Isolating Ebola-affected nations could worsen outbreak, experts say

As the Ebola outbreak continues to devastate West Africa and in the wake of the first two cases diagnosed outside of Africa, some American politicians have begun calling for the United States to shut its borders to West Africans, extending the effective partial quarantine of the three countries where Ebola is raging.

But experts say closing U.S. borders to Guinea, Sierra Leone and Liberia would not stop Ebola from spreading outside Africa and could even worsen the outbreak there.

This Ebola outbreak is the first to have spread to countries’ capitals, sparking a widespread fear that planes harbor the potential to become a new and highly unpredictable disease vector. Much of the early media coverage about how this Ebola outbreak was different focused on the growth in the number of people with access to international travel and how globalization could mean an unstoppable spread of the virus.

Despite calls from international health organizations not to restrict travel or trade to West Africa, on April 1, Saudi Arabia ceased issuing hajj visas to residents of Guinea and Liberia. Some neighboring African nations closed their borders, and others, including South Africa and Kenya, restricted and in some cases outright banned travel to and from countries affected by the deadly virus. Later in the summer, a number of airlines — including Kenya Airways, British Airways, Air Côte d’Ivoire, Arik and Asky — discontinued air travel in and out of the region, and many others greatly cut back on their flights.

In the wake of two cases of Ebola in Spain and Texas — the first known cases diagnosed outside West Africa — some have begun calling for the U.S. and EU to do the same.

Western health officials have repeatedly assured the public that it was extremely unlikely Ebola would make it to the U.S. or Europe and that if it did, advanced infectious disease management systems and protocols would stop it in its tracks.

But recently public confidence in that narrative changed. On Sept. 24, a 42-year-old Liberian man named Thomas Eric Duncan went to an emergency room in Dallas with fever and flu-like symptoms. He told staff there that he had recently flown from Liberia but was sent home unscreened for Ebola. Three days later he was back at the hospital, and this time he was admitted and subsequently diagnosed with Ebola — the first such diagnosis on U.S. soil. On Oct. 8, Duncan died.

Like all travelers leaving the affected countries, Duncan was screened at the airport for fever and given a questionnaire that, among other things, asks passengers if they have recently been in contact with a known Ebola patient. Duncan had no fever at the time, and he answered the questions to the screeners’ satisfaction, so he was allowed on the plane. Later, in the U.S., it was discovered that Duncan had apparently lied: The week before he flew, he reportedly held the body of a child who had died of Ebola.

Experts say this trust is key to stemming the outbreak, which grew as it did in part because of lack of trust in government at the outset. Jeffrey Stern, reporting for Vanity Fair, traveled to a remote Guinean village believed to be the source of the current outbreak, and he found that to villagers there, isolation centers were “fearsome places” where “relatives or friends went in and then you lost them.” The health care workers and their procedures seemed so foreign that some villagers even began to believe the workers in full-body yellow protective suits were harvesting the bodies of the locals.

Fears bred by this lack of knowledge led families to hide their sick. In a few cases locals have responded violently, attacking health care workers.

“Coercive measures, such as laws criminalizing the failure to report suspected cases and forced quarantines, are driving people underground, pushing the sick away from health systems,” Joanne Liu, the international president of Doctors Without Borders, said recently at a United Nations special briefing on Ebola. “These measures have served only to breed fear and unrest rather than contain the virus.”

Experts say that the problem would only be exacerbated by the isolation of entire countries and that instituting a travel ban of this nature not only is a herculean task but also wouldn’t do much to keep Americans safe. Dr. Atul Gawande, who recently discussed the issue in an article for The New Yorker, cites models that predict that even if we could reduce travel from Ebola-stricken countries by 80 percent, new transmissions would be delayed by only a few weeks.

Travel bans would also likely increase the number of Ebola cases in the source countries, said Amesh Adalja, an expert in emerging infectious diseases and pandemic preparedness at the University of Pittsburgh.

“Quarantine can make matters worse by blocking the flow of water, food, health care workers and supplies into the quarantined region,” said Adalja. “Additionally, waste removal becomes difficult, and you may see scenes such as dogs eating bodies — as happened during the quarantine in West Point [in Monrovia, Liberia]. While trying to lock disease in, quarantine locks civilization out.”

Nevertheless, the European and U.S. policy response to Ebola was isolationist for much of the outbreak. Throughout the spring and summer, Western governments largely treated the disease as an African problem. Organizations like Doctors Without Bordes, groups of missionaries and other volunteers went to help, but for the most part, the U.S. and the rest of the world watched from a distance. “The international response was contemptible,” said Gawande.

Despite President Barack Obama’s pledge that the U.S. government would send help, the Pentagon has to date provided one isolation unit with a 25-bed capacity for all of Liberia. Regional flights in West Africa have basically stopped, and it is becoming increasingly difficult to get medical supplies and personnel into the area.

And on Wednesday, federal officials announced their next step to fight Ebola would be screening passengers arriving from West Africa for fever.

Jonathan Epstein, an epidemiologist at the nonprofit EcoHealth Alliance, said that while the effort would help reduce risk, it would also have limited success.

“We should expect that some individuals who are infected and asymptomatic at the time of arrival will enter the country,” he said.

Things will likely get worse, both in the U.S. and abroad, before they get better. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said last week, “It is entirely conceivable there may be another case” in the U.S. The World Health Organization recently raised the Ebola tally to 8,033 confirmed cases and 3,879 dead, adding that there is no evidence that the outbreak is anywhere near under control.

Beth Bell, director of the CDC’s National Center for Emerging Zoonotic Infectious Diseases, told Congress in September, “The best way to protect the U.S. is to stop the outbreak in West Africa.”