Al-Ahram Weekly Online   7 - 13 May 2009
Issue No. 946
Published in Cairo by AL-AHRAM established in 1875

Banned from entry

At airports and seaports, the authorities are ready with contingency plans to ensure swine flu does not get past them. Amirah Ibrahim reports

On Monday, Elizabeth, an Austrian tourist who landed in Hurghada Airport, was suspected of having swine flu after suffering from high fever. She was sent to a hospital for medical tests and was kept under observation for 24 hours. The Health Ministry on Tuesday gave Elizabeth a clean bill of health and she was released after being treated for the common flu.

Elizabeth was just one of a number of passengers suspected of carrying the swine flu virus, but all have been proven free of the germ.

At Cairo International Airport, Egypt's main gateway, masked faces of customs and immigration officers have been receiving arrivals at TB1, TB2 and the newly opened TB3 terminals.

As they pass through, passengers are stopped by a medical team of doctors and technicians who keep one eye on the passengers' general health. The other eye runs through passports in search of a previous entrance visa to any of the reportedly infected countries.

"The passenger is questioned for a few minutes to test his health and see whether he or she is suffering from fever, vomiting or other symptoms," said Dr Hassan Shaaban, head of the central department of Cairo International's quarantine unit.

Additional counters have been set up for medical teams who temporarily joined the airport quarantine unit. Shaaban says the Health Ministry has provided Cairo International with an additional 50 doctors, 40 nurses and 60 technicians.

Health authorities have already started converting the Heliopolis mental hospital, located near the airport, into a quarantine unit. Patients have been moved to Abbasiya hospital while the one in Heliopolis is being readied at present to receive suspected cases to carry out blood tests and for medical surveillance.

In addition to Cairo International, aviation authorities have set up quarantine centres in five high- traffic international airports in Hurghada, Sharm El-Sheikh, Alexandria, Luxor and Aswan.

Scanning passengers coming from African countries poses a particular problem for quarantine doctors who may be unable to identify swine flu cases swiftly enough to prevent the spread of infection because of the many diseases with similar symptoms.

"We are overwhelmed with tuberculosis, pneumonia and malaria, all of which present similar symptoms to swine flu. The problem is identifying swine flu when so many people are sick with similar fever- causing illnesses," Mustafa Rifaai, a medical technician at Cairo International's quarantine unit, said.

Cairo International is still studying the possibility of equipping its terminals with thermal scanners but which would take at least a month to install.

When the arrival of a British Airways flight was announced over the airport's intercom system, the medical staff, immigration officers and custom officers swung into action, putting on their masks to their mouths.

Kate, 24, and her two sisters said they were comforted by the thought of visiting "a country that is still clear of swine flu."

"I do not think travellers should change their plans unless there are strong warnings by WHO," said Kate who, along with her sisters, were masked.

"Doctors have not examined us. I think because we do not look sick, do we?"

Four flights arrived during the following hour -- from Kuwait, Athens, Istanbul and Lagos. No exceptional procedures were taken and only a few passengers were subjected to a medical examination.

In the wake of the outbreak of swine flu, international travel authorities have refused to impose restrictions on travel. Some countries have introduced new immigration regulations committing passengers to state which countries they visited six days before entering any other nation.

"Influenza can be transmitted at home among family members, in shopping malls, on the street, in buses or in aircraft," says Sherif Galal, chairman of EgyptAir airlines which operates more than 200 daily flights on domestic and international routes. "WHO figures show that between 250,000 and 500,000 people die every year from flu infections. The WHO has not identified any specific risks from air travel.

"So far, we have no intention of cutting routes or reducing flight frequencies. We do not operate flights to Mexico, and we do not see a need to interrupt the network with such procedures," Galal added.

Along with general guidelines for dealing with public health emergencies, guide material from the International Aviation Transport Authority (IATA) covers maintenance, passenger agents, cabin crews, cleaning crews and cargo.

Galal said IATA had provided guidelines for cabin crews when facing a suspected case of communicable disease on board.

"A communicable disease is suspected when a traveller has a fever (temperature 38C/100F or greater) associated with one or more of the flu symptoms such as persistent coughing, impaired breathing, persistent diarrhoea and or vomiting and appearing obviously unwell," Galal said.

He added that airlines had provided its cabin crews with, among other things, gloves and masks to help deal with sick passengers.

"Suspected passengers onboard flights are to be relocated in a more isolated area if space is available. One cabin crew member is designated to look after a sick traveller. When possible, the crew designates a specific lavatory for the exclusive use of the sick traveller. If the sick traveller is coughing, the crew will require that the passenger wear a surgical mask or put a tissue over his or her mouth and nose. The captain is then informed who in turn reports the suspected cases to air traffic control and to advise the destination station that cleaning and disinfection will be required," Galal added.

If H1N1 reaches a sixth alert level, said Galal, medical tests will be imposed on all passengers before they come to Egypt, at the expense of EgyptAir.

Similar guidelines have been provided to travel agents about suspected cases of communicable diseases at the airport which are reported to supervisors.

"Passengers should be reassured that aircraft are regularly disinfected even in regular operations. Modern aircraft have very advanced air filtration systems which ensure a high level of air quality despite the confined environment," Galal said.

Crews who carry out maintenance on an arriving aircraft with a suspected case of communicable disease are requested by WHO to be careful in dealing with High Efficiency Particulate Air (HEPA) filters.

"About 50 per cent of the air in most modern aircraft is re-circulated" said Abdel-Aziz Fadel, chairman of EgyptAir's maintenance and engineering. "Technicians should wear disposable gloves while replacing HEPA filters of an infected plane, avoid hitting, dropping or shaking the filter and are not to use compressed air to try and clean a filter," Fadel said.

Fadel indicated that the entire national carrier's fleet is equipped with HEPA filters.

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