Coronavirus (766) YouTube as a Source of Patient Information for Coronavirus Disease

21 June, 2020

Citation, abstract and a substantive comment from me below.

CITATION: Rev Med Virol. 2020 Jun 15;e2132. doi: 10.1002/rmv.2132.

YouTube as a Source of Patient Information for Coronavirus Disease (COVID-19): A Content-Quality and Audience Engagement Analysis

Tomasz Szmuda 1, Mohammad Talha Syed 2, Akshita Singh 2, Shan Ali 2, Cathrine Özdemir 2, Paweł Słoniewski 1

PMID: 32537771 DOI: 10.1002/rmv.2132


YouTube is the second most popular website in the world and is increasingly being used as a platform for disseminating health information. Our aim was to evaluate the content-quality and audience engagement of YouTube videos pertaining to the SARS (severe acute respiratory syndrome)-CoV-2 virus which causes the Coronavirus Disease 2019 (COVID-19), during the early phase of the pandemic. We chose the first 30 videos for seven different search phrases: "2019 nCoV," "SARS CoV-2," "COVID-19 virus," "coronavirus treatment," "coronavirus explained," "what is the coronavirus" and "coronavirus information." Video contents were evaluated by two independent medical students with more than 5 years of experience using the DISCERN instrument. Qualitative data, quantitative data and upload source for each video was noted for a quality and audience engagement analysis. Out of the total 210 videos, 137 met our inclusion criteria and were evaluated. The mean DISCERN score was 31.33 out of 75 possible points, which indicates that the quality of YouTube videos on COVID-19 is currently poor. There was excellent reliability between the two raters (intraclass correlation coefficient = 0.96). 55% of the videos discussed prevention, 49% discussed symptoms and 46% discussed the spread of the virus. Most of the videos were uploaded by news channels (50%) and education channels (40%). The quality of YouTube videos on SARS-CoV-2 and COVID-19 is poor, however, we have listed the top-quality videos in our article as they may be effective tools for patient education during the pandemic.

COMMENT (NPW): The authors find that the 'MedCram Medical Lectures Explained Clearly' are 'the best quality videos as a source of patient information for SARS-CoV2 on YouTube'. I had a look at their top recommendation and it is a dense 17-minute account that starts with a now-obsolete description of (10 March) of spread of coronavirus in various countries, and then moves into molecular biology (!). Here is some of the text from the first few minutes of the video:

'look at the molecular biology of the cell once again here is the nucleus of the cell and the nucleus of the cell is the DNA the DNA is a double-stranded string of nucleotides which are the codes those codes are transcribed using RNA polymerase into RNA that RNA then goes out of the nucleus gets a 5 prime cap and gets a 3 prime poly a tail and it's ready for ribosomes to come on to read that code and that code is then translated into the code of amino acids which amino acid after amino acid will turn into a polypeptide which turns into a protein and proteins are how the cell gets things done so it moves by proteins actin and myosin it can bind oxygen through hemoglobin it can do cellular metabolism all of those enzymes in glycolysis in the citric acid cycle all those things that you learned in biochemistry those are all enzymes those are all proteins so that's the normal situation now enter coronavirus coronavirus has its own genome it is made out of RNA and that RNA just happens to have a five-prime head and a poly a tail so when it pops into the cytosol it's going to be read by those same ribosomes that can't tell the difference except this time instead of making a that's useful to your cell this RNA that comes out of the virus is going to make something called a RNA dependent RNA polymerase and it's this enzyme right here that is going to read from the three prime m to the five prime end of the viral RNA and replicate it so this RNA dependent RNA polymerase makes more viral genomes it's also known as replicase for that reason and there's something that has been shown to inhibit this replicase and that is zinc zinc will shut down RNA dependent RNA polymerase or replicase and so that is what we learned the problem is how do you get zinc inside the cell the problem with zinc is that it's an ion it's a 2 plus ion and ions cannot get through the cellular membrane unless there's a transporter that allows it to come in in fact the way that they tested this in the paper is with an Iona 4 which allows the zinc to come into the cell so they could see that the activity of this RNA dependent RNA polymerase was reduced this is the paper zinc inhibits coronavirus RNA polymerase activity in vitro and zinc ionophores blocked the replication of these viruses in cell culture when they looked at the SARS cub virus that was the one that was seen back in 2002 as the zinc concentration inside the cell went up you can see that the byproduct of the RNA dependent RNA polymerase went down down down clearly demonstrating that zinc acellularly is going to block this very important enzyme of the virus well that's great we've got zinc that's gonna block it but how we get zinc inside the cell it's one thing to say that you're gonna take zinc supplements but how do those zinc supplements first of all get absorbed into your body in the blood into the extracellular space and then finally how are you gonna get that zinc from the extracellular space into the intracellular space in the cytosol where it needs to work on these infected cells and these viral proteins well that's another thing altogether what you need is some sort of ionophore or some sort of gated mechanism to open and to allow that zinc to come into the cell increasing the concentration of zinc into the cell so it can block Rd RP well enter this paper that was pointed out by some of you commenting chloroquine is a zinc ionna for this paper was published back in 2014 and the point of this paper was something completely different they weren't thinking about coronavirus they probably didn't even know perhaps that zinc blocks RNA dependent RNA polymerase what they were looking at here is that zinc may help some of these cancer cells basically eat themselves in the lysosomes...'

Really?!! This is 'the best quality video as a source of patient information for SARS-CoV2 on YouTube'?

The authors of the paper conclude by saying: 'We recommend that people verify the facts they learn on YouTube with more reliable sources of information like peer-reviewed research papers, healthcare professionals or online updates by the WHO or the Centers for Disease Prevention and Control. We recommend physicians to refer patients to the list of the highest quality videos that we provided if a patient wishes to use YouTube as a source of their medical information.'

This makes more sense that their choice of #1 video, but I'm not convinced this highly specific recommendation is adequate or appropriate to empower patients to find the information they need. To do this requires attention to health literacy, not only for coronavirus but for all health conditions: health literacy of individuals (including the ability ot differentiate reliable from unreliable information) and health literacy of health information services and providers (recognising and addressing the information needs and range of health literacy of their audiences). With regards to the latter, there is a strong case for accrediting websites where reliability and quality are built into their operating models, facilitating identification of quality by users. The HoNCode from Health on the Net Foundation is the leading example of this approach: Of course, HoNCode looks at whole websites rather than individual YouTube videos. A lesson for YouTube videos is to be highly cautious and to pay special attention to the credibility of the video producer. A much simpler conclusion to the above study could be to simply rely on YouTube channels such as the WHO Youtube Channel:

We still have a long way to go to understand and address information needs.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages (English, French, Spanish, Portuguese). Twitter: @hifa_org FB: