Hello, everyone, and thank you for joining us today. My name is Dr. Kelly Cockett, and I am an Associate Professor of Infectious Diseases and Critical Care Medicine at University of Nebraska Medical Center in Omaha, Nebraska. It's my pleasure to be sharing with you a primer on emerging special pathogens, what you need to know. I have no disclosures relevant to this topic or to any of the content that will be presented in this presentation today. Our objectives today are to start by defining what emerging special pathogens are as they are relevant to critical care clinicians, to optimize early recognition of these special pathogens, and to incorporate evidence-based strategies for early management and ICU preparedness for special pathogens and possible outbreaks. To start us off, I want to start with this quote by Steve Turner, history repeats itself. It has to because no one ever listens. This is absolutely true when we talk about emerging and re-emerging special pathogens, and when we think about the risk of pandemics and how to prepare. Having just exited out of a large global pandemic, we all have much we can learn from what has happened over the last several years, and it is absolutely true that the future is paved with the knowledge of the past. We do need to listen to these histories, both of the most recent COVID-19 pandemic, but also of other pandemics from emerging pathogens in the more distant past in order to really prepare for today and for future pandemics and outbreaks moving forward. As we go through this talk, I urge you to be a thoughtful and active listener as we discuss emerging special pathogens. So as we start to discuss this more, I really want to highlight both what emerging special pathogens are, with an example here on this slide of both Ebola on the left side of your screen, and of course our well-recognized SARS-CoV-2 causing COVID-19 infections on the right. But also equally important when we think about emerging special pathogens is what we do to contain these infections as much as possible, and that includes considerations for biocontainment. So we will have emerging special pathogens and biocontainment 101 in this talk. And because I did just highlight that the future is paved with the history of the past, we are going to start with a little bit of history. As we think about pandemics across history, first it's important to understand that pandemics are different from epidemics and outbreaks based upon the geographic spread on a global perspective that defines a pandemic. When we think about these large global spreads, we think about some very key examples of infections over time. So in the 540s and 1300s, we had pandemics of plague caused by Yersinia pestis. And in the 1300s, this was really focused on the Black Death or bubonic plague, as many of us have learned in history. In the 1800s, we have five separate cholera pandemics, a pandemic again of plague, and the first viral respiratory illness pandemic with influenza. Now historically, this was a very important time because there was increasing urbanization and people living in closer and closer proximity together in which the spread would continue to rise rapidly in large urban centers. In the 1900s, we had another cholera pandemic, and now really see that transition to predominance of respiratory viral infections with three separate influenza pandemics. And then finally, most recently in the 2000s, we've had our SARS-CoV or SARS pandemic, influenza pandemic, MERS pandemic caused by MERS-CoV, and then COVID-19, of course, caused by SARS-CoV-2 virus. But as we think about these transitions, it is also important to recognize that this is when we saw the rise of biocontainment expertise and the recognition that we may need improved biocontainment with these pandemics and emerging special pathogens. The first United States military biocontainment unit opened in approximately 1970, along with interestingly, the Lunar Receiving Laboratory, which was meant as a biocontainment center and decontamination center for the astronauts returning from the moon to ensure that no extraterrestrial pathogens could infect humans. Simultaneously, the military had built their first biocontainment unit, really focused on protecting and isolating laboratory personnel working with highly infectious pathogens in the setting of considering developing these pathogens for biowarfare. We went just over 30 years with just this military biocontainment unit before the first civilian biocontainment units were opened in the United States at Nebraska Medicine in Omaha and at Emory in Atlanta, Georgia. So really a huge need, but very small amount of services up until truly more recently with the Ebola outbreaks and epidemics that occurred in which we've had substantial increased interest in biocontainment processes and practices and in building units in the United States. So with this in mind, we really should touch on what exactly is a biocontainment unit. So these are units that are very specifically designed and highly intentionally designed to treat patients with highly hazardous and communicable diseases in an environment that maximizes the safety of the staff and also the community in which the biocontainment resides. This is really the definition used at Nebraska Medicine of what our biocontainment unit means and what it means to serve in that area. These are usually also associated with a high biosafety level laboratory or a BSL lab with safety for testing patient specimens, and many of these are contained within or in extremely close proximity to the biocontainment unit. Most of the associated labs with biocontainment units are a 3 plus or 4, meaning really at the highest levels of protection for the most contagious pathogens. This becomes incredibly important when we think about the risks of laboratory personnel in processing blood and body fluids with highly contagious pathogens or with a new emerging pathogen which we do not know in full how it transmits and what body fluids and contamination risks our