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Public Health Goes Viral—Online

How social media is changing disease and disaster response

By Lauren Weisenfluh

Published November 28, 2012

As Hurricane Sandy left lower Manhattan in darkness, social media sites like Twitter and Instragram remained lit up during the night of the storm with information about the damage before many leading news outlets, transmitting real-time photos of the damage and information about shelters, school closings, and transportation disruptions.

As it has for popular uprisings and flash mobs, social media has changed the way public health is communicated, allowing users to get information from many different sources in real time, without the need to turn to rely on official channels. Tools like Twitter, Google Flu, and Health Map are today being used for collecting information after natural disasters, surveillance of infectious disease outbreaks, and reporting sex crimes in war zones.

In this new era, a tweet from a farm of infected pigs during a swine flu outbreak can help prevent the spread of H1N1, and an Instagram photo from a flooded parking lot in Lower Manhattan can warn people of where to avoid during a hurricane.

But as the public health response to disaster and disease relies increasingly on digital technology, especially social media, it is testing the fine balance between swift and valid information, creating concern about the spread of dangerous rumors that could do much more harm than good.

Social media has perhaps been most effective in the world of infectious diseases, where outbreaks can be tracked based on user activity weeks before traditional surveillance methods, saving countless lives.

One of the leading surveillance technologies is Google Flu Trends, which aggregates flu-related terms that users search for on Google, to predict the arrival of flu season. A 2009 study of the new technology praised Google Trends for its “great promise as a timely, robust, and sensitive surveillance system.”

When swine flu, also known as H1N1, swept around the world, researchers found that on Twitter, trending tweets accurately reported H1N1 disease activity. In the future, it is believed such activity could help public health professionals fight disease by focusing educational and quarantining efforts.

Social media is useful as a public health surveillance tool because of the rapidity of information.

“The speed is useful…an extra week or two can be massively important in preparing a response,” remarks Ken Eames, head of the Flusurvey website, a flu-information aggregation site, in a BMJ article.

In Haiti, both Twitter and HealthMap—another online disease outbreak monitoring system—accurately predicted a cholera outbreak after the 2010 earthquake a whole two weeks before public health officials did.

Despite the great promise of social media, the spread of false information has been a problem during several health crises.

During the H1N1 outbreak, hysterical tweets circled the globe. One read: “be careful of the swine flu!!!! (may lead to global epidemic) Outbreak in Mexico. 62 deaths so far!! Don’t eat pork from Mexico!!” Another read: “Short Ribs! How long before the Swine Flu hysteria crashes the pork market? 2 hours? 3?” This despite the fact that H1N1 isn’t transmissible through infected pork consumption.

The quick spread of these messages has tapped into fears that people with malicious intentions could capitalize on social media to disable or confuse responders.

I think it’s only a matter of time before the next generation of cyber-terrorists… take advantage of the escalating fears over the next epidemic and pollute the networked public sphere with scares that would essentially paralyze the global economy,” writes Dr. Evgeny Morozov, a visiting scholar at Stanford University and Schwartz Fellow at the New America Foundation, in his Foreign Policy blog.

On the other hand, during Hurricane Sandy the Twittersphere quickly shut down a user named @ComfortablySmug, who tweeted false information like that the New York Stock exchange was flooded with three feet of water, to his 6,000 Twitter followers.

By the next morning, his tweets had been debunked and his true identity as a hedge fund analyst was revealed.

However, before he was discredited, he had been re-tweeted 500 times.

While the hysteria campaign of @ComfortablySmug ended relatively swiftly, other falsifiers were not publically reprimanded. As fake photographs of the damage of Hurricane Sandy—such as a threatening cloud over the Statue of Liberty—circulated Twitter, so too did reminders “Think before you RT (re-tweet).”

Still, after Sandy, the benefits of Twitter seemed to outweigh the costs. The Twittersphere kept users in the Northeast informed about power outages, fallen trees, dangerous roads, and other information.

In a sign of its power as an informational tool, even official sources have in the last few years taken to Twitter to communicate up-to-the-moment developments.

During Sandy, government officials, like New Jersey Governor Chris Christie, New York Governor Andrew Cuomo, and New York City Mayor Michael Bloomberg, regularly tweeted information to their followers, including adjusted transportation schedules, power outage information, and shelter and food distribution sites.

Even the federal government has gotten on board. The Department of Homeland Security in November hired Accenture for $3 million to investigate public health trends using social media. The goal is to spot the next public health outbreak as it happens.

Even if the government is not equipped to spot the next outbreak, millions of other Twitter users will be.

Edited by Elaine Meyer. Additional research by Josh Brooks.

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The views and opinions expressed on this website are solely those of the authors and do not represent those of the Department of Epidemiology, the Mailman School of Public Health, or Columbia University.