Cure or Poison?

Image: Penu Kiratzov

By Velina Barova

Velina Barova is a journalist and deputy editor of Evromegdan and BlueLink Stories, online platforms of Blue Link Foundation. She has participated in a number of media trainings and projects in Europe and Africa.

In times of a global health crisis equated with a war, the world is rapidly trying to find out as much as it can about the unknown enemy: the novel coronavirus.
Tens of thousands of scientific papers on COVID-19 have been released since the start of the pandemic. However, another portion of scientific information finds itself in the media, hastily published and leaving important details between the lines. Is this information a cure or a poison? 

While in the summer medical professionals repeatedly told the public that what they know about the novel coronavirus is limited to what had been discovered by scientists, the media demanded that “some medical laboratory of some scientific institution” discuss more, says associate professor in journalism at Sofia University Zhana Popova, “It is too much of a responsibility to announce all these versions of studies and then leave audiences to judge which one is right.” 

According to Popova, science provokes the reader’s interest, because during exceptional situations such as the current pandemic “we rely on science to tell us how to save ourselves”. In her view, people generally take a scientific discovery as final. “They are not seen as interim, but rather something after which the study of a subject is more or less over. Which is not the case.”

Earlier this year, among the vast amount of preliminary scientific findings announced in the press – from how the coronavirus affects the human body, through immunity-building, to the impact of hydroxychloroquine in treating COVID-19 – two studies caught the media and readers’ attention more than any others: will nicotine protect us and is ibuprofen dangerous if one has COVID-19? Despite their differences – ibuprofen is an over-the-counter medication, and the nicotine contained in cigarettes is a highly addictive harmful substance – these two subjects in particular stood out in the press with their controversial message, multiple discussions, sensational headlines, and fake news. 

Do not take ibuprofen 

At the beginning of June 2020, BBC announced that a team of British scientists was conducting a study aimed at finding whether ibuprofen could help COVID-19 patients. Two and a half months earlier, the painkiller was the target of media interest and never-ending public debates, but not as a potential cheap cure; quite the opposite. 

Initial doubts were stirred by a March 11 letter sent to the editorial office of the Lancet Respiratory Medicine medical journal. The authors put forward the hypothesis that the use of nonsteroidal anti-inflammatory drugs increases concentrations of the ACE2 enzyme, which allows the novel coronavirus to enter the cell and thereby possibly worsen COVID-19’s symptoms. 

On March 14th, the French Ministry of Health published recommendations for COVID-19, including advice to take paracetamol in cases of high fever and pain, and if there is a suspected COVID-19 infection. A day later, the French Health Minister Olivier Veran warned on Twitter that “the use of anti-inflammatory drugs (ibuprofen, cortisone, and others) might play a role in worsening the infection. If you have fever, take paracetamol. If you are already on anti-inflammatory medication or you are in doubt, contact your physician for information.” 

On March 17th, The Lancet journal offered clarifications on Twitter about the letter, which by then had become exceptionally popular: “Drugs listed in this Correspondence have been reported (at least once) to affect ACE2 synthesis or action. The authors DO NOT claim that these drugs, including ibuprofen, increase the severity of COVID19.”

On the same day as the French authorities’ warning was announced, the World Health Organization (WHO) recommended that people exhibiting COVID-19 symptoms avoid taking ibuprofen. WHO’s spokesperson, Christian Lindmeier, said that WHO’s experts are further studying the information published in The Lancet. “In the meantime, we recommend using paracetamol, and do not use ibuprofen as a self-medication. That’s important.” The next day WHO clarified on its Twitter page that “it does not recommend against the use of ibuprofen.”  

In Bulgaria, these claims were received critically by the experts in the coronavirus National Task Force but were nevertheless granted a central spot in news coverage. 

The wave of sometimes confusing messages from official sources was diligently covered by journalists, although the articles did not always manage to explain facts and controversies clearly and comprehensively. Some outlets offered the next piece of information on the subject with astounding speed in the form of news, without including Bulgarian or foreign expertise to “translate” scientific data in a comprehensive way. Sensational headings and unsourced claims were also abundant. All of this could obscure otherwise important messages due to the growing scepticism on what is true, if anything at all. 

On March 15th, the claim that the French Health Minister Olivier Veran’s profile was hacked appeared in some Bulgarian media, and “Figaro’s and France Presse’s information that medication containing non-steroidal, anti-inflammatory ingredients such as ibuprofen and cortisone could worsen the condition of those sick with the coronavirus turned out to be unverified”, Nova Television announced. Standard Daily published the same piece of news and quoted the TV channel with an even more sensational headline: Ibuprofen and cortisone help! All else is lies. Fake news about ibuprofen goes around the world, wrote online news website Medialpool. 

None of these articles point to a source to confirm that Veran’s profile had actually been hacked. As of the time of publication, his initial Twitter post is still online, and has not been disowned by the Minister. There is no information on the hacking of his profile in the French press. 

An in-depth report compiled by Cardiff University’s Crime and Security Research Institute (CSRI) from March 24th analyses the rumours about the efficiency of ibuprofen and paracetamol in treating COVID-19. The authors point out that Veran’s tweet does not cite sources, and there are no more publications from him on Twitter regarding this subject. 

“The following day, the report notes, the Bulgarian news agency Novinite wrote that his account was hacked in an article entitled “Fake News: Ibuprofen and Cortisone may Worsen your Condition if you are Infected with COVID-19”. However, the day after, this headline was changed to “Not Fake News: Ibuprofen and Cortisone may Worsen your Condition if you are Infected with COVID-19 – UPDATED”. 

While both Bulgarian versions of the article state that the information on the hacking of Veran’s profile is untrue, the English versions still contain the claim: “It turned out that the minister’s profile had been hacked and the information disseminated was incorrect. False information was reported by Figaro newspaper and quickly circulated through the media.” 

