COVID-19 Infodemic Case Studies: How Social Media Shared Information Rapidly to Global Health Care Teams (Preprint)

BACKGROUND The COVID-19 pandemic has led to a health care infodemic. While social media is useful for rapidly spreading clinical and scientific information. The accuracy of the scientific information shared on social media is a concern.We used a social media aggregator and searched social media platforms for public posts for 2 case studies. We measured the reach of social media posts related to the global coronavirus disease 2019 (COVID-19) pandemic, the number of times the posts were shared, the number of countries the posts reached, and the speed of dissemination. Our 2 health care examples demonstrate the rapid global distribution of clinical knowledge across the medical community through social media in less than 1 week. OBJECTIVE To demonstrate the rapid global distribution of clinical knowledge through social media. METHODS To identify posts for this study, we used the social media aggregator Crimson Hexagon, which allowed searches of more than 1.4 trillion public posts, including 100% of Twitter. For case study 1, we searched Twitter for retweets of the original @CMichaelGibson post. For case study 2, we searched YouTube, Twitter, forums, comments, blogs, Reddit, and Tumblr for public posts between March 22 and April 3, 2020, with the following search string: “intubationbox” OR “intubation box” OR “intubationboxes” OR “intubation boxes” OR “aerosolbox” OR “aerosolboxes” OR “aerosol box” OR “aerosol boxes.” This search yielded 26,402 posts, of which 11,578 had an identifiable location. RESULTS Social Media Case Study 1 On March 16, 2020, @CMichaelGibson tweeted about a comparison of different do-it-yourself mask materials from a University of Cambridge research article (Figure 1). This tweet (with the hashtag #macgyvercare) was heavily retweeted and gave interesting results. Within 3 days the post had been shared by people in 53 countries, and within a week, 79 countries. During this time, the US and the Centers for Disease Control and Prevention had not commented on the utility of masks for the public or on a universal need for health care workers to wear masks except during procedures with a high risk of aerosolization. Social Media Case Study 2 On March 22, 2020, a Taiwanese news portal reported a story about Dr Lai Hsien-Yung, an anesthesiologist at the Mennonite Christian Hospital (Hualien, Taiwan), who built an improvised, low-cost, aerosol box to help give health care workers additional protection against aerosol exposure to the novel coronavirus when intubating patients. He described his idea for a simple yet ingenious plexiglass box on his Facebook page.1 The #aerosolbox idea soon spread across other platforms, including Twitter.2 Repostings and retweets of this idea and variations of it spread to hospitals and universities around the globe. This concept was later described by physicians in Boston, who wrote a letter to the editor that was published in the April 3, 2020, issue of the New England Journal of Medicine.3 The idea that was initially posted on March 22 on Facebook subsequently spread through news media and social media to 6 continents (Figure 2), was modified and implemented in hospitals around the globe, and was ultimately described in a leading medical journal. That all this occurred within only 12 days is a testament of the reach and impact of social media. Also, within the same 12-day span, from March 22 to April 3, information about #aerosolbox was shared publicly over 26,400 times on social media by people in 110 countries. These numbers include only posts that have search terms defined in English and that are shared publicly and have an identifiable location. The box described in #aerosolbox, however, was not without its limitations. A peer-reviewed article published on May 12, 2020, described an in situ observational simulation in which the box posed potential hazards, including longer intubation times for patients and damage to personal protection equipment from the edges of the box, which could increase exposure to the virus.4 CONCLUSIONS Social media is a powerful tool for the dissemination of digital health information. Such information traveled far and fast during the COVID-19 pandemic and underwent considerable online feedback while spreading, often transforming into news articles and traditional academic peer-reviewed publication.