Biopreparedness Oral History Interviews

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Ali Khan, MD, discussing biopreparedness initiatives in the College of Public Health

Ali Khan: So this growing prominence has reinforced the role of the College of Public Health in emergency preparedness. We have additional faculty members who work on health security issues, all of them affiliated obviously with the Global Center since the Global Center is a function of all of us coming together. We've increased the number of our domestic activities. We've increased the number of our international activities. We've added in additional academic programs. Our responsibility is all the academic programs around preparedness, so we've always had a Masters of Science in Emergency Preparedness. We've added, then, an MPH in Emergency Preparedness. Now we have a DRPH, Doctorate in Public Health and Emergency Preparedness, so we've slowly, you know, increased all the programs that are available to individuals who would like to get more academic training in emergency preparedness and response.
Angela Hewlett, MD, discussing working with the media during Ebola

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.”
Christopher Kratchovil, MD, discussing clinical research with the NBU

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.
David Brett-Major, MD, discussing the Critical Questions and Ethics mechanism created for research during COVID-19

David Brett-Major: I pitched a critical questions and ethics mechanism to be embedded as part of the response team and Dean Khan and Chris Kratochvil and Shelly Schwedhelm they were very receptive to this, and I reached out to two really excellent UNMC faculty members. Rachel Lookadoo, who's a public health attorney, and Abbey Lowe, who's a bioethicist, and they took on that mission and have continued to do it, convening a weekly open table responding to targeted questions and there were a lot of them initially and ultimately expanding those lanes of work when it seemed like it mattered. Abby eventually formed an external ethics board and has been managing referral ethics consultations and position papers. In addition to that group, critical questions and ethics, still operating, Rachel, with Abby and others, and with help and I think some guidance from Shelly Schwedhelm they really leaned in and organized the Nebraska Crisis of Care—Standards of Care activities. That has turned out to be really useful and I think unique. I'm not aware of an actual response team structure that's ever tried to do quite that.
Elizabeth Beam, PhD, RN, discussing donning and doffing

Elizabeth Beam: [T]he thing that we tried to do, one of the media projects we took on pretty early was not only this donning and doffing and respirators in general, which we kind of had that one in the bag, but we worked on one for the extended use and reuse, because reuse was something that really nobody had anything on, and that was one of our fastest growing videos once it came out. Initially, we kind of tried to do everything and we realized that was like a 30 minute video and nobody watches a 30 minute video. So we focused on that reuse piece, because extended use is pretty much just wear it longer. But if you're going to reuse something, you really have to think about the dance of taking it off gently and putting it somewhere where it can kind of desiccate and dry. And so, helping people understand that was important. And so, we kind of filtered it down to just that part. But all of that, you know, were the things that we could do to help people. And, you know, I had people reach out who had been our long term—long time HEROES, groupies, if you will, who said, “My gosh, thank you. Like, we used your video to make sure everybody was educated on how to wear their respirator” and so on and so forth. And so, I think that's the weird thing about being HEROES is you don't know exactly every story, but like you hear later, whether it was COVID or whether it was Ebola. Like I remember, you know, like I said, I was breastfeeding and other things during that time, but a lot of the groups that went down to like Texas after the Thomas Duncan case to help with education down there that like, “HEROES is amazing. [Laughter] Like, we found so much stuff on there, it was great.” It was just like, it was kind of cool to hear at least secondhand from people that people were finding our content and were really grateful for, not because it was exactly what they were going to do, but at least it was an example and then they could tweak. I remember we went to Denver Health for one of the site visits for NETEC and they were so—they were like, “We get it, we get it. So we’re going to do this part and then we're going to walk a little bit further into the decon shower and take this part off and that part off based on kind of what you did. But our situation is a little different.” Like that's exactly what the education’s designed to do.
Elizabeth Rupp, spouse of Mark Rupp, MD, discussing the frustrations of misinformation during COVID-19

