OUTBREAK

>> NARRATOR: Tonight... From the jungles of West Africa to the cities.

>> Dead bodies-- 15, 16, 17, 18.

>> NARRATOR: The inside story of how the Ebola virus spread.

>> It's pure craziness, like watching a zombie movie.

>> NARRATOR: And the global failure to stop it.

>> The world has never faced anything like this.

We've never prepared for it.

>> Ebola was not an exception.

Ebola is a precedent.

>> NARRATOR: Tonight on Frontline, "Outbreak."

>> I got a call saying that there is a walker on his way down to market.

I could hear and see the crowd of people screaming and shouting.

I can see that he's afraid.

I see he has picked up a rock and he's waving it around.

He's followed by a lot of people, telling us, "You have to take him down.

"He is infecting our community.

We don't know where he's going."

(shouting continues) The pressure from the crowd is mounting.

They're yelling at us.

So the guys in the suits wrestle him to the ground and lift him into the back of the pickup.

It was like watching a zombie movie or something.

It's just crazy, it's pure craziness.

Where am I?

How did I end up here?

Was this just a bad dream?

But no, it wasn't.

It was for real.

>> NARRATOR: In December 2013, the children of Meliandou village discovered hundreds of bats nesting in a hollow tree.

They had no idea that bats are suspected of carrying a deadly virus.

Nobody knows for sure but the villagers now think that this is where it all began.

(thunder rumbling) >> NARRATOR: Nobody knew what had killed one-year-old Emile Oumanou.

His sister died nine days later.

Then his mother fell ill. She was seven months pregnant.

>> NARRATOR: A traditional healer gathered everyone together, including more family members who had become sick.

A villager filmed the ceremony on his cell phone.

>> NARRATOR: The next victim, Emile's grandmother, left the village to seek treatment.

She infected a nurse at a local hospital.

The sickness began to spread across the Forest Region of Guinea, but for three months was mistaken for cholera and malaria.

By March, the virus had traveled hundreds of miles and killed more than 50 people.

The government sent a team of scientists to investigate and take blood samples.

>> NARRATOR: The doctor tracked down a teenager named Khalil, who was sick with the mystery disease.

His colleague started filming on an iPad.

(moaning) >> NARRATOR: Khalil's blood would later be tested.

The results: Ebola.

>> NARRATOR: The government of Guinea had no idea how to respond.

All previous Ebola outbreaks had occurred over 1,000 miles away.

But the relief group Doctors Without Borders had decades of experience with Ebola.

Within 48 hours, they set up a field hospital in the town of Guéckédou, the epicenter of the outbreak.

The first patients began to arrive.

>> Most of those cases came from different villages or different areas in the city of Guéckédou.

That's a very bad sign, because it means that you don't have just one cluster or one family or one village that is hit.

It means that it's already spread out.

>> NARRATOR: Past outbreaks had shown that the key to stopping Ebola was to isolate the sick, monitor anyone who had contact with the infected, and safely bury the dead.

This complex operation needed a level of manpower and coordination beyond the resources of Doctors Without Borders.

>> I remember my headquarters asked me, "What do you think?

"Is it five villages, or ten villages, or 15 villages, or more?"

And I remember I said, "If I have to choose between those three options, I do believe it's 15 or more."

And I said, like, "I think we have a big problem."

>> NARRATOR: The World Health Organization, WHO, is part of the United Nations and has a mandate to help governments coordinate their response to outbreaks.

>> We thought, "Okay, here is a disease that we have dealt with for a number of decades before," and you know, in our own mind, we had the idea that Ebola was something which was severe, but typically occurred in a certain way and then could be handled.

But at that time, we didn't really know how complex it was going to become.

>> NARRATOR: The WHO left the response in the hands of its officials in Guinea, who had no experience of Ebola.

They set up what would become daily meetings with the government of Guinea, Doctors Without Borders, and other aid organizations.

>> Those daily meetings were a nightmare every day, day after day.

Disorganized meetings, no decision taken, no one knowing what they were talking about.

The WHO people were really not at the level required for the job.

Their coordinator never worked on Ebola before, and WHO was really downsizing the scale of the epidemic.

Immediately, I thought, "Those people are useless.

They don't even understand what they are supposed to do here."

>> WHO, although it's a very important technical agency, our powers are limited when we are operating in countries.

The countries take the lead, we advise honestly, and this is what we tried to do in Guinea.

>> NARRATOR: The outbreak quickly spread 400 miles to Guinea's capital, Conakry.

Doctors Without Borders' top Ebola expert spoke out.

>> NARRATOR: The government of Guinea accused the group of sowing panic.

