ILLNESS, CRISIS & LOSS, Vol.

13(2) 117-128,2005

BITS OF FALLING SKY AND GLOBAL PANDEMICS:

MORAL PANIC AND SEVERE ACUTE
RESPIRATORY SYNDROME (SARS)

STEPHEN L. MUZZATII
Ryerson Unversity

ABSTRACT

Whether it's a story about crime, the weather, politics, Hollywood celebrities,
or public health, sensationalistic and exploitative coverage is a media staple.
The mass media's coverage of the outbreak of Severe Acute Respiratory
Syndrome (SARS) in the spring of 2003 was no exception. The media's
construction of the source, virulence, and transmissibility of this disease, a
previously unknown cousin of the common cold, diverged considerably
from its medical realities and contributed to a widespread though short-lived
moral panic. Drawing on work in the areas of the sociology of health and
critical criminology, this article explores the claims-making activities behind
the SARS "epidemic." Specifieally, it addresses how threats to the public
well-being are manufactured by the media and how these threats draw upon
past and present cultural myths of dangerous "others" and contribute to
unwarranted public fear, intolerance, and distrust.

Key Words: SARS, moral panic, racism, media

[T]he great medical edifice ofthe nineteenth century cannot be divorced from
the concurrent organization ofa politics of health, the consideration ofdisease
as a political and economic problem for social collectivities which they must
seek to resolve as a matter of overall policy.
-Michel Foucault'

I Michel Foucault. (1980). Power/knowledge: Selected interviews and other writings. C. Gordon
(editor) New York: Pantheon Books, p. 274.

117
© 2005, Baywood Publishing Co., Inc.
118 / MUZZAnl

INTRODUCTION

During the past decade, we have been increasingly inundated with mediated
images of our own demise. These allegedly apocalyptic threats have taken
many forms, both "natural" and sociopolitical in origin, including killer bees,
flesh-eating bacteria, anthrax, West Nile virus, Y2K, crack babies, predatory
youth gangs, and weapons of mass destruction wielded by terrorists or rogue
states. One such threat that commanded considerable media coverage and
subsequent public attention in the spring and early summer of 2003 was Severe
Acute Respiratory Syndrome (SARS). Drawing on work in the sociology ofhealth
and critical criminology, this article seeks to explore the claims-making behind
the SARS "crisis" of 2003, the racialization of illness, and the consequences of
that process.

A BRIEF GENEOlOGY OF SEVERE ACUTE

RESPIRATORY SYNDROME (SARS)

Severe Acute Respiratory Syndrome (SARS) is a disease caused by the SARS

coronavirus; SARS-CoV (WHO, 2004, p. 31). The class of virus that causes
SARS includes colds and some respiratory ailments commonly found in infants.
The incubation period is believed to be between two and ten days. At least
initially, SARS symptoms mirror those of the flu and include fever, headaches,
myalgia, and respiratory compromise. As the disease advances into its second
week, sufferers experience dry cough and diarrhea along with rapidly progressing
respiratory distress and oxygen desaturation that can result in death.?
While the origin of SARS is highly contested, many epidemiologists believe
that it began alongside an influenza outbreak in China's Guangdong Province in
mid to late November 2002 (British Medical Association, 2004; Dave & Dywer,
2004; Heymann & Rodier, 2004). It then spread within China and subsequently
affected Hong Kong's Special Administrative Area, Vietnam, Singapore, and
Canada. Within six months, SARS had spread to 27 countries and, by the end
of 2003, it had sickened 8,439 people and killed 813 worldwide (WHO, 2004).
Despite its swift spread and the tragic deaths of over 800 people, SARS did not
spread as quickly or easily as predicted, nor did it become the fatal global
pandemic foretold by some members of the medico-administrative establish-
ment and by much of the corporately-owned mass media. In many respects, the
SARS "crisis" of 2003 proved to be yet another example of the moral panics
which are becoming a routinized part of the West's mediated consciousness in a
globalized world.

