October 15, 2022 - Citizen Journalist

Citizen Journalist

I gave the following talk to the fall workshop of Alabama Media Professionals and I would like to share it with you here. This presentation was made for an audience of journalists but I believe it has more universal application.

I grew up in the Golden Era of Journalism. The 1960’s and ‘70’s were an era when Vietnam War investigative reporters, like David Halberstam & Seymour Hersh, were war-time heroes. Bob Woodward & Carl Bernstein were fearless saviors of American democracy. Perhaps my favorite journalist of all was Anthony Lewis, who covered the U.S. Supreme Court in the ‘60’s and ‘70’s. Lewis wrote the book, Gideon’s Trumpet, the story of Clarence Gideon, who was the plaintiff in the Supreme Court case of Gideon V. Wainwright. That case stands for the principle that indigent defendants charged with serious crimes have a constitutional right to a lawyer. 

I always thought I’d like to be a reporter. After finishing college, however, I went in a different direction. I went to law school. I was 22 years old and newly married, so I took the safe path. But journalism has continued to fascinate me. In fact, I thought I might merge my twin interests in journalism and the law by becoming a First Amendment lawyer. Floyd Abrams, who represented the New York Times and argued the Pentagon Papers case, is someone I have always admired.

But that, too, was not to be. As the saying goes, “Life is what happens when you're busy making other plans.” After graduating from law school, I accepted a one-year judicial clerkship with Judge Sam Pointer, Chief Judge for the Northern District of Alabama, and my wife and I moved to Birmingham. I later joined a Birmingham law firm, then left to form the Maynard, Cooper firm, and became a specialist in public finance and economic development.

When I look back on my career as a lawyer, I realize there were two passions or skills that influenced my career path. The first was an immense respect for the power of words. As any attorney will tell you, regardless of practice area, words matter. Whether you’re a trial lawyer or negotiating a complex transaction, to effectively represent a client, your language must be persuasive, precise and truthful. In that way, practicing law is a lot like being a good journalist. 

The second thing that influenced my career is a love for numbers and data. Ever since I was a little boy, I’ve been a baseball fanatic. The outsized role that numbers play in that sport has always appealed to me. I discovered that numbers can tell a story just as powerfully as words can. 

So, fast forward to early 2020. I retired from my law firm at the end of 2019 mostly because my wife and I love to travel. We especially love to hike. We looked around and decided we needed to pick up the pace while we were still young enough and healthy enough to do it. Little did I know that the worst global pandemic in more than a century loomed just around the corner.

In the beginning of this tragedy, all we knew about Covid-19 was what we read in the newspapers, which wasn’t much. The way the pandemic first spread in the United States just seemed so random. In the spring of 2020, NYC became the epicenter, claiming the lives of 500-1,000 persons per day at its peak. There were other pockets, too, such as the Upper Midwest. And the State of Washington, home of the first American to die from Covid in February 2020. New Orleans was also hard-hit in the aftermath of Mardi Gras. 

But here in Alabama, the press portrayed the pandemic almost as if it were confined to these few pockets. And that was reflected in the attitudes of our state politicians. You may recall Governor Ivey’s comment in April, when she refused to issue a stay-at-home order. She said the order wasn’t needed because, “Y’all, we are not Louisiana, we are not New York, we are not California.” The State’s political leaders and media were singing the same song - that  the virus would disappear as soon as the weather warmed up. Remember when President Trump said it would be over by Easter?

Epidemiologists and infectious disease experts knew better, of course. Throughout human history, epidemics and plagues have been game-changers, wiping out entire civilizations. A lot of people are surprised to learn that the 1919-20 flu epidemic killed more than twice the number of people who died in World War I - an estimated 50 million died from the flu, while 20 million people died in the Great War, counting military and civilians. The scientific community tried its best to sound the alarm, but it had trouble being heard. After all, 2020 was an Election Year and politicians had a vested interest in deflecting responsibility for the suffering. While the White House task force recommended that businesses and schools should remain closed until cases subsided, President Trump did everything in his power to do the opposite. “Liberate Michigan”, he said, as he worked to undermine that State’s stay-at-home order.

