Insights into the Positive Role of a Higher Education Institution in the Prevention of Misinformation During Pandemics: The Health Committee Model During COVID-19

The world is facing an unprecedented challenge with the emergence of the coronavirus disease 2019 (COVID-19) pandemic. In December 2019, a novel disease outbreak is suspected to originate in Wuhan city, Hubei province, China, when a cluster of clinical presentations greatly resembling viral pneumonia, was observed and reported [1,2]. The disease subsequently spread, both domestically and internationally, and was declared a pandemic by the World Health Organization (WHO) on March 11^th, 2020 [3]. The outbreak was attributed to a novel betacoronavirus that was called the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [4,5]. SARS-CoV-2 is believed to be a spillover of an animal coronavirus that later developed the ability of human-to-human transmission [6]. COVID-19 is mainly transmitted by respiratory droplets and direct contact with infected patients; it has an incubation period of approximately 2-14 days with common symptoms that manifest as dry cough, tiredness, and fever. In more severe cases, the symptoms may develop into pneumonia, chest pain, difficulty breathing, confusion, and loss of speech and movement [7,8]. In addition, the disease has an estimated mortality rate of 3.4% [9]. A tremendous body of data is accumulating about the disease in an effort to uncover its underlying pathogenic mechanism, discover a cure, and create a vaccine [10]. With over 30 million people having contracted the virus and over 950,000 having lost their lives, a tremendous social and economic constraint is felt across the globe [11]. In light of the current absence of a specific antiviral treatment effective against COVID-19, several agents previously used for the treatment of other infections are being used and tested, and many clinical trials are investigating potential therapies [12]. Amidst the growing burden of the pandemic, nations remain under quarantine, institutions and businesses are partially or completely closed, and the world seems to have reached a standstill.

The first case of COVID-19 was officially confirmed in Lebanon on February 21^st, 2020; by July 25^th, the number of confirmed COVID-19 cases was 3582, with 47 confirmed fatalities [13]. The Lebanese Ministry of Public Health (MOPH) established a national plan of action to scale up preparedness and response capacities in Lebanon for prevention, early detection, and rapid response [14]. On March 15^th, and in an effort to contain the spread of the disease, the government imposed a general lockdown on different sectors of the country that included schools, universities, clubs, restaurants, businesses, places of worship, as well as the closure of the airport and suspension of all travels. Messages approved by the MOPH were circulated through the media, asking people to practice social distancing and self-isolation while stressing on the importance of hygiene [15]. Updates on COVID-19 status in Lebanon were made available to the general public through the MOPH official website, mobile application, and social media pages. Also, press conferences were held to issue important notices and communicate the changes in the pandemic on a national level. After re-evaluating the situation, the government extended the lockdown on April 9^th for two additional weeks, which was extended again on April 24^th till the end of May [16]. As of July 26^th, a current partial lockdown is still in effect amidst uncertainties regarding a second episode of the pandemic. It is worth noting that in a country like Lebanon, with the unparalleled political, economic, and financial crisis, the role of non-governmental organizations in raising the voice about the pandemic and spreading accurate information is critical.

During these difficult times, the reliability of data remains a major concern as a cyclone of information, both scientifically confirmed and otherwise fake, has been circulating and creating an overwhelming infodemic among the general public [17]. This has increased the need for trustworthy and reliable sources of scientific information to reduce the spread of COVID-19 misinformation. This article aims to summarize the role of a health committee established at a private university in Lebanon to raise COVID-19 awareness, based upon the guidelines and recommendations of renowned health authorities and professional societies, to help reduce the spread of misinformation and, ultimately, the spread of the disease. Our motivation to share this model stems from our belief that similar committees in academic institutions may have a pivotal role in the fight against future pandemics, basically through the spreading of knowledge and raising awareness.

The Lebanese International University (LIU) is a private, independent institution of higher education founded by the philanthropist and former Lebanese education and higher education minister Abdul Rahim Mourad and governed by an autonomous Board of Trustees. The University was established in 2001 in a primarily rural area of Lebanon in Bekaa Governorate, and is recognized by the Lebanese State as a private Institution of Higher Education. LIU’s mission is to provide accessible and affordable higher education in line with its adopted motto, “Education for All”. Since its conception, the University has established 8 additional campuses spread out over the different Lebanese Governorates, including the capital, Beirut. The University is comprised of five schools: Pharmacy, Engineering, Arts & Sciences, Business, and Education, and currently offers 36 undergraduate and 16 graduate programs. During the academic year 2019 - 2020, a total of 30,415 undergraduate students and 4,915 graduate students were enrolled at LIU. Recently, LIU was ranked as the eighth Lebanese university in Scimago Institutions Rankings.

LIU has an official website (www.liu.edu.lb) that contains information about the University, including admission guidelines, available schools and majors, study plans and curricula, tuition and registration fees, international affiliations, student life, and much more. Students, faculty, and staff alike can use a link from the website to log in to the University Management System (UMS). UMS allows students to register their courses online, view their schedules, financial aid, tuition payments, attendance record, grades, etc. In addition, the University uses the UMS to post announcements and pop-ups to deliver important messages to the students upon logging in. Similarly, faculty and staff have their own UMS service that allows the delivery of important messages through posted announcements and pop-ups.

