Germany Plans to Repatriate Ebola Patients

As Heiko Maas disembarks through the German military plane at the Goma Airport from the Democratic Republic of Congo, he is actually greeted by two men in white. One of the men sprays the German foreign minister’s hands that has a disinfectant, while the some other holds a thermometer to his temple.

Every air traveler must undergo the infrared fever test. the item’s part of an effort by the Congolese authorities to assert control over a virus of which has been threatening the region for more than a year: Ebola.

The first epidemic of the fatal fever between late 2013 as well as 2016 cost more than 11,000 people in West Africa their lives. In Congo, around 2,0 people have died since summer 2018. the planet Health Organization (WHO) declared the outbreak a “public health emergency of international concern.”

Unlike in West Africa, the epidemic hasn’t spread regionally so far. nevertheless the danger has not yet been averted. as well as since many Germans are helping out from the areas of infection, protecting them — as well as, should they themselves become infected, treating them — has become a matter of great urgency for the German government. Thanks to the initiative of the German Foreign Ministry, German citizens who have contracted the dangerous disease could soon be flown home for treatment for initially.

In With Malaria, out With Ebola

There are currently two Ebola vaccines, nevertheless comprehensive immunization in Congo still remains elusive. One reason is actually of which some infected areas are under rebel control. One WHO representative in Goma told Foreign Minister Maas of which hygiene standards in many Congolese hospitals were catastrophic. “You go in with malaria as well as come out with Ebola,” he said.

To of which day, two-thirds of sick people still die through the disease there. The danger of the disease spreading on both a national as well as regional level is actually “very high,” according to the situation reports published every week by the Foreign Ministry’s health service.

In order to guarantee German doctors as well as some other aid workers the best possible treatment in an emergency, the government in Berlin might like to fly them back to Germany. nevertheless there’s one problem: “The federal government currently has no means of evacuating German citizens suffering through Ebola to Germany while maintaining German treatment as well as occupational safety standards,” says Gerhard Boecken, 60, a tropical medicine specialist who has headed the Foreign Ministry’s health service since 2015.

Prior to his current job, Boecken spent eight years working in Africa. Even as a medical officer for the German navy, he pushed for a transport solution for infected soldiers.

During the first major Ebola epidemic in West Africa in 2014, the government hastily commissioned Germany’s flagship airline, Lufthansa, to convert an Airbus A340 because of of which purpose. The plane was named after the late German physician as well as Nobel laureate Robert Koch. In about three months, the eponymous German medical research institute, Berlin’s Charité hospital as well as Lufthansa, along with the German Foreign Ministry, transformed the large-capacity Airbus aircraft into a flying, isolated intensive care unit.

nevertheless plane got decommissioned almost a year later because the item proved to be too expensive. Maintenance alone amounted to around 1 million euros ($1.1 million) a month, partly because a Lufthansa crew had to be on standby around the clock for emergencies.

Since then, the Foreign Ministry has been working on a plan for how to provide German aid workers with maximum protection at a reasonable cost. One idea is actually a mobile, modular evacuation unit.

Crisis Reaction Center

Frank Hartmann is actually the Foreign Ministry’s crisis management officer. The 54-year-old as well as his staff offer around-the-clock support to German citizens all over the planet, whether they’re affected by natural disasters or political earthquakes or kidnappings.

The crisis reaction center is actually located from the basement of the Foreign Ministry, behind vault doors 50 centimeters (19.7 inches) thick. (The building in central Berlin housed Germany’s central bank through 1876 to 1945.) Inside, the walls are adorned with maps of crisis areas, one of which shows the area affected by Ebola in Central Africa.

“The medical workers on the ground have been providing support for over a year despite extremely difficult circumstances,” Hartmann says. “If they fall ill, the item is actually crucial they be evacuated through the crisis area to ensure they may receive the best possible treatment.”

Hartmann carries a copy of the project sketch for the “infection transport module” on his desk. The system consists of three containers: The first, marked in red, is actually the treatment module. from the item, patients might receive intensive medical care on the flight back to Germany. of which is actually connected to a second container, marked in yellow. of which is actually the airlock where doctors as well as medical workers might don protective suits before entering the treatment module, as well as the item’s where they might be decontaminated after leaving the red area. A third module, marked in green, might serve as a preparation as well as storage room.

