NETEC Leadership Reflects: A Decade of Special Pathogen Preparedness in the US

Hello and welcome to Transmission Interrupted.

2

My name is Jill Morgan.

3

I'm a nurse here at Emory

University Hospital in Atlanta.

4

For those of you not yet familiar with

NETEC our mission is to set the gold

5

standard for special pathogen preparedness

and response across health systems in

6

the US with the goals of driving best

practices and closing knowledge gaps

7

and developing innovative resources.

8

NETEC works alongside and in

cooperation with the CDC and is

9

funded by ASPR the Administration for

Strategic Preparedness and Response.

10

And that's exactly what we're gonna dive

into a little bit today, which is...

11

where we started, how we

came to be as NETEC, and why.

12

So, I get the opportunity to talk

with three of the NETEC leaders,

13

our principal investigators.

14

That's, usually sort of a research term.

15

It may not be familiar to people outside

of academic medical centers or other

16

research areas, but it means that these

leaders are responsible for what happens

17

with grant funding and overseeing NETEC's

mission and management and finances.

18

So, these three represent NETEC's

three founding institutions

19

of - University of Nebraska Medical

Center, Emory University, and New

20

York Health and Hospitals Bellevue.

21

And we're gonna look back to where

we as an organization and they

22

were a decade ago, and where

they see us going in the future.

23

So, I am thrilled to have

today, people that I have a

24

tremendous amount of respect for.

25

Dr.

26

Aneesh Mehta, who's the Professor of

Medicine, Chief of Infectious Disease

27

Services, and the Assistant Director

of Transplant Infectious Diseases at

28

Emory University Hospital in Atlanta.

29

I have Dr.

30

Vikram Mukherjee, who is Chief of

Critical Care at New York Health and

31

Hospitals Bellevue, Associate Professor

of Medicine in Pulmonary Critical Care

32

and Sleep Medicine at NYU Grossman

School of Medicine, and he's the Chief

33

of the Bellevue Special Pathogens Unit.

34

And John Lowe, who's a virologist and

environmental scientist at the University

35

of Nebraska Medical Center, where he is

also the Executive Director of Global

36

Health Security and the director of

their special pathogens unit at UNMC.

37

So, welcome guys.

38

I'm thrilled to have you, and I'm so glad

you could carve out some time for today.

39

John Lowe: Greetings, Jill.

40

Happy to be here.

41

Vikram Mukherjee: Absolute pleasure, Jill.

42

Thanks for having us.

43

Jill Morgan: All right, let's take

a look into the way back machine.

44

Vikram, I'm gonna start with you.

45

' I think that you are maybe

the youngster of this group.

46

What were you doing a decade ago

that led you into this world?

47

Vikram Mukherjee: Great question, Jill.

48

So, back in 2014 when Bellevue

was just about entering the world

49

of high consequence infectious

diseases, I think almost a decade

50

and more behind Emory and Nebraska.

51

In 2014 I was the pulmonary critical

care fellow here at Bellevue, but in

52

absolute awe of my predecessors, Dr.

53

Laura Evans and Dr.Amit

54

Uppal, who not just prepared Bellevue for

a safe, effective response in New York

55

City, but were the clinicians in the room

along with Director of Nursing, Trish

56

Tennill to take care of Craig Spencer

in a safe, effective manner without

57

any healthcare workers being infected.

58

So I was in absolute awe of the response

and the preparedness efforts that went

59

into it in a very accelerated manner,

but also absolutely surprised by the

60

entire ripple effects that surrounded

patient care response between public

61

health, and media, and the entire eyes

of the nation watching patient care.

62

I think that took me by a lot of surprise

as a young fellow going through somewhat

63

of a response adjacent role at that time.

64

Jill Morgan: Well, certainly in critical

care you think about all the things that

65

put people in ICUs across United States.

66

Sepsis and respiratory

failure and things like that.

67

And, the care you ended up delivering,

or was ended up being delivered

68

at bio containment units, was not

that different, but certainly not

69

what you might've expected when you

got into critical care medicine.

70

A little different for Aneesh.

71

So, Aneesh, you a decade ago where coming

at this from a little different angle.

72

Aneesh Mehta: Yeah.

73

So Jill, you know this as well as I do.

74

So, Jill Morgan, for those of you

don't know, was part of my training.

75

So when I was a resident fellow,

Jill was a MICU nurse and, was

76

part of my bringing up as a doctor.

77

We happened to be the physician

and nurse on call when the Emory

78

unit was activated in 2014.

79

And, I had the pleasure, and the anxiety

was quelled by, working with a partner

80

that I had worked with for many years.

81

So yeah, we started out, I think as

you mentioned, doing what we normally

82

do every single day in the hospital,

but not knowing exactly how that was

83

gonna go in, this, special setting.

84

Jill Morgan: And then, as that response

grew we got to work with the great team at

85

the University of Nebraska Medical Center.

86

Remember, being on call with Shelly

and, Phil Smith in those early

87

days, working all together, figuring

out how we were gonna do this.