healthcare workers and laboratorians may face. The photo that you see on the right is actually from Nebraska Medicine from an ABC News article showing the interior of our biocontainment unit. This unit is very specifically designed with separate rooms, its own air handling center, impermeable walls, it has the capacity for us to don and doff PPE in a singular workflow from entry into exit, so there are hot zones for potential exposure and where PPE is required and a decontamination process for exiting that biocontainment unit. As mentioned, we do have a lab in ours and in addition, we have autoclave processes within the biocontainment unit with plans for everything from how to transport a patient safely in to how to dispose of any waste from within this biocontainment unit safely without causing contamination to anyone else. Globally, there are more biocontainment unit centers but in the United States, we have three lead institutions who comprise the NETEC or National Emerging Special Pathogens Training and Education Center. This was originally founded by the United States Department of Health and Human Services and the CDC and the three lead institutions are Emory University Hospital and University of Nebraska Medical Center, Nebraska Medicine, which as previously mentioned, were the first two civilian biocontainment units in the United States. Additionally, New York Health and Hospitals Bellevue is the third institution. These groups and NETEC as a whole work together to provide continued education and training both on emerging special pathogens but also on general preparedness and care of patients in the setting of the rise of a special pathogen. And if you have not looked at NETEC information in the past, I would highly recommend that you review this website because it is a wealth of information and an excellent resource after this lecture is complete. When we consider how many biocontainment units are in the United States, we also need to consider the 13 U.S. Regional Emerging Special Pathogen Treatment Centers and they are illustrated on the map below and so you can see where these are currently located. These serve as an area in which there is expertise in emerging special pathogen treatment and care of these patients. They also may serve as a potential location for transfer of a patient who may have an emerging special pathogen infection and needs a higher level of care. All other organizations in general are considered frontline organizations if they are not within this matrix of these patients and may have some capacity to care for patients within their own walls depending on the state of the pathogen, the risk of infection to others, and the number of patients being impacted in health care centers if it is indeed a pandemic setting. So with understanding a little bit about biocontainment history and pandemic history, let's actually get into what I'm talking about, which is emerging special pathogens. So what does that actually mean? According to the CDC, these are special pathogens that are really highly infectious and capable of creating severe disease in humans. And in those scenarios, it is preferential that these patients be treated and contained within biocontainment units, again to protect the patient and the health care workers and the local community. Special pathogens are often referring to viruses and very specifically frequently refer to viral hemorrhagic fevers, but could include other highly transmissible viruses. And we'll continue to talk about this throughout the talk. There are also other pathogens that could arise, such as if we had another active pandemic of plague ongoing, we could see certainly bacterial pathogens that could arise as an emerging special pathogen or a re-emerging special pathogen in these scenarios. Where do these special pathogens come from? That's a very frequent question that comes up. And when we look at these viruses that have become far more predominant in the scenario of our history of global pandemics, but also when you look at some of the additional epidemics and outbreaks that have happened where there has been threat of pandemic, we really see a lot of animal exposure with viruses jumping from animals to humans. Now, this has been specifically noted and of concern as it relates to different coronaviruses. And these coronaviruses are frequently seen in animals and then have transitioned to humans. And that includes the SARS outbreak, the MERS outbreak, and our COVID-19 outbreak. And then as many will remember, our influenza outbreak also had specific novel influenza strains that have come from animals. And we frequently talk about animal reservoirs and things like avian flu, which may transmit over and have high risk for potential future pandemics in humans. The examples here are the pangolin, which you see on the left of the screen and has been referred to as a scaly anteater, which was an animal of concern for the SARS-CoV-2 pandemic as a potential animal source in markets. Chickens have specifically been a concern for a multitude of different viruses, including coronaviruses and influenza viruses. And bats have been responsible for transmission of multiple different infections and viruses and also have been commonly cited as a high-risk animal in which we may see a pandemic potential virus arise into the human population. The next most critical thing to consider as we think about emerging special pathogens or other known high-risk pathogens is how do we identify them and when should they be considered for biocontainment? Now, it is important to note if we truly have a new emerging special pathogen, we will not have a lot of data about that right away, but we may be seeing pandemic proportions of human illness. And in those scenarios, if we don't know, we assume the worst case scenario that it is highly contagious and impactful to human health in which we would consider it appropriate for biocontainment until proven otherwise. But the four key aspects that we need to consider when thinking about if a high-risk