Covering a measles epidemic with cultural sensitivity Date: 06/26/19
Measles is one of the most infectious diseases on the planet. Just by breathing, someone with measles can spread the disease to 12 to 18 other people. The U.S. is experiencing one of the worst outbreaks of measles since 1994 and one of the hardest hit communities has been New York City. As of mid-May, more than five hundred cases have been reported to city public health officials.
Amanda Eisenberg, a New York health reporter for Politico, has been in the middle of covering this unfolding epidemic. She and her colleagues have not only been covering breaking news stories about the outbreak, but also have found different angles, such as looking at what hospitals were doing to prevent measles in their institutions, the political impact of public health officials’ efforts to stop measles spread and the cost to the city. (Stories are behind a paywall.)
Eisenberg talks more about how she is covering the measles outbreak there:
Q: How did the story begin?
A: It started with measles cases in Brooklyn in Williamsburg [in October]. We were keeping an eye on the numbers and then it was growing at a fast rate. It coincided with an outbreak in Rockland County where there is another Orthodox Jewish community, near where I grew up. So the city kept releasing numbers, and it seemed for a little while they were falling and then all of a sudden, new cases started popping up. It became more evident that this was going to be an epidemic and more than a standard outbreak.
Q: What is this like to cover the measles outbreak as a breaking news story?
A: Well, at Politico I write about policy and politics, so on Mondays, I check the city’s measles website and I call the city health department to get the latest measles numbers. The big thing is tracking lawsuits and any executive orders. Both the state and city health departments have issued executive orders to stymie the spread of the disease. Then you have groups supporting and opposing it, so it’s legal reporting and some math, and understanding public health measures. Disease detection is also part of this. State and city health officials will go to homes and find out where people have been the past three weeks. They find out 'Oh, you went to Home Depot.' That store or school then becomes an exposure site, where unvaccinated people could catch a highly contagious disease like measles.
That might be an exposure [point] for people with kids not vaccinated yet. So it is letting the public know where measles exposure may have been. So that is my day to day. Legal challenges, what the numbers of have been, where exposure has been, and then the political implications of the outbreak.
Q: Where is the story right now?
A: This outbreak is still ongoing [as of May 22, 2019]. It takes two to three weeks for incubation. There can’t be any new cases in that time before health officials can say the outbreak is over. Right now, we are at 523 cases in the city. Nationally, we are nearing 900 cases.
Q: What have been the biggest obstacles to covering this story and how did you overcome them?
A big conversation we have had in our newsroom and seen play out with the media is how to make sure coverage isn’t anti-Semitic. On one hand, there is nothing in Judaism that says not to vaccinate [your kids] and all these rabbis have come out to say, ‘vaccinate your kids.’ They say, ‘vaccinate’ and ‘we care about science, safety and education.’ These rabbis have been instrumental in helping people get vaccinated. The city has administered 22,000 MMR [which stands for measles, mumps and rubella] vaccines since October.
When you see these measles outbreaks, they tend to come from the Jewish Orthodox community. Many of [the families] have six kids and if one gets it, all of them do. So you want to make sure, as a reporter, that you are addressing this in a way that is fair and sensitive and not scaring people. You [don’t want to] say, ‘all Orthodox Jews don’t vaccinate their kids.’ You want to make sure you aren’t using scare tactics as well. You want to make sure that a reader understands that measles is both contagious and preventable.
I want to make sure anyone who reads my story understands what measles is, how it spreads and how to prevent it, [and] that there is no link between vaccines and autism. The MMR vaccine is safe. We want to be culturally sensitive in promoting science.
Q: Are there certain words you don’t use in your stories?
A: No. There is nothing taboo about this one.
Q: What would be some of your lessons learned and your advice to other reporters who may be covering an outbreak, whether it be measles or another disease?
Distinguish your reporting and find a way to take this to a new angle. My colleague said: “We have an outbreak. What are other ways that you can think about to cover this story?” So I wrote about how the hospitals are adding extra measures to ensure immune-compromised people are not exposed to measles on site, which could be deadly.
What were they doing with those patients that were immune-compromised? How are they making sure a measles outbreak doesn’t happen in they hospital. How do they make sure measles isn’t spread at a hospital? In Rockland County, there was an exposure site there at a hospital. Someone was waiting in the emergency room with measles. We got good traction on our story about that and how that hospital made sure that measles wasn’t being spread there. [Write about the fact that] there will be more vulnerable people caught up in this [outbreak] and [about writing about] more than just, this is the latest on the measles count.
Q: Who were some of your best sources to recommend?
A: The health department for the county that has had the outbreak. The Rockland County spokesman has been wonderful. We text a lot. The New York City health department is wonderful. [New York City] has a director of infectious disease at the department, so he has been good to talk to about the seasonality of the measles. Measles tends to be a fall and winter disease. Warm weather isn’t favorable to outbreaks, so talk to someone about that. Check with the National Institutes of Health and the Centers for Disease Control and Prevention. They have been helpful. It has been interesting to talk to doctors and scientists who have been around of a long time. With [the success of vaccines and] measles not having not been around for a long time, there are a lot of doctors that haven’t seen measles before. It plays into misdiagnosis. So look for seasoned older researchers and doctors. It gives you a better perspective than someone who is younger.
Q: How would you recommend applying what you have learned to other types of outbreaks that likely will occur in the future?
A: Diseases are so different [from one another]. Understand that the flu travels differently than measles. I suggest that anyone who cares about [outbreaks] get better at data scrubbing and what an outbreak of measles looks like for a community. I wrote a story about 400 schools in the state that had high rates of religious exemptions for vaccinations. The schools spanned from teaching Muslim children to special needs children. It’s not just the Orthodox [Jewish] community that has low vaccination rates. So if you can look at data for an outbreak, then you can find stories out of that. Pay attention to vulnerable populations. They are important. They are the ones who can get the most sick, like kids going through chemotherapy.
You know how we explain that people need to get the flu shot, because in reality you are putting other [vulnerable] people at risk [if you don’t get a flu shot?] Measles travels differently than the flu. You have to [be sick with the] measles for it to be passed along. Talk to those infectious disease specialists. They are really important for understanding how disease travels and spreads.
Q: What do you mean about data-scrubbing?
A: The state health department collects data on schools. Pretty much every school, in every state is supposed to send those vaccination records [to the state]. So I emailed the state and said ‘Hey, what are your vaccination records for the schools in the state and city?’ They directed me to a database and I could filter it by the most recent school year and then I could filter through which schools had religious exemption rates. Because anything more than 5% [of vaccine exemptions] weakens herd immunity, I could search for segments that had [enough] religious exemptions that would make the school [vulnerable] with herd immunity. Of those 400 schools, we asked, are they all Orthodox Jewish? Or were they not? And they were not. There were Montessori schools and other religious schools.
Q: How did you get into health journalism?
A: I studied journalism at the University of Maryland. I knew I wanted to be a writer and I figured that reporting was a job where you could be paid to write, instead of a book author who might not get paid to write. So I worked on reporting projects during my senior year on health outcomes in Baltimore and Maryland. After graduation, I started working for a trade publication where I focused on health care information technology and health insurance. About a year ago, Politico hired me to cover health policy and politics for the city.