Presentation at the Public Health Preparedness Summit (2016) on how the New York CIty Department of Health use social media during Ebola (2014), Legionnaires Outbreak (2015) and Zika (2016).

1. Social Media Monitoring During Public Health Emergencies:
Ebola and Legionnaires’ Disease Outbreak in New York City
Tamer Hadi
Office of Emergency Preparedness and Response
NYC Dept. of Health & Mental Hygiene
@tamer_hadi @nycHealthy

2. Overview
 Brief Background
o Reminder - Why Monitor Social Media?
o ICS Structure
 Social Media Monitoring During Public
Health Emergencies
o Ebola 2014
o Legionnaires 2015
o Zika 2016
 Tools & Techniques
 VOST Considerations
 Future Direction & Discussion

3. 3 Critical Reasons to Monitor SM
1. Situational Awareness
o Latest developments, Pics, videos, Public Commentary
2. Assess How Well / Poorly Message Getting Across
o Unanswered questions or confusion
o Reach of public messaging
3. Rumor, Misinformation, Reputation Control
o Identify and dispel false information
o Respond to questions and mentions
o Opinions on agency response operations/services

4. Bonus Reasons to Monitor SM
Detecting Public Need or Requests for Help
o Respond or route calls for assistance
through appropriate channels
Supplement ongoing disease surveillance
o Identify patterns or trends in health
related issues

5. Operationalizing SM Monitoring

6. Social Media Monitoring Team Structure
PIO
Monitoring Team
Leader
Monitoring
Specialist
Analyst

7. Social Media Monitoring:
• Ebola
• Legionnaires’ Disease
• Zika

8. Timeline of Significant Ebola Events in USA
Green Dates = NYC Events
07/31/14 - News that 2 Americans w/ Ebola would be
transferred to Emory from Liberia
08/01/14 - NYC DOHMH conducts largest no notice
POD full-scale exercise in NYC History
08/05/14 - NYC begins preparedness / surveillance meetings
09/30/14 - Dallas Patient confirmed Ebola
10/03/14 - NYC DOHMH officially activates ICS
- Social Media Monitoring officially begins
10/08/14 - Dallas Patient dies in hospital
10/12/14 - Nurse 1 confirmed Ebola
10/15/14 - Nurse 2 confirmed Ebola
10/23/14 - NYC Case confirmed
11/11/14 - NYC Patient Discharged
12/29/15 - Active Monitoring Call Center Shutdown
- 5791 people monitored
02/02/16 - NYC DOHMH deactivates for Ebola
- 1 year, 3 months, 30 days
▪▪▪

9. 07/31/14 - 2 Americans w/ Ebola to be transferred to Emory
08/01/14 - NYC DOHMH conducts largest mass prophylaxis
full scale exercise in NYC History (#RAMPEX)

11. News Coverage on Exercise

12. Conspiracy???

13. August - October 2014 – Plenty of Scares

14. No Shortage of Scares….

15. Psychic ???
The Very Next Day….

16. Ebola Case in NYC (10/23/2014)

17. Overall NYC Ebola Summary
• DOHMH Led a Large & Resource-Intensive Interagency Response
– 25 city, state, federal agencies
– 1000+ DOHMH staff and 500+ MRC volunteers
– Cost exceeding $6.5M ($23M citywide)
• Coordinated preparing NYC hospitals to identify and isolate potential
EVD cases and worked with 5 hospitals to ready treatment centers
• Conducted extensive epidemiologic investigations with rapid
laboratory diagnostics for potential EVD cases in NYC.
– 12 EVD tests performed, 88 Persons Under Investigation.
• Developed active monitoring call center
– 5800+ travelers via JFK
– 114 healthcare workers
– Quarantined 3 case contacts for 21 days.
• Created and distributed culturally sensitive material
– 100,000+ “Am I at Risk?” palm cards (9 languages)
– Utilized Community Outreach Teams to canvass 14 neighborhoods
– Conducted 116 community engagement and education events.