>> NARRATOR: The Ministry of Health now ordered its teams in the field to include only laboratory-confirmed cases of Ebola in their death count.

>> NARRATOR: The Ministry of Health teams now stopped investigating deaths that weren't confirmed Ebola cases.

Some of those deaths were in villages right on the international border between Guinea and Sierra Leone.

Locals cross freely between the countries every day.

Louise Kamano lived in Sierra Leone, but in March, she came to stay with relatives in Guinea.

Her mother had Ebola and had already crossed the border twice since she got infected.

>> NARRATOR: When Louise fell sick too, she was frightened by rumors that foreign doctors were killing people.

>> NARRATOR: Louise walked through the bush until she reached a river: the border with Sierra Leone.

There were no checkpoints, no immigration police.

>> NARRATOR: Like her mother before her, Louise had crossed the border carrying the sickness with her.

No one knew it yet, but Ebola was spreading in Sierra Leone.

A few days after her journey, the WHO got a tip-off that Louise was sick and had crossed into Sierra Leone.

Louise's name and location were logged in an internal report and passed on to the Sierra Leone government.

>> We did bring Louise to the attention of the Sierra Leone government, and they came back and told us that Louise had gone back to Guinea and that she was not in Sierra Leone.

That was the last that we heard of this particular case.

>> NARRATOR: The Sierra Leone government says it was never informed about Louise.

What's certain is that Ebola was soon spreading through her home village.

One of those to fall sick was a renowned traditional healer known as Mendinor.

>> NARRATOR: On April 8, Mendinor died, and her body was prepared for burial.

The corpse of an Ebola victim is highly infectious, but in West Africa, it's customary for villagers to spend hours washing and preparing the body for the funeral.

>> NARRATOR: These traditional burial practices played a major role in the spread of the virus.

Mourners often touch the body at the funeral itself.

>> NARRATOR: The healer's funeral was a catastrophe.

It set off a chain reaction of infections that would lead to thousands of deaths.

The outbreak was already raging in Guinea, and now it began to spread unchecked through the villages of Sierra Leone, wiping out entire families.

The healer's niece even took the virus 250 miles to Monrovia, the capital of Liberia.

Nobody yet knew it, but the outbreak was completely out of control.

For more than a month, the government of Sierra Leone missed the deaths in its border villages.

Doctors without Borders says it tried to get the government to pay attention.

But Sierra Leone had turned for advice to an American company called Metabiota, who had a long-standing presence in the country researching tropical diseases.

Metabiota had no experience in controlling Ebola outbreaks.

>> I said, "This outbreak will not last more than a few weeks."

And that was after we identified the first week.

The first two weeks, we said, "Okay, that's a normal outbreak.

We are confident it will be over in two months."

>> We were getting advice from Metabiota, and complacency set in.

What can I say?

Yes, it was Ebola, but the magnitude had not hit us.

So we took steps at that time that were advised by Metabiota, but we never knew that it was going to be so big.

>> NARRATOR: The government decided to treat Ebola victims at the state hospital in the town of Kenema, which already had a ward for Lassa Fever, a disease similar to Ebola but less infectious.

But within days, the hospital was overrun with patients.

Then the nurses started to die.

(crying) >> If you go to the morgue, you see dead bodies, 15, 16, 17, 18 dead bodies all in body bags.

Then I start to wonder, "What is happening?"

Maybe this is the end of the world.

Maybe everybody's going to die.

>> NARRATOR: Far from containing the outbreak, the hospital was helping to spread it.

Will Pooley, a British nurse, volunteered to work on the Ebola ward.

>> When a patient arrived, they'd walk in past these corpses that would be piling up across the path and sometimes next to the path.

They were smelling quite bad until the burial team came, and it might take days.

I was constantly gobsmacked that this wasn't a bigger deal.

Like, people weren't... You know, this wasn't being shouted out.

>> NARRATOR: The government called in Doctors Without Borders.

The plan was to build a dedicated Ebola clinic in the neighboring district.

The group says that the government and their advisors, Metabiota, were still underestimating the scale of the problem.

>> Do you think Metabiota was the right organization to be doing outbreak response?

>> No, we're not specialists in outbreak response.

We know how to do it because we have some kind of expertise in the domain, but we are too small, I mean, we are a very small company.

>> NARRATOR: The government and Metabiota had no system in place to monitor people who had been in contact with Ebola victims.

This lack of contact tracing meant that hundreds of cases went undetected.

>> And a month is a disaster.

>> A disaster, yes.

We wasted time.

>> It was wrong, yeah.

>> NARRATOR: The outbreak had now spread to three countries: Guinea, Sierra Leone, and Liberia, some of the poorest nations in the world.

