COMMENTARY

Should American Ebola Patients Return Stateside?

Brandon Cohen

Disclosures

September 15, 2014

The recent, tragic outbreak of Ebola in West Africa has generated deep sympathy for the victims of this disease. It has also created concern over the possibility of the virus spreading to the United States. The evacuation of two American medical volunteers from Liberia to Emory University Hospital in Atlanta prompted a spirited debate on Medscape Connect, an all-physician discussion group.

A primary care physician ignited the conversation with a few alarming observations and a question:

The oceans provide a vast barrier to importation, if we want them to. But here, we've broken the barrier. This has apparently happened without any widespread discussion among the infectious disease community...Is the importation of these patients ethically justifiable?

Although colleagues shared these concerns, one internist saw Americans' return as a moral requirement:

At this point, it is ethical to bring the American citizens back home, if feasible, rather than allowing them to be subjected to any sub-standard (for the disease) medical management in those countries already subjected to apparently overwhelming difficulties.

But a neurologist disagreed, arguing that the move was off-base, not only for the safety of the American public but also for the infected patients themselves:

On a practical matter, there are a lot more qualified medical professionals with personal experience in assessing, treating, and working with Ebola patients than what we have here in the US. Wouldn't it make more sense to send a mobile medical unit to the site, provide the resources that are deemed best for optimized care, and have, if necessary, US specialists working in conjunction with local African experts? So on multiple levels, something doesn't seem right with this decision, and...the public is not being made privy to the details of this expanding epidemic.

An internist questioned not only the transfer of the infected Americans but also the competence of the CDC:

Even if it is ethical to bring the 2 volunteers home, the worrisome part is the recent news about the CDC and their inattention and mishandling of smallpox and anthrax. Maybe it will all turn out OK since all eyes of the public will be on the CDC, whereas with the other sad behavior, no eyes were really looking.

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