Even as the Ebola outbreak in the Democratic Republic of the Congo appears poised to become the largest on record, Trump administration officials have not articulated a clear plan to care for Americans at risk of contracting the disease.
Hundreds of Americans, including federal officials, aid workers and journalists, are expected to be in parts of Congo where the disease is widespread in the coming months. Officials from previous administrations say there is a clear playbook for when such people are exposed to Ebola or become ill: Take them home to one of 13 facilities in the United States built for exactly these circumstances.
The United States does not have the authority to quarantine Americans in other parts of the world and cannot prevent them from re-entering the country.
But last week, Secretary of State Marco Rubio declared that the administration “cannot and will not allow any case of Ebola to enter the United States.”
The Trump administration has already sent one American doctor sick with Ebola to a hospital in Germany, and six others with possible exposure to the virus to Germany and the Czech Republic for follow-up. Public health experts who watched the situation closely said they did not know of any other Americans with risky exposures.
The administration announced plans to build a 50-bed quarantine unit in Kenya for others who may become exposed or fall ill. But the unit's fate is now uncertain. A Kenyan court on Tuesday delayed efforts to build it by at least three weeks, and the plan for Americans who may need help in the meantime is unclear.
A State Department official said Tuesday that officials were optimistic about resolving any objections to Kenya's plan. But the department did not respond to repeated questions about whether U.S. citizens who refuse transportation to Kenya or wish to receive treatment in the United States would be allowed to enter the country.
Decisions will be made on a case-by-case basis, the department added.
“American citizens are being kept in the dark at a time of great risk to their lives,” said Lawrence O. Gostin, director of the World Health Organization Collaborating Center on National and Global Health Law.
“I find the United States response to this outbreak opaque, confusing and contradictory,” said Gostin, who has worked with multiple administrations on Ebola responses.
The outbreak in Congo and Uganda so far has 359 confirmed cases, including one American, and 61 deaths. Those numbers are expected to increase as officials locate other cases and contacts. The disease is believed to have spread for months before being detected.
Ebola spreads through contact with bodily fluids. It can devastate organ systems and cause rapid death. Unlike Covid, the disease is not typically transmitted from asymptomatic patients, so people who have simply been around those infected are often advised to simply monitor their symptoms.
The Kenyan unit was intended to monitor Americans exposed to Ebola during the 21-day quarantine period, as well as provide them with some treatment if they develop symptoms. But even with equipment shipped from the United States, it is unlikely to match the sophistication of American facilities. A similar medical unit created in Liberia during the 2014 Ebola outbreak had a 56 percent survival rate, compared to 81 percent of those treated in the United States.
“I don't know how you can deploy Public Health Service officials and not commit to bringing them home if they get sick,” said Stephanie Psaki, global health security coordinator in the Biden administration, a position that is now vacant. “It's just unethical.”
Dawn O'Connell, who served as undersecretary of health for preparedness and response from 2021 to 2025, said she had authorized the purchase of specialized equipment during her tenure, including two mobile biocontainment units, which would “enable extraordinarily safe transportation between airports and hospitals.”
“There is a system to be able to do this,” he said.
On Tuesday, Rubio told lawmakers that the administration was considering “a couple of people” to play a role in coordinating the federal government's response to Ebola.
His statement last week echoed President Trump, who said on social media in 2014 that “the United States cannot allow people infected with EBOLA to return,” adding, “People who go to faraway places to help are great, but they must suffer the consequences!”
The administration has also invoked a public health law known as Title 42 to bar entry into the United States for immigrants and legal permanent residents who have been in the Congo, Uganda or South Sudan in the previous 21 days.
On Tuesday, State Department spokesman Tommy Pigott suggested that the quarantine at the Kenyan unit was “voluntary” for Americans who do not have symptoms. But he said those who refuse “will remain subject to relevant health, travel and screening measures by U.S. and foreign governments.”
The plan for those who test positive for Ebola or have symptoms is even less clear. Officials can arrange evacuation to certain locations designated as safe, the State Department said, without specifying possible locations.
In the absence of a clear plan, “the concern would be that people would hide their exposure,” said Dr. Nahid Bhadelia, director of the Center for Emerging Infectious Diseases at Boston University, who has also been part of multiple responses to the Ebola outbreak.
“I imagine it's a very real equation for people who are deployed right now, and particularly if you can't give clear answers about what will happen to them if they go to Kenya,” he said. Some may be hesitant to volunteer to help with the outbreak, he added.
Workers may have reason to worry. In 2014, U.S. officials established the Monrovia Medical Unit in Liberia to help treat health care workers of other nationalities who fell ill. Of the 18 confirmed Ebola patients who were treated there, only 10 survived.
“We weren't prepared to intubate anyone,” recalled Dr. Karen Wong, a former Public Health Service official who was part of the first group sent to the unit. “We didn't have that kind of equipment or the personnel to be able to do that kind of thing.”
By contrast, of the 27 Americans who were repatriated and treated in the United States during the 2014 Ebola outbreak in West Africa, all but five survived. About 26 percent of those Americans required invasive mechanical ventilation and 70 percent needed supplemental oxygen.
Even a sophisticated medical unit in Kenya will likely face shortages of oxygen or even basic supplies such as intravenous fluids, and may not have ventilators or other equipment needed to treat Ebola. A spokesperson for the Department of Health and Human Services declined to say whether such equipment would be available.
And the training that Public Health Service officials who were deployed to the Kenya unit received may not be enough to treat Ebola. The three-day training offered this time was much less in-depth than in 2014, according to a person familiar with both programs who spoke on condition of anonymity to avoid retaliation from the Trump administration.
Without specific training, even health care workers in American hospitals have been poorly prepared to deal with Ebola. Kenyan officers will be required to treat patients wearing full-body protective gear in hot weather and without much equipment.
“I would be deeply uncomfortable caring for Ebola patients with three days of training,” said Dr. Fiona Havers, an infectious disease physician and former Public Health Service official. Dr. Havers worked in Liberia at the Centers for Disease Control and Prevention during the 2014 outbreak, but did not treat patients. She resigned from the agency last year.
Kaci Hickox, a nurse epidemiologist, was in Sierra Leone in 2014 and was forcibly quarantined in a makeshift tent outside Newark Liberty International Airport when she returned, even though she had no symptoms. She later successfully sued the state of Maine for attempting to quarantine her.
“This plan makes America look weak,” Hickox said. “It makes it seem like we can't take care of our own people, and we can.”
