American History Tellers - Sponsored | American Epidemics - Dark Days In Dallas | 2

Episode Date: May 24, 2019

This episode is brought to you by Wondery in partnership with National Geographic in anticipation of their new series, The Hot Zone. In 2014, Ebola is tearing through Guinea, Liberia and Sierra Leone, but the deadly disease hasn’t yet made landfall in the United States. Then Thomas Eric Duncan, a Liberian visiting his fiancee and son in Dallas, stumbles into a local hospital with a fever. His eventual diagnosis — Ebola — sets off a nationwide panic that a full-scale outbreak might be looming. As local healthcare workers and epidemiologists put their lives on the line confronting a crisis they were never trained for, government officials struggle to mount an effective response. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Wondery Plus subscribers can binge new seasons of American History Tellers early and ad-free right now. Join Wondery Plus in the Wondery app or on Apple Podcasts. This episode of American Epidemics is brought to you by Wondery in partnership with National Geographic. The Hot Zone, starring Julianna Margulies, premieres this Memorial Day, May 27th at 9, 8 central on National Geographic. It's September 2014 in Monrovia. Thomas Eric Duncan stares down at the letter in his hand and tries to remember the last time he was this happy. He, a citizen of war-torn Liberia, has secured a U.S. visa. With this one piece of paper, Duncan can finally visit his family and reunite with Louise and their teenage son, Karzaya. The two of them got their visas years ago, and now, finally, Duncan can see them again and leave his tiny apartment in Liberia's capital behind. Thomas! Thomas! We need your help! Duncan rushes to the door of his apartment and

flings it open. In the hallway, Martha Lean, the daughter of his landlord, is doubled over in pain. She's a woman not much older than his son and seven months pregnant. She's been helped down the stairs by her brother and her father, Duncan's landlord. Duncan runs over and turns to the older man. Is it the baby? I don't know. Help us get her downstairs. Outside, Duncan flags down a taxi. He helps the girl and her family into the back, then jumps in next to the driver.

You know the main hospital? Get us there as fast as you can. But the hospital is no help. It's totally overrun. Panicked doctors scramble in every direction, dozens of people waiting to be treated. The waiting room is a sea of misery. Duncan looks around. He sees people crying, moaning, sweating, bleeding, struggling to stay conscious. He stops a passing doctor. Excuse me, she needs help over here. We don't have a free bed. Take her home. She's in pain. Look at her. I'm sorry, but everyone in this room is in pain. The doctor walks away as Duncan stares in shock. With nothing else to do, the desperate group returns to the apartment where Duncan helps carry the ailing young woman inside.

At three o'clock that morning, Martha Lean dies. She was only 19 years old. In the weeks that follow, Duncan's family will say he denied assisting the young woman, although several of Martha Lean's family members and neighbors report witnessing the incident. What is known is that days later, at the airport, Duncan is stopped at a checkpoint. With Ebola consuming the country, to be stopped is routine for everyone leaving Liberia at this time.

Each outgoing passenger is asked the same question, have you been in contact with anyone infected with Ebola? Duncan answers no and boards the plane. He arrives in Texas on September 20th. Four days later, after embracing Louise and Karzaya with tears of joy in his eyes, after officially beginning his life in America, Thomas Eric Duncan's stomach explodes in pain. The pain spreads to his joints. His temperature skyrockets. At 10 p.m. on Thursday, September 25th, Duncan stumbles into his car and drives to Texas Health Presbyterian Hospital. Locally, it's known as Presby.

But despite a temperature of 103 degrees and his travel history, the staff missed the signs. They send him home with antibiotics. But at home, his condition only gets worse. By Sunday, he can't stand. He returns to the emergency room in an ambulance. The doctors run through the possibilities until only one unthinkable option is left. Thomas Eric Duncan is placed in isolation. A blood test is ordered. Doctors begin a tense waiting period. The hope is that their worst fear is not confirmed. A fear that grows more and more credible with each passing moment.

The fear that one of the most deadly diseases on Earth has found its way from West Africa to Texas with the potential to rapidly spread. From Wondery, I'm Lindsey Graham, and this is American History Tellers. Our history, your story. In this third of three episodes, we're partnering with National Geographic in anticipation of their new series, The Hot Zone. The three-night limited series is inspired by true events surrounding the origins of the Ebola virus and its arrival on U.S. soil in 1989. This is episode three of our three-part series about American epidemics, Dark Days in Dallas. Painful, deadly, and enigmatic, the Ebola virus first rose near

the banks of the Ebola River in what is now the Democratic Republic of the Congo, then known as Zaire, in 1976. That year, there were two distinct outbreaks, one in Central Africa, in what's now the DRC, and another one to the Northeast, in what is now South Sudan. The outbreaks claimed 431 lives that year, and medical professionals immediately recognized that a formidable viral threat had emerged. That threat would go on to devastate rural communities in Central Africa over the years, but it wasn't until a deadly strain emerged on the other side of the continent in Guinea, Liberia, and Sierra Leone that it made the jump into more populated areas. In 2014, it would go

on to find its way from West Africa to U.S. soil, sparking widespread public concern. Officials rushed to contain the West African outbreak and to halt the deadly disease, both lethal and terrifying, in its march from town to town, city to city, and eventually continent to continent. Like all viruses, Ebola has one goal, to replicate. When it enters a human body, it is ruthlessly efficient in achieving this objective. Ebola first hunts down special immune cells and disables the body's ability to fight the infection. Then it starts to replicate in earnest, spewing thousands of copies of the Ebola virion into the bloodstream. The virus spares skeletal muscles and bones, but not much else. Then the disease lies in wait. Symptoms can take up to three weeks to appear. When they do, they might first be mistaken for those of the flu, fatigue, fever, joint and

