During the episode, the Carecube was used as an “isolator” to protect an immunocompromised young patient from any potential outside contaminants while her doctors tried to find a donor for stem cell treatment. While not exactly an intended, real-life use case of the Carecube, its presence on this popular show serves as a powerful reminder that our mission to eliminate infectious disease transmission in healthcare settings is critically important.

For those of us who have been hard at work on this for years, seeing our product prominently featured on network television is both meaningful and gratifying.

At UNMC, that responsibility doesn’t end at the edge of our campus or even our state. It extends to the frontlines of every outbreak, every rural hospital, and every community vulnerable to the threats of infectious disease.

Today, with the public launch of Carecubes and the announcement of its Series A funding, we’re proud to see one of UNMC’s most important innovations go global. Carecubes is more than a product—it’s a symbol of how institutions like ours can lead with purpose, science, and service.

Why This Work Matters Now More Than Ever

Throughout history, microbes have claimed more lives than armed conflict. The COVID-19 pandemic made this threat painfully clear, taking more than a million lives in the U.S. alone. Yet even before COVID, UNMC had earned a national reputation as a leader in pandemic preparedness and infectious disease response.

In 2014, we were one of only three institutions nationwide equipped to care for Ebola patients. That didn’t happen by accident. It was the result of more than a decade of investment in biocontainment, training, research, and readiness. We had already built the state-of-the-art Nebraska Biocontainment Unit in conjunction with Nebraska Medicine, our major clinical partner. We had already drilled on protocols. We had already created a team that knew how to respond. When the moment came, we were ready.

When COVID emerged, we once again played a critical role, receiving the first confirmed U.S. patients from the Diamond Princess cruise ship, and standing up the only federally-funded National Quarantine Unit in the country right here at UNMC.

The Nebraska Model

That track record is what has become known nationally as the “Nebraska model”: a commitment to being ready before the crisis hits, and a deep belief in partnerships across sectors, disciplines, and borders. Through our Global Center for Health Security, we collaborate with the CDC, HHS, and the U.S. military. We train with rural hospitals and international ministries of health. And we approach every threat—be it Ebola, measles, or the next unknown pathogen—with humility, discipline, and science.

It was this spirit that led us to help develop the Carecube: a portable, negative pressure isolation unit that flips the traditional model of infectious disease care. Rather than wrapping the provider in layers of personal protective equipment (PPE), Carecube isolates the patient—creating a safe, HEPA-filtered environment where care can be delivered more quickly, more safely, and with fewer barriers.

Innovation Rooted in Real-World Needs

Carecube wasn’t built in a vacuum. It was built in partnership with hospitals in rural Nebraska, field teams in Africa, and frontline healthcare providers around the world. I’ve personally traveled with this device overseas and seen the way people respond. They immediately understood how transformative it can be. From questions about heat in hot climates to storage, transport, and cost—Carecubes listened, iterated, and improved.

Now, with this Series A investment, Carecubes can scale. Carecubes can help save lives not only in major medical centers, but in critical access hospitals, refugee camps, and mobile clinics. Carecubes can help prevent small outbreaks from becoming large ones. And Carecubes can protect the very people we rely on to protect us: our nurses, our doctors, our public health workers.

In a world where pathogens can cross borders in hours, preparedness is not a luxury. It’s a necessity.

In 2014, when the Ebola outbreak hit West Africa, the Department of Defense asked us to help with containment. Through a DARPA contract, we were tasked with exploring immediate interventions. That’s when we began rethinking personal protective equipment (PPE).

The traditional approach – wrapping doctors and nurses in layers of gear – was slowing down care. In hot clinics, donning and doffing limited the amount of time providers could spend with patients. We asked a different question: instead of constraining the mobile caregiver, why not surround the immobile patient? That inversion of the PPE problem became the foundation of Carecubes.

From the start, we leaned into rapid prototyping.

At Otherlab, we modified laser cutters and built heat-press machines so we could iterate quickly. Friends and family, including my sister, stepped into early prototypes. Frontline doctors and nurses gave us candid feedback. That back-and-forth between engineers and clinicians never stopped. If “co-design” ever applied, it’s here—both groups were excited to build something that reflected their needs and intuitions.

Many of the big ideas were there from the beginning.

The defining feature of the Carecube that we kept is what we call the “hug wall.” It allows providers to use gloved arms to reach into the unit and lets patients see more than a sliver of a masked face. During Ebola, doctors sometimes wore photos of themselves pinned to their gowns so patients would remember there was a human on the other side. Carecubes makes that connection real, in the moment. That still excites me most: it restores humanity to care.

