U.S. infectious disease experts say there is a low but non-zero chance that a traveler infected with Ebola will arrive in the United States during the 2026 World Cup, which began last week, and that U.S. hospitals are prepared to respond if that happens.
It wasn’t always like that.
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During the 2014 Ebola outbreak in West Africa, Thomas Eric Duncan, a Liberian man, arrived at a Dallas hospital complaining of Ebola symptoms but was turned away before being admitted.
Two nurses were infected but survived.
This led to $260 million in funding for Ebola preparedness training and response capabilities in the United States, as well as 13 specialized treatment centers, all aimed at helping hospitals identify, isolate, and safely treat suspected Ebola patients.
“We can’t prevent infection 100%, but we are certainly the best prepared we’ve ever been,” said Dr. Gavin Harris, a serious infectious disease expert at Emory University in Atlanta, one of 11 U.S. World Cup host cities.
Public health officials and hospitals in the U.S. host city have been bracing for a variety of infectious disease threats as 6.5 million fans travel across North America during the 39-day event, which features 104 games in the U.S., Mexico and Canada.
The US Centers for Disease Control and Prevention (CDC), the Pan American Health Organization and the World Health Organization (WHO) have all said the risk of Ebola in World Cup host countries is low, citing measles, COVID-19 and influenza (which spreads when large crowds gather) as the most likely threats.
However, the Ebola outbreak in the Democratic Republic of Congo (DRC), which has infected more than 675 people and killed more than 135, remains a concern.
“The risk of Ebola for those attending the World Cup is very low. Ebola is not airborne and cannot be spread through everyday contact. It requires direct contact with the body fluids of a sick person,” said Dr. Tom Frieden, CEO of Resolve to Save Lives and former director of the CDC.
“But low doesn’t mean zero. It won’t go to zero until the source is stopped in the Democratic Republic of the Congo.”
The U.S. Ebola preparedness effort, which began in 2015, grew out of a collaboration between Emory University, the University of Nebraska Medical Center, and the NYC Health + Hospitals/Bellevue facility in New York City, which cared for Ebola patients during the largest Ebola outbreak in West Africa to date.
“There was a recognition that we had an obligation to train other facilities to recognize potential patients who could be infected or sick with something like Ebola,” Emory’s Harris said.
Since then, thousands of healthcare workers have been trained to recognize and treat patients infected with Ebola and other serious pathogens.
In the run-up to the World Cup, preparedness experts conducted nationwide training to simulate a potential MERS outbreak at the tournament.
It has also compiled guidance for doctors to raise awareness of diseases that are not endemic to their home cities, such as mosquito-borne diseases such as malaria, dengue fever and chikungunya.
The United States, Mexico and Canada have introduced airport screenings and travel bans to restrict the entry of non-nationals who have recently traveled to countries affected by the outbreak, and the United States is urging Europe to impose similar restrictions. Harris said these bans will likely reduce the chance of Ebola outbreaks at World Cup venues.
To comply with US restrictions, the DRC national soccer team left the country in May and trained in Belgium before heading to the US.
In each host city, FIFA, local public health officials and hospital systems form a medical committee to conduct an assessment of the threat of Ebola and other infectious diseases based on the teams playing in that city, diseases prevalent in their home countries, visa restrictions and stadium logistics, Harris said.
Some regions are discussing providing disease-specific treatments and protective gear to venues, and using surveillance tools such as wastewater monitoring, air quality data, and electronic medical records to detect unusual disease clusters.
FIFA said medical-related risks will be assessed as part of overall tournament planning and managed in close collaboration with host cities, who will provide oversight and coordination of services to medical leaders.
It said it was monitoring the Ebola outbreak and was in contact with sports and health authorities in the Democratic Republic of the Congo and the three host countries.
Dr. Michael Osterholm, an infectious disease expert at the University of Minnesota, said plans for large gatherings in the United States are not new.
“State and local health officials, in collaboration with the CDC, have been on the front lines for many years with individuals entering this country,” he said.
To assist with disease surveillance and coordination, Georgetown University partnered with more than 30 public and private sector organizations to establish an independent Health Safety Operations Center.
More than 700 state and local health authorities have subscribed to the group’s daily reports, as well as approximately 60 federal partners, FIFA and the CDC.
Still, cuts to the CDC, the U.S. withdrawal from the WHO, and the strain on state and local health officials battling the largest measles outbreak in the U.S. in decades are taking a toll, Frieden and two other experts said.
“My biggest concern is whether the CDC, which has lost thousands of employees both here and in the Democratic Republic of Congo, has the capacity, support and authority to act quickly enough,” Frieden said.
The U.S. Department of Health and Human Services, which oversees the CDC, did not respond to a request for comment.
Gene Marrazzo, CEO of the Infectious Diseases Society of America, said Health Secretary Robert F. Kennedy Jr.’s cuts to public health led to an exodus from the agency.
“Nevertheless, we know that the people still there are working around the clock, often around the clock, to keep us safe,” she said at a briefing.
