Hidden Brain - Episode 54: Panic in the Streets

Episode Date: December 6, 2016

It sounds like the plot of a movie: police discover the body of a young man who's been murdered. The body tests positive for a deadly infectious disease. Authorities trace the killing to a gang. They race to find gang members linked to the murder... who may also be incubating the virus. This week on Hidden Brain... disease, panic, and how a public health team used psychology to confront an epidemic.

This is Hidden Brain, I'm Shankar Vidantam. In 1950, before he directed the film on the waterfront, Elia Kazan made another dramatic thriller, a movie called Panic in the Streets. There's a reason you probably haven't heard of it. It is in a great movie. Here with recorded is the story of a silent savage menace, the events, incidents and emotions of the people who are apart of it. It is in a great movie. Here with recorded is the story of a silent savage menace, the events, incidents and emotions of the people who were apart of it, who found time running out as they looked into the face

of mortal peril. The film tells the fictional story of a murder in New Orleans. When the police investigate, they find the victim suffered from a deadly infectious disease, a version of the plague. Public health officials believe the killers may have contracted the disease as they carried the victim's body away. What follows is a race to track down the criminals and halt an epidemic, a collision of law enforcement and public health. If the killer is incubating humanic plague, he can start spreading it within 48 hours. 48 hours? Yes, we have 48 hours. law enforcement and public health.

Today on the show, we have a story where life imitates art. It's a story about disease and panic, but it's also a story about psychology. To control an epidemic takes more than medical skill. It requires an understanding of human behavior and the forces that drive people to act in certain ways. Our story starts in Munrovia, the capital of Liberia. A deadly crisis was sparking fear, news reports were filled with dramatic language and catastrophic warnings. The Ebola virus is back to its end.

Ebola breakout in West Africa is, quote, totally out of control. A catastrophe is unfolding. The world's deadliest outbreak of Ebola. Highly infectious, quick to kill with no vaccine and no cure. The Ebola outbreak reached its peak in the fall of 2014. By the end of the year, it was subsiding. But then, in early 2015, in a poor part of Mondrovia, there was a new outbreak or cluster.

And it led to the complex case we're focusing on today. I got a call from someone who said, if your passport isn't in my office in the next two hours, you won't make your flight to Liberia. Ethelia Christie is an epidemiologist with a Centers for Disease Control and Prevention or CDC. She flew to Mondrovia to help track and stop the outbreak. Lots of CDC officials joined her, like Frank Mahoney.

People were scared. It was a crisis. You could drive through the city and see people that were being left out on the street, you know, for people to come pick them up. Frank and Athelia told me how the case we're following today started. Police in Mondrovia discovered a body in a warehouse. A young man dead with multiple staplons. Police were called in. A swab was taken as mandated by the official policy that any dead body be swabbed.

So even though the police who arrived there initially thought they were investigating a murder, they did follow the procedures and have the body swabbed, at which point we were alerted because the test came back positive. Positive for Ebola. Once police identified the youth, they quickly realized they had a major problem on their hands.

It turned out the young man was actually part of a large street gang. Yeah, it was like a gang. One of them, for whatever reason, he got stabbed by other members of the group. As we understand it, there was a knife fight, and we're not quite sure how it happened, but the friends turned on him. Just a review. A young man contracts Ebola, he gets in a fight, and it stabbed repeatedly by fellow members of his gang.

Ebola remember is highly contagious, come into contact with an infected person's sweat or blood and you could fall sick too. The gang had as many as 35 members, each had connections far and wide across the city. And just like in that movie, Panic in the Streets, public health officials needed to quickly stop the outbreak from spreading. They needed to try and find every person who could have come into contact with the young man.

