Inside the Nebraska quarantine facility responding to hantavirus

[AUDIO LOGO] FLORA LICHTMAN: Hey, it’s Flora and you are listening to Science Friday. Two disease outbreaks are dominating the news, Ebola in the Democratic Republic of the Congo and hantavirus, which started spreading on a cruise ship. In the US, there’s one of a kind medical facility that exists just for emergencies like these. It’s called the National Quarantine Unit, and it’s in Omaha, Nebraska. Americans exposed to dangerous diseases are evacuated there.

Right now, 18 Americans from the cruise ship where hantavirus broke out are in quarantine at that facility in Omaha, and today we’re going behind the scenes with one of the nurses who’s worked there for the last 17 years to hear how the facility works, the latest with these travelers exposed to hantavirus, and how this facility is preparing for the possibility of Ebola-exposed patients. Angie Vasa is the director of Emergency Preparedness and Special Pathogens Programs at Nebraska Medicine. Angie, welcome to Science Friday.

ANGIE VASA: Thank you for having me. Happy to be here.

FLORA LICHTMAN: How many hantavirus-exposed patients do you have right now, and how are they doing?

ANGIE VASA: Yeah. So right now we have 18 individuals who have been with us since May 11th, and they– all of our individuals remain well. So with quarantine, we’re providing monitoring and observation for the potential development of symptoms, and then if those symptoms develop, they would be moved over to our biocontainment unit, which is in our hospital. And so thus far, all of our guests remain well.

I think most folks that would be in a quarantine situation, people get a little bit stir crazy after a few days, and so our focus right now on this phase of response is really maintaining mental and physical stimulation opportunities. And so we’re really focusing in on making sure we’re supporting holistically what they need to sustain their time here with us, which was, proposed to be 42 days for the full incubation period.

FLORA LICHTMAN: 42 days.

ANGIE VASA: Yes.

FLORA LICHTMAN: Wow. That’s not a small amount of time.

ANGIE VASA: No, it isn’t.

FLORA LICHTMAN: So what is it like there? Should I be picturing a hospital or a hotel or some hybrid?

ANGIE VASA: It’s definitely a blend of both. So each individual has their own room, and so it’s interesting in that we have our rooms set up. They are all along the outer wall of our floor so that every room has natural sunlight, access to the windows so you can see out of the building. Each of the rooms has exercise equipment so either a treadmill or a bike, free weights, a yoga mat, a yoga ball, some stair stepper blocks.

Each of the rooms are at least 300 square feet, and they have a full-size bed, en suite bathroom. So what you would expect from a hotel. But then we layered in engineering controls, so all of the rooms have negative pressure so that no airborne particles can escape out into the hallway. The hallway is also negative pressure to the general space.

All of the floors are sealed seam flooring and so easily wipeable. So it’s a really interesting blend between a hotel room and a hospital room.

FLORA LICHTMAN: Is there room service?

ANGIE VASA: Yeah, there is. So because they’re not allowed to leave the room, our staff provides everything including meal delivery, snack delivery, personal items. We also do all of their laundry, so we do that each evening. And then I think one of the unique things about our facility is that we also have an autoclave on site.

So for some of our pathogens that produce category A hazardous substance waste, if people become sick, you need to be able to inactivate that waste prior to shipping it out. And so we have the ability to escalate to those full isolation procedures on this floor should somebody become ill prior to being able to move them over to the hospital side.

FLORA LICHTMAN: What does that mean deactivate the waste?

ANGIE VASA: Yeah. So when you have– Ebola virus disease is actually a great example or any of the viral hemorrhagic fevers because they virus can persist on surfaces for an extended period of time. And it takes such a low amount of virus to infect someone. So infectious dose is a big consideration.

That waste can’t just be sent out to the normal waste streams. And so it goes into the autoclave, and we essentially use steam sterilization to denature the virus so that it is no longer viable. And then it gets packaged up as a category B regulated medical waste and sent for incineration. So it really is to decrease any risk to the downstream workers who would be receiving that waste from our facility.

FLORA LICHTMAN: Let’s talk about Ebola. As of this interview, the Trump administration said it plans to send Americans exposed to Ebola to Kenya rather than bringing them back to one of our facilities here. Have you heard anything about this?

ANGIE VASA: Yeah, so we have been tracking that. So the current strategy to potentially move American citizens who have been exposed to Ebola to Kenya for monitoring and observation is going to require a lot of different strategies to make it successful. So I think it’s still in the beginning stages of planning.

It’s interesting because I would also note that at this time, the United States is more prepared than it has ever, has the highest capacity that it’s ever had to be able to provide care for individuals within the national special pathogen system.

FLORA LICHTMAN: So you have room for them. You could handle both these hantavirus-exposed patients and Ebola-exposed patients if you needed to?

