Raine S, Choudhury N. Social media in the social distancing era: paramount and pitfall. Harvard Public Health Review. 2021; 31.
Birthed with technology at our fingertips, Millennials and Gen-Z medical students have seamlessly incorporated internet-enabled devices into every facet of our lives. As the COVID-19 pandemic entered the public consciousness, these phones and tablets were the first things we reached for to find out the up-to-the-minute impact on our community and the world at large. The internet and social media enabled many of us medical students to educate ourselves on epidemiology and treatments, transition glitch-free into distance learning, and feel the pulse of the international community. As we capitalized on the benefits of social media during the pandemic, some of us also discerned first-hand how these platforms enabled unforeseen harm and mistrust in the realm of public health. In reflection of the year, we now recognize that social media is a double-edged sword and that as health practitioners, we have a role to play in sharpening the benefits and blunting the risks of social media use in public health.
Social media has empowered public health departments to deliver targeted health messaging to the most at-risk populations at low cost, instantaneous speeds, and in the post viewer’s preferred language. Unfortunately, many of us students witnessed content containing medical misinformation harnessing these same delivery strategies to wreak havoc on public health and safety. Thumbing through our Timelines, we became overrun with videos of quacksalvers backing scientifically unfounded treatment methods and outlandish conspiracy theories. One such theory was detailed in the infamous ‘Plandemic’ video, which had over 2 million interactions on Facebook prior to being removed within two weeks of the original post (Frenkel, Decker, & Alba, 2020). As medical students, we are often asked to be the trusted health information consultants by our friends and families to validate the legitimacy of these viral posts. This new wave of questionable content puts this responsibility of ours into overdrive and highlights how critical our truth-seeker role is as future physicians for the public.
Compounding this issue of misinformation, guidance posted on official CDC social media pages was initially unclear regarding the need and adequacy of face masks (Jingnan, 2020). Furthermore, multiple government leaders took to social media spaces to question the impact of the virus as well as the easy-to-implement mitigation strategies (Abutaleb, 2020). Some of these administrators outright refused to wear a mask and proceeded with mass gathering events in direct conflict of their health department’s social distancing guidelines (Victor, 2020). This contradictory behavior from the top-down created a culture war regarding masking, fueled and fanned by pictures and discussions within social media platforms. Efforts to protest face covering requirements and minimize the benefit of masking exploded across the internet to include outright resistance, cutting holes in masks, and intentionally crafting coverings with inadequate materials like lace and mesh (Segall, 2020). A study evaluating the effect of masking in fifteen states on the percent change in daily COVID-19 transmission rates identified that within twenty-one days of a mask mandate, there was a decrease of 2.0% of cases per day (Lyu, 2020). The model suggests that by May 22, 2020 these masking efforts would have averted 230,000-450,000 COVID-19 cases in the US. This masking benefit on mortality may have been severely hampered by social media content by our own government officials.
Research into the more subversive misinformation campaigns we encountered this past year have shed light on the maleficent origins of the content posters. A study out of Carnegie Mellon University identified that nearly 50% of all Twitter accounts protesting state-wide business closures with “Reopen Businesses/America” content had activity indicating they were “bot” accounts with digital fingerprints in Russia and China (Carley, 2020). By directly encouraging US citizens via social media to ignore and act against masking and business/school closure efforts, foreign actors successfully derailed public health campaigns in multiple states across the US. What is being done to protect and prevent these nefarious acts of digital disruption from reaching our TikTok feeds? From Facebook to Pinterest, social media platforms have enabled fact-checking protocols that are handled by third parties, many of which are triggered after the content has gone viral, allowing these adversarial attempts to have large scale success prior to even being identified as misinformation (Rich, et al., 2020). These barriers are loose and retroactive. However, a more ardent approach is being made in regard to content surrounding COVID-19 vaccines.
With vaccine distribution surging, it comes as no surprise to see these similar mechanisms deployed in an attempt to spread mistrust with the goal of propagating vaccine hesitancy (Wilson et. al., 2020). Investigations of the digital fight between pro- and anti-vaccination attitudes developed from social media content suggest that the scales will tip towards the side of anti-vaccination within the decade (Johnson et al., 2020). However, social media platforms have implemented new tools to mitigate these effects. Facebook and Instagram have made headway by automatically labeling all COVID-19 related posts with links to official sources at the moment of content posting (Facebook Newsroom, 2021). When we scroll across a post that uses vaccine related verbiage, we now see messaging from the CDC alongside that post. It is the first proactive, albeit low threshold, barrier in the battle against health-related social media misinformation. The onus of fact checking still rests on the shoulders of the platform users, who need to access the credible information via link.
