On the SARS Beat   

Caution is the watchword for journalists involved in frontline reporting on the mysterious, highly contagious disease. Some editors are discouraging in-person interviews and implementing other health precautions to reduce the risks. Meanwhile, a debate swirls: Has the coverage been hyped or on target?

In May, a Wall Street Journal editor opened a conference call with correspondents in Asia by asking, "What is the radius of a sneeze?" At first, reporters thought he was speaking rhetorically or joking. Then came the answer. "It's 15 feet. One sneeze and you're screwed," John Bussey, a deputy managing editor based in Hong Kong, told his staff.

Vigilance has become the watchword for journalists operating in the epicenter of the SARS epidemic, where sneeze droplets are described as "biological bullets" and leaky sewer pipes turn into deadly carriers.

As the virus spread, retooling news operations and reporting strategies became a matter of survival.

CNN Beijing Bureau Chief Jaime FlorCruz admits to being compulsive about washing his hands since Severe Acute Respiratory Syndrome surfaced in his backyard. He pushes elevator buttons with his car keys, checks his body temperature every day and no longer plays pickup basketball with a group of jocks.

Every time he sneezes, coughs or feels fatigued, FlorCruz frets: "Could it be SARS? Could I pass it on to my family and friends?" The longtime resident of Beijing has reason to worry.

In April, he traveled with a CNN crew to Foshan in southern Guangdong province, an area known as the petri dish of SARS. Entering a hot zone, says FlorCruz, is like "living in a virtual battlefield, confronting an invisible, mysterious enemy."

When Matt Pottinger of the Wall Street Journal received a care package from his mother, there were no homemade brownies. Instead, he found boxes of sterile alcohol pads, high-quality plastic gloves and containers of Purell, a hand sterilizer, which boasts a 99.9 percent germ kill rate--precious commodities for a reporter pursuing the trail of the killer virus in Hong Kong.

Residents picked shelves clean of safeguards as the infection swept the former British colony famous for its exotic nightlife and international trade. Pottinger's newspaper supplied N95 surgical masks, specially designed to filter out viruses. Journal staffers have been required to wear them in the office and many "have stacks of these in our homes," he says.

Freelance photographer David McIntyre was on assignment for BusinessWeek when he entered the lobby of one of the world's largest factories in the south China city of Zhuhai. Suddenly, he was confronted by a glum-faced security guard who poked a thermometer into his ear.

He was allowed to enter only after a card was attached to a visitor's badge, designating his temperature as normal. McIntyre noted that at airports in China, the Ground Zero of SARS, infrared guns are aimed at passengers' foreheads to check for fever, a symptom of the mysterious ailment.

"We can't be sure where it is lurking," the photographer says. "When someone coughs, you always wonder if they are a carrier. Everyone is suspect."

SARS, with its far-reaching tentacles and long shelf life--scientists discovered it can live for 24 hours or more on doorknobs or tabletops and up to four days in fecal matter--has sent tremors through the medical community. Billions of dollars' worth of international commerce, air travel and tourism already have been lost. The crisis has delivered the most devastating blow to the Chinese economy since the 1989 massacre in Tiananmen Square.

A check of the Internet underscores the wide-sweeping press attention. "SARS: talk of town," says a headline in the Yemen Times. The Jerusalem Post reports that a SARS screening system has been put into place at Tel Aviv's Ben Gurion Airport. The Times of Zambia explores the dangers of traveling in the SARS era.

In the United States, where 65 "probable" cases had been reported as of mid-May, Time, Newsweek and U.S. News & World Report have devoted covers to the mysterious disease. The New York Times has produced a series on its impact, with reporters scouring poverty-stricken Chinese villages in pursuit of details. A special CNN report portrayed SARS as "a deadly virus on the loose, the world on alert."

As coverage soared, so did criticism that the world's press corps was hyping the new disease. Nobel Prize-winning virologist David Baltimore was among those who accused journalists of spreading hysteria. Critics point out that AIDS and malaria are far more lethal than SARS.

Foreign policy expert David J. Rothkopf argues that the media have failed to put SARS into perspective, which, in turn, has led to distortion and confusion about the virus. This "infodemic," as he calls it, has made the crisis harder to control, especially as panic and rumors spread via chat rooms, bulletin boards and e-mail world-wide.

On May 1, columnist Bill Steigerwald of the Pittsburgh Tribune-Review wrote: "Based on the media attention, you'd think SARS had killed 400,000 earthlings by now, not 400." He compared it with the Spanish flu epidemic of 1918, which killed 20 million in 18 months.

