COVID–19 will be an all-consuming story for the next few months. It will require access to expertise and the ability to understand complex disciplines such as epidemiology and global health. It will also demand a considerable amount of resources from newsrooms that were already overstretched. Our Journalist Fellows spoke about these challenges with public health experts Peter Drobac and Trudie Lang in two virtual seminars chaired by Meera Selva. Peter Drobac is the Director of the Skoll Centre for Social Entrepreneurship at the Said Business School. Drobac works at the intersection of education, health and technology and he played a role in the transformation of Rwanda’s health system. He holds a Master of Public Health from the Harvard Chan School of Public Health, and a Doctor of Medicine from the Medical College of Wisconsin. Trudie Lang is a Professor of Global Health Research at the University of Oxford and a Senior Research Scientist in Tropical Medicine at the Nuffield Department of Medicine. Lang is the Director of the Global Health Network, a free online platform for health workers and researchers around the world to exchange knowledge, share methods and form collaborations.
Here are eleven tips (and a final takeaway) from those seminars. Lang’s and Drobac’s responses have been edited for clarity purposes.
1. On what sets this crisis apart from other crises.
Peter Drobac. There are at least three things that set this situation apart from other crises.
First, this is a story that has become all-consuming in a way that is unprecedented to me. It’s hard to even find a news story that’s not about coronavirus. That all-consuming nature affects things because it pulls a lot of journalists in who may not have the relevant kind of expertise.
The second thing that’s different is the degree of newness and uncertainty about this. The virus has been with us for about three months. There’s a lot of uncertainty around aspects such as public health behaviours, the way it’s transmitted, how quickly it’s transmitted. There’s so much we don’t know. It’s such a fast-moving thing. That uncertainty leaves a lot of space for misinformation, for speculation, and for us to go down rabbit holes. You want to portray information in a way that is clear and measured. But sometimes it’s difficult to do that while admitting how much uncertainty there is because that can undermine trust in the first place.
The third thing that’s different is the role of social media. It’s been around with past epidemics. But this might be the first major epidemic for which our culture has been so reliant on, engaging with social media. I’ve seen misinformation and conspiracy theories but also really important ways to convey information early and bypassing traditional channels. And also it’s an important mechanism for community building at a time when we are isolated.
2. On the role of misinformation and social media.
Peter Drobac. This pandemic is new and scary. There are lots of unknowns. So it’s the perfect breeding ground for conspiracy theories. Unfortunately, those theories get clicks because they inspire fear and emotional responses.
One thing I observed is that the big tech companies have tried to make a fairly robust response to misinformation. If you think about their response to misinformation in the context of Brexit or the US Presidential election, Facebook was really wary of stopping misinformation because it didn’t want to be seen as taking a political stand. This is less inherently political because it affects everybody and these companies face less backlash when taking a stronger stand. They’ve acted more quickly and that’s been heartening. On the other hand, they’ve been overwhelmed. But this shows what a massive effort is required from these companies to combat the problem.
3. On how to spread public health messages.
Trudie Lang. Public health messaging is absolutely important in all of this. Public health messages need to be right for the population and the context. I work with lots of social scientists and anthropologists. They tell us that for a public health message to be successful you have to reach 80% of the population. That’s what we saw with Ebola. We persuaded 80% of the population to trust our messages: that they should wash their bodies and practise social distancing and all that. Those things are really key and the press is absolutely critical for that.
“For a public health message to be successful you have to reach 80% of the population and the message needs to be the right message for the population and the context”
4. On the need to convey this is a real threat.
Peter Drobac. This is really serious. This is the big one. This is something real. This is going to be the most significant public health catastrophe in a generation. It’s important for everyone to realise that. Everyone has a moment when they realise they’re not in real times anymore and it’s actually important to get to that place. So there’s a balance. But it’s not wrong to be scared. It’s wrong not to be conveying information that this is big and scary because it is. Ideally there’s the right amount of fear that can inspire action without being paralyzing.
