Travel to and from Africa should be restricted
Charles M Hilbers
ITT Tech

Abstract
On October 19, 2014, the evening news announced the return of two Poplarville, Mississippi residents from West Africa. Their neighbors expressed major concern, especially since one of them was a preacher and a school bus driver. The other one said that what should have been a lifetime opportunity for her had been spoiled by phone calls from concerned neighbors. She maintained that they had done their research and concerns over their return were unfounded, based on fear not fact (Grace, 2014). I found her attitude not only ambiguous, but self-centered and showing little concern for her friends, family, and neighbors. Living in South Mississippi myself, and in light of recent cases of travel related Ebola in the United States, I wanted to know if these concerns are truly founded or not. I used Local TV and newspaper articles, CDC website, and various articles I found on the Virtual Library to research the situation. In my opinion, based on my research, these people did not research well enough or reached a decision based on their personal bias rather than fact. My research shows that although there has not been any cases reported in Ghana, where they actually went, there have been cases in the neighboring countries of Sierra Leonne, Liberia, Guinea, Senegal, and Nigeria, with travel related cases popping up all over the world. Therefore, there is some danger of being exposed to Ebola, and in spite of expert disagreement over the risk of outbreaks outside of Africa, they all agree on one thing: control is dependent on proper handling of patients and contaminated waste and that the possibility of human error is a very real threat. This is demonstrated by the cases of Ebola that turned up in Dallas, Texas and New York. My conclusion is that any reasonable person would realize that there is very real danger, would limit frivolous travel to Africa, and would be happy to go through quarantine and whatever other inconveniences are necessary to protect others here from unnecessary risk of exposure. People tend to underreact to things they are not aware of and overreact to things they do not understand, especially when fueled by conjecture and hearsay. In the case of recent events related to the Ebola outbreak in West Africa and the risk to the US, both of the above are applicable. In most cases, people are more afraid than they should be because there is almost no possibility of an uncontrolled outbreak in the US. However, human error is always possible, and all it takes is one mistake to expose one or more people to almost certain death from a virus such as Ebola. The real risk, however, is from brazen risk taking and under reaction due to overconfidence, under education, or just plain human attitude. It is my intention to show that travel to and from Africa should be restricted to essential purposes and that those who go there should be prepared to endure quarantines and whatever other personal inconveniences are necessary to ensure the physical safety, economic stability, and mental comfort of one’s families, friends and neighbors. Further, I will show that the travelers from Poplarville, MS who recently went to West Africa should have altered their plans or at the very least their attitudes to accommodate and protect people back home who did not spoil the travelers’ “wonderful experience” by being concerned.
First, Ebola is a virus which was first identified in northern Zaire (now the Democratic Republic of Congo) in 1976. It was named for the Ebola River in Zaire and Neighboring Sudan where several hundred deaths were recorded. Among many strains of the virus, fatal in various animals, there are four strains which cause human disease: Zaire ebolavirus (EBOV), Sudan ebolavirus (SUDV), Bundibugyo ebolavirus (BDBV) and Tai Forest ebolavirus (TAFV) (Ghayourmanesh and Hawley, 2014). Since the original known outbreak, there have been sporadic outbreaks including: Democratic Republic of Congo in 1977, 1995, 2007, 2008, 2012 and 2014; South Sudan in 1979 and 2004; Gabon in 1994, 1996, and 2001; Ivory Coast in 1994; South Africa in1996; Uganda in 2000, 2007, 2011 and 2012; Republic of Congo in 2001 and 2003; and now in Senegal, Guinea, Liberia, Nigeria, Sierra Leone, and the Republic of Congo (CDC, 2014). The first case in the current outbreak was diagnosed in Guinea on March 21, 2014 (Dixon and Schafer, 2014).The current outbreak is by far the worst yet, having appeared in at least 6 African countries and 3 others, with 10,114 confirmed cases and 4,912 deaths as of October 24, 2014 (CDC, 2014). According to Dr. Joanne Liu, International President of MSF (Medecins Sans Frontieres), “Ebola is out of control in Guinea, Liberia, and Sierra Leone” and the actual number infected is thought to be two and a half times that reported and doubling every three to five weeks with a mortality rate of about 70 percent. In order to get the outbreak under control, the sick need to be isolated from contact with others, but as few as 20 percent are being isolated. The US CDC predicts 1.4 million cases by early next year (Buck, 2014).
