Coronavirus Files: New Symptoms, Looking Abroad & Research Whiplash
By Lindzi Wessel
The Center for Health Journalism has begun offering a special newsletter geared to journalists as they report on one of the biggest and most complex stories of our times. Each Monday, while the pandemic runs its course, The Coronavirus Files will provide tips and resources and highlight exemplary work to help you with your work. The Center for Health Journalism’s Coronavirus Files Monday newsletter is curated and reported by science writer Lindzi Wessel. Have a suggestion or a request? Write us at editor@centerforhealthjournalism.org.
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Sign up for this Wednesday’s Webinar: Covering Coronavirus: What the Data Tells Us. Kaiser Health News data editor Liz Lucas will walk us through data sources that can aid informed, in-depth reporting on the overall trends of the pandemic, the infrastructure needed to survive it, and the people who are most vulnerable. We’ll talk about what data exists nationally, and what data you should pursue locally. For more information and to sign up for the 10-11 a.m. PT/1-2 p.m. ET webinar, go here.
Apply now to our National Fellowship: Have a great project in mind about COVID-19? We can help with funding, mentoring and training! The USC Annenberg Center for Health Journalism is focusing its annual National Fellowship in July on the health, welfare and well-being of vulnerable families and communities — as seen through a COVID-19 lens. We’re offering reporting and engagement grants of $2,000-$12,000, six months of mentoring and five days of informative and stimulating programming in an online Fellowship program that takes place July 20-24, 2020 (with additional three-hour trainings once a month through December 2020). The National Fellowship will equip reporters to take a close look at racial, ethnic and geographic disparities, how communities of color are disproportionately suffering from the economic and health burdens of COVID-19 and the structural forces that contribute to unequal outcomes. The Deadline to apply is May 26, 2020. Don’t miss out!
Making Sense of Symptoms & Looking Abroad
Disparities in Health Care Delivery: Equity and Rationing Care
Medical professionals continue to caution against rationing guidelines that could systematically disadvantage already vulnerable communities. Of particular concern is how we allocate scarce medical resources, write physician Nathan Chomilo and his coauthors in a blog post for Health Affairs. Just prioritizing treatment for those with highest life expectancies becomes problematic, they write, as disparities in wealth and health care access “translate into life expectancy that varies widely by zip code.” A similar problem arises when rationing resources based on pre-existing conditions that complicate the disease — conditions that are generally more common among historically disadvantaged populations. The authors urge anyone involved in such guidelines to consider the social determinants of health disparities and seek out existing racial equality toolkits that “provide health care leaders prompts to guide their decision making.”
Some States Open Up
Stay-at-home guidelines from the Trump administration expired last week, leaving states to decide how to handle next steps. After initially saying that he alone could decide on lifting restrictions, now the president is leaving decisions up to the states. While many have stayed the course, instructing residents to stay off the streets, nearly a dozen states including Texas and Maine, have joined in a mass reopening of businesses, and, in many parts of the country, warm weather is drawing crowds to parks and beaches. “The inconsistent patchwork of state, local and business decision-making is exactly what could drive a second wave of the coronavirus,” cautions Joanne Kenen, executive health care editor of Politico Pro. “Opening safely takes a lot of work, a lot of consistency and a lot of carefully thought out planning — none of which have been hallmarks of the early devastating months of the pandemic.”
New Symptoms Keep Coming
Perhaps one of the scariest things about COVID-19 is that it continues to surprise us. Two months out from the first then-recognized coronavirus death on U.S. soil, the virus is still confounding doctors with new symptoms. For weeks the Centers for Disease Control and Prevention had listed only cough, fever and shortness of breath as core symptoms of COVID-19. Now, six new complaints have made the list: headache, muscle pain, chills, repeated shaking with chills, sore throat and new loss of taste or smell.
But that’s likely not the end of it, as doctors continue to document and grapple with additional mysteries of the pandemic. Could it really be, for example, that coronavirus is driving a bizarre surge of toe rashes? Some dermatologists believe that a pinkish, burning rash that looks like frost bite could be caused by COVID-19. Eye, liver, kidney and gastrointestinal problems have all been reported in coronavirus patients. And, recently, aggregated reports from doctors in various hospitals seem to show a pattern of young people with coronavirus dying from stroke — it’s a very small number of cases, but enough to call notice. How could a disease defined by respiratory symptoms be wreaking havoc on bodily systems from our toes to our brains? One possibility is that the virus may somehow be causing abnormal blood clotting, a problem that could explain both toe symptoms and strokes, as well as problems in the lungs, writes Jennifer Couzin-Frankel for Science. The theory might help explain other mysteries of the disease as well.
COVID Abroad: What Can We Learn?
We can find good news in COVID-land — we just have to travel quite far away. New Zealand, this week, declared victory against coronavirus, with Australia poised to follow on the heels of its smaller neighbor. New Zealand, a country of just under 5 million, responded aggressively to early coronavirus cases, closing the borders to foreigners and sending the nation into lockdown before any deaths had occurred. Australia’s leaders also quickly declared an emergency and took immediate steps to increase their hospital capacity. Damien Cave of The New York Times argues that the island nations achieved their current enviable positions in part by letting go of partisanship and letting “experts lead.” Leaders of both nations responded with strict and decisive action and have “received praise from scientists for listening and adapting to evidence,” Cave writes. Still, both countries will have to monitor closely for new cases, and they can expect to experience some rebounds, as we saw in China, Singapore and Hong Kong (mostly from international travel) after those nations brought the epidemic under control within their borders.
