COVID-19's impact on World Trade Center Cough Syndrome news coverage

I recall the moment I first read about COVID-19.

I was sitting at my kitchen table in Phoenix, looking down at a print edition of The Arizona Republic. I don’t remember the article's byline or headline, but I recall the journalist’s description of the nascent virus, particularly that people with underlying medical conditions, such as chronic respiratory disease, were more susceptible to severe disease and death than other people.

The first thing I thought after reading this was, What would this virus do to New York?

When the World Trade Center towers in New York City collapsed on September 11, 2001, their contents were largely pulverized and thrown into the air. Glass. Computers. Concrete. Carpets. Paint. Office stuff. Between 400,000 and 650,000 people were in the vicinity and inhaled this “dirty bomb.”

It wasn’t long after that many of these people began experiencing coughs, headaches, and chest tightness. 9/11 survivors’ respiratory problems, such as chronic rhinosinusitis, bronchitis, gastroesophageal reflux disease, and asthma — are symptoms of what is now known as World Trade Center Cough Syndrome. (If you're interested in research on WTC Cough Syndrome, some studies are Brackbill et al., 2006; Farfel et al., 2008; Friedman et al., 2013; Kotov et al., 2015; Li et al., 2011; Luft et al., 2012; Mahaffey et al., 2017; Nair et al., 2012; Niles et al., 2011; Prezant et al., 2002; Welch et al., 2015; and/or Yip et al., 2016.) About 70 cancers have been linked to the attacks. As of September 2021, at least 4,500 people have died of illnesses attributed to 9/11 toxin exposure.

For the sake of transparency, I should disclose that I was in the vicinity during the WTC attacks. I met a local in a phone booth who took me in. This stranger fed, housed, and clothed me until international flights reopened and I was on my way to the University of St. Andrews in Scotland, where I was studying. I was 20 years old.

On Saturday, I presented a paper at the International Communication Association conference in Paris in which I examined news coverage of WTC Cough Syndrome through two content analyses: One of American, English-language news coverage of WTC Cough Syndrome before the COVID-19 pandemic, and another during. I tracked where the stories or broadcasts were published or aired, respectively, and the most common themes.

The pre-pandemic sample had 204 articles or broadcast transcripts (radio and television), published between 2001 and 2019. The pandemic-era sample had 73, published in 2020 and early 2021. This already caught my attention. That pre-pandemic sample spanned about 18 years. With 204 articles or transcripts, that would be, on average, about 11 articles a year. The pandemic-era sample, however, spanned a little more than a year, yet had 73 articles or transcripts.

One reason for this dramatic jump is because content creators (and/or their bosses) reasoned that the topic was newsworthy more frequently during the pandemic than in the past. When journalists select and organize news topics, they act as what we call gatekeepers. Gatekeeping is the process in which a potential news message goes from being just that – a potential news item – to actually being published or aired. Many things influence this process. (If you're interested in more on that, I recommend Pamela J. Shoemaker's book Gatekeeping, her chapter in Daniel Berkowitz' Social Meanings of News, and the book Gatekeeping Theory, which she coauthored with Timothy Vos.) What a journalist deems “newsworthy” is one of these things. Scholars such as Shoemaker and Stephen D. Reese showed how factors such as proximity, importance, interest, impact or consequence, conflict or controversy, sensationalism, prominence and novelty, human interest, timeliness, and unusualness are indicators of newsworthiness in traditional American journalism.

One of these values, proximity, was of special interest to my study. Proximity is the perceived distance of an object. Not just distance as in geographical, physical distance. Proximity can also be temporal, the distance between the present and the past or future event; social or cultural, the extent to which the object is similar; probability of an event happening; and accessibility to information. (For more on proximity, see Duan et al., 2017; Fiedler, 2007; and/or Liviatan et al., 2008). This is an important news value because, according to Yaacov Trope and Nira Liberman's 2010 study, the more psychologically distant an object is from an individual, the more abstractly that person will construe the object to be. And when a media consumer perceives an event or subject as being psychologically distant, they are more likely to discount it.

A lot of research has been done on 9/11 media coverage in the United States. I won't rehash it here. Scholars such as Ian McDonald and Regina G. Lawrence concluded in a 2004 study that though news was prevalent following the attacks, its emotional content outweighed its informational and analytical components. Chiara Ferrari also concluded in a 2019 book chapter that national news coverage generally embraced abstract rhetorical themes of unity, patriotism, and nationalism. This type of journalism is what Sarah Oates' 2008 book and 2021 monograph refer to as the Patriotic Model of News. Characteristics of the Patriotic Model of News are journalists shying away from questioning government rationale for war, not discussing foreign policy options, reflecting neither elite nor public dissent, relying on nationalistic images, framing troops as heroes and foreign leaders as demons, under-examining consequences on the attacked country’s civilians, relying heavily on military information, producing more propaganda than useful information, contributing to “patriotic fervor,” branding dissenters as traitors, and allowing war coverage to overwhelm the typical journalistic practices.

The severity of 9/11 survivors' health problems were largely credited to government mismanagement, specifically that of the Environmental Protection Agency. With many national reporters, either consciously or unconsciously, embracing the Patriotic Model of News, I wondered if WTC Cough Syndrome coverage was mostly limited to news organizations geographically proximate to the attacks. Results suggested this to be true. Coverage published or aired in New York and its adjacent states accounted for about 60 percent of the pre-pandemic sample.