muscle pain, headache. But then comes abdominal pain, diarrhea, vomiting, and finally, internal hemorrhaging that in some cases may cause bleeding from the victim's eyes, ears, nose, or mouth. There is no cure, no vaccine. Previous outbreaks of Ebola have killed about half those infected, with a few more deadly epidemics claiming up to 9 out of every 10 victims. Like HIV, Ebola is spread through direct contact with bodily fluids of an infected person. Nursing mothers can pass it to their infants. Husbands can give it to their wives. Healthcare workers can contract it caring for a sick patient or disposing of a contaminated

needle. Ebola is very difficult to treat, but it can be contained. Victims can't spread the disease until they begin to display symptoms, which means that since Ebola's discovery, periodic flare-ups of the disease have been managed through careful quarantine and the courageous work of dedicated health and community workers. Containment has kept Ebola in check. But those who have worked on the front lines during these outbreaks worry that a threat is looming, that the unthinkable could happen, and one day it does. The outbreak starts in late 2013 in Guinea, a country on the western edge of Africa. It spreads from a single tree at the edge of a village so remote its name,

Miliandu, translates to, this is as far as we go. There, two-year-old Emil Uemwano is ready to play. This afternoon, his mother is busy preparing food for the week. Bored, Emil wanders off to the most fun place in the village, the large, dark, hollow tree where the bats live. The tree has small vines to tug on, and Emil can't wait to climb it when he gets just a little bigger. As he peers up into the dense branches that disappear into the sky, he reaches out to touch the tree bark, then rubs his eye. Maybe he inadvertently touched

a drop of bat guano laced with the virus. Maybe he was unknowingly bitten. No one will ever know for sure. But what people will later come to understand, however, is that it began in this moment in Miliandu with Emil. Within days, Emil is vomiting. He has a fever and blood in his stool. His condition worsens quickly and on December 6, 2013, the boy dies. Within weeks, his mother and sister join him, and his grandmother becomes ill. Emil's grandmother, recognizing that she has come down with whatever sickness just killed her daughter and grandchildren, travels to the largest nearby town, Gekidu, for treatment. There she stays with a nurse who does his best to treat the dying woman, but fails. Eventually,

the nurse dies as well, but not before traveling to Masentogini, a town of nearly 90,000 people. The virus only spreads from there, beginning to engulf the entire region. On March 22, 2014, the World Health Organization makes the official announcement. Ebola is in Guinea. At this point, the agency knows an investigation is needed. WHO operatives spend months tracing the disease all the way back to Emil Uemwano's tree. But the agency stops short of declaring an emergency. By July, the virus is also tearing

through Liberia and Sierra Leone, and by mid-August, more than 1,000 people are dead in all three countries. Unlike the Democratic Republic of Congo or Uganda, these countries have no experience with the disease, and their health officials are also grappling with crushing poverty and barely functioning government health systems, making a timely response even more challenging. As international health groups try to respond, efforts are hindered by poor communication, lack of coordination, and turf wars among aid groups and government agencies. Health officials are also at odds over how to describe the dangers of Ebola, trying to balance the urgent need for public

awareness with heading off panic. When local aid workers with Doctors Without Borders try to raise the alarm, highlighting early mortality rates of up to 90%, the top spokesman for the World Health Organization sharply and publicly warns them not to exaggerate, citing the potential disruption to economic life in the local countries. The squabbling and missteps leave some aid workers frustrated. The prospects of the disease taking hold and spreading across the globe are real and growing, and American government officials know the time has come to prepare a response. In August 2014, two organizations mobilized to help curtail the toll of Ebola. The Centers for Disease Control, or CDC, handles epidemiological and scientific concerns.

The United States Agency for International Development, or USAID, executes logistical and coordination efforts, but the agencies aren't used to working closely together and it's rough going at first. Officials focus on a containment plan called 70-30. Its creators have looked at previous outbreaks and concluded that Ebola can be contained if 70% of those infected remain isolated until the epidemic wanes, 30% totally isolated in specialized treatment units, and 40% of them partially isolated at home, away from family members. If the remaining 30% of the infected people go untreated, the isolation plan will still be effective. Not all health officials are comfortable with those odds.

But in a world with no effective mass-producible vaccine against Ebola, 70-30 is the only practical response. The American government is confident in its ability to take action. But this faith is tested on September 11, 2014, when Michael Osterholm, Director of the Center for Infectious Disease Research and Policy at the University of Minnesota, publishes an op-ed in the New York Times. Medical experts know that, for now,

airborne transmission of the Ebola virus is impossible. But in his op-ed, Osterholm paints a grim possibility. You can now get Ebola only through direct contact with bodily fluids, he wrote, but viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person may be genetically different from the virus entering the next. If certain mutations occurred, it would mean that just breathing would put one at risk of contracting Ebola. Infections could spread quickly to every part of the globe. The op-ed scares readers in every major city in America. It reverberates coast to coast, its impact penetrating directly into the White

