Mali’s first case of Ebola was a little girl who arrived in the country from Guinea. She was admitted to the pediatric ward of the Fousseyni Daou Hospital in Kayes on October 21 with visible symptoms of the dreaded virus. Her diagnosis took just a matter of hours in the level-three biosafety laboratory (BSL) set up by the American National Institute of Health in Bamako’s national laboratory.
The child had come into contact with a lot of people on her bus journey from Guinea and since she died On Oct 24, healthcare providers, contact tracers and the Ministy of Health are on the lookout for the next case. An interesting article in eboladeeply.org that chronicles the author’s experience inside Mali’s Ebola testing lab rightly points out that this facility run by local doctors and infectious disease scientists will be the country’s most invaluable resource if Ebola stays in Mali.
In the U.S., there are four such level-three biosafety laboratories set up to contain and treat highly infectious diseases and bioterrorism attacks — National Institutes of Health (NIH) in Bethesda, Md., Emory University Hospital’s Isolation Unit near the Centers for Disease Control and Prevention (CDC), University of Nebraska Medical Center, and Saint Patrick Hospital, Missoula, Mont. Funded and tapped by the U.S. Government, these centers were not designed to treat Ebola, but nevertheless have the best laboratory equipment, the right protocols and the properly trained personnel necessary to confront this ‘scary’ disease and others like it. Let’s take a look at the basic features of these biocontainment units.
Level-3 biosafety facilities have negative air pressure, meaning air inflow but not outflow. They have their own ventilation system, unconnected with the larger facility or hospital in which they are located. Backup systems and alarms sound warnings in case a ventilator malfunctions. Their humidity and temperature are controlled. They have a dedicated autoclave for sanitizing equipment as well as work hoods, boxes of gloves, paper towels and bottles of disinfectant. No sound moves between the interior and the exterior. Also typical are showers, dressing procedures and total segregation from the rest of the building. Most important, according to an NIH statement, the staff of the high level containment facility like Bethesda, Md is specially trained in “strict infection-control practices optimized to prevent spread of potentially transmissible agents”.
In Mali, the medical specialists who run the BSL perform the analysis to detect the Ebola virus in a couple of hours. Sealed in the lab, they open the box of samples and mix them with the lysing agents to get the ‘soup’ of impotent genetic material. This is placed in a Polymerase Chain Reaction machine which performs the genetic analysis and proves Ebola.
Cleaning up and stripping down in any contact with Ebola is a meticulous process. The doctors take care to see that they scrub everything down, slather chlorine over their hands and clothes, and remove their special gear in a way that nothing that was possibly exposed to the virus comes into contact with their face or body.
The CDC is working closely with other U.S. government agencies to prevent the further spread of Ebola within the United States. It is unrealistic to expect that a few, specialized biosafety facilities can handle potential crises on their own. Experts say that training and empowering local and regional hospitals and laboratories and their staff to deal with infectious disease patients is critical for long-term epidemic preparedness.