"Imagine how Geraldo, Dan and Paula would have covered that baby," mused Steigerwald.

(As of May 19, 7,864 cases of SARS had been identified, about 643 of them fatal.)

But for those on the front lines, SARS is no laughing matter. In regions where a cough on a crowded elevator could send passengers ducking for cover, journalists had to rethink methods of newsgathering.

Instead of going to jam-packed press briefings on SARS, some correspondents in Beijing and Hong Kong kept up by watching them on Webcasts. Faxes, telephones, e-mail and the Internet became lifelines to the story. Web sites for the World Health Organization and the U.S. Centers for Disease Control and Prevention took on critical importance.

Face-to-face interviews became more of a rarity. "I have never stretched the use of e-mail and the phone so far," says the Wall Street Journal's Pottinger. "It's frustrating as hell. It also forces us to be more resourceful."

The realities are stark. If a reporter contracts SARS, an entire staff could be quarantined, bringing news production to a screeching halt. As a hedge, many began working out of their homes. Reuters news agency moved correspondents into two different offices in Hong Kong and forbade personal contact as an insurance policy.

In the last weekend in March, Wall Street Journal editors and business department chiefs in Hong Kong began developing their SARS strategy. Deputy Managing Editor Bussey was concerned that one of his staffers might get sick and that an infection would result in government quarantine of the facilities. Bussey's mantra became, "Report by phone if possible."

The paper decided that many editors and reporters based in Hong Kong, Beijing and Shanghai would work out of their apartments. "We now have a few dozen people in Asia writing on PCs from home," Bussey said in early May. A skeleton crew, including editors, tech and production managers, staffs the newsroom.

Reporters operate on a communications network that can be accessed from remote locations with cell phones, Blackberrys and computer modems. "Conference calls keep everyone networked and focused on coverage," Bussey says. "We'll continue to operate in our current mode until the number of cases declines." Pottinger says managers have discussed the possibility of buying inexpensive mobile phones and prepaid calling cards to distribute to doctors and nurses in SARS zones so reporters can talk to them without risking their health. Seeking out families of SARS victims who have not had personal contact with their sick relatives is another portal into the story.

Pottinger used e-mail and the telephone to pull together a highly detailed account of the efforts of Tom Buckley, a Hong Kong physician who in March found himself face to face with the outbreak. For days, Buckley sent out messages to more than 1,500 intensive-care doctors worldwide, alerting colleagues to the dangers of the mystery illness.

Buckley's diary was a rich chronology. From a March 18 entry: "Events are starting to overtake us in terms of caseload though some ventilated patients have improved.... I have five beds left in ICU. We will have to start thinking about triage of cases!!!"

March 21: "Last night [a] senior nurse rang me to say she was resigning. She is petrified. [Hong Kong] government is downplaying the whole thing presumably because of the economic implications, but own hospital has been taken over completely by this infection."

March 25: "Three ICU nurses have come down with this.... We have had to think way out of the box in terms of infection control."

At times, the journalistic instinct to see firsthand overwhelms the imperative for caution. Agence France-Presse reporter Cindy Sui ignored her boss' concerns when she entered a Guangzhou hospital ward to interview a SARS carrier in his room. In Beijing, she stood in a courtyard outside an isolation ward and talked to patients from their windows. "They wore masks when they spoke to me even though they were sitting on their beds and not leaning out the window," Sui explains.

The reporter documented a serious lack of understanding about the severity of the disease. Sui talked to a patient whose 84-year-old mother died in a hospital where there were SARS victims. Eight of 11 relatives who visited her ended up infected, including another daughter who succumbed to the virus. Sui's compelling accounts made it clear that Chinese health officials were doing little to educate a vulnerable populace.

Sui says she wasn't worried about contracting the virus because "I was too absorbed in the stories and was just trying to do the interviews as quickly as I could before being told to leave." Afterward, she went home, scrubbed her hands and washed all the clothes she was wearing. Today, her attitude has changed.

Since more information about SARS has surfaced, Sui has decided to stay away from hospitals. "I'm no longer seeking in-person interviews with patients. We know more now. It's best to be careful," she says.

Some journalists feel the odds are in their favor. David J. Lynch, USA Today's Beijing bureau chief, doesn't view reporting out of the Chinese capital as a risky proposition. "Sure, SARS is a scary, potentially fatal illness," he says. "But measured against this city's 14 million population, the number of those affected remains tiny. I think there is literally a greater chance that I will be killed on my commute to work by one of the notoriously inept local drivers."

