More than two months after the first case of the H1N1 virus was reported in Mexico, "swine flu" remains front-page news - now predominantly in the Southern Hemisphere, where many countries are just at the beginning of the winter flu season.
Meanwhile, journalists in the North continue to receive criticism for coverage deemed, in hindsight, to be alarmist and over-the-top.
Photos of deserted towns and people covering their faces with masks have become emblematic of the media frenzy surrounding the flu.
The story "unfolded so quickly," said Rob Stein, a National Health Reporter at the Washington Post, "which made it incredibly unusual" to cover.
It remains to be seen how the flu will affect the global South - and how journalists will cover the story, which is ridden with unknowns.
Because flu viruses are so unpredictable, "the first rule of thumb when covering pandemic is to always second guess your plans," according to Jeffrey Levi, the Executive Director of the Trust for America's Health, speaking at a June 29 panel on "Communicating pandemic" in Washington, D.C.
"Planning is based on assumptions," which can change at any time in the case of influenza, he said.
WHO Director-General Margaret Chan has conceded the reality of the unknown, saying "the virus writes the rules and this one, like all influenza viruses, can change the rules, without rhyme or reason, at any time."
Especially in the early days of the outbreak in Mexico, reporters struggled with a lack of information but a responsibility to protect public health, according to Joe Neel, the Deputy Health Editor/Correspondent at National Public Radio (NPR) in the U.S.
"We wanted our audience to have a better idea" of the situation," Neel said, "but we were not [allowed] to [enter] Mexico" and had limited information.
Journalists relied on data and reports from WHO, which were, indeed, cause for alarm.
Within five days of the first case reported in Mexico on April 22, WHO increased the pandemic alert from phase 2 to 4. Phase 4 is characterized by human-to-human transmission and the potential for "community-level outbreaks," according to WHO. Two days later, WHO alerted a phase 5 - a strong signal that a pandemic was "imminent."
In mid-June, WHO raised its alert to level 6, a pandemic, based on geographic spread of the virus.
"We went from zero to 60," Stein said, referring to the Post's and other news outlets' urgency to cover the issue," but "then as data came, it wasn't as bad as it seemed and [the story] dropped off a cliff."
Some have called the level 6 warning misleading, since the case fatality rate was less than half of one percent of those reported infected.
Washington Post media critic Howard Kurtz called the "tone and volume [of the coverage] out of proportion to what we knew about the outbreak." The "saturation coverage turned excessive, even scary," he said, "and then the [story] fizzled."
In hindsight, coverage may have been over the top, both Neel and Stein agreed, but "we had no choice but to report it," Neel said.
"If the media overreacted, it ended up being good for public health," he added, as it motivated people to take preventive measures such as buying hand sanitizer and staying home from school and work.
There is also a looming fear that H1N1 could, at any time, mutate with other flu viruses, possibly developing greater virulence.
The flu does "appear to be following seasonal routes," said Andrew Pekosz of the Johns Hopkins Bloomberg School of Public Health, on the June 29 panel, so it is likely "cases will spike in the North when fall comes."
Right now, "there are still too many question marks," Pekosz said; this virus "dodged a lot of the rules we though were steadfast."
Reporters throughout the newsroom should prepare as best as possible, such as through internal education on the science involved, panelists recommended.
In reporting the influenza, Neel recommends keeping language simple, so "people get it." NPR decided to keep the "swine flu" label, rather than H1N1, the influenza's official name, he said. "The more technical you get, you lose people."
Neel said his newsroom had conducted an internal training so reporters on a variety of beats were well informed. If the story gets big, "you're going to have non-science and health reporters" covering it, he said.
A variety of resources and information exist online, as well, including through social networks, where much of the news of the virus has been circulated. As of July 1, WHO's Twitter account, "whonews," had 11,918 followers.
Thus far, Chile, Argentina and Australia have been hit hardest in the Southern Hemisphere. On July 1, Argentina's widely circulated Clarín newspaper led with two stories on the flu, which it calls "Gripe A," or Flu A.
As of July 1, there had been 4,190 reported cases in Australia, and seven deaths, according to WHO. In Argentina, 1,587 cases, and 27 deaths had been reported.
According to Neel, unfortunately circumstances are ripe for the influenza to "wreak havoc" in the Southern Hemisphere, which could be a "huge problem in countries where information is not as good."
Especially in areas with poor healthcare infrastructure and high numbers of people with weak immune systems, there is potential for "a lot of confusion," he added.
In Africa, Neel predicted, swine flu "will be the story for the next two to three months."
Resources for journalists covering H1N1:
- Association of Healthcare Journalists
- World Health Organization
- U.S. Department of Health and Human Services
- The Nieman Foundation (Harvard University)
- Poynter Institute
- Centers for Disease Control and Prevention (for case-report data)
- The Lancet
Feel free to share additional resources below.