Kenya confirms third Ebola case as US quarantine center faces court challenge

CDC and USAID cuts, WHO exit erode US outbreak response capacity

A Kenyan man fell ill in the Democratic Republic of the Congo before traveling by road to Uganda and then flying to Nairobi on 3 October, the Guardian reported. He died in a hospital two days later. On Wednesday, officials announced that a close contact — reportedly a 39-year-old man who is a family member of the first patient — developed symptoms while quarantining. On Friday, officials announced the third case, a 65-year-old woman closely related to the first two patients.

Kenya’s emergence into the outbreak comes as the second-largest Ebola outbreak in history has killed more than 4,300 people and sickened more than 9,000 across the region, the Guardian reported. The border between DRC and Uganda has been closed since May. Uganda was declared Ebola-free in August after reporting 20 cases and two deaths. About 108 people have been quarantined in Nairobi.

Kenya’s Ministry of Health pointed to the success of contact tracing and quarantine. “The general feeling is that the contact tracing systems are working,” said Allan Maleche, executive director of the Kenya Legal and Ethical Issues Network on HIV and Aids. But Maleche said Kenyans are also wondering why there were “many lapses” that resulted in a sick person traveling across countries. Kenyans are “very cautious around any information that is being given by the government around Ebola,” he added.

A Kenyan court has ordered a halt to a controversial US-built quarantine center at Kenya’s Laikipia air base, where Americans returning from DRC would have been required to quarantine, the Guardian reported. The center, opposed by locals, has stirred distrust in the Kenyan government and led to protests. Maleche said the litigation will be decided in November.

“Many Kenyans were concerned about the fact that there was no information and people did not know why the quarantine place was being set up, who was actually going to use it, and what had informed that,” Maleche said.

Americans who questioned whether the US has the legal authority to quarantine citizens on foreign soil and prevent them from returning home are pushing back against the center, the Guardian reported.

“Is this still a viable solution for the US?” asked Jennifer Nuzzo, director of the pandemic center at Brown University’s School of Public Health. “Are we posing not only an undue burden on the Kenyan government to be able to handle this, but also is this the safest place to be bringing Americans?”

The US already has “world-class” Ebola treatment units, Nuzzo said. “American taxpayers built these units for precisely this purpose, and it’s mind-boggling to me that we’re going to leave them empty,” she said. In previous outbreaks, actively ill patients had been evacuated safely to those centers and had recovered without further spread, she added.

Concerns about the quarantine plan have been compounded by sweeping cuts to US health support abroad, the Guardian reported. The Trump administration has moved to dismantle USAID and cut funding and staff at agencies including the US Centers for Disease Control and Prevention. On 1 October, the CDC closed HIV prevention offices in Angola and South Sudan, with plans to close offices in Zimbabwe. The US has slashed programs across the world — including DR Congo, where the Ebola outbreak is centered, and other countries, like Kenya, bracing for cases as the outbreak widens.

“We have had a lot of concerns after the US first cut funding for HIV promptly without any direction,” Maleche said. “It led to clinics closing. It led to a lot of anxiety among people.”

The US is now negotiating bilateral agreements with each country, including Kenya — a process that has been mired in secrecy, Maleche said. “It’s not very clear what’s the plan, who’s rolling it out, and what will be involved,” he added.

Cuts to decades-long programs mean the affected countries and the US have less insight into what is happening, in addition to a lessened ability to prevent and stop outbreaks, the Guardian reported. “When you pull back on those, not only do you leave those countries less prepared to deal with that day-to-day threat, but it also means that they’re less prepared to deal with future emergencies,” Nuzzo said.

The US officially left the World Health Organization in January, making it much harder to collaborate on the response to crises like these, the Guardian reported. When the US left, it also “pulled out a substantial amount of funding,” Maleche said, adding that the WHO’s response has been “weakened.”

A French doctor who returned from DRC in June tested positive for Ebola, and several Americans have been evacuated from DRC to Europe for treatment or monitoring.

Senator Raphael Warnock, a Democrat from Georgia, and Senator Bill Cassidy, a Republican from Louisiana, wrote to the Senate Appropriations Committee in June opposing the Trump administration’s plans to cut back on HIV prevention and monitoring, the Guardian reported.

Warnock said in a statement that dismantling USAID, withdrawing from the WHO, and abruptly cutting foreign aid are “degrading our outbreak preparedness” and have “seriously weakened our ability to keep Americans safe from infectious disease.”

“These cuts to global health funding have led to the erosion of international disease-monitoring infrastructure that helps us catch threats like Ebola before they reach our shores, at a time when the world needs American leadership most,” Warnock said. The US should be strengthening these systems, not abandoning them, he said.

Nuzzo agreed. “It’s about having an understanding of the systems and the conditions in other countries, and eyes and ears in those countries to detect when something out of the ordinary happens, and to get that information as early as possible,” she said. That benefits the US and the countries themselves, she said.

Work like HIV prevention “can be repurposed,” she added. “You have connections with clinical care, the ability to move medicines, the ability to conduct laboratory tests. the ability to move specimens around – all of those capacities are things that you would use in other disease emergencies.”

In Kenya, “the biggest fear is around how will other countries react” to the outbreak, with travel bans a particular worry, Maleche said. The US put travel bans in place from DRC and neighboring Uganda and South Sudan once the outbreak was detected in May, but it would be “very ironic” if the US instituted travel bans given its quarantine center in Kenya, Maleche said.