About 800 Frontier passengers may have been exposed to Ebola virus

CDC Expands Passenger Notification
A nurse who had treated the first US Ebola patient was exposed to the Ebola virus and later contracted the disease. Before she was hospitalized, she had taken the following two airline flights in early October 2014 on Frontier Airlines:

• October 10th: Fight 1142 from Dallas, TX (DFW) to Cleveland, OH.
• October 13th: Flight 1143 from Cleveland to DFW.

Several days ago, it was revealed that this passenger had a fever while on the return flight, and may have put others on the aircraft at risk. The CDC and the airline started working together to contact passengers who were on flight 1143 from October 13th in order to interview them and to provide any necessary advice or information.

On Thursday October 16th, the CDC also revealed that they were looking for passengers who were on the earlier flight on October 10th. This is because the infected nurse, who was hospitalized one day after the October 13th flight, may have been exhibiting Ebola symptoms during the earlier October 10th flight.

What should those passengers do?
If you were on either of these Frontier Airlines flights, the CDC suggests that you contact them at the following numbers:

• 800-CDC-INFO (800-232-4636)
• 800-232-6348 (TTY)
• 1-404-404-639-3311 (main switchboard)

Were the airplanes contaminated?
It is unclear if the airplanes used on those flights were contaminated with the Ebola virus. According to an October 15th article from the Denver Post, the plane used for flight 1143 was cleaned using procedures that were consistent with CDC guidelines after the October 13th flight, and and again after flying on five additional flights on October 14th.

After Frontier was notified about the infected passenger on October 15th, the aircraft was removed from service. The aircraft has since been cleaned two more times, had its environmental filters changed, and had seat covers and carpets in the vicinity of the infected passenger replaced. The two flight crew and four cabin crew members were placed on paid leave for 21 days. The article did not mention the taken for the aircraft and crew used for flight 1142 on October 10th.

Passengers on other flights may be at risk
While the CDC is only actively seeking out passengers on flights 1142 and 1143, according to another Denver Post from October 16th, Frontier Airlines attempting to contact the roughly 800 passengers who were on the following five flights from October 14th and suggesting that they contact the CDC:

• Flight 2042, DFW-CLE, departed 7:50 am CDT
• Flight 1104, CLE-FLL departed 12:13 pm EDT
• Flight 1105 FLL-CLE departed 3:43 pm EDT
• Flight 1101 CLE-ATL departed 7:14 pm EDT
• Flight 1100 ATL-CLE departed 9:57 pm EDT

Related resources
October 15th Denver Post article
October 16th Denver Post article
Ebola and airline travel issues

Evolving issues with Ebola and air travel

The recent news that a nurse, Amber Joy Vinson, who was both infected by the Ebola virus and showing Ebola-related symptoms, was on an airline flight with 132 other passengers (and at least five crew members) was disturbing for a couple of reasons. The primary concern was that this nurse, who had a low-grade fever but no other Ebola-related symptoms, put all the passengers and crew on that plane at risk of being infected by the Ebola virus.

The secondary concern is that passengers on other flights may have also been exposed to the Ebola virus. The October 13th Frontier Airlines flight, which was flight number 1143, departed from Cleveland and flew to the Dallas DFW airport. This airport is a major hub airport for American as well a popular airport for international flights. It is likely that many of the passengers on that Frontier flight were changing planes in Dallas, may have exposed thousands of other passengers to the Ebola virus.

Nurse Vinson was not reckless or unaware of the risk of her flying. She had been directly involved with treating an Ebola patient in Dallas, and had been monitoring her health status for signs of an Ebola infection. She realized that she had a fever, which is a symptom of Ebola infection, and had contacted the Centers for Disease Control for advice on wether she should fly.

At the time, her fever was low enough to allow her to fly, and the CDC gave her permission to take that flight. Since then, the CDC has admitted that their decision was not the right one, and have changed their policy on travel by health workers who have been exposed to the Ebola virus.

Recent interviews
Below are several recent Ebola-related interviews and articles by Todd Curtis of AirSafe.com

• 17 October 2014: CJOB Winnipeg, Canada radio interview
• 17 October 2014: Newsmax television interview
• 15 October 2014: WFAA television Dallas, TX
• 15 October 2014: CTV television Canada
• 9 October 2014: CJOB radio with host Charles Adler
• 9 October 2014: Article: US airport screening procedures

Additional resources
Background information on Ebola
Passenger with Ebola flies to Dallas
Patrick Smith of AskThePilot.com on air travel and Ebola

New Ebola screening measures likely not effective

On October 8th, 2014 the US Centers for Disease Control (CDC), along with US Customs and Border Protection (CBP), announced a series of new screening measures at selected US airports. These measures, which will focus on travelers arriving from the west African nations of Liberia, Guinea, and Sierra Leone, the three nations most affected by the latest Ebola outbreak.

These new screening measures will be at five airports: New York's JFK and Newark airports, Washington Dulles, Chicago O'Hare, and Atlanta. The first airport to begin screening will be JFK on October 11th, and the enhanced entry screening at the other four airports by the end of the following week.