House's Oval Office. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has just emerged from a meeting with the president. His waiting assistant quickly stands and follows his boss as Fauci heads briskly towards the White House lobby. How'd it go, Dr. Fauci? Well, naturally the president is concerned about Osterholm's peace in the times. At 74, Fauci has been in the game for a very long time. He's studied infectious diseases for decades and is a native of Brooklyn, not easily rattled. Still, he read Osterholm's op-ed too, and he must admit that it raises some

very frightening questions. What did you tell him? I told him the truth. We don't know as much about Ebola as we should, but currently the virus cannot survive in the air. It needs a liquid substance in order to survive, blood or other bodily fluids. This has been true likely for thousands, maybe even millions of years. So you told him it's impossible for the virus to go airborne? No. Technically, anything's possible. But I told him what I told you. In the history of virology, there are no instances that we know of where a virus has completely changed the modality of how it's transmitted. Look, the way I see it, that op-ed is going to sell a lot of papers. And yes, it will sow new fears, but ultimately,

it's a PR problem. Osterholm's views don't represent what's commonly believed by people like us, the ones actually fighting the disease. The assistant nods, but looks somber. But PR problems can still do real harm. Whether it's fair or not, a line has been crossed with the American public. If we don't get our arms around this thing once and for all, there could be a panic, especially if the situation in West Africa gets worse. The situation does get worse. By October 2014, Ebola has not slowed laying waste to many African communities. More than 7,000 West Africans are infected, over half of them residents of Liberia. All of this despite the best efforts of local Liberian doctors,

the CDC, and other international organizations such as Doctors Without Borders. President Obama decides the U.S. must step up its response. He dispatches Lieutenant Colonel Ross Leitze of the 101st Airborne Division to Liberia. Leitze puts the Army to work, deploying soldiers to erect Ebola treatment units and blood testing labs. The Obama administration and Leitze himself recognize the potential for troubling optics. It doesn't look good for the American military to mobilize in a foreign country, even with a humanitarian objective. Leitze tries to reassure skeptics, declaring, Liberia is the center of gravity here. The U.S. Army is not the center of gravity. We don't own Liberia. We don't own this mission. We're in a supporting role. And with

the Army at work, mindful of maintaining respectful and supportive dynamic with both local Liberians and the CDC, all seems to be going according to plan. That is, until a horrible announcement is made in the United States, one that was never part of any plan. The possibility of the worldwide spread of Ebola strikes deep, dark fear in our hearts, because in a palpable way, it threatens the very future of Ebola strikes deep, dark fear in our hearts, because in a palpable way, it threatens the very future of human existence. From cholera to influenza to malaria, global pandemics have tested the limits of human ingenuity, and in every case, heroes have emerged.

The Hot Zone, an upcoming National Geographic series, is inspired by true events and portrays the 1989 arrival of Ebola on U.S. soil. When this killer virus suddenly appeared in monkeys in a scientific research lab in the suburbs of Washington, D.C., there was no known cure. A heroic U.S. Army scientist, Lieutenant Colonel Nancy Jax, played by Julianna Margulies, put her life on the line to head off the outbreak before it spread to the human population. I got to preview the show, and it is gripping edge-of-your-seat television, and even more terrifying by the fact that it is inspired by true events. So don't miss The Hot Zone, a three-night limited series premiering on Memorial Day,

May 27th at 9, 8 central on National Geographic. And stay tuned at the end of this episode to hear a trailer for The Hot Zone. On Tuesday, September 30, 2014, the CDC discloses to the world that there is a man in Dallas being tested for Ebola. His name is Thomas Eric Duncan, the Liberian who received a visa to visit his family in the U.S. and began to show symptoms four days after reuniting with his fiancée and son. Duncan lies in Presbyterian Hospital, feverish, vomiting, growing sicker by the day. His blood work has not returned, but no chances can be taken, especially after Duncan reveals for the first time that, before he left Liberia,

he had to help a gravely ill young woman get to a hospital, a woman who later died. Unbeknownst to Duncan, her brother is now dead too. Upon hearing about the woman, Dallas County Chief Epidemiologist Wendy Chung raises the alarm. Duncan is placed in a secure isolation ward, the nurses tending to him do so only after outfitting themselves with gloves and positive pressure respirators. Presbyterian doesn't have full-body biohazard suits, much to Chung's chagrin. Still, she dons what protective gear she can and approaches Duncan's sickbed. She's convinced he has Ebola. Chung sits at Duncan's bedside. She can see he's dying a painful death, and she feels for him.

However, important questions must be answered honestly and accurately, while the only man who can do so is still alive. So Chung questions Duncan. When you got to America, where did you go? Who did you cross paths with? Who did you touch? All of Duncan's contacts must be traced within days. If Chung fails to do so, the ultimate horror might be unleashed on the American public,

a full-scale outbreak. Later that day, the nightmare is one step closer to becoming a reality. Duncan's test results come back, he has Ebola. When the news breaks, the city begins to panic. Parents are afraid to send their children to school, especially when their kids' classmates include the children of Louise Troh, Duncan's partner, and other kids she's caring for. At those schools, attendance swiftly drops more than 10%. Responsibility for coordinating the local response falls on surprised Dallas County Judge Clay Jenkins. Jenkins consults with CDC Director Tom Frieden, who informs him that protocol forbids the CDC from running Ebola response operations in Dallas. The organization can only assist. It is Jenkins who must run the

show. With the aid of his staff, Jenkins takes the necessary steps. An emergency operations center is established downtown. Workers from the center arrive at the Ivy Apartments, where Tro lives, and sanitize her unit top to bottom. They tell Tro and her family that they must not leave their apartment until blood work can confirm that they're Ebola-free. Officials distribute flyers to the neighbors meant to educate residents on Ebola and the best ways to guard against it.

