First, Do No Harm: Covid-19, Conspiracy and Social Media

We have never dealt well with viruses. Of any sort. The reality is that, until the very recent development of a very few antiviral agents, the only effective medical treatment for viruses has been prevention by vaccination and/or isolation. Even these new antiviral agents tend to be virus specific, and generally treat but not cure, unlike the broad-spectrum antibiotics used for bacterial infections.

It took centuries of vaccination to rid the world of smallpox, as those of us with vaccination scars on our arms or thighs can attest. Measles and polio might also have been eradicated had not the anti-vaxxer movement come along, substituting new age conspiracy theory for medical evidence.

To those who say it is okay, we will develop “herd immunity” to the virus by culling out the weak, not only do you not really understand the concept, your epidemic solution by Darwinian selection depends on three factors.

One, that once exposed or recovered from illness, you can not get the virus again, or in a more virulent form. That is unproven. There is some evidence that that may not be true. If it is not true, it bodes ill for vaccine development.

Two, Sequelae. A fancy medical way to say “What follows?” We currently have little to no information about long term sequelae to this virus, our total experience with it being only about six months. Why is this important? Because death is not the only measure of an illness’s effects on health and economics.

  • Chickenpox, a relatively minor viral infection in most children, can and often does, return as “shingles” in later life. (Having had shingles, trust me you do not want it. Period. )
  • Mumps can cause infertility in post adolescent males
  • German Measles can cause birth defects
  • Hepatitis B and C often return as liver cancer 20 years down the road. There are many more such examples.

So far there have been several serious complications identified as possible COVID-19 sequelae, heart damage, strokes in relatively young people, renal failure , coagulopathy and even a Kawasaki-like disease syndrome in children, long thought to be relatively immune to the worst effects of COVID-19 . If you measure the impact of the virus solely by death rate you overlook the human and economic cost of perhaps permanent conditions caused by the same disease. I would posit that a 40-year-old man unable to move his arm or speak should be considered in your rush to open your favorite sports bar, that a woman having to spend many hours each week in dialysis while awaiting a kidney transplant should figured in to your economics. (Not to mention your humanity.)

Three, human value does not end at age 60. This really should not require further explanation.

Even as folks argue that the exposure rate has been higher than reported, taking it as evidence that the death rate is less than previously thought, there is significant evidence that the death rate is being significantly UNDER reported. The total mortality rate for those areas hardest hit is far higher than normal. On the order of 50% higher. Correlation does not necessarily imply causation, but there is no other easy or reasonable explanation why there is such a spike in total deaths at the same time as the virus appears, a spike not accounted for by deaths officially reported as due to COVID-19. That is not conspiracy theory, that is an unfortunate fact.

Misinformation, Myths and Outright Lies

Which brings us to the point of all of this, the unending stream of misinformation, myths and outright lies bombarding us on social media.

I have had the misfortune of receiving many of these posts from friends and colleagues who should know better. People whose professional training and livelihoods are supposed to be based on the best medical science available. Yet they lend credence to preposterous fables by sharing them on their own social media, and within groups organized for the benefit of their profession. The recent video by a disgraced biologist is but one such example.

These stories generally fall into three categories but all rely on both factless conspiracy theory and scientific ignorance for propagation:

Snake oil cures: From drinking bleach (no, I’m not talking about him…though it’s interesting that you thought so) colloidal silver, megadoses of vitamins to hydroxychloroquine and azithromycin. The motives behind these fables these are usually quick profit, self-aggrandizement, or both. Beware the story that contains the phrase “They don’t want you to know about this…” or its equivalent. If it sounds too good to be true, it probably is. The down side is some of these “cures” are toxic and dangerous, and for those involving real medicines they cause shortages for people who actually need them for other illnesses. Everyone wants a quick cure, and many will pay a lot for it. But remember, we suck at treating viruses. A miracle cure would be just that…. a miracle. The Alleged Bad Guys: FDA, Big Pharma, CDC, WHO

It’s not that bad: Yes, it IS that bad. “_____ kills more people than the Coronavirus…” is an invalid argument on its face. We went to war over the 3,000 people killed at the World Trade Center attacks. More than that are dying every day from COVID-19. The current observed mortality rate from Covid-19 in the U.S. is about 6%. While we do not yet know the true fatality rate because there has been so little testing, it is exponentially higher than the seasonal flu. Also, as above, there is little said about the level of morbidity in survivors of the disease. This is why it is better to “Plan for the Worst, and Hope for the Best” rather than “Plan for the Best and Screw the Rest”. The motives here are generally political and economic. Whether in fear of the ballot box or of the bottom line, these myths are propagated to demonize those whose interest is public health. It “only kills the old and infirm” is an unbelievably immoral argument, even if it were true. Unfortunately for that argument, around 20% of fatalities are under age 65. Sadly, these posts are almost invariably followed by a post lamenting the loss of a Firefighter, Paramedic, Nurse or Physician while nobley fighting the pandemic. The danger? By down playing the severity of the disease, we create doubt about the need for safety measures, more people ignore the restrictions and thus become ill… transmit the disease to yet more people… a vicious circle. The Alleged Bad Guys: Hospitals, CDC, WHO, Big Government, Governors, The Other Political Party, Science

It is All Someone Else’s Fault: Here is where the biggest conspiracy theories originate. From the Bondian “Dr. No created this virus in a lab so he could develop a vaccine so he can implant a microchip in my brain” to “It was developed in a Lab in China and paid for by Obama” These myths are generally political in nature, trying to save face and blame shift, or advance an extreme viewpoint that it is in no way associated with the disease. “They are trying to take away your right to _____” is often the danger signal in these posts. Remember, extraordinary claims require extraordinary evidence. Do you really think that thousands of scientists around the world managed to keep a secret to which only your special friend on YouTube is privy? These kind of hoax posts take valuable time and attention away from solving real problems. The Alleged Bad Guys: Tech Firms, China, The Other Political Party, the United Nations, The Illuminati, Scientists, Medical Doctors , Obama, Vaccines and maybe Space Aliens

Malpractice by Facebook ?

If you carry a title or initials after your name that implies some degree of expertise in medicine or public health policy, you have a responsibility to make sure that those things you support on social media reflect actual medical science and best practices, just as you do on the job. Your politics, personal financial interests, sense of humor or mood should not play a role. In this area, if no other, you are obligated to do the research. Yes, everyone should do the same, but your sources should be impeccable. What you say and do does MATTER. Do not be the one shouting FIRE in a crowded theatre.