A University Email Service using Google G Suite is used as one of the main forms of communication with students, staff, and faculty. Also, each of the 9 campuses has its own Facebook page that is constantly updated with news and activities related to the concerned campus, with many followers from the student body, faculty, staff, and the general public. WhatsApp is one of the most popular messaging apps used in Lebanon and the University employs the use of this app in its communications. Overall, LIU has an extensive network of communication with its student body, faculty, staff, and the general public, creating the basis for a larger LIU community.

The LIU Health Committee (LIUHC) was launched on February 23^rd, 2020, as an independent body to organize health efforts during the COVID-19 pandemic. The mission of LIUHC is to act as a consulting body to the University Council (UC) on all health-related matters. During the ongoing COVID-19 pandemic, the health committee launched a health awareness campaign that targeted the students, faculty, staff, and the general community. It circulated posters and videos, organized training sessions for the university staff, coordinated with the ministry of public health (MOPH) on all newly adopted health-related measures pertaining to COVID-19, and coordinated with the local administration of all 9 campuses on all health-related matters that concern the university. The committee is comprised of 8 members who are themselves faculty members of the university:

1. The Chairperson of the committee, who is also an academic director of one of the campuses, is also a member of the University Council and the VP of academic affairs.

2. An assistant professor from the School of Arts and Sciences, department of Biomedical Sciences, with a M.D. in Infectious Diseases.

3. The Chairperson of the department of Biomedical Sciences, School of Arts and Sciences, who is a medical doctor and also the head physician at a local COVID-19 care center.

4. The Assistant Dean of the School of Arts and Sciences, who is a faculty member of the department of Biomedical Sciences and holds a Ph.D. in Microbiology and Immunology.

5. The Chairperson of the department of Pharmacy Practice, School of Pharmacy, who is a clinical associate professor and holds a PharmD and a Ph.D. in Epidemiology.

6. The Chairperson of the department of Pharmaceutical Sciences, School of Pharmacy, who is an assistant professor and holds a Ph.D. in Pharmaceutical Microbiology.

7. An assistant professor from the School of Arts and Sciences, Department of Biological and Chemical Sciences, who holds a Ph.D. in molecular cell biology, is an academic director of one of the campuses, a member of the University Council, and acting liaison with the MOPH.

8. A faculty member from the School of Arts and Sciences, department of Radio and TV, who holds a BA in communication arts, a MA in education management, and who is a long-time volunteer in the Lebanese Red Cross.

The committee would usually have two online meetings per week. The meeting would usually start with a general assessment of the current situation of the pandemic in Lebanon based on news and updates from the Lebanese MOPH and local hospitals and health care centers. The members would then discuss the latest findings, recommendations, and guidelines of the scientific community, the World Health Organization (WHO), the International Pharmaceutical Federation (FIP), and the US Centers for Disease Control and Prevention (CDC); they would also assess the currently circulating unapproved information on the disease (e.g., unapproved remedies and preventive measures, information and recommendations that have not been proven scientifically, etc.) and make their recommendations as to the type of information that needs to be delivered to the greater LIU community. The LIUHC would then discuss with the department of Radio and TV-the most convenient and appealing format by which such information, guidelines, and recommendations are to be shared with the public (e.g., videos, posters, brochures, WhatsApp stickers, pop-ups, video recorded episodes of a health-related show called “2 Minutes of Health”, etc.). After the LIUHC reviews the product of the department of Radio and TV, the committee shares the product with the UC for final approval. Once approved by the UC, the files are then shared with the students, faculty, staff, campus administration, and local community through the university’s official website (all documents are available at http://www.liu.edu.lb/HealthCommitee.php), Facebook pages of all 9 campuses, University Email Service, and WhatsApp groups (Fig. 1). In addition, detailed minutes of each meeting were shared with the University Council.

On average, it took close to a week between the selection of the topics that needed to be shared by the community and the actual dissemination of such products in their final format. Since the committee met twice a week, new material was shared with the public at least twice a week. Of course, the material was released based on a previously agreed-upon timeline in order not to overwhelm the public with the shared data and in order to give each topic the necessary time to circulate among the larger community.

Fig. (1). A block diagram showing the flow of information from WHO, FIP, CDC, MOPH, Scientific Literature, and local hospitals and care centers. It also exhibits the direct communication between LIUHC, the department of Radio and TV, and the University Council. The product of this intensive network of communication is shared with the student body, faculty, staff, campus administration of all 9 campuses, and the local community as guidelines and recommendations in the form of videos, posters, stickers, pop-ups, and shows using LIU’s website, LIU Email Service, Facebook pages, and WhatsApp groups.

