Caring for Patients in High-Consequence Infectious Disease Hot Zones

Right now, there is an ongoing Ebola outbreak in the Democratic Republic of Congo (DRC). As of September 4, there has been 15 deaths , and 28 suspected cases identified across 2 health zones (Bulape and Mweka) in the Kasai province of the DRC. Four of the cases were among healthcare workers. Laboratory tests have confirmed it is the Zaire strain of Ebola.¹ This is considered a hot zone, which is an area that has contagious pathogens creating an outbreak of high-consequence infectious disease (HCID).

“Africa CDC stands firmly with the people of the Democratic Republic of Congo. I have met with the Minister of Health to coordinate an urgent response, and we are taking strong measures to bring this outbreak under control — protecting communities and supporting the health workers on the frontlines,” Jean Kaseya, Africa CDC Director General, said in a statement.

This current outbreak is a reminder that these scenarios can flair up anytime. These types of high-consequence infectious disease outbreaks such as Ebola, Lassa Fever, and Marburg Virus, have occurred outside the US. However, they can potentially happen anywhere.

With that in mind, the US has developed a plan to address such scenarios. Specifically, the US federal government in partnership with state and local areas are building regional biopreparedness strategies. Part of this is to create specialized medical centers across the country to transport and treat patients with HCID.

For example, UNC’s Special Pathogens Response Center (SPARC) is one of 13 facilities that can handle these types of situations. These centers interact and coordinate training with other health care facilities, such as local and regional hospitals, to aid them in dealing with individuals with high-consequence ID (HCID).

Part of the training is to ensure any necessary quarantining of individuals is done in a way that minimizes the risk to the greater public. To prepare for big public events such as next year's FIFA World Cup being held in the US, national readiness exercises have been conducted this summer for HCID threats.² These exercises have been named Tranquil Passport and are led by the US Department of Health and Human Services’ Administration for Strategic Preparedness and Response.²

UNC conducted its Tranquil Passport exercise earlier this summer. Leading these exercises were William A. Fischer II, MD, director of emerging pathogens at UNC’s Institute for Global Health and Infectious Diseases, and David Wohl, MD, professor of medicine in the Division of Infectious Diseases at UNC. To learn more about this particular exercise, check out our first segment of the interview with Fischer and Wohl listed below.

First Segment: Biopreparedness Exercises Look to Contain High-Consequence Infectious Disease Outbreaks

Fischer and Wohl have both spent time in hot zones in Africa treating patients with Ebola and Lassa fever. They have set up field treatment units during outbreaks to isolate and care for patients. Their work in Liberia has directly informed emerging pathogen response and preparedness in North Carolina.

When in the field dealing with outbreaks, Fischer says they are not difficult, but there are complicated and require an incredible amount of coordination.

“What's really complicated about these events is the unknowns,” Fischer said. “And a lot of times what's happening is that patients are presenting—many of these diseases, in fact—present with nonspecific symptoms. So, the first big problem is identifying an outbreak occurring and then trying to identify who has that specific infection. Then it's setting up a multidimensional response that is able to ensure the safe delivery of care to people who are infected with that special pathogen, while at the same time maintaining essential health care services. And that's a pretty complicated feat in the field.”

“And it involves a number of different—what we refer to as pillars of response—basically trying to identify who's been infected and who's at risk of becoming infected,” Fischer said.

These pillars of response include:

• Diagnostic testing to identify those who become infected
• Case Management of patients with these special pathogens
• Infection prevention and control
• Epidemiological and outbreak analysis
• Community engagement

Wohl says there are distinct differences in dealing with an outbreak in a hot zone in Africa compared to western countries. “These are not places that have a lot of health care,” Wohl said. “Diagnostics are not readily available; Just basic treatment could be really stretched, and the expertise isn't often there.”

Although western countries such as the US have better infrastructure in place that doesn’t mean there are not inherent challenges here. Wohl says the West Africa Ebola outbreak of 2014 to 2016 that infected over 28,000 people with the deadly disease informed the US of its shortcomings.

"We could be better prepared,” Wohl said of that outbreak. “Even though we have the diagnostics, the IV fluids, dialysis machines, ventilators and lots of really smart people, that doesn't mean everything's there. So even with that head start, there's a lot of coordination.”

And another aspect of this that is significant—both here in the US as well as in Africa—is public trust.

“Part of our efforts are trying to build bridges with communities so that there is a trusted source of information about how to stay safe during an outbreak, whether it's in this country or around the world, and how to get information as that outbreak or as that public health threat evolves,” Fischer said.

References
1. New Ebola Outbreak Confirmed in the Democratic Republic of Congo. Africa CDC. September 4, 2025. Accessed September 5, 2025.
https://africacdc.org/news-item/new-ebola-outbreak-confirmed-in-the-democratic-republic-of-congo/
2. Tranquil Passport: testing the nation’s special pathogen readiness ahead of the FIFA World Cup. National Emerging Special Pathogens Training & Education Center. July 2, 2025. Accessed August 26, 2025. https://netec.org/2025/07/02/tranquil-passport-testing-the-nations-special-pathogen-readiness-ahead-of-the-fifa-world-cup/