It's a process called contact tracing. It's exceedingly difficult to do if If you tried to imagine constructing the last three weeks of your life and determining every single person that you came into contact with, whether it was casual contact or a family member who you saw every day, it's extraordinarily difficult to do. So we interview people multiple times. And we also talk to their family members and their friends

to try to determine everyone who might have had any contact with this person during the time that they could have been infectious. Ethelian Frank knew the young man who died had sought medical treatment for his tab wounds. Had a healthcare worker suture the young man's wounds and come into contact with his blood? Ethelia visited a lot of clinics trying to track down facilities the young man may have visited. She paged through logbooks of patient names with no luck. Then she got to one clinic. And I took this big dusty logbook and I opened it up and literally the page I opened it

to, there's maybe 30 names to a page and I read down them and there he was at the bottom of the first page. A healthcare worker at this clinic had sutured the young man's knife wounds. Ethelia knew what she had to do. The most difficult part of these investigations come when you need to tell the clinicians and all of the staff who work in these healthcare facilities that someone with Ebola entered the facility. And I remember how nervous the individual was when I told him that the person he,

he sutured had been positive for Ebola at the time. It's hard to imagine what he was going through. Can you recall what you told him and what he said? We were standing in the hallway and I told him that there's no easy way to tell anybody this. So we just told him very matter of fact that we needed to maintain daily contact and monitoring with him coming in for treatment the moment that you have symptoms and the reason I remember this so clearly is that he didn't

do that. He was very reluctant to go to an Ebola treatment unit. The health care worker refused to be quarantined. He insisted he'd followed all safety procedures as he bandaged the young man's wounds. He told a Thalia he'd followed all safety procedures as he bandaged the young man's wounds. He told the Thalia he'd get in touch if he started to have any symptoms. Ethelia knew there was a reason the healthcare worker had refused to come into an Ebola treatment unit. It had to do with a lack of trust in the system. In fact, the more Ethelia and Frank saw, the more they realized that Ebola wasn't

the only enemy they were fighting in Mondrovia. They were dealing with an epidemic of mistrust. After a long history of civil war and corruption, a lot of people in Liberia simply didn't trust the government or international organizations. When Ebola broke out, the government's first response was to try and control it using coercion. Coordining off sections of towns, it created panic. The government had attempted involuntary quarantine and they had a really bad experience in the slums of Manrovia. And so we talked about, you know,

is this a viable strategy? We all agree, no, we can't use involuntary quarantine. This is not something that's going to build trust in the community. It's not a way to manage the outbreak. People also worry that if they did go into quarantine, they would never come out. Ethelia pointed to the construction of one of the largest Ebola treatment units in Liberia. And it was chaotic and difficult, and they built it all, and they forgot to put an accident.

They didn't build an exit because we weren't thinking about survivors at that time. And although this was many months later, many people understandably so thought that going to an Ebola treatment unit meant that you would not come home. Dealing with mistrust, the public health officials knew was central as they began to trace all the leads of this complex case. As a failure had been tracking down the healthcare worker, Frank had been pursuing a different strand of the investigation, tracking down the members of the young man's gang. This was a community that was not on the best terms with the government. You know, they were very suspicious of the government.

So it really is a trust building exercise to go into this community to piece together all these pieces of the story. Very quickly, Frank and Ethelia realized they were in over their heads. They needed help. So when we did the investigation, I went with this librarian. Fantastic librarian epidemiologist. Moussoka Fala. I'm Mussoka P. Fala. As a librarian, Mussoka Fala understood things far better than the Americans. He also understood the horrors of Ebola, first hand. The disease had killed his sister. Mussoka's first order of business was to help track down the young men in the gang. Surprisingly, they weren't hard to find, but they were scared. Scared that the police, who were still investigating

the case as a homicide, would arrest them for their role in the knife fight. The police wanted to go in. However, if we allow the close to 35 young men who are all hard-wrapped on the loose. This is similar to what happened in panic in the streets. Wait a minute, wait a minute, wait for what? Somebody else to die? Friends suggested that there should be no arrests. Musoka says Frank sat down with the police. He told them that any investigation of the murder would send gang members into hiding

and potentially spread Ebola further. This will allow the Ebola team to go in and negotiate so that we can have the contact and the police agreed and the police will view their arrest. And that's how we went into negotiate. And this, everyone told us, is what allowed public health officials to start talking to the young men in the gang. So, to recap, public health officials had tracked down the health care worker who treated the young man and identified all the people they could tell the young man had come into contact with.

The epidemiologists quickly found themselves staring at a growing web. There were three important strands. First, the young men in the gang would have to be persuaded to enter an Ebola quarantine facility for 21 days. Second, there was a woman running a drug house who was connected to the gang. Gang members were in and out of her home all the time. Most worris him, the public health officials heard the woman was sick, and they thought that she might have Ebola. She had a hard day, we are for two days, and she was getting sick. Finally, there was one member of the gang they could not track down.

