Mysterious Illness Takes Control Of Holiday Resort | Diagnosis Unknown | Real Responders

an invisible killer stalks a summer resort and panic sweeps the island of Martha's Vineyard and as residents and tourists succumb to the symptoms of a lethal bacteria its victims once active and healthy are left delirious struggling to breathe as the illness spreads medical investigators race to find its source and before it threatens more lives [Music] some of the names in this program have been changed Martha's Vineyard just over an hour from Boston is one of the most popular vacation spots in America the summer home of artists politicians and actors each June nearly 100,000 tourists flock to the island but in the summer of 2000 another visitor arrived an unseen enemy stalking the streets of the island [Music] June 18th 2014 was working at a construction site on the western side of the island a landscaper by trade he was digging holes to plant trees normally Patrick enjoyed his physically demanding job but this morning he began to feel lethargic rundown to Patrick it felt like a case of the flu he decided to take the rest of the day off by that evening he was too weak to even answer the phone his girlfriend tried to reach him when he didn't answer she became concerned and drove to his house Paula Strobel knew Patrick had been feeling ill for several days but he looked even worse than she expected [Music] Patrick was pale shaking with fever sweating uncontrollably and I said please let me take your temperature you know when you touched his skin he was getting warmer and warmer he was just burning up with fever the mercury had shot up so high Paula thought the thermometer must be broken she tried again Patrick's temperature was 106 degrees [Music] paulla needed to get Patrick to the hospital right away she knew it would be faster if she took him herself and it was hard dragging him to the car because it was like dead weight you know he was not resistant but he was just heavy I was afraid he was gonna pass out or something on the way to the hospital Patrick started to become incoherent the fever was affecting his brain he seemed to be getting progressively worse he was talking under his breath and I didn't understand what he was even saying at the time by the time they reached Martha's Vineyard Hospital Patrick wasn't even able to speak he got really quiet and that scared me even more he was taken into an examination room where a nurse took his vital signs his temperature was still 105.9 degrees the ER staff rushed him to intensive care fluids were administered to bring down his fever if they didn't work fast the fever could cause seizures brain damage even organ failure listening to Patrick's chest the doctor heard sounds that suggested he might be suffering from pneumonia inflamed lung tissue confirmed the diagnosis Patrick had pneumonia but doctors didn't know exactly what had caused the disease in the hospital lab technicians analyzed Patrick's blood and urine samples looking for clues a high white blood cell count indicated the body was fighting off a possible bacterial infection but the small island hospital didn't have the facilities to test the samples further they would have to be sent to the Massachusetts state lab the results would take several days doctors tried to treat Patrick as best they could starting him on intravenous antibiotics that would attack many kinds of bacteria but it would take 24 to 48 hours for the medication to take effect [Music] it was amazing how how weak he was Heather there wasn't much left of him he was just laying there and I I cried I was just beside myself I really didn't think he was gonna survive the whole evening that night the ER physician alerted the hospital's infectious disease specialist dr. Dennis Hulk pneumonia in the summer in an otherwise healthy person who's a strong and healthy worker is this is a little more unusual and you have to think of different things that might be happening what's happening in the community doctors questioned Paula about his medical history when dr. Hulk learned that Patrick was a landscaper working outside he began to suspect that the source of his infection might be an insect bite Martha's Vineyard has this unusual collection of tick borne diseases tularemia of Ibiza OSIS or leaky OSIS Rocky Mountain spotted fever and Lyme disease and the local physicians knowing that we've got this collection of diseases really have to think about it in any fever that comes through in the summer dr. Hulk believed Patrick was suffering from a tick-borne illness but he had to wait for lab results and his patient wasn't getting any better on the other side of the island another resident had contracted a mysterious summer illness this time the victim was a child thirteen year old Chris Baker had been looking forward to spending the day at the beach with his friends instead he had a fever and was too weak to move his mother Mary was becoming concerned she and her husband decided to take Chris to the hospital the Baker's lived at the eastern tip of Martha's Vineyard the hospital was almost half an hour away Chris started to cough his condition was deteriorating with each passing minute his parents were scared but there was nothing they could do for their boy until they reached a doctor at Martha's Vineyard Hospital emergency room physicians examined the teenager Chris was running a low-grade fever it was hard to figure out what was going on it seemed like the flu but the Baker's had never seen him so sick the doctor couldn't find anything that would explain his illness he inspected Chris for insect bites or other telltale markings but couldn't find any he