key: cord-0813224-aq2lbaoi
authors: Patel, Vishal R.; Gereta, Sofia; Blanton, Christopher J.; Mackert, Michael; Nortjé, Nico; Moriates, Christopher
title: Shifting social media influences: Discussions about mechanical ventilation on Twitter during COVID-19
date: 2021-10-06
journal: J Crit Care
DOI: 10.1016/j.jcrc.2021.09.017
sha: a6fe183b936007737df73ca2d192082ec83ff358
doc_id: 813224
cord_uid: aq2lbaoi

nan

During the COVID-19 pandemic, social media platforms like Twitter have facilitated the delivery of information about preventative measures, treatments, and even national lockdown protocols [1] . Consequently, online discussions have emerged regarding mechanical ventilation, an increasingly limited resource used to treat critically ill COVID-19 patients [2] . Such conversations can elucidate public viewpoints or issues about limited resources during emergencies and help guide communication of related public health recommendations. This study tracked discussions about mechanical ventilation on Twitter during COVID-19 and identified types of participating users over time.

English-language Tweets containing variations of the word 'ventilator' (e.g., 'ventilation', 'vents') created between January 2019 and June 2021 were collected using Twitter's application programing interface. Tweets with geolocation information were mapped for the time intervals corresponding to the largest peaks in conversations.

Twitter users were classified as individuals, influencers, or organizations. Individuals and organizations were first identified using namedentity recognition [3] . Individuals with over 100,000 followers or a verified account [4] were marked as influencers. Organizations were subdivided as news, health, government, or miscellaneous organizations by searching account descriptions for category-specific terms (e.g., for news organizations: 'news', 'television'). Impressions for each user were computed by multiplying the number of created tweets by the number of their followers. Impressions estimate the number of people that see a tweet and are measure of potential exposure.

There were 130,132 ventilation-related tweets by 82,211 users between January 2019 and June 2021. Before COVID-19, there was a maximum of 17 ventilation-related tweets/day. A 'first peak' of tweets occurred during March-May 2020, reaching a maximum of 704 tweets/day with a diffuse geographic distribution among Englishspeaking countries. A 'second peak' occurred during April-June 2021, reaching a new maximum of 1331 tweets/day concentrated to the Indian subcontinent (Fig. 1) .

During the first peak, 19,215 users made 334,096,936 impressions, where individuals made up the majority of users (80.3%) and news organizations made the most impressions (49.3%). During the second peak, 29,261 users made 530,285,733 impressions, where individuals still made up the majority of users (87%), but influencers made the most impressions (43.1%). From the first to the second peak, the percentage of impressions by government organizations increased over ten-fold, while that of influencers only approximately doubled (Table 1) . Despite this considerable government response, influencers still had more total impressions, likely because of their larger following.

At the start of the pandemic, news organizations dominated the spread of real-time information about ventilators. During India's 2021 COVID-19 outbreak, influencers overtook their role as the most impactful users. Since users decide who to follow, this shift may be related to a public preference for consuming online information from influencers instead of news, government, and health organizers.

Rajdeep Sardesai, a journalist with approximately 9 million followers, posted the tweet with the most impressions. His tweet, like many others, requested a ventilator for a specific COVID-19 patient and contained the patient's name, age, location, and oxygenation status [5] . Although fame should never determine who survives a pandemic, here, online prominence may have widened disparities in access to life-saving ventilators [6] . As online healthcare discussions shift towards unofficial channels, similar potential issues must continue to be identified through real-time surveillance.

Additional demands on medical resources created by COVID-19 will inevitably continue in developing countries like India. Government and health organizers could partner with influencers to maximize their reach and address emerging issues surrounding these resources. For instance, in July 2021 the White House collaborated with Olivia Rodrigo, a singer with over 1 million Twitter followers, to create official online content encouraging undervaccinated populations like young adults to vaccinate against COVID-19. Future efforts should support such alliances during public health crises.

The authors declare that they have no conflicts of interest or financial disclosures.

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Patient Name -Satish Kumar Sharma Age -75 COVID report -positive Oxygen level with support -ranging between 60-65 NEED VENTILATOR SUPPORT Location -sector 29, Noida Contact No -8010880803

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