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CDC to implement elaborate monitoring for West African visitors

Travelers from Guinea, Liberia, and Sierra Leone will receive a CARE (Check And Report Ebola) kit when they arrive in the United States.
Travelers from Guinea, Liberia, and Sierra Leone will receive a CARE (Check And Report Ebola) kit when they arrive in the United States. CDC

The U.S. will soon require every airline passenger from Sierra Leone, Guinea, and Liberia who arrives in one of six states to undergo 21 days of official monitoring for symptoms of Ebola.

The new initiative, which begins Monday, will require state and local health officials in Georgia, Maryland, New Jersey, New York, Pennsylvania and Virginia to collect detailed information from the travelers as part of an elaborate plan to keep tabs on their whereabouts while they’re in the U.S.

Under the new protocols, visitors must provide contact information to local health authorities who will maintain daily contact with them, search for those who don’t comply and arrange transportation for the sick to medical facilities.

“These new measures I’m announcing today will give additional levels of safety so that people who develop symptoms of Ebola are isolated early in the course of their illness,” said Tom Frieden, the director of the U.S. Centers for Disease Control and Prevention. “That will reduce the chance that Ebola will spread from an ill person to close contacts and health care workers.”

It's unclear, however, whether underfunded state and local health departments will be up to their heightened responsibilities under the new plan. And some question whether a travel ban for the three countries might be a less burdensome but equally effective alternative for health officials.

The U.S. receives about 150 travelers each day from the three Ebola-ravaged West African nations. About 70 percent of them are headed for the six target states, Frieden said. Most are either U.S. citizens or longtime legal visitors to America, he said.

Travelers from the three countries already undergo a basic level of screening for the virus upon arrival in the U.S. through any of five airports that were designated Wednesday to receive all passengers from those countries: They have their temperatures checked, are asked to provide contact information and are questioned about their possible exposure to Ebola.

Those airports are New York’s John F. Kennedy International Airport, Newark Liberty International Airport in New Jersey, Chicago O’Hare International Airport, Washington Dulles International Airport and Hartsfield-Jackson Atlanta International Airport.

But starting Monday, local health officials in the six states must collect much more detailed information and maintain daily contact with the travelers for the three weeks they’d be at risk of contracting the virus after exposure.

Under the plan, a West African traveler must provide two email addresses, two telephone numbers, a home address, an address for the next 21 days and the name, address, email address and phone number of a friend or relative in the U.S.

“This information is essential for health departments as they track individuals who have arrived in this country,” Frieden said

Visitors will also be given “Check and Report Ebola” kits at the airport, known simply as CARE kits. The kit will include a tracking log, a description of Ebola symptoms, a thermometer and instructions on how to use it, and a wallet card with information on whom to contact if they develop symptoms.

During the next 21 days, the travelers will be required to provide daily reports to health officials of their temperatures and whether they have Ebola symptoms. These include fever, headache, joint and muscle aches, stomach pain, lack of appetite, weakness, diarrhea, vomiting or abnormal bleeding.

If the visitors plan to travel within the states or out of state, they must make arrangements with health officials to have their temperatures monitored while traveling “in a manner that is acceptable to the state or local health department that has jurisdiction,” Frieden said.

Health officials also must provide round-the-clock phone numbers for the visitors to report any Ebola-like symptoms. For those who fail to maintain daily contact, the health officials will “take immediate steps” to locate them and re-establish daily contact.

For those who become sick, officials must make arrangements to safely transport them to medical facilities by nonpublic means. The patients will then be expected to show their wallet cards from the CARE kits, which identify them to health care providers as possible Ebola carriers.

The CDC will help local jurisdictions with the effort by providing information on arriving travelers and, if requested, technical support, consultation and funding.

Jack Herrmann, the senior adviser and chief of public health programs at the National Association of County and City Health Officials, said the new effort would be a challenge for large and small health departments, some of which have only two employees with lots of other responsibilities.

“Of course there are going to be concerns, because they can’t project, necessarily, what the burden will be. How many people will they have to monitor and track?” Herrmann said.

Larger urban departments may have more staff and resources, but federal and state budget cuts have left them lean as well.

“There’s about 150 people per day that come in potentially from these affected countries,” Herrmann said. “Do the math. That can add up over a short period of time.”

But Hermann said the group’s 2,800 member health departments had been uniformly committed to doing what was best for the public health.

“They’re all saying we know we’ve got to do this, so we have to work together to figure out how to make this happen,” Herrmann said.

Scott Briscoe, spokesman for the Association of State and Territorial Health Officials, declined to comment on the new plan until the organization could review them further.

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