Vague fears about coronavirus over the past few weeks have exploded into panic this week after the CDC issued a warning and the market plummeted, reflecting anxiety about supply chain and potential work disruptions. President Trump accused the media of stoking that panic and has tried to centralize all information coming from the government in the hands of Vice President Pence. Yet Trump’s attention to individual victims seems likely to heighten anxiety among the public.
Whether one agrees with Trump or not, we should recognize that panic may be the worst possible response. It can undermine trust in public health officials and compromise appropriate responses to the outbreak. That’s why we should look to history for guidance on how to interpret news reports about the disease’s spread. Our goal should be to deliver accurate information, convey appropriate levels of concern and encourage effective preventive measures.
The case of the “Russian influenza” more than a century ago is instructive. In the second week of December 1889, several members of the Klamroth family in New York City fell victim to a disease spreading across Europe and predicted to reach the United States at any moment. Dubbed the “Russian influenza” after being observed in the capital city, St. Petersburg, this disease was widely anticipated by newspapers, which quickly identified the Klamroth family as America’s “first case.”
Across the country, newspapers republished detailed lists of symptoms, speculated on paths of infections and disseminated glib predictions that the disease was not dangerous. Detailed descriptions of illness in the Klamroth family appeared in New York City newspapers on Dec. 17, 1889, with further reports over subsequent days in the New York Times, Evening World, New York Tribune and the Sun. The first victim, Clara, 25, became sick on a Thursday after she visited the home of a family that had recently arrived from Europe. The next day, her mother, Josephine, and little brother fell ill. By the end of the weekend, at least three more family members and a cook had become ill, bringing the total number to seven cases in the household. Local newspapers provided a detailed account of symptoms such as headaches, vertigo, chills, nausea, fever and coughing.
Similar reports about sick Klamroths appeared in newspapers across the United States over the next few days, with the “first victims” capturing national attention. Headlines illustrated how readers were primed to look for cases of this global epidemic: “The Great European Influenza is With Us,” from the Evening Star (Washington, D.C.) and “Imported Influenza” in The Washington Post on Dec. 17; “La Grippe is Here. A New York Family Sneezing — The Outlook for the Rest of Us,” from the Portland, Maine, Daily Express; and “It’s in the Air,” from the Telegram Herald in Grand Rapids, Mich. The latter phrase, “it’s in the air,” is especially significant, as it combined medical understanding of airborne transmission of influenza with public awareness of how newspapers quickly, widely and easily disseminated information — and misinformation.
The reporting of these cases followed a model that would be replicated in subsequent disease outbreaks, including the far deadlier 1918 Spanish influenza, and is evident in today’s reports of first cases of coronavirus in the United States and globally. At the time, Cyrus Edson, chief inspector of contagious diseases for New York City, personally dispatched Inspector Ramon Guiteras to the Klamroth home to determine whether they had succumbed to the Russian influenza. Guiteras and the family’s physician, Carl Lellman, agreed that the family suffered from the Russian influenza, a finding endorsed, if cautiously, by Edson.
But public health officials, whose statements were widely reported in newspapers both locally and nationally, managed to heighten public anxiety and offer misguided reassurance about possible impacts. For example, Edson initially declared that the disease was “decidedly unpleasant” but “not dangerous.” Health Commissioner Bryant stated that the disease would produce “general discomfort,” but was unlikely to “have the effect of increasing the death rate greatly.” The Evening World made light of the first cases by publishing a cartoon with the caption “Hear Us Sneeze!” Ten days later, however, newspapers reported that “a wave of physical affliction” had spread across the city, with as many as 50,000 people ill with influenza. Among the victims was Edson, confined to his bed.
In the weeks that followed, significant increases in deaths from influenza and associated diseases proved that public health authorities had underestimated the actual impact of the epidemic. The 1,202 deaths recorded in the first week of 1890 were significantly higher than 762 deaths the previous week. This spike finally caused Edson to acknowledge that “the epidemic of influenza is here in its most aggravated form.” Although death rates returned to normal by early spring, the New York City Health Department reported 2,613 deaths in 1890 from influenza and associated diseases, such as pneumonia and bronchitis, a total nearly twice as high as any year in the preceding decade.
There’s no evidence that any of the Klamroth family died during the Russian influenza. Yet their experience as the focus of national attention provides lessons broadly applicable to current news about the coronavirus. First, we should read reports of first cases carefully, cautiously and critically. Second, we should try to resist media cycles that exaggerate individual cases into general patterns. Third, we should seek reliable information about public health measures. Finally, we must be empathetic to the experiences of individuals and families. Falling ill is always unpleasant and often quite worse. Falling ill with a disease that places patients in the media spotlight, with close attention to hourly or daily symptoms, with the potential to become symbols of policy failures or global tensions, can exacerbate the trauma.
As consumers of media and as members of a community where collective decisions affect outcomes for individuals, we must learn to use historical examples to guide decisions about promoting good health. Newspaper accounts of sick Klamroths “went viral” in their day because their experience fulfilled widespread anxiety about the potential spread of a specific disease. Understanding how reports of individual patients contribute to an outbreak narrative is essential for the public confronted with disturbing details about a new and frightening disease.
