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Shared Wisdom

Sometimes all we need is a quick suggestion from our peers to zero in on a good story. Here we turn to front-line journalists for advice, some simple insight to add to our repository of “shared wisdom.”

The typical definition of the word epidemic means ‘a widespread occurrence of an infectious disease,’ but it has been used to describe all kinds of non-infectious diseases public health crises, including the number of people overdosing and become addicted to opioids. Should journalists be using the word ‘epidemic’ when writing about opioids? Is the word ‘epidemic’ so overused that that it risks being too glib? What might be alternative wording to convey the seriousness of this public health emergency?

There is definitely a strong case for categorizing and tagging opioid overdoses as casualties in an "epidemic." After being on the beat for a few years, I don't think “opioid epidemic” is the best description for what's happening right now. I prefer to say “overdose crisis,” and when editors don’t let me get away with that, I say “opioid overdose crisis.” Communities, truly, are in crisis.

Some of the rhetoric out there (that I find misinformed) renders opioids like they're Malaria-carrying mosquitoes. The problem is, opioids are used everyday by patients at home and in hospitals, without any complications. That's not to say that they're without risk, but by using the word epidemic, we have dramatically inflated who is at risk for addiction and why:

People with depression, anxiety, and trauma; people who feel economically left behind by society. The risk also intensifies the younger you are, too.

Moreover, a lot of overdoses are not just opioid-related, they're polysubstance, typically involving alcohol, benzodiazepines, and increasingly, cocaine. People must be informed that mixing drugs is super dangerous, and doing so dramatically increases the risk of overdosing. Now we’re dealing with illicit fentanyl, which is synthesized in clandestine laboratories. We need to do a better job communicating that these drugs are not being prescribed.  

 Zachary Siegel is a freelance journalist based in Chicago. He covers public health and criminal justice with a special emphasis on drugsIn 2018, Siegel was selected as a Guggenheim Reporting Fellow at the City University of New York's John Jay College of Criminal Justice. His work has appeared in The New York Times Magazine, Wired, Slate, Vice, New York Magazine, The Appeal, and elsewhere. Follow him on Twitter @ZachWritesStuff.

If a reporter is looking to cover an aspect of pandemic preparedness that hasn’t been written about before, what would you recommend?

There are a lot of hospitals [throughout the U.S.] that have bio containment units and that do regular training [for pandemic preparedness.] They do mystery patient drills. I wanted to see one of those [for my recent story on pandemic preparedness], but I never quite managed to do that. There is something called CLADE X [a pandemic tabletop exercise, sponsored by Johns Hopkins Bloomberg School of Public Health] that I would have included [in my piece] if I could have. I think every bit of reporting that people do on this, whether it is in a big magazine story or week by week beat stuff, it all matters it all adds up. These are issues that need to be grappled with and they aren’t easy.

Ed Yong is a science journalist who reports for The Atlantic, and is based in Washington D.C. His work has featured in National Geographic, the New Yorker, Wired, Nature, New Scientist, Scientific American, and many more. He has won a variety of awards, including the Michael E. DeBakey Journalism Award for biomedical reporting, the Byron H. Waksman Award for Excellence in the Public Communication of Life Sciences, and the National Academies Keck Science Communication Award. "I Contain Multitudes,", his first book, was a New York Times bestseller, and a clue on Jeopardy! He has a Chatham Island black robin named after him. 

What should reporters know about covering fungal infections?

Consider the complexities of covering antifungal resistance. Fungi are not bacteria but, like bacteria, are becoming resistant to medications designed to kill them or stop them from growing. Reporters have written a lot about resistance to antibacterial medications, cleaners, and sanitizers, but not antifungals. This is an emerging area of concern to health care providers both in the United States and the rest of the world. It is an area that deserves more media attention.

One invasive fungal infection of particular concern is candida, which is one of the most common cause of health-care associated bloodstream infections in U.S. hospitals. Rural communities are at increased risk for certain fungal diseases, like candida, because these hospitals lack funds to employ infectious disease specialists on staff that could recognize resistant fungal infections. Reporters in rural areas may want to look into whether their local health care systems have the resources to spot and treat these resistant infections.

