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Education and Training

Mysterious Illness

The Case of the Mysterious Illness

It was a rarity during this time of February – a beautiful, sunny, and somewhat warmer day compared to the prior month of dreary, cold, and snowy weather. The students at Academy High all were working hard to convince their teachers to let them outside for a while to enjoy the day, and to burn off some of that “stir-crazy” energy that had been building over time.

Academy High was a medium-sized private high school located in an affluent suburb. The majority of the children came from the homes of influential business and community leaders, including the Mayor's two oldest teenage daughters. It was an elite school, and the students were quite use to getting their way with gentle protests. As such, Mr. Jones, the physical education teacher, caved in and let three of his classes go outside in the afternoon to the soccer field for some exercise. It was the last class of 40 students who noticed the fine mist at one end of the field, which seemed to be coming from the woods close by. As they ran through this mist, the students noticed no particular smell. At the end of class, a few of the students reported the incident, and Mr. Jones went to investigate. Seeing no mist or noticing nothing unusual, he reassured the students that it probably was some localized fog that was in the area but had now cleared.

None of the students gave this a second thought, until a week later. Mrs. Kline, the school nurse, was the first to notice something unusual as 12 students came to her over the course of the morning complaining of “just not feeling well.” The symptoms the students complained about varied, but most of them had an abrupt onset of a fever, some as high as 102°. Other complaints included typical flu-like symptoms such as chills, weakness, runny nose, mild sore throat, eye irritation, muscle aches and joint pain, and dry cough. Some of the students were sicker, complaining of more shortness of breath and chest pain with deep breathing. Since flu season was over in the community, Mrs. Kline thought at first it was an isolated viral syndrome. However, as more students presented to the infirmary, she became more concerned.

After the 12th student from the same class presented with these symptoms, she notified the school administration. When she found out that another 10 students in that class were out sick, she became more alarmed, and advised Mrs. Brown, the school principal of her concerns. At the same time, she called her neighbor, Dr. Park, who was a physician who worked at the local urgent care center. Mrs. Kline described the situation to Dr. Park, who became concerned about this isolated outbreak, as she had noticed nothing like this coming through her office. Dr. Park thought about the possibility of meningococcal meningitis, although none of the students had a rash or stiff neck. Despite this, Dr. Park advised Mrs. Kline to quarantine the students for now, and said that she would come over to look at the students. Upon arriving to the school infirmary, Dr. Park found some very ill-appearing students, and recommended immediate transfer to the local hospital emergency department.

As the ambulances began to arrive, at curiosity, and then panic, began to spread throughout the school. Suddenly, dozens of students came to see Mrs. Kline for various complaints, although none had a fever or any other objective evidence of being ill. Also, concerned parents began arriving at the school, and Mrs. Brown, not knowing exactly what to do, would not permit the parents into the school, quaranting all of the students until she heard from the physicians at the emergency department. At the same time the local news media heard about the incident, and several television stations sent their crews to the school to cover this “late breaking news.” Mrs. Brown had a real fiasco on her hands!

Dr. Morris, who was in charge of the emergency department, agreed with the quarantine, and contacted the hospital's infectious disease expert, who in turn, notified Dr. Harrington, the head of the county's public health department. Dr. Harrington and his crew immediately went to the school. Upon further investigation, he discovered that all of the initially ill students came from one class. As Dr. Harrington began talking to the teachers, Mr. Jones recalled the incident at the soccer field the week before. Being concerned that something suspicious occurred, Dr. Harrington activated the homeland security system, notifying the local FBI of the incident.

It was a long month for the community. Of the 22 students who initially became ill, two remained in the hospital with pneumonia. The investigation was extensive, and eventually soil samples taken from the area confirmed F. tularemia as the potential agent. Further lab tests taken from the ill students confirmed that they had been exposed to tularemia. Considering the nature by which they were exposed, a bioterrorist event was strongly suspected. Over the course of that month, nearly three-quarters of the students from Academy High, and hundreds from the local community, presented to the emergency department complaining of vague symptoms – none of them were found to have tularemia.

It was also a difficult time for the Ibrahim family. Mr. Ibrahim was a successful and well-respected businessman in the community. Initially from Syria, the family had immigrated to the United States five years ago, and all had become US citizens. However, after this event, accusations and suspicion arose that this family may be behind the attack. The two students, Ramon and Hajiv, happened to be out of school on the day of the attack to observe a religious ceremony at their local mosque. Although the FBI investigation into the family failed to confirm any ties to the event, several threatening phone calls and letters were sent to the Ibrahim family.

One can imagine what it was like a month later when Academy High opened the doors again to the students. Many students were still traumatized by the event, and once again Mrs. Kline found her infirmary filled with students, many of them complaining of feeling bad and not sleeping well. In addition, Ramon and Hajiv were experiencing night mares and panic attacks. They eventually left the school, and community, while Mr. Ibrahim was contemplating legal action against many of the parents and school administration. Mrs. Kline asked Mrs. Brown for counseling services. It was going to be a long time before the teachers and students were able to feel comfortable in that environment.

General Questions to Ask All Students
Critique the entire event as it unfolded. In what ways could each of the major participants done differently that could have resulted in a better outcome?
What lessons have you learned during this course that could have resulted in a better outcome? Be specific.

Specific Questions for Medical and Nursing Students
Critique the way the health care workers handled this situation.
What would have been the first clue that something was not right?
What differently could have been done at this time?
Was quarantine a necessary action? If so, why? If not, why not?
What is the proper treatment for tularemia? How is it spread? Is human-to-human transmission possible? How is the diagnosis confirmed? What is the best treatment for this condition, both for those who have symptoms, and those who were exposed but yet have symptoms?
Who should have been notified right away?

Specific Questions for Allied Health Students
How is the diagnosis of tularemia made?
Would those who are exposed to those who are ill need to take prophylactic medicine? For example, does the radiology tech taking the chest x-ray film need to take any other precautions?

Specific Questions for Social Work Students
Critique the way this case was handled.
What role, if any, does social work have in this situation?
What obligation does social work have to the Ibriham family? What can they do to help in this situation?
What role does social work services have with post-traumatic stress disorder after a disaster?

Specific Questions for Law Students
Critique the way this case was handled.
Discuss the role of protecting the public vs. the private citizen in the face of a terrorist event.
What legal rights do the FBI have in a case such as this?
What legal recourse could the Ibriham family have? Is discrimination an issue here, and how can it be resolved?

Specific Questions for Education Students
Critique the way this case was handled.
How can the school system protect itself against a terrorist activity? What plans should be in place?
What should the school administration do when confronted with numerous students developing an illness such as this? What is the proper response?
What can the school do after a disaster for its students? For its parents?

Specific Questions for Pastoral/Counseling Students
Critique the way this case was handled.
Discuss the actual steps that should be taken to minimize panic, to minimize discrimination, to minimize post-traumatic stress disorder.