SIERRA LEONE - Tags: HEALTH
Medical staff take a blood sample from a suspected Ebola patient at the government hospital in Kenema, July 10, 2014. Ebola has killed 632 people across Guinea, Liberia and Sierra Leone since an outbreak began in February, putting strain on a string of weak health systems facing one of the world's deadliest diseases despite waves of international help. Picture taken July10, 2014. REUTERS/Tommy Trenchard (SIERRA LEONE - Tags: HEALTH) - RTR402VX Tommy Trenchard/Reuters
No one knows for sure just how many people Patrick Sawyer came into contact with the day he boarded a flight in Liberia, had a stopover in Ghana, changed planes in Togo, and then arrived in Nigeria, where authorities say he died days later from Ebola, one of the deadliest diseases known to man.
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Now health workers are scrambling to trace those who may have been exposed to Sawyer across West Africa, including flight attendants and fellow passengers.
Health experts say it is unlikely he could have infected others with the virus that can cause victims to bleed from the eyes, mouth and ears. Still, unsettling questions remain: how could a man whose sister recently died from Ebola manage to board a plane leaving the country? And worse: could Ebola become the latest disease to be spread by international air travel?
Sawyer's death on Friday has led to tighter screening of airline passengers in West Africa, where an unprecedented outbreak that emerged in March has killed more than 670 people in Guinea, Sierra Leone and Liberia.
The World Health Organization is awaiting laboratory confirmation after Nigerian health authorities said Sawyer tested positive for Ebola, WHO spokesman Gregory Hartl said. The WHO has not recommended any travel restrictions since the outbreak came to light.
"We would have to consider any travel recommendations very carefully, but the best way to stop this outbreak is to put the necessary measures in place at the source of infection," Hartl said. Closing borders "might help, but it won't be exhaustive or foolproof."
Risk to travellers low
The risk of travellers contracting Ebola is considered low because it requires direct contact with bodily fluids or secretions such as urine, blood, sweat or saliva, experts say. Ebola can't be spread like flu through casual contact or breathing in the same air.
Patients are contagious only once the disease has progressed to the point they show symptoms, according to the WHO. And the most vulnerable are health care workers and relatives who come in much closer contact with the sick.
Still, witnesses say Sawyer, a 40-year-old Liberian finance ministry employee en route to a conference in Nigeria, was vomiting and had diarrhea aboard at least one of his flights with some 50 other passengers aboard. Ebola can be contracted from traces of feces or vomit, experts say.
Sawyer was immediately quarantined upon arrival in Lagos — a city of 21 million people — and Nigerian authorities say his fellow travellers were advised of Ebola's symptoms and then were allowed to leave. The incubation period can be as long as 21 days, meaning anyone infected may not fall ill for several weeks.
Health officials rely on "contact tracing" — locating anyone who may have been exposed, and then anyone who may have come into contact with that person. That may prove impossible, given that other passengers journeyed on to dozens of other cities.
Patrick Sawyer had planned to visit his family in Minnesota next month to attend two of his three daughters' birthdays, his wife, Decontee Sawyer, told KSTP-TV in Minnesota.
Two American aid workers in Liberia have tested positive for the virus and are being treated there. Both had been working with a Christian group, and are described as being in "grave" condition.
Nigerians on edge
The mere prospect of Ebola in Africa's most populous nation has Nigerians on edge.
It's an unprecedented public health scenario. Since 1976, when the virus was first discovered, Ebola outbreaks were limited to remote corners of Congo and Uganda, far from urban centres, and stayed within the borders of a single country. This time, cases first emerged in Guinea, and before long hundreds of others were stricken in Liberia and Sierra Leone.
Those are some of the poorest countries in the world, with few doctors and nurses to treat sick patients let alone determine who is well enough to travel. In Sawyer's case, it appears nothing was done to question him until he fell sick on his second flight with Asky Airlines. An airline spokesman would not comment on what precautions were being taken in the aftermath of Sawyer's journey.
International travellers departing from the capitals of Sierra Leone and Guinea are also being checked for signs of fever, airport officials said. Buckets of chlorine are also on hand at Sierra Leone's airport in Freetown for disinfection, authorities said.
Still, detecting Ebola in departing passengers might be tricky, since its initial symptoms are similar to many other diseases, including malaria and typhoid fever.
"It will be very difficult now to contain this outbreak because it's spread," Heymann said. "The chance to stop it quickly was months ago before it crossed borders ... but this can still be stopped if there is good hospital infection control, contact tracing and collaboration between countries."
Nigerian authorities so far have identified 59 people who came into contact with Sawyer and have tested 20, said Lagos State Health Commissioner Jide Idris. He said there have been no new cases of the disease.