American with Ebola back in U.S.; Dallas patient in critical condition

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(CNN) — Another American Ebola patient arrived in the United States on Monday, reminding the nation that the virus killing thousands of people in West Africa, will likely continue crossing U.S. borders.

As freelance cameraman Ashoka Mukpo — who contracted it while covering the outbreak’s carnage — was on his way for treatment in isolation at Nebraska Medical Center, government officials talked of shoring up defenses at airports.

“All options are on the table for further strengthening the screening process here in the U.S.,” a federal official said. That includes thermometer checks for fever, something West African authorities are already carrying out.

But finding the right passengers to screen is not so simple.

Direct flights from Ebola-affected areas are rare. Travelers typically take flights that connect through other countries. “Then they come here, so that makes it more of a challenge,” the official said.

Mukpo, who worked for NBC, is not representative of that challenge. He was diagnosed on Thursday in Liberia and left there on a specially-equipped plane on Sunday.

But another patient, Thomas Eric Duncan, may be. To fly from Monrovia, Liberia, the country hit hardest by the epidemic, to Dallas, Texas, where he lies in an isolation unit in critical condition, he had to connect.

But even if Duncan had undergone a temperature screening, it would have turned up negative, and he would have made it into the country undetected.

His Ebola — and his fever — did not break out until he was within U.S. borders.

Screening and monitoring

The Centers for Disease Control and Prevention is considering enhanced screenings at major U.S. airports, a CDC official said. But it does not appear to have concrete plans in place yet.

Officials want to make sure that the gain of new screenings will be worth potentially disrupting air travel and that they don’t unintentionally increase the risk of spreading the disease.

“The question that’s being considered now and readdressed is that, should there be entry screening of some sort?,” said Dr. Anthony Fauci, of the National Institutes of Allergy and Infectious Diseases. “If you do implement it, what would it look like and what would be the resources that are necessary to implement it? That’s the kind of thing that’s being actively discussed right now.”

Director Dr. Tom Frieden has said that authorities are taking suggestions from Congress, the public and the media. He is expected to brief President Obama on Monday.

Beyond screenings, Frieden is confident the U.S. can prevent an Ebola outbreak by following prevention and containment procedures.

In Duncan’s case, family members who had close contact with him will be monitored constantly for at least 21 days. That’s roughly the maximum amount of time it takes for the disease to break out.

And they are not allowed to leave their living quarters during that time. If any of them gets a fever, he or she will be isolated, Frieden said.

“That’s how you stop it in its tracks. That’s why we’re confident we won’t see a large number of cases from this.”

Containment delay

But when Duncan first fell ill, containment went wrong.

He had flown to the United States on September 20 with plans to get married, but started to feel sick days later.

When he first went to the hospital with Ebola like symptoms, he told staff that he had recently been in Liberia. That should have raised a red flag.

They sent him home with antibiotics.

Days later he went back and was quickly isolated. A blood test confirmed his Ebola infection.

Texas public health officials spent the next 24 hours tracking down anyone who may have come into contact with Duncan after his infection broke out.

In all, they found 50 people, 40 of whom they consider low-risk. Still, they are being monitored, too.

Duncan’s is the first documented case of an Ebola infection breaking out in the United States, but there have been other scares, in which people checked into hospitals with suspicious symptoms.

None of them so far have turned out to be Ebola infections.

In Liberia and other West African countries, the outbreak has killed more than 3,400 people. Battling the disease will be a “long, hard fight,” Frieden said.

“The virus is spreading so fast that it’s hard to keep up.”

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