Governor Jim Pillen (00:00):
... incredibly smoothly. It's due to outstanding communication and coordination of everyone involved. I simply want to acknowledge and be grateful for their incredible hard work. The passengers who are here at UNMC are going to receive nothing but world-class care. It's a guarantee. You can take it to the bank. This is not the first time Nebraska's been called upon to provide the facilities and care that's required critical medical situations like this arise. As [inaudible 00:00:32] know, these capabilities exist in our state and then we can provide the assistance when it's needed. I know all of my fellow Nebraskans are as well. As I could speak directly to the passengers who are now calling Nebraska and UNMC home for the coming days, we're glad that you're here. We're going to ensure that you have the best world-class care possible. We know it's been very difficult for you on this journey, one that will keep you away from your friends and your loved ones a little while longer, but you can be assured the medical [inaudible 00:01:10] are highly trained and compassionate, extraordinarily compassionate caregivers. And whatever they are and we can do make your stay as comfortable as possible we will do.
(01:26)
We have walked hand in hand with our federal partners from the White House to Secretary Kennedy to the CDC and all of their great teams. I am satisfied and Nebraskans can be that the rest of America can be satisfied that there is a strong plan in place and to ensure the folks are secure for their initial assessment and we are working diligently to ensure no one leaves this security in an unsecured way at an inappropriate time. No one who poses a risk to public health is walking out the front door of the streets of Omaha or beyond. Again, I simply want to say thank you again, Dr. Gold, to you and your team and all of our federal partners and state and local agencies that have all had a hand in facilitating and make an impact on getting Americans back home. Thank you.
Dr. Gold (02:28):
Thank you, Governor. And it's now a pleasure to provide some more information specifically on the operations and the condition of the passengers. I'd like to introduce Admiral Brian Christine. Admiral Christine is the Assistant Secretary for Health of the United States Department of Health and Human Services. Admiral.
Admiral Brian Christine (02:51):
Well, good morning. Thank you all for being here. Thank you especially to our partners at the Administration for Strategic Preparedness and Response. Thank you to Nebraska Medicine. And thank you to the University of Nebraska Medical Center. Thank you all for your leadership and your readiness in this response. At the Department of Health and Human Services, our approach is grounded in science and it's grounded in transparency. This is a whole of government effort across federal, state, and local partners who are all working together to ensure the safety of the American people. And let me be clear, risk of hantavirus to the general public remains very, very low. The Andes variant of this virus does not spread easily and it requires prolonged close contact with someone who is already symptomatic. Even so [inaudible 00:03:46] very seriously from the very start. We've taken it seriously across HHS and particularly through the Centers for Disease Control and Prevention. And I'm proud to see many of my US Public Health Service officers have been actively engaged in the response.
(04:04)
The CDC rapidly activated its emergency operations center. It deployed medical teams to assess passengers and coordinated closely with international partners. They have notified state health departments. They have initiated [inaudible 00:04:18] exposed individuals and they have [inaudible 00:04:21] through the Health Alert Network. They have also brought together national partners through coordination calls. They've developed tools and resources to support public health decision making. And they have ensured that both clinicians and the public have clear, timely information. Transparency has been and is the order of the day. And now with the safe arrival of these US citizens here in Nebraska, CDC teams are working side by side with ASPR, with UNMC, and with state and local officials to conduct assessments and provide ongoing monitoring and care.
(04:58)
This is what strong public health system looks like, experienced professional, seamless coordination, and a shared commitment to protecting the American people. We'll continue to follow the science. We will stay vigilant. And we'll keep the public informed every step of the way. As I said, transparency is the order of the day. Thank you. Thank you for being here. God bless you. God bless the state of Nebraska. And God bless our republic. Thank you.
Dr. Gold (05:32):
Thank you so much for those words. And now it is my pleasure to introduce Mr. John Knox, who's the Principal Deputy Assistant Secretary, Administration for Strategic Preparedness and Response in the US Department of Health and Human Services. And he will give us an update on planning and as we move forward.
John Knox (05:56):
Thank you, Dr. Gold. And thank you everyone for being here today. As mentioned, I'm John Knox. I'm the Principal Deputy Assistant Secretary for the Administration for Strategic Preparedness and Response. I'll start by noting that what you're all seeing here today is a true partnership and a demonstration between public and private partnerships. As all of you are aware, last night with the coordination of multiple federal agencies and in partnership with state officials, HHS supported the Department of State in a safe repatriation of 18 US citizens from the MV Hondius. This is a coordinated [inaudible 00:06:39] safely return Americans home while protecting public [inaudible 00:06:44]. Passengers were transported via Department of State plane from the Canary Islands to Nebraska with appropriate medical capabilities on board. HHS has worked with the State Department from the start for a seamless transfer back into the United States.
