The Island Resort That Was Hit With A Bacterial Disease | Diagnosis Unknown | Real Responders

an island in Hawaii is invaded by a terrifying virus entire communities are infected and the disease is on the move it is spread by mosquitoes that feed on human blood there is no vaccine and no cure no one is safe from the potentially deadly threat now health officials must eradicate the source before the virus threatens the entire island [Music] [Music] Maui is one of the most popular tourist destinations in America each year over 2 million people from all over the world visit the island to enjoy luxury resorts and unspoiled beaches but tourists only experience a small part of the islands beauty over 700 square miles of Maui is covered with untamed jungle there the warm temperatures and frequent rain have created a tropical paradise it is also the perfect breeding ground for a deadly disease in September 2001 Maui health officials responded to an emergency call doctors on the remote eastern side of the island had reported several cases of a bizarre illness I think this is a little bit further up here any idea where we are on the map yeah I think we're right here dr. Lauren pang heads Maui's district health office he and Chris Mills an epidemiology specialist made the two and a half hour drive from their office to the isolated village of nahiku the doctors who first treated the sick patients had never seen these symptoms before they could not make a diagnosis but as epidemiologists pang and Mills are trained to investigate mysterious infectious diseases if this disease was spreading they needed to get a first-hand look at the patients and their symptoms Debbi stoner first contacted public health officials when her entire family became ill [Music] people from the health department are here mr. stoner now her husband and daughter were sick and Debbie was worried what do you have today beaver so words don't describe how I feel Bruce stoner was suffering from blinding headaches extreme muscle pain and exhaustion his fever had spiked to 104 degrees males went to check on the stoners daughter while dr. pang examined Bruce so this is something unusual for you though Makena by Mahina I'm Chris and with the health department how you feeling I'm not feeling very good no but the feeling through me just some 16 year old Mahina was so weak she could barely move like her father she was experiencing extreme headaches joint pain and fever Mills took a medical history and a blood sample maybe the lab could figure out what was making mckenas family so sick for my whole family to come down with it was very scary because it was a strange illness and I was the first one to be sick for six days I was in bed for six days okay now Makena and Bruce were also sick the health officials also took blood samples from the entire family as Mills examined Debbie she found an alarming symptom press this for about a minute yeah baby's rash Owen we need to light her Debbie's arms were covered with a strange rash I look like I'd been boiled and it was so itchy I could hardly stand it I came on at night and it felt like pins and needles when I first got it like your hands had been asleep and they were waking up and then it just got so itchy and there was nothing I could do to stop the itching yeah you see that nothing on the face don't know the rash was worrisome but what Debbie told paying next alarmed him well I'd heard rumors of people being sick in the neighborhood from my neighbor and she told me she goes Debbie I've been so sick she disappeared for two weeks and I hadn't seen her and she told me Debbie I've been so sick it was a strangest thing Mills and PEG did not yet know what they were dealing with but they knew it could be infectious gelding the stoners neighbor lived less than a mile away I'll draw your blood first and then we'll talk a little bit later she had gotten sick two weeks ago she still felt weak and tired we interviewed her and gathered as much information about her illness her recent she had any recent travel or she could have also gotten sick and we did draw her blood gelda symptoms were identical to the stoners but she had not come in contact with them for over a month [Music] anybody else sick in the heat way that you know of oh yes like you sick like you're not the flu the pattern was ominous pang and Mills feared they were seeing the beginning of an outbreak by the end of the day they had seen four cases of the mysterious illness they agreed no single symptom pointed to a specific disease they all got the same thing but the combination of symptoms worry doctor paying the fever minutes associated with a rash when you don't know what it is you worry because it could be lots of things which could mean a thought following protocol dr. pang sent his detailed case notes to the State Department of Health in Honolulu on the island of Oahu Michelle Nakata received the information as an epidemiology specialist for the state it is her job to monitor disease outbreaks on the seven main Hawaiian Islands Nakata reviewed the case notes with state health director dr. Bruce Anderson hey Paul come on over here for a second let me know what you think she also consulted dr. Paul kit sue Thani an expert in infectious diseases as they briefed get suit on e Chris Mills called from Maui Mills had assembled the small staff from the Maui health office they were anxious to hear Nakata's opinion on the cases well we haven't thought that be easy to do that the spyro sis is also a possibility [Music] nincada was worried about dengue fever the maui team was surprised if there's anything that we can do to help you give me a call again no I most definitely will Thanks dengue is a human disease that is carried by the 80s a gym time mosquito but in the 1950s this species had been eradicated from the island a dengue outbreak seemed impossible and unthinkable historically dengue outbreaks are massive and unstoppable thousands can die when the disease strikes dengue fever is caused by a virus that attacks the body's immune system there is no vaccine and there is