COVID-19 on TikTok: harnessing an emerging social media platform to convey important public health messages

Introduction

COVID-19 is caused by SARS-CoV-2, and has triggered a worldwide pandemic. According to the World Health Organization (WHO), as of May 3, 2020, there have been 3,349,786 cases and 238,628 deaths globally, of which 1,093,880 cases and 62,406 deaths have occurred in the United States (US) [1]. As this is a novel disease with widespread reach, there has been a quest for answers to questions that arise consistently. To that end, the heightened level of information seeking, and subsequent exposure to potential misinformation has been categorized as an “infodemic” [2]. For public health officials to combat potential misinformation, they must understand the type of information accessed and explore the potential platforms for disseminating information with widespread reach for the intended audience. While public health content has been widely studied on platforms like YouTube and Instagram, other platforms emerging in popularity have been under-investigated. One such platform is TikTok, which has 800 million users worldwide, and over 30 million monthly users in the United States specifically [3]. In the US, users generate 37 billion video views on a monthly basis [3]. TikTok is a platform that features 15 s video streams in which are entertainment based. However, during the COVID-19 pandemic, some health professionals have turned to use TikTok to convey public health messages [4]. The WHO followed suit with the intent of joining TikTok to provide reliable information as well [5]. To our knowledge, there are no published studies describing on the content of COVID-19 material on TikTok. Therefore, this was the purpose of this study.

Methods

A cross-sectional study of the content on the social media platform TikTok was conducted in April, 2020. Using the discover feature, the search was conducted using the specific hashtag #Coronavirus as it had the greatest number of views (∼68 billion versus #COVID19 at ∼20 billion) at the time of data collection. The first 100 videos posted under the hashtag #Coronavirus search as of April 16, 2020 were included in this study. Additionally, all (n=17) posts uploaded by the WHO were analysed using the same coding scheme. Coding categories were adapted from prior studies [6], [7], and a CDC fact sheet [8] which was current at the time of study. These categories are included in Table 1, and focused largely on prevention, symptoms, information delivery, and feelings related to COVID-19. Additional characteristics of videos that were coded included number of views, comments, and likes. One individual (CJ) coded content across all videos and a second (CHB) coded a random selection of 10 videos to establish inter-rater reliability. Descriptive analyses were conducted that included frequency distributions for categorical variables and the calculation of mean and standard deviation for continuous variables. Videos were stratified by source of upload (consumer vs. WHO) and the cumulative proportion of all videos by source was computed. There were no human subjects involved in this study, and as a result, this was not reviewed by the Institutional Review Board at William Paterson University.

Results

Of the 117 TikTok videos, 100 (85.5%) were uploaded by consumers and 17 (14.5%) by the WHO. Overall, these videos were viewed 1,194,081,700 times with approximately 12,000 [SD 12,078.6] comments and 1.8 million [SD 897,396.7] “likes”. The majority (98.3%) used a live presenter and all were in English. The most commonly featured topics included anxiety (14.5%) with more than 190.6 million views and quarantine (10.3%) with 106.6 million views (Table 1). While very few videos (n=5, 4.3%) posted misinformation about COVID-19 and all of these were uploaded by consumers, none, including the WHO videos, discussed death and death rates, viral incubation time, wearing a facemask when caring for the ill, and restricting travel. Fewer than 10% of videos mentioned how the virus is transmitted, symptoms, and prevention. In general, consumer videos presented more anxiety and fewer facts and useful information than did WHO videos. WHO videos more often focused on viral transmission and symptoms but covered these topics in fewer than 10% of the videos.

Conclusion

The videos in our sample were viewed more than one billion times collectively demonstrating the widespread reach of this platform. That the content of these videos provided little to no useful information in videos with a Coronavirus hashtag represents a lost opportunity of monumental proportions. This study indicates that TikTok has the potential to be a valuable and influential platform for disseminating public health information as evidenced by the large number of views generated from a small number of posts. However, as this platform is largely entertainment based, professional sources of health information have not yet tapped into this rich source of viewers, young and old alike. The presence of the WHO on TikTok is recent, and despite the popularity of posts to date, the content covered is lacking in terms of conveying comprehensive information on prevention and transmission and is evidence that effort to effectively leverage this medium and the 15 s video stream concept are in their infancy.

According to recent TikTok statistics, the largest age group of users are those who are 18–24 years of age (42%), followed by those who are 13–17 years of age (27%) [3]. The US Centers for Disease Control and prevention suggest that cases of COVID-19 may be less severe in those under 18 years of age [9]. However, they note that social distancing remains paramount in all age groups due to the possibility of transmission, even in those with minimal or no symptoms [9]. It is also noteworthy that there is an emerging literature suggesting that social distancing has put a strain on the mental health of many individuals. For young adults in particular, the WHO suggests staying connected through social media and making every attempt to stay positive [10]. TikTok has the potential, not only to convey important health information, but to address these aspects of the COVID-19 pandemic as well.

This study is limited as data was collected at only one point in time, and content on TikTok is constantly changing. Similarly, as more is learned about COVID-19, content categories of relevant information would change over time, as was the case in this study with additional symptoms being noted after the data collection period. Nevertheless, this study fills a gap in the literature and offers insight into an emerging social media platform. Further research into the use of TikTok to promote health is needed.