(07:01)
Upon arrival, they were transferred here to the University of Nebraska Medical Center. UNMC was selected as the US entry point due to its extensive expertise in handling special pathogens and is the only national quarantine unit in the country. It is one of ASPR's 13 Regional Emerging Special Pathogen Centers, also known as RESPCs, that are within the National Special Pathogens System. ASPR's established this system over the years to prepare for high consequence infectious disease outbreaks with trained personnel ready to safely manage situations like this. ASPR's mission is to protect the health security of Americans. And this response reflects the strength of the national preparedness system. As mentioned by others here this morning, over the next several days, passengers will undergo initial health assessment and receive guidance on next steps from the CDC experts and other partners. This event reflects our ability to coordinate across federal, state, and local partners when the health of any American is on the line. So at this point, I'm going to turn it back to Dr. Gold to continue. Thank you.
Dr. Gold (08:26):
Well, thank you, Secretary Knox. We have several people here as of course you can see. Just to introduce them quickly, we have Brendan Jackson. Dr. Jackson is from the Centers of Disease Control and Acting Director of the Division of High Consequence Pathogens and Pathology. Captain Michael Gardner also from ASPR, is the Regional Administrator for Region 7 of the Mission Field Operations. We have Matthew Ferreira, who's a DVM and is an HHS counselor. We have Dr. Michael Wadman here from the University Medical Center and Nebraska Medicine and is the director of the National Quarantine Unit. We have Dr. Angela Hewitt, who's the medical director of the Nebraska Biocontainment Unit. We have Dr. Dele Davies, who's the interim chancellor of the University of Nebraska Medical Center. Dr. Michael Ash, who's the chief executive officer of Nebraska Medicine. And by the way, thank you for hosting us. And we have Dr. Ashley Neumeier, the Director of Public Health for the state of Nebraska.
(09:32)
And before I take your questions, I just want to say that UNMC and Nebraska Medicine are very honored to have this responsibility to repatriate these American citizens. There is no place in the country that they could be better cared for more safely and more effectively. As the governor said, it is the people of the state of Nebraska and indeed here in this microcosm, it is the people of UNMC and of Nebraska Medicine that really make a difference to truly lead the world today. As you're all gathered here, there is no other place in the country where they could be more safely and more humanistically cared for. We have a very simple rule here and having served as the chancellor of the med center for more than a decade of my life, if we treat our patients the way we would treat family members and loved ones, we're going to be okay and that's the rule.
(10:26)
So with that, we're very willing to take your questions. There are microphones that we will pass around. If you do have a question, I will recognize you. And there are some folks who are carrying the microphones just to be sure that everybody can hear your question. And if there's a specific individual that you want to address it to, that's fine or we can just have volunteers.
Waverle Monroe (10:56):
Hi. Waverle Monroe with KETV. Just wanted to talk a little bit about AP confirmed overnight that there was a person who was experiencing symptoms but they had not been tested positive for hantavirus. Can you talk a little bit more about that? And is that person at the national quarantine unit or is that person at the Nebraska Biocontainment Unit?
Brendan Jackson (11:24):
That's right. So part of the decision was to make sure that they preserve space within the biocontainment unit here to make sure there's adequate care for anyone who might need it among the other passengers. Other patients were, sorry, passengers were flown to Atlanta for further assessment and care there.
Waverle Monroe (11:40):
So that person is not here?
Brendan Jackson (11:41):
Correct.
Waverle Monroe (11:42):
Okay. Thank you.
Dr. Gold (11:46):
So again, just to be very clear on that point, we want to maintain optimal space in our biocontainment facilities on the small chance that it becomes necessary [inaudible 00:11:56] and the individuals who were transported.
Brendan Jackson (11:59):
If you don't mind, I'd just love to add that we're going to expect to see people have symptoms. That's just, if you think in any given week or month, how many times do you experience some level of nasal congestion or upset stomach or something. We're being very, very liberal in how we're framing symptoms and monitoring for symptoms here. And so that's how the system is working. It doesn't necessarily mean just because someone has symptoms that they're going to end up having this illness.
Speaker 1 (12:21):
Go ahead since you have the mic.
Dianne Gallagher (12:30):
Hi. Dianne Gallagher, CNN. Could you clarify first then how many of the passengers who were on the plane from the crews are here and how many [inaudible 00:12:40] to another facility in the country?
Dr. Gold (12:43):
Yeah, go ahead.
Brendan Jackson (12:46):
[inaudible 00:12:46]. I can just address that briefly. So of the 18, 16 passengers are here and two are in Atlanta.
