An Italian air force tanker-transport plane on Jan. 10, 2020 departed its base near Rome and headed east toward Wuhan, China, on a dangerous mission.

Transporting back to Italy an Italian student who contracted the novel-coronavirus in Wuhan, the center of a fast-expanding epidemic.

The Italian KC-767 is one of just a few military aircraft in the world that can carry the special equipment that makes possible the safe evacuation of an extremely contagious patient.

The U.S. Air Force and Royal Air Force also possess aircraft and equipment for transporting infectious patients. American airmen have practiced transporting patients infected with the Ebola virus.

A group of Italians evacuated Wuhan on Feb. 2, 2020, but one member of the group had developed a fever and could not leave with the others, David Cenciotti reported at The Aviationist. That patient had to wait for the air force to take them home for treatment.

The KC-767 already had visited Wuhan once in the aftermath of the coronavirus outbreak that began in December 2019. Experts believe the virus leaped from animals to humans in one of Wuhan’s markets for illegally-trapped wildlife.

For the KC-767, one of four such planes in Italian air force service, the Feb. 10, 2020 mission is the first in “bio-containment mode.” The KC-767 is a 767 freighter that Boeing converted into a dual-role tanker and transport. The Japanese, Brazilian and Colombian air forces operate similar aircraft. The U.S. Air Force has begun buying as many as 179 767-based KC-46 tankers.

The Italian air force bought its first bio-containment kit back in 2005 and has used the kits several times since on C-130J, C-27J and KC-767 aircraft. In 2006, a C-130 transported to Italy a patient suffering from a severe form of tuberculosis. In 2014 a KC-767 carried back to Italy a doctor who had been working in a Sierra Leone Ebola clinic and contracted the virus.

The main piece of equipment for bio-containment mode is a so-called “Air Transit Isolator,” or ATI.

“An ATI is a self-contained isolation facility designed to transport safely a patient during air evacuation, protecting healthcare personnel, air crew and the aircraft from exposure to the infectious agents,” Cenciotti explained.

“The ATI provides a microbiologically secure environment using a multi-layer protection: around the rigid or semi-rigid frame, a PVC ‘envelope’ surrounds the patient while allowing observation and treatment of the patient in isolation and an Air Supply Unit puts the ATI unit under negative pressure,” Cenciotti added, “with HEPA Inlet and Outlet filters that filter out 99.97 percent of particles 0.3 millimeters and larger, preventing the passage of potentially infected micro-particles. Four 12-volt batteries with an operating time of six hours each provide the ATI 24 hours of independent time.”

A special team accompanies the ATI. Led by a doctor, the team also includes an anesthesiologist and an infectious disease specialist plus six non-commissioned officers who take care of the patient during the flight.

“Needless to say, all the team wears protective gear that may vary according to the required biosafety level and that can range from simple gown, facial mask and gloves up to the full bodysuit … with positive pressure gloves,” Cenciotti noted.

The U.S. Air Force keeps all its own ATIs at its air base in Charleston, which is home to a large wing of C-17 transports. The American air arm has certified C-17s and C-130s to carry the bio-containment gear.

USAF C-17s each can carry two ATIs. The Pentagon invested heavily in ATIs following an Ebola outbreak in 2014. Regular exercises improve the Air Force’s ability quickly to repatriate Americans with highly infectious diseases.

“We don’t know what the bug of the future might be,” Maj. Heather Cohen, Air Mobility Command’s deputy chief of medical modernization, said following one ATI exercise in 2018. “This is the next step in preparing for as many scenarios as possible.”

David Axe serves as Defense Editor of the National Interest. He is the author of the graphic novels  War Fix, War Is Boring and Machete Squad.