The swine flu spread is not yet pandemic, but the Centers for Disease Control and the President urge us all to be prepared. The World Health Organization raised the pandemic alert level to Phase 4 on Monday. Phase 4 is just short of a full-blown pandemic.
WHO describes the pandemic influenza stages as (highlights are my own):
"In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans.
"In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.
"In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.
"Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause 'community-level outbreaks.' The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.
"Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region ... While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.
"Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way."
So far in the U.S, the swine flu has been mild, not even requiring hospitalization yet. But this is a new strain, we have no natural immunity, we have no vaccine.
Schools, churches, hospitals, social services are all being told to prepare. But what about newsrooms? What should you do? How would you do your job if there were a national outbreak and you were to cover it? What would your newsrooms' policy be for journalists who do not want to interview or come in contact with people who have been sick? How will you keep from spreading the illness? How would you deliver the news if your folks could not come in? How would you cover the story of the sick?
In the event of a pandemic, there could be massive loss of life, deep psychological injury and the economic losses might be impossible to calculate.
AIDS was a pandemic. SARS and the Avian flu were something of a test run, but what did Americans and journalists learn from those outbreaks? Are we prepared for a pandemic?
I got an e-mail from my friend Melissa Ludtke at the
Nieman Foundation for Journalism at Harvard, who said, "Take a look at the collection of stories we published in our Spring 2007 issue of Nieman Reports -- a compilation of expert advice garnered from a two-day conference held at Lippmann House." Below I excerpt some of what was said at that conference.
Read what Margie Mason, the AP's medical reporter in Asia, said in that 2007 Nieman Report:"If a pandemic flu strain were to emerge and started spreading easily among people, our coverage would change. I'm always asking questions like, 'What would you do? How would you work? Would you stay or would you leave?,' and I think that these are extremely difficult questions to answer, and I don't have the answers. I think it would be a very fluid situation that none of us have ever dealt with on a worldwide scale.
"Even for a disaster like Hurricane Katrina or the Asian tsunami, no one on the ground knew how to respond until they knew what they were up against and, even then, there were major problems, especially in the beginning. I don't think anybody in the news business, regardless of how much planning we do, will be following a step-by-step manual on how to work. I think that if it's the size of the 1918 Spanish flu pandemic, we will all be winging it to try to do our jobs. I can tell you that I won't be in the office, and I won't be out on the street interviewing people, and I won't be going into hospitals if that was to occur. I would likely be home, working the phones, and avoiding contact with as many people as possible and sleeping with my Tamiflu under my pillow at night."
CNN's Senior Medical Producer Christy Feig said:
"About the time when the anthrax situation was happening, in the fall of 2001, CNN hired a team out of Britain to basically serve as our security advisers on all of these kinds of things. They go with us to war zones and to Katrina. They're medical advisers, security advisers, and they have a lot more information on this stuff than we do. They think about the 'Don't set your camera down there.' It's been very interesting what we've learned from them. And what we have decided so far for avian flu is that we've got Tamiflu stockpiled in certain places and HAZMAT suits in certain places. We train teams in certain areas. We have a doctor on call who will brief anybody before they go in -- will give them an oral quiz before they go in. They are the first people the reporters talk to when they come out. And anyone can decide at any particular time that they don't want to go in."
The essay continued with these sobering insights:
"We've got some interesting things going on in preparing for this. If you've been in the CNN Center in Atlanta, there is the huge food court and the Omni Hotel. It's a bubble, and they've actually got plans in place to take over the whole bubble with people that they can just keep inside the bubble for months on end if they need to, and that's where they can broadcast from."
How would the nation handle massive grief in a pandemic?
Read this passage from an essay by Dori Reissman, Commander, United States Public Health Service. She spoke of something she called psychological first aid:"...it has certain underpinnings -- safety, calming, connection, efficacy and hope. Safety is about removing people from a threat. Calming happens when you want to lower the state of arousal so people can function, concentrate and take concrete steps towards what they need to do to protect themselves. People's basic need to connect with others and not be isolated needs to be attended to. Efficacy occurs when someone is capable of taking action on their own; when they do so as a member of a group, that's collective efficacy. The idea that the world is predictable and we will get through it, that's hope.
"If journalists could take these five ideas and infuse them in their messages, I'd be very happy. Absent this, we don't have a leadership set up to handle grief. How do we manage massive grief and loss? How do we do ceremonies when you can't attend them? How do we support people who have lost a lot when you can't touch them? Continuity of operations goes way beyond business. It's continuity of life as we know it."
