Findings
In keeping with the original aims of this study and the nature of questions posed in long interviews, results are presented in six broad categories: engagement with mainstream media; cybercommunication and cyberviolence; from onscreen to in-person; the impact of COVID-19-related workplace violence on individuals, their families, their staff and on public health; strategies for mitigating the impact; recommendations for change.
We begin, however, by noting that despite their years of experience and previous work as public health practitioners and leaders, the duration and intensity of the COVID-19 pandemic, and particularly the nature of public engagement was unprecedented for participants in this study. It was described by participants as, ‘a three year marathon with non-stop action’, ‘relentless’, and ‘exhausting’. Further, participants reported: “The duration, the intensity and the intense scrutiny on me as an individual was entirely unexpected.”; “I was completely unprepared…I had no idea that this was going to come.” The extended nature and ongoing intensity of the pandemic combined with the novelty of the challenge formed the basis on which threats and harassment were experienced by participants in the study.
Engagement with mainstream media
While some participants indicated that they had previous training in dealing with mainstream media, and others were engaged in media briefings before COVID-19 (eg, on topics such as sexually transmitted disease, disease transmitted by insects, or natural disasters), the intensity and volume of media engagement during the pandemic was unprecedented. One participant stated, “It was baptism by fire…the learning curve was pretty steep.”
Participants served as the public face of COVID, as spokespersons ‘for the public, for the government, for public health.’ Out of a sense of commitment to share public health data, many appeared in the media daily ‘to try and get the information out that people needed to do what we needed them to do, and media was one of the main ways of doing that.’ They ‘walk[ed] the line between the public service and the political space’, and there were varying senses of support from political leaders when public ire was raised regarding recommendations and restrictions. In some cases, political leaders remained closely aligned with public health professionals. As stated by one participant, “I spoke to the public health aspects and technical pieces and why, the epidemiology…and the political decisions, that is what [political leader] delivered”. In other cases, public health professionals were left with the perceived responsibility for unpopular measures, with political and other leaders essentially indicating: “We’re just following public health advice, so don’t blame us, blame public health if you don’t like it.”
Demand for media engagement was described as ‘relentless’ and the pace challenging: “We didn’t have time to really work things through and confirm things in that same way we normally would because information was changing so much.” One participant reported, “it was exhausting and it’s stressful because you want to get the right tone to get the right message out there and everything was criticized.” Another noted, “[media coverage] was a bit bimodal, a lot of the coverage was very positive and very factual…on the flipside, [other] media was very hostile.” Given that mainstream media has increasingly moved online and engaged in social media, the ‘bimodal’ views quickly moved to the realm of cybercommunication.
Cybercommunication and cyberviolence
Overall, participants reported relatively little engagement with social media prior to the pandemic, either personally or professionally. Nevertheless, to disseminate information to the public during COVID-19, new social media accounts were activated either by the individuals or their communications departments, often spurred by sudden interest in accounts which had exponential increases in followers. One individual explained, “We realized that people were, in larger numbers than before, using social media as a way to get the latest and changing information, or try to evaluate on what’s happening here.” Another participant reflected that “this is the first pandemic in the social media age… So, if you’re not there and create that credible, trusted voice on a sustained basis, then the whole of the social media will be drowned out by people who are not in the public health leadership space.” In addition, it was noted that “by and large, I still believe to this day that the vast majority of the population believes in science, has trust and confidence in public health officials, and will actually take advice. The issue is how to best reach all of the various segments of the population.” To this end, public health agencies reached out to ‘influencers’ including gamers, sports icons and religious leaders. In addition to common social media sites, they communicated through such means as YouTube videos and webinars.
Participants recounted a change in tone of social media as the pandemic continued unabated. One stated: “In the beginning, there was sort of this wave of hero worship that made me uncomfortable…I was definitely anxious about the inevitable backlash…any time people see you as some sort of superhuman hero, you’re going to disappoint them.” Content on social media became increasingly abusive and threatening. Comments included: “As time went on, the people who support you come off the comments, and what you’re left with are the residual persistent negative comments that are, in some cases, propagating hate”; and “ then that sort of just continued to escalate over the next number of years.” Several participants were called Nazis or likened to war criminals who would “be going to the Hague, where [they] would be held accountable, or Nuremburg.” One stated: “I was [accused of] killing kids, promoting vaccines as an instrument of control.” This abuse came from both sides of a polarised population:
”The physical harm and the nastiest stuff tends to come from those who believe nothing should ever have been done for COVID. The side that feels not enough was done to protect from COVID, that tends to be more like you should lose your license, you have blood on your hands, that kind of vitriol, but they don’t usually advocate for my public execution or imprisonment.”