Four neighboring countries risked infection at any moment.

The WHO was considering declaring an international health emergency, which would have acted as a global distress signal.

But officials were concerned about causing panic.

>> At that time, I think all of us thought, "Wait a minute.

"Let's be cautious, let's see how it evolves.

"We are deploying people in the field, we think we are making headways."

With hindsight, if I went back to June 2014, I would probably be saying something entirely different.

I'd probably be standing up and calling my Director General and saying, "Please do it."

>> NARRATOR: The WHO opened a new coordination center in Guinea to try to improve the response across West Africa.

>> There was absolutely no change at field level.

Still the very same few organizations on the ground doing the work.

No additional people coming to support.

More people at coordination level, more useless people, more meetings to be organized.

But on the ground, on the field, impact: zero.

>> NARRATOR: Kenema Hospital in Sierra Leone was now overwhelmed.

The WHO had sent two doctors to help with the caseload.

But the patients kept coming, and the nurses kept getting infected.

>> I think you'd have to be crazy to think that anything but shutting that place down would be the thing to do.

And everyone knew that's what needed to happen, and that should have happened months before that, and had that have happened, there's a whole cohort of nurses, lab techs, and cleaners that wouldn't have died.

So many lives would have been saved.

(crowd shouting) >> NARRATOR: There were now so many deaths at the hospital that wild rumors started to spread through the town.

>> This crazy woman came out and stood right at the center of the town in the marketplace and started shouting, "There is no Ebola!"

>> This woman was shouting, "I am a nurse!

"I am telling you people that we are just doing cannibalism.

"We are the ones that are killing people.

We are removing their parts."

>> And everybody in the marketplace, they go haywire, running, "Oh, there is no Ebola!

"A nurse is confessing that there is no Ebola.

Come and see the nurse, come and see, a nurse is confessing."

Now everybody started throwing stones at us.

They said, "We are going to the hospital, we are going to burn the Kenema Government Hospital down."

>> I was walking up to the unit, and there was this stream of nurses and lab techs walking at a very hurried pace past me in the other direction.

And I could hear this mob, an angry mob.

It's a really unique sound.

And the WHO, they all evacuated, so they got into their cars and drove off, leaving just a handful of people probably inside the whole hospital really, when there was a risk of the hospital being overrun.

>> NARRATOR: The police used tear gas to disperse the crowd.

The streets went quiet, for now.

But Sierra Leone was on the brink of chaos.

The outbreak had now killed more than 800 people in three countries.

As the death count rose, Doctors Without Borders had been urging the WHO to declare an international emergency.

>> I said that I've been telling the world for the last few months that it's an unprecedented, out-of-control Ebola epidemic.

I don't have the authority, people don't listen to me, but you, you need to step up and declare it, because you have the authority and you have the legitimacy.

>> We felt that if you simply go around and say things are out of control or they're this way or whatever in a categorical way, it really doesn't help.

And at this time, we knew that we had something which was not ordinary, but we were not dealing yet with the full-blown, you know, global crisis.

>> NARRATOR: Then the outbreak moved to another level.

An infected Liberian took the virus to Nigeria, Africa's most populous country.

And two American health workers forced Ebola into the headlines around the world.

>> We're just getting word in from the CDC, it's confirmed the first Ebola case diagnosed.

>> Two infected missionaries flown from Liberia and in isolation at an Atlanta hospital... >> NARRATOR: The WHO declared an international emergency.

>> I am declaring the current outbreak of Ebola virus disease a public health emergency of international concern.

The committee acknowledges the serious and unusual nature of the outbreak and the potential for further international spread.

>> NARRATOR: The WHO now put a high-level team in Geneva in charge of the response.

They came up with a plan that would require thousands of Western medics and experts to be put into action.

>> We were looking at one of the most dangerous pathogens that we knew, growing at an exponential rate across a broad geographic area, something we had never seen before.

We needed clinical management people to go in there and manage the Ebola cases.

We needed public health expertise on the ground to be able to do the contact tracing.

And I realized, that capacity to manage something on this scale doesn't exist.

>> NARRATOR: The problem was, the WHO had no standing army of emergency medics and no authority or budget for this kind of operation.

They now needed to persuade wealthy countries to send people to fight the outbreak.

And that would take time.

Back in West Africa, the virus had found a new hunting ground: West Point slum, the most densely populated district of Monrovia, the capital of Liberia.

>> I was called by the Minister of Health to say that people were dying.

Total, total confusion, chaos, disbelief, fear.

No means of response because we didn't have the knowledge, we didn't have the equipment, we didn't have the means whereby we could attend to people.