But outreach is tricky. Many residents are immigrants who speak English as a second language, and some are confused by the flyers. Meanwhile, the growing sense of panic begins to infiltrate nearby towns. Sixty miles from Dallas, Navarro College, a two-year community college, sends letters to recent applicants from Nigeria. The students are no longer welcome due to the fact that they're coming from a country where people have died of Ebola. Several members of Congress call for complete travel bans on West African countries. Anthony Fauci and Rajiv Shah, director of USAID,

believe that a travel ban is precisely the opposite of what needs to happen. They warn the president that a ban would bar American specialists from where Thomas Eric Duncan lies, succumbing to the virus. They're trying to track down anyone who may be a risk. Chung stands in the dark hallway of a squat apartment complex, four blocks from the hospital. Hello? Good afternoon. My name's Wendy Chung. I'm an epidemiologist with Dallas County. All right. Sir, are you aware of the confirmed Ebola case that has occurred in this area?

Yeah. Isn't everyone? Is there a problem? Possibly, sir. Chung pulls a photo from a tan folder. This is the man with Ebola. My colleagues and I understand he was recently in the grocery store you work in. Do you recognize him? Hundreds of people come and go through the store every day. It's a supermarket. Wendy nods. She knows that this is almost an impossibly hard task, trying to locate and interview every last person Duncan interacted

with before he was hospitalized. She pulls a small sheet of paper from her folder. We found this receipt in Duncan's belongings, dated September 23rd, 3 p.m. You're noted as the clerk. Do you understand? Oh my god, I don't want you to panic. I feel fine though. That's good. But we're going to need to take you under observation. If you haven't felt anything off, like I said, that's a very good sign, but we can't take any chances. Do you understand? Yeah. Okay, good.

Now, I need you to list every person you've come into contact with in the past week to the best of your recollection. Once a supermarket employee is safely taken into CDC custody for observation and possible quarantine, Chung rejoins her colleagues outside on the sidewalk, both of whom who have just completed interviews of their own with nearby residents of the neighborhood. Okay, we have the supermarket clerk squared away.

I'll need to contact his girlfriend and everyone he worked alongside that day in the store. But let's keep things moving. Amy, I need you to talk to all of Louise Tro's co-workers. They may have been exposed. We also need to speak to the teachers at their kids' schools and the athletic coaches. Duncan said he took a taxi, so we need to find a cab driver. And Ken, I want you to talk to the staff at the movie theater in the restaurant closest to Tro's apartment. Duncan mentioned a date night when he got into town. Every employee at both locations must be questioned.

Chung frowns as she pages through her notes. Can we think of anyone we might have missed? We initially estimated two dozen local contacts for Duncan. But now, after hunting down those 24 people, we've found a total of nearly 100 potential contacts, all of whom will now need to be monitored. It's going to be a rough three weeks for them. She shuts her eyes tight for a moment, then opens them.

I'll join you back in the field in two hours. I need to get back to Presby, check on Duncan. On October 7th, 2014, when Chung returns to Duncan's isolation unit, she can see he's taken a turn for the worse. Doctors report that there is blood in his urine, his lungs are infected, and they're failing. Duncan can't talk. Tears run down his cheeks. His sister, nephew, and mother arrive from North Carolina to be with him, but doctors can't permit them to get close. In agony, they watch Duncan suffer via a closed-circuit TV monitor. The next morning, at 7.51 a.m., he draws his last breath. The medical community at Presby and around the world grapples with the ramifications of Duncan's diagnosis and death.

Most pressing is the issue of the 177 neighbors, family, friends, and medical workers who came into contact with him while he was contagious. All are asked to check their temperatures regularly and report any aches or coughing fits. It's at this time when Nina Pham, a young nurse at Presby who treated Duncan, realizes she has a fever. Nina Pham is 26 and has a reputation as one of the most meticulous nurses at Presbyterian. She is a child of Vietnamese refugees and studied at Texas Christian University. Only two weeks before Duncan wound up in her hospital, Fam earned her certification in critical care nursing. Fam takes her job and her health seriously. When she notices that her temperature is elevated, she immediately calls the Dallas County epidemiologists and

reports her condition. She remembers Duncan, remembers treating him. She takes her temperature again. 100.5. This is all the evidence she requires to realize she might be in trouble. She gets into her car and drives to Presby. 90 minutes after driving, she's placed in isolation. All signs point to Pham being infected and the epidemiologists are appalled. They have no idea how she may have been exposed to the virus. Pham will later describe the first days of care for Duncan as chaotic, but CDC officials insist that hospital staff was given information on Ebola. Three days after checking in, Pham officially tests positive for Ebola. Days later, 29-year-old Amber Joy Vinson returns to Dallas from Cleveland,

where she spent time with her family planning her upcoming wedding. Vinson is a co-worker of Pham's who's treated Duncan alongside her. One day, Vinson is delightedly trying out wedding dresses. But the next day, she has a temperature of 99.5. Vinson takes herself to the hospital and reports her symptoms. Blood tests are ordered. The next day, the results confirm that she too is infected with Ebola. Vincent's diagnosis prompts a spike of unease among federal personnel. With Vincent's help, they calculate that the young

nurse interacted with 150 people in Ohio and 87 people from her flights there and back. Multiple airline workers are placed on paid leave, and one of the planes she sat on is removed from service. News of both Pham and Vincent's conditions quickly goes public. Both women are separated from everyone they love as they undergo treatment. They now fear for their lives. Pham is especially concerned for Bentley, her cavalier king Charles Spaniel. He'll have to be tested too, and if he has Ebola, he'll have to be put down. Meanwhile, Pham and Vincent are transferred

to special biosecure medical facilities in Maryland and Atlanta, where they receive antibody-rich blood transfusions from Ebola survivors and 24-hour care. They are both fortunate that their illness was confirmed and treated early. The treatments are effective, and by the end of October 2014, both Pham and Vincent are Ebola-free, having recovered mere weeks after their initial diagnoses.

