Where now in the danse macabre of covid-19 and misinformation?

Rumours of covid-19’s death have been greatly exaggerated. A new wave of infections reminds us that covid is with us probably forever, but the real question is whether we can say that it’s reached a phase of “sustainable endemicity.”1 Even if that is the case, even when surveillance is downgraded covid remains a troubling disease for individuals and health systems (doi:10.1136/bmj.p1885; doi:10.1136/bmj-2023-076222).23 What are now the right policies for protecting vulnerable people and limiting transmission in healthcare settings (doi:10.1136/bmj.p1648; doi:10.1136/bmj.p1860; doi:10.1136/bmj.p1666)?456 Does anything need to be done to prevent transmission among the general population? Why, when accountability on behalf of those most affected must be paramount, is the UK’s covid inquiry failing to be responsive to bereaved families (doi:10.1136/bmj.p1853)?7

The cause of covid’s resurgence isn’t clear. Cramming people indoors to watch new movie releases or escape bad weather, the inevitable ebb and flow of endemicity, and a possibility that we haven’t yet reached endemicity are among the proffered explanations. Covid-19 has unique features that make it hard to control, and the behaviour of new variants that are now emerging isn’t easy to predict (doi:10.1136/bmj.p1833).8 If endemicity means an equivalent death toll and population disease burden to that of influenza, is that an acceptable balance of risks?

This was the first pandemic in the social media age. Social media acted as the pandemic’s great disruptor. This accelerated understanding and debate, but it also spread misinformation and discord. The power of social media skewed the coverage of traditional broadcasters. Social media science influencers were in demand on national television and radio, seeking to balance the narrative, and in turn their broadcast appearances at times seemed manipulated to create social media clips to satiate their followers. Nothing has become more certain than the danse macabre of covid-19 and misinformation.

The challenge for broadcasters is a complex one. Medical journals find it hard enough to present and properly nuance uncertainty. The task of doing that successfully on a national news bulletin in a matter of moments, to an audience largely unfamiliar with science, is monumental. Like medical journals, and with the best of intentions to deliver “accurate, reliable, impartial information,” broadcasters get it wrong regularly (doi:10.1136/bmj.p1684).9 But as covid unleashed an unprecedented wave of emotion, combined with the forensic attention of social media, no slip-up went unposted, unliked, or unshared.

Sympathy towards broadcasters extends to their attempts to juggle impartiality with false equivalence. But bending over backwards to be seen to be impartial or to provide balance risks fringe views, even harmful ones, being given undue prominence. On top of that comes the added risk of a guest manipulating a live interview to advance some personal agenda. Yet the responsibility isn’t one to be shirked by broadcasters: it requires thorough preparation, diligent vetting of guests, and adequate training and briefing of presenters so that a live interview doesn’t fall prey to misinformation.

At the very least, there is some attempt to regulate traditional broadcasters and print media in many countries, but the misinformers and the hobbyhorse riders do their damage in the minimally regulated chaos of social media. They lend authority to their views by citing and often misinterpreting or misrepresenting studies published in trusted scientific publications. Given the difficulties in regulating broadcasters, to hold them and their guest experts to account, any attempt to bring to heel the fact checkers at Facebook (BMJ 2022;376:o95),10 the owner of X (formerly Twitter), the vastness of YouTube, or the mayhem of TikTok—where Kim Kardashian is promoting whole body MRI scanning (doi:10.1136/bmj.p1868)11—seems a forlorn one, but it must still be done. In words attributed to the cellist and peace activist Pablo Casals, “The situation is hopeless. We must take the next step.”