key: cord-325729-2c7btqpl authors: Larrouquere, Louis; Gabin, Manon; Poingt, Emmanuelle; Mouffak, Amelle; Hlavaty, Alex; Lepelley, Marion; Khouri, Charles; Bellier, Alexandre; Alexandre, Joachim; Bedouch, Pierrick; Bertoletti, Laurent; Bordet, Regis; Bouhanick, Béatrice; Jonville‐Bera, Annie‐Pierre; Laporte, Silvy; Le Jeunne, Claire; Letinier, Louis; Micallef, Joëlle; Naudet, Florian; Roustit, Matthieu; Molimard, Mathieu; Richard, Vincent; Cracowski, Jean‐Luc title: Genesis of an emergency public drug information website by the French Society of Pharmacology and Therapeutics during the COVID‐19 pandemic date: 2020-05-11 journal: Fundam Clin Pharmacol DOI: 10.1111/fcp.12564 sha: doc_id: 325729 cord_uid: 2c7btqpl On March 16, 2020, the French Society of Pharmacology and Therapeutics put online a national Question and Answer (Q&A) website, http://https%20%5Ch://sfpt-fr.org/covid19 on the proper use of drugs during the COVID‐19 pandemic. The working group “Drugs and COVID‐19” was composed of a scientific council, an editorial team and experts in the field. The first questions were posted online during the first evening of home‐confinement in France, March 17, 2020. Six weeks later, 140 Q&As have been posted. Questions on the controversial use of hydroxychloroquine and to a lesser extent concerning azithromycin have been the most consulted Q&As. Q&As has been consulted 226,014 times in 41 days. This large visibility was obtained through an early communication on Twitter, Facebook, traditional print and web media. In addition, an early communication through the French Ministry of Health and the French National Agency for Medicines and Health Products Safety ANSM had a large impact in terms of daily number of views. There is a pressing need to sustain a public drug information service combining the expertise of scholarly pharmacology societies, pharmacovigilance network, and the Ministry of Health to quickly provide understandable, clear, expert answers to the general population’s concerns regarding COVID‐19 and drug use and to counter fake news. Faced with the inexorable spread of the COVID-19 pandemic, the French President, Emmanuel Macron, presented priorities for public action in response to the spread of COVID-19 in a televised speech broadcast at 8 p.m. on March 12, 2020 , that included mobilization of the French healthcare system. Compulsory home-confinement was announced by the President at 8 p.m. on Monday, March 16, 2020 Very early on the French Society of Pharmacology and Therapeutics (SFPT) realized the gravity of the health situation, in particular for patients being treated for chronic diseases. The same day as the second presidential television broadcast, the SFPT's scientific council had met (at 3 p.m.) and decided to create a national Question and Answer (Q&A) website within 24 hours, https://sfpt-fr.org/covid19 [1] to inform on the proper use of drugs during the COVID-19 pandemic. The aim of the website was to give clear documented information about drug use during the COVID-19 outbreak and to battle against misleading information or fake news. The first Q&As were posted on Tuesday, March 17, Here we report on the genesis of this emergency public drug information website from the SFPT, as well as website traffic after 6 weeks of existence. The SFPT working group "Drugs and COVID-19" was created on March 16, 2020. It is composed of a scientific council, an editorial team and experts in the field. This article is protected by copyright. All rights reserved audience. The council's mission is also to make the SFPT's opinions and actions known to the health authorities in order to share common concerns, and finally to obtain endorsement that distinguishes its website from commercially sponsored or non-scientific sites. The objective of the web platform was first to answer questions from the general public about their medications for chronic diseases in the context of the pandemic, and secondly to inform the public about medication use in the event of COVID-19. This article is protected by copyright. All rights reserved experts in the field, manage the flow of information between experts to reach a consensus, and post the answers online. It met daily, excluding Sunday, during the first 2 weeks, and every day excluding weekends thereafter. Q&As were posted with their first publication date. They were then updated daily if new data became available that warranted a response. The same review and validation process were used for the updated versions. Once the answers have been posted online, Prof. Alain Eschalier, professor emeritus of pharmacology at Clermont-Ferrand, is in charge of on-site proofreading. The editorial committee analyses the statistics of https://sfpt-fr.org/covid19 on a daily basis. The questions came from several sources: 138 questions came from pharmacovigilance centers, emergency call centers or from direct questions by patients to the website, among which many relate to fake news. One