Authored by: Venkat Rao
With a growing and continued onslaught of high-consequence infectious diseases such as Viral Hemorrhagic Fevers, Monkey Pox, and variants of SARS-CoV-2 in the past decade, there is a growing demand for mobile pathogen containment units for deployments to study emerging infectious diseases as well as patient care under austere conditions. These mobile pathogen containment units, known as High-Level Isolation Units (HLIU) are designed to specifically treat patients as well as safely handle at the highest biocontainment levels clinical and laboratory work and manage patient care under austere environments in the mobile high-level biocontainment units serving both as a mobile clinic and high-containment biological/clinical laboratory.
A just published study by Herstein et al. (2022) on the role of international collaboration and networking among HLIU programs, recognized the growing importance of HLIU by public health agencies towards preparedness and response to new, high-consequence infectious diseases. National health systems in countries such as the United States, Australia, United Kingdom, and Malta have invested in manufacturing more HLIUs and have established networks of HLIUs to share resources and coordinate on disease outbreak response. For example, the National Emerging Special Pathogens Training and Education Center (NETEC) consortium of three US academic medical facilities, Emory University Hospital, Nebraska Medicine, and NYC Health + Hospitals/Bellevue, originally established in response to the 2014-16 Ebola outbreak in West Africa, now has 10 HLIUs and serve as Regional Emerging Special Pathogen Treatment Centers.
Patient containment units used to transport Ebola-infected patients from West Africa were not without problems, as evident from a nurse who contracted Ebola at the receiving hospital in Dallas (TX). The report cited improper use of protective equipment and lack of training on containment and treatment of patients as the reason for contracting the infection.
An earlier study by Rao and Bordelon (2019) on Mobile High-Containment Laboratories, reported its role as invaluable resources and are deployed on a regular basis for public health surveillance, environmental monitoring, and field research studies.
However, this study pointed out that many mobile laboratories currently operational are used for environmental monitoring and involve the standard plethora of analytical instruments, climate control systems, and materials for wet chemistry laboratory work, but not necessarily equipped with engineering and process controls required for high-containment laboratories. These mobile high-containment laboratories were introduced in response to 2014-16 Ebola outbreak in West Africa. However, it was unclear if the mobile High-containment laboratories manufactured in South Africa and China and deployed in Africa during 2014-16 Ebola outbreak response complied with the stringent Level-4 biocontainment requirements for laboratories working with Ebola virus from both clinical and environmental samples.
Existing biosafety guidelines are inadequate to address the unique operational environment and modified laboratory processes for the Mobile High-Containment Laboratories. A thorough risk assessment should guide modifications to the biosafety guidelines to address these mobile units, considering their unique operational environment and modified laboratory processes. These modified guidelines should also address physical security systems specifically for mobile biocontainment laboratories. Existing physical system requirements for fixed laboratory facilities have expensive upfront capital investments, as well as maintenance and operational costs, which often are the deciding factor for many public health laboratories and academic institutions to let the select agent registration expire.
Public-sector investments such as the ongoing NETEC consortium for HLIUs would have to address the need for patient isolation as well as laboratory containment related stringent standards developed exclusively for mobile biocontainment facilities.
Mobile labs and patient containment units will be the hallmark of future models for deployable resources during public health emergencies and/or response to bioterrorism events. Public health agencies around the world do not have clear policy or biosafety guidelines specific to mobile biocontainment labs and clinics, which is the first key step as nations around the world look for more effective approaches to respond to emerging infectious diseases.