key: cord-0855115-hrt32uxh
authors: Gabarron, Elia; Oyeyemi, Sunday Oluwafemi; Wynn, Rolf
title: COVID-19-related misinformation on social media: a systematic review
date: 2021-06-01
journal: Bull World Health Organ
DOI: 10.2471/blt.20.276782
sha: ef3e5c3088231746ed0c7946d7d31b5780c5395a
doc_id: 855115
cord_uid: hrt32uxh

OBJECTIVE: To review misinformation related to coronavirus disease 2019 (COVID-19) on social media during the first phase of the pandemic and to discuss ways of countering misinformation. METHODS: We searched PubMed®, Scopus, Embase®, PsycInfo and Google Scholar databases on 5 May 2020 and 1 June 2020 for publications related to COVID-19 and social media which dealt with misinformation and which were primary empirical studies. We followed the preferred reporting items for systematic reviews and meta-analyses and the guidelines for using a measurement tool to assess systematic reviews. Evidence quality and the risk of bias of included studies were classified using the grading of recommendations assessment, development and evaluation approach. The review is registered in the international prospective register of systematic reviews (PROSPERO; CRD42020182154). FINDINGS: We identified 22 studies for inclusion in the qualitative synthesis. The proportion of COVID-19 misinformation on social media ranged from 0.2% (413/212 846) to 28.8% (194/673) of posts. Of the 22 studies, 11 did not categorize the type of COVID-19-related misinformation, nine described specific misinformation myths and two reported sarcasm or humour related to COVID-19. Only four studies addressed the possible consequences of COVID-19-related misinformation: all reported that it led to fear or panic. CONCLUSION: Social media play an increasingly important role in spreading both accurate information and misinformation. The findings of this review may help health-care organizations prepare their responses to subsequent phases in the COVID–19 infodemic and to future infodemics in general.

The coronavirus disease 2019 (COVID-19) pandemic is spreading around the world with an increasing number of people becoming infected. Naturally the demand for information is high and people want to share news about the pandemic and their experiences. Social media have occupied a central role during the ongoing pandemic and the resulting wave of content related to COVID-19 has been referred to as an infodemic. 1 However, incorrect information about COVID-19 can be dangerous because it may divert people away from taking appropriate actions that would help protect their health and the health of others and could lead them to take actions that may spread the illness or to engage in other problematic behaviours. 2 The World Health Organization (WHO) has already recognized the importance of COVID-19-related misinformation and is participating in an awareness campaign aimed at encouraging people to check information with trusted sources. 3 A distinction has been made between misinformation, defined as incorrect or false information that is shared without the intent to harm, and disinformation, defined as incorrect or false information that is shared with the aim of causing harm. 4 However, making this distinction involves assessing the intent of the person spreading the information, which may be problematic. 5, 6 Consequently, in this review we use misinformation as a general term for incorrect or false information, regardless of intent.

Our review focuses on misinformation that appeared early in the pandemic. During this phase, little was known about the virus, such as how it spread or how infected people could be treated most effectively. There was a shortage of protective equipment in many countries, no vaccines had been developed and it was uncertain how fast an effective vaccine could actually be produced. We believe this high degree of uncertainty during the initial phase may have been conducive to the appearance of a substantial amount of misinformation on social media. A synthesis of the evidence on COVID-19-related misinformation on social media is needed to provide guidance for the health-care sector and to help in the assessment of guidelines for social media.

We carried out a review of publications on COVID-19-related misinformation on social media that appeared during the first phase of the pandemic. The review followed guidelines detailed in the preferred reporting items for systematic reviews and meta-analyses and in a measurement tool to assess systematic reviews. 7, 8 The review is registered with the PROSPERO international prospective register of systematic reviews (CRD42020182154).

