- - Tuesday, August 6, 2019

Once again, a deadly outbreak of the Ebola virus disease is spreading throughout parts of Africa, mostly in the northern provinces of the Democratic Republic of Congo (DRC).

The fate and severity of this current outbreak will greatly depend on the level of response from public health officials and politicians throughout the international community. Policy makers and health officials would be wise to learn from previous mistakes and optimize screening protocols for this current outbreak.

The outbreak, officially declared in August of last year, has now claimed more than 1,700 lives and infected more than 2,500 people. While these numbers are horrifying, this current outbreak has not yet reached the scale of the previous Ebola outbreak in 2014. That crisis claimed more than 11,000 lives and created panic around the world, all while exposing how ill-prepared the United States and its allies were to handle an epidemic of this scale.

In the fall of 2014, the Ebola virus raged throughout Western Africa, prompting movements for closing borders and barring travelers’ entry from that effected region into the United States. Mass hysteria ensued when cases inevitably appeared in the United States and politicians call extreme measures in the name of protecting the American people. 

The outbreak of 2014 was officially declared “over” in 2016, only to resurface two years later with vigor within the DRC. This outbreak, labeled the  “second deadliest in history” by the World Health Organization (WHO), has now reached Uganda and is dangerously close to Rwanda, creating the possibility to infect areas with international airports and associated worldwide traffic. 

This heightened threat forced the WHO to declare the current Ebola outbreak in the DRC as a public health emergency of international concern under the International Health Regulations.

During the 2014 Ebola outbreak, the WHO recommended exit screening at airports in infected areas, denying boarding to any passengers deemed a high-risk or demonstrating any Ebola symptoms. Further complicating containment protocol is the long incubation period of the Ebola virus, which ranges from two to 21 days.

This long incubation period means that those infected with Ebola could appear healthy during the initial screening, but their symptoms could worsen over long international flights. This prompted several countries, like the United States, to implement entry screenings for arrivals at the passengers’ destination.

For the current outbreak, the WHO is only recommending exit screening, deeming entry screening as “not effective and involving large amount of resources.” The lessons learned from ill-considered airport screening protocols during the 2014 Ebola outbreak mirror those airport security mistakes immediately following 9/11 – both indicating that it is nearly impossible to find a needle in a haystack. 

Travel screening for Ebola is especially difficult because early symptoms of the disease are often nonspecific and can be easily attributed to the common cold or flu. Moreover, because of the long incubation period, the current status quo allows many exposed travelers the opportunity to fall through the cracks.

Learning from previous missteps, officials can opt for a more nuanced approach. An alternative policy that combines the 2014 Centers for Disease Control and Prevention (CDC) protocol with a more comprehensive risk assessment called social contact tracing (SCT). 

SCT simply uses questions to determine if a traveler may have come into contact with a person infected with the Ebola virus and assesses the potential footprint of contacts that they may have over the 21-day period following their destination arrival.

This would place the burden on passengers to provide additional data when traveling from infected areas, as well as share how and where they will travel after arriving at their final destination, filling in information about their 21-day window during which symptoms can appear and limiting opportunities to spread the disease.

This additional data will provide passenger information on direct exposure to Ebola as well as data necessary to effectively contain the virus if they become ill with Ebola at a later date. Although the implementation of this secondary risk level requires additional data collection costs and time, the potential societal and public health benefits justify such expenditures and efforts.

Moreover, with an Ebola vaccine available, though not licensed by the U.S. Food and Drug Administration (FDA), action is needed to give serious attention for reviewing such a product if it becomes needed.  

By adding a second criterion to passenger-risk evaluation, the power of analytics and data science can be unleashed on the Ebola screening process, much as we now see with risk-based security and the value that TSA PreCheck brings to millions of travelers passing through security checkpoints.   

Now is the time for the CDC to update its Enhanced Entry Screening procedures, so informed public health policy, not a knee-jerk reaction, positions our nation to meet the impending challenges. 

• Sheldon Jacobson, a professor of computer science at the University of Illinois at Urbana-Champaign, is chairman of the INFORMS National Science Foundation Liaison Committee.

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