drew samples of blood for analysis and ordered a series of chest x-rays the results chrissa's lungs were inflamed like patrick ryr he was suffering from pneumonia two cases in the summer within a week of each other was unusual [Music] especially at a small island Hospital the ER physician contacted infectious disease specialist dr. Denis Hoch the doctor asked Chris if he had suffered an insect bite recently his parents couldn't recall any until the lab results came back the exact cause of this illness remained a mystery all the doctor could do was prescribed multiple antibiotics dr. Hulk was troubled by the sudden increase in summer pneumonia cases he started reviewing the literature on infectious diseases searching for clues the two cases were so similar it reinforced his theory of a tick-borne illness Martha's Vineyard is home to all sorts of ticks they thrive in the warm summer months hidden away in the high island grasses and they can carry a whole list of diseases dr. Sam Telford has monitored tick borne diseases on Martha's Vineyard for nearly a decade for the Harvard School of Public Health Telford tracks the creatures across the island trying to gauge their impact we study the patterns of tick abundance how many ticks are there each month how many cases do we see each month of any of the tick borne diseases now dr. Telford would need to go back over his findings for the summer and so the idea is that by looking at ticks can we find out some pattern that'll allow us to predict whether a year will be bad for tick transmitted disease or relatively few cases won't be around so far he hadn't noted anything unusual but with this mysterious disease on the island his search would intensify at the hospital dr. Houk pursued the investigation further Patrick ryr wasn't out of the woods yet but he was at least coherent enough to answer a few questions dr. Houk asked Patrick about any animal contact a frequent source of ticks and infections still weakened dazed Patrick couldn't remember anything unusual Hulk decided to check if other cases with similar symptoms had come in earlier that summer he went back through hospital files and found yet another pneumonia patient John Franklin a man in his late 40s had contracted pneumonia just two weeks earlier that made a third suspicious case in Boston at the Massachusetts Department of Public Health technicians tested the blood samples from the three patients what they were looking for was a telltale clue the antibodies the body builds up to fight off bacteria it has been exposed to when a reagent is added to the samples a color change indicates the presence of an antibody evidence of an infection viewed under a microscope a positive sample will glow green all three patients blood were testing positive for tularemia an unusual bacterial infection that is both rare and deadly there are many ways you can get the disease bites from infected ticks can cause skin ulcers but if it is inhaled it can lead to life-threatening pneumonia tularemia most commonly infects small mammals it's widespread among rabbits and rodents even cats and dogs but it doesn't always kill them many people refer to it as rabbit fever because the rabbit is a mammal that happens to carry it often but it's not the only mammal that does there are probably hundreds of different kinds of mammals that can carry tularemia and these are animals that won't always get sick and so they're what we call a reservoir they allow the bacteria to grow and reproduce and then it gets from them to people in a variety of different ways because it takes such a small amount of the bacteria to cause infection tularemia is on the government's list of possible biological weapons dr. Matt Yosh and the Massachusetts Department of Public Health were concerned 200 cases of tularemia occur in the United States each year only 20 of those are the dangerous pneumonic form now Martha's Vineyard had experienced three in less than a month it was more necessary than usual to make sure that we knew what we were dealing with and the reason for that is that pneumonic lorina is it's a dangerous disease to have health officials worried that news of a possible outbreak might create widespread fear they didn't want to start a panic especially in tourist season we really worked very hard to keep people comfortable and not afraid we are a vacation community and we we do exist on a lot of the dollars that come through in the summertime a lot of us do a lot of people on the island do and you would hate to see people not come here because of this kind of a panic at the end of June as ferries continued to bring in thousands of tourists Martha's Vineyard was entering the height of the summer season but somewhere on the island a deadly bacteria was spreading by the end of June 2003 residents of Martha's Vineyard had contracted a mysterious form of pneumonia for a resort town dependent on tourism it was an alarming development especially given the cause a dangerous disease known as tularemia state health officials didn't know who or where it would strike next they contacted the Centers for Disease Control and Prevention when she first heard of the situation on the island the CDC's dr. Catherine Feldman was alarmed the organism that causes tularemia is considered a category a bioterrorist agent category a means high-priority and it gets that classification because it's potentially easy to disseminate it has a high mortality if untreated it can cause up to 60% mortality and folks who acquire infection and it has the potential to cause widespread panic in this case we certainly had to consider whether this was a bioterrorist event one of the most infectious