The Centers for Disease Control and Prevention is investigating illnesses that sickened dozens of passengers on three separate international flights headed into the US this week. It looks like many of the sick passengers were traveling from Mecca, where the Hajj was recently underway, and massive crowds of millions of people gathered. Public health experts say this was a lucky break. The incident points to how we may not be prepared for a worst-case scenario with a different bug. There have been a lot of coughing, feverish, sickly passengers flying into the US this week. First, there was an Emirates flight from Dubai that landed at JFK airport Wednesday morning and had to be quarantined. Nearly a dozen passengers on board that flight were hospitalized and given anti-viral drugs. The Centers for Disease Control and Prevention said "preliminary tests indicate that some patients tested positive for influenza and/or other common respiratory viruses." But the agency isn't quite sure this was the common flu. Then, on Thursday, two flights coming in to Philadelphia from Paris and Munich were briefly held upon arrival because of passengers on board with sore throats and coughs. As NBC reported, those sick passengers were all traveling from Mecca, Saudi Arabia where the annual Hajj pilgrimage was underway in late August. It's not too far from where the first plane took off (in the United Arab Emirates). If a more serious illness showed up at a gathering like the Hajj, it could quickly spell disaster. "This is kind of a warning shot," Marc Lipsitch, a professor of epidemiology at Harvard who studies infectious diseases, told Business Insider. "It, fortunately, arrived in a place that was about as well prepared as any place could be," Lipsitch said of JFK airport, which has its own quarantine station. James Steckelberg, a Mayo Clinic doctor who's also a flu expert, told Business Insider in an email that it looked like the Centers for Disease Control and Prevention (CDC) did a pretty good job "getting on top of it." Had the illness been something more deadly, or had the planes flown off to a different destination, the experts agree: this could have been a nightmare scenario. "Public health experts have been saying for years that, first, there's inadequate surveillance around the world of human illness to really detect infections," Lipsitch said. "Large gatherings, including the Hajj, which may be involved here, are particular points of risk." Both Saudi Arabia and the United Arab Emirates are home to laboratory-confirmed Middle East Respiratory Syndrome (MERS), a viral illness which includes symptoms of fever, cough, and shortness of breath. Death rates from MERS are much more concerning than a seasonal flu: about 4 in 10 who contract the illness die, according to the CDC. You can pick it up just from being in the line of an infected person's cough. "Imagine that it was MERS, and it arrived in an airport where nobody recognized it, and then those people all went, scattered," Lipsitch said. "I do wonder why we've seen relatively few transports or movements of the really scariest diseases." A perfect breeding ground of global diseases The Hajj gathers between two and three million people from around the globe every year to meet in Mecca, the holiest Muslim city. MERS and the flu aren't the only deadly viruses that may circulate there. Not everyone who travels to Mecca can afford to get vaccinated before they go, and people traveling from countries dealing with dengue fever, schistosomiasis, and leprosy send nearly 700,000 pilgrims to the religious site every year, as a 2018 study in the journal PLOS Neglected Tropical Diseases points out. This happens at other religious sites too. In 2017, researchers at Hong Kong Polytechnic found that flu outbreaks over an eight year period (2009-2017) tracked closely with Hanukkah in Israel, as well as with the Hajj in the Middle Eastern countries of Bahrain, Egypt, Iraq, Jordan, Oman, and Qatar. The danger doesn't disappear after the holiday is over. The flu has a range of incubation times, and some people won't show symptoms until four days after they've contracted the illness. Sharing a plane with a sick person is arguably one of the safest ways to travel with them; the state of the art air filtration systems aren't like the ones you'll find on the ground, once the flight is over. How to protect from future outbreaks The CDC warns travelers to the Hajj from the US that "because of the crowds, mass gatherings such as Hajj and Umrah are associated with unique health risks." The agency advises getting a checkup and making sure you're up to date on shots before you go, while the Saudi Ministry of Health encourages some medically vulnerable travelers — such as pregnant women, elderly adults, children and terminally ill people — to avoid the pilgrimage altogether. Lipsitch says one of the best ways for the world to prepare for future outbreaks would be to have more health care professionals around the world trained to identify and report illnesses, sending in samples for testing before sicknesses head off into airplanes buzzing about the globe. "When the people disperse, it becomes a multi-point outbreak, which is much harder to control," he said. That's especially true in the case of a respiratory infection like MERS, which can be passed around easily through coughs and shared airspace. "One thing we can't stop doing is breathing," Lipsitch said.