New fears about Ebola spread after plane scare

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New fears about Ebola spread after plane scare
A picture taken on July 24, 2014 shows staff of the Christian charity Samaritan's Purse putting on protective gear in the ELWA hospital in the Liberian capital Monrovia. An American doctor battling West Africa's Ebola epidemic has himself fallen sick with the disease in Liberia, Samaritan's Purse said on July 27. AFP PHOTO / ZOOM DOSSO (Photo credit should read ZOOM DOSSO/AFP/Getty Images)
A picture taken on July 24, 2014 shows staff of the Christian charity Samaritan's Purse putting on protective gear in the ELWA hospital in the Liberian capital Monrovia. An American doctor battling West Africa's Ebola epidemic has himself fallen sick with the disease in Liberia, Samaritan's Purse said on July 27. AFP PHOTO / ZOOM DOSSO (Photo credit should read ZOOM DOSSO/AFP/Getty Images)
A picture taken on July 24, 2014 shows protective gear including boots, gloves, masks and suits, drying after being used in a treatment room in the ELWA hospital in the Liberian capital Monrovia. An American doctor battling West Africa's Ebola epidemic has himself fallen sick with the disease in Liberia, Christian charity Samaritan's Purse said on July 27. AFP PHOTO / ZOOM DOSSO (Photo credit should read ZOOM DOSSO/AFP/Getty Images)
A picture taken on June 28, 2014 shows members of Doctors Without Borders (MSF) putting on protective gear at the isolation ward of the Donka Hospital in Conakry, where people infected with the Ebola virus are being treated. The World Health Organization has warned that Ebola could spread beyond hard-hit Guinea, Liberia and Sierra Leone to neighbouring nations, but insisted that travel bans were not the answer. To date, there have been 635 cases of haemorrhagic fever in Guinea, Liberia and Sierra Leone, most confirmed as Ebola. A total of 399 people have died, 280 of them in Guinea. AFP PHOTO / CELLOU BINANI (Photo credit should read CELLOU BINANI/AFP/Getty Images)
Health workers wearing protective suits walk in an isolation center for people infected with Ebola at Donka Hospital in Conakry on April 14, 2014. Guinea's Foreign Minister Francois Fall said on April 14 that the west African country had brought the spread of the deadly Ebola virus under control after more than 100 people have died. The outbreak is one of the most deadly, with 168 cases 'clinically compatible' with Ebola virus disease reported, including 108 deaths, the World Health Organization (WHO) said in its latest update on April 14. CELLOU BINANI/AFP/Getty Images
Members of the Guinean Red Cross speak with a resident during an awareness campaign on the Ebola virus on April 11, 2014 in Conakry. Guinea has been hit by the most severe strain of the virus, known as Zaire Ebola, which has had a fatality rate of up to 90 percent in past outbreaks, and for which there is no vaccine, cure or even specific treatment. The World Health Organization (WHO) has described west Africa's first outbreak among humans as one of the most challenging since the virus emerged in 1976 in what is now the Democratic Republic of Congo. CELLOU BINANI/AFP/Getty Images
A woman prepares food at a 'maquis,' a small African restaurant, in Kobakro, outside Abidjan, which now serves various types of meat instead of bushmeat, on April 8, 2014. The Ministry of Health has asked Ivorians, 'particularly fond of porcupine and agouti,' a small rodent, to avoid consuming or handling bushmeat, as an unprecedented Ebola epidemic hit West Africa, claiming more than 90 lives. The virus can spread to animal primates and humans who handle infected meat -- a risk given the informal trade in 'bushmeat' in forested central and west Africa. Photo credit should read ISSOUF SANOGO/AFP/Getty Images
People walk past the sign of a 'maquis,' a small African restaurant which serves bushmeat, in Kobakro, outside Abidjan, on April 8, 2014. The Ministry of Health has asked Ivorians, 'particularly fond of porupine and agouti,' a small rodent, to avoid consuming or handling the meat, as an unprecedented Ebola epidemic hit West Africa, claiming more than 90 lives. The virus can spread to animal primates and humans who handle infected meat -- a risk given the informal trade in 'bushmeat' in forested central and west Africa. ISSOUF SANOGO/AFP/Getty Images
Staff of the 'Doctors without Borders' ('Medecin sans frontieres') medical aid organisation bury the body of a person killed by viral haemorrhagic fever, at a center for victims of the Ebola virus in Guekedou, on April 1, 2014. The viral haemorrhagic fever epidemic raging in Guinea is caused by several viruses which have similar symptoms -- the deadliest and most feared of which is Ebola. SEYLLOU/AFP/Getty Images
