British Journalism Review

http://bjr.sagepub.com Pandemics, plagues and panic

Phil Harding British Journalism Review 2009; 20; 27 DOI: 10.1177/0956474809348261 The online version of this article can be found at: http://bjr.sagepub.com/cgi/content/abstract/20/3/27

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Pandemics, plagues and panic

Phil Harding
How swine u coverage hit fever pitch, went away and returned when the virus became worrying: a salutary health warning for editors
First reports from Mexico of an outbreak of some form of unidentified respiratory illness started circulating in early April. The New York Times reported that the World Health Organisation (WHO) got its first alert on April 10. On Thursday April 24 tests from a Canadian laboratory confirmed that it was a new type of influenza, A(H1N1). All schools in Mexico City were closed. The Mexican government told the WHO that it suspected 60 people had died. This decision by the Mexican authorities to start releasing numbers of suspected deaths seems to have been a big mistake on their part one that the worlds media were only too willing to amplify. Only later did the Mexican authorities start releasing figures for confirmed deaths. The number of suspected deaths rose very quickly to more than 100 and then to 176. But the number of people who were actually confirmed as having died from the virus was much lower starting at 10, then rising to 20. Even by the end of June two months later the total number of conrmed deaths had reached only 108. This was one of those rare stories where the death toll dropped. The early misreporting of the figures was to play a significant part in the genesis of this story. Over the weekend of April 25/26 the story quickly took off in Britain. On the Saturday morning, the Today programme ran a down-schedule item reporting the 60 suspected deaths, as did some newspaper websites. The rest of the media followed up quickly. By Sunday the story was across most papers and it led BBC1s main Sunday night news. One of the phenomena of British journalism these days, with its hungry 24/7 news cycle, is the way that over a
Phil Harding; DOI: 10.1177/0956474809348261; [2009/9] 20:3; 27-33; http://bjr.sagepub.com
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British Journalism Review vol.20 no.3 september 2009

weekend stories can rise to prominence extremely quickly. There is still as much space to fill but a less crowded news diary. The reporting that weekend very quickly lost any distinction between those deaths that were suspected and those that were confirmed. The death toll was reported as having risen to 80 by Sunday, by Monday to 149, without any qualification. The picture that was painted in much of the British media was of a country overrun by a new plague. Yet even if the early, inflated death figures had turned out to be true, the proportion of the population affected would have been minute. Mexico has an estimated 109 million inhabitants. Mexico City alone is a metropolis of some 20 million people. Stephen Gibbs, the BBC correspondent in Mexico City, who was on air frequently in the early days of the story, described his experience thus: Living in Mexico City I didnt know anyone who had the flu, yet I was constantly being asked by presenters whether there was panic in Mexico City and in fact there wasnt any.

