The coronavirus pandemic has been accompanied by a disinformation pandemic, sometimes called the "infodemic." We have discussed how individual health care professionals trying to counter disinformation by educating patients and the public have encountered resistance, opposition and worse. Here we discussed how health care professionals who sought to educate demonstrators who advocated quickly "reopening" the economy about the perils of doing so were subject to screams, insults, and charges they were "crisis actors." Here we discussed how health care professionals who tried to counter disinformation online were subject to online challenges, insults and threats, and worse, how President Trump's campaign was organizing a cadre of "extremely pro-Trump" professionals who would parrot his messages, no matter how disinformative.
The Worsening Infodemic
Since then the disinformation problem has gotten much worse. A recent study by Islam and colleages(1)
identified 2,311 reports of rumors, stigma, and conspiracy theories in 25 languages from 87 countries. Claims were related to illness, transmission and mortality (24%), control measures (21%), treatment and cure (19%), cause of disease including the origin (15%), violence (1%), and miscellaneous (20%). Of the 2,276 reports for which text ratings were available, 1,856 claims were false (82%).
So the challenge to health care professionals from disinformation has gotten much worse. On August 18, 2020, the New York Times reported
Doctors on the front lines of the global pandemic say they are fighting not just the coronavirus, but also increasingly combating a never-ending scourge of misinformation about the disease that is hurting patients.
The Times article included multiple anecdotes suggesting that the infodemic is directly harming patients:
An internist in New York treated a vomiting patient in May who drank a bleach mixture as part of a fake virus cure found on YouTube.
And in June a paramedic in Britain aided a clearly sick man who had refused to go to a hospital after reading misleading warnings about poor coronavirus treatment on social media.
Also,
Dr. Ryan Stanton, an emergency room physician in Kentucky, said a number of sick patients had waited until it was nearly too late to visit a hospital because they were convinced by what they had read online that Covid-19 was fake or 'no big deal.'
Similarly, the article by Islam et al noted estimates of the numbers of people who may have had adverse effects because of actions they took in response to disinformation: 800 dead and 5876 hospitalized world-wide after "consuming methanol as a cure for coronavirus"; "rumors have been the reported cause of 30 deaths in Turkey;" etc.
According to the Times article, health professionals who tried to challenge disinformation did not find it easy:
An emergency room doctor in Illinois was accused in April of profiting from naming coronavirus as the cause of a patient’s death, a rumor spreading online.
Also,
Some doctors say they face abuse when they participate in online discussions to correct the record.
And,
Dr. Mell, the physician in Illinois, encounters regular abuse from Facebook users when he has pushed back on false information.
Presumably efforts to combat disinformation should be informed by understanding of its sources. The Times article briefly discussed physicians opinions of them.
Before the pandemic, medical professionals had grown accustomed to dealing with patients misled by online information, a phenomenon they called Dr. Google. But in interviews, more than a dozen doctors and misinformation researchers in the United States and Europe said the volume related to the virus was like nothing they had seen before. They blamed leaders like President Trump for amplifying fringe theories, the social media platforms for not doing enough to stamp out false information and individuals for being too quick to believe what they see online.
A Major Source of the Infodemic: the US President and His Cronies
It would have been unthinkable a few years ago, but some physicians now are willing to state that a major source of dangerous health care disinformation is the current US president.
[Trump Chicago Hotel]
In fact, the media has been replete with accounts of such disinformation propagated by President Trump. Multiple articles have cataloged examples of such disinformation. The most recently updated were in published in August, 2020, in the Washington Post, and the Atlantic.
Here is a summary of instances of disinformation that Mr Trump has peddled related to the coronavirus pandemic. Sources are the two articles above or as noted.
Epidemiology, Diagnosis, Prognosis
The coronavirus is the same as influenza: "This is a flu. This is like a flu." (from the Washington Post, March, 2020.) However, coronavirus differs from the flu in its structure, epidemiology and clinical manifestations.
The coronavirus pandemic would spontaneously diminish or vanish, e.g., "disappear," "fade away," or "go away." There is no rationale for this, and no trend in this direction in the US.
The pandemic is already going away, e.g., “Coronavirus numbers are looking MUCH better, going down almost everywhere,” and cases are “coming way down.” The national case rate did decrease for a time, but then greatly increased, and now is considerably higher than it was a few months ago.
COVID-19 is not a severe disease, especially for children, e.g., children are "virtually immune," "99% of COVID-19 cases are 'totally harmless'" There is no evidence children are immune. Cases in children are now rising. The rate of significant morbidity or death is much higher than 1%.
Tests for coronavirus in the US are extremely accessible, e.g., "anybody that needs a test gets a test," "we're going up proportionally very rapidly," the US has done more testing "than all other countries combined." There have been multiple reports of shortfalls in and inaccessibility of testing.
The US case rate is high because the US testing rate is so high: "There is a rise in Coronavirus cases because our testing is so massive and so good, far bigger and better than any other country." (from the Independent, July, 2020.) By many measures, the US testing rate is lower than that of many other developed countries.
If testing stopped, then there would be no more cases, e.g. "If we stop testing right now, we'd have very few cases, if any." (from the Independent, June, 2020.) This appears to be an instance of the logical fallacy of the appeal to ignorance, often characterized as "absence of evidence does not imply evidence of evidence" (see this from Logically Fallacious).