Dianne Gallagher (12:52):
And the biocontainment unit, we have the one who had the mildly positive PCR test. Can you explain a little bit more about mildly
Speaker 2 (13:00):
... I think positive. I initially thought that we were not testing people who were not symptomatic. I know they said this person was not symptomatic. Can you go into a little bit more about what it means to be mildly positive?
Brendan Jackson (13:12):
Sure. And I welcome my colleagues from the University of Nebraska to weigh in as well, but I'll note that this test was not collected in the United States. The specimen was collected back, I believe, in one of the islands. It was taken on the ship. There were two specimens. One was positive and the other one was negative. With these PCR tests, it's not necessarily exact cutoff. There's a range in where they can fall. And so for that reason, we just want to make sure there's further testing to evaluate that at this point more.
Speaker 2 (13:47):
And are the two individuals who stayed here, one of whom is in the bio-containment unit, did they have prolonged contact with each other and that's why they're both here? Or what was the idea behind moving the 16 into other parts of the country?
Brendan Jackson (14:03):
Sorry. So 16 people are here and for all the reasons that was mentioned, can you repeat again what your question was related to that?
Speaker 2 (14:13):
The two who were moved. What was the reasoning behind moving them besides was it just space or were they traveling together? Are we keeping people together since this is a prolonged contact transmission?
Brendan Jackson (14:24):
Got it. It may be helpful for you all to explain the difference between the sections within University of Nebraska Medical Center as well.
Mike Wadman (14:31):
Sure. I'm Mike Wadman. I'm an [inaudible 00:14:37] unit. We welcomed 15 passengers to the quarantine unit early this morning. One passenger did go to the bio-containment unit and all that Dr. Hewlett address the issue. The 15 that were welcomed here were in good shape. They were in good spirits. They definitely were tired and needed some rest. So we did a quick assessment. We brought them into the unit. Very smooth, successful, safe transfer. A lot of coordination between our teams here. And I'd like to thank our nurses and techs in the bio-containment unit as well as all the administrative support that we have for this. And also our federal, state, and local partners. It's definitely a well coordinated activity and really proud to be a part of that team.
(15:23)
Once they're in the unit, we've been doing symptomatic as well as temperature checks. Everyone here is asymptomatic and afebrile. We do not have a temperature at this time. They're all resting now and we'll do further assessments later in the day once they've had a chance to sleep, but that's where we're at with it now. But all asymptomatic, all very great for them to rest up and then we'll do the further assessment. But to be clear, as far as Nebraska Medicine, we have 15 patients in quarantine and we've got one patient in the bio-containment unit.
Brendan Jackson (15:56):
Do you maybe just explain the difference between the two, a bit more of that's helpful?
Angela Hewlett (16:03):
Sure. So I'm Angela Hewlett. I'm an infectious disease physician and I'm the medical director of the Nebraska Containment Unit. And so with our two facilities, our quarantine unit is designed for well individuals who need to be monitored. It is not a patient care space. It is much more like a hotel than a patient care space. We don't have the typical things that you'd see in a hospital room. It's a much more comfortable environment actually with some things to help keep people comfortable like exercise equipment and it's a larger space, TVs and things like that.
(16:37)
The bio-containment unit is a patient care space. And that's our unit, which is also located on this campus and that's where we provide hospital-based care to people who need it. And those patients could range from being relatively well and stable to critically ill, requiring multiple procedures and multiple interventions. And so we do have one individual who, as you know, was taken to the bio-containment unit earlier this morning. And I'm happy to report that we assessed that individual. They are doing well actually. They currently do not have any symptoms and have a good appetite, although they're very tired, understandably, but that's been a really long journey for these folks.
(17:21)
And so again, everything appears to be going very smoothly. I'm really proud of how our team responded and how we all came together to execute this very complicated transfer of multiple different individuals into these different units.
Brendan Jackson (17:38):
So I might just underscore that it's a contingency planning reason. They want to make sure that other of the people that are in the more residential side of that, need potential medical care, there is space available. And so by moving other people who may have symptoms to another location and make sure there's that space to care for them.
Mike Wadman (17:54):
And then those are the preliminary conversations planning that we had in terms of bringing in a number of individuals for quarantine is when those patients develop symptoms or test [inaudible 00:18:05] contingency plan. Because bio-containment capacity would not be able to accommodate 16 persons who would turn positive and turned into in-patients. So those conversations look at patients that may be identified early and travel to other bio-containment centers across the country, which is what happened in this case. Or if we have quarantine patients here and they have symptoms, positive testing where those would be decanted to if they were stable or would go to our bio-containment unit. All those contingency plans are in place. And the example of the two passengers traveling on to Emory is an example of that.
