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Two Americans in West Africa have ebola. Why aren't they coming home?

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The largest ebola outbreak in history is also a reminder of global inequality in healthcare

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The current ebola outbreak is the largest in history, with 672 dead in Guinea, Liberia, and Sierra Leone. At least two Americans have now been infected with the disease: Dr. Kent Brantly of Texas and Nancy Writebol of North Carolina, who both worked in an ebola clinic in Monrovia, Liberia. That's also where they're being treated, with no plans to evacuate them to more developed countries.

It's awful to think that Americans might be airlifted to better hospitals while locals suffer and die in one of the poorest countries in the world, but it wouldn't be unheard of. A doctor working for the World Health Organization (WHO) who contracted ebola may soon be taken to Hamburg, Germany at the organization’s request.

The US Centers for Disease Control and Prevention (CDC), which has been active in the ebola crisis, says there is no established protocol for evacuating American aid workers. "Whether an American citizen would be transported to another country would be determined on a case by case basis, and it’s something we’re working now on figuring out now," spokesperson Kristen Nordlund tells The Verge.

There is no established protocol for evacuating American aid workers

Ebola, which is spread through contact with bodily fluids, has no cure and typically kills between 50 percent and 90 percent of its victims. The body suffers symptoms including fever, vomiting, diarrhea, and bleeding from the orifices, until multiple organ failure causes death. Because the disease is so contagious, many victims die in isolation. The current outbreak has a mortality rate of 55 percent.

"There is currently no specific treatment to cure the disease," says Nordlund. "Some patients will recover with the appropriate medical care, though more research needs to be done to know why some people survive and others don’t."

Doctors concentrate on "supportive therapy," or keeping the patient hydrated, ensuring they receive proper nutrition, monitoring blood pressure, and curing any secondary infections. This protocol "can be done anywhere," says Gregory Hartl, a spokesperson for the WHO.

At the same time, resources do make a difference.

"These three countries in West Africa are among the poorest in the world, so they have very few resources," he says. "They don't have much equipment, they don't have much material." Liberia's health system is especially broken due to more than a decade of political instability, and is highly dependent on support from aid organizations to deliver basic services.

Health experts agree that intensive care after infection with ebola is critical to beating the disease, and richer countries are better equipped to provide that than poorer ones.

If you have ebola, you're better off in a Western hospital than a West African one

"There is a significant disparity in access to healthcare and quality of healthcare between an under-resourced country and a resource-rich country, especially with respect to intensive supportive care and clinical monitoring capacity," says Dr. William Fischer, who treated ebola patients in Guinea last month.

Patients infected with Marburg, a virus similar to ebola, experienced a lower mortality rate when cared for in Germany as opposed to Angola, Kenya or Uganda, he says.

So if you’ve got ebola, you’re probably better off in a Western hospital than a West African one. However, there are also practical challenges to repatriating Americans who get sick. A mobile contagious patient raises fears of spreading the epidemic across continents. The patient also may not be strong enough to travel.

The ebola outbreak shows no signs of slowing down, with new cases reported every few days. The CDC says 42 days, or two incubation periods (the maximum time between contracting the disease and showing symptoms) with no new cases must pass before the outbreak can be considered over. Even then, the disease may return.

"This is a rapidly changing situation," Dr. Steve Monroe, deputy director at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases said on a call with reporters today. "The response to these outbreaks will be more of a marathon than a sprint."