The Centers for Disease Control and Prevention sent an urgent request to its workforce this week to recruit personnel to screen passengers arriving from Central Africa for signs of Ebola illness, an email sent by acting CDC Director Dr. Jay Bhattacharya said.
An HHS official confirmed the authenticity of the letter. The recruitment drive comes after the CDC last week temporarily barred entry to non-U.S. citizen travelers who had visited the Democratic Republic of Congo, Uganda or South Sudan in the prior 21 days.
Those travelers must arrive at a designated U.S. airport. On Tuesday, the Department of Homeland Security added New York's JFK International Airport to the list, bringing the total to four designated airports — Dulles International outside Washington, Hartsfield-Jackson Atlanta, George Bush Intercontinental in Houston and now JFK. The DHS move follows warnings from aid groups that the outbreak is accelerating.
The CDC's internal call for help asks staff across job series and pay grades to assist. The recruiting list specifically names public health advisors and emergency management specialists as well as licensed medical providers. Assigned staff will observe passengers for any signs of illness, check temperatures for fever and refer any ill travelers for further assessment.
The International Rescue Committee issued a stark warning on Tuesday: "the ongoing Ebola outbreak in the Democratic Republic of the Congo and neighboring Uganda is now spreading faster than responders can contain it and risks becoming "the deadliest on record" without urgent international action." The IRC said the outbreak is no longer limited to remote areas of northeastern Ituri province: cases and contacts have spread into the major city of Goma in North Kivu and into Uganda's capital, Kampala. The group reported over 900 suspected cases and at least 223 deaths across the DRC and Uganda.
The outbreak is caused by the Bundibugyo strain of Ebola, which aid groups say standard Ebola tests struggle to detect. The World Health Organization has said previous Bundibugyo outbreaks have had case fatality rates ranging from 30% to 50% and that there are no approved vaccines or treatments for the Bundibugyo strain compared to other Ebola strains responsible for past outbreaks.
Heather Kerr of the International Rescue Committee warned bluntly that "Every delay has a human cost. Eastern DRC's years of conflict and displacement have left health systems on their knees, and that makes containing this outbreak all the harder," and added that "the outbreak is spreading faster than the response." Those assessments underscore the limits of symptom-based screening: the CDC teams being sent to ports will look for visible signs and measure fevers, measures that may miss infections early in their course or cases harder to detect with standard tests.
The policy combining travel restrictions, designated-airport routing and rapid staffing is a clear attempt to reduce the risk of importation. The designated-airport requirement applies to travelers entering the United States from the Democratic Republic of Congo, Uganda or South Sudan. But with infections moving into large urban centers and diagnostics less reliable for the Bundibugyo strain, public health officials face a narrowing window to stop exportation of cases while responders scramble to expand testing, treatment and containment on the ground.
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Adding jfk to the list and mobilizing staff from across the CDC buys time at U.S. ports of entry; it does not change the basic arithmetic on the ground in central Africa. Unless international action accelerates diagnostics, treatment and containment where the disease is spreading, the measures at four airports will be necessary but insufficient to prevent the outbreak from growing into the catastrophe aid groups fear.
