CLINICAL MATTERS
With the predictable seasonal increase of Covid-19 cases last December, viral fake news was not far behind. Some of the fake items were even recycled ones from past years. And yet people continued to share them without as much as doing a simple fact check. Some of the people who shared these messages were very smart and savvy individuals, including more than a few doctors. I was bombarded with questions as to whether any of this was true, when even a quick Google search would have exposed the lies very quickly. What is it about fake news that is so enticing that otherwise intelligent people fall for it and share it with others? Let’s examine a couple of these fake messages and try to figure out what makes them so compelling.
One piece of fake news which was resurrected last month is more than a year old and had to do with the old Covid-19 Omicron sublineage XBB. It had the heading, “Singapore News.” It advised that everyone should wear a mask because XBB was the worst variant yet, that it did not behave like other variants in terms of symptoms, that it might not be detectable by swabs, and that it was spreading fast. It claimed that XBB was five times deadlier than Delta, that it infected the lungs directly, and caused acute respiratory distress. To end, it exhorted the reader to not “keep this information to yourself, share it with as many other relatives as possible, especially your own friends and family.”
The best (or is it worst?) fake news items usually mix truth with falsehood. At the time this first came out in October 2022, there was a surge in cases in Singapore, and it was driven by XBB. XBB (no number, this is the parent lineage) is a recombinant lineage made up of two Omicron lineages BA.2.10.1 and BA.2.75. This lineage has not been dominant in a very long time, having been quickly supplanted by its sublineage XBB.1.5 and downstream XBB.1.5 sublineages. Masking is always a good idea when community transmission is high so there is nothing wrong with that particular statement.
There is no evidence symptoms from XBB infection are any different compared to other lineages, and there are no scientifically validated reports that it could not be detected by antigen or RT-PCR swabs. XBB seemed to have some increased immune escape properties but there was no indication it was deadlier than any previous Covid-19 lineages. It was definitely not anywhere near as deadly as Delta, and vaccination continued to protect against severe disease. In addition, there was no evidence it caused more acute respiratory distress than any of the other Covid-19 lineages. The last statement encouraging the reader to share with others should also serve as a red flag that the post is trying too hard to become viral. Checking with health authorities should always be our next step when we get these kinds of messages instead of reflexively sharing because any important health news can easily be verified and confirmed by official channels.
Another fake piece of news which was recently shared is more than two years old. It purportedly was from St. Luke’s Hospital and even named a prominent pulmonologist as the spokesperson. It stated that the hospital’s Covid-19 ICU was full and that most of the cases were vaccinated but not boosted. More cases were anticipated and they suggested limiting socializing and not to remove masks in gatherings.
Again, the fake news had a kernel of truth in that Covid-19 cases last month were going up, and that boosting adds additional protection against infection. A cursory check with the latest Department of Health bulletin shows however that healthcare utilization is very low, and ICU bed capacity is below 20 percent. In fact, we had to deal with this exact same piece of resurrected fake news in December 2022, and it had already been debunked by St. Luke’s. There was never any such exact bulletin released although some elements of it may have been present in 2021 when hospitals were overrun with Delta.
There are likely different motives for making and spreading fake news, from attention seeking behavior to more sinister destabilization plots. Whatever the reason, these fake messages rely on people’s gullibility and their propensity to panic in order to spread. It is unfortunate that some unsuspecting doctors and healthcare workers are ensnared in these schemes and further propagate the fake news in social media and even mainstream media. Non-official sources of information may also, without malice, make erroneous analyses of their own which inadvertently scare people.
For instance, the obsolete metric of positivity rate continues to be bandied about by some media companies despite having a negligible impact on hospitalization rates and deaths at this stage of the pandemic. The WHO-recommended five percent positivity rate threshold was an estimate of adequacy of testing during the early part of the pandemic when there were no vaccines and there were no effective treatments. The idea was that a less than 5 percent positivity rate showed that enough tests were being done, without taking into account epidemic spikes and the decreasing mortality of Covid-19 as vaccination and effective treatments came online. There never was a good scientific basis for this metric and it was just an attempt to come up with some guidance on testing without considering the different nuances of the tests being employed (RT-PCR vs. antigen vs. antibody), the resources of each country, and the levels of restrictions being employed.
One modeling paper in the Lancet estimated that the impact of “mass testing” five percent of the population every week would cost billions of dollars over the long term with only a five percent effect on decreasing transmission. As more people were vaccinated and had mild disease, testing became more selective, resulting in a higher pretest probability which pretty much invalidates the five percent assumption. Unfortunately, some groups continue to push their flawed analysis and it adds to the confusion.
To be sure, only the emergency phase of the pandemic has been declared over by the WHO. Covid-19 infections still cause deaths. WHO reported that 10,000 people died of Covid-19 in the last month. In addition, the burden and impact of long Covid-19 is only beginning to be understood. The levels of death and hospitalization, however, are much lower than before, and interventions need to be weighed in terms of risk versus benefit.
One excellent intervention that many Philippine hospitals have kept is to continue to require masking in patient care areas. Many US and European hospitals are scrambling to reinstate their hospital mask mandates as their Covid-19 cases surge, but we never completely removed them in the Philippines despite our high vaccination rates. This speaks to the continued attempt to balance our interventions with the safety of our people in this new normal. The Philippines continues to do better in terms of Covid-19 management than many richer countries because our policies are grounded in science, and our people continue to follow these strategies. We have to make sure that these good policies continue and that fake news does not derail our progress.