4. LIUHC SCOPE OF WORK AND ACTIVITIES

On their first virtual meeting, members of the LIUHC brainstormed ideas and interventions to promote protection against COVID-19 among LIU students, faculty, and staff. It was agreed that LIUHC would raise COVID-19 awareness using benchmark scientific resources, including WHO, FIP, CDC, MOPH, and scientific literature. Due to the growing reliance on technology and media, especially among the younger population [18], LIUHC embraced the use of communication technology to combine the proficiency of health specialists with input from media experts to deliver its messages conveniently and efficiently for larger community outreach. LIUHC launched its activities through an email announcement to the University community announcing its mission and notifying the community that future communications will include information, recommendations, and guidelines pertaining to the disease and its prevention. The awareness campaign realized by the LIUHC can be summarized into a set of products and steps, as described below.

4.1. COVID-19 Awareness Posters, Brochures, and Videos

The first step taken by the LIUHC was to create posters and brochures, addressing COVID-19 background, symptoms, transmission, and preventive measures. Entitled “Coronavirus: Facts and Prevention”, the posters and brochures were composed and designed in Arabic, the native language, and English, the language of instruction at LIU. Posters and brochures were disseminated across all LIU social media and groups. Selected posters were added to personal University accounts as pop-up messages to maximize visibility and impact (Fig. 2). To make the information more interactive, posters were converted into an awareness video, which was widely disseminated as well.

4.2. Hygienic Information for Cleaning and Disinfection of Campuses

LIUHC prepared a guideline for cleaning and disinfecting the campuses, which was extracted from CDC guidelines on the disinfection of workplaces [19]. The guideline was communicated to the administrative directors of all 9 campuses, with clear instructions on the university-wide adopted training procedure for housekeeping workers and custodians. Additional key hygienic information regarding handwashing and virus viability on surfaces was also disseminated.

4.3. LIUHC Webpage and COVID-19 Questions/Answers

LIUHC created a special link on the University website, which was considered as a repository to archive all its products and activities. In addition to the disseminated information, this link contains a question/answer portal that is continuously updated to reveal the most recent information about COVID-19.

4.4. Stickers, Positivity Vibes, Emails, and Social Communication during the Lockdown Period

To maintain communication with our community, especially during the period of lockdown, LIUHC disseminated different positivity and educational tools. These included a smartphone stickers kit about COVID-19 prevention and the importance of social distancing (Fig. 2), communication via emails, and inspirational videos from LIU staff to raise positivity and maintain a positive mindset while staying at home.

Fig. (2). Samples of LIUHC awareness materials used for dissemination of COVID-19 information to university community and the public. (A) samples of awareness posters. (B) samples of messaging app stickers (e.g., WhatsApp).

4.5. Twice-Per-Week Video Show

Recognizing the significant role of media in health communication [20], LIUHC created and produced a video show of 2-3 minutes duration, to be broadcasted on LIU social media twice per week, and which was called “2 Minutes of Health”. In this platform, two committee members chatted about a single focused point pertaining to COVID-19, such as the use of gloves and masks, misuse of medications, vaccine development, disease transmission, sanitization of grocery, and the like. To broaden the scope of the show, specialists from the field of nutrition and others were hosted as guests to highlight different aspects of healthy living during the pandemic.

4.6. COVID-19 Awareness Linked to Holy Events

During the lockdown, Lebanon observed two major religious events (Easter and the Holy month of Ramadan). Observants had to accommodate both events during a situation of unparalleled lockdown in sharp contrast to communal feasts and prayers, as well as social and family congregations. LIUHC prepared awareness information for the community to observe these events in a safe manner, enjoying the spirit of the events while maintaining social distancing and staying safe. Awareness information was extracted from WHO resources and focused on physical and spiritual health and mental wellbeing [21].

To disseminate the aforementioned activities and ensure wide visibility, LIUHC used different platforms to reach a wider audience. These platforms included University Email Service, social media, WhatsApp groups, and physical dissemination of posters when possible. The reachability and influence of some disseminated material are shown in Table 1. Moreover, as mentioned above, all material produced by LIUHC was uploaded to a special portal on the LIU website. The UMS was also used to disseminate some products through personal accounts of students, faculty, and staff.

LIUHC realized that the global public health concern growing as a result of COVID-19 needed a collective and interprofessional response [22], especially with the fast and transparent sharing of data being threatened by rumors and misinformation [23]. As such, LIUHC regularly followed up with MOPH on COVID-19 numbers, updates, and newest recommendations. It also held open discussions pertaining to COVID-19, including, but not limited to, scientific literature, frequently asked questions, trials about treatment and vaccines, public health measures, avoidance of inaccurate or misleading information, and other concerns, both formally through meetings, as well as informally. Triggered by the members’ research interests, LIUHC is taking part in international projects, including a European-backed project on COVID-19 awareness among Syrian refugees, as well as other research activities.

Table 1. A representation of sample products of the LIUHC with numbers of the audience reached and numbers of reactions on different social media.

Awareness Product Disseminated by LIUHC	No. of People Reached	No. of Likes	No. of Comments	No. of Shares
Awareness posters	97,347	1442	53	102
Inspirational video	68,194	1411	24	98
First episode of video show	13,563	268	10	12
Second episode of video show	20,002	559	8	36

*The numbers are based on statistics gathered from the various Facebook pages of the University.