Viewpoint: Infection Preventionist Guide to Dealing with COVID Misinformation

Recently, there has been a lot of misinformation being disseminated over the internet whose source has been mixed messaging sometimes spurred by federal agencies. Some of the information has been contradictory but some has also been ill advised.

The US Centers for Disease Control and Prevention (CDC) has recently posted information which has been used to cast doubt regarding the number of individuals who have died of COVID-19 and even questioned whether it is more deadly than the flu.

“While there is still much to learn about COVID-19, at this time, it does seem as if COVID-19 is more deadly than seasonal influenza; however, it is too early to draw any conclusions from the current data.”

“For 6% of the deaths, COVID-19 was the only cause mentioned. For deaths with conditions or causes in addition to COVID-19, on average, there were 2.6 additional conditions or causes per death.”

Kevin Kavanagh, MD

This comes on the heels of no longer recommending that one test for asymptomatic carriage of the virus.

The messaging is then amplified on the internet by what often seems to be a perverse and coordinated effort. A study from Carnegie Mellon University found that over half of the accounts tweeting about the coronavirus are likely bots and appear to have similar playbooks to those of Russian and Chinese intelligence agencies. Reuters has reported that a European Union document which outlines a Russian campaign of fake news; which is both confusing and malicious, making governmental communications regarding the coronavirus difficult.

Unfortunately, the CDC’s mixed messaging may be used against infection preventionists, and for the most part infection preventionists need to assume the role as the top messenger of reliable information.

But it is imperative that infection preventionists engage and combat this messaging on social media and wherever it occurs. To not do so, allows misinformation to fan the pandemic, placing all of our lives at risk.

First, they have a playbook. Infection preventionists also need to develop one. Keep a list of the common themes you are seeing and make a corresponding list of retorts, with references, that you can cut and paste into social media. Also, I would use the term “COVID-19 virus” not “SARS-CoV-2” since the latter is not in common use by the public.

I like to respond to comments in either my own posts or posts that I agree with. If you do not like a comment, it is best to start a new post. The reason, the more comments a post has the higher the ranking it achieves with a search engine. Thus, I seldom argue with a post I disagree with. I will instead start a new post with a train of comments.

Here are some major misinformation themes and examples of a few retorts to be used in responses:

#1. The young rarely die from COVID-19, so they do not need to follow precautions and we do not need to implement new strategies to open schools.

Retort: “It is just not “death.” With advances in medical care, President Trump has stated, the mortality rate has fallen by 85%. I’m not sure it is that low, but it is lower. But to “survive” is not the same as “recovered.” The reason why the Big 10 and Pac 12 football season was postponed was because 15% of their athletes who tested positive for COVID-19, including those with mild or no symptoms, developed inflammation of the heart, according to school officials. This can be very serious, and we do not know the long-term effects. Eighty percent of children who contract the COVID-19 virus are asymptomatic. Even though they do not show symptoms, they are still highly infectious which places their teachers, parents, and grandparents at grave risk. (Note that many will likely believe Sport Team Physicians, over trained Epidemiologists.)

Sources:
A) Remarks by President Trump in Press Briefing on COVID-19. White House. July 27, 2020. https://www.whitehouse.gov/briefings-statements/remarks-president-trump-press-briefing-covid-19/.

B) Upadhyaya P. PSU football doctor clarifies comments on percentage of COVID-positive athletes with myocarditis. Centre Daily Times. September 4, 2020. https://www.centredaily.com/sports/college/penn-state-university/psu-football/article245448050.html​

C) Davies NG. et al. Age-dependent effects in the transmission and control of COVID-19 epidemics. Nature Medicine. June 16, 2020. https://www.nature.com/articles/s41591-020-0962-9​

#2. You cannot believe the elite scientists.

Retort: It is not that the scientists are smarter than anyone else, but they have more experience. This is not their first rodeo. Many have obtained a PhD in studying the various methods of measuring how and why diseases spread and have dealt with epidemics throughout the world for decades. They have been there and done that. Their advice is not just coming from recent events in the United States, but from what has happened with COVID-19 in Europe and with numerous pandemics which have occurred over the last century. An excellent historical review of epidemiology and pandemics is A Pandemic Century by Mark Honigsbaum. (Be sure to stay away from “expertise,” or “smarter.” Stress experience instead.)

#3. COVID-19 is not as deadly as the flu, it is all overblown.

Retort: We have already lost far too many souls. Over 180,000 in the United States. This figure is confirmed by the over 200,000 excess deaths (as of August 1, 2020) we have seen this year as compared to historical data. And we must not forget that unlike the flu, COVID-19 affects every organ of the body. Approximately one third of college football players have inflammation of their heart which may manifest symptoms years later. Many are now using complex misleading statistics to lower the case fatality rate by counting the large numbers of those who may have asymptomatic disease. However, in doing so, the infectivity of the virus is then also greatly increased which produces the same number of societal deaths. And there is mounting evidence that asymptomatic individuals may not have lasting immunity.