There was consensus among participants that the level and nature of abuse were differential for women. As one male participant noted, “the physical threats themselves and the hatred, often took on threats of sexual violence and a lot of derogatory, demeaning terms. And the actual type of harassment was entirely different for female health professionals versus male.” Another participant added, “I think emergencies like this bring out certain elements in society who are there to target people in visible positions, and particularly women and visible minorities or racialized populations will be targeted.” One participant concluded, “Twitter can just be a cesspool of such bad, bad, things. There are these people who are anonymous behind a keyboard who think they can just say anything and there are no repercussions.”
While negative and abusive comments from the public were unsettling, several participants indicated that the negative engagement of medical colleagues on social media was most distressing. In describing the impact, a participant shared, “The thing that really bothered me, that actually gave me tachycardia, when I was reading some tweets from other physicians about me, my personal professional judgement, my advice, my assessment.” This included ad hominem attacks by other physicians and assertions such as, “your restrictions are killing my patients, their mental health”. These interventions by other physicians were viewed to ‘undermine social cohesion and public trust.’
Participants managed social media abuse and threats by relying on administrative staff and communications teams to sift through and manage communications. However, the public nature of roles held by participants meant that they were also accessible through telephone and email. Most agreed that the highest level of threat and harassment occurred through direct email contact, reflected in the following participant quote: “I had one individual email 700 or 800 times…[their] emails became more and more disorganized, and more and more religious-based, apocalyptic religious-based…That same person threatened to come to my house.”
From on screen to in-person threats and violence
Inevitably for participants, online anger, abuse and threats moved off screen and became in-person encounters. In addition to professional and personal email addresses, home addresses and home phone numbers began circulating online. Participants received phone calls at home saying such things as ‘you’re going to die, you’re going to die.’ Letters and packages were delivered to homes and offices of public health professionals containing threatening messages. Individuals and groups of protesters regularly showed up at the homes of participants as represented by this remark: “They were driving around my neighbourhood coming by my house yelling and screaming. People tried to break into my house. I was terrified.” This activity was provoked and then glorified on social media, as such provoking future rounds of abusive and threatening behaviour.
Given that public health professionals had become highly visible through engagement with the mainstream media, they were easily recognised and accosted on the street and in grocery stores; people followed them and surrounded and banged on their cars. Children of participants were approached on the street or near their schools and children’s social media was bombarded with hateful comments. Threats and harassment of public health professionals have not ended with COVID-19 with several participants reporting ongoing hate and threats, continuing to have security detail and significantly limiting their activities to avoid risk.
Impact of workplace violence against public health professionals
Not surprisingly, online vitriol, threats and harassment experienced by the public health professionals in this study had significant impacts on themselves, their family, their staff and ultimately the public health system. First, while participants were able to identify that threats and abuse arose from the nature of their work, prolonged and repeated exposure to negative messages in some cases undermined their sense of personal and professional self, particularly when comments came from other than what might be viewed as a fringe element. Prolonged stress and abuse also resulted in somatic symptoms including sleeplessness, and exhaustion. As one participant stated, “the scrutiny by everybody and obviously, journalists was unrelenting, and then it was just the length of it. You can do this kind of intense exposure for a short period of time, but when it’s continued for that long, it’s pretty exhausting.” Several participants reported losing friends who ‘get their news from social media and they were convinced that I was a bad person.’ As a threat to their professional status, most participants faced or continue to face problems to professional licensing bodies.
Because of security threats, participants reported restricting their activities, including not walking alone, going out to eat, or attending places where they may be accosted. All had police involvement in the threats; many with round-the-clock security presence at their homes for several months; some continue to have police details that accompany them. Police presented participants with photos of threatening individuals ‘in case I ever saw them’. Participants reported adding security systems to their homes, having to leave home during intense periods, or moving. For instance, “The [police] came to our house and told us we shouldn’t be home…you need to be gone.”
Family members were also significantly affected by the threats and harassment. One participant noted, “[my children] are active on social media and they both struggled…it created a lot of stress and anxiety, to have their [parent] out there and some pretty personal things attributed to me through social media.” Protests outside participants’ homes created a sense of siege and children were schooled on safety measures: “My kids were afraid to go out, I had to sit down with my kids and say, if you are not expecting somebody, don’t answer the door… I don’t want you to be scared, but at the same time we have to be careful.” Impact on family members went beyond nuclear families to include others outside the household, as one participant noted, “I don’t divulge anything about my family…the younger generation, they’re told not to tell people that I am their family member.”