Despite the adverse effects of social media, these platforms were essential in building up a robust healthcare response to mitigate the virus’s impacts. Online crowdfunding on “GoFundMe.com” in the month of March 2020 for PPE, living necessities, and healthcare workers neared $2.6 million (Rajwa et al., 2020). Thousands of DIY videos and documents instructing the general public on how to make their own masks, hand sanitizer, and face shields were readily available to anyone with a smartphone or computer. Daily coronavirus updates to the state level were optimized for social media distribution on mobile devices, strengthening the public’s health literacy on COVID-19 (Fuerer, 2020). The increase in telemedicine service advertisements fostered an increased access to care for people who otherwise would be limited by transportation and may have reduced their risk of transmission (Koonin, 2020). For many health care providers, this pandemic-tested form of delivery may impact the future of clinic operations and increase access to care.
As Black Lives Matter spread awareness of racial injustice via social media, the public also became aware of the disproportionate effect that coronavirus was having on People of Color (Division of Viral Diseases, 2020). Although the pandemic widened the divide between underserved populations and their counterparts, online conversations centering on COVID-19 outcome disparities by race and ethnicity bolstered the general public’s understanding of health inequity (Raine et al., 2020). As future physicians, it is imperative that we join in these conversations online and advocate for our communities. We hope to help these dialogues transform into tangible change in underserved communities and the nation as a whole.
As social distancing mandates became an integral part of the coronavirus containment and management response, the social isolation caused feelings of loneliness to emerge. The pandemic ripped away numerous mental health protective factors including robust social supports and routines. Young adults seemed to be hit the hardest by this loneliness and are an at-risk group for self-harm and suicide risk (Walsh, 2021). It became imperative to find replacement protective factors for these groups to mitigate any ill social effects of the pandemic response. Social media proved to be critical in creating a social infrastructure without any in-person interactions. From sharing silly TikTok trends to scribbling pictures on Houseparty, these virtual opportunities to connect facilitated the development of coping skills to mitigate the pandemic’s isolation and loneliness.
The pearls and pitfalls of social media regarding health are significant and walking the line between them requires tact and patience on the part of healthcare practitioners involved in their communities. In an effort to bolster the online community interactions related to healthcare, the current generation of medical students will undoubtedly be called upon to participate in the “hot wash” of this pandemic. Due to our native integration with technology and social media mastery, this generation is masterfully equipped to reduce the impacts of bad actors spreading misinformation on social media and advocate for proactive infodemic policies across platforms. By using our own social platforms and spheres of influence, we can be the leaders in encouraging future public health interventions and sharing evidence-based medicine across the digital realm.
Frenkel, S., Decker, B., & Alba, D. (2020, May 20). How the ‘Plandemic’ Movie and Its Falsehoods Spread Widely Online. The New York Times. Retrieved from https://www.nytimes .com/ 2020/05/20/technology/plandemic-movie-youtube-facebook-coronavirus.html
Jingnan, H. (2020, April 10). Why There Are So Many Different Guidelines For Face Masks For The Public. Retrieved from https://www.npr.org/sections/goatsandsoda/2020/04/10/ 829890635/why-there-so-many-different-guidelines-for-face-masks-for-the-public
Abutaleb, Y., Dawsey, J., Nakashima, E., & Miller, G. (2020, April 04). The U.S. was beset by denial and dysfunction as the coronavirus raged. Retrieved from https://www.washington post.com/national-security/2020/04/04/coronavirus-government-dysfunction
Victor, D., Serviss, L., & Paybarah, A. (2020, October 02). In His Own Words, Trump on the Coronavirus and Masks. Retrieved from https://www.nytimes.com/2020/10/02/us/politics/ donald-trump-masks.html
Segall, A. B. (2020, July 16). Anti-mask protesters’ new weapon: Wearing masks that offer no COVID-19 protection. Retrieved from https://www.wthr.com/article/news/investigations/13-investigates/13-investigates-anti-mask-protestors-turn-to-mesh-yarn-crochet-masks-covid-coronavirus/531-5350260c-d6b1-4bd8-857e-860fe84e0f52
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Carley, K. M. (2020). Coronavirus: Misinformation and Disinformation Regarding Coronavirus in Social Media. Center for Informed Democracy & Social – cybersecurity (IDeaS). Carnegie Mellon University. Retrieved from https://www.cmu.edu/ideas-social-cybersecurity/research/ coronavirus.html
Rich, T., Milden, I., & Wagner, M. T. (2020, November 2). Research note: Does the public support fact-checking social media? It depends whom and how you ask | HKS Misinformation Review. Misinformation Review; HKSMisinformationReview. Retrieved from: https://misinforeview.hks.harvard.edu/article/research-note-does-the-public-support-fact-checking-social-media-it-depends-who-and-how-you-ask
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Division of Viral Diseases. (2020, February 11). Health Equity Considerations and Racial and Ethnic Minority Groups. Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html
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Walsh, C. (2021, February 17). Young adults hardest hit by loneliness during pandemic, study finds. Harvard Gazette. https://news.harvard.edu/gazette/story/2021/02/young-adults-teens-loneliness-mental-health-coronavirus-covid-pandemic/.