Do you think the media should be showing more visual imagery of the medical consequences of COVID?

John AdamaStaff - July 5, 2020

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I’d love to hear if you disagree, but it seems like the mainstream media has been holding back on showing sensitive medical images/videos of what it’s like with COVID and how nuts things are in certain hospitals.

(This is not a political/tribal discussion, eg. Fox News vs. Mother Jones.)

It’s understandable in normal times that this would be distasteful, but these aint normal times and a major problem in society is a culture of people who seem to not comprehend all of the facets.

Sometimes those visuals and sounds are the best way to make things click for a person. It’s similar to how the public campaigns against underage smoking stopped focusing on pitches like “if you smoke, you’re going to die!”or “these yummy-looking scrambled eggs are your brain on drugs!”, and instead started saying narratives like “if you smoke, you’re going to smell bad and get ugly!” and “your sperm die and your friends dump you!”

… the latter being far more effective at ‘moving the needle’ in the real world.

I have no way of editorially-vouching for this image, but I saw it in a Facebook group and it struck me that it was effective imagery. What do you think? Should this happen more?

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Yes, it’s justified.

Because the average person doesn’t fully understand the gravity of this pandemic.  “It’s just a bad flu, right?”

No it isn’t.

Those pictures are legitimate images of mechanically ventilated ARDS patients placed in the prone position to improve oxygenation.  These particular images could represent patients with non-COVID disease but this exact treatment is what is being utilized in the vast majority of COVID cases requiring mechanical ventilation.

Mechanically ventilated COVID cases with ARDS (Acute Respiratory Distress Syndrome) have a lower overall survival rate when compared to other ARDS causes, plus they are requiring ventilators for a much longer duration when they do survive.

It’s important to remember that COVID patients only have a 20% chance of being successfully extubated, so far (hopefully this improves with the relatively new data showing that treatment with corticosteriods is effective at preventing severe respiratory and cardiovascular complications).  And those 80% who remain in the ICU will likely die alone because of hospital isolation policies to minimize further spread of the disease.

Hospitalization in the ICU causes PTSD in a large percentage of patients.  Plus, a large percentage of the healthcare staff caring for these patients during the pandemic are at risk for PTSD, too.  PTSD is horrible, often career-ending for people suffering from it, and sometimes life-ending by means of suicide.

This is no joke.  This is an insidious pandemic that appears to be capable of slowly culling the human herd of its poor, old, unhealthy, and unlucky in the months to years ahead.

Basic public health measures, such as contact tracing, isolation, and minimizing contact in public spaces is our best bet for containing this disease at this time.  If these pictures lead to increased social isolation, we’re all the better for it.

 

You make a great and chilling point about the PTSD aspect. While I know there are so many other things for people to be wary of, I think you nailed the long term issues beyond scarring of lungs or other parts of the body. And if seeing some unpleasant photos is a way of reminding people of that, I think it’s warranted.

 

I have this theory that I’ve been mulling over, it’s a bit blunt but it goes something like this:

If you’ve had to personally care for, and clean up after, a terminally ill family member or close friend, if you’ve experienced leaving a hospital not knowing if you’ve just said your last goodbye, you don’t need to imagine the pain, fear, uncertainty, or trauma involved in this situation – its just the scale thats different.

If you haven’t experienced this first hand, up close, and literally gotten your hands dirty in the process no image or video is going to explain it to you.  Honestly, if you’ve never seriously thought about living wills, medical powers of attorney, or the conditions under which you might opt for a DNR, this might not really sink in.

The images I’ve found most effective for COVID19 are the before/after pictures of survivors (often posted on the blogs here).  If there were time, and I imagine at some point in the future, some clinical comparisons of lungs of victims versus otherwise healthy-looking lungs might drive the point home too.

Honestly, if images of refrigeration trucks being set up as temporary over-flow morgues don’t communicate the severity of this I’m not sure what will.

When I see the image above I have to admit I’m mildly disturbed, but I’m disturbed because there is no dignity in this, and those people on those beds have probably not given their consent (even if identifying features are not present).  I’m not sure how often [traumatic?] death and dignity go hand in hand, and I wish these images had pictures of the nurses and caretakers involved because what little dignity there is to be had comes from the humanity of those caring for the people in those beds.

 

I agree with you on the nurses thing. The photos of hospital staff with literal dents and welts on their faces from wearing masks to tightly for so long? You would have to be completely ignorant or unfeeling to not grasp how real this whole thing is.

 

Unfortunate that it takes something personally affecting people before it sinks in. And you hit it on the nose with the before and after lung photos — I really want to see those.

 

I agree that–unless one has personally experienced COVID through self, family or close friends, OR is a HCW involved with the response–most folks don’t have a sense of the medical toll. It is impersonal, elsewhere, and other. We are all definitely feeling the economic impact, and I think it’s the vague medical exposure/awareness coupled with the visceral economic struggle that is also driving a lot of the “fuck this let’s get back to work” mentality. I understand that completely. In the past week in my area of Brooklyn, I’m seeing about 50% non-mask wearing, and a good chunk of that is no mask at all (versus pulled down or in hand). Per John’s blog post last week, that doesn’t bode well for potential uptick in cases.

