Biopreparedness Exercises Look to Contain High-Consequence Infectious Disease Outbreaks

We are continuing our new series, Media Day, where we spotlight individual medical institutions and infectious disease (ID) programs. Today, we spotlight UNC’s Institute for Global Health and Infectious Diseases (IGHID).

The University of North Carolina’s Special Pathogens Response Center is 1 of 13 centers across the US that are responsible for building regional preparedness. This means these special centers interact and coordinate training with other healthcare facilities like local and regional hospitals to aid them in dealing with individuals with highly infectious diseases.

“We lead regional trainings to better prepare other healthcare facilities, because we're trying to make sure that anywhere a patient can present, they are prepared to identify, and initiate safe delivery of care, and then transfer that individual to a regional treatment center,” UNC’s Director of Emerging Pathogens Institute for Global Health and Infectious Diseases William Fischer II, MD, said.

Part of the trainings are to ensure any potential individuals who need to be quarantined are done so in such a way that minimizes the risk to the greater public.

To prepare for big events such as the FIFA World Cup in the US next year, there have been national readiness exercises being conducted this summer for high-consequence infectious disease (HCID) threats.¹ 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. Specifically, they tested a coordinated national response to an HCID scenario.¹

Back in June, UNC's Medical Center Special Pathogens Response Center (SPARC) team conducted a test for a high-consequence infectious disease patient using a mannequin. This training exercise focused on "interdisciplinary coordination among pediatric specialists, infectious disease experts, and transport teams. The simulation also included a mock surgical procedure within the biocontainment unit, allowing the team to exercise infection control, communication, and clinical workflows required to safely perform emergency interventions in a high-risk environment."¹

"The country is in much better shape right now than they were from before we did this exercise, because now a lot of us in this country now know how to handle this much better," said David Wohl, MD, professor of Medicine in the Division of Infectious Diseases, UNC.

As individuals with HCID won’t know about these special pathogen centers, these trainings between the pathogens centers and the regional hospitals are critical, explains Wohl.

“We really have to prepare this network of regional hospitals,” Wohl said. “One thing that's really important to understand is infectious diseases that are emerging and reemerging are becoming much more common and frequent—and they're becoming bigger in scope.”

He references the West Africa Ebola outbreak of 2014-2016 and that infected over 28,000 people with the deadly disease.² Wohl says this is massive in size compared to previous large outbreaks, which was thought of in terms of 100 to 200 people being infected.

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William Fischer, MD

David Wohl, MD

As part of their experience, both Fischer and Wohl have been in hot zones in Africa treating patients who have had Ebola and Lassa fever. They have experience setting up field treatment units during outbreak settings to isolate and care for patients. Their work in Liberia has directly informed emerging pathogen response and preparedness in North Carolina. (Contagion will cover their work in Africa in a future episode.)

Although Ebola has not had an impact in the US, he references mpox that has been seen in the US during outbreaks recent years. Fischer says the concept of specialized medical centers is not a new one.

“These centers of specialization…they parallel what's been done for trauma; They parallel what's been done for sepsis—what's been done for ARDS [Acute Respiratory Distress Syndrome],” Fischer said. “If you can develop expertise at specific centers and then educate and increase awareness among all providers, we can then identify individuals that might have a special pathogen, get them to the center of specialty where that specialized care can be provided, and we know that model works.”

In the next episode, Ben Smith, MD, discusses logistical and safety challenges in preparing for the transport of infectious patients from outside facilities to UNC.

Biopreparedness Exercises Look to Contain High-Consequence Infectious Disease Outbreaks

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