Mila Burnell (18:47):
So two things. Mila Burnell with NBC News. How long do you anticipate people to stay here and do they have a choice to leave or are they being told you have to stay here for a particular amount of time? And then in terms of the two passengers that are in Atlanta, same question: How long are they anticipating to have to stay in this facility in Atlanta? And also that the one in Atlanta has symptoms. Is the second person a partner? Just more clarity on why there is that separation between the patients in Atlanta and the patients here.
Brendan Jackson (19:26):
It's a great question about the plan in terms of where things will happen. So right now the folks, the passengers that are all in the assessment phase, they're going to be here for at least a few days while we do assessments and then coordination from what happens next. They certainly have the option to stay here for the entire 42-day period, if that's just the safest and most effective option for them. There's going to be an individualized decision plan for them to determine if it makes more sense for them to complete their 42-day monitoring period at home.
(19:57)
And there's going to be a couple of things that go into that decision. First and foremost, do they remain symptom free? But then also do they have all the structures and support to be able to continue that period at home, making sure that they can be able to isolate in a separate part of the structure from anybody else, make sure that they can contact their [inaudible 00:20:17] if necessary if they develop symptoms. Or if they need a higher level of medical care, that that's available to them.
(20:22)
So there's a range of structures that need to be in place before anyone will be transferred to their home. And that will be done in close coordination with the health department in the states that would be receiving them.
Mila Burnell (20:34):
Ultimately though, will it be their decision?
Brendan Jackson (20:36):
Yes. We want to do this in the least restrictive way possible that is still safe that protects the health and safety, both the passengers and their communities.
Mila Burnell (20:44):
And then in terms of the patients [inaudible 00:20:46]?
Ashley Neumeier (20:48):
I just wanted to make a brief comment. So Ashley Neumeier, Director of Public Health for Nebraska. Our partnership with our federal partners has been tremendous as it has been with Nebraska Medicine and UNMC. But I do want to just reiterate as the governor made a comment here earlier that we are here also to make sure that no one poses a public health threat. As the team is assessing and monitoring the individuals, we understand that there is... They've been through an unimaginable experience already and we know there's that human element, but we also want to make sure that there is a structure in place. Safety is number one across the board here, but we are here to make sure that there is no public health risk.
Dr. Gold (21:44):
And we've been reassured that in the event that one of these individuals who is asymptomatic chooses to finish their period of observation elsewhere, in their home or elsewhere, wherever that may be, that they'll be escorted under the very appropriate circumstances from endpoint to starting point.
Speaker 3 (22:06):
Dr. Roland?
(22:09)
I just want to reiterate what Ashley was saying. What you're seeing is coordination from Washington to the state to the local levels with the governor, here at UNMC. This is what true public healthcare looks like. It's important for the administration. It's certainly important for Secretary Kennedy that we work together. That there are no silos or walls between us. This is how public health should work. This is how it is working. And I think this is a perfect example of how we are coordinating, how we are speaking, how we are interfacing and doing things together for the good of the nation, certainly the good of the people of Nebraska and the good of the individuals who've been repatriated here.
Mila Burnell (22:45):
And then the patients in Atlanta, are they quarantining there as well? Is there a reason other than space as to why they're there? Any explanation as to the separation?
Brendan Jackson (22:58):
Nothing more to add. There would be evaluation of symptoms there and then next steps would be similar to what happens here.
Mila Burnell (23:04):
And they're quarantining as well?
Brendan Jackson (23:06):
They're under medical evaluation right now, similar.
Kailey Schuyler (23:13):
Hi, Kailey Schuyler with Fox News back here. If one of the patients who's currently located here in Nebraska were to test positive, would they remain here? And is it always a six-ish week quarantine or can it vary?
Dr. Gold (23:29):
I'll start off by saying that is why we've maintained space in the bio-containment unit in event that becomes necessary. And how it [inaudible 00:23:39] would depend upon if that was the only individual or if there were multiple individuals that would get us to capacity of the BCU. We would work with our federal partners very closely and make sure that they were transported to another facility that had the capability.
Brendan Jackson (23:56):
Sorry, I was just going to add on, the 42-day monitoring period. The reason for that is that's the maximum incubation period that's been seen for the Andes virus. So incubation period is the time from when someone was exposed to when they develop symptoms. That's really at the very, very long end. Most people who end up infected with this virus will develop symptoms much sooner than that. So that's a conservative timeframe and that's the number we're using. I'll note this is a much longer incubation period than we see for a lot of other viruses, but typical for hantaviruses.
Ian Lee (24:26):
Ian Lee with CBS News. You mentioned this incubation period being so long. We know that there are some Americans who already traveled back to the United States who are in their communities. How can you guarantee that they don't have the virus and can you guarantee that when people leave here that they will not be carrying the virus?
