“Whoever controls the media, controls the mind.”
(Jim Morrison)
Introduction
While the last few months witnessed a global health threat named coronavirus disease 2019 (COVID-19), the spread of information about the pandemic was much faster than the virus itself. There has not been 1 day since the World Health Organization (WHO) declared COVID-19 as a “public health emergency” that people have not come across messages, memes, or videos related to COVID content, going widely viral on the social media.[1] Added to that is the plethora of information about the outbreak statistics (number of cases and causalities in every single geographical distribution), being fed daily to the common masses. As billions are isolated or quarantined at their homes, in an attempt to contain the infection, “digital screen time” exposure has increased with much more penetration of media.[2] Subsequent to the same, every single day “information pollution” about COVID-19 adds to the already existing uncertainty and panic about the virus and lockdown. In our daily lives, we have seen people with eyes glued to their television, laptop, or mobile screen busy consuming news feeds related to the coronavirus. This often assumes a “compulsive” nature, with the need to stay updated on every single facet about the illness, that further increases the psychological discomfort and physical unrest.[3] Keeping this in background, this review looks at the significance of information during COVID-19, the psychology behind spread of misinformation, and finally, perspectives on a balanced role of media in such disasters, proposing ways for its healthy integration into public and psychosocial health.
Information and Coronavirus Disease 2019: Role of Media
Contrary to popular belief, COVID-19 is not the first “digital infodemic.” In the recent past, the outbreaks of Zika in Brazil, Ebola in Africa, influenza in Europe, and Nipah in India had similar bidirectional relationships with media.[45] However, the degree of “media panic,” the amount of media consumption, and the consequent change in public reaction have been paramount during COVID-19, especially considering that the modern world has been unprepared for such a large-scale biological disaster. Harding in “Pandemics, Plagues and Panic”[6] highlights how the spread of an outbreak and the resultant human behavior can be influenced significantly by the flow and vectors of information. Any piece of news attaching an existing belief or theory to the ongoing “topic of interest” can serve as a potential vector (for example: during COVID-19, the well-known antiviral effect of garlic according to Ayurveda has been generalized to garlic being considered as an antidote of coronavirus, which is definitely a false news propagating vector). Identifying such vectors is useful in debunking misinformation. Health communication and understanding of public health depends a lot on how the data about an illness are interpreted by the masses.[7] Within every bit of news, there can be a potential admixture of “fake information” with the major challenge being teasing out both separately. This health-related misinformation becomes all the more crucial during a pandemic like COVID-19 when the “fear of an unknown infection without a definitive cure” mixed with “an anxious mind” tends to easily accept “fast solutions and theories,” irrespective of visible loopholes in their logic and reasoning.[8] One senseless forward of a wrong message in wrong hands can snowball the spread, increasing the acceptability as it moves along the chain. Often, names of credible public health agencies such as the WHO and Centers for Disease Control and Prevention are tagged along wrongly to make the piece of false news more credible and acceptable.[9] Similar things were being circulated during the first wave of infection in China, implicating “biological weaponry” in the manufacture of coronavirus. It unfortunately remained viral on various social media platforms for more than 2 weeks till the WHO finally discredited it.[10]
Misinformation and Rumors: Mechanism of Spread
There is a certain price we pay for being social beings. This includes the continued sharing of misperception and faulty interpretations of information. Like the Aesop's Fables where a boy starts chasing a crow after hearing from a stranger that the crow has his ear, we all tend to follow lucrative and hope-generating information in times of fear and crisis, irrespective of the authenticity of evidence. Fake news or rumors are sometimes socially useful half-truths with strong emotional overtones that help it spread fast, gripping human minds to create “common” consciousness and agency, but with dire social consequences.[7]
Health-related misinformation has been studied extensively in health communication and cognitive psychology. Jamuna Prasad, a social psychologist, was the first to establish a relationship between high levels of anxiety and the spread of false news.[11] Later, multiple studies have established the link between various forms of disasters, human-made or biological, and rumor mongering.[1213] At times of uncertainty, people rely on knee-jerk speculation and prejudice. Based on the theories summarized by a systematic review of literature on health-related misinformation,[14] here are some psychological perspectives as to why the snowballing of fake news occurs, with examples from the current pandemic.
