How Infection Preventionists Can Battle Misinformation

“Infodemic” combines the words “information” and “epidemic,” typically referring to rapid, far-reaching spread of both accurate and inaccurate information about a topic such as disease or treatment.¹ The word first appeared in 2003 but has seen increased use during the COVID-19 pandemic.²

The volume of information disseminated since the beginning of the pandemic has been tremendous. In addition to scientific articles and journals based on research about the novel virus and its impact, there have been government statements, health agency advisories, news articles, opinion pieces, and a tidal wave of social media postings and commentary.

Under the infodemic umbrella we have 3 categories: information, misinformation, and disinformation.³ Information is considered accurate at the time based on current knowledge. Because of the ever-changing nature of the pandemic, information was updated regularly; many members of the public and some within the health care industry began to have doubts about how much of it was accurate.

This provides an excellent illustration of how science works. New ideas are tested and more data are gathered to continually improve upon prior hypotheses. Such rapid information updates in a situation involving a novel pathogen are expected, with new knowledge shared as it is uncovered. This does not necessarily mean earlier information was bad. Instead, the best information is shared in real time based on evolving knowledge.

False, False, False

Misinformation is false information without intent of causing harm or challenges to care. It often comes from individuals trying to understand something but not having all the data or not being able to interpret that data correctly.

Disinformation is false information created to cause harm or delay care, for various reasons. It is strategic and intentional and can have severe repercussions.

During this pandemic, we have seen many examples of misinformation and disinformation. The deluge of information makes risk communication and public health messaging more challenging. The social media aspect of this pandemic is unlike anything health responders have experienced previously. The level of expertise for social media postings is not regulated and public figures can exacerbate confusion by promoting misinformation and disinformation.

Early in the COVID-19 response, infection preventionists (IPs) scrambled to get as much credible information as they could to share with hospital leadership, staff, and patients. The days were filled with updates from the CDC, White House staffers, international health organizations, and the news media. Topics covered by IP education included isolation guidance, personal protective equipment information, modes of transmission, viral transmissibility and virulence, risk factors, and risk reduction strategies.

Sifting through the data was a full-time job. Then came the need to organize the information and package it in a shareable manner that could address all concerns and questions. Much time was spent talking through fears, unknowns, what was known, or even best guesses.

A challenge was the frequency with which information was updated. One of the best ways to address that is to let individuals know from the beginning that in pandemic response, we learn as we go and we make decisions based on the best evidence known at the time. We must be open to changing course and being flexible as new data become available.

Infodemiology is an emerging field in public health and has some basic tenets that can be used by IPs in navigating the pandemic. One author has described 4 pillars of infodemic management: (1) facilitating accurate knowledge translation, (2) refining, filtering, and fact-checking, (3) building online health literacy, and (4) monitoring and analyzing data.⁴ All 4 pillars were utilized by IPs during the initial COVID-19 response and continuously since.

An example of the ripple effects of misinformation involves the antiparasitic drug ivermectin. A preprint journal article indicated a huge reduction in risk of death for patients with COVID-19 who were receiving ivermectin. As other academics and researchers began reviewing the data behind the conclusions, concerns were raised. The content was pulled from the server based on those concerns, but not before it made an impact. It had been viewed more than 150,000 times and cited more than 30, including meta-analyses that concluded ivermectin was effective in treating COVID-19.⁵

Ivermectin was being prescribed as treatment and, for many, as prophylaxis for COVID-19. This example highlights how quickly information spreads digitally, and the desperation for providers to find something that could help patients before vaccines were available. Even now, as the controversy continues, studies have been inconclusive as to the true efficacy of ivermectin, yet there are calls from the public for prescribing it.

Educate

At the time of this writing, our department was called by a concerned patient with COVID-19 who wanted a friend to bring ivermectin to the hospital to help treat her. This situation is a great opportunity for providing education and resources, but it also goes against medical advice of providers across the country who are using more proven methods to treat COVID-19.

The World Health Organization has published steps for navigating the infodemic to help the public in using self-assessment tools; however, these can be applied to IPs as they help staff utilize resources.² The steps are: (1) assess the source, (2) go beyond the headlines, (3) identify the author, (4) check the date, (5) examine supporting evidence, (6) check your biases, and (7) turn to fact-checkers.

