A convoy of emergency vehicles transported the family of a US national who tested positive for Ebola in Congo to the Charité hospital in Berlin on Wednesday. The US is imposing strict restrictions on American travelers exposed to dual Ebola and hantavirus outbreaks, which experts say could infringe on legal rights and deter volunteers in future public health crises.
Restrictions and Expert Concerns
The latest restrictions highlight officials' previous rhetoric on public health measures and attempts to contain outbreaks. Reports indicate opposition from the White House to allowing Americans to return home. Instead, an American doctor sickened with Ebola and six others with exposure are being moved to Germany and the Czech Republic.
Alexandra Phelan, an associate professor at Johns Hopkins Bloomberg School of Public Health, stated that it is unlikely there will be no more cases of US citizens wishing to return from Ebola-affected regions. She noted that the unofficial policy could substantially dampen the response from volunteers providing critical assistance in the region. Phelan emphasized the real likelihood of the outbreak becoming more serious, requiring significant international support.
Quarantine Measures and Legal Rights
The move follows mandatory quarantine measures in Nebraska for passengers from the MV Hondius exposed to Andes virus, a type of hantavirus, despite requests to quarantine at home. The American Ebola patient is now hospitalized in Germany in stable condition, while other US citizens are en route to Germany or Czechia. Satish Pillai, Ebola response lead at the CDC, stated that these locations were chosen as the most expeditious options given the need to move quickly.
Phelan clarified that US citizens and green card holders have a legal right to return to the United States. The travel restriction order issued on Monday explicitly does not apply to US citizens. She added that the US has some of the best biocontainment facilities and medical care, with millions of dollars invested for such situations. Doubt about returning home could deter health workers and outbreak responders from volunteering, potentially worsening the crisis.
Historical Context and Comparisons
During the 2014-15 Ebola outbreak, then-candidate Donald Trump called for Americans with Ebola to be turned away. In the current outbreak, the White House opposed bringing at-risk Americans home, according to the Washington Post. Craig Spencer, a doctor who contracted Ebola in 2014, noted that difficulty in returning home would reduce volunteers, allowing the epidemic to continue and increasing risks for everyone.
When asked about deterring volunteers, Pillai pointed to existing organizations in the Democratic Republic of the Congo and Uganda that provide healthcare support. In the hantavirus case, passengers were initially not subject to mandatory quarantine but are now required to stay in Nebraska until May 31, despite some attempting to leave for home quarantine. The decision reportedly came from Jay Bhattacharya, who is performing some duties of the CDC director.
Legal and Ethical Implications
Bhattacharya previously criticized the US Air Force Academy for quarantining cadets, highlighting the harms of social isolation. Phelan stressed that any public health measure must be based on reasonable scientific evidence and be proportionate and necessary. The guiding concept in global health law is implementing the least restrictive measure necessary. Most people prefer voluntary home quarantine as the least restrictive option.
In the case of passengers testing negative with no symptoms and a safe way home, a judge could find mandatory facility quarantine unreasonable. A precedent from the 2014 Ebola outbreak saw courts reject then-Governor Chris Christie's attempt to mandate quarantine for nurse Kaci Hickox.