Elizabeth Rupp: [I]t's so frustrating, if people knew—he has nothing to gain by advocating vaccines or face masks or—he has no personal gain and he's so careful about reading the studies and analyzing them and determining the validity of the findings. “Yes, that's a good study and it makes sense and you can trust those findings” or “no, they didn't do things right.” He has—no horse in the race, so to speak. It's just like, he's working hard for the betterment of everybody, but yet people think he's motivated by some sinister or personal gain. I don't know what it is. It's just—it's hard to see that happening it’s really—when he just has dedicated his life to vanquishing these kinds of things and educating people about them, but it's not appreciated and he's criticized because of it and called names and threatened. That's hard to watch. If they knew him and knew what he was doing and how he goes about his life, they would feel very differently. And I think the access to social media is just a very scary thing that anybody can say anything they want to say and people will believe them. It's just very disheartening when the facts are not held as closely as the fallacies.
James Lawler, MD, MPH, discussing the Global Center for Health Security's response to COVID-19

James Lawler: I think we all essentially filled in whatever holes needed to be filled in at the time. And that's true not only at—I mentioned that kind of the Global Center team has from its inception been willing and able to wear multiple hats at any given time, doing what's necessary. I think that was true, certainly, across our entire institution here, the university and hospital, that people did what needed to be done and I think our team did that as well. So, some of it was dealing locally with things within the hospital and within the university that needed to be addressed. How do we create safe infection prevention control practices for managing patients? Advocating for airborne isolation for all the patients very early on, again, based on some of the information we were getting in some of what we saw in managing early patients. Helping response across the state and region, particularly in places that were seen to be especially vulnerable or, early on, had huge issues. So, meatpacking facilities obviously being one, right, where we put together teams and we went out to these facilities to see firsthand what was happening, where were vulnerabilities, how could we create interventions that would you know, reduce spreading and keep what is critical infrastructure running. Same thing for nursing homes and long-term care facilities, that was recognized very early on as a very vulnerable segment in society and, same thing, sent teams out and we went to these places, and you know, did training, assessed their procedures and physical layouts, and, again, did things to try and reduce risk. Schools, same thing. So, wherever we thought there was a need we would jump in.
Jane Meza, PhD, discussing developing COVID-19 contact tracing at UNO and UNMC

Jane Meza: And then one day we got a call over at UNO from the Health Department and they said, “We're going to need you to do contact tracing.” That was something that we were—I knew something about contact tracing, but certainly was something that I had never done and weren't really prepared to stand that up right away, but we did it. We stood up contact tracing at UNO for all of our students, because the idea was that you know as a campus better when students say they went to their math class and then they went to their engineering class. Then UNMC started to do some testing here, and I think we had like one day where people could come get tested and that was a big success. Then we realized that we need to have testing at UNO, and so we set up a testing center at UNO. Those are things I'd never done before. I never thought in a million years I would be doing this. But what was really great about it is I knew all the people at UNMC that were doing this. Talked to Dr. Hinrichs and Tony Sambol and Teresa Fowler, and next thing you knew we had a testing center set up at UNO, so that's kind of what I did at UNO. Then one day, I got a call that said Ted was looking to retire. Would I be interested in doing this at UNMC? I thought, “Well, it does make sense since I know a lot about what Ted is doing, and I know what we're doing at UNO,” so I said yes. Then for a while, I was the interim executive director for health security at both UNO and UNMC, and also associate vice chancellor for global engagement at both institutions, and that was a lot.
Jennifer Larsen, MD, discussing development of the National Strategic Research Institute

