Ebola In The Air

Amber Vinson, the second nurse to contract Ebola after treating Thomas Eric Duncan in Texas, took a commercial flight from Cleveland to Dallas on Monday, one day before she entered the hospital with symptoms. Now we learn that Vinson had called the CDC to ask whether she could fly – and wasn’t told not to:

CBS News reports that Vinson called several times before boarding the flight, and reported that she had a temperature of 99.5 degrees. She was allowed to fly because only a fever of 100.4 degrees or more is considered “high risk.” “I don’t think we actually said she could fly, but they didn’t tell her she couldn’t fly,” an anonymous federal health official told the New York Times. “She called us,” he said. “I really think this one is on us.” While her symptoms did not appear until she returned home, the CDC is interviewing the 132 passengers who flew with her on Monday.

Amy Davidson is none too impressed with how CDC Director Thomas Frieden has handled this situation:

His account of how Vinson got on the plane, related in the conference call on Wednesday, was at least evasive and, depending on what he knew and what exactly Vinson was told, may have been worse. He was asked three different ways if Vinson had been told not to fly, and each time dodged the question in a way that left the impression that Vinson was some sort of rogue nurse who just got it into her head that she could fly wherever she wanted. He talked about her “self-monitoring,” and that she “should not have travelled, should not have been allowed to travel by plane or any public transport”—without mentioning that his agency was who allowed it.

Dreher is alarmed:

Do you know how many people in Texas Presbyterian hospital became exposed to Ebola via Thomas Duncan?

According to the AP, “about 70.” How many people want to have anything to do with that hospital today? Doctors, nurses, staffers, they all have to show up there to work, but patients? Would you go to an appointment in that hospital right now, knowing how lax it was with the Ebola patient? … How many other patients in that hospital were exposed inadvertently through the nurses doing “normal patient care duties” after having been shat and vomited on by Duncan? Those patients, do we know their travel schedules? And on and on.

Kent Sepkowitz tries to calm everyone down:

Speaking of air travel, the single most important epidemiologic fact arguing for the public’s safety is this: Patrick Sawyer, the American who flew from Liberia to Nigeria while sick with Ebola, spread infection to absolutely no one who shared the plane with him. This information should go a long way to assuring those Frontier Airlines passengers who accompanied the second infected nurse from Cleveland to Dallas this week.

And still more: Spain, where a nurse caring for two repatriated patients dying of Ebola herself developed the disease, has not seen a second case related to these men’s care or the ill nurse’s, despite what has been reported by local groups as a complete lack of preparation and appropriate supplies to minimize the risk of transmission. Despite a raging, unconscionable epidemic in West Africa, no other cases other than Duncan have appeared unexpectedly outside of Africa. Europe: Zero cases. USA: No further cases three weeks since Duncan’s illness began. Obviously past performance does not predict future returns and the world is not out of the danger zone but for now, the infected traveler is a rare event.

And Alex Davies notes that “despite the common belief, airplanes are not flying petri dishes … because the air in the plane is much fresher than you may think, and constantly scrubbed by high quality filters”:

When the air is pulled into the grills in the floor, pilot Patrick Smith writes in Cockpit Confidential, about half is expelled from the plane. The rest is filtered and recycled with fresh air from the compressors. High efficiency particulate air filters, installed on every commercial airliner made since the late 1980s, remove up to 99.97% of all microbes, and “there’s a total changeover of air every two or three minutes,” Smith writes. According to the WHO, “under normal conditions cabin air is cleaner than the air in most buildings.”

The highest risk of catching something nasty from your fellow travelers comes when you’re sitting on the ground. The engines aren’t running, so fresh air isn’t being pulled in. That’s why WHO recommends airlines ensure “adequate cabin ventilation” during ground delays of 30 minutes or more.

In any case, the revelation has raised the possibility of an Ebola no-fly list and sent airline stocks falling:

As of 2:50 pm on Wednesday, no doubt in response to the news, virtually every major air carrier had seen its stock drop. Shares of American Airlines had fallen nearly 1.5 percent (though they have since recovered, and closed half a percentage point up on the day), Delta had dropped by almost 2 percent, United Continental had dipped by more than 3.6 percent on the day, and Spirit Airlines had tumbled by roughly 3 percent. The dip, though particularly pronounced today, actually spans back to the beginning of the month–tracking pretty closely with rising concerns about Ebola continuing to spread.