We searched the PubMed®, Scopus, Embase®, PsycInfo and Google Scholar databases on 5 May 2020 and 1 June 2020 for articles that included keywords related to social media and COVID-19. The full search strategy is detailed in Table 1 (available at: http:// www .who .int/ bulletin/ volumes/ 99/ 6/ 20 -276782). Articles were included in the review if they: (i) focused on COVID-19 and social media; (ii) considered misinformation; and (iii) were primary studies that reported findings. Articles that did not meet these criteria or were in a preprint version were excluded. duplicates were removed. Two authors examined the articles' titles and abstracts, respectively, to assess their eligibility for inclusion in the study. In a second assessment round, the full texts of the articles selected in the first round were carefully analysed to confirm their eligibility by two independent reviewers. Doubts about eligibility were discussed with the third author until agreement was reached. Finally, the selected articles were divided among the three authors for data extraction and data were abstracted onto a specially standardized spreadsheet. The quality of the evidence in, and the risk of bias of, the articles were classified by two authors using the grading of recommendations assessment, development and evaluation (GRADE) approach. 9

In total, we identified 1351 publications. After removing duplicates, we screened 825 titles and abstracts for eligibility and 22 articles finally met the inclusion criteria (Fig. 1 ). 2,5,10-29 A list of articles whose full text was examined but which were excluded from the review is available in the data repository. 30 Table 2 shows the main characteristics of the 22 studies included in the review; details of submission dates, fund-ing and conflict of interests are available from the data repository. 30 Fourteen of the 22 studies were cross-sectional and based on data extracted from social media, whereas eight were based on surveys or focus groups or both. Thirteen studies involved a single social media platform: Twitter (nine studies), Facebook (two studies), WhatsApp (one study) and YouTube (one study); the remaining nine studies involved several social media platforms. The monitoring period of social media ranged from 1 to 123 days. Two studies did not specify the monitoring period. According to GRADE evaluation criteria, 9 11 of the 22 studies were awarded 1 point, and the remaining 11 were awarded 2 points, which means they were all of low quality. However, the low quality was principally due to the studies being observational, whereas randomized trials, in contrast, provide the highest quality of evidence. 9

Six of the 22 studies reported the proportion of social media posts that contained misinformation on COVID-19, including false information and jokes. Four of these six studies reported the proportion on Twitter only, one reported the proportion on Twitter and Weibo and one reported the proportion on Facebook (Table 3 ). The proportion of misinformation ranged from 0.2% (413/212 846) to 28.8% (194/673) of posts.

Eleven studies did not categorize the specific type of COVID-19-related misinformation, nine described specific misinformation myths and two categorized the misinformation as sarcasm or humour related to COVID-19 (Table 2 ). Sarcasm and humour can draw on hyperbole or false claims to make a point but typically the intent is not to misinform. However, if the person receiving the message does not understand it is a joke or sarcasm, they may end up being misinformed.

Only four studies examined the effects of misinformation: all reported that it led to fear or panic ( Table 2 ). One of the four mentioned that misallocation of resources and stress experienced by medical workers were also possible consequences of misinformation. 26 Another study found that 46.8% (525/1122) of survey respondents were tired of COVID-19 being the main theme across all media. 17

Sixteen of the 22 studies proposed one or several ways of tackling COVID-19-related misinformation. The most popular measure, mentioned in eight studies, was promoting and disseminating trustworthy information. 11, 12, 15, 16, 22, [26] [27] [28] Seven studies suggested addressing, containing or debunking misinformation: 2 ,5 ,10 ,14 ,15 ,26 ,27 misinformation could be replaced by facts and accurate information, or health authorities could debunk myths and help answer people's queries. Four studies mentioned increasing the health literacy of social media users: 10 ,23 ,27 ,28 they highlighted the need to educate social media users on how to determine what information is reliable and to encourage them to assume personal responsibility for not circulating false information. Three studies proposed that social media should be supervised by an authority or government: 10 ,19 ,26 misinformation could be addressed by the government providing more comprehensive reports on the current epidemiological situation. Three studies suggested introducing policies or regulations for social media, 20, 27, 29 and two mentioned the need for more research. 22, 23 Six studies did not suggest any solutions. 13, 17, 18, 21, 24, 25 

Studies done during the first phase of the COVID-19 pandemic found that 33 The studies identified several CO-VID-19-related myths that were spread through social media but provided no clear evidence of the effects of this misinformation. However, a few studies reported that misinformation led to fear and panic and to people becoming tired of hearing about COVID-19. There is evidence that misinformation can evoke negative emotions, 34 which could, in turn, further contribute to its spread. 35 Although misinformation is not a new phenomenon, today it can spread rapidly on social media and potentially reach more than half the world's population. The studies in our review proposed six main ways of tackling CO-VID-19-related misinformation: (i) disseminating trustworthy information; (ii) addressing, containing or debunking misinformation; (iii) increasing social media users' health literacy; (iv) officially supervising media in general;