We did not have full awareness of how quickly this disease could spread, how deadly this disease was.

We were confounded because it just spread so rapidly in these communities.

>> NARRATOR: Monrovia had one small Ebola clinic, and it was full.

For the infected, there was nowhere to go.

The government decided to use a school in West Point as a makeshift isolation center for suspected Ebola cases.

Finda, whose husband had just died, was forced to come here with her six children, even though none of them appeared to be sick.

>> NARRATOR: A local journalist filmed Finda and her children in the isolation center.

There was no separation between the sick and the healthy.

Very quickly, Finda's son Sasko fell sick.

>> NARRATOR: Outside, crowds were protesting that the slum was becoming a dumping ground for Monrovia's Ebola victims.

And once again, rumors were spreading that Ebola was a hoax, a conspiracy to kill poor Africans.

Four days after it opened, the isolation center was overrun.

(people shouting) >> At the time he was dead, they placed the body on the ground and removed the mattress.

And they saw the blood on the floor, they saw fluids on the floor, and they're marching the floor with their feet.

>> NARRATOR: The looters took mattresses and sheets contaminated with the virus, and the Ebola victims disappeared back into the slums.

>> NARRATOR: West Point was now out of control.

(sirens, gunfire) >> Fellow citizens, it has become necessary to impose additional sanctions.

The communities of West Point in Monrovia are quarantined on a full security watch.

This means there will be no movement in and out of those areas.

We ordered the military to quarantine the place, to stop anybody from leaving.

Our fear was people would run away and come from there and then go into other communities.

That's why we did that.

(gunfire) >> NARRATOR: The quarantine backfired immediately.

The army shot a teenage boy, who later died from his wounds.

And the infected had nowhere to go except the streets, so the virus was spreading more quickly.

By now, one of Finda's children, Sasko, was dead.

The rest desperately needed help.

>> NARRATOR: As West Point descended into chaos, Doctors Without Borders had been constructing ELWA 3, the biggest Ebola hospital ever built.

But when it opened, it was immediately clear it would not be enough.

Brett Adamson was the field coordinator for the clinic.

>> People were dying outside, families were dying in taxi cabs outside.

They were arriving seeking care.

The families had nowhere else to go, the center was full, and essentially, they were waiting...

The center was waiting for someone to die to then make space.

>> NARRATOR: Stefan Liljegren was recruited on short notice to work at the clinic.

He had no Ebola experience.

>> I arrive and there are mattresses just next to each other full of people and they're dead, and I look at them and, "Okay, so that's how a dead person looks like."

They're telling me that "Stefan, we can't just watch.

"We need to go in and move bodies.

Are you ready for it?"

And I start to panic, and my pulse goes very high.

There are dead bodies in there, and in gruesome positions.

We go to the next one, and there are dead bodies in there as well.

And we go up to a man in a chair.

The guy with the spray goes up and he starts spraying his face, and that's when it really hits you, he's really dead.

And we place out the body bag and zip him up, and we carry him away.

And family are crying and screaming and yelling, and many are in panic.

That was my first day with Ebola.

>> A normal medical round for me would be going in, pronouncing five or six people dead, and it's extremely horrible because people are dying sometimes very distressing deaths beside a child.

The mother that was trying to care for her child dead, and then you've got a baby, and trying to work out, "How on earth are you going to try and deal with an unaccompanied child in an over-full center?"

It was really hard.

It was just so far beyond what could normally be expected of humanitarian workers, I would say.

The pointlessness of it, that's what it felt like.

Normally, if you work to the point of exhaustion, you can come away from something and feel a degree of satisfaction knowing that you did what you could.

I didn't feel any satisfaction at all.

It was never about feeling like you'd failed in the level of medical acuity.

We did everything we could.

It was about feeling the shame of what the world had to offer for Liberia at that time, and yeah, the sheer number of deaths.

It was just really seeing death, yeah.

>> NARRATOR: After sleeping on the streets for five days, Finda and her surviving children were finally picked up by an ambulance crew in West Point.

(siren wailing) They were taken to the new clinic, but when they arrived, there was no room for them.

>> It's just crazy, to stand there and look in the face of people and tell them that there is no space.

It's surreal, really surreal.

If you had to make a choice, who do you take?

If I have to take someone, I have to take this woman who lies on the ground here.

She is very, very sick, and if I have to take someone, I have to take her.

I can't take you.

There is no space for you here today.

>> NARRATOR: Eventually, the Doctors Without Borders team found room for Finda and her children.

But by now, Finda's youngest boy, Tamba, was slipping away.