For reporters looking for a global angle, one less-obvious-yet-significant element in covering antifungal resistance is exploring how social determinants and the predominating geopolitical climate impacts access to treatment. From a global perspective, Cryptococcus Neoformans, (a fungus that can cause severe lung and center nervous system disease) which typically only affects people who have reached advanced stages of HIV/AIDS, has become endemic to sub-Saharan Africa, Asia, and the Pacific largely because the first-line treatment for the condition is unavailable and second-line treatments are not as effective. Seek out stories of organizations that may be addressing this now endemic disease.  

If you’re new to covering fungal diseases and antifungal resistance, the Centers for Disease Control and Prevention provides a good overview regarding fungal diseases and antifungal resistance, treatment, severity, and geographic reach, here and here. However, state, county, and city records also offer good insights. Examples of places to look for regional data on fungal diseases can be found in: California, New York and Texas. The World Health Organization and PubMed search are good starting points for international and global perspectives.

Frieda Wiley is a freelance journalist who covers health and medicine. A pharmacist by trade and a former consulting editor for the American Botanical Council, her byline has appeared in AARP, Infectious Disease Special Edition, Undark, US News & World Report, and MedPage Today.

What advice would you give someone who is covering the connection between infectious diseases and climate change? 

This connection is an emerging topic and one of the ways to really bring it home to readers is to tie it in with a current event or outbreak or to localize it to the region of your readers. 

To find out what infectious diseases might become more prevalent, or widespread, I would suggest visiting the Centers for Disease Control and Prevention, Climate and Health website.

And this section of the CDC site enables reporters to drill down by state and county on climate change data to track expected expansions of flood zones and extreme heat days.

A more global perspective can be found in the Lancet report. The Lancet Countdown tracks progress on health and climate change and every two years releases a report, the last being released on October 2017. The report can be downloaded for free.

The World Health Organization provides climate and health country profiles and its website is a good place to find sources for the global perspective.

For U.S. specific stories it is worth noting that the changing climate has shifted the geographical distribution of tick fevers: If you live in a state where a disease like Lyme disease isn’t a problem are you seeing the first cases of the disease? 

Even if the incidence of a disease like dengue is increasing in another country, due to international travel and trade, it could mean higher risks to the U.S. population. 

There are many angles for stories on the connection between climate change and infectious diseases and different ways to illustrate that this really is a global health problem. 

Jane Palmer is a science journalist based in Eldorado Springs, Colo. She covers public health, medicine and health care. She has recently written two stories on the impact of climate change on public health for Mosaic Science. In 2017, she traveled to Puerto Rico after Hurricane Maria where she reported impacts of extreme events on public health and how islanders build more resilience into the health system in anticipation of future extreme events. Examples of her work can be found at www.tjanepalmer.com

What would you encourage reporters who cover infectious disease to consider that might not seem obvious?

I’d highlight the important role that socioeconomic status plays in shaping infection risk and disease outcomes. People living in poverty often live in more crowded conditions than affluent people do and are more likely to take public transportation, both of which increase their susceptibility to infection. They may also be under more stress, get less sleep, and eat less nutritiously, all of which hinder immunity and increase vulnerability, too.

And then once people are sick, socioeconomic factors shape their prognosis. People living in poverty often have no or poor access to health care. They might feel compelled to work when sick — low-paying jobs often have strict sick leave policies — which means their ailments, might worsen while they’re also spreading their illness to their colleagues. The upshot is that people on the lowest rungs of the socioeconomic ladder are extremely vulnerable in outbreak situations, so they should be an important focus for reporters who are thinking about risks as well as outbreak responses.

Melinda Wenner Moyer is a science and health writer based in New York's Hudson Valley. She is a contributing editor for Scientific American and a columnist for Slate. She won a 2016 AHCJ Award for Excellence in Health Care Reporting. 

What advice would you give to someone covering infectious disease issues like the flu or antibiotic resistance – topics you have had written about recently?

