“There is no greater hunger for news than in situations which affect millions globally and are indiscriminate, such as that of COVID-19. Earlier this month figures showed BBC News had been devoting 83 per cent of its coverage to the pandemic while other major national news outlets including The Guardian, Daily Mail and Mail Online mentioned coronavirus in almost a third of its news reporting (Press Gazette). The internet adds another dimension. On one day alone, 11 March, a record 20 million mentions of coronavirus terms were recorded (Vox). Just last week coronavirus or COVID-19 references reached 2.1 billion (COVID-19 datapack). A study by Colombia University suggested almost 60% of people who share stories on Twitter will do so without ever reading past the headline (Medium). As a result, the necessity to be aware of social responsibility in the context of communications materials is of the utmost importance.
On the morning 27 April, the Health Service Journal published an exclusive article on an alert issued to GPs in North London from their clinical commissioning groups which stated that in the “last three weeks, there has been an apparent rise in the number of children of all ages presenting with a multisystem inflammatory state requiring intensive care across London and also in other regions of the UK”.
The document added: “There is a growing concern that a [COVID-19] related inflammatory syndrome is emerging in children in the UK, or that there may be another, as yet unidentified, infectious pathogen associated with these cases.” The development of this communication and its subsequent “leak” has resulted in a swarm of media and social media interest which, given the statistics outlined above, is of no surprise. The appetite for COVID-related news is great, but it is imperative that focus comes at the most appropriate moment for all concerned.
Just on 11 April the Royal College of Paediatrics and Child Health issued guidance for parents during the pandemic following concerns raised by specialists across the country that many children with conditions unrelated to the virus were not being brought to healthcare professionals as quickly as they normally would. A concerted effort by specialists and organisations across the country was made to highlight this issue and provide reassurance and guidance to parents. Despite this, over the course of a 48-hour whirlwind those efforts have been weakened as a result of widespread coverage of what is, at present, an unconfirmed association.
Within a day of the HSJ publication, the Secretary of State for Health told LBC Radio: “There are some children who have died who didn’t have underlying health conditions. It’s a new disease that we think may be caused by coronavirus and the COVID-19 virus, we’re not 100% sure because some of the people who got it hadn’t tested positive, so we’re doing a lot of research now but it is something that we’re worried about.” (Reuters).
A selection of headlines that followed tell the story of just what has generated so much anxiety for parents and clinicians – especially as the narrative to-date has been that COVID-19 in children is extremely mild: Children falling critically ill with new ‘coronavirus-related syndrome’ as NHS issues alert (The Daily Telegraph), Parents warned as serious coronavirus-related syndrome seen in UK children – urgent alert (Daily Express), Dozen children left fighting for life with ‘Kawasaki disease-like syndrome thought to be triggered by coronavirus’ (The Sun), ‘Some children have died’ from inflammatory syndrome which could be linked to coronavirus, says Matt Hancock (Evening Standard).
There is no doubt clinicians in London were right to escalate this – a rapid influx of unwell children being admitted to paediatric intensive care units in London with an unusual inflammatory presentation. It was absolutely appropriate to inform paediatricians, emergency department doctors and paediatric intensive care staff as it needed to be considered as a possible differential when managing the shocked child, as well as impacting on potential treatment and the importance of collecting additional data on these patients through rapid recruitment to research studies. However, subsequent events resulted in the alert being circulated to a far wider audience via social media. In this current state of intense focus, we are in the perverse situation of publicly-shared anecdotal documents providing the evidence-base not only for media to report further content on the pandemic but also to act as a trigger for involvement of the Secretary of State and further comment which will act, in the world of media and social media, as fuel to the fire of the debate.
What are the learning points?
1) Although it is important that concerns raised by clinicians can be rapidly escalated and used to inform clinical decision-making in real-time, healthcare professionals need to be mindful of the potential impact of any communications being shared with media or circulated via social media – especially during this period of heightened anxiety and with communications relating to children. One needs to consider the needs of individual patients as well as the population as a whole. In this case, the wording, although appropriate for the intended audience, was likely to generate widespread panic if circulated to the public. Communications should add context and perspective – the default should be that the information will be seen by the public.
2) Individuals need to be held accountable if information is circulated inappropriately. Not only does this include sharing it with the media or publishing on social media, but also inappropriate circulation to groups of healthcare professionals to whom the information was not intended. This needs to be made clear by those drafting the document.
The fundamental basics of good medical practice see us strive to ensure quality control measures are in place to prevent potentially harmful information entering the medical and, in turn, public domains. The undue concern of a headline triggered by information which lacks context or perspective can have severe consequences. It is imperative every effort is made to avoid this, particularly at a time when families will be at their most vulnerable. Clearly there is always a balance to be struck between the care for our individual patients and the risk of causing unintentional but undue harm to many people. In this instance, while there is no question those responsible for this communication were acting in the best interests of patients, these actions disregarded the commitment we should all make to social responsibility in a global pandemic.”
Dr Sanjay Patel, Consultant in paediatric infectious diseases at Southampton Children’s Hospital, @doctorsanjay
Matthew Watts, Head of news at University Hospital Southampton NHS Foundation Trust, @MattWattsMedia