The Intercept
Nov. 13, 2021
United Memorial Medical Center is a small hospital in a working class part of Houston, with just over 100 beds and 40 doctors. Most of its patients lack health insurance, and a wrecking company is located opposite its main building, which has the look of a brutal mall from the 1970s.
Yet nearly every major U.S. news outlet — the New York Times, the Washington Post, CNN, NBC, CBS, and others — published stories or photos about United Memorial in the first year of the Covid-19 pandemic. One of the pandemic’s iconic pictures shows the hospital’s then-chief of staff, Dr. Joseph Varon, embracing an older patient. No other hospital came close to getting as much coverage in the early phase of the pandemic.
The reason is simple: Unlike virtually every other hospital in the country, United Memorial was opening its doors to journalists trying to document the suffering on the front lines of the pandemic. The photographer who shot the picture of Varon visited the hospital more than 20 times. Because journalists were being turned away elsewhere, they flocked to United Memorial.
“One of the things a hospital has to do, to provide care for an acute illness, is to educate the public,” Varon told The Intercept. “And the only way I can educate the public is through the media. I need the world to understand what is going on.”
An investigation by The Intercept reveals that in the first months of the pandemic, only a small number of the more than 6,000 hospitals in the U.S. let journalists inside — and when access was permitted, it was usually limited to a short time span. The upshot is that most hospitals, citing safety and privacy concerns, turned themselves into vaults that hid the strongest evidence of the virus’s lethality. Doors were shut so firmly that an award-winning documentarian even gave up on his effort to film in the U.S. and instead made his documentary about a country where he could get access to Covid patients: China.
When it began in the U.S., the pandemic was a mass casualty event with few pictures of the casualties.
Journalists who have covered wars and epidemics told The Intercept that the obstacles they encountered during the first waves of the pandemic were unparalleled in their careers. Isabeau Doucet, who reported on cholera in Haiti, was completely shut out. “I spent months trying and failing to get access to hospitals or even to get permission to interview doctors who I had spoken to off the record,” Doucet said. “The stonewalling from hospitals was unlike anything I’ve ever experienced.”
Misha Friedman, who worked in public health before becoming an award-winning photojournalist, was shocked at the obstruction in New York City. “I tried to go through doctors and nurses, I tried to go to the top, I even went to someone who was on the board [of a hospital], a billionaire, and he said, ‘I understand, but I don’t want to get involved,’” Friedman explained. Lucas Jackson, a photographer with Reuters, noted recently that he “worked for one of the biggest news companies in the world and couldn’t get access to a single hospital within 100 miles of NYC.”
One of the few photographers who had success early in the pandemic was Victor Blue, working for the New York Times. But Blue is deeply critical of what happened to other reporters. “NYC hospitals should be ashamed for keeping out journalists — I believe it worsened and prolonged the pandemic,” Blue wrote on Twitter earlier this month, adding, “I was frustrated and angry more hospitals weren’t opening up. … There was plenty of room for every outlet to get access.”
The experience of being shut out was not universal. Blue worked alongside Sheri Fink, who has a medical degree from Stanford University and embedded in an Ebola treatment unit in Liberia in 2014. Fink reported from inside a number of hospitals early in the pandemic and noted in an interview that the early months were truly the great unknown, with tremendous fears that hospitals could spread the virus. “In previous emerging outbreaks, hospitals have become points of amplification,” she noted. “They have become places where the disease explodes and spreads.”
The Times seems to have gotten more access than other news organizations in the first months of the pandemic, but even so, its front pages featured just a few images of people afflicted with Covid-19 in American hospitals. For the month of March, the newspaper had just one front-page photo of a patient in a U.S. hospital. The next month, the Times had only three front-page photos of patients inside U.S. hospitals, on April 5, April 13, and April 26. There were a lot of photos in the Times and other outlets about Covid-19 — pictures of empty streets, of people wearing masks, of socially distanced lines, of exhausted doctors and nurses — but scant photos of anyone sick with the virus in a hospital, which is where virtually all acute cases could be found.
There are many reasons the U.S. Covid death toll has surpassed 750,000, beginning with dismissive rhetoric from the Trump administration that encouraged Americans to doubt the seriousness of the virus. But there is a less examined reason too: Hospitals hid the human devastation in the pandemic’s early days, when opinions and policies were indelibly shaped. The Covid-19 pandemic began as a mass censorship event.