I have found that one of the most helpful interview tactics I have developed over time is to end every interview by asking if there is something else that should be on my radar or something that journalists haven’t been covering about X issue but we should all know. Some of the best stories or nuances in ongoing stories have come from replies to that question.

I also think there is a lot of value in communicating uncertainty to your readers. Telling them what scientists do not know about a disease or condition (as well as what we do know!) is a good idea because it helps build trust with your readership and it allows you to provide a fuller picture. As a writer, this approach also helps me organize my thoughts and think about where potential future stories may lie.

Dina Fine Maron is an editor at Scientific American who handles medicine and health. She covers everything from infectious disease and global health to cutting-edge lab research. She is based in Washington, D.C. Her award-winning work has also appeared in publications including Newsweek, The Boston Globe, The New York Times, Time.com and E&E News. Follow her on Twitter @Dina_Maron.

The number of syphilis and gonorrhea cases is on the rise in the U.S. How should a reporter go about covering sexually transmitted diseases and watch for an outbreak in their community?

It’s tough to get timely data regarding STDs or other infections. You often hear things anecdotally at first and then need to follow up. Check with local colleges and urgent care centers, where people might go for more timely care. Talk to local internists and nurses—ask what problems they are seeing. Ask your own physician, nurse or friends for insights.

Try to give social justice and political context for the rise in STD infections, such the recent cuts in public funding for women’s health. For example, 21 STD clinics closed⁠ in 2012 alone. Planned Parenthood closed in Scott County, Ind., fueling a sharp rise in HIV. The clinic had been the only location for HIV testing in the county. It’s critical to give that social and political context for your stories.

Health departments may lag with STD data, but here are some web sites with useful information:

  • The CDC’s STD social media feed: @CDCSTD on Twitter

  • Columbia University’s health information website on sexually transmitted diseases; Go Ask Alice!

  • Respected STD blog site: The STD Project has interviews with patients as well as many resources.

  • Outbreak News has a good primer on syphilis here.

Judy Stone (@drjudystone) is an infectious disease physician and writer. She also conducted clinical trials, prompting her to write "Conducting Clinical Research: A Practical Guide: (available as an open access PDF as well as for purchase). She is a Forbes contributor writing about antibiotic resistance and infections, public health, and drug development.

Why should you pay attention to infectious disease threats among hospital workers?

Medically fragile and immune-suppressed patients spend a lot of time in the hospital, where they face an additional threat of getting a hospital-acquired infection. But when it comes to tracking the emergence and spread of diseases, the nurses and other professionals who care for them may actually be the “canaries in the coal mine.” While health care workers take precautions to prevent transmission, they sometimes become infected and their own illnesses can reveal important information about emerging diseases.

For example, methicillin-resistant Staphylococcus aureus (MRSA) was primarily a threat in hospitals before it emerged in the community, and even today the Centers for Disease Control and Prevention is wrestling with how to handle health care workers who are either infected or colonized with MRSA. (Health care workers can carry the organisms without having any symptoms.)

The epidemic of severe acute respiratory syndrome (SARS) killed 1,707 health care workers worldwide in 2002 and 2003 — which represented about one in five deaths from the disease overall. More recently, hospital workers have become infected with Middle East respiratory syndrome coronavirus (MERS-CoV), a disease that is not easily transmissible. The World Health Organization plans to vaccinate at-risk health care workers in Africa with the experimental Ebola vaccine.

You might find the earliest reports of diseases among health care workers from two of CDC’s advisory committees: the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC). They meet two or three times a year; if you can’t attend in Atlanta, you can tune in via a teleconference. Another division of CDC, the National Institute for Occupational Safety and Health, also investigates disease risks of health care workers. A recent study looked at the toxic effects of cleaning solutions that are meant to protect against disease — so that reveals the complexities of this issue.

If you want to contact health care workers who have become injured or ill from their work, you could try the unions or professional organizations: Service Employees International Union, the American Nurses Association, or National Nurses United.

Occupational medicine physicians treat work-related injuries and illnesses, and every major hospital will have an occupational medicine physician. You can tap into their network.