Sources

A) Lu D. The True Coronavirus Toll in the U.S. Has Already Surpassed 200,000. New York Times. Aug. 13, 2020. https://www.nytimes.com/interactive/2020/08/12/us/covid-deaths-us.html​

B) Robbiani DF. Et al. Convergent antibody responses to SARS-CoV-2 in convalescent individuals. Nature. 584, pages437–442(2020). https://www.nature.com/articles/s41586-020-2456-9​

C) Long QZ, Tang XJ, Sit QL, et al. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. Nature Medicine. June 18, 2020. https://www.nature.com/articles/s41591-020-0965-6​

D) Ibarrondo FJ., Fulcher JA, Goodman-Meza D. Rapid Decay of Anti–SARS-CoV-2 Antibodies in Persons with Mild Covid-19. NEJM. July 21, 2020. https://www.nejm.org/doi/full/10.1056/NEJMc2025179​

E) Upadhyaya P. PSU football doctor clarifies comments on percentage of COVID-positive athletes with myocarditis. Centre Daily Times. September 4, 2020. https://www.centredaily.com/sports/college/penn-state-university/psu-football/article245448050.html

#4. Hydroxychloroquine can cure COVID-19. This is a difficult issue since there is a highly organized effort with nearly 100 low-quality papers (some of which are erroneously described as trials) on the internet. There are even complex websites supporting this effort. The most successful retorts are:

Retort: There have now been 5 randomized controlled trials with three being double blinded which have found Hydroxychloroquine to not be effective. These studies include those who are without symptoms having been recently exposed, and patients who are mildly and severely sick. In addition, there is a new laboratory study which has found that HCQ works on the monkey not the human enzyme which allows the coronavirus to enter cells. And why not focus on the drugs (Camostat mesilate or nafamostat mesylate) which are currently in human trials which block the enzyme found in humans? All of the effort spent on HCQ would be better placed on other more promising compounds. This is really inhibiting our efforts to find a cure.

Sources
A) Kavanagh KT. Hydroxychloroquine Works in Monkeys, Not Humans. Infection Control Today®. August 3, 2020. https://www.infectioncontroltoday.com/view/new-study-hydroxychloroquine-works-in-monkeys-not-humans​

Troll Answer: Yes, but these studies did not use zinc for azithromycin and did not follow the Zalinski Protocol. Thus, they were set up to fail.

Retort: “Vladimir Zalinski has claimed his protocol to have a 99% success rate, which I find hard to believe. There is no scientific evidence that excess zinc will help a viral infection (although one certainly does not want to be zinc deficient). And adding the antibiotic azithromycin is a toxic mix. Both hydroxychloroquine and azithromycin prolong the heart’s QT interval which will have additive effects on causing life-threatening heart arrhythmias. COVID-19 virus positive patients often have inflammation of their heart and I feel giving them this cocktail is both dangerous and has little if any benefit.”

Sources:
A) Zev Zelenko. Newly Published Outpatient Study Finds that Early Use of Zinc, Hydroxychloroquine and Azithromycin Is Associated with Less Hospitalizations and Death. CISION PR Newswire. July 15, 2020. https://www.prnewswire.com/news-releases/newly-published-outpatient-study-finds-that-early-use-of-zinc-hydroxychloroquine-and-azithromycin-is-associated-with-less-hospitalizations-and-death-301094237.html​

B) Upadhyaya P. PSU football doctor clarifies comments on percentage of COVID-positive athletes with myocarditis. Centre Daily Times. September 4, 2020. https://www.centredaily.com/sports/college/penn-state-university/psu-football/article245448050.html​

Finally, as you become successful, trolls will try to redirect your conversation by baiting you into highly controversial, but unrelated topics. Do not take the bait, just respond to the answer at hand. If they do not wish to engage in this, then you have prevailed and just reinforce your position.

Trolls will also try to bait you by leaving disparaging and insulting comments. Your efforts will be successful, then the trolls finally accuse you of “genocide.” This is common, even guests on news programs have talked about this accusation. Do not fall for this, just ignore it. Remember, if you both get banned, you have an account which has taken years to develop, the trolls almost always have a sham account which they can repost in minutes. Just politely respond and report them to the page moderator.

After you have done all of this, you will notice that you have numerous exchanges with one individual. That this individual has left a junkyard full of highly complex and intwined web of misinformation. Yet for all of this work, when you go to the troll’s home page, it will most likely be blank. This tells you may be dealing with a professional. If the troll responded to you throughout the entire day, he may well be on a payroll.

With a little effort and experience, you will have prevailed, which elevated the visibility of your original comment on search engines and have prevented a misinformation initiative whose genesis may have been from a foreign intelligence agency.