NEW YORK, NY March 17, 2006 —More than 100 million people fly into and out of the United States annually. They all carry germs, and public health officials believe some day, one of them could bring in something much worse -- the seeds of a pandemic. So, the federal government is increasing the number of health officers posted at airports, and the metropolitan area is getting its second international quarantine station. WNYC's Fred Mogul takes a look at the system the Centers for Disease Control considers its first line of detection and defense.

REPORTER: If you fly into the country through Newark International Airport, you’ll shuffle into a big hall like this one in Terminal B. You’ll line up and march with your passport through one of dozens of booths staffed by customs officials. Chances are, you won’t notice a small room off to the side. But that’s where they’d send you, if you had, say, more than a sniffle but less than a heart attack. There’s no one dedicated specifically to mass health screening, but the same people that stamp your passport and inspect your luggage, in theory, are trained to keep an eye out for severe coughs and rashes. They’d refer you to someone like John Bateman, who runs the Centers for Disease Control’s quarantine station here.

BATEMAN: We have a small room with a hospital bed, also bathroom and shower facility. The room has negative flow air that is vented to the outside, so if there were a potential for aerosol infection it would lessen the exposure for other passengers

REPORTER: Newark airport two of these new rooms. They don’t get a lot of use, because they’re really intended for some pretty rare diseases. Rare, but highly contagious and deadly -- like cholera, smallpox and plague. In recent years SARS has been added to the list, and so has pandemic flu, which may or may not emerge from the bird flu that is slowly spreading around the globe. More likely, but still pretty rare, are diseases like measles and meningitis. Federal authorities won’t isolate you for these, but local health authorities might. In an unusual case last year, Newark officials decided to confine a family of West African refugees in a city facility because the teen-age son had measles. Dr. Andrew Plummer says they weren’t allowed out, and almost no one was allowed in.

PLUMMER: The family ended up being in quarantine for 21 days in a facility that the city of Newark designated specifically for quarantining. No one became ill.

REPORTER: Not all measles patients would be picked up. But this family was, because the immigrant community they would live among is not well vaccinated against the disease. A single case could pose a big public health risk. Immigrants and refugees are among the more thoroughly screened people who pass through Newark. They are required to have physical exams before they leave. And when they get here, they just get their papers checked by the quarantine officers, a slightly more attentive than usual visual check to make sure they’re not noticeably sick, and they’re free to go.

BATEMAN: It’s not the daunting experience you see of the photos of Ellis Island with the firm--faced inspector sticking a needle under someone’s eyelids looking for disease or putting a chalk mark on their jacket. It’s done today a little more efficiently, I think, than it was done 100 years ago.

REPORTER:: Well, this step – screening refugees -- might be more efficient than Ellis Island. But immigrants and refugees are a pretty small slice of the pie -- several thousand people a year out of the millions who pass through Newark. Many observers say the quarantine station network as a whole has yet to join the 21st century. Dr. Georges Benjamin, the head of the American Public Health Association, chaired a committee of experts last year who analyzed the quarantine system. Benjamin was impressed with some things, but appalled by others.

BENJAMIN: If someone is on an airplane, and they have an infectious disease and of course is not picked up and that person then becomes sick once they’re in the country, once they’re back in the community, and they get picked up. Then we find they were in an airplane. Right now the system isn’t well-established to tell me what seat that person was sitting in and who was sitting around them…Right now the system isn’t well-established to tell me what seat that person was sitting in and who was sitting around them.

REPORTER: The Centers for Disease Control has been revamping and expanding the quarantine system. Eventually, 25 high-volume airports will get these stations – triple the number just a few years ago. It was the CDC that commissioned Benjamin and other panelists to analyze the evolving network. Georgetown Law School Professor Lawrence Gostin joined the committee to give legal opinions on the quarantine system. He feels less safe for having looked at it up close. He’s also troubled that people can be forced into isolation without any way of challenging quarantine orders – except in front of a CDC administrator…

GOSTIN: But that hearing is not by a court. It’s not by an independent tribunal. It can quarantine you, and all you can do is apply to the person who’s already quarantined you.

REPORTER: Detention, of course, would be an especially thorny question for a large outbreak of a highly infectious disease, such as pandemic flu. Could an entire planeload of people be quarantined – legally or logistically? Some airports have space on-site. Most or all would transfer passengers to some kind of holding facility. Newark’s policy hasn’t been established yet. Professor Irwin Redlener at Columbia University’s National Center for Disaster Preparedness says politicians and public health officials have shied away from defining who would have what legal authority in the event of a catastrophe.

REDLENER:We need to clarify it not in the heat of a pandemic flu outbreak, but now in the calm of daylight. The more likely scenario is we won’t actually solve this, because there are just too many opinions and it’s a charged issue. And we’ll end up having to solve it on the fly, in the middle of a major epidemic situation. And that’s unfortunate, but it’s sort of the way this country responds to crisis.

REPORTER: The committee report says the quarantine system used to be up to its task, but has failed to keep up with the global travel boom. The report’s authors and other observers praise say the network is improving, but they’re not sure how it will perform, if avian flu jumps the gene barrier and sweeps across the planet.