Michele Cohen Marill (www.michelemarill.com) is an Atlanta-based health and medical writer. She is a contributing editor for Atlanta magazine and has been published in Stat, Nature Medicine, Proto, WebMD magazine, and AARP online, among other publications. She was previously editor of Hospital Employee Health, a newsletter for employee health professionals in hospitals.

How can reporters explore the cultural stories behind vaccine doubters?

There has been a campaign of anti-vaccine activists targeting specific communities, such as Somali parents in Minneapolis, Orthodox Jewish parents in California and parents of homeschoolers.

Whether the groups are secular or religious, these communities tend to have their own internal social networks. Journalists looking for a local angle on the vaccine debate may want to explore whether such campaigns, like this, exist in their communities.

Some of the questions to explore include the mentality behind these anti vaccine groups as well as why some parents may be vulnerable to vaccine nay-sayers. Explore the social factors unique to each community. They are vulnerable to anti-vaccine propaganda for very different reasons, but the common thread that is used is some kind of emotional appeal.

For example, the Somalis in Minneapolis had children who were affected with autism. Many of these parents already felt their concerns were not addressed by their health care providers and were willing to listen to people who said they cared about their health. In the Los Angeles Orthodox Jewish community, where outbreaks spread in Jewish day schools and Yeshivas, many people believed that measles was a mild disease and that not vaccinating children was their way of exercising choice over health based on misinformation spread by anti-vaccine groups.

Talk to social scientists at local universities and public health officials about how they may be changing their communications strategies to address the specific concerns of these different communities.

In the case of the L.A. Orthodox community, public health officials worked with leaders in the orthodox community to explain that by vaccinating their children, they were adhering to Jewish law by protecting the vulnerable.

To find out more about vaccination rates in your community, the Centers for Disease Control and Prevention has excellent data here.

Wendy Wolfson is a science writer based in Irvine, Calif. She covers innovation in biotechnology, medicine and healthcare. She was a columnist for Chemistry & Biology (Cell Press), and freelance contributor to Nature Biotechnology, Science, Red Herring, The Lancet, Bio-IT World, Wired, The Boston Globe and CURE magazine. She can be reached at wendywolfson@gmail.com.

What are a few tips for reporters covering global health issues?

First, subscribe to Pro-MED Mail, a mailing list on global emerging diseases that provides broadly sourced, up-to-date information on outbreaks important to both human and animal health worldwide. The volume can be a little high, but there's no better way to stay ahead of the curve on emerging infections – except, perhaps, for actually working in global health.

Global health issues unfold in complex contexts that we often hear very little about in daily mainstream news – but understanding those contexts can greatly inform your reporting. Read about issues in global aid and development both on-topic and peripheral to global health: Devex and The Development Set are both good resources for development-related news, and the Economist and Foreign Affairs are good for more general global sociopolitical context.

Although it's best to report global health issues from the places where they're happening, that's not always possible. When finding sources from afar, note that while large multilateral organizations like the Centers for Disease Control and Prevention, the World Health Organization, and United Nations agencies may give you good high-level information, they may also avoid addressing problems related to aid delivery, or developments in an outbreak that reflect poorly on their organizations.

For more nuanced viewpoints, look to the small, non-governmental organizations on the ground, especially organizations aligning themselves with human rights work, or academics affiliated with institutions who have research collaborations in the area. And be prepared for slow email communication or communicating by text message – SMS is often the most reliable way to communicate in remote areas in low- and middle-income countries, and a phone call may be nearly impossible.

Keren Landman (@landmanspeaking) is a practicing physician and writer who covers topics in medicine and public health. She is trained in internal medicine and pediatrics with specialties in infectious diseases and clinical microbiology, and served as a disease detective at the U.S. Centers for Disease Control and Prevention. As a researcher, she has focused on the prevention and treatment of HIV and malaria in resource-poor countries, and she has worked as a medical epidemiologist at the New York City health department. She lives in Atlanta.

What advice do you have for journalists covering emerging diseases?


Kris Hickman

Word choice matters, especially when it comes to covering a deadly disease.