This is the context in which I posted my first note on Facebook on May 1, 2020. By that point, the United States already had reported over 1.1 million cases, and 70,000 Americans had already died, more than all the Americans who died in the Vietnam War. In my first note, I simply listed the rising number of cases, hospitalizations and deaths in Alabama during the last 14 days - and then I posed this rhetorical question: “Do these numbers demonstrate a downward trajectory?” Anyone could see that the trajectory was not down…. but up. 

I posted that first note 8 months before vaccines were available, so our only defense to the life-threatening virus was our own personal behavior, like wearing masks and maintaining social distance. Perhaps naively, I believed that exposing the facts would cause people to modify their behavior and be more careful. I had no idea my initial FB post would mark the beginning of an odyssey that would lead me to write over 450 letters, detailing data at the heart of the worst global catastrophe of our lifetime. 

Before writing, I had to come to grips with the fact that I had no formal training in public health or epidemiology. Though I know how to analyze and interpret data, I certainly did not want to give bad or misleading advice. So, I asked Dr. Michael Saag and Dr. Jeanne Marrazzo, the leading infectious disease experts at UAB, to give me feedback. Both of them urged me to keep writing. They were confident in my sources, my approach and my judgment. They felt the public needed to hear voices like mine, which laid out the facts with compassion and empathy.

So I kept writing. I’d like to pause here and give a shout-out to David Marconnet, a young statistician from Huntsville who founded Bamatracker.com. His clear and sensible presentation of the data published each day by the Alabama Department of Public Health, made my newsletter possible during the first year of the pandemic. Other sources I used in the early days include the Johns Hopkins Coronavirus Resource Center, the Mayo Clinic database, and numerous scientific journals. When analyzing trends in other states and foreign countries, I turned to sources like worldometers.com, the NY Times and Washington Post.

Throughout the first year of the pandemic, my knowledge and confidence grew. I started delving into related topics, such as vaccines and vaccine distribution, the history of the anti-vaccination movement, the jurisprudence surrounding mask mandates, and research concerning aerosol transmission of the virus. I compared infection rates at Alabama’s colleges and universities as well as local school systems. I wrote about comparative access to public health in rural versus urban counties.  I highlighted infection trends in various parts of the country and the world. And I spoke about what I called the Complacency Trap, when people would normalize the grim data, and then start to rationalize because at least it wasn’t getting worse.

I eventually found Facebook to be a really cumbersome way to communicate with a growing readership. My letters were getting longer and more informative, often including tables of comparative data. So, I explored alternative forms of communication. That’s when I discovered Substack. 

Substack is a really easy-to-use self-publishing platform. Heather Cox Richardson’s “Letters from an American” is the most prolific example of Substack. You simply upload your column, press a button, and it generates a very professional-looking finished product, emailing it to everyone who subscribes. Substack gives you the option of charging a subscription fee or allowing access for free, which is what I chose to do. Soon, I had over 1,600 free subscribers. Substack also gave me the option of posting a link to the letter on Facebook and Twitter, where hundreds more people could read it. 

I’ve been asked what caused me to devote hundreds of hours to this letter and then distribute it for free? I like to give two answers to that question. First, I was convinced that the Alabama local media simply was overmatched by this pandemic. I could find no one who was doing more than regurgitating the Alabama Department of Public Health’s daily reports on cases, tests, hospitalizations and deaths, which, in the absence of context or analysis, were often confusing or even misleading.

Here is an example of what I mean. For months, ADPH would report only positive case results that were confirmed by a PCR test, not those resulting from antigen tests. Early on, PCR tests, which required the use of a lab, took days or weeks to process, while antigen tests could be processed within hours. ADPH’s policy obviously led to a gross undercounting of positive cases. Eventually, ADPH changed its policy and began reporting positive antigen test results as “probable” cases. But, the media typically would omit the “probable” cases after receiving complaints from the anti-vax community that “probable” cases weren’t “real”. The truth is, while antigen tests sometimes resulted in “false negative” results, they almost never generated “false positives”. Therefore, excluding positive results from antigen tests clearly resulted in an undercounting, which added to public overconfidence and complacency.