Jennifer Larsen: The National Strategic Research Institute was an opportunity that came about early on as I was becoming the vice chancellor of research and, you know, it was kind of a foreign concept from my standpoint. It’s a university-affiliated research center. It's a designation by the Department of Defense saying that you can have sole source contracting for research kind of jobs that are relevant to your areas of competency, which are combating weapons of mass destruction. Now, as a clinician, it's like, “Are we doing that [laughs] here on our campus?” But I think I came to realize that the Department of Defense, you know, you have to think in Department of Defense terms, but we absolutely were and are doing research that combats weapons of mass destruction. If nothing else, keep in mind—first of all this was a University of Nebraska initiative, so obviously UNL had a role to play, UNO, UNK. But if you think about if you have a weapon of mass destruction, it doesn't just destroy things, it impacts people. And there has to be healthcare at the moment, in a remote site, in a plane—in a ship, in a remote field, and remote medicine is a lot about what we are trying to do here at University of Nebraska Medical Center. Nebraska is a rural state, so we already were doing a lot of telemedicine or other strategies to be able to provide remote care. And so that dovetailed very, very well.
John-Martin Lowe, PhD, discussing preparing to receive the first COVID-19 patients

John-Martin Lowe: [I]n the COVID response and my initial roles and responsibilities, again, because I had been so involved in transport, got pulled into how do we do a lot of the local coordination and integration with federal organizations for receiving patients that are going to need to be provided medical care or monitored. So, a fair amount of liaising and pulling together those organizations here in Omaha that do all of the planning and do the piece to get people safely to the airport and from the airport to wherever they're going. Also very involved in kind of rewriting protocols. So, we have lots of protocols for viral hemorrhagic diseases. We had a variety of protocols for respiratory pathogens but, knowing what we knew and knowing what we didn't know in February of 2020, we really—it was a great opportunity to refine our protocols based off of the current body of information, or lack thereof, to kind of maximize safety. So, it was prepping for transport and doing a final deep dive on our safety protocols for the initial response where it was—we were so integrated and embedded with federal agencies, it was really just helping make sure that the federal agencies had the information that they needed and a lot of coordination on behalf of the biocontainment unit with different federal agencies that thought they might have somebody that would need to come to the biocontainment unit.
Kathleen Boulter, MPH, RN, discussing UNMC and Nebraska Medicine supporting the NBU during Ebola

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.
Keith Hansen, MBA, discussing the history of the Center for Preparedness Education

Keith Hansen: The Center for Preparedness Education is the group that was started shortly after September 11th when the bioterrorism funds came out. Early on, that organization was responsible for training and education in Nebraska for public health, for healthcare, but it was primarily around bioterrorism. We did a lot with these seven agents—anthrax, smallpox, tularemia—the seven category A agents. A lot of education on that. Early on, we were fairly focused on the bio part of it. Since then, we've become more focused on the preparedness part of it. Doesn't matter if it's a tornado or hurricane or whatever it is, a lot of those principles apply. If you have to evacuate a hospital for a fire or a shooter, doesn't matter. It's the same evacuation, right? You still have to move patients. So we broadened our definition quite a bit, but our job is to work with planning and training and exercising healthcare and public health in Nebraska. Darby Kurtz: So with the Center for Preparedness Education, are you often coordinating with Nebraska Health and Human Services? KH: Absolutely. That's where a significant part of our funding comes from. So for example, we're work—I'm currently working on an exercise with them that we will do with Nebraska Health and Human Services and Nebraska public health departments and what we call organizations that represent access and functional needs populations here in the state. We work quite closely with them, because it's their job to identify what the priorities are for the state and that's our job to help execute that.
Kenneth Bayles, PhD, discussing UNMC/Nebraska Medicine's partnership with the U.S. Department of Defense

