The 2013–2016 outbreak of Ebola virus disease (EVD) first hit remote parts of Guinea in March 2013. The virus then crossed unannounced to neighboring Liberia in the summer before moving on to Sierra Leone, unleashing untold human misery and wreaking extraordinary public health havoc in these impoverished West African countries.
Liberia was the hardest hit, with daily death tolls in the tens. For some time, the outbreak failed to capture news headlines in the United States—at least not until a seminal Ebola-related incident in Dallas, Texas. By the end of September 2014, this unprecedented event, linked to importation of the virus from Liberia, dramatically changed all that, sending the developed nation on an emotionally charged Ebola alert.
As the largest Ebola outbreak ever recorded percolated, resulting in thousands of deaths in Liberia alone by mid-September 2014, it began to rapidly dominate international news headlines and conversations on social media across the globe. “On Twitter, a whopping 10.5 million tweets mentioning the word ‘Ebola’ were sent between Sept. 16 and Oct. 6 from 170 countries around the world,” wrote technology reporter Victor Luckerson on Time.com on October 7, 2014.1
October 7 was one week after Thomas Eric Duncan, a 42-year-old Liberian national who had traveled from his country to reunite with his fiancé in Dallas, was confirmed to have EVD at Texas Health Presbyterian Hospital in Dallas. This marked the first time an Ebola infection had been diagnosed on American soil, and, overnight, news of the West African immigrant’s diagnosis elevated Ebola to a water-cooler-and-dinner-table conversation topic and lit up the Twittersphere in record numbers.
“On the night of Oct. 1, Twitter users were firing off missives about Ebola at the rate of more than 6,000 per minute, up from about 100 per minute before Sept. 30,” Luckerson reported, citing “exclusive Twitter data” Time magazine had obtained.2
“The country where Ebola dominates conversation most is Liberia, where the virus has already claimed more than 2,000 lives. In terms of sheer volume, though, most Ebola tweets are sent from the United States,” Time.com reported.3 Veteran Dallas television medical reporter Janet St. James was among those jamming up Twitter to bring the far-away Ebola story out of West Africa home to a frightened American audience.
On September 30, St. James scooped all her news competitors—in print, broadcast, and online media—by breaking the news that Duncan was being tested for Ebola at the Dallas hospital exclusively on Twitter. The next day, October 1, she outwitted them again on Twitter with Duncan’s positive Ebola diagnosis.
“Twitter is much more immediate than the news [on television] is,” explained St. James in a phone interview. “I didn’t have to wait for there to be a newscast. I could break it on Twitter and I knew that people would get the news much faster. Once I chose to break it [on Twitter], I knew that it could go multiple other places and people could share it.”4
The WFAA-TV news reporter had been on the medical beat for more than 15 years in the Dallas-Fort Worth area. St. James is one of a rapidly growing number of medical reporters who welcome social media as both tools and allies on their beats in the convergent journalism era of the twenty-first century.
St. James deliberately circumvented her traditional medium of television in favor of Twitter—with its unique power to connect its users instantaneously with a global audience of followers. “I knew that I was going to break [the Ebola news] exactly the way I wanted it phrased” more or less without a gatekeeper, she said.5 “I broke the story in the evening probably at 8:30 or 9. I was at home so I could break this news from the comfort of my kitchen,” St. James added.6 After St. James broke the Duncan story, Duncan’s positive EVD diagnosis shook not just the Dallas hospital and dwellers of the Dallas-Fort Worth metropolis, but also Americans of all political and social persuasions. The US Centers for Disease Control and Prevention (CDC), public health departments, and public and private hospitals around the country were equally on high alert. With the explosion of Ebola messages on Twitter and Facebook and American television networks including CNN dubbing Ebola “the ISIS of biological agents,”7 the United States was figuratively on an Ebola lockdown.
Duncan never left the Dallas hospital. He died there on October 8, 2014, just days after his diagnosis and short-lived treatment. Days later, two nurses who cared for him in the hospital, Nina Pham and Amber Vinson, tested positive for the Ebola virus, further heightening the public health urgency of eliminating further transmission in America.
Pham and Vinson were the first individuals to become infected with the Ebola virus within the borders of the United States. Pham was admitted and treated at the National Institutes of Health Clinical Center in Bethesda, Maryland, from which she was discharged on October 16. Admitted at Emory University Hospital in Atlanta, Vinson was another high-profile patient because of her travel to the Cleveland area to visit family and shop for a bridal gown, despite her exposure to Ebola. She was discharged from Emory on October 28, the fourth patient treated there.
Dr. Kent Brantly and Nancy Writebol, who were the first EVD patients to be treated in the United States, had been admitted at Emory in early August 2014. They became infected with the Ebola virus during their stints as humanitarian aid workers in Liberia. Writebol was discharged August 19, and Brantly followed on August 21. A third patient who declined to be identified publicly was admitted at Emory on September 9 and discharged on October 19. All four patients were treated in Emory’s Serious Communicable Disease Unit, which was established 12 years ago jointly with the CDC to care for CDC scientists and others who get exposed to infectious diseases during travels abroad.
If social media had become helpful tools for reporter St. James, their benefits were a mixed bag for Emory. Despite the successful EVD treatments, Emory was not unscathed by innuendos that were rampant on Twitter and other social media as patients were admitted to the specially equipped unit at Emory, said university spokesman Vince Dollard in a phone interview.8 Consider this tweet on October 20, 2014 from @moneyries, following the discharge of an unidentified Ebola patient from Emory the day before: “Emory University had an Ebola patient this whole time and nobody knew it. Well done.”9 The tweet implied a cover-up by hospital officials.
“Social media was vitriolic, but the tide overwhelmingly turned and our supporters began to weigh in. The number of supporters outweighed our detractors,” Dollard said in the interview.10
“In the first few days of the Ebola issue—July 31 through the first week of August 2014—I read comments such as: ‘People who go to Africa deserve to die,’ ‘People who care for those people are crazy,’ comments along those lines, including opinions such as Ebola patients shouldn’t be allowed back in this country,” added Nancy Seideman, Emory University’s senior spokesman.11
“We were able to shift the national social media conversation with Susan M. Grant’s Washington Post op-ed that ended with the line: ‘We can fear, or we can care.’12 This op-ed was picked up widely by mainstream and social media, and as a result of this op-ed—and the accurate information consistently provided by Emory, the CDC, and other organizations—and media coverage—the social media negativity trended way down, and remained down,” said Seideman.13
For its part, the CDC also faced an unrelenting social media barrage, from both a highly anxious American public and elected US officials, for its handling of the Ebola outbreak (how the CDC found itself in this situation is covered by Marjorie Kruvand in chapter 11). Some of the biting criticism was directed at what some considered the agency’s lack of an emergency protocol on how to not only protect health care workers like Pham and Vinson, but also how to stop the Ebola virus at US borders and entry points.
Wall Street Journal editorial page writer Sohrab Ahmari slammed both the CDC and the World Health Organization for “shameful, incompetent, slow” bureaucracy in handling the EVD outbreak.14
A scathing October 16, 2014 Newsday editorial titled “CDC must get its act together on Ebola” blasted the head of the CDC.15
“Dr. Thomas Frieden, who runs the U.S. Centers for Disease Control and Prevention, learned Thursday what happens when a crucial American health sentry is caught snoozing during an invasion,” it read.16
The editorial continued: “The agency charged with keeping America safe from life-threatening illnesses was forced to face hard questions from a congressional subcommittee—and to admit that it didn’t know exactly how two nurses contracted the Ebola virus from patient Thomas Eric Duncan in Dallas.”17
As the criticisms flew like arrows from several angles—from press and public attacks to heated congressional hearings—the CDC also took to social media to defend itself.
“CDC joined the social conversation where and when it was occurring,” explained Jessica Schindelar, a health communication specialist in the CDC’s digital media branch. The CDC disseminated more than 200 messages across social media platforms during the first week of August 2014, as the Ebola outbreak was picking up steam in US media.18
“People are getting more information from different sources than ever before, especially nontraditional ones like social media,” Schindelar continued. “This provides an opportunity for trusted sources like us at CDC to share reliable, scientifically accurate information with multiple audiences, including the general public, via their preferred channel.”19
From monitoring trends on social media regarding Ebola to identifying rumors and misconceptions to filling information gaps, Schindelar said CDC’s social media use was as steady as it was unabashed.20
Tweets21 by business and real estate magnate Donald Trump about Ebola were among some of the boldest and most controversial public criticisms. “I have been saying for weeks for President Obama to stop the flights from West Africa. So simple, but he refused. A TOTAL incompetent!” Trump tweeted from @realDonaldTrump on October 23, 2014, to at least two million followers.
While Trump’s numerous Ebola tweets fanned panic and fear in Americans, the CDC’s communication on social media was aimed both to counter and to clarify.
“During the height of the Ebola outbreak, one of the biggest misconceptions we identified and clarified [on] social media was about why health care workers wear so much personal protective equipment if Ebola is not airborne. It is because CDC recommends health care workers wear protective gear due to the possibility of large amounts of blood, other body fluids, vomit, or feces present in the environment,” Schindelar said.22
“A game changer” was Schindelar’s characterization of the CDC’s health and crisis communication in highlighting the work its experts, health care professionals, and global public health partners “do every day to prevent and control the spread of disease around the world.” The benefits of communicating via social media warrant their continued deployment in public health communication. “An outpouring of appreciation and support [of the experts, health care professionals, and global public health partners] continues to grow out of the sharing of their experiences on social media,” Schindelar explained.23
If the CDC was fighting to maintain its image and credibility, Louisiana officials were more bent on keeping Ebola at bay from their state. By late October 2014, they adopted a unique, if contentious, prescription to prevent “unnecessary exposure of Ebola to the general public.” Kathy Kliebert, secretary of the Department of Health and Hospitals (DHH) in Louisiana, and Kevin Davis, the director of the Governor’s Office of Homeland Security and Emergency Preparedness,24 jointly requested that all individuals who had traveled to Ebola-affected countries in West Africa voluntarily quarantine themselves for 21 days following their travel history with or without symptoms. Furthermore, they disinvited several experts among about 4,000 people preparing to attend the 63rd annual meeting of the American Society of Tropical Medicine and Hygiene slated for November 2–6, 2014, in New Orleans, Louisiana. Nevertheless, the officials admitted this was more a precautionary measure than one based on science.
“Individuals who have traveled to and returned from the countries of Sierra Leone, Liberia, or Guinea in the past 21 days, or have had contact with a known [Ebola] patient in that time period, should not travel to New Orleans to attend the conference. Given that conference participants with a travel and exposure history for [Ebola] are recommended not to participate in large group settings (such as this conference) or to utilize public transport, we see no utility in you traveling to New Orleans to simply be confined to your room,” stated the email signed by Kliebert and Davis.25 Government officials required ASTMH to pass on the email message.
“We certainly respected the work of the conference attendees, but our big obligation was to the public health of all Louisiana residents and the conference attendees as well. Certainly, in the abundance of caution, we felt it was best to issue the public health advisory for the conference attendees planning to visit New Orleans,” Kliebert explained in a phone interview.26
Like health reporters breaking news on Twitter and holding conversations with their audience on Facebook, Louisiana public health officials engaged with their constituents via Twitter and Facebook primarily, providing them information for re-tweeting or posting on Facebook walls.
“We know that social media is the place where individuals go to share their frustration, their fears, they ask questions of one another. So it’s critical that, as a public health entity, we share accurate, timely information to help individuals feel reassured so that they know what the state is doing to help protect their health and safety,” said Olivia Watkins Hwang, director of media and communications for Louisiana’s Department of Health and Hospitals.27
“The strategy for social media isn’t very different [from] a general strategy for crisis communication. You want to be first, you want to be accurate, you want to be timely, and you want to give people something that makes them feel reassured, that makes them feel empowered. So information about things they can do, or steps they can take, or things they can be aware of is always critical to emergency-response communication,” Hwang said. “That was part of our strategy with Ebola.”28
A brief visit to her family in Summit County in Ohio by Amber Vinson, the second Dallas nurse infected with Ebola, thrust public health officials there into crisis communication high gear. A local, national, and international news spotlight focused on Summit County, as social media and the 24-hour news cycle became a dual challenge for health officials.
