As social media companies fail to limit lies and conspiracies, doctors are speaking out to set the record straight.
The “infodemic” of misinformation during the COVID-19 pandemic has been labelled an “enemy” by the United Nations and “fears, rumours and stigma” as “our greatest enemy” by World Health Organization (WHO) Director General Tedros Adhanom Ghebreyesus.
SARS, MERS, and Zika all caused global panic but social media has amplified fears around the coronavirus to an unprecedented degree.
While the battle for accuracy may seem politicized to some, Dr. Bram Rochwerg says misinformation can have lethal consequences. The Hamilton ICU doctor recently needed a 20-minute conversation to convince an otherwise healthy middle-aged man with COVID-19 to accept mechanical ventilation. The patient, quoting U.S. President Donald Trump, refused to be intubated.
“This was crazy, the misinformation out there that mortality on the ventilator is near 100 per cent is bonkers, especially in a previously healthy middle-aged person,” Rochwerg told me. The man is expected to survive after eventually consenting.
COVID-19 has worsened a pre-existing “fake-news” crisis that social media giants have been slow to control. Even before this pandemic, more than 70 per cent of Canadians looked online to find credible health information – and misinformation frequently ran rampant.
The pandemic has pushed these companies into a willingness to take action. Now, Facebook curates a COVID-19 information page, Instagram directs users to trusted government health authorities, and Pinterest highlights infographics and memes from the WHO. Google searches for coronavirus return results curated by fact checkers, not algorithms or ad dollars.
The WHO has partnered with social-media platforms such as Facebook, Twitter, Instagram and now TikTok to distribute accurate information. It is creating targeted ads for Facebook users and reaching out to influencers to combat disinformation.
Twitter is verifying academics and health experts posting about COVID-19. In a public statement, Facebook has committed to connecting “people who may have interacted with harmful misinformation about the virus with the truth from authoritative sources” by directing those users to a WHO myth-busting site.
But much more must be done to rid the web of dangerous politicized misinformation that promotes unhealthy and deadly behaviour. The problem is complex; disinformation campaigns may employ automated bots, human trolls and technology that can alter photographs, video and audio files. Further, and perhaps most consequentially, disinformation campaigns can be divisive, targeting deeply emotional themes that often entangle democratic rights such as personal freedoms. According to Kate Starbird, an associate professor at the University of Washington who studies crisis informatics, a combination of technology and emotion can override critical thinking. “We need models that can encompass how disinformation changes hearts, minds, networks and actions,” she wrote in a recent Nature article.
In the days after Trump promoted hydroxychloroquine and bleach as potential cures for coronavirus, poison control phone lines saw spikes in cases in which people ingested toxic amounts of both or needed information. And Trump continues to plant public doubts about social distancing and testing strategies.
But Trump isn’t acting alone. A “mega cluster” of fake news generation has stemmed from social media accounts, according to an April report by Graphika, a company that researches social media behaviour. These fake accounts amplify Trump’s mixed messaging, adding to public confusion and mistrust.
Similarly, a 2018 Knight Foundation report found that misinformation accounts on Twitter posted 1 million times on a typical day.
In an Internet ecosystem that encourages runaway tweets, viral messages and addictive consumption of unedited content, it’s not surprising that some of these tweets have enough reach to result in dire consequences.
In a landmark study, researchers classified large “clusters” of social media accounts as pro- or anti-vaccination and tracked them during the 2019 measles outbreak in the United States. Some anti-vaccine clusters grew by more than 300 per cent while most pro-vaccine clusters grew less than 50 per cent. Anti-vaccine clusters also dominated the 50 million individual accounts classified as undecided, presenting many different views compared to the more monothematic pro-vaccine clusters.
Misinformation during public-health crises is nothing new. An organized anti-vaccine movement can be traced back to 1853, when the Anti-Vaccination League was formed in London, England, to protest the Vaccination Act. What is new is social media companies, alongside journalists, being uniquely positioned as responsible stewards of truth. It is up to social media companies that amplify and disseminate misinformation to shut that down before its harms can materialize. If they can’t – or won’t – governments will have no choice but to step in and more strictly regulate these platforms. But is it already too late?
Health experts and public health agencies are not waiting to find out.
Historically, the medical establishment’s risk averse culture created a reluctance – or even disdain – to speak to journalists or speak up on social media. With a few notable exceptions, content produced by academic experts is often unengaging or overly complex. And the ivory tower mentality creates the false assumption that if you speak “the truth,” the audience will come to you. It won’t.
The result is a content void too easily filled by those peddling lies and misinformation.
This is starting to change: the WHO employs a team of myth-busters that scan social media for falsehoods and create engaging videos and Instagram stories. The Centers for Disease Control and Prevention is producing evidence-based infographics that are easily shareable online. And individual doctors are making a concerted effort to be more media friendly and active online.
Infectious disease doctor Zain Chagla is one such expert who has taken to the airwaves to spread reason while also leading his hospital’s pandemic fight. “When I saw not only the media and lay people publishing misinformation but healthcare providers including physicians, I knew I had to use whatever means to communicate out the reality,” he says.
More than just reaching the general public, Chagla tries to get real evidence out to his colleagues to combat the onslaught of pre-prints (research that has not been peer-reviewed) and predatory journal articles being shared.
Andrew Healey, an intensive care doctor in Brampton, Ont., also felt compelled to speak up in a series of newspaper articles that highlighted the terrible consequences of COVID-19.
“I engaged (with the media) because there is an important role for physicians as advocates – not only for their patients but for society as a whole,” he says of his motivation to spread the message to “stay home, keep physically distant and bear with us while we help everyone we can through this crisis. It helped the public understand the danger they faced by not following the advice of public health experts.”
Healey’s experience with journalists paid off, he says. “We see that many of our media colleagues are really there to help the public. They want to tell the truth. This is one of the many things we can be proud of as Canadians.”
Both Chagla and Healey credit public relations experts employed by their hospitals for helping them strike the right tone and communicate effectively. Cara Francis, Director of Public Relations for William Osler Health System, says the pandemic has increased the pace of media activity and required a larger pool of experts to respond to requests.
“While it has been nerve-wracking at times – both for me and the spokespeople – the payoff has been huge as we have been able bring forward perspectives and views of the care delivery experience that were generally not heard/seen before,” she says.
It is imperative that social media companies do more to remove fakes stories and amplify authoritative voices in the digital environments they control. But health experts also have a role to play by speaking up, speaking out and sharing their expert views with journalists. As Healey points out, “there is an inherent risk in not getting it right but there is also a risk in not acting, not mobilizing quickly enough.”
Or, as the WHO Director General said in March, “This is a time for pulling out all the stops.”