88

and then later, of course the great

preparedness, of the New York City Public

89

Health System and York City Health and

Hospitals, reaching out to both of our

90

institutions to work with all of us.

91

And we all learned together and we grew

together, and it's been an organic,

92

family growth for the, past decade plus.

93

Yeah, you know it's interesting to me.

94

You guys almost each have an aspect of

NETEC within your own backgrounds, right?

95

Like the critical care and the importance

of that level of medicine, and then you

96

have infectious diseases and really

being on the lookout for these things.

97

And then you have Dr.

98

John Lowe who is coming at this

really from the, virology,

99

laboratory science, environmental

science of safety kind of aspect.

100

So, John, a decade ago for you as

a virologist and really thinking

101

a lot about what we would think

of as maybe environmental and

102

occupational health risks.

103

What was happening in

your world 10 years ago?

104

John Lowe: Oh man, Jill, so, you said

it, I'm the non-clinician of the group,

105

which is always interesting, right.

106

Especially in a very clinically

focused, stream of work.

107

But I, I was brought into the Nebraska

Biocontainment Unit years before as

108

part of my doctorate program by Phil

Smith and, and Shelly Schwedhelm,

109

to really bring science and to push

forward an interdisciplinary lens

110

to how the Nebraska Biocontainment

Unit developed protocols and things.

111

So, I was a few years post-PhD,

112

I was having a bit of an existential

crisis, Jill, where at that point

113

in time, these high level isolation

units were really fledgling and in a

114

tenuous situation where I was in a new

faculty role, focusing my scholarship

115

on biocontainment unit operations.

116

So how do we bring in science of virology

and industrial hygiene to answer questions

117

that the clinical care team had that

there just wasn't evidence for and

118

trying to generate our own evidence.

119

So things like how do we decontaminate a

patient room after viral hemorrhagic care?

120

How do we know if the way that we're using

personal protective equipment is actually

121

safe and effective for our care provider?

122

So doing a lot of that, but at that

point in time there was no interest of

123

funding agencies in supporting that work.

124

In June of 2014, we actually had a

meeting where we reviewed that our annual

125

operating budget to sustain readiness of

the biocontainment unit was about $17,000.

126

And for us, this was a crisis moment where

we came together as a small leadership

127

team and said, you know, we think we can

commit to this for one more year, but

128

we're not sure we can sustain readiness

of a clinical care team for high level

129

isolation with this amount of funding.

130

And so for me as an individual, I was

kind of at this point where I was like,

131

I've maybe made a huge mistake with my

career choices and should maybe start

132

looking at a completely different path.

133

And then as Aneesh said, things changed

really quickly to where perhaps the

134

irrelevance of what we were doing, and

we were spending a lot of time focusing

135

on, all of the sudden became very

relevant and very crucial, not only to

136

ourselves, but to our health system,

the US health system, and probably most

137

importantly, the frontline healthcare

care providers that were deployed for

138

that 2014 West Africa Ebola outbreak.

139

Jill Morgan: Yeah, really important to

put this in place because you mentioned,

140

John, sort of that late spring, early

141

afar, most of us, really the terrible loss

of life that was going on in West Africa

142

at the time with the Ebola outbreak.

143

So in some ways, looking back, I

think, well, gosh, if we weren't

144

willing to fund it, then when there

was all of this stuff going on.

145

Yes, I can imagine from your perspective

it'd be really discouraging, for all

146

of you to think about how are we ever

gonna convince people this is a smart

147

thing to do if we can't do it now?

148

So, I wanna kind of pivot to

when did you realize things were

149

changing and gonna change a lot?

150

I think, John you just alluded to

that, but Vikram really like did

151

you see, after the team at Bellevue

had taken care of your patient, did

152

you see that this was going to be

something that was gonna take off?

153

I mean, did you really feel like,

oh yeah, this is a time of change?

154

Vikram Mukherjee: That's

a good question, Jill.

155

And you know, I think the

Bellevue experience with Ebola

156

was honestly a wake up call.

157

And I think, just looking at the

last 11, 12 years since then,

158

that wake up call has proven true.

159

That yes, we had a few Ebola

patients here, but that's not

160

once in a lifetime experience.

161

With many factors, be it global warming

or increased human to animal interface,

162

to increased international travel.

163

These outbreaks, wherever they start

on the planet will come to US shores.

164

An outbreak for anyone becomes

an outbreak for everyone.

165

I think it was towards the tail

end of the West African outbreak

166

is when the team realized that the

threat's gonna come to your doorstep.

167

Whether you prepare is your choice,

but the threat's don't wanna avoid you.

168

So, might as well invest in preparedness.

169

Make sure two priorities, that

the patient himself or herself

170

gets good standard of care.

171

It shouldn't be a patient that's

relegated to a corner of an ER and

172

everyone's so scared that he or she

doesn't get the care that they need.

173

And the healthcare workers,

which I think I've repeatedly

174

mentioned, is the strongest asset

for any healthcare delivery.

175

A hospital bed is useless if we

don't have physicians, nurses,

176

respiratory therapists providing care.

177

So, making sure that they're safe

in a high risk environment as an

178

HLIU is a high priority for us.

