By Peter Russell
WebMD Health News
Reviewed by Brunilda Nazario, MD
Dec. 31, 2014 -- Procedures for screening people returning to the United Kingdom from countries affected by Ebola will be reviewed after an infected nurse was cleared to fly from London to Glasgow, Scotland, despite apparently telling airport staff she felt unwell.
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Another National Health Service worker, who was on the same flight as the infected woman, described the screening process at the airport as "chaotic."
Nurse Pauline Cafferkey, 39, asked officials at London's Heathrow Airport to check her temperature several times. Afterward, she was allowed to board another flight to Glasgow.
The U.K. Department of Health says she received seven temperature checks, and all the readings were within an acceptable range.
Cafferkey, who's now getting care in an isolation unit at Royal Free Hospital in London, has decided to be treated with blood plasma from Ebola survivors. She'll also take an experimental antiviral drug, the hospital says. She is sitting up in bed, talking, and reading.
"We are giving her the very best care possible," Dr. Michael Jacobs says in a statement. He's an infectious diseases consultant at the hospital. "However, the next few days will be crucial. The disease has a variable course and we will know much more in a week's time."
Specialized Isolation Unit
Within hours of her initial return to Glasgow, Cafferkey was admitted to the infectious diseases unit at Gartnavel Hospital.
But U.K. rules for dealing with dangerous infectious diseases like Ebola required her to be transferred early Dec. 30 to the high level isolation unit (HLIU) in London's Royal Free Hospital.
Earlier this year, that same unit successfully treated British volunteer nurse William Pooley, who caught Ebola while working in Sierra Leone, Africa.
Access to the HLIU is restricted to a small team of specially trained medical staff. The patient is treated inside a tent with its own controlled ventilation system to minimize the risk of infection.
Cafferkey, an NHS nurse working with Save the Children at the Ebola Treatment Center in Kerry Town, Sierra Leone, left on Dec. 28. She flew to Glasgow via Casablanca, Morocco, and London's Heathrow as part of a larger group of volunteers.
Health authorities have insisted the risk to other passengers is low. But Public Health England (PHE) is contacting 132 passengers and the crew on board Royal Air Maroc flight AT0800 from Casablanca to London.
Health Protection Scotland is carrying out a similar exercise for 71 people on board British Airways flight BA1478 from London to Glasgow.
Those who are contacted are being made aware that a person on their flight was confirmed with Ebola after they returned to the U.K., although the person would have been in the very early stages of disease and extremely unlikely to be infectious.
Public Health England says even though the risk is considered very low, as a precaution, those sitting within two rows of the infected passenger will be advised to take their temperature twice daily until Jan. 18, 2015. If their temperature rises to 99.5 degrees F or higher, they should seek medical advice.
Dr. Martin Deahl, a consultant psychiatrist from Shropshire, England, who travelled with Cafferkey, tells the BBC that too few staff appeared to be on duty at Heathrow to carry out health checks. "The whole process was a bit chaotic, considering they knew a big group of us were coming back," he says.
But the Department of Health is insisting that the correct procedures were followed at Heathrow. A spokesperson says in a statement: "We have been clear -- this person was tested as part of the screening process at Heathrow, and as with all health workers, she was advised to contact PHE if she had any concerns. She did this, while still at Heathrow, and went through a further six temperature checks.
"Her temperature was in acceptable ranges and she was cleared for onward travel, with the advice that if she did start to feel unwell, she should contact health authorities.
"After this person got home, she alerted health authorities that she was experiencing symptoms and was admitted to hospital for tests.
"Naturally, we will be reviewing what happened and the screening protocols, and if anything needs to be changed it will be."
Ebola is spread by direct contact with the bodily fluids, such as the blood, vomit, or feces from an infected person with symptoms. The symptoms typically appear anywhere from 2-21 days after exposure to the virus.
Professor Tom Solomon, director of Liverpool's Institute of Infection and Global Health, says in a statement: "From as early as July, we predicted that the U.K. was at risk of importing a case of Ebola. Despite restrictions in airline routes, and screening at airports, we thought we were likely to see a case before the end of the year. This has now happened.
"Because this was a health care worker, who knew what to look out for, and what to do once they felt unwell, the risks to the general public are minimal."
The Ebola virus has killed 7,842 people, mostly in West Africa, since it broke out a year ago. There have been 20,081 reported cases of the disease.
SOURCES: Department of Health. Public Health England. Royal Free Hospital. Professor Tom Solomon, Liverpool's Institute of Infection and Global Health. Science Media Centre. BBC News.
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