It is thought that outbreaks start when someone comes into contact with an infected animal, including carcasses of dead animals. Certain species of fruit bat are suspected to be a natural source of the disease, but this has yet to be confirmed. The virus can be transmitted through contact with body fluids, such as blood, semen, mucus, saliva, urine, and feces. The Ebola virus appears to have an incubation period of two to twenty-one days, after which time the impact is devastating (Ghayourmanesh and Hawley, 2014). The current outbreak is characterized by fever, severe diarrhea, and vomiting. There is no known treatment effective against Ebola and mortality rates run 50-90 percent. Transmission can also occur post mortem by contact with the body during funeral preparations and has been detected in the semen and organs of survivors for up to 61 days after onset (Dixon and Schafer, 2014). To contain the spread of Ebola, first, patients must be diagnosed properly and as soon as they show symptoms, because they are contagious at that point. Second, infected patients must be immediately isolated from the healthy population. Finally, protocols must be strictly followed by medical professionals for protective gear, handling of patients, and disposal of infectious waste and bodies.
Opinions about the danger of Ebola to unaffected areas varies from one extreme to the other by both medical professionals and laypeople. On the one hand, Dr. Liu says “What’s going on is her idea of a worst-case scenario. Ebola is out of control in Guinea, Liberia, and Sierra Leone,” spreading beyond our control and to other countries too (Buck, 2014). On the other, Melissa Leach, Director of the Institute of Developmental Studies at the University of Sussex, says that Ebola is not an especially dangerous pathogen. “It’s not airborne, and it kills its victims too quickly for them to pass it on efficiently: it just doesn’t spread fast enough” (Brooks,M., 2014) Kaci Hickox, the first nurse forcibly quarantined in New Jersey under the state’s new policy said her isolation at a hospital was “inhumane,” adding: “we have to be careful about letting politicians make health decisions,” (Eltmen, 2014) New Jersey Gov. Chris Christie on Sunday defended quarantining as necessary to protect the public and predicted it “will become a national policy sooner rather than later.” (Eltman, 2014) Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, says that we shouldn’t make our volunteers uncomfortable or they won’t volunteer (Eltman, 2014). President Obama says ”any measures involving health care workers should be crafted to avoid unnecessarily discouraging people from responding to the outbreak” (Porter and Barry, 2014). At the same time, the US Army will isolate any and all troops returning from affected areas whether they show symptoms or not, in order to ensure their family members’ comfort (Porter and Barry, 2014) and Canada has warned against any non-essential travel to West Africa.
No matter what one’s opinion is, recent events have shown that concerns are very legitimate. On September 19, Thomas Eric Duncan, a native of Liberia, flew from Liberia to Brussells, then to Wahington DC, and into Dallas, TX. More than a week later, he went to a hospital with a fever of 103 where he was misdiagnosed and sent home, already contagious. Two days later he was admitted to the hospital that had sent him home, where he died a few days later. Duncan did not know he had been in contact with Ebola. His daughter had died of the disease, but everyone thought she had died of complications of pregnancy. He passed all the screening procedures at the various airports he went through. Now, more than 100 people back home have died from contact with his daughter and more than 1000 people here are on a watch list. (Hennessey-Fiske, Dixon, and Lee, 2014). “As recently as late July, an official at the CDC deemed it a ‘very remote possibility’ that a traveler from West Africa could carry the Ebola virus to the US. Two short months later, when a feverish visitor from Liberia named Thomas Eric Duncan showed up at a woefully unready Dallas emergency room, that remote possibility became a lethal reality” (Von Drehle, Sifferlin, Bajekal, Baker, Park, and Altman, 2014) Even those medical professionals who think they should be exempt from quarantines and other preventative measures need to check their attitudes in light of (1) over 240 health care workers have died from Ebola (Santora, 2014),(2) the New York doctor, who recently worked with doctors without borders, and was diagnosed with Ebola after returning home (Ochs, 2014), and (3) the two nurses who treated Thomas Duncan and later were diagnosed with Ebola, but not before one of them flew halfway across the country and back (Schmall and Merchant, 2014).
