"VIRUS SPREADS AT TWO COLLEGES" screamed the boldface headline on the front page of a recent Times of Trenton in New Jersey. For those encountering this alarming story for the first time, there was at least some reassurance: the smaller boldface subheading announced, "Officials say contagion's peaked." Anyone skimming the front page could also learn that the "highly contagious norovirus" was "basically contained" on the two campuses.
The problem was that the story was misleading and incomplete. As one who studies public health preparedness, I believe, however, that it may represent some of the challenges we could face as a nation when confronted with a life-threatening epidemic.
The story was positioned to attract public attention and allow readers to learn the salient details even without buying the newspaper. This was not the first reporting of the epidemic on the two campuses, but the bold face type and text above the fold on the front page caught the attention of more than just dedicated newspaper readers. If the headline provoked fear, the visible text effectively told readers that they need not worry.
To be sure, news reporters and editors face difficult decisions on how to report a developing story about the unknown course of a disease. In reporting on the New Jersey disease outbreak, however, the media lost an opportunity to establish its credibility as a source for useful and accurate information during an unfolding crisis. For example, once it dramatically announced the contagion, nowhere on the front page did the paper include advice on how people could protect themselves from contracting the disease or what to do if they or someone in their family got sick. Since the norovirus cannot be prevented by a vaccine or medicines, the story missed an opportunity to educate the public about their role in preventing the spread of disease.
While most stories mentioned the role of frequent hand washing, they did so only in passing and buried it at or near the end where only dedicated readers might see it. They failed to emphasize that hand washing means more than running one's hands under water. Approximately twenty seconds of lathering with soap, rinsing and drying with a clean towel are essential. Researchers at the Massachusetts Institute of Technology have shown the preventive value of non-pharmacological measures, including frequent hand washing and social distancing that reduces exposing people to the disease. Ironically, the article only referred to social distancing by informing readers that neither of the colleges had cancelled any classes.
Should we experience a highly contagious and deadly novel virus without an available vaccine, citizens cannot simply wait for the government to protect them. Yet, the initial paragraphs of the story also omitted instructions on what a reader should do if he or she gets sick. Reassurances that the vomiting and diarrhea were not long lasting were hopeful but not helpful when the preceding paragraphs implied that an alarming number of people with the virus ended up hospitalized. Even though many of us often feel like dying when experiencing such symptoms, we can often prevent the dehydration that sends many to the hospital. Thus, it would have been useful to advise people of the amounts and types of liquids that best prevent complications. Since a major disease outbreak might tax existing resources, such as hospital beds and medical services, it is helpful in advance to educate people as to when they can help themselves and when they should seek medical attention.
The dearth of information about how individuals can help themselves contrasts with the reports on the activities of officials at health departments and the universities. Certainly it is good that government health officials were monitoring developments round-the-clock and coordinating responses, and maintaining communications among campus, local, and state personnel. This reporting, however, effectively relegated the individual to a bystander.
The headline appeared on February 11, although the contagion was first noted on January 29. Princeton University health officials sent students and employees a public health email alert on the spreading norovirus on February 3, a full eight days before the headline. By the time the paper gave prominence to story, it was also quoting officials' opinions that the disease was contained and waning. Not only does this reporting sequence raise questions about what to expect the next time a threat appears, the optimism appears to be misleading.
A week after the headline story, the numbers of ill students had more than doubled. Contrary to the claim of a local health official that the disease was "confined to campus," other campuses have reported outbreaks. Rider University's decision not to cancel classes or public events resulted in a visiting basketball team returning home with several sick players. Moreover, as a Princeton resident I know of at least a few people unconnected with the University who experienced the same symptoms as those suffering from the virus. Since they recovered without consulting a doctor, there is no official record of their illness. While it cannot be confirmed that they had the norovirus, those who became ill in the past two weeks and those who knew people who were ill could doubt the officials' reassurances.
My point is not that officials made incorrect decisions based upon the information available or that the media was wrong to report what officials told them. Rather, the stories failed to explain that the uncertainty associated with an outbreak of a contagious disease means we do not have all the answers to enable accurate predictions. The episode demonstrates that reporting on officials' intentions, hopes, and disinfection efforts will likely be insufficient to end the spread of a robust virus. The media will not serve the public by minimizing the bad news, the disruptions, and the dislocations that may be required for the public to understand how to protect themselves from and respond to a highly contagious disease.
In a serious epidemic, people facing decisions that may have life or death consequences will need to trust their information sources. If health officials and the media lose their credibility, it may be impossible to recover.
At a time when the media is reporting on the potential for human transmission of the deadly bird flu and the capacity of terrorists to create a bioweapon, the public is ripe for education about what to expect during and how to respond to a serious contagion. Deciding when to report what types of information, and what to identify as fact and what to question, involve making difficult choices.
The media and government officials must be careful neither to spread hysteria nor to offer false assurances. The experience in New Jersey these past weeks highlighted the challenges of balancing the risk of creating undue alarm with the danger of failing to provide timely warning and valuable advice. If New Jersey's experience was a test, we have not achieved a passing grade.
Leslie Gerwin is Associate Director, Program in Law and Public Affairs, Princeton University; she teaches Public Health Law and Policy as an Adjunct Professor of Law at the Benjamin N. Cardozo School of Law.