Inside the massive, urgent response to the 'mystery' outbreak on Flight 203

When Emirates Airline Flight 203 was quarantined last week at John F. Kennedy International Airport public health officials sprang into action, executing a system "years in the making" that requires hospitals, transportation officials, and others to coordinate with federal, state, and local officials to detect and stop potentially dangerous illnesses from entering the United States, Helen Branswell writes for STAT News.

Background

Public health officials were put on alert when more than 100 passengers flying from Dubai to New York City Wednesday developed flu-like symptoms that ranged from mild to more severe, Branswell writes. The flight's departure location caused some public health officials to grow particularly concerned, as Saudi Arabia has had more cases of Middle East Respiratory Syndrome (MERS) than any other country in the world. According to Branswell, MERS has killed about 37% of the just over 2,200 people who have contracted it.

The disease has surfaced in only two instances in the United States, but other countries have seen major outbreaks. For example, in 2015 a businessman travelling from the Middle East to his home in South Korea caught the disease, initiating a major outbreak that resulted in 185 cases and 36 deaths.

Ultimately, U.S. public health officials determined Flight 203 was not going to result in a major airborne disease outbreak. According to Branswell, just 10 people were hospitalized from the flight, and they didn't have MERS—rather, several tested positive for influenza and other cold-causing viruses.

But to reach that relatively benign conclusion, officials first had to launch a "hidden safety net" that has been decades in the making.

Inside the 'hidden safety net'

Upon hearing about the incoming flight, officials set up a mobile specimen site at JFK to immediately begin testing passengers, even as a group of pre-designated hospitals prepared to receive patients as needed.

According to Branswell, the system that enabled this rapid mobilization was crafted in the early 1990s when "the Institute of Medicine—now called the National Academy of Medicine—issued a clarion call of the threat emerging infectious diseases posed to the United States."

Since then, the system has been tested and fine-tuned—creating what Martin Cetron, director of the CDC's division of global migration and quarantine, described as a "hidden safety net" that prepared officials for Wednesday's crisis response.

Cetron explained that airports and other ports of entry practice for these scenarios. Research has shown large airports are more likely to have routine drills and respond faster, Branswell writes.

Cetron said, "[T]here have been port preparedness plans for years that have been written and revised and iterated in partnership with state and local health departments, with other federal partners at ports, with the local EMS response system, with communications officers," and other stakeholders.

"[W]e had a contingency plan for 'What if it's 50 or 100 [sick people] versus what if it's just 15 sick people?'" Cetron said. He added, "All of those things are laid out in advance. And executing against a pre-planned and pre-exercised scenario really helps things go smoothly."

According to Kamran Khan, an infectious disease physician at St. Michael's Hospital in Toronto, the incident at JFK showed a system doing what it's supposed to do. "The fact that this is happening within a matter of hours is encouraging," he said. He added that, "[d]espite whatever uncertainty comes during the hysteria and the lead in," it's important "not to be guided by the fear of the extreme" (Branswell, STAT News, 9/7).

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