For 15 years, the University of Nebraska Medical Center and Nebraska Medicine prepared for this moment.

The Front Lines

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How UNMC and Nebraska Medicine became the nation’s first responders in the fight against COVID-19.

For 15 years, the University of Nebraska Medical Center and Nebraska Medicine prepared for this moment.

They trained their physicians, nurses and staff to wear personal protective equipment — the heavy hazmat-style layers that protect against dangerous pathogens — perfected medical procedures under the weight of those layers and ran drills on providing care in areas of deadly contamination.

In the wake of 9/11, as the country scrambled to respond to a new, devastating threat, hospitals, universities and state governments were called on to prepare. For what was unclear. The veiled, recondite threat of terrorism meant unknown dangers, including the possibility of biological warfare, thrown into sharp relief by the series of anthrax attacks that followed the World Trade Center’s fall. 

Few responded to the call with the diligence of UNMC and Nebraska Medicine. Immediately, their leadership began drawing up plans for a biocontainment unit: a 10-bed facility, the largest of its kind at the time, fitted with negative air flow, a pressurized entrance and decontamination autoclaves, which would provide a safe environment to deal with the world’s worst pathogens.

“We took it seriously,” said Ken Bayles, Ph.D., executive director of basic science research for UNMC’s Global Center for Health Security. “Not only did we stand it up and invest in and build this structure, but we prepared year after year.”

The Nebraska Biocontainment Unit officially opened in 2005. Then it sat empty, as the world waited and attention drifted to other things. But it was never unused. UNMC and Nebraska Medicine continued to prepare — training staff, running drills, learning and getting better.

Then, in 2014, Ebola hit West Africa, and U.S. physicians and a journalist who had been exposed to the deadly virus were flown to the place best equipped to treat them. The “hospital in Omaha” — still without name recognition in the national press — rocketed into the global spotlight.

“Not only were we ready,” said Bayles, “we took on patients, and we did a good job. Then afterwards, we became a leader. We rose to the top pretty clearly. And I think the federal government really took notice of that.”

Two patients were treated and discharged; one, whose disease was advanced by the time he arrived, didn’t make it home. It was a defining experience for the team. It gave them practical knowledge that advanced their understanding of pathogens and how to treat and contain them. It also led to further federal partnerships and the establishment of the National Ebola Training and Education Center (NETEC), which trains health care and public health professionals nationwide to prepare for catastrophic diseases.

It made them even better.

“One thing we learned from taking care of the Ebola patients,” said Cheryl Rand, clinical operations lead of the Nebraska Biocontainment Unit, “is no one got sick. The disease didn’t spread anywhere from here. So we knew we could do that again.”

They continued to prepare. NETEC grew; it has now reached more than 120 hospitals nationwide, and NETEC staff has trained more than 8,000 health care and public health professionals on deadly pathogen preparedness.

“I would say the majority of hospitals in the country in one way or another has benefited from NETEC training,” said James Lawler, M.D., executive director of international programs and innovation at the global center.

Few could have predicted how necessary that training would prove to be — the devastating scale of what was to come. In the months since COVID-19 began spreading throughout the world, it has ravaged communities, touched nearly every country in the world and caused massive shutdowns to curb its spread that have created Great Depression-like economic pain.

But UNMC and Nebraska Medicine’s preparedness and expertise have helped not just Nebraska or even just the U.S. but the whole world battle the pandemic. They treated some of the U.S.’s first COVID-19 patients. They conducted some of the earliest virus tests and clinical treatment trials. Their leadership ran models of the virus’s spread and was critical in informing state and federal policy.

Fifteen years of gathering expertise, running drills over and over and preparing for every scenario put UNMC and Nebraska Medicine in a position to make a substantial difference in one of the world’s most deadly and dramatic crises. They were front and center in the global fight — right here in Nebraska.

We took it seriously. Not only did we stand it up and invest in and build this structure, but we prepared year after year.

