ABSTRACT
As the plague in Oran slowly spreads, Dr. Rieux, Albert Camus’s protagonist in The Plague, tries to convince the town authorities to take action and declare an epidemic. Unfortunately, the officials are slow to react. Dr. Richard, the chairman of the Oran Medical Association, argues that “it was a mistake to paint too gloomy a picture, and, moreover, the disease hadn’t been proved to be contagious.” The officials, afraid to arouse public alarm, refuse even to officially admit that plague had broken out. Instead, they refer to it as a “special type of fever.” Camus’s description of the authorities’ reaction to the plague was not detached from reality. In 1576, in the midst of the plague that struck northern Italy, the Bishop of Verona criticized the government’s “refusal to use the ‘formidable name’ of the plague,” as one of the major factors that led to chaos and uprisings in the city (Cohn Jr, 2010, p. 264). Today, as Samarajiva and Gunawardene (2013) argue, the controlled dis-
semination of information is no longer an option for any government or health authority. This major challenge is demonstrated in almost every outbreak in recent years, beginning with the 2002-2003 SARS outbreak. The SARS (Severe Acute Respiratory Syndrome), which eventually infected 8,096 people in 27 countries and killed 774, broke out in November 2002 (WHO, 2003a) in the southern Chinese province of Guangdong (WHO, 2003b). Yet, three months later, the Chinese government was still trying to contain information about it and actively suppressed news of the outbreak (Yu and Madoff, 2004). Nevertheless, a post written by a Chinese citizen managed to permeate the
Chinese wall of secrecy. In his post, “Ben” described an illness that began like a cold, but killed people in days (Drexler, 2008). On February 9, 2003, Catherine Strommen, a teacher from California, read the post on Teachers.net, an international online community for teachers, and emailed it to a friend, Dr. Stephan Cunnion, a consultant in the field of infectious diseases and a retired Navy physician. After failing to find any information on the Web about this strange outbreak, Dr. Cunnion posted an email to ProMED-mail (Drexler, 2008), an electronic mailing list run by the International Society for Infectious Diseases, which alerts subscribers to the spread of infectious diseases and toxins (Cunnion, 2003):
Date: 10 Feb 2003 This morning I received this e-mail and then searched your archives
and found nothing that pertained to it. Does anyone know anything about this problem? Have you heard of an epidemic in Guangzhou? An acquaintance of
mine from a teacher’s chat room lives there and reports that the hospitals there have been closed and people are dying. Stephen O. Cunnion, MD, PhD, MPH International Consultants in Health, Inc Member ASTM&H, ISTM
Ben’s report quickly spread by email to tens of thousands of Americans, enabling the world to learn about the fatal outbreak. That same day, the WHO sent a query to Beijing, asking for information about the outbreak, and on February 11, the Chinese Ministry of Health officially reported to the WHO that an acute respiratory syndrome had infected 305 people and caused five deaths (Brookes and Khan, 2005). Other examples, including the most recent ones, such as the 2014 Ebola epi-
demic, the 2015 measles outbreak in California and the Zika outbreak in 2016, further illustrate that in the age of socialmedia, when the authorities hesitate or are reluctant to declare an outbreak, the first indication of it comes from the public. On July 24, 2014, four days after the first case of the Ebola virus in Nigeria
(WHO, 2014), Twitter users were talking about the case, discussing the disease trends, as well as its risk factors and prevention measures. Among the messages tweeted were: “#EbolaVirus 1st case discovered Lagos, pls spread the word”; and “Guys, #EbolaVirus is in Lagos. Be informed. Be careful.” The tweets, reaching 1,196,793 people on the first day alone, started to circulate 3-7 days prior to the official announcement about the first suspected patient (Odlum and Yoon, 2015). Similarly, in the 2015 measles outbreak in California, the story broke by way of a post tweeted by a pediatrician from San Diego, who wrote about the cases diagnosed and their connection to the Disney parks. The formal statement by the California Department of Public Health was only issued on January 7-over 15 hours later (Matthews, 2015).