(v) introducing policies and regulations for social media; and (vi) increasing research on the topic. These suggestions have been included in published proposals for managing infodemics. 1, 36 Recently, WHO launched social media chatbots in Rakuten Viber and WhatsApp to provide accurate information about COVID-19. 37, 38 Several studies confirm that health professionals and public health authorities could assist by debunking misinformation and providing true information. 2, 5, 10, 14, 15, 26, 27 Correspondingly, WHO has created a specific webpage for correcting misinformation about the disease. 39 However, although messages that debunk misinformation on social media may have the desired effect, it has been observed that such messages can also contribute to the persistence of misinformation. 40 As social media users can easily lose track of what information can be trusted, teaching users how to identify reliable information is important. 10, 23, 27, 28 One way of educating users about what information is trustworthy is to mark misleading posts as such. 41 In addition, nudging (i.e. prompting or encouraging) people to think about the accuracy of a social media post has also been proposed. 42 However, some form of self-regulatory behaviour may already exist on social media, whereby a collective intelligence acts to identify and stop misinformation by not forwarding it to others. 43 Officially supervising media in general and introducing regulations for social media are sensitive topics because both measures can conflict with freedom of the press and the principle of free speech. Nevertheless, they may be considered during a pandemic. In fact, several large social media companies have introduced policies on controlling false or manipulated information. [44] [45] [46] [47] A good strategy for tackling CO-VID-19-related misinformation could employ several or all of these proposed measures along with any new approaches that might appear. In addition, as misinformation appears to spread faster on some social media than on others, 48 platform-specific strategies could be developed. However, further research is needed. 22, 23 Investigations into the effectiveness of different approaches to countering misinformation will provide valuable knowledge that could help governments fight misinformation in future pandemics or health emergencies.

Evidence on the proportion of COVID-19-related misinformation on different social media platforms is insufficient. Moreover, little is known about the relative importance of the different reasons why people propagate misinformation. Accounts that are not verified by social media platforms as authentic seem to spread more misinformation than verified accounts. 15, 25 However, we do not know if social media users respond differently to these different types of account. Nor do we have much understanding about the impact of misinformation spread by bots. 49 Studies that examine the longitudinal development of misinformation and the effect of that development is needed. Although information posted on social media may encourage specific behaviours, it is difficult to attribute people's actions solely to social media postings because other factors may have an equal or even more important influence on determining when people decide to act.

In addition, the most effective strategies for tackling COVID-19-related misinformation are currently not known. Although there are many ongoing attempts to correct misinformation, we were unable to identify any study that examined the effects of these attempts, such as whether they enabled people to be better informed or helped them feel safer. Systematic reviews COVID-19-related misinformation on social media Elia Gabarron et al.

The study has several limitations. Our review considered only peerreviewed articles that were published during the first few months of the CO-VID-19 pandemic. We did not explore the grey literature and we excluded a considerable number of non-peerreviewed preprints. We also excluded one article that met the inclusion criteria because the full text was not available and it was not possible to obtain a copy from the authors. 50 The low quality of the articles included in the study is an important limitation. Moreover, there was a high risk of bias because data were collected over a short time period and because several studies used only part of the collected data in their analyses. We could not conduct a meta-analysis, because of the small number of studies that reported the effects of COVID-19-related misinformation and the nature of these studies.

In conclusion, our review found that COVID-19-related misinformation on social media is an important issue, both in terms of the amount of misinformation in circulation and the consequences for people's behaviour and health. Despite rapidly growing scientific interest in the topic of misinformation, few studies have examined the scope of the problem, including why misinformation is spread, its impact and how best to tackle it. The impact of COVID-19-related misinformation could be reduced by: (i) social media users, who should avoid spreading it; (ii) social media platforms, which should identify it, label it as misinformation or remove it; and (iii) public health authorities and health providers, who should increase their presence and COVID-19-related activities on social media. Our review investigated only the initial phase of the pandemic; future developments are likely to result in new types of misinformation.