- Ken Bayles, Ph.D., executive director of basic science research for UNMC's Global Center for Health Security

Carl Goldman and his wife were sitting at dinner when the captain of the Diamond Princess cruise ship made an announcement. A passenger, who had recently visited Hong Kong, had come down with a new form of coronavirus — the same virus that had led to a lockdown in Wuhan, China, and was slowly drawing the world’s attention. It was Feb. 3. They were docked in Yokohama, Japan, and it was their last night of a trip around Southeast Asia, which Goldman had purchased for his wife as a Christmas present. Goldman, who owns a radio station in Santa Clarita, California, said Japanese officials began working their way through the passengers, taking temperatures and logging their travel histories.

But that was before anyone knew how quickly and easily this virus spread.

By the next day, 10 passengers were reported to have a fever, and everyone was told to go into quarantine in their cabins.

Looking out from his balcony onto the pier at Yokohama, Goldman said it was like a scene out of a movie.

“On the right side were dozens of ambulances and military trucks,” he said. “There were people in hazmat suits. On the left side was media with their cameras and vans … two media helicopters … and a number of media boats circling the ship as well.”

More and more passengers were taken off the ship.

“Each day, the numbers went up,” Goldman said. “So it put us into a definite tense, tense situation.” Goldman kept himself busy blogging his experiences.

By Feb. 11, 135 passengers were infected.

The next day, Lawler, who has a long career working on pandemic preparedness in the administrations of both George W. Bush and Barack Obama and field experience treating Ebola patients in sub-Saharan Africa, was asked to fly immediately to Japan to assist an operation to evacuate every American on board.

“It was a hastily assembled team that went out there to manage a situation that nobody ever had before,” Lawler said.

Lawler’s team, equipped with special helmets and breathing oxygen from portable PAPRs (powered air-purifying respirators) boarded the ship Friday, Feb. 14. They were tasked with locating every American, screening and testing them, and moving them to cargo jets set to arrive two days later.  

By 10 p.m. Sunday night, Lawler and the team had tracked down and briefly assessed the more than 400 Americans on board the ship.

They rushed the passengers to the waiting cargo planes. It was a chaotic departure, but Lawler knew if he could just get them to Omaha, they would be safe and UNMC could contain the virus.

Finally on the plane, Goldman, who had fallen asleep after an exhausting few days, woke with a fever of 103. He and the other 12 sick passengers were routed to Omaha, where they landed Feb. 17. A convoy of ambulances and police cars transported them to UNMC.

“We had a motorcade that was longer than President Trump’s or the queen’s,” Goldman said.

It was a hastily assembled team that went out there to manage a situation that nobody ever had before.

- James Lawler, M.D., executive director of international programs and innovation at UNMC's Global Center for Health Security

Inside the Nebraska Biocontainment Unit, UNMC’s nurses and physicians were ready for the patients to arrive. They waited, encased in full-body suits of impermeable material, three layers of nitrile gloves, knee-length protective boot covers and PAPRs, pulled overhead with clear face shields and tubes pumping in clean air.

“We’ve been training for years and years for all of this,” Rand said. “Our staff was ready.”

Some patients were treated in the BCU; others were taken to the 20-bed National Quarantine Center — the nation’s only federal quarantine facility — which, along with a state-of-the-art simulated biocontainment unit for advanced experiential training, is housed on the ground floor of the Dr. Edwin G. & Dorothy Balbach Davis Global Center.

While the biocontainment unit had been operational since 2005, the quarantine center had opened Jan. 29 — less than three weeks before the first COVID-19 patients arrived.

“We ended up housing people (in the quarantine unit) who needed a relatively significant amount of medical attention,” Lawler said. “The staffing plan had to be reinvented on the fly. And I think it’s a testament to the flexibility and just the quality of our team that our folks are able to do that so quickly.

“It came off as a seamless exercise.”  

For the health care workers in the units, the first days were stressful, but the muscle memory ingrained by years of training quickly took over.

“Everybody’s role was important,” said Morgan Shradar, clinical education coordinator for the Nebraska Biocontainment Unit. “It’s been extremely impressive to watch everybody come together and using their knowledge and skill to … counter challenges.”

The staff routinely put in 13-hour shifts or longer, and when they left the hospital, the work never really left them.

“It’s the two o’clock in the morning conversation you’re having with yourself about things that you want to make sure that you get done,” Shradar said.

