Medical Misinformation in the Covid-19 Pandemic Sarah Kreps and Doug Kriner Department of Government, Cornell University Abstract The World Health Organization has labeled the omnipresence of misinformation about Covid-19 an “infodemic” that threatens efforts to battle the public health emergency. However, we know surprisingly little about the level of public uptake of medical misinformation and whether and how it affects public preferences and assessments. We conduct a pair of studies that examine the pervasiveness and persuasiveness of misinformation about the novel coronavirus’ origins, effective treatments, and the efficacy of government response. Across categories, we find relatively low levels of true recall of even the prominent fake claims. However, many Americans struggle to distinguish fact from fiction, with many believing false claims and even more failing to believe factual information. An experiment offers some evidence that corrections may succeed in reducing misperceptions, at least in some contexts. Finally, we find little evidence that exposure to misinformation significantly affected a range of policy beliefs and political judgments. One of the challenging public health aspects of the Covid-19 epidemic has been the misinformation surrounding the virus. Misinformation in the midst of a pandemic has a long history, dating back at least to the Plague of Athens, as the local population tried to shift blame onto an adversary or far-flung land rather than the local government. What makes the current misinformation context new and potentially threatening is that the internet facilitates the transfer of misinformation—defined as “false or misleading information”1—further and faster than either traditional forms of media or than accurate information.2 How pervasive and persuasive is the spread of medical misinformation? Prior studies offer few clues. Rumors about death panels surrounded the Affordable Care Act, showing that the high stakes of public health is not inoculated from misinformation and may be even more susceptible because the life-and-death consequences make people prone to fear and anxiety.3 Beyond the case- specific study, however, the pervasiveness and persuasiveness of medical misinformation is understudied compared to the focus on political misinformation, especially since the 2016 election. Recent research hints that medical misinformation may be less ubiquitous than political misinformation. Confronted with rapidly spreading false claims about Covid-19, social media platforms, the major vehicle for the diffusion of misinformation, have enacted unprecedented moderation policies, removing content and users that the platforms deem a public health risk. Because of the exigent threat to public health, the public has tacitly endorsed these draconian measures and entrusted platforms to act as a private regulator of the public information domain.4 However, the sheer volume of Covid-19 related content means that misinformation continues to propagate,5 although the degree of public exposure and impact remains unclear. According to one recent study, a small sample of fake claims on Facebook was shared 1.7 million times and viewed an estimated 117 million times as of mid-April 2020.6 In this research, we investigate the extent to which misinformation has percolated into the salient considerations on which Americans draw when thinking about the novel coronavirus. Can Americans faithfully recall Covid-19 misinformation? Can they distinguish factual information from misinformation? How does the spread of fake news affect public attitudes about the pandemic, trust in government, and international adversaries? We answer these questions with a pair of studies focusing on misinformation about Covid- 19, the disease caused by the novel coronavirus. First, we measure public uptake and perceived credibility of misinformation, comparing recall rates and accuracy perceptions across factual information, prominent misinformation about Covid-19, and placebo misinformation that has not appeared widely on social media. Second, we measure the impact of false claims on a range of attitudes, including public policy preferences, evaluation of and trust in government leaders and institutions, and perceptions of foreign competitors. These studies are the first to measure recall of 1 David Lazer, Matthew Baum, Yochai Benkler, Adam Berinsky, Kelly Greenhill, Filippo Menczer, Miriam Metzger, Brendan Nyhan, Gordon Pennycook, David Rothschild, Michael Schudson, Steven Sloman, Cass Sunstein, Emily Thorson, Duncan Watts, and Jonathan Zittrain, “The Science of Fake News,” Science, 359 no. 6380, 9 March 2018; 1094- 1096; 1094. 2 Soroush Vosoughi, Deb Roy, and Sinan Aral, “The spread of true and false news online,” Science, 9 March 2018, 359, No 6380, 1146-1151. 