A nurse of the 'Doctors without Borders' ('Medecin sans frontieres') medical aid organisation examines a patient in the in-take area at a center for victims of the Ebola virus in Guekedou, on April 1, 2014. The viral haemorrhagic fever epidemic raging in Guinea is caused by several viruses which have similar symptoms -- the deadliest and most feared of which is Ebola. SEYLLOU/AFP/Getty Images
Members and supporters of the Parti Democratique Senegalais (PDS, Senegal's Democratic Party) hold poster showing their leader, former Senegalese president Abdoulaye Wade and his son Karim, and a placard reading 'Macky Ebola Sall' (referring to the current president and the deadly virus) as they rally in front of the party's headquarters in Dakar on April 23, 2014. Senegal's former president Abdoulaye Wade was due to return home on Wednesday after two years abroad following his election defeat, with his son facing jail for corruption. Wade, who held power from 2000 to 2012, moved to France after suffering a bitter defeat to current President Macky Sall, his former prime minister turned arch-rival, in March 2012. SEYLLOU/AFP/Getty Images
Health workers speak to relatives of peolpe infected with Ebola at an isolation center at Donka Hospital in Conakry on April 14, 2014. Guinea's Foreign Minister Francois Fall said on April 14 that the west African country had brought the spread of the deadly Ebola virus under control after more than 100 people have died. The outbreak is one of the most deadly, with 168 cases 'clinically compatible' with Ebola virus disease reported, including 108 deaths, the World Health Organization (WHO) said in its latest update on April 14. CELLOU BINANI/AFP/Getty Images
Health workers walk in an isolation center for people infected with Ebola at Donka Hospital in Conakry on April 14, 2014. Guinea's Foreign Minister Francois Fall said on April 14 that the west African country had brought the spread of the deadly Ebola virus under control after more than 100 people have died. The outbreak is one of the most deadly, with 168 cases 'clinically compatible' with Ebola virus disease reported, including 108 deaths, the World Health Organization (WHO) said in its latest update on April 14. CELLOU BINANI/AFP/Getty Images
Staff of the 'Doctors without Borders' ('Medecin sans frontieres') medical aid organisation carry the body of a person killed by viral haemorrhagic fever, at a center for victims of the Ebola virus in Guekedou, on April 1, 2014. The viral haemorrhagic fever epidemic raging in Guinea is caused by several viruses which have similar symptoms -- the deadliest and most feared of which is Ebola. SEYLLOU/AFP/Getty Images
A worker transports dirt in a wheelbarrow at a center for victims of the Ebola virus in Guekedou, on April 1, 2014. The viral hemmorrhagic fever epidemic raging in Guinea is caused by several viruses which have similar symptoms -- the deadliest and most feared of which is Ebola. SEYLLOU/AFP/Getty Images
Guinean hospital staff and staff of the 'Doctors without Borders' ('Medecin sans frontieres') medical aid organisation listen to a nurse from the aid organisation speak on April 1, 2014, in Guekedou, during a talk about viral hemorrhagic fever. The viral hemorrhagic fever epidemic raging in Guinea is caused by several viruses which have similar symptoms -- the deadliest and most feared of which is Ebola. SEYLLOU/AFP/Getty Images
A Senegalese hygienist demonstrates how to protect oneself against the Ebola virus on April 8, 2014 at Dakar airport, during a visit of the Senegalese health minister to check the safety measures put in place to fight against the virus' spread in western Africa. West Africa's Ebola outbreak is among the 'most challenging' ever to strike since the disease emerged four decades ago, the World Health Organisation (WHO) said on April 8, as the suspected death toll from the virus hit 111. SEYLLOU/AFP/Getty Images
Senegal's health minister Awa Marie Coll Seck (2nd L) listens to Alioune Fall (R), chief doctor of Dakar airport, as she visits Dakar airport on April 8, 2014 to check the safety measures put in place to fight against the spread of the Ebola virus in western Africa. West Africa's Ebola outbreak is among the 'most challenging' ever to strike since the disease emerged four decades ago, the World Health Organisation (WHO) said on April 8, as the suspected death toll from the virus hit 111. SEYLLOU/AFP/Getty Images
A view of gloves and boots used by medical staff, drying in the sun, at a center for victims of the Ebola virus in Guekedou, on April 1, 2014. The viral haemorrhagic fever epidemic raging in Guinea is caused by several viruses which have similar symptoms -- the deadliest and most feared of which is Ebola. SEYLLOU/AFP/Getty Images
A health specialist prepares filtered water at an isolation ward for patients at the Doctors Without Borders facility in Guékedou, southern Guinea. Guinea's President Alpha Conde warned of a 'health emergency' as authorities raced to contain a spiraling Ebola epidemic which has killed 78 people and prompted neighboring Senegal to close its border. SEYLLOU/AFP/Getty Images
