The UW Now Livestream with Ajay Sethi

Ajay Sethi wants you to know that none of these things is true:

  • Gargling with saltwater will kill coronavirus.
  • Hydroxychloroquine prevents you from getting COVID-19.
  • America will achieve herd immunity to coronavirus if young people go out and get sick.
  • The spread of coronavirus tracks with the launch of 5G cell phone towers.

Disinformation such as this has spread rapidly, particularly online, during the COVID-19 pandemic. And though scientists around the world are racing to learn as much as they can about the virus — and to disseminate that knowledge — falsehood moves just as fast. Sethi is an epidemiologist who studies medical conspiracy theories, and he teaches a course called Conspiracies and Public Health. He has been tracking the race between knowledge and confusion. On June 9, he spoke with Wisconsin Foundation and Alumni Association president and CEO Mike Knetter at The UW Now Livestream event.

“We are now at 18,000 publications about COVID-19 in PubMed,” he says. “Since the first case of COVID was reported to WHO five months ago, we have learned a great deal. … But with so much scientific information generated daily, everyone — scientists, decision-makers, and the general public — all of us have a hard time keeping up. Our understanding of COVID-19 is improving in time. The problem, however, is that running in parallel with the expansion of knowledge about COVID-19 is the spread of vast amounts of misinformation and disinformation, called the COVID-19 infodemic.”

Sethi shared what he has seen about the spread of misinformation — simple ignorance — and disinformation — active attempts to push falsehoods. He fielded questions from participants, including about hydroxychloroquine, about how campus might safely reopen, and about why scientists think a second coronavirus wave will hit in the fall.

He also offered solid sources for where to find good information about the pandemic, including UW–Madison’s covid19.wisc.edu website, Dane County Public Health, Wisconsin’s Department of Health Services, the CDC, the World Health Organization, and a group called Dear Pandemic, which operates on Facebook, Twitter, and Instagram. The last of these was started by UW researcher Malia Jones and several colleagues.

Further, he noted that the fight against misinformation and disinformation requires diligent, patient work. “You should avoid thinking that educating someone is an immediate solution,” he said. “Demonstrating your encyclopedic knowledge and talking at someone isn’t particularly effective at changing someone’s views. And changing someone’s mind is not necessarily the goal of a conversation. You want someone to move toward a different viewpoint on their own.”

The UW Now Livestream is itself a response to the COVID-19 pandemic. Though originally planned as a series of events in cities across the United States, it is instead offered via YouTube and will continue through the spring and early summer. The next event will be June 16 and will cover wellbeing and mental health with guests Richie Davidson, founder of the UW’s Center for healthy minds, and Alvin Thomas, assistant professor of human development and family studies.

Information Learned in the Media

The WHO statement that was just released seems to have led a lot of people to differing conclusions, especially regarding asymptomatic persons and spread of the disease. How does a pivot like that lead to misinformation?

It causes an erosion of trust and leads some people to begin to rely on less-credible sources of information. It does not affect someone who is patient and waits for such unexpected pivots to play out.

China reports only three new cases today; the U.S. reports more than 19,000. Should we be learning from what they’re doing? Or are China’s numbers not to be believed? Do you think that speaks more to the fact that the virus is subsiding and the U.S. is doing more testing?

China was the first to face the pandemic, and the Chinese had an aggressive response that led to declines in cases. Countries like New Zealand, Taiwan, and South Korea also had rapid and national-level responses that succeeded. The U.S. was very slow to react, it did not have a national-level lockdown, and many areas of the country started to prematurely reopen. Thus, we never had control of the epidemic in the U.S., overall, and we will continue to see high daily numbers of cases and deaths.

What are some of the telltale signs of misinformation?

If we define misinformation as information that is incorrect and coming from a well-meaning source, there aren’t always clear clues. However, the best way to know if information is incorrect is by comparing it to correct information you learned from credible sources.

What if the source is the president of the U.S.?

Any person or organization that consistently communicates misinformation is not a credible source of information.

What works or doesn’t work with Sweden’s approach?

Sweden recommended mitigation strategies to stop the spread of COVID instead of making them mandatory. Most people in Sweden accepted the lax approach because of their culture of trusting experts. Architects of the approach were hoping to reach herd immunity sooner, but seroprevalence studies indicated otherwise. Instead, their strategy caused many deaths, prompting officials to state that they should have taken a different approach at the start.

What about the recent news that this virus may be a blood vessel virus and not a respiratory virus?

The main portal of entry for the virus is the respiratory system. The virus binds to the ACE2 receptor, which is found in many cell types and tissues through the body, including the lungs, heart, blood vessels, kidneys, liver, and gastrointestinal tract.

