COVID-19 Mental Health Working Group

concept paper series

Topic – Fighting the infodemic to promote
resilience in our shared online minds
An RMIT Enabling Capability Platform Research Initiative – A Healthier Start, September 2020

The COVID19 pandemic has affected us all. However, the effects on mental health have not been
universal. Therefore, the road to recovery after COVID-19 is complex. This series of papers
engages experts across multiple disciplines, addressing digital engagement and the need for
information, and the unique mental health recovery challenges experienced by students, carers,
older adults as well as stigmatised or marginalized communities. Each of the papers in this series
is structured as follows: What we know, what we don’t know and what we can do to map a
nuanced path to effective creative recovery.

What we know

The word “Infodemic” was coined as a mix of “information” and “epidemic” in 2003 by journalist and
political scientist David Rothkhopf [1] and has been used by the World Health Organisation
Director-General Dr. Tedros Adhanom Ghebreyesus recently to refer to the fast spread of
misinformation about COVID-19 [2]. In addition to creating confusion and even panic about the
origin of a disease, infodemics can also spread misinformation about treatments and preventive
measures, posing serious threats to public health [3]. The WHO established the Information
Network for Epidemics (INE) in response to the COVID-19 infodemic, to provide access to timely,
accurate and easy-to-understand advice and information from established medical research
institutes on public health crises (https://www.who.int/teams/risk-communication).

Misinformation during a pandemic can be traced back to the Middle Ages. During the Black Death
plague pandemic in Europe, it was believed that plague spread through poisons in the air, and
doctors wore beaked masks as personal protective equipment [4]. At the present time, the WHO
has stated that there are no known effective interventions for preventing or treating a SARS-COV2
infection. Unfortunately, misleading claims by some health professionals, as well as
unsubstantiated home remedies to treat COVID19 abound on the internet, disseminated via both
social media, as well as some traditional media outlets. For example, some Canadian
chiropractors promoted their interventions as capable of boosting immunity against as SARS-
COV2 [5], despite a statement by a Canadian chiropractic regulatory body that “the prevention and
treatment of infectious disease is not within the scope of chiropractic practice” [6]. As another
example, messages are spreading through social media naming garlic as a miracle remedy for
treating COVID-19, despite a complete lack of evidence [7].

Is the public ready for the ramifications of the COVID-19 infodemic? Seeking health
information online has become routine for many people during lockdown. Research
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concept paper seriesUnclassified

shows that most people are credulous and easily believe information on social media sites like
Twitter [8]. The credulity in misinformation by the public can lead to severe and even lethal
consequences. A report [9] released by the Iranian government showed that over 700 deaths from
alcohol poisoning may be associated with a fake “alcohol remedy” which originated in social media
accounts, suggesting “alcohol builds immunity against COVID-19", without any supporting
evidence.

What we don’t know

There is an immediate need to research the connection between consumption of COVID-19 related
misinformation, and the emotional reactions and the behavioural patterns that eventuate for
individuals, and at the population level. Exaggerated reports about the risks of the disease can
trigger anxiety and unnecessary visits to hospital emergency departments, stressing the healthcare
system. Conversely, a recent study in the UK warns of substantial increases in cancer diagnoses
overall, as well as presentation at more advanced stages of cancer after the COVID-19 pandemic
is over, due to decreased or postponed cancer screening tests [10]. Depending on their
personality, some individuals may continue to avoid hospitals for medical screening tests for fear of
being infected, even when it becomes safe to do so.

Repeated exposure to the misinformation such as exaggerated information on pandemic estimates

[11] can cause persistent negative emotions, which may develop into clinical mental health
conditions. It is important to establish whether particular types of misinformation may lead to
longer-term cognitive changes, given the associated behavioural changes may promote further
damage to the health of individuals. For example, misleading claims by some physicians during the
pandemic may lead people to mistrust healthcare professionals in general, and resist critical
medical interventions when these are required [11].

It may be especially important to determine and manage the psychological distress faced by
vulnerable groups during the pandemic, as a result of misinformation about COVID-19. Individuals
with pre-existing underlying mental health conditions such as anxiety and depression may be
uniquely reactive to misinformation about a global health crisis. Research is needed to examine
how health misinformation may trigger or deepen anxiety or depression. As such, it will be also
important to understand what strategies could effectively mitigate infodemic-driven episodes of
stress, anxiety and depression during crises like the COVID-19 pandemic.

