Yet while this coverage may seem relatively mundane, it is a significant achievement. So many other types of medical reporting dominate health headlines: sensationalist accounts of sudden outbreaks, unusual examples of individual deaths and exaggerated cases of celebrities who become ill, among them. And this sort of coverage is dangerous.
We know because flu coverage once looked like that. And particularly in times when a significant share of the public thinks that government agencies may be withholding, neglecting or downplaying vital information, a news cycle that only features the most extreme or unusual cases can produce misleading impressions of both the scale of medical danger and the experience of victims. As a result, the public may ignore or disregard vital warnings while becoming distracted by a relatively small number of extreme but generally unrepresentative cases.
A century ago, American newspapers faced the challenge of covering an unprecedented disease outbreak, the Spanish influenza, which ultimately took nearly 3,000 lives in the nation’s capital, an estimated 650,000 lives in the United States and more than 50 million lives around the world. The most deadly wave of Spanish influenza first appeared in an army camp outside Boston in late August 1918. By the second week of September, the disease had spread to major cities, including Washington.
Newspaper coverage spread along with the epidemic. On Sept. 16, Lt. Arthur Henne, who had recently returned from a trip to New York City, fell ill and did not go to work at the Chemical Warfare Service of the War Department. Two days later, his wife, Lillian Maclean Henne, also fell ill. Arthur Henne’s symptoms seemed like hay fever or an “old-fashioned cold,” but much worse, with a headache, backache and slight fever, according to the Washington Times and other papers.
Arthur and Lillian Maclean Henne were probably not the first victims of the influenza — they were just the first individuals whose illness attracted close attention from public health officials as well as the city’s newspapers. But instead of effectively warning the public by educating them on how the disease spreads, how to identify common symptoms and what preventive measures were feasible — crucially important information — newspapers instead sensationalized the disease, focusing on individual stories like those of the Hennes.
This type of coverage, which personalized the danger without providing adequate counsel on how to respond to widespread disease, intensified as people started to die of the flu. On Sept. 21, John W. Clore, a railroad worker from Virginia who was just 24, died of Spanish influenza. He had also recently visited New York, and his illness lasted just a day before he died at Sibley Hospital.
The newspaper coverage soon led to a discrepancy between what the media reported and official public health statements — both sides of which were deeply problematic. Front-page articles that chronicled individual deaths such as that of Clore were accompanied by reassuring statements from health officials suggesting greater concern with monitoring and moderating public opinion than with fully addressing the danger posed by this unexpected epidemic. Even after Clore’s death was attributed to Spanish influenza, Washington’s health officer, William C. Fowler, denied that there was a widespread problem: “If there are any other cases, they have not been reported to my office,” according to the Washington Evening Star.
Less than a week later, even as the Health Department prepared posters advising people to maintain cleanliness, wear proper clothing and get plenty of fresh air, the health officer offered this strikingly misguided recommendation: “Sleep with the windows open, and you will be in little danger.”
By appearing to dismiss these first cases, public health officials inadvertently — and tragically — underestimated the potential impact of the epidemic, which further compromised the implementation of appropriate preventive measures. And even once the city introduced more stringent measures — closing schools and theaters, banning public meetings, changing hours for stores and offices and postponing two major Liberty Loan parades that would have brought thousands into the streets of the city — Fowler spoke in reassuring terms: “There is no cause for panic or hysteria, but men and women must exercise care and caution if we are to stay the epidemic.”
These reassuring words first lulled Washingtonians into a false sense of security, and then created skepticism that listening to public health officials offered the best course, given the discordance between their words and reality.
But the media coverage exacerbated the problem by making the opposite mistake. The Washington Post’s headlines told a very different story from the one conveyed by public health officials: “47 More Die of ‘Flu’ ” on Oct. 10, “72 Dead from ‘Flu,’ Record for District,” on Oct. 11, and “74 Die, High Record, and 1,594 New Cases,” on Oct. 12. The deluge of numbers became the attention-grabbing headlines, and while individuals’ stories still got published, they were usually about deaths, and often involved particularly bizarre cases, such as the deaths of brothers Peter and Paul Haddad, who died within an hour of one another.
But these numbers, and the stories of deaths, did little to convey what preventive measures the public could take, instead exaggerating the risk of death from the disease. The Spanish influenza had a remarkably high case fatality rate (the most reliable estimates are in the range of 3 to 5 percent, although some scholars claim that the rate was higher), yet even this unprecedented rate meant that roughly 95 of every 100 people who fell ill with influenza survived. The Hennes disappeared from the newspaper because they survived their illness. In fact, Arthur Henne lived for another 18 years, until his death in New York City in 1936. Lillian Henne remarried, moved to California and lived another half-century, until her death at age 85.
Headlines about deaths, or sensational stories about those who died, helped create anxiety and skepticism among the public that blunted more serious, consistent and ultimately realistic efforts to describe the disease’s impact and recommend appropriate sanitary measures by public health officials during the peak weeks of the epidemic in October and November.
Thanks to this coverage, the public may have learned to fear the disease, rather than learning how to combat it.
There are several lessons germane to our handling of disease today. The influenza outbreak in Washington was exacerbated by a medical establishment (and public) not prepared for the scope or severity of the epidemic. But the media’s coverage also provides a very different cautionary tale.
Focusing on spiking numbers of cases or the potential for a death may have shaken the public out of a harmful complacency. But the focus on individual victims — and deaths — also had the potential to substitute fear for prudent preventive measures.
Today, we must remember this lesson: While illnesses, ranging from the rare to fairly common, claim lives every day, we must understand these ailments in context. The media’s coverage of disease ought to be focused on what Americans can do to prevent the spread of communicable conditions, beginning each year with the flu. An emphasis on preventive measures, not the most tragic cases, will better help to contain any outbreaks, possibly decrease the number of deaths and certainly reinforce the public’s trust in expert guidance.
In the case of historic maladies such as Spanish influenza, paying attention only to the most extreme outcomes also denies or forgets how most people experienced this disease and distorts our understanding of history, as well. While the stories of those who died are important, so too are the stories of those who survived, and their experiences provide lessons in how to endure a public health crisis.