Heroes and Bureaucrats
The work of medical staffs — nurses, doctors, custodians, and others — is rightly regarded as heroic. These workers saved innumerable lives, sometimes at the cost of their own. But hospital bureaucrats undercut those efforts by turning away journalists seeking irrefutable evidence that could reduce the skepticism in America. Hospital administrations even investigated staff members who shared videos they had shot themselves.
Administrators who spoke with The Intercept or provided written statements emphasized that they limited access because of privacy and safety concerns as well as worries about medical staff being deluged. It’s certainly true that in the early months of the pandemic, everyone was overworked and exhausted, there was a shortage of personal protective equipment, and fears of spreading the virus led hospitals to close their doors even to the spouses and children of patients who were dying. Many final farewells had to be made using iPads.
“At the height of the pandemic, during March and April, we thought that embedding media in the hospital would be a distraction both to the hospital and to the staff,” said Steve Clark, a spokesperson for St. Barnabas Hospital in New York City. St. Barnabas is in the Bronx, a part of the city that was hit particularly hard by Covid-19. Clark described the hospital’s staff as overwhelmed in the first months of the pandemic and added, “We had a policy that we followed very closely that we didn’t let any media into the building.”
Even hospitals that opened their doors tended to do so sparingly. Houston Methodist Hospital, one of the largest hospitals in Texas, allowed a team from the Times to report from its Covid care units in the summer of 2020, when the state was going through the first of its Covid waves. But that was it — no other journalists were given access in those crucial months, not even from the local newspaper, according to Stefanie Asin, the hospital’s media relations director.
“It would be poor practice to let a bunch of journalists into Covid wards, into waiting rooms, into cafeterias,” Asin said. There was a singular reason, she explained, for giving a green light to the Times: The writer was Fink, who had reported from the hospital in the aftermath of hurricane Harvey. “We didn’t want to bring in outside people who we didn’t know,” Asin said. “We didn’t allow spouses into the Covid units. We’re not going to let in a photographer.”
Decisions of this sort, occurring one by one at hospitals across the country, created a visual drought. Some of the fiercest criticism is now coming not just from journalists but also from medical staff who sought greater public awareness of the harm caused by the virus as the pandemic got underway.
“There was no appetite to let anyone in,” said Dr. Craig Spencer, director of global health in emergency medicine at Columbia University Irving Medical Center, speaking about hospitals in general. Spencer, who treated Ebola patients in Guinea in 2014 and contracted the disease himself, has been frank about his disdain for policies set by administrators. “My presumption is that they would assume it would only be embarrassing. There was no benefit to them showing the apocalypse and what it looked like. Having patients all over the emergency department on oxygen canisters and people intubated is not going to be a good image for your hospital. At the end of the day, hospitals are a corporation with a focus on the bottom line.”
Power of Photography
There is a long-running debate about the impact of photography — whether pictures or videos can really change public opinion and government policy. But in the early days of the pandemic, a short burst of graphic images of the dying and the dead had a concrete effect, leading President Donald Trump to take the virus more seriously. Unfortunately, instead of encouraging hospitals to allow more access, things went in the opposite direction.
The breakthrough occurred in late March, when freezer trucks were used in New York City to store corpses for whom there was no room inside hospital morgues. Pictures and video emerged of body bags being transferred to these freezer trucks, and some images showed rows of corpses inside the portable morgues. Trump, who had vowed to reopen the country from a brief lockdown, announced on March 29 that the lockdown would continue. He specifically cited the imagery coming out of New York.
“I’ve been watching that for the last week on television, body bags all over in hallways,” Trump said in a Rose Garden press conference. “I have been watching them bring in trailer trucks, freezer trucks — they are freezer trucks because they can’t handle the bodies, there are so many of them. This is essentially in my community in Queens — Queens, New York. I have seen things I’ve never seen before. I mean, I’ve seen them, but I’ve seen them on television in faraway lands.” Trump added, “These are trucks that are as long as the Rose Garden, and they are pulling up to take out bodies, and you look inside, and you see the black body bags. You say, ‘What’s in there? It’s Elmhurst Hospital, must be supplies.’ It’s not supplies; it’s people.”