Discussions about ibuprofen’s effects were also fed by disinformation attempts through direct messages to certain individuals. On March 14th, the German daily Die Welt wrote about the propagation of a voice message in which a woman claims to have spoken on the phone with a friend working at the University Hospital in Vienna. According to her, tests were done in the University’s laboratory which prove that medication containing ibuprofen affects COVID-19 patients negatively. 

The University Hospital refuted the claims in a Facebook post that same day: “We would like to state clearly that this is false news, which has nothing to do with the Vienna University Hospital.”

Can smoking prevent coronavirus? 

Another widely discussed matter in the first months of the pandemic concerned the effects of nicotine and smoking on COVID-19. Media coverage on the matter changed from one day to another.

The strong initial push came from a February 2020 research by a team of Chinese scientists, who studied the clinical characteristics of 140 COVID-19 patients. According to their results, 3,4 percent of critically ill patients were smokers, 6,9 percent – former smokers. Among those with less complications there were no smokers, and 3,7 percent were former smokers. 

The conclusions state: “The relationship between smoking and coronavirus infection is not clear, and the exact underlying causes of the lower incidence of COVID‐19 in current smokers are still unknown.[…] Although our study found that COPD and smoking populations were less likely to be infected with SARS‐CoV‐2 but the outcome of SARS‐CoV‐2 infection in smokers may be more severe.”

When presenting the data from this Chinese study, some Bulgarian media indulged in a looser interpretation of hard numbers. Amazing: Smokers Don’t Catch the Coronavirus, wrote Maritsa Daily in a publication from March 12th. “Amazing, but true – tobacco can be healthy! Smokers face 20 times lower risks from coronavirus infection than non-smokers”, the piece states, citing the Russian website Vazhno.Ru, which in turn quotes Federal Press. The content of a news article in the online site Dunav Most entitled Scientists: the Coronavirus Avoids Smokers is almost identical, and it directly cites the Russian Federal Press. Sensation from Wuhan: the Coronavirus does not infect smokers!, the website Blitz chimes in, too.  

Dr Sofia Angelova, a pulmonologist and chair of the National Association for Lung Disease Prevention, is critical of the Chinese study’s conclusions, pointing out that the age of the patients is not stated. “It is known that 52 percent of men and 2,6 percent of women are smokers in China. It is also known that most Chinese smokers are aged between 40 and 59 years old. Most of the critically ill patients were between 70 and 80 years, among whom are the lowest numbers of smokers”, the expert said

Dr Angelova draws attention to data from a meta analysis of five Chinese studies, according to which smokers are 1,4 times more likely to develop severe symptoms of the disease, and 2,4 more likely to be admitted to intensive care, increasing the risk of a lethal outcome. 

Another study which fuelled discussions on the potentially beneficial effect of nicotine in combating COVID-19 came from France in April. A team of French scientists examined COVID-19 patients. Among 343 hospitalized patients with an average age of 65 years, the share of smokers was 4,4 percent, and from 139 at-home patients with an average age of 44 years, 5,3 percent were smokers. The study hypothesizes that smokers are less likely to develop mild or severe symptoms of SARS-CoV-2 infection compared to the general population. 

Dr Angelova expressed doubts regarding the methodology of the study. “The number of patients in both groups are compared to smokers among the general population in France in 2018, which did not sound credible to me”, she said. The pulmonologist is sceptical of the French scientists’ hypothesis that nicotine can prevent the virus’s molecules from attaching to the receptors in the human body, one of which is ACE2. She quotes a Canadian study comparing the number of ACE2 receptors among smokers, former smokers, and non-smokers. According to her, one can clearly see that the receptor expression is highest among smokers in comparison with non- and ex-smokers. The authors draw the conclusion that “quitting smoking will help smokers with COVID-19 prevention”, Dr Angelova said. 

But these doubtful results from the French study did get publicised: COVID-19 Does not Infect Smokers, French Scientists Said and Explained Why, Blitz wrote, quoting France Presse and information on future tests to be performed with nicotine patches on patients and first-line respondent doctors. “Now French scientists make it clear that nicotine protects from COVID-19”. 

The general director of the French National Health Agency Jerome Salomon said that at this stage, the relationship between nicotine and the severity of COVID-19 symptoms is an unproven hypothesis and warned that “smoking remains the number one killer in France, with 75,000 people who die of smoking-related complications each year.” 

In a statement on May 11th, WHO underlined the lack of information to confirm the relationship between tobacco or nicotine and prevention or treatment of COVID-19. WHO urged caution from researchers, scientists, and media when it comes to sharing unverified claims. 

Controversial information from scientific journals and media publications also affects public perceptions. Dr Angelova says that during the period of social distancing in the spring, when both publications “urging people to smoke in order not to contract COVID-19” appeared, she received many phone calls from patients asking whether smoking really prevents the disease. 

Sensational headlines and the lack of expertise when covering these two cases show us how important journalism is in times of a pandemic. According to assistant-professor Zhana Popova, “media hunger” for scientific coverage is the result of a long process of transforming scientific discoveries into a sensation. She brings up two main issues in media coverage of such subjects: how is expert information translated to a language accessible to the audience and how the immense quantity of available scientific information is communicated. 

Popova sees a silver lining in science news, namely that “after all, the general public needs to get used to the fact that patience is needed” when it comes to a little-known virus, and scientific conclusions on the topic turn out to be temporary, provoke controversial interpretations, or allude to hypotheses that are yet to be proven. But media responsibility is key. 

“There is no problem in having discussions in science. But when all of this becomes public knowledge with the flat statement that “this is the cure” or “that will save us”, that is problematic, because it sounds like a promise”, she says.