“We, in the very early hours of this incident, started monitoring social media. … We are a small health department. … So this was an overwhelming presence, the whole Ebola situation,” said public health information officer Marlene Martin in a phone interview. “So very early on, our emergency operation center was opened in our county. We also had someone stationed in there that was monitoring social media for us as well.”29
Rather than chase and respond to every social media rumor or misconception on the Ebola connection to Summit County, even from talking heads on national television, officials were determined to counter with expert information on the virus in an effort to calm the flared-up nerves of their constituents.
“Again, we felt it [was] very important to get out the information, the facts [about Ebola], and so we didn’t take a lot of time to respond to people who were saying strange things and mean things on social media,” Martin said. “We were just reinforcing that we were putting out the truth: This is how it is contracted, these are the symptoms.”30
Television talking heads and “so-called experts” had it wrong most of the time about how Ebola is transmitted, according to Dr. Marguerite Erme, medical director of Summit County (Ohio). “Dealing with some of the information that came out on the news media, on what people’s opinions [were] and having to counteract that with science, was a little challenging. The people who were talking the most about this on the news were not the people who know the most but the people who are the most recognized, and they weren’t always the best educated [on Ebola],” she said.31
If the 2014 Ebola outbreak in an age of social media posed communication challenges to public health officials like those in Summit County, it offered scholars opportunities for research on how people were seeking information about the disease, tracking its spread, and voicing concern over it among various users and populations.
One study used trend data from Twitter and Google searches in late September 2014 when the first Ebola diagnosis in the United States was confirmed to draw conclusions that television news clips drove Americans into panic and sent them querying “Ebola symptoms” and whether or not they were free of Ebola.32 The study analyzed Ebola-related news video broadcast on Fox News and MSNBC networks to assess how they spurred tweets and Google searches on Ebola.
“It appears that basically every news video that was aired—Ebola-related news video—inspired thousands of tweets and internet searches related to Ebola,” explained study co-author Sherry Towers of Arizona State University’s Simon A. Levin Mathematical, Computational, and Modeling Sciences Center in a phone interview.33
“And the Internet searches ranged from searches that perhaps reflect simple curiosity, like people searching for information on Ebola symptoms to people doing Google searches relating to such terms as ‘Do I have Ebola,’ which reflects something more than simple curiosity. It appears that the news media [were] actually—you can call it somewhat contagious in inspiring people to do Ebola-related tweets or internet searches” during the period that was studied.
As much as social media helps the medical reporter break news scoops and engage in ongoing conversations with his or her audience members, some lament that it robs health reporting of the necessary depth and context often associated with it.
“In fact, having had a long background in traditional media, I find that the growing reliance on social media feeds the negative trend of minimizing detail and context in reporting,” said Earle Holland, a former newspaper and science reporter for more than 35 years. “The constraints of social media, coupled with the lack of editorial oversight in almost all cases, [are] a major limiting factor in providing comprehensive and complex reporting.”34
Emory University’s Seideman acknowledged that social media often provides a forum where users can counter misinformation by offering “accurate” information and even drum up empathy, as was eventually the case with Ebola patients. “Social media can be wonderful at self-correcting when you let issues play out.”35
As for medical reporters who use social media, Seideman offered a caveat. “As always with social media, traditional media representatives need to check the accuracy of all information shared and consider the source of all information, particularly when dealing with medical issues,” she said.36
Holland concurred and also elaborated.
“Medical journalism has a great responsibility to its readers, given that the news it provides directly affects people’s well-being. Patients, and their families and friends, deserve to receive relevant medical information in the proper context. Social media inherently can’t do that since it is more oriented towards speed than completeness, and context—how the story fits into a larger perspective—is almost always missing,” he said.37
WFAA-TV’s Janet St. James comfortably and conveniently broke her Ebola stories in Dallas, Texas, using Twitter and Facebook, which she considers important reporting tools in modern journalism. For that, she has nothing but counsel for both budding and seasoned journalists in the use of social media.
“The lesson for me is that you can shape the message and shape it responsibly on social media,” she said. “It doesn’t always have to be about rumors and innuendos. Social media can also be about facts, not fear.38
“I think [journalists] should become comfortable with [social media]. Most of us didn’t grow up using social media, so I think they should become comfortable with it, how to phrase it and how to use in an accurate and timely manner. I think that’s critical for all reporters.”39