<doc-sep>NEW YORK (AP) — The Latest on the emergency response around a plane carrying sick passengers (all times local): 6:41 p.m. The 10 passengers and crewmembers who were hospitalized in New York City after arriving sick on a flight from Dubai appear to have the flu. New York City health officials say they obtained respiratory samples from the patients and their symptoms look like influenza. They say they won't know for sure until they get final results. All of the patients were listed in stable condition. The Emirates flight was quarantined after landing a Kennedy Airport Wednesday morning. The U.S. Centers for Disease Control and Prevention says about 100 of the 520 people aboard the plane had complained of illness, including cough and fever. ____ 3:30 p.m. An airliner from Dubai with 10 passengers and crew members who were hospitalized with flu-like symptoms was carrying 1990s rapper Vanilla Ice. A manager for the rapper confirmed on Wednesday that he was on the Emirates flight that landed at New York's Kennedy Airport. Ice, whose real name is Robert Van Winkle, used Facebook to post a video of the emergency response to an initial report that dozens of people could be sick. On Twitter, he described looking out the window to see several ambulances, firetrucks and police vehicles converge on the plane. He also said he was thankful he was on the top deck to the twin-deck jumbo jet. He said the sick people were on what he called the "bottom floor." ___ 2 p.m. Fire officials say 10 of the people who arrived sick to New York City on a flight from Dubai have been taken to a hospital. Emirates airline says they included seven crew members and three passengers. The plane was quarantined Wednesday at Kennedy Airport. The U.S. Centers for Disease Control and Prevention says about 100 of the 520 people aboard the plane had complained of illness, including cough and fever. Medical workers in masks and gloves took passengers' temperatures on the tarmac while evaluating them. Story continues News helicopters showed the jet sitting on the tarmac surrounded by ambulances, vehicles and airport personnel. ___ Noon A plane was quarantined at New York's Kennedy Airport amid reports of numerous ill passengers aboard a flight from Dubai. There were conflicting reports about how many people were sick aboard the Emirates flight, which landed around 9:10 a.m. Wednesday. The airline says about 10 passengers were ill and got medical attention "as a precaution." The U.S. Centers for Disease Control and Prevention says about 100 of the 520 people aboard the plane were being evaluated after complaining of illness, including cough and fever. Video from news helicopters showed the jet sitting on the tarmac surrounded by ambulances, vehicles and airport personnel. Passengers were exiting the plane with their luggage and getting on to buses. A New York police counterterrorism division tweeted it appeared to be a "medical situation." ___ 11:10 a.m. A plane has been quarantined at New York's Kennedy Airport when about 10 passengers became ill aboard a flight from Dubai. The Emirates flight landed around 9:10 a.m. Wednesday. The airline says the passengers were getting medical attention "as a precaution." Video from news helicopters showed the jet sitting on the tarmac surrounded by ambulances, vehicles and airport personnel. Passengers were exiting the plane with their luggage and getting on to buses. Representatives of the U.S. Centers for Disease Control and Prevention were on the scene. A New York police counterterrorism division tweeted it appeared to be a "medical situation." ___ This story has been corrected to delete a reference to an erroneous tweet from the mayor's spokesman saying the flight stopped in Mecca. ___ 10:40 a.m. A plane has been quarantined at New York's Kennedy Airport amid reports of ill passengers aboard a flight from Dubai. The Emirates flight landed around 9:10 a.m. Wednesday. The airline says about 10 passengers were sick and were getting medical attention "as a precaution." Video from news helicopters showed the jet sitting on the tarmac surrounded by ambulances, vehicles and airport personnel. Representatives of the U.S. Centers for Disease Control and Prevention were on the scene. Eric Phillips, a spokesman for Mayor Bill de Blasio, tweeted that