pathogen requires biocontainment are as follows. First, infectivity. What is the infectious dose of the organism? Do you need a large inoculum with many organisms to cause human infection? Or does a single organism potentially cause infection in a human? Obviously, the smaller the amount of organisms, the higher concern because it takes so little to cause infection. Second, communicability, or how contagious is it? And this refers to the idea that you have a singular patient who has active infection and you want to understand how many other people are likely to be infected if exposed to the virus. And in epidemiologic terms, this is referred to as the R-naught. Third, hazard. What is the morbidity and mortality that this infection can cause in humans? The more severe the morbidity and mortality, the more likely that we would be looking towards biocontainment. And then the special consideration is, are there effective medical countermeasures? And a medical countermeasure can be as simple as having an effective vaccine. You could have something that is highly contagious with a low infectious dose for infectivity and reasonably high morbidity and mortality, such as measles. But when you have effective countermeasures that can be effective, you can have a high morbidity, you can have effective countermeasures that can be employed and utilized that render a lot of these top three to be far less significant. Then it becomes a consideration of whether or not biocontainment is required. And this is both for staff safety and, again, community safety in these situations. As an additional example, with that list of potential components we're thinking about with whether or not a pathogen requires biocontainment, we can look at this Venn diagram to aid in additional understanding. So we have highly hazardous infections, such as anthrax and botulism. We have highly infectious or low inoculum requiring infections, such as Q fever and brucella. And we have highly communicable or transmissible infections, such as mumps and norovirus. And all of these on their own do not necessarily meet that criteria for biocontainment, because we're really looking for where they all overlap. And that's where we can see moving in towards something like Ebola becomes a biocontainment unit candidate, because it is highly communicable, hazardous, and infectious. And there have not historically been effective medical countermeasures, such as things like vaccines, which we have for several of these, or active and effective direct medical treatment for the infection. And specific to the sentiment, yeah, this is all great, but I'll probably never see a case. I would counter that there's increasing likelihood that, in fact, you will. When we think about this historical timeline on the bottom, we've seen increasing numbers of respiratory viral pathogens that have caused pandemics. And when this data is all taken into account and future projections are reviewed, the probability of seeing another pandemic is increasing two to threefold in frequency currently. And there are new threats or new emerging special pathogens that are also increasing in frequency as they are being identified. So, although in the past it may have been perhaps less likely that you would ever see a case of an emerging special pathogen, as we all know now, it certainly has the capacity to enter all of our organizations. And with global travel, urbanization, and climate change, the likelihood is only increasing that we will see this happen and that it will present to any one of us in our emergency rooms or ICUs. Beyond viral hemorrhagic fevers, what else might we see in biocontainment units and as emerging or re-emerging special pathogens? So, this includes additional infections beyond the Ebola and influenza we've talked about, but also could include Nipah virus, pneumonic plague, similar to prior plague pandemics, smallpox, should it re-emerge or be used as a bioterrorism weapon, monkeypox, particularly prior strains, the most recently spread strain initially required biocontainment until it was deemed to be less infectious, new rising influenza strains, and XDR tuberculosis also could fall into this realm along with several of these other infections that we've already mentioned earlier in this presentation. Emerging pathogens can present anywhere in the world at any time, particularly due to the highlighted changes in climate, travel, and urbanization. They are constant threats to human health and any new emerging pathogen has to have a high concern for needing biocontainment unit level care because the infectivity, communicability, and hazard are unknown early on after the emergence of these pathogens. Echoing back to the sentiment that yeah, but I'll probably never see a case from a few slides ago, if we think about VHF or viral hemorrhagic fevers as an example, there's actually a high number of people with one third of the global population who live in at-risk areas for viral hemorrhagic fevers, which substantially changes the way we think about the likelihood of seeing one of these infections, particularly based on your geography as where you practice and those who have been traveling into these endemic areas. Recognition of the specialist pathogens, particularly viral hemorrhagic fevers, is incredibly important to critical care clinicians because patients presenting with a viral hemorrhagic fever can rapidly deteriorate and have multi-organ failure prompting ICU admission. Therefore understanding the risk and the differences based on epidemiology are very important when such patients may arise. When considering the fact that one-third of the global population lives in at-risk areas for viral hemorrhagic fevers and such patients could present to an ICU with multi-organ failure, then prompt recognition becomes the most critical next step in order to provide effective patient care but also to prevent transmission of infection to other patients and healthcare workers and the community at large. What might the clinical presentation look