A modular solution has many advantages, Hartmann explains. Four meters long as well as 2.4 meters wide, the containers might fit into any standard cargo plane. Smaller aircraft could also be used, such as for landing at airports with shorter runways or on sand, allowing patients to be picked up directly through remote areas. of which might save precious time; the item doesn’t take long for Ebola to destroy large parts of the body. Patients can die in as little as 10 days.

Another advantage of the modules is actually of which upon arrival in Germany, patients might not have to be transferred to special ambulances, which can be cumbersome as well as might increase the risk of infection. The red module could be loaded directly through a plane’s cargo bay onto a normal tractor-trailer as well as then taken to a special isolation station. of which way, the patient might not have to leave the container through the point of pickup to reaching a special isolation station in Germany.

Dealing With Negative Pressure

Nevertheless, transporting a patient with Ebola still poses enormous challenges for doctors, says Alexander Uhrig of Berlin’s Charite university hospital. The 52-year-old runs the intensive care unit as well as the special isolation ward of the hospital’s infectiology as well as pneumonology division. In 2014, he advised the missions flown by the “Robert Koch.”

“Because the disease advances extremely quickly, the patient’s life depends on us being able to treat them on the plane,” Uhrig says. “Otherwise the patient might already be suffering through multiple organ failure by the time they reach Germany.”

Given of which the virus doesn’t spread through the air, the risk of infection is actually generally lower than with influenza viruses. Ebola is actually transmitted through blood as well as some other bodily fluids such as sweat, saliva, stool, urine or vomit through sick or deceased people.

“For medical personnel, the highest level of caution is actually therefore required at even a normal special isolation ward,” says Uhrig. “In an aircraft of which often makes unpredictable movements, the risk as well as strain on personnel increase. One has to be careful when using sharp objects such as syringes or scissors.”

Doctors as well as nurses wear respirator suits with air filters as well as communicate via two-way radios. Because the oxygen content as well as humidity in an airplane’s pressurized cabin at an altitude of 10,000 meters is actually lower than on the ground, they can’t work for longer than three or four hours. On longer flights, more shift adjustments are required than in a conventional isolation station.

The most dangerous thing of which could happen is actually a sudden drop in pressure. Inside the treatment tents onboard the “Robert Koch,” there was negative pressure.

“At the time, we were in uncharted territory, technically speaking,” says Peter Atzpodien, a senior account manager at Lufthansa Technik who is actually responsible for the company’s government relations. “We had to find a solution to prevent the tents through tearing if the pressure dropped. If of which happened, contaminated material might spread throughout the plane as well as as well as put everyone onboard in great danger.”

The solution was an airbag of which took up almost half of the aircraft. “If the pressure were to drop, the contaminated air might escape there,” Atzpodien explains. The solution was one-of-a-kind. Lufthansa has applied for a patent.

Plenty of Infectious Diseases

The evacuation module has not yet been commissioned. For a long time, the item was unclear which German ministry might be responsible for the project. The Health Ministry or the Defense Ministry made sense, nevertheless neither showed much interest. Officials through the Foreign Ministry, however, found a receptive audience at the Chancellery, particularly with chief of staff Helge Braun, who is actually also happens to be a doctor.

the item’s an unusual project for the Foreign Ministry, nevertheless Boecken as well as Hartmann are proud of the item. There’s also the fact of which since the end of November, secure funding has finally been in sight. In November, a working group at the European Council, the body of which represents the leaders of the member states, decided the European Union needed an evacuation unit like the one the Germans designed as well as agreed to finance the item. The project is actually estimated to cost 10 million euros for the development as well as construction of the container modules.

The European Commission has put the project out to tender as well as Germany has made a bid on the item. Considering its experience with the “Robert Koch” as well as the cooperation between the Foreign Ministry, Lufthansa Technik as well as Charité, chances are not bad of which Berlin will be awarded the contract. through of which point on, the item might probably take another 18 months before the modular system might be ready to use.

nevertheless what happens if the Ebola crisis is actually solved by then?

There are some other infectious diseases, Hartmann says. Take the lung disease SARS, for instance, which spread around the globe within a few weeks back at the turn of the millennium. Others, such as lassa fever, the pneumonic plague as well as the Marburg virus are also far through being eradicated. “With the mobile evacuation containers,” Hartmann says, “we Europeans might be prepared for any eventuality.”

Icon: Der NewsGerman

Germany Plans to Repatriate Ebola Patients

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