Brendan Jackson (24:49):
May I take that question?
Dr. Gold (24:50):
Certainly.
Brendan Jackson (24:52):
There's been contact made with all those passengers who returned. The state health departments have been monitoring them on a daily basis, symptoms and temperature checks. They have plans in place to make sure that they can isolate effectively in their home should they develop symptoms. If they are developing symptoms, they have ways to get tested safely and to make sure that they're not going to spread it to others. Again, based on what we know about this virus and this, again, I want to emphasize this is not a brand new virus. This is a virus, even though it's new to many of us, it is a virus that has been known for decades now and there's been outbreaks that have been dealt with in other countries and even here in the United States. This is not the first time we've had Andes virus in the United States before.
(25:33)
The data that we have now all suggests that transmission that's spread between people happens when people are symptomatic. And so I think that gives us... When they have symptoms. And so that gives us one layer of added protection to know when the risk is going to be greatest and how we can best protect health and safety of the passenger and the American public.
Ian Lee (25:52):
Can you give us more details about those other Americans? What kind of procedures are they undergoing? Are they getting quarantine as well? And what
Speaker 4 (26:00):
... medical treatment are they receiving?
Brendan Jackson (26:02):
So, they're not receiving medical treatment when they're not symptomatic. And it would only be for evaluation or testing and if their symptoms progressed, then they would require it if it turned out to be positive or knew they needed care for something else. Again, they're following the recommendations that we have in our overall guidance for this daily monitoring and contingency planning.
Speaker 4 (26:22):
And when it comes to testing, there was one symptomatic and they tested positive. With this test [inaudible 00:26:29] who has symptoms, have they been tested? Are they confirmed positive with the virus?
Brendan Jackson (26:39):
So, when it comes to testing, I actually will defer to my colleagues at University of Nebraska to discuss their plans on testing. The traditional way of managing hantavirus testing has been that you can really focus on testing people who are symptomatic or having symptoms. That's the current stance right now. But clearly, we're going to keep reevaluating this as we learn more about this virus. I'll turn it over to my colleague here.
Angela Hewlett (27:03):
I mean, we're in the process of evaluating all of the individuals. And as was mentioned, we're giving them a little bit of a rest period now, just given their ordeal. And then we are going to go back, and jointly with our federal partners, ask questions about their exposure, and get a lot more information from that individual. And then we will make individualized decisions on testing based on those conversations. The individual in the biocontainment unit will be tested. And that's only because that individual did have this kind of equivocal positive test previously not in the United States. And so, we will be testing that individual. But the individuals in the quarantine unit, that will be a conversation, and a lot of conversations between us and those individuals that are in the unit now.
Speaker 5 (27:49):
And just to add to that. In partnership with the Nebraska Public Health Lab and the university, we've developed and validated the necessary testing so that can all be done and done quickly.
Speaker 6 (28:03):
If I can follow on what you were just saying about the individual in the biocontainment unit. Has that person developed or shown any symptoms since they've been here? And do we know if there is any evidence that this could be transmitted by someone who is asymptomatic [inaudible 00:28:20] but is there evidence that that could happen?
Angela Hewlett (28:25):
So, first question, the individual is doing well and not having any symptoms at this time. But again, just arrived a few hours ago, and so that will be an ongoing assessment, and we will continue to ask those questions and ensure that they remain asymptomatic. And second question was about transmitting without symptoms. So, there are a lot of unknowns here. But as was mentioned earlier, it seems that with hantavirus, a specific Andes virus, that this can be transmitted person to person, but it typically does require very close contact and typically when those individuals are symptomatic.
(29:05)
Now, again, recognizing that, like I said, although there are some unknowns and this is not a new virus. This is not the scenario that we encountered with COVID, where we had a brand new virus. So, there is some information known about Andes virus and we feel fortunate to at least have that. But again, this will be an ongoing assessment. There are a lot of moving parts right now. But we'll do our best to take care of the individuals both in the quarantine unit and in the biocontainment unit, and make sure they receive the best care.
Speaker 7 (29:34):
Just to make sure that we reiterate that even here, the quarantine center, the rooms have negative pressure so that the virus cannot leave the room generally. And then the ventilation is separate from the rest of the building. It goes right out and then it's filtered through high efficiency particulate air filters. So, the risk to the general public for those patients who are here, even if they were to become symptomatic, is very, very minimal to non.
Angela Hewlett (30:04):
And just to add on to that also. We're doing everything in our power to protect our healthcare workers, who are wearing appropriate protective equipment both in the biocontainment unit and at the National Quarantine Unit as well.
Speaker 6 (30:15):
And just for clarification, especially you mentioned there were a lot of people who I'm sure parkins back to six years ago who were watching this. What is the definition of very close contact? What does that mean?