ANGIE VASA: I would say yes with a caveat. So we could in theory provide quarantine care for two different pathogens simultaneously without any cross contamination, so to speak. I think for the definitive care piece where people become sick, that’s really where we would need to use the national special pathogen system, so those 13 regional emerging special pathogen treatment centers. So if folks were here in the quarantine unit and needed biocontainment care, we would be wanting to move those individuals out to the other regional treatment centers so that they could have ready access to those critical care services.

FLORA LICHTMAN: It sounds like a busy time right now. What do you– what happens when you’re not busy? Are you prepping?

ANGIE VASA: So that’s a great question. So our team maintains a constant state of readiness. And so we’re required through our contracts to be able to activate our unit within eight hours or less. And so we train our team on a quarterly basis. We have over 100 people who voluntarily apply to be on our biocontainment unit quarantine unit teams, and they come in for training every three months.

And then we also participate in assessment and preparedness measures for other hospitals across HHS Region VII, which is Nebraska, Kansas, Iowa, and Missouri. And so we collaborate with the health departments on exercises, and we’ll do protocol review if people reach out and say here’s what we’re thinking for a response plan. What guidance do you have?

So we spend a lot of time in our region doing additional preparedness work, which is extremely important because the World Cup is coming and we have games in Kansas City starting June 16th. And so we’ve been working on that for about a year, making sure that if there’s any infectious disease risk whether intentional or natural that we’re prepared to support not just our own team but the rest of the region.

FLORA LICHTMAN: Intentional or natural, that’s heavy.

ANGIE VASA: It is, yeah. And I think there is a difference in the way that you respond to those types of threats and so making sure that people have at the forefront of their mind what does this mean for me, what does it mean for my team, what does it change in the way that we respond. Unfortunately, we do have to look at all of those risk factors when we’re preparing for events like this.

FLORA LICHTMAN: Yeah, bioterrorism. Angie, what calls you to do this kind of work? Health care seems stressful generally, but this seems really high stakes.

ANGIE VASA: Yea. So I joined our team in 2009. Our unit has been open since 2005, and I really have to give a lot of credit to Dr. Phil Smith, who was the founder of our special pathogen program here at Nebraska. And the way that he led our team and the way that he inspired people was really saying there was a monkeypox case well before mpox came in 2022. A

Small child who got infected from an animal, and the health care workers refused to take care of them because they were scared. And there was a very small group of people who stood up and provided that care. And after 9/11, and we would– had access to additional funding for improving the US capability to respond to international threats. He really framed it as there is no person in the United States who should be treated in a way that we are afraid to give them appropriate care and they suffer an adverse outcome.

And so for our team, for me to be able to have the knowledge and the skills and the ability to provide that care, hands on, frontline, but then also to help others be prepared to provide that care just really is satisfying and fulfilling. And it really is a small group of individuals who want to be in the responsive world because it’s unpredictable, and it does require a high degree of training and attention to detail. But I feel like for me, I’ve always been motivated by being able to do things that other people either can’t or don’t want to do and then expanding the field so that we have more people to follow behind us.

FLORA LICHTMAN: It sounds like a calling.

ANGIE VASA: Yeah. I’m fortunate that I have been able to find where I really feel like I can make the most difference while I’m here.

FLORA LICHTMAN: Obviously, people like you’re saying get scared of deadly diseases. What are the people in Omaha make of this center?

ANGIE VASA: So it’s interesting. Our– we’ve done a lot of work since 2005 to build trust and establish relationships with our local community, and throughout Ebola, COVID, mpox, we responded to Lassa fever in Iowa, and now this response, our local community has shown an outpouring of support. So on multiple times a week, we get a reach out from a local business or a local group asking what can we do to support you. What can we do to support the guests?

We’ve had sponsored meals. Actually today Omaha Steaks is here. They’re grilling in the parking lot, putting together lunches for the guests and the staff to make sure that they get the Nebraska Nice experience I guess you could say. And we’ve had businesses put together care packages that they’ve donated books and local artisan soaps and just a wide variety of products that are unique to Omaha and to Nebraska.

And so I think in our immediate Omaha metro area, we have a high degree of support because what our capabilities are. I think that’s in juxtaposition of what we’re seeing on some of the national front where people are asking why are we bringing people to the middle of the United States. Why Nebraska? What is the thinking behind this type of a strategy?

And so being able to reassure people that our team does train for this, we are ready to be able to provide care, that we have all of the measures in place to make sure that we have not– we are not posing additional risk to our community, to our state, to our health personnel. I think being able to demonstrate that and be able to stand behind those words with our team makes the public trust what we’re saying.

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FLORA LICHTMAN: Angie Vasa is the director of emergency preparedness and special pathogens programs at Nebraska medicine. Angie, thanks for talking to us today.

ANGIE VASA: Thank you. Flora, I appreciate the time. Good to be on your show.

FLORA LICHTMAN: Thank you for coming on. This episode was produced by Rasha Aridi. Thank you for listening. I’m Flora Lichtman.

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