Listen: Misinformation Mailbag

Listeners wrote into the Social Distance podcast with questions about all kinds of pandemic misinformation: tests, masks, supplements, vaccines, and more. Hosts James Hamblin and Katherine Wells discuss conspiracy theories, false remedies, and how to approach the people that believe in them.

Listen to their conversation here:

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What follows is a transcript of their conversation, edited and condensed for clarity:

Katherine Wells: Here’s a question from a listener: “I live with someone who believes the reported number of U.S. COVID-19 cases is being inflated by hospitals to ‘get more money.’ They don’t believe there is a pandemic or even an epidemic.”

James Hamblin: Well, hospitals are not doing well on the whole. It’s been a tremendous burden on staff. It’s meant closing and canceling and delaying a lot of the elective procedures that tend to be revenue-generating streams for hospitals. Hospital beds are usually close to capacity. So, no, hospitals are not profiting off of this.

Wells: They’re actually losing money for the most part, right?

Hamblin: Yeah, for the most part.

Wells: One of the problems with our system is that the way hospitals make money is with elective procedures. So the things they do make money on, which they might have an incentive to inflate or perform when it’s not absolutely necessary, are far lower than it would be another year.

Hamblin: Right, in most cases, you know. Not just elective stuff, but high-cost imaging tests and procedures like cardiac catheterization and surgeries that aren’t really part of the COVID-19 experience. You might get a standard CT scan to look at your lungs. But for long periods, people are just convalescing. They don’t need a lot of new expensive diagnostic tests. They don’t need big surgeries or procedures. They do need to occupy a hospital bed for a long time. And they do require a lot of vigilance and attention from staff.

Wells: Here’s a similar question from Emily: “One of my long-time, staunchly conservative family friends was telling me that an older relative of his was tested days before her death for COVID-19. Allegedly, both tests came back negative, but the hospital wrote on her death certificate that the cause of death was COVID-19. My friend tells me that this is because hospitals receive money from the government when someone dies of COVID-19.”

Hamblin: You know, I’ve had to fill out death certificates when I was in residency. You have to go down and fill out paperwork. You go through the chart and do your best to put in order what were the issues going on here. And it’s actually uncommon that one person died of only one thing. Maybe if it was an accident or an injury, that would be the case. But oftentimes people get old and they have heart conditions and diabetes and they developed pneumonia and then they have a stroke. Sometimes it is legitimately hard to say what was the thing that put them over the edge.

Wells: But what would be the possible scenario where tests came back negative but the hospital wrote that the cause of death was COVID-19? That seems strange, for sure.

Hamblin: Yeah, that seems very strange. So, I don’t believe this has definitely happened. But if we take that as a fact that it did happen somewhere, COVID-19 is a clinical diagnosis. It is something that is made in the presence of symptoms, a person’s appearance, their history, and diagnostic tests.

Wells: So it’s not the test alone? It’s the test combined with other evidence?

Hamblin: That’s the whole art of medicine. If there were just one test, anyone could do it. A robot could do it. If you come in to the emergency room and you’re having chest pain and you have a history of heart disease and there’s pain radiating down your left arm and you’re sweating and they do an EKG and it doesn’t look bad, they don’t say: “Oh, you’re fine.” There’s no one single thing that can make diagnoses like this. And COVID-19 is similar. So it’s possible that someone had all the symptoms, had the CT that looked like they had COVID-19, and had a test that came back negative—because they sometimes do that—that they still were diagnosed with COVID-19. We’re running through hypotheticals here.

Wells: But in either case, there’s no financial incentive for hospitals to say that someone died of COVID-19 when they didn’t?

Hamblin: There is not a financial incentive. The CARES Act did give a little bit of money for hospitals that are being hard-hit by COVID-19, but it seems that in almost every case, these hospitals are struggling financially. It’s not enough for them to recover. And when you’re filling out a death certificate, when you’re making a diagnosis at an individual level as a doctor, there’s no financial incentive to lie. Even if you were that unscrupulous, there’s not a financial incentive to lie about death counts. That’s just an extremely cynical idea. And it just doesn’t accord with the fact that hospitals are struggling right now financially.

It’s the same theme that you see in a lot of concerns: fear that there’s a systematic profit motive to have people suffer, or to lie about the prevalence of a disease. That’s a constant trope in misinformation and myths. And there’s good reason to be skeptical of the medical establishment, but no. Health-care workers are suffering. Hospitals are suffering financially. No one is benefiting from this.