The challenge for journalists in confronting the SARS outbreak is to adequately inform the public about the hazards of a new, highly contagious disease that continues to surprise medical experts without exaggerating its impact and unduly frightening people.

"You don't want to create hysteria, but also you don't want to lull people into a false sense of security," says Andrew Holtz, president of the Association of Health Care Journalists. He points out that there have been a small number of deaths compared with the annual toll of flu and other infectious diseases. At the same time, he says, "It's also new and unknown, and that accounts for the high level of concern."

At the onset, conspiracy theories linked SARS to bioterrorism. "Is bug from outer space?" the Sun of Great Britain asked in a headline. There was speculation that Asian food, cockroaches, toilet seats, chickens and even owls were to blame. Web sites were rife with rumors.

Adding to the turmoil, the World Health Organization issued a global warning urging the public to stay away from Hong Kong, Beijing and the Chinese provinces of Shanxi and Guangdong. Toronto was the first Western city to make the WHO's blacklist. Outraged Canadian health officials challenged the international watchdog's assessment of the danger.

Suddenly, the focus switched to a high-profile scientific policy dispute and billions in lost revenue as Toronto, for a brief time, became an international pariah. Fears of rapid mutation and worldwide deaths filled the nightly news.

"There still are many unknowns" about SARS, says Stephen Prior, research director for the National Security Health Policy Center, an Arlington, Virginia-based think tank. "The idea this coronavirus is suddenly going to be subject to some vaccine or some treatment that is going to give us the answers probably is not going to be the case with this."

Prior speculates that the virus may have existed previously in a different form, then mutated into more of a menace. Some have expressed the view that SARS could become dormant for a time, then roar back with a vengeance.

When it comes to assessing media coverage, there clearly are two camps. One, embraced by Nobel laureate Baltimore, accuses the press of overreacting. In a Wall Street Journal column, he wrote that "a media-transmitted epidemic of concern for personal safety outpaces the risk to the public health from the actual virus."

In another swipe, Baltimore noted, "[M]edia viruses are immune to rational inoculation. The anthrax scare of late 2001 was the preview."

Prior strongly disagrees. "David [Baltimore] is wrong about this.... I don't think the media have been sensationalist," the scientist says. "I also think we have been spared the excesses we might have seen by the fact that, as of now, SARS is not a real problem in the United States." How American journalists react if there is a serious outbreak or deaths here is another matter, he says.

Rothkopf, a member of the advisory board of the Johns Hopkins/Bloomberg School of Public Health and CEO of Intellibridge Corp., is among those who think the media have overreacted. He believes journalists have a built-in disincentive to place information into context. "SARS is a good story for a reporter or editor if it's really scary," he says. "If I were to write a story saying there is a disease outbreak in China, and it could be bad and could spread rapidly but right now is fairly small, am I going to get airtime? Yet that is the prudent way to cover it."

Other experts take a more positive stance. Ivan Oransky, Web editor for The Scientist, a news journal for the scientific community, says the press has done a "fantastic job" covering SARS, and he thinks he knows why. Much of the coverage has been in the hands of experienced medical and science reporters. "You had balanced stories, with context," the physician says. "They knew the difference between endemic, pandemic and epidemic, and that is not a trivial matter."

Without the war in Iraq, the rise of the virus might have grabbed bigger headlines and more page-one space. "When the fighting started to die down, there tended to be this turn toward SARS as the next big story," says David Olmos, health editor for the Los Angeles Times. "Initially, it tended to be underplayed."

The most spectacular medical story of the new century began with a massive Communist cover-up, a courageous whistleblower and a rolling of heads. SARS may go down in history as China's Chernobyl.

According to an account by Chris Taylor of the Sunday Age in Melbourne, Australia, Jiang Yanyong, a 72-year-old semiretired surgeon, was watching the nightly news in Beijing when he heard the health minister announce that there were only 12 cases of SARS in the capital city. Jiang was stunned. He worked part-time at Military Hospital 301 and knew of 50 cases there alone. He pounded out an angry e-mail message to the state-run station, CCTV-4.

"I simply couldn't believe what I was seeing," Jiang wrote. "All the doctors and nurses who saw yesterday's news were furious."

