A Brave New Social Media World

I’m Jennifer Kasten. I’m an assistant professor at Cincinnati Children’s Hospital, and I’ve been in practice as a pediatric pathologist for less than two years. I don’t run a laboratory, I’m no pulmonary pathology expert, and I’m not employed anywhere as an epidemiologist. So basically, in the world of academic medicine and COVID-19 decision-making, I’m absolutely nobody. (My parents are proud of me, though).

One thing I do have is a rather unusual background, and I don’t mean in the whimsical Zoom call sense. I trained as an infectious disease epidemiologist at the London School of Hygiene and Tropical Medicine, did a year’s postgraduate work in the mathematical modeling of epidemics at Oxford, have some fieldwork experience in epidemic control, a second master’s in the history of medicine, and even spent a few years as an undergraduate in a virology laboratory. As many of us do, I have a robust autopsy practice and spend lots of time reading papers (in AJCP, natch), reviewing papers, writing papers, having papers rejected, etc. If you smash all of that together, and squint a bit, the shape of it comes out looking remarkably like the COVID-19 pandemic.

As the storm clouds started to gather back in March, the climate (medical and public) was one of fear, misinformation, and rampant speculation. It felt as though the most panicked voices were trapped in a room together, amplifying each other. The people who were actually running things were far too busy to respond to conspiracy theory videos or the latest tweetstorm. Putting out serious, real, validated data is a full-time occupation—no time to digest, interpret and communicate it to the public. The void howled to be filled. So, I did what any self-respecting millennial would do, and began expressing myself. My personal Facebook page switched over from kid pics and running shots to analyses of COVID. It took off like a bottle rocket; by 10 days into it my personal life was completely overrun and I segregated the content out by launching a public Facebook page.

If you asked me six months ago to choose the more likely scenario amongst these options:

1. I launch a public Facebook page
2. I switch careers to become a cat milkmaid
3. I free solo El Capitan

I probably would have selected No. 2, and I’m allergic to cats.

And, once the correct answer was identified, if you asked me to predict the response:

1. The world pats me on the head and says “that’s nice, dear, but no one cares.”
2. It goes massively viral and is being seen by 1.6 million people a week.

My money would have been on No. 1. Luckily, I’m an academic pathologist and don’t have all that much money to lose.

The whole point of this public Facebook page has been and is science communication, pure and simple—collating, parsing, synthesizing, translating and passing on important advances in our understanding of COVID-19. There are few ground rules on the page. The first is that it’s rabidly, emphatically, apolitical. No discussions of policies, the economic impact of COVID, or anything remotely partisan (domestic or international) is permitted—only epidemiology, virology, pathology and laboratory medicine. The second is that I almost never use the word “I,” except when making jokes, because it’s not “the world according to Jennifer.” The third is that sources are cited and only serious research is discussed, never journalism or opinion pieces. The fourth is, jokes. They may not be good jokes, but E for effort.

It has been extraordinarily gratifying. As pathologists we are not patient-facing, and as such, we rarely engage with the public, even though we have a lot to say. Pathology social media tends to focus on diagnosing cases and as such has a rather “closed” audience, as most people simply can’t appreciate the staghorn vasculature of a hemangiopericytoma, etc. And even though clinical doctors lean on us, we don’t often find ourselves in the limelight with our clinical colleagues. Nearly 40,000 people follow the page now, and interact with it quite heavily, and the message over and over again has been gratitude for a clear-headed rational tone, and for explaining abstruse (to them) topics in an easy-to-understand manner, and for keeping politics out.

Another line has been strictly scientific debunking of the conspiracy theory du jour. These are the posts that have attracted the most attention, but also the most vitriol, including discussions of the infamous “Plandemic” video, the Bakersfield ER doctors’ video, the “you can’t exercise because this guy in Holland thinks you’re a COVID spray nozzle” study, and more. I’ve learned a lot: how to deal with attack mobs, and even how to give snappy TV and print media interviews. Although we in medicine might find this stuff to be absolute nonsense, the public doesn’t know what to do with it and really, really needs guidance.

The other angle is that it’s been incredible PR for pathology in general. Besides the public, I’ve been very active in a 40,000+ member Facebook group for physicians discussing COVID-19, and recorded some podcasts and given online lectures geared towards clinical doctors (including for ACEP). They were quite literally crying out for someone to discuss the laboratory medicine issues around testing, and the pathophysiology via early autopsy studies (direct quote: “where are the pathologists?!”). Being able to basically say—look, isn’t pathology rad?! Look at all this cool stuff we do and know!—has also been rather delightful.

I circle back to the “Who the heck are you?” question rather frequently. I’m not anybody, but in a way that’s exactly what has allowed me to take on this science communication angle. If I were doing original research or had access to epidemiological data or was the one validating diagnostic assays, I couldn’t discuss it on a Facebook page.

The need for science communication isn't going away, especially around COVID-19. If you'd like to visit the page (even to hurl abuse, you wouldn't be the first), visit facebook.com/jenniferkastenmd. As long as there is a demand for information and knowledge, I will be there to provide.