The airport

Sitting in an airport (for a change) but one without wireless internet. Unfortunate downtime. After two lng days at a meeting without a regular connection I am suffering withdrawal. Not that I have an addiction. I'm connected almost continuously every day and have been for years and still don't have the habit. Meanwhile (another) weather delay. I am anxious to get home.

But I can still sit here and blog about bird flu and airplanes. What if bird flu had gone human to human in Indonesia and we were waiting here for the other shoe to drop? Let's say a plane is coming in from Europe with connecting passengers and someone aboard is sick with flu-like symptoms: headache, fever, cough. He feels really lousy. When the plane lands at this international airport the passengers are met by health officials and the other passengers separated and their temperatures taken and contact information collected. The sick passenger is segregated in a small room at the airport where he is examined. If there is a reasonable index of suspicion of avian influenza, he will be isolated in a hospital, forcibly if necessary. If tests confirm he is infected with H5N1 the other passengers will be contacted and follow-up started for secondary cases.

That's the theoretical scenario. If successful it might retard the start of a wave of influenza cases by a couple of days. If successful. Lots of luck. Consider the elements here. Someone on the plane would have to notice the person was sick and notify the flight attendant (who is busy servicing a full plane by not giving out meals). The attendant is not a medical professional but has to make a decision whether to notify the captain, who in turn will notify the destination airport. At the airport there has to be a "quarantine station," which despite its name is usually no more than a designated medical officer (most often not an MD) and a room with a cot and some rudimentary medical supplies. The personnel there will have to recognize a potential flu case (as opposed to a migraine or some other common medical problem) and the other passengers will have to be properly vetted and adequate contact information obtained. Since H5N1 has a variable incubation period infected passengers might not show symptoms for up to a week or more, by which time they may have infected others.

That's if all goes according to plan (if you call this a plan). At O'Hare International in Chicago almost 16,000 international passengers arrive daily. It has to go according to plan for all of them. And that's just O'Hare.

"The notion that we can detect people with (avian flu) with any kind of assurance and then contain the people that may have been exposed, and then think it will have anything but a trivial impact seems unlikely," says William Schaffner, an infectious disease specialist and chair of Vanderbilt University's Department of Preventative Medicine.

Indeed, there are concerns about whether flight attendants will be observant enough to notice someone's symptoms.

"We are talking about people who are not trained as medical professionals and have other challenging duties," said Katherine Andrus, assistant general counsel for the Air Transport Association, which represents major U.S. airlines.

Airlines are required to train flight crews to recognize illnesses at the basic stages. Currently, that consists of training videos or pamphlets. With a pandemic flu outbreak, the government would likely increase that education, adding particular symptoms for the disease. (by-line Joseph Ryan, The Daily Herald [suburban Chicago])

So the benefit will be marginal and it's not likely to work. The airlines are not happy either. They understand a flu pandemic will be a catastrophic economic blow.

The airlines have disputed some of the CDC's pandemic flu plans, fearing the agency could unnecessarily scare passengers - and money - away from the industry if a deadly flu breaks out in a foreign country. The airlines' lobbyists are currently fighting for clearer language in the plan that would limit when passenger screening would be implemented.

"There is always a concern that implementing measures either prematurely or more extreme than called for will send a signal to the public that the threat is greater than it might be," Andrus said. "If people start to see a health screening they will assume there is some threat to their health."

The bird flu surveillance plan. Now the bird flu airport security plan. Both looking more and more like a PR mirage.

Like the 6000 National Guardsmen at the US -Mexico border.