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Viewpoint
March 23, 2020

Social Media and Emergency Preparedness in Response to Novel Coronavirus

Author Affiliations
  • 1Penn Medicine Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 2Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 3Coalition for Epidemic Preparedness Innovation, Washington, DC
  • 4Massachusetts General Hospital, Boston
JAMA. 2020;323(20):2011-2012. doi:10.1001/jama.2020.4469

The 1918 influenza pandemic affected one-third of the world’s population and resulted in 50 million deaths. One hundred years ago, medical therapies and countermeasures were significantly limited, and information exchange that could facilitate any public health intervention primarily occurred by telephone, mail, or person-to-person interaction.

Now, more than a century later, a novel coronavirus is the cause of a new global pandemic threatening millions of lives.1 Today, many methods of sharing information have been subsumed by giant social media platforms that have incredible speed, reach, and penetration. More than 2.9 billion individuals use social media regularly, and many for long stretches of time.2

Current understanding of how these platforms can be harnessed to optimally support emergency response, resilience, and preparedness is not well understood. In this Viewpoint, we outline a framework for integrating social media as a critical tool in managing the current evolving pandemic as well as transforming aspects of preparedness and response for the future.

Directing People to Trusted Sources

To date, social media platforms have been important for disseminating information during the outbreak of coronavirus 2019 (COVID-19). The Centers for Disease Control and Prevention, the World Health Organization (WHO), numerous journals, and other health care organizations are regularly posting guidance across a host of platforms. Teams employed by larger social media platforms have also been involved in the response as searches for information about coronavirus are escalating and, at times, dominating conversations online.3,4 Facebook is using the news feed function to direct users to the WHO website and websites of local health authorities.3 Google Scholar has highlighted leading medical journals and other sites. Twitter and other social media sites are similarly pointing individuals who search (accounting for misspellings) for coronavirus-related content to reliable resources.4 Health care organizations, clinicians, and social media influencers should also actively direct online traffic to trusted sources.

It may also be time for social media platforms to take on an active public health role and in parallel use banners, pop-ups, and other tools to directly message users about hand washing and social distancing. This approach increases the likelihood of millions of people seeing the same messages whenever they access the platform, even if they forgo accessing the WHO website or other trusted sites.

Counteracting Misinformation

Social media has also become a conduit for spreading both rumors and deliberate misinformation, and many perpetrators are deploying sites such as Facebook, Twitter, YouTube, and WhatsApp to create a sense of panic and confusion. Unlike any prior event, WHO has identified that the “the 2019-nCoV outbreak and response has been accompanied by a massive ‘infodemic’—an over-abundance of information—some accurate and some not—that makes it hard for people to find trustworthy sources and reliable guidance.”5 Research is needed to better understand the origins and spread of misinformation as well as coordinated efforts to disrupt its sources and identify, remove, and reduce its dissemination.

Social Media as a Diagnostic Tool and Referral System

Social media should be used to disseminate reliable information about when to get tested, what to do with the results, and where to receive care. If a vaccine becomes available, the same platforms could be used to encourage uptake and address challenges associated with vaccine hesitancy. These targeted efforts can occur in response to what people search for or in a more personalized approach based on an individual’s online profile, posts, and underlying risk. Health systems may become overwhelmed as testing becomes more available and as more mildly ill yet concerned individuals seek care; yet, social media platforms are well poised to enable users to remotely assess symptoms and determine their most appropriate course of action.6 The Facebook Preventive Health tool provides individuals with vetted guidelines about preventive health recommendations (eg, heart disease, cancer screening) and then directs users to geotargeted locations (eg, federally qualified health centers, retail clinics) where these services are available. Users also have the option to share the tool and their scheduled testing with their network.7 This could be modified to direct individuals (when relevant) to resources for COVID-19 testing. For those whose test results are positive for COVID-19, the platform could enable users to inform their contacts about the potential exposure and how to follow up for testing.

Enabling Connectivity and Psychological First Aid

As individuals start to self-quarantine and telecommute, new forms of social isolation are occurring. In some places in the US, funerals, weddings, religious services, in-restaurant dining, and other places of traditional socialization have already been severely limited or completely restricted. The long-term effects of social distancing and isolation will likely affect populations differently, necessitating comprehensive strategies for addressing the downstream sequelae. Navigating social isolation will be particularly challenging for already disadvantaged populations, such as older individuals, individuals with low socioeconomic status or housing insecurity, individuals managing chronic illnesses or disabilities, and individuals who are undocumented. Social media should be used to raise awareness about the needs of these groups in disasters and for development of new methods for communities to mobilize resources and support in the absence of physical contact. The “crisis response,” “safety check,” and related functions available on some social media platforms could enable more frequent status updates and sharing.8 Psychological first aid could be delivered through chatbots that use artificial intelligence to learn from the millions of interactions that are occurring in response to the pandemic and better understand critical needs. While social media cannot replace in-person contact, there may be ways to better use it to support recovery and resilience.

