1. [Pertinent to medical responders] When asking a travel history, TRUST BUT VERIFY and err on the side of caution. Senegal, Nigeria, South Africa in 1996, and now Dallas are all examples of traveler failure to disclose.
2. We are at Day 14 of post-exposure in Dallas. We are running an open experiment to provide evidence of the relative low transmission efficiency of Ebola. We should have seen several of the core contacts become symptomatic by now. This is a good development and serves to tone down the hyperbole regarding aerosol transmission / pandemic potential. This should also help bolster public confidence in sound public health practice (see below comments regarding erosion of trust).
3. Significant lack of data and active information suppression in West Africa is inhibiting accurate assessments. This is a poor indicator. Epidemic curves now falsely show a "peaking out" of cases. This is not the reality. Things remain very much completely out of control, and the three-country region involved is rated at an IDIS CAT 6 with pockets of CAT 7.
4. We have seen several African nations resume airflights to Liberia. We think this is an exceedingly poor decision.
5. There has now been a significant extension of new cases to the NW border of Cote d'Ivoire. We are waiting for declaration of involvement of this country either via direct land extension or newly re-established air flight connection.
6. While Nigeria has achieved containment, we continue to monitor them given they are still seeing diaspora from the effected region.
7. We have intercepted reports of West Africans who have successfully fled by airflight to Colombia, and reported intercepts at the southern border of the US. Some of this information requires verification, but if true is obviously a point of concern for the involved southern US states.
Currently in the US, we see the following issues regarding preparedness:
1. Public health preparedness is a world away from true frontline medical preparedness. The two communities are talking past each other. The civilian medical community is compromised due to the upheaval of healthcare in our country.
2. Five airports are checking for fevers at checkpoints. LaGuardia was left off this list, prompting an airline worker strike. The US Department of State has not indicated whether / what they are doing in regards to the granting of Visas (the true core of the issue). DHS TSA has failed to provide key information regarding passenger movement beyond the Ports of Entry. Understanding critical information regarding intra-country travel beyond the Ports of Entry is essential at this juncture. We do not believe checking for fever at Ports of Entry addresses the core concern, which is the prevention of citizens from the core affected countries from entering the United States until containment has truly been achieved.
3. There continues to be a serious erosion in public confidence in public health's leadership writ large. This lack of confidence permeates our medical community.
In short, the situation is out of control, and our country remains exposed with the potential for more surprise translocations. We do not anticipate significant potential for an uncontrolled epidemic here in the US, however preparedness is a serious problem.