Why has there been a proliferation of bots, and what is their negative impact on misinformation?

Bots are the 21st-century tools for people and governments to push their messages and agendas to sway public opinion. Bot creators with ill intentions aim to spread misinformation.

Predictive models must pass verification and validation, be based on adequate data, and provide unique solutions. Are predictions becoming more accurate or plagued by divisive political agendas?

The accuracy and value of a model really depends on what prediction is being sought, the context, how far out projections are desired, and the quality of the inputs for the model, so it’s hard to give a single answer to this question. However, it’s safe to say that there is nothing positive about divisive political agendas.

How trustworthy is the World Health Organization? It took WHO longer than many expected to declare COVID-19 a pandemic.

The initial delay in declaring COVID-19 a pandemic doesn’t mean the entire WHO is not trustworthy. Although there was a delay in the official declaration, many people around the world, including WHO, were beginning to understand that COVID-19 was indeed a pandemic.

Why is a second wave expected, other than that was the model in 1918–19?

Ongoing transmission through the summer, a return to activities taking place indoors in the fall and winter, and a vast majority of people susceptible for infection are the reasons why a second wave is expected.

Besides COVID, what are some other examples of conspiracies or misinformation that have occurred in public health?

A notorious conspiracy is Andrew Wakefield’s falsifying data to implicate the measles, mumps, and rubella (MMR) vaccine as a cause of autism while he was investing in a rival measles vaccine and diagnostic tools to replace MMR.

Another conspiracy was Merck’s intentional withholding of information on side effects associated with its drug Vioxx. When those side effects were discovered, the drug was pulled from the market. Merck was fined, but the fine was very little relative to how much it had made while the drug was approved for sale and use.

Operation Neptune Spear was the U.S. government mission to capture Osama Bin Laden. The CIA set up a fake vaccination campaign in Abbottabad, Pakistan, in order to gather intelligence. After the mission was complete, outrage and distrust toward legitimate WHO vaccination workers grew in Pakistan, and some were even killed. The Gates Foundation’s global polio eradication effort experienced major setbacks. Unfortunately, the movie Zero Dark Thirty, which is about the U.S. operation, includes the fake vaccination campaign in telling the story.

What are the best national resources to follow? Global?

For data, I rely on the Johns Hopkins University COVID-19 Dashboard and the New York Times. For news, a few of the sources I use are NPR, the New York Times, the Wall Street Journal, the Washington Post, The Atlantic, and Politico.

COVID Precautions

What is the best way to explain the need for precautionary behaviors to continue — e.g., PPE, social distancing — in communities minimally affected by the virus?

In general, precautionary behaviors are hard for people to adopt. We have to find creative ways to appeal to people’s understanding of the old adage, “an ounce of prevention is worth a pound of cure,” and implement them one opportunity at a time.

Do you feel a homemade cloth mask will help prevent the spread of COVID-19?

Yes. A cloth mask is better than no mask at all for reducing the transmission of COVID-19. The higher the density of fabric used, the better the mask.

What do you see so far as the most effective ways to encourage facemask wearing?

I have not looked for studies that have examined which ways are more effective. We have to change social norms. Influencers are helping in this regard, but more work is clearly needed.

The CDC first said we didn’t need to wear a mask unless we were sick; now they want us to wear one. What changed?

Initially, the CDC did not want the public to use PPE supplies needed for healthcare settings, where there were shortages. In fact, communities were making cloth masks for healthcare workers (HCWs). Once PPE supplies for HCWs were mostly secure, and evidence grew for asymptomatic spread, the CDC began recommending the public to wear facemasks. The public is still discouraged from using medical grade masks to prevent future PPE shortages in healthcare settings.

Travel, Socializing, and Reopening

When will it be safe to come back to Wisconsin?

It depends on where you will start your journey and the method of travel. The CDC has guidance for travelers: https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-in-the-us.html.

What can we expect related to seeing family in skilled nursing facilities? It seems inhuman to deny in-person access to each other for so long.

It is indeed a terrible consequence of all of this. I am hopeful that facilities can have protocols in place to facilitate family members seeing each other, but I do not know when that will be.

What is your professional opinion on how the UW can reopen for face-to-face classes for fall semester in late August and protect the safety of everyone on campus?

There are workgroups working on this, and an announcement will be made soon. In general, it would require assuring proper physical distance, mask use, regular symptom screening and COVID testing, maintaining proper hand hygiene, contact tracing, and other important steps. Risk will not be eliminated as long as we have ongoing community transmission of COVID, so an evaluation of the risks and benefits of face-to-face classes will have to be evaluated individually, collectively, and continually.

