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SARS epidemic in the press.

To the Editor: On March 12 2003, the World Health Organization (WHO) issued a global alert regarding severe acute respiratory syndrome (SARS) in Vietnam, Hong Kong, and China's Guangdong Province. Three days later, for the first time in its history, WHO recommended postponing nonessential travel to the affected areas and screening airline passengers (1). These initiatives, together with the awareness of the modes transmission of the coronavirus associated with SARS (SARS-CoV), led to extensive press coverage.

To describe the extent of this coverage in Italy and to identify the events that prompted peak coverage, we reviewed the five Italian daily newspapers with the highest circulation (2) from March 12 to March 30. The articles were identified by hand search (reading headlines, subheads, and titles) and were classified according to the publication date and page number. We assigned one point to full articles and to front-page articles or headlines and half a point to short articles. We also reviewed all national newspapers for articles published before the travel advisory (March 12-15)(Figure).


Before the travel advisory, no articles were published in the five newspapers, whereas on March 14, one article was published in a smaller newspaper ("Osservatore Romano," the Vatican newspaper). On March 16 (the day after the advisory), six articles appeared in the five newspapers; through May 31, a total of 750 articles were published. The proportion of articles that appeared on the frontpage was 9.6%, although this percentage was higher early in the study (50%) than at the time of absolute peak coverage (12%).

After the first wave of articles in mid-March, several peaks occurred until mid-April. The events prompting these peaks were identified by determining the most frequently covered topics, specifically: the death of Carlo Urbani, the Italian WHO officer who identified the disease in Hanoi; the first two probable cases in Italy; the death of a suspected case in Naples; and the press conference announcing the first meeting of the Italian National Task Force. The highest peak occurred on April 23, after the announcement that the number of cases had reached 4,000 and that a vaccine would not be available anytime soon. In the days after the peak, coverage remained quite high, in association with the definition of SARS as a "global threat" by WHO and the twofold increase in the number of probable cases in Italy. The high press coverage was followed by an overall decrease, although small peaks occurred in association with the conflicts among European Ministries on airport measures, increased quarantine measures in China, and the identification of the civet cat as a probable source of SARS-CoV. Coverage tended to be greater on weekends, probably because political stories constitute less competition for space on these days.

Evidently, the daily newspaper coverage of SARS has been quite extensive in Italy, especially in the aftermath of WHO alerts and statements by the Ministry of Health regarding new cases and more stringent control measures. During outbreaks of infections, both the media and the public are often criticized for overreacting, yet public concern over serious health hazards is essential in guiding prevention activities (3-5) and in deciding whether to adopt measures that could place restrictions on civil rights, such as quarantine (6). Although we did not evaluate the quality of risk-communication of the journalists or of the experts quoted in the articles, wide press coverage of the WHO global alert may have contributed to public-health bodies' taking action towards containing the epidemic.


The authors thank Nancy Binkin for her advice concerning related literature and Mark Kanieff for his editorial assistance.


(1.) World Health Organization. WHO recommended measures for persons undertaking international travel from areas affected by severe acute respiratory syndrome (SARS) Wkly Epidemiol Rec 2003;78:97-9.

(2.) Prima Communicazione; May 2003. n. 329. p. 176.

(3.) Sandman PM, Lanard J. Fear is spreading faster than SARS and so it should! [cited April 28, 2003]. Available from: URL:

(4.) Covello V, Peters RG, Wojtecki JG, Hyde RC. Risk communication, the West Nile virus epidemic, and bioterrorism: responding to the communication challenge posed by the international or unintentional release of a pathogen in an urban setting. J Urban Health 2001:78:382-91.

(5.) CDCynergy emergency risk communication: your guide to effective emergency risk communication planning. Atlanta, GA: U.S. Centers for Disease Control and Prevention, 2003. [cited September 25, 2003]. Available from: URL: http: //

(6.) Rezza G. Severe acute respiratory syndrome. J Epidemiol Community Health 2003;57:643.

Address for correspondence: Giovanni Rezza, Department of Infectious Diseases, Istituto Superiore di Sanita, Viale Regina Elena 299, 00161 Rome, Italy; fax (+39) 06 4938 7210; email:

Giovanni Rezza, * Raffaella Marino, * Francesca Farchi, * and Mirella Taranto *

* Istituto Superiore di Sanita, Rome, Italy
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Title Annotation:Letters
Author:Taranto, Mirella
Publication:Emerging Infectious Diseases
Date:Feb 1, 2004
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