Prevention, Management, Treatment
Hydroxychloroquine is safe and effective as a treatment or preventative drug, e.g., "I happen to be a believer in hydroxy. I used it. I had not problem," There is no good evidence that hydroxychloroquine is an effective treatment or preventative measure. There is evidence that it has important and not rare adverse effects.
Bleaches or disinfectants could be administered internally for prevention or treatment (from the New York Times, April, 2020.) Doing so actually would be extremely dangerous, and possibly fatal. Note that there is reason to suspect that Trump's disinformation on this topic has harmed people. After he publicly discussed using bleach or disinfectant internally as a treatment for coronavirus, calls to poison control centers seemed to rise (from Vox, April, 2020.) The article by Islam et al noted instances of patients harmed by ingesting disinfectant.
No Organized Challenges to Trump's Disinformation from Health Care Professionals
Donald Trump has extensively promoted disinformation about the coronavirus. As US President, he commands a substantial "bully pulpit." Essentially everything he says publicly is reported by US and foreign media. He holds forth on Twitter daily, reaching millions of followers. Thus his information is influential, and apparently dangerous.
Health care professionals have seen patients whose beliefs about the coronavirus pandemic are now apparently inspired by disinformation, including specific points pushed by Mr Trump. These beliefs have led to dangerous actions, and at times adverse effects. Professionals sworn to put their patients' welfare ahead of all other concerns are thus in a bind, needing to challenge the leader of the richest country in the world to persuade their patients to avoid dangerous choices.
While physicians on the front lines are now struggling with how to best deal with the disinformation influencing their patients coming from the highest office in the US, they have gotten little support from their leaders. I found only a few instances of physicians in positions of leadership and influence willing to challenge President Trump.
The most direct challenge was found in an editorial in the British Medical Journal by two American authors, both academics at respected institutions, one a full professor in a global health institute. The authors had the courage to entitle their article "Donald Trump: a political determinant of covid-19." (2) They asserted that
After the US confirmed its first case of covid-19 on 22 January 2020, Trump responded with false reassurances, delayed federal action, and the denigration of science.
In particular, they were willing to state:
Trump’s anti-scientific pronouncements during covid-19 have been particularly perilous. On 28 February, he said that the coronavirus would soon disappear on its own 'like a miracle.' On 21 March, he promoted the anti-malarial drug hydroxychloroquine for 'use immediately' as a treatment, despite the lack of evidence for its effectiveness. His promotion triggered 'panic-buying, skyrocketing prices, and overdoses in malaria-prone regions in Africa and South Asia,' and led to shortages of the drug for those who need it to treat other conditions such as lupus, for which it has proved benefit. Rick Bright, the director of the US agency that oversees covid-19 vaccine development, says he was removed from his post because he questioned Trump’s promotion of hydroxychloroquine. On the day that the CDC advised the public to wear face masks, Trump said he would not wear one himself. On 23 April, Trump suggested that injecting disinfectant or bringing 'light inside the body' could cure covid-19, prompting experts to urgently warn the public against inhaling or ingesting bleach.
Beyond this moral clarity, I could find only one other instance of a senior academic physician directly challenging Trump, and that was only indirectly about Trump's enthusiasm for disinformation. From the Independent, July, 2020:
A leading professor of medicine has called president Donald Trump 'unteachable' on the subject of masks and said that it indicates he is not competent to manage the response to the coronavirus pandemic.
In an appearance on CNN, Dr Jonathan Reiner, professor at the George Washington School of Medicine & Health Sciences, responded to the president’s latest remarks regarding the wearing of masks.
'He is unteachable and I can’t understand it. His failure to understand this simple public health measure, his reluctance to accept the advice of all of his public health experts, makes me wonder whether he is qualified now to manage this.'
I have so far found no other instances of leading academics, like professors, chairpersons, deans, chancellors, vice-presidents for health affairs, university presidents; or of journal editors, hospital executives, leaders of professional societies, executives of health care corporations, etc, etc who were willing to publicly challenge Trump's disinformation. I have found no official statements from any of these institutions or organizations that challenge Trump's disinformation.
At best, medical societies have put out statements reiterating the need to base policy about the pandemic on the best evidence. For example, the American College of Physicians put out a statement that supported "the use of scientific expertise, based on the best available evidence, in the fight against COVID-19." However, these statements do not explain the context, that is, how the current president has denigrated scientific expertise and evidence as informative in efforts to manage the pandemic.
Fighting a deadly pandemic is hard enough. It is gut wrenching that the fight is being subverted by political leaders spreading disinformation. It is sad that front line clinicians are hardly supported by those who claim to lead them. Where is the courage? Where is the outrage?
"If not now, when?"
References
1. Islam MS, Sarkar T, Khan et al. COVID-19-related infodemic and its impact on public health: a global social media analysis. Am J Trop Med Hyg 2020. Link here
2. Yamey G, Gonsalves G. Donald Trump: a political determinant of covid-19. Brit Med J 2020; ; 369 doi: https://doi.org/10.1136/bmj.m1643. Link here.
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