UTMB strengthens frontline preparedness for special pathogens

It's 2014. The West Africa Ebola outbreak is taking a devastating toll. It'll eventually kill more than 11,000 people in places like Liberia, Sierra Leone, and Guinea.

So far away. Until it isn't.

A single case - one patient, a man from Liberia - shows up in a Dallas hospital. Although it's noted that he had recently traveled from Africa, he's discharged with antibiotics rather than being isolated and tested for Ebola.

Three days later, Thomas Eric Duncan is back in the ER in worse shape. Two days after that, he's diagnosed with Ebola - the first case of the virus in the United States.

Eight days after that, he dies.

In that time, two nurses who treat Duncan are infected - the first two cases ever contracted on U.S. soil. They eventually recover.

The events in Dallas exposed significant gaps in the nation's preparedness for highly infectious diseases. Today, through its Biocontainment Care Unit (BCU) and Special Pathogens Excellence in Clinical Treatment, Readiness, and Education (SPECTRE) Program, UTMB helps ensure healthcare workers, hospitals, public health agencies, and emergency response partners are prepared to safely identify, isolate, transport, and care for patients with high-consequence infectious diseases.

"The Ebola outbreak fundamentally changed how healthcare organizations think about preparedness," said Corri Levine, PhD, assistant director of SPECTRE and an associate professor in the Division of Infectious Diseases at UTMB. "It demonstrated that even diseases occurring thousands of miles away can quickly become local healthcare challenges."

What doesn't recover in the wake of the Duncan case, however, is the perception - a conceit, almost - that "it can't happen here" in the U.S., that diseases like Ebola, Marburg, and Crimean-Congo hemorrhagic fever are exotic and far away and nothing for "us" to worry about beyond 30-second clips on the nightly news.

The 2013-2016 West Africa Ebola outbreak changed that perception.

"Before 2013, these diseases were recognized as highly dangerous, but they were largely seen as exotic illnesses occurring in remote, separated villages in places like the Democratic Republic of the Congo or Uganda," said Dr. Susan McLellan, medical director of the Biocontainment Care Unit and director of the SPECTRE Program at UTMB. "Because the outbreaks happened in small, isolated pockets, they remained limited in scope.

"When the 2013 outbreak hit West Africa, the virus behaved very differently. The ecological conditions allowed it to leap into a much more densely populated region with fluid borders, active travel hubs like diamond mines, and complex linguistic barriers. Suddenly, we weren't looking at an isolated village outbreak; tens of thousands of people were infected and dying."

Since then, the world has become increasingly connected, making the spread of infectious disease easier and faster than ever. The speed of modern travel has outpaced the incubation periods of many high-consequence pathogens.

"Someone could be in Europe or Africa in the morning, and by the afternoon or the next day, they're in America, walking into an emergency department completely sick," Levine said. "The speed of modern travel means these are no longer distant, international issues - they can arrive at your front door very quickly."

Gaps exposed, action taken

Duncan's case and the nurses' infection exposed problems with hospital preparedness, protective equipment training, and guidance at the time from the U.S Centers for Disease Control and Prevention. Nurses later described confusion, changing protocols, and inadequate protective gear during Duncan's treatment. Across the U.S., schools closed and people avoided hospitals as panic spread through Dallas and beyond, fueled in large part by nonstop cable news coverage.

"When an Ebola patient was treated in Dallas, the outcome was devastating for the patient, the hospital, and the staff," McLellan said. "It rapidly exposed a massive lack of preparedness in general hospitals largely due to a lack of comfort, training, and a deep understanding of the exact mechanics required to stay protected while delivering intensive care.

"The realization hit hard. For public safety, public perception, and clinical reality, our country needed more facilities that were genuinely comfortable and ready to treat high-consequence pathogens."

The Duncan case led to the federal establishment of the Regional Emerging Special Pathogens Treatment Center (RESPTC). Originally, one for each of the 10 Health and Human Services regions was funded, McLellan said, and three more have been added in recent years. UTMB was selected to house the RESPTC for HHS Region 6, which covers Texas, Arkansas, Oklahoma, Louisiana, and New Mexico.

"If any patient within those five states becomes ill with a high-consequence infectious disease (HCID), they are transferred to UTMB for care," Levine said.

RESPTC at UTMB

The Biocontainment Care Unit is the heart of RESPTC at UTMB. Far from a traditional medical space, it is a fully functional, self-sustaining unit. Its specific mission is reflected even in the unit's name.

"Initially the unit was built with a strict focus on preparing for a very small number of patients - maybe just one or two at a time - in an Ebola-like scenario," McLellan said.

"When I arrived at UTMB in 2018, there was a lot of administrative debate over whether to call it a biocontainment center, a critical care center, or something else. I pushed to call it the Biocontainment Care Unit to keep the word 'care' front and center, reinforcing that the facility is there not only to isolate infected patients but to safely provide the highest level of care to save their lives."

The BCU at UTMB is unique in several respects. First, it has the advantage of residing on the same campus as one of the country's few major national high-containment laboratories - the Galveston National Lab or GNL - which gives McLellan and her colleagues quick access to some of the most respected minds in infectious disease research and care, bridging the gap between science and clinical application.

"Frankly, you didn't see major cities like Houston or Dallas volunteering to put a biocontainment care unit in their backyards," McLellan said. "But because of our institutional expertise, it made perfect sense here."

