US infectious disease experts say Ebola risk tied to the World Cup is extremely low, but hospitals and agencies have expanded readiness since 2014.
The chance that Ebola reaches a World Cup venue in the United States is extremely low, infectious disease experts say, but hospitals and public health agencies are preparing for the possibility as the tournament brings large numbers of fans across North America.
The concern is not that Ebola is likely to spread through stadium crowds. Experts cited by Al Jazeera said the risk is low because Ebola is not airborne and requires direct contact with the body fluids of someone who is ill. But the outbreak in the Democratic Republic of the Congo, where more than 675 infections and more than 135 deaths have been reported, has kept the disease on preparedness lists for host cities.
“The risk of Ebola to anyone at the World Cup is extremely low. Ebola isn’t airborne and doesn’t spread through casual contact – it requires direct contact with the body fluids of someone who is ill,” said Dr. Tom Frieden, chief executive of Resolve to Save Lives and former director of the US Centers for Disease Control and Prevention. “But low isn’t zero, and it won’t be zero until the outbreak is stopped at its source in DRC.”
The World Cup, which began last week, is being played across the United States, Mexico and Canada with 48 teams and 104 matches. Estimates of the travel surge vary by measure: public health planning cited by Al Jazeera refers to 6.5 million fans moving across North America during the 39-day event, while a Deutsche Bank scenario cited by CNBC modeled 1.2 million international fans. The practical challenge for health officials is the same: large, mobile crowds require quick detection and coordination if unusual illness appears.
The CDC, the Pan American Health Organization and the World Health Organization have all described Ebola risk to host countries as low. They have pointed instead to illnesses that spread more easily in crowds, including measles, COVID-19 and influenza, as more likely public health threats during the tournament.
US readiness for Ebola has changed substantially since the 2014 West African outbreak, when Thomas Eric Duncan, a Liberian man with Ebola symptoms, was initially turned away from a Dallas hospital before later being admitted. Two nurses were infected and survived. After that episode, the United States invested $260 million in Ebola preparedness training and response capabilities and developed 13 specialized treatment centers to help identify, isolate and safely care for suspected patients.
“We’re not going to be able to prevent 100% of infections, but we certainly are the most prepared that we have ever been,” said Dr. Gavin Harris, an expert in serious communicable diseases at Emory University in Atlanta, one of the US host cities.
Preparedness work for the tournament has included nationwide training exercises based on a possible MERS outbreak at the games, guidance for physicians on diseases that may be less familiar in their cities, and planning around mosquito-borne illnesses such as malaria, dengue and chikungunya. FIFA said medical risks are part of overall tournament planning and are being managed with host cities, which provide medical leaders to coordinate services.
The United States, Mexico and Canada have also imposed airport screening and travel restrictions for non-citizens who recently traveled to countries affected by the Ebola outbreak. To comply with US restrictions, the DRC national football team left the country in May and trained in Belgium before traveling to the United States.
Local medical committees involving FIFA, public health officials and hospital systems have been assessing risks based on which teams are playing in each city, disease patterns in those teams’ home countries, visa restrictions and stadium logistics. Some areas have discussed placing disease-specific treatments or protective gear near venues and using tools such as wastewater monitoring, air quality data and electronic medical records to look for unusual clusters of illness.
Georgetown University has also established an independent Health Security Operations Center with more than 30 public and private partners. More than 700 state and local health authorities, about 60 federal partners, FIFA and the CDC have signed up for its daily reports, according to the Al Jazeera report.
Still, several experts warned that readiness is being tested by broader strains on the US public health system, including CDC staff cuts, the US departure from WHO and pressure on state and local health departments responding to the country’s largest measles outbreak in decades. The US Department of Health and Human Services, which oversees the CDC, did not respond to Al Jazeera’s request for comment.
For now, the official message is that Ebola is unlikely to pose a threat to World Cup spectators. The next test is whether surveillance systems and local health teams can move quickly if a suspected case or another infectious disease signal appears during the tournament.
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