The story theyd been waiting for

The apparent speed of the rise in the suspected death toll undoubtedly contributed to the way the story took off. But there was also a second factor. This was a story that, for a long time, many health correspondents and editors had been waiting for. Both the WHO and the Chief Medical Officer for England had been persistently warning that a flu pandemic was inevitable. The Government had elaborate flu plans in place as did many media organisations. Avian flu may have failed to materialise, but this could be the real thing. Editorial reflexes were just waiting to be tapped. On the Monday, by the time the first cases of swine flu were reported in Britain (Daily Express: Killer flu: its here) the media covered little else. Swine flu dominated the front pages and covered many inside. It led television and radio news bulletins for days; with giant video-wall graphics of a menacing black spiky virus, the news channels covered little else for hours on end. Even when you werent watching television, you couldnt escape: and if youre leaving the house but you want to catch up on the latest news on the flu, remember our website. The Guardian set up a minute-byminute blog so as not to miss even the smallest detail. Ten per cent of travellers coming back to the UK from Mexico were said to have a cough of some sort. The Jeremy Vine Show on Radio 2 was reporting that Heathrow taxi drivers were refusing to carry anyone recently arrived from Mexico. The headline writers had a medical field day. We were warned that 1.2
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million Britons could die, that 40 per cent of the population could catch swine flu and that fear was spreading like a Mexican wave. The BBC gave us hourly updates from the Scottish hospital where two Britons were (not very) ill, a BBC correspondent delivered a piece to camera in Mexico wearing a facemask. ITN interviewed an early British victim through her closed front room window via a mobile phone Im scared I might have infected friends. The Sun warned us that a deadly strain of superbug MRSA could team up with swine flu to kill thousands, thus managing to hit two editorial scare jackpots in one go. But it was probably the Daily Mail that scooped the headline hysteria prize with How swine flu could be a bigger threat to humanity than nuclear war over an article by their science editor, Michael Hanlon (the article itself didnt actually go that far). Frequent comparisons were drawn with the Spanish flu outbreak of 1918, which killed about 50 million people across the world (some estimates say more). Scratchy black and white film of the time was often shown, ITN grimly reported: This time around swine flu could be just as devastating. Few bothered to mention that in 1918 immunity levels were low because of the end of a major war, or that standards of hygiene and health have improved dramatically since, or even that there werent any antiviral drugs then. In every paragraph swine flu was described as the deadly virus. There was very little attempt to explain the difference between the infectiousness of the new virus (high) and its deadliness (low). Health experts were interviewed and quoted where they could back up the scariest projections but rarely were those experts careful caveats and qualifications included. When it came to giving figures, the top of the range was always quoted and the words up to, could or may were usually lost. There was very little context. Rarely were we reminded that normal or seasonal flu regularly kills between 4,000 and 12,000 people in the UK every year. As one reporter confessed: We put the worst case in the first paragraph and the caveats in the fifteenth. In the first few days of coverage, Shaun Ley on Radio 4 was one of the few to show a sense of perspective. He started The World At One with these words: Sars, avian flu and now swine flu the mention of the first two of those is perhaps a reminder that the amount of media attention is not always a totally reliable guide to the seriousness of a disease But never let it be said the British media lack balance. This early, scary coverage rapidly provoked its own reaction when several columnists flew to their keyboards to denounce what they saw as over-the top panic reporting.
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British Journalism Review vol.20 no.3 september 2009

British Journalism Review vol.20 no.3 september 2009

First out of the blocks was Simon Jenkins, who rounded on both the media and officialdom in The Guardian with the cry: We have gone demented. He was swiftly followed by Deborah Orr in The Independent We need to be inoculated against outbreaks of panic and that perpetual sceptic Christopher Booker in the Daily Mail: Pandemic of panic. These columns, though sometimes overstated, were a useful corrective to much that had gone before and helped to start a real debate about how serious an outbreak this was. They caused several editors to reconsider. This strident outburst of scepticism in turn then produced its own counter-reaction as several science journalists pitched in to argue that it wasnt all hype. Jeremy Laurance in The Independent put forward the view that there was a genuine cause for alarm, and Tom Sheldon from the Science Media Centre, writing in The Guardian, responded to Jenkins with the stinging rebuke: In his dismay at the lack of a pandemic he reminds me of a man playing Russian roulette who, after two squeezes of the trigger, declares: Ha! This isnt dangerous after all. Even The Guardians Ben Goldacre, that scourge of bad science reporting, refused to join the sceptics side, arguing that this wasnt all hype and that the risk was real (more on risk later). So within the space of a few days the newspapers went from total panic to major disbelief and then halfway back again to a genuine cause for alarm.

Headlines became less lurid

As the death toll in Mexico dropped and most of the British flu victims turned out to have nothing more serious than aching limbs and a temperature, the coverage seemed to settle down and become much more measured. It also dropped off the front pages. The headlines became less lurid and more context was added as we were finally reminded that seasonal flu in Britain normally kills several thousand people every year. The important caveat was also added that the summer low flu season would probably not be the time to judge the full severity of this virus. Several health editors also pointed out that even if the virus did not come back in a deadlier form in the autumn, it could still be a substantial killer. Though this is a story that is obviously far from over, clearly there are some lessons to be drawn both for the media in the way they covered the story and for governments and other bodies in the way they released information. When asked whether there had been an over-reaction in coverage, one editor replied: We were well aware of the dangers of overDownloaded from http://bjr.sagepub.com by Manuel Moreira on October 24, 2009