bacteria known to man and almost always deadly if not treated tularemia has the makings of a classic bioterrorist agent investigators from the CDC responded immediately meeting with officials from the Massachusetts Department of Public Health agents reviewed the patient's information trying to figure out how the cases had arisen there were a number of clues in this investigation that made us lean towards this being a naturally occurring outbreak the outbreak on Martha's Vineyard was not clustered in time or space what you might think with a bioterrorist event is that there would be one release of the agent say at a concert or at a public forum or something in this case although all of the patients in July were spread out over time they didn't come to a hospital in one or two days they they really occurred throughout the whole month of July in addition they lived all over the island the evidence pointed away from a premeditated attack but investigators were no closer to finding the source of the bacteria all they knew was that it did not spread person-to-person other diseases that are similar such as plague if somebody gets the pneumonia form of plague they can transmit it to another person by coughing in in the case of tularemia that's never been documented people will get a pneumonia form they may be coughing and yet there's been no evidence that you can transmit tularemia from person to person then only days after their arrival in Massachusetts they learned of another confirmed case only this time the patient was miles away from Martha's Vineyard in a Boston hospital officials wondered how the disease apparently not transmitted from person to person had made the jump to the mainland agents interviewed 58 year-old Neil Kravitz they asked if he had recently visited Martha's Vineyard they learned he owned a cottage on the island and often spent weekends there a few days prior to his illness he had been at the cottage mowing his lawn and playing golf with four confirmed cases of a highly infectious disease health officials knew they had an outbreak on their hands they feared the disease was spreading through the air or insect bites or some totally different way the hunt for answers was on CDC investigators met with the medical staff at the Martha's Vineyard Hospital we wanted to learn what the physicians impressions were when they first saw the patients and then as they worked them up and diagnosed tularemia their first step was to determine the scope of the problem they needed to know whether any previous cases of tularemia had gone unnoticed or misdiagnosed we reviewed maybe around 40 charts at that time and found that none of them fit the criteria for tularemia so we really do not believe that there were any cases before those initial cases besides the patient's symptoms and their time outdoors there were few similarities investigators went back to find the first confirmed case of tularemia john franklin had contracted a pneumonia two weeks before Patrick ryr agents wanted to pinpoint the location where he could have gotten the disease the very first patient reported running over a rabbit with a brush cutter so we had an obvious exposure for him rabbits are clearly associated with tularemia and he had a rabbit exposure the other patients had begun their slow recovery thirteen year old Chris Baker was lucky he had recovered without complications after nearly a week Patrick ryr was released from the hospital investigators hoped he would help them pinpoint the source and we started thinking about the environment we started thinking about where the patients lived where the patient's work to get a sense of whether this was isolated to one part of the island whether it was clustered in one part of the island Patrick didn't know where he could have picked up the disease all he could tell them was that around the time he became ill he was working at a construction site on the west coast of the island he couldn't remember coming in contact with any dead animals and he tics or anything else suspicious the investigators still hadn't ruled out ticks as a possible source they hunted for samples of the insects at the home of the young boy who had contracted the disease they also talked to the Baker family the boy did not know any of the other victims and none of their activities overlapped with their tick and soil samples in hand investigators turn to dr. Sam Telford Zrii search for answers the CDC tends to come in when there's a public health emergency when we're invited in by the state to help respond to something and so dr. Telford has the advantage of being able to go back over time he has collections of ticks or of eye slits from ticks by extracting blood from ticks and small mammals on the island who can carry the bacteria Telford tries to isolate any tick borne diseases in his research earlier that summer he hadn't found anything unusual except an increase in the number of tick species that carry the disease Martha's Vineyard outbreak has been such a mystery we need to make sure of what we're seeing so we need to take our time in doing our testing and if we're confident in our results then when we're trying to piece together the puzzle as to how people have gotten infected we can rely on on what we're trying to conclude and make some recommendations as to what can we do about it but so far he had no explanations of how and where people were coming down with pneumonic tularemia health officials needed more information infection control nurse Donna Styles eNOS asked doctors to keep her informed of any patients exhibiting symptoms of tularemia and we just really had heightened awareness as to what was