Participants also expressed considerable concern about staff members who managed communications during COVID-19. One participant stated, “There was no down time for anybody, our team worked for two and a half years.” Staff members dealt with abusive and threatening phone calls and email messages, resulting in removal of publicly available contact information for some administrative assistants. Other staff had to monitor social media “because you cannot look at strategies to deal with mis or disinformation on hate-related messaging unless you know what’s in it.” As one participant summarised, “people are dealing with the pandemic in their own lives and their families on top of working 24/7, and then on top of that having to deal with this kind of messaging, it’s obvious that it’s having an impact.” Others indicated that staff have gone on “prolonged stress leave… [as a result of] having to deal with a lot of quite upset and angry individuals.” In the end, “Seeing the impact it had on my staff, it was horrible, that part was horrible.”
Finally, participants expressed deep concern about the impact of social media misinformation and vitriol on the public health of the population. One aspect is the undermining of public trust in public health advice and measures: “I think one of the biggest threats that we’re facing right now is this confirmation bias. So, everyone picks the side of an issue they’re on and then that’s the only people they follow or hear messages from.” When other health professionals engage in the social media storm, this concern is amplified, “If there’s physicians saying Public Health is wrong, who’s going to listen to Public Health? I think there are much better ways for people to message their discontent, that would serve the public better.” Further, there was concern about the impact of the media and social media storm on political decision-making. Participants reflected, “Misinformation had a slowing or breaking effect on policy at times, and probably made government react a little more slowly”; and “[Twitter] impacted the efficiency for decision-making”. Finally, there was concern that given the way public health leaders were treated during COVID-19, others would be dissuaded from serving.
Strategies for managing cyberviolence
Participants developed several strategies for dealing with harassment and abuse they received: setting personal boundaries; disconnecting from social media; not checking emails on weekends. Others described ‘compartmentalizing’ various aspects of life and work. One participant stated: “You necessarily need to separate yourself from the hate and craziness. It’s today’s world with social media. I think it is good for information, but it’s not a space for any rational dialogue.” Some spoke about focusing on the positive and literally or cognitively blocking negative content. For instance: “I try to always focus on the vast majority of people out there, they’re very, very kind, very thankful, very positive. Just focus on that and try to push anything else away and not pay attention to it.”
A second set of strategies involved managing communications. Initially, participants reported attempting to respond to email and social media, with the aim of correcting the record and sharing accurate information. However, as time continued, they sought other approaches, such as blocking individuals who frequently sent hateful messages, redirecting email to a specific mailbox, redirecting phones, and having messages from various sources monitored by communications teams. Nevertheless, for ‘the day-to-day sort of general vitriol…we tried a few different things to try to manage it, but it just didn’t work well.’
All respondents required intervention by police or security personnel at some points during the pandemic. Police conducted threat assessments, provided individual physical protection and around homes. New or enhanced security systems were installed in participant’s homes. Further, as indicated earlier, individuals restricted their own activities and spoke to family members about safety measures.
Finally, most spoke about the benefits of mutual aid and support through meeting with others in similar positions; sharing experiences and realising that everyone was facing the same challenges. It was commonly stated: “We trusted each other, we were a safe space to laugh, cry, to vent to each other and support each other.”
Recommendations for addressing cyber-instigated violence
Participants provided recommendations for preventing and mitigating effects of cyber-instigated violence against public health professionals that clustered in three areas. First, several participants identified the need for better mental health supports for public health workers and the obligation of employers for the safety of staff whose role and responsibilities place them at risk of threat.
Second, participants noted that public health organisations were unprepared for the nature of communications during the pandemic and the unprecedented role of social media. One noted, “We hadn’t developed a correspondence team”. A participant reflected, “We in government need to sit down and think about social media, how we use it, what our policies are going to be if we encounter any of the negativity that comes with it.” Another added, “[we need to] look at our structures and how they can manage this new phenomenon we need to be prepared”.
Finally, participants focused on the need to regulate social media, and reduce anonymity that is believed to protect those who harass, threaten and provoke violence. One participant noted “the other big risk is this anonymity. Like, some of the characters that sent me the most personal threats and threats against my safety. I doubt many of them would say something like that to somebody’s face.” Others stated:
“There needs to be systemic ways to address what’s going on. Governments should be holding these companies to account for the level of vitriol that happens, for the algorithms that thrive on hate and the echo chambers they create where people believe that everybody thinks the way they do.”