like? First we start with the key phrase used for a person who may have a special pathogen and this is a person under investigation or PUI. And special pathogens have two key components when we consider whether or not they qualify as a PUI. First the clinical syndrome and second the epidemiologic history. The clinical syndrome is critical to know the onset of symptoms, any prodromal symptoms, and what in full the patient has experienced as symptoms. In addition to this we need to recognize that if a patient presents with multi-organ failure to the emergency room and ultimately at the ICU it could very much look like a patient with sepsis and so having the high level of suspicion to ensure that you also get the appropriate epidemiologic history when reviewing cases. So the epidemiologic history includes requiring exposure to an infected person or travel to an area with widespread transmission or known widespread cases. Additionally to this the travel history is important as it relates to the onset of clinical symptoms. So when did the travel occur and when did symptoms start? All of these infections that are established have incubation periods and the epidemiologic history and clinical syndrome would be compared against the incubation period at the long end to understand if this infection might be feasible. In a new emerging pathogen this becomes a interesting point where we may not always know the full incubation period and then again have a much higher level of concern for potential infection and need for biocontainment. So in review well-detailed clinical syndrome and epidemiologic history with the timing and dates of travel and timing and dates of symptom onset all become critical and will be questions if you look for expert assistance in determining whether or not special testing is required that any of those experts will be asking for. A little further depth about what a viral hemorrhagic fever clinical symptom could look like. There are multiple overlapping clinical symptoms with other syndromes such as fever, severe headache, fatigue, myalgia, abdominal pain, and other GI symptoms and then of course the development of unexplained hemorrhage. Although the hemorrhage may not be present if the patient is presenting early in the course. So as mentioned this can overlap and look like many other things including having the risk of malaria in which we can see co-infection. The key aspect to these is if we do not think about it we will not find it and establish appropriate care for the patient and healthcare workers involved. So again really having that high level of suspicion and ensuring we have good histories on our patients especially if they are presenting with an unusual array of symptoms or are reporting recent travel to areas where infections are noted to be. As we think about key things that can help you optimize your early recognition of emerging special pathogens that are not previously identified. So considering if you have any unusual disease presentations or patterns that don't fit your usual realms of clinical presentation seem significantly more severe or are existing but have negative testing for standard infections. If there are small outbreaks this also raises the concern for a emerging special pathogen. So this could be a number of people who were in the same place at the same time in which they all come down with similar symptoms. And then always be aware of travel related exposures. This of course includes traveling in endemic areas but there have been cases of exposures even from being on airplanes from different areas. So keeping that in mind and understanding any travel related issues understanding if the patient became ill while in route traveling and if so particularly if special pathogens arise following through with reporting to local and state health departments to determine if others who are traveling have become ill becomes an important part of that investigation. To further illustrate what to do if you think you might have a case I'd like to walk through this clinical scenario. Three patients are being admitted from the emergency room to the ICU with respiratory symptoms concerning foreign and influenza-like illness with fever, cough, shortness of breath, and impending respiratory failure due to acute hypoxemia. They report to you that they've traveled in a group of five to Saudi Arabia recently and had travel in both rural and urban areas including travel with camels and they returned three days ago. As you're taking that travel history and epidemiologic history regarding exposure to other sick persons they did note that the guide who was also caring for their camels had become sick on the last two days of their trip with a cough. This raises concern for potential special pathogen and specifically in this area is based off of prior MERS cases and exposures. So in this setting what are the next immediate steps? The first critical steps in a scenario like this are to utilize the established identify, isolate, and inform strategy. So utilizing the identify, isolate, inform approach for transmissible infectious diseases after identifying a possible special pathogen based on clinical symptoms and epidemiologic history amongst a group of travelers like this with high risk of exposure to high-risk exposures should result in immediate isolation of all ill and exposed persons. So if they were traveling to the emergency room together with a mix of ill and asymptomatic persons we would want everyone in that group isolated and at times we have allowed isolation together if that is the only thing that your facility can provide. This should include a private room with private bathroom or commode and then healthcare workers need to step into escalation of appropriate PPE which when in doubt should include a gown, double gloves, surgical mask, and face shield. And then utilizing dedicated patient equipment until further discussion and potential testing can be used to determine if there is indeed a special pathogen as some of these would require