2 According to data from 2003, the case fatality ratio (CFR) ranged from 0%-50%, depending
on country, the patient's age, medical condition, and other factors. According to the WHO, the crude
global CFR for SARS was 9.6% during the epidemic.
 BITS OF FALLING SKY I 119

MORAL PANIC

The concept of moral panic has been a core element in the work of many
sociologists of deviance and criminologists, especially those with allegiances to
the interactionist and critical schools (Muzzatti, 2002; Rothe & Muzzatti, 2004).
While originally formulated to provide a tool for understanding the sets of
interrelations that constitute the complex social reality of crime, particularly
interrelations among "deviants," social control agents, the mass media, and the
pUblic, its value as a concept is by no means restricted to that area of inquiry.
Although the term "moral panic" was coined by British criminologist Jock
Young (1971), it was his colleague, Stanley Cohen, who first systematically
outlined the indicators and elements of moral panics, as well as the actors involved
in them. In his seminal work, Folk Devils and Moral Panics (1972), Cohen
observed that a moral panic takes place when:
A condition, episode, person or group of persons emerges to become defined
as a threat to societal values and interests; itsnature is presented ina stylized
and stereotypical fashion bythemass media; themoral barricades aremanned
by editors, bishops, politicians and other right-thinking people; socially
accredited experts pronounce their diagnoses and solutions; ways of coping
are evolved or (more often) resorted to; the condition then disappears,
submerges ordeteriorates and becomes more visible. Sometimes theobject of
the panie is quite novel and at other times it is something that has been in
existence long enough, butsuddenly appears in thelimelight. Sometimes the
panic passes over and is forgotten, except in folklore and collective memory;
at other times it has more serious and long lasting repercussions and might
produce such changes asthose inlegal and social policy oreven inthewaythe
society conceives itself(Cohen 1972, p, 9).

Cohen's work focused on the reactions of the media, agents of social control, and
the general public to relatively minor clashes between youth subcultures (the
Mods and the Rockers) in 1960s England, and, as the above excerpt illustrates,
how these reactions influenced the formation and enforcement of law and social
policy as well as societal conceptions of the youth culture-delinquency nexus.
Simply put, a moral panic is a media-generatedexaggeration or distortion of some
perceived deviant behavior or criminal activity followed by collective over-
reaction. According to Cohen, this includes grossly exaggerating the seriousness
of the events according to criteria such as the numbers of people taking part,
the number involved in violence, and the amount and effects of violence and/or
damage (1972, p. 31). This process of panic and overreaction, of course, is not
something that happens spontaneously; instead, it is a result of a complex inter-
play of behaviors and responses involving several actors.
While many scholars have extended Cohen's concept of moral panic by apply-
ing it in their analyses of youth subcultures(e.g., punks, skaters, goths,and ravers),
others have used it to explain public reactions to more generalized and adult
120 / MUZZATII

manifestations of deviant and criminal behavior (e.g., soccer hooligans, immi-

grants, welfare mothers, terrorists, pedophiles, squeegee merchants, and serial
killers). In a related vein, the concept of moral panic can be applied usefully in
analyzing the SARS crisis of2003. Just as this concept reveals the discrepancies
that often exist between the empirical and social realities of crime, it illustrates
how social and political responses to an illness may diverge considerably from
the illness's medical (i.e., etiological and epidemiological) realities. Through
analyzing SARS as a moral panic, we can better understand how social responses
to illness are shaped by far more than the objective features or consequences of
that illness. We can also learn a great deal about the organization of our society
and its relationships with the larger, global community.

