Infodemic vs. Pandemic Factors Associated to Public Anxiety in the Early Stage of the COVID-19 Outbreak: A Cross-Sectional Study in China.

Introduction: Every outbreak of an epidemic or pandemic disease is accompanied by the tsunami of information, which is also known as the infodemic. Infodemic makes it hard for people to find trustworthy sources and reliable guidance when they need it, and causes social panic about health, widens the gaps between races and regions, and even brings the social chaos all over the world. While most researchers and related parties made efforts to control the inaccurate information spreading online during the COVID-19 pandemic, the infodemic influence caused by the overload of accurate information were almost or completely ignored, and this will hinder the control of infodemic in future public health crises. This study aims to explore the infodemic vs. pandemic influence on people's psychological anxiety across different media sources in the early stage of the COVID-19 outbreak in China. Methods: A cross-sectional study using online survey method was conducted by a data-collection service provider in April 2020. A total of 1,117 valid samples were finally collected from 5,203 randomly invited members via webpages and WeChat. The sample distribution covered the 30 provincial administrative divisions of mainland China. Results: Hierarchical regression analysis for the potential pandemic sources and infodemic sources of psychological anxiety showed that the infodemic factors of attention to the coronavirus information (β = 0.154, p < 0.001) and commercial media exposure (β = 0.147, p < 0.001) is positively related to the level of anxiety. Statistics indicated that influence of the infodemic factors is over and above that of the pandemic factors (ΔR2 = 0.054, F = 14.199, and p < 0.001). Mediation analysis showed that information overload (B = 0.155, Boot SE = 0.022, and 95% Boot CI [0.112, 0.198]) mediates the link between attention to coronavirus information and anxiety; both information overload (B = 0.035, Boot SE = 0.014, and 95% Boot CI [0.009, 0.062]) and media vicarious traumatization (B = 0.106, Boot SE = 0.017, and 95% Boot CI [0.072, 0.140]) mediate the link between commercial media exposure and anxiety. Conclusion: This study suggested that the influence of infodemic with mixed accurate and inaccurate information on public anxiety does exist, which could possibly go beyond that of the pandemic. Information overload and vicarious traumatization explain how infodemic may be associated to public anxiety. Finally, commercial media could be a major source of infodemic in the Chinese media context. Implications for the related parties were discussed.

Xu J ，Liu C 《Frontiers in Public Health》

Factors Influencing Anxiety Among WeChat Users During the Early Stages of the COVID-19 Pandemic in Mainland China: Cross-sectional Survey Study.

The rapid outbreak of COVID-19 around the world has adversely affected the mental health of the public. The prevalence of anxiety among the public has increased dramatically during the COVID-19 pandemic. However, there are few studies evaluating the effects of positive psychological responses and information-seeking behaviors on anxiety experienced among social media users during the COVID-19 pandemic. This study evaluated the prevalence of anxiety and its associated factors among WeChat users in mainland China during the early stages of the COVID-19 pandemic. From February 10 to February 24, 2020, a nationwide, web-based cross-sectional survey study was carried out using convenience sampling. Participants' levels of anxiety, positive psychological responses, and information-seeking behaviors were assessed. The survey was distributed among WeChat users via the WeChat smartphone platform. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with anxiety. This study found that the prevalence of anxiety (Generalized Anxiety Disorder 7-item [GAD-7] scale score ≥7) among WeChat users in China was 17.96% (446/2483) during the early stages of the COVID-19 pandemic. Results of multivariable logistic regression analysis showed that information-seeking behaviors such as cannot stop searching for information on COVID-19, being concerned about the COVID-19 pandemic, and spending more than 1 hour per day consuming information about the pandemic were found to be associated with increased levels of anxiety. Additionally, participants who chose social media and commercial media as the primary sources to obtain information about the COVID-19 pandemic were found more likely to report anxiety. Conversely, participants who were confident or rational about the COVID-19 pandemic were less likely to report anxiety. This study found that positive psychological responses and information-seeking behaviors were closely associated with anxiety among WeChat users during the COVID-19 pandemic in China. It might be paramount to enhance mental well-being by helping people respond to the COVID-19 pandemic more rationally and positively in order to decrease symptoms of anxiety.

Zou C ，Zhang W ，Sznajder K ，Yang F ，Jia Y ，Ma R ，Cui C ，Yang X ... -  《JOURNAL OF MEDICAL INTERNET RESEARCH》

Media Exposure and Anxiety during COVID-19: The Mediation Effect of Media Vicarious Traumatization.

Liu C ，Liu Y 《-》

Temporal and Location Variations, and Link Categories for the Dissemination of COVID-19-Related Information on Twitter During the SARS-CoV-2 Outbreak in Europe: Infoveillance Study.