This is just one example of the local and state media not devoting time and attention to get the Covid-19 story right. And politicization of the pandemic just made matters worse. There were voices in the scientific community that were being drowned out by those who claimed that scientists were not to be trusted because scientific recommendations naturally evolved as the data evolved.

The second reason I decided to keep writing, in addition to my determination to get the facts right, is that I felt an obligation to put a human face on it. More and more I was hearing from readers who experienced tremendous personal loss stemming from this virus. A spouse or parent who was hospitalized and made to suffer alone. It was a terrible way to face the prospect of death - isolated in an ICU unit, cut off from loved ones. I felt the human component of this pandemic was just not being addressed by the media, so I felt an obligation to tell the story in human terms. It’s difficult to do but I thought it was imperative to try. 

On Christmas Eve 2020, I pointed out that more Americans were hospitalized on that day than at any other point during the pandemic. In Alabama, 2,542 people were getting inpatient treatment for Covid on Christmas Eve, the second consecutive record-setting day. On the same day, over 1,000 residents of Bethlehem were crowding into hospitals and the Palestinian Health Ministry reported that all intensive care beds were occupied. Quite literally, there was no room left at the Inn. So, I closed my letter that evening with these words from the opening prayer in the Festival of Lessons & Carols, “Lastly, let us remember before God all those who rejoice with us, but upon another shore and in a greater light, that multitude which no man can number”. 

Feelings of isolation and loneliness were a common refrain throughout this pandemic. And not only physical isolation. I’ve received comments from readers who said they shared my letters with family members who didn’t believe the pandemic was real. People who suffer from long-haul Covid are especially vulnerable to such skepticism because their symptoms continue for weeks or months after a negative test. Strident politicization contributed to feelings of isolation and made it harder for people to do what was necessary to stay safe. Things like wearing a mask or quarantining. 

I tried really hard to avoid mistakes in the delivery of top-line data. It was not easy. I already mentioned the distinction in the early days between “confirmed” cases and “probable” cases. As long as ADPH reported those numbers separately, I did the same, though I continued to argue that the distinction was bogus and harmful. There were numerous instances when ADPH would report a pile of positive cases from tests performed in the past. I called it a “data dump” and did my best to separate the older results from the newer ones in order to produce a more accurate picture. 

The only actual data-related mistake I can recall making occurred in late August of 2021, when the Delta surge was at its peak. On August 28, I wrote that ADPH had reported 11,228 new Covid cases in Alabama, an increase from 6,207 cases the previous day. That was a stunning development, a near doubling of the prior day’s total. The next morning, I discovered that the higher number - 11,228 - was actually a two-day total, so I had effectively double-counted. 

I learned from that experience that when you make a factual error in reporting, it’s important to own up to it right away, and make no excuses. I immediately distributed an errata sheet to everyone who had received my earlier letter and pledged not to make the same mistake again. When facts change rapidly, as was the case in the pandemic, it’s important to evaluate the data with a skeptical eye and look for independent confirmation.

So, four months after that incident, in late December, the Omicron variant struck the United States with a vengeance. Although Omicron was highly anticipated, having first arisen in South Africa around Thanksgiving and quickly spreading through Europe, the United States was unprepared for what was coming. 

Just after the first of the year - on January 3, 2022 - the Washington Post first reported  over 1 million cases in the U.S. in a single day. When I read that report, I was astonished. If true, it was 3 times higher than the nation’s highest number of reported cases in a single day since the pandemic began. Mindful of my earlier mistake, I was immediately skeptical, in part because the initial article didn’t make a big deal out of it. So, I decided to flag the number in my newsletter but emphasize that we should wait for independent confirmation before accepting it.

