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Who made the decision to fly Ebola victims to Atlanta?

Amid the largest Ebola outbreak on record, airports worldwide are on high alert for ill-appearing passengers arriving from west African nations. Thermal scanners are being used to detect feverish people within moving crowds.

So it’s understandable that many Americans were surprised at Thursday’s announcement that at least one Ebola patient will be brought from Liberia to a hospital in Atlanta. (It is Emory University Hospital, where I hold an affiliation with the medical school.)

More surprising is that the unnamed officials who made this decision did so outside of public scrutiny.

There’s no question that the two American Ebola sufferers -- Kent Brantly, a doctor, and Nancy Writebol, a missioinary -- deserve the best medical care possible.

Working with the private Christian relief organization Samaritan’s Purse, they risked their lives caring for Liberia’s sick and dying Ebola victims, and contracted the virus despite their rigorous application of the Centers for Disease Control and Prevention’s recommended techniques to limit transmission, including wearing elaborate safety suits.

But what these two heroes deserve has to be weighed against the small but catastrophic risk that the virus might spread in the United States.

The announcement that at least one of these Ebola sufferers will be flown to Atlanta didn't mention who made the decision. It seems not to have been a high federal official, because the jet being used is a private charter.

And just hours before it took off from Georgia, Tom Frieden, the CDC director, was talking with journalists and gave no hint of the impending action.

To the contrary, Frieden stated that such an intervention might be unwise. “There is the potential that the actual movement of the patient could do more harm than the benefit from more advanced supportive care outside of the country,” he said.

At the same time, he said the CDC would work with Samaritan’s Purse “to facilitate whatever option they wish to pursue.”

Transporting a victim to the U.S. violates the core containment principle that medical authorities and now militaries are enforcing on west African citizens: quarantine.

It brings a contagious Ebola victim to a city of 6 million on a continent never before exposed to the virus. These are weighty considerations Americans should expect their government officials to make.

I’d expect the head of the CDC, perhaps the president himself, to be the one to give the go-ahead on a military-facilitated operation, and only after extensive deliberations and consultation of community leaders. Is it instead the case that the CDC went along with “whatever option” Samaritan’s Purse wished to pursue?

If so, the decision to bring an Ebola sufferer may have been made because there were no other options. If the government were involved, why would it not send one or more military cargo aircraft to Liberia, stocked with the crucial elements of a modern intensive-care unit?

Ebola patients need IV fluids, ventilators and, if it comes to it, dialysis, but this involves equipment and expertise that can be set up in a field hospital.

That said, it’s also likely that both Ebola victims stand a better chance of survival at a CDC-designed ward at Emory University Hospital in Atlanta.

Exactly how much better -- and whether the difference is enough to risk bringing the virus to the U.S. -- is a determination that shouldn’t be left to a private organization, either Samaritan's Purse or Emory Healthcare.


Vox, a doctor at the Shepherd Center for brain and spinal-cord injury in Atlanta, writes about health-care policy.

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