the flight stopped in Mecca, which is experiencing a flu outbreak, and "early indications point to that as a possibility." A New York police counterterrorism division tweeted it appeared to be a "medical situation." ___ 10:30 a.m. The New York City mayor's office says a plane has been quarantined at New York's Kennedy Airport amid reports of numerous ill passengers aboard a flight from Dubai. The Emirates flight landed around 9:10 a.m. Wednesday. Video from news helicopters showed the jet sitting on the tarmac surrounded by ambulances, emergency vehicles and airport personnel. Eric Phillips, a spokesman for Mayor Bill de Blasio, says representatives of the U.S. Centers for Disease Control and Prevention were on the scene. Phillips tweeted that the flight stopped in Mecca, which is experiencing a flu outbreak, and "early indications point to that as a possibility." Airline representatives did not immediate respond to an email. A New York police counterterrorism division tweeted it appeared to be a "medical situation." ___ 10:20 a.m. The New York City mayor's office says a plane has been quarantined amid reports of numerous ill passengers aboard a flight from Dubai that arrived at New York's Kennedy Airport. The Emirates flight landed at about 9:10 a.m. Wednesday. Video from news helicopters showed the jet sitting on the tarmac surrounded by emergency vehicles and ground control personnel. A spokesman for New York City Mayor Bill de Blasio says representatives of the U.S. Centers for Disease Control and Prevention were on the scene. Airline representatives did not immediate respond to an email requesting information. A New York Police Department counterterrorism division tweeted that it was monitoring what appeared to be a "medical situation."<doc-sep>THE initial reports were alarming: 100 passengers on an Emirates Airlines flight from Dubai to New York had taken ill, and the plane was in quarantine at New York’s JFK Airport. That was probably an exaggeration. A spokesman for New York’s mayor later reported that 19 people were ill; ten of them were taken to a nearby hospital, and the other nine refused treatment. (Other reports said 11 were taken to the hospital.) The sick passengers appeared to have flu-like symptoms. Planes are widely regarded as flying disease-incubators. If one passenger is sick with a contagious disease and coughing those germs into the air, it makes sense for fellow-flyers to feel that the germs will simply be inhaled by everyone else on the flight, since there is nowhere else for the things to go. In reality, though, the situation is not that bad. Allen Parmet, a former US Air Force flight surgeon who serves as an aerospace medicine consultant, explained recently to The Verge, a technology and science news site, that infections actually don’t spread well on planes. The reason is the very dry air in the cabin. Many bacteria die in the low humidity. As for viruses, they travel on water droplets when a person coughs or sneezes. But these water droplets also evaporate in the low humidity, and the plane’s fast airflow from ceiling to floor prevents them from travelling far. The downside is that people do cough more on planes, due to the same low humidity. People are also likely to sneeze more, due to the presence of allergens. Cat allergy problems are particularly common, said Mr Parmet, since cat owners have dander all over their clothes, and neighbors who are allergic to the dander end up sneezing. But it is unlikely that a particularly scary disease like Ebola will spread on a plane. Precautions around this are high in countries with serious epidemics. In much of southern Africa, due to the Ebola outbreak in Congo, all outbound passengers walk through thermal scanners to determine whether they have a fever. Elsewhere, visibly sick passengers are sometimes denied boarding. The greater danger is when a plane lands, because the airflow stops, the humidity may rise, and diseases can begin to spread more effectively. This is when public health officials must make quick decisions about whether and how to isolate sick passengers or those who were sitting near them. But in the absence of a major outbreak like Ebola, it can be hard to compel passengers to be screened or quarantined, although at this point the risk can be more about introducing new diseases in the arrival country than about fellow-passengers getting sick. On the Emirates flight, all 549 passengers underwent a medical screening before entering the Airport, according to the Centres for Disease Control. An epidemiologist told Popular Science that the procedure was not really a true quarantine, which would require isolating everyone involved from the general population, but rather a temporary detention for a few hours to allow for testing and treatment. Given the long distance from Dubai to New York, it might seem possible for disease to spread and incubate on board. But most viruses take days to show symptoms, and there were indications that the illness was contracted by people before they boarded the plane. This tale will probably end the usual way. A few passengers, by the laws of probability, will get sick in the coming week, and they will assume it had something to do with all the germs floating around the plane. It may not be true, but it is for them a satisfying enough explanation.<doc-sep>
