Enhancing Special Pathogen Preparedness Through Exercises: Navigating Dual Quarantine Activations

This case study describes findings from an exercise conducted in April 2023 to assess the readiness of the National Quarantine Unit (NQU) and identify opportunities for improvement. The exercise is part of a multiyear effort to assess the readiness of quarantine and transport capabilities at the NQU through annual workshops, discussion-based exercises, and functional and full-scale exercises. The April 2023 exercise tested interagency coordination and decisionmaking, transport of individuals for monitoring, quarantine unit operations, and escalation of care for symptomatic individuals out of quarantine to high-level isolation units in the United States. Findings showed that collaboration and engagement of local, state, and national organizations increases awareness of novel and emerging high-consequence infectious disease pathogens and enhances capabilities and capacity for patient transport. It also improves timely and efficient diagnostic testing and increases the availability of dedicated assets to support activation and mobilization of the NQU, the Regional Emerging Special Pathogen Treatment Center network, and the future national special pathogen system of care. Given the changing landscape of emerging special pathogens, an objective evaluation of the state of readiness is an essential element of preparedness and response.