The Obama Administration has finally announced that it will implement entry screening procedures for Ebola in the five US airports that receive 94% of travelers from Ebola-afflicted Guinea, Liberia and Sierra Leone.  JFK Airport begins tomorrow. The gesture suggests that, up until now, screening protocols at US airports were either non-existent, too lax to be effective, or not being enforced -- calling into doubt the administration’s repeated assurances that public health precautions had been taken to prevent exposure to Ebola and intensifying  the public’s waning trust in government institutions.

No one opposes exit or entry screenings -- in fact, they are welcomed.  But, even if strictly enforced, a conundrum still lingers:  What good is it if travelers are screened and cleared in Monrovia, the US and all stops along the way -- infection free throughout the entire process -- only to become symptomatic and contagious once they are out and about in the US? 

The only recourse the public can entertain, given this scenario, is to err on the side of caution and ban all non-essential, non-humanitarian, commercial travel into and out of Ebola-ravaged nations until the situation in West Africa is under control-- as several African nations, the UK, and France have done, and now, Israel, which is tightening controls on people entering the country who have visited Liberia, Guinea, and Sierra Leone.   

The Thomas Duncan scenario makes us uneasy because an asymptomatic person from a hot zone can pass through all exit and entry screening procedures with an undetectable infection, then arrive in this country a fully contagious, time-released Ebola bomb.  It doesn’t matter if travelers are truthful about their exposure or even aware of it.  A maximum incubation period of 21 days creates a dangerous time lag between exposure, infection, symptoms, and contagiousness that allows supposedly healthy people to get through well-intentioned screening procedures.  

Once through, what is the back-up plan?  To deal with the sick once they are stateside and infectious, scrambling to dispose of contaminated property, locate all of the exposed, contain the spread, isolate the infected, and treat them with expensive, untested, experimental medications?  This requires considerable manpower and resources and is costly, time-consuming, and fraught with room for human error -- especially tracing and tracking everyone who might have been exposed.

Americans want to help the disease-plagued people of West Africa but simultaneously prevent the infected from gaining entry into the US.   And, until there is a test that can predict infection during the incubation period, screening -- while helpful -- is not enough.

From the point of view of the public -- which is clearly at odds with experts in the public health community -- if you have been in a hot zone, you are a potential threat.  These are the people we don’t want to take any risks with -- because ultimately it’s between our survival and theirs.

The safest and least costly bet would be temporary and limited restrictions on travel to and from Ebola-stricken nations, international cooperation on the travel history of passengers, continued humanitarian support to West Africa, strict implementation of exit and entry screenings, and, ultimately, stricter enforcement of immigration laws at the border. 

Regrettably, nothing is 100% foolproof and desperate people will slip in by foot, car, train, plane, or boat.  But if we take this multi-pronged approach and stop with the zero-sum game playing between either containment in Africa or travel bans/quarantines/isolation, we can minimize costs, limit the number of people exposed to Ebola in America, and, the conundrum will no longer be such a conundrum.