After three weeks of testing, even Bentley gets a clean bill of health to Pham's tremendous relief. Pham and tremendous relief. Pham and Vincent's success stories are a major victory in the war to fight the growing American fear over a potential Ebola epidemic. Many in the White House feel it's important Americans understand that those successfully treated for Ebola pose no further threat. To underscore the message, President Obama hosts Nina Pham in the Oval Office and embraces her for the

cameras. By the end of 2014, the outbreak still has yet to kill a single native-born American citizen. Even so, coverage of Ebola dominates the political conversation and headlines as well. It's a marked contrast from the Spanish flu crisis nearly 100 years earlier. Then, following the lead of the government, newspapers declined to report on the crisis, even as the death toll rose into the hundreds of thousands. Now, media coverage of the outbreak is fueling public fear. Polls indicate more than four in ten Americans have not much or no confidence in the federal government's ability to deal with the emergency. Government officials continue to urgently monitor all intelligence

related to the Ebola scare. The president authorizes the Pentagon to summon National Guard troops in the event they're needed to join the fight against the spread of the virus. Washington recognizes that Americans need to see a public face that will represent the government's efforts to keep its citizens safe. A person whose sole job will be to coordinate the American government's efforts to decisively overcome the menace of the epidemic, an Ebola czar. The president assesses several potential candidates before settling on Ron Klain. He's served as chief of staff to two vice presidents, and he has a reputation as a problem solver. The White House announces Klain's appointment on October 17th.

On October 23rd, Craig Spencer, a 33-year-old aid volunteer with Doctors Without Borders, is back home in New York, having recently returned from Africa. He wakes up in the morning with a fever. It doesn't take Spencer long to grasp the reason why. He dresses and checks into nearby Bellevue Hospital with a temperature of 100.3. He's placed in isolation and tested for Ebola. Bellevue notifies federal authorities, and when Spencer's results come in, the news is bad. He has contracted the virus. In the White House diplomatic room, Ron Klain meets with President Obama, Chief Homeland Security Advisor Lisa Monaco, and Chief of Staff Dennis McDonough to discuss options. In Klain's mind, there are only two.

First, Spencer must make a full recovery. Second, they better make sure the disease doesn't spread from him to anybody else. If not, the consequences could be catastrophic. Americans will believe an epidemic is truly underway, one with no cure, no hope, and no telling where the vicious disease may strike next. Craig Spencer is national news within hours of his diagnosis. An American who calls the country's largest and most iconic city home has Ebola. The anxiety in New York City is palpable. This is a city with millions of people in it, the majority of whom rely on public transportation to get around.

Many worry they can get Ebola from riding the subway or touching the wrong door handle. Ron Klain recognizes he's been confronted with a major test. Spencer must survive without spreading the disease to anyone else. If he dies or infects anyone else, the national panic might increase. His death could be a major setback to future Ebola treatment efforts, causing other hospitals throughout the country to resist accepting afflicted patients. Klain receives regular briefings on Spencer's progress in New York, but just a few miles from Bellevue Hospital, where Spencer is being treated, a new problem has landed, one that will put further strain on the American officials doing

their best to limit Ebola's damage. Officials across the country are confronted with a tough task. Where to draw the line and how to balance privacy with public safety amid an increasingly edgy public. That conflict soon comes to a head. Casey Hickox arrives at Newark's Liberty International Airport on Friday, October 24, 2014. It's been a very long flight from Sierra Leone, and she's utterly exhausted. Like Spencer, Hickox is a volunteer with Doctors Without Borders. She's worked in an Ebola treatment clinic where the toll of the disease was so severe, workers had long given up on counting the dead. The last thing Hickox did before boarding the plane back to the United States was stand

powerless as a 10-year-old girl perished just feet from where Hickox stood. The aid worker thought she was prepared for the carnage she would encounter in Sierra Leone, but she wasn't. She wonders when the numbness will wear off as she approaches the immigration officers after exiting the plane. When asked if she's returning from West Africa, Hickox responds with the truth. It takes her a moment to process what happens next. The immigration officer pulls her aside and tells her to follow him, and she does. They wind down corridors descending into the depths of the airport before arriving at a small, windowless screening room illuminated by painfully harsh fluorescent lights. Inside, there's a plain aluminum table and two chairs. Hickox instantly recognizes this as some

sort of interrogation facility. Before leaving, the immigration's official orders her to take a seat. Hickox is now worried, wondering what is about to happen to her. She waits alone in the interrogation room for what feels like an eternity. Finally, she is greeted by an unsmiling government official, who declines to introduce himself and instead begins questioning her. Miss Hickox, you say you recently returned from West Africa. Yes, can I... Where in West Africa?

Specifically, Sierra Leone. And I Can I wear in West Africa? Specifically, Sierra Leone. And I understand you were with Doctors Without Borders, working with Ebola patients. Yes. Well, then you obviously understand our concerns. Not really. I followed strict protocols to prevent infection, and I have no symptoms. I'd like to leave now, if that's okay. It is not okay. We're obligated to protect the health and safety of American citizens. It's very difficult to trust the word of someone who would go to an infected area and then casually attempt to re-enter the country. I'm sorry, what are you accusing me of? I did nothing wrong. We'll make that determination. You say you don't have Ebola.

What makes you so sure? I think I would know. Like I said... The door opens, and a second man walks in. He's carrying a thermometer. I need to check your temperature. Check my temperature? What, to see if I have a fever? You already know it's going to be elevated. I've been stuck in this room for hours. I can tell my cheeks are flushed because I'm frustrated.

