Keeping Ebola Out of America, Whatever the Cost to Americans

The White House is abdicating its responsibility to our own by sending Americans exposed to or infected with Ebola to Kenya rather than bringing them home

I heard incredibly unsettling news today. And I think it’s something everyone—and especially every American—should know.

Some background: you’ve probably heard that the U.S. has imposed travel restrictions on nationals from the countries hardest hit by the current Ebola outbreak. You may also have heard that even long-term permanent residents — including green card holders — won’t be allowed back into the U.S. if they’ve recently been in the DR Congo, Uganda, or South Sudan. These restrictions don’t surprise me, even if I doubt they’ll have any meaningful impact. They’re political points and meant to make it look like we’re “doing something”, but will do essentially nothing to actually help end the outbreak.

But what I heard today is much more disturbing.

A few days ago Keren Landman reported that the U.S. was planning to set up a quarantine center in Kenya to screen Americans returning home from high-risk countries. As I dug in and asked around, it got worse. Multiple reliable sources told me the facility wasn’t just being set up for quarantine — it would be used to treat Americans with Ebola, too. Tonight, a New York Times covered the core of it: the administration plans to send U.S. citizens exposed to the virus to Kenya rather than bring them home, and now intends to provide treatment there as well.

The government is training a few dozen Public Health Service officers — uniformed members of the U.S. commissioned corps — to deploy to Kenya to staff it. These are people we send under orders, often to crises, disasters, and outbreaks. And under this plan, if one of them is exposed, or falls ill, the government apparently does not intend to bring them home either.

As I understand it, this transfer to the Kenyan facility would apply to any “high-risk” exposure as defined by the CDC, or to anyone with symptoms while they await testing. Providers who cared for Ebola patients in full PPE, with no other known exposure, wouldn’t fall under it.

Let me tell you why this is unbelievable to me, and what I think it could mean.

Imagine a U.S. citizen treating Ebola patients in the DR Congo. A piece of their equipment fails. They get a splash in the eye, or a needlestick injury. Or they care for a patient later found to have Ebola, without full PPE during the encounter. Under this plan, that person wouldn’t be sent back to the U.S. — to a country with an extraordinary network of hospitals built to quarantine and care for exactly this. They’d be put on a plane to Kenya.

Or take an American who recently cared for patients in Congo, Uganda, or another hotspot, and chooses to spend their 21-day quarantine in Europe. If those treatment centers are full, or there’s some diplomatic spat and countries feel no reason to help us, this plan would put them on a plane to Kenya too — not back to the U.S.

I’ve spoken with multiple people inside the administration and the Ebola response who confirm the directive comes from the White House. One put it bluntly: “They don’t want anyone with Ebola in the U.S. No one. Period.” I heard the same thing earlier this week, when American providers were being evacuated from the DR Congo and the administration argued that sending them to Germany made the most sense because it was a shorter flight. The Washington Post subsequently reported that the White House had “resisted allowing an American doctor exposed to Ebola while working in the Democratic Republic of Congo to return to the United States.” People with knowledge of those discussions have confirmed the same to me.

And so now, when Americans will need us most — especially those who go abroad to help end this outbreak at its source — the U.S. government plans to send them to a hospital it is standing up from scratch in Kenya.

So why should we care?

For one, part of the reason the response to this outbreak is so slow and flat-footed is that the U.S. dramatically pulled back its humanitarian support over the past year, including in the DR Congo. We abdicated our leadership role in global health, and we’re watching the consequences play out. I know many people who don’t have any sympathy for the cuts, and don’t think these programs are America’s responsibility.

But now we’re abdicating our responsibility for our own.

I find it incredibly difficult to believe that we can stand up a facility in the next few weeks — or even months — with the staff, the supplies, and the experience we’ve built over the past decade in more than a dozen hospitals across the U.S. There’s no approved treatment for this strain of Ebola, which means survival depends heavily on the quality of the system and the people around you. We have that system—I survived Ebola and am here today partly because of it—but we are choosing not to use it.

I also worry this could push people to hide potential exposures, or incentivize individuals or organizations to downplay those exposures. If you know that any “high-risk” exposure will get you shipped to Kenya instead of sent home, it’s not hard to imagine people not being fully forthcoming about what may have happened to them. That is exactly backwards from how you contain a disease.

This will also discourage Americans from joining as part of the response. I know of multiple healthcare providers who are considering deploying with humanitarian organizations, and we need a cavalry to help support the on-the-ground response if we have any hope of ending this outbreak. But programs and policies like this are exactly the reasons people will hesitate to sign up.

And there’s a harder truth underneath all of this, one that I know all too well. I lived because I was treated for Ebola at Bellevue in NYC. I have never stopped thinking about the patients I cared for in Guinea who had nothing close to the quality of care I received, who died of the disease I survived, separated from me by little more than a passport and a plane. When it comes to Ebola treatment, we already run a two-tiered system on the ground in outbreak zones and in wealthier countries, and I have been on the lucky tier of it. So let me be precise about what I’m angry at. Not that Americans deserve more than Congolese patients — that gap is its own moral failure, one we reproduce across every Ebola outbreak.

I’m angry because this plan does nothing to close that gap and opens a new one. It raises no floor in Congo. It just builds a lower rung for the Americans we send to help, out of fear of letting the disease touch our shores.

When you send people into an outbreak in your name, you owe them the best you have.

The administration has said its number one priority is keeping Ebola out of America, and its number two priority is ending the outbreak in central Africa. Nowhere on that list are the Americans we are asking to step up and respond.