This was a pivotal moment: Trump was swayed not by his science advisers or elected officials but by pictures he saw on his television. If this had been constructed as an experiment — can graphic images change the mind of the most powerful Covid cynic in the country? — the hypothesis would have been proved. Yet hospitals reacted by tightening their crackdowns on anyone trying to get this kind of opinion-changing footage.
Some of the imagery that shocked Trump came from Brooklyn Hospital Center. In late March, photographer Braulio Jatar shot a particularly chilling picture of a body wrapped in sheets as it was carried by a forklift onto a freezer truck outside the hospital. But when Jatar returned to the hospital in April, a fence had been built to keep the bodies out of view. This was happening at other hospitals too. The president and the rest of the country would not be discomforted by further publication of disturbing imagery.
“It was a tough time emotionally,” said Lenny Singletary, Brooklyn Hospital’s senior vice president of external affairs. “My feelings at the time were a bit of frustration: ‘Wow, have some dignity for the loved ones.’ … We didn’t want people taking photos of bodies being transported.”
Singletary’s reaction is understandable. In ordinary times, it would be ghoulish to facilitate photography of body bags. In ordinary times, the sheer numbers of corpses, the statistics on their own, would be proof enough. But these were not ordinary times. “The numbers have become a concrete wall,” noted historian Mary Dudziak. “Covid-19 tables and graphs both reveal and conceal. They are intended to illuminate, but turning casualties into numbers accomplishes an erasure of the dead themselves.”
For some Americans, erasure was preferable. A telling example came as Los Angeles was going through its worst days of the pandemic in 2020. A Washington Post reporter, Scott Wilson, visited a mortuary and posted pictures of bodies wrapped in white cloths on Twitter. By the end of the day, he deleted his post due to complaints from other accounts on the social media site.
“Mass death is ugly,” Wilson wrote. “But I’ll self-censor.”
And it wasn’t just hospitals or social media that sanitized what the public would see as the pandemic got underway. When photographer George Steinmetz flew a drone over a mass grave on New York City’s Hart Island, officers from the city’s police department charged him with a misdemeanor and confiscated his equipment. Though the charge was later dropped, the incident was another manifestation of the barriers that prevented Americans from seeing the pandemic’s true toll.
“If people had seen the reality of what it was like, they would have been more likely to follow social distancing and all the things we were recommending as public health measures,” said Spencer, the Columbia University doctor. “I think that if people were to have a better understanding of what it looks like for hospitals that are completely overwhelmed and struggling, what it looks like to be intubated — if people were able to see the apocalyptic conditions inside hospitals, I think it would change how willing people are to adhere to public health guidelines.”
War Hospitals
Whether in a pandemic, hurricane, or war, hospitals function as calamity’s mirror. I saw this during the siege of Sarajevo in the 1990s.
The Bosnian capital was surrounded by Serb troops who bombed and strafed the city, killing and wounding civilians by the thousands. Sometimes a journalist would be present when a mortar exploded at a marketplace or a sniper’s bullet hit its mark — one day I happened to see a man get shot and try to crawl to safety — but much of the time we caught up with the wounded at Kosevo Hospital, which would often get bombed too. There were no restrictions; you could talk to any doctors or patients who were willing to speak.
The war’s tragic face was revealed at this hospital. After all, how could you understand a war, how could you feel in your gut its darkness, how could you convey this to the rest of the world, without seeing the wounded and the dead and knowing their stories? How can anyone understand a calamity without seeing its victims? To be shut out of Sarajevo’s hospital would have meant being shut out of one of the most important battlegrounds of the war.
I cannot remember a doctor or patient declining to talk. They wanted the rest of the world to know the war’s brutality and inhumanity. Stories and images of victims are inherently powerful; casualties are evidence. The less evidence we see, the less we might believe or be aware of the disaster. That’s why, for instance, the U.S. military tries to prevent photographers from taking pictures of injured or killed soldiers. For nearly two decades, the Pentagon even banned journalists from covering the transfer of military coffins at Dover Air Force Base.
It is dark outside as I write these words, and I wonder why hospital photography has taken such a hold on me. There is an answer. I have spent much of my life writing about the dying and the dead, not in pandemics but in war, and on one occasion I got some photographic evidence that was scant at the time, and it was stolen from me. This was in 2005, when I got on a U.S. military flight in Baghdad that was heading for Kuwait. Before boarding, I was asked by a soldier whether I was willing to travel with “HR.” I didn’t know that military acronym, so I asked what it meant. Human remains, he said, not looking up.
