This paper discusses the growing role of social media (SM) platforms to inform and connect communities during epidemics in the digital age, compared to a time when online networks were not as available or utilised by the huge volume of global citizens and Government agencies who use them today. While acknowledging valid concerns around the ease with which misinformation may be spread on SM, important uses of SM platforms are examined in relation to their ability to assist with disease surveillance, their capacity to inform a broad demographic in a timely manner and their assistance in uniting citizens in efforts to control disease outbreaks, concluding that SM is a vital communication tool for keeping populations both informed and connected during an epidemic.
Citizens, governments and medical professionals are uniting around the globe in efforts to slow the spread of the current COVID-19 pandemic that has (as at 25 April, 2020) claimed 184,681 lives and reported 2,686,785 confirmed cases (Health.gov.au). This paper will discuss the important use of social networks to engage and inform online communities and gather information during a public health crisis. I will consider a time when SM was not available during previous epidemics, such as the Severe Acute Respiratory Syndrome (SARS) epidemic. I will explore how the development of Web 2.0 innovations has better impacted dissemination of information by whistle blowers, concerned professionals, health organisations and Government agencies. While acknowledging the concerns around the spread of misinformation and rumour on SM, I will demonstrate the effective use of SM platforms in previous epidemics and during the Dresden Floods in 2013. I will demonstrate how Twitter mining has been used in disease surveillance, and finally I will demonstrate how SM has become a vital component during the COVID-19 pandemic to connect, inform, entertain and unite global citizens. This paper will argue that, despite the ease with which misinformation and fake news can spread on SM, it has evolved in the digital age as an essential and effective tool for communication and information during epidemics.
Unsubstantiated Claims and Fake News
There have long been valid concerns about misinformation and rhetoric during epidemics. Professor Huiling Ding in her 2014 book Rhetoric of a Global Epidemic: Transcultural Communication about SARS, includes information on rhetoric communicated during the SARS epidemic in 2002-2004. Ding (2014) explains that, due to the secrecy of the Chinese Government, citizens relied on limited communication tools to share their concerns (p.106). Ding says speculation and rumour had begun to circulate via alternative media, including websites and text messages, stating that:
In the media contestation in China during the SARS outbreak, the state apparatuses maintained strategic control of both traditional mass media and the Internet through constant policing. To circumvent the state surveillance, the public resorted to the tactical use of alternative media to distribute and receive unauthorized risk messages and dissenting political views. (Ding, 2014, p. 106).
Ding (2014) explored two types of emerging rhetoric. The first she terms “the rhetoric of proclamation,” (p.107), which she explains was used by individuals to distribute dramatic and exaggerated claims to eager audiences who were happy to accept and share statements that were often unverified (p.107). The second, Ding termed: “the rhetoric of personal narratives which [she said] was [used mostly anonymously] by professionals and individual whistle blowers” to disseminate what they deemed important health risk information (p. 107). I will explore this second example later, when examining the importance of developing technology to connect and inform global citizens during an epidemic.
Ding (2014) cautions that many of the anonymous narratives, initially sent (mostly via text messages) by professionals to warn their immediate networks of the emerging epidemic, were very embellished by gossip and rumour, travelling rapidly among expanding networks (p.112). She explains that: “In such messages, the disease was identified as avian flu, Pestis, the plague, Legionnaires disease, and anthracnose. Some versions attributed the disease to mutation of imported pollen. Others claimed it was bio attacks from the United States or Taiwan” (Ding, 2014, p.112).
These same type of unsubstantiated claims and rumour (also known as fake news) are present in today’s digital age during the current COVID-19 pandemic on SM sites such as Facebook, Twitter, YouTube and Instagram. Resulting patterns include panic buying, rumour and division, however these were experienced in epidemic situations long before the advent of SM (Ding, 2014, p.104). While SM may assist in amplifying those scenarios, fake news forms only part of the information disseminated via SM and other sources during an epidemic. There are many positive examples of the use of SM to spread credible and vital information which I will now explore.
Whistle blowers and concerned citizens
The emergence of technology has played an important role in the history of epidemics, enabling whistle blowers, professionals and concerned citizens to warn their fellow countrymen and other global publics of what they consider to be important public health risks.