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reacting. After all most of us had been through the fiasco of the over-the-top coverage of the dead swans in Britain which didnt bring an epidemic of avian flu. But then when the WHO started holding daily briefings and started escalating the level of pandemic, what were we supposed to do? Ignore it? There is certainly a lot in this argument. Health officials may argue that they were responding only to media interest and a need to inform the public, but when someone as prominent as EU Health Commissioner Androulla Vassiliou advises against non-urgent travel to the whole of the United States, it does little to encourage proportionate reporting. Some editors suspect that the WHO may have been deliberately using its media campaign to encourage some laggard governments to do more to prepare for a flu pandemic. Some governments, including the UKs, were reported as being critical of the WHOs stance. As Deborah Orr pointed out, the WHOs scale of alerts advises that in a phase one situation, as well as in phases two and three, countries should prepare the health system to scale up. In other words, as she put it the official advice is to live constantly in fear. Later the Financial Times reported that the WHO had bowed to international governmental criticism and had raised the threshold necessary for it to declare a full flu pandemic. In these circumstances officials and politicians have to steer a careful course between alerting the public to a potential threat and reassuring them. Certainly there is always a temptation for politicians to be seen to be in charge and to be reacting swiftly to a crisis. That in turn feeds the media cycle. If the governments emergency COBRA (civil contingencies) committee meets, thats news. If the Health Secretary makes a statement in the Commons, that again becomes news. If the Scottish Health Secretary holds daily media briefings, that makes even more news. The whole thing becomes a vicious spiral. The media feed off officialdom and officialdom feeds off the media. As journalists, we have some issues to ponder, too. Of course newspapers have to sell copies, of course broadcasters want to attract an audience, but if part of the argument for journalism and for its special and sometimes protected space in society is that it is a necessary medium to inform the public reliably about important things, how good a job did it do this time? Journalists need to ask themselves some hard questions about the way this story was covered, especially in the early stages. Was there anything like enough scepticism about those early figures coming from Mexico? Was there enough interrogation of the supposed death rate or the way some experts
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British Journalism Review vol.20 no.3 september 2009

British Journalism Review vol.20 no.3 september 2009

extrapolated that into possible figures for the UK? Was there and I think some of the experts themselves must bear responsibility for this enough explanation that epidemiology is necessarily a very imprecise science relying, as it does, on a lot of assumptions, wide ranges of prediction and considerable margins of error? Was there enough context and enough of an attempt early on to explain that flu kills people all the time? Was there enough straightforward admission that there was lot about this story we didnt know at the time? Journalism is bad at dealing with uncertainty and risk two concepts that lie at the heart of this story. By its very nature, journalism, as the early draft of history, tries to establish and make concrete facts which at the time may be incomplete or not known. It tries to make connections and suggest scenarios when the correlations may be at best tenuous or speculative. Journalists hate saying they dont know even when its clear they dont. Yet good journalism should sometimes be as much about saying what we dont know, as well as reporting what we do.

What the headline writers prefer

Assessing risk and conveying the nature of it to a readership or audience is not an easy thing to do. It is certainly not easy to do in a way that makes immediate sense or is in the slightest bit catchy. Saying that you have a 0.7 per cent chance of dying from something is not an immediately graspable concept. Saying you have a seven in a thousand chance doesnt help a whole lot more. Does it mean that if there were a thousand people in this building seven of them would die? Well, er not quite. It means that on average seven would die. So what does on average mean? And so on. In any competitive journalistic environment even the most responsible headline writer is going to prefer: Experts say up to a million could die to Experts say on average 0.7 per cent chance of dying from flu. But journalism in general and medical journalism in particular needs to find some form of language that does a better job of conveying risk than that which is currently on offer in newsroom style books. By mid-summer the one-time deadly virus had become overwhelmed by the deluge of receipts from MPs claims for second homes, duck islands and moat clearing. When the WHO did finally declare that the outbreak had reached a full stage 6 pandemic, the story had become relegated to the inside pages of most papers. Yet, as I write, it is clear that swine flu is far from over.
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There have been fresh outbreaks in Britain, and more deaths. Swine flu a see-saw story if ever there was has been sporadically in and out of the headlines throughout the summer. Journalism is often bad at finding any sort of middle ground. A story is either apocalyptic or its ignored. The awkward truth about swine flu, thus far at least, appears to be that, while it can be a serious illness, its not going to wipe out the world. The problem the media have now set for themselves is that if the illness does return in a more serious form this winter, it is going to be difficult to find the language and prominence of coverage that is going to convey convincingly the true level of threat. After the disproportionate hype of early summer, will anyone believe a word that is written or spoken?
British Journalism Review vol.20 no.3 september 2009

Phil Harding is a journalist and media consultant. He is a former controller of editorial policy at the BBC, and has been editor of the Today programme and director of news at the BBC World Service.
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