Wells: Another big area of misinformation is masks. In fairness, I was extremely confused about masks for the first couple of months because the guidance from official sources was in fact incorrect, so it’s not unreasonable for there to be confusion about masks. However, here’s an email from a listener named Alicia. She said that a mask requirement in her state had parents freaking out. She said there’s a lot of talk about pulling students because they don’t think their kid should wear a mask all day:

“They’re claiming there is no science that masks work and that they do more harm than good. One of the arguments being that people are ‘breathing their own CO₂’ and that masks ‘can cause other lung issues.’ I’m able to find tons of evidence to refute what they say, but it feels futile because people are so set in this misinformation.”

Hamblin: Just in case anyone’s unclear: Masks are effective. They’re not perfectly effective. There are always going to be stories where someone was wearing a mask and got it nonetheless. That doesn’t mean it wasn’t effective. All these things are tools in a tool kit.

When someone comes to you, you can kind of break it down: Is this a genuine concern? Are they really afraid of wearing a mask? In which case, that deserves to be taken seriously. Or are they using this information to justify their belief that they just don’t want to wear a mask?

Wells: Can masks trap CO₂ that you’re breathing out and make you breathe it back in in a bad way?

Hamblin: No, masks are not suffocating you.

Wells: Could there be bacteria or something that is getting caught in there?

Hamblin: If you’re sharing a mask and the person you’re sharing it with was sick, you could expect that you would get sick. But if it’s just your own exhalation, there’s not a problem. You eventually do want to clean it because you’ll have accumulations of whatever you might have been exposed to, but there’s no credible evidence that I’ve seen that anyone should be concerned about masks making you sick.

Wells: Why do you think this mask misinformation exists? I really do think we got off to a bad start on mask information at the beginning.

Hamblin: This is how a lot of problems start with health information. When you start going into rabbit holes of: How could something possibly go wrong from this healthy thing you advised?, Is it possible for you to tell me that no one has ever had a negative consequence of wearing a mask or that no one has ever had a negative consequence of getting a vaccine?, et cetera.

And then people focus on that rare possibility, which can never totally be ruled out, over the overwhelming evidence that if everyone wore masks, we would save thousands of lives. It’s easy to go down that rabbit hole, but everyone wants to be safe. And it can be real seductive to believe the thing that you want to believe rather than the thing that the evidence is telling you. Most people would actually love it if it turned out that masks were not necessary. I don’t like wearing them.

When someone comes to you with a bizarre idea—like that their kid shouldn’t wear a mask because they’re going to get sick from it—they may have adopted that idea because it is anti-establishment, maybe not consciously even. And so, the more you come at them with scientific consensus and established media, the worse that could make things. And that’s why individual conversations are really important. We need to get people on the same page, especially as the vaccine rolls out, because we need, like, 70 percent of the population to take it.

Wells: Vaccines have long been fodder for misinformation and pushing back against the consensus. Vaccine skepticism and conspiracy theories are not new to the coronavirus. We’ve certainly gotten a lot of questions about that. But I think the thing that is interesting with the coronavirus is: Even people who are not vaccine skeptics have written in with safety questions because of the speed and unusual nature of the development of this vaccine.

Hamblin: I think the term anti-vaxxer is misused a lot. There is a small set of people who are knowingly misleadingly and profiting from spreading conspiracy theories. Many more people who just have questions, don’t understand, are concerned, are hesitant … when you label a person “anti-vax” who’s in that space, you can risk radicalizing people. And now, everyone is in that space with this coronavirus vaccine.

But there’s going to be a lot of reasons to believe in the safety of these vaccines. You have multiple international agencies vetting them, leaders of countries and leaders of the pharmaceutical companies taking them, all kinds of medical experts taking them. There’s going to be every possible reassurance that no one is being deliberately misleading. But it will never be possible to say that, five years from now, we don’t recognize some patterns among people who got the vaccine that were simply impossible to have known about.

Yet, all the good news about the vaccine falls apart if we have a wave of disinformation and we only get something like 35 percent of the population vaccinated. Because then we’ll still have to wear masks and distance. The virus will still percolate in our society for a long time, and in a way that we won’t be able to feel certain that we’re not going to get it.