A new paper in JAMA Network Open released yesterday describes a study of whether an association exists between targeted social media campaigns on personal hygiene, physical distancing, and prevention of person-to-person transmission of SARS-CoV-2. Researchers in the Netherlands designed a survey to determine the behaviors of personal hygiene and social distancing at two points in time. The investigators distributed the survey through the national newspaper (De Telegraaf) and through a social media influencer. Impressively, 16,072 participants completed the survey. Gaps in behavior identified in the survey included handwashing, face touching, and physical distancing. Using this information, the researchers created a social media campaign at the national level to address these deficits, which was subsequently redistributed at a national level. A post-campaign survey was later used to assess whether the national campaign had contributed to any changes of the behavioral practices of persons living in the Netherlands. Importantly, however, it should be noted that those surveyed in the post-campaign survey were not necessarily the same as those who participated in the pre-campaign survey. In fact, more people (17,189) responded to the post-campaign survey, which is more than the number of individuals who initially took the survey.

 To examine the effectiveness of the campaign, survey respondents were divided into four groups based on exposure to the campaign: unexposed, video only, infographic only, and exposure both to the infographic and the video. Of note, there were baseline differences in the demographic characteristics between all four groups, as this was an observational study and there was no randomization of participants. In a statistical analysis (using a logistic regression model) that attempted to control for the differences in baseline demographics, exposure to the video plus the infographic or exposure to the infographic alone was associated with higher odds of reporting proper hand hygiene and physical distancing in the post-campaign surveys. Interestingly, exposure to video only was not associated with improved handwashing. 

This study has some notable limitations that render its findings less definitive than may appear. The first limitation is that the study design did not allow the investigators to directly determine whether the social media campaign actually influenced behavior. More ideally, the researchers would have been able to re-survey the same participants of the first survey after the campaign rollout to assess if there was any effect related to consumption of the information in the social media campaign. As it stands, we do not know what the baseline hygiene and other relevant practices were among the people surveyed in the post-campaign survey. This introduces a potentially important bias to the results which is impossible to detect given the design of the study. 

Do social media campaigns influence personal hygiene and social distancing practices during a pandemic? It's possible. Certainly, such campaigns are unlikely to cause harm. But we still do not have direct evidence of their effectiveness, nor whether efforts such as this can contribute to lowering case counts.

On a recent call with the National Governors' Association, Vice President Mike Pence and of the Secretary of Health and Human Services Alex Azar reassured state leaders that the coronavirus declaration of a national emergency due to the coronavirus outbreak likely would not be ending any time soon. While the continuance of the nationwide state of emergency is not yet official policy, the high ranking Trump administration members stated that an extension is currently moving through the administrative process. Secretary Azar noted that he didn't know of any reason that the continuance would not be authorized, though those who have watched the often mercurial President closely may have other ideas on that matter. Initially granted in January when the novel coronavirus was still largely in China, the declaration gives sweeping powers to the administration to make swift changes including increasing reimbursement for telehealth visits for the treatment of Medicare beneficiaries and allowing the Food and Drug Administration to temporarily authorize medications and medical devices including diagnostic tests. Under the declaration, state governments can also use federal employees to help with their responses to the pandemic. The public health emergency must be reauthorized every 90 days and is currently set to expire on July 25th. If granted, the extension would be set to expire shortly before Election Day, currently scheduled for November 3rd. Politico.