Covering Ebola

As of September 14, 2014, 2,630 people have lost their lives to the Ebola virus, according to the CDC, with a total case count of 5,347. The current outbreak has been the subject of extended media coverage globally.

But as journalists, bloggers and scientists come together to discuss the causes, implications, 'what if's', challenges and potential solutions of this outbreak, many of us have questioned whether we are focusing on the right things. Are we being scientifically accurate? Are we conveying the larger social and cultural context of this outbreak? Are we incorporating needed elements of crisis communication, ethics and citizen journalism? Or, in the worst cases, are we writing about Ebola to get clicks? Are we sensationalizing and pursuing the 'what if's' (what if the virus mutates? what if it becomes airborne? what if it reaches the U.S.?) at the expense of focusing on the immediate issues involved in helping people and minimizing the outbreak?

Several of us here at SciLogs are interested in taking a more critical look at how journalists and bloggers (and scientists and citizens, as well) are covering the 2014 Ebola outbreak. Below, I share a Q&A I initiated with Erika Check Hayden, biomedical reporter @NatureNews; Jason A. Tetro, AKA 'The Germ Guy'; and Kelly Hills, blogger and professional editor and writer in the medical sciences and humanities. The topic of discussion? Their perceptions of media coverage of the outbreak so far, and how we can do better.

In another exciting project, SciLogs.com blogger Nsikan Akpan, author of That's Basic Science and science reporter @nprGlobalHealth, is leading us into our second installment of OpenSciLogs with Outbreak Abroad, a story project about how journalists cover outbreaks like Ebola. Outbreak Abroad, a crowd-funded and open, citizen journalism project, will launch on Indiegogo early next week, so be on the lookout.

Now, let's hear from Erika, Jason and Kelly. Erika Check Hayden has done an amazing job bringing human and ethical angles to the outbreak with her coverage at Nature News. Jason has been working in laboratories since 1987 and has worked with some of the most important microbes in human health. He has quelled some fears with his coverage at Huffington Post, has written about the historical context of the current outbreak and has addressed the airborne allegation. He has also served as an expert source for journalists writing about various health communication aspects of this outbreak. Kelly Hills has been consistently rocking critical coverage of the Ebola outbreak, and news about the outbreak, on her blog and in her tweets. Her 'Wielding a Red Pen: Correcting a Fear-mongering Ebola Piece with Facts' is simply fantastic.

1. What are your overall perceptions of the media coverage of the 2014 Ebola outbreak so far? (Focusing on US coverage, but can also comment on global coverage)

Erika Check Hayden: I think most journalists are trying to do what they can to make sense of an evolving and unprecedented situation. It's very difficult for any single piece to convey the complexity and sheer scale of what is happening; it's not simply a medical or science or economic or foreign affairs story: it is a humanitarian crisis.

Jason ‘The Germ Guy’ Tetro: Basically, it’s the usual US-centric coverage. It was a sideline story until Dr. Brantly was infected and then it became an issue. The most recent coverage comes in light of the obvious lack of support shown by the US until now. How this plays out, however, will be anyone's guess. It all depends on whether reporters will become embedded with the military.

Globally, Canada, UK and Australia seemed to take it seriously. Only when it spread to Nigeria did it really wake up the French populations and many other regions of Africa. Surprisingly, nothing really changed with the declaration of the Public Health Emergency. Only when the number exploded and the roadmap emerged did the rest of the world decide to get involved.

Kelly Hills: Middling at best. There's been too much focus on the American health care workers and British nurse who were sick, and not enough on the folks in West Africa dying of the disease. There's also been a lot of supposition and fear mongering, especially about "the disease must have mutated" and a strong focus on "what is the risk to the US?"

Global coverage has varied; the best I've seen has come out of Nigeria and South Africa, which isn't too surprising, if you think about it.

2. What, in your opinion, makes coverage of Ebola / this outbreak particularly tricky, difficult, etc.? How can journalists / crisis communicators overcome this 'trickiness'?