Employees of the sanitary control of Conakry airport check passengers before they leave the country on April 10, 2014. International aid organisations launched a series of emergency measures across west Africa on Thursday in a bid to contain one of the worst ever outbreaks of the deadly Ebola virus, which is threatening every country in the region. The tropical bug is thought to have killed more than 110 people in Guinea and Liberia since January, with suspected cases reported in Mali and Sierra Leone and aid workers warning that vital hygiene products could run out. AFP PHOTO / CELLOU BINANI (Photo credit should read CELLOU BINANI/AFP/Getty Images)
Employees of the sanitary control of Conakry airport check passengers before they leave the country on April 10, 2014. International aid organisations launched a series of emergency measures across west Africa on Thursday in a bid to contain one of the worst ever outbreaks of the deadly Ebola virus, which is threatening every country in the region. The tropical bug is thought to have killed more than 110 people in Guinea and Liberia since January, with suspected cases reported in Mali and Sierra Leone and aid workers warning that vital hygiene products could run out. AFP PHOTO / CELLOU BINANI (Photo credit should read CELLOU BINANI/AFP/Getty Images)
Employees of the sanitary control of Conakry airport check passengers before they leave the country on April 10, 2014. International aid organisations launched a series of emergency measures across west Africa on Thursday in a bid to contain one of the worst ever outbreaks of the deadly Ebola virus, which is threatening every country in the region. The tropical bug is thought to have killed more than 110 people in Guinea and Liberia since January, with suspected cases reported in Mali and Sierra Leone and aid workers warning that vital hygiene products could run out. AFP PHOTO / CELLOU BINANI (Photo credit should read CELLOU BINANI/AFP/Getty Images)
Employees of the sanitary control of Conakry airport check passengers before they leave the country on April 10, 2014. International aid organisations launched a series of emergency measures across west Africa on Thursday in a bid to contain one of the worst ever outbreaks of the deadly Ebola virus, which is threatening every country in the region. The tropical bug is thought to have killed more than 110 people in Guinea and Liberia since January, with suspected cases reported in Mali and Sierra Leone and aid workers warning that vital hygiene products could run out. AFP PHOTO / CELLOU BINANI (Photo credit should read CELLOU BINANI/AFP/Getty Images)
A member of the Guinean Red Cross uses a megaphone to give information concerning the Ebola virus during an awareness campaign on April 11, 2014 in Conakry. Guinea has been hit by the most severe strain of the virus, known as Zaire Ebola, which has had a fatality rate of up to 90 percent in past outbreaks, and for which there is no vaccine, cure or even specific treatment. The World Health Organization (WHO) has described west Africa's first outbreak among humans as one of the most challenging since the virus emerged in 1976 in what is now the Democratic Republic of Congo. AFP PHOTO / CELLOU BINANI (Photo credit should read CELLOU BINANI/AFP/Getty Images)
A man reads a newspaper featuring a front page story on the death of Liberian diplomat Patrick Sawyer (pictured with his wife Decontee) who died of the Ebloa virus in Lagos on July 30, 2014. Nigeria is on alert against the possible spread of Ebola after the first confirmed death from the virus in Lagos, Africa's biggest city and the country's financial capital. The victim, who worked for the Liberian government, collapsed at Lagos international airport after arriving on a flight from Monrovia via the Togolese capital Lome, according to the Nigerian government. Doctors Without Borders (MSF) warned that the crisis gripping Guinea, Liberia and Sierra Leone would only get worse and could not rule out it spreading to other countries. AFP PHOTO/PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images)
A pharmacist searches for drugs in a pharmacy in Lagos on July 26, 2014. Nigeria was on alert against the possible spread of Ebola on July 26, a day after the first confirmed death from the virus in Lagos, Africa's biggest city and the country's financial capital. The health ministry said Friday that a 40-year-old Liberian man died at a private hospital in Lagos from the disease, which has now killed more than 650 people in four west African countries since January. AFP PHOTO / PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images)
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By KRISTA LARSON and MARIA CHENG