During the fight, this man had held down the stabbing victim as the blades came out and the blood splattered and Now fracking others found he'd run away. Oh, what was his name? His name ironically was time bomb Coming up how to stop the outbreak and find time bomb. Stay with us. This is Hidden Brain, I'm Shankar Vedanthan. We're exploring how, in early 2015, epidemiologists tried to stop Ebola from spreading in a poor slum in Liberia. They had three fires to put out. Time bomb had gone underground. The rest of the

gang had been identified, but were reluctant to be quarantined. And then there was the woman known as drug mama. She was the godmother of a drug den frequented by members of the gang. She was in her 30s and appeared to have symptoms that suggested Ebola. If Ebola struck the heart of the drug. She was in her 30s and appeared to have symptoms that suggested Ebola. If Ebola struck the heart of the drug den, it would spread very quickly through the community. Frank and Musoka realized they had to quickly run a test to get drug mama diagnosed, but they anticipated problems. Our dilemma was how do we approach such that she accepts us to do an Ebola test.

The mere mention of Ebola was sending people into a panic. If they told her they were worried she had Ebola, would she vanish and go underground? They didn't want to take the chance. So rather than take her into confidence, they decided to trick drug mama. It wasn't ideal, but they were dealing with the crisis. They had to improvise. So Frank being a smart guy he is, we stopped at a pharmacy and we bought him a mirror medicine.

And we went there at night and Frank said, ah, you're not so well. So we brought you some medicine. This is around 9 p.m. She said, yes. So Frank said, take this medicine. I will come back tomorrow and check on you. And so the goal was the next morning, we asked for her blood to go check if she had my liver and then we'll run the Ebola test.

The trick worked up to a point. The problem was the next morning, when they took drug mama to the hospital to get her blood drawn, they had to tell healthcare workers at the hospital what was going on so everyone would take proper precautions. A nurse got scared when they told her they wanted to test for Ebola. Drug Mama noticed the nurse acting oddly. And then she suspected something else. The drug Mama left and went back home and began angry with us.

Musoka and Frank realized the trickery was backfiring. So they tried bribery. We sat down with her, we negotiated, and we told her we gave her $100 US. If she allowed us to do a blood draw at a house. So we took the blood, and at 7 p.m. that night, we got a response that she was negative. And we all went to bed reading a side of a release.

Frank and Musoka turned their focus to the second strand in the web, the young men in the gang. Patiently, they explained to the young men that they would be safe from police harassment in the Ebola treatment unit. We worked it out with them. We worked out an arrangement where they, if they agreed to come into the isolation facility, you know, the CDC, I think we ended up paying their families some support costs because they were no longer able to earn money for their families. And the government provided the families with food. And so it worked out really well. But even this was not enough.

It turned out some of the young men were drug addicts. Frank realized he had to keep asking the government to bend the rules in the Ebola treatment unit or E.T.U. I told the government that we had to anticipate that some of these young men may be drug users and they may go into withdrawal if we put them in the E2U. And in fact, that was the case, about two to three days later. They were some of them getting agitated.

And somehow they found a way to support their needs or drugs. Did you have to do some of that to help them get what they needed to keep them in this facility where they could be quarantine? No, I didn't wouldn't see the seat and pay for that or do that But the government found a way for the communities for them So they were doing that so in but in some ways it's sort of an awkward situation for the government because in some ways You're asking the government to sort of look the other way while someone's doing something illegal here Yeah, I think that they, but at the same time they'd be like any withdrawal, they need a treatment. It wasn't a conventional treatment, that's for sure.

It was art for public health officials to be sanctioning illegal drug use. But again, when you're in the middle of an unfolding catastrophe, you sometimes have to bend the rules. Even though CDC wasn't actually supplying anyone drugs, the arrangement produced lots of double takes. One day, a Liberian government minister turned to frang during a discussion and joked about the backdoor drug channel. And he says, and I understand that CDC is providing them with the marijuana. And I said, excuse me, sir, I said, I'd like to correct that. He said, CDC is not providing the marijuana,

but we're providing the copain. Incredibly, the epidemiologist actually managed to quarantine the gang members. These were young men who no one thought would listen to the authorities. But by reposing trust in them and treating the young men as partners, the public health officials had found a solution that seemed to work better than coercion or trickery. Still, this wasn't the end. There was a third strand of the web they had to track down. Time bomb. Time bomb became very elusive. We could not find time bomb. At first, gang members did not

want to tell Musoka of Frank where time bomb was. But as we built friendship and rapport with the other criminals, one of them took us to his house. There, they found a young man, a young woman, and a baby. The epidemiologist asked the young man if he was time bomb. He said, I'm not time bomb. Time bomb is going out. I'm his younger brother. But if he comes back, I will let you know. Then I say, OK, thank you very much.