Erika Check Hayden: Three things have made covering this particular Ebola outbreak difficult for me as a reporter based in the U.S.: One, it's taking place far away from the U.S. and the situation is highly unstable, so it's difficult for me and for most other U.S. journalists to see firsthand what's happening and it's difficult for many readers to care. Two, it's been going on for a very long time, so it's difficult to continue to make the case to our editors and readers that they should continue to run stories about it and to read about it. Three: the scope and scale is simply unprecedented.

The only ways to overcome these obstacles is to try as best we can to get close to the ground in covering the story. One way is to contact the agencies working there and ask them to connect us with their people on the ground (http://www.nature.com/news/world-struggles-to-stop-ebola-1.15768). This gives us more human anecdotes and stories to tell about how individual people are experiencing the outbreak or working to stop the outbreak. For instance, we can say that hundreds of health workers are dying; but that broad statement won't be as compelling as a story that tells the story of the bravery or difficulties faced by one particular health care worker.

The outbreak as a whole is so large and abstract and remote that it's easy for people to just ignore our coverage - unless we give them a relatable human story that will draw them in and make them care. You can do this no matter what kind of outlet you write for and no matter your role. I have seen health workers and scientists, for instance, do an outstanding job of humanizing the epidemic (http://www.nature.com/news/make-diagnostic-centres-a-priority-for-ebola-crisis-1.15880, http://www.nejm.org/doi/full/10.1056/NEJMp1410179 and http://www.nytimes.com/2014/09/07/opinion/sunday/studying-ebola-then-dying-from-it.html?_r=0).

Jason ‘The Germ Guy’ Tetro: Coverage is not easy due to the location, the climate, the overall reception from the people and of course, the sociopolitical history of the environment. From my contacts on the ground in these affected areas as well as discussions with WHO [World Health Organization] and MSF [Medecins Sans Frontieres], there is a lack of trust of anyone from the West. This only compounds the problem.

As for crisis communication, it’s hard to develop a good means to accomplish this when the current view of the public regarding governments and other experts is poor. If there’s no trust, there is definitely no means to have communication heard.

Kelly Hills: Probably the biggest issue is getting over/around the 'OMG BLEEDING OUT' fear that has been...encouraged by some books and movies that revolve around Ebola or Ebola-like diseases. There is a misconception of how the disease spreads that directly activates a panic/fear response in a lot of people, because they don't actually stop to think about how the average cold or flu is spread (seriously, so much worse than Ebola if you think about it for a minute).

So, covering Ebola often requires walking back the fears that are part of an unconscious cultural zeitgeist because of the pervasiveness of say, Preston's The Hot Zone.

How do you overcome this? Well, obviously a good hook helps–the current epidemic does give one, in that it gives journalists/communicators an easy hook in something along the lines of "If you came of age at a certain time, when you hear Ebola, you almost certainly associate it with stories of people horribly bleeding from every orifice, eyes weeping blood, as they die a violent and wet death. Graphic, it makes for good thriller reading or movies–and yet, is so inaccurate, people are actually dying because it doesn't look like you think it 'should' from these popular media reports."

Essentially, I think you have to walk back what people think they know, in order to share not only what they should but need to know. The problem with this, of course, is that it's not a snappy and dramatic and click-bait-y as 'THREE SIMPLE TRUTHS ABOUT EBOLA THAT COULD SAVE YOUR LIFE' style headlines.

3. What does good coverage of Ebola / this outbreak look like? (specifically from a crisis communications point of view, if you have thoughts on that). What does it take to cover an outbreak like this well, in news stories or blog posts or other mediums?

Erika Check Hayden: The best coverage that I have seen of the outbreak so far has been firsthand accounts from health workers (see the instances cited above) and journalistic pieces that bring humanity to the outbreak, such as much of the coverage by Adam Nossiter at The New York Times, i.e. http://www.nytimes.com/2014/08/19/world/africa/surviving-ebola-but-untouchable-back-home.html.