no cure it is often referred to as breakbone fever because patients experience pain similar to their bones being broken brusatte quindi suffered with the disease I'd say this would be easily a hundred times worse than then your worst headache you've ever can imagine you know right behind the eyes your heads pounding you feel like your eyes are gonna pop out of your head a week after becoming infected patients break out in a painful rash a condition caused by veins bleeding under the skin after two more weeks the symptoms disappear if dengue spreads unchecked victims with a repeat infection can develop dengue hemorrhagic fever with this patients bleed internally and from the eyes nose and mouth the disease can be fatal if dengue fever had invaded Maui Nakata had to determine the extent of the outbreak she sent a medical alert to hospitals and health care officials statewide she advised them to watch out for patients with rashes headaches joint pain and high fever the main reason that we asked them to do this was to get prompt notification of new cases at the Maui District Health Department the small lab wasn't equipped to test blood for dengue a technician prepared blood samples collected in the remote village of nahiku for shipment they would send them to a specialized lab at the Centers for Disease Control and Prevention in Puerto Rico tragedy struck in New York City this morning two planes crashed into the World Trade Center towers a third plane hit the Pentagon in Washington DC we will keep you updated terrorists had struck on September 11th for the first time in history air traffic was shut down all over the country all the parting flights are suspended indefinitely passengers should either stay home if their local residents or if they're tourists they should not check out of their hotel Maui was cut off isolated it affected us in the sense that we couldn't send out samples to be tested for dengue fever but so it was very challenging hold it for CDC's they were dealers the potentially deadly outbreak and they had to face it on their own without lab tests Mills and Peng went back to nahiku to examine more of the residents first they checked on the stoners Bruce was starting to feel better but their daughter Mahina was still weak her fever had subsided but she ate all over okay all right there was little her family could do but give her fluids and some medication for the pain at the town pavilion Chris Mills questioned more of the residents she believed she might be looking at as many as 20 new cases it was more than the small staff could handle now we had an epidemic on its hands when the possibility of dengue fever came to Maui it's really over overwhelmed their office so we really needed a lot of help Mills asked the State Health Department to send her more manpower to deal with the epidemic while flights outside of Hawaii were grounded flights between the islands were still running dr. Paul kazoo taani and a team of epidemiologist arrived from Honolulu they needed to examine every suspected case and quickly an outbreak was unthinkable if the virus was dengue fever nobody knew where it came from or where it would strike next [Music] with a suspected dengue fever epidemic on the island of Maui public health officials were perplexed and overwhelmed they asked for help from the state health department a team of epidemiologists arrived on the island as they made their way into the hot zone Maui health official Chris Mills briefed the epidemiologists but like I said we sat at the Town Meeting so fast there could be a lot more in the community than even those twenty there's about 150 to 200 people the community so as the population of nahiku was tiny and it was in a remote location far away from the more populated areas in such a small community officials hoped they could locate the source of the disease and stop it before it spread [Music] arriving in nahiku they set up a temporary medical station worried residents were already waiting [Music] the district health team needed to get a better idea of the number of people who had been sick most residents were past the debilitating stage of the illness [Music] but they had all suffered from fever muscle aches and a persistent painful rash volunteers from the local clinic took case histories and drew blood samples within a few hours they documented over a dozen suspected cases males entered the patient's information into a database all the symptoms continue to point to dengue fever in Hawaii it is not unusual to see isolated cases of the disease but the victims are always travelers who caught the virus in another country other tropical areas such as Tahiti Samoa the Philippines were all experiencing increased rates of dengue from the interview so far no one had traveled outside of Maui they headed to the town church to meet with residents for now the outbreak was isolated to the small town of nahiku dr. pang explained that their blood could not be shipped out for testing the 9/11 terrorist attack had halted all air traffic without laboratory analysis they could not confirm dengue fever still paying recommended a massive spring campaign to protect the residents from the virus with stakes this high they couldn't afford to wait for lab results any pesticides no DDT but residents knew mosquitoes were everywhere the response was overwhelmingly negative the residents of nahiku lived simply and close to nature they did not want pesticides to pollute their tropical paradise pang was fighting a losing battle despite the risk that townspeople wanted confirmation before they would allow the Health Department to act they are very opposed to spraying any kinds of pesticides in their town and we really were trying to respect their wishes but at the same time and the outbreak Bruce and Debbie stoner were the only residents to allow spraying outside their home they were terrified for their family if any of them were infected with the virus again it could lead to dengue hemorrhagic fever a painful and potentially fatal form of the disease the risk was too great this donors hope that