As it turned out, the report was confirmed the next day and it was indeed headline news. For the remainder of January, the Omicron variant set records for reported cases every single day. Because the Omicron virus typically lodged in the upper respiratory system instead of the lungs, a lower percentage of cases were severe enough to require hospitalization. However, since there were so many more cases overall, hospitalizations recorded new records by the end of January.

Nine more months have passed since the peak of the Omicron surge and here we are - in October 2022. Much of the world - at least much of the United States - is convinced the pandemic is over and it’s time to move on. I suppose it’s human nature, and probably a good thing, that humans have the resilience to move on from an event as horrific as the Covid pandemic. Over 650 million cases worldwide and 6.5 million confirmed deaths. About ⅙  of those cases - nearly 100 million - and ⅙  of those confirmed deaths - nearly 1.1 million deaths - involved Americans.

By the way, those are conservative numbers. The prestigious British journal, The Lancet, conducted a 2-year study which recently concluded that COVID-19 is actually responsible for a staggering 17.2 million deaths worldwide. If true, then it’s likely that more Americans died, perhaps as many as 2-3 million - roughly the population of the State of Mississippi.

The Lancet Commission went on to list some of the factors that contributed to this tragedy:  #1: the absence of timely notification of the initial outbreak of the disease; #2: the delay in acknowledging crucial airborne transmission of the virus;  #3: the lack of coordination among countries regarding suppression strategies; #4: the failure of governments to adopt best practices for controlling the pandemic and managing economic and social spillovers from other countries; #5: the lack of funding for low and middle income countries, which proved to be breeding grounds for the emergence of variants such as Delta and Omicron; #6: the failure to ensure the global supply and equitable distribution of protective gear, diagnostics, medicines and vaccines; #7: the lack of timely and accurate data on infections, deaths, viral variants and health system responses; #8: poor enforcement of biosafety regulations, raising the possibility of a laboratory-related outbreak; #9: the failure to combat systematic disinformation; and #10: the lack of global and national safety nets to protect vulnerable populations.

Some of the problems the Lancet Commission identified are a consequence of a failure in communication - the lack of timely notification of outbreaks, for example, and the distribution of systematic disinformation. I find it interesting that this week’s edition of the Journal of the American Medical Association (JAMA) published the results of a nationwide survey of 1,700 Americans conducted in December 2021, which found that 4 in 10 Americans admitted to having misrepresented their Covid-19 status, vaccination status, or told others that they were following public health measures when they weren’t at some point during the height of the pandemic. The survey raises concerns about how such dishonesty may have contributed to the spread of the virus. Again, if the media had more aggressively called out or rebutted disinformation, would it have affected behaviors and shortened the pandemic or limited its severity? 

To be honest, I’ve learned that science communication is not easy. It takes a lot of work and the media cannot be expected to do all the heavy lifting. For that matter, it shouldn’t be left to volunteers like me. The scientific community itself has to do a better job of communicating. I have witnessed only a few leaders and organizations who have stepped up, distilled scientific information and explained it in language ordinary people can understand. This is what Dr. Katelyn Jetelina has said about science communication: “To build trust, to build relationships, to improve health, our field needs to communicate. Be first. Be right. Be credible. Express empathy. Promote action. Show respect. And say ‘we don’t know’ more.”

This global pandemic confirms that we live in an interconnected world where timely and accurate exchange of information - between nations and among populations within nations - is critical to saving lives. I believe that a failure of communication will be a lasting legacy of this pandemic.

Thank you for giving me this opportunity to reflect on my experience. Your invitation to come and speak is timely because my newsletter is at a crossroads right now. I am taking a breather from my newsletter because Alabama’s Covid status is quite encouraging at the moment.

I will admit I’m still concerned about the possibility of a seasonal surge. Indeed, some cold climate states and some countries in continental Europe have seen a recent uptick. And it really concerns me that only 4% of Americans have gotten the bivalent booster, which specifically targets the Omicron variant. Somehow, even after over 1 million of our fellow citizens have died, most people still have not gotten the message that it is within their power to stay safe and keep others safe - if only they would try.

We’ll just have to see how it goes in Alabama and keep an eye on it.