Outbreaks of infectious disease can make for unsettling times, especially if they have a high fatality rate. More and more people get sick and die. Health—care workers fight heroically to save lives but sometimes succumb themselves. Panic, fear, and mistrust can settle in. Rumors spread about why an infection is striking now and here, about who is responsible and who stands to benefits. For reporters, there are plenty of stories to mine; but sometimes it’s hard to know what’s right and what’s wrong.
What follows is a list of issues that reporters covering Ebola—or an outbreak of any disease—will encounter.
One good rule of thumb: remain skeptical of everything and everybody—without being cynical. Look for trusted sources; two is better than one. Always try to dig deeper to understand if what you’re being told is reasonable and correct.
It’s tempting to make too much out of too little. On August 29, 2014, CNN carried a story about a Liberian doctor, Gorbee Logan, who had treated 15 Ebola patients with lamivudine, an HIV drug. Thirteen of those had survived, he said. That was an 85% survival rate at a time when only about 30% of all Ebola patients were surviving. It seemed like a spectacular success, and some saw in Logan’s approach an “African solution” that had evaded Western scientists.
It wasn’t crazy to think this particular drug might work. Lamivudine fights HIV by targeting a an enzyme called polymerase which the Ebola virus has as well (although Ebola has a different version.) And some antiviral drugs do target several viruses.
But lamivudine wasn’t a magic bullet against Ebola. Researchers at the U.S. National Institutes of Health (NIH) had tried it against the virus in test tubes before Logan’s story came out, and it didn’t do anything. A scientific committee that advised the WHO on drug and vaccine studies in November said lamivudine should not be tried in people. Just to be sure, and because Logan’s story drew so much attention, the NIH researchers repeated their experiments. In March 2015, they confirmed in this letter to a scientific journal that lamivudine has no effect on the Ebola virus.
We don’t know if Logan has continued treating patients, and if so, what he found. But what could explain his initial success?
For starters, we don’t know if Logan really cured 13 out of 15 patients; there has been no independent verification, so we only have Logan word for it. But even if he is right, 15 patients is a small number, and it’s possible that the high survival rate was due to luck or chance. Maybe the patients that reached the clinic where he worked were for some reason not as sick as those elsewhere, and had a higher chance of survival to begin with.
In any case, Logan’s numbers don’t prove that the drug worked. They are what scientists call “anecdotal evidence,” by which they often mean reports from a single doctor or about very few patients.
Always treat anecdotal evidence with skepticism. As we explained in the chapter Drugs, Vaccines & Diagnostics, it takes a long time and a series of rigorous scientific tests to show that a drug works. It’s good to be aware of this when you hear someone claiming remarkable success with a treatment. As science journalists like to say: “Extraordinary claims require extraordinary evidence.”
Anecdotal evidence can be a problem—but miracle cures are far worse. In August 2014, when an imported case from Liberia kicked off a small Ebola outbreak in Nigeria, there was briefly a great deal of excitement about “nanosilver,” supposedly an experimental drug against Ebola. Nigerian health minister Onyebuchi Chukwu announced the arrival of the drug in the country on August 14. Nanosilver is sold by a physician in the United States, Rima Laibow; a Nigerian living in the U.S. reportedly helped ship the drug to Nigeria.
Laibow claimed that nanosilver is “the definitive prevention and therapy for Ebola virus,” and that it “inhibits every disease organism it has ever been tested against, without exception.”
The latter claim was ridiculous: No single drug targets every disease organism. As we explained in the chapter Drugs, Vaccines & Diagnostics, it takes many years and a long, complicated testing process to know if a drug works. Nanosilver hadn’t been through any of those steps. Nothing about its anti-Ebola effects had been published in the scientific literature. Respectable scientists dismissed the claims out of hand.
Chukwu apparently realized that too when he announced on August 16 that Nigeria would not try nanosilver after all. A month later, the U.S. Food and Drug Administration wrote Rima Laibow a “warning letter” telling her to stop marketing nanosilver as an Ebola therapy.
The lesson: If you hear a story about a drug that sounds too good to be true, it almost certainly is. Always ask yourself: Where are the data?
Behavioral and cultural issues
A lot has been said and written about the way human behavior and cultural beliefs have helped the spread of Ebola. Combined with Ebola’s rain forest origins, this has sometimes reinforced the stereotype of Africa as an exotic but backward place.
The fact that human behavior and culture are important in the spread of disease is nothing new. Sexual behavior drives the global spread of HIV. The Chinese taste for wild meat may have triggered the 2003 SARS outbreak; the virus is thought to have transferred from bats to civet cats—a delicacy in parts of Southern China—to people. In many Western countries, children contract measles, and sometimes they die, because their parents mistakenly worry that vaccines—which are cheap, safe and effective—are too dangerous, or because they belong to religious groups that oppose vaccination.
In the Ebola epidemic, traditional healing ceremonies and burial rituals played an important role in the rapid spread of the disease. Many patients, wary of a health system that had failed them in the past, sought help from trusted traditional healers who weren’t aware of the risk these patients posed. The bodies of the dead were often washed and touched, sometimes by many people, in rites that helped relatives deal with their loss. But the body of someone who died from Ebola is very infectious. According to the World Health Organization (WHO), the burial of one widely respected traditional healer in Sierra Leone led to as many as 365 deaths from Ebola. That’s why early in the epidemic, the focus was on getting rid of bodies quickly and safely, with little respect for family wishes—which many relatives felt was impersonal, cold, or even sacrilegious. (Many people in Western countries would too if it happened to them.)
Journalists should obviously be sensitive to such issues, but they should still report on them; they can play an important role. It’s important not to judge, and to stress that traditional beliefs or practices aren’t wrong, bad, or backwards—just that they sometimes pose a big risk of infection, and may need to be temporarily halted.