During the SARS epidemic, Ding (2014) explains that Transnational and International media, while receiving many sources of information from within China, were lacking someone they could deem a credible whistle blower (p.119). That whistle blower emerged as “Dr. Jiang Yanyong, a [retired] 76-year-old veteran physician from the People’s Liberation Army General Hospital” (Ding, 2014, p.119). Dr Jiang was angry when China’s then “Health Minister Zhang Wenkang claimed in a press conference on April 3, 2003 that SARS was under control, that Beijing had twelve cases and three deaths, and that it was safe to travel and work in Beijing” (Zhu, 2003, as cited in Ding, 2014, p.119). Dr. Jiang learned from colleagues of 146 confirmed cases of SARS across just three military hospitals in Beijing. In efforts to warn his fellow Chinese citizens and others abroad, on April 8, he met with Susan Jakes, a journalist from Time Magazine. Dr Jiang’s story was published on Time’s website and was picked up by major media all over the world, alerting global citizens to the concerning spread of SARS (Ding, 2014, p.120). Ding suggests Dr. Jiang bridged the gap between China’s Ministry of Health updates to the public and the true experiences of health professionals in China. The impacts of his actions enabled other doctors to validate his concerns (p.122). This event highlights how important it is for communities going forward to have a voice to disseminate important knowledge and information during an epidemic.
Another important incidence of whistle blowing in an epidemic occurred in December 2019. Before the world was aware of a new Coronavirus, Dr. Li Wenliang, a 33-year-old Chinese Ophthalmologist working at the Wuhan Central Hospital, reported a suspected outbreak of a SARS like illness. After hearing that patients were being quarantined, Li sent a message to a group of his colleagues in a closed group chat via a SM platform called WeChat (Green, 2020, p.682). Li’s initial intention was to warn his fellow medical professionals whose health could be impacted working near possible infections (p.682). Sadly, this concern was substantiated when Li himself became ill with the virus and passed away on February 7. Prior to his death, Li spoke with The New York Times and said: “If the officials had disclosed information about the epidemic earlier, I think it would have been a lot better. There should be more openness and transparency” (The New York Times as cited in Green, 2020, p.682). His courageous efforts enabled others to raise concerns and as such forced the Chinese Government to release information in relation to the virus.
It is not only whistle blowers who have shared valuable knowledge and rallied support on SM during a public health crisis. Many medical professionals have made pleas via sites such as Facebook Twitter and YouTube to demand early action from Governments and to inspire public support for the necessary social distancing and isolation practices during COVID-19. This type of activity on SM echoes what Delanty (2009) defines as community. Delanty defines community as “a system of social relations, rather than something deﬁned by place,” stating that: “community also entails belonging in the sense of sharing something” (p.214). Using the above examples, people of varied citizenship and with varied knowledge are sharing information, advice, statistics and personal narratives in online communities about a pandemic that has unprecedented social, economic and political impacts, proving many global citizens experience a wide versed connectivity via SM during an epidemic.
The effective use of Facebook and Twitter during epidemics and disasters
As official agencies recognise SM as an important tool for both gathering and communicating information, the affordance of particular SM platforms appear more useful during an epidemic. On June 11, 2009, the World Health Organisation (WHO) declared the first global flu epidemic in 41 years (National Public Radio Inc [US], 2009). The H1N1 flu was problematic due to its ability for rapid transmission around the globe (Liu and Kim, 2011, p.233) and initially it attracted a flurry of media attention. Liu and Kim explain that, over time, media attention waned and public health agencies and crisis management teams were faced with a challenge to keep communities both informed and engaged over the longer term of the pandemic which lasted until August 2010 (Fisher Liu and Kim, 2011, p.233).
Fisher Liu and Kim (2011) also found that, although experts at the time claimed that the H1N1 pandemic represented a benchmark for effective use of SM to respond to crises (Smith, 2009, Suter, 2009, as cited in Fisher Liu and Kim, 2011), traditional media was used more heavily to frame the crisis as a disaster (p.241). The researchers suggest this was because formal policy around SM use by government and corporate organisations was only in the early stages of development in 2009 (p.241). Fisher Liu and Kim (2011) also found that SM was often used to link to traditional media during the H1N1 pandemic (p.241), this is an important development as it enables information to be spread quickly to a much broader demographic.
