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On March 23, 2014, the World Health Organization (WHO) declared an outbreak of Ebola Virus Disease caused by Zaire ebolavirus in Guinea. The highly infectious nature of the virus led it to spread quickly to bordering countries Liberia and Sierra Leone. With the unprecedented spread into urban centers, the WHO declared a Public Health Emergency of International Concern (PHEIC) in West Africa on August 8, 2014. The Nebraska Biocontainment Unit would receive its first patient from Liberia the following month.
Named after the country where it was first described, Zaire ebolavirus is one of four known ebolaviruses that cause severe and often fatal hemorrhagic fever known as Ebola Virus Disease. It can infect humans and other mammals and is primarily transmitted from animal to human and between humans via body fluids. The natural reservoir of Zaire ebolavirus is believed to be bats.
Courtesy of the Research Collaboratory for Structural Bioinformatics (RCSB) Protein Data Bank (PDB) "Molecule of the Month": Inspiring a Molecular View of Biology
Due to the high fatality rate (83-90%) and lack of a reliable vaccine, Zaire ebolavirus is listed as a CDC Category A Bioterrorism Agent and a WHO Risk Group 4 Pathogen. These are the highest ratings for a pathogen and are given to agents that cause life-threatening disease, can be readily transmitted to others, and for which preventive vaccines and medical cures are not yet available.
Donated by Angela Hewlett, MD, medical director of the Nebraska Biocontainment Unit, from the McGoogan Health Sciences Library Special Collections and Archives
Biopreparedness efforts at UNMC and Nebraska Medicine were put to the test in 2014 when the Nebraska Biocontainment Unit received and cared for three Ebola patients.
In 2014, UNMC/Nebraska Medicine was recognized as a national asset for treatment and development of safety protocols to handle Ebola and other highly infectious diseases.
Representatives from the U.S. State Department visited Nebraska Medicine in July to take a closer look at the capabilities of the 10-bed Nebraska Biocontainment Unit (NBU). In early September, the NBU successfully treated its first patient, Rick Sacra, MD. Dr. Sacra contracted Ebola while treating patients in West Africa. He was discharged from the NBU later that month.
In early October, the unit received a second patient who was declared Ebola-free and discharged later that month. In November, a third patient arrived in the unit. Martin Salia, MD, was exposed to Ebola during his service treating patients in West Africa. Tragically, his disease was very advanced by the time he was flown back to the United States. Dr. Salia died a short time later. A plaque honoring his service and sacrifice hangs on the wall of the NBU.
The successes during the NBU’s first activation created widespread interest in the unit’s protocols, processes, and programs to safely treat patients. This led the College of Public Health to put together a collection of resources and free courses deemed, “The Nebraska Ebola Method,” that can be found through their website.
UNMC HEROES also created several video resources for healthcare professionals on the Nebraska Ebola Method related to the PPE and infection control procedures that were used in the NBU. These resources are readily available through their website.
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Angela Hewlett: [O]ur main outreach, though, was actually through the media, which I would say was something that we really did right here in 2014. And the reason I say that is because we have some really amazing people in our public relations department here both at UNMC and Nebraska Medicine. And they originally in 2014, when we were accepting our patients and even prior to that actually, when we—when the Ebola outbreak was escalating and we knew that we would probably be a potential site to receive patients, our PR group really said, “We're going to be very transparent. We're going to tell people what's going on. [Laughs] We're not going to hide anything. And that way we're going to make sure that they trust us and that we're doing the right thing.” And I think they kept that mantra throughout all of our care and even now. Just making sure that we're out there and that—we met—I mean, we had media appearances every day or almost every day at least while we were caring for patients with Ebola. There were multiple of those appearances, both local, national, and international as well. We had people from CNN here. We had people from national NBC News here doing different interviews and things like that with our team. We also enlisted—so Phil and I did a lot of that, but we also had other team members that also did these different interviews to talk about from the nursing standpoint or from the lab standpoint or the critical care doctor that cared for the patients. And so, we did a lot of press conferences. So the way that we really reached the public was through the media, and that was both print, TV, internet, I mean, anything at the time. And I do think that that really helped us to—and it helped people. There were definitely people who were concerned, and understandably, about receiving these types of patients here in Omaha. But what we needed to say is, “We—these patients are coming to the US. We have a facility here that is unlike really any other—with the exception of maybe two in the United States—in that we can protect—we can take care of these patients, we can protect our healthcare workers, we can protect our community. And so, this is exactly where you want these patients to be cared for.”