going on and we really started to screen very carefully all of the patients that would come to the emergency room that did have anything that could be a flu type illness that could possibly be a tick-borne illness with doctors and investigators on the lookout for new patients and new clues the month of July came to a close and as it did more tourists continued to pour on to the island each of them unaware of the potential danger in the summer of 2000 a rare disease began striking residents on Martha's Vineyard for cases of mnemonic tularemia had been confirmed on the tiny island [Music] the source of the outbreak remained a mystery then on August 25th two months after the first cases appeared the outbreak took a terrifying turn Douglas Carter a 43 year old house painter and landscaper staggered into the ER with a high fever he had been sick for over a week and thought he had the flu in the ER he went into respiratory distress soon he could no longer breathe on his own this staff intubated him inserting a tube into his windpipe so a respirator could pump air to his lungs [Music] the emergency room physician gave me a call and said do you think this might be tularemia pneumonia how should we proceed with in terms of antibiotics the chest x-ray showed that the patient's lungs were inflamed Carter had clearly contracted pneumonia because of the high number of tularemia cases doctors decided to treat him for the disease within several hours however this patient clinical situation deteriorated very rapidly and the pneumonia was rapidly progressing the infection had a head start and the antibiotics couldn't stop it his grave condition required a greater degree of care than the tiny local hospital could give him we are a very small rural Hospital and although we do a pretty good job with what we do anytime someone needs higher technology or critical care and we ship them out and quick racing against the clock emergency technicians airlifted Carter to the mainland 20 minutes away by helicopter [Music] at a Boston hospital the high fever and pneumonia continued to ravage Carter's body and then without warning his organ systems began to fail one after another the medical staff tried desperately to save him but the bacteria had done too much damage Douglas Carter died the first casualty of the outbreak any fatality will make you think twice that about what's going on and be more observant about your own health and what the factors are that may have led up to that the medical examiner performed an autopsy on the deceased patient because the deadly bacteria might still be alive in Carter's tissue the examiner had to wear protective clothing he sent samples of the lung tissue to the CDC laboratory their technicians cultured the samples and confirm the disease that killed Douglas Carter was tularemia for Martha's Vineyard it was a nightmare in the making it was the Saturday before Labor Day weekend one of the busiest holidays of the year news of the outbreak would have a disastrous impact on the community but health officials had no choice now they had to warn the public stories of the rare disease and Carter's death made news in the Boston papers the community became very concerned and wanted more information wanted to know how we could possibly prevent this for the teams of health officials on the island and agents from the Centers for Disease Control the search now took on an extra edge they decided to do a case control study distributing questionnaires to the patients who contracted tularemia they had discovered a promising clue the only commonality was that they most of these individuals worked in landscaping they went to talk to local landscapers looking for answers the team tried to narrow down precisely what about the occupation could have allowed the patients to contract the disease we really don't know whether these people all acquired it by inhalation after landscaping or whether they were bitten by something and just didn't notice a bite and then it spread secondarily and I think that's the the issue here investigators didn't know what had caused the disease but almost everyone who got it had mowed their lawns before becoming ill public health officials issued an alert the folks on the island we're very concerned and we had the public advisors posted on kiosks and everywhere we could think of so that really everybody was doing their part to try to get the word out residents were cautioned that if they were going to mow their lawns they should be careful to wear masks while mowing to wear insect repellant at all times and not to handle dead animals but they still weren't sure exactly where the disease was coming from unlike the situation where you know CDC you're a state health department or a local health department can track something down to the food item on a shelf and then pull them all and everybody's okay there was nothing like that here yeah there there were people who had been all over the island and there had been no one place that they shared and there was no smoking gun that allowed us to say yep this is where they were exposed investigators had several theories first they wondered if something unusual could be happening in the domestic animal populations we contacted veterinarians and we asked about cats cats can get it severe illness associated with tularemia so if we asked if they'd seen cats that came in with some sort of fever and feeling lethargic and whether they thought there was an increased number of these kinds of animals compared to previous years the veterinarians reported that they'd seen nothing out of the ordinary next investigators talk to researchers looking at wild animal