KANSAS CITY, Mo. _ A Kansas City research institute became part of the international novel coronavirus story this week when a unique, high-tech biocontainment pod it designed was used in the evacuation of more than 300 Americans quarantined on a cruise ship off the coast of Japan.
The U.S. State Department owns four of the units created by MRIGlobal, formerly the Midwest Research Institute.
The department said 14 of the Americans on the Diamond Princess who tested positive for the virus "were moved in the most expeditious and safe manner to a specialized containment area on the evacuation aircraft to isolate them in accordance with standard protocols."
On Friday, federal health officials said more infections are expected among the people who were passengers aboard the ship and are currently in quarantine.
MRIGlobal created the containment pods _ 44 feet long and 8 feet tall _ in 2014 to use during the Ebola outbreak. They look like freight containers and were designed to eliminate the risk of transporting patients with contagious diseases.
"We don't believe they've been used until now," said MRIGlobal's Dean Gray, who shepherded the creation of the units. "Certainly we've had training exercises with them, over the past several years, both internationally and nationally. But as far as we know this is the first time they've been deployed and used in an evacuation scenario of some capacity.
"We're just so proud to be a part of it in any small way, because if we've helped a customer make a product that ultimately saves lives, what else can we ask for?"
Midwest Research Institute was founded by Kansas City business leaders after World War II, and over the years researchers there have worked on everything from defense projects, cancer research, renewable energy, rocket fuel development, astronaut clothing, even that candy coating on M&M's.
Based on Volker Boulevard near the Country Club Plaza, its current work includes pharmaceutical studies, infectious disease surveillance and technology to counter weapons of mass destruction.
In 2014, during the outbreak of the Ebola virus in West Africa, the company developed mobile medical laboratories "with diagnostic capabilities" for the U.S. Defense Department, Gray said.
Then, the State Department and the Paul G. Allen Ebola Program contacted the company with a different request. Allen, who co-founded Microsoft with Bill Gates, pledged millions to fight the Ebola virus before he died in 2018.
With so many Americans _ from first responders to workers with nonprofit organizations _ headed to West Africa to help eradication efforts, the State Department worried that there was no way to safely bring sick people home without endangering others.
There was concern, too, that having no safe way to evacuate health workers who became ill would hurt efforts to recruit medical professionals.
"The best that we can do is one person at a time in a Gulfstream, and that is not going to cut it," government officials told the company, according to Gray.
The feds needed something bigger: Some method of transportation large enough to hold four patients, four caregivers and the medical support needed to keep patients alive, safely sealed to contain the infectious disease within.
And, "it had to be able to be loaded on and off a large aircraft, completely contained, and be able to run on its own battery power for a certain amount of time," said Gray.
"And then also be able to transport patients not just in the air but also on the ground, on the back of a semi-truck to a hospital where the people can be treated."
Nothing like that existed, said Gray. "But look, that's what we're here for. This is the kind of stuff that we do," he said. "The best phone call you can receive is a customer who calls and says, 'We have got something that we don't even know is possible and you're the first group that we wanted to call.'"
The Allen group and the State Department formed a $5 million private-public partnership to pay for the project.
The time frame was tight.
"By the time we were able to start working on this, it needed to be done almost immediately," said Gray. "This was from design, back-of-the-envelope design, all the way through fabrication and delivery, which we did in 191 days."
Working day and night over the 2014 holiday season, a team of MRIGlobal mechanical and electrical engineers designed a 22,000 pound container _ aluminum on the outside, insulated steel walls on the inside _ that can fit inside a plane.
There are no corners inside. "That was super important in this design, because viruses are going to stay alive for days in little nooks and crannies," said Gray. "But in this container there are no corners, (just) one continuous epoxy coating from floor to ceiling."
And it's sealed tight, he said. "It's continuously pulling clean air from the outside through several ... filters on the inside to make sure that everything is under negative pressure, meaning there can't be any escape of air ... unless it's gone through all these filtration steps. That's how you keep people safe in the rest of the aircraft."
The pod is divided into three areas. The largest is the "hot" zone that holds four patient hospital beds, four seats for caregivers and medical equipment. Caregivers climb into protective gear in the "warm" zone.
The "cold" zone, Gray said, "is a clean area where caregivers end up getting a rest between shifts. Because a flight like that one from Japan back to the United States was at least 12 hours ... that's going to be a pretty long shift for a caregiver. We had to make sure that there was a place for them to rest and trade off shifts as they needed to."
Staff has access to a bathroom.
MRIGlobal provided the government four pods, designed in Kansas City and built in Utah.
In 2016 the state-of-the-art Containerized Biocontainment System _ CBCS _ won a coveted innovation award from R&D magazine.
Gray said the State Department didn't give the company any heads-up that one, or maybe more, of the containers would be used, finally, for the evacuation of the cruise ship this week.
A company spokesperson said MRIGlobal found out from news reports.
The news reports reflect an evacuation process fraught with chaos. The State Department initially said the American passengers evaluated by medical personnel from the U.S. Department of Health and Human Services didn't show symptoms and were fit to fly.
But U.S. officials received notice after the passengers left the ship and went to the airport that 14 Americans, who had been tested two to three days earlier, had, in fact, tested positive for the virus.
After what The Washington Post described as a "fierce debate" between State Department and administration officials, and the Centers for Disease Control and Prevention, which reportedly objected to allowing infected and uninfected passengers to travel together, all the Americans were allowed to fly back.
On Friday, a State Department spokesperson would not confirm to The Kansas City Star whether one of MRIGlobal's pods was used, but said that during the flights, infected passengers "continued to be isolated from the other passengers" and were "closely monitored by medical professionals."
Gray said MRIGlobal can produce more containment units if needed.
"They were built to help with the Ebola transport, to fight that epidemic in West Africa, but now they're being used in some capacity for the coronavirus outbreak," Gray said. "Because of the way they are built they don't have a shelf life.
"They are very robust systems, so with maintenance there's really no expiration date on how long these can be used. So they're going to be ready for any outbreak that comes in the future as well."
On Friday, a CDC official said that 18 Americans evacuated from the Diamond Princess ship have now tested positive for coronavirus, and that several American passengers hospitalized in Japan with the virus are seriously ill.
Eleven of those who tested positive are being treated at the University of Nebraska Medical Center in Omaha.
The CDC also announced that it is changing the way it reports cases to separate out citizens the State Department "repatriated" from overseas, including the Diamond Princess passengers.
"We don't believe those numbers accurately represent the picture of what is happening in the communities in the United States as of this time," Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases, told reporters.
As of Friday, there were 13 cases of coronavirus in the United States, and an additional 21 cases among citizens who returned from overseas, she said.
Because the cruise ship passengers were in such close quarters, "they are considered at high risk for infection and we do expect to see additional confirmed cases among the passengers," Messonnier said.
And, because so many of the passengers were older than 60, she expects them to have other medical problems that will require hospitalization.
On Thursday the State Department advised citizens to reconsider traveling by cruise ship to or within Asia _ for one reason to avoid strict screening procedures many countries have implemented to prevent the spread of the virus.
Charter flights home, like the two from Japan this week, are not standard operating procedure, State Department officials warned.
"While the U.S. government has successfully evacuated hundreds of our citizens in recent weeks, such repatriation flights do not reflect our standard practice and should not be relied upon as an option for U.S. citizens under potential risk of quarantine by local authorities," Ian G. Brownlee, an assistant secretary with the department, told the media on Friday.
"We urge U.S. citizens to evaluate the risks associated with choosing to remain in an area that may be subject to quarantine."