179

So, I think that was a wake up call

that, yes, Ebola came to our shores,

180

but these things, as we saw in the

pandemic, as we saw in Embox, will be

181

recurring themes for the near future.

182

Jill Morgan: Yeah, a high

level isolation unit may.

183

Not seem like something

everybody needs until you do.

184

And then everybody wishes

they had one, but you won't.

185

So I think you're absolutely right.

186

We have to work on this idea of,

ready or not, something will come.

187

So you were all in this sort of

stage and really contributed to the

188

readiness of your facilities and then

coalesced into what has become NETEC.

189

Can you walk us through, Aneesh, maybe

a little bit about how that happened

190

and a little bit maybe, I know we a

lot of time, but a little bit about

191

NETEC between 2014 and where we are.

192

now.

193

' Aneesh Mehta: Yeah, so I, I've

been reflecting a lot, as we

194

all have, on how we started and

where we're going in the future.

195

So it's really interesting.

196

Just picking up from what

Vikram has been talking about.

197

I think what brought us together

at NETEC were events like

198

what happened in New York.

199

And most specific to our origin

is actually not only what happened

200

in New York with a domestic case,

but a domestic case in Dallas,

201

Texas that actually then led to two

healthcare workers getting infected.

202

And that really sort of opened my eyes

to a different paradigm of what we

203

prepare for, at least at Emory, right?

204

Which has really controlled, transport

of patients into our setting, being able

205

to care for them, knowing what to expect.

206

And the fact that we had cases

that were discovered in the United

207

States and particularly led to

transmission to our colleagues.

208

I think that was not only

eye-opening for all of our teams.

209

I remember.

210

on a conference call with the team at

UNMC, at University of Nebraska, talking

211

about this a as it was unfolding in Texas.

212

And then, being part of the care.

213

And I think that's what

drove us all together.

214

But most importantly for our funders,

the Department of Health and Human

215

Services, the real understanding that

the US healthcare systems needed to

216

be prepared for this, not only to care

for the patients, but really to protect

217

our healthcare workers, our colleagues,

and to make sure that the continuity of

218

care of all of our patients was able to

continue, and be supported appropriately.

219

And so I think in those discussions,

our three institutions came

220

together very quickly and I

really would turn it over to Dr.

221

Lowe, who was very much a leader in

those conversations, of how NETEC

222

developed, but in my perspective, I,

again, was a clinician and a clinical

223

scientist, and was just really excited

to see leaders like Phil Smith,

224

Bruce Ribner, Laura Evans, Shelly

Schwedhelm, Trish Tennill, Jill.

225

and then our PhD scientists,

like John Lowe, and several

226

others, and also administrators.

227

So we had strong healthcare administrative

leads that worked at our three

228

institutions to bring all of this

together because I think what we realized

229

in our teams is that it cannot, one,

be hierarchical, and two, it can't be

230

just based off of what an infectious

disease doctor thinks, or what a critical

231

nurse thinks, or, critical care docs.

232

It really required all of our disciplines

to work together and to design an

233

intricate and fundamental, training

and education center that it, that

234

touched all those disciplines and

integrated them into one system of care.

235

John Lowe: So Aneesh, like what you

flagged is just we lived this, this same

236

experience and, October of 2014 - you

just described a lot of that for me to

237

where, even after Emory had taken their

first, or one or two repatriated patients

238

from West Africa, Nebraska, we had

taken a repatriated patient from here,

239

there was still a dialogue, Jill, that

had proceeded this and was still going

240

on, which is these specialized units or

programs that focus on this are probably

241

appropriate when we are intentionally

plucking a highly hazardous patient from

242

a location and deciding where in the us

to drop them for care, because there's

243

a lot of geopolitical implications.

244

There's a lot of that.

245

But the debate that underpin that

was that the US healthcare system

246

is really robust, it's highly

resourced, and we have accreditation

247

standards and we deal with infection

prevention control on a daily basis.

248

And so there was this...

249

this dialogue that underpinned that

all the way up until October, September

250

30th, 2020 14 and and into October.

251

That was any, any hospital in the

US at that point in time should

252

be able to care for a patient and

prevent that patient from infecting

253

healthcare workers and other patients.

254

And I think that we didn't realize

it at the time how much hubris was

255

driving that perspective of the

US healthcare system's capacity.

256

Right, Jill?

257

And so September 30th, 2014, this patient

presents who had traveled back from

258

West Africa, presents to a hospital

in Dallas, and there were a number of

259

things that were not implemented at

that particular hospital or in that

260

health system because they didn't have

a special pathogens program, right?

261

What played out was that the

patient was misdiagnosed, sent home.

262

There was, broad exposures in the

community and in the health system.

263

The delay in care for that patient,

I think, escalated their illness.

264

By the time they got definitive

care, it was almost too late.

265

It fractured the confidence in the US

health system overnight to where we saw

266

nursing unions in Dallas and in New York

and across the country going on strikes

267

and marching in the streets saying,

we're not safe to provide care for this.