- False but commonly held beliefs: A message on social media that ginger and turmeric can cure COVID-19 went viral after an accidental text. Although it is a commonly held belief that ginger has antiviral properties, there is no evidence about its effectiveness in fighting coronavirus
- Generalization of other false beliefs to the current crisis: A common false belief is that the consumption of hot water helps combat multiple illnesses. Not surprisingly, it is wrongly believed that hot water can kill coronavirus
- Cultivation theory: Repetitive exposure to consistent and regular news (fake or true) can “reiterate, confirm, and modify” values, beliefs, and perceptions of reality. How the news is portrayed is important. This is commonly how advertisements work
- Social learning theory: New behaviors can be fostered by imitating and observing popular or idealized others in the media. Certain stereotypes, mannerisms, and choices of celebrities tend to get popular in community cultures through this mechanism
- Theory of negativity bias: The prohibition or negation of certain acts is often accepted as preventive measures. For instance, decreased consumption of chicken or seafood has led to a marked reduction in their sales. This is more acceptable as a preventive strategy to most people than wearing masks or maintaining good hand hygiene
- Modeling of rumor: A hearsay or rumor becomes a learned behavior for fear of social deprivation. If a majority of members in one's social network are doing something, it is easier to blindly follow them
- Overanalysis and faulty interpretation of science: Phenyl/cresol/autoclave is known to kill viruses. The same logic is being used for coronavirus without any evidence. Furthermore, there are half-baked theories about reptiles and birds spreading the virus. The widespread hoarding and use of hydroxychloroquine (HCQ) immediately after it came in news has led to many inadvertent side effects and mortality [15]
- Motivated reasoning: Human beings, usually, accept things in keeping with their culture and traditions. For instance, Indians are more likely to believe that herbal remedies made of tulsi (holy basil) and triphala (ayurvedic herbal formulation) are effective, even if there is little scientific evidence to support the claim. Similarly, religious or local customs often compound the practices related to the disease outbreak
- Fear reasoning: Human beings fear the “unknown” or “uncertain.” In such cases, the anxious mind cooks up its own remedies and tends to accept the most irrational or logically bizarre facts. That explains why antibiotic sale has increased considerably due to self-medication and prescriptions, even though they have no efficacy against coronavirus. Hoarding of protective medical equipment, antivirals, and sanitizers has not only led to panic but also their unavailability for hospitals and patients who need them
- Boomerang effect of social media: Hundreds of fake videos about the outbreak in India, mass burials in China, virus spreading through cattle, etc., on various social media platforms bear testament to the perils of senseless sharing. Conspiracy theories like coronavirus being used as a biological weapon or biowaste may make for stimulating debates, but eventually, they add to the global panic and hysteria.
The Impact of Information during Pandemics
“We have sold our priced jewelry to go to this treatment camp. They charge high for each vial of medicine. It is also far from our house. Many people from our village told it works and we can prevent corona infection. Now my son is so ill after taking this tonic. Doctors are not able to help much” (mentioned by a lady from rural Assam).
“People don't talk to me anymore. They move away when they see me. My neighbors give me a strange look. I fail to explain them my role in the whole process. It makes me frustrated when I return home” (from a doctor working in a COVID-19-designated hospital in Karnataka).
“I was too scared. I just wanted to get the medicine to save my elderly mother. It was all over the news. I got lot of messages that it must be taken by all at risk to stay safe” (son of a senior citizen, who had cardiac arrest after taking inadvertent dose of HCQ in West Bengal).
These excerpts have been slightly modified for anonymity and reproduced with informed consent from the individuals. They are obtained from the crisis calls made to the National Institute of Mental Health and Neurosciences COVID-19-related mental health helpline.
The excerpts mentioned above are both from general public in urban and rural areas as well as frontline health workers, all of whom were the victims of misinformation and related stigma.
The impact that information or misinformation can have on human behavior is remarkable. It can range from faulty treatment, noncompliance to precautionary measures, panic, mass hysteria, agitation, and competition for health-care resources.[16] On the other hand, relevant and timely information has shown to improve preparedness for infectious diseases and strengthen public health infrastructure.[17] One of the main related platforms, social media, thus can be a “double-edged sword.” A review by Kadam and Atre [18] points out that social media reach has risen three times during the lockdown period in India, with COVID-19-related search spiking significantly. The inherent insecurity and lack of daily structure that strikes people during lockdown makes them feel inadequate without the constant feed of health-related information. It is indeed extremely challenging to ensure a fine balance between the “toxic overuse” of technology and the healthy and systematic harnessing of health data. Many distress calls that the helplines of our tertiary mental health-care center cater to nowadays are related to compulsive use of the Internet and social media leading to health anxiety, somatic complaints, anxiety, depressive disorders, agitation, and insomnia. On a different note, children and adolescents being exposed to more “online time” tend to develop technology and gaming addiction. It is vital to remember that certain unhealthy habits will long outlast the pandemic to cause continued problems in life. Furthermore, anxiety and apprehension about an unknown illness might increase irrational decisions and inadvertent self-medication. One such popular example is the selective appearance of HCQ in the media as a “life-saving” drug against COVID-19 which has overshadowed the strictly prescribed guidelines for its use and the weak scientific evidence for its widespread use against the coronavirus.[15] Such a selective portrayal of scientific literature generalizing the effects of treatment in its early phases, especially during a crisis like pandemic, can quickly generate a “false hope” with overuse against the recommended safety guidelines. Furthermore, social media-related “blame” can also lead to stigma, marginalization, communalism, and violence, especially at such times of crisis.[19] In India, people from the North East, certain religious communities, and lower socioeconomic classes like the migrants and homeless have already been victims of such stigmatization related to COVID-19 in our country.[20] This labeling of “outsiders” in these polarized populations can further increase the social unrest during the already difficult situations. Furthermore, the generation of “self-stigma” in the minority groups increases stress, delays the detection and treatment of mental comorbidities, and perpetuates the vicious cycle of social prejudice.[19]
“Digital Balance”: the Integrative Role of Media and Technology
Information dissemination definitely has its own merits. It cannot be looked into as an “all-or-none” process. History has proven that continued and timely liaison between media personnel and scientific community can help immensely for the information-education-communication outreach in the community.[21] The increased use of social media can be a powerful tool for debunking misinformation itself. The linkage of various media platforms with scientific databases such as PubMed and Google Scholar can provide appropriate search guidance, and content analysis of the search data gives useful information about the search trends, the popular “sought for” information, and the unmet need for data.[22] Those can then be harnessed for authentic updates and fighting false news. Social media owing to its increased penetration, popularity, and consumption is uniquely equipped to aid public and mental health during such times. Various proposed ways of this integration are summarized in Table 1.