Jason ‘The Germ Guy’ Tetro: There is no ‘good’ way to cover this outbreak without incorporation of the local media. They are the ones who understand the culture, the people and how the tide has turned (and whether this is unusual - it may not be).  As for crisis communication, it needs to be centralized on the ground in affected areas and focus on the people there. While it is good to have people like Dr. [Tom] Frieden and Dr. [Anthony] Fauci offer their comments, it will do nothing to stop the outbreak there.

I also believe there is an onus on the various mediums to expand the call for help expressed by both the WHO and MSF. Unfortunately, this didn't happen quickly.  As a result, little was done for months after the Public Health Emergency was declared. While traditional media may not choose this route, blog posts and social media can be used to spread the word. MSF has done a good job but they can’t do this alone.

Kelly Hills: All it really takes to cover this well is a bit of an education–self-directed or otherwise–and patience to fact-check your information. Unfortunately, both of these things seem to be in short supply right now. ...I suppose that while it should go without saying that Chicken Little "sky is falling" coverage does no one good (and in fact does appreciable and noticeable damage), it should probably be said: sensationalized and inaccurate speculative media coverage of the Ebola epidemic is irresponsible and immoral.

4. Can you give examples of good and bad coverage of this Ebola outbreak? What makes the coverage good or bad?

Kelly Hills: Good coverage? I've enjoyed Helen Branswell's coverage, as well as Martin Enserink. My favourite piece from Developed World media so far was by Gretchen Vogel for Science/AAAS: she covered the heavy toll of Ebola, looking at the deaths of multiple authors on the paper on genetics of the new outbreak. I also think Andrew Pollack at the NYTimes has written a few good pieces, including this one about those who continue working and this looking at the decision to NOT treat Dr. Sheikh Umar Khan. The Wall Street Journal has been running fantastic op-eds from people like Jeremy Farrar, but I'm not sure that counts.

Blog-wise, I think there have been some good pieces up on FluTrackers and Ian Mackay's Virology Down Under Blog. (I'm of course also partial to my own blogging on the topic.)

The most consistently awful reporting has been on CNN, hands down. The Seattle Times had a piece a bit ago about health care workers panicking about Ebola protection guidelines in the United States that really irritated me; while uneducated health care workers exist, I think it was irresponsible of the Seattle Times to use it to push an 'OMG FEAR' narrative.

5. What would you tell journalism students who might cover outbreaks like this in the future, to make sure their coverage is of high quality?

Erika Check Hayden: Whatever angle you are covering the outbreak from should be informed by your humanity. For instance, if you are asked to cover a particular research study on Ebola; do what you can to put some kind of human element and context into the story that will make people care about the outbreak as a whole. Pay attention to what stories have drawn you in, and made you read all the way to the end. Try to emulate their approach.

Jason ‘The Germ Guy’ Tetro: I believe the word ‘context’ must be discussed. A look at the history, the sociopolitical issues, the economic issues, the culture, the behaviors, and the reaction to intervention needs to be explored. Also, a look at how previous encounters in other areas of the world (SARS, cholera, etc.) can offer perspective on how this current outbreak is either unique (it’s not) or similar to other epidemics.

Kelly Hills: It's okay to not be a specialist in the topic you're writing about, and disease outbreaks in particular require a lot of knowledge and expertise. So find the people with that knowledge and expertise; if they're too busy, they should be able to direct you to other people. (Don't be afraid to look for help on Twitter or other social media avenues.) Ask questions, and then ask more questions. Remember that scientists use different language than "normal folk" - so when you hear a virlogist talking about droplet dispersal for Ebola, don't assume this means *airborne*, because the terms have VERY different meanings. Ask questions, and then rephrase the answers back to the person you're talking to. It sounds so simple and Journalism 101, but you'd be surprised at how many people don't do this, and go on to publish inaccurate information.

Also remember that almost every disease outbreak (or epidemic) requires more than just a bacteria or virus; think about what's going on that might be influencing the outbreak. Is the country just out of a civil war? What's the health care like? How is sanitation?

