Twitter and the Endocrinologist’s Response to COVID-19

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Many endocrinologists — both clinicians and scientists — have been using social media for years to communicate their own research, share information with patients, or simply stay informed of late-breaking developments from around the world. Joy Y. Wu, MD, PhD, discusses her use of Twitter and why it has been so vital during the COVID-19 pandemic.

 

For several years I have encouraged trainees and colleagues to join academic Twitter. Twitter allows me to stay current with published literature in both my clinical (osteoporosis and metabolic bone disease) and research (skeletal biology) arenas.  It’s also a terrific way to follow the proceedings of scientific conferences in real time, and valuable for networking, education, and advocacy.

In recent months as the world was upended by the COVID-19 pandemic, Twitter has played an important role in the global response, enabling information to be shared among physicians and researchers with unprecedented speed and wide-ranging impact. Among endocrinologists, Twitter has been a valuable forum for discussing the clinical, research, and academic issues that have arisen as a result of the pandemic.

Raising the Alarm

The global COVID-19 pandemic unfolded with astonishing rapidity. From the first reports of a novel viral pneumonia in Wuhan, China, in late December 2019, to a dramatic global response including travel restrictions, quarantines, and national border closings, the number of COVID-19 cases world-wide has surpassed several million in only a few short months.

As large parts of the world are currently under lockdown conditions, Twitter has been a valuable resource for networking and setting up collaborations among researchers.

For a few weeks in February, as the quarantine imposed by officials on Hubei province gradually slowed the appearance of new cases in China, the total number of confirmed cases in the rest of the world was fewer than 1,000. But public health experts were sounding warnings against complacency in the rest of the world. In a tweet that now seems hauntingly prescient, on February 8, Trevor Bedford, a computational biologist at the Fred Hutchinson Cancer Research Center in Seattle, noted that cases in Wuhan had progressed from the index case to several thousand cases over a 10-week period. Since international seeding events were believed to have started in mid-January, there was therefore a critical 10-week period (until late March) to contain these nascent outbreaks in the rest of the world.

Ashish Jha, Professor of Global Health at Harvard, highlighted in a series of tweets the need for greater U.S. preparation, testing, and social distancing. On March 8, he warned that hospitals in Northern Italy were being overwhelmed with COVID-19 patients and that the same could happen to U.S. hospitals. This point was soon brought home by chilling reports from physicians in Italy on the dire circumstances in hospitals, for example, here. Sadly a few weeks later a similar scenario began to play out in New York City hospitals as the epicenter of the pandemic shifted to the US, as eloquently documented by Dr. Craig Smith, chairman of the Columbia University Department of Surgery.

A crucial contribution to growing public support for the necessity of social distancing came from widely shared graphics demonstrating that such measures could #FlattenTheCurve, that is spread out the number of cases over a longer period of time to avoid overwhelming medical systems. The original figure (which appeared in a 2007 CDC report) was adapted by Rosamund Pearce, a data visualization journalist, for an article in The Economist. The figure was subsequently revised by public health educator Drew Harris, who added a line to represent healthcare system capacity, and then converted into GIF by New Zealand microbiologist Siouxsie Wiles and illustrator Toby Morris.

As a growing sense of urgency related to COVID-19 spread in the U.S., physicians and hospitals took to Twitter to appeal for donations of personal protective equipment so desperately needed by healthcare workers. Likewise, as early efforts to ramp up testing were hampered by shortages of supplies and reagents, tweet appeals for donations were met with tremendous response.

Global Exchange of Clinical Information

As COVID-19 spread inexorably around the world, Twitter facilitated the rapid sharing of clinical information. In one early example, webinars hosted jointly by the Chinese Cardiovascular Association and the American College of Cardiology allowed Chinese cardiologists to share their clinical expertise and to discuss clinical questions including the safety of ACE inhibitors/angiotensin II receptor blockers and management of acute coronary syndrome in patients testing positive for COVID-19.

We are just beginning to see the results of an enormous effort by researchers to develop strategies to diagnose, treat, and ultimately prevent COVID-19 infections. As large parts of the world are currently under lockdown conditions, Twitter has been a valuable resource for networking and setting up collaborations among researchers.

The University of Washington shared its protocols relating to COVID-19. The department of Medicine at Stanford University School of Medicine converted its weekly Grand Rounds into virtual updates on the COVID-19 pandemic, and, like many institutions, made these recordings publicly available.

Publications on COVID-19 have appeared with impressive speed and are widely shared and discussed on social media. Some of the earliest examples included an article published in JAMA on March 3 describing the measures that so far have enabled Taiwan, located only 81 miles from and with close business and travel ties to China, to effectively contain the spread of COVID-19, and an article reporting the characteristics of 21 critically ill patients in Washington state.

Preprint servers have also played a prominent role in disseminating information. MedRXiv was launched in June 2019, and along with BioRXiv has become a repository for a large number of publications on COVID-19. While there are concerns about the widespread release of data that have not yet been peer-reviewed, social media has allowed for extensive discussion and evaluation of these data.