That's going to throw off the reading. I don't see why it would. Now open up. The official places the thermometer in Hickok's mouth, turns to her interrogator and reports, 101 degrees. Hickok explodes. This is insane. I told you my temperature was going to be elevated. That reading has nothing to do with Ebola and you know it. The official with the thermometer only leaves. Hickox begins to realize she's in serious trouble. The remaining official tells her, you're not up to date with the latest news. The governors of New York and New Jersey have declared that any traveler arriving from West Africa who has had contact with an Ebola victim, as you have, is subject to a mandatory 21-day quarantine. You're allowed to remain in your home for the duration of the isolation period,

subject to daily check-ins with medical personnel. Hickok swallows hard. I live in Maine. Well, in that case, I suggest you make yourself comfortable, because you're going to be staying with us for some time. Hickok is eventually transported in an ambulance with a police escort to a hospital in New Jersey. There, she's quarantined in a heavily guarded isolation tent. The tent has a portable toilet, but no shower.

When Hickox asks how she's supposed to clean herself and maintain basic daily standards of hygiene, she is handed a sponge, a bucket, and nothing else. The tent staff draws her blood for testing. Hickok's blood is tested twice and comes back negative for Ebola twice, yet she is still not allowed to leave. Her detention makes headlines and sparks a national debate. Finally, about 80 hours after she stepped off the plane from Sierra Leone, Hickok's lawyer is finally able to step in and free his client. Hickok returns to Maine, where she is critical of the

ordeal she's been through and calls for science and compassion instead of fear. Compassion means responding to this outbreak instead of ignoring it, she writes in an op-ed for The Guardian. It means fighting our own irrational fears and learning more about Ebola and the people who are battling it. Finally free, she is relieved to know it's over at last. Also relieved is Craig Spencer. The staff of Bellevue Hospital triumphed, and Spencer has made a full recovery. Meanwhile in Dallas, thanks to the efforts of the CDC and local government, the disease is contained by November 2014. There are no further reported Ebola cases in America that year or the following year. Though quarantine procedures were properly applied, doctors recognize that they are no nearer to a cure. They continue their ongoing struggle to understand the virus.

The next year, encouraging signs emerged from West Africa. In December 2014, Guinea, Sierra Leone, and Liberia collectively report more than 3,000 new cases of the disease. But in 2015, that number begins to steadily fall. By April, only 1,120 new cases are reported. The containment strategies and the global mobilization of scientists, the military, and local West African citizens have done some good. The outbreak is at last beginning to die down, just as past outbreaks did. This time, though, more infected people have recovered than ever before. Official tallies count 17,000 West African survivors,

though the death toll has been enormous. Through the massive challenges of the response to the outbreak, health officials reflect on vital lessons. They find the most effective response came from staff who took into account local culture and community dynamics. Many NGO employees who visited remote villages recognized that they couldn't simply make speeches about the dangers of Ebola. They needed to build trust in the community first. So they spoke to village elders and won them over. The elders in turn told those who looked up to them to take Ebola seriously and seek treatment. Many did so, and lives were saved. Also, health workers who were from these communities themselves took a lead role interviewing patients,

caring for the sick, and navigating crucial family ties to determine how best to stem further infection. But back in the U.S., Wendy Chung is troubled. Disaster was averted this time. But what about next time? One day, another epidemic will come. Will the government be any better prepared than it was in 2014? She doesn't think so, and she wants the world to know that this is a very serious problem. In 2015, Chung participates in a panel to discuss how urban public health departments can defeat

infectious disease. She tells those in attendance that it's time to wake up. Her team didn't have enough resources when Ebola came to Texas. The information tracking system they used was out of date. Epidemiologists were called upon to handle logistical tasks they were never trained for. She tells the audience, we can't continue like this. The next war against disease will arrive. It's inevitable. To meet that threat, Dallas County Health and Human Services needs more personnel. At present, Chung says the county has only one epidemiologist per 300,000 residents. It needs one for every 100,000. Chung stresses that there are no shortcuts to the human investment in a public health response. You need to invest in your people, she says, and you need to invest in a particular type of people.

On her way out the door from the lecture, she can't help but wonder, will her government heed her warnings? Lives hang in the balance, and the clock is ticking. In 2015, President Obama invites key members from various health organizations involved in combating the virus to an event in Washington where they are thanked and given the opportunity to meet survivors. Craig Spencer, Amber Vinson, and Nina Pham are there. So is American Ebola survivor Kent Brantley, a 33-year-old missionary who beat the disease after contracting it in Liberia.

Pham owes her life in part to Brantley, for it was a blood transfusion from him that helped her overcome the disease. In a televised speech, Obama declares that when it comes to Ebola, the United States will pivot from containing the virus to eliminating it altogether. Our focus now is getting to zero, he says, because as long as there is even one case of Ebola that's active out there, risks still exist. Every case is an ember that, if not contained, can light a new fire. The war against Ebola continues. In 2018, another outbreak begins in the Democratic Republic of the Congo. 1,500 people are infected from mid-2018 to April 2019. In less than a year, 1,000 people die.

