CDC will require all U.S.-bound air passengers to attest they have not been in Congo

By Miriam Tolliver

WASHINGTON — Starting next week, every passenger boarding a flight to the United States from anywhere in the world will have to sign a statement saying they have not been in the Democratic Republic of the Congo in the previous 21 days, under a Centers for Disease Control and Prevention order published in the Federal Register on Tuesday.

The order, signed Oct. 22 by Adm. Brian Christine, the Department of Health and Human Services’ assistant secretary for health, takes effect at 11:59 p.m. Eastern time on Nov. 3 and runs through Dec. 18. CDC says it is needed to keep Ebola disease caused by the Bundibugyo virus out of the country, and that its “paramount objectives” are the “preservation of human life” and “preventing the introduction, transmission, and spread of the Ebola virus into the United States.”

The agency’s rationale is laid out in the order itself. “The confirmed ongoing outbreak of BVD in the DRC continues to escalate in intensity,” it says, reporting 9,455 confirmed cases and 4,561 deaths in 66 health zones across eight provinces as of Oct. 18. CDC “has determined that the risk profile presented by the DRC is materially distinct from that of other affected countries,” and that “a categorical temporary measure directed at travelers with recent presence in the DRC is appropriately tailored to the elevated importation risk presented by that country.”

The Washington Inquisitor is seeking comment from CDC, HHS, airline industry groups and the Congolese embassy on how the requirement will be carried out.

What travelers and airlines must do

The attestation requirement applies to all passengers on flights arriving in the United States, including those only connecting through a U.S. airport on the way to another country. It does not apply to overflights that do not land. “Presence” in Congo includes changing planes at a Congolese airport, even without leaving the aircraft, according to the order’s definitions.

Passengers can sign on paper or digitally. Parents or other authorized people can sign for children under 18 and for travelers who cannot act for themselves. The order says the attestation counts as a statement under 18 U.S.C. 1001, the federal false-statements law, and that CDC may ask the Justice Department to prosecute people who knowingly submit false ones.

Airlines and other aircraft operators, including private and general aviation, must confirm before boarding that every passenger has signed, refuse to board anyone who has not, keep each attestation for at least 42 days and hand them to the government on request. The order works as a “controlled free pratique,” meaning an airline’s permission to unload passengers at a U.S. airport is conditioned on that confirmation. Customs and Coast Guard officers will help implement it, and the Homeland Security and Transportation departments may assist.

Two groups are exempt: aircraft operators flying patients with Ebola under U.S. government authorization, and people CDC exempts for “humanitarian or other important government considerations,” such as emergency medical evacuations.

How it fits with existing restrictions

The attestation is layered on top of rules already in place. Under current CDC policy, travelers who have been in Congo within 21 days, including U.S. citizens, are not allowed to board flights to the United States and should stay outside the country until day 22. Non-citizens, including green-card holders, who have been in Uganda or South Sudan in the past 21 days may not enter, and Americans returning from those two countries are routed through designated airports for screening.

A separate CDC order under 42 U.S.C. 265 suspending the entry of certain people from outbreak countries was continued on Oct. 11 through Nov. 10, and public comments on it are due Oct. 30. The new order says it “does not supersede, modify, or replace” that one.

Until now, the Congo restriction relied largely on airlines and screeners identifying travelers from the region. The new order puts the question to every passenger on every U.S.-bound flight. CDC said complex, multi-leg itineraries through hubs in Africa, the Middle East and Europe can “obscure their original point of departure.”

The outbreak behind the order

According to the order, the outbreak is centered in Ituri province in eastern Congo, with cases also identified in North Kivu, South Kivu, Haut-Uélé, Bas-Uélé, Tshopo, North Ubangi and South Ubangi. The World Health Organization has reported that only about 20% of cases were identified by following up listed contacts, which CDC cites as a sign of “substantial undetected transmission.” There are no widely approved vaccines or specific antiviral treatments for Bundibugyo virus disease, though clinical trials are under way in Congo.

CDC also points to spread through air travel. A physician infected in Congo was diagnosed only after arriving in France, and Kenya reported its first case on Oct. 6 in a person who had flown from Kampala to Nairobi. By Oct. 19, Kenya had confirmed eight cases. CDC says the outbreak is already the largest known for the Bundibugyo strain, and the agency has raised its response to Level 1, the highest in its framework.

The agency’s travel notices advise avoiding all travel to Ituri and North Kivu and reconsidering nonessential travel to Haut-Uélé and Tshopo.

The order lasts 45 days and can be amended or rescinded earlier. CDC says any extension will be based on “case counts, geographic spread, community-transmission indicators, and containment capacity in affected countries.”