SM has proved an effective tool historically to recruit public action during a crisis. Danish scholar Kristoffer Albris (2018) explains the citizen response via SM to the Dresden Floods in 2013 which he claims created a “switchboard mechanism” (p. 350). Facebook and Twitter groups gathered information from citizens needing help and then connected them with volunteer organisations to coordinate offline response (Albris, 2018, p.353). Albris explains that online communities formed by Facebook Groups such as Fluthilfe Dresden (Flood Help Dresden), Hochwasser Dresden (High Water Dresden) and Elbpegelstand (Elbe Level) “traded pictures and eyewitness accounts [on their Facebook group pages and in doing so], actively participated in the management of the emergency” (p.353). Locals shared general narratives about the floods and also distributed important location advice for areas most needing sandbags and floodwalls. They coordinated the preparation of food for victims and other volunteers and participated in real-world tasks (Albris, 2018, p. 353). This ability of SM to inspire public response is also essential during an epidemic.
Important studies in relation to SM use in regard to public health surveillance have emerged in recent years (Jordan et al., 2018, p.2). A 2016 study examined the effect of mining Twitter data to track the outbreak of Bubonic Plague in Madagascar in 2014 (Da’ar et al., 2017), the study found that Twitter is able to contribute in alerting public health agencies about the outbreak of disease faster than the more traditional means of disease surveillance (p.397). The study explains that globally, public health agencies used “electronic monitoring systems such as EpiSPIDER, HealthMap, BioCaster and the Global Health intelligence [to] Network mine websites like Twitter [using keyword searches] for any reports of flagged diseases [to] provide a real-time tracking of disease progression” (Da’ar et al., 2017, p.397). A similar study in 2019 examined the use of Twitter data to improve surveillance of the 2016 Zika Virus. Researchers found that Twitter could be used to predict disease activity as well as “serve to signal changes in disease activity during an outbreak period” (Masri et al., 2019, p.12). The affordances of particular social networks to inform public health agencies and to encourage positive and effective public action against disease transmission are essential developments as we consider the use of SM during the COVID-19 crisis that has occurred in a now truly digital age.
Epidemics in the Digital Age
The rapid evolution of SM has seen SM platforms and apps become vital communication tools. A WHO report in 2011 titled Strengthening Response to Pandemics and Other Public-Health Emergencies: Report of the Review Committee on the Functioning of the International Health Regulations (2005) and on Pandemic Influenza (H1N1) 2009 recommended that in future crises “WHO should invest in a robust social media presence for rapid communication to a wider, more diverse, audience” (WHO, 2011, p.20). Findings by the review committee include the following statement (in relation to SM use during H1N1): “Facebook, Twitter, YouTube etc have given global communication new dimensions. Because WHO had no policy on (and few resources dedicated to) social media, the Organization’s dialogue with the outside world was compromised” (WHO, 2011, p.120). This was an important finding in relation to future epidemics. According to a 2019 report by Datareportal cited in financesonline.com, there were 3.484 billion SM users in the world in 2019, with estimates forecasting four billion SM users by 2021, equating to a potential 6 out of every 10 people in the world having a social network account by 2024 (financesonline.com, 2019). A 2018 study found WHO and the Centre for Disease Control and Prevention (CDCP) have now developed policy and procedures around SM messaging that have seen public relations expand into the social network space to ensure that all necessary demographics are reached, particularly in a time of crises (Tang et al., 2018, p. 963). In 2020, response to the COVID-19 pandemic has seen health agencies active on SM. There are also links to live updates on traditional media sources from Prime Ministers, Ministers and Presidents streamed across sites including Facebook and Twitter.
Social networks have been utilised for a variety of purposes during this pandemic. Medical professionals have shared their recommendations. Musicians have broadcast messages of hope and entertained through online concerts to ease the burden of isolation. Satirical memes have added to comedic relief. Online gaming communities and streaming services such as Netflix have provided important releases for families. Technology including Zoom, Skype, Facetime and other Cloud based software have saved jobs by enabling a work from home option. Websites have been linked on SM that provide information on Government stimulus packages providing support during unprecedented months of unemployment and economic uncertainty. Images are shared on SM of situations faced by medical professionals in countries where their systems have been overwhelmed, because of inadequate early response. Social distancing and lock-down measures are being communicated and complied with in many countries and images of those in lock-down applauding the work of health professionals are shared around the world. This online connectivity provides a sense of belonging and impacts on citizen response promoting the sentiment that we are all in this pandemic together.
This paper concludes that SM is a necessary and vital component in the digital age for keeping populations both informed and connected during an epidemic. SM is a significant tool when there is need to encourage widespread public response and action. During this latest pandemic, SM has seen contributions that have provided understanding of the COVID-19 virus and the enormous response required to reduce its transmission rates. This paper has also evidenced that keyword data mining of social networks can contribute to disease surveillance.