Kenneth Bayles: [W]e have unique access to the biomedical portfolio of the DoD, unique access in the country compared to all other institutions, we had this special access. So then the question is how do you take advantage of that? How do you leverage that access? We have a seat at the table with this major department that's a big funding agency. So you got to figure out how to take advantage of that. And we're just kind of like building this plane as it's flying. And we made mistakes along the way, but then we eventually figured out that if we have a funding vehicle that makes it easy for the federal government to send us money, then we better be thinking about things that they want to buy, right? So that's when I started thinking about core capabilities that they might be interested in, and that's where I came up with the idea of the Nebraska Drug Discovery and Development Pipeline. I would go to different DoD labs and pitch this idea, “Come to us. I know you're interested in making different drugs that—” in, you know, in those days I was thinking about—as a microbiologist, I'm thinking about antibiotics and I was pitching this, “use this core capability to make antibiotics that would kill anthrax or that would kill tularemia bacteria or, you know, some of these biological weapons of mass destruction.” That was my pitch. They liked the concept, but there was a group within the DoD that had no interest in antibiotics. They were interested in countermeasures to radiation exposure. And so, they said, “Hey, we can use this core capability, but we want you to help us make radiation counter measures, radiation drugs.” And so, that's what we're doing now. We're making anti-radiation drugs for the federal government.
Kevin Schwedhelm, MSN, RN, spouse of Shelly Schwedhelm, MSN, RN, discussing Omaha hospitals supporting the NBU during Ebola

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.
M. Jana Broadhurst, PhD, discussing the creation of the first effective COVID-19 test

Jana Broadhurst: I don’t know if collaboration’s so much the right word, but a lot of getting on the phone [laughs] with our lab people, talking to lab people about how to select the right targets for the test and ensure that you are not detecting any of the common coronaviruses that are circulating around and really just understanding how to do this quickly and safely. So we were among many laboratories globally who were going through this process. We were unique in the US in that, right, we had this responsibility of caring for many of the first cases in the country before there was known community transition here in the US. So again, this is in some ways the bread and butter of our trade. We know how to do this, but we’re not often faced with this type of pressure and these sorts of stakes. There was plenty of people who were also very keen to learn from our early experience. Emily Brush: But is it fair to say that your test was one of the first or the first successful test? JB: Yeah.
Mark Rupp, MD, discussing the COVID-19 response

Darby Kurtz: [W]hat is the role of an infectious disease professional when dealing with a pandemic? Mark Rupp: The COVID pandemic has been incredible. It really was something that stressed the division and really the whole medical system to the breaking point, and our group and the Medical Center has responded so tremendously well and so heroically. It's really inspirational to have seen how people rallied and did what they needed to do. Sort of in comparison to the Ebola patients, that was incredibly stressful for a period of about three months. This has been incredibly stressful for going on starting our fourth year. It's been impactful not only for ID, but for all groups of clinicians. There's a lot of folks who are frayed at the edges and suffering a little bit.
Peter Iwen, PhD, discussing helping fix the CDC's first COVID-19 test kits

Peter Iwen: [T]he CDC got in big trouble, you probably remember reading it in the news, because of their test. It was too complicated to begin with. Second off, they didn't know what was wrong with it. So they came to us, the special pathogens lab at the CDC's directors called us up in a meeting to ask us for our help to find out what is wrong with their test. So we did some laboratory manipulations and told them, “You know, this is what we think is wrong with your tests.” And they corrected that, resubmitted it to the FDA to get emergency use authorization approval. And lo and behold, they had a test that worked. But that was pretty touchy for the CDC because they had everybody looking at them saying, “You blew it guys.” And some of those people no longer work in that lab [laughter] unfortunately. But we were part of that process. It was because we had a relationship with the CDC in the past and we knew their directors and they looked at us, said, “Hey, can you help us?” So it was fun, but that's what we did. And lo and behold, now a lot of labs can test for it, but—it's still something that we're dealing with.
Philip Smith, MD, discussing, "Why Nebraska?"

Philip Smith: That’s the $24,000 question. Why Nebraska? Because it doesn't seem logical, but then when you think about it, it made sense, because—first of all we thought of it, and other people—nobody else really came up with the idea at that point. Things changed after Ebola, I can tell you, but Nebraska's in the center of the US. There were only two other biocontainment units, one in Atlanta, Emory University, and one at USAMRIID. And they were both two-bed units and they were both on the East Coast. We had a number of other things going for us as well. We had the fact that we had both civilian and military airports with dual access to the civilian and to the military casualties that might lead us to activate our units. And Dr. Hinrichs had built a BSL-3 laboratory that was very good and safe and capable of dealing with pathogens like this. So for all those reasons, it just fell into place, it had to be in Nebraska.
Sharon Medcalf, PhD, discussing UNMC's involvement in GOARN

