Dozens of New York City fire and health officials lined up behind Bellevue Hospital on Wednesday afternoon to watch as paramedics in silver hazmat suits and oxygen masks transferred a man wrapped up in sheets like a burrito from an ambulance onto a stretcher.
He was rolled inside by clinicians in dressed in protective gear from head to toe, including face shields and multiple pairs of gloves.
The scene was one of the final steps in a lengthy practice drill simulating what would happen if a patient showed up at an NYC health clinic with symptoms of Marburg virus, a severe hemorrhagic fever similar to Ebola that’s rarely seen in the U.S. After outbreaks of Marburg popped up in Tanzania and Equatorial Guinea earlier this year, city health officials decided it should be the subject of the annual simulation, in which they practice the protocols for responding to a case of a rare or emerging disease.
“It’s a low-probability event, but low doesn’t mean zero,” said Syra Madad, the senior director of the special pathogens program at NYC Health + Hospitals.
Because Marburg can be spread from person to person through bodily fluids, clinicians and first responders donned extensive protective equipment during the exercise. But the U.S. has only recorded a single case in its history — a traveler brought it to Colorado from Uganda in 2008. Include miners and people exposed to Egyptian rousette bats are among those most at risk of infection in regions where the disease has been spotted, according to the Centers for Disease Control and Prevention.
Still, Madad said, these drills are key to ensuring that a disease like Marburg doesn’t spread if it ever makes its way to New York. Clinicians must practice isolating patients and protecting themselves, while public hospital officials contact the city and state health departments and the CDC. Such steps are crucial for stemming transmission through a major transportation hub with a high population density.
“Given that we live in a world where there’s so many different factors that influence the emergence and re-emergence of different infectious diseases, we want to make sure we’re prepared for these types of low probability, one-off events,” Madad explained.
She added that many of the protocols for responding to Marburg could be applied to Ebola, which also spreads via bodily fluids. Bellevue responded to one real case of Ebola in 2014.
Despite being a one-off event, the city then conducted a practice drill around the disease in 2019, before suspending its annual simulations during the COVID-19 pandemic. Last year, the drills resumed with a simulated response to mpox. Last summer, NYC grappled with a monthslong outbreak of mpox, which was once unheard of in the U.S.
How the drill went
Wednesday’s Marburg exercise began at NYC Health + Hospitals’ Gouverneur clinic in Lower Manhattan, where a patient actor — played by a special pathogens intern — showed up with some early signs of the disease: a severe headache, worsening rash, fever and abdominal pain. Other Marburg symptoms can include nausea and diarrhea and, if left untreated, the disease can lead to organ failure and death, according to the CDC.
When questioned about his travel history, the fake patient said he had recently returned from a trip to Kenya, where he explored Kitum Cave.
After that, the city’s multipronged response kicked in: When Madad arrived at Gouverneur, she was discussing the response on a real call to the CDC.
The patient actor was isolated in a small room at the health center, while the clinicians pretending to treat him practiced putting on robes with hoods, gloves, booties and face masks. EMS workers arrived in an ambulance shortly after and were debriefed on the situation before being taped into their hazmat suits.
At Bellevue, the patient actor was transferred to the hospital’s Special Pathogens Unit, while the first responders who brought him there engaged in a painstaking decontamination process in a tent outside. It involved having their suits hosed down with bleach before being removed.
Members of the special FDNY hazmat team that wiped down the workers are trained to deal with dangerous substances, not limited to contagious bodily fluids. Most recently, they have been responding to the uptick of e-bike fires caused by exploding lithium-ion batteries, said FDNY Captain Jason Wendell.
While this time the patient was released after the exercise, a real case of Marburg would involve careful monitoring for days, said Dr. Mary Foote, the medical director of the city health department’s office of emergency preparedness and response.
“You have to be really aggressive about making sure you’re replacing all the electrolytes and fluids [that are lost],” Foote explained.
When asked how Wednesday’s exercise went, Madad said it went well but added that the goal is always to identify areas for improvement – particularly when it comes to communication among all the players involved.