I’ve certainly seen too much uninformed journalism saying this wasn’t that bad. We’ve seen many leaders trying to calm the public or the markets but in doing so actually minimizing this is a real threat. That is not a good thing. We have to realise this is a different scenario. We have to realise that all our lives are going to change.
5. On the role of the research community.
Trudy Lang. The research community’s job is to listen to what the politicians are saying and the decisions they’re making, and help the journalists to put those decisions into context and try to explain them. Politicians have to plan for the worst-case scenario and put everything in place. But then journalists are writing that up and our role as scientists is saying: “They are doing this because…”. We can explain what it means to have effective testing. We can explain the science behind all those decisions.
6. On how to inspire trust while being critical.
Peter Drobac. I’ve been quite critical to the UK government’s response to the pandemic. Early on there was a clear, very aggressive preparatory response. Over time it became less clear that this was the case. And then, the alarms went off for many of us in the medical and public health communities. There was a big backlash and pressure caused a U-turn. But we lost a lot of time in the process.
Over that period, journalists were in an uncomfortable place. We are on a wartime footing. We need folks to work together. We want to be able to believe our government is going to lead us. So if our government is providing a strategy and guidance, shouldn’t we trust that they’re saying the right thing? And when they’re not saying the right thing, not necessarily out of malevolence but maybe just through their own decision-making, is it right to say that?
Critics like me have faced scepticism and have been told things like: “Are you being alarmist here? Are you just trying to get attention?” And we were just questioning the decisions that were being made. I felt there was a little bit of a timidity in the UK media and not enough scepticism in government. Only when there was an uprising from the public health community and others, they were able to get at the story that way, rather than asking the government directly.
7. On what not to do as a journalist.
Trudie Lang. I’ve spoken to a few journalists who had decided their angle beforehand and they were completely wrong, to the point of being irresponsible. Here’s an example. In many Asian nations we are seeing very few cases and a journalist from a [British] national newspaper asked me about that. He asked me if I thought they were hiding the cases in those countries. And no, I didn’t think so. I think countries are behaving responsibly. So that’s a very bad line to go down, but the journalist kept going and I didn’t want to be misquoted. That kind of thing can stop me from taking a request from another journalist.
8. On how to encourage people to stay home.
Peter Drobac. People have different motivations for being cavalier and not doing this. To me the most important message is this one: “It’s not about you. It’s about the people you care about.” It could be your neighbor or a member of your family. There’s a little bit of a butterfly effect here: this kind of notion that the choice that you make can hurt other people. Let’s be educational but also let’s do public shaming. This goes back to wartime footing, that a lot of us haven’t experienced in our lifetimes. This is a World-War-II kind of thing. There will need to be wartime mobilisation efforts. Factories will need to start making different things. We need to get into that kind of wartime footing really soon.
“This crisis is serious. If you are a journalist, convey seriousness and severity while doing that calmly. Whenever possible, try to inspire this notion that we are all in this together”
9. On what the next four months will look like.
Peter Drobac. It will almost certainly get worse before it gets better. Even two weeks after the lockdown, it’s not under control in Italy yet. And this shows that once it reaches some velocity it’s tremendously difficult to stop. We are in the quickening phase in the UK and the US. We’ve been caught flat-footed. We’ve been complacent. We are going to see a lot of disease and a lot of death. It’s not going to be pretty.
In the Middle East, in Africa and in Latin America, we are still learning. In South-Saharan Africa we have seen few reported cases. And this raises questions on whether it’s because of the warm weather, or because the people are younger or because governments are not testing. I suspect it’s the latter.
So I think in four months some parts of the world are going to be still reeling from this. Once it sort of hits, if you don’t do anything to flatten the curve, you’re looking at something between nine and 13 weeks. However, because almost every country is doing something to slow the spread, this could drag on for many more months. That means we may still be actually at a peak in a lot of those countries in a few months.
