The Outbreak Next Time
When another pandemic hits, will the sensationalism and ill-informed reporting that infected H1N1 coverage strike again?
The morning ritual at CBC begins in a typical boardroom with a long wooden table and well-worn chairs. The windows overlook the hydro substation across the street. The room is busy. People mill in and out, preparing for different deadlines, but there are always 10 or 12 in the boardroom. The microphone in the centre of the table lets them communicate with journalists in other bureaus across Canada.
On this day in April 2003, veteran reporter Maureen Taylor is there with a team of reporters who, for the past two weeks, have been following the outbreak of SARS, a new virus that’s proving highly infectious. The body count is mounting in Toronto, and with so little known about SARS, it has quickly taken over the evening news.
“Hey, folks,” says editor George Hoff. “Do you think somewhere in Maureen’s story tonight we could squeeze in a line about how people are actually getting better who’ve had this disease?”
As Taylor watches the people around the table nod in agreement, it dawns on her just how gloomy her reporting has become. “That was a good wake-up for me,” she says now. “I think in the beginning I may not have understood. I may have created panic.”
That lesson stuck with her when bird flu first appeared in Toronto a couple of years later. The virus was a particularly dangerous strain of influenza that some epidemiologists predicted could morph into a pandemic and kill as many as 50,000 Canadians. As grim as that sounded, Taylor worked to keep her reporting balanced and in context. She wanted to educate her audience without contributing to widespread panic about a potentially catastrophic illness. It’s a lesson that reporters across the country are now considering in the wake of the recent H1N1, or swine flu, pandemic. With the benefit of hindsight, it appears that many journalists treated the outbreak the same way they cover most infectious diseases—recklessly.
Driven by audience demand, saturation reporting of potentially dangerous viruses can leave people feeling either panicked or apathetic. Even before the second wave of H1N1 fizzled out, almost everyone felt fed up. That suggests newsrooms failed to maintain perspective, and audiences took notice. If journalists don’t change the way they approach these stories, they may be giving people one more reason to shut outtraditional media.
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The appearance of H1N1 wasn’t sudden—that’s not the pattern these kinds of outbreaks follow. In late March and early April 2009, reports emerged about an influenza-like illness killing people in Mexico and spreading to the southern United States. This virus was different from other flu bugs because it was killing so many young, healthy people, and by April 25 the World Health Organization (WHO) declared the virus an international threat.
Two days later, Canada had six confirmed cases of what became known as H1N1. The first death came one day after that: 39-year-old Tina L’Hirondelle of Gift Lake, a Métis settlement in northern Alberta, suffered from asthma and other ailments. The first peak of H1N1 coverage soon followed, with hundreds of stories about the virus appearing in newspapers and on television sets across the country in late April, according to CBC. By June 11, who declared a level six pandemic, the highest level possible, for the first time in over 40 years. Nevertheless, H1N1 fear dwindled over the summer, but as fall came, so did fear of a second wave, which hit Canada in mid-October.
On October 26, the vaccination program finally rolled out to priority groups. That day, a 13-year-old Toronto boy named Evan Frustaglio died of H1N1. This sparked another surge of reporting. Canadians rushed to get vaccinated, waiting in line for hours and sometimes being turned away entirely. The panic subsided as more of the vaccine became available; public health’s worst-case predictions failed to come true and the number of cases dropped. By January, almost half of Canadians had been vaccinated.
As H1N1 calmed, accusations of irresponsible coverage ran rampant. Soon, even news organizations were questioning their work. At the height of coverage—late October to early November—the amount of reporting exceeded that of SARS, even though that virus killed almost one in every five Canadian patients, and H1N1only about one in every 250,000, according to Dr. Brian Goldman, the host of CBC’s White Coat, Black Art. (Although since Canadian health authorities stopped counting H1N1 cases in the summer, an accurate mortality rate is impossible to come by.) On November 5, The Globe and Mail’s Judith Timson wondered whether the media had hyped the pandemic, causing unnecessary anxiety. Her column ran the day before the paper published a piece about H1N1 paranoia terrifying children, filling them with anxiety about even attending school. Timson wasn’t a columnist gone rogue—and she wasn’t alone.
On the same day, Wendy Mesley moderated a CBC debate between Richard Schabas, a former chief medical officer for Ontario’s health ministry, and Allison McGeer, director of infection control at Mount Sinai Hospital in Toronto. While Mesley told viewers there had been 225 stories about Evan’s death, Schabas slammed the media for not providing context: “There has been a constant lack of trying to put the story in perspective, of trying to take a step backwards and saying, yes, someone died, but remember people die actually all the time.” And a National Post story noted how reporters repeatedly drew comparisons betweenH1N1 and the 1918 Spanish Flu, which killed more than 50 million people around the world. The piece quoted a British sociology professor who denounced the reference, saying it only served to “transform the flu into an apocalyptic threat.”