Aggressive patient tracking and quarantines seem to be responsible, too, for Taiwan’s early successes in controlling the virus. But other countries are taking a starkly different approach. Sweden, a country of just over 10 million, has implemented no lockdown at all, instead asking their citizens to be mindful of social distancing guidelines and banning gatherings of more than 50. With a death rate of 22 per 100,000, akin to neighboring, locked-down Ireland, the nation has labeled its hands-off approach a success. But some analysts say Sweden might have fared much better with stricter measures, noting that nearby Denmark, Norway and Finland all had death rates of less than eight per 100,000. (Last week New York State reported a death rate of 76.2 deaths per 100,000, while California reported 3.3 deaths per 100,000.)
Health-care Industry Disparities: Filipino Nurses Bear Front-Line Burden
We’ve written previously about how the pandemic is spotlighting disparities in health care access along racial lines. Now health care workers say the crisis is also exposing long simmering inequalities within their profession. Filipino nurses, who make up an estimated 4% of America’s overall nursing force — and a much higher percentage in some regions, including in California where that number reaches 20% — are a population that has been hit particularly hard, writes Usha Lee McFarling for STAT. The Philippines became a global source of professionally trained nurses after the U.S. colonized the island nation in 1898 and began training Filipinos to provide care to American soldiers. Often on the front lines of medical procedures that carry high risk of exposure, Filipino nurses have historically been underappreciated and underprotected, writes McFarling. In Filipino families with multiple members working in health care, the risk can feel especially acute.
“Many Filipino nurses feel they are treated as expendable even though their large numbers and work ethic, they say, keep the American health care system functioning,” McFarling writes.
Handling Science Whiplash with Science Journalist Siri Carpenter
Readers desperate for good news might be feeling some whiplash this week with yet another round of results about Gilead’s experimental coronavirus treatment, remdesivir. Early leaked results promised hope that then seemed quickly dashed by a second leak. Now, though, with research still ongoing, new promising results have pushed the drug through the Food and Drug Administration’s emergency approval process, allowing its use in patients severely ill with COVID-19. That’s a lot of back and forth for just a few weeks of news. But it won’t be the last scientific roller coaster we experience before this pandemic is over. We asked science journalist Siri Carpenter how reporters can smooth the ride for readers trying to understand the ups and downs of treatment research. Carpenter is president of the National Association of Science Writers and co-founder and editor-in-chief of The Open Notebook, a non-profit organization “dedicated to helping science journalists cultivate fundamental skills.”
Center for Health Journalism: How is the pandemic challenging reporters covering medical science?
Siri Carpenter: It's difficult to report on emerging science in the best of circumstances. And these are certainly not the best of circumstances. It can be so extremely challenging to deal with all of the uncertainties that are built into science and the stakes are so high right now. Everything is happening so fast, and it's playing out so publicly. It’s particularly hard to try to balance the search for solutions and good news with the reality that there are no silver bullets and the need to avoid giving people false hope.
Center for Health Journalism: What are the risks of not striking this balance — of overhyping some potential treatment, for example?
Siri Carpenter: At the most extreme, of course, there's the risk that people will make drastic decisions that could impact their health — that people will drink bleach, for example. As reporters, the thought that we could contribute to that is terrifying. When you’re talking about preliminary results of drug trials, the stakes are high. The risks run the gamut, from people simply being disappointed that something they put hope into doesn't pan out, to seeing people bogging down the medical system with expectations of having access to drugs that are experimental and not yet approved, to people being unwilling to be in the control group of studies that are testing other drugs if they have the impression that there's a drug that is the standard of care. And that isn't, of course, even getting into issues about longer term trust in science.
Center for Health Journalism: Can you share some tips for instilling appropriate doubt into stories about drug studies? What should journalists be looking out for to help give readers realistic expectations?
Siri Carpenter: Science is a gradual process. I always like to say that science is a process of being less and less wrong over time. It's really important to continually be reminding people that the way science works is not through one single study, but through an accumulation of information where each individual piece is imperfect.
When you're interviewing researchers, ask them for the key specific things to know about their studies and what the limitations of the study are. Then ask the same questions to outside experts who weren’t involved in the study. Consider what the results mean for a human being. How many people would need to be treated for one person to benefit and by how much would they benefit? Think about those kinds of practical ways of understanding the data. And any good story that's about medical treatment and medical results should report on the negatives — the costs and the adverse effects, and quantify them and say how often they occur.
Think about what tools you’re giving your audience to place results in perspective, and always be mindful of the fact that every study has limitations. If you have a story that does not relate any limitations to a study, then your story is almost certainly incomplete.
Resources
- Have more questions about covering science? Ask them through the NASW-COVID19 discussion list, open to any journalist covering the pandemic who might have questions about how to report a specific story, need help interpreting statistics and more.
- And for tips on how to read a scientific paper, spot shady statistics, handle the emotional toll of crisis reporting and more, visit The Open Notebook’s collection of articles relevant to pandemic coverage.
- The pandemic is leaving journalists strapped for time and cash even as readers demand coverage of critical stories. If you need help funding an important project, check out the grants listed in Poynter’s recently published guide. And, remember, our National Fellowship comes with reporting grants ranging from $2,000 to $12,000. See more here.
- For many of us, the news cycle is moving faster than normal, which might make it hard to consider the small, but important details, like source diversity in our stories. But resources exist to help you. You can quickly find women experts in specific fields through the Request a Woman in STEMM page, published by 500 Women Scientists.
- A new resource from the Reporters Committee for Freedom of the Press for journalists reporting on COVID-19 breaks down the Health Insurance Portability and Accountability Act, or HIPAA, and provides information about what the federal health privacy law does and does not cover.
And Don't Miss...
- “As Coronavirus Strikes, Crucial Data in Electronic Health Records Hard to Harvest.” Kaiser Health News
- “Scores of Coronavirus Vaccines are in Competition — How Will Scientists Choose the Best?” Nature
- “Teenagers in ICE Detention Are Worried about COVID-19.” High Country News
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