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Covid-19: how doctors and healthcare systems are tackling coronavirus worldwide

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1090 (Published 18 March 2020) Cite this as: BMJ 2020;368:m1090

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Rapid Response:

Going viral: doctors must combat fake news in the fight against Covid-19

Dear Editor

“Dúirt bean liom go ndúirt bean léi – a woman told me that a woman told her”
(old Irish proverb)

The Covid-19 pandemic is unprecedented in our lifetime. The general public has been overwhelmed with information related to the novel coronavirus. In 2020, information sources have expanded from conventional newsrooms and broadsheets to digital applications and social media. Some newer information outlets are not subject to rigorous fact-checking, facilitating propagation of ‘fake news’. The rapidly advancing knowledge base surrounding Covid-19 has compounded the problem.

In Ireland the medical community has noted a trend of messages containing incorrect information about Covid-19 spreading rapidly via social media and messaging applications. Misinformation is defined as false information that is communicated without deliberate malice, while disinformation is false information that is communicated with the intent to deceive. [1] The motivation behind creating these messages is unclear, but may relate to attention-seeking behaviour and conspiracist ideation. [2,3]

The false messages that we have seen tend to contain three common features.

• There is a claim that the source has inside information eg ‘a young researcher from Wuhan’, ‘a Taiwanese expert’, or ‘Dr Tim in Cork’. However no further reference is provided to support the alleged source.
• The nature is vague eg ‘doctors have said’ without providing definite details eg names, positions, or affiliations. The tone has been alarmist, suggesting that if the suggested action is ignored, serious consequences will occur eg ‘please do this before it’s too late’.
• The emotive effect is intended to trigger panic in the reader, and induce fear. This increases the likelihood that the message will be shared with family and close friends.

These false messages have predominantly compromised of text. However some images have been shared, with text describing information that is factually discordant with the image. For example, an image of the Irish Defence Forces assembling a Covid-19 testing centre in Dublin was shared with the message ‘army setting up camp on the quays… complete lockdown’. Voice notes have also been shared with false information, with local accents to increase credibility. One such voice message claimed that the Irish military would be used to patrol the streets imminently, enforcing a ‘status red lockdown’.

Misinformation has centred around four key themes: food and beverages as ‘cures’, hygiene practices, medicines, and government responses.

One message from ‘Japanese doctors’ suggested drinking hot water every 15 minutes as the heat would ‘kill the virus and pass the virus into the stomach’. Garlic, vitamin C, and zinc lozenges have been claimed as cures for Covid-19 due to antimicrobial activity, despite there being no evidence that they have protected people from the new coronavirus.

A message on Whatsapp stated that a hospital in Galway was ‘saying that the virus was mainly being spread via petrol pumps’. While the novel coronavirus can survive on surfaces for several hours or even days, the main route of transmission is person-to-person. Another message allegedly from South Korea advised using the non-dominant hands for tasks as ‘it is very difficult to touch your face with your non-dominant hand’. A more dangerous video suggested directing a hairdryer at maximum temperature upwards through the nasal airways to kill the virus.

Another Whatsapp message spread falsely stating that ‘four healthy young people were in serious condition with coronavirus’ in Cork following ingestion of ibuprofen. While a retrospective cohort study from Wuhan published in the Lancet showed that corticosteroid use was associated with increased mortality, [4] there is no evidence that non-steroidal anti-inflammatory drugs are problematic. As Covid-19 is almost universally a febrile illness, this would have serious implications for management for pyrexia. A post shared widely on Facebook suggested that being able to hold one’s breath for ten seconds meant that one could not have coronavirus.

Other messages falsely claimed that ‘the government was advising stockpiling food and supplies’, and that the government had ‘shut down off licences’ on St Patrick’s Day (when no alcohol is typically sold before 16.00).

We have seen implications of these fake messages in clinical practice in Cork. Patients have been unwilling to take ibuprofen, leaving non-Covid-19 illnesses untreated. Other patients with serious time-sensitive non-Covid-19 illnesses (such as stroke) have had delayed presentations, becoming critically unwell, due to concerns about contracting Covid-19 in hospital. [5] Furthermore, the false information in the messages has detracted from the evidence-based precautions that the health service is promoting, such as social distancing, and hand hygiene.

The World Health Organisation has confronted fake news by offering a WhatsApp service (+41798931892) for updates. There is evidence that healthcare professionals can stop the spread of false information by refuting or rebutting misleading health information on social media and by providing appropriate sources to accompany their refutation. [6,7] We exhort our international colleagues to support each other in combating fake information as part of the fight against Covid-19.

References
1 Journalism, 'Fake News' and Disinformation: A Handbook for Journalism Education and Training. UNESCO (2018). ISBN: 978-92-3-100281-6 
2 Wang, Y.et al (2019). Systematic literature review on the spread of health-related misinformation on social media. Social Science & Medicine, 112552. doi:10.1016/j.socscimed.2019.112552 
3 Weigmann, K. The genesis of a conspiracy theory: Why do people believe in scientific conspiracy theories and how do they spread?. EMBO reports vol. 19,4 (2018): e45935. doi:10.15252/embr.201845935
4 Zhou F et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 11. pii: S0140-6736(20)30566-3. doi: 10.1016/S0140-6736(20)30566-3. [Epub ahead of print]
5 https://twitter.com/ronancollins7/status/1239507193940058113
6 Chou, WY et al. (2018). Addressing Health-Related Misinformation on Social Media. JAMA. doi:10.1001/jama.2018.16865 
7 Bode, L et al. (2017). See Something, Say Something: Correction of Global Health Misinformation on Social Media. Health Communication, 33(9), 1131–1140. doi:10.1080/10410236.2017.1331312

Competing interests: No competing interests

26 March 2020
Cathal P O'Connor
Doctor
Michelle Murphy
South Infirmary Victoria University Hospital
Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland, T12 X23H