Keywords
,
. However, some studies suggest that Twitter may play an important role in propagating misinformation in previous epidemics such as the Zika, Ebola, and yellow fever virus outbreaks
,
,
. In the COVID-19 era, scientists and clinicians utilize Twitter to echo scientific evidence, especially towards an academic audience. However, in non-academic contexts, the effect of the utilization of Twitter in the COVID-19 era on public perception, whether beneficial or harmful, remains unknown. We hypothesize that there may be significant variation in signals of Twitter related to COVID-19 in non-academic contexts.
We extracted all Tweets and hashtags related to COVID-19 using keywords (e.g., “covid”, “covid-19”, “corona”, “coronavirus”, “positive”, “test”, “tested”, “feel”, “I”, “we”, “my”, “us”, “our”) between April 1, 2020 and June 1, 2020 using Twitter’s application programming interface (API). Two investigators reviewed 25% of the extracted Tweets to develop an initial conceptual framework. Then, three investigators reviewed an additional 25% of extracted tweets to refine an initial conceptual framework. Ultimately, we then identified the final coding framework with two investigators and disagreements were resolved by discussion among the co-authors to establish a consensus. All analyses performed in this study relied on public, anonymized data and adhere to the terms and conditions, terms of use and privacy policies of Twitter. Data mining was performed with R version 3.2.3, and subsequently with Python version 3.4.2.

FigurePercentage of Tweets Related Patients Perception and Attribute to COVID-19.
To our knowledge, this is the first study utilizing Twitter to identify individuals’ self-reporting of COVID-19 perceptions and attributions in non-academic settings. Our results demonstrate that Tweets related to the COVID-19 pandemic in non-academic settings may be a valuable source of public health research, especially related to misinformation dissemination. Interestingly, after manual review, we found that Tweets related to the COVID-19 pandemic in non-academic contexts primarily contain unverifiable information or blatant misinformation.
,
. Additionally, a recent study does suggest higher rates of co-infection between SARS-CoV-2 and other respiratory pathogens.
Additionally, another study found that coronavirus infection rates in individuals who received the influenza vaccine were significantly higher than in unvaccinated individuals (OR = 1.36; 95% C.I. 1.14, 1.63,
. However, those results might be due to various confounding variables such as pharmaceutical company sponsoring, geographic variability, climate, or immune-related ethnicity. Notwithstanding, COVID-19 is an evolving disease, and there has been no robust clinical evidence linking the influenza vaccine and SARS-CoV-2 infection.
. Most importantly, a recent single-center study in Wuhan, China showed that a history of allergies may not be a risk factor for the SARS‐CoV‐2 infection.
. One online article claimed that 5G in some way accelerates or triggers the new coronavirus infection by suppressing the immune system via the transmission of radio waves
. However, there is no evidence to support this claim. Additionally, this theory fails to explain as to why the SARS-CoV-2 virus is rapidly spreading in countries where no 5G networks exist.
This study has certain limitations. First, we could not identify the clinical characteristics of Twitter users such as educational status, socioeconomic status, occupation, cultural factors or influencer level. Second, although we manually reviewed the data gathered, this research question’s hypothesis might be subject to selection biases, leading to an overrepresentation of Tweets containing misinformation rather than novel reports. In addition, we intentionally excluded academic Tweets, which may influence in non-academic settings that we did not capture in this study.
Twitter may provide an essential resource for public health research and a virtual platform for sharing academic data and research in an ever-changing COVID-19 pandemic. However, the spread of misinformation and unverifiable information are significant limitations to the use of Twitter, especially in non-academic contexts and users.
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2020
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Funding: None; Conflict of Interest: None; All authors have seen the data and have participated in the preparation of the manuscript.
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© 2020 Published by Elsevier Inc.