People who contract Ebola in West Africa can get through airport screenings and onto a plane with a lie and a lot of ibuprofen, according to healthcare experts who believe more must be done to identify infected travellers.
At the very least, they said, travellers arriving from Ebola-stricken countries should be screened for fever, which is currently done on departure from Liberia, Guinea and Sierra Leone. But such safeguards are not foolproof.
"The fever-screening instruments run low and aren't that accurate," said infection control specialist Sean Kaufman, president of Behavioral-Based Improvement Solutions, a biosafety company based in Atlanta.
"And people can take ibuprofen to reduce their fever enough to pass screening, and why wouldn't they?
If it will get them on a plane so they can come to the United States and get effective treatment after they're exposed to Ebola, wouldn't you do that to save your life?"
Read: Airlines spooked by Ebola-infected passenger
On Thursday, Liberia said the first Ebola patient to be diagnosed in the United States had lied on a questionnaire at the Monrovia airport about his exposure to an Ebola patient. He flew to Brussels and then Dulles airport outside Washington, D.C., before landing in Dallas on Sept. 20.
The traveller, Thomas Eric Duncan, had no symptoms when he left Liberia, and fever scans there had shown a normal body temperature of 97.3 degrees Fahrenheit, U.S. health officials said. He therefore could not have been identified through examination as carrying the Ebola virus.
His arrival and hospitalization in Dallas have underscored how much U.S. authorities are relying on their counterparts in West African countries to screen passengers and contain the worst Ebola outbreak on record.
Stay up to date: All the latest news on the Ebola outbreak
Part of the screening burden rests on connecting airports.
For example, Kaufman flew from Monrovia to Casablanca to London to Atlanta. He was fever-screened in Monrovia and Casablanca, but not London's Heathrow, he said, and not when he arrived in Atlanta.
"At Heathrow, there were no questions about where I had come from," he said. "I offered the information to the official in Atlanta, and he said, 'Thank you. Be safe.'"
In August, experts from the U.S. Centers for Disease Control and Prevention (CDC) began teaching airport workers in Monrovia and other cities in the Ebola zone to conduct screenings, CDC medical worker Tai Chen said in an interview.
Ebola cases and deaths have been reported in Guinea, Liberia, Sierra Leone, Nigeria and Senegal. The World Health Organization has put the death toll at 3 338 out of 7 178 cases since March.
The CDC also worked with Liberian authorities to develop the questionnaire that was completed by Duncan: before travellers enter Roberts International Airport in Monrovia they are asked if they have had contact with anyone showing symptoms of Ebola.
There are at least two other screening points before a passenger is allowed to board a plane, with trained airport personnel asking about exposure to Ebola in the previous 21 days and any symptoms including fever, severe headache, bleeding, vomiting, diarrhoea, and abdominal pain.
This process relies on an honour system, Chen said.
Read: The signs and symptoms of Ebola
A Muslim faithful on pilgrimage to Mecca undergoes temperature checks for the ebola virus at the Hajj Camp, Murtala Mohammed International Airport in Lagos, on September 19, 2014. Over two hundred Muslim faithfuls from Oyo State in southwest Nigeria on pilgrimage to Mecca in Saudi Arabia underwent stringent health checks by Nigerian health officials in collaboration with its counterpart from the Who Health Organisation to prevent Ebola spread in the holy land. Nigeria is the only country in the region, which has been affected by Ebola that has clearance to send pilgrims to Saudi Arabia for the Hajj. Image credit: PIUS UTOMI EKPEI/AFP/Getty Images.
Officials at the CDC and the Department of Homeland Security would not say if they are considering using hand-held fever detectors on passengers arriving at U.S. airports. But Homeland Security spokeswoman Marsha Catron said the agency "will not hesitate to execute additional safety measures should it become necessary."
CDC Director Dr. Thomas Frieden cautioned on Thursday that a more restrictive approach to travel could make the Ebola outbreak harder to contain.
"The approach of isolating a country is going to make it harder to get help into that country," he said.
Read: Could Ebola hit SA?
It's all about fever detection
Virologist Heinz Feldmann of the National Institute of Allergy and Infectious Diseases has studied Ebola for years and helped develop an experimental Ebola vaccine. He told Science magazine in September that airport screeners in Monrovia, where he spent three weeks, "Don't really know how to use the devices."
He said he saw screeners record temperatures of 32 degrees C (90 F), which is so low it "is impossible for a living person."
Feldmann said in an email that according to his colleagues who have returned from Liberia in the last few days procedures for taking temperatures and doing clinical checks have improved.
Since August, major U.S. airports that receive international flights have displayed signs alerting passengers to the presence of Ebola in West Africa and telling them to be on the look out for symptoms, said Customs and Border Protection (CBP) spokeswoman Jennifer Evanitsky.
On Wednesday October 1 2014, customs personnel began distributing information prepared by the CDC describing Ebola symptoms and noting, "You were given this card because you arrived to the United States from a country with Ebola."
It tells travellers that if they were exposed to Ebola overseas, "call your doctor even if you do not have symptoms."
Facts about the worst Ebola outbreak in history
SA health workers urged to be on the lookout for Ebola symptoms