ILLNESS AS CONDITION AND EPISODE:

SARS AS FOLK DEVIL
According to the criminological conception, folk devils are the individuals
responsible for the deviant or criminal behavior. Unlike "normal" deviants or
criminals, these people are "unambiguously unfavorable symbols" (Cohen 1972,
p. 41); that is, they embody evil. While it is often members of youth subcultures
(garners, bling-kids, tag artists, hip-hop fans, etc.) who get designated folk devils,
the label is not solely reserved for them. As the work of many scholars illustrates
(Ben-Yehuda, 1990; Berry, 1999; Hall, Cuthcher, Jefferson, Clarke, & Roberts,
1978; Kappeler, Blumberg, & Potter, 1996; Muzzatti, 2004; Rothe & Muzzatti,
2004; Visano, 1998), folk devils are highly stylized images of despised and
marginalized masses of people (such as people of color, immigrants, people with
HIV/AIDS, political dissidents, the working class, or gays and lesbians). In
short, folk devils are demonized groups that represent all that "we" (i.e., some
apparently homogenous majority group of good, clean-living, healthy, law-
abiding folks) are not. Similarly, as Foucault (1980) asserts, because health is
one of the essential objectives of political power and a social condition necessary
to ensure order, any threat to it must be constrained, whether it be a disease,
conditions conductive to "miasma," or sufferers of disease themselves. Hence, as
a precondition to re-establishing order, it stands to reason that through discursive
constitution a threatening illness and its carriers take on the essential qualities
of the folk devil. In this article I will examine how this took place in the case
of SARS. As illustrated below, SARS was transformed into a folk devil through
a multifaceted process-one with a long, notorious, and, sadly, "successful"
history upon which to draw.

IMAGING INVASION-IMAGING SARS

In the early decades of the 20th century, "war" became a common metaphor
for dealing with illnesses such as tuberculosis and syphilis. Through the use of
 BITS OF FALLING SKY / 121

military metaphors, diseases were envisaged as "alien"/"other," much like

enemies in times of war, and this process contributed to their stigmatization
(Sontag, 1989). This "othering" of illness (and the ill), represented in the impulse
to make dreaded diseases "foreign," had roots in 15th century Europe where
syphilis was "the French Pox" to the English, "Morbius Germanicus" to the
French, and "Naples sickness" to Florentines (Sontag, 1989, pp. 135-136). The
link between imagining disease and imagining the other was rooted in the notion
of one's own home as a safe and clean place that must be protected from lethal
diseases and the "outsiders" who carry them. It was also tied to the scientifically
discredited, though still popularly held belief, in miasma.' Such historic mythol-
ogies are fuelled by the notion of polluted spaces-particularly the view of the
city as pathogenic and its inhabitants as carriers of disease," When considered
in combination with extant mythologies of densely populated urban areas and
racialized ghettos, it is little wonder that media coverage and public understanding
of SARS was so heavily dominated by a focus on East and Southeast Asia and
On communities of people from those parts of the world living in or visiting
major North American cities.
As recently as the early 20th century, Chinese immigrants were accused of
bringing the bubonic plague to northern California. To dismiss such a widely-held
belief as nothing more than a dark episode from a far-removed racist past would
be to forget that barely two decades ago similar tales of Africans (and later,
Haitians) and AIDS abounded in the media and public discourse. As Sontag
(1989) observes, such constructions about "diseased foreigners" draw heavily
upon subliminal connections about a primitive past and disease transmission
from animals (whether rats, Rhesus monkeys, or, in the case of SARS, cats and
palm civets).
Clearly fear of communicable disease generates a preoccupying distinction
between the sick and the well (Sontag, 1989). Such a dichotomous construction
involves not only the drawing of distinctions between diseased and healthy
persons, but also between safe and contaminated groups/communities and
locations/places. In the highly globalized 21st century SARS, the quintessential
foreign illness, served as an ideal projection for the paranoia of the privileged. S