Like the pre-pandemic sample, most articles or broadcasts during the pandemic were also published or aired, respectively, in New York. However, the state with the second-highest percentage was Florida. New Jersey was third, followed by Connecticut, Virginia, North Carolina and Tennessee. According to World Trade Center Health Program data, enrolled 9/11 survivors and rescue workers now live in all 50 states, with New Jersey and New York having the most registered residents, followed by Florida, North Carolina, South Carolina, Connecticut, Virginia, and Pennsylvania. Many 9/11 survivors, struggling with respiratory issues, have since-then moved and/or retired to the warm U.S. Southeast.

Whereas pre-pandemic coverage tended to fall within three themes (i.e., journalists’ investigation of survivors’ health ailments, lack of government transparency, and heroism), the most common pandemic-era themes were COVID-19's effect on these survivors, and survivors comparing and contrasting their experiences on 9/11 to the pandemic. In an April 1, 2020, Fox News piece by Michael Ruiz, former Deputy Chief and current Director of 9/11 Community Affairs at Barasch & McGarry law firm Richie Alles said, for example, “The lessons of 9/11 haven’t been learned. One of the biggest issues of that time was the lack of proper breathing equipment. You would think that all levels of government, even the private sector... would be prepared in situations such as this. And we’re not.”

Themes of heroism and calls for caution and safety protocols were also prevalent. Jeffrey Conti, a first responder at Ground Zero, told Josh Sidorowicz in a July 18, 2020, WTSP-TV (Tampa Bay, Florida) broadcast, “Coming from a job where you put people before yourself, I find it mind-boggling that people tend to be so selfish about this. Putting on a mask is such a simple thing." A September 11, 2020, ABC News broadcast package by Ivan Pereira said retired construction demolition supervisor and FealGood Foundation founder John Feal "has urged anyone that can listen to his voice to wear a mask, socially distance and listen only to medical experts." "I don't care if you're wearing a flag on your car, you're not patriotic if you're not wearing a mask," Feal said.

The September 11 Victims Compensation Fund was also mentioned frequently. The VCF, administered by the U.S. Department of Justice, compensates injured survivors and families of the deceased. The World Trade Center Health Program is administered by the U.S. Department of Health and Human Services and screens first responders and survivors for health conditions. As of March 2022, the WTC Health Program had 83,371 first responders and 33,724 survivors enrolled. As of April 30, 2022, the VCF had processed 74,173 claims, 3,158 so far from 2022 alone. Cumulatively, the VCF has awarded about $9.89 billion in compensation to enrollees, or, if deceased, to their next of kin.

The final theme, lack of government transparency, continued from the pre-pandemic sample. For example, FDNY EMS Local 2507 Union President Oren Barzilay said in a March 24, 2020, amNY piece by Todd Maisel that his “union members were lied to after the 9/11 attacks that the air was safe after the collapse of the World Trade Center. That has led to great skepticism about the efforts to keep first responders safe now. We’ve gone from the N-95 mask to surgical masks and now even a bandana is good enough. Who are they trying to fool? They fooled us on Sept. 11, 2001, when the EPA said it was safe to breath. Now it’s happening with the virus."

As I reflected on the pre-pandemic sample, I noticed that journalists' difficulty accessing credible information in the then-evolving health crisis of 9/11 was eerily similar to what journalism scholars have noted in early COVID-19 coverage. In a 2022 comparison of 1918 Spanish flu and COVID-19 pandemic coverage, Samantha N. Edwards noted that when a news consumer does not perceive a crisis as having a direct personal impact, they are less likely to alter their routines. This is a problem when a threat requires collective action early, when neither experts nor journalists have the necessary facts. “This puts newspapers in a precarious position," Edwards said, "as they are required to report on matters in a way that does not downplay the danger so much that it is ignored nor to overhype it and thereby cause unnecessary panic. The media is commonly accused of promoting alarmist views, yet it is also the first to receive harsh criticism in the case of minimizing crucial health risks."

Journalists in the pre-pandemic sample often had evidence people were sick, but lacked longitudinal data showing that survivors’ ailments were caused by, instead of correlated with, the attacks. Devlin Barrett, who covered 9/11 survivors' developing health issues as a reporter for The Washington Post, said at the Impact of 9/11 Toxins 20 Years Later and the Federal Response webinar in 2021 that the data did come, eventually. But by then, multiple survivor's conditions had grown worse, if not had already killed them. “If you sit around waiting for everything to be known, it’s going to be 40 years – it’s going to be 2041, and a bunch of people will be dead, and then you’ll know the definitive answer as to why," Barrett said. "As a reporter, I’d approach that as, what would the point of that be? That would have served no purpose to anyone."

The pandemic's influence on 9/11 survivors will be palpable in numerous ways moving forward. As stated earlier, the VCF has awarded about $9.89 billion in taxpayer funds to enrollees or their next of kin. The price tag of WTC Cough Syndrome and cancers, on top of newly added COVID-19 complications, will likely continue to rise, and it will be the American taxpayer who picks up the tab. According to then-VCF Special Master Rupa Bhattacharyya at the Impact of 9/11 Toxins 20 Years Later and the Federal Response webinar, "We're faced with a large number of claimants who are extremely sympathetic, who are clearly suffering, and we want to give them whatever we can. But we know that there are limitations. We are responsible to the U.S. taxpayer who provides the funding. And what Congress giveth, Congress can taketh away.”