There are deeply technical elements too. Air handling is critical. You need negative pressure to pull potentially infectious air inward, filtration to scrub particles, and enough fresh air for patient comfort. Waste handling is another challenge. Every fluid in and out of the unit has to be safely managed. These are not easy problems, but solving them well is what makes the Carecube safe and scalable.

Looking ahead, I see two essential uses: the first is rapid deployment in the earliest stages of an outbreak, treating the first thousand cases of something like Ebola or a new airborne pathogen. The second is integration into hospitals for the surge moments that follow, when thousands or millions of patients need care without overwhelming staff or spreading infection further.

And beyond outbreaks, the possibilities excite me even more: from surgeries complicated by antibiotic-resistant bacteria to everyday infection control in hospitals and clinics.

What began as a DARPA experiment in 2014 has become a certified medical device, shaped over ten years by engineers, doctors, nurses, and the Carecubes team. I’m proud of what we’ve built together, and optimistic about where it goes next.

There is a whole world of possibilities ahead.

That experience drew me into the world of biocontainment and, eventually, into the development of the Carecube.

I joined the Carecube project in early 2021. My role was to help answer a very specific question: Can you actually perform emergency procedures inside this thing? My focus wasn’t theoretical. It was grounded in what I do every day in a trauma bay, including airway management, central lines, CPR, and chest tubes. If a solution was going to be truly useful, it had to support those critical interventions without delay or compromise.

We designed and tested every inch of the Carecube with that goal in mind.

Built for the Realities of Emergency Medicine

The Carecube is a mobile isolation unit designed to invert the traditional PPE model: instead of wrapping the provider in gear, it encloses the patient in a negative pressure environment. That protects staff and other patients. Just as importantly, it creates a space where care can still happen quickly, effectively, and safely.

We modeled dozens of emergency procedures inside the unit, including:

• – Full resuscitation and CPR
• – Intubation and airway management
• – Central line placement
• – Chest tube insertion
• – Lumbar punctures
• – Paracentesis and thoracentesis
• – Bedside ultrasound—without contaminating the probe
• – Real-time cardiac and pulmonary imaging
• – Difficult IV access under ultrasound guidance

Everything from glove placement to visibility to equipment flow was stress-tested by emergency physicians and nurses. We didn’t just want to prove it was possible. We wanted it to be intuitive.

Planning Ahead for Moments You Can’t Predict

One of the most valuable lessons I’ve learned in the ER is that your setup matters. When you’re doing a procedure under pressure—especially in a biocontainment scenario—you don’t want to discover two minutes in that a critical tool or medication isn’t in the room.

That’s why we didn’t just test procedures. We built guidelines: what meds and equipment should be preloaded into the unit, how to prepare for a rapid sequence intubation (RSI), how to anticipate and prevent common delays. For rural or under-resourced providers, these guides can reduce stress and increase safety, especially for teams without routine biocontainment training.

Why Carecubes Matters for Rural and Community Providers

At a large academic medical center like UNMC, we’re lucky to have some built-in surge capacity. But even here, one viral hemorrhagic fever patient can shut down five ER beds. For rural hospitals, the consequences are even more stark.

Most small hospitals don’t have negative pressure rooms. Many don’t have easy access to advanced PPE. The Carecube gives those providers a way to isolate patients quickly, protect staff, and maintain the rest of their operations—even during an outbreak. It allows them to provide excellent care without quarantining off half the ER or placing their nurses in uncomfortable, exhausting gear for hours.

It also protects patients: by enabling face-to-face care without full PPE, it reduces anxiety and restores a sense of normalcy. In some cases, it even allows family members to safely see and speak with a loved one, something we lost during COVID and shouldn’t accept as the norm.

What Comes Next

I hope we see the Carecube and its next-generation versions deployed widely across rural America and in low-resource settings globally. There’s already talk of a self-contained, climate-controlled model that could function like a mini field hospital. That would be a game-changer.

But even in its current form, the Carecube represents something we don’t talk about enough in healthcare: proactive preparedness. It’s not just a device—it’s a system built with providers in mind. As someone who works at the sharpest edge of patient care, I know that makes all the difference.

Today’s accepted best practice involves an onerous combination of infrastructure, consumable supplies, and protocols applied across a spectrum of outdated transmission precaution formulas (“Droplet,” “Contact,” “Airborne,” etc). This approach invites inappropriate choices for isolation procedures and often contradicts a nuanced and modern understanding of pathogen transmission. More importantly, our current paradigm for patient isolation care is highly dependent on resources, personnel, and time to operate safely, all while simultaneously obstructing access to the bedside, which reduces time spent with patients.