What we can do

In the internet age where the public can easily generate and share information online, health
misinformation will exist well beyond the current COVID-19 pandemic. The spread of
misinformation will remain one of the grand challenges of the 21st century [12]. We advocate for
cross-disciplinary joint research efforts to understand the impact of health misinformation on the
mental status of the population during the crisis, and its impact on the mental wellbeing of
individuals beyond the crisis period.
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To directly counteract the infodemic, we call for establishment of an agile, inclusive, national
information network as the authoritative information source to disseminate evidence-based
information and behavioural guidelines about COVID19. While there are government or health
organization websites, they have a limited focus, and are not curated to provide information to
diverse vulnerable groups, for example those with mental mood disorders. By providing sensitively
real-time information, this network could prevent needless mental distress.

Software tools for monitoring media contents and automatic detection of harmful misinformation
about pandemics are also needed to effectively combat the spread of misinformation on social
media platforms. For example, algorithms have been developed to automatically detect rumours
about COVID-19 on Twitter (https://xiuzhenzhang.github.io/rmit-covid19/). Additionally, education
tools on the credibility of information and guidance to public fact-based sources, should be co-
developed by researchers, governments, minority and disadvantaged groups and others.

Advanced technologies such as big data and artificial intelligence (AI) can be integrated into other
disciplines to achieve digital transformation for mental health care. Online misinformation attracts
reactions from the public, resulting in large volumes of natural language text data from users
expressing their feelings and emotions. Such big data enables the development of AI tools to
analyse and monitor the mental health status of the nation in relation to generating and accessing
misinformation. Moreover, social science researchers could exploit and further fine-tune such AI
tools for focused analysis of different community groups. Results from such large-scale analysis
will ultimately drive mental health researchers develop novel, evidence-based diagnosis and
treatment of mental health issues triggered by misinformation.

To address a grand challenge at the population scale like the COVID-19 pandemic, concerted
efforts from multiple disciplines including information technology, biology, mental health science
and social science are required [13], to help sustain the mental wellbeing of society, by reinforcing
healthy online information channels and enabling society to react appropriately and confidently to
any future global health challenges.

References:

1. https://www.merriam-webster.com/words-at-play/words-were-watching-infodemic-meaning.
Accessed on 10 July 2020.
2. Zarocostas, J., 2020. How to fight an infodemic. The Lancet, 395(10225), p.676.
3. Mian, Areeb, and Shujhat Khan. "Coronavirus: the spread of misinformation." BMC
medicine 18.1 (2020): 1-2.
4. Black, Winston. The Middle Ages: Facts and Fictions. ABC-CLIO, 2018, pp. 169-190.
5. Kawchuk, G., et al., 2020. The use of internet analytics by a Canadian provincial
chiropractic regulator to monitor, evaluate and remediate misleading claims regarding
specific health conditions, pregnancy, and COVID-19. Chiropractic & Manual Therapies, 28,
pp.1-7.
6. https://www.chirobc.com/ccbc/wp-content/uploads/2020/06/CCBC-Professional-Conduct-
Handbook-JUNE-2020.pdf. Accessed on 20 July 2020.
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7. " Coronavirus ‘cure’ involving boiled garlic water appearing on WhatsApp, Facebook”.
https://7news.com.au/technology/coronavirus-cure-involving-boiled-garlic-water-appearing-
on-whatsapp-facebook-c-703797
8. Shariff, S.M., Zhang, X. and Sanderson, M., 2017. On the credibility perception of news on
Twitter: Readers, topics and features. Computers in Human Behavior, 75, pp.785-796.
9. https://www.abc.net.au/news/2020-04-28/hundreds-dead-in-iran-after-drinking-methanol-to-
cure-virus/12192582. Accessed on 10 July 2020.
10. Maringe, C. Spicer J., Morri M., Purushotham A., Nolte E., Sullivan R., Rachet B., Aggarwal
S. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in
England, UK: a national, population-based, modelling study. The Lancet Oncology July
2020, DOI:https://doi.org/10.1016/S1470-2045(20)30388-0
11. https://litfl.com/i-dont-trust-doctors/. Ioannidis, JPA. 2020. Coronavirus disease 2019: The
harms of exaggerated information and non-evidence-based measures. Eur J Clin Invest.
50(4).
12. https://www.bbc.com/future/article/20170301-lies-propaganda-and-fake-news-a-grand-
challenge-of-our-age
13. Holmes, Emily A., et al. 2020. "Multidisciplinary research priorities for the COVID-19
pandemic: a call for action for mental health science." The Lancet Psychiatry.

Authors:

Associate Professor Xiuzhen Zhang, Professor Magdalena Plebanski and

Associate Professor Keely Macarow

RMIT contact:

Associate Professor Xiuzhen Zhang: [email protected]

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Author: Andrea Davies
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