Federal agencies are preparing to deploy dozens of uniformed personnel to Kenya with the goal of screening Americans who are returning home after travel in Ebola-affected countries.
The Public Health Service in conjunction with the Department of Defense (also called the Department of War sometimes, by some people) is planning to deploy officers to Kenya to stand up a 50-bed facility for screening US citizens traveling to the US from Ebola-affected countries.
Approximately 40 Public Health Service officers are anticipated to be among those deployed. Officers are expected to train at Andrews Air Force Base starting this coming Monday, May 25, and deploy to Kenya on Friday, May 29.
If these plans go forward, it will mark an abrupt re-entry into a fight against an outbreak that has caught the global health world on its heels following American withdrawal of funds and personnel from the region.
I don’t yet have answers to some really important questions about the facility these personnel will staff:
Will returning American citizens be forced to be screened at this facility before returning home? If so, who will pay for it?
What will happen to asymptomatic people after screening? Will they be forced to quarantine at the same facility in Kenya, and if so, for how long?
Will the decision trees look different for people at low risk for Ebola exposure vs. people at high risk?
Where and how people will get treatment if they get sick while at this facility?
Based on the way the administration has handled the passengers potentially exposed to hantavirus on the MV Hondius, there’s a lot of concern about how it will handle Americans potentially exposed to Ebola.
One reason is that people at both low and high risk of exposure are being treated as high-risk — which means all of them are being forced to quarantine in Nebraska instead of at home. Decisions about where an exposed person should be quarantined should be made based on interviews and individual risk assessments, but that did not happen in the case of the cruise ship passengers. Centers for Disease Control and Prevention published guidance indicating asymptomatic passengers, even those with high risk exposures, could quarantine at home, and at least one state public health department agreed to monitor a passenger on home quarantine. However, passengers who’ve tried to leave the Nebraska unit to quarantine at home have been forced to stay by orders signed by CDC leader Jay Bhattacharya.
If a similarly blunt-instrument approach is taken with Americans traveling in Ebola-affected areas, it could lead to several big problems.
It could create incentives for people to lie about where they’ve been to avoid being stuck overseas against their will. That makes it more likely a returned traveler could end up without the US-based monitoring that would help them get to care quickly if they got sick.
It could discourage Americans from volunteering to work to stop the outbreak, whether for non-governmental organizations providing care to Ebola-affected people, or for the CDC. That’s bad because the best way to prevent importation of disease into the US is to stop it at its source.
There will be a lot more to say when we know what this field unit will actually do, who it will do it to and for, and who will be paying for travelers to go and be there. I’ll share updates here as I learn more.
What’s the PHS, again?
The PHS flies under the radar for most Americans. Its roughly 5,000 uniformed officers are non-combatants — health professionals whose day-to-day work is spread across federal agencies including the Food and Drug Administration, CDC, and Indian Health Service. They often deploy for humanitarian crises, including disease outbreaks or natural disasters, and occasionally, those deployments are overseas.
During the 2014 Ebola outbreak in Liberia, PHS officers ran a field hospital for infected health care workers. A few years later, officers led an effort to reunite migrant families separated by the Department of Homeland Security at the U.S.-Mexico border.
Sometimes, the deployments violate PHS officers’ moral centers: I recently wrote an NPR story about officers quitting over deployments to Immigration and Customs Enforcement migrant detention facilities. If you want to learn more about the PHS, you can check out this deep dive I did on the agency in 2019.
Correction, May 23, 9:14pm ET: An earlier version of this post was ambiguous about the level of coordination between the CDC and state and local health departments on MV Hondius passengers’ suitability for home quarantine.
If you’re a PHS officer with a tip related to this story, or you have information about any of the other stories I’m covering, email me at [email protected], fill out this form, or find me on Signal at kerenlandman.07.
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