Taking on the doomsday bugs

An equally strange contraption is wheeled from the back of one ambulance to collect the mysterious patient. The trolley, which is completely enclosed in transparent plastic, a self-contained atmosphere cut off from the real one, contains one human being.

Unconscious, sweating, bleeding from every orifice, his body is wracked with a disease so deadly the unfortunate patient will only emerge from the bubble if his immune system can fight off this killer plague. A deadly scenario.

The transfer is swift and professional - 20 to 30 staff caring for one - and the ambulance and back-up vehicle are escorted by police from the airport to the Newcastle General Hospital. There, it reverses into the ward, a hi-tech room dedicated to containing the worst diseases known to man.

It looks like a scene from a Hollywood blockbuster and countless books and films have been written on doomsday bugs. Dustin Hoffman starred in the most notable, Outbreak, where an infected monkey passed on its lethal pathogen to a hapless thief. Hoffman, in space garb, tries to find a cure before the Pentagon firebombs the infected town. All very dramatic, all very far-fetched - or is it?

A British aid worker died recently from just such a virus. The man had been working deep in the jungles of Sierra Leone and contracted Lassa fever, probably by coming into contact with the urine of a rat which harbours the killer strain. His chances of survival would have been 60 per cent, at best, unfortunately he didn't make it.

British aid worker Ian Janeck died at the Coppets Wood Hospital in north London. Although his condition improved briefly after he was given anti-viral drugs, he developed a chest infection and his condition deteriorated. A hospital spokeswoman said he died of heart failure.

His suffering was real. Not a movie. Not an exercise.

The Newcastle "incident" is an exercise, a scenario drawn up for North-East medics, paramedics and police, to practise their skills, because next time it could be for real. The "infected" patient is a member of staff, thankfully fit and well.

Next month, the only other high security contagious disease containment unit in the country, at Coppets Wood, London, closes for six months for refurbishment, leaving Newcastle General's facility on full alert.

The unit is designed to cope with people suffering from the worst diseases mankind has to fear - haemorrhagic fevers, including Ebola, Lassa fever and Marburg - viruses which when contracted, too often result in death.

Just 12 cases of Lassa fever have been detected in Europe and North America since 1970, although 5,000 people in West Africa die from it every year.

But the risk is growing as holiday-makers visit the country of its origin, Africa; as 2,000 British troops serve in countries where the diseases are endemic, particularly Sierra Leone and the Balkans; and as a North-East population burgeons from Afghanistan, where there have been outbreaks.

Victims suffer a high fever, headaches, diarrhoea, brain inflammation, nausea and internal bleeding. Anti-viral drugs can help but there is no cure and one in five victims dies from the fever and resultant organ failure.

Ebola and Marburg are worse. Scientists are baffled as to the origins of the former while the latter is contracted from monkeys. Over a period of eight to 12 weeks, the virus will attack the blood cells and clotting mechanisms which sustain life. The linings of blood cells break down under the barrage and the patient bleeds, internally and externally.

During that time the patient will excrete body fluids, any of which could spread the disease. The only way to prevent that is to isolate the patient completely from the outside world.

So the ambulance backs up to the back door of Newcastle General's Ward 25, an infectious diseases unit more used to dealing with malaria, salmonella and gastroenteritis, and the trolley is wheeled in.

Oxygen is pumped in and out of the trolley bubble through special filters to ensure the virus does not spread, and doctors and nurses wear a special suit. The trolley then docks, like a spacecraft, with the Tyvec isolation tent, a £30,000 bubble which contains all the medical equipment needed to nurse the patient.

His stricken body is manhandled from the trolley to the bed inside the tent by nurses who put their arms through sealed long plastic tubes which end in gloves, allowing them to touch without making contact.

"The whole aim is that there are no breaks in the system which would allow contamination through the atmosphere," says staff nurse Allan Harrison, one of a specialist team working on the ward and on stand-by for the containment unit. "I've never had a case in my time here but more and more people are bringing back diseases with them and we are prepared for a patient should we ever get one."

Once the patient is settled in, attached to a drip and respirator, depending on his condition, the basic nursing skills remain the same - observation, maintaining fluids, washing, temperature taking and attending to the toilet.

There is no cure but the nursing supports life by tackling the complications caused by the constant bleeding. So platelets and plasmas are introduced to replace those blighted by the virus, clotting agents to try to slow down the organ damage. And it all has to be done from behind a sheath of airtight plastic. Bodily fluids carry the disease and must be isolated at all cost.

Unit head Ed Ong is an expert - he trained at the London School of Tropical Medicine and Hygiene - and one of three consultants in infectious disease. "We have got to have strict protocols and procedures. We have a dedicated laboratory, one of only two in the country, which does nothing else but blood investigations," he says. "It still is extremely rare but we want to be sure the medical staff, paramedics, in fact everyone involved, knows exactly what is involved. The main issue is containment to make sure the public and staff are not at any risk."

The patient is isolated and everything that comes out of the tent must be sealed, sterilised and eventually incinerated. Clothing and waste go to the furnace and the whole room itself has lower air pressure than normal so nothing can leak into the outside world.

When the patient moves on, either by recovering or dying, the whole isolation tent and contents must be destroyed too.

The two hour exercise goes well and the unit wins praise from the Inspectorate for Dangerous Pathogens and the Institute of Pathology's department of communicable disease control.

Public health consultant Dr Nicol Black says: "Heroes come in all shapes and sizes. These people volunteer for a job where they are caring for people who could kill them.

"It is delicate, hazardous work where exposure could be fatal. It is an enormous tribute to the skill, courage and dedication of all the staff involved that they go on providing this service quietly, determinedly, every day, all year, every year."

While there has been no recorded case in Newcastle so far, there are half a dozen scares a year, more often than not the culprit turning out to be malaria.

And as holiday-makers become more adventurous and British troops play world policemen in the diseases' back yard, interest grows in the Newcastle isolation unit as the country's first line of viral defence.