The countries that have already contained this (China, Singapore, South Korea) have a different kind of problem. They have shut down most businesses and stopped social interactions. As soon as they get back to normal, they can see another surge. So what we don’t know is how to get back to normal without creating that risk. Is it possible?
So even in those countries that have been successful in beating it back, there’s going to be other set of challenges around how we get back to a little bit of normal, how do we increase economic activity to minimise pain and harm for the most vulnerable and balance that with the risk of the virus coming back. That could be this kind of ease off a little bit, lock down a little bit more happening over the course of the next year and a half. So it’s not going away any time soon.
10. On which countries are better equipped.
Peter Drobac. Health systems with more resources tend to be better off. Anywhere between 10% to 20% of the people who’ll get infected are going to be seriously ill. So no matter how well organised a country like Rwanda happens to be, if they only got a dozen ventilators in the country, they are going to be overwhelmed.
Another asset that is really important is universal health care. In a place like the US where 28 million people are uninsured and lots of others are under insured, where it might cost you hundreds of dollars to get you in front of a doctor, people are not going to go. People are not going to be tested and that’s going to be a problem.
In addition to that, whatever the health system will do for coronavirus, there’s also the question of how your health system is going to cope with people with other kinds of diseases. With Ebola, we saw an equivalent number of deaths from malaria, diarrhea, women dying in childbirth and other regular conditions because the health system collapses.
Finally, you need to create an effective public health response. In order to contain the outbreak, you need the ability to test very widely. From there, you need to isolate those individuals and trace the people they’ve been in contact with in the last seven days and screen them and isolate them for two weeks.
A lot of Asian countries were worried about the next SARS and jumped on this very early. Another country that’s been effective has been Rwanda, sometimes called the Singapore of Africa. They’ve had multiple scares about Ebola and that infrastructure from past epidemics has been operationalised right away. Around 95% of the population has some kind of health coverage. They were very quick to introduce screening in airports, to put hand washing stations at bus stations and they built screening capacity much more quickly than other countries in Africa.
11. On the measures taken by the most successful countries.
Peter Drobac. The countries that have done well all of them have done some combination of the same things.
First, they acted early. They took this seriously. They had a bias for action. We are in a situation of uncertainty and this can cause us to overreact or underreact. I’d rather be wrong for doing too much and be accused of freaking out than the counterfactual, which is lots of people dying because we reacted too slowly.
Secondly, they did widespread testing. South Korea is famous for this.
They ramped up testing. They’ve done 10,000 people per day. You’ve probably read about the drive-through test centers. Anybody can get a test. It’s very easy to do and you can do it in a way that doesn’t overwhelm the health system because people don’t have to come to an emergency room and sit with a bunch of other sick people to get a test. Testing is good. It gives you intelligence about what’s happening in the epidemic, what are your actual cases and how they are increasing instead of having to guess, where are the hotspots and then you can make really targeted action to go after those hotspots.
The third big element is social distancing: stopping mass gathering, working from home, closing bars and restaurants, closing schools, limiting public transportation. We don’t have a great sense of which of those things is the most important. But the general idea is that the more of that that’s happening, the more we can limit the spread of the virus.
One last thing. Every country should prepare its health system for the surge. Flattening the curve is a part of it. But you have to make sure the health workers are protected because if they start falling, the health system collapses. You have to be able to prepare a parallel health system and take care of people with coronavirus in places that are totally separated from the rest of the patient population. This takes weeks.
The main takeaway
Peter Drobac. Transparency, good communication and public trust are very important. We face very difficult tradeoffs between individual liberties and the collective good. Think about the lockdowns that we are seeing around the world. Everyone is asked to make sacrifices. Everyone has to give something up. So communication and public trust is really critical at a time like this.
This crisis is serious. If you are a journalist, convey seriousness and severity while doing that calmly. Be authoritative without hubris. Be authoritative while recognising the uncertainty and the risk that exists. Whenever possible, try to inspire this notion that we are all in this together and that we need to work together to beat this thing.
Courtesy: The Reuters Institute for the Study of Journalism