One of the things (relating to The Seattle Times fail of a report I mentioned above) I keep seeing journalists assume, with this Ebola epidemic, is that health care is health care is health care. But what an Ebola containment center looks like in Sierra Leone is much different than what an isolation ward looks like in the United States. Among other things, we have electricity. ...it kind of helps. It got to be so irritating I wrote a picture-based tutorial blog on the topic.

6. Any other tips for other communicators not in journalism, including crisis communicators, university or science PR professionals, etc., in communicating about this Ebola outbreak or similar outbreaks?

Erika Check Hayden: PR professionals: Please don't send journalists lists of potential sources who do not have direct knowledge of the disease in question and who don't have direct knowledge of what is going on on the ground. Please do connect me with people who study the disease causing the outbreak, or who are going to help or have just returned from the outbreak, or are in direct contact with colleagues on the ground. 

Jason ‘The Germ Guy’ Tetro: Be careful and only speak when the evidence is known. A great deal of harm could have been done by the Op/Ed in the NYT by Osterholm. He had little to no basis for any of his ‘What If’ predictions and only contributed to increasing fear.

On that note, avoid at all costs the ‘What If’ scenario. As we’ve seen in a recent survey http://policyoptions.irpp.org/2014/09/15/contagion-fear/ - people already can make up their own fantasies and fears. They don’t need this to be fueled by experts.

Kelly Hills: Rely on the experts. And University PR/PIO? Check all your departments! Don't be afraid to mass email! Look under rocks–and I mean that kind of literally; my alma mater? The epidemiologists often were in the geography department, because diseases are often impacted/affected by natural terrain. Your bioterrorism and select agent specialist might be tucked away in the medical ethics department (UPenn-they have two). Your best bet for epidemiology may actually be the public health department at Harvard.

Ideally, university and science PR professionals know exactly who studies what in which department. In a not-so-ideal but probably more realistic world, you at least know what each department covers as area of specialty and expertise that can be commented on, even if you don't necessarily know who, within the department, does that.

7. Is science literacy an important aspect for media coverage of this outbreak, as well as public understanding?

Jason ‘The Germ Guy’ Tetro: I would argue science is secondary in this case. Yes, we know the virus, we know how it infects, how it spreads and how it can lead to an outbreak and epidemic. So do the experts and they should be given the time needed to express their knowledge. Public understanding as I mentioned earlier is imperative in terms of the local environment. Also, based on the survey from the previous answer, public knowledge in terms of the audience is also needed.

I would suggest the best way to approach this outbreak and any crisis communication is to look for the best way to keep the calm. If this means science, use science with experts. If this means culture, ask an anthropologist. If this means political, talk to the UN. If this is medical, talk with MSF. If this is ethical, talk with the WHO. Any other sources can be asked later, when it’s over. We will have all the time in the world to review and critique. In this moment, when there is such a crisis happening, choose your experts wisely and let them teach you what is needed.

Kelly Hills: Definitely: see the above for the difference between droplet and airborne dispersal. If you're not literate in not only science but virology/epidemiology, you're probably going to make the mistake of assuming these are the same thing. But I think it's important to note that just because you’re science literate doesn't mean you're literate about all science: know your limits. Me? I can happily talk epidemiology when it comes to mechanism of infections, virology, behaviour, and general biological stuff like that for days. Put me near physics and my eyes cross like a stereotypical blonde caricature confronted with maths.

The public–at least the American public–isn't working at a level of scientific literacy necessary to understand most academic reports. This is one of the reasons it's important for a journalist to find someone, even if they're not necessarily the scientific expert in the field, who can translate from "scientist" to "everyday Joe/Jane on the street." Some scientists have this skill, and they're worth their weight in gold. Others know enough to say "here's the quote you want from me, go talk to X for more information." Many are impenetrable, and it's up to the person doing the story to seek out the person who has the expertise to both talk science and talk simple and soundbites.

More Reading:

Scientists see risk of mutant airborne Ebola as remote, via Reuters

Studying Ebola, Then Dying From It, a piece that brings humanity to the outbreak