This article from NYTimes.com has been sent to you by psa188@xxxxxxxxx Airlines Burdened on a Global Scale by War and Illness April 6, 2003 By EDWARD WONG At airports across Asia and Canada, travelers are lining up at counters and gates for the inevitable questions. Do you have a dry cough, fever or nausea? Have you had contact with anyone with these symptoms? Where are you coming from? The scenes are reminiscent of those in the 150 immigration stations on American borders a century ago. At places like Ellis Island, health officials checked arrivals for contagious diseases. Some were held, forced to undergo a medical exam and shipped back if judged a health hazard. In the post-9/11 era, airports have begun taking on a role similar to those immigration stations, slowly transforming into the choke points of a globalized world - particularly between developing countries and North America or Western Europe. That process was accelerated last week by fears over severe acute respiratory syndrome, or SARS, the potentially deadly illness that is believed to have originated in southern China. In the last few weeks, it popped up almost simultaneously in at least 15 more countries, inadvertently carried there by infected passengers on commercial flights. The rapid spread brought to mind the grim ending of the movie "Twelve Monkeys," in which a madman intends to start a global plague simply by flying with the germs to cities around the world. Deregulation and falling fares have democratized air travel in recent decades, but the role of the airline network in shrinking the world makes it vulnerable to clampdowns when it helps bring unwanted elements across borders. Those "invaders" could include terrorists and disease. "It certainly raises the question of these vast networks that we have, in which people can easily travel from one place to another," said James D. Ott, co-author of "Airline Odyssey: The Airline Industry's Turbulent Flight into the Future" (Republica, 1998), speaking of the new disease. "It could rise to a global problem within a couple of flights. I think the network is certainly going to be an issue." Anxiety among travelers over SARS and the fighting in Iraq - as well as the transformation of airports into paramilitary zones and disease control centers - herald an apocalyptic time for the airline industry. The four horsemen are arriving one by one. First came death on Sept. 11, 2001, now war and pestilence. What's next? When the World Health Organization recommended last week that travelers cancel trips to Hong Kong and the adjoining Chinese province of Guangdong, both critical economic hubs in Asia, corporations took that advice to heart, steering managers and salespeople - its laptop-lugging road warriors - away from runways and toward telephones or video-conference screens. "The major shock was 9/11," said Kevin P. Mitchell, president of the Business Travel Coalition, an advocacy group. "Yet, 18 months later, we're still in a major downturn, still facing a bad economy, a second gulf war, Al Qaeda around the corner and now this SARS. The business traveler is looking for ways not to travel." But if corporations are barring people from going to Asia, governments and health officials are using airport checkpoints to keep potential disease carriers from traveling in the other direction. Airline workers in Asian airports have been told to question passengers closely on their health and recent contacts. If their answers indicate they could be infected, they have to get a medical certificate clearing them of health risk before flying. Continental Airlines and other carriers have asked workers to watch for any passengers with signs of SARS. The problem, though, is that symptoms - like dry coughing - are virtually indistinguishable from most respiratory diseases, including the common cold. Making hasty guesses raises questions of discrimination over a medical condition, or based on country of origin, as was evident last week when the Swiss government barred all visitors from China, Hong Kong, Vietnam and Singapore from a watch and jewelry convention. Similar quick judgments took place at Ellis Island in the late 1800's and early 1900's. There, immigrants filed down the gangplank from steerage holds and up into a vast registration hall. Two federal health officials stood at the top of the staircase, scrutinizing the arrivals for coughing, limping, head-scratching, runny noses, runny eyes, stooped backs - anything indicating ill health. This was called the "six-second medical." Health officials made a chalk mark on the lapels of anyone exhibiting symptoms: X for mental disorder, S for scalp condition, H for heart condition, TB for tuberculosis and so on. Those immigrants, mostly from southern and eastern Europe, would be herded into detention pens and forced to undergo a medical exam, said Jeffrey S. Dosik, a librarian at Ellis Island. About 2 percent of arrivals were sent back for legal or medical reasons. "They looked in particular for tuberculosis, contagious scalp disease or contagious trachoma," Mr. Dosik said. "Those three disorders back then were medically untreatable. They were like the AIDS of their time." So far, no treatment has been found for SARS. Scientists also have not come up with a test for the disease, so the best airport screening method now - if a highly inefficient one - is for workers to question travelers. If a test were devised, then health workers might be able to better examine passengers, but that would likely pose significant logistical problems. "There are turnaround times of an hour at least," said Dr. Roger E. Wetherbee, an infectious-disease specialist at New York University Medical Center. "It would certainly be very cumbersome. The travelers would object to it certainly. And if they were trying to make connections, it would screw that up." Some might argue that airports should be turned into quarantine stations for potential SARS carriers. Travelers coming from regions of epidemic yellow fever without proof of immunization have been kept for days at ports of entry until the incubation period passed. The problem with this new disease is that its incubation period may be as long as 10 days, there are huge numbers of travelers from countries with the illness, and detaining so many people for so long runs counter to the way the global travel network operates. If governments devise far-reaching ways of screening or detaining travelers, then that will undoubtedly heighten concerns over civil liberties. Even now, many people are calling the Swiss government's actions last week heavy-handed and possibly racist, though government officials said they were acting to ensure public safety. The same debate has been raging here since the 9/11 terrorist attacks over detention of Muslims. Casino-style surveillance and facial-recognition technology could soon be installed at airports to allow less disruptive ways of monitoring threats, but critics still raise ethical concerns over these. THE Transportation Security Administration is working on an invisible step that would tighten the flow at airports: a computer database called CAPPS II that has background information - and a risk score - on anyone flying. The agency has declined to give details on the system. Privacy groups decry it as a step toward Big Brother. Agency officials say they just want to ensure that travelers are, as they put it, rooted in the community. But in a world made smaller by planes and other technologies, where mobility and commerce go hand in hand, where Toronto virtually exists next to Hong Kong and Detroit to Baghdad, what community is that? http://www.nytimes.com/2003/04/06/weekinreview/06WONG.html?ex=1050643558&ei=1&en=3b33e580515102ee HOW TO ADVERTISE --------------------------------- For information on advertising in e-mail newsletters or other creative advertising opportunities with The New York Times on the Web, please contact onlinesales@xxxxxxxxxxx or visit our online media kit at http://www.nytimes.com/adinfo For general information about NYTimes.com, write to help@xxxxxxxxxxxx Copyright 2003 The New York Times Company