268

And so the net effect of that right,

was that it took these few programs that

269

were maintaining, you know, barely on

a shoestring, these capabilities and

270

it pushed the approaches to infection

prevention and control patient care,

271

and all of the wraparound things like

attending to family, supporting their

272

loved one who's admitted, working with

public health in the community to the

273

forefront as this is a model that needs

to be validated across the country.

274

So, and Jill, I think,

you're a part of this.

275

I know Marshall Lyons from Emory and

I deployed to New York in November to

276

go look at three or four hospitals in

New York and look at their readiness

277

to receive patients like this.

278

And this happened rapidly.

279

This was the rapid Ebola preparedness

initiative that CDC marshaled as

280

a result of it over about 30 days.

281

We, in partnership APIC and CDC

and Emory, Nebraska visited and

282

assessed the readiness of, of

50 hospitals across the country.

283

And, this list was published, right,

of these are 55 hospitals that, have

284

had some level of assessment and are

ready to care for these patients.

285

And it immediately kind of deescalated

the t emperature of US healthcare

286

providers that okay, there are places

where we can send those patients if

287

they come to our site and we'll be safe.

288

And that really led to a series of

events that the formalization of

289

training, of assessment and of standard

setting, opened the opportunity to

290

create this national center to really

attend to that for the country.

291

And when that opportunity dropped, it

was initially worded as we're gonna

292

fund one entity in the US to do this.

293

And I remember it was, I think within

three days of that dropping, Jill, a

294

group of us convened in Atlanta at Emory,

Bruce Ner, Laura Evans, Phil Smith.

295

I was lucky enough to be in the room and

it took about 15 minutes of conversation

296

about there's this opportunity, we've all

had this collective experience, but we

297

think what the nation needs is something

that's backed by all three of us.

298

And in that room that day, we agreed

to form a consortium and kind of stand

299

up the nucleus of this national center.

300

It did require that we went back to the

federal government, ASPR at the time and

301

say, could you rewrite the opportunity

and allow a consortium, a group of

302

partner sites to do this together?

303

They did.

304

and we kind of proceeded from there.

305

Jill Morgan: That's fantastic.

306

Vikram, I wanna give you the opportunity

before to really kind of talk about the

307

vision you have for where we need to

go, where you see us going, what the,

308

barriers are to getting there because I

know that, you had some thoughts on that.

309

Vikram Mukherjee: thank you Jill.

310

As John and Anisha were, mentioning,

we shouldn't have the hubris that

311

every single hospital across the US

can take care of high consequence

312

infectious disease patients.

313

Back a few years ago, there were

10 RESPTCs along with a couple of

314

pediatric partners, a few years

ago that went to 13 RESPTCS.

315

But even that leaves massive, massive

gaps in US territory for patients to

316

come and present in a frontline hospital.

317

And, uh, it's tough for a frontline ER

to have the same level of preparedness

318

as a well-resourced, RESPTC.

319

Great news, earlier this year, NETEC

announced 54 new level twos on the

320

NSPS map, and hopefully over time

those will come to capabilities

321

to providing safe, effective care.

322

but I think the biggest challenge

that, where I wanna see this going

323

is we have those mountains of gaps

covered so that a patient, wherever

324

he or she presents, can have the

same level of safe, effective care.

325

Healthcare worker safety.

326

And, good, supportive care, gets,

met wherever the patient arrives.

327

Of course, easier said than done.

328

This needs funding.

329

So far we've relied entirely

on, you know, federal funding.

330

I would love to see some more private

partnerships being built because

331

when a, for example, during COVID, a

city, like New York City shuts down.

332

Huge amounts of GDP drops.

333

I know I was looking at the numbers.

334

The US GDP dropped $14 trillion

dollars, and, that doesn't even

335

negate the fact that we have had 1.2

336

million deaths in the US from COVID alone.

337

So I think to get to a state where

we have, not just the centers of

338

excellence, the 13, not just the 54

level twos, but more capabilities

339

across the US, needs funding.

340

And I think instead of going into the boom

and bust cycle where there's an outbreak

341

funding pours in, peace time funding

recedes, we need to advocate and continue

342

to press for sustained federal and

public-private partnerships to make sure

343

that preparedness is key to any response.

344

Jill Morgan: I think that's well said.

345

And certainly, we think

about preparedness in other

346

ways in our lives, right?

347

How many of us have smoke

detectors in our house?

348

Have you ever had a fire in your house?

349

Would you think oh, I haven't had a fire

in my house for the last five years let

350

me just get rid of these smoke detectors.

351

I don't think most of

us would think that way.

352

And yet people feel like, oh, we

haven't had one of these happen in a

353

while, eh, we don't need to fund that.

354

It's kind of kind of scary.

355

So it sounds like to me, and again I

was immersed in Emory's program, but

356

really not thinking about anything

global until we got the call that

357

we're gonna get a, repatriated human.

358

Our unit was designed really to

serve just the interest of our CDC

359

neighbors, in case somebody got

exposed in the field or in a lab.

360

So, we weren't expecting something like

a sick human coming from another country,

361

but it seems like we went from, this'll

never happen to, well, everybody really

362

should be ready to, well, let's make some

places that are specialized and ready.

