key: cord-0777433-2kxhav4q authors: Kearsley, R.; Duffy, C. C. title: The COVID‐19 information pandemic: how have we managed the surge? date: 2020-06-02 journal: Anaesthesia DOI: 10.1111/anae.15121 sha: 999259da7a716ac3570e461572c448ee66424342 doc_id: 777433 cord_uid: 2kxhav4q The severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) or Coronavirus 2019 (COVID-19) pandemic has permanently impacted our everyday normality. Since the outbreak of this pandemic, our e-mail inboxes, social media feeds and even general news outlets have become saturated with new guidelines, revisions of guidelines, new protocols and updated protocols, all subject to constant amendments. This constant stream of information has added uncertainty and cognitive fatigue to a workforce that is under pressure. While we adapt our practice and learn how to best manage our COVID-19 patients, a second pandemic - information overload - has become our Achilles' heel. Anaesthetists, by the nature of our work, are exposed to COVID-19, and we have been at the helm of creating pathways and guidelines to support staff and ensure safety. As leaders in patient safety [1] , we have learnt and adapted process and safety improvements from other industries, most notably aviation [2] . Simple, clear and structured guidelines such as the Difficult Airway Society guidelines are important cognitive tools that help aid our decision-making processes especially in emergencies [3] . It is recognised that presenting multiple differing techniques introduces cognitive overload, confusion and increases the chance of error [4] . As we adapt our established clinical practices to deal with COVID-19, we must be cognisant to the fact that these changes potentially expose us to an increased risk of error. During this period, we do not have the luxury of time; to reflect on previous practice; to rely on large scale randomised controlled trials; or to review guidelines before publication. This is a pandemic in action, where well-intentioned guidelines, which present accurate and understood practices in one moment, are liable to frequent and drastic change. Lessons learnt from Wuhan, China and northern Italy gave other global healthcare systems a vital time advantage. This allowed them to start creating guidelines for the impending surge with the important caveat that they would require near daily revision [5] . We have seen an explosion of guidelines, released by multiple organisations, in good faith and often only differing in their visual presentation; as illustrated by infographics from Hong Kong and Italy [6, 7] . At times, guidelines from reputable organisations have also provided contrasting clinical opinions, such as the use of high-flow nasal oxygen in patients with COVID 19 [8] . We are invariably playing 'spot the difference' between newly published guidelines; which is to be expected as we react in action rather than reflect on action. Frequent revisions, though often necessary, have the potential to create confusion, miscommunication and fear. The SARS outbreak demonstrated that strict hierarchal structures are required during a crisis [9] . Similarly, the same concept should be applied to our search for guidance regarding COVID-19. When organisations join forces (e.g. the Association of Anaesthetists, the Royal College of Anaesthetists, the Faculty of Intensive Care Medicine and the Intensive Care Society) to produce a strong united platform with one message, there is a greater sense of trust and security for their members. In times of a pandemic, clear, simple guidelines abate fear and anxiety [9] . We have witnessed a race to publish articles on COVID-19 with unedited proofs, pre-prints and rapid review articles during this news drought. We saw the use of hydroxychloroquine was heavily promoted in the media despite any positive evidence for its use [10] . There is an enormous amount of information in the ether, and unfortunately not all of it reliable, as the number of retracted papers also grows [11] . With clinical information coming from multiple sources, it is important to ensure that the most important, accurate information filters through. Information chaos leading to alert fatigue is well recognised in the healthcare environment [12] . When increased volume of communications are sent through an increasing number of platforms, alert fatigue may impact individual's ability to recall specific messages, due to 'noise' created by the greater frequency. Information delivered too frequently and/or repetitively through numerous communication channels may have a negative effect on the ability of healthcare providers to effectively recall emergency information [13] . We live in a technological age where we can be easily accessed by emails, text-messaging and social media alerts; the magnitude of the potential for alert fatigue should be acknowledged. Keeping healthcare workers informed during a pandemic is critical and the way in which we do that needs to be co-ordinated and measured to avoid the risk of alert fatigue and potential for important information to be lost in the 'noise'. The COVID-19 pandemic is demonstrating that we are utilising social media as one of our main sources for the dissemination of medical information [14] . Knowledge and debate surrounding personal protective equipment (PPE) has been one of the most prominent COVID-19 discussion points, due to the high risk of contagion via droplet spread [18, 19] , with frequent social media use [22] . As part of our response to managing stress and minimising burnout, it is important to appreciate the impact that information overload and cognitive load has had on us. Modifying our social media use and consumption of general news is important to support our mental well-being. We have witnessed an increase in public interest, awareness and knowledge of the role of the anaesthetist in healthcare due to this pandemic. We know from previous research, the public's knowledge of the role of the anaesthetist can be limited [23] . Google trends worldwide have shown a surge in searches for the word 'ventilator' and the term 'PPE' since the beginning of March 2020. For the first time ever, an anaesthetist featured on the front cover of Time magazine [24] . We find our specialty in the spotlight. Although longterm effects of increased public knowledge about our healthcare role may prove positive, we must also recognise with added exposure comes added pressure. There has been much debate publicly surrounding the allocation of resources such as intensive care beds and ventilators and the limitations of treatment for some patients, which has served to highlight the difficult ethical decisions which we face on a daily basis. This increased focus within mainstream media makes it difficult to escape the day job. We need to utilise the well-being and psychological supports on offer to give ourselves some time away from intensity of the day job. This growing interest in who we are and what we do is another example of the surge in information associated with COVID-19. As we learn to live with this virus, it is important for us to be cognisant that we are all at risk of error; we need to work to reduce information overload and focus on unifying our approach to both information dissemination and presentation. 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Anaesthesia 2020. Epub Selak T Dissemination of medical publications on social media -is it the new standard? Airborne transmission of severe acute respiratory syndrome coronavirus-2 to healthcare workers: a narrative review Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic -a narrative review Association of Anaesthetists. Fatigue and anaesthetists Faculty of Intensive Care Medicine. Staff wellbeing resources Mental health problems and social media exposure during COVID-19 outbreak Irish patients knowledge and perception of anaesthesia Front line workers tell their own stories in the new issue of TIME No competing interests declared.