3 The work of Koch, Pasteur, and others had, by the 1880s, replaced the view of miasma with
the germ theory of contagion, although as Sontag (1989) and Foucault (1980) illustrate, the belief
that disease generated spontaneous in "other" (i.e., unclean) environs was still widely accepted by
the public well into the 20th century.
4 Foucault's (1980) historieal analysis reveals that urban spaces were viewed as perhaps the most
dangerous (i.c., unhealthy) environments and that the idea of the pathogenic city inspired a whole
mythology and very real states of popular panic in 19th century Europe.
5 See Sontag (1989, pp. 150-170). In the case of SARS, these projections included both those of
the most developed world onto the developingllest developed world, and those of "non-Asians" onto
East and Southeast Asians in developed countries like the United States and Canada.
122 I MUZZATII

Falling Sky
On March 12,2003 the World Health Organization (WHO) issued a global alert
about cases of severe atypical pneumonia in Vietnam, Hong Kong, and China's
Guangdong Province (British Medical Association, 2004; WHO, 2003). Three
days later on the 15th of March, for the first time in its history, the WHO issued an
advisory against travel to Vietnam, Hong Kong, China's Guangdong Province and
Toronto, Canada (Rezza, Marino, Farchi, & Taranto, 2004; WHO, 2003). The
travel recommendations were at first "non-specific," advising travelers to be
suspicious if they had traveled in the affected areas. Soon, however, the advisories
became quite overt, urging travelers to avoid the areas and airlines to screen
passengers from the identified regions. The WHO's second alert also was the first
time the term SARS was used publicly by the organization. In an editorial which
appeared in the prestigious New England Journal ofMedicine, the head of the U.S.
Centers for Disease Control and Prevention (CDC) fueled concern by writing that
"[a]irbone transmission may have a role in some settings and could account for the
extensive spread within buildings and other confined areas that has been observed
in some places in Asia" (Gerberding, 2003). What some observers characterized as
the outset of "a coordinated global outbreak response that brought heightened
vigilance everywhere and intense control efforts," (Heymann & Rodier, 2004)
others saw as not only unfounded, but highly irresponsible.f
Perhaps unsurprisingly, although the Canadian media and medico-bureaucratic
establishments were quite critical of the WHO's position, the same could not
be said of their counterparts in the United States (CDC, 2003b). In fact, almost
before the print was dry on the WHO press release the Commissioner of the U.S.
Food and Drug Administration (FDA) cautioned Americans against traveling
to countries identified in the WHO's advisory (CDC, 2003c).

Mediated Illness-Mediated Panic

The U.S. media's coverage of the SARS epidemic was dually pronged, with
some coverage devoted to Asia, but most focused on Asian communities in
North America. Because of its proximity to the U.S. border and sizeable East
and Southeast Asian populations, Toronto became a very attractive media target."
The Washington Post incorrectly reported that many Toronto residents were
wearing masks on downtown streets and CNN reporters provided global
audiences with SARS updates, live on location from Toronto's Union Station

6 Among the more notable were the CDC's Dr. Clifford MacDonald, Chinese Health Minister
ZhangWenkang, Ontario Medical Commissioner Colin D'Cunha, and Health Canada's Paul Gul1y.See
Appelbe (2003). Pul1ing no punches, Dr. Donald Low, one of the world's leading infectious-disease
experts, and a member of the SARS containment team, referred to the WHO's travel advisory as "a
buneh ofbul1s"t." See Seeman (2003).
7 Toronto's metropolitan area is home to approximately half a million people who claim East
and/or Southeast Asian descent. Toronto is also home to North America's second largest "Chinatown."
 BITS OF FALLING SKY I 123