As more countries experience additional surges in severe acute respiratory syndrome coronavirus 2 infection rates, social media will come to play an increasingly important role in disseminating accurate information. The knowledge acquired in our review of COVID-19-related misinformation may help health-care organizations prepare their responses to subsequent phases in the COVID-19 infodemic and to future infodemics in general. ■ 

Objetivo Revisar la desinformación relacionada con la enfermedad por coronavirus 2019 (COVID-19) en las redes sociales durante la primera fase de la pandemia y debatir las formas de contrarrestar la desinformación. Métodos Se realizaron búsquedas en las bases de datos PubMed®, Scopus, Embase®, PsycInfo y Google Scholar el 5 de mayo de 2020 y el 1 de junio de 2020 en busca de publicaciones relacionadas con la COVID-19 y las redes sociales que trataran sobre la desinformación y que fueran estudios empíricos primarios. Se siguieron los elementos de informe preferidos para revisiones sistemáticas y meta-análisis y las pautas para el uso de una herramienta de medición para evaluar revisiones sistemáticas. La calidad de la evidencia y el riesgo de sesgo de los estudios incluidos se clasificaron mediante el enfoque de valoración, desarrollo y evaluación de las recomendaciones. La revisión está registrada en el registro internacional prospectivo de revisiones sistemáticas (PROSPERO; CRD42020182154).

Resultados Se identificaron 22 estudios para su inclusión en la síntesis cualitativa. La proporción de desinformación sobre la COVID-19 en las redes sociales osciló entre el 0,2% (413/212 846) y el 28,8% (194/673) de las publicaciones. De los 22 estudios, 11 no categorizaron el tipo de desinformación relacionada con la COVID-19, nueve describieron mitos específicos de desinformación y dos informaron de sarcasmo o humor relacionado con la COVID-19. Solo cuatro estudios abordaron las posibles consecuencias de la desinformación relacionada con la COVID-19: todos informaron de que provocaba miedo o pánico. Conclusión Las redes sociales desempeñan un papel cada vez más importante en la difusión tanto de información precisa como de desinformación. Las conclusiones de este estudio pueden ayudar a las organizaciones sanitarias a preparar sus respuestas a las siguientes fases de la infodemia de la COVID-19 y a las futuras infodemias en general.

Framework for managing the COVID-19 infodemic: methods and results of an online, crowdsourced WHO technical consultation

López Seguí F. COVID-19 and the 5G conspiracy theory: social network analysis of Twitter data

Countering misinformation about COVID-19: a joint campaign with the government of the United Kingdom. Geneva: World Health Organization

Information disorder: toward an interdisciplinary framework for research and policymaking

an evaluation of tweets about older adults and COVID-19

Systematic literature review on the spread of health-related misinformation on social media

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both

GRADE-Leitlinien: 3. Bewertung der Qualität der Evidenz

The impact of social media on panic during the COVID-19 pandemic in Iraqi Kurdistan: online questionnaire study

The views of medical faculty students in Turkey concerning the COVID-19 pandemic

Assessment of COVID-19 knowledge among university students: implications for future risk communication strategies

Patients with cancer and COVID-19: a WhatsApp messenger-based survey of patients' queries, needs, fears, and actions taken

The use of internet analytics by a Canadian provincial chiropractic regulator to monitor, evaluate and remediate misleading claims regarding specific health conditions, pregnancy, and COVID-19

Coronavirus goes viral: quantifying the COVID-19 misinformation epidemic on Twitter. Cureus

Using social media for rapid information dissemination in a pandemic: #PedsICU and coronavirus disease

Consumo informativo y cobertura mediática durante el confinamiento por el Covid-19: sobreinformación, sesgo ideológico y sensacionalismo

Perception of exaggeration or fear propagated by the media among the Peruvian population during the COVID-19 pandemic

Genomics, social media and the novel coronavirus pandemic, COVID-19

Public reaction to COVID-19 on Twitter: a thematic analysis

Profesional de la información

COVID-19 infodemic: more retweets for science-based information on coronavirus than for false information

False news around COVID-19 circulated less on Sina Weibo than on Twitter. How to overcome false information? International and

World leaders' usage of Twitter in response to the COVID-19 pandemic: a content analysis

Desinformación en tiempos de pandemia: tipología de los bulos sobre la Covid-19]. Profesional de la información