spring would protect them health officials went to the most remote corners of nahiku during their interviews they learned that many more people were sick at one home doctor kit soutane he found a woman who said her daughter had come down with a severe case of flu two weeks earlier she was still feeling weak from the disease her symptoms were familiar fever headache joint pain and a rash the girl was too weak to walk to the car a week after the first case was reported the team got unexpected good news which transportation officials say will return the place origin on September 19th the ban on US air travel had been lifted at last the blood samples could be sent to the CDC lab it would still take them several days to identify the virus Chris Mills shipped the samples on the first available flight to Puerto Rico Maui health officials would finally get the answers they needed and they could call in reinforcements from the mainland at the CDC's lab in Puerto Rico the nahiku blood samples were given top priority scientists there specialized in dengue fever the fastest way to test for dengue is to inject the patient's blood into the most common carrier of the disease the ATS a time mosquito samples of the species are kept frozen for testing purposes if dengue is present the virus will multiply inside the mosquito the insects tissue is highly sensitive to the virus tissue samples are then removed from the carrier and combined with a reagent under an ultraviolet light infected blood cells will glow scientists finally had their answer they were facing a full-blown epidemic it was the worst case scenario the nahiku blood samples had tested positive for dengue fever given how many mosquitoes we have here and from the history of other countries in tropical areas not ever being able to get rid of it it was it was a big deal the situation was urgent there were now 30 documented cases of the disease in nahiku the Health Department was losing the fight you were told by the CDC that no one can catch her control of dengue epidemic once it begins CDC told us in general every time you detect one case to your system there's two or three hundred more out there undetected according to the CDC's calculations the number of victims could now be in the thousands and they still had no idea how the virus was spreading the species of mosquito that carries dengue had been eradicated from the island in the 1950s had the eighties at time mosquito returned to answer that question Maui health officials brought in an entomologist a scientist who specializes in insects they needed to catch mosquitoes and examine them to learn whether another species was spreading the disease dr. Paul reader works for the CDC he is an expert on Maui's number one public health enemy the mosquito the first thing that we were interested to know was what mosquitos are around here and of course we knew before we came here that ADEs albopictus which is another species is actually now known as the Asian tiger mosquito was in fact common and how common we hadn't expected to see at not until we came here in Naha ku reader and his colleague conducted an experiment to measure the mosquito population the best way to measure the number of mosquitoes is to collect them in an aspirator reader used himself as bait in minutes they had collected dozens of the insects in the lab they only found the eighties albopictus or Asian tiger mosquito this species carries the dengue virus but doesn't exclusively feed on humans and is rarely the cause of an outbreak this year breeding conditions had been ideal the mosquito population swelled with so much competition for food Asian tiger mosquitoes were now biting more humans there were millions of Asian tiger mosquitoes all over the island and they were carrying a deadly disease in the fall of 2001 Maui health officials fought to contain an outbreak of dengue fever millions of mosquitoes carried the virus the entire island was at risk the dengue fever outbreak is bigger than we thought originally state health director dr. Bruce Anderson and held a press conference announcing the outbreak hundreds of calls flooded the Health Department retired nurses were recruited to help with the workload the phone's just kind of went off the hook calls from the mainland US tourists who had either been here and we're worried about did I get sick or tourists who are coming and then our local people who are really upset few people in Maui had ever heard of dengue fever panic swept through the community the Department of Health distributed leaflets explaining the symptoms of the disease and its dangers they asked residents and tourists to call the health department if they experienced dengue x' characteristic pain fever and rash the effect on Maui was immediate and devastating Island hotels cleared out reservations were cancelled Hawaii's tourist industry was already suffering from the effects of the terrorist attacks on September 11th now it was also dealing with an epidemic officials went back once again to nahiku and pleaded with residents to let them spray some people were still very opposed to pesticides and a property but a lot more people were much more open they they figured they'd rather have the pesticides and help prevent other people from getting sick technicians spray pesticides around the homes of infected residents they sprayed the tropical flowers with soap and water the solution killed the larvae without harming the environment there was no way they could spray enough to kill all the mosquitoes but if they could reduce the insect population they might keep the mosquitoes from spreading the virus when news of the outbreak hit the island sold out of insecticide the Health Department received an emergency shipment to keep residents and tourists protected the public health nurses opened up a booth where tourists and also were a lot of local people who live here passed by and they handed out information and also wipes or spray if people didn't have bug repellent with them but Mills knew they would have to fight them at their source pools of water surrounded