Sharon Medcalf: [C]redit to Dr. Khan and his connections with the WHO—and this is a small division of the WHO called GOARN, G-O-A-R-N, Global Outbreak Response and Alert Network. So, this group's been around since 2000 and he was involved with them when he was at CDC before he came here. So as that group grew—and the premise behind GOARN is that they have partners across the globe, and I think they're up to about 200 or 250 partners. A partner is an organization or an institution. So we, as UNMC, are one of 250 partners in this global outbreak network. And then what happens is when there is an outbreak around the globe, regardless of how large the outbreak is, they put out a call to all these partners to say we need people with epidemiology experience, infection prevention, and they'll list it and they'll give the criteria. And then what we try to do is find people who can fit the bill and propose that they deploy. As an institution and as a partner with GOARN, we have committed to allowing deployees the time and the resources to do that deployment. WHO pays for the deployment, but we give them the time off. So, our dean has gone multiple times. We've had a couple of faculty in the college that have gone on deployments, but as this partnership has grown and as GOARN has grown—they formed in about 2016 or ‘17, a training subcommittee. What they did is they recruited people from the partner institutions who had expertise in training and workforce development, so we became—we got involved with that in 2017. And the first meeting was in London, and they've moved the meetings around, because again, these are partners around the globe, so they try to move these meetings around the globe so that no one person is traveling literally around the world to get to a meeting. So, they've been in London. They've been in Geneva. We had one in Vancouver. There's one coming up in August in Singapore, and what this group is doing—and we're part of this group—is building the training for all these people that deploy to these outbreaks around the globe. And so, what we feel like we're bringing to the table, we as in UNMC, is that vision for using state of the art simulation.
Sharon Smith, spouse of Philip Smith, MD, discussing helping the NBU team during Ebola

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.
Shelly Schwedhelm, MSN, RN, discussing development of the NBU

Shelly Schwedhelm: It was an old bone marrow transplant unit that had been sort of set aside—a pediatric bone marrow transplant unit. And it had its own air-handling, so that was really a feature that made a lot of sense financially, so we were able to really operationalize it with limited capital and had some support to do that from the state of Nebraska, from those bioterrorism dollars. And then we literally functioned it for 10 years on a shoestring. We had some money from our state health department through hospital preparedness funds that was given to us, I think it was $20,000. [Laughs] And we exercised with our team every three months and most every exercise included personal protective equipment training. We did an exercise like twice a year and then I had a small part of an FTE that was supported to help write protocols, procedures, and the nurse you're going to interview is Kate Boulter, who sort of led on that and just kind of kept things moving for all that time. But we really, we didn't keep supplies on the shelf, we created just in time inventories. So if we literally needed to be activated, we could quickly, you know, within four to eight hours, be good to go.
Steven Hinrichs, discussing development of the clinical laboratory connected to the NBU

Steven Hinrichs: Actually, we had a lab in the unit in the beginning, but they actually needed that space and the actual number of tests that the laboratory in the unit could perform was so minimal it wasn’t worth keeping up anymore. And another interesting thing happened—so the doctors who we originally had interviewed, Dr. Smith—and said what test do you need us to provide. And it was very similar, they were very simple, “CBC, smear analysis, that’s all we’re going to ask you to provide when we take care of a patient in the unit.” As soon as Ebola actually happened, the doctors said, “If we’re coming into the unit risking our lives, we want as many tests as if this patient was in the ICU of the hospital and don’t tell us you’re only going to give us these five tests. We want every test available.” So now the whole clinical laboratory became involved and we had to develop a method and a process for bringing potentially contaminated samples into the laboratory and running them on automated instruments in the laboratory environment, which was not BL3, and how to develop a containment policy and infection control policy, all those sorts of the things was a very significant challenge.