363

And now in many ways we've gone

back to this idea that maybe we

364

really can make everybody ready.

365

That's a big lift.

366

And so I want to explain a few

things that, we've been probably

367

referring to with acronyms.

368

So, NETEC started out as the

National Ebola Training and

369

Education Center, N-E-T-E-C.

370

that's because our funding

was specific to Ebola.

371

And now as we think more about special

pathogens, we've expanded that to the

372

National Emerging Special Pathogens

Training and Education Center.

373

We have what we call RESPTC facilities,

regional emerging special pathogens

374

treatment centers, and there are

13 of those across the country.

375

As Vikram just said, we've now

funded 54 additional level twos.

376

So if you think about the trauma

network, you have a Level 1 trauma

377

center, can handle anything.

378

Level 2, you know most things really well.

379

We need more Level Twos

that are out there.

380

And so now we're funding 54 and getting

them to the point where they feel

381

confident accepting a, patient like this.

382

This idea of a national special pathogen

system of care, actually integrated

383

into the US healthcare system is so...

384

gosh, I'm not even sure what

adjectives I should use.

385

It's big, it's complex, it's

overwhelming to think about.

386

It's a lot.

387

So tell me what y'all think about this

future of this as a special pathogen

388

system, not just these little polkadots

of people that might be prepared.

389

John Lowe: Yes, I'm happy to jump on that.

390

You know, I think one thing that we

know is that 13 highly specialized,

391

small capacity facilities are never

gonna meet the needs of a country

392

the size of ours geographically

and from a population standpoint.

393

Right?

394

Um, On the flip side of that,

Jill, you, you nailed it.

395

We can't shoot for an endpoint where every

hospital in the country is a definitive

396

care site for this type of thing.

397

So, I do think that this envisioning of

a system with levels of care defined,

398

that can be applied throughout the US

health care system to make sure that

399

some of the core lessons learned,

that we already flagged, right?

400

So.

401

Some of the things that we saw back

402

are addressed system-wide, our

ability to identify and diagnose any

403

patient that walks in anywhere in

an effective way so that we limit

404

secondary transmission to loved ones,

to community members, to healthcare

405

providers is really the goal, right?

406

And that we can initiate definitive

care as fast as possible and still

407

protecting all of those populations.

408

So a big part of it has become.

409

Defining these different levels and

each level as you go down in level,

410

There's a, a smaller capability set and

a higher number of facilities across

411

the country that can provide that.

412

And for those frontline facilities that

are throughout the US where if you're

413

sick, you could go to any one of these

and present and you really need them to

414

figure out what you have and to do care

in a way that doesn't threaten others.

415

So that's really what the foundation of

the system that we're shooting for now

416

is, some kind of minimum capabilities that

we have distributed across the US that

417

really drive for identification, right?

418

That this is a disease that we're

managing and ability to effectively

419

isolate, those cases and to inform

the overall apparatus of the system.

420

Government agencies, higher level

care sites, to make sure that we

421

can marshal all the resources that

we have in the US to provide care.

422

I think the reality that's driven that

forward is the standard of care in the US.

423

and this is part of what we got past

the hubris with this acknowledgement,

424

which is we are not okay in the US with

saying, you've got a disease, probably

425

gonna die from, go sit in the corner, or

here's an IV and standing back, right.

426

Our healthcare providers, day in and day

out, throw everything at saving lives.

427

And that doesn't change because

it's like a highly risk pathogen.

428

So that is what really drives this

need for a higher level of a, readiness

429

and a robust, sophisticated system.

430

Jill Morgan: Yeah, I agree completely.

431

Aneesh.

432

Aneesh Mehta: I think, John, you

said it very eloquently, I go back

433

to what you were just talking about,

Jill, this cycle that we've gone

434

through in this thinking right?

435

The hubris that, we really all

could do this, should do this.

436

The US healthcare system, as John

mentioned, I think we all had this

437

facade that we could just take care of

everything that came at us and we're

438

ready because we're highly resourced and,

and realizing that that is not always

439

true and not in the way, and then we

created these specialty centers, but then.

440

Other things let us know very

quickly that 13 sites are not enough

441

and we've come back to this cycle,

wherever it needs to be prepared.

442

But I think the maturity in what NETEC

has conveyed and what ASPR has conveyed

443

is that everyone needs to be part of this

solution, but everyone doesn't have to

444

play the exact same part in that solution.

445

And I really credit, a lot of this

to, Shelly Schwedhelm, who really

446

took the conversation about the

NSPS strategy and really helped us.

447

with the uh, system of care group working

with hospitals of all types, partnering

448

with Paul Biddinger, really put

together some great thoughts on minimal

449

capabilities at each of these levels

that had been defined and how people can

450

easily obtain the right level, the right

minimum capabilities for their setting.

451

So that we really figured out the way

that everyone can participate, but we

452

also make sure that we can have the

appropriate levels of care when needed.

453

And we know this has been successful

in many other, systems of care here in

454

the United States and around the world.