Physical and temporal separation are inherent byproducts of present-day infection prevention and control (IPC) standards, and they adversely impact quality of patient care. Even the simplest IPC protocols—the commonly used “contact precautions,” for instance—require the added time and effort of donning (putting on) personal protective equipment (PPE) such as gowns and gloves, with proper disposal and hand hygiene following afterward.

Several studies have demonstrated that these actual and perceived barriers to patient access reduce the amount of time that staff spend at the bedside and result in worse patient outcomes. Barriers to bedside access increase when patients are put in airborne or respiratory isolation, dictating an airborne infection isolation room (AIIR), where they will be located behind a closed door and, generally, a certain physical distance from workstations.

Worldwide Impact

I have seen the negative impact of IPC on patient care in the hospital and in outbreak treatment units time and again. High-quality patient care becomes particularly challenging when adhering to isolation precautions for high-consequence infectious diseases (HCID), such as potential cases of viral hemorrhagic fevers like Ebola, Marburg and Lassa fevers.

In most instances in the United States, patients suspected of suffering from such conditions are ultimately diagnosed with a different disease, but during their imposed purgatory in isolation, we are slow to perform a comprehensive history and physical. It takes an extended amount of time to get the routine laboratory and radiographic data we need for effective care, and we don’t provide frequent assessment and intervention. During times of heightened Ebola virus outbreak awareness (e.g., during the 2014-2015 West Africa Ebola crisis), U.S. hospitals experienced deaths due to slow diagnosis and management of treatable diseases such as malaria.

A Logistical Conundrum

Easier to quantify compared to quality of patient care, the associated logistics and resource requirements of appropriate IPC are often a nightmare for health systems. Hospitals already consume a steady supply of gloves, gowns, masks and N95 respirators, all of which are a cost burden by themselves. In any period of outbreak or heightened vigilance, the cost of additional PPE can easily burn through hospital budgets and disrupt fragile, just-in-time supply chains, as most of us experienced during the early COVID-19 pandemic.

Adequate availability of AIIR spaces requires a large infrastructure investment, and the lack of sufficient negative-pressure isolation rooms in most small (and many large) hospitals creates significant risk. Waste management presents an additional challenge, particularly in the context of HCID. Few hospitals have the ability to manage highly hazardous infectious waste on their own, and the cost of contracted Category A waste removal is exorbitant.

Finally, our current IPC approach puts healthcare workers and hospital staff at risk. Despite the application of other controls, PPE constitutes the first and last line of defense against nosocomial transmission during direct patient care. And PPE is only as good as the skills of the user, who must appropriately complete the meticulous tasks of donning, using, and doffing the PPE.

The level of skill required to manage hazardous or high-consequence infections necessitates high-quality training and frequent refreshment. Our own biocontainment unit team conducts intensive multi-hour training on a quarterly basis for maintenance of these skills. PPE’s dependence on appropriate human action makes it an unreliable hazard control. Attesting to this fact are multiple studies identifying healthcare workers as among the highest-risk occupations for being infected with COVID-19.

A New Concept for Isolation

The Carecube Isolation System for Treatment and Agile Response for Infectious Diseases (ISTARI) concept was developed specifically to counteract these problems and liberate patients and providers from the tyranny of separation. With the Carecube ISTARI, we intentionally worked to turn IPC practice on its head and create a new paradigm, building infrastructure, protocol, supplies and skills into a single flexible device. The Carecube provides safe isolation from pathogens (including airborne transmission) without the need for costly brick-and-mortar construction. With built-in patient interfaces, it allows direct patient care without a reliance on the PPE supply chain or staff proficiency in appropriately donning and doffing of PPE. The Carecube device also limits the waste generated by the constant cycle of donning and doffing.

Most importantly, from our perspective, the Carecube eliminates the separation between caregiver and patient. Immediate access and unlimited dwell-time at the bedside allow for constant monitoring and timely intervention. Eliminating the required time and effort for donning and doffing lets healthcare workers be more efficient, providing care to more patients in the same space of time. Patients can feel supported by and connected to their healthcare provider—as a real person, not simply a pair of eyes behind a plastic shield. Patients also have a closer connection with family and loved ones who are able to visit in person and without risk.

