Public Attitudes About COVID-19 in Response to President Trump's Social Media Posts

Misinformation has hampered health officials’ ability to control the coronavirus disease 2019 (COVID-19) pandemic.^1-3 Public beliefs about COVID-19 are influenced by political ideology and media.⁴ In particular, President Trump’s tweets regarding his clinical status may have affected the beliefs of US individuals about the pandemic’s severity. Surveys and interviews, typically used to gauge public perspectives, have collection lag times.⁵ Accordingly, we sought to use near real-time social media data to capture the public’s changing COVID-19–related attitudes during President Trump’s recent infection.

For this cross-sectional study, from September 23 to October 8, 2020, we collected 22 800 tweets regarding public views on COVID-19 using Twitter’s free application programming interface. Search criteria included COVID-19–related keywords (eg, COVID-19, coronavirus) within 15 characters of a supporting (eg, serious, real) or contradicting (eg, hoax, #CovidHoax) adjective or hashtag. Tweets were collected from “swing states” (Florida, Michigan, Colorado, Iowa, Minnesota, Nevada, New Hampshire, North Carolina, Ohio, Pennsylvania, Virginia, and Wisconsin) (Box), were restricted to individual accounts, excluded retweets, and were obtained from 1 of 3 periods: (1) September 23 to October 1, 2020 (before President Trump’s tweet that he had contracted COVID-19); (2) October 1 to October 5, 2020 (between his infection announcement and his tweet, “Don’t be afraid of COVID”); and (3) October 5 to October 8, 2020 (after his “Don’t be afraid” tweet). This study and the consent process were exempted by the University of California, Irvine, institutional review board because all data were public. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

Box Section Ref ID

We randomly selected and manually labeled 3000 tweets from each period into 1 of 4 categories: (1) COVID-19 is not real, (2) COVID-19 is real but not serious, (3) COVID-19 is real and serious, and (4) unrelated or no stance (Box). Interrater reliability among 4 labelers on 93 randomly selected tweets yielded a Krippendorff α of 0.47. Tweets were restricted to 1 tweet per Twitter username by discarding any tweets after the first. Unrelated tweets from each period (301, 354, and 788 tweets, respectively) were removed, leaving 5945 tweets for analysis. A χ² test was used to assess differences in tweet proportions for each category across periods. Significance was set at a 2-sided P = .05. Analyses were performed using Excel, version 1808 (Microsoft Corp).

We found statistically significant differences in the proportion of COVID-19 severity categories between periods 1 and 2 (χ² = 569.9; P < .001), 2 and 3 (χ² = 283.5; P < .001), and overall (χ² = 582.9; P < .001) (with Bonferroni correction) (Table). Most tweets showed that COVID-19 was perceived as a real and serious issue across all periods (period 1, 1441 [67.3%]; period 2, 2060 [95.6%]; period 3, 1284 [78.0%]). Initially, 417 tweets [19.5%] showed the belief that COVID-19 was a hoax, and 284 (13.3%) showed the belief that it was not serious. After President Trump tweeted about his infection, 66 tweets (3.1%) showed the belief that COVID-19 was a hoax, and 30 (1.4%) showed the belief that it was not serious. This pattern reversed slightly after he tweeted, “Don’t be afraid of COVID-19” (hoax, 164 [10.0%]; not serious, 199 [12.0%]).

These results suggest that some members of the public adapted beliefs in response to President Trump’s tweets and that social media may be used as a near real-time data source to capture these changing perspectives, including COVID-19–related misinformation. This analysis has several immediate public health implications. First, health departments, political leaders, and influencers should leverage social media to support science on health issues, especially during pandemics.³ Second, social media can be used to assess the public’s changing responses to public health–related communications. Third, social media analysis can and should be explored to identify sources of and ways to combat misinformation.

Limitations of this study include Twitter not being representative of the general population.⁶ Although we manually reviewed tweets, restricted data to individual accounts, excluded retweets, and limited tweets per Twitter username, online manipulation (eg, “bots”) remains a potential issue. In addition, we did not have demographic data, such as political affiliation, limiting more detailed analyses.⁶ Overall, the results suggest that social media can be used as a tool to capture public perspectives, identify misinformation, and aid public health efforts.

Accepted for Publication: January 3, 2021.

Published: February 1, 2021. doi:10.1001/jamanetworkopen.2021.0101

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Ugarte DA et al. JAMA Network Open.

Corresponding Author: Sean D. Young, PhD, Department of Emergency Medicine, School of Medicine, University of California, Irvine, 333 City Blvd W, Ste 640, Orange, CA 92868 (Syoung5@hs.uci.edu).

Author Contributions: Dr Ugarte had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Ugarte, Flores, Young.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Ugarte, Young.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Ugarte, Cumberland.

Obtained funding: Young.

Administrative, technical, or material support: Flores, Young.

Supervision: Young.

Conflict of Interest Disclosures: Dr Young reported receiving grants from National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health during the conduct of the study; receiving personal fees from ElevateU Consulting; having equity in Motispark; receiving speaker honorarium from City University of Data Science, Hong Kong; receiving funding from Intel and Facebook to UC Institute for Prediction Technology; serving on a National Academy of Sciences, Engineering, and Medicine study committee; receiving book royalties from HarperCollins Publishers; and serving as an advisor for Cphere. No other disclosures were reported.

Funding/Support: This study was supported by grant 7R01AI132030 from the NIAID (Dr Young) and grant 5R01MH106415 from the National Institute of Mental Health (Dr Young).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Nicole Woodruff (University of California, Los Angeles) and Victoria Rong, Ali Al-Hakeem, and Armin Abaye (University of California, Irvine) helped annotate data for this study. They were not compensated for this help.