Cetron Airports Transcript

Cetron Airports Transcript

At some point, and initially, we had the first start of this at New York at JFK [John F. Kennedy International Airport]. It was JFK, Atlanta, Chicago, Newark, and DC at Dulles [International Airport]. Those were the five ports, and the reason to be there is, although we had talked about in theory a structure, we had developed concepts of operation for what we called "risk-based border screening" for more than a decade, back into the early--post-SARS. We'd really talked about what that would look like with different pathogens, and how we would structure and stage, and what we would do, and how we would manage people that hit the triggers and interfacing. We'd never really executed a full-on implementation of this concept. This is just like anything else. There's nothing like being on the ground, and if you go to any port, you've just seen one port. The physical structures, the flow, the people, the engagement. Not only had we not done this, and we were the tip of the spear from public health in implementing and instituting--we had critical partners across the government and outside of the government at the community level. Emergency responders, hospitals, ambulance drivers. This was a really intricate, big network that needed to function seamlessly, and nobody had ever done this in this way before. Part of this was not only figuring out what the physical landmark would be in every different location, but also we had CBP [US Customs and Border Protection] officers that were way outside their comfort zone. They were in law enforcement, and they were involved in the primary assessment and screening. We had datasets that were being captured. We had contracted people from the Coast Guard to do the initial temperature checks. We had lots of people that were in a lane that was untraditional and unfamiliar, and there was a huge amount of fear. Some of those people were listening to the global rhetoric about, why are we letting anybody in in the first place? Isn't it safer just to stop all this? Being there, it was really important to actually try to address this epidemic of fear and risk of stigma. But a lot of fear. That often meant daily "musters" of these just-in-time educational messages, where before a shift started, I would--in the middle of a room full of CBP officers, I would just start, "How many of you are afraid to execute this mission?" Once the first few hands went up, everybody's hands were up. "What are you afraid of? What worries you? What's most on your mind?" Just bring that out to a conversation. Not expecting people to do something because they were told to, but to actually get them to understand it. Most of the time, the fears were in excess of the reality of the risk. What they mostly needed to hear was no, we weren't expecting a massive inflow of Ebola-infected people at the port. This is what was already going on before anyone would ever see them. This is what they could do in terms of, they were wondering about wearing all sorts of protective equipment. I said, "You're not in an Ebola treatment unit. You don't need to be dressed up to that degree. The likelihood of you having an active case sitting in front of you is really, really, exceedingly small. This is mostly about doing the risk assessment so that people in the future can do risk management once someone's sick. The sickest people are never being allowed on the plane in the first place." They didn't know we had this infrastructure upstream, or what was going on. Then every time a shift turned over and the new people were coming in, it was doing that all over again.

Q: Do you remember any individuals in particular who were freaked out about their role?

CETRON: There were several, and not in any way judgmental, I've worked with law enforcement before. I've been in other situations where there was a security threat and we were in caravans going in and out of refugee camps and we were under armed guard and so on, and I felt very afraid because I didn't understand that risk. I'm not sure how much that risk was actually mitigated by me wearing a flak jacket or being in a caravan. But I couldn't grapple with my understanding of the threat or the measures that were done and how safe I was. So, I'd seen people in law enforcement training who will go into a room with active shooting scenarios and know exactly how to address that threat. An unseen pathogen that can liquefy you scares the hell out of most people. You may be a very brave soldier with a gun or CBP law enforcement officer, but Ebola is not a threat that you have a handle on. I think a lot of it is just allowing people to express their concerns, to go through the protocols and procedures, to say what's in place that's protecting them and their family, and why we wouldn't put them at excessive risk in this setting. Again, that kind of activity is a big deposit into a trust account. If you're willing to be there and spend the time and explain this, or meet all the people that are in the line without any protection, then they know that you wouldn't be doing that--exposing yourself unnecessarily, and it can't be that unsafe for them.

This scene was repeated over and over again at every port. The problem with a lot of international flights is they come in all day and all night. It's always on, and there was a lot to learn, and the flows were large. I found myself with very few hours of sleep over the course of setting these programs up. Mostly, we have an isolation room. It's really an examining room. It's like an examining table with stirrups and stuff, and I was basically sleeping on the exam table in the isolation room for a few hours between events for weeks on end until this was set up.

But I do think it was a very necessary and a very successful program. I didn't think that back in June when we set up exit screening, and I wouldn't have done that in lieu of doing exit screening, which had a higher yield. But I do understand why it was a necessary step, and there aren't a lot of situations in which I think that's an appropriate strategy of control, but there are some. I would also argue that when you battle an epidemic of disease and also are realistic about the epidemic of fear and stigma and you take all three of them into account, you're probably in a better place than if you try to get by on these narrow, scientific definitions of "I'm only going to worry about the epidemic of disease and not deal with the epidemic of fear." I think fear actually increases the risks of exposure and transmission in ways that people don't appreciate, as does denial. So I think it's necessary to have strategies that embrace all of that. The vaccine for both ignorance and illusion is basically education. That's what we have, and a lot of that standing up of programs like that, once they're strategically designed, they basically rely on a heavy component of education and communication and confidence-building and trust-building in order to be able to execute.