The final 2 steps are of particular interest for IPs. We all have unrecognized biases that we need to acknowledge, especially when it comes to infectious disease prevention, because this is our area of expertise. It can be easy to forget that the public and even health care workers are not as familiar with terminology associated with infectious disease and disease transmission. IPs can approach staff with a certain empathy as they try to better understand risks based on all the information.

Fact-checking is a role that IPs have embraced as part of the research-based and data-based foundations of the field. Evidence-based care is the goal, and the same goes for COVID-19 response. IPs know the reliable sources and are familiar with reading scientific studies and being able to translate those findings to staff in an understandable way. Again, IPs should utilize the 4 pillars and incorporate skills many have learned from prior outbreaks and epidemic experiences.

Another way IPs can help fight the infodemic is to gain the trust of the staff they serve. Individuals are more likely to listen and accept information from a source they trust. IPs are collaborative, striving to facilitate and build relationships to promote behavior change and implement interventions to combat health care–associated infections.

IPs can also be creative with messaging. Infographics, using common language like “flatten the curve,” and combining public health messaging with storytelling are all ways IPs can bring innovative methods to education.⁶ Storytelling is used when reviewing cases of health care–associated infections or other patient safety events. Using stories of patients or from IPs’ personal lives to help others understand the risks and benefits associated with COVID-19 treatments and vaccination can be an effective way of overcoming emotional and fear-based decision-making that we see among the public.

Know the Audience

IPs must also craft their messages to ensure the audience is appropriate. Typically, those with set beliefs about vaccination or the existence of COVID-19 are not easily swayed.⁷ Instead, the focus should be on those displaying hesitancy; those questioning but who have not fully committed one way or another. This group will be more open to credible information from a trusted source. Utilization of social media and other digital methods to convey infection prevention messages is an opportunity for health care organizations. Screen savers, social media posts, scannable QR codes that link to health messaging, and digital town halls are all innovative ways of engaging audiences.

Finally, a core competency for IPs is the need to emphasize pandemic response skills, risk mitigation strategies, infodemics, and risk communication. These skills are difficult to master but should be a part of every IP’s toolkit. As in any crisis, communication is a key to achieving the best outcome. IPs serve as a beacon for keeping science and evidence at the front of minds as information is shared.

REBECCA LEACH, MPH, BSN, RN, CIC, has been an infection preventionist since 2010 with a background in nursing and epidemiology. Leach, a member of the Infection Control Today® Editorial Advisory Board, works at a health care system in Phoenix, Arizona, that includes 5 hospitals and more than 100 outpatient treatment centers.

References:

1. Words we’re watching: ‘Infodemic.’ Merriam-Webster. Accessed September 10, 2021. https://www.merriam-webster.com/words-at-play/words-were-watching-infodemic-meaning
2. Rothkopf DJ. When the buzz bites back.The Washington Post.05-11-03. WP website. https://www.washingtonpost.com/archive/opinions/2003/05/11/when-the-buzz-bites-back/bc8cd84f-cab6-4648-bf58-0277261af6cd/. Accessed October 5, 2021.
3. Let’s flatten the infodemic curve. World Health Organization. Accessed September 10, 2021. https://www.who.int/news-room/spotlight/let-s-flatten-the-infodemic-curve
4. Eysenbach G. How to fight an infodemic: the four pillars of infodemic management. J Med Internet Res. 2020;22(6):e21820. doi:10.2196/21820
5. Reardon S. Flawed preprint highlights challenges of COVID drug studies. Nature. 2021;596(7871):173-174. doi:10.1038/d41586-021-02081-w
6. Scales D, Gorman J, Jamieson KH. The Covid-19 infodemic - applying the epidemiologic model to counter misinformation. N Engl J Med. 2021;385(8):678-681. doi:10.1056/NEJMp2103798
7. Arnold C. Countering the infodemic. Hopkins Bloomberg Public Health. September 8, 2020. Accessed September 10, 2021. https://magazine.jhsph.edu/2020/countering-infodemic