COMMENTARY

COVID-19: Getting the Information You Need, When You Need It

Prof Mamas Mamas

Disclosures

April 27, 2020

This transcript has been edited for clarity.

Hi, welcome to Medscape UK. My name is Mamas Mamas. I'm professor of cardiology based at Keele University.

We're currently in the middle of the COVID-19 pandemic and this is unlike any other pandemic that we've dealt with, certainly in our lifetimes.

We have a situation where we know little about the virus, little about how to treat it, which treatments are effective, the outcomes of patients, and how best to manage them and restructure our healthcare service to deal with this pandemic.

Often, this type of information has traditionally come from national and international guidelines, but because of the lack of data, these are rapidly developing as we speak. And so there is little guidance from national societies towards this end.

The second source of data traditionally has been the scientific literature, which is peer reviewed.

However, from submission to publication can take many months or even years, and what we need is guidance and guidance now.

Therefore, the purpose of the current video will be to look at exchange of information amongst medical professionals. At the moment when dealing with an infectious agent where we don't know which is the best treatment strategy, we don't know how best to manage it, we rely on experience from colleagues across the world. And we need to be able to have platforms that can support instantaneous communication with such colleagues.

This video will explore three different aspects of this information and communication of this information:

  1. Over social media

  2. Through online repositories for journals

  3. Through platforms such as Medscape and TCTMD, and so forth, that can provide an important service.

Social Media

My first guest is Dr Robert Yeh. He is the Susan and Richard Smith chair in outcomes research at Harvard, and he will focus around the utility and the role that social media has played in disseminating this information. Both the upsides and the downsides.

Dr Robert Yeh

Social media has undoubtedly proven itself yet again to be the most effective medium for real time dissemination of new knowledge during this pandemic. Initial reports of how COVID-19 presented, and its effect on patients and health systems in Wuhan, shortly thereafter in northern Italy, and now the ongoing images from our colleagues in New York City, came first from social media, and in particular from Twitter.

During this pandemic, news cycles can be measured in minutes to hours. The slow updating of traditional media sources, such as television or news websites, have made them seem quickly out of date as new updated statistics on infections and death counts have disseminated in near real-time on Twitter.

Patients posting threads from their hospital rooms, describing their symptoms, their treatment, and their fears, healthcare workers posting pictures of their faces marked by masks worn for hours on end. These have become the most important stories of the pandemic thus far. They've added faces and voices to the statistics.

Social media has played a particular role in the dissemination of treatment practices and science.

Some of these observations have included the benefits of early proning, delayed intubation, the fact that COVID-19 could lead to a syndrome mimicking ST elevation myocardial infarction.

Under assault by a virus for which there has literally been no prior evidence about treatment, we've had the opportunity to see best practices develop in real-time through trial and error, and disseminate around the world within minutes.

The impact of social media during the pandemic hasn't always been universally positive, however.

We've seen the false promise of untested therapies be touted on social media, most prominently by US President Donald Trump, who tweeted about his belief in the effectiveness of the combination of hydroxychloroquine and azithromycin for treatment of COVID-19.

Less newsworthy but equally unfounded beliefs and untested therapies, treatment strategies, have abounded on social media. And on the positive side, these claims have often been met with equally if not more forceful voices of scientific reason.

One must wonder, though, if the mixed signals and disputes about the validity of scientific forecasting models, and about the effectiveness of treatment, about the severity of the disease itself, have created distrust among the public. With so much public disagreement, who is to be trusted?

Expertise has perhaps never held so important a position, yet been so precariously seated as it is today.

True experts and those playing experts on Twitter are difficult to distinguish even for seasoned academic eyes. Traditional media playing catch-up, have seized upon popular Twitter voices, and have been quick to cast these faux experts as true experts on television interviews and news stories. Meanwhile, the true warriors, the health care workers in hotspots around the world, wage their battles, taking occasional breaths to update the rest of the world with images from the front lines.

Theirs are the images and stories that I will remember most vividly when I think about the impact of social media during this 2020 coronavirus pandemic.

Thanks so much for listening. For Medscape UK, I'm Robert Yeh.

Dr Robert Yeh, Katz Silver Family Associate Professor of Medicine in the Field of Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, USA. Dr Yeh has reported no relevant conflicts of interests.

Preprint Servers

Preprint servers provide the means by which researchers can share their information with the wider scientific community.

They do this by uploading a manuscript which has not been peer reviewed, that can be read by anyone, anywhere across the world.

In association with this, they can also submit their manuscript through traditional channels for peer review and for publication.

Dr Harriette Van Spall from McMaster University will talk around how preprint servers have helped in the dissemination of information during the COVID-19 pandemic.

Dr Harriette Van Spall

Fuelled by a demand for quick knowledge dissemination and the setting of the COVID-19 pandemic, preprint servers such as medRxiv and bioRxiv have had more than a 100-fold surge in downloads in the past several weeks. These servers provide a terrific forum for researchers to share results of their studies months in advance of scientific peer review and formal publication.

Manuscripts that pass a basic screening test to assess for plagiarism and harmful health claims are posted on the server within a matter of days. And as with other forums, authors can withdraw their manuscript if they no longer stand behind their work.