But they felt privileged to be doing something so important. The challenging days fell away in their memories. Talk to them now, and all they will recall are the high points: the days when patients got to go home and they succeeded in keeping people safe.

“We were here as long as it took,” Shradar said. “I hate to quantify it. It doesn’t matter. We were here.”

Goldman, who spent 10 days in the BCU and 19 more in quarantine, said the nurses and physicians who cared for him were his “angels.”

“They were just unbelievable,” he said. “All of the staff in Nebraska have that Midwest, really wonderful attitude of looking you in the eye and really caring and being sympathetic and compassionate.”

The staff held internal town halls so the patients could talk to each other about their experiences, and they eased their feelings of fear and isolation as much as they could. Goldman spent his 67th birthday in the BCU, and the staff brought him a slice of cake, wrapped in plastic, and a balloon that hung in the corner of the room throughout his stay.

“The whole time I was there, I kept thinking … that if I had to be anywhere in the world, it would be here,” Goldman said. “I ended in the right spot at the right time.”

The whole time I was there, I kept thinking … that if I had to be anywhere in the world, it would be here.

- Carl Goldman, UNMC patient

On March 18, the last passenger of the Diamond Princess left quarantine. But by that time, there were 6,520 known cases of COVID-19 in the U.S. and more than 205,000 worldwide. The focus shifted from containing the virus to “flattening the curve.”

UNMC and Nebraska Medicine prepared the hospital and intensive care units for an influx of patients. For the biocontainment team and global center experts, that meant shifting to a training role, not just for other areas of their own hospital, but for hospitals state- and countrywide.

“Our biocontainment unit leaders and team have become extenders for infection prevention and control practice and safety,” said Shelly Schwedhelm, executive director of emergency management and biopreparedness at Nebraska Medicine. “They’ve now turned into consultants on the front lines.”

That meant taking their training on the road to hospitals and essential workplaces, including long-term care facilities and meatpacking plants that stayed open while schools and many other businesses had closed. It also meant turning their attention to testing, treatment and every other aspect of fighting a global pandemic.

Once again, they led the way. The Nebraska Public Health Laboratory, which is partially housed in the biocontainment unit, was one of the first to run COVID-19 tests. UNMC was the first site of a federally sponsored trial, which ultimately expanded to 68 sites, of remdesivir, a promising COVID-19 treatment, which was fast-tracked for approval by the Food and Drug Administration in late April.

“We were the first site in the world to activate that critically important study,” said Chris Kratochvil, M.D., executive director of clinical research for the global center. “Because patients came here for care early in the outbreak, we were teed up for it.”

Meanwhile, Bayles worked with a team in South Dakota to develop virus antibodies, which could be used therapeutically or to protect health care workers. John-Martin Lowe, Ph.D., executive director of training and education at the global center, developed a system to decontaminate health care workers’ safety respirators using ultraviolet light that was a breakthrough with worldwide implications as hospitals everywhere battled with supply shortages. Lawler developed virus models that guided state and federal policies on social distancing and curbing the virus.

“I think it’s clear that the vision of university leadership has always been to create UNMC as an international leader,” Lawler said. “The prescience of that vision is now playing out.”

I think it’s clear that the vision of university leadership has always been to create UNMC as an international leader. The prescience of that vision is now playing out.

- James Lawler, M.D., executive director of international programs and innovation at UNMC's Global Center for Health Security​

As COVID-19 and the vast economic toll it has taken on the world play out, the leadership, physicians, nurses and staff at UNMC and Nebraska Medicine credit teamwork for helping them succeed in this crisis.

“We work together really well,” Bayles said. “I think that’s just sort of innate in our DNA, and that is really paying off in these types of situations.”

“You can’t underestimate the power of a good team,” echoed Kratochvil. “None of what we’ve done could have been done alone.”

Schwedhelm just hopes there is time to take stock of what they’ve learned before the next wave or crisis hits.

“These sorts of scenarios don’t happen in isolation of one another,” she said. “We need to pause, and we need to learn what from what went on, and do that in a big way … to understand what we need to do better next time and try to get things put in place for whatever is the future.”

Because Schwedhelm knows, as everyone does at UNMC and Nebraska Medicine, that whatever comes, they will be there.

On the front lines.

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