public transportation hub (Appelbe, 2003; Koc, 2003). Similarly, The New York
Times referred to Toronto's public health management as "a leaky dike" while a
headline from the New York Post proclaimed, "Uh-oh Canada" (Seeman, 2003).
CNN also reported that Major League Baseball warned players to minimize
contact with fans and refrain from signing autographs while playing the Blue Jays
in Toronto." During the frenzy, American media outlets also incorrectly labeled an
avian influenza (H7N3) strain circulating in British Columbia as an "outbreak" of
SARS on Canada's west coast (Health Canada, 2004).9
The media's construction of Asian communities as breeding grounds of con-
tagion was not focused exclusively on Canada. Rather, news coverage in the
United States saturated viewers with images of East and Southeast Asians
wearing masks and creatively-framed camera angles provided footage of deserted
Chinatowns in American urban centers, further fueling the stigma. In early
April the New York Times erroneously reported that the owner of a Vietnamese
restaurant in the city's Chinatown had died of SARS, and in Boston a story of
SARS-infected employees in a downtown Chinese restaurant appeared on the
Massachusetts' Institute of Technology website (Schram, 2003). Similarly, in
Los Angeles rumors of Chinese restaurants and grocery stores being closed
by police circulated widely (Joseph, 2003). Public alarm was exacerbated by
heavy media coverage of a Korean Airlines' crew quarantined in Boston, and
an American Airlines' flight detained for hours in San Jose (Mitter, 2003).
Moreover, President Bush's announcement that SARS would be added to the
list of diseases warranting mandatory quarantine, the first such addition in over
twenty years, did little to quell the widespread panic.
In a similar vein, the U.S. media, particularly CNN and other cable news
channels, went to great lengths to focus public attention on egregious although
isolated incidents of collective over-reaction to SARS in East and Southeast Asia.
Notable in this media coverage were stories of the highly intrusive mandatory
(though obviously cursory) medical examinations of all passengers at airports
and railway stations in China, the cancellation of live studio audience tapings by
a television station in Singapore, the issuance of decree in Thailand that all visitors
from Singapore wear surgical masks, the ransacking of a government office in
Beijing, and the cull of tens of thousand of market civets, cats, dogs, badgers and
raccoons in Guangdong Province (Hurley, 2004).
This type of coverage made SARS appear far more widespread, contagious,
and dangerous than it truly was. It also served to tear away the thin and flimsy
veneer of "tolerance" in America, revealing deep-seated racism and xenophobia.
Across the nation, Asian-owned businesses suffered greatly and Chinatowns
were unusually devoid of tourists. As SARS became an increasingly dominant

8 www.cnn.com/2003/worldlamcricas/04/24/sars.toronto
9 See Health Canada (2004). Not surprisingly, like Toronto, Vancouver, BC has a sizeable East and
Southeast Asian population.
124 / MUZZATII

element of the media and public lexicon, more egregious instances of racism
became evident. In many large U.S. cities, public transit drivers donned surgical
masks and gloves as their vehicles approached Asian neighborhoods, real estate
agents were told by property owners not to bring Asian clients to viewings,
and multiple empty seats could be found around persons of Asian descent in
otherwise-crowded public venues and university classrooms (Schram, 2003).
Additionally, in a repetition of the run on duct tape and plastic sheeting that took
place the previous year, sales of surgical masks surged and a fearful public loaded
up on disinfectants that supposedly "killed SARS" and pills that "bolstered the
immune system against SARS" even before researchers in Atlanta and Geneva
completed their analyses ofthe disease (CDC, 2003c). Equally disturbing were the
comments of a senior international trade specialist in the U.S. Department of
Commerce who saw SARS as "a sudden opportunity to explore new export
markets" and officials at the U.S. Embassy in Beijing who touted the great timing
for critical market entry into China (Bokal, 2003).

