As the world finds itself in the middle of the COVID-19 pandemic, social media has
become inundated with content associated with the virus. Although all social media
platforms (e.g., Facebook, Instagram, blogs) are currently providing us with medical
content, perhaps no other consistently plays a more prominent role in the medical
world than Twitter.
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Emergency medicine (EM) is on the bleeding edge, where practice at the bedside is
continually being shared on social media and this pandemic has resulted in immense
activity on Twitter.
Twitter is a microblogging and social networking service where users post messages
using “tweets” that are limited to 240 characters. For well over a decade, Twitter
has become increasingly used as a platform where medical practitioners exchange ideas,
information, and commentary. The hashtag #FOAMed garners thousands of tweets per hour,
and at this momentous period in medical history, no subject is more prominent than
COVID-19. With the free-flow of messages and ideas that are not vetted or peer-reviewed,
unlike classic medical educational resources, is there a risk of harm? What are the
benefits to the EM community from Twitter? Finally, how does the average emergency
physician (EP) get the most out of the information out there?
HARMS
Hysteria. You cannot be on Twitter and paying attention to the pandemic without noticing
multiple posts declaring this is the apocalypse. Although tongue in cheek for some,
there is a hashtag #apocalypse2020 for all those who are preparing for the end. This
is risky for many reasons and, very importantly, the mental well-being of Twitter
users. Social media have been associated with increased mental distress, self-harm,
and suicide.
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Additionally, the spread of information is not limited by distance, such that the
pandemic of fear can and has spread before the actual C-19 pandemic.
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This has an effect on our patients’ mental health, putting their physical and mental
well-being at risk. This can lead to an increase in suicidal ideation or attempts
and is something that the EP has to prepare for at increasing rates during this pandemic.
Let's not forget the similar risk to frontline medical providers, being exposed to
the same stresses and endangering our mental well-being.
Social media platforms are well known for the spread of misinformation and denial
of scientific literature. Perhaps, no example is more prominent than the rise of vaccine
hesitancy and the role that social media play in the spread of inaccurate and negative
information.
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The current COVID-19 pandemic is not immune to this misinformation and, in fact, is
the “first social media pandemic.”
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Few examples of misinformation are more obvious than U.S. President Donald J. Trump's
tweet touting the combination of hydroxychloroquine and azithromycin as one of the
“biggest game changers in the history of medicine.”
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This, of course, turned out to be a falsehood with multiple respected medical bodies
asking for physicians to keep from prescribing the combination.
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Whether well-intentioned or malicious in nature, the spread of misinformation leads
to fear, inappropriate prescribing, less response to warnings on issues such as social-distancing,
and mistrust in the medical advice due to the plethora of misinformation.
Figure 1.
Infographic – Twitter pandemic.
A deluge of information. There really is no other way to describe the amount of information
being microblogged about COVID-19. This can be a good thing, but the massive amount
of information can be overwhelming to the end-user. One of the most commonly cited
reasons people do not use platforms such as Twitter is the sheer amount of information.
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As Choo et al. described it, “drinking from a firehose” of information becomes a barrier
to education, whether it relates to COVID-19 pandemic or other topics.
BENEFITS
Fortunately, there are multiple positives to Twitter in the age of the COVID-19 pandemic.
It allows users to be inspired by stories of courageous acts, positive role models,
and global efforts to combat the pandemic. From frontline health care workers with
their tales of unimaginable sacrifices, to the non-medical users simply surviving
through a quarantine period with some humor, these are the type of stories that can
help people get through this crisis together. One of these inspiring examples is Dr.
Yale Tung Chen, an EP who chronicled his COVID-19 infection, including ultrasound
findings,
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and simultaneously demystifying the illness while educating the world in a novel format.
To counter concerns regarding misinformation and the validity of claims being made,
Twitter is actively fighting to stop the misinformation or damage that may come to
users from posts on their platform.
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They are actively removing tweets with content that denies global or local health
authority recommendations to decrease someone's likelihood of exposure, description
of treatments that are harmful or not immediately harmful but are known to be ineffective,
content that denies facts about transmission, and claims impersonating official government
agencies. These efforts can go a long way in appeasing the real and perceived inaccuracies
of the content on the social media platform.
One of the criticisms of conventional medical education (textbooks, journals) is that
they are often behind the curve in terms of knowledge translation. The benefit of
social media is that the content is often more novel. In the middle of a pandemic,
the ability to rapidly share information is critical for knowledge translation and
dissemination, and Twitter is able to do this in a way that is typically not feasible
for textbooks or journals. Most relevant to the EM community, we are seeing the free
exchange of protocols/guidelines from specialty groups such as the Canadian Association
of Emergency Physicians, highly reputable international journals (such as Journal
of the American Medical Association, New England Journal of Medicine, BMJ [formerly
British Medical Journal], and others), and academic/community hospitals. Leading on
this front are many of the established medical educators who use Twitter as part of
the Free Online Access Medical Education (FOAMed) effort to educate EPs on the global
pandemic. Just one of these examples is the “Protected Airway Process” from Dr. Christopher
Hicks, widely shared and retweeted by frontline practitioners to ensure that health
care providers remain safe during intubations.
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It's amazing to think that medical professionals everywhere around the globe have
the same database of information with the simple use of a website or mobile application.
Although the user must remain vigilant in the face of any new information presented
to them, these respected institutions and users can equip health care workers worldwide
with the knowledge to combat the pandemic.
Our advice when using Twitter as a source of information during the COVID-19 global
pandemic is the following:
1.
Limit your intake. The “firehose” is on 24/7 but you should not be. Set aside some
time in the day and stick to that limit. It's a rapidly evolving crisis but not such
that it should overwhelm you.
2.
Engage in the conversation. Contribute to the discussion or present your ideas/protocols.
This form of post-publication feedback may be key to ensuring you are doing what is
up to date.
3.
Allow yourself to be inspired. This will be a marathon, not a sprint, and you will
need these positive stories to keep your spirits up.
4.
Ensure you use information from trusted sources. Follow those accounts that truly
interest you, unfollow those that don't contribute to your learning. If you are struggling
with where to start, follow #COVIDFOAM and #COVIDFOAMED. Consider adding @CJEMonline
and @CAEP_Docs to accounts you follow, as we are committed to be the voice of Canadian
EPs throughout this pandemic.
5.
Most importantly, stay safe.