That said, while probably jarring and productive in terms of building awareness for the unexposed public, I am against publishing photos of COVID patients. Consent, HIPPA, etc all come into play. Honestly, if we didn’t have such a back-and-forth from medical authorities early on regarding clarity and consistency of communication, I think we’d likely be in a much better place as far as public solidarity in support of non-pharmaceutical interventions.

The next 4-6 weeks are going to be very interesting.

 

Regardless of politics, I think most can agree that the messaging failed across the board in the beginning, which then leads to this situation where ‘shock images’ might be what’s needed to get people to understand / reframe their first impressions.

 

Agreed, but given the consent/dignity issues, I wouldn’t support publicizing them, even if would make a dent in public perception.

If a patient post-recovery or a family post-death agrees to share images to further awareness, I’m all for it.

Per @RickDC’s excellent point: if seeing refrigerator trucks as morgues isn’t resonating for folks, then there’s no way any imagery will get around a person’s confirmation bias.

 

I agree, and I think showing images of overflow might be even more powerful. People can see a single patient and think “too bad, but not me”. If they see tons patients flooding out of the ER, people lying on mats on a sidewalk, it his them that this is really bad. Trouble is, even if you forget patient privacy and hospital policies for a second, these images aren’t very common even in overwhelmed hospitals. Most hospitals are very organized, even in crisis conditions, so alot of the overflow is quickly maneuvered onto new floors and areas, with few dramatic images to really depict the level of severity they are experiencing. We saw some good images from ERs in NY, but even then they looked (to lay people anyway) pretty organized and calm, just crowded.

Pandemics aren’t very dramatic if the disease itself isn’t particularly gruesome, and that’s a big problem for conveying their seriousness. We often conflate drama with danger.

 

Maybe this would work for the “average person” but I know people who think every single bit of bad news about it is a hoax. Family members. I try to talk with them but what I really do is keep my distance and wear doubled-up PPE when I am near them, which I have to be at times, although I do not have to let them into my home. Them- nothing. Me, gloves, mask,  doing the 6-foot-distance dance, disinfecting everything in sight when they leave.

 

@chicksnhens given what you described about a lack of good imagery of the overflow issue… what do you think the most effective images are? The ones in OP?

 

Probably the before and after pictures of the lungs and patients since they get the closest to conveying the severity of the illness. I don’t know if anything other than painful personal experience can convince individuals like AnnieP described, but images that reinforce the danger of the disease might at least keep concerned citizens motivated to continue with precautions as time progresses.

 

Even though I’ve been taking covid seriously, I’ll admit that the whole “you might not get really sick but your lungs will be permanently hurt” thing has definitely had a personal effect and made me more careful.

 

I have started sending people articles about the consequences of sars-cov-2 but they say it is a hoax. I point out that media outlets on all political “sides” are reporting it- still a hoax. Regarding the concerns about privacy, I think that if a person (if even able to) gives consent to have their images publicly shared, then it’s OK. Otherwise I have the same concern. I am going to think about whether or not I will, if I ever get it, allow my images to be posted. I just might. If I do, I will give it to the medical personnel and to my family, in writing. Nothing else gets through.

 

Setting aside the patient privacy concerns for a moment, I agree that more vivid imagery is needed. The early videos from the Italian hospitals showing wards full of helmet CPAP were a wake-up for me before my own hospital became a COVID hotspot.

Along similar lines, the impact on youngish/healthy people has been downplayed. Sure, elderly are hit the hardest, so the percentages of young/healthy deaths seem small in comparison. But by raw numbers, a lot of young people have been badly affected. Many of my sickest patients were in their 30s and 40s and had no serious medical problems before getting COVID.

 

I think most people still think it’s only dangerous for the elderly. But death isn’t the only danger based on everything I’ve read. Someone further up the thread talked about the before and after images of people’s lungs and other damaged systems that people will have to deal with for years. So sure young people might not be at the highest risk of dying from the virus, but it could severely impact their quality of life for a while.

 

So you’ve been treating covid patients in a hospital? Wow, what’s that been like? (Maybe a new post?)

 

Speaking for myself personally, as a person with a lot of anxiety and as something of a hypochondriac, I am plenty worried about COVID-19 and really don’t need any more scary stories or images. YMMV

 

A friend sent me this last night.

A news report on a Texas ICU overwhelmed by Covid patients. Several patients frightened and in pain, a woman in the ICU now whose 35 year old daughter died of Covid. I hadn’t realized there would be many beds in the same room. The title is “Texas hospital overwhelmed by Covid patients…”, in case the link doesn’t work. It’s a Rio Grande hospital. I still feel shaken by seeing the faces and hearing the words of patients who may very well die.

 

Good find. Short segment, but makes the point.