The appeal of that angle is obvious. At a time when traditional media compete with an explosion of online and alternative news sources, everyone’s looking for an advantage. Minute-by-minute coverage of a scary disease guarantees people stay glued to radios and TVs and keep buying newspapers. The desire to squeeze the most from a story isn’t necessarily bad. But because many reporters didn’t include enough context in their stories information that would educate rather than alarm—Canadians ended up consideringH1N1 a far worse threat than it was, or not considering it a threat at all.
Back in late May 2009, TNS Healthcare, a market research and public polling company, discovered a disparity between the severity of the illness and how Canadians perceived it. Fifty-three percent of Canadians surveyed believed H1N1 was serious or “extremely serious,” even though it was fairly mild. Journalists who neglected to write about people recovering from the illness and focused on the number of H1N1-related deaths contributed to the prevalence of such misinformation. Joseph Hall’s Toronto Star story on September 11 suggested that the late arrival of the vaccine would mean an ineffective immunization program. Hall didn’t mention that only 74 patients of the 1,445 who ended up in hospital since the pandemic began five months earlier had died. The vast majority of cases didn’t require hospitalization. These details would have helped readers put the late arrival of the vaccine into perspective; instead, the impression was that having to wait longer to be immunized would put people at considerable risk. On November 13, a Globe story by Caroline Alphonso and Karen Howlett featured this lead: “A sudden spike in H1N1 deaths over the past week reveals that the pandemic virus is taking a far greater toll on Canadians during the second wave, raising fears that it’s just as severe, if not worse, than seasonal flu.” And by not comparing the number of deaths to the number of infected people, the story made the virus appear far deadlier than it was. In the roughly 650-word article, variations of the words “died” and “killed” appeared 15 times, which may have left readers with the impression that an H1N1 diagnosis was a death sentence.
Part of the problem, of course, is that more context isn’t the best way to draw readers into a story. The pull is often a big, scary number or equally terrifying anecdote. Star faith and ethics reporter Stuart Laidlaw says there’s a desire among journalists to use the biggest number possible. Headlines illustrate his point. The Star: “Hundreds of flu shot doses get thrown out” and “2M swine flu doses await go-ahead.” Globe: “Cost of vaccinating the nation hits $1.5 billion and climbing.” London Free Press: “H1N1: Ontario is now reporting 1,781 cases, five in London.” Even when they weren’t entry points into the story, numbers were crammed into copy, sometimes distorting the perception of the virus.
Numbers may be enticing for readers, but personal stories are far more affecting—and without the proper context, they can be just as misleading, as Evan’s case shows. The otherwise healthy 13-year-old died within a few days of showing H1N1 symptoms and the media pounced on his story. The response to a father willing to give interviews was an explosion of coverage, with headlines ranging from “Grieving father struggles with son’s death,” to “Healthy boy’s death leaves dad reeling,” to “Officials urge calm as H1N1 claims teen.” This story single-handedly changed the way Canadians perceived the threat. A week before Evan’s death, polls suggested that just 36 percent were worried about the disease. Two weeks later, 55 percent of Canadians feared catching H1N1, and 54 percent had either received the vaccine or planned to receive it. People swarmed vaccination clinics, and no one could tune in to a news channel or pick up a newspaper without reading something—anything—about the long waits in panic-induced lineups.
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The sheer volume of coverage wasn’t the only alarming aspect of the story. Many reports failed to say that, however tragic, Evan’s death was a rare event. On October 28, an article in TheHamilton Spectatortallied the total number of deaths in Canadian adults and children—almost 100. It failed to compare the tallies to the total number of people hospitalized with H1N1 by that date—almost 2,500. The story quoted Ontario’s chief medical officer of health saying that death from H1N1 was rare halfway through the piece. As with similar stories, that viewpoint was buried; by then, readers may have lost interest.
Although some reporters say they don’t control how audiences interpret their work or what they end up believing, the failure to take a step back and put deaths into perspective may have painted a deceiving picture of H1N1. According to risk amplification theory, when people are overexposed to a single-issue story, they imagine the threat is more perilous than it actually is. York University researchers Daniel Drache, David Clifton and Seth Feldman discovered that’s what happened with SARS, and Drache thinks it likely happened with H1N1. The team looked at over 1,600 articles about SARS from the Star, Globe, Post and two American papers. They found that during “saturation periods,” each one ran up to 25 SARS-related articles a day. The researchers concluded the intense coverage shaped the public notion of the ferocity of the crisis. Drache says the media just aren’t effective at covering breaking infectious diseases. “Did they do a better job this time?” he asks. “I doubt it.”
Many reporters don’t see it that way, of course. They see themselves as “fair and measured,” says A News health reporter Jan Sims, based in London, Ontario. “I think coverage has been done in a way that hasn’t inspired fear.” Ioanna Roumeliotis, who tracked H1N1 for cbc, agrees. “I don’t think that we don’t put things in perspective,” she says. Reporters may be defensive, but so are editors, who share the burden of accountability. “I think we’ve done a responsible job,” says Sun Media national news editor Mike Therien, who oversees the company’s wire service.