You may hear health professionals use the terms “infectious” and “contagious” interchangeably. That is adequate in many instances. However, minor differences between the two terms may play a role in which one you decide to use in a story. Contagious means a bacteria or virus can be transmitted from person to person (a communicable disease), and is quantified by R-nought, a mathematical construct that predicts the number of people a contagious individual will infect.

Infectious refers to how many bacteria, virus, or other pathogens are needed to infect an exposed individual. Ebola, for example, is not terribly contagious, but it is dangerously infectious. This matters in determining a person’s risk of contracting a disease.

Also be careful with the words “quarantine” and “isolation.” They both refer to separation, but are for different purposes. For example, people who are already infected with Ebola would be isolated, while quarantine is for those who have been exposed and may become sick, but aren’t sick yet.

Kris Hickman (@the_index_case) was a graduate research assistant for AHCJ, pursuing a master’s degree in public health. She has a bachelor's degree in anthropology, with a minor in journalism, from the University of Missouri. She spent two years in Zambia as an HIV/AIDS community education volunteer in the Peace Corps. She aspires to be an epidemiologist and science writer.

What is a good starting point when you are looking for new sources for covering the infectious disease beat?


Bara Vaida

This may go without saying, but read as many books as you can for context on the disease and experts to call. For example, are you covering mosquito-borne diseases? Read “Zika” The Emerging Epidemic” by Donald G. McNeil Jr. and “The American Plague: The Untold Story of Yellow Fever, The Epidemic That Shaped Our History” by Molly Codwell Crosby. If you are covering local hospitals, read “The Checklist Manifesto,” by Atul Gawande, and find out if your hospital has a surgical checklist and is using it. If it is late summer, and writing about the seasonal flu, read “Flu: The Story of the Great Influenza Pandemic of 1918,” by Gina Kolata. All these books will also help deepen the context of your reporting and expand your source list.

Bara Vaida (@barav) is AHCJ's core topic leader on infectious diseases. An independent journalist, she has written extensively about health policy and infectious diseases. Her work has appeared in outlets that include the National Journal, Agence France-Presse, Bloomberg News, McClatchy News Service, MSNBC, NPR, Politico and The Washington Post.

What are some of the best resources you use regularly to cover antibiotic resistance as story?


Maryn McKenna

I read lots of scientific journals like, Clinical Infectious Diseases, the Journal of Infectious DiseasesEnvironmental Health Perspectives,Emerging Infectious Diseases, the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

I also regularly read the Lancet, the Lancet Infectious DiseasesScienceNatureInfection Control and Hospital EpidemiologyAntimicrobial Agents and Chemotherapy, and the Center for Infectious Disease Research and Policy.

Maryn McKenna is an independent journalist who specializes in public health, global health and food policy. Her latest book, “Big Chicken: The Incredible Story of How Antibiotics Created Modern Agriculture and Changed the Way the World Eats," was released Sept. 12. She blogs for Wired and is a columnist for Scientific American and a long-form and investigative writer for Self, the Atlantic, the Guardian, Nature, and other publications in the United States, Europe and Asia.  She serves on AHCJ's board and Freelance Committee. You can follow her at @MarynMcK.

What makes a good anecdote in a health story?

If readers see themselves, or someone they love, in the person’s story, that’s a good anecdote. Reporters need to look for characters, not just quotes. A good anecdote dramatizes a situation rather than simply describing it, but it also illustrates the larger story while conforming to — not contradicting — the evidence. Inappropriate anecdotes are those that are not part of any trend and which are unsupported by the evidence or outright contradict the evidence base, such as Jenny McCarthy’s use of her son Evan to suggest that vaccines cause autism, a “poster child” for using an anecdote irresponsibly because it goes against the evidence.

Liz Szabo, John A. Hartford Senior Correspondent for Kaiser Health News, is an enterprise reporter focusing on acute care and end-of-life issues. She has an extensive background in medical reporting, including 12 years as a health writer at USA Today. Her work has won awards from the Campaign for Public Health Foundation, the American Urological Association and the American College of Emergency Physicians. Szabo worked for the Virginian-Pilot for seven years, covering medicine, religion and local news.