Health officials in West Africa are scrambling to contain a possible widening of an Ebola outbreak after a man believed to be affected by the virus traveled by plane from Liberia to Ghana to Togo to Nigeria, where he died on Friday.
The death of Patrick Sawyer, 40, has led to tighter screening of airline passengers in West Africa, Ebola has killed more than 670 people in Guinea, Sierra Leone and Liberia since the outbreak began in March.
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."
Sawyer was a former resident of Coon Rapids, Minn., and his wife, Decontee, said he had planned to visit next month to visit his three daughters, two of whom had birthdays in August. Decontee Sawyer said her husband, a U.S. citizen, had moved back to his native Liberia to work for the country's Ministry of Finance. She told KARE-TV that she believed he had contracted Ebola from his sister.
Witnesses told the Associated Press Sawyer 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.
The new concern comes as the condition of an American doctor diagnosed with Ebola reportedly deteriorated. The Associated Press reported that Dr. Kent Brantly, 33, is in grave condition and fighting for his life in an isolation unit on the outskirts of Monrovia, the capital of Liberia. A former colleague of Brantly, Dr. David Mcray, told AP that efforts to evacuate Brantly to Europe for treatment have been thwarted because of concerns expressed by countries he would have to fly over en route to any European destination.
On Sunday, another American aid worker tested positive for the virus. Nancy Writebol, a worker with allied aid group Serving in Mission (SIM), is in stable and serious condition, according to an official at the North Carolina-based aid group Samaritan's Purse.
According to Ken Isaacs, a Samaritan's Purse vice president, Writebol, who had been working as a hygienist decontaminating those entering and leaving the Ebola care area at the hospital, was showing full symptoms of the virus.
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.
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.
The Associated Press contributed to this report.