North Carolina directly benefits from the work of global health researchers working in other countries, monitoring disease and containing outbreaks. For years, Fischer and David Wohl, MD, have contained diseases like Ebola virus, Marburg virus, Lassa virus, in West Africa, setting up field treatment units during outbreak settings to isolate and effectively care for patients. Their work in Liberia has directly informed emerging pathogen response and preparedness in North Carolina.
As the U.S. prepares for large-scale international events like the FIFA World Cup in 2026, national readiness for high-consequence infectious disease threats is more critical than ever. UNC Medical Center recently participated in Tranquil Passport to test North Carolina’s readiness, in coordination with the U.S. Department of Health and Human Services’ (HHS) Administration for Strategic Preparedness and Response (ASPR) and North Carolina state agencies.
As a designated Regional Emerging Special Pathogen Treatment Center (RESPTC), UNC Medical Center is one of 13 in the country dedicated to the care of patients with high-consequence infectious diseases, and the only one in North Carolina. The scenario practiced the international transfer of individuals exposed to a dangerous pathogen, similar to Ebola, using a newly developed portable biocontainment unit (PBCU) to safely isolate and transport patients with highly contagious diseases. This unit also allowed responders to safely continue treatment of patients until they can receive care at a RESPTC hospital.
Dr. William A. Fischer, II, Co-Director of the UNC Regional Special Pathogens Treatment Center and Director of Emerging Pathogens at the UNC Institute for Global Health and Infectious Diseases, explained how the center was designed for preparedness.
“As outbreaks of special pathogens increase in frequency and size, there is an increasing need to be able to respond both for the patients affected and to maintain the normal function of our healthcare system. The focus of the UNC Special Pathogen Response Center has been to create a system that enables the safe provision of the same comprehensive care to a patient with a special pathogen that every patient receives at UNC. UNC’s strategy, treatment space, diagnostic laboratory, and treatment team have been developed based on considerable experience responding to outbreaks of special pathogens. Leaning in during public health emergencies is part of the fabric of this University.”
Multi-Phase Exercise
The scenario began June 24 with federal officials facilitating a series of coordinated calls to plan the safe transfer of a cluster of simulated American patients from Toronto, Canada, to the U.S. Over the following days, the exercise tested all aspects of the National Special Pathogen System (NSPS)—a tiered network of hospitals and response partners trained to manage dangerous infectious diseases.
For UNC Medical Center, the drill began June 25, at Raleigh-Durham International Airport, where UNC’s Special Pathogens Response Center (SPARC) team rehearsed procedures for safely moving a patient arriving in a biocontainment unit, from a large aircraft to a Carolina Air Care ambulance.
SPARC is a team of experts in emergency medicine, critical care, infectious disease, trauma surgery, psychiatry, nursing, laboratory science and more, promoting a culture of preparedness and readiness for special pathogen outbreaks. Over the past year, this response team has been training extensively, both in Chapel Hill and around the state, conducting exercises with a hands-on approach to preparedness.
The next phase of the drill took place June 26 with the SPARC team receiving and managing the patient at UNC Medical Center. The team tested patient care, focusing on interdisciplinary coordination among critical care specialists, infectious disease experts, laboratorians, and transport teams. The simulation also included a mock surgical procedure within the biocontainment unit, allowing the team to exercise infection control, communication, and clinical workflows required to safely perform emergency interventions in a high-risk environment.
“Historically high mortality rates associated with special pathogens have been sustained by inadequate supportive care and lack of access to critical care. We have worked hard to change this paradigm at the sites of outbreaks and have put into place a system at UNC that enables the full complement of care. “This exercise will help us identify challenges in doing all the things that we normally do for patients.”
SPARC’s Infection Prevention Program Manager Brooke Brewer, BSN, RN, MS, CIC, described Tranquil Passport as a unique opportunity to push the boundaries of preparedness.
“The drill not only simulated routine biocontainment care, it included a surgical procedure within the unit,” Brewer said. “This served as a critical test of our infection prevention protocols, interdisciplinary coordination and teamwork, and our ability to deliver complex medical and surgical care while maintaining the highest standards of teammate and patient safety.”
“In addition to patient care, UNC’s SPARC also works with local, regional and federal partners to build national preparedness, and then coordinates response to an actual event” said UNC SPARC Co-Director Dr. David Wohl.
SPARC Training
Nurse Erica Gales volunteered to be on the SPARC team to train rural areas of the state in preparedness. On a regular day, she manages the hip and knee replacement program at the UNC Hillsborough Campus.
“If someone with a high-consequence infectious disease threat comes through our front door, we activate this whole team. But most hospitals across the state don’t have a team like this. That’s why we’re training frontline individuals, people with EMS, emergency departments and staff, anyone who works on a response team at a local rural hospital.”
Training introduces core skills like lab collection, waste management, and the cleaning of patient rooms, as well as logistics. “We talk through policies, procedures, and standards of practice, and we share what we’ve learned. Then, we talk through response algorithms.”
SPARC Laboratory
Dawn Smith manages the SPARC Laboratory, working with laboratory specialist Catherine Gatlin and Dr. Herbert Whinna, director of UNC McLendon Laboratories and associate professor in pathology and lab medicine.
“If the SPARC unit is activated, our self-contained lab activates. Samples are brought down to us where we can perform the laboratory testing safely. We hope we never see anything like Covid again, or another infectious disease threat, but if we do, we’ll be prepared.”
In October 2022, the U.S. Department of Health and Human Services’ Administration for Strategic Preparedness and Response (ASPR) selected UNC to become a regional expert in civilian biodefense, joining Emory University, as the only two RESPTCs in the Southeast.
Nationally, this multi-agency, multi-hospital exercise in June involved more than 50 international, federal, state, and local partners. It simulated the coordinated movement of American patients with high-consequence infectious diseases to five U.S. regional treatment centers, including UNC Medical Center in Chapel Hill.