The proximity of the BCU to the GNL and that synergistic relationship also imparts a sense of safety to UTMB patients seeking care while virus outbreaks are top of mind.

"We have built a culture where people look at this unit and say, 'We've got this, it's OK,'" McLellan said. "You can come to our hospital to get your hip replaced right next door and feel completely safe because our protocols ensure absolute isolation."

Training for now - and the future

SPECTRE, housed within the Division of Infectious Diseases, supports the UTMB mission as a RESPTC location through training, preparedness, regional coordination, and readiness activities across HHS Region 6.

Beyond the operational aspects of the BCU, SPECTRE leads a broad educational mission across HHS Region 6. Each year, the program delivers regional training events, facility-specific preparedness consultations, BCU training activities, webinars, workshops, and other educational offerings designed to strengthen healthcare readiness across the region.

SPECTRE also fosters collaboration with regional healthcare partners and public health entities, helping strengthen preparedness efforts across HHS Region 6.

"Strong preparedness depends on strong partnerships," said Kara Marshall, SPECTRE program manager for regional coordination. "By bringing healthcare, public health, and emergency response partners together before an event occurs, we can build relationships and coordination that make the entire region more resilient."

While the world holds its breath waiting to see where the hantavirus and Ebola outbreaks will take us, SPECTRE is busy making sure that HHS Region 6 healthcare workers are equipped to handle it wherever and whenever that is.

Melissa Massey, program manager for the SPECTRE program, oversees training and workforce development efforts that help healthcare workers across HHS Region 6 build confidence and competency in responding to high-consequence infectious diseases.

From large regional workshops to facility-specific training events and ongoing BCU readiness activities, Massey helps ensure healthcare workers have opportunities to build and maintain critical skills before they are needed in a real-world event.

Training sessions operate under the credo, "practice like you play," a concept borrowed from sports that emphasizes training under realistic, high-stakes conditions that mirror real-world scenarios, Massey said<_o3a_p>

"Within our broad educational training, we actually try to keep the days uplifting and fun because the material itself is so heavy," she said. "But for our Biocontainment Care Unit team at UTMB, they have a totally different, very serious perspective because staying ready to care for a real patient is always at the forefront of their minds."

Emotionally and mentally taxing

The material is indeed heavy, as is the emotional toll it can take on those working in biocontainment care. And, Levine said, that toll is exacerbated by the lingering memory of COVID-19: healthcare workers stripping off their clothes in the garage to avoid getting their children sick or staying in hotels to protect their elderly parents - not to mention the exacting toll of what they dealt with on the job.

Healthcare workers have historically been conditioned to compartmentalize and suppress their emotions, but SPECTRE actively works to dismantle that culture, integrating a dedicated clinical social worker into its training sessions.

"We bring up those past experiences often so our team members know they aren't alone and don't feel isolated in their fear," Massey said. "Healthcare workers are notorious for pushing their emotions away, but we intentionally dig those feelings out with our BCU team to ensure they are fully supported and addressed."

COVID-19 caught the world off guard, and the United States was no exception. Ongoing SPECTRE education, training, and preparedness efforts are designed to ensure that won't happen again - and it's particularly important now, when outbreaks of hantavirus and Ebola emerge in various parts of the world.

Houston is preparing for record-breaking crowds coming from around the globe for the World Cup and Los Angeles is doing the same as it prepared to host the 2026 Summer Olympics. Both events are important reminders that biological threats can be closer than we want to think.

However, SPECTRE and the BCU aren't just looking at the pathogens we know. They continue to prepare for "Disease X" - the unknown, unpredictable pathogen of the future, the one that has yet to mutate, jump species, or emerge from the environment with pandemic potential.

"We use the term 'Disease X' to represent the unknown disease that is inevitably coming," Levine said. "It is never a question of if it's going to happen but when. COVID-19 taught us that viruses evolve and change incredibly fast, and those changes have a massive, real-world impact."

'If we don't swim together …'

McLellan said that, ultimately, the work driven by SPECTRE highlights a profound ecological truth about public health: In a hyper-connected world, isolationism is a dangerous illusion and the health of the individual is irrevocably bound to the health of the community. True public safety, she said, relies on robust infrastructure, dedicated training, and public trust.

"We are living in a very difficult environment of mistrust where people think, 'I don't need to worry about the health or safety of my neighbor.' But that is a fallacy," McLellan said. "When you're dealing with living, evolving organisms, isolationism simply does not work.

"If we don't swim together, we will all sink separately. The ecological truth of health and disease is that we must work together to build a safe, functioning environment for everyone."

Pictured above, top row: Participants in a SPECTRE regional training event at the Health Education Center in March learn the proper way to don personal protective equipment.

Bottom row, from left:

• Participants prepare to take off PPE gloves covered with shaving cream. The shaving cream is meant to indicate hazardous contaminants. Once the gloves are off, the participants were able to see whether they got them off without getting the "contaminants" on their skin.
• SPECTRE Assistant Director Corri Levine, PhD, talks with participants.
• The group didn't let the serious subject matter - or a little wind - stop them from having a little fun.

Pictured at top of page: Dr. Susan McLellan addresses attendees at a regional training event presented by the SPECTRE Program at UTMB.