Most laboratorians remember the fear. In 2014, Ebola dominated the headlines. Images of healthcare workers wearing powered air-purifying respirators and full-body protective suits left many laboratory professionals wondering whether they should even touch a specimen from a suspected patient. Some laboratories refused testing altogether. Others improvised procedures that often created as much confusion as protection.
Fast forward to today, and the CDC's guidance has changed —not because Ebola has become less dangerous, but because we've become better at understanding the actual risks and how to manage them. That change is an important one.
One of the biggest misconceptions surrounding viral hemorrhagic fevers (VHFs) is that laboratory testing should stop until the diagnosis is confirmed. In reality, the opposite is true. Patients with suspected Ebola, Marburg virus disease, Lassa fever, Crimean-Congo hemorrhagic fever, or other highly infectious diseases are often critically ill. Physicians cannot make life-saving decisions without laboratory data. They still need CBC results. They still need chemistry values. They still need coagulation studies. Laboratory medicine doesn't stop because a disease is dangerous.
The question has shifted from "Should we perform laboratory testing?" to "How can we perform it safely?" That subtle change represents one of the most significant shifts in laboratory biosafety in the past decade.
The CDC's newest recommendations emphasize laboratory-specific risk assessments rather than blanket prohibitions. Instead of telling every laboratory exactly what to do, the guidance recognizes that every laboratory is different. A small rural hospital, a regional medical center, and a major academic laboratory all have different equipment, staffing, engineering controls, and capabilities. One solution simply cannot fit every situation.
This approach may initially feel uncomfortable because it places more responsibility on laboratory leadership. Instead of following a checklist, safety officers and managers must evaluate their own processes. Can specimens be transported safely? What testing must be performed immediately? Which instruments could generate aerosols? What PPE is appropriate? How will waste be managed? These are questions no national guideline can answer for every laboratory.
That doesn't mean you're on your own. One of the first considerations should be understanding your hospital's role within the larger healthcare system. Not every hospital is expected to manage patients with suspected VHFs from diagnosis through recovery. The National Special Pathogen System (NSPS) has established different levels of care for facilities based on their capabilities. Some hospitals are expected only to identify and isolate patients before transfer. Others are prepared to provide definitive care. Knowing where your facility fits within that network is critical.
For example, in a health system of twelve hospitals, one hospital has been designated as a Level 2 Highly Infectious Disease Unit. If a patient with suspected Ebola presents at another sister hospital, that patient is stabilized and transferred to the designated Level 2 facility for ongoing evaluation and treatment. That system allows specialized resources, trained personnel, and laboratory procedures to be concentrated where they are needed most.
Many smaller hospitals should be asking the same question: Do we really need to build the capability to manage these patients, or is our role to safely stabilize and transfer them? The answer to that question drives everything else.
Of course, transfer doesn't eliminate the need for laboratory testing. Patients often require immediate testing before transfer decisions can even be made. That means every laboratory should have at least a basic plan for handling specimens from patients under investigation.
Perhaps the greatest lesson from Ebola—and reinforced during COVID-19—is that preparedness cannot begin after the patient arrives. Too often, laboratories assume that because these diseases are rare, planning can wait. History suggests otherwise. Emerging pathogens continue to surprise us. Twenty years ago, few laboratories had heard of SARS. More recently, COVID-19 demonstrated how quickly healthcare systems can become overwhelmed. Marburg virus outbreaks have expanded. Lassa fever remains endemic in parts of West Africa. Mpox reminded us that diseases once considered geographically limited can suddenly appear much closer to home.
Preparedness isn't about Ebola. It's about being ready for whatever comes next. Fortunately, the CDC's updated guidance reflects that philosophy. Rather than focusing on a single disease, it encourages laboratories to strengthen biosafety systems that apply to any highly infectious pathogen. Those improvements—better risk assessments, clearer specimen workflows, stronger communication, enhanced PPE programs, and improved emergency planning—benefit laboratory staff every day, not just during a once-in-a-career event.
The laboratory that prepares for Ebola is also preparing for the next pathogen we haven't even named yet. That's a worthwhile investment.
In Part 2, we'll move beyond the "why" and focus on the "how." We'll explore the practical questions every laboratory should be asking: Can our instruments safely test these specimens? What PPE is really necessary? What happens to the waste? And perhaps most importantly, what should smaller laboratories realistically expect to do when the next suspected case arrives?