Why these five airports? While the CDC admits that no procedure will completely eliminate the risk of an Ebola outbreak in the US, These new screening measures will be at five airports: New York's JFK and Newark airports, Washington Dulles, Chicago O'Hare, and Atlanta. According to the CDC, these five airports represent the US entry point for the first airport to begin screening will be JFK on October 11th, and the enhanced entry screening at the other four airports by the end of the following week.

Why these five airports? According to the CDC, these five airports receive over 94 percent of travelers from the Ebola-affected nations of Guinea, Liberia, and Sierra Leone. From August 2013 to July 2014, with JFK alone accounting for almost half the arrivals

What are the new procedures? Travelers from these three countries, who would have already gone through exit screening protocols in the affected West African countries, will face the following process:

• Travelers from Guinea, Liberia, and Sierra Leone will be escorted by CBP to an area of the airport set aside for screening.
• They will be observed them for signs of illness and asked a series of health and Ebola exposure questions.
• They will also have their temperature taken by a non-contact thermometer.
• If the travelers have fever, symptoms or if the health questionnaire reveals possible Ebola exposure, they will be evaluated by a CDC quarantine station public health officer, and if necessary referred to the appropriate public health authority.
• Travelers from these countries who are not Ebola-like symptoms exhibiting symptoms and who have no known history of exposure will receive health information for self-monitoring and will be allowed to enter the country.

How effective has exit screening been?
According to the CDC, since exit screening began about two months ago in Liberia, Guinea, and Sierra Leone, 36,000 people were screened and 77 people were kept from boarding a flight.

None of these 77 passengers were diagnosed with Ebola. However, at least one passenger who was infected with Ebola, but who was apparently not exhibiting any Ebola symptoms, was able to depart Liberia on September 19th, and flew to the US through Washington Dulles airport and then onward to Dallas, TX. This passenger, Thomas Eric Duncan later fell ill and died from Ebola.

How effective will this new entry screening process be?
In order for this screening process to identify passengers who are infected with Ebola, passengers must either be being both able and willing to provide accurate information on their Ebola exposure, or the passenger has to be exhibiting a fever or other symptom associated with Ebola.

Perhaps most importantly, in order to be even screened by this procedure, a passenger must be on a flight that comes directly from one of the three affected countries, and they must enter into one of the five airports that are part of the new screening program.

This means the roughly 6% of passengers who fly directly from the affected countries into another airport are not screened at all. However, there is a potentially much larger pool of passengers who will not be screened or who will not be identified by the proposed screening process, including passengers in the following categories:

• Not flying directly from the three targeted countries, for example having a layover of one or more days before flying onward to the US.
• Persons exposed to Ebola, who are not showing any symptoms, and who are either not aware of their exposure or who are not truthful about their exposure.
• Either exposed to or infected by the Ebola virus, and possibly even showing Ebola-related symptoms, but who are not flying from the three targeted countries.
• Entering the US by sea or through a land border.

Why make the effort if it will not be 100% effective?
The goal of these new procedures is the find and treat any passenger infected with Ebola upon arrival in the US. Clearly, these new procedures were not designed to screen every passenger entering the US, or even every passenger who is from a country that has had one or more reported Ebola cases (which include Nigeria, Senegal, and Spain).

Like many risk-reduction procedures, they will reduce the likelihood of that an Ebola-infected passenger will enter the US. However, given that passengers who are not exhibiting symptoms can easily escape notice, and that many categories of people entering the US will not be screened at all, it is quite likely that these new CDC and CBP procedures will at best be only somewhat effective and preventing an infected person from entering the US.

On October 9th, Todd Curtis of AirSafe.com and CJOB radio's Charles Adler discussed Ebola airline travel issues and risks airline passengers may face.

Additional information
AirSafe.com Ebola overview
How one Ebola-infected passenger made it to the US
CDC fact sheet on new screening procedures

Ebola risks and airline travel

The recent Ebola outbreak in Africa has claimed nearly 1,000 lives since March 2014 in Liberia, Sierra Leone, Guinea and Nigeria, represents a potential risk for air travelers because the virus that causes the disease can be spread by direct contact with an Ebola victim.

Map of 2014 Ebola outbreak (CDC)

Recently, Emirates and British Airways became the largest airlines to suspend airline service in one or more of the most affected countries. Other airlines like Delta have allowed passengers to change flights to, from, or through certain west Africa airports in the affected areas without penalty.

Several media outlets, including the Premium Times of Nigeria stated that the first Ebola death in Nigeria was from a man who flew into Nigeria on July 23rd and two died two days later from Ebola. The report also states that the victim had shown signs of illness during the flight.

What is Ebola?
Ebola, also known as Ebola virus disease (EVD) or Ebola hemorrhagic fever, is a severe, often fatal illness in humans, with a fatality rate of greater than 50%. It is caused by a virus that is commonly spread through close contact with an infected person.