The spread of the 2019 novel coronavirus disease, COVID-19, across Asia and Europe sparked a significant increase in public interest and media coverage, including on social media platforms such as Twitter. In this context, the origin of information plays a central role in the dissemination of evidence-based information about the SARS-CoV-2 virus and COVID-19. On February 2, 2020, the World Health Organization (WHO) constituted a "massive infodemic" and argued that this situation "makes it hard for people to find trustworthy sources and reliable guidance when they need it." This infoveillance study, conducted during the early phase of the COVID-19 pandemic, focuses on the social media platform Twitter. It allows monitoring of the dynamic pandemic situation on a global scale for different aspects and topics, languages, as well as regions and even whole countries. Of particular interest are temporal and geographical variations of COVID-19-related tweets, the situation in Europe, and the categories and origin of shared external resources. Twitter's Streaming application programming interface was used to filter tweets based on 16 prevalent hashtags related to the COVID-19 outbreak. Each tweet's text and corresponding metadata as well as the user's profile information were extracted and stored into a database. Metadata included links to external resources. A link categorization scheme-introduced in a study by Chew and Eysenbach in 2009-was applied onto the top 250 shared resources to analyze the relative proportion for each category. Moreover, temporal variations of global tweet volumes were analyzed and a specific analysis was conducted for the European region. Between February 9 and April 11, 2020, a total of 21,755,802 distinct tweets were collected, posted by 4,809,842 distinct Twitter accounts. The volume of #covid19-related tweets increased after the WHO announced the name of the new disease on February 11, 2020, and stabilized at the end of March at a high level. For the regional analysis, a higher tweet volume was observed in the vicinity of major European capitals or in densely populated areas. The most frequently shared resources originated from various social media platforms (ranks 1-7). The most prevalent category in the top 50 was "Mainstream or Local News." For the category "Government or Public Health," only two information sources were found in the top 50: US Centers for Disease Control and Prevention at rank 25 and the WHO at rank 27. The first occurrence of a prevalent scientific source was Nature (rank 116). The naming of the disease by the WHO was a major signal to address the public audience with public health response via social media platforms such as Twitter. Future studies should focus on the origin and trustworthiness of shared resources, as monitoring the spread of fake news during a pandemic situation is of particular importance. In addition, it would be beneficial to analyze and uncover bot networks spreading COVID-19-related misinformation.

Pobiruchin M ，Zowalla R ，Wiesner M 《JOURNAL OF MEDICAL INTERNET RESEARCH》

Framework for Managing the COVID-19 Infodemic: Methods and Results of an Online, Crowdsourced WHO Technical Consultation.

An infodemic is an overabundance of information-some accurate and some not-that occurs during an epidemic. In a similar manner to an epidemic, it spreads between humans via digital and physical information systems. It makes it hard for people to find trustworthy sources and reliable guidance when they need it. A World Health Organization (WHO) technical consultation on responding to the infodemic related to the coronavirus disease (COVID-19) pandemic was held, entirely online, to crowdsource suggested actions for a framework for infodemic management. A group of policy makers, public health professionals, researchers, students, and other concerned stakeholders was joined by representatives of the media, social media platforms, various private sector organizations, and civil society to suggest and discuss actions for all parts of society, and multiple related professional and scientific disciplines, methods, and technologies. A total of 594 ideas for actions were crowdsourced online during the discussions and consolidated into suggestions for an infodemic management framework. The analysis team distilled the suggestions into a set of 50 proposed actions for a framework for managing infodemics in health emergencies. The consultation revealed six policy implications to consider. First, interventions and messages must be based on science and evidence, and must reach citizens and enable them to make informed decisions on how to protect themselves and their communities in a health emergency. Second, knowledge should be translated into actionable behavior-change messages, presented in ways that are understood by and accessible to all individuals in all parts of all societies. Third, governments should reach out to key communities to ensure their concerns and information needs are understood, tailoring advice and messages to address the audiences they represent. Fourth, to strengthen the analysis and amplification of information impact, strategic partnerships should be formed across all sectors, including but not limited to the social media and technology sectors, academia, and civil society. Fifth, health authorities should ensure that these actions are informed by reliable information that helps them understand the circulating narratives and changes in the flow of information, questions, and misinformation in communities. Sixth, following experiences to date in responding to the COVID-19 infodemic and the lessons from other disease outbreaks, infodemic management approaches should be further developed to support preparedness and response, and to inform risk mitigation, and be enhanced through data science and sociobehavioral and other research. The first version of this framework proposes five action areas in which WHO Member States and actors within society can apply, according to their mandate, an infodemic management approach adapted to national contexts and practices. Responses to the COVID-19 pandemic and the related infodemic require swift, regular, systematic, and coordinated action from multiple sectors of society and government. It remains crucial that we promote trusted information and fight misinformation, thereby helping save lives.

Tangcharoensathien V ，Calleja N ，Nguyen T ，Purnat T ，D'Agostino M ，Garcia-Saiso S ，Landry M ，Rashidian A ，Hamilton C ，AbdAllah A ，Ghiga I ，Hill A ，Hougendobler D ，van Andel J ，Nunn M ，Brooks I ，Sacco PL ，De Domenico M ，Mai P ，Gruzd A ，Alaphilippe A ，Briand S ... -  《JOURNAL OF MEDICAL INTERNET RESEARCH》