Lead Scientist Alan Williams  discusses the High Level Isolation Unit’s laboratory at the Royal Free Hospital, which recently had its first patient in six years..

The High Level Isolation Unit (HLIU) at the Royal Free Hospital is a unique, secure facility, in which a specialist team manages patients that have confirmed viral hemorrhagic fever infections - diseases such as Ebola and Marburg, which are incredibly dangerous, highly transmissible, and have a high mortality rate.

Sonic Healthcare UK provides the unit with diagnostic services in a special lab on-site: a small, self-contained CL3 laboratory identified by the somewhat lengthy acronym, HLIUPL (High Level Isolation Unit Pathology Laboratory). Inside, there is a sealed isolator, in which the testing takes place, to reduce the risk to staff.

Although infection sciences is a big department of around 80 people, the HLIU is served by a small team: at any one time there are between eight and 15 scientists working there. Alan Williams heads up the laboratory team as Lead Scientist.

Alan is also a clinical scientist in infection sciences at the Halo. After beginning his career in research, he decided to enter the clinical scientist training programme at the Royal Free as part of the microbiology department, where he has been working as a clinical scientist for the past 10 years.

First patient in six years

Because these kinds of diseases are very rare in the UK, it’s not often that you’ll find the laboratory in full swing.
Recently, however, the HLIU had their first patient in six years, an individual who had contracted the potentially deadly Lassa Fever, a disease endemic in areas of west Africa, and picked up on this occasion by a traveller to Mali. This was the first time that a case has been managed by Sonic Healthcare UK, with the Royal Free having entered the organisation in 2014.

Together with Covid and the rarity of cases cropping up in the UK, it all kicked off at rather an unexpected time:
“It’s unusual to have received this call when there was very little global travel... it was not expected.”

Constantly on call

The department is conditioned precisely for these sudden changes in pace, with everything ready to be scaled up at a moment’s notice thanks to the diligence of its staff.

During its down time, Alan explains that there is a constant rotation of staff who make sure everything is ticking over: checking the stock levels, maintaining the analysers and ensuring the airflow is safe.

They are constantly on call, ready to jump into action on the rare occasion that a patient is identified:
“We are required to be available 24 hours a day, seven days a week, 365 days a year, and we are ready to activate and start patient testing within six hours.”

A collaborative effort

It’s not only the HLIU scientists that are involved in this daunting task. The operation requires the support of a range of other teams and departments:

“It’s a real collaborative effort. We rely on the rest of the Infection Sciences department to support us, and also have great help from Blood Transfusion and Haematology at the Royal Free, and HSL IT and FM teams, and even borrow reagents at short notice from Northwick Park Hospital. It shows the strength of the wider Sonic Healthcare UK group that we could call on so many colleagues who all gave help at incredibly short notice.”

Since our conversation with Alan, the unit has been activated for a second time, something of a shock after such a long wait for the first:

“Having gone over six years without a patient, we waited only three weeks for the next. The unit had
a second patient admission who was diagnosed with Crimean- Congo Haemorrhagic Fever. This, thankfully, was a much shorter admission, and the unit is now back in ‘peace-time’ preparedness.”

Featured on the BBC

As if all that wasn’t quite enough to be getting on with, it just so happened that the BBC decided to rock up to the Royal Free on the very day that the first patient entered their care.
Filming for Hospital, and in this case for a follow-up piece to their Covid-specific episodes, the programme reveals just how much preparation went into receiving this patient.

To prevent any risk of transmission, areas were cordoned off, entrances blocked, staff had to be trained and security was ramped up... all within a short space of time.