Covid-19 guide for visual journalists

These general tips for visual journalists were created by Jenell Stewart, DO, MPH, Infectious Diseases physician-scientist at University of Washington. Dr. Stewart is married to Peter DiCampo, a visual journalist and cofounder of The Everyday Projects, and she created this guide to help journalists who are struggling with ethical and safety considerations in the current void of job specific information. These tips are based on the most recent data and expert opinions available on SARS-CoV-2 (please take note of the version and date at the top of the page). This is meant to be a job specific guide and does not include essential basic information on COVID-19 infections. For more general information please visit covid-101.org a trusted website with content created by medical professionals and experts. This document is not officially endorsed by any governing bodies, and you may find contradictory guidance elsewhere. Please note that new information is becoming available all the time (and out of urgency many tips are not written by infectious diseases experts). If you find a discrepancy or an important issue is not addressed here, please feel free to contact Dr. Stewart at twitter: @drjenellstewart or email: jenells@uw.edu.

[NOTE: The virus that causes COVID-19 infection is called SARS-CoV-2.]

Version 4.0 – April 28, 2020

Don’t

1. Don’t do nonessential assignments outside of your house right now. I know you need to pay the rent and freelance journalists are living late payment to late payment, but please delay assignments that are not truly urgent or topical - the risk to yourself, others, and the healthcare system isn’t worth it.

2. Don’t fly! Editors should not be sending people on any assignments that require a flight. There are talented photojournalists and videographers all over the world, and there is no excuse for flying anywhere other than straight home right now.

3. Don’t break quarantine to take an assignment (and editors should be asking about quarantine when giving assignments). For example, if you have just flown from a country with high community spread (Italy, Iran, Spain, Germany, USA, France, South Korea, Switzerland, UK, etc.) back home to a country where there are few known cases (most countries in Latin American, sub-Sahara Africa, and Central Asia), you are required to do 14 days of quarantine to reduce the risk to that country. Quarantine means do NOT under any circumstances leave your house/apartment or let anyone else in. This can save lives.

4. Don’t trust the numbers. You shouldn’t be making decisions about risk based on the number of reported cases. I have heard the sentiment, “there are only a few cases here” echoed many times. As you’ve all heard, testing is a limited resource and given the large numbers of people with little to no symptoms who are infected, you should assume that in most places there are far more cases than you know about.

5. Don’t assume you know what you’re doing. This virus is new. By the time you read this, there may be updated information that is not included here. Many visual journalists have gained important skills to keep themselves safe while covering Ebola. While some of them (good equipment cleaning and hygiene practices) are helpful, others may lead you to a false sense of security. Thankfully, COVID-19 infections are not as severe as Ebola infections; however, that means it is harder to detect and contain cases of COVID-19. Please monitor yourself for symptoms, but unlike Ebola, a daily temperature reading doesn’t exclude the possibility that you have COVID-19.

6. Don’t go out if you don’t have to. If you have symptoms (fever, cough, muscle aches, sore throat, headache) do NOT leave your home, at all (unless you’re having trouble breathing, then go to the hospital). No one comes in and no one goes out. Otherwise, you are putting other people at risk. If you live with others, please have designated “hot zones” where you alone are allowed to go, no one else. Have “hot zone” towels, etc. Do not leave your house until your symptoms are gone. If you are tested for SARS-CoV-2 and it is negative you can leave your house 24 hours after symptoms resolve. If you do not have access to testing, wait a full 72 hours after symptoms resolve. If you test positive (and your breathing is fine, and therefore you don’t need to be hospitalized), you need to stay quarantined in your home for 72 hours after symptoms resolve or 7 days total, whichever is LONGER.

1. Do take assignments on COVID-19 – but be safe and responsible while doing it. Seek out and accept local assignments (within driving-distance) on COVID-19. There is an urgent need for people to understand the severity of the situation and how their actions today will dictate the overall impact of this pandemic on our society and healthcare. Additionally, we will need documentation of this unique and challenging moment in history as we will most certainly face similar epidemics or pandemics at some point in the future.

2. Do distance yourself. Take your telephoto lens with you, because you should be doing your documenting from 2 meters (6 feet or two arm lengths) away. SARS-CoV-2 virus is spread two ways: droplets in the air and contaminated objects (followed by touching your eyes, nose, or mouth). Distancing yourself by 2 meters means that any droplets that you or the person you are photographing produce will not reach the other person’s airway. Yes, you produce droplets – any time that you sneeze, cough, sing, or talk, you produce small droplets in a cloud around you, and if the other person is far enough away, they won’t be at risk of inhaling infected particles. Droplets can infect a person at a distance closer than 2 meters by entering their body through their mouth, nose, or eyes, or by landing on clothing or other objects which are touched later. This is why healthcare workers wear an eye shield or goggles, a mask covering nose and mouth tightly, and a full disposable gown.