Advancing Remote Learning

New approaches to enhance the education of health care professionals is needed. Social distancing will affect clinical training (eg, emergency department rotation) and didactic education (eg, anatomy laboratory). Stand-alone video conferencing services may be overwhelmed as many institutions move entirely online. Social media can be a useful tool for facilitating contact among students and supporting active learning. Front-line health care clinicians and other health care workers who provide care for critically ill patients with COVID-19 would also benefit from being able to share their experiences broadly in a deidentified way to advance education and teaching in an evolving crisis.

Accelerating Research

Social media data about symptoms, interactions, photos at events, travel routes, and other digital footprints about human behavior should be analyzed in real time to understand and model the transmission and trajectory of COVID-19. At present, Facebook is providing aggregated and anonymized data to researchers about how people move from location to location and associated population density maps to better inform how the virus is spreading. Merged social media data and electronic medical record data from consenting patients could also provide insights about individual-level risk.9 Basic and translational science can also be advanced through social media channels. Foundations have funded researchers to sequence the complete genome of COVID-19 in a short period of time. The output of these efforts included a research tool to further analyze the genome and a cell atlas that can be used to study how COVID-19 affects different organ functions. This infrastructure can be strengthened to facilitate communication among scientists working to address critical priorities related to animal and environmental research and candidate therapeutics and vaccines.

Enabling a Culture of Preparedness

More than 100 years ago, a global pandemic affected more than 500 million people worldwide. Today, in the midst of another public health emergency, some lessons from history demonstrate the importance of understanding how information spreads and individuals interact. Integrating social media as an essential tool in preparedness, response, and recovery can influence the response to COVID-19 and future public health threats.

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Article Information

Corresponding Author: Raina M. Merchant, MD, MSHP, Penn Medicine Center for Digital Health, Center for Health Care Innovation, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 (raina.merchant@pennmedicine.upenn.edu).

Published Online: March 23, 2020. doi:10.1001/jama.2020.4469

Conflict of Interest Disclosures: Dr Merchant reported being funded by grants from the National Institutes of Health/National Heart, Lung, and Blood Institute (R01HL141844) and the National Human Genome Research Institute (R01 HG009655). Dr Lurie reported currently being a compensated strategic advisor for the Coalition for Epidemic Preparedness Innovation and serving as Assistant Secretary for Preparedness and Response in the US Department of Health and Human Services from 2009 to 2017.

References
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Paules  CI, Marston  HD, Fauci  AS.  Coronavirus infections—more than just the common cold.   JAMA. Published online January 23, 2020. doi:10.1001/jama.2020.0757PubMedGoogle Scholar
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Clement  J. Number of global social media users 2010-2021. Statista website. Published August 14, 2019. Accessed March 16, 2020. https://www.statista.com/statistics/278414/number-of-worldwide-social-network-users/
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Jin  K-X. Keeping people safe and informed about the coronavirus. Facebook Newsroom website. Updated March 18, 2020. Accessed March 19, 2020. https://about.fb.com/news/2020/03/coronavirus
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Josephson  A, Lambe  E. Brand communications in time of crisis. Twitter Blog website. Published March 11, 2020. Accessed March 16, 2020. https://blog.twitter.com/en_us/topics/company/2020/Brand-communications-in-time-of-crisis.html
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World Health Organization. Novel coronavirus (2019-nCoV): situation report-13. Published February 2, 2020. Accessed March 16, 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200202-sitrep-13-ncov-v3.pdf
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Merchant  RM.  Evaluating the potential role of social media in preventive health care.   JAMA. 2020;323(5):411-412. doi:10.1001/jama.2019.21084PubMedGoogle ScholarCrossref
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Connecting people with resources. Facebook Preventive Health website. Accessed March 16, 2020. https://preventivehealth.facebook. com/
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How do I use Crisis Response on Facebook to give help? Facebook Help Center website. Accessed March 16, 2020. https://www.facebook.com/help/1786622978265847?helpref=related&source_cms_id=1761941604022087
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Merchant  RM, Asch  DA, Crutchley  P,  et al.  Evaluating the predictability of medical conditions from social media posts.   PLoS One. 2019;14(6):e0215476. doi:10.1371/journal.pone.0215476PubMedGoogle Scholar
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    2 Comments for this article
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    Social Media earning a "F" on serving as "Psychological First Aid"
    Avinash Patwardhan, M.D., M.S., CHES | George Mason University
    Panic among the population is common, natural, and obvious in the times of crises. The degree of panic has a positive correlation with "lack of information/knowledge." When minds are already primed to focus on the negative or the worst, while what is being said becomes influential in how people respond to crisis, what is not being said (error of omission) but should be said can prove to be of immense injurious consequences. Public health agencies, governments, and media collect and hold huge amounts of data, even in real time. However they do not always share all they have. Whatever information is shared or not shared, it is always said to be "in the best interest of the public". Scientific research and conclusions demand a certain minimum amount of data for conclusions or decision. In crises any truthful data greater than zero is valuable.

