Experts criticise plan for American-only Ebola quarantine centre in Kenya

Former top US officials and other experts are urging the Trump administration to abandon plans for an Ebola quarantine and treatment centre in Kenya, as the union for workers with the US Centers for Disease Control and Prevention (CDC) calls for Americans exposed to Ebola to be brought home for treatment.Soon after the US revealed it was setting up a field hospital in Kenya for the Ebola quarantine and treatment of Americans, the Kenyan high court blocked the order – but the Kenyan and US governments moved forward anyway, with the first American responders reportedly landing at the Laikipia airbase on Saturday.Several former US health leaders, including previous top-level CDC officials, laid out their objections in a letter to Congress. “This policy raises profound clinical, ethical, operational and legal concerns,” they wrote.Daniel Jernigan, who spent 31 years at the CDC, including overseeing the agency’s Ebola response in 2014-15, before resigning last year, said it was not clear how current officials had arrived at this plan “because it’s against so many ethical underpinnings that we have relied on for all of the past responses”.European Commission Civil Protection and Humanitarian Aid Operations (ECHO) crew after loading essential medical supplies on to a plane in Nairobi, Kenya. Photograph: Monicah Mwangi/ReutersThe US is in the process of building a 50-bed unit at the airbase. Patients would have access to medications and some respiratory support, but those needing higher levels of care would be flown to as-yet unidentified hospitals in Europe.Yolanda Jacobs, the president of the AFGE Local 2883 government employees’ union, said in a statement that the Trump administration was “abandoning” CDC workers responding to the outbreak, in “a sharp departure from the standard upheld by every previous administration”.The White House did not respond to inquires about whether the facility would be accessible to Kenyans and others working on the Ebola response, and whether all Americans working on the Ebola response would be required to quarantine or whether it would be required only of Americans with high-risk exposures. Previously, the White House did not say whether Americans wishing to return home rather than going to Kenya would be allowed to do so.The US Department of Health and Human Services referred inquiries to the state department, which has been approached for comment. Last week the US secretary of state, Marco Rubio, said: “We cannot and will not allow any cases of Ebola to enter the United States.”.During the 2014 Ebola epidemic in west Africa, several people treating patients were safely evacuated to and treated at US facilities in Atlanta, Bethesda, Omaha and New York, with no onward transmission. The US president, Donald Trump, vehemently opposed the move at the time, saying that returning volunteers “must suffer the consequences” and should not be allowed into the US.Ronald Nahass, the president of the Infectious Diseases Society of America and the medical director of research at ID Care, said Americans could safely quarantine in place after a high-risk exposure to Ebola, and that if they developed symptoms, the US had some of the best quarantine and treatment facilities in the world.“We’ve spent taxpayer dollars to create some really first-class biocontainment units to specifically address this type of an issue and have trained staff who are extraordinarily expert in dealing with this,” Nahass said. Those facilities “can handle it in a better way than a field hospital in Kenya”, he added. “Why wouldn’t you evacuate American citizens if you’re concerned?”During the 2014 outbreak, the US created a field hospital specifically for health workers from all countries who might need Ebola care. “If you come over to west Africa to help, we’ve got your back,” Jernigan said of the 2014 approach. Creating a quarantine centre in another country for Americans only would be highly unusual and a major reversal from such plans, he said.It is also not clear what would happen to Americans in quarantine if they needed outside medical care for non-Ebola causes, such as a heart attack or appendicitis, Jernigan said. “Are you going to send them to Kenyatta hospital in Nairobi, and if so, are you going to send them in a bubble and have a dedicated ward there? If you would just send them back to the United States to a designated facility that has already been established with millions of dollars to do it, they’re surrounded by specialists.”Travel bans and restrictions such as these were ineffective at stopping the spread of disease, Nahass said. “Borders are porous, you can’t keep infectious diseases out of the country” in this way, he said. Instead, Nahass said, tried-and-true public health measures such as monitoring potential exposures and making sure health care providers are prepared for potential cases wooould be much more effective.International collaboration is also crucial for controlling outbreaks, Nahass said. “​These are global events and not being part of the global discussion in which the platform for that is the WHO [World Health Organization] is problematic.” America’s absence on the world stage is notable and will have lasting repercussions, he added.