Any comments about the New York Times article “When 511 Epidemiologists Expect to Fly”?

The wide ranges in perceived risks for engaging the various activities tells me that epidemiologists are people, too.

With the recent protests and demonstrations, is there a higher risk of COVID-19 infection spread?

Yes, and it’s hard to predict how many more cases will result. It will also be hard to attribute any increase in cases to the demonstrations specifically, since they are occurring in the context of a reopening society.

What considerations do we need to think about when traveling? With our families? Meeting other family members at destinations other than their homes?

The CDC has guidance for travelers: https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-in-the-us.html. Two households that are truly free of COVID can conceivably meet up at a destination, if the travel to that destination keeps everyone safe along the way.

Maine is requiring a two-week quarantine upon arrival or evidence of a negative COVID test given within 72 hours of arrival. Is there any way to accomplish this?

It’s definitely a tall order and complex to execute. I believe it could be accomplished but not without a lot of cost and time. I have not read up on what Maine is doing already or plans to do.

COVID Cases, Vaccines, and Treatment

Will India be number two in active cases soon?

I do not know. A country’s rank and change in rank is not important. Any ongoing, uncontrolled community spread of COVID-19 is a cause of concern for people in any country.

We have never had a coronavirus vaccine developed, only flu vaccines. Will it be a crap shoot for the next year or so?

I am hopeful that the investments being made to get a vaccine soon will yield one that is effective. But since we have never worked at this kind of pace before, we will just have to wait and see, keep our fingers crossed, and remain focused on the prevention tools we have.

What accurate claims can be made for hydroxychloroquine?

It’s a drug that has been around for decades that is used to prevent or treat malaria. It’s also used to treat autoimmune diseases such as rheumatoid arthritis and lupus.

How meaningful is the antibody test?

In general, it depends on which test was used, the timing of testing relative to having COVID, and the community prevalence of past COVID. Antibody tests are more meaningful when carried out by a reputable health system and interpreted in the context of other information, such as medical history.

Can you give some general information on the progress in finding a vaccine?

Presently (June 12), there is one vaccine candidate in a phase II trial, about six in phase I trials, and many more in preclinical phases. I rely on NIAID [the National Institute of Allergy and Infections Diseases] for updates on the progress.

How is testing handling false positive and false negative results?

For PCR tests, false positives are rare. False negatives are, too, when someone has COVID symptoms. If someone has presymptomatic COVID, false negatives are possible, and repeating the test in a couple of days may be indicated. For antibody tests, it is important to get one through a reputable health system or lab, and results should be interpreted in the context of one’s medical and exposure history.

There are concerns about claims of herd immunity. Some claim that many have already had COVID-19. Are there any fact-based estimates yet of general immunity in Wisconsin’s hotspots?

Claims of herd immunity should not be made until we know more about the nature of immune responses in people who survive COVID. We first have to establish who among asymptomatic, mild, moderate, and severe cases of COVID develop immunity, whether it’s the kind of immunity that can protect someone from getting the virus again, and for how long. There are some seroprevalence surveys that are or are soon to be underway.

Insights from Your Class and Research

What parallels do you see in your experience with HIV and now COVID?

When HIV first emerged, I remember the fear and uncertainty, particularly since there was no test available for several years, and the blood supply was known to be contaminated; the misinformation on how HIV could be spread; and it being the dominant news item on a daily basis, often about the lives of people who had died of AIDS.

If we do as you say and don’t become aggressive and try to educate or convert some one with non-science-based beliefs, how are we to hope for new beliefs to take hold?

It’s important to be patient because it can take time. New beliefs are more likely to take hold when they come from a trusted source and from multiple trusted sources.

How do you counter confirmation bias?

Make a conscientious effort to scrutinize information that comes your way, conceive of and look for disconfirming information, and critically evaluate all available information on a topic before accepting any one interpretation.

Why do people create conspiracy theories around pandemics?

During times of uncertainty and fear, it’s easy to feel a loss of control, and that can cause any of us to seek alternative realities, perhaps to shift blame, to make us feel better, or to better fit our view of how the world works. For people who deliberately create (and spread) conspiracy theories, it’s hard to know one’s motivation without knowing and talking to them individually. Based on past conspiracies, they likely have something to gain personally, perhaps a monetary incentive.

What do you say to people who say this is no worse than the flu?

Unfortunately, it’s much worse than the flu. The number of COVID deaths that have occurred in the U.S. in five and a half months is 114,000, far higher than the number of deaths caused by the flu in a typical year. And this year is not over yet. I’d also say that even if COVID were no worse than the flu (and it is worse), does anyone want a second lethal respiratory virus circulating among the most vulnerable in our community? I would hope not.