Adaptation to SARS-CoV-2 under stress: role of distorted information

Use of social media among intern doctors in regards to Covid-19

Mining physicians' opinions on social media to obtain insights into COVID-19: mixed methods analysis. JMIR Public Health Surveill

Healthcare information on YouTube: pregnancy and COVID-19

Repository: COVID-19-related misinformation on social media during the first phase of the pandemic: rapid review

Pandemics in the age of Twitter: content analysis of Tweets during the 2009 H1N1 outbreak

Are internet videos useful sources of information during global public health emergencies? A case study of YouTube videos during the 2015-16 Zika virus pandemic. Pathog Glob Health

Twitter, and misinformation: a dangerous combination?

The presumed influence of digital misinformation: examining US public's support for governmental restrictions versus corrective action in the COVID-19 pandemic

Negative messages spread rapidly and widely on social media

How to fight an infodemic: the four pillars of infodemic management

COVID-19-related misinformation on social media Elia Gabarron et al

Geneva: World Health Organization

The World Health Organization launches WHO Health Alert on WhatsApp. Menlo Park, Facebook Inc

COVID-19) advice for the public: Mythbusters. Geneva: World Health Organization

Debunking: a meta-analysis of the psychological efficacy of messages countering misinformation

An update on our work to keep people informed and limit misinformation about COVID-19

Fighting COVID-19 misinformation on social media: experimental evidence for a scalable accuracy-nudge intervention

Network dynamics of social influence in the wisdom of crowds

Updating our approach to misleading information

Keeping WhatsApp personal and private. Menlo Park: Facebook Inc

San Bruno: YouTube; 2020

The COVID-19 social media infodemic. Sci Rep

The spread of low-credibility content by social bots

COVID-19 related misinformation on social media: a qualitative study from Iran

COVID-19-related misinformation on social media Elia Gabarron et al

Scopus (ALL ("social media") OR ALL ("social networking") OR ALL (facebook) OR ALL (twitter) OR ALL (youtube) OR ALL (whatsapp) OR ALL (telegram) OR ALL (instagram) AND ALL ("2019 nCoV") OR ALL (2019-ncov) OR ALL (2019ncov) OR ALL ("2019 novel coronavirus") OR ALL ("COVID 19") OR ALL (covid19) OR ALL (covid-19) OR ALL ("new coronavirus") OR ALL ("novel coronavirus") OR ALL ("SARS CoV-2") OR ALL (sars-cov-2) OR ALL ("SARS CoV 2") OR ALL (sarscov) OR ALL ((wuhan AND coronavirus))) AND (LIMIT-TO (PUBSTAGE, "final")) AND (LIMIT-TO (DOCTYPE, "ar")) AND (LIMIT-TO (SRCTYPE, "j")) 31 387Embase ("social media" OR "social networking" OR facebook OR twitter OR youtube OR whatsapp OR telegram OR instagram) AND ("2019 nCoV" OR: 2019-ncov OR: 2019ncov OR "2019 novel coronavirus" OR "COVID 19" OR covid19 OR covid-19 OR "new coronavirus" OR "novel coronavirus" OR "SARS CoV-2" OR sars-cov-2 OR "SARS CoV 2" OR sars-cov OR (Wuhan AND coronavirus)) 39 88PsycInfo ("social media" OR "social networking" OR facebook OR twitter OR youtube OR whatsapp OR telegram OR instagram) AND ("2019 nCoV" OR: 2019-ncov OR: 2019ncov OR "2019 novel coronavirus" OR "COVID 19" OR covid19 OR covid-19 OR "new coronavirus" OR "novel coronavirus" OR "SARS CoV-2" OR sars-cov-2 OR "SARS CoV 2" OR sars-cov OR (Wuhan AND coronavirus)) 3 8Google Scholar "social media" OR "social networking" OR facebook OR twitter OR youtube OR whatsapp OR telegram OR instagram AND ("2019 nCoV" OR: 2019-ncov OR "novel coronavirus" OR "COVID 19" OR covid-19 OR "SARS CoV-2" OR sars-cov-2 OR sars-cov OR (Wuhan AND coronavirus)) 217 367

NA 363 988 COVID-19: coronavirus disease 2019; NA: not applicable.