The plane was a C-17, and it carried a dozen flag-draped coffins that were made of a shiny metal. The flight lasted for what seemed like hours. My knees were inches from a coffin. At the Kuwait military airport, an honor guard removed the caskets with aching respect. It was nighttime, so I held my camera at chest level, turned off the flash to attract minimal attention, and shot a set of photos. This was against the rules: Photos of coffins were still forbidden. After the last coffin was removed, the passengers, mostly soldiers and contractors, filed out of the back of the plane and onto a bus.
As the doors of the bus were about to close, a military police officer jumped on board.
“Someone was taking pictures,” he announced. “Who was it?”
I stayed quiet as a soldier raised her hand. The MP deleted her photos and left. But a few seconds later, the MP returned and asked, standing at the front of the bus, “Who else was taking pictures?”
I was traveling with a photographer, Gilles Peress, and didn’t want to jeopardize the photos he had taken during our work together in Iraq. The MP might confiscate his film. So I raised my hand, and the MP walked down the aisle to me. As he deleted my photos, he said he had the same camera and he really liked it. He smiled as he handed it back to me. My photos of the dead were gone.
Pandemic Economics
When there is a hurricane, flood, or wildfire, the damage is not hidden. In those emergencies, there are few restrictions on what journalists and the public can see — the snapped trees, submerged streets, bodies floating in water, houses in flames. But the worst destruction of Covid-19 is not on display in places where journalists can bear witness as they wish. Most of the sick, dying, and dead are in medical facilities whose economic interests are best served by keeping journalists away. That’s how you get a cataclysm without the visuals of cataclysm.
U.S. hospitals are a mix of for-profit and not-for-profit entities, though all must focus on the bottom line, some more fiercely than others. Their executives often earn salaries on an exorbitant par with the rest of corporate America. At Mass General Brigham, a not-for-profit hospital system in Massachusetts, 17 executives earned more than $1 million in 2018; the chief executive earned about $4 million that year. One of the system’s main hospitals, Massachusetts General, told The Intercept in a statement last year that it did not allow photographers inside “for the privacy of our patients and also for their safety and that of our staff.”
The economics concept of “positive externalities” may help explain, in addition to safety and privacy concerns, why hospitals supposedly devoted to saving lives would refuse to allow journalists inside their walls during a pandemic. “Positive externalities” describe a situation in which the benefits of a company’s activity do not accrue entirely to the company paying for it. If the activity is costly to perform, the company will do less of it than society would like.
That might sound confusing, but here’s an example: When a hospital grants access to a journalist, the abundant upside of its action — public awareness of the danger of Covid-19 — would be spread across society rather than concentrated in the hospital. In doing so, however, the hospital may face a variety of potential costs, such as the publication of off-brand photos of chaos in its wards, a malpractice suit if a journalist sees something go awry, a privacy lawsuit if a patient’s identity is disclosed without permission, or the liability of a journalist contracting Covid-19.
“It’s a private cost and a public benefit,” said Ashvin Gandhi, an assistant professor at UCLA Anderson School of Management. Gandhi, who researches the health care industry, noted that “the more an activity helps third parties, the more of it that society as a whole wants to be done.” But that doesn’t change the core problem. The company performing the activity — let’s say it’s letting journalists into a Covid ward — doesn’t derive enough benefits to justify doing more of it. As a result, Gandhi added, “the larger a positive externality, the greater underprovision there will be.”
That raises a question about the relatively few hospitals that opened their doors a crack in the early days of the pandemic: Why did they?
Brooklyn Hospital, although it erected a fence to shield the transfer of body bags, did allow two teams of journalists inside in March 2020. Singletary, the hospital’s head of external affairs, played a key role. He was a newcomer to the health care industry, joining the hospital in 2018 after a career on Wall Street, and when the moment came to decide on giving access to journalists, “I was naive enough to take the risk,” he told The Intercept.
One consideration, he said, was that his hospital is a minor player in the industry: It’s a community facility that’s not affiliated with a large chain, and most of its patients do not have health insurance. Unlike the major medical centers everyone has heard about in New York — Mount Sinai, NYU Langone, NewYork-Presbyterian — Brooklyn Hospital has a hard time getting attention and is not drenched in donations from billionaires. Singletary said that as the pandemic began, a hospital trustee told him it could be an opportunity for good publicity.