When station managers ignored Jiang's message, his protest found its way to Time magazine, the Wall Street Journal and other international press outlets. The Chinese leadership was forced to admit that it had lied about the number of SARS cases. The mayor of Beijing and the nation's health minister were sacked. The World Health Organization, which had fallen for propaganda asserting that the virus was under control, demanded immediate access to hospitals.

In May, Taylor described the "Chinese Plague" this way: "A tiny virus that hatched somewhere in Guangdong province had percolated 2,000 kilometers north to the Chinese capital and infected close to 1,000 people, rocking the central government. It had hitched rides to nearly every corner of the world, throwing the international airline industry into turmoil and snatching headlines from the U.S.-led war on Iraq."

SARS was running rampant among impoverished farmers, factory workers and military units in the hinterland, where China's health care is at its worst. In May, the WHO reported a sharp increase in the SARS death rate, placing it at 15 percent. News reports quickly put that number into perspective, noting that less than 1 percent die in a typical flu season. The devastating Spanish flu, which killed millions in 1918 and 1919, had a death rate of less than 3 percent.

By mid-May, the CDC reported 65 "probable" cases--and no deaths--in the United States. For American journalists, lessons learned 18 months ago clicked into play.

Unlike the anthrax scare, where reporters had no precedents, no blueprints and precious little accurate information from official sources (see "The Anthrax Enigma," December 2001), SARS struck a familiar note. Since September 11, 2001, the country's press corps had been on heightened alert for smallpox, dirty bombs and other terrorist tactics. Preparing to cover bioterror became part of newsroom routine.

The media learned from the anthrax experience to be more skeptical of official pronouncements. Back then, contradictions and misinformation emanated from the White House and other government sources, causing widespread confusion. With SARS, the CDC took charge.

Medical experts like Oransky credit that agency with being more careful to say, "Here's what we know and here's what we don't know." Daily press briefings on the Internet provided updated information and an opportunity for journalists to submit questions.

"There wasn't as much of an information vacuum as existed in the early days of anthrax," says Holtz of the health care journalists association. He cites the Iraq war as a factor in the media's less-frenzied approach.

"SARS tended to be a little crawl at the bottom of the TV screen or a story below the fold in the newspaper. It was not No. 1 on the news agenda during the early weeks," he says. "We would have seen bigger and more lurid headlines if it had been a quieter news cycle."

Some worry that the constant images from Beijing and other places in Asia of citizens wearing masks as they went about their daily routines might create irrational fear among Americans. "I don't know what you do about people who see that and become afraid of Chinese food in Toledo," says Holtz. "The CDC has not warned anyone within the borders of the United States to change their daily activities. News reports can point that out."

In April, the Asian American Journalists Association issued a media advisory about terminology that could cause ethnic backlash and stereotyping. Among the guidelines: SARS "should never be referred to as an 'Asian disease' in the same way that HIV/AIDS should not be called a 'gay disease.' "

News reports out of Asia are a clear indicator that the SARS scare is not over. As part of the New York Times series, correspondent Elisabeth Rosenthal visited an animal market in China where she described an alarming scenario. "In hundreds of cramped stalls that stink of blood and guts, wholesale food vendors tend to veritable zoos that will grace Guangdong Province's tables: snakes, chickens, cats, turtles, badgers, frogs. And in summer, sometimes rats, too.

"They are all stacked in cages one on top of another--which in turn serve as seats, card tables and dining quarters for the poor migrants who work there. On a recent morning, near stall 17, there were beheaded snakes, disemboweled frogs and feathers flying as a half-alive headless bird was plunked into a basket."

Rosenthal surmised that a coronavirus such as SARS would have little trouble moving from animal to human in such a setting. She quotes a doctor: "There is so much we don't know about this virus--how long it will be with us? Will it mutate and become more easily transmitted?"

CNN's FlorCruz and other reporters search for elusive clues. During the Chinese cover-up, the bureau chief battled bureaucrats and local functionaries. His camera crews faced off with overzealous hospital security guards and had film confiscated by the police.

"We were stonewalled at the top, and the local press was effectively muzzled," says FlorCruz, who turned to unofficial sources, whistleblowers and frustrated Chinese journalists for leads.

Always, there was a nagging fear.

After a trip to Guangdong province, he sweated it out for 10 days--the length of the incubation period – before he dared to sigh with relief.

"It's like being in a war, yet, these are invisible bullets," FlorCruz said as he prepared to head into the bustling streets of Beijing to attend a press conference on SARS. "I always remind myself and my crew, there's no story worth dying for."