Story highlights There's a complex international network in place at all times, combating the spread of infectious diseases Twenty US ports of entry are prioritized for the CDC (CNN) — At least four times this week, in the span of just two days, health officials jumped into action to greet sick flight passengers. An Emirates flight from Dubai landed at New York’s John F. Kennedy Airport on Wednesday morning with more than 100 passengers reporting symptoms including coughing, vomiting and fever. Eleven were taken to the hospital. That story got the most attention, but it didn’t stand alone. An ASL Airlines France flight from Algeria to Perpignan in France was briefly quarantined Wednesday when a child aboard was suspected of having cholera. And two American Airlines international flights into Philadelphia on Thursday – one from Paris, the other from Munich – landed with a combined 12 passengers who were evaluated by health officials for influenza and respiratory problems. When contagious disease symptoms present in the air, how do officials mobilize on the ground? What response mechanisms are in place? And how often are they activated? There’s a complex international network in place at all times, combating the spread of infectious diseases. This includes the global reporting of diseases, how and where they spread and the integration of data. It involves international, federal, state and local partners that, among other things, engage in surveillance of the travel experience, whether that be by land, air or sea, explained Dr. Marty Cetron, director of the US Centers for Disease Control and Prevention’s Division of Global Migration and Quarantine. Cetron cited a “prescient report” released in 1992 by the Institute of Medicine (now the National Academy of Medicine) as the impetus for the network’s development. That report signaled that globalization, increases in international trade and travel, migration patterns, world conflicts and more would lead to emerging infectious diseases. And so, since 1996, the CDC has been part of a mobilized effort to detect, protect and respond. Twenty US ports of entry – those with the highest volume of passenger arrivals and international travelers, including animals – are prioritized. But all ports of entry have points of contact. What unfolded at JFK was part of a usually “hidden network of protection,” Cetron said. It’s one that, day to day, “is relatively silent to the US public, as it should be.” It’s not entirely rare to see a medical response at an airport, he explained. New York City Acting Commissioner of Health Dr. Oxiris Barbot said her city sees five or six instances a year. But Cetron said the bulk of cases come up after passengers have moved on. In most cases, 80% to 90% of the time, Cetron said, the CDC and its partners are working to re-create history after a flight. Someone ends up in a hospital with the measles, for example, and a health care provider concludes from the patient’s travel history that other flight passengers may have been at risk. That’s when the network kicks into gear, tracking down where the patient has been and who needs to be notified and screened. It’s the same system that swung into action in 2014 after nurse Amber Vinson was diagnosed with Ebola she had contracted from caring for a patient in Dallas who later died from the disease. Vinson had flown from Dallas to Cleveland before her symptoms began and before she was diagnosed. Still the CDC and Frontier Airlines contacted all of the passengers on that flight about their health and well-being. Sometimes, as was the case on the Emirates flight, Cetron said, a call came in to JFK 30 minutes before the plane landed. The airport, in turn, contacted the CDC. Enough people on the flight – many of whom were returning from the Hajj, the Muslim pilgrimage to Mecca – were exhibiting symptoms to cause alarm. And as they were coming from the Arabian Peninsula, the worst fear was the emergence of Middle East respiratory syndrome, or MERS. An organized system was ready to respond. The jet was not brought to the gate, to prevent the possible spread of disease. A team of officials boarded to do an assessment. Specimens were collected. EMS, fire and rescue workers were there in case they were needed. All 549 people on board, passengers and crew, had a temperature check before most were free to go, said Caitlin Shockey, a CDC spokeswoman.