The Human Stages of Dealing with a DisasterSandro Galea, Associate Professor, Center for Social Epidemiology and Population Health, University of Michigan,described the predictable human response to disaster. As you read this, recognize the vital role journalists have in holding the nation/world together.
"There is no question that the first reaction to a disaster is fear and initial anxiety. People are afraid. They seek information. They do what is necessary to figure out how to save themselves. Information-seeking behavior is probably the primary modifier of what happens after these events. With the right information provided, there is a tremendous effort -- usually guided by what we call pro-social behavior -- to help others. That's called group preservation and represents stage two.
"Stage three involves internalizing. We understand the psychological consequences much better than we do the behaviors, and many psychological consequences fall in place during this stage. With disasters, we talk a lot about emotional responses, about change in normal activities. We talk a little bit less about the notion of seeking redress and addressing vulnerabilities and strengths. After self-preservation and group preservation, this leads into efforts to try to figure out who is to blame and to do something about it by addressing the vulnerabilities and strengths that we have that resulted in that hazard becoming a disaster.
"...Stage four is externalizing. This is the stage that unfortunately in this country we've become all too familiar with at this point, which is action against perpetrators, against those who are considered responsible. It's part of seeking redress. It's an effort for justice seeking."
You have to wonder how long it will take, how bad the outbreak will have to become before we start seeing fingerpointing against Mexico. The potential for this kind of reaction could include discrimination or retribution against Mexicans and Mexico. Muslims know this reaction all too well after 9/11.
"...Stage five is where we get the renormalization and adaptation. The group adapts to the threat. The normalizing of these new behaviors is seen as a direct response to the perceived threat."
Communicating in a Disaster or PandemicDick Thompson, Team Leader, WHO Pandemic and Outbreak Communication, published these guidelines on how the World Health Organization should communicate during a crisis. The guidelines were reduced to a single index card. I think the guidelines are good ones for journalists too.Trust is the most important thing. As a communicator, this is the currency I work in. Every communication we make is really a pandemic communication, because we're either building trust or it's costing us.
Be as transparent as possible. This is very, very difficult, especially for people who work within a culture that's generally used to working behind closed doors and coming out with peer review publications. It's very difficult for them to allow the public in to see what they are doing, but once we do that, it increases the trust and confidence people have in us.
Announce early, even when there's incomplete information. This is another thing that's a very difficult aspect of this; a lot of times officials will want to wait and use the reason that they don't have all the information they want. They use that to delay and delay and delay. Finally, journalists pick up the information and report it, and then they have to respond that, yes, they've known about it for three weeks, and they lose a lot of trust.
Listen to the public and then plan for the extreme demands of outbreak communication. On the back of this little card, we've got hints for interviews. There are special hints for outbreak interviews, such as to clearly say what you don't know. This again is hard, especially for physicians. To say what they don't know is something that doesn't come naturally to these professionals. Also there is a need to share dilemmas and to leave room for the unexpected in your comments. In an outbreak, we urge people not to make definitive statements about anything because even as an outbreak is drawing to a close that can be the most dangerous time, because people relax their guard, somebody slips through, and you have another outbreak.
Finally, never over-reassure or mislead.
Pandemics are Global Events but Produce Local StoriesIn 2007, freelance journalist Maryn McKenna, who has covered pandemic and flu stories, wrote for the Nieman Report:
"We think of the beats in newsrooms as silos. We're going to have to let go of the silos. I really believe covering pandemic flu is a web with lots of cables connected in it. If you tug on any one of them, all the others start to give.
"The second lesson that I want to offer -- and one I resisted for a long time -- is that I really think that the pandemic story is local, local, local. The fact is, what people feel about a pandemic, whether they're willing to prepare, how well they're preparing, what we really want to tell people is what is happening in the local school district, in your neighborhood cop precinct, and in the shopping mall. That's where the real drama, the real narrative, for those of you who want to do narrative, of pandemic planning and pandemic coverage is going to be.
"Here are some examples:
Whether kids in the school lunch program are going to get fed, even though the school lunch program is a federal program, is a local story.
Whether people will come to work if they feel ill because they live paycheck to paycheck and they can't afford to stay home is a local story. It's a story that you have to ask about locally to prove and to embody.