question came from the scientific board (#136 on clinical trials) and one from the French Ministry of Health (#126 on povidoneiodine). Responses are based on systematic ongoing analyses of recommendations from scholarly societies, an ongoing systematic review of the literature from Pubmed, Bibliovid [5] and Meta-Evidence [6] . This article is protected by copyright. All rights reserved On the first evening of home-confinement, March 17, 2020, the first questions posted online were quickly relayed on Twitter and Facebook. Six weeks later, 140 Q&As have been posted and are updated on a daily basis following changes in recommendations and new scientific publications. Some of them have been enriched with small educational videos. The Q&As have been accessed 226,014 times between March 19, and April 28, 2020, and have been frequently relayed via multiple media (press, radio, TV) ( Fig. 1, 2 ). An early communication through the French Ministry of Health and ANSM have helped to maintain the website's visibility after the peak of the first wave of the pandemic in France. We observed that the controversial questions concerning the controversial use of hydroxychloroquine and to a lesser extent azithromycin were the most frequently consulted (Fig. 1) following the public release of the French cohort data on hydroxychloroquine and azithromycin as a potential treatment for COVID-19 [7] . Interestingly, the 10 most viewed Q&As (see legend Fig. 1 ) concerned the treatment of asthma, allergies and chronic diseases, such as renin angiotensin system medications, antihistamines and corticosteroids. This was completely in line with our aim to inform patients about the safety of using their chronic disease treatment(s) during the COVID-19 pandemic. The number of daily views widely varied over time. Most of the Q&As such as #018, #019, #031, #004, #001 had a peak of daily views soon after being posted online and then views decreased slowly over the following weeks (Fig. 1, Fig. 3, Fig. 4) . We observed an important impact of scientific news, and announcements in web and print media or from the French Ministry of Health in terms of daily number of views (Fig. 4, Fig. 5 ). The overall kinetics of Q&A views showed the highest number of views during the first two weeks (Fig. 2) . However, contrary to our expectations, daily views have remained high after one month, due to new Q&As, modifications in Q&As, and the high impact of This article is protected by copyright. All rights reserved communications from the establishment (e.g. the ANSM and the French Ministry of Health). Moreover, the website has been used by others websites and newspapers as a reliable source of information. For example, the online newspaper "The Conversation" used information from our Q&As [8] for their article released online on April 9, 2020. This article was then reused under license by 6 other online newspapers and websites during the following week. All in all, continuous citation of our website by general media has helped to maintain a high daily number of views. Detailed analysis of the most daily viewed Q&As (Fig. 3, Fig. 4, Fig. 5) This analysis indicates the trends in the public's concerns about potential treatments for COVID-19. First, the use of hydroxychloroquine as a potential treatment for COVID-19 became the lead news item on French television and in the press the week after the release of results of a small clinical study using hydroxychloroquine as a potential treatment for COVID-19 [7] . Accordingly, our two Q&As (Fig. 4) on hydroxychloroquine, in which we recommended against self-medication and advised to wait for further results on its efficiency and safety, became our top viewed questions. Then, azithromycin became one of the main subjects of concern (Fig. 4) This article is protected by copyright. All rights reserved the subject resurged and daily views rose from 42 to 1284 (Fig. 5) . This effect is reciprocal; Q&A #126, directly corrected emergent fake news on social media that recommended using povidone-iodine as a mouthwash to decrease the oropharyngeal carriage of SARS-CoV2. As soon as the Q&A appeared on our website, the French Ministry of Health released a warning on social media (Twitter, Facebook, etc.). The Q&A was viewed 1714 times in the next 48 hours (Fig. 5) . This article is protected by copyright. All rights reserved posted respectively, at the date of April 28, 2020, approximately 36, 24 and 2 Q&As related to drugs and COVID-19, respectively [9-10-11]. The WHO provided general guidelines as to the characteristics and contents that medicines regulatory authority websites should have in order to offer high quality drug information to consumers [12] . This included the need to offer reliable and unbiased drug information as a potential tool to help fight the inappropriate use of the Internet. However, in Europe the availability of advanced evidence-based comparative drug information suitable for the general public is extremely