    In the COVID-19 crisis, when statistics started accumulating, the lay population started getting bombarded with numbers: "In last 24 hours, xxx new cases were detected, xxx people died." If something seemingly unusual happened, it would be promptly reported: "One single family lost xxx members" or "xxx young adults around 30 years succumbed to COVID-19" or "A 14 year old died due to COVID-19"

    Imagine, if with those same very numbers, the public was told "In the last 24 hours newly detected cases, out of xxx, xxx were 85 and above, xxx were 60 and above and xxx had xxx, and xxx co-existing disease or xxx were on specialty drugs that suppress immunity" or "of xxx persons who died of COVID-19 at the age of 30 or 14, xxx had xxx preexisting condition." Would the public's degree of panic have been different?

    Of course those details become available or are available somewhere else, often buried in the long narrative of another article or in the maze of technical reports, but hardly ever are those data displayed up-front and right by the side of the nascent numbers. And that lack of information might have made all the difference! One example being the case of the scarce masks, many of them lying in the closets of the citizens, rather than being on the faces of the doctors and the nurses in a hospital.

    Playing the devil's advocate one can say that were the lay people told that primarily the older people were affected or endangered, they would not take the problem seriously and that would have caused faster and wider spread of the disease and therefore this justifies withholding of information.

    Complexity science is not new to medical science. Life is a complex process. Many phenomena trace a U-shaped relationship curve. Nonchalance is bad but so is panic. Bravado is bad but so is cowardice. Life is a dance on a razor's edge stepping to the beat of Langton's lambda. Who decides where the sweet spot of the optimum is?

    I would not comment on the role of public health or government agencies regarding data sharing, but with a reference to the article by Merchant & Lurie, if media was privy to those data that I allude to, and if they did not share it with the public, then they did a great disservice to it and instead of serving as a good first aid to sooth anxiety of the lay population, it flares it up.

    Criticism is only constructive if it ends on a positive note. The COVID-19 crisis is still ahead of and around us. It is not in our rear view mirror. Can I hope that the media will correct its approach?
    CONFLICT OF INTEREST: None Reported
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    Social Media (Mis)Information and (Mis)Handling of COVID-19
    Michael McAleer, PhD (Econometrics), Queen's | Asia University, Taiwan
    Social media is designed as a forum for personal opinion, where everyone is an entitled and self-appointed expert on everything, rather than as a platform for accurate and informative statements based on provable facts.

    With respect, contrary to the well-intentioned aims of the highly informative paper, social media is not intended to support emergency responses to pandemics, as (mis)information can and will be distributed with great speed, spread, reach, and penetration.

    Trying to make sense of (mis)information sharing on social media, as well as academic social media such as ResearchGate, can be challenging, frustrating, disturbing, and unsettling.
    /> This is all the more so regarding topical and complex issues such as misunderstanding and (mis)handling of issues surrounding COVID-19, and the associated emergency preparedness.

    Examples include individuals and businesses flouting the requirements that govern personal hygiene practices, social distancing, self isolation, quarantining, and hoarding and theft of personal protective equipment, that have been mandated to try to "flatten the curve" to lower the speed of transmission.

    Anyone whose sources of purported "fake news" include one or more of Facebook, WhatsApp, QQ, QZone, Tumblr, Instagram, Twitter, and the like, might not appreciate that accurate fact checking would close down much of social media.

    The generally unyielding views expressed on pro-Trump Fox News, and anti-Trump CNN, among others, add to the general confusion about many topics where it is widely accepted that everyone is entitled to their opinion.

    Such a presumption should not be extended to issues associated with emergency preparedness for pandemics, where the health and safety of every member of society is affected by individuals who might be infected with the SARS-CoV-2 virus that causes the COVID-19 disease.

    Once information has been uploaded on to any social media platform, there is no quality control or fact checking over subsequent cross-postings, regardless of the original intention.

    Nothing is more apropos about the lack of quality control and factual inaccuracies than the self-appointed polymath, President Trump, whose legendary tweets are frequently confused, confusing, and provably false.
    CONFLICT OF INTEREST: None Reported
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