It was at this point that Musoko and Frank did something very kind and very wise that led to a breakthrough in the case. Your wife had a young baby and I remember giving them a wife at $100 and said, go ahead and buy milk for the baby, feed the baby and we'll take care of you. Something changed in the young man's demeanor. After I did that, he turned to me and said to me, I am Tom Boom. Frank and Musoka told Time-Bomb and his wife

that they would be back that night. They promised they would return with more food. Frank came to me with the food and said, Musoka, we need to go to meet this guy. This was in a ghetto. I went with Musoka and it was like 10 o'clock at night. There was no electricity. This place was pitch black. We had to go and drive to the grass. This was like a slump community. It's known to have gangsters and that's why the friend was emphasizing

that we had to keep our word. We had to trust us. This was the key. So we brought food to him and his family. I think a couple of sex to rise in things. As we walked towards them and the saw us come to a rise on our pseudo, for some reason it trusted us. And it came to the car and helped us take the rise. Frank and Musoka gently asked time bomb, whether he was willing to come to the Ebola treatment facility

to be quarantined. Timebomb said he wasn't ready to do that. Frank and Masoka said they understood that they were willing to trust him to do the right thing. If you get sick, you call us and he said I will do that. I trust you guys. And so I think it was a matter of building a trust and comfort level for him to talk to us. In the end, none of the young gang members contracted Ebola, not even time bomb. The cluster did not spread in the ghetto.

Drug Mama recovered from her illness. Only one person connected with the cluster was affected. The medical worker who'd sutured up the young man's wounds, the one that went into hiding after a thalia talked to him, he came down with Ebola-related symptoms. Eventually, he did seek treatment, but it was too late. He died, unfortunately, in the Streets. At the end of that movie, the hero, a public health worker, ends up in a warehouse with the criminals who are carrying the deadly plague.

He pleads for them to hand over their guns. Come off now, surrender! And I promise nothing will happen to you! But... They get into a climactic shootout and the criminals are killed. The public health workers in Liberia never solved things with guns. And really, when it came down to it, Ethelia says, they achieved some of their best results without coercion or trickery. Building those invisible but very real bonds of trust took time, but it was essential

to stopping an outbreak. When it comes down to what we were asking people to do, either to trust the healthcare system or to trust, the government enough to agree to this voluntary precautionary isolation. That's an extraordinarily difficult thing to do. You're asking people to leave their friends and family for 21 days, or we were asking people to change their burial customs. And it's difficult. It can sound simple, and I know that I spoke to people here who would say,

I don't understand why can't they just change the way they bury the dead, or change the way they care for their family members if they're sick, but as a mother, I can't imagine not touching my child if he was sick and not trying to provide comfort. So it's really understanding what it is that's that's driving people. You have to understand their context, their concerns, and their needs. I think it's about interpersonal relationships. You have to be honest and straightforward about what you need and why. And most importantly, I think you need to be human. This episode of Hidden Brain was produced by Chris Benderev and edited by Tara Boyle and Jenny Schmidt.

Our staff includes Maggie Pennman and Renee Clarre. We had original music from Rampteen Arab Louis. To find more Hidden Brain, go to Facebook and Twitter and listen from my stories on your local public radio station. Our unsung hero this week doesn't work at NPR. He's Tom Frieden, director of the Centers for Disease Control and Prevention. He got in touch some time ago to say he loved the show, but wanted to know why we weren't doing more stories about public health.

I told him those stories tended to be a little dry. He said, wait a minute, I've got a great one for you. Tom, you were right. This was a great story. If you have an idea for a Hidden Brain episode, a topic with interesting ideas and great characters, drop us a line that HiddenBrain at npr.org. I'm Shankar Vedantam, and this is NPR. Thank you.