DAKAR, Senegal (AP) - 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.

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. But some health authorities expressed little confidence in such precautions.

"The best thing would be if people did not travel when they were sick, but the problem is people won't say when they're sick. They will lie in order to travel, so it is doubtful travel recommendations would have a big impact," said Dr. David Heymann, professor of infectious diseases at the London School of Hygiene and Tropical Medicine.

"The important thing is for countries to be prepared when they get patients infected with Ebola, that they are isolated, family members are told what to do and health workers take the right steps."

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."

The risk of travelers 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 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 travelers 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.

International travel has made the spread of disease via airplanes almost routine. Outbreaks of measles, polio and cholera have been traced back to countries thousands of miles away. Even Ebola previously traveled the globe this way: During an outbreak in Ivory Coast in the 1990s, the virus infected a veterinarian who traveled to Switzerland, where the disease was snuffed out upon arrival and she ultimately survived, experts say.

The mere prospect of Ebola in Africa's most populous nation has Nigerians on edge.

In Nigeria's capital, Abuja, Alex Akinwale, a 35-year-old entrepreneur, said he is particularly concerned about taking the bus, which is the only affordable way to travel.

"It's actually making me very nervous. If I had my own car, I would be safer," he said. "The doctors are on strike, and that means they are not prepared for it. For now I'm trying to be very careful."

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 centers, 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.

Liberian Assistant Health Minister Tolbert Nyenswah told The Associated Press last week that there had been no screening at Liberia's Monrovia airport. That changed quickly over the weekend, when President Ellen Johnson Sirleaf said a new policy on inspecting and testing all outgoing and incoming passengers will be strictly observed. She also announced that some borders were being closed and communities with large numbers of Ebola cases would be quarantined.

International travelers 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. Among them were officials from ECOWAS, a West African governing body, airline employees, health workers and the Nigerian ambassador to Liberia, he said. He said there have been no new cases of the disease.

What's To Blame For Worst Ebola Outbreak In History?

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Associated Press Medical Writer Maria Cheng reported from London. Jonathan Paye-Layleh in Monrovia, Liberia; Clarence Roy-Macaulay in Freetown, Sierra Leone; Erick Kaglan in Lome, Togo; and Heather Murdock in Abuja, Nigeria, also contributed to this report.

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