Failing CeilingTile

Contrary to the assertion by the head of the CDC that the media played a
vital role in communicating accurate and up-to-date information about SARS to
the public (Gerberding 2003), the media's coverage of SARS was often charac-
terized by little more than sensationalism and xenophobic fear-mongering.
Highly-charged footage of public health officers in bio-hazard suits and airline
passengers in surgical masks incited unwarranted public anxiety and harkened
back to tales of the "yellow peril" allegedly posed by East and Southeast Asians
living in or visiting the US. Despite touting "special cover story," "in-depth
expose," or "investigative report" coverage that promised all the vital facts
about SARS, the media provided little substantive information about the disease.
Noticeably absent from most of its coverage was the fundamental fact that SARS
was not easily communicable, nor was it fatal in the overwhelming majority
of cases. For example, at the height of the "epidemic" there was virtually no
media coverage of the findings by researchers at Harvard's School of Public
Health that SARS had an infectiousness Ro of slightly more than 2 (the flu, by
contrast has an Ro of 10),10 and that transmission was not airborne or casual but
rather required a person to ingest droplets of virus-laden mucus. Additionally,
media reports conflated "suspected," "probable," and "known" cases and failed to
follow up on them. Instead, one researcher's outlandish (and quickly discredited)
prediction of "up to 1 billion cases by next year" (Seeman, 2003) was chanted
like a mantra by the media.

ItRo is the measure of a disease's infectiousness and corresponds to the number of people,
on average, who are infected by someone with the disease in the absence of any control measures.
See Pearson, Clarke, Abbott, Knight, & Cyranowski (2003).
 BITS OF FALLING SKY / 125

Perhaps most telling was how the media presented SARS fatalities. The
allegedly "mounting death toll" the media constructed through its callous and
exploitative coverage (e.g., "SARS Update-Another Death"), was far removed
from the reality of SARS mortalities. The media paid virtually no attention to
the fact that 94% of people who contracted SARS recovered and that while
even the WHO's figures pointed to a crude fatality rate of slightly less than
10%, which was considerably lower than many other potentially fatal infectious
diseases, the reality was that the mortality rate for otherwise healthy people
under 50 years of age was between 0%-4% (Fox, 2003; Ho, 2003; Rohe, 2003;
Seeman, 2003; WHO, 2004).
Contrary to media messages, the SARS outbreak of 2003 failed to attain the
pandemic proportions predicted. According to research conducted by the WHO
and the U.S. National Center for Infectious Diseases, the containment of SARS
was attributable to traditional public health interventions such as isolating case
patients, quarantining close contacts, and enhanced infection control. It was not
due to increasing social distance, to the dissemination of health information, or to
screening or thermal scanning travelers (Bell, 2004).

CONCLUSIONS
The approximately 800 deaths worldwide attributed to SARS were indeed a
tragedy. Perhaps an even greater social tragedy was how the media-orchestrated
panic diverted public attention and healthcare resources from other pressing
issues and contributed to the victimization of already disenfranchised groups. As
SARS garnered much public and governmental attention in the most developed
world, the almost 2.7 million malaria deaths (most of whom were African
children), the 2 million tuberculosis deaths in the developing world, and even
the 36,000 influenza deaths (Sagar, 2003) in the United States went virtually
unnoticed, to say nothing of the 12 million people UNICEF estimates die annually
throughout the world from malnutrition and lack of clean water. As revealed in
the case of SARS, by focusing on "body counts" and racializing illness the
media diverts much needed attention away from fundamental global health
questions, such as the role of the pharmaceutical, chemical and bio-technology
industries in creating conditions conducive to the development and spread of
new infectious diseases, the WHO's purely vertical approach to global health,
and the fact that even in the wealthiest countries in the world public health
agencies are grossly underfunded.

AUTHOR'S BIOGRAPHY
Stephen L. Muzzatti (Ph.D., York University) is an Assistant Professor of
Sociology at Ryerson University in Toronto, Canada where he teaches courses in
deviance, media, and popular culture. He has written on such diverse topics as
126 / MUZZATII

State crime, criminological theory, Marilyn Manson, youth, street racing, and
motorcycle culture. He is a member of the American Society of Criminology's
Division on Critical Criminology and co-editor of The Critical Criminologist
newsletter.

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Direct reprint requests to:

Stephen L. Muzzatti
Ryerson University
Department of Sociology
350 Victoria Street
Toronto, Canada M5B 2K3
e-mail: muzzatti@ryerson.ca