455

I think the US we have an amazing,

system of trauma care and great

456

system for burn care and stroke care.

457

And so we've learned from those lessons

that again, everyone has to take part, but

458

everyone's role is a little bit different.

459

And the other thing I would add is,

touching on what John was just talking

460

about, our healthcare workers are

built, to take care of people and

461

they want to take care of people.

462

So we have to create structures

in which they can safely and

463

effectively care for individuals.

464

And we talk a lot about this, particularly

in academics, of what that pathogen in

465

the room is and what tests we're gonna

do, and what treatments we're gonna do.

466

But the crux of the system, and Jill, this

is something you and, and, uh, nurses like

467

you have taught me from the very beginning

of my training is in that room as a

468

human being who's part of our community.

469

That's part of a family

just like our family.

470

And the people, regardless of what their

role is, going in and out of those rooms,

471

are also human beings that have other

responsibilities and want to care also for

472

that human being in that room who is sick

and care for their colleagues as well.

473

And so I think that is part of the

driving culture of NETEC and we brought

474

that culture of humanity in science and

in medicine, and our approach to special

475

pathogen care, into what is the NSPS.

476

And again, it gets right back to everyone

takes part, everyone plays their own

477

role and working together, we have an

integrated sustainable network of care.

478

John Lowe: Yeah, and I, I wanna,

you know, just as the non-clinician

479

in the, in the group, the national

group, I wanna be just the hype man

480

for a minute, for you two, right?

481

Because.

482

We've talked a lot about the system and

like, you know, protecting different

483

communities at the, at the end of the

day, it's about saving lives and, um,

484

the, the fatality rate of patients that

were cared for in the US was different.

485

They received a different level of care.

486

I mean, the work that you two

did at Emory that really set

487

the roadmap for the rest of us.

488

I think that the first to do dialysis,

the first to intubate, these are types

489

of advanced supportive therapy we

would've never dreamed of providing

490

to patients with a disease that's

highly lethal and easily transmitted.

491

And so the reality of what's

created in these spaces of these

492

care units is the ability to

really provide deep advanced care.

493

And what we learned is that these

diseases, that in some cases have well

494

over a 50% fatality rate, we can buy

that down to 10%, 15% with the level

495

of care that we are able to provide.

496

But the trade-off is the risks increase

when we do those interventions.

497

And so back to the hype man, what

you guys did at Emory before anyone

498

else in the world had done it, was

really groundbreaking and I think,

499

really gets back to why we do this.

500

It's not just about preventing

secondary infections.

501

It is about saving lives of, the

patients that present, and that

502

is uniquely possible for these

types of pathogens in this space.

503

As you were saying that, Aneesh I went

straight back to remembering as we were

504

preparing to take our first patient and

watching everything that was being done

505

at Emory and realizing these advanced

interventions work, and we can do them.

506

It's not easy, we have to do a lot of

planning, but this is why we do it.

507

And then to see patients walk out

the door and be hugged by their

508

care team and their families.

509

When they were brought to us nobody

envisioned that that was a possibility.

510

Jill Morgan: Yeah.

511

No, it's absolutely possible, John, , and

I appreciate being prompted to think

512

back to that because we really did

have patients that were brought to us.

513

Thinking that they maybe had

been brought back to the United

514

States in order to just die here.

515

And what a terrible psychological

place that is for them to be in.

516

And we really did feel like if we could

do it safely, we were gonna try to do it

517

no matter what it was, so we could deliver

the same level of care that we deliver

518

in our intensive care units every day.

519

That's the goal, I think for everybody,

but we have to marry it with staff

520

safety and I think to me, this is

what, you know, I tell people this is

521

the hill I am willing to die on, which

is we have to elevate staff safety.

522

This is not a situation

where people can be.

523

cavalier it literally would be

like running into a burning building

524

without any fire protection on.

525

We can't let people do that.

526

We have to raise the level of awareness

about what PPE does and doesn't do.

527

We have to raise the level of

understanding about infection

528

prevention and control, and using

the right tools for the right job.

529

And just making sure that the care

we want to deliver doesn't bring

530

with it any unnecessary risks.

531

And I, I mean, I tell the people this

all the time, you know, I get it.

532

I was an ER nurse at a 36 bed hospital.

533

When somebody runs in the door

carrying a limp child, I'm

534

gonna take that limp child.

535

Right?

536

PPE be damned.

537

But if I've got somebody with a

fever, cough, travel, history,

538

rash, nausea, vomiting, diarrhea,

alright, ding, ding, ding.

539

You've got a travel history, you've

got symptoms I'm putting on PPE.

540

I'm putting you in isolation.

541

We're gonna deliver great care, but

we're also gonna protect ourselves.

542

We're at 10 years and we've done

so much and we've touched so

543

many people across the country.

544

I'm so grateful for the opportunity

this has given me, to go out and

545

teach what I would consider the

gospel of PPE, but I think that.

546

There's so much more to do.

547

So I just wanna spend a couple

minutes with you guys thinking about

548

like, what are concrete next steps?

549

What can other places do?

550

Other facilities?

551

What should we be asking

when we are in front of our

552

governmental relations people?