3 Adam Berinsky, “Rumors and Health Care Reform: Experiments in Political Misinformation,” British Journal of Political Science, Vol 47, No. 2 (April 2017), 241-262. 4 Sarah Kreps and Brendan Nyhan, “Coronavirus Fake News Isn’t Like Other Fake News,” Foreign Affairs, 30 March 2020. 5 Ramez Kouzy, Joseph Abi Joaode, and Khalil Baddour, “Coronavirus Goes Viral: Quantifying the Covid-19 Misinformation Epidemic on Twitter,” Cureus, March 2020 12 (3): e7255. 6 Avaaz, How Facebook Can Flatten the Curve of the Coronavirus Infodemic, 15 April 2020, https://secure.avaaz.org/campaign/en/facebook_coronavirus_misinformation/ 1 Covid misinformation as well as the first to assess the efficacy of corrections in combatting accuracy perceptions and propensity to distribute misinformation online. We report five main findings. First, while misinformation concerning the pandemic is ubiquitous, our data suggest that uptake and retention of misinformation overall is modest, though it varies by category. We find that true recall of fake headlines about the origins of Covid-19 is modest. However, misinformation about alleged treatments and the effectiveness of the government response to the virus have gained some traction. Second, we find that many Americans fail to correctly identify fake news as false. Perhaps equally if not even more troubling, even more Americans failed to correctly identify factual information as true. This suggests a more indirect, but potentially more dangerous mechanism through which misinformation threatens public health – not by causing majorities to believe erroneous claims, but by saturating the information environment to an extent that it drowns out accurate information.7 Third, these problems are particularly acute among certain partisan subgroups and among heavy consumers of social media. Fourth, corrections to fake news can counter beliefs in misinformation and reduce Americans’ propensity to contribute to its spread; however, these effects are variable across categories of fake claims. Finally, exposure to misinformation had little direct effect on Americans’ policy preferences for responding to the pandemic and on their political judgements. Medical Misinformation The democratic dilemma suggests that sound democratic governance hinges on a well- informed citizenry that can meaningfully weigh tradeoffs between policy proposals. Yet most individuals are underinformed about the very policies that they are meant to adjudicate. 8 Citizens could become more informed if they took measures to acquire policy-relevant information, but increasingly the marketplace of ideas is crowded and indeed fraught with misinformation that can impede the acquisition of accurate information. Research on the spread, uptake, and persuasiveness of misinformation has tended to focus on political misinformation, especially since the 2016 election. Some scholars have found that exposure to misinformation does not translate into persuasion, in part because those most exposed are partisans seeking pro-attitudinal information. 9 Other studies, however, have shown that individuals do fall prey to misinformation, although not for directionally-motivated, partisan reasons. Rather, scholars suggest that individuals are cognitively “lazy” and judge accuracy on the basis of plausibility, which requires some sort of prior about what is reasonable or not.10 Research on medical misinformation has similarly suggested that individuals believe rumors on the basis of cognitive fluency. The more prevalent a rumor, which can arise from partisan political actors frequently trafficking in particular narratives, the more credible it becomes and the harder it is to upend.11 7 The mechanism is similar to the arguments of Berinsky as well as Pennycook and Rand that suggests that fluency of information, which comes from repeat exposure, increases the plausibility of claims. 8 Arthur Lupia and Mathew McCubbins, The Democratic Dilemma: Can Citizens Learn what they need to know? Cambridge University Press, 1998. 9 Andrew Guess, Brendan Nyhan, and Jason Reifler, “Exposure to untrustworthy website in the 2016 US election,” Nature Human Behavior (2020), https://www.nature.com/articles/s41562-020-0833-x?proof=trueMay%252F 10 Gordon Pennycook and David Rand, “Lazy, not Biased: Susceptibility to Partisan Fake News is Better Explained by Lack of Reasoning than by Motivated Reasoning,” Cognition (2018). 11 Adam Berinsky, “Rumors and Health Care Reform: Experiments in Political Misinformation,” British Journal of Political Science, Vol 47, no 2 (April 2017), 241-262. 2 We investigate the applicability of these findings in the Covid-19 context. Previous research suggests that political misinformation travels faster or farther than