On March 24, Jeffrey VanWingen, a family physician in Grand Rapids, Michigan, posted his first-ever video to YouTube.
VanWingen, decked out in medical scrubs in his kitchen, spent 13 minutes explaining how to disinfect a cereal box, a carton of broth, and some broccoli, while a masked friend filmed him from a safe distance. He gave it a title likely to show up in anxious web searches: "PSA Grocery Shopping Tips in Covid-19."
Within a week, the video had over 20 million views, and VanWingen was fielding calls from across the world to translate it into other languages.
By then, it was too late to alter the ninth minute, when VanWingen tossed bags of apples and oranges into a sink of soapy water - something scientists say could cause more harm than good. He tried futilely to contact YouTube to edit that portion out of the video. He settled on inserting a disclaimer: "Correction: Rinse fruits and vegetables with water-no soap."
Millions of people have been frantically scouring the internet in recent weeks for health advice, turning doctors like VanWingen into YouTube’s newest, unexpected stars - and putting significant weight behind their recommendations.
"I’m not tech savvy and I am not vain. I just wanted to help people," he said in a phone interview. "With something like this pandemic, there's no guidebook."
VanWingen didn’t tout an experimental drug or a "silver solution" as cures for Covid-19, and didn’t blame the spread of the virus on 5G networks – all claims that have appeared on YouTube.
But his video, coming from a medical professional, did create alarm in a way that some viewed as irresponsible. "He’s treating handling your groceries like doing open heart surgery," Donald Schaffner, a biologist at Rutgers University.
"He’s giving people panic attacks." There is no evidence that Covid-19 is transmitted through food or grocery packaging, according to the US Food and Drug Administration.
The World Health Organisation has described the overabundance of covid-related communication online as an "infodemic," making it hard for people to find credible information within the deluge.
YouTube is relying on a secretive ranking system to separate legitimate medical advice from quackery. The choices aren’t always straightforward.
The site has to decide how to handle videos from experts on contested medical topics or posts, like VanWingen’s, that are popular and useful but also contain seemingly honest mistakes. It’s even harder to know where to set boundaries when official opinion on subjects like whether people wearing masks in public is still in flux.
A big part of YouTube’s solution is an authoritativeness score, an algorithm that gleans the credibility of people who post videos about news events and certain topics including health.
The company has said it surfaces videos from news outlets, hospitals and "experts" to viewers most often. Videos from creators with lower scores aren’t necessarily taken down, but are punished by YouTube’s automated system for video recommendation.
Layers of Review
YouTube relies on medical doctors to review videos about medical treatments. Its process often includes multiple layers of review, a company spokeswoman said, but she wouldn’t name the doctors or say how many are involved. Even video creators that YouTube actively promotes during the pandemic, like Mikhail "Doctor Mike" Varshavski, who has some 5.5 million followers, know little about the process. "I don't know what my score is," he said. "Honestly, it’s really confusing to us as creators."
Roger Seheult, a California pulmonologist, produces MedCram, an eight-year old YouTube page that, before January, posted mostly arcane lectures for medical students.
Then Seheult turned to the coronavirus, posting dozens of dispatches on the outbreak. Traffic exploded. One of his most popular videos, with over a million views, is a seventeen-minute clip from March 10 in which he says he is "cautiously optimistic" about hydroxychloroquine, a malaria drug US President Donald Trump has suggested as a coronavirus treatment, with mixed scientific support.
In the video, Seheult reads through several medical studies and reports about the experimental drug. He ends the video by saying randomised control trials on hydroxychloroquine are still needed. In an interview, Seheult said he believes the drug’s potential benefits outweigh the risks "for many patients under my care."
Like other social-media platforms, YouTube was criticised in recent years for the way its recommendation engine promoted conspiracy theories about health, particularly those raising suspicions about vaccines. Since then, YouTube has worked to remove false claims from search results and recommendations.
It now puts a link to health organisations and Google’s own virus information page below every clip about coronavirus and has instituted a policy to remove videos "promoting medically unsubstantiated" prevention and treatment. YouTube pulled down two clips from Brazil’s president for breaking that rule and has removed "thousands" more, according to the company.
But wavs of new footage about the virus is posted to YouTube daily, even as Google’s own shift to remote work has led it to reduce its staff for content moderation.
An added moderation challenge is that it isn’t immediately apparent some problematic videos are connected to coronavirus. Searches for chloroquine and other experimental treatments produce videos from YouTubers, some of them claiming to be doctors, who only recently joined the site.
YouTube hosts pages and pages of videos filed under the hashtag #FilmYourHospital, a viral stunt that encourages people to shoot footage suggesting the virus is a hoax. State officials have warned hospitals about the trend.
Sheltered in Michigan, VanWingen spent hours on the phone trying to get in touch with someone at YouTube to cut out the soap washing part. (As a rule, YouTube lets creators change text but not video content after uploading.)
YouTube didn’t promote his video on its newly created news section for the virus or widely in its recommendations, according to the company, but the clip still continued to spread on its own.
Ultimately, he posted a revised version of his PSA a week later, shorter and more "toned down". It only received a fraction of the original’s traffic.