On March 22, Dr. Janine McCready, an infectious disease specialist at Michael Garron Hospital, called out the province for maintaining that COVID-19 is coming primarily from foreign travellers.
“We need a clear statement openly acknowledging community transmission & letting go of the preoccupation with travel,” she tweeted, saying this information was weeks behind the reality she was seeing in the emergency room. “(This) lack of recognition of the increasing number of cases with NO LINK TO TRAVEL is irresponsible.”
McCready continued, arguing that the public had been led to believe they were not at risk if they had not been in contact with travellers. But, McCready went on: “People need to modify their behaviour NOW & we need to give them accurate information so they can do so.”
The next day, the province ordered all non-essential workplaces closed. The day after that, Dr. Theresa Tam, Canada’s chief medical officer of health, announced that community transmission had overtaken travel as Canada’s primary source of virus cases.
While it’s questionable if Tam was influenced by McCready’s tweets, the episode is one of many examples of social media presaging public health authorities.
The daily press conferences held by Canada’s public health officials are supposed to provide the most up-to-date information on the pandemic and the best advice for how to stay healthy.
But expert voices on social media have become an alternative source for the latest science and most effective policy options — and they often get it right before public health.
Frontline physicians and academic researchers on Twitter proved prescient when they called for borders and road lanes to close, dramatic increases in testing and the public to wear masks. They were right when they warned of asymptomatic spread in long-term-care homes well before it was publicly recognized by officials.
While this expert advice is available online, it’s lost in the rapids of Twitter’s river — a volatile mixture of specialist and layman messages that the WHO has called an “infodemic.”
Much of the legitimate scientific criticism is motivated by a desire to speed up clunky government policy making, which by design is cautious and careful.
“The virus is very fast and it requires a speedy and nimble response,” McCready told the Star in an interview. “I was raising those (issues) in the public view to try and move things along.”
“As a front-line health worker at a hospital, I have the luxury of seeing everything unfold,” she said. “Seeing people die in front of me makes me more impatient and makes me want to move those things ahead. Whereas at the policy level, that’s not happening right in front of you. And you’re seeing the numbers and they don’t look that bad.”
Public officials say they rely on data-based decision making, but some online critics assert that we need to loosen our definition of good data.
“You can’t wait for class 1A evidence when you’re in a fast-moving pandemic with a brand-new microbe that nobody knows anything about,” said Dr. David Fisman, a professor of epidemiology at the University of Toronto’s Dalla Lana School of Public Health.
“To say: ‘We’re not certain yet, so we’re not going to make a decision yet and we’re going to hold off on acting while we gather more data.’ Sometimes that’s appropriate. But in the face of a public health emergency where lives are on the line and things are moving fast, I think that’s actually very dangerous,” he said.
A good example, Fisman said, was a general reluctance to acknowledge the “silent spread” of COVID-19 through asymptomatic or minimally symptomatic transmission.
“That information has been out there for a couple of months now,” he said, citing reports from coronavirus outbreaks in Asia, the U.S. and Europe. “At this point, it’s pretty hard to ignore.”
Yet Ontario didn’t prohibit personal care workers from working in multiple long term care homes until April 22, allowing them to spread the disease within a particularly vulnerable population for weeks. More than 950 people have died in long-term-care homes.
“To be hauled, kicking and screaming over a period of three weeks to that position (instead of) taking action based on the possibility that that might have been correct in March, when people were starting to flag this, I think it’s quite likely that would have saved some number of lives,” Fisman said.
Frontline doctors are used to making quick decisions based on incomplete evidence. They do it all the time, said Dr. David Walker, a professor and the former dean of the medical school at Queen’s University. Public health officials, on the other hand, must be far more conservative in their decision-making.
If doctors get it wrong, their patients die and that impacts patients’ families and friends.
“When public health gets it wrong, the quantum is so much greater. It isn’t just you who dies, it may be hundreds of you that die,” said Walker, who chaired the expert panel on SARS in 2003.
Yet Walker still sees the benefit in the public exchanges between patient-facing physicians and number-crunching epidemiologists, even if they can give the impression of infighting and uncertainty.
“Transparency has tremendous risks, but is far better in the long run for gaining the faith of the public than the reverse,” he said. “But it also makes for a hell of a lot more work.”