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Kathleen Boulter: Prior to Ebola, we thought our communication was pretty much going to be through the telephone, using the Starview phone, and our IT department—and this kind of shows you what it was like being here at this hospital at that time, because everybody was looking at ways and how they could help us, and our IT, our telehealth department, they were like, “we can make this better for you.” And they brought in vidYO and little webcams that we could use in the unit and it totally made things so much better for us. And—but anyway we had to make sure the nurses’ station was ready with the communications, with computers, that all our nurses had access into the electronic recordkeeping. People who work in the emergency department, they don’t have access to inpatient, so we had to make sure that all of that was taken care of. We had to make sure that our autoclaves were ready, that they were functioning correct—or one, at that time, that it was functioning correctly and it was ready to take care of our waste the way that we hoped it would. The rooms had to be made ready. Another example of how the hospital came through for us was in linens. A lot of places use disposable linens so that’s kind of like paper, you put your patient in between sheets of paper. Our hospital, for many years before that, any time there’s linen that was stained, ripped, or you just couldn’t use it for normal, everyday patients, they dye it blue and they call it disaster linen. And so linen services, they said to us “would you want to use that?” and we’re like “absolutely.” That way our patients got real linen that we could throw away without it being any cost to the hospital, so it was fantastic. They also said “hey, we’ve got these scrubs, their L and D got new scrubs for their staff, we’re going to throw these away, do you want them for your staff?” and we said “absolutely.” So it was a lot of things like that, you know. People coming together and making it so much better for us. We also had to set up a command center, so the conference room across from the biocontainment unit, that became a command center and that’s where incident command set up. And it was a full incident command at first, but then it got modified after that to just the people that we need. Our staff, they were going to do 12 hour days so they needed to have nutrition and so we were looking at how were we going to provide it, and that’s when Sodexo came forward and said “we’re going to give you meals, we’re going to give you breakfast, lunch, and dinner, and the night shift, we’re going to give them snacks.” And it was amazing, you know, when all of that just all came together.
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Chris Kratchovil: But, you know, very early on it was very collaborative, very controlled, very data-driven, and so we were kind of assessing, should we bring this patient in? And so I was one of the members of the leaders that got together with Chancellor Gold in his conference room and we basically went through what was the situation, the assessment, and what were the recommendations of all the folks sitting around the table, and he literally went around the table and had each person vote. “Do you think we should accept this person?” Everyone said yes, and then we went to work with what that would look like. My role was working with pharmaceutical companies that had products, some of which had only been used in animals, or very little human data, working with the FDA on getting an emergency investigational new drug approval, bringing in the Institutional Review Board because they had to quickly meet and then review the protocols and the consent forms which were being created at that time. So again, you can see this team-based approach that everyone came in rolled up their hands and needed to do and so while the biocontainment unit team was doing their thing, the clinical research teams and infrastructure and regulatory and contracts were doing their thing simultaneously, literally around the clock, while the patient was being prepared and then being flown from West Africa.
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Sharon Smith: Well, you know, what can you expect? I've been married to a doctor for almost 40 years. And they work long hours. This was different. But I just—my heart was just with him 100%, all the way, and I wanted to do anything I could do to help him. I felt really helpless because there wasn't anything I could do. I did do one thing. One day Phil called me from the unit and said, “We need Crocs without holes in the top.” I said, “Okay. I don't think I've ever seen any like that.” But he said, “As many as you can get. And we need them now.” I said, “Okay.” So I got on the phone, started calling shoe stores and you'd be surprised that all the Crocs have holes in the top. I called every shoe store that I could think of in Omaha. I googled. I went to several. I finally found one and I don't even remember what store it was, but they had some. So I drove there, and I went to the shoe section and there they were, and so I just took—I took all of them. Every size, every color, piled them in my shopping cart. Went to the checkout stand, and there were, you know, some employees milling around there, and they looked at my cart and they were curious. And so they asked me, “Is there something special going on?” I told them. And they were, “Ah. Wow. Well—we're going to give you five dollars off.” [Laughs] So that's just a little anecdote.
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Kevin Schwedhelm: [Y]eah, just being there, I mean, we could—knowing as much about it as I did and being in healthcare as much as I would, we'd have more—for us it was more questions about staffing and how do you staff hospitals and how's the team doing? And can they really work for 12 hours in a pap or be masked up for 12 hours? Because that's hard work in and of itself. So, I don't know, we spent a lot of time talking about it. We have a hot tub at home. So, we'd sit in the hot tub and we'd chat about this and that and what was going on and what she needed, and ,you know, I said—we even talked about if you need my folks to come here and we were trying to figure out how to get credentials for a CHI employee to be able to support that and obviously I had many folks that would volunteer to do that if the Med Center’s folks were getting too tired. So again, just because of my role, it seemed like there was just a lot that we talked about and just walked through different scenarios. If we needed to, we could do it, and that type of thing. So, we kind of still focused on the work more than we did kind of the emotional drain of it all.
