The evolution of biocontainment unit care for high-consequence infectious diseases: progress, lessons learned, and future directions

Biocontainment units (BCUs) are specialized facilities designed to treat patients with high-consequence infectious diseases (HCIDs) which are pathogens with high mortality rates, limited treatment options, and significant potential for healthcare-associated transmission. Since the opening of the first modern BCU in 1971, these units have evolved from simple isolation environments into advanced centers capable of delivering comprehensive critical care while maintaining rigorous infection control. This evolution has been driven from the lessons learned from past outbreaks of Ebola, Marburg, Middle Eastern Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), among other emerging infectious threats. Four key domains contribute to the care of patients with HCIDs – laboratory capabilities, critical care delivery, healthcare workforce readiness, and safe patient transport. Improvements in diagnostic capabilities have allowed for earlier disease recognition while greater access to routine laboratory tests better inform clinical decision making. Clinical care capabilities now match those seen in intensive care units while maintaining infection control standards. Training of specialized workforce and multidisciplinary staffing models have improved bedside care and operational readiness. Meanwhile, innovations in ground and air transport have enhanced the ability to safely transfer HCID patients to facilities best suited to provide care. This review synthesizes the evolution of BCU capabilities globally, examining advances in critical care, diagnostics, investigational therapeutics, workforce models, and patient transport.