Pratica Di Mare Air Base — The patient, a slight woman in her 30s, lay motionless on the stretcher as a half-dozen men in biohazard suits transferred her from a C-27J cargo plane into an ambulance and then into a mobile hospital isolation ward, never once breaking the plastic seal encasing her.
The exercise put on Wednesday was just a simulation of the procedures that would be used to evacuate an Ebola patient to Italy. But for Italian military, Red Cross and health care workers, it offered essential experience, especially for those on the front lines of the country's sea-rescue operation involving thousands of African migrants who arrive here every day in smugglers' boats.
Italian authorities and medical experts insist that the risk of Ebola spreading from Africa to Europe is small, given that the virus only spreads by direct contact with infected blood or other bodily fluids. They say Italy's first case of Ebola will probably be an Italian doctor or missionary who contracts the disease while caring for patients in Liberia, Sierra Leone or Guinea — the three hardest-hit countries — and is airlifted home for treatment.
Yet concern runs high: EU health ministers who met this week in Milan spent an entire session discussing Ebola and the EU. They concluded that, while the risk of the disease coming to Europe is low, the EU must improve coordination and prevention measures to better diagnose, transport and treat suspected cases.
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"There is an emergency," said Dr. Natale Ceccarelli, who heads the infirmary at the Pratica di Mare air force base south of Rome, where the training course was staged. "If one person is infected, he infects everyone."
Ceccarelli has already flown once to an Italian navy transport ship taking part in the Mare Nostrum rescue operation after a would-be refugee who was picked up at sea was flagged during a routine health screening.
The patient was airlifted in one of the same self-contained mobile isolation units used for the defense ministry's simulation drill. He went first to Sicily and then to Rome aboard a C-130 transport plane and was taken immediately to the capital's Spallanzani hospital, which specializes in infectious diseases.
It turned out he had monkeypox, a virus similar to smallpox, not Ebola.
Ebola is believed to have infected more than 5,800 people in Liberia, Sierra Leone, Guinea, Nigeria and Senegal. Compared with swine flu, the number of infections is relatively small. But the World Health Organization has declared the outbreak an international public health emergency, and U.S. President Barack Obama has ordered up to 3,000 troops to be deployed to West Africa to build field hospitals and train medical staff.
Britain and France — which both have colonial ties to the region — have pledged to build treatment centers in Sierra Leone and Guinea. Italy has pledged to build a 90-bed treatment center in Sierra Leone, send experts from Spallanzani and give 1.5 million euros for the WHO to buy equipment and medicine.
Italy also has isolation units developed by a British engineer that are big enough for doctors to stabilize a patient on long-haul flights. Physicians can attach intravenous drips through the plastic sheeting without breaking the protective seal or even intubate a patient. Other European countries use smaller, simpler units that are suitable only for short flights, Ceccarelli said.
"It's very nice to have that option," said Dr. Benjamin Neuman, a virologist at the University of Reading in Britain. "Right now, there's a limited range" for transport, preventing patients with late-stage Ebola from being evacuated if the distances are too long or if they are already vomiting blood or suffering from diarrhea.
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Italy has had the units on hand since 2005 and has used them 11 times to extract Italians suffering from dengue in Congo and hemorrhagic fever in Nepal, said Lt. Col. Marco Lastillo, an air force medic. The defense ministry stages the training courses twice a year, but added this extra session at the request of the health ministry because of the Ebola threat.
"This capacity that we have created for ourselves should be put to everyone's disposition," Defense Minister Roberta Pinotti told reporters at the base after watching the students perform the biohazard evacuation drill. She insisted that Italy's migrant crisis posed no particular Ebola threat, saying the medical screenings done in the Mare Nostrum operation would prevent any infected people from reaching the general population.
One of the students taking the course was Massimo Mazzieri, a volunteer with the Knights of Malta, the Catholic association that has a medical-relief corps working in war zones and natural disasters around the world, and with African migrants arriving in Italy. He and his classmates staged the drill, meticulously making sure the patient was passed from mobile isolation unit to mobile isolation unit without breaking the seal holding her germs inside.
"In this particular moment, Ebola is really on our minds, maybe a bit excessively," he said. "But we are ready."