How can a person get Ebola?
A person can become infected with the Ebola virus from direct contact (through broken skin or mucous membranes) with the blood or bodily fluids of infected people, or from contact with objects or environments contaminated with such fluids.

What are the effects of Ebola?
The effects of an infection are not immediate, with symptoms showing up between two and 21 days after infection. A person who falls ill may experience a sudden onset of fever, intense weakness, muscle pain, headache and a sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.

Is there a vaccine or treatment for Ebola?
There are currently no approved vaccines available for Ebola. While symptoms such as dehydration can be treated, there is no proven treatment for the underlying viral infection.

What risks do airline passengers face?
Although there are no reports of airline passengers or airline staff being infected on an airliner, there is the possibility that someone can be infected with Ebola while in an airplane or while at an airport. In areas where there has been an outbreak of Ebola, airlines and governments have done the following to reduce risks to air travelers and airline professionals:

• Provide updated information about Ebola risks (see links below)
• Limiting flights to or from areas experiencing Ebola outbreaks
• Screening passengers prior to boarding

What can passengers do?
The two most important things that you can do is to avoid travel to areas experiencing an Ebola outbreak, and to seek medical attention before traveling if you are experiencing Ebola-related symptoms.If you already have a trip planned into an area with an active outbreak, you can delay or cancel the trip (check with your airline on their policies for areas of high risk).

If you are on a flight where another passenger is exhibiting Ebola-like symptoms, do your best to stay away from that passenger and inform your flight attendant about the situation. If you are unable to do this, avoid direct contact with that person, or with any object or surface touched by that person.

Basic Ebola information
AirSafe.com Ebola information page
World Health Organization (WHO) Ebola fact sheet
Centers for Disease Control (CDC) Ebola overview
Ebola Q&A from the CDC

Travel warnings and advisories
CDC travel health advice
US State Department travel alerts and warnings
UK Foreign and Commonwealth Office
Canadian government travel advice by country

AirSafe.com Swine Flu Update for 29 April 2009

The first US swine flu fatality was confirmed by the CDC 29 April 2009. The victim was a 23-month old child who was being treated in a Houston area hospital. The CDC also reported that there were 90 other cases of swine flu in the US. Yesterday, the World Health Organization reported that seven countries have officially reported cases of swine influenza (H1N1) infection, including 26 cases and seven deaths in Mexico. The number of confirmed cases and deaths from the CDC and WHO may be very different from the numbers reported by other health authorities or the media. There have been no reports of swine flu infections involving airline passengers.

Swine Flu Risks for Airline Passengers

Audio: MP3 | Video: iPod/MP4 | WMV | YouTube
For more videos, visit the AirSafe.com YouTube channel.

AirSafe.com Passenger Resources
Centers for Disease Control Swine Flu Information
World Health Organization Swine Flu Information

Discussion of Fatal Bird Flu Outbreak on Airliners in 2003 (5:44)

Swine Flu Risk for Airline Passengers - Yes, a Virus in the Sky Can Kill You

With the recent reports that swine flu (H1N1) epidemic in Mexico may be spreading around the world, one of the fears is that air travel may make it easy for the flu to spread. Given the global nature of air travel, and nature of swine flu, by the time authorities were aware that there was a risk, it was already too late. In addition to the US and Mexico, reports of swine flu infections have already been made by authorities in a number of countries in Europe, Asia, and South America. In at least one case, authorities suspect that a cluster of flu cases in New York may be due to a group of students who had recently visited Mexico.

When events like this happen, one question that gets asked is whether anyone has ever died after being exposed to some kind of virus on an airline flight. That answer appears to be yes, and it involved the SARS virus in 2003. The next question in your mind may be whether it happen with swine flu virus in 2009. Only time will tell if it will happen again.

The New England Journal of Medicine reported that in March 2003, six passengers from two different flights in Asia died after being exposed to the SARS virus on those flights. Two of the flight attendants and 17 of the other passengers on those two flight were also infected, but survived.

Another question that may get asked is what kind of person is at the greatest risk of getting infected. A report in the online edition of The Times of London, quotes Michael O’Leary, the head of the Irish airline Ryanair, as saying that the virus was only a risk to Asians and Mexicans “living in slums.” The official position of AirSafe.com is that unlike human beings, a virus does not discriminate on the basis of national origin or economic condition and would certainly never be quoted saying anything so blatantly asinine.

AirSafe.com suggests that passengers who are concerned about swine flu should follow the news media for the latest bulletins and to refer to the following resources for information:
Travel Warnings and Other Passenger Information
US Centers for Disease Control
World Health Organization

Additional Resources
Background Information on SARS (Severe Acute Respiratory Syndrome)
http://www.airsafe.com/issues/medical/sars.htm

Podcast from 29 April 2009: Swine Flu Risks for Airline Passengers (2:35)

Background Information on Bird Flu (Avian Influenza)
http://www.airsafe.com/issues/medical/birdflu.htm

Podcast from March 2006: Bird Flu Risks for Air Travelers (5:44)
http://www.airsafe.com/podcasts/show9.mp3