Reporting Locally

Although a pandemic is in essence a disease that spreads globally, many of the responses to pandemics occur locally. How much people are willing to prepare and how much discomfort they are willing to endure to protect their neighbors are determined by local conditions and attitudes.

On this page, veteran flu reporter Maryn McKenna explains why the granular details of the disease need to be investigated and how that that can be done; and why every reporter needs to look beyond his or her beat to get the flu story right.

On this page...
  Finding a healthy distance on a frightening topic »
  Story ideas to explore »
  The flu pandemic as an agent of disruption »
  Explore this story beyond your beat »
  The pandemic story is local, local, local »
  Ask how things will work »

Maryn McKenna, independent journalist specializing in infectious disease, global health and health policy:

(follow McKenna on Twitter @marynmck)

Finding a healthy distance on a frightening topic

I've been writing about avian flu and pandemic flu for a very long time: In August 1997, I wrote the first story to appear in the U.S. media on avian influenza H5N1. As a result, I've seen a lot of other journalists come in and out of the story, and have watched them climb the curve that I myself climbed: first learning about a very difficult topic, realizing the implications for society and my own life and becoming somewhat frightened; and then gaining control of my disquiet and getting enough distance from the topic to write about it dispassionately.

Story ideas to explore

After I had been writing for a number of years about avian and pandemic flu as a global health and health-policy story, my then-editors redirected me to explore the potential for pandemic flu as a domestic and local issue. That request caused me to branch out into stories that at the time seemed tangential to the threat of avian flu, but which now are very relevant to H1N1 swine flu, with its lesser virulence but emphatic contagiousness.

Some of the stories I did then, that people should consider doing in the swine flu era, included:

How businesses are strategizing their response to pandemic flu.
What historically under-funded local health departments are doing to anticipate the demands pandemic flu will place on them.
How worried emergency rooms are about pandemic flu’s potential to completely disrupt their already overstressed operations.
How cultural imponderables and inherent resistance to change can make even well thought-out plans challenging to execute.

The flu pandemic as an agent of disruption

None of those stories were purely about H5N1 avian flu; instead, they were about an influenza pandemic as an agent of social, economic and political disruption. They have turned out to be useful training for the advent of H1N1 swine flu, because the new flu has turned out to cause great disquiet, social disruption and questioning of public institutions, but not the death toll that would have been expected if H5N1 avian flu had become a pandemic.

Because I have been further along on the curve of this story than other reporters, I have had a chance to think about what the key issues are. Out of my past work on H5N1 flu and my current work covering the H1N1 epidemic, I extract these lessons:

1. Explore this story beyond your beat
  Journalists should be prepared to quickly learn beat topics that may be new to them. This is especially true in post-layoff newsrooms where reporters may be tasked with flu coverage despite having no health-beat experience. Even experienced health reporters, though, need to understand that covering a pandemic is not only about symptoms or insurance coverage or vaccine decision-making.
  If you're a health reporter, be prepared to start learning about globalized businesses. If you're an education reporter, now would be a good time to start reaching out to law enforcement. If you already know about the business and financial world—a key part of the pandemic flu story—start finding out how your local public health department works.
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2. The pandemic story is local, local, local
  How people react to the advent of a pandemic, how much they are willing to prepare and how much discomfort they are willing to endure to protect their neighbors are determined by local conditions and attitudes. And what people will want to read, in order to make decisions that they feel comfortable with, is what is happening in the local school district, in the neighborhood cop precinct and in the shopping mall. People are much more likely to want to know the quarantine-dorm arrangements at the college their child attends than the Department of Education’s national philosophy regarding quarantines on campus.
  Consequently, even those of us who are national health-beat reporters, whose inclination is to cover the big global and national story, need to pay attention to very local, granular details. Here are some examples:
Whether kids in the school lunch (and breakfast) program will be fed if schools close (even though the school lunch program is a federal program)
Whether people will go to work if they feel ill because they live paycheck to paycheck and they can't afford to stay home.
Whether people will insist on going to the local hospital ER, even if the local health authorities have told them not to, because they are concerned about a family member who is sick—or because they have no health insurance and thus nowhere else to go.
Whether local residents can't read messages from the local public health department because they are illiterate, or because English is not their primary language and the messages haven't been translated into whatever language they use or sent to their local ethnic media.
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3. Ask how things will work
  The most important questions for science and medical reporters to ask are almost always: "How do you know that?” And “What's your evidence?" But in covering a pandemic, there is a third question to keep in mind: "How does that work?" That is the question that gets you to the heart of the hyper-local experience of flu. And, an important note: While H1N1 is currently mild, in epidemiologic terms, there is no guarantee that it will stay that way so it is important also to keep thinking about what would happen in a severe pandemic such as H5N1/avian flu was expected to be. Here are some examples:
If schools close or children are sent home to enforce social distancing, what controls are in place to keep them from just gathering somewhere else, such as a mall?
If the H1N1 vaccine arrives and people are willing to take it, what are the plans for holding presumably massive vaccine-administration clinics at doctors’ offices, health departments, schools, and at other sites? What are the plans for getting people to return for the second shot if that will be necessary? What are the plans for people who refuse?
What have local hospitals said to their nurses and mid-level staff about whether the institutions will provide respiratory protection? and what are the nurses saying back? Are they acquiescing or resisting?
How often does the tertiary care hospital in your town get its deliveries of pharmaceuticals and medical supplies? Is it three times a day? Is it once a day? Do they have a three-day backlog? Do they have a five-day backlog? What happens if deliveries are disrupted?
How many of the changes that were supposed to improve local and county health departments after the 2001 anthrax attacks actually happened? What was the federal money spent on? What is the state of law enforcement radio communications in a particular town? What is the state of e-mail communications between the state or local health department and individual physicians’ offices?
If you have a Fortune 100 industrial company in your area, where does it get its raw materials? Has the company thought to book back-up suppliers if the supply chain breaks down due to illness, and are all the suppliers in one country? If the company runs out of materials and has to slow down manufacturing, what furloughs would be ordered?
How strong or fragile is the transport chain that brings food to local grocery stores? Could it be disrupted by significant amounts of minor illness? What would happen to local food sales if the flu got dramatically more serious and deliveries were disrupted?
  The most important thing to stress here is that preparation takes advance planning, in newsrooms and on beats just as much as in municipalities. None of that time can be made up when the crisis comes. Studying up on the basics of flu and the health care system is a task that can be tackled now. Figuring out the possible vulnerabilities of hospitals, schools, businesses and law enforcement—and what questions should be asked in order to elucidate them—should be handled as soon as possible. This is extra work, at a time when newsrooms are thinly staffed and reporters and editors are overworked, but it is essential.

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