key: cord-0898891-1n8rnfyf authors: Cuello-Garcia, Carlos; Pérez-Gaxiola, Giordano; van Amelsvoort, Ludo title: Social Media can have an impact on how we manage and investigate the COVID-19 pandemic date: 2020-06-27 journal: J Clin Epidemiol DOI: 10.1016/j.jclinepi.2020.06.028 sha: 9a6bbf7fb4022eff2f494813fe917b249d0b1e38 doc_id: 898891 cord_uid: 1n8rnfyf • In situations of emergencies and urgencies, such as the COVID-19 pandemic, many are disseminating information through social media channels; this have an impact on billions of persons worldwide. • Misinformation about the current pandemic occurs frequently in these platforms and can have serious consequences. • When properly used, social media can be a useful tool that provides opportunities to disseminate and receive relevant information for patients, clinicians and scientists. • Better research methods and proper use of these platforms by health scientists and the public are warranted to address social media’s role in health policy and individual decisions. A multi-disciplinary approach with better outreach and dissemination is optimal. With more than 3.8 billion people using social media around the world [1] it is not surprising how the significant amount of information received through these platforms affects how we perceive and cope with the current COVID-19 pandemic. [2] Even before the outbreak, patients, clinicians and scientists were frequently obtaining health and science-related information from Twitter, Facebook or other social media channels. [3] With the advent of these technologies, healthcare professionals are nowadays able to communicate among each other and with different stakeholders across the wide-ranging fields of medicine. [4] Similarly, scientists from all fields are able to rapidly interconnect and disseminate their research findings, thus increasing their scientific outreach and supporting easy access to information beyond the hindrances of the past. Social media is now more than ever part of a big extent of our lives -for example, how we use it to cope with social distancing -and although it can give opportunities for better communication, it can certainly have its shortcomings and dangers. In this commentary, we describe and explore the use of social media and science during the pandemic: first, we briefly explore the role social media has on the current wave of information and misinformation (also called an "infodemic" [5] or "infoxication") that affects billions, and offer guidance towards their optimal use. Second, we address social media as a health technology intervention or tool that merits more research to improve our understanding of the COVID-19 pandemic. The term misinformation, the same as the term 'fake news', is not new, [6] yet today especially takes big significance due to its "virulent" effect and all the entailed consequences. With just one tweet, powerful "influencers" -from head of states to celebrities -can affect people's lives by disseminating scientific news without veto or fact-checking to an audience of millions. From endorsing the use of hydroxychloroquine to recommending parenteral light or disinfectants as potential treatments for the virus, [7, 8] they brandish a powerful weapon and must be accountable and have a responsibility for introspection before using it. Initial evidence suggests that the use of social media as a source of information about COVID-19 has been correlated with stronger beliefs in conspiracy theories and with less protective behaviours during the pandemic. [9] Certainly, more than half of people on social media have encountered some to a lot of information about the COVID-19 pandemic which, for them, seemed completely made up. [2] Just in YouTube, the second most commonly used social media platform (second to Facebook), more than a quarter of the most viewed videos related to COVID-19 contained misleading information, representing more than 62 million views. [10] The World Health Organization (WHO) is acting by enhancing its communication efforts to properly address rapidly spreading rumours and questions from the public obtained in social media channels; also using search optimization strategies within the social media platforms to guide anyone asking questions about the pandemic by redirecting them to reliable sources. [5] Similarly, social media platforms themselves are including alerts or 'warnings' with links to reliable sources and fact-checkers when searching for information on COVID-19 and other health-related issues. [11] Although these represent good first steps, more is needed on the research efforts to understand the origins and spread of misinformation. Social media is an inevitable part of today's information channels. The risk of negative health effects (including death) from misguided health news in this pandemic is real. [12] Health professionals and scientists are unavoidably active social participants and have a responsibility to enter the arena. Here we expand on some advice/proposals for scientists obtained from different experts to counteract misinformation: [13] [14] [15] • Scientists should engage in social media. Sharing research knowledge with peers and learners is not only natural but desirable; furthermore, new evidence provides more certainty that social media can increase visibility and citations over time. [16] Sharing science is perfectly achievable and several strategies that take advantage of social networks technology can help (e.g., Tweetorials, Reddit's 'explain-it-like-I'm-5' , 'ask-me-anything [AMA] sessions, videos, etc.). [17, 18] • Assist and advocate for expert fact-checking. The scientist is the single greatest 'weapon' to counteract 'fake news'. Whether by serving as a professional factchecker for a news network, or by crowdsourcing (the use of multiple minds to reach a common goal of better knowledge) on any of these platforms, their shared knowledge will always be the best source to scrutinize the news. [19] • Interact in social media channels with non-experts (public) to raise the alarm when detecting misinformation by sharing the evidence or, if such is the case, by pointing out the scarcity of evidence and how we should make sensible recommendations under these circumstances -by weighing the desirable and undesirable consequences. [20] This includes teaching patients about science and how to deal with distressing interactions; for example, handling 'online trolls' by ignoring them, responding with facts, blocking them, etc. Guidelines and policies on this issue are available. [21] • Use, whenever possible, traditional media (TV or radio) to provide evidence-based information and reach a broader audience. This will eventually trickle down to social media users. Advantages and disadvantages of social media use in clinical epidemiology and for other relevant stakeholders are summarized in the Table. Additionally, for each of the three groups, key advice is provided on how to shift the effects of social media use in a positive direction. Social media is another technology that behaves in many situations as a health intervention or exposure, and as such it should be well planned, designed, and evaluated in the pool of studies addressing the pandemic. There are several areas of research in social media that justify more exploration. Research on Misinformation: Current research on misinformation in social media