How’re we doing so far? A post-SARS report card

By
Candace Gibson

The swine flu outbreak is the first real test both of the media and of many of the pandemic plans put into place by hospitals, public health agencies and local, provincial and federal levels of government since the SARS epidemic played out in Toronto in 2003. From my vantage point as an interested scientist and science journalist, most seem to have been doing a much better job of communication and a more balanced job of reporting on the potential risks this time around.

As the initial news of the outbreak settles in, it’s worth taking stock of the lessons Learned from SARS.

Communication, communication, communication: Inform the public; inform the health professionals; inform the government officials. And avoid mixed messages.

The big lessons learned from SARS for the public health side on communication seem to have improved connections between all levels of government and coordinated media messages from public health officers and other spokespersons. In fact, the Public Health Agency of Canada was formed in 2004 on the basis of recommendations of the Naylor Report on SARS.

The federal minister of health, Leona Aglukkaq, appeared with head of the agency Dr. David Butler-Jones at a news conference to allay public fears and announce what actions the federal government is taking.

All are giving the same messages. Don’t panic; this is mild in Canada. Yes, we’ll see more cases – that’s inevitable, but we hope they will remain mild. If you have symptoms (and remember this is still flu season so people are likely to get ill in the normal course of events) and more importantly have recently travelled to Mexico, call your family doctor (call first so they can arrange to protect you and others and also set up tests for the flu virus strain). A travel advisory for Mexican travel was issued by Canada – which is prudent under the circumstances of what is happening in Mexico City.

Reporters should be getting the same message out to the public: Don’t panic. Take the usual precautions against any type of flu or respiratory illness. Wash your hands!

The numbers: Report CONFIRMED cases NOT suspected cases; report NEW cases NOT cumulative totals.

Two of the biggest mistakes made by reporters in the SARS crisis were in reporting the numbers. As it took time for a reliable test for the SARS virus to be developed, cases were designated as ‘suspect’ until they could be confirmed or considered “probable” SARS. Reporting on the number of suspected cases greatly inflated the number of “real” cases of SARS and made the epidemic look much worse than it was. The best indicator of an epidemic’s progression is the number of new cases (or incidences) of disease rather than the total number of cases. Again, the cumulative or total number creates a snowballing effect and the impression that the epidemic is still growing when in fact the number of new cases may be subsiding.

Watch the visual images: A picture is worth a thousand words

The dominant images of SARS were intimidating looking face masks (some with breathing apparatus) and stop signs on hospital doors. Powerful images that stayed in everyone’s mind for far longer than the epidemic

In some cases average citizens started wearing masks in the street – an exaggerated response to the epidemic. Curiously, since SARS was spread by direct contact, similar to the spread of this swine flu virus, it’s not clear what protection the mask affords as you’re walking down the street.

We’re still making the same mistake here – I guess it looks like a dramatic image but it does contradict the “don’t panic” messages that are out there. I hate to say it but my local newspaper plastered a photograph of the local hospital media officer wearing a mask holding a hand sanitizer on the front page. Better they should have shown her washing her hands with the sanitizer – that’s the dominant message we should be getting out there. Ludicrous photos in a city where there are no confirmed cases, in a province where there are no confirmed cases.

Watch the headlines. War, it’s not.

The headline can be the dominant message that is received by readers. Some examples from SARS: “Fatal pneumonia strain stumps health officials”; “Frantic, fearful Torontonians swamp clinic”; “War on deadly foe enters critical phase”.

All of those metaphors of doing battle with the virus – them against us. All of those metaphors of doing battle with the virus – them against us! The headline that accompanied the above photo – “Hospital at the ready” – ready to do battle! Great to hear we’ve got a pandemic plan at the ready and we’re whipping it out.

The truth, however, is more complicated than the metaphor.  They (the organisms) are smarter than us (the mere humans) – always have been, always will be. They’ve had millions (maybe even billions) more evolutionary time to perfect the survival of the fittest. They can adapt rapidly and they do, but ultimate victory for these organisms isn’t to kill us, but to reach equilibrium where they can continue to grow and prosper in a readily available source that provides nutrients, warmth and optimum growing conditions. So if you’re talking battles – we’ll always lose. Let’s find a new metaphor.

There are no absolutes: Seeking certainty is futile

Science is all about probability – not certainty. That’s what makes reporting on these situations and reporting on risks in general so difficult. When pressed to give an answer on the inevitability of more cases coming to Canada or fatalities being seen in Canada, responsible officials will always say that there is a probability of that. Risks are relative – this was pointed out after SARS too. Deaths from flu and pneumonia still make the top ten leading causes of mortality in Canadians every year – mostly in the most vulnerable populations (the elderly, sick or those with compromised immune systems). Forty-four people died from SARS, but about 8,000 people die from influenza and pneumonia every year.

The story goes beyond health: It’s about  economics and politics, too

Toronto’s economy was hard hit by the coverage locally, nationally and internationally on the SARS crisis and it took several years for the tourism industry to recover. We can already see some of the economic impact in this case with world markets in a very unsteady time reacting immediately with a downturn. Individuals were affected by forced or voluntary quarantines that resulted in lost wages (and the government responded slowly to ensure that EI benefits could compensate). Media coverage led to thousands of people staying at home during the SARS epidemic – laudable that individuals heeded messages of voluntary quarantine, but unfortunate that far more went under voluntary quarantine than were actually warranted.

Some links:

York University study – Drache et al, 2003. “Media coverage of the 2003 Toronto SARS outbreak.” Analysis  of media coverage during SARS epidemic, found that the media defined the nature of the crisis itself with its saturation coverage of the issue (one paper printing as many as 25 articles per day).“There is a need to strike a balance between the medical realities of an epidemic and the media’s use of saturation coverage during particularly “newsworthy” moments. To the general public, the severity of the crisis was often communicated by the quantity of news coverage. Busy front pages were, inevitably, read as indications that becoming infected was suddenly more likely.” (This always reminds me of some wise words from a former mentor when we were looking at a multi-multi-authored journal article in the medical literature – “There should never be more authors than subjects” in your papers. Here I could paraphrase – there should never be more stories than people sick.)

S. Detzer, NEJM 360: 1, 2009. Communicating Medical News — Pitfalls of Health Care Journalism

ProMed mail – International Society for Infectious Diseases – tracks infectious diseases around the world –

Public Health Agency of Canada

SARS Report – D. Naylor et al – Learning from SARS: Renewal of Public health in Canada

Google flu trends –  tracks search terms related to flu; so far still only showing regular flu tracking for the US, says its reports are about two weeks faster than official tracking through the US Centres for Disease Control and Prevention (CDC does have up-to-date stats for confirmed cases of swine flu on its web site).

Candace Gibson is an associate professor of journalism at the University of Western Ontario. With a PhD from M.I.T. and a background in the sciences, Candace specializes in medical and science reporting and online journalism. Her previous experience was as a medical reporter for the Discovery Channel, hosting a weekly science program on CHRW FM97.4, and freelance writer for The Globe and Mail and London Free Press.