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Table 1: Role of social media during pandemics
Awareness for healthy use of technology can be spread by social media itself with administrative reforms regulating unnecessary forward and rumormongering related to the ongoing pandemic.[2] In the short run, such regulations are imperative. In the long run, destigmatizing pandemics, preventing prejudice in community, and addressing the collective anxiety need to be the goals of the government. Recently, the Regional Outreach Bureau of the Ministry of Information and Broadcasting, Government of India (GOI), had launched a digital media and messaging campaign drive related to COVID-19 for the rural areas.[23] The messaging service focused on the following targets: maintaining good personal hygiene, abiding by the lockdown rules, ensuring social distancing, targeting mental and physical health, prevention of rumormongering, and downloading the Aarogya Setu app. The messages were also made in local languages and dialects to cater to the sociolinguistic diversity of the country. The audio version of the same was popularized by all the telecommunication companies which played the message compulsorily during any call and also appropriate advertisement on audiovisual and print media. The Aarogya Setu (Health Bridge) application, developed by the National Informatics Center, was introduced by the GOI to spread awareness and connect essential COVID-19-related health services to the people of India.[2324] It is a tracking app that uses smartphone's global positioning system (GPS) and Bluetooth features to track the coronavirus infection. It tries to determine the risk if one has been in the proximity of a COVID-19-infected person, using geolocation and containment zone data. Although debates have persisted about the “coercive nature” of its use and security concerns, it has definitely been a novel use of technology during the pandemic for the greater good. The various modalities of media with their respective challenges are summarized in Table 2.
Table 2: Proposed channels of media communication during a pandemic
The pandemic has also led to increase in suicidality and self-harm attempts. Although systematic studies are yet to emerge, various reports have been published globally including India.[2526] Besides the usual psychological impact of stress, isolation, and panic on suicide, media reporting can also have a significant effect on suicide prevention efforts. Extensive coverage, portrayal of information, fantasizing suicide in vulnerable groups, and drawing inconclusive evidence between the pandemic and suicidality can all lead to misinterpretation and public chaos. The “Werther effect” is already a well-known manifestation of “copycat suicides” in vulnerable consumers of media. Studies have consistently found a relevant association between how suicide is portrayed in the media and the effects on the viewers/readers. On the other hand, the protective effect of media is paramount in suicide prevention.[27] Also known as “Papageno effect,” this involves responsible reporting of suicides (especially during disasters and for popular figures), educating the audience about prevention strategies, raising awareness about the early signs of self-harm, encouraging prompt detection and management, targeting at-risk population during the pandemic, and finally, enhancing care for those already suffering from psychiatric disorders.[28] Liaison between the media outlets and suicide prevention helplines along with those for woman, child, and elder safety can not only decrease self-harm but also age- and gender-based abuse that has increased during the ongoing crisis. It is also important to remember that media professionals themselves get affected with suicide reporting and vivid visual content, with studies showing a high prevalence of insomnia, acute stress, depression, and complex posttraumatic stress disorder in them.[29] Hence, peer support, counseling, and managerial sensitivity are prime necessities at all hierarchical levels in media organizations. Public health agencies like the WHO has clear guidelines for suicide reporting by the media, especially in sensitive situations.[30] Few facets of the same are highlighted in Table 3. These are, however, more commonly overlooked than implemented.
Table 3: Responsible reporting of suicides by media
Conclusion
Irrespective of profession or socioeconomic background, it becomes the collective responsibility of stakeholders at all levels to join the fight against health-related false news that can have devastating public health and social consequences. Societies can never be fully informed or secure, so rumors are inevitable, particularly during the present times. However, providing active and relevant rebuttal will help in tackling this “unwarranted fatalism” of information. Importantly, we need to understand that we do need information, but “loads of statistics” about every single aspect of “the virus” make no sense to the masses. They will do more harm than good. Maintaining a conscious and informed distance from social media can help increase the “COVID-free” time which is so necessary for the mental well-being.[31] Technology can rather be used for social connectedness than isolating people in their own “digital spaces” that can add to loneliness, isolation, and depression. When the viral caseload is peaking globally, the most desired plan is obviously to prevent COVID-19 from invading our “mental peace.” In keeping with those lines, “digital distancing” can be best practiced through these words of Abraham Lincoln, “Discipline is choosing between what you want now and what you want most.”[32]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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