Coronavirus: Falsehoods and misunderstandings propagate in a vacuum of uncertainty

How deadly is Covid-19?

There are many unknowns surrounding the current coronavirus situation. That which we do know is frequently transient, and subject to rapid change. But in a vacuum of uncertainty, rumours and myths propagate unimpeded.

In the unrelenting barrage of claims to which we’re subjected, it has become increasingly difficult to distinguish between claims reputable and reprehensible. And in recent weeks, an explosion of false claims about the virus has begun to cause serious harm. In the words of the World Health Organization (WHO), we are fighting an “infodemic” – “an overabundance of information, some accurate and some not, that makes it hard for people to find trustworthy sources and reliable guidance when they need it”.

Firstly, it’s worth stating what we know about coronavirus – and what we don’t. Coronaviruses are a large family of related viruses that can cause illness, from the common cold to more severe disease. Some of the more dangerous strains include severe acute respiratory syndrome (Sars) and Middle East respiratory syndrome (Mers). December 2019 saw the emergence of a novel coronavirus, now designated severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2). Like other coronaviruses, Sars-CoV-2 appears to be zoonotic, originating in animals before eventually making a leap to humans. Initial reports stemmed from a cluster in a live seafood market in the Chinese city of Wuhan, home to more than 11 million people.

How deadly is Covid-19?

We do not yet know the precise mortality rate of Covid-19, to which Sars-CoV-2 infection can lead. Early estimates from Wuhan put the mortality rate at about 2 per cent; more recent reports published in the New England Journal of Medicine last week put the estimates at 1.4 per cent. In March, the WHO said that the global mortality rate for Covid-19, was 3.4 per cent. There seems to be geographical variation too.

The vital point is that our current estimates will likely change markedly. While some affected by Covid-19 develop life-threatening illness, emerging evidence suggests that it most frequently manifests with mild or even non-existent symptoms. Of confirmed cases thus far, 80 per cent have been deemed mild. At the less severe end of the spectrum, Covid-19 resembles more common colds and flus, potentially indistinguishable from them without specialised testing. It is quite possible that current mortality rates are overestimates, as milder cases could resolve without clinical presentation.

If one compares this with the higher morality rates of Sars (around 10 per cent) and Mers (around 35 per cent), they could be forgiven for thinking that Covid-19 is less dangerous. But this is too much of a simplification – to date, about 8,000 people have had reactions deemed serious, including severe respiratory problems and death. There is substantial variation in how patients respond, with older patients and those with weakened immune systems at much greater risk from serious consequences. Unlike the seasonal flu, there is currently no vaccine nor specialised anti-viral treatment for Covid-19. That means that even if most people infected suffered only mild effects, a large outbreak could still result in many seriously ill people, potentially overwhelming medical resources.

How infectious is Covid-19?

This raises another pertinent question – just how infectious is the new pathogen? The base reproduction number, R0, has frequently figured in conversations about the virus. This is effectively a measure of how many subsequent cases a single case leads to. Most recent estimates for Covid-19 cluster between 2 and 2.5, indicating each case leads to on average to just over two new infections. To put this in context, HIV has an R0 of 2-5 while measles has an R0 of 12-18. But R0 is also not an intrinsic biological property of a pathogen, but rather an estimate of the average number of infections arising from a single case. This is dependent on many other factors, including the impact of public health measures, and does not tell us how dangerous an outbreak might be. Sars, for example, despite having an R0 of 2-5, has to date had only limited reach. Seasonal flu, by contrast, has an R0 of 1.3, and yet infects millions annually.

R0 is also typically estimated from mathematical models in epidemiology with different domains of applicability. This means one often cannot readily compare diseases by R0 alone without deeper cognisance of the problem at hand. Also, R0 doesn’t typically consider the complex spatial dynamics of transmission, which vary considerably worldwide – a virus might run rampant through an area of high population and low immunity, or be effectively arrested if the population is more sparse, or if other measures are introduced to curtail the spread of infection. While useful, R0 demands nuance in its interpretation, and cannot in isolation convey precisely how infectious a disease will be, nor how dangerous it might become.

Falsehoods and misunderstandings

The reality is that we simply don’t know enough yet about Covid-19 to ascertain how contagious it is nor how dangerous it will ultimately be, which is why a cautious, proactive approach is best maintained. What we know about Covid-19 will constantly and rapidly evolve, and so too will our response to it. Uncertainty is inevitable for the foreseeable interim, while the scientific and medical communities continue to put Herculean effort into better understanding the situation at hand. But unfortunately, the vacuum that uncertainty brings is all too often filled by falsehood and misunderstanding. In the era of social media, this has become endemic, and has already begun to cause problems in the current outbreak scenario.

Surgical masks only recommended for infected people

Some aspects of this stem from simple misunderstanding, and understandable panic reactions. Due to fear of the virus, there has been a run on surgical masks which many believe will protect them from infection. But this is in general misguided – the WHO and other public health bodies only recommend use of a mask for healthcare providers and carers in direct contact with suspected Covid-19 cases, or for those who are symptomatic to reduce the chances of infecting people. For others, they are not recommended, and are only effective with correct handwashing protocol. Masks also need to be handled with and disposed of with care if they are to be effective. Worn improperly, they can increase the risk of viral spread. The unintended consequence of not heeding this advice has led to worldwide shortages of masks where they are vital, prompting the US surgeon general to express concern that not only was the panic buying of masks ineffective, it was putting communities at risk.