“The statement was that it would be a shame if we wasted this crisis,” Singletary said. “In order for us to get a little place like ours the attention it so deserved, we had to do something a little bit different.”
Singletary said he asked his staff to contact the New York Times and he personally facilitated the visit of the newspaper’s journalists. After their first story was published, the hospital was inundated with requests from other media outlets. Singletary allowed one more team inside — a crew from CBS — but refused all others.
New York to Wuhan
When the U.S. death toll reached 500,000 early this year, the New Yorker published a story about the milestone, using a photo that showed a crematorium worker amid stacks of coffins. But these were not U.S. victims — they were Italians. The photo was shot in Italy in 2020.
It has not been unusual for U.S. publications to use pictures from other countries to illustrate the human toll of the pandemic. When the New York Times published a “Year in Pictures” portfolio for 2020, the main photo for March was from Bergamo, the epicenter of Italy’s outbreak. The photo, which shows medical workers around a Covid patient at his home, was shot by Fabio Bucciarelli and is one of the strongest images to emerge from the pandemic’s early phase. The picture’s intimacy stemmed from Bucciarelli gaining close access to Covid patients, access that most U.S. photographers could only dream of.
“It was very frustrating to see in March that all of the great stuff was coming from Italy,” noted Friedman, the photographer who was turned down across New York City. “They understood and were giving people more access.”
The saga of documentarian Hao Wu is instructive. Born and raised in China, Wu has lived in the United States for nearly 30 years, and in 2018 he directed the award-winning documentary “People’s Republic of Desire.” When the pandemic began, he wanted to make a documentary about Wuhan, the Chinese city where the pandemic originated, and New York City, where he lives. But he had no luck getting access to hospitals in New York, so he focused his attention on Wuhan, where it turned out that for a brief window of time, some Chinese journalists were able to get inside Covid wards.
Wu worked with journalists who gained access to four Wuhan hospitals in the early days of its lockdown. At the time, things were incredibly chaotic, and the central government in Beijing hadn’t yet issued guidelines for media access, Wu told The Intercept. Individual hospitals could decide on their own whether to let journalists inside, though this would change later on as Beijing took more control. At the lockdown’s outset, the journalists who collaborated with Wu were able to work with relative freedom, and their footage included a terrifying scene in which sick people banged on a hospital’s locked door to get inside for treatment. Wu turned the footage into the Emmy Award-winning “76 Days,” a reference to the length of Wuhan’s lockdown.
This is one of the most stunning facets of the pandemic’s opening stages: America’s hospital industry may have been even more effective in censoring the media than China’s government. A one-party state that detained and imprisoned citizen journalists for criticizing the government’s handling of the pandemic, China nonetheless had a brief window when its journalists could carve out more freedom to work inside hospitals than their American counterparts.
A Long Island Exception
What did it take to maneuver around the roadblocks in America?
Matthew Heineman is one of the most prominent documentarians in the U.S., and when the pandemic broke out, he wanted to get inside a hospital. His 2015 film about the drug trade, “Cartel Land,” had won a slew of awards. In 2017, he directed another award-winning documentary, “City of Ghosts,” about citizen journalists in Raqqa, Syria. But it was an earlier and lesser-known film, “Escape Fire,” that gave him the key he needed to get where he wanted to go.
“Escape Fire” was about the American health care system, and one of the authorities it featured was Dr. Donald Berwick, who headed the Centers for Medicare and Medicaid Services during the Obama administration. As the Covid-19 pandemic began, Berwick vouched for Heineman with Michael Dowling, the chief executive of Northwell Health, the largest health care provider in New York state. Dowling supported Heineman’s effort to make a Covid-19 documentary and connected him with Michael Goldberg, the executive director of one of Northwell’s flagship hospitals, Long Island Jewish Medical Center.
With the backing of Northwell’s top administrators, Heineman got to work — but he still had a ways to go. The initial agreement was that he would not film any patients. This is one of the barriers that journalists who have been fortunate enough to get inside a U.S. hospital usually run into. Because of the federal privacy law known as HIPAA, hospitals are concerned about fines from the government or lawsuits from patients if journalists disclose the identities of patients without approval. However, there have been just two cases in the past decade in which media organizations were found by the government to have breached patient privacy — and each case, in 2011 and 2014, involved reality TV teams, not journalists.