Articles on preprint servers can stimulate rich scientific discussion, offering the opportunity for researchers to quickly weigh in on the work and to suggest further analysis or improvements prior to publication. They offer the opportunity for knowledge transfer to the wider public and to media outlets. They can also quickly stimulate new ideas for research.

A drawback though, is that not having undergone rigorous scientific peer review, manuscripts can sometimes be suboptimal in quality, from study design, to analysis, inferences, and conclusions.

They can risk misleading the public, who may lack scientific expertise. They can misinform the public on a wider scale when media outlets start to report erroneous findings.

In the end, not all of the manuscripts on preprint servers meet the standards of scientific review, and about 25 to 30% are never formally published.

Some manuscripts are even retracted. An example of retraction is the study that reported similarities between the structure of the coronavirus and HIV, which subsequently inspired a conspiracy theory about laboratory engineering of the coronavirus. Other manuscripts are merely revised based on public scrutiny.

On balance, preprint servers have sped up the process of knowledge dissemination, discussion and public engagement in research studies, which are amazing benefits.

And despite the urgency of new information required though, the quick access has to be balanced by timely scientific peer review before firm conclusions can be drawn and results safely translated to practice. So room to improve in the process of knowledge dissemination through the use of preprint servers.

Harriette Van Spall MD MPH FRCPC, Associate Professor of Medicine, McMaster University, Canada. Dr Van Spall has reported no relevant conflicts of interests.

Medical Websites

Websites such as Medscape have an important role in the dissemination of medical information to healthcare professionals.

They help in the provision of CME, they provide latest data and new stories, and have experts opine over the relevance and role of data in the management of patients with disease.

Our next guest, Dr John Mandrola, a regular conributor to Medscape, will discuss the utility of such websites in the provision of information and how this information can help guide our management in patients with COVID.

Dr John Mandrola

Hi everyone, John Mandrola here. I'm on my emergency EP (cardiac electrophysiology) rotation here at my hospital in Louisville, Kentucky. Professor Mamas wanted me to discuss the role of cardiology news sites during the crisis. The first thing to emphasise is what Professor Bin Cao from China said early on. He said: "It's not a normal life. It's a COVID-19 life. A pandemic life."

So here are five things I'm looking for during this immense reset.

The first role of cardiology news sites, I think, is to understand the enormity of the moment.

Before the pandemic, medicine was practised in silos: cardiology had a silo, ID [infectious diseases] had one, epidemiology... The virus has shredded these distinctions. Now, basically, we're just doctors.

So that means the second role of these sites is to teach us about the virus. We want to understand things like, for instance, the early management. The site I work with, Medscape, featured a discussion with a young intensivist in New York who early on understood or observed the unique nature of the happy hypoxaemic patient.

He dared to question their early intubation strategy. And now weeks later, the pulmonary literature is embracing such a 'zen-tensivist' type of approach.

Now the pulmonary is just one example I used, we want to know about all aspects of this virus.

So the third thing I'm looking for, which should be easy for cardiology sites, is the overlap with cardiology. We know COVID-19 causes thrombotic issues, myocarditis, this ought to be in the wheelhouse of these sites.

Fourth, I'm looking for coverage of epistemiology. And here I mean the investigation of knowing itself.

To me one of the most remarkable aspects of COVID-19 is how hydroxychloroquine (HCQ) and azithromycin got accepted into normal practice, even codified into algorithms.

It's not just HCQ, remdesivir, IL-6 [interleukin-6], steroids are all being used with really less than compelling, or no compelling evidence.

So I want to read about the tension between clinical judgement and the use of RCTs [randomised controlled trials] for practice.

How do doctors deal with the notion of equipoise during a pandemic?

Finally, I hope that the COVID reset adjusts our concern over tone. My friends, tone is so overrated.

I mean, one of the reasons that fewer and fewer people read regular medical journals is the staid and unimaginative tone in those journals.

In COVID, there is no certainty; there are no true experts. Coverage on internet websites ought to have multiple views, even those that dare question the status quo.

Thank you for your time.

Dr John Mandrola, Clinical Electrophysiologist, Baptist Medical Associates, Louisville, Kentucky, USA, and a regular contributor to Medscape. Dr Mandrola has disclosed no relevant financial relationships.

Final Thoughts

So some final thoughts. I think first and foremost, all three speakers have shown that these modalities of dissemination of information, namely social media, preprint websites, and news websites have played an important role in guiding our practice during this global pandemic.

I think they've also showed downsides associated with each of these media which are very different.

First and foremost, in social media, the loudest voices are often not those with the greatest insight, but rather those with the greatest number of followers.

In preprint websites, whilst they provide an important platform for the rapid dissemination of information, there are no checks and balances around who is uploading this information and whether this information was carried out in a robust environment, or whether even experiments were done.

And finally, whilst news websites have some form of editorial control over the content that they deliver this perhaps lacks the spontaneity and the rapidity that is often seen in social media and other media.

I'd like to thank my guests for offering their insights and I'd also like to thank you for joining us. Please leave your comments below and stay safe

You can follow Mamas Mamas on  Twitter

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