special handling of any materials and equipment in the room that were used. Infection control and any relevant agencies such as your local public health authorities should be informed only after isolation has occurred. Any further testing of the patient should be limited until further guidance is available. Again this is due to the risk of healthcare and laboratory personnel due to the high risk of transmission of infection with blood and body fluids. Further history could also be obtained safely after isolation has occurred if the history comes out very rapidly for travel and concern is raised. It is far better to err on the side of isolation and informing than not in a situation in which you may have a question. As we think about appropriate infection control and isolation strategies and prepare in advance for potential special pathogens arriving at our organizations, I think it is important to touch on the hierarchy of infection controls and components so that we can focus on a reduction of risk to healthcare workers. Without appropriate plans and procedures in place, the risk to healthcare workers is significant due to error or missed opportunity. As we work from the top to bottom of this particular hierarchy, elimination is to physically remove the hazard which in this case may be specifically to remove the infectious pathogen which is not immediately available. Substitution is to replace the hazard which of course we cannot replace the hazard of the infection, but this does become important when we consider the dedicated equipment versus shared equipment. By substituting dedicated patient equipment for patients who are under investigation, we minimize the risk to other patients because our normal infection control policies for cleaning that equipment may no longer be appropriate. Engineering controls isolate people from the hazard, so this is recognizing the pathogen and getting patients into isolation in private rooms. Administrative controls change the way people work to decrease the hazard, so this could be ensuring that you have adequate access to PPE, signage to warn staff not to enter rooms, and additional administrative controls with perhaps one-way strategies or closed areas in which there are highly transmissible pathogens such as things like policies with one-way flow through infectious areas. The least effective strategy is actually PPE which only provides protection to the worker, and although we focus very heavily on PPE and we have during the most recent COVID-19 pandemic, we do need to consider in each of our organizations if there are better ways to address this entire hierarchy of controls so that we can minimize risk to any future hazards that arise in our organizations. After proceeding with identify, isolate, and inform, what's next? Care for the patient really is next, and early care with emerging special pathogens is supportive care, particularly when they are still a person under investigation or in many of these scenarios where there really aren't immediately available therapeutics and perhaps are no therapeutics against the infectious pathogen. Expert care in these infections should be requested because of the uniqueness of some of these infections, and to understand if there are any approved treatments and medical countermeasures, or if there are any active trials in which a therapeutic may be available in a research or compassionate setting. Now clearly in this brief emerging special pathogens and biocontainment 101 lecture, I'm not able to go into the full depth and breadth of information that we would all love to have. So how can you learn more? I mentioned NETEC early on and the amount of education that they provide, and this is a screenshot on their website from their opening page, and I really want to highlight the fact that they have an enormous amount of education, including formal education and training. They also have a podcast. They have webinars on YouTube that are available. They have their news and blog that provide updates on pathogens and outbreaks, and then they have additional services if you're interested in looking more at how to prepare your organization, including consulting services and readiness assessments. There's also additional support for researchers who are interested in studying biocontainment and emerging special pathogens. So I would urge you all to really get more detail and depth here. I will also note that the CDC does have additional resources as does the WHO. Given that I shared earlier that a third of the global population does live in at-risk areas for viral hemorrhagic fevers, making it a plausible presentation of a special pathogen to an organization anywhere in the world, I wanted to share this publication from Lancet Infectious Diseases published in 2013, and this is a manuscript really assessing standard of care for viral hemorrhagic fevers as a systematic review for clinical management guidelines, and when they reviewed this, what they did find was that guidance on supportive care and therapeutics did not have as much detail perhaps as we would all like as clinicians, and the guidelines were sometimes contradictory. They are based at times on uncertain evidence, which makes this a challenge for clinicians on how to implement appropriate care, and frankly, how to implement appropriate clinical trials for appropriate standard of care due to the heterogeneous guideline recommendations that exist across the globe. We do need clearly better guidelines for VHFs, but I do want to touch on some of the details that they highlighted in variation of care that are specific to VHFs so at least there is some understanding on the basic care for these patients. This table truly highlights some of the different types of viruses that all can cause a viral hemorrhagic fever, including the arena viruses, bunia viruses, and filoviruses, and when we look at the table, what you can see are some key pieces, which is based on fluid resuscitation choice and administration. Now there is variation on how this is managed, but