3. Do wash your hands! You’re going to need to prioritize and get creative for how you can wash your hands several times a day while out on assignment. Hand sanitizer (>70% ethanol) is great for when you don’t have easy access to a sink, but even more effective than sanitizer is soap and water. Hopefully you’ve already gotten the memo to wash all your hands pretty much before and after you touch anything. To wash your hands well, imagine you have just touched something disgusting (because you probably did), and to get all that SARS-CoV-2 off you need to wash all the surfaces of your hands for more than 20 seconds. When you get home, immediately wash your hands again, and consider taking it to the next level: when I get home from the hospital after working with a serious infectious disease, I don’t wear my shoes in the house and go straight into the shower.

4. Do sanitize everything. Assume that all objects, including all of your equipment, are contaminated with SARS-CoV-2. Here’s how long SARS-CoV-2 has been detected on different surfaces (Doremalen, NEJM, 2020; Kampf, JHI, 2020) – these are all estimates that do not account for large volume of virus (such as being spit on or directly sneezed-on at short range)

i. Plastic – 72 hours
ii. Silicon Rubber – 110 hours
iii. Glass – 96 hours
iv. Stainless Steel – 48 hours
v. Copper – 8 hours
vi. Cardboard – 24 hours
vii. Clothes/Cloth – 1 hour

(See below a detailed guide on sanitizing camera gear)

5. Do know what “high risk” means. No one has immunity to this new infection, so we are all at risk of getting a COVID-19 infection, but most people (about 80%) will have no symptoms when sick or have only flu-like symptoms (fever, cough, muscle aches, sore throat, etc) without developing any pneumonia or difficulty breathing. “High-risk” refers to the people with increased risk of getting pneumonia, and if you or the person you are planning on interviewing is “high-risk,” you and the interviewee should be aware that what you’re doing is dangerous. All people with “high-risk” of developing pneumonia should be in their home and no one else (who doesn’t already live there) should come in – you really need to have an extremely compelling reason and strict safety plan to enter the home of someone “high risk” and put them in danger to tell your story. Again – you will be putting these people in danger. Hopefully the people you are photographing and interviewing know whether or not they have increased risk of pneumonia, but many won’t, so you should be aware of these vulnerable people.

People with higher risk of developing pneumonia and needing a ventilator to survive include:
i. Age greater than 63. This is not a hard cut off. Risk really starts to increase at 63 and continues to increase with older age.
ii. Hypertension (don’t stop your antihypertensive medicine – I have seen this rumor circulating)
iii. Diabetes
iv. Heart disease
v. Chronic kidney disease
vi. Immunocompromised. – There are many reasons for immunocompromised status, including chemotherapy, a transplanted organ in the past, bone marrow transplant, HIV, etc. Not enough is known about each condition to comment separately on varying risks.
vii. Pregnancy, potentially. Thankfully there aren’t very many documented cases of COVID-19 in pregnancy to make a strong recommendation, but unfortunately that leaves me with educated guessing. People who are pregnant have a reduced immune response and are at high risk of complications with influenza, so I would err on the side of caution and include pregnancy on this list of “high risk” conditions. However, I will point out that a series of 9 pregnant women with COVID-19 infections in China reported that none of them developed pneumonia.

6. Do know that you are a threat. Prior to this pandemic, visual journalists and their editors needed to consider how to protect journalists when doing dangerous things. This is still true now (there are rare cases of young healthy people getting quite ill, so don’t assume you are invincible), but a larger concern should be protection of the people you are reporting on and the general population. While many people are staying inside their homes, you are out on assignment, and it is your responsibility not to track SARS-CoV-2 with you everywhere you go.

Sanitizing Camera Gear

Sanitizers – here is the science, use your own judgment about what should or shouldn’t be used on your equipment. I personally use ethanol-based sanitizer on my phone every time I walk in the door and chlorhexidine-based wipes on medical equipment at the hospital. Many medical labs use an ethanol spray.

i. Soap and water – this is very effective at breaking down dirt layers, which can trap virus on your skin, as well as directly destroying SARS-CoV-2 virus if applied for > 20 seconds.
ii. Ethanol – must be >60% to sanitize, but I would highly recommend >70% ethanol to ensure effectiveness - the higher the concentration the shorter the time needed to kill virus.
iii. Hydrogen peroxide – must be > 0.5% and left on for 1 minute (at that concentration)
iv. Chlorhexidine digluconate – must be >0.02% and left on for 10 minutes (at that concentration)
v. Bleach (or sodium hypochlorite) – at concentrations >0.21% and left on for 30 seconds [this can be made by mixing 1 part bleach to 10 parts water (or 3 Tablespoons of bleach in 2 cups of water) and only stays active for about 24 hours, so don’t make a big batch and don’t mix bleach with anything else besides water, because chemistry].
vi. UV light – In theory, sunlight could kill virus, but the time needed completely depends on the amount of UV exposure, which is difficult to measure. My recommendation is to not rely on sunlight to sanitize equipment. UV light is only an effective solution if you have access to a UV germicidal irradiation tower.