Ancestry has nothing to do with it

Darker still has been the racist overtones in much of the early messaging around Covid-19. Because of the Wuhan-origin of the initial outbreak, there has been an alarming rise in ugly rhetoric directed towards people of Asian ancestry. Across Europe, there has been a marked uptick in racial abuse and discrimination against those of Asian appearance, with Asian restaurants experiencing declines in business of up to 70 per cent. Chinese nationals in Russia have been targeted by police raids and enforced quarantines, while an Australian tabloid demanded that children of Chinese extraction be isolated from schools. But this is patently absurd, as ancestry does not determine one’s infection status, nor does it impact on their infectivity. Perhaps inevitably, far-right politicians across Europe are falsely trying to conflate the outbreak with immigrants. Italian demagogue Matteo Salvini, for example, has baselessly asserted that African migrants are responsible for cases in Italy. Despite public health bodies explaining repeatedly that border restrictions wouldn’t be effective in stemming infections, it hasn’t stopped far-right figures from insisting upon them, with cynical, feigned concern for public health.

There are no alternative remedies

The panic over the virus has also led to a lucrative market for purveyors of snake-oil. As fears have intensified, an abundance of charlatans and fools have pushed everything from vitamin C to garlic to alternative medicine for coronavirus. An investigation by the Telegraph in the UK found that homeopaths especially were claiming their remedies would stave off infection, while the Indian government proclaimed homeopathy to be effective at treating Covid-19. It is worth being absolutely categorical here – none of these alleged remedies have any medical efficacy whatsoever. Homeopathy especially is a long-debunked idea rooted in vitalism, completely at odds with modern physics and medicine. There’s zero reliable empirical evidence it works, and plenty that it doesn’t. There is no plausible mechanism whatsoever to suggest homeopathy has any efficacy whatsoever against coronavirus. While profoundly irresponsible, false cures are eagerly promoted on social media, undermining public understanding of science and medicine while elevating pseudoscience, with potentially dangerous consequence.

Social media perpetuates falsehoods

Sadly, the rapid perpetuation of falsehoods has been a hallmark of the current outbreak. Dubious messages circulating on WhatsApp especially have created needless panic, despite being utterly bereft of any veracity. Fake health advice and claims have perpetuated virulently across different social media platforms. These frequently masquerade as being from official health bodies; in many jurisdictions, falsified letters ostensibly from trusted health bodies have circulated wildly, replete with scaremongering claims, or fraudulent cures. Such forgeries are supremely unethical, but their existence serves to illustrate that not all claims are shared in good faith. These falsehoods are supremely damaging, spreading panic and misinformation, and by creating a perception of a cover-up where there isn’t one, they undermine trust in public health.

Conspiracies travel further than the truth

Conspiratorial thinking plays a substantial role too – across social media, armchair epidemiologists and basement virologists make alarming pronouncements in a pathetic bid to go viral, a fitting ambition for the topic at least. Unencumbered by reality, these claims swell to grandiose conspiracy theory buttressed by pure assertion; claims that Covid-19 is a hoax or a bio-weapon have been circulated aggressively. A slew of conspiracy theorists on YouTube and beyond assert that the virus is a CIA ploy, or manufactured to make profit from the eventual vaccine. These ideas are outlandish, and not even original; in the mid-1980s, similar claims asserted that Aids was man-made, a fringe view that persists to this day. In something of a historical echo, Soviet intelligence were the main vector of that falsehood, with the intention of fermenting distrust in the US. Today, Russia remains the dominant force in viral propaganda, and already there is evidence that Russian-based social media accounts are disseminating explosive falsehoods at an industrial rate.

Alarmingly, such falsehoods have travelled exponentially further than reliable information. An analysis by Newsguard makes for troubling reading; claims on just one conspiracy site that the "coronavirus is a bioweapon stolen from Canada" achieved over 2 million engagements on social media in the past few months, while similar claims by the Mind Unleashed, another conspiracy site, amassed 15 million engagements. In the same period, the Centers for Disease Control and Prevention (CDC) website garnered only 175,000 social media engagements, despite being the top result in Facebook searches for "coronavirus". The WHO website on Covid-19, while authoritative, achieved only 25,000 engagements.

Faced with figures this stark on the dominance of falsehoods on social media, it is difficult to disagree with the WHO’s assessment of the situation as an “infodemic”. While we have lived on the cusp of pandemics before, we have never had to endure the simultaneous assault on reality that unrelenting disinformation brings. Sadly, research to date indicates we are supremely poor at differentiating falsehood from reliable information. We are far more likely to react than reflect, to our collective detriment. Psychological literature to date indicates we are exceptionally vulnerable to emotive falsehoods, and deeply uncomfortable with uncertainty.

Observe information hygiene

Covid-19 is a potent reminder that whether in medicine or politics, the only protection we have against those who would mislead us is our capacity for critical thought. And while this isn’t intuitive, it can be learned, and it is urgent we do so. To circumvent the worst consequences of disinformation, we must strive to maintain a healthy scepticism, accepting only information from reputable sources. Carl Sagan’s dictum that “extraordinary claims require extraordinary evidence” is crucial to keep in mind when confronted with the cacophony of falsehoods this outbreak will unleash. We should strive for a policy of information hygiene, only sharing substantiated and verified claims. It’s also vital we remind ourselves that empty vessels frequently make the most noise, and that many who spread falsehoods are motivated by ego and need for attention rather than good faith.

This is crucial to keep in mind, as subscribing to falsehood and conspiracy theory only serves to jeopardise public health. We should be guided by the good advice of public health bodies, such as the WHO, CDC, and HSE, to minimise infection risk; thorough hand-washing, isolating ourselves if we are ill, and avoiding touching our faces. While the period ahead is uncertain, it’s vital we do not surrender to scaremongering – our collective wellbeing depends upon it.

Dr David Robert Grimes is a physicist, cancer researcher, and author of The Irrational Ape: Why Flawed Logic Puts us all at Risk and How Critical Thinking Can Save the World