believe Congress should enact travel restrictions from areas that have been affected by this contagious disease," Rep. Renee Ellmers (R-N.C.) wrote to MedPage Today in an email. "It's important that we isolate and stop the spread of Ebola, and securing a travel restriction would be the first step."
Sen. Bill Nelson (D-Fla.) was an early proponent of travel restrictions. "It would seem that another means of reducing the chances of exposure to the virus here at home would be to temporarily suspend unnecessary travel to the U.S. under existing visas and the issuance of new visas for citizens of countries that the Centers for Disease Control and Prevention identifies as areas with high rates of infections," Nelson wrote in a letter to Secretary of State John Kerry on Oct. 7.
CDC director Tom Frieden, MD, MPH, was asked several times about a travel ban during a House hearing on Thursday. "If our fundamental job is to protect the American public ... why can we not move to a ban on travel from these countries as some other countries have?" said Rep. Fred Upton (R-Mich.).
But Frieden said he was not in favor of a travel ban. "Right now we know who is coming in," he said. "If we try to eliminate travel, the possibility that some will travel over land, will come from other places, and we don't know that they are coming in will mean we won't be able to do multiple things.
"We won't be able to check them for fever when they leave ... we won't be able to check them for fever when they arrive, we won't be able, as we do currently, to take a detailed history to see if they're exposed, we won't be able to impose quarantine as we now can, we wouldn't be able to include detailed location information as we can now... [and] we wouldn't be able to provide all that information as we do now to state and local health departments so they can monitor them under supervision."
Rep. Peter Welch (D-Vt.) noted at the hearing that, from Congress' viewpoint, a travel ban "sounds like something we can do and it will eliminate any possibility of an infection coming here, but that might be a psychological answer and not necessarily a medical answer."
President Obama was leaning against a travel ban Thursday. "I don't have a philosophical objection necessarily to a travel ban if that is the thing that is going to keep the American people safe," Obama said after meeting with Frieden and other advisers at the White House.
"The problem is, is that in all the discussions I've had thus far with experts in the field, experts in infectious disease, is that a travel ban is less effective than the measures that we are currently instituting that involve screening passengers who are coming from West Africa -- first of all, screening them before they get on the plane there to see whether they're showing signs of the disease -- and screening them again when they get here, taking their temperature," Obama continued.
"If we institute a travel ban instead of the protocols that we've put in place now, history shows that there is a likelihood of increased avoidance. People ... may engage in something called broken travel, essentially breaking up their trip so that they can hide the fact that they have been to one of these countries where there is a disease in place. ... They're less likely to get treated properly, screened properly, quarantined properly. And as a consequence, we could end up having more cases rather than less."
Other medical experts also weighed in against a ban. William Schaffner, MD, an infectious disease specialist at Vanderbilt University in Nashville, Tenn., said in an interview with MedPage Today that although travel restrictions do address anxiety, they are "not really science-based. I'm not so sure these travel restrictions are a good idea. We can manage these importations -- if there are any more -- effectively in other ways. We don't have to stigmatize whole populations."
Travel bans also could result in unforeseen dilemmas, he noted. For example, what about a Liberian immigrant who is here legally and then travels to Liberia to care for his mother, who is sick with an unknown illness? If a travel ban is instituted, "are we going to let him back in? We're going to run into a myriad of problems like that."
Because the ban is such a controversial issue, some experts have decided to keep their own counsel. The public relations department at one major hospital center declined to comment on the issue, saying its leadership was refraining from discussing the matter.
As well, most of the rhetoric from Washington and elsewhere in favor of travel restrictions has been short on specifics: that is, who exactly would be prevented from entry and how they would be identified.
Nelson's Oct. 7 letter mentioned citizens of countries with identified Ebola epidemics, but that would not cover individuals of other nationalities who have been in those regions, such as healthcare workers and business travelers. Identifying those with "broken travel" itineraries is no small task for Customs and Border Patrol agents.
Travel ban proponents on Capitol Hill have also been silent on whether they would keep out American doctors and other healthcare professionals who have been working to fight Ebola in the stricken regions, or force them to be quarantined on their return.
In addition to international travel from West Africa, some concerns are being raised about domestic travel, especially in cases involving patients later found to have Ebola.
On Thursday evening, the CDC issued an announcement asking all passengers on Frontier Airlines Flight 1142, which flew from Dallas to Cleveland on Oct. 10, to call the agency so they can be screened by CDC personnel. Amber Vinson, one of the Dallas nurses who developed Ebola after treating patient Thomas Duncan, was a passenger on that flight, which occurred three days before she began developing symptoms.
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