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Screening for Ebola. Probably Not.

So the federal government is going to keep Ebola virus out of the United States by screening travelers at entry points. This is the same government that brought us Benghazi, the Veterans’ Administration debacle, the Children’s Crusade across the southern border, the IRS hard drive scandal, the Secret Service missteps, and the over $800 million healthcare.gov disaster. Yes, they will protect us from Ebola. They cannot keep a military veteran alive, but they will thwart a 60% lethal virus.

Be clear, the victory against Ebola virus will be containment/prevention, not treatment. Treatment will result in a grave for 7 out of 10 infected people, maybe 1 in 4 with the best possible U.S. healthcare.

But, let’s look at this proposal from a number of viewpoints. First, no infection has a continuous fever. I have consulted on infections of every type for about 40 years and fevers are discontinuous – there are many minutes of the day when a person overwhelmed with infection has no fever, in fact, may be hypothermic. In the most advanced infections, depending on how the invading agent behaves and many other factors particular for the case, fever only occurs a couple times a day, and may be low grade (100°F or below). So, you test a patient at one brief moment in a 24-hour period as they pass through Customs and they have no fever. They’re ok. What if they have a fever one, two, six hours later? What if they were not symptomatic on day 9 (at the airport) after Ebola virus exposure, but the illness started on day 18 (up to 21 days incubation)? Where are you then? Sorry, U.S. citizens.

Illness does not obey strict numerical rules in individual cases. It is biology, not physics. One moment in time you are infection free, then, a microsecond later, you are “infected”. You pick up virions (viral particles smaller than the size of a cell) and they replicate. You are still not “infected”. You are infested or contaminated. The infecting agent is in you, but not yet interacting with your immune system. The state of infection is when you, the host, recognize a foreign invader (by your immune system) and there are physical and lab signs of inflammation – fever, sweats, chills, discomfort, changes in white blood cell count and other lab indicators. This is a continuum that starts on a microscopic level and eventuates in signs and symptoms of illness. Can you see where someone could be infected at the airport, lie on their paperwork, pass the gross temperature screening, and then import Ebola virus to spread to others later as they become increasingly ill before they seek care. So, this continuous subtle process could be ongoing and undetectable without labwork and a meticulous medical exam, not a cursory screening by a non-medical immigration official.

Furthermore, what if an individual desperate to get into the U.S. (because they are worried they may have Ebola virus and want access to the best care in the world) uses an anti-pyretic, a fever lowering drug, like acetaminophen (Tylenol) or ibuprofen to lower their temperature? There is no screen for that. They might take such meds around the clock for a day or two pre-travel to get through the screen.

Finally, any rational person who has had a legitimate Ebola virus exposure would lie to get into the U.S., knowing that once here they would get the best care possible. You and I would probably do it. This apparently happened with the first U.S.-imported case in Dallas. This fact will make the U.S. a magnet for every person suspecting they have been exposed to Ebola virus; just like those droves of Central American kids who poured across our southern border (only now it will literally be an immediate life/death proposition). And, they know once they’re at Customs they’re in. That is, screening at the endpoint of travel is futile and dangerous for this country. It is negligent and irrational as policy. And, this is what our leaders and their experts on government payroll have come up with.

The final argument against screening as the preventive approach is the possibility that terrorists will catch on to the potential of Ebola virus as a weapon – sending their agents into infected countries and using their bodies as vehicles as potent as the airliners flown into the Twin Towers to disrupt the American society and economy. The “screening” approach would be permissive to the potential success of such a cynical act of aggression. And, with a wide-open southern border!

Yes, this is outside-the-box thinking. But “9/11” showed that terrorists think that way, to attack obtusely.

The only way to deal with the Ebola virus threat with maximum reliability and security is an entire lockdown on immigration by anyone coming from the affected Ebola virus “hot zones” until the epidemic has ended.

This will not be a perfect process since there are no West Africa to U.S. direct flights. It will require deliberate effort to trace to origin each traveler’s itinerary by airline and passport checks. It will require restricting Ebola virus country departures until the epidemic is over. It will not be easy, but we must do the best we can. It will be far better than destination “screening”.

Nothing short of that is acceptable or will work.  It is not politically correct. It is simply the right thing to do medically and for national security.

Speak out against this to your elected leaders. With elections next month, maybe you have some leverage.

 

Edward R. Rensimer, MD, FACP

Director, International Medicine Center