>> NARRATOR: Eventually, Finda would lose three of her children.

Three survived.

By now, Ebola cases were rising exponentially.

Doctors Without Borders made a direct plea to the United States to provide thousands of soldiers to help isolate and treat patients.

The director of the U.S. Centers for Disease Control and Prevention came to the Ebola clinic in Monrovia to see the situation for himself.

>> I still get goose bumps thinking about it, and I will never forget the experience.

In ELWA 3, I saw a level of devastation that I have never seen.

I went into one of the tents and there was a woman lying on the ground.

She had beautifully plaited hair.

When I looked more closely, I realized that she was dead, and the staff were too busy trying to care for the living to even remove her.

It was seeing a country essentially in free-fall and knowing, knowing with certainty that no matter what we did, it was going to get a lot worse before it got better.

>> NARRATOR: Tom Frieden called President Obama.

>> I was frankly furious.

What I said was that this isn't about response in the next three months, it's response in the next three days that matters.

Cases were increasing exponentially, they were doubling every three weeks.

Each month of delay would result in a tripling of cases.

>> The world still has an opportunity to save countless lives.

Right now, the world has a responsibility to act, to step up, and to do more.

>> NARRATOR: Ten months after the outbreak had begun, the fight back was underway.

The United States sent in thousands of troops and medics, and other countries followed suit.

The United Nations created a new emergency mission of the WHO and other agencies to coordinate the response.

Work began building new treatment centers and training burial teams.

But the outbreak was still ahead of the response and even threatened to spread beyond Africa.

>> The second health care worker in Dallas has tested positive for the Ebola virus.

>> Public health officials confirm the first human-to-human transmission of Ebola in the U.S. >> We definitely arrived too late.

I was absolutely petrified it would just be this, like, black plague with this inexorable spread across the continent and beyond.

We were also deathly afraid that someone would get on a plane and go to Dakar or Jakarta or Johannesburg, somewhere, and land in an urban setting and Ebola would get totally out of control.

We didn't have a plan B.

>> NARRATOR: Then, in Monrovia, something extraordinary happened.

Cases began to drop sharply.

>> When we saw the numbers starting to go down, I was really worried.

It was cause for more concern than jubilation because the response still seemed so inadequate that it was inconceivable that it could be successful.

And of course the fear is that if people are not presenting, that they were staying at home, which means if they're staying at home, they're infecting more people, that then the curve would bounce back in a much more dramatic way, and that was the fear.

>> NARRATOR: But the drop in numbers was real.

With death all around them, Liberians were changing how they lived their lives.

They stopped trying to nurse their sick and began to bury their dead safely.

>> The entire Monrovia knew Ebola was real, Ebola kills, Ebola's gonna kill me unless I do one or two things differently.

There was a huge fear.

And they changed their behaviors in ways that suddenly slowed down and took the heat out of this thing.

And that's what turned it around-- Liberians turned their country around.

We got in there a little bit afterward and took a lot of credit.

>> NARRATOR: Thousands more were still to die across West Africa.

But the changing behavior of the population and the massive international response gradually turned the tide.

The fight against Ebola is still far from over.

But health officials are already worrying about the next outbreak, and how the world will respond.

>> Sometimes, the world has got to learn things the hard way.

There are gonna be more of these, no matter what we think.

More and more new diseases are emerging.

We've seen pandemic flu, we've seen SARS, we've seen Ebola like this, and we are not prepared.

Ebola was not an exception, Ebola is a precedent.

>> NARRATOR: Officially, more than 10,000 people have died.

The true figure is believed to be much higher.

>> 37 health workers died at the Kenema Government Hospital here.

37, including doctors, nurses, porters, cleaners, security, lab technicians-- 37 of them died in this hospital.

>> Nurse Rebecca, Alex Smogboy, Nancy Yoko, Sister Barlou, Doctor Khan, Nurse Alice, I.P.

Borry.

>> Next time on Frontline... >> If they would have instituted a recall, then my son would have never gotten sick.

>> About one in four pieces of raw chicken carries salmonella.

>> The strains of salmonella are tougher, stronger, and many of them are antibiotic-resistant.

>> What is the government doing to protect us?

>> We didn't have the direct evidence to request the recall.

>> We don't have laws that are protecting us.

>> "The Trouble with Chicken," a Frontline investigation.

>> Visit pbs.org/frontline for more on the failure to stop Ebola.

>> No matter what we did, it was going to get a lot worse before it got better.

>> Was this just a bad dream?

No, it wasn't.

>> And what we've learned for the next global health crisis.

>> There are going to be more of these, no matter what we think.

>> Then subscribe to our YouTube channel.

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