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    Rumors, confusion, and conspiracies: Can doctors defeat COVID-19 misinformation?

    Physicians and researchers take the front lines in the “infodemic” war, using blogs, social media, and conversations to steer people to safe practices.

    A question mark with coronavirus molecules

    For Nicholas Stark, MD, the spread of COVID-19 rumors and misinformation hits home, literally: Although he has labored in the emergency room at UCSF Health in San Francisco to save victims of the disease, many of his relatives and neighbors where he grew up in South Dakota dismiss warnings about the pandemic as “part of a corrupt agenda that is weakening our society.”

    Still, Stark finds ways to make a little headway by discussing COVID-19 with people who remain open-minded — such as his mother. He says she’s evolved into “a public health advocate” about containing the virus in her community.

    Eve Bloomgarden, MD, learned to pick her spots as well by leveraging her role as both a doctor and a mother. The endocrinologist at Northwestern Medicine in Illinois implores people in her online moms’ groups to remove posts about COVID-19 that are not based on scientific evidence: “I say that it’s feeding fear. Most of the time, they will take it down.”

    Lindsey Leininger, PhD, found a way to assuage the confusion of strangers. She joined several health researchers in running a Facebook project, Dear Pandemic, that provides science-based answers to such queries as, “Can you use a neti pot to prevent coronavirus infection?” and “Is blood plasma a cure?”

    These are some of the ways that doctors, nurses, and researchers are fighting what’s been dubbed the COVID-19 infodemic — a mix of evolving and conflicting findings, factual errors, rumors, and conspiracy theories, spread lightning-fast through all forms of media, often to promote political agendas rather than public health. As an Associated Press headline declared, “Misinformation on coronavirus is proving highly contagious.”

    Fighting the infodemic “is exhausting,” Bloomgarden admits — so much so that in a recent Twitter chat hosted by Doctors on Social Media, one participant wrote, “Sometimes I feel like I’m yelling into a black hole and I feel like I should give up.”

    Do not give up, infodemic combatants say. They say medical professionals have a responsibility to correct misinformation because it impedes efforts to curtail the disease. Doctors are well-positioned to deliver the truth because of the credibility of the profession — a 2019 Gallup poll ranked nurses and doctors first and third for perceived honesty — and because many of them have earned credibility with patients, neighbors, and family.

    “There is a real concern among physicians about not wanting to alienate their patients by getting quote-unquote political,” says Vineet Arora, MD, a co-founder of a new advocacy group, the Illinois Medical Professionals Action Collaborative Team (IMPACT). “Standing up for your patients and what’s right for health care is not political.”

    Those finding success against the infodemic cite several key strategies:

    • Use facts but don’t lecture.
    • Build on relationships.
    • Focus on shared goals.
    • Don’t challenge core beliefs.
    • Meet people where they are.

    The infodemic combatants start with meeting people where they are along the misinformation spectrum. Are they confused by all the information, skeptical about some of the science, or vehement that assaults on their liberty are at play?

    Confused by information overwhelm

    Health care workers and researchers across the country took to social media early in the pandemic to keep friends and family accurately informed about the novel coronavirus and to smack down rumors. After one group of researchers watched some posts go viral, spreading to audiences exponentially larger than their own, they realized how hungry people were for trusted experts to cut through the fog.

    So they created Dear Pandemic, where nine self-described “nerdy girls” — all with PhDs in health and science research — provide the latest science-based information to a confused and frightened public. One typical post: “How do I know how much community transmission there is in my community? I am swimming in data! Someone throw me a rope!”

    Such pleas are particularly striking to Leininger, the project CEO, because they show how a large part of the COVID-19 infodemic isn’t “the outlandish stuff,” like misinterpreted findings and conspiracy theories.

    The Dear Pandemic logo
    The Dear Pandemic logo.
    Courtesy: Dear Pandemic

    “The thing that makes me scratch my head is how even well-intentioned, well-informed people are struggling with information overwhelm,” says Leininger, who teaches data analytics for health care leaders at Dartmouth College’s Geisel School of Medicine and its Tuck School of Business in New Hampshire.

    To address the confusion, Dear Pandemic strives not only to answer specific questions but also to teach how to assess scientific pronouncements. “We’re trying to coach people to think critically,” Leininger says. “We’re trying to build a community of people who can go educate others.”

    That’s also the idea behind IMPACT, launched this spring by doctors in Chicago to educate the public and policymakers about COVID-19. The project enlists other doctors to the cause: A blog entitled "Masks Are Not a Partisan Issue" appeared on the medical site KevinMD, and one that urged physicians to advocate for science-based government policies to combat the disease appeared in Physician’s Weekly, a 35-year-old publication for front-line health care providers. IMPACT also provides infographics about such things as effective social distancing and COVID-19 fatalities, suitable for posting on social media, on websites, and in doctors’ offices.