nahiku insect larvae the next wave of mosquitoes were visible on the surface the stagnant streams were caused by a reservoir which diverted Maui's water supply to the tourist areas district health officers requested the water be released if they flooded the streams it might destroy the mosquitoes breeding ground the reservoir was opened the water rushed towards nahiku a few hours later pang and Mills inspected the streams the water level had barely increased their attempt to destroy the breeding grounds had failed the mosquitos were multiplying and the virus was still spreading health officials were outnumbered and surrounded ten miles away from nahiku in the town of Hana doctors were called in to examine a group of sick high school students the disease had spread out of the hot zone in nahiku dengue was on the move for epidemiologists the high school students provided an important clue the students had recently visited Tahiti a country that was also suffering a dengue outbreak dr. Paul KITT suit on he wondered if the high school students had become infected with dengue fever in Tahiti and then brought it back to Hawaii blood samples were sent to the CDC where they could compare the strain found in Hana with the strain from Tahiti as they waited for results students like Kara Henderson were frightened everybody in Hana was really worried there were lots of people getting sick and so everybody was trying to take care of each other the outbreak had already spread from nahiku to Hana to neighboring communities on the east coast of Maui I wasn't surprised to hear of more cases outside of our community because it spread so fast in our community I was you know kind of sad for the people out there and I wanted to warn them you know to watch out wear mosquito repellent and wear long sleeves and pants and don't come down here the health department was fighting a losing battle roadblocks would keep residents and tourists away from high risk areas but as the CDC had told them the mosquitoes would be nearly impossible to contain the swarm of hungry insects threatened both human life and tourism the main source of the state's economy state health official Michelle Nakata Hawaii is because it's still part of the United States it's considered to be a nice tropical exotic venue and I think with a dengue fever appearing the impact was that you lost some of that safety Nakata flew to Maui to help the team but the number of cases continue to multiply at the time that I arrived in Maui we were fighting an uphill battle they were just getting lots of telephone calls the possible cases and there was just a lot of work that needed to be done on September 21st two weeks into the outbreak dr. pang received devastating news another suspected case of dengue had turned up outside the hot zone the virus appeared to be moving towards a more populated area to a town called haiku East Maui is quite isolated and we kind of drew a line into our drawing a line in the sand and we said if it crossed over to this area called haiku park was very wet lots of mosquito and the population about four times as big as the other side I said if across this into here where did that I mean we it'd be like a fire raging out of control investigators drove several hours north to haiku Chris Mills and her team had to stop this latest outbreak in its tracks technicians from vector control armed with pesticides had already arrived at the patient's house once they got confirmation it was dengue they would move into action a telltale rash on sunny weathers arm confirmed her worst fears once again dengue had spread to another area technicians began spraying around the home Mills gave the family detailed information on how to prevent further infection she told them to wear long pants and long sleeves outside and to use bug spray it was important to reduce the mosquito population around the home but Mills wondered if it was doing any good when cases of dengue fever started happening in other parts of Maui really like it's gonna be spread all over the island and we're just gonna be living with this forever and that's that's kind of a scary thought not just as a health worker but as a resident as the disease raged through the village of haiku reports of dengue fever came in faster than ever the team was frustrated and worried [Music] by late September they had 60 suspected cases the Maui officials refused to give up they knew that if they didn't stop the virus it could turn deadly in October of 2001 dengue fever was spreading across the island of Maui the mosquito-borne disease had been confined to three small villages on the island now it was spreading west and threatening more populated areas not only that hi cool start having cases but far away in Lahaina with a population of twice 17,000 twice how cool now you have a lot of people but it's not so wet and you wonder how how did it get there located on the western side of the island Lahaina is where the tourist vacation and has the highest concentration of people because of Maui's fragile tropical environment they couldn't do aerial spraying officials would have to combat the mosquitos house by house their massive eradication effort wasn't working new cases were reported by the hour if dr. pang and Chris Mills hope to fight the epidemic they needed to map where it was spreading we called in the Pacific disaster center to help with GPS mapping so we could get a good view of where every possible case and confirmed case of dengue fever lived out in the nahiku and Han area most of these homes don't actually have physical addresses doctors met with Mike Napier at the Pacific disaster center Napier monitors earthquakes volcanoes tsunamis and severe storm activity in the Pacific and Indian Ocean regions for health officials this outbreak could be just as devastating with Napier's help the team would use satellite imagery to get an overview of the epidemic but first they had work to do on the ground the team assembled in nahiku Napier outfitted them with hand-held global positioning systems or GPS units working in pairs their