The Trump administration plans to send to Kenya U.S. citizens exposed to the Ebola virus rather than bring them home for observation and treatment, according to three people with knowledge of the plans.
The approach is a stark contrast to the way previous administrations responded to outbreaks, during which health care workers and other U.S. citizens exposed to the virus were brought home to be treated at specialized medical units. The administration this month flew an American doctor who developed symptoms to a hospital in Germany, and transported six other Americans for monitoring in Germany and the Czech Republic.
The Ebola outbreak in the Democratic Republic of Congo is estimated to have ballooned to more than 1,000 cases and more than 200 deaths in just the 11 days since it was first announced, making it the third largest on record already. Aid cuts by the Trump administration shut down crucial disease surveillance networks and medical supply chains that might have detected and contained the epidemic sooner.
Last week, the Trump administration invoked a public health law known as Title 42 to bar immigrants and legal permanent residents who had been in Congo, Uganda or South Sudan in the previous 21 days from entering the United States.
The administration’s new plan would also keep U.S. citizens who might have been exposed to Ebola out of the country, according to two of the people with knowledge of the plans, who spoke on condition of anonymity because they were not authorized to discuss the matter publicly.
A few dozen Public Health Service officers are now being trained to deploy to Kenya to provide medical care to Americans who are deemed at high risk of developing Ebola. The initial plan was to monitor those Americans in Kenya, but to move anyone who started to show symptoms for treatment in Europe.
But the administration now plans to provide treatment in Kenya as well, according to two of the people with knowledge of the planning. Government scientists and physicians who develop symptoms will also be treated in Kenya.
The administration is setting up a facility in Kenya where American citizens can quarantine or be treated, through a coordinated effort with the State and Defense Departments, and the Department of Health and Human Services, according to one of the people with knowledge of the plans, a Trump administration official. Each case will be evaluated in case more advanced care is needed, according to the official.
A White House spokesman declined to comment.
Ebola has a death rate of about 50 percent, but early access to high-quality care and treatments can dramatically improve the odds of survival.
“We know that their chances of getting through an Ebola infection would be higher in specialized units that have been designed to care for them,” said Dr. Tom Inglesby, the director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health.
The United States has multiple facilities with state-of-the-art resources for monitoring and treating people with dangerous diseases, including Ebola. These include a unit in Omaha where 18 Americans are under observation for hantavirus following an outbreak on a Dutch cruise ship this month.
Dr. Inglesby said he was particularly surprised by the plan to not repatriate Public Health Service officers back to the United States for treatment. “We have a strong ethical commitment to care for them with the best possible care in the U.S.,” he said.
While the facility in Kenya may be better than those in Congo, it is unlikely to match the sophistication of those established in the United States for Ebola and other dangerous pathogens, according to Dr. Craig Spencer, a public health expert at Brown University.
“I find it hard to believe that they’re going to be able to stand up in the span of a couple days or even months a similar system that has been created over the past decade to do exactly this,” Dr. Spencer said.
Dr. Spencer is an emergency medicine physician who contracted Ebola in 2014 after treating patients in Guinea. He was in the intensive care unit at Bellevue Hospital in New York City for 19 days. Leaving Americans in Africa rather than bringing them home is “a dramatic abdication of what we owe our own,” Dr. Spencer said.
The Ebola outbreak is centered in Ituri Province, which has near-constant conflict and high population mobility, both of which make it more challenging to snuff out an outbreak. The rapidly escalating epidemic in Congo has prompted the World Health Organization to call it a public health emergency of international concern.
Apoorva Mandavilli reports on science and global health for The Times, with a focus on infectious diseases and pandemics and the public health agencies that try to manage them.
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