“Wherever you are in the world, it’s important to get buy-in from the top, and then generally once that happens, it smooths the path below,” Heineman told The Intercept. “We gained access with the leadership team [of Northwell Health], and then the individual leadership team at Long Island Jewish, and then the doctors and patients.”
About 18 months later, the result of Heineman’s efforts is a 93-minute documentary that is being released on November 19 and is truly breathtaking, with emotional scenes not just of doctors and nurses performing their front-line work but also the patients they were trying to save — and those they were unable to save. “The First Wave” contains some of the most explicit scenes that have been filmed in U.S. hospitals: There are shots of patients being intubated, of others dying as staff administer CPR, and of bodies being zipped into bags. The film also has an expertly layered narrative that is already being hailed, in advance reviews, as a masterpiece.
Heineman feels that on a certain level, his film might be too little, too late. While he was inside the hospital, he was in touch with colleagues who were also trying to document the pandemic but were not able to get access to other medical centers. “I think one of the greatest tragedies of Covid is the fact that the general public did not see what was happening,” he said. “An already divided nation was further divided by misinformation and lack of clarity and real visual images.”
It’s impossible to know whether more reporting in the early days would have made a significant difference; that is the realm of the counterfactual. Fink isn’t sure it would have mattered. “I was very motivated early on by the thought that this could help people to understand the reality, help inform their decision-making, keep them safe, and contribute to saving lives,” she said. “But I don’t know. As I reported on surge after surge in hospitals overwhelmed in various places, I started to wonder whether or not I was right about the impact.”
She doesn’t doubt the importance of what journalists were doing and would have liked to see more of it, but after 18 months and the accumulation of a considerable amount of information on the virus, there are still lots of people who refuse to be swayed by evidence. “There are literally people who are in hospitals now with Covid or who have family members in hospital with Covid who still feel exactly as they did about not trusting vaccines, not believing in the utility of masks,” Fink said. “So people have the data, and they are making different choices. They have different beliefs. I am not sure that more images of hospitals, more reporting out of hospitals, would change that.”
Heineman has a different view. “Stats and headlines can only do so much,” he said. “If people truly saw what was happening, the overall narrative and dialogue about this pandemic would have been different. Everyone was clapping at 7 o’clock, but they didn’t really know what they were clapping for.”
Industrial Censorship
Censorship operates in ways that are far more complicated than a government getting between journalists and a story, though that’s one element of what happened in America.
As The Intercept previously reported, the Trump administration contributed to the suppression of Covid journalism by tightening HIPAA guidelines on media access to health care facilities. In May 2020, the Department of Health and Human Services, which oversees HIPAA, reinforced a set of restrictions on hospitals letting journalists inside. However, the fact that some journalists got access to United Memorial and other facilities shows that a willing hospital could open its doors.
In other words, the White House’s instructions were not ironclad. This was less a matter of state censorship and more a matter of industrial censorship. When you step back, it’s truly remarkable that in an era of hypersurveillance, with cameras in everyone’s phones, with billions of images and videos created and shared every day, there was so little to be seen of the virus’s victims in the first months of the pandemic. In many ways, it is easier to find pictures of Americans suffering from the 1918 flu pandemic than from Covid a century later.
United Memorial’s defiance of the tide is explained by a single, illuminating factor. It is a small hospital and was pretty much ruled by one person last year — Varon. He was the chief of staff, chief of critical care, and chair of its board (though he recently stepped down from those positions and is now chief of Covid-19 and critical care). Varon is a confidence-filled maverick who does not mind the attention of the media or the disapproval of his peers. This year, for instance, he took another unconventional path by prescribing the human version of the drug ivermectin to some of his patients, in concert with treatments the Food and Drug Administration has approved for Covid-19. Last year, when he began bringing journalists inside the hospital, United Memorial’s general counsel “wasn’t too happy,” Varon recalled, but he bulldozed ahead.
Varon has spent a lifetime making diagnoses, and he has one for his profession in an era of pandemics. “The problem is that big hospitals are run by lawyers,” he said. “They are not run by doctors.”