Angela Hewlett (30:27):
I may let our public health partners answer that a little more definitively. They're asking the definition of very close contact and what you would consider. And the reason I bring that up is because there are some guidelines that just came out on this.
Brendan Jackson (30:41):
Right. So, there's guidance that you can look to specifically on our website about close contact and how that defines exposures. Typically, we're talking about exposure specifically to bodily things, like saliva. So, if you're sharing eating utensils, kissing, touching, those type of things. It can also mean just being really, really close to that person for a fairly long period of time. So, we're calling that right now six feet for at least a cumulative number of 15 minutes. I want to be clear, there's nothing magical about six feet. It's not a forced field, but it's a rough number that gives us a sense of how close somebody has been. 15 minutes, again, it's a bit arbitrary, but it again gives some sense of how close someone has been. I think that's actually a fairly conservative approach given the evidence we should have so far about how this virus has spread in the past.
Speaker 8 (31:28):
I have one clarification question then a few more questions. I believe just someone said 18 US citizens were on the plane yesterday. I believe officials were seeing 17. I saw reporting that one person was a British national who's a US resident. Can we confirm those numbers?
John Knox (31:50):
Yeah. That is true. The last person was a British dual national, who decided to come back to the United States.
Speaker 8 (31:56):
Are they in Nebraska right now or in Atlanta?
John Knox (31:59):
They're in Nebraska.
Speaker 8 (32:00):
They're in Nebraska? Okay. And they are one of the people who are in the quarantine unit, not in the bio quarantine containment?
John Knox (32:07):
Yes.
Speaker 8 (32:09):
Okay, thank you. And then just in terms of how limited the quarantine is, can you talk about what protocols are? I'm assuming family members want to visit, is there room for that? What does that look like?
Speaker 10 (32:21):
Well, currently, each quarantine individual is in a private room, their own room. And there are no direct visitation. They do have access to technology. They can conduct phone conversations, video teleconferencing, family members and friends. So, intermingling of any of the quarantine individuals, there's no visits from anyone outside of the quarantine unit. They do see our nursing staff, our technicians, our physicians on a daily basis. Of course, some full PPE, following the precautions that we have in place to prevent transmission of the pathogen. But there's no direct contact with anyone.
Speaker 8 (33:04):
In terms of the bio quarantine unit, can you just quickly describe, is it similar, completely isolated? What are the differences between how many beds there are, et cetera?
Angela Hewlett (33:16):
So, the Nebraska Biocontainment Unit is a completely separate entity from the National Quarantine Unit. And it is designed as a patient care unit. We have five rooms in the Nebraska Biocontainment Unit. One of those rooms being operated as an in house laboratory, which is actually an important aspect of our clinical care, to make sure that we're able to perform our lab work in a timely fashion with a good turnaround time. The remainder of the patient room, so we have one individual who's occupying one of the rooms. At this point, that's the only patient that we have in the biocontainment unit, but it also is similar to the quarantine unit. It's its own separate entity. It has its own air handling system we don't share with any of the rest of the facility.
(33:59)
It has HEPA filtration out on the roof. And so, it's a very different facility [inaudible 00:34:06] routine patient care room in a regular hospital. Everything is negative pressure throughout on a gradient. And there's just a lot of environmental and engineering controls that we have in the unit that makes it just very distinct from a typical patient care unit.
Speaker 8 (34:21):
And how many people can it hold?
Angela Hewlett (34:23):
So, depending on the pathogen and our waste stream, the unit also has autoclaves, which is how we are able to decontaminate waste. And so, the actual capacity of the unit is dependent on the pathogen, and what we're dealing with and how much waste we're having to process out. I know that's an interesting answer to your question then, but it actually depends. For airborne diseases, we typically can take 10 patients with an airborne disease. And by that I mean avian influenza, MERS-CoV, something to that line. With this type of a disease and the fact that these individuals could become ill fairly quickly, as we've learned from what went down on the cruise ship, we typically are a two to three bed unit for that scenario.
Speaker 8 (35:10):
And so, just one more question. How often are people continuing being tested and what are the symptoms that you all are looking out for?
Speaker 10 (35:17):
Well, as far as the testing, that's going to be decided in conjunction with the physician medical direction team, CPC colleagues. There's no frequency of testing for asymptomatic individuals that's agreed to at this time. Then in terms of the symptom monitoring, I mean, it's all the things that you would think of in terms of an influenza-like illness. But it includes fever, headache, nausea, vomiting, diarrhea, muscle aches, generalized malaise. Also, for respiratory symptoms, cough, shortness of breath, dizziness, things that would indicate low blood pressure. Those sorts of things are on the symptom monitoring that we do on a twice a day basis.