    “When we go with a physician audience, the goal is to galvanize the physicians,” says Arora, a hospitalist and professor of medicine at UChicago Medicine. “We’re going to be stronger with more physicians that are amplifying positive messages” about how to fight the disease. 

    For many doctors, however, the struggle with misinformation is personal: It involves their patients, family, and friends. How do they talk with them — especially those who have turned skeptical of official pronouncements about the spread, impact, and treatment of the disease?

    Skeptical about scientific claims

    “Start with empathy.”

    So suggests Kate Starbird, PhD, an associate professor of human centered design & engineering at the University of Washington (UW) who is part of a team that won a grant to study how scientific knowledge and communication have affected online information about COVID-19.

    “Acknowledge that the information space is difficult and you can understand why somebody would be confused, even skeptical,” she says.

    Then, avoid what seems like a natural next step: lecturing with facts.

    “As scientists, if there is misinformation spreading, we go, ‘Oh, but we’ve got facts,’” observes Seema Yasmin, MD, director of the Stanford Health Communication Initiative in California. “We tweet. We disseminate pamphlets.”

    But, she stresses, “facts are not sufficient” by themselves to overcome skepticism that builds from information provided by friends, family, and favored media sites. She suggests using facts as the foundation for a strategic conversation.

    “Try to understand why somebody might have a belief,” such as that hydroxychloroquine cures COVID-19, Yasmin says.  

    A physician or scientist can then explain what they’ve learned about it. Even if that doesn’t completely dispel the misinformation, it can soften the belief enough to open the way for a health-based solution.

    At Northwestern Medicine, Bloomgarden looks for shared experiences, especially with patients who have children. When those patients claim that masks cause oxygen depletion, Bloomgarden calmly notes, “It’s possible that your kid is going to find it a little harder to breathe with a mask. My kids are 3 and 5. They wear masks. They’re not struggling. I wear a mask. It’s not lovely.”

    Gopi Astik, MD, a hospitalist at Northwestern, looks for shared goals: that people don’t get sick and that everyone gets back to doing things that they value.

    “I say, ‘Who else do you interact with?’ They say, ‘My mom. My aunt.’ I say, ‘We don’t want to get them sick.’

    “‘You want to get back to having big services at your church? Then we need to get this virus under control.’”

    Such strategies are even more important when conversing with people whose objections to COVID-19 advice are based on something more fundamental than an alleged fact: their very values and worldviews.

    Vehement that virus responses assault liberty

    “A lot of my family members are afraid of having the wool pulled over their eyes,” says Stark, the San Francisco doctor with South Dakota roots. “Those fears are very deep-seated.”

    Many people in his rural hometown area, which has seen few COVID-19 cases, believe institutions have hyped the risk of the virus and contrived facts. They gather in large groups, eschew masks, and promote coronavirus conspiracy theories on social media.

    Stark’s given up trying to correct dangerous misinformation in online chats, because “people just kind of pile on. I’ve had more success having personal conversations.”

    While those conversations led his mother to advocate for basic safety precautions, he’s had “some incredibly tense conversations” with his brother. “He has a big fear of losing some of his liberties or being duped by government or institutions,” Stark says.

    He customizes his responses according to who he’s talking with and tries to “keep the lines of communication open.”

    Those are sound strategies, say experts in science communication.

    “If the person’s position is part of their political or social identity, it can be difficult to correct,” says Starbird at UW. “It isn’t just that they’re misled. They’re committed to a particular interpretation based on their worldview.”

    In such cases, Yasmin says, “bringing facts into the conversation is like pouring kerosene onto a fire.”

    Phil Cochetti has stoked a few fires. The research coordinator at Perelman School of Medicine at the University of Pennsylvania in Philadelphia set out to correct misinformation about COVID-19 on social media and websites — with mixed results. He’s been called “a sheep” and got kicked out of three online chat groups.

    Still, Cochetti has found success with some people by finding common objectives (such as safely reopening schools) and suggesting that the potential benefits of some precautions are worth a little trouble. “I’ll say, ‘Other countries have been successful with masks. Why not try wearing one?’”

    Cochetti’s goal is not to merely counter specific factual errors but also to educate people about how scientific research works — including the length of time required, the ever-changing and even conflicting findings, and the need to verify results. He says it’s worth it when someone replies, “Now that you’ve explained it in a clear way, I understand.”

    What if a conspiracist won’t budge? Advocates like Cochetti and those at Dear Pandemic and IMPACT know when to disengage. “I can’t change a closed mind,” Leininger says.

    Doctors, however, can’t just disengage from patients, who might contract the virus and spread it. Those who already suffer other afflictions are especially vulnerable to the impacts of the disease.

    “I have a few patients who are sure this is a conspiracy,” Bloomgarden says. “I stand my ground.”

    Her message renders the conspiracy theory irrelevant to health care: “My role is to see that you don’t get sick. Politics aside, Facebook and news outlets aside. I don’t care who you think started this [virus]. You can’t leave your house until this is over, or if you have to, wear a mask.

    “I don’t care about what anybody else says. I care about you.”