ABSTRACT

Introduction

The COVID-19 outbreak has been declared a pandemic by the World Health Organization, because of ‘alarming levels’ of spread, severity and inaction.1 As of 25th March 2020, there are over 414 000 cases globally and over 18 400 deaths.2 The causative novel human coronavirus, severe acute respiratory syndrome (SARS)-CoV-2, is primarily transmitted by respiratory droplet spread and direct contact; moreover, it can also survive in air.3^,4 Transmission is also possible in asymptomatic carriers.5 It is therefore crucial that world leaders mount effective public health measures to limit human-to-human transmission, including hand hygiene, social distancing and self-isolation.1^,6^,7

Twitter may represent a powerful public health tool for world leaders to rapidly and directly communicate information on COVID-19 to citizens, in addition to more conventional media such as television, radio and newspapers. Twitter is a free microblogging social media website with 152 million registered daily users.8 Furthermore, over 500 million people visit Twitter per month without logging into an account.9

The Group of Seven (G7) is an international intergovernmental organization, which comprises the seven most advanced economies in the world according to the International Monetary Fund: Canada, France, Germany, Italy, Japan, the UK and the USA.10 The European Union (EU) is also an invitee to the G7, represented by the Presidents of the EU Council and EU Commission. The language used by world leaders, such as the G7 heads of state, can influence the opinions and behaviour of citizens.11 Furthermore, the nature of communication by political leaders affects public policy outcomes.12 Thus, political leaders can use their influence over public opinion to address public health issues, ideally by disseminating evidence-based public health information.13

A MEDLINE search for the keywords ‘COVID-19’ and ‘Twitter’ delivered no results. Thus, to our knowledge, this qualitative study is the first to evaluate the role of Twitter as used by G7 world leaders in response to COVID-19.10^,14 Content analysis is performed exclusively for ‘viral’ tweets, meaning those which rapidly spread across a high number of users.15

Primary research objective: To explore how G7 world leaders are using Twitter in response to the COVID-19 pandemic.

Secondary research objectives:

• To determine what proportion of G7 world leaders use Twitter and assess their reach (followers);

• To perform content analysis for all G7 world leaders’ viral tweets and classify into appropriate themes;

• To evaluate associated characteristics of these tweets, including weblinks to official government-based information sources and use of video; and

• To determine what proportion of these tweets are in non-English languages.

Methods

Verified Twitter accounts16 were sought for the following G7 members:

• Justin Trudeau, Prime Minister of Canada;

• Emmanuel Macron, President of France;

• Angela Merkel, Chancellor of Germany;

• Giuseppe Conte, Prime Minister of Italy;

• Shinzo Abe, Prime Minister of Japan;

• Boris Johnson, Prime Minister of the UK;

• Donald Trump, President of the US;

• Charles Michel, President of the EU Council; and

• Ursula von der Leyen, President of the EU Commission.

The advanced Twitter search function was used to filter by the following inclusion criteria: keywords ‘COVID-19’ or ‘coronavirus’; search dates 17th November 2019–17th March 2020 (inclusive); and viral tweets. There is no strict definition for what constitutes a ‘viral’ tweet—we stipulated a minimum of 500 ‘likes’. Primary tweets meeting these criteria, plus any secondary tweets as part of a viral thread, were included in our analysis. No language restrictions were stipulated; Twitter’s built-in Google translate function was used for non-English tweets.17 Exclusion criteria were as follows: non-verified Twitter accounts and non-viral tweets.

Data were analysed on 18th March 2020 from a UK IP address. The following outcome measures were recorded: name, number of followers, number of viral tweets, number of associated weblinks to official government-based information sources, top tweet characteristics, languages used and number of viral videos with views. Top tweet characteristics included ‘likes’, ‘retweets’ and ‘comments’. A ‘like’ indicates that a registered Twitter user appreciates the tweet, while a ‘retweet’ indicates that they have shared the tweet on their own Twitter page and a ‘comment’ indicates that they have added written commentary for the tweet. All of these actions increase the reach of the viral tweet in question. Content analysis was performed by the lead author (SRR) to identify and categorize viral tweets into key themes.

This study has been reported as per the Standards for Reporting Qualitative Research.18 No ethical approval was required as all data (tweets) were retrieved from the public domain.

Results

Verified Twitter accounts were identified for eight out of nine (88.9%) G7 members; no active account was identified for Angela Merkel, Chancellor of Germany. Results for all outcome measures are displayed in Table 1. The included G7 members had a total following of 85.7 million Twitter users, and 203 viral tweets on COVID-19. 56 (27.6%) viral tweets were in non-English languages, including French, German, Italian and Japanese. All non-English tweets were successfully translated into English using Twitter’s built-in Google translate function.17

Content analysis revealed three key themes for viral tweets:

• (i) Informative—seeking to share information or updates.

• (ii) Morale-boosting—seeking to boost morale or galvanize.

• (iii) Political—seeking to raise a point of political debate.

In any cases of overlap, the majority of the tweet content dictated its thematic classification. Out of 203 viral tweets, 166 (82.8%) were ‘Informative’, of which 48 (28.6%) had associated weblinks to official government resources, while 19 (9.4%) were ‘Morale-boosting’ and 14 (6.9%) were ‘Political’. All ‘Political’ tweets were sent from the Twitter account of Donald Trump, President of the US. Additionally, 19 viral videos were embedded within Informative viral tweets, with a total of 12.4 million views. Figure 1 displays the number of followers and breakdown of viral tweet themes per G7 world leader for comparison. Table 2 displays examples of viral tweets per theme.

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Fig. 1

G7 World leaders’ individual twitter data. Breakdown of followers and viral tweet characteristics per G7 world leader. *Viral tweet defined as attracting at least 500 likes on the subject of ‘COVID-19’ or ‘coronavirus’. Key: G7 = Group of Seven.

Discussion

Conclusion

This study has demonstrated the widespread use of Twitter by the majority of G7 world leaders with many viral tweets on the subject of COVID-19. The majority of viral tweets were ‘Informative’, and many had weblinks to official government-based sources. Twitter may represent a powerful tool for world leaders to rapidly communicate with citizens during public health crises. We would urge general caution when using Twitter as a public health information source and give preference to tweets containing official government-based health information and advice.

Conflicts of interest

No conflicting relationship exists for any author.

Financial disclosures

The authors have no proprietary or commercial interest in any materials discussed in this article.

Acknowledgements

Notes

Sohaib R. Rufai, Doctoral Fellow

Catey Bunce, Reader in Medical Statistics

References