Abstract
I
The contributions of HLIUs have extended far beyond the care of individual HCID patients. HLIUs played a role in treating some of the first patients in their respective countries with COVID-19 when SARS-CoV-2 emerged as a novel virus, they have supported the design of innovative systems for HCID isolation and transport, and, for many countries, HLIUs serve as centers of HCID expertise that can support regional HCID preparedness.5,6 Therefore, HLIUs are a crucial resource to manage outbreaks of novel pathogens—not only because of the physical biocontainment facility but also the highly trained workforce members who are mentally prepared to handle unusual diseases.
Despite these successes, HLIUs face ongoing challenges. The exodus of trained personnel from the healthcare workforce during the COVID-19 pandemic has adversely affected health systems; for HLIUs, this trend has exacerbated the difficulties in recruiting and retaining highly trained staff, particularly for units that rely on staffing on a voluntary basis. Another significant challenge is sustaining the funding necessary to maintain operational readiness, particularly for a capability that may rarely, if ever, be used. Funding challenges, as well as the infrequent nature of HCID incidents and HLIU activations, creates limited opportunities to advance the field of high-level isolation. Furthermore, tabletop exercises have shown that existing HLIU capacities in many countries would be insufficient in the event of an HCID outbreak requiring surge capacities.
Innovative approaches to addressing these and other challenges are emerging through global collaboration and research. Advancements in technology and scientific research are generating new tools and methods for improving high-level isolation practices, and increased experiences of treating patients in HLIUs prompts lessons learned with each case. International partnerships between HLIUs fills a critical gap by facilitating the sharing of best practices, expertise, and experiences.
In 2018, the National Emerging Special Pathogens Training and Education Center (NETEC), in conjunction with the Johns Hopkins Center for Health Security and the US National Institute of Allergy and Infectious Diseases, hosted an international workshop on high-level isolation with representatives from more than 20 HLIUs in Washington, DC, to share experiences, best practices, and foster relationship building.7,8 That workshop underscored the importance of global collaborative efforts; when funding was allocated by the US Administration for Strategic Preparedness and Response that allowed for engagement with international partners, NETEC established its International Partnerships and Programs to strengthen networking and facilitate collaboration with global HLIU teams. This special issue, which includes experiences and lessons learned from HLIUs in 11 countries across 5 continents, marks a significant milestone in those efforts.
This supplement is truly unique because it compiles in a single volume descriptions of approaches taken by different countries and regions to achieve optimal clinical preparedness for and response to HCID cases and incidents. It focuses on the current global landscape of high-level isolation and highlights the contributions of global HLIUs in responding to HCID events. It describes the ongoing challenges HLIUs face and innovative approaches to address those challenges through national and global HLIU research and collaboration. Additionally, it provides a vision for a future network of HLIUs that can be leveraged to strengthen national, regional, and global health security. This collection explores the current state and prospects of HLIUs in managing HCIDs, emphasizing the national, regional, and global importance of these unique facilities and the expertise inherent to them. These papers underscore the opportunities and significance of sharing experiences, best practices, and establishing relationships with other teams in this specialized field to improve individual HLIU practices, as well as the broader field of HCID management.
It is our hope that this issue will create opportunities for broader collaboration, expanded reach and impact of HLIUs, and enhanced awareness of the essential value that HLIUs bring to health systems across the globe.
Footnotes
Acknowledgments
We wish to extend our sincere gratitude to our colleagues that work in the HCID field, particularly those who contributed their work to this supplement. We are deeply grateful to the healthcare professionals and researchers who have shared their knowledge and experiences in these pages to continue advancing the field of high-level isolation and HCID management. We also wish to acknowledge and thank all of the patients treated in HLIUs, globally. We gratefully acknowledge our colleagues on NETEC’s Leadership Team and the International Workgroup whose dedicated efforts have been pivotal in expanding NETEC’s international initiatives, a cornerstone of this special issue. We also wish to express our appreciation to our colleagues at the Administration for Strategic Preparedness and Response, particularly Dr. Rick Hunt, Ms. Jennifer Hannah and Mr. Joe Lamana, for their advocacy in sustaining and expanding the opportunities provided to NETEC to facilitate global HLIU networking. We are immensely thankful to Dr. Eric Toner and Ms. Jennifer Shearer, co-guest editors, for their invaluable contributions and support in shaping the quality and impact of the articles included in this special issue of Health Security and to Sophia Shea, Sara Donovan, and Anthony Lo Piccolo for their support in reviewing abstracts and providing recommendations. Finally, our special recognition and heartfelt thanks to Ms. Kathleen Fox, the journal’s managing editor, and Ms. Katherine Stern, program manager for NETEC’s International Partnerships and Programs, for their steadfast support in making this supplement happen. This special issue was supported by the Administration for Strategic Preparedness and Response (U3REP150549).