Editor's note: The book 'The Coronavirus, What You Need to Know About the Global Pandemic' co-authored by Dr Swapneil Parikh, Maherra Desai and Dr Rajesh Parikh give an illustrated account on human history's tryst with pandemics. Apart from talking on the current health crisis, it talks about several other issues that have emerged as a fallout of the pandemic.
Here is an excerpt from the book:
One of the most haunting videos from Wuhan shows a woman slumped on the floor of her balcony in an upper floor of an apartment building. Desolate, she bangs an improvised gong and cries out repeatedly, ‘There’s nothing I can do, please can someone come help us. Help! Somebody please come!’ Her distressed cries for help were captured and posted on social media by an unsung hero. The video was deleted within a day by Chinese censors. Were it not for social media, we would not know of her.
Social media was born in 1997, with the launch of the website SixDegrees.com. It allowed people to connect with one another on the Internet more personally than was possible through email. In 2001, Wikipedia democratized and decentralized user-generated information. In 2004, with the launch of Facebook, social media and human interaction changed forever. Today, Facebook has well over 2 billion user accounts and social media has become a behemoth that has permeated into the fabric of human communication. In 2005, YouTube videos changed how humans access and communicate information. A year later, Twitter and real-time communication allowed instant updates on major events. Studies revealed that tweets about earthquakes spread faster than the seismic waves themselves!
While social media has played a pivotal role in shaping global events, elections and revolutions, most of us use it to share pictures of delicious meals and watch funny cat videos. Today, around 2.5 billion people are empowered by social media, but we also need to be cautious with it. Big data, materialism, digital addiction, peddling algorithms, fake news, echo chambers and privacy violations are some problems associated with social media.
As the crisis in China unfolded, social media revealed its world-shaping power by enabling a decentralized record of humanity and human interaction accessible to anyone with an Internet connection. This record is maintained on smartphones in pockets, computers in bedrooms and massive data centres all over the world. In China, authoritarian leaders have tried desperately to censor and control this record. However, their attempts have only revealed that while an individual’s truth is powerful, a society’s collective truth is unstoppable.
Chinese censors, equipped with the latest technologies and backed by fierce forces, have waged an information war on their citizens. A powerful government attempted to use its might to hide the truth from its own citizens and the world. It failed largely due to the efforts of a few heroes armed only with an Internet connection and a social media account. So much truth is making it past Chinese censors that some are calling it a digital revolution. Others find it heart-breaking that the mere act of sharing one’s truth through social media is considered a revolution. Many voices will go unheard, and some who have dared to speak out will disappear as quickly as their voices. However, social media will preserve and disseminate a record of their human experience of the outbreak.
In a video posted on social media, an unsung hero wears a face mask to protect herself from the virus. One imagines she hopes the mask will also protect her and her family from the reprisals of Chinese authoritarianism. In the video she declares bravely, ‘My purpose is to make sure that all of this information is not lost or deleted. I started to collect hundreds and hundreds of screenshots. As the outbreak got really bad I thought it would be important to keep these or to collect and systematically archive this information. At the beginning, I was just doing this on my own. Now it is about a hundred of us and we are translating news articles and social media posts that are constantly being deleted. The censorship that followed us further galvanized us.’
Through social media and these heroes, we learnt of the true scale of the outbreak. Users shared horrific stories, images and videos in WeChat groups and on Weibo. Their accounts on the ground revealed long lines outside hospitals, large numbers of unattended patients inside hospitals and bags of heaped corpses on the floor. The videos depicted heart-rending scenes of patients pleading for help and families crying and grieving over their dead. Social media posts shared personal stories of what it was like to live at the epicentre of the outbreak. In one video, a lady in her forties, without a mask, without her face censored, shielded only by her courage, cried in desperation: ‘Nobody cares about our lives, ordinary people’s lives. You cannot get medicine, even if you are rich. You cannot get a hospital bed, even if you have money.’
Other users posted horrific scenes of Chinese law enforcement teams in hazmat suits dragging people from their homes and locking them in small boxes loaded on trucks. No one knows where they were taken. One video showed a family being dragged out of their home by force and carried away kicking and screaming. Unverified videos of armies of drones depicted a bleak dystopian landscape. Some drones stopped people outside their houses and reminded them to wear masks; others presented QR codes that users had to scan every time they passed a checkpoint. Videos depicted trucks, aerial vehicles and numerous workers spraying roads and pavements with disinfectant. A once-busy city looked like a deserted ghost town with empty streets and shuttered stores.
Besides keeping the world informed of the experience of the people of China through the outbreak, social media provided organizations like the WHO and CDC actionable data about the outbreak. According to the WHO, over 60 per cent of initial outbreak reports were from ‘unofficial informal sources’. Subsequent official reports corroborated the veracity of these informal sources. Were it not for social media, it is possible that the Chinese government would have been less forthcoming with information about the outbreak.
Social Media: Delivering Healthcare, Identifying Outbreaks, Novel Research Tools
For several years, social media has become a healthcare tool for information about diseases, to connect with patient support groups and to share personal experiences with the healthcare system. Preventive medicine and wellness have exploded on social media. Medical professionals are also using social media to connect with patients, offer telemedicine consultations and create informative educational content.