Tom O’Brien, a Photo Engineer at National Geographic, provided us with these additional recommendations for equipment cleaning:

Do not soak/submerge cameras or lenses in any solution. Lightly mist it on, let it sit, and then then wipe it around and into crevices. Get everything. Cotton swabs can be useful for cleaning small areas around control dials.
- Rotate dials to all positions when cleaning. This includes the typical front and back thumb/index finger dials.
If you have to use a hand sanitizer or sanitizing wipe, make sure to get into small crevices, and then also wipe down with a damp (not soaking) wet towel.
I suggest everyone use a sacrificial UV/clear filter on front of lens, so that you can clean your camera as often as needed without worrying about damage to lens coating. A front lens element repair is hundreds of dollars, while a half decent UV/clear filter is well under $50 USD.
If you are using a lens hood that has a 'fuzzy' or felt interior, you will have hard time cleaning this. Avoid using felt lined lens hoods when photographing this subject when possible.
When using zoom lenses that have a moving/retracting section (the lens physically moves when zooming) be sure to fully extend the lens to disinfect as much as possible.
A weather sealed camera is not air tight, so assume the inside of the camera to be 'hot' (contaminated) if you are going into 'hot' areas (i.e. ICU, ride alongs with EMT).
Clean your viewfinder and wear eye protection to limit transmission via mucous membranes (your eyes).
There is no standard recommendation for sanitizing microphones, which are very moisture sensitive. High concentration alcohol spray may be ok, but there are no guarantees. After 3-4 days left in your hot zone at home, the virus will be dead, and the microphone will be safe to touch again. If you don’t have the luxury of time, you may need to invest in a UV light machine to sanitize delicate equipment like microphones.
>70% Ethanol or >70% IPA sprays are the best option, and higher concentrations reduce the time needed to kill virus and dry faster. An important note: If using ethanol that is denatured, which is what most people can find for purchase, it should only be denatured with compounds like IPA or methanol as these are compounds are common in lens/sensor cleaning solutions and thus safe for the cameras. Often you will find ethanol that is denatured with things like kerosene and other nasty petrochemicals. We do not want these on our cameras or around us.
Straps:
- Use multiple straps and put the dirty/'hot' straps into sealed plastic bags until you can clean them or they wait 3-4 days for the virus to die off.
- Put metal rings on your camera strap loops and just use disposable straps that you make every day. Suggested materials: paracord and old climbing rope, if you have them.
- Or if you have daily access to a washing machine/sink + drying rack, wash your strap(s) in cold water only and hang dry.

A Word on Wearing Masks

I would be remiss not to mention masks, however, I acknowledge that this is part of a much larger social and political conversation. Here are a few basic scientific facts: Masks are incredibly helpful for preventing the spray of droplets when worn by a sick person, or for healthy people who have to be in close proximity to someone who is shedding virus. Ask yourself and your editor if it is really necessary for you to be closer than 2 meters (6 feet or two arm lengths) from someone for this assignment.

There is no evidence that cotton masks, scarves, or bandanas prevent spread of the virus, and in fact I have significant concerns that cotton absorbs and traps infectious droplets on the wearer’s face. So, I advise against relying on homemade masks to protect you.

The use of cloth masks by a person who feels healthy and is going out of the home for essential tasks could theoretically reduce the spread of SARS-CoV-2 if that person is pre-symptomatic or has an asymptomatic infection and is going into a small, poorly ventilated space with other people. Physical distancing is still needed for those wearing cloth masks, and masks need to be worn correctly (completely covering mouth and nose, and hands need to be cleaned before and after any touching of the mask).

Surgical masks, which are made of polyurethane material and repel water, are very effective when worn in combination with goggles, but can only be worn for up to four hours as they are not as effective once they become moist. N-95 masks are excessive protection outside of medical procedures, and in cases where there is a shortage of masks, it is possible that by using one, you are contributing to that shortage.

You should absolutely protect yourself if your assignment requires close contact with other people or working in crowds; however, there is a severe shortage of masks for health care workers in many countries right now. You need to wear a mask if you are getting closer than 2 meters, but I want to make sure that you are also considering the fact that you are diverting precious resources away from healthcare providers – these are the people that masks should be going to right now (unless you happen to live in a country where masks are readily available).

Remember that SARS-CoV-2 can be transmitted through the air into your eyes, mouth, or nose, so masks should be worn with goggles.

If you absolutely must be in close contact with someone who has COVID-19, you really should be wearing full Personal Protective Equipment (goggles, mask, plastic gown, gloves, etc.) and know how to use PPE correctly - watch https://m.youtube.com/watch?v=bG6zISnenPg for how to put them on and more importantly how to take them off. Again, this gets into issues of resource allocation, but please be informed about how to protect yourself.

For more information, see recommendations regarding the use of masks from the WHO and CDC.

Webinar: covid-19 safety training for visual journalists

Online training and Q&A session for journalists working in the field with infectious disease physician and researcher Dr. Jenell Stewart, held on April 16, 2020. Dr. Stewart authored The Everyday Projects COVID-19 Guide for Visual Journalists. She provided a basic overview on COVID-19 transmission and safety tips for working in the field.

The Webinar includes discussion around:
-Understanding transmission
-What droplet and contaminated surfaces mean
-How to prevent transmission on contaminated surfaces
-How to prevent transmission via droplet (with mask info)
-Categorizing assignments as low risk, medium risk, or high risk and what supplies you need to safely complete those assignments.

Co-hosted by CatchLight and Institute for Nonprofit News