populations across the island we asked whether they were seeing more sick animals than they'd seen in previous years or whether they thought the rabbit population had gone up or gone down or whether they thought there was one particular species of wildlife whose population had gone up or gone down we were just trying to look for for changes from previous years we weren't sure exactly what we were looking for but we were looking for something different while investigators look for any sign of something different on the island more people were getting sick by the end of August 2000 two months after the outbreak began health officials were still no closer to finding a conclusive source of the tularemia outbreak as tourists left the island each day doctors were becoming concerned that if they were infected they might not receive the right treatment for this deadly disease when they returned home I'm sure there are many visitors who come to the island get a tick bite and then they go back to Ohio or New Jersey or Iowa or somewhere where the physicians there may not think about the particular diseases we've got here investigators were worried that an infected pet or rodent could have carried the disease on a ferry back to the mainland if this mysterious outbreak began to spread across the country the effects could be devastating at a Boston hospital 43 year-old Douglas Carter had lost his battle with tularemia a rare illness spread by a highly infectious bacteria doctors had done everything they could to save him but the disease was just too aggressive Carter was one of eight other residents who had contracted tularemia on Martha's Vineyard most of the infected patients had worked in landscaping and had mowed lawns before becoming sick as public health officials tracked the source of the outbreak their research pointed them in one direction our patients lived all over the island there were no clues gained by where the patients lived however when we looked at where they had actually used a lawn mower it seemed that most of the cases were associated with the southern part of the island this area of the island is less developed making it a haven for wildlife including ticks CDC agents decided it was time to conduct an environmental investigation the cases have been presenting as pneumonia and so the idea is that people who are working in the soil who are landscaping are breathing in the organism somehow and getting infected that way how it gets in the soil we don't know suited up against the danger they visited possible exposure sites trying to recreate the patient's lawn mowing activities they had a radical new theory that it was the lawn mowing itself that was creating the danger in this case we believe that lawn mowing over over the grass in which the the bacterium is sitting we believe that that was enough to aerosolize the bacterium and let people in halen the investigators collected samples of the grass and clippings for analysis but in the lab as the samples were cultured for tularemia the results were disappointing unfortunately our lawn mowing samples were all negative again we tried to grow the bacterium out of those samples and they were all negative the epidemiologist decided they had to turn their attention back to the mammals to determine which species might be carrying the bacteria but it wouldn't be easy to capture a wild animal that's infected catching a sick animal is tough because if they're really sick they're not interested in food anymore and they're not gonna come to your trap traps were set in rural areas of the island where they believe the patient's had come in contact with the disease they did manage to catch several small mammals including a rabbit mice skunks and rats the rat population in particular seems to have increased in recent years on Martha's Vineyard and we we initially pointed our fingers at rats because rats are one of the few animals that don't die of tularemia and therefore are good candidates for reservoirs they can keep the organism the bacteria going from year to year the investigators pluck ticks off the captured animals and took blood samples from all of them they needed to determine if these mammals were carrying the disease lab test detected tularemia in two of them a skunk and a rat really all that indicates is that they also were exposed to tularemia which is interesting because each of those animals was from a property where we believed a patient had been exposed so that's further evidence that that tularemia was on those properties now for the first time they had at least a partial idea of where the disease was coming from determined to capitalize on their discovery the CDC team packed up their specimens and their samples with summer drawing to a close they headed back to the labs but just when they thought it was safe to leave the island the bacteria struck again the summer season was done but the disease wasn't and then all of a sudden a bunch of cases started coming in and we continue to have cases in September and even one in October by the time all was said and done there had been 15 cases of tularemia reported from the island eleven of which were pneumonic cases and as winter hit new england the cases stopped what officials didn't know was the disease hadn't disappeared it had merely gone into hibernation an outbreak of tularemia on Martha's Vineyard had claimed one life and infected more than a dozen other people health officials and scientists had few conclusive answers to why the disease had appeared on the island some speculated people became infected inhaling particles of dust soil or grass contaminated with the bacteria while mowing lawns others felt