U.S. lacks plan on airborne diseases
Despite outbreaks, little progress has been made
When it comes to a comprehensive plan to prevent and contain the spread of diseases through air travel, America is not ready. That’s the conclusion the U.S. Government Accountability Office reached in 2015. It still holds true.
A series of outbreaks over the past
15 years hammered home the link between air travel and communicable diseases: Severe Acute Respiratory Syndrome (SARS) in 2003, swine flu in
2009 and Ebola in 2014, among others. “If you’re in aviation, you’re in the infection control business. The volume of air travel is just so vast,” said Mark Gendreau, chief medical officer of Beverly and Addison Gilbert Hospitals in Massachusetts and one of the first to study the spread of infectious disease on aircrafts.
When airlines serving the USA carried a record 932 million passengers, and the global total reached almost
3.7 billion, the GAO’s report found numerous examples of poor coordination on communicable diseases.
Centers for Disease Control and Prevention officials complained that the information on sick passengers
they receive from airlines and the control tower is often incomplete or inaccurate.
Cleaning crews said cabin staffers sometimes fail to inform them when a plane has been contaminated by blood, vomit, feces, saliva and other potentially infectious bodily fluids.
Airline workers complained about the cleaners; one said, “Cabin cleaners sometimes use the same towels to clean potentially infectious materials and later to clean food service equipment such as coffeemakers.”
“If it’s happening the way they describe, that’s a real concern,” said Jonathan Quick, a faculty member at Harvard University and author of the forthcoming book The End of Epidemics: The Looming Threat to Humanity and How to Stop It.”
When chaos occurs
Airport officials said agencies responding to sick passengers sometimes end up working at cross-purposes. In a suspected Ebola case, a group of responders blocked off a road at the airport to give themselves room to dress in protective equipment. Inadvertently, they blocked all the baggage-handling trucks, which in turn blocked other responders arriving at the scene.
Department of Transportation officials complained that the CDC sometimes issues guidance to airlines without running it past the DOT, leading to potential safety problems.
For example, if the disinfectant used to clean suspected Ebola contamination is not compatible with aluminum and other materials on a plane, “the aircraft could be damaged, which could negatively affect its airworthiness,” the GAO noted.
Sara Nelson, international president of the Association of Flight Attendants and a flight attendant herself for 20 years, watched how the airlines handled the outbreak of SARS in 2003.
She said the companies appeared to have learned little when the Ebola outbreak occurred in 2014.
“Nothing had really changed,” Nelson said. “And I would argue the airlines were less prepared.” As one example during the Ebola outbreak, she said, “the union had to fight to wear gloves on board.” Flight attendants asked to wear gloves and masks and were told by the airlines that they could not. Some airlines struck what they viewed as a compromise, Nelson said. Flight attendants could wear gloves but only in economy class.
Health experts are dubious about whether gloves, or even masks, would be of much help to flight attendants dealing with a sick passenger.
“If you are with somebody who is symptomatic with Ebola, you need a lot more protection than that,” Quick said.
When asked about the problems cited by flight attendants, the trade association Airlines for America sent this statement: “Airlines work continuously to keep their aircraft clean for their passengers and crew members.”
In addition, the association works closely with the CDC and other government agencies.
Prevention problems
Preventing diseases from passing country to country via air travel is no easy matter. The SARS outbreak prompted airports in Asia to use thermal screening tools to measure the body heat of passengers before they boarded flights. Airport workers searched for people with high temperatures, because fever is often a sign that the immune system is fighting an illness.
Critics said the equipment does little to keep diseases from crossing borders by plane. “You have to screen many, many people to find anybody with an infectious disease,” said Michael Osterholm, co-author of Deadliest Enemy: Our War Against Killer Germs.