Whether people will insist on going to the local hospital, even if the local health authorities have told them not to, because they have a family member who's sick and they're prepared to go through the National Guard troops at the front door of the emergency department in order to get that family member care is entirely a local story.
If people go on with their lives as normal once the pandemic starts because they're illiterate and can't read the messages from the local public health department, or English is not their primary language and the messages haven't been translated into whatever language they use or put into their local ethnic media.
"The stories on that list are situations that are going to be stories -- local stories, specific and different in every area if or when a pandemic starts. But I really believe that there are stories that we can be doing now that are about preparation for a pandemic that are also very local, very specific stories, different in every place."
She suggests that you get busy preparing to cover the story by answering fundamental questions:
"For a lot of science and medical people, the essential questions we ask are: 'How do you know that? What's your evidence?' But I think there's another question that we have to keep in mind: 'How does that work?' That's the question that will get you to the very local, very granular details of the stuff that you need to be writing about. Here are some examples:
- How often does the tertiary care hospital in your town get its deliveries of pharmaceuticals and medical supplies? Is it three times a day? Is it once a day? Do they have a three-day backlog? Do they have a five-day backlog? This is something I'm going to need to learn if I write about the hospital preparations.
- Have many of the changes that were supposed to beef up local and county health departments after the anthrax attacks actually happened? What really is the state of the radio communications in a particular town? What's the state of the last mile of Internet?
- If you have a Fortune 100 heavy industrial company in your municipality, where do they get their raw materials from? If there's something like Target, where are they buying? Does all of Home Depot get its fasteners from China? If they have redundancies and they've booked five fastener factories, are all of them in China? Have they thought to go to Thailand or Vietnam or somewhere else instead?
- How far away are food wholesalers that supply local grocery stores? How much of a backlog do they have? Do they go from the port with their refrigerated truck straight to a grocery store?"
Evaluating Your SourcesWhen a story is this big and this international and keeps growing by the hour, people will be crawling out of the woodwork trying to get interviewed. They have books or products to sell. But can you trust them?
Helen Branswell, Medical Reporter, Canadian Press (CP), Canada's Domestic News Agency, wrote for the Neiman Report in 2007:
"What is fantastic is to hear a dependable source say, 'This is outside of my realm of expertise.' I trust them more, and I go back to them more. Anybody who wants to talk about every story regardless of what sort of subhead it comes under in flu, you really don't want to be talking to that person.
"How do you know how expert an expert is? There's been an explosion of experts on this issue since it hit the prime time last fall. Quite a few are selling books, and there's been an explosion in that, too. To be honest, I don't know an actual flu expert who's written a book in the past few years. None of them have had the time to do that. That doesn't mean that the people who've these books haven't done their homework, but they have got a vested interest, and they aren't on the front line. Add that to the mix when you're thinking about whether or not these are the right people to call.
"If you're writing about the science of flu, whether it's seasonal, avian or pandemic, and you're thinking about quoting somebody who isn't a well-known, mainstream flu specialist, it's really worth
doing a PubMed search on them. See what they've published on flu. Right now, a New York University medical professor who's written a book about pandemic fear is widely quoted on a variety of topics including molecular biology, with such topics as whether this virus is attaching to the right receptor binding sites, could it bind to more human sites, and what it would take to do that. Search in PubMed and the only thing that you'll find under his name is an article in
Forbes -- not even medical literature. So if he hasn't published anything in the medical literature on any topic at all, is he really the right person to be talking about the molecular biology of flu? Just think about that.
"Who you talk to matters, both for the quality of the work that you're producing for your readers and also because the people who are taking the subject seriously read the serious work. The experts watch us; if they see us quoting people who aren't really high caliber, it's going to influence whether or not they're going to take your call.
"This brings me to my next point: If you can afford it, if your bosses don't mind, or if you're freelancer and can afford it, there's no reason to stick to the continental United States. You can dial anywhere, and there are experts on this subject in Hong Kong; Jakarta; Beijing; Atlanta and Athens, Georgia; Columbus, Ohio and Ho Chi Minh City. I call these places all the time. They're great people. There's no point in not using them. But generally I would say e-mail first."
The Association of Health Care Journalists has a "covering flu and pandemics" resource page.
The WHO handbook for journalists says pandemics occur about every 10-50 years. A pandemic in 1918 caused 40 million deaths, a pandemic in 1957 caused two million deaths and a pandemic in 1968 caused a million deaths. I am confused with some of the stories the news...