Preventing the spread of Ebola requires responsibility, preparation, and vigilance. “The risk of actually having a case is very small, but you have no choice but to prepare” says Dr. Caroline Quach (Gatehouse, 2014). “The most important aspect of safety anywhere is that protective measures must be used 100% correctly 100% of the time, and that takes leadership, commitment, protocols, training, and a lot of practice” (Herper, 2014). “The risk of human error is very substantial, so we’re trying to limit the number of health care workers who would actually come into contact with Ebola Patients,” Says Dr. Suzy Hota, infectious disease specialist. “The important thing is to keep the clean and the dirty separate. It takes a lot of concentration” (Gatehouse, 2014). Dr. Tom Frieden, director of the CDC in Atlanta, GA explains: “ ‘The care of Ebola can be done safely.’ Successsful treatment of Ebola patients at Emory and the tiny number of similarly prepared facilities proves that. But ‘it’s hard to do it safely,’ he added, as the infected health care workers painfully learned. ‘Even a single inadvertent, innocent slipup can result in contamination.’ ” (Von Drehle, Sifferlin, Bajekal, Baker, Park, and Altman, 2014)
As for the Poplarville residents who traveled to Ghana in mid-October, one of them spoke to WLOX news: It was meant to be the trip of a lifetime. A wedding officiated by her beloved pastor, some sightseeing, but most importantly, spreading the gospel to all who would listen. “We came to enjoy ourselves. It was a lifetime opportunity and we took it. I got married, evangelizing, witnessing, Pastor visited a few churches, vacation time,” said the resident. What was supposed to be a wonderful experience, turned sour, when they began to receive phone calls that people back in their hometown of Poplarville were concerned about their return. “We did our research. We’ve kept up with what’s going on within the regions of Africa and the US concerning Ebola. We knew it had not reached the borders of Ghana so it wasn’t really a high risk issue”. Still, they have been told Poplarville residents are on high alert about their return. “It’s understandable that they have concerns and fears, but they need to go by facts and not just hearsay” (Grace, 2014). If they had done their research properly, however, they would have seen that they were traveling right into the middle of the current outbreak, as shown by the following map. They would have also known that many cases are not being reported for fear of cremation which goes against religious beliefs in this area (Paye-Layleh, 2104), that many cases that do get reported start in rural areas where it takes time to get out or gets misdiagnosed, and , therefore, there is no way to be sure that there were not already cases in Ghana. Additionally, it is irresponsible to call something that over 10,000 people in neighboring areas have, is spreading like wildfire, and that kills 2 out of 3 people who get it “not a high risk priority”. If these people had stopped to think for just a moment about the risk to their neighbors or the children who ride the pastor’s school bus, instead of their “chance of a lifetime vacation”, they would have thought twice about going.