553

Or we're in front of, our, church giving

a speech, or whatever we're doing...

554

where do we need to go with this?

555

Aneesh Mehta: Yeah, well, I'll jump in

and then, let, John, also contribute

556

some important information, Just

building on what you just talked about,

557

and now I'm gonna be the hype guy.

558

So, I think as healthcare workers, we go

in and, we wanna take care of patients.

559

What you guys have both brought from

the clinical perspective and the

560

scientist perspective is how do we do

this well and how do we do this safely?

561

And I think it would've been really easy

and, and probably my instinct to say,

562

well, we, we took care of four patients.

563

None of us got sick.

564

We probably did it all right.

565

Right?

566

And we did do it safely.

567

None of us got sick, but like people like

the two of you were like, but okay, how

568

are we gonna do it better the next time?

569

How are we gonna keep more people safe?

570

How are we gonna make sure that a

different type of pathogen doesn't get

571

through our, protocols our our barriers?

572

I remember as we were having those

early conversations in NETEC and

573

seeing all of John's papers and like,

oh, wow, there's a lot more to think

574

about than I've been thinking about.

575

And then in COVID just watching the

great work that all of our sites

576

did, but thinking about how we decon

things appropriately coming out of

577

John's group and then you, Jill, like

really driving us to think about...

578

beyond what people tell us protection

does, like what does it actually do

579

for us and how do we make that better?

580

How do we work with these tools

better and integrate them better?

581

So I feel, fundamentally, we are safer in

the work that we do in biocontainment care

582

- high level isolation units today than we

were 10 years ago, and I am very confident

583

in 2, 5, 10 years we'll be even better off

and better able to care, for individuals.

584

And I, I would not have had that

thought process, without, folks like

585

you pushing, and bringing that to

NETEC I think it's really important

586

as we have these discussions, one of

the differences between what we do in

587

special pathogen care and what happens

in burn and what happens in trauma is

588

those events don't affect, usually, the

health of the caretakers, the caregivers.

589

But these events do.

590

I think the other fundamental part, and

that has to be part of the conversation,

591

is that these events, like trauma

unfortunately, and burn unfortunately,

592

happened on a daily basis in our country.

593

Fortunately for our communities,

high consequence infectious diseases

594

don't happen very frequently,

and we wanna keep it that way.

595

But the, flip side of that coin is because

it doesn't happen, it is not on the

596

front of everyone's mind all the time.

597

And it takes major events

as Vikram mentioned.

598

We have to make sure that we, that

have been part of this, we that have

599

seen patients go through this, have

seen that, concern in our colleagues

600

face, as they're thinking about doing

this to make sure that it is on the

601

front of the minds of our healthcare

systems, of our government officials.

602

And in our communities to understand

that we're out there working very hard

603

to make sure that we're all safe and

be able to do the work that we do.

604

And that unfortunately, while

not frequently, um, these events

605

will eventually affect Americans.

606

But also to put a silver lining on that

particular part of the cloud is that,

607

work that we do in this preparedness and

the care that we give actually makes us

608

safer, not only, as healthcare workers,

but as communities in the future.

609

And one example that, , I think has

been really insightful to me are

610

things that, , I've heard from, Dr.

611

Brantley and, Dr.

612

Crozier, well after, they were no longer

our patients, is that when they've gone

613

back to Africa, they have seen the work

that our three institutions and other

614

institutions in the United States, whether

it be getting a piccolo device or some

615

sort of, ability to look at electrolytes

into the field, the protective equipment

616

that is usable for human beings for

more than 30 minutes into the field.

617

And because of that fundamental work

that I think our three centers did in

618

our care, and then putting it into the

scientific literature, training people

619

on it and showing its effectiveness has

actually allowed the care in the places

620

where a lot of these outbreaks occur

to greatly improve, protect healthcare

621

workers, there, protect American citizens

who are there so that we don't need

622

to transfer, people back frequently.

623

People who do come back and travel

back are safer doing so in their

624

communities, are safer doing so.

625

So I think keeping all of those in

the forefront of our colleagues in

626

healthcare and our community, uh, members

is really important to our mission.

627

Sustainability.

628

Speaker 2: Alright, John, your turn to

just wrap it up, knock it outta the park.

629

Just, finish us off here.

630

John Lowe: What more

can you say than that?

631

I agree with Anish and

that was really eloquent.

632

I think It's about saving lives, right?

633

And, you underscored the translation

of some of the lessons learned from our

634

dedicated and highly resourced health

system and units, to really frontline

635

where outbreaks occur, solutions and

implementations, measuring and managing

636

electrolytes, not something that was

doable or there wasn't a commitment

637

to do at some of these outbreak sites.

638

And now whenever there's an outbreak,

there is a will to make sure

639

that that's part of the response.

640

And there, that's just

one example of many.

641

So I think a big part of it is.

642

addressing the lessons learned that

we've been able to develop from a

643

small number of patients, but in a

high resource setting and figuring

644

out how can we get that to where these

cases are occurring at, that at the

645

highest level is a big part of it.