that an infected rat and skunk they had discovered meant that animals were in some way passing the disease but there was no clear answer and as the next summer approached doctors at Martha's Vineyard Hospital braced themselves in the year 2001 the advisories were updated in anticipation of perhaps the same kind of cluster of cases happening it happened sooner than they anticipated in May 2001 Tammy and Frank daily brought their four-year-old son Jonathan to a Children's Hospital in Boston the boy was feverish and suffered a variety of symptoms including headache an ear infection swollen glands and an ulceration on his neck the parents told doctors they had discovered an engorged tick at the site of the wound that was nine days earlier on a family vacation on Martha's Vineyard they pulled out the tick but the bite grew infected the doctor's diagnosis came fast tularemia the boy had contracted it from a tick but showed no signs of the deadly pneumonia the summer season had not yet arrived and already tularemia had reemerged on Martha's Vineyard we don't know much about how the bacteria that causes tularemia goes from year to year anywhere and it's especially important for the Martha's Vineyard outbreak because we don't even know how the people are getting infected as investigators searched for answers another case turned up in June of 2001 landscaper Daniel Marsh arrived at an emergency room in a Boston hospital he and his wife lived outside of the city but every Friday the landscaper cut lawns on the vineyard he thought he had the flu but his wife grew more concerned when his temperature climbed past 100 degrees Marcia's lungs were inflamed an infectious disease specialist diagnosed pneumonia Daniel Marsh had tularemia the patient was put on high doses of antibiotics to help him fight off the infection but as the illness race through his body the high fever left him delirious Marsh was dangling on the edge [Music] health officials feared that Martha's Vineyard was once more in the grip of a tularemia outbreak just in time for the tourist season the CDC hurried to the island eager to pursue their landscaping theory from the previous summer three-quarters of the cases that we've seen and recently have been in landscapers and therefore we need to see whether the landscaping population in general is at more risk than the rest of the population this time investigators needed to get more definitive proof setting up a table outside a lawnmower repair shop they obtained blood samples from patrons the evidence was conclusive the epidemiological studies that have been done by the CDC and our group show that landscapers are maybe at six times greater risk than the general population for getting tularemia Daniel Marsh began to recover from the disease that turned out to be pneumonic tularemia because of his case and others the CDC put out a new alert for physicians warning them to be extra vigilant for any person contracting pneumonia with a history of lawn mowing or brush cutting the investigators had to find a brand-new way of catching the lethal disease it had never been documented before that people could get tularemia from mowing their lawns so we were able to identify something new that was going on some some new way of getting trauma tularemia unfortunately we haven't been able to figure out everything landscaper patrick ryr took months to recover from his near-fatal bout he had barely survived the disease for a while everyday life was a struggle the disease affected me for about two months after I got a hospital I could do something for about a half an hour and had to go lay down or sit down I really didn't have much strength to do anything Patrick finally did recover and on August 3rd 2002 he and Paula were married to this day he is grateful for her quick thinking and for his life it really shocked me that somebody could have died from this who didn't seek medical attention and I'm really grateful that I did they thought to my girlfriend that she you know took the time to take my temperature and give me the doctors cuz I if I was alone I probably wouldn't it and on the fourth day or the fifth day I probably would have been dead you know it's that serious today doctor Telford continues taking tick samples on Martha's Vineyard while he and the CDC had several breakthroughs their work on how the disease is transmitted is only beginning well we know that tool ring is transmitted by ticks we found it in ticks we found it an animal material from the vineyard but we haven't found it in soil we haven't found it in lawn mower clippings things that people would have inhaled during the course of their activities so it's been a real mystery to us as to how people are actually getting toward investigators continue their tireless search to locate the source of the bacteria in the summers that have followed the first outbreaks a half-dozen cases of mnemonic tularemia have been reported on the island troubling but not nearly as bad as many had feared but the mystery remains and the investigators are still looking for clues answers that like the disease lie dormant in the soil just waiting to emerge [Music] [Music]

Channel: Real Responders

Views: 727,641

Keywords: CDC, Real Responders, Tularemia, bacterial infection, bacterial outbreak, dietary supplement, disease detection, disease treatment, health crisis response, health emergency, health scare, health science, medical emergency, medical emergency response, medical research, medical television show, outbreak containment measures, public health alert, public health crisis, viral outbreak

Id: ER3xwAXGc14

Length: 49min 1sec (2941 seconds)

Published: Fri Feb 07 2020