KEY: Red: Areas known to be affected by current outbreak. Green: Areas known to be affected by past outbreaks. Yellow: Area where Poplarville travelers visited. As Philip Roth once wrote: “In every calm and reasonable person there is hidden a second person scared witless about death” (Brooks,D., 2014). Fear is the basis for responsible and safe behavior. Lack of fear and consideration for how our actions affect those around us leads to reckless activity that endangers not only our own health and livelihood, but that of our families, friends, and neighbors as well. We need more people like the Seebees from Gulfport and other military people who have gone and served and done what they could to help and who are willingly undergoing quarantine upon their return to protect their families and friends from even a remote possibility of infection. We need less people who want to toot their whistle by volunteering, but who are not willing to take one extra step to protect their homeland. Yes, we need to encourage volunteers to help, and we should not unnecessarily inconvenience them, but it will not do any good to stop the epidemic elsewhere if we bring it home in the process, and anyone who is truly giving of themselves should be more than willing to take whatever additional steps are necessary to ensure the safety of their home and the other people there. We need less people like the Poplarville residents who irresponsibly maintained their “vacation of a lifetime” plans in spite of the very real dangers to themselves and others because they foolishly overlooked the very real hazards that exist in West Africa. Our government needs to stop playing Russian Roulette with travelers to West Africa (unknown, 2014) and take more steps, like the governor of New Jersey, to proactively prevent any more cases of Ebola from coming to the US by restricting travel and imposing mandatory quarantines, regardless of the purpose of their trip..

Reference Page
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Brooks, D. (2014, October 22). The roots of our hysteria. Sun Herald, pA Brooks, M. (2014, October 17). The Great Ebola Scare. New Statesman, 143 (5232), pp. 30-33. retrieved from: https://portal.itt-tech.edu/shared/library/Pages/HomePage.aspx Buck, G (2014, October 27) WEST AFRICA, ‘It is hell on Earth’. Maclean’s, 127 (42), pp. 30-31. retrieved from: https://portal.itt-tech.edu/shared/library/Pages/HomePage.aspx
Centers for Disease Control and Prevention. (2014) 2104 Ebola Outbreak in West Africa – Case Counts. Retrieved from http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html Dixon, M., Schafer, I. (2014, June 27) Ebola viral disease outbreak. Morbidity & Mortality Weekly Report, 63 (25): pp. 548-51 retrieved from: https://portal.itt-tech.edu/shared/library/Pages/HomePage.aspx
Eltman, F (2014, October 27). US disease expert argues against Ebola quarantine. Sun Herald,p.10A Gatehouse, J. and Buck, G (2014, October 27). EBOLA EPIDEMIC, How safe are you? Maclean’s, 127 (42), pp 32–34. retrieved from: https://portal.itt-tech.edu/shared/library/Pages/HomePage.aspx Ghayourmanesh, S. Phd., Hawley, H. MD. (2014, August). Ebola virus. Magill’s Medical Guide (online edition) retrieved from: https://portal.itt-tech.edu/shared/library/Pages/HomePage.aspx
Grace, C. (writer). (2014, October 19). Poplarville residents return from trip to Ghana [Evening News] Biloxi, MS: WLOX/Biloxi Broadcast T.V. retrieved from http://www.wlox.com Herper, M. (2014, October 18). Ebola Outbreak Shows The Dark Side Of Mother Nature. Forbes.com., p.1 retrieved from: https://portal.itt-tech.edu/shared/library/Pages/HomePage.aspx
HTTP://bing.com/images/search/africa---map of Africa
Ochs, R. (2014, October 24). Volunteer doctor test positive for Ebola virus. Sun Herald, p1C
Paye-Layleh, J. (2014, October 24). Many Liberians don’t seek help for fear of cremation. Sun Herald p5C
Porter, D. and Barry, C. (2014, October 28). US governors, Army go own way on Ebola quarantines. Sun Herald, p12A
Santora, M (2014, October 25). New York Ebola patients steps retraced. Sun Herald, p14A
Schmall, E. & Merchant, N. (2014, October 16). Second nurse tests positive for Ebola. Sun Herald p 12A
Unknown, Soundoff (letter to the editor) (2014, October 23). Roll the dice on Ebola. Sun Herald p2A Von Drehle, D., Sifferlin, A., Bajekal, N., Baker,A., Park, A., Altman, A.(2014, October 27). The New Ebola Protocols. Time, 184 (16), pp 20-23. retrieved from: https://portal.itt-tech.edu/shared/library/Pages/HomePage.aspx