heterogeneous. While regulatory information and safety alerts are available in all European countries, Germany and the United Kingdom stand out by showing an advanced framework of evidence-based, comparative drug information for both health professionals and for the general population [13] . In the context of the COVID-19 pandemic, a striking concern is the amount of fake news and misleading information circulating worldwide, that profoundly affects public health communication in all countries, as reported in Ireland [14] , Italy [15] , Japan [16] , and India [17] . While the mass media must take responsibility for providing correct information and facilitating comprehension by citizens, the role of the SFPT as a scholarly society was to contribute to the national effort to provide reliable drug information. In addition, monitoring social media helps to anticipate questions from the population and fake news [18] . Before the pandemic, actions to counter health-related misinformation circulating in social media were well described. They included identifying the emerging trends and prevalence of health misinformation, understanding how health misinformation is shared in the community, evaluating its influence on health and finally developing interventions to fight it [19] . However, a recent analysis shows that during the present COVID-19 health crisis [20] , not only the appetite for information, but also demand for unproven and potentially hazardous COVID-19 treatments is massive and is further increased by endorsements of public health leaders. In 2014, we had already forewarned that a major effort was badly needed in France to inform and educate both health professionals and the general public concerning drug use, and this in the absence of a crisis situation [21] . Current events highlight the need for scholarly societies, regulatory agencies, public health leaders, and the media to promote and amplify accurate and reliable information on drug use. This article is protected by copyright. All rights reserved Our experience has several limitations. First, our initial priority was to inform the general population. However, it is clear that our Q&As went further than initially expected and we learned that many general practitioners, pharmacists or health care workers were using our Q&As for themselves and to inform patients. If it is continued beyond the crisis, our website will have to evolve towards information at two levels: general population and health professionals. Another limitation was that we did not ask all committee members and experts for a public declaration of interest in the context of urgency. To date, only those involved in a public action, such as members of the pharmacovigilance network, There is a pressing need to sustain a public drug information service combining the expertise of scholarly pharmacology societies, pharmacovigilance network, and the Ministry of Health to quickly provide understandable, clear, expert answers to the general population's concerns regarding COVID-19 and drug use and to counter fake news. This article is protected by copyright. All rights reserved Groupe de travail « médicaments et Ministère des solidarités et de la santé Français. Réponses à vos questions sur les médicaments pendant la crise du Ministère des solidarités et de la santé Français. Questions -Réponses COVID-19 et bon usage du médicament | Santé.fr. 2020 Agence Nationale de sécurité du médicament et des produits de santé. COVID 19. Vous avez des questions sur vos traitements ? Veille scientifique sur le COVID-19 Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an openlabel non-randomized clinical trial The Food and Drug Administration (FDA), frequently asked questions -COVID-19 Model website for medicines regulatory authorities, WHO Drug information by public health and regulatory institutions: Results of an 8-country survey in Europe. Health Policy Going viral: doctors must tackle fake news in the covid-19 pandemic Novel Coronavirus (COVID-19)-related web search behavior and infodemic attitude in Italy: Infodemiological study 2019-nCoV, fake news, and racism Social media panic and COVID-19 in India Top Concerns of Tweeters During the COVID-19 Pandemic: Infoveillance Study Addressing Health-Related Misinformation on Social Media Unproven COVID-19 Therapies in the United States Accepted Article This article is protected by copyright. All rights reserved Information and Communication on Risks Related to Medications and Proper Use of Medications for Healthcare Professionals and the General Public: Precautionary Principle, Risk Management, Communication During and in the Absence of Crisis Situations We thank Alain Eschalier, professor emeritus of pharmacology at Clermont-Ferrand, for proofreading Q&As on the website. This article is protected by copyright. All rights reserved This article is protected by copyright. All rights reserved This article is protected by copyright. All rights reserved