focuses on better detecting its sources and how to efficiently counteract them to lessen any possible harm. [15] Certain gaps in research, however, should be explored, including the detection of susceptible populations and the socio-demographic and ideological asymmetries in the intention to spread misinformation. [6] This will certainly benefit from an interdisciplinary approach. For example, social scientists could team up with artificial intelligence (AI) scientists and clinicians to understand ideologies and susceptible populations to design and study better interventions. Big data and data mining: Another opportunity of research comes with the association of social media with big data, data mining, and surveillance [22] that it can be used to better detect patterns of future outbreaks or consecutive (second) waves of a pandemic. Artificial intelligence (AI) can be added to this promising partnership as a powerful tool that can help develop, for instance, data-driven algorithms (using text-mining or topic modelling) and insight-led methods to acquire patient and consumer's experiences of health and illness, for example, to discover and manage "filter bubbles" or "community clusters" that reinforce confirmation bias. [23, 24] AI can assist with this and other future developments as a robust computational research tool. It is encouraging to see that nowadays the most common use of AI for patients and healthcare consumers are secondary analyses of social media data. [25] This field is still in its early stages and it is not free of error, but it is an area worth exploring. Other ways social media is being used by researchers is as an application to help them recruit patients or populations that are hard to reach (e.g., rare diseases), or are very specific to their research needs (e.g., military veterans, teenagers, etc.). There are promising findings about obtaining representative group demographics for their research purposes in areas such as cancer and mental health; most studies, however, focus on study recruitment rather than retention. [26, 27] Lastly, there is currently an explosion of research papers related to COVID-19, and worries about quantity over quality, research waste, and duplication are justified. [28, 29] . Social media and other technologies could help in this area by properly monitoring, filtering, and sharing research. Disseminating health policies and valid information for the purpose of reducing the knowledge translation gap is another advantage that scientists and clinicians can make use of and deserves further examination. [30] Social media platforms can have a role in improving several steps in the knowledge transfer cycle, for example, researchers can assess barriers to knowledge use, tailor and implement interventions, monitor knowledge use, or by researching negative and positive behaviours once a health intervention is being disseminated so they obtain feedback and continue the cycle. The importance of increasing and improving research on a technology that is having a massive impact in the current pandemic cannot be overstated. As of the writing of this commentary, a search on clinicaltrials.gov yields only four studies related to COVID-19 and social media (out of 1,546 related to COVID-19). All are surveys or observational studies aiming to explore behaviors and monitor the impact and spread of misinformation. Clinicians and researchers are using social media to share recommendations and explain the decisions being made in times of the COVID-19 pandemic, no matter if there is enough, scarce, or even no evidence at all. [20] They are the frontline not only in hospitals and laboratories but also in the cyberworld. Fact-checking of online content is certainly rapidly evolving, and its impact can be perceived when it is even creating major political disputes. [31] Social media is in no way a cure for misinformation, but it is widely use and is here to stay. Just sharing facts will not change behaviours, and more needs to be done. The research methodology to address social media's role in health policy and individual health decisions has yet to be defined, but it is worthy of examination by using a multidisciplinary approach to obtain better research methods and dissemination. -Overload of information and disinformation (i.e., "infoxication"). -Be active and visible on social media. -Start with a relevant and clear profile. -Link to social media channels of journals related to your publications; react and get involved in relevant messages and discussions. -Follow relevant experts active on social media. a. For example: TestingTreatments.org, informedhealthchoices.org, Thatsaclaim.org • In situations of emergencies and urgencies, such as the COVID-19 pandemic, many are disseminating information through social media channels; this have an impact on billions of persons worldwide. • Misinformation about the current pandemic occurs frequently in these platforms and can have serious consequences. • When properly used, social media can be a useful tool that provides opportunities to disseminate and receive relevant information for patients, clinicians and scientists. • Better research methods and proper use of these platforms by health scientists and the public are warranted to address social media's role in health policy and individual decisions. A multi-disciplinary approach with better outreach and dissemination is optimal. 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Staying safe and informed on Twitter Fearing coronavirus, Arizona man dies after taking a form of chloroquine used to treat aquariums. CNN Strategies to combat medical misinformation on social media Social Media and Emergency Preparedness in Response to Novel Coronavirus Addressing Health-Related Misinformation on Social Media Does Tweeting Improve Citations? One-Year Results from the TSSMN Prospective Randomized Trial Tweetorials -From Early Beginnings to Huge Growth and Beyond Why Is a Cow? Curiosity, Tweetorials, and the Return to Why Fighting misinformation on social media using crowdsourced judgments of news source quality Using GRADE in situations of emergencies and urgencies: Certainty in evidence and recommendations matters during the COVID-19 pandemic, now more than ever and no matter what (in publication) Social Media Trolls: A Practical Guide for Dealing with Impossible People Predicting the Next Influenza Pandemics Analyzing the Impact of Filter Bubbles on Social Network Polarization The filter bubble and its effect on online personal health information Section Editors for the IYSoE, Consumer Health I. Artificial Intelligence in Health: New Opportunities, Challenges, and Practical Implications The Use of Facebook in Recruiting Participants for Health Research Purposes: A Systematic Review Digital tools for the recruitment and retention of participants in randomised controlled trials: a systematic map Waste in covid-19 research Scientists are drowning in COVID-19 papers. Can new tools keep them afloat? Social Media, Health Policy, and Knowledge Translation Trump signs executive order targeting social media companies. CNN Carlos Cuello is member of the GRADE working group.All authors have no financial conflicts to declare. Carlos Cuello: Conceptualization and writing of original draft; Giordano Perez-Gaxiola:Writing, review, and editing; Ludo van Almesvoort: Writing, review, and editing.