The same could happen anywhere in the world. During the 2003 SARS outbreak, for instance, Roman Catholic churches in Toronto, Canada, decided to suspend the part of the mass in which parishioners give each other a sign of peace—generally shaking hands. They also stopped the practice of drinking wine—in the Catholic mass a symbol of the blood of Christ—from a communal chalice because of the infection risk it posed.
In West Africa, reporters also helped discuss and advocate for safer alternatives. In November 2014, the WHO issued a “safe and dignified burial protocol,” with specific instructions for Muslim and Christian burials. It stressed that families can be included in a burial and that traditional rites can be replaced with similar ones that don’t pose a risk to the bereaved. Safer burials eventually became common, and are believed to be one key factor in Liberia’s success in the battle against the virus.
Rumors and hoaxes
In August 2014, a health hoax emerged in Nigeria. People were told salt water baths and drinking lots of salt water could prevent Ebola infection. “Please ensure that you and your family and all your neighbors bathe with hot water and salt before daybreak today because of Ebola virus which is spreading through the air,” it said. The message raced around the social media, and soon people were being hospitalized for drinking too much salt water, which can be very dangerous. Two people reportedly died from it.
Similar rumors and scams surface during every epidemic—especially when it’s a major, terrifying event. During the SARS epidemic, there were rumors in China that vinegar, turnips or even smoking could keep the dangerous virus at bay. With Ebola, some people thought that eating raw onions or condensed milk could also protect against disease, according to WHO.
As a reporter, don’t repeat such claims; you can report that they are going around, but you should at the same time explain that they are nonsense, and teach people how they can really protect themselves from Ebola. (The main piece of advice: Avoid contact with suspected or confirmed patients and with their bodily fluids.)
If you’re not sure about what advice to give, go to the WHO website or your country’s ministry of health.
The strangest rumor we’ve seen is that two people were resurrected after dying from Ebola, as the New Dawn in Monrovia reported in September 2014. “The victims, both females, believed to be in their 60s and 40s respectively, died of the Ebola virus recently in Hope Village Community and the Catholic Community in Ganta, Nimba. But to the amazement of residents and onlookers on Monday, the deceased reportedly regained life in total disbelief,” the paper said.
This can’t be true, and journalists shouldn’t report a resurrection as if it might be a fact.
Every epidemic has its conspiracy theories. When AIDS emerged in the 1980s, some claimed it was a biological weapon designed by the CIA to kill gay men and African—Americans. When the H1N1 influenza pandemic took off in 2009, some people thought it was a plot by WHO or some other group to depopulate the world, or to make pharmaceutical companies rich by selling H1N1 vaccine. Some Americans were worried that flu patients would be shipped off to secret concentration camps run by the Federal Emergency Management Agency.
The Ebola epidemic is no different: Conspiracy theories abound. In September, the Liberian newspaper the Daily Observer published an article by Cyril Broderick, a plant pathologist, who claimed that the Ebola virus was designed by the U.S. military and that African citizens were being used as unwitting test subjects. (The story later went viral.) American singer Chris Brown added his own two cents when he tweeted: “I don’t know… But I think this is Ebola epidemic is a form of population control.”
Such conspiracy theories have real consequences; they can make people shy away from treatment, for instance. In April 2014, a team from Médecins sans Frontières (MSF) had to halt its work at the isolation ward in Macenta, Guinea, because its staff was accused of bringing Ebola into the country. This blaming of aid workers has been seen repeatedly in Ebola outbreaks over the years.
It’s easy to see why people would fall for these theories. Disease outbreaks can be terrifying events that seemingly come out of the blue, and it’s tempting to look for a pattern behind them. Ebola always strikes in Africa, and the Western world has not made it a priority to develop drugs or vaccines against it. (We explain some of the reasons in this chapter.) The response from rich countries to the epidemic has been too slow, and often inadequate. The disease didn’t really capture the public’s attention in the United States until two American citizens came home sick─and received far better treatment than was available in Africa. And Western companies may benefit if they make a successful drug or vaccine.
But all of that does not mean that anyone deliberately developed the virus or started the epidemic; there is no evidence whatsoever for that. There is no reason to believe this epidemic started any differently than previous ones—when a human came into contact with an infected animal.
When reporting on infectious diseases, you should critically examine what went wrong, and ask who could have done better, including international organizations and local governments. (The WHO itself has already asked an independent committee to examine how it handled the emergency; its first report is expected in May 2015.) But don’t fall for conspiracy theories. They’re almost always wrong. Again, ask yourself: Where is the evidence?
If you followed the U.S. media last year, you might have thought that the country was overwhelmed by a terrible Ebola epidemic. Republican politicians were blaming President Barack Obama for letting the situation get out of control. Billionaire Donald Trump argued that American aid workers infected with Ebola in West Africa should stay there instead of being repatriated for care. A nurse, Kaci Hickox, was quarantined in a tent in an New Jersey airport parking lot after she returned home from Sierra Leone, even though she had no symptoms of Ebola and there was no reason for her not to go back to her normal life. Many people were worried that they themselves might contract Ebola in the United States
Hysteria is often a byproduct of a disease outbreak. Only two people became infected in the United States, and both were nurses caring for an Ebola patient from Liberia who died from the disease. The risk for the average American to become infected was smaller than the risk of being struck by lightning. But fear and misinformation ran rampant, fueled by politicians who wanted to look tough in the lead up to the next U.S. election. Some media clearly exacerbated the panic.
You may not be able to stop hysteria as a reporter, but you should not contribute to it. Avoid stoking needless fears by providing accurate, factual information about the disease and the risks. Debunk false stories and claims. Try to be a calm voice of reason and a source of accurate information.