Critical thinking and caution are important factors in effectively separating useful information from fake news and personal agenda on SM. Though the ability for whistle blowers and knowledgeable professionals to use SM to spread their concerns and advice has proved extremely valuable, wild unsubstantiated claims can also be spread, not only by individuals, but by those who may otherwise be viewed as ‘credible’ sources. This paper has proven however that SM is nonetheless a vital tool in the now digital age to disseminate and demand the flow of essential, credible, public health advice and to keep citizens united in the fight to control disease outbreaks.
Future studies stemming from the current pandemic in relation to SM platforms and their effectiveness in conveying (and providing) accurate information in a timely manner and in championing the necessary measures (from Governments and their publics) to slow down transmission rates of disease, will provide useful data for future health crises.
Albris, K. (2018). The switchboard mechanism: How social media connected citizens during the 2013 floods in Dresden. J Contingencies and Crisis Management. 2018(26), 350–357. https://doi.org/10.1111/1468-5973.12201
Da’ar, B., Yunis, F., Hossain, N. Md., Househ, M. (2017). Impact of Twitter intensity, time and location on message lapse of bluebird’s pursuit of fleas in Madagascar. Journal of Infection and Public Health 10(4), 396-402. https://doi.org/10.1016/j.jiph.2016.06.011
Delanty, G. (2018). Community 3rd Edition. London. Routledge. https://doi-org.dbgw.lis.curtin.edu.au/10.4324/9781315158259
Ding, H. (2014). Rhetoric of a Global Epidemic: Transcultural Communication about SARS. Southern Illinois University Press. https://ebookcentral.proquest.com/lib/curtin/detail.action?docID=1653795
Fisher Liu, B., Kim, S. (2011). How organizations framed the 2009 H1N1 pandemic via social and traditional media: Implications for U.S. health communicators. Public Relations Review, 37, 233-244. https://doi-org.dbgw.lis.curtin.edu.au/10.1016/j.pubrev.2011.03.005
Green, A., (2020). Li Wenliang. The Lancet, 395(10225) 682-682. https://www-sciencedirect-com.dbgw.lis.curtin.edu.au/science/article/pii/S0140673620303822
Health.gov.au, (2020, April 25). Coronavirus (COVID-19) current situation and case numbers. https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers#across-the-world
Jordan, S.E., Hovet, S.E., Fung, I.C.-H., Liang, H., Fu, K.-@., Tse, Z.T.H. (2019). Using Twitter for Public Health Surveillance from Monitoring and Prediction to Public Response. Data 2019, 4, 6. https://www.mdpi.com/2306-5729/4/1/6
Masri, S., Jia, J., Li, C. et al. (2019). Use of Twitter data to improve Zika virus surveillance in the United States during the 2016 epidemic. BMC Public Health 19, 761. https://doi.org/10.1186/s12889-019-7103-8
National Public Radio Inc [US], (2009, June 11). WHO Declares Swine Flu A Pandemic. https://www.npr.org/templates/story/story.php?storyId=105250549
Smith, S. (2009, December 11). New media spread the word on H1N1: Twitter, YouTube messages aimed at public. Boston Globe. http://www.boston.com/news/local/massachusetts/articles/2009/12/11/new_media_spread_the_word_on_h1n1/?s_campaign=315.
Sutter, J. D. (2009, April 30). Swine flu creates controversy on Twitter. CNN http://www.cnn.com/2009/TECH/04/27/swine.flu.twitter/
Tang, L; Bie, B.J., Park, S.E, Zhi, D.G. (2018). Social media and outbreaks of emerging infectious diseases: A systematic review of literature. American Journal Of Infection Control, 46(9), 962-972. https://doi-org.dbgw.lis.curtin.edu.au/10.1016/j.ajic.2018.02.010
The New York Times (February 7, 2020) He Warned of Coronavirus. Here’s What He Told Us Before He Died. https://www.nytimes.com/2020/02/07/world/asia/Li-Wenliang-china-coronavirus.html
World Health Organisation (WHO), (2011). Report of the Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009. https://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_10-en.pdf
Zhu, Y. (2003, April 3). Minister of Health Zhang Wenkang announced, ‘China is Safe.’ Zinghua News Agency.