The Carecubes ISTARI was born out of two decades of work in biocontainment and a constant stream of “I wish…” My wish now is that we can share this amazing technology widely, so that healthcare workers and patients across the globe can benefit from better, safer and more compassionate care.

That night, I scrubbed my face with rubbing alcohol, replaying every patient interaction and inevitably thinking, “Could I have brought an invisible pathogen home?”

That was our reality during the COVID-19 pandemic. A healthcare system with brittle seams, hanging on half-built policies and solutions yet required to operate at full capacity.

Early in my career, I knew I couldn’t accept the persistence of carelessly curated policies as both patients and clinicians were put at risk. Part of what ignited my interest in this realm was my research on the stroke belt in my home state of North Carolina. This region had significantly higher rates of stroke incidence and mortality compared to the national average.

I thought, “These are my people who are being impacted adversely by stroke.”

The research I did with my mentor gave me a broader perspective on how I can help large communities through research, which can be translated into policies and guidelines for a larger population.

Frustrated by what I witnessed happening across healthcare, I decided to take on leadership roles to advocate for better resources and regulations. I joined the board of the American College of Emergency Physicians in 2017, then became its president in 2023. I was also director of the Health Policy Fellowship Program at George Washington University, where we took physicians’ voices to Capitol Hill to work in congressional offices and play a vital part in important policymaking. Both roles have allowed me to translate bedside realities into actionable policy and national advocacy.

Shaped by Crisis

The COVID-19 pandemic taught us, painfully, that we must be ready for any spontaneous crisis and not let our guard down. Preparedness is an ongoing investment strategy that requires supply abundance, workforce resilience and a flexible infrastructure.

The scarcity of operational resources such as negative-pressure and isolation rooms, personal protective equipment (PPE) and rapid testing forces clinicians to improvise. While thinking quickly on your feet can save lives, many physicians can be restricted from properly treating a patient due to safety risks. These moments can create mortal injury, which leads to burnout and affects the workforce.

The consequences of poor policies are not theoretical; they directly impact how patients receive care and how clinicians deliver it. A few examples include:

• Limited availability of affordable insurance. Patients will often delay seeking care until their conditions become emergencies, which can overwhelm an ED and lead to worse outcomes. Reimbursement models don’t often take into account underserved communities where hospitals have fewer resources, leading to longer wait times, limited service and gaps in follow-up care.
• The high costs of PPE, especially in the climax of the pandemic, forced frontline teams to reuse masks or improvise, which left them severely exposed to dangerous contagions that followed them home.
• Access to care for rural communities means traveling long distances for even basic care. These hours or even days of travel often turn manageable cases into emergencies. The absence of local specialists makes it harder for patients to receive a diagnosis and treatment plans.

In recent days, the adoption of innovative solutions like tele-health is becoming the new norm to combat these issues. Pairing them with strong policies and regulations can become a gamechanger.

A big win for the ED specifically is the Carecube, which is unique for its portability and uses a simple yet very effective concept to reduce the need for patients to relocate. It also protects staff, enabling them to safely deliver care.

From Advocating for One Patient to Advocating for Many

Yet technology alone is not the answer. To truly bridge the gap between policy and bedside care requires intentional advocacy and direct engagement of decision-makers at both the local and national levels. Clinicians hold valuable insights into the realities of patient care, and sharing these needs is critical for creating safer, more effective healthcare policies.

Here’s what we can do as physicians:

• Engage with local leaders
  Participate in hospital committees, advisory boards and community health initiatives to ensure frontline perspectives are getting a seat at the table.
• Communicate with national policymakers
  Provide testimony, submit comments on proposed regulations and collaborate with professional associations to influence legislation.
• Highlight real-world challenges
  Use data, case studies, research and personal experiences to demonstrate the impact of poor policy decisions on patient flow and safety.
• Foster ongoing dialogue
  Build relationships with decision-makers to ensure our voices are consistently considered in policy development.

By taking these steps, we can shape healthcare policies that are both realistic and patient-centered, ultimately elevating the quality and safety of care across the system.

I’ve stood at the bedside through waves of crisis, and I’ve sat in rooms where all hope has seemed lost, but while it can be easy to feel down, it’s important to realize that we don’t have to accept half-solutions.

We can’t wait for perfect solutions or moments to appear. Let’s take the proactive route to build new solutions with intention and consistency. The work is challenging, but the stakes are too high to settle for anything less than healthcare policies that truly reflect the realities of the bedside.

Rural communities, underserved populations and overlooked yet integral clinicians within the workforce are counting on us.

