LEVEL1 CASE 1

Problem Title: Breathless in the Midwest

Investigator: Brent Ronald S. Almerol
Number of sick: 15
Hospitalizations: 15
Deaths: 7
Location: US
Overview:
A startling outbreak has been reported in Chicago and Milwaukee. Within the past 2 days,
15 people have visited emergency rooms complaining of high fever, fatigue, coughing,
chest pain, and difficulty breathing. A total of 15 individuals who were infected, and
according to CDC, emergency centers reported 15 hospitalizations. Also, there are
already 7 deaths of the said outbreak and more people are on the brink of death.
Steps that were taken in investigating the outbreak:
1. Within the past 2 days, 15 people have been complaining of high fever, fatigue,
coughing, chest pain, and difficulty of breathing. There were 15 individuals who
were hospitalized and there are 7 death reports and more people are on the brink
of death, according to US reports.
2. Chicago and Milwaukee hospitals have sought help and reported more cases of
the mysterious illness.
3. The investigation deeply tracked the first reported case. Zeke, a 37 year old
musician from Chicago, who started coughing and feeling very tired shortly after e
led a music workshop.
4. According to the data:
 The first case started to feel ill after he led a music workshop for 50
students at a Chicago concert hall.
 The patient suspects that he might have accumulated the disease from
one of his students or he caught it 2 days ago on a flight home from Africa.
 According to the patient, he took a side trip to meet a drum maker and
taught him how to make djembes (African drums made of animal skins and
wood). Zeke brought home 4 of the djembes he made in Mali.
 After interviewing the friends of Zeke, after the 20-hour flight, Zeke is the
only one who accumulated the disease and is experiencing symptoms.
5. The doctors suspect that the reported cases in Chicago and Milwaukee are
infected with a bacterium that might be anthrax according to the lab results of the
patients.
 6. The investigator interviewed everyone who is sick and their families in order to find
out what are the activities they participated before they felt sick.
7. The investigator interviewed 85 people who are not sick, but also participated in
the similar activities as those who are sick or died. The investigator studied the
attack rates based on the interviews to find the possible source of the outbreak.

8. According to the results, a large number of government workers are sick and also
those who attended the music event in Chicago.
9. During investigation, police reports show that there was a bioterrorism threat 3
days before Zeke and the others got sick.
10. After thorough investigation and questioning, authorities found no evidence of
anthrax and proved the bioterror threat was a hoax.
11. After sending the results of the blood tests to the Centers for Disease Control and
Prevention (CDC). The results from the laboratory Bacillus anthracis, the bacteria
that causes the anthrax.
12. According to the results, the doctors diagnose each patient with inhalation anthrax
and told the patients to begin treatment immediately.
13. The investigator, reviewed the attack rates and interviews again since the bioterror
attack on the government building was a hoax.
14. The investigator found out that everyone who’s tested positive for anthrax also
attended a music event at the same Chicago concert hall where Zeke held his
music workshop.
15. The investigator once again interviewed Zeke and revealed that he remembers the
drum make in Mali was coughing and having trouble taking deep breaths, which is
similar to the symptoms of all the sick people from the music workshop.
16. The investigator contacted health authorities in Mali. Also, Zeke tells that he
demonstrated how to make a drum using a goat skins he brought from Mali during
the workshop in Chicago.
17. The investigator decided to talk to the participants and ask about it. The
interviewees revealed that they noticed a large amount of dust and particles
floating in the air, which might be the cause of disease.

Discussion:
Step 13 is the most important step since after confirming in step 10 that the bioterror was
a hoax, the investigator reviewed the attack rates and interviews and focused more on
the other place that has a large number of disease. In step 13, the investigation was more
closer to get the answer to the problem where the disease came from.
Results:

 The drums or the djembe that Zeke played at the workshop that has a goat skin
used to make the drums in Mali was contaminated with anthrax spores.
 When Zeke demonstrated the djembe in the workshop, spores were released into
thin air.
 People who were at the event and came closest to the djembe breathed the
spores, making them sick.
 People can get anthrax through contact with infected animals or their products
such as hides or hair. Since the drum and the goat hides he brought back from
Mali were not treated effectively with chemical to anthrax spores, people from the
workshop including Zeke inhaled the anthrax.
 Zeke also did not report the goat sins he brought back from africa to Customs and
Boarder Protection. Therefore, it wasn’t verified that they had been properly treated
to kill anthrax spores.
Reflection:
After studying and investigating the case, we realized that it is very important to report
foreign objects brought from other countries to Customs and Boarder protection in order
to know if it is contaminated. It is our responsibility as individuals and travellers to also
think the safeness of the community and the country. We should be accountable for the
things we brought from other countries, and we should be responsible in reporting foreign
things to the authorities to prevent spreading of diseases.