But it’s hard for reporters and editors to do a good job covering breaking health stories because, in most cases, they don’t have the experience or knowledge to fully understand what’s going on. According to research by Maija Saari, a journalism professor at Wilfrid Laurier University, 70 percent of reporters spend less than two years on any sort of medical beat. And anyone looking to editors for institutional memory should think again. Saari found that most strong science journalists had trouble explaining their stories to scientifically illiterate editors. Most editors are spread thin, overseeing a number of reporters in different areas, and “these things affect how much room the reporter gets to write,” she explains. Without understanding the complex nature and nuances of many health stories, editors have trouble guiding their reporters.
And lacking the right experience or background, editors can sometimes encourage over-coverage. This past summer, Charlie Fidelman, a health reporter at Montreal’s The Gazette, had to keep writing H1N1 stories even though she wasn’t convinced the virus was proving serious enough to warrant it. “How do you write about something that seems to be sort of benign?” she asks. Her assigning editor, Michelle Richardson, wanted to keep the story going because she knew it would return in the fall; she never discussed temporarily shelving the issue with either of her two health reporters. “I don’t think either of them ever thought it wasn’t worth covering,” says Richardson.
That’s not to say journalists don’t face considerable challenges—short deadlines, limited resources and shrinking newsrooms. Many reporters also wrestled with public health officials for tidbits of information. Tamara Cunningham, a reporter with Alberta-based Didsbury Review, was on the brink of tears when she called Michelle Lang, who was the health reporter at the Calgary Herald. (Lang died a few months later covering the war in Afghanistan.) Cunningham was tired of fighting with the bureaucracy at Alberta Health and Wellness for information and access to sources. But with some advice from Lang, she was able to get around the public relations people.
With layoffs and buyouts, the institutional memory has evaporated in many newsrooms, but veteran health reporters, such as Maureen Taylor, still have valuable advice to share. She’s currently on leave and studying to become a physician assistant. (Taylor doesn’t plan to return to journalism. She grew tired of revisiting the same stories.) “I don’t like to tell other reporters what to do,” she says. “I don’t want to be seen as Miss Know-It-All.” Yet, after some cajoling, she shared some of what she learned covering SARS in a piece for J-Source. Taylor says asking medical experts and public health officials for predictions is asking for trouble because no one really knows what will happen, particularly with a virus like H1N1. But that doesn’t mean reporters shouldn’t push for accountability. Taylor remembers when David Butler-Jones, the country’s chief public health officer, kept saying the H1N1 vaccine was rolling out on schedule. “He would say very emphatically Canada is on track to get millions of doses of vaccine on time. And nobody would say to him, ‘How do you define on time?’ There were already cases in B.C.”
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Taylor’s advice may have fallen on deaf ears, but not all reporters succumbed to sensationalist reporting. ThePost’s Tom Blackwell thinks the story was blown out of proportion from day one and his stories reflected that skepticism. His editor, Scott Stinson, shared his view, and together they decided on more restrained coverage than what they saw their competitors producing. For example, just three paragraphs into an early November 2009 article, Blackwell soothed readers with the fact that the flu hadn’t reached the levels of the previous wave and that it was far from a crippling pandemic. In an earlier piece, he wrote there was no reason to believe Canada was at risk for a severe second wave, based on the southern hemisphere’s experience with H1N1.
Surprisingly, the over-the-top H1N1 reporting may have been a made-in-Canada phenomenon. According to an article by Blackwell on November 14, the terms “flu” and “vaccine” found their way into 36 stories in his paper, 66 in the Globe and 72 in the OttawaCitizen during the two previous weeks. South of the border, the terms appeared 23 times in The New York Times and 10 times in The Washington Post.
According to a Harris/Decima poll released in mid-November, 61 percent of Canadians believe their government did a fair to good job on “preparing for and dealing with” the virus. Even more—65 percent—believe the media overreacted.
That’s bad news for journalists. But the future doesn’t have to be gloomy; institutions can change. And now is the time to decide if, after this latest fiasco, news organizations are willing to adapt. Yet, improvement is hard when some of the most experienced reporters are reluctant to offer constructive criticism. “I would never want any of my colleagues to tell me I wasn’t doing a good job,” says Taylor. “When they did, I can tell you I didn’t take it very well.”
But when it came to including context, she learned her lesson seven years ago, thanks to an editor who was conscious of public fears. And that lesson must become part of the institutional memory of newsrooms across the country if journalists hope to regain the public’s trust and remain relevant. Reporters and editors require better training on how to cover breaking health and medical stories, and they should consider the cumulative effects of their work on the public.
The next time a new, potentially deadly virus strikes—and there will be a next time—newsrooms need to be ready to cover the story with context and restraint. If they aren’t, they risk sending their audiences elsewhere. “If you’re constantly screaming with the most alarmist headlines,” says Laidlaw, “after a while, your own credibility starts to suffer.”