646

I think the other Jill, i'm probably

oversimplifying, but I always go back

647

to this, which is we can build the best,

most effective system in the world to

648

save lives, but if we don't know when

we need to use it, it's not any good.

649

So for me, it, really does continue

to come back to two things.

650

Astute clinicians, like ability to

recognize what you're looking at , and

651

what needs to be done with it.

652

And the other is a distributed

ability to, diagnose.

653

So, we still run into challenges and I

think we saw this really great vignette

654

with COVID where we as a country

struggled to marshal a distributed

655

test to diagnose if someone had

COVID or not for months into COVID.

656

That is emblematic of something that

a lot of people are familiar with,

657

but it's an emblematic of our US

health system's ability to diagnose

658

for diseases we don't see regularly.

659

And so I think, it's important for us as

a country and us as a special pathogens

660

collective, to really advance and

think about how do we diagnose better.

661

And this is applied in two ways, Jill.

662

One is there's pathogens that

have existed for decades.

663

We know what they are, we

know what they look like.

664

How do we develop diagnosed diagnostic

tools that help us identify them quickly

665

and readily at the point of care.

666

The other is that we are living in a new

world where synthetic biology is a thing

667

and pathogens that have not existed for

decades that we've never seen before could

668

be introduced and could be presented.

669

And how will we even start to

figure out what we're looking

670

at and, and diagnoses it.

671

But I think we have this awareness and

we have the technology, so advancing our

672

ability to identify what's in front of us

so that we can marshal these resources in

673

this advanced system of care effectively

is a huge priority I think for the

674

next 5 to 10 years from my perspective.

675

Excellent.

676

Jill Morgan: I so appreciate the

opportunity to talk to you guys.

677

This is something that has become a

passion for me and a real driver for

678

this, season of my professional life.

679

And I think while these are rare

events, I wanna loop back to something

680

Aneesh said, which is, preparing for

special pathogens can make us better.

681

And keep us safer from the everyday

things and when I'm teaching the

682

identify, isolate, and form and

initiate care model, one of the things

683

I say is if somebody has a fever and

a cough, I don't care what it is.

684

I don't want it.

685

If you've got a fever and diarrhea,

thank you, i'm gonna back up.

686

I don't want any of those

things, whether it's your cold

687

or your flu or your norovirus.

688

I just don't want it.

689

And therefore we need to put into

place, I think a thinking at the triage

690

level, at the first points of entry.

691

If this is something I don't wanna take

home to my children, or my parents,

692

or my spouse, or my partner, I need

to make sure I'm protecting myself.

693

And if I do that i'm gonna be much safer

whether that next human has influenza

694

or the next COVID or MERS or Ebola.

695

We need to think infectious disease.

696

We need to think about it being

something that we can protect ourselves

697

from instead of having a fatalistic

attitude that I completely admit I had.

698

I'll probably be MRSA positive anyway,

just from all these years in healthcare.

699

What the heck?

700

No, I don't wanna have

all the rest of the stuff.

701

Thank you very much.

702

So I'm grateful for the opportunity that

NETEC has given me to preach the gospel

703

of better healthcare worker safety, and

better knowledge about PPE, and really

704

driving this idea forward that we can

deliver great care in a safe environment.

705

That we can keep our community safe

and that it doesn't have to be an

706

awful experience for our patients.

707

That we can deliver great care

to them and their loved ones.

708

It's just been an honor and a

privilege and I've been so grateful.

709

So, I will not be here for the next 10

year reunion, but, I greatly appreciate

710

these last 10 years with all of you guys.

711

Aneesh Mehta: Jill, I just really

enjoyed this look back and look forward.

712

so thank you so much for hosting it.

713

John Lowe: Yeah, same here.

714

I just am so appreciating this moment

in time to reflect and think about how

715

we all went through something really

crazy and unique together and to be

716

able to spend 10 years continuing to

work together, I think sometimes my

717

family and my kids are like, what?

718

This is such a weird work thing because

you guys are all so close and you do so

719

much together, but we have become family

through a decade of really incredible

720

and unique circumstances, and I just

really appreciate the opportunity to

721

kind of reflect on that with you two.

722

Jill Morgan: Yeah.

723

Thank you.

724

It has been a tight knit club and we would

like to expand our membership, please.

725

So healthcare communities

country, we want you to join us.

726

Alright, well thank you to

Vikram, and to John, and Aneesh.

727

And thank you for joining us today

as we talk about this origin story of

728

NETEC and where we hope to go with the

national special pathogen system of care.

729

For those of you listening at

home, thanks for tuning in.

730

We hope you'll join us for future

episodes on a wide range of topics

731

that are interesting to you, including

healthcare worker safety and of

732

course personal protective equipment,

occasionally some stuff about trash.

733

And more about infectious

diseases of all kinds.

734

If you have questions for NETEC or

ideas for future shows, please feel

735

free to contact us at info@netec.org

736

or find us on the web

at netec.org/podcast.

737

Where you can also subscribe to future

episodes and find more information

738

about NETEC and today's guests.

739

So thank you again and we'll see you

next time on Transmission Interrupted.