goal was to map each household that had either confirmed or even suspected cases of dengue fever this overview would help health officials visualize where climate and vegetation might be harboring concentrations of the mosquitoes in the field the teams interviewed each patient who exhibited symptoms of dengue they used the GPS units to record their geographical position the State Health Department used the points to show where exactly the outbreak was occurring and to as a to a certain extent limit travel to those areas at the end of one day Napier downloaded each teams data into his computer health officials would finally see their enemy swarms of mosquitoes all over the island they laid out a perimeter around the houses and outlined areas or hotspots to be targeted for mosquito control we created two hundred yard circles around each hot case and the reason we did that is because the albopictus mosquito has a range of 200 yards now that the teams knew exactly where the mosquitoes were they targeted areas around the houses of any suspected cases by now there were a hundred suspected cases documented covering a 70 mile area across the island each area had to be sprayed by hand to prevent further infection they needed to find more resources and fast in October 2001 scientists and health officials on Maui had identified the source of an epidemic mosquitoes millions of them nearly a hundred cases of dengue fever were confirmed thousands were suspected dr. Lauren pang and his team were in a race against time they had to stop the mosquitoes or people could die [Music] the outbreak along with the events of September 11th threatened to destroy the main source of Maui's economy tourism many workers lost their jobs others faced the outbreak of a deadly disease Maui was in trouble [Music] the Hawaiian government responded with a bold and practical solution Hawaiian State Senate representative Kalani English we took people who that were unemployed that lost their jobs from 9-1-1 and other unemployed people we skipped the civil service roles allow them to come directly on hired directly gave them training and have them go out to eradicate breeding grounds for mosquitoes so we created what's known as the emergency environmental workforce the newly formed task force was grateful for the work and highly motivated their own families were at risk day after day they cut down brush eliminating the mosquitoes breeding ground pesticide spraying intensified but so did the infection rate there were now over a hundred confirmed cases of dengue Chris Mills was worried it was scary as a health worker we just didn't know if we were gonna be able to handle it or actually get rid of it a dengue epidemic had never been successfully contained but all across the island residents pitched in to help a new series of public service announcements educated them on the dangers of dengue a clogged rain gutter 1,000 mosquitoes an uncovered wheelbarrow 10,000 mosquitoes most importantly they learned how to stop the mosquitoes from breeding [Music] residents checked around their homes for stagnant water where mosquitoes lay their eggs those who had been sick were particularly concerned they were terrified of getting a repeat infection after months of work the number of cases of dengue fever in Maui dwindled and then stopped at one point we were projecting literally hundreds of thousands of cases which would have been a worst-case scenario as it turned out we had just over a hundred cases and and the problem was largely kept under control since the first case in nahiku scientists at the CDC had tested hundreds of blood samples and found the source of the outbreak in this case we found the Hawaiian dengue virus was most closely related to the Tahiti virus of the which we got from the same year and more distantly related to the Samoan dengue one of the previous year so our conclusion is that the most likely origin of the Hawaiian virus was Tahiti for the people who had been infected recovery was long and difficult but the quick action of the Health Department averted a disaster as soon as the Health Department found out about it they acted on it immediately they came out the next day and they were very interested and very detailed gave us a lot of personal attention and started meetings with the community right away they really made me feel more secure about the whole thing eight months after Debby stoner reported the first case of dengue fever on Maui the outbreak was contained we declared the outbreak to be officially over in April that was about two months since the last case was reported we figured that given that mosquitoes lived for about a month if it were no longer circulating in the mosquito population then there would be no longer any risk of transmission miraculously there had been no fatalities I think we were successful in stopping or having an effect because of the early response and I think we had an early response because we had education and people told us so we knew where it was and we could respond very quickly so a lot of people said how can I personally help so breeding site control and all that so we had a very very motivated educated community health officials doctors scientists and the public had achieved the impossible working together they had contained an epidemic defeated a disease and restored Hawaii as a safe tropical paradise for the first time in history Hawaiian public health officials had stopped an outbreak of dengue fever [Music]

Channel: Real Responders

Views: 244,812

Keywords: Communicable Disease, Contagious Disease, Disease Control Measures, Disease Management Protocols, Epidemic Preparedness, Health Crisis, Health Crisis Management, Health Risks, Infection Prevention, Public Health Alert, Real Responders, Summer Holiday, Symptom Management, bacterial outbreak, disease investigation, health crisis management, infectious outbreak, infectious outbreak response, medical emergency protocol, medical emergency response, public health alert

Id: kLumGIWG8Wc

Length: 48min 53sec (2933 seconds)

Published: Fri Feb 21 2020