Speaker 5 (36:04):
A good way to think about it would be quarantine is sort of like a very well-managed air-handled hotel room. And the bio containment unit is like a very well-managed air-handled intensive care area.
Speaker 9 (36:21):
Jeff Co ABC News right in the front. The two patients that went to Atlanta, why did those two patients go to Atlanta specifically, if you haven't already answered that? And what facility exactly in Atlanta are they at?
Brendan Jackson (36:39):
So, the reason they went there is I discussed previously this contingency planning. That means since there was symptoms involved, they want to make sure that if they turn out to actually have the hantavirus, that it makes sure that the biocontainment unit care that provides medical care doesn't take up too much spacing cases needed by the other passengers who are currently here in the more residential section.
Speaker 9 (37:04):
And what facility exactly in Atlanta?
Brendan Jackson (37:06):
I don't know if you want to speak to me. It might be able to talk about the... Oh, Dr. [inaudible 00:37:11].
John Knox (37:13):
So, I'll step back a little bit because this question keeps popping up, as to how this system works, why people are in certain places. Asper designed this system along with UNMC, Emory and other hospitals, which are ETEC's National Emerging Special Path Treatment and Education Centers. There's three of those across the US. And this is a system, a national special pathogen system. It's not designed as one hospital does everything. So, the National Quarantine Unit is here at UNMC. And it is designed to house a large group of patients or passengers from a plane or a ship, like what we have now, to monitor and assess them. If they get symptomatic, become sick, they can be moved into the bio containment system and have a higher level of care. Right now, they're just being monitored and assessed. So, as a system, it works. We have 13 respects, which are the [inaudible 00:38:19] centers across the US, so that those patients can be distributed, load balanced across the system in one place like UNMC.
(38:28)
She said we have 10 beds, but depending on the pathogen, that can change those beds. And right now, we have 16 people here. We have 15 in the quarantine center down in Emory. So, that being said, why did they go there? Because we knew somebody was symptomatic and we have 16 people that are here. If someone were to get sick or multiples get sick,
John Knox (39:00):
We don't want to take the time and energy and lack of care transporting them to a different location. So this is how the system is built and designed so that we can do it across the system. I think that hopefully should answer the questions.
Interviewer 2 (39:16):
And what facility in Atlanta is it? What's the name of it?
John Knox (39:20):
Currently, they're at Emory University.
Interviewer 2 (39:25):
Back over here, Ian Lake, just a couple questions.
Interviewer 3 (39:28):
Are they in the bio containment unit or ...
John Knox (39:30):
I'm sorry. There's multiple people talking.
Interviewer 3 (39:32):
Is there a bio containment unit there and are those two people in a bio containment unit or just quarantine?
John Knox (39:40):
Currently, at this time it's my understanding, Matt, do you know? They are currently in a quarantine, so this is the only quarantine unit in the country right here. So they would be in a bio containment unit down there. Okay. It can still be used as a quarantine unit, right? Understand that.
Interviewer 3 (40:00):
But it's a bio containment similar to what you have here with the filters and the desanitation homes.
Speaker 12 (40:05):
Yes, that is correct. And it is because that one passenger was symptomatic so that is the reason they went to the bio containment unit at Emory. Additionally, to build on what Mr. Knox was saying, this is a system that exists for exactly this kind of scenario and what you are seeing is the system working. The system kind of will absorb passengers as needed and this is a very well rehearsed system that exists and what you are seeing is that system work exactly as intended.
Interviewer 3 (40:36):
And is this a couple? Are they together or in two separate rooms? How does that look like?
Speaker 12 (40:42):
Yes. So it is a couple and they are ... I'm not sure of their exact situation. The plane just landed recently in Atlanta and the passengers were taken to Emory, but because of their situation on the ship, they were traveling together to Emory.
Interviewer 2 (41:00):
And just one of them symptoms?
Speaker 12 (41:02):
That is correct.
Interviewer 3 (41:03):
I do have another question. You mentioned the 42 days. If someone recently tested or possibly tested positive, we've seen someone else with symptoms, do the 42 days start now all over again or when do the 42 days start?
Brendan Jackson (41:23):
So it would be a different story if the person is already known to have an infection if it's a true actual PCR positive. I actually like to defer a bit to our clinical partners because I think this is something that is going to require somewhat of an individualized decision making process to make sure when we feel confident that the person would be no longer in [inaudible 00:41:38]. I don't know if there's anything you want to add to that or just leave it there.