you can see that the vast majority of all patients do receive fluid resuscitation, but fluid choice is not identified well, nor is appropriate route of administration or endpoint of how much volume to give. So much like sepsis, fluid is a bit of a Goldilocks in care, meaning we're not really sure what is just right in these patients. Supplemental oxygen is commonly used, but not necessarily a widespread recommendation, and this is really something to be thinking about in this setting of the unexplained hemorrhage and perhaps a question akin to traumatic bleeding scenarios on whether or not we should be having supplemental oxygen in active hemorrhage, regardless of the O2 sats at the time of clinical presentation. Blood product transfusion, also very common in these scenarios, but again, not consistent across the board. And symptom control, similarly common, but not consistent. And you can see as we go farther down, you have increasing variation on treatments, including key, as mentioned before, antimalarials. We must always think about co-infection with malaria in these settings, and because of the potential risk for co-infection, particularly with Ebola and Marburg viral disease, we would be thinking about empiric malaria treatment if we are unable to get quick, safe testing for malaria in these scenarios. The use of antibiotics has varied significantly, and again, this is not a surprise. We did see this early in the COVID-19 pandemic where antibiotics were used heavily because we were uncertain if there was additional co-pathogens, or we may not know immediately if this is a viral hemorrhagic fever or some other type of septic shock when there's a person under investigation. Antiviral therapy varies, and this is significant because not all viral hemorrhagic fevers have antiviral available. So again here, really requiring expert opinion to understand what to give, when to give it, and if it's appropriate to give. And then interestingly, and pertinent to the ICU, is the percentage of advanced supportive care, including invasive monitoring, renal replacement therapy, and the use of vasopressors and ionotropes. Significant variation here, again, on this partially due to safety of placement of central lines, exposure to blood, and ability to maintain circuitry for RRT treatment. So again here, this would require special assessment, and frankly, most of these patients at the point you'd be considering these levels of therapy would probably be escalating to a regional or one of the three lead centers for care outside of a massive pandemic in which those facilities are full and unable to take more patients. So to summarize some of those key points, mortality is improved with high quality resourced care. This has been demonstrated in the Ebola outbreaks with care of these patients in biocontainment units. We do have a paucity of data on optimal treatment strategies, but resuscitation for fluid and bleeding is key in viral hemorrhagic fevers. Additional therapies really must rely on expert opinion, and not all organizations support full life support measures due to the risk of healthcare workers and the ability to mitigate those risks. After caring for a person under investigation or a patient with emerging special pathogens, it is really important to walk through phases of incident management with your team and organization in order to reassess opportunities for improvement, which includes review of preparedness, mitigation strategies, response, and recovery. This is critical post-COVID-19 and will be critical post any other outbreak or even a single PUI to make sure that you are as prepared as possible to execute safely. Risks are mitigated appropriately, and you have the supplies, resources, and appropriate communication strategies in place that you have the ability to execute predetermined plans and procedures, and the ability to restore them back to prior state, or rebuild or reopen units or rooms as needed. Finally, I want to recognize that human factors impacting healthcare when it pertains to special pathogens are really important to consider. To err is human. We can make mistakes on PPE, isolation, and care, and to fear is human also, and special pathogens generate a lot of fear about getting infected yourself or potentially transmitting infection to your loved ones at home or to others. In these scenarios, when fear overtakes our ability to care for the patient, we tend to overcompensate by changing infection control practices and adjusting based on what we think is best, and when we do that, there is clear data that we are more likely to make mistakes when we're donning and doffing, causing exposure. We are more likely to make mistakes during patient care and cause inadvertent exposure to other healthcare workers, morbidity and mortality to our patients, or exposure to laboratorians. Education is key to this, and so please always remember to call for help after isolating patients and provide clear communication to those around you when there is a PUI so that the fear can decrease and there's a clear strategy on how to care for these patients. With that, my key take-home points from this lecture are that emerging pathogens and other highly infectious diseases are going to continue to arise and continue to be global problems. Pandemics will continue to occur at increasing rates, as previously noted, so we need to be diligent as they can arise anywhere. Use the identify, isolate, and inform strategy, and remember that supportive care is the fundamental basis of care for most special pathogens. Additional therapy should be based on expert advice. The CDC Viral Special Pathogens link is here for you. The National Emerging Special Pathogens Training and Education Center is linked here, and the WHO has a wealth of resources on different pages also. Thank you so much for your time and attention.

Emerging Special Pathogens

Patient Care

ICU Preparedness

Biocontainment Units

Infection Control Measures

Viral Hemorrhagic Fevers

Supportive Care

Incident Management