During the COVID-19 outbreak, social media platforms have been used to access accurate information from the WHO and CDC. News outlets have used Twitter and Facebook to keep users informed of the latest statistics about the disease. YouTube has provided access to a tremendous number of excellent videos about the virus and the disease.
On a larger scale, social networking giants and governments have worked together using social media to spread public health information, track signs for the outbreak of new illnesses and take measures to contain them, gather global resources and respond in times of a global pandemic.
The CDC routinely tracks tweets and Facebook posts for signs of a disease outbreak in various parts of the world. Using social media, they follow digital epidemiology to better understand the disease. Google tracks search trends; a spike in specific search terms can detect public health concerns or epidemics. Social media companies can analyse the trends of the posts and the numbers to gauge the situation on the ground and alert public health officials, who can take rapid measures to respond. These same social media channels can reassure or alert users in the geographical region of concern. Social media facilitates a unique and never-before-seen direct interaction between people and public health officials and allows a personalized and targeted outreach.
Social media platforms also provide scientists and researchers with new tools to access new data sets and to share information in real time. A team at the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University built an interactive dashboard to visualize and track reported cases of the COVID-19 in real time. They obtained their data from DXY.cn, a Chinese healthcare social network.
Established in 2000, DXY.cn provides relevant real-time healthcare information by Chinese physicians, healthcare professionals, pharmacies and healthcare facilities. Using data from this website and other social networks and media sources, the team at Johns Hopkins created a dashboard that updates every fifteen minutes and illustrates the location and number of confirmed COVID-19 cases, deaths and recoveries across the world. They publicly shared this dashboard on 22 January 2020. The dashboard provides researchers, public health authorities and the general public with a user-friendly tool to track the outbreak as it unfolds.
Just as LinkedIn connects professionals, there are specialized scientific collaborative networks for scientists and researchers. During the SARS outbreak in 2003, the WHO established a collaborative laboratory network for experts on infectious diseases and, within a month of its creation, the network conclusively identified the SARS-CoV. Similarly, during the MERS outbreak, Dr Zaki, an Egyptian virologist, posted details about the new virus on ProMED. This information proved crucial in identifying the first MERS cluster in April 2012. With an average of thirteen posts per day, ProMED provides users with up-to-date information about infectious disease outbreaks on a global scale, making this professional network an invaluable resource to fight outbreaks.
During the COVID-19 outbreak, the Chinese CDC used a professional network known as GISAID (Global Initiative on Sharing All Influenza Data) to rapidly disseminate information about the gene sequencing data of the new coronavirus. This allowed multiple teams to work on treatments and vaccines simultaneously. Scientists also used preprinted scientific paper networks like bioRxiv to rapidly share scientific papers.
Less than two weeks after China’s CDC uploaded the SARS-CoV-2 genome, and just three weeks after the world first learned about the outbreak, researchers in the US set up a new collaborative workplace on Slack, a workplace instant messaging platform. It included researchers around the world and it was named Wu-han Clan, a parody of the famous hip-hop group Wu-Tang Clan (scientists have a sense of humour too). Wu-han Clan researchers shared insights with each other that they would not have been able to before. This approach allowed multiple teams to share data and rapidly solve big problems by avoiding redundancy and maximizing scientific output. Each team can work on different parts of the problem without overlap and put all the pieces together.
COVID-19 is the first major outbreak where we have seen teams like the Wu-han Clan, and it represents a huge shift in how research teams address disease outbreaks.
Information available on social media has also enabled a new era of digital epidemiological research. Researchers at the US National Institute of Health used a new approach to study the epidemiology and progression of the COVID-19 outbreak. The novelty of their approach was the reliance on social media and news reports for data. Researchers crowdsourced reports from DXY.cn.
Every DXY.cn report was linked to an online source allowing researchers to access detailed information on individual cases. As the network is physician-oriented, it enabled researchers to compile accurate and in-depth information, including robust clinical and demographic data. The researchers used Google Spreadsheets and Twitter to rapidly make their data publicly available in real time and accessible for multiple research teams worldwide. DXY.cn even maintains a special section dedicated to debunking fake news, myths and rumours about the COVID-19 outbreak.
Crowd-sourced data provided interesting and significant information about the outbreak. Approximately 30 per cent of COVID-19 patients had reported a travel history to Wuhan, 30 per cent were residents of the city, but more worrisome, 16 per cent had no direct relation to the city. After analysing data from other parts of China, they established that there was sustained human-to-human transmission outside Wuhan. Their research also shed light on access to and utilization of healthcare services. They found that before 18 January 2020, patients in mainland China waited for nine days after falling sick to seek medical care at a hospital or clinic. Then, as awareness of the coronavirus outbreak increased, this decreased to just a two-day delay. Delays in seeking care were longest in Hubei province, where patients waited almost twelve days after falling sick to seek medical aid. In comparison, the delay between symptom onset and seeking care at a hospital or clinic was just one day for international travellers. The publicly available information also increased transparency in data reporting. In the future, a similar approach may also help contact tracing and control outbreaks.
The e-book has been published on April 5, 2020 by Penguin Random House India and is now available for readers on various e-commerce websites.