Healthcare professionals rush to respond, but the dangerous work is made even more risky by conditions on the ground. Many locations are already wracked by political violence. Into this chaos, health workers are often caught in the crossfire as they try to provide services to sick patients. Others are attacked intentionally by skeptical residents, gangs, and militias who see the workers as aligned with the country's leadership or foreign powers. In April 2019, a Cameroonian doctor working for the World Health Organization is killed in an attack by armed groups. As always, there is the ceaseless

search for a cure, but success has been limited. There is currently a vaccine created since the 2014 outbreak, but is in very low supply and experimental. The World Health Organization and the government of the Democratic Republic of the Congo have agreed to use it in emergency cases. Some policy and medical professionals continue to work around the clock to ensure the world is prepared should a massive outbreak spread to countries throughout Africa and beyond. But many warn of the persistent gaps that remain, gaps that make the ability to quickly respond to the next epidemic even more challenging. The outbreak in 2014 wasn't America's first brush with Ebola. In fact, the virus first landed on U.S. soil in 1989 in the suburbs of Washington, D.C. The story of how it got there and what happened next is the subject of The Hot Zone, a three-night limited series premiering on May 27th on National Geographic.

The series stars Golden Globe and Emmy Award-winning actor Juliana Margulies as Lieutenant Colonel Nancy Jacks, a real-life Army scientist who worked to identify the virus and contain it. We heard from Juliana on last week's episode about her experience making the show. Go back and listen if you haven't already. But today, we've got the real Nancy Jacks here to talk to us about her experience fighting Ebola back in 1989 and how prepared the U.S. is today. I hope you enjoy our conversation.

Colonel Nancy Jacks, thank you so much for speaking with us today. You're welcome. In this episode, we've heard what it was like for public health care workers and officials in the U.S. to deal with Ebola in 2014. But that was a fairly different experience than what you went through. What was it like to work on the front lines of Ebola in the 1980s? Well, it was a lot different. Actually, probably the reason I got primarily involved with the Reston and played such a central role is I had been doing Ebola research work for quite a few years, and I was very experienced with it. My husband and I are both Army veterinarians. We met in vet school. There was a military post.

He was a year ahead of me in school. And he worked at Fort Riley, which was adjoined Kansas State University. And then when I got out, I needed a job. So we joined the Army and the rest is kind of history. We have been stationed in a lot of really cool places and done a lot of really cool things. In this moment in 1989, when you're confronted with the virus, how much did we know about Ebola? Well, there wasn't much known about the disease in the late 70s, or we actually started working with it in the late 70s and early 80s. And there was almost nothing known about it other than its very high lethality rate. At that time, there were two strains of Ebola,

but the most deadly was Ebola Zaire. And that had nearly a 90% mortality rate in the early stages. The virus, we were at that time able to characterize it as a filovirus. There are only two viruses in that family. That's Marburg virus and Ebola. They're both very deadly pathogens for humans and non-human primates as well, or monkeys, and a lot of other species. It does not affect at all. It tend to break out in very explosive outbreaks, but it did respond to quarantine. And so at the time,

once it was under control and adequate quarantine was maintained, it gained a history for just going in and out of the forest. We searched for the reservoir and searched for the reservoir and searched for the reservoir, and we never really knew why we weren't able to find it. We didn't understand a lot of how the interaction with people eating bushmeat and how exposures and funereal rituals, how they spread the disease. We didn't know it was spread by bodily fluids. And it wasn't highly contagious when I say that.

It's not truly an airborne virus, but the droplets are very infectious. It has a very rapid rate of multiplication. And so that makes it a very lethal virus. It's very hard to get ahead of the game. Well, I'm interested in your career trajectory. I don't think many people who study veterinary science then aspire to join the military and study lethal diseases. Well, I would agree with that. I, you know, everybody said, why did you want to be a veterinarian or how you get,

how did you get interested? My husband and I both grew up in rural communities, but I don't ever remember wanting to be anything else. And for the standard reason, you love animals, you love horses, you love dogs. I never wanted to be anything else. And my trajectory was very linear until I got through vet school. And at that time, Jerry and I, the Army was always really good to us. We were stationed together.

And I really enjoyed internal medicine. I did a lot of guard dog work. And there's a stage in the Army where they want you to get advanced education. And I was lucky enough, Jerry and I both actually, when we were doing guard dog work in Europe, we reported the first case of coronavirus that had ever been documented. And I found myself really, what my true love was at that time, which was figuring out how these things work in the body. Once you make the diagnosis, that's a big deal, but you want to learn the pathogenesis of it.

So we had an opportunity to go to residency programs at USAMRID, and Jerry went into the laboratory animal preceptorship, and I went into the veterinary pathology preceptorship. At that time, I was the only woman. I was the first woman formally admitted to the program. And then I just became fascinated with Ebola. Nobody knew anything about it. And it was just an amazing thing to see how lethal it was and how predictable it was. And it was so difficult to develop. We had a lot of treatments that we had used for other viruses, and they just didn't work. So that was kind of how the trajectory was. I laugh, and we talk to a lot of vet school students, and they say, well,

when did you decide to be a pathologist? And I went, you know, I'd already been a vet for quite a long time. I never really decided until we got to USAMRID. And that's how it started. Well, you came face to face with Ebola in 1989. That's the subject of this new series, The Hot Zone on National Geographic. Can you tell me, did you feel the U.S. was prepared to deal with a potential outbreak then? We did not. I mean, it was, if you want to know what the most terrifying thing about it was, we were not set up to deal with, and at the time, and I'm sure you know, when we first, the only Ebola we were aware of or that we knew of was Ebola Zaire, and then there was another strain that was not quite as lethal, but still very, very lethal. So, as far as we knew, we were dealing, we thought originally it might be

Marburg or Ebola, but they're close enough that it is an alarming event. And it became pretty clear that we were not really well-equipped to deal with an outbreak that would involve many people. What were your first thoughts in those moments in 1989 when it finally dawned on you that this was Ebola and that it was on American soil? I think the first thing that goes through your, and I know what went through mine, I went, it's a mistake, run it again. It can't be because it didn't fit. You kind of go into what I call brain lock. These monkeys had been imported from Asia. It had never been reported. A natural outbreak of Ebola had never been reported in any kind of a primate. It only existed, I mean, other than humans.