Endocrinologists & COVID-19

The practice of endocrinology has been dramatically altered by the COVID-19 pandemic. Conversion of in-person clinic visits to telemedicine has been widely adopted by endocrinologists, and Twitter has provided a valuable forum for sharing experience and best practices. Professional societies devoted to endocrinology around the world have issued statements, collated resources, and hosted webinars dedicated to the management of endocrine conditions during the pandemic.

Management of many endocrine issues during COVID has been addressed on Twitter. For patients with diabetes, COVID-19-related issues have included management of type 1 diabetes in ICU patients on mechanical ventilation, protocols for the management of diabetic ketoacidosis, and use of continuous glucose monitoring in hospitalized COVID+ patients.

For patients with asymptomatic thyroid nodules, experts recommended deferral of FNA biopsy while many regions were in various states of lockdown due to the pandemic. The American Thyroid Association developed a resource center with answers to frequently asked questions by patients and physicians. And as some regions begin to emerge from lockdown, discussions have begun to focus on how to safely resume thyroid nodule biopsies.

Other resources for endocrinologists available on Twitter include a webinar on the safety of pituitary surgery during COVID, recommendations on the use of glucocorticoids in patients with adrenal insufficiency and COVID-19, and joint guidance from multiple societies on the management of osteoporosis.

Endocrinologists have used Twitter to share their experience in clinical practice during COVID, and to share resources to prepare for redeployment to the clinical front lines as needed. Social media has also been an effective platform for advocacy on behalf of patients and providers, for example in urging the U.S. Congress to address issues related to COVID-19, and for raising awareness of the amplification of health inequities by the pandemic.

Sustaining the Academic Mission Virtually

Schools and universities closed around the world in response to the pandemic, displacing millions of students and upending academic pursuits everywhere. Teaching medical students, residents, and clinical fellows has similarly faced drastic changes. Medical educators have used social media to share recommendations for using technology to maintain resident education, and discussions on Twitter have focused on sharing resources available to endocrinology fellowship programs. More changes await as interviews of residency and fellowship applicants for the upcoming academic year will move online.

As early efforts to ramp up testing were hampered by shortages of supplies and reagents, tweet appeals for donations were met with tremendous response.

The COVID-19 pandemic has led to the cancellation of many medical conferences including, of course, ENDO 2020. Seeking to sustain opportunities for networking, clinical and research updates, and career development, organizations have launched online virtual meetings that have been widely advertised on social media. Online journal clubs such as #EndoJC have also facilitated global discussions of publications of interest to endocrinologists.

For scientists in academic research laboratories, discussions on Twitter raised the need to plan for impending laboratory closures. Unable to work in the lab, academics have turned to social media to learn new skills such as bioinformatics. Academic issues including challenges faced by women and the impact of research cessation have also been raised on social media. Now as regional lockdowns begin to end, institutions are sharing their plans for safely reopening laboratories.

Data Sharing & Research

As with everything else related to COVID-19, research on COVID-19 has also progressed rapidly. As one example, genome sequencing of viral samples from across the U.S. have revealed how the infection has unfolded in this country.

We are just beginning to see the results of an enormous effort by researchers to develop strategies to diagnose, treat, and ultimately prevent COVID-19 infections. As large parts of the world are currently under lockdown conditions, Twitter has been a valuable resource for networking and setting up collaborations among researchers.

For data aficionados, real-time tracking of confirmed COVID-19 cases and deaths is readily available on many sites including the Johns Hopkins Global COVID-19 Tracking Map, Our World In Data and the COVID Tracking Project.

A Sense of Camaraderie

The global pandemic has been a time of heightened stress for everyone. Concerns abound relating to safety, health, financial, and professional impacts. In many parts of the world previously inconceivable measures such as widespread lockdowns and closures of schools and business left many feeling dislocated and anxious. In these times Twitter has also played a role in providing support and camaraderie.

Perhaps, one day, looking back we will be able to more quantitatively estimate the impact of Twitter on the COVID-19 pandemic. In the meantime, it serves as an invaluable source of both information and connection for endocrinologists.

While social distancing has led to physical isolation from family, friends, and colleagues, Twitter provided links to resources, such as a one-year subscription to the Headspace meditation app for healthcare providers. Yo-Yo Ma offered daily performances for comfort. And even in these difficult times there is humor and levity as in these videos of penguins set free to roam aquariums now closed to visitors.

At the moment we are still in the midst of the pandemic with cases steadily increasing in many parts of the world. Perhaps, one day, looking back we will be able to more quantitatively estimate the impact of Twitter on the COVID-19 pandemic. In the meantime, it serves as an invaluable source of both information and connection for endocrinologists. Curious about how to get started with social media? That information is also available on Twitter.

Joy Y. Wu, MD, PhD, is an associate professor of medicine in the department of medicine (endocrinology) at Stanford University School of Medicine, and a member of the Board of Directors of the Endocrine Society. Both her clinical practice and laboratory research focus on the prevention and treatment of osteoporosis. She speaks regularly on the professional benefits of social media. Follow Joy Wu on Twitter: @JoyYWu

Links to specific tweets are provided as examples of the discussion on Twitter. Inclusion of a tweet does not imply endorsement of the clinical recommendations.

Wu has no equity ownership in Twitter or any other social media platform.

 

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