Speaker 13 (41:40):
Well, day one is typically the last known exposure. And so these individuals were brought over, but they also were all been wearing PPE on the plane on the way over. And so I would say, again, we need to go in and assess these individuals. We did give them a little bit of a rest. And so we are going to go and ask a lot more questions about their exposure, how much contact [inaudible 00:42:05] positive individuals that were on this cruise ship. And so once that is more established, and I think we'll have a better idea of when day one is, because day one was your last known [inaudible 00:42:17] risk or someone who was infected. And so once we get in there and actually can ask some more questions, I think we'll have a much more kind of clear idea of the 42-day period.
Interviewer 2 (42:30):
We've had several people ... Over here, we've had several people already die from this virus. When they're here in the United States getting the treatment, does that change the survival rate? Are they more likely to fight and beat this virus now that they're under your care unlike when they're on a ship?
Speaker 13 (42:52):
Well, as was mentioned, the reason that we need these [inaudible 00:42:57] care, whether that's here in the national quarantine unit or for the individuals that are already out in their home jurisdictions to make sure that they have access to critical care, is because the real management of this disease, this is not a disease, it has a whole lot of therapeutic options and things. Everything is experimental when it comes to that. We don't have any FDA approved therapeutic options for Andes Hantavirus. And so because of that, we rely on aggressive supportive care. And by that I can mean everything from IV fluids to oxygen if they need it, to more aggressive things like mechanical intubation, even ECMO, which is extracorporeal membrane oxygenation. That is something that when people are in dire straits and really can't oxygenate their blood, then sometimes that can be a lifesaving measure for people. And so these are those very aggressive measures.
(43:47)
We do think that being able to provide those aggressive measures to people can change outcomes. And that's the importance of being close to this type of care and to be able to provide that critical care for individuals should they need it.
Interviewer 2 (44:00):
And then finally, just for the general public, can you guarantee that no American will catch this virus from the passengers who return to the United States?
Brendan Jackson (44:12):
I just want to emphasize that our top priority across all levels of government here and partners is the health and safety of the passengers and their communities. And that's what we're working constantly to address through all the measures that we're putting in place.
Interviewer 2 (44:25):
So you can guarantee no American will catch this virus from these returning passengers.
Brendan Jackson (44:33):
There are no guarantees in life. We're putting as many measures in place as possible to ensure that people are safe and healthy and we keep the community safe and healthy as well.
Dr. Gold (44:40):
Just speaking on behalf of our staff and the capabilities that we have, we will guarantee that every single precaution that can be taken to keep the communities and our staff healthy and of course to keep these passengers healthy will be taken.
Speaker 11 (44:53):
I just wanted to talk a little bit about the passengers [inaudible 00:44:58] here. What are the age ranges of the passengers and how does that factor into the level of care? Are they part of a vulnerable population for this virus? And then also as they then move home out of Nebraska, hopefully, does care change depending on what part of the country they're from and what they might have been exposed to based off of where they're going?
Mike Wadman (45:23):
Just [inaudible 00:45:24] the quarantine unit ages ranges from late 20s to late 70s, early 80s in general. And definitely people who have coexisting disease comorbidities would be more vulnerable. In terms of returning to their home community, resources that are available there, one of the main benefits of being in this unit, as the doctor has stated, is that it's a great resource for the country in that you are approximate to critical care in a bio containment unit that can treat high consequence infectious disease the best and the best teams, the best policies and procedures, the best training for these things and also the experience that we've had over the years to be able to provide this care in a safe manner, that that track record I think is really, really one of the things that sets us apart. So if I was exposed to this and I had the option to stay in a quarantine unit proximate to that care, I would definitely take that because you're putting yourself in a position. If you were to turn positive, it should be in a position to take advantage of all those things.
Speaker 11 (46:45):
And with the people on the older end of the spectrum that you talked about, are they considered a vulnerable population or at more risk of having severe complications if they contract the Hantavirus?
Speaker 13 (46:58):
Yeah, generally it's thought that people who are older or have those medical comorbidities could potentially be at higher risk of more severe disease or potentially more adverse outcomes should they get infected?
Dr. Gold (47:12):
So I'm getting the message that we need to adjourn. I want to thank all of you for being here today. Rest assured that we will periodically provide some updates. I'm sure all of you from the media know how to contact our communications people at any time and rest assured, as you've heard, said earlier, transparency is the name of the game here. We will be totally transparent and as we continue to learn more and more about these individuals and what their plans will be. So thank you [inaudible 00:48:11] this morning.
Speaker X (48:28):
[inaudible 00:48:12]
(48:28)
That person is here.
(48:29)
Okay. Thank you so much.
(48:29)
Okay.
(48:29)
[inaudible 00:48:33].
(48:29)
Just email.
(48:29)
[inaudible 00:49:31].
(48:29)
Oh, yeah. Thank you. Nice to meet you too.
(48:29)
[inaudible 00:49:58].