What began as a seemingly routine and silent illness quickly escalated into a multi-state bio-emergency response involving Iowa, Nebraska and Illinois, which required federal support. For many of us working in healthcare preparedness, this outbreak became a real-world test of our systems, communication pathways and collective readiness for high-consequence infectious diseases.

In my work supporting regional preparedness initiatives and helping healthcare organizations strengthen their emergency response capabilities, I’ve seen firsthand how quickly a rare pathogen can challenge even the most experienced teams. That’s why UNMC’s Angela Vasa (Director of Isolation and Quarantine for Special Pathogens at Nebraska Medicine and the Director of Emergency Preparedness and Special Pathogen Programs at UNMC) and I recently hosted a CareCubes webinar, “Lassa Fever in the Heartland: Lessons from the Iowa Case and Regional Response.” Together, we walked through the outbreak in detail, from the science behind the virus to the coordinated response and the lessons it gave along the way.

The webinar is now on-demand, and I encourage you to watch it to explore how to continue improving readiness at every level of care.

Here’s an overview of the key themes we cover.

Understanding Lassa Fever: A Rare but High-Consequence Threat

Lassa Fever is an arenavirus transmitted to humans primarily through contact with the urine or feces of infected Mastomys rats. Human to human transmission is possible, especially in healthcare situations, through contact with infected materials and fluids.

The virus is endemic to West Africa and early symptoms often resemble common viral illnesses such as fever, malaise and gastrointestinal discomfort, making early recognition difficult. One in 5 people who are infected go on to have severe disease and eventually organ dysfunction.

Inside the Iowa Case: A Rapidly Evolving Clinical Picture

In the webinar, we discussed the clinical progression of an Iowa patient who became possibly the ninth Lassa fever case to ever make it to U.S. soil in the last 50 years.

The case began with a seemingly routine post-travel illness and evolved into something far more serious very quickly. After returning from several months in Liberia, the patient went to a local urgent care clinic, which is where individuals experiencing early symptoms often go first. Although his initial labs and imaging didn’t point to a clear diagnosis, his condition worsened over the following days, prompting transfer to a higher‑acuity facility for intensive care.

It wasn’t until a more detailed travel history emerged that the admitting clinicians, public health partners and the Centers for Disease Control and Prevention (CDC) began to suspect a viral hemorrhagic fever. His care team, many of whom had trained extensively for high‑consequence pathogens, described the emotional weight of the case, not only because of the outcome, but because of the speed at which events unfolded.  Ultimately, over 150 people were exposed to this virus, with most of them being healthcare workers from several different entities.

This case illustrated how quickly a rare pathogen can move through routine care pathways before anyone realizes what they’re dealing with and why early escalation, travel history and strong coordination are so essential.

A Multi-State Response: Coordination in Motion

The encouraging light amidst this outbreak was the level of coordination across Iowa, Nebraska and Illinois. Multiple hospitals, emergency medical services (EMS) partners and federal agencies rallied in real time to manage the response.

The states worked together with remarkable speed and alignment. The Level 1 Regional Emerging Special Pathogen Treatment Center (RESPTC) in Omaha played a central role, offering real-time consultation, readiness support and coordination with EMS partners.

EMS teams are often overlooked in the emerging pathogen planning, but they’re crucial to ensure safe patient movement and prevent secondary exposures. Public health agencies across these state lines collaborated closely with the CDC to conduct risk assessments, monitor exposed individuals and maintain consistent communication.

The Key Lessons

Several themes from the webinar deserve attention:

• • • Early recognition is essential. Rare pathogens often look like common illnesses at first, which puts a thorough travel history as the key in early identification. Frontline clinicians need the training and tools to escalate quickly when something doesn’t fit the usual pattern.
    • Regional treatment centers are indispensable. Their expertise and coordination capabilities can make the difference between a contained event and a widespread crisis.
    • EMS integration is critical. Transport teams must be fully embedded in emerging pathogen planning, not brought in as an afterthought.
    • Preparedness investments matter. Training, exercises, PPE competency and communication pathways are the backbone of an effective response.

A Call to Strengthen our Preparedness

The Iowa Lassa Fever case was a wake-up call. It showed us what can happen when a rare pathogen intersects with everyday healthcare operations. It also highlighted both the strengths and vulnerabilities of our current systems. Strengthening U.S. bio-emergency preparedness will require sustained investment, cross-sector collaboration and a commitment to learning from every event, no matter how uncommon.

I hope you’ll access the on-demand webinar to explore the full case details, the lessons learned and the strategies that will shape our preparedness efforts moving forward.