One year later, we followed up with the ETCs and found that several high-level isolation units had not been provided sufficient resources to sustain their capabilities and capacities in the event of an HHCD. Some had reverted to regular units.  Funding to expand training and education initiatives continues to dwindle, and media coverage that would draw public attention and advocacy around the issue has become nearly non-existent. These combined factors leave the U.S. once again in a vulnerable position as much of the infrastructure developed to provide care and response to HHCDs—which was minimal before—has further deteriorated.  HHCDs may be out of sight and out of mind for the general public, but they remain a threat to human health and safety. The ease of international air travel and transport of goods likewise increases the ease of disease transmission. An asymptomatic individual who travels to the other side of the world could easily be your neighbor returning from a business trip or a family member returning from vacation, unaware that they are carrying a highly infectious pathogen like EVD.  Even with epidemiologic data, it is challenging to predict which HHCD will soon emerge as the most troublesome; unfortunately, it’s usually the ones we least anticipate. In summer 2017, another EVD outbreak in the Democratic Republic of the Congo resulted in four deaths and the monitoring of 583 individuals. Soon after, CDC cautioned the public about a rise in the number of cases of Yersinia pestis (plague), which has been endemic to the American southwest for decades; the agency had observed an increase in fleas infecting people and their domesticated pets. Lassa fever, another acute viral hemorrhagic illness like EVD that is endemic to West Africa, continued to kill in 2017 and has been more problematic in Nigeria this year. Even some of the more common communicable diseases (non-HHCD) that do not typically have high mortality rates saw an uptick in the U.S. last year. For example, a sizable hepatitis A outbreak in San Diego, Calif., claimed more than two dozen lives. This year’s influenza outbreak has been deadlier.  Additional factors such as changes in climate have caused the proliferation of many vector populations, creating an increase in infectious diseases with grave outcomes. The world is seeing more cases of Zika virus, which is caused by the bite of an infected Aedes aegytpi or albopictus mosquito and poses the greatest threat to pregnant women and their fetuses; leishmaniasis, a disease caused by the bite of infected sand flies that can result in large skin sores; and Crimean-Congo hemorrhagic fever, which is transmitted by tick bites or infected livestock and can result in death by the second week of infection if left untreated. Furthermore, the ever-expanding threat and subsequent challenges posed by antimicrobial resistance will require action from healthcare professionals as well as those involved in exposure assessment and control. Though many unforeseen factors can contribute to an epidemic, one of the few things we can control is our level of preparedness and prevention efforts. To help prepare the U.S. for potential epidemics, we suggest creating a formal highly infectious disease care network, which is described in detail in the of the journal Health Security. Such a network would expand the current scope of plans and procedures in place for EVD to be applicable and appropriate for the care of other HHCDs; maintain a formal, updated inventory of the capabilities and capacities of high-level isolation units throughout the country; and provide frontline providers, clinicians, and other first responders with an easily accessible, curated internet application or surveillance system to stay up-to-date on current outbreaks. We also recommend continuing to provide training and education to workers—including those outside of hospital settings—who might have exposures to HHCDs.  It’s easy for some to think that events as serious as evacuating EVD-confirmed patients to the U.S. are rare, and that using valuable time to prepare for slim-chance eventualities is neither cost-effective nor the most efficient use of one’s skill sets. But sometimes unexpected scenarios or disasters force industrial hygienists and related professionals to deliver training quickly. “Just-in-time” training provides a quick skills- and education-based session in these situations. Take Hurricane Harvey as an example: there were not enough professionals available to address all the environmental, structural, and health issues that resulted from the storm, and volunteers needed to receive appropriate PPE training before beginning cleanup and recovery efforts. Industrial hygienists play a vital role in training and educating workers on proper donning and doffing techniques, as well as the appropriate care, usage, and limitations of their PPE. (In our experience, many workers do not fully understand the limitations of PPE, so it’s a subject we stress in our trainings.) Just-in-time PPE training should take a broad, all-hazards approach since donning and doffing techniques can be applied to various respirators that protect individuals from different particles. Safe glove removal (for example, the glove-in-glove technique) has the same underlying principles and techniques; while an HHCD like EVD calls for additional layers of gloves and complexity, an individual would take similar steps to protect themselves from Methicillin-resistant Staphylococcus aureus (MRSA) or Clostridium difficile (C. diff).  The basics of IH and PPE that apply to HHCD response can also help protect workers every day. For example, proper glove removal protects a police officer in a range of situations, from responding to a potential HHCD event to giving aid to a victim of a car accident. The injured individual may have breaks in the skin and could have an infectious disease like hepatitis C. Proper respiratory protection will protect a laboratory researcher from influenza as well as extensively drug-resistant tuberculosis, or XDR-TB.  Unfortunately, many organizations have come to rely on just-in-time training as their sole source of PPE training and do not conduct it on a consistent basis. As a result, just-in-time PPE training is frequently workers’ first time learning how to don and doff an ensemble. For others, it’s a “refresher” training that is far removed from their original training and is not conducive to high-pressure, high-stakes scenarios such as responding to HHCDs. There are many steps involved in safely donning and doffing high-level PPE ensembles, and the potential for cross-contamination is high. Workers often experience psychological and physiological stresses in these scenarios, so the chances of them remembering every detail of the just-in-time PPE training are low. In this way, just-in-time PPE training is like placing a Band-Aid on a gaping wound.  An example that illustrates the importance of effective training occurred in 2014, when two nurses at a Texas hospital became infected with EVD after providing care to an EVD-confirmed patient. The nurses were likely not provided the proper training to doff in a safe, evidence-based, and concerted manner. This is not to place the blame on the nurses—far from it—but rather to highlight how just-in-time PPE training may have been inappropriate in that situation. Had the institution conducted regular drills and monitored basic training on proper PPE donning and doffing techniques as it applied to more commonly encountered scenarios for PPE use, the hospital might have been in a better position to reduce the likelihood of exposure. In turn, the institution could have avoided panic in the surrounding community and the exorbitant costs and damage that stemmed from negative media coverage.  Just-in-time training has a place in our overall tool set, but it should not be the primary source of training to familiarize workers with PPE and appropriate donning and doffing processes. Workers should receive training on PPE early in their careers, and training should be tailored to include a focus on scenarios that they are more likely to encounter. They should then undergo regular refresher trainings. This practice will better support just-in-time trainings when an unusual or rare event comes up.  As the incidence of HHCDs continues to rise, we must prepare to respond by involving all relevant professionals—including the industrial hygienist, who has a dynamic and broadly applicable range of knowledge and skills—in prevention efforts, training and education for occupations with potential exposure, and in advocacy for increased federal support. In this new and challenging era of HHCD prevention, now is not the time to shy away. Industrial hygienists can make a difference and leverage their skill sets on both the national and global stage.    Send feedback to The Synergist.