It only existed as far as we knew in Africa, not in Asia. And the pieces just didn't fit. And I kind of tell people, you go into kind of diagnostic brain lock because your eyes are telling you it absolutely has to do that. And your brain is trying to wrap around, how did it get here? What are we going to do? You know, how did it happen? And so initially, I mean, we did rerun the diagnostics multiple times. And there was just no question. We were running Marburg as a control.

That would have been the most likely filovirus because that had been associated with an outbreak in imported monkeys in Marburg, Germany. And that had been transmitted to the staff and was very lethal at the time. And that actually is the reason for quarantines for monkeys being imported in the United States for research or other reasons. There was a 30-day quarantine and it was based on that outbreak. But Ebola had never been reported in that kind of a situation. So maybe the nation was not prepared. But what about you? Did you feel you were prepared personally, professionally to be in the room with the virus? Well, I'd been in the room personally with the virus for a lot of times. So yes, I was prepared. I think the amazing thing about this whole story is at that time, there weren't that

many people who had actually done a lot of work with it. So the group that really handled the outbreak was my husband's group, the laboratory animal group. It was all volunteers, and many of those had never even had a suit on. We had some very experienced animal caretakers. We had a really three to four really experienced PIs, and it didn't go a lot deeper than that. Well, now, 30 years later, after two instances of Ebola hitting our shores, are we as a country and a global community better prepared to prevent and fight future outbreaks? Well, we certainly have more tools at our disposal, but I think you can look back at what happened in Dallas, and you have to ask yourself, you know, the thing about it is when you get into a true health emergency, you're talking quarantine of large numbers of people.

And when you deal with these diseases, every patient is different. It requires, because it's a foreign disease and it's on our soil, it requires very intense procedures that you're simply not used to doing. And you can only deal with a pretty small number of patients. So a mass casualty event is pretty scary. And I think it didn't surprise anybody that it could happen. I mean, we all know that as travel has expanded, as people are moving from one continent to another, we just have a lot more mobile society. We've also made inroads into a lot of places we haven't been before. And that's what happens. And

then just viruses alone, we pop up with a new pretty deadly one about every 10 years. Is that one of your largest fears, a new virus? Well, you're always worried about a new one because you don't know anything about it generally. And so you have to work through a group of assumptions. I think the other one would be that it's a known virus that we maybe thought would have been exterminated, but we now know a lot about, but we have a pretty naive

population immunologically. People aren't vaccinated for a lot of diseases that they used to be. Smallpox was really a classic example. They eradicated smallpox, and that was a great victory, but smallpox is not a zoonotic disease. And zoonotic disease is a disease that's maintained in another population other than human and then infects humans. So there are a lot of those that are pretty scary and pretty contagious. And finally, not too many of us get to see our lives reenacted on television. What was it like? Well, it's interesting.

I mean, primarily because this happened 25 years ago. So you're transporting yourself back to an event, and you're a lot older. I think that the thing that we are most, and I say we because Jerry and I have worked very closely together for many, many years. And I think the thing that we felt the proudest of and the thing them who say the book, The Hot Zone, actually was responsible for defining the kind of work that they are now doing, whether that's tropical disease, infectious disease, microbiology. They were inspired by that book, and they read it at a very young age. And I think it was an amazing story. And that's the thing that happened that we felt was the biggest positive thing that came out of that. Well, Colonel Nancy Jaxx, thank you so much for taking the time to speak with me today.

You're welcome. That was my conversation with Colonel Nancy Jaxx. Her story is the subject of a new three-night limited series on National Geographic called The Hot Zone. It premieres on May 27th at 9, 8 central. From Wondery, this is American History Tellers. I hope you enjoyed this episode brought to you by National Geographic. If you did, subscribe now on Apple Podcasts, Spotify, Google Podcasts, Wondery.com, or wherever you're listening to this right now. If you're listening on a smartphone, tap or swipe over the cover art of this podcast.

You'll find the episode notes, including some details you may have missed. And if you like this show, one of the best ways to show your appreciation is to give us a five-star rating and leave a review. I always love to know your thoughts, and reviews are the best ways for others to find the show. Tell your friends and family,

and show them how to subscribe. You can also find us and me on Twitter and Facebook. Follow the show at A.H. Tellers, and I'm at Lindsey A. Graham. And thank you. If you'd like to learn more about Ebola, we can recommend a great book we drew on for this episode, Epidemic by Reed Wilson. American History Tellers is hosted, edited, and produced by me, Lindsey Graham, for Airship. Sound design by Derek Behrens.

This episode is written by Hannibal Diaz. Edited by Dorian Marina. Edited and produced by Jenny Lauer Beckman. Our executive producer is Marshall Louis. Created by Hernán López for Wondery. And now, the audio trailer of The Hot Zone from National Geographic. This is one of the deadliest places on Earth. From National Geographic.

Every known virus is here. Comes a terrifying story. What are we testing for? Ebola Zaire. Inspired by true events. It's learning. This Memorial Day. It's evolved.

When Ebola landed on U.S. soil. It will wipe us out if we don't get ahead of it. They risked everything to contain it. It's evolved. When Ebola landed on U.S. soil. It will wipe us out if we don't get ahead of it. They risked everything to contain it. It's here. You brought it back here? Julianna Margulies stars in The Hot Zone. May 27th at 9 on National Geographic.