In many ways, the online discussion is the scientific method being played out in full view of the public.
“I find it incredibly useful,” said Ashleigh Tuite, an assistant professor of epidemiology at the Dalla Lana School. “You have people who are from outside your area of specialization, who may not be experts in a particular topic, but they’re asking questions that you might not otherwise ask.”
Tuite’s first epidemic after graduation was the 2009 H1N1 virus, which started in the U.S. and Mexico. Back then, the way public health officials and scientists grappled with the newly discovered virus couldn’t have been more different.
“At that time, science was science and you communicated by email and in meetings,” she said.
During the outbreak of Ebola in West Africa in 2014, things began to change, said Tuite, and collaborating with people you had never met became commonplace. Scientists and researchers started exchanging information online via specialized networks like ResearchGate, and were soon publishing co-authored papers.
The COVID-19 pandemic of 2020 has taken that one step further, with the scientific conversation moving out of specialist forums and into the public domain.
“What’s different now is that you have scientists communicating in these open forums, but you also have the public much more engaged than then,” she said.
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“You can read in real time what people are thinking and what they’re debating and you’re not just a passive viewer. You can interact with these people.”
Twitter can be a double-edged sword because it can help scientists digest and evaluate the massive amount of research that is coming out, but it can also muddy the waters for the public, which is not used to being presented with preliminary findings, unconfirmed results and research study “preprints” that have yet to be peer-reviewed.
“It’s fraught,” said Tuite. “The reality is that everybody is overwhelmed. Everybody is in a rush to get data and research out. And even when something is peer reviewed, it doesn’t necessarily mean that it’s good quality science.”
Tuite receives emailed requests to peer review studies virtually every day. In the rush to get published, some of them only give her 48 hours to evaluate and sign off on the work.
Watching this scientific truth-finding work itself out in real time can be exciting for those participating, but disorienting for outsiders — the public looking for trustworthy information.
“It’s a really good moment for thinking about scientific literacy,” said Colleen Derkatch, an associate professor of English at Ryerson University who studies rhetoric in health and medicine.
“We’re seeing scientific and medical research unfold in real time,” she said. “The debate over fact status is totally normal in the academic disciplines. It just doesn’t tend to spill out into the public.”
Discerning which expert to pay attention to is the hard part, she said.
Twitter announced on March 20 that it would ramp up its proactive verification of accounts belonging to epidemiologists and public health experts, adding a blue check mark to help distinguish specialist accounts.
The social media platform has also added a feature that puts local public health recommendations at the top of any search results related to COVID-19.
Designating authorities does little to prevent bad science from circulating and even getting promoted by politicians and celebrities, said Derkatch.
Whether it’s U.S. President Donald Trump speculating that an anti-malarial drug could be used to treat COVID-19 or musing about injecting disinfectants, misinformation and pseudo-science are working their way from the fringes of the internet to government advisories.
One video of a family doctor demonstrating how to disinfect groceries went viral in late March, racking up more than 25 million views. The only problem? It was bad advice (microbiologists say you should not scrub your fruit and vegetables with soap. It could make you vomit or give you diarrhea.)
“That video caught like wildfire because he had all the right rhetorical apparatus: He had scrubs on, his name was Doctor. He tapped into that kind of fear that people have and gave people a way to gain a sense of control,” said Derkatch.
People are desperate for answers, and when they find something online they have a tendency to grab on to it, said Dr. Isaac Bogoch, an infectious disease expert at the University of Toronto’s medical school.
“Everyone’s looking for a win. And rightfully so, this is truly affecting the world. We’re starving for information and positive and negative information is pounced on,” he said. “A study comes out and all of a sudden people say: ‘Oh my god, we have to rethink everything we’ve done.’ Well, no we don’t.”
Anecdotal data, small scale studies and research that hasn’t yet been peer reviewed is released and the public doesn’t know how to interpret how reliable the data is, he said.
“They’re going right from pre-print to the media without any filter. And all I can think is ‘Ugh. It’s going to take a week to dispel this one.’”
While there has always been debate within the medical and scientific community around translating data to policy, he said, now people have a front-row seat.
“Yes, senior health leadership have to be held accountable,” he said, “but it has to be factual.”
“If you follow the data, you will find the right path.”