Airport health screeners in hazmat suits and armed with gun thermometers are becoming a familiar sight in Guinea, Liberia and Sierra Leone, where the Ebola epidemic continues to spiral out of control. Passengers boarding aircraft are checked for fever. If cleared, they receive a stamped leaflet declaring them fit for travel.
The precautions are similar to steps taken during previous outbreaks of contagious diseases, including Middle East respiratory syndrome and deadly bird flus.
For now, the threat to air travelers outside West Africa appears to be low. The World Health Organization is recommending that in non-affected countries, authorities should strengthen the capacity to detect and immediately contain new cases, while avoiding measures that will create unnecessary interference with international travel or trade.
In addition, medical experts note that even if a passenger infected with Ebola were to board a flight, other passengers would not be in imminent danger. The risks of contracting the virus from an infected passenger are "extremely low," according to Lee Norman, the chief medical officer at the University of Kansas Hospital and an adviser to homeland security on infectious diseases.
"If a traveler were to come in contact with a symptomatic Ebola patient who was bleeding, having diarrhea or vomiting, and the traveler came in contact with those bodily fluids, then it would be possible," he says. "But one would hope that a patient that ill would not be allowed on the airplane in the first place."
Nonetheless, the Ebola outbreak is raising questions that apply to any passenger who is not well. What are your rights to a refund or new ticket if you cancel a trip because you have an infectious illness? And what right does an airline have to deny you boarding?
A passenger who is ill might prefer to cancel and receive a full refund for the ticket. That's possible if you've purchased a top-dollar, refundable ticket. But most passengers opt for the cheaper, nonrefundable fare. If you're too sick to fly, you can rebook a different flight but there will be a change fee of $200 to $300. And you'll have to pay the difference if the new fare is higher than the old one.
But there is an exception: If a passenger shows up at the airport and is denied boarding because of a visible illness, then the airline may offer a full refund.
The reasons behind the airlines' reluctance to offer full refunds appear to be mostly financial. Simply put, airlines don't want to refund tickets on a wide scale.
Every exception costs an airline potential revenue. Last year, domestic airlines collected $2.8 billion in ticket change fees, up from $2.5 billion the previous year. (Although it's not clear what percentage of that is from customers who had to cancel their flights because of an illness.)
If you do show up and inform the airline you are too sick to fly, a gate agent will make the decision whether to refund your money. Refunds are approved on a "case by case basis," says Steve Loucks, a spokesman for Travel Leaders Group, a network of travel agents.
"The availability to cancel a ticket depends on the situation, the airline and the type of ticket purchased," says Victoria Day, a spokeswoman for the Airlines for America, or A4A, a trade association for domestic airlines.
The same goes for tickets to international destinations. That information is typically contained in a document called the contract of carriage or conditions of carriage, according to Perry Flint, a spokesman for the International Air Transport Association. "Each airline makes its own decisions with regard to the refundability of a fare, subject to any government regulations as applicable," he adds.
In the wake of the Ebola outbreak, A4A is recommending that passengers who believe they have been exposed to the virus and possibly are infected not go to the airport but go to a medical professional for treatment. A doctor's note can sometimes persuade an airline to offer a refund, even on a nonrefundable ticket.
And what if you think you're well enough to fly, but the airline disagrees? Under federal regulations, airlines may deny boarding a passenger who is a "direct threat" to the health of other passengers. "To be a direct threat, a condition must be both able to be readily transmitted by casual contact in the course of a flight and have severe health consequences," according to the federal regulation. It lists SARS and active tuberculosis as examples of direct threats.
Airlines have their own policies as well that give them the right to prevent a passenger from boarding. For example, American Airlines' international contract says it has "the right to refuse carriage to any passenger who has not complied with applicable laws, regulations, orders, demands, or requirements or whose documents are not complete."
Although this rule is thought to apply mostly to passengers with invalid visas or passports, it could also be used to send a sick passenger packing. Passengers with paperwork problems are offered a flight credit, in accordance with the rules of their fare.
Meanwhile, as the Ebola epidemic continues, the Centers for Disease Control and Prevention wants to make sure airlines know how to handle a potential patient. A document called "Ebola Guidance for Airlines," updated on Aug. 11, suggests providing a surgical mask and air sickness bag for a traveler who is coughing, sneezing or vomiting. The crew is advised to "wear impermeable disposable gloves for direct contact with blood or other body fluids."
And indeed, there have been cases of passengers flying who were later diagnosed with Ebola. Liberian-American Patrick Sawyer hopped a plane in Liberia, arrived in Nigeria, then collapsed and died of Ebola. It does not appear that he infected anyone on the plane, but two health care workers who treated him in Nigeria were subsequently diagnosed with Ebola.
The Sawyer story is a reminder that even if ticket refunds are an important issue for passengers, preventing the spread of Ebola by airline passengers is a far greater concern.
Christopher Elliott is a consumer advocate who writes about travel issues for The Washington Post, USA Today and National Geographic Traveler magazine. His latest book is How To Be the World's Smartest Traveler.