Viruses on a Plane: What Emirates Flight EK203 Teaches Us

Journal Articles

Viruses on a Plane: What Emirates Flight EK203 Teaches Us

By Marian W. Wentworth

This article was originally published in Scientific American.

Even before Emirates flight EK203 arrived in New York on September 5 carrying dozens of ill passengers, the crisis response was under way. Crew members alerted authorities about the sick travelers from the air. Health officials dispatched an emergency response team with mobile diagnostic equipment to the tarmac to await the plane’s arrival. Ambulances waited nearby. EMTs notified hospitals about a potential influx of severely ill, potentially infectious patients. And after the flight landed, health officials evaluated more than 500 passengers at the airport and transported at least 10 to a local hospital for further testing.

It was an excellent dry run to test our capabilities for fast detection, reporting and interagency coordination. Luckily, this happened in the United States, a country with significant resources and one of the strongest health systems in the world.

But what if an airplane carrying passengers harboring an unknown and possibly deadly pathogen landed in a country without a robust health system? Imagine that these people had been forced to stay on the plane, or shuttled through a busy airport and sent to an unprotected hospital ward. If passengers harboring the virus but without symptoms then returned home to their families or boarded another plane, you’d have the beginnings of an epidemic.

Managing a crisis requires authorities on many levels to mobilize quickly. While the public sees only the flashing lights of an ambulance or people with moon suits dispensing treatments and vaccines, those of us who work in public health see what lies beneath—a web of complex protocols and well-maintained equipment and treatments, strong leadership and skilled health workers.

Preparedness doesn’t happen by chance. A responsive, resilient health system requires commitment and investments of money and time. It is important to stop outbreaks both inside our country and before they reach our borders. The United States engages in thwarting diseases overseas through the Centers for Disease Control (CDC) and U.S. Agency for International Development (USAID). We spend $108.2 million each year through the CDC alone on global health security. Activities include setting up emergency operations centers to manage crises; shoring up leadership and regulations; implementing early warning information systems; and training clinicians, nurses and community health workers on how to spot and contain disease. 

These investments pay off. With support from the CDC on disease surveillance, border health screening, logistics and supplies and community engagement, the Democratic Republic of the Congo (DRC) was able to contain the outbreak of Ebola that began in May. These modest investments save lives overseas, keep Americans safe at home and protect our livelihoods. A pandemic would likely crash the U.S. stock market, sending the economy into collapse and society into turmoil. The World Bank estimates that an epidemic such as the 1918 Spanish Flu could cost as much as 5 percent of the global GDP.

The threat comes from the known and the unknown. The World Health Organization has warned that the next pandemic may be sparked by a pathogen we haven’t yet seen, “Disease X,” perhaps loitering in a once-hidden cave or mutating in a hog pen. The way to fight a new disease is the same as it is for a known foe: a coordinated response from a strong health system.

However, we are in danger of letting down our guard. Our country’s commitment to preventing infectious disease epidemics is weakening. We continue to see proposals to scale back funding for programs designed to prevent, detect and respond to disease threats in the countries where they originate. This is a grave mistake. Even as one Ebola outbreak in the DRC was ending, another more intractable outbreak erupted in a conflict zone that is proving harder to contain. Failing to make necessary investments now will virtually guarantee that a future epidemic will cause great human suffering and be economically disastrous.

We must continue to invest in building strong health systems equipped with sufficient resources to catch the next deadly pathogen before it has a chance to get on an airplane and spread across continents. We need to adequately fund CDC operations overseas to help countries get and stay prepared for worst-case scenarios. And we must continue to fund USAID projects that complement this work with projects that strengthen governance and health services around the globe. Only then will we be safe to fly.