I know, I know. See that can of worms over there that I probably shouldn’t touch with a ten foot pole? Yea, I just opened that can of worms.
I’ve seriously been meaning to write about this article for weeks. And I’ve wanted to discuss the topic actually since the Ebola outbreak started. Because who seriously doesn’t wonder about things like this.
[Oh wait, you don’t? Sorry, then, just me. Because I wonder about transmission risks of diseases on a daily (ok hourly) basis.]
So let’s cut to the chase: this is just my opinion of the article, as written. It’s may or may not reflect my personal or professional opinion on the actual, quantitative risk of Ebola transmission via commercial air travel. Why bother writing about it? Simply put, this is a good article in a high impact (read: well-respected) journal that is worth a read by anyone interested.
On that note, did you know that most peer-reviewed articles are read by one or two people? And yes, that includes when you send an article to your parents so they can tell you that they are proud of your publication. Sometimes statistics are depressing. It’s also why you should always be encouraged when your articles are cited elsewhere.
And……I’m already off topic here. Moving on:
Why You Should Care
Planes are a great way for people to travel quickly from one continent to another. But they may also pose some level of risk for disease spread–as seen in the Ebola outbreak (which continues, though most of the world has stopped paying attention…Guinea, in particular, still has cases each week).
But How Risky Is Commercial Air?
The million dollar question, and one all policy makers wanted to know (like yesterday). To analyze the actual risk of transmission, the authors analyzed actual data of worldwide flight schedules, and travelers itineraries, to better understand how people move via commercial air travel from Guinea, Liberia, and Sierra Leone.
How Did they Assess Risk?
In order to better understand how likely commercial air flights are to transmit Ebola virus, the authors created a model with the data on travel itineraries, Ebola surveillance data, the efficiency of screening methods, and the impact of air travel restrictions that were implemented quickly when it became apparent the outbreak was out of control.
Important Limitations
The authors decided that all travelers originating from airports in these three countries, from any airport, could have Ebola (more specifically, exposure to Ebola); all other travelers were not to have any significant risk of exposure. Demographic data of air travelers were also not included in the study, nor was the purpose of the air travel including in the data sets. This information (e.g., traveling for business? visiting family?) could also impact these findings and recommendations.
Findings
Travel restrictions can have serious and detrimental effects on countries where they are imposed, both social and economic. As such, the authors suggest that exit screenings (upon leaving a country affected by Ebola) is the best way to both limit the risk of further transmission should an individual be infected but not yet detected, while also avoiding the more significant consequences of total or partial travel or flight bans to/from an affected country. They suggest that this method would be more effective than entry screening, particularly when entry screening is implemented at airports where there are no direct flights from affected countries.
Certainly this is easier said that done, as the authors do a good job of noting. Exit screening (and any screening or disease control measure, in reality) adds a “human” element. And while you can have quantitative or objective measures of things to look for (like temperature), people are a wild card. As history (and this Ebola outbreak) has demonstrated, people can make bad/uninformed/self-motivated/inadvertent decisions that have serious consequences for others when a disease is involved. Importantly, the authors carefully considered the number of travelers that would have to be screened to catch one infected person that remained asymptomatic at the time of the screening. But I think when you want something bad enough (e.g., to leave a country), if there is a will there usually is a way.
Conclusion
Overall, the authors stress the need for good information for policy makers, as well as a better understanding of the consequences of different policy choices: they argue that these pros and cons must be weighed by the international community collectively to respond to the outbreak in the most efficient way possible. But they also acknowledge that each country has exercised and will continue to exercise their own prerogative to make independent decisions on these issues.
Responding to Ebola is hard, and the answers aren’t so easy as “oh, the science tells you what to do.” If only they were.
Citation: Bogoch, I.I., Creatore, M.I., Cetron, M.S., Brownstein, J.S. et al. 2015. “Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 West African outbreak.” The Lancet. 385:29-35.
[Academia Meets Life is a TS’ series that presents useful/interesting articles published in peer-reviewed journals that are relevant to travel, in a easy-to-digest-quickly manner, in an effort to better connect academia/published articles to people who aren’t in that field of study .]