18. DAY 1: 10/23/14
Notification: Patient called MSF  MSF called DOHMH
DOHMH coordinated w/ FDNY-EMS & Bellevue
Hospital for safe/rapid transportation w/ minimum
exposure to others
Case Investigation and Contract Tracing:
• Interviewed patient by phone before EMS transfer
• Began contact tracing while patient en route to hospital
Lab Testing:
• DOHMH staff at Bellevue assisted w/ packing and transporting
• Test results returned ~3 hours after specimen received
Press Conference at 6:30pm Confirming Case

19. MOST IMPORTANT SOCIAL MEDIA
DISCOVERY ON DAY 1
• Patient information leaked!
• Discovered by SMMT immediately
– Reported to PIO and Incident Commander
• Prior to first official press conference
• Prior to confirmation of lab results
• Changed approach to press conference and
preparing Commissioner talking points
• Required immediate risk communication and
community engagement

20. 1st Article Leaking Info @ 2:44pm
http://nypost.com/2014/10/23/nyc-may-have-its-first-ebola-case/

21. 1st Tweet @ 2:51pm

22. 1st Time Patient Name Appeared in Tweet @ 3:03pm

23. ONLINE MADNESS ENSUES

24. 1st DOHMH Tweet in Response to Leak
~40 mins
after leak
reported

26. Initial Leak Caused Lots of Misinformation and Panic
Wrong Bowling Alley!

27. Cleaned and Re-Opened Bowling Alley
“We cleaned
every square
inch of the
place – every
hole in every
bowling ball”
said Sal Pain,
Bio-Recovery’s
chief safety
officer.

28. Subway Hysteria

29. Lots of Great Subway Advice Too!

30. Cab / Uber Hysteria

31. 1st Press Conference

32. Public Sentiment on Press Conference
Positive Negative

33. SM Summary from 10/23 (Day 1)
Mixed accounts of patient’s timeline in media:
• Reports he came back 10 days ago - actually 7 (10/17)
• Most sources initially reported he was at Brooklyn Bowl not The Gutter.
• Initial reports he took Uber to Brooklyn instead of back from Brooklyn.
• Details around his subway travel emerged later on; initial reports
focused on the cab ride
• Residents of Harlem and Williamsburg expressed increased concern
and panic about having been in close proximity to the patient.
• Many jokes / word play around bowling and Ebola, humorous scenarios
related to getting Ebola from bowling, and hipster-related jokes
• Viewers of the press conference found Dr. Bassett calming, reassuring,
and authoritative
• Continues to be criticism around her statement that the patient was
self-quarantining.

34. Day 2
More Details of Patient Activities Shared at 2nd Press Conference
Oct 21 – No symptoms – felt fatigued, but no fever
• “The Meatball Shop” Restaurant
• “Blue Bottle” Coffee Shop on High Line
• 1 Train Home to Harlem
Oct 22 – No symptoms – felt fatigued, but no fever
• Jogged 3 Miles in W. Harlem Neighborhood
• Took A and L Train lines to Williamsburg, Brooklyn
Bowling Alley
• Took Uber home
Oct 23 – Low-grade fever
• Fever  Called MSF  DOHMH Notified

35. Community Outreach Teams

36. DAY 3 and Weeks Later

37. Last Week Tonight – John Oliver
Episode from 10/26/14

38. Misinformation on Ebola Cures / Prevention
Marijuana?
Garcinia Kola (Nut)?
Bathing / Drinking Salt Water?
Nano-Silver?

39. SM Summary from 10/24 (Day 2)
• Fears around having been at the additional locations shared by NYC (Blue
Bottle Coffee, Meatball Shop).
• New Yorkers continue to take photos of themselves and others wearing masks.
• Riders of A,1, and particularly L trains show concern about riding subway,
while some joke about precautions taken by others (wearing masks, people
not touching poles).
• Instagram users shared pictures of the DOHMH clean-up of the Gutter and the
press conference. The first paying customer after the clean-up shared a video
his first play on Instagram.
• Continued bowling-related and hipster jokes, with the later addition of
meatball jokes.
• While previously we've seen those at airports show concern about Ebola while
traveling, we now also see some now joke about being happy to leave NYC to
escape Ebola.
• There is also conversation Dr. Bassett having a calm, reassuring tone, with two
news articles (WSJ and NY Times) adding to the discussion.
• Many messages specifically around Dr. Bassett’s tweeting.
• Meat Ball Shop visit by the mayor and Dr. Bassett resulted in tweets and
photos due to media presence
• There is also retweeting of the patient update at Bellevue and the fiancée
being transferred into quarantine at home, no additional commentary yet.

40. Social Media Monitoring Helps Awareness
for What Concerns the Public
Helps Leadership Create Strong Messaging
Lots of Repetition to Battle Rumors /
Misinformation / Confusion
Cannot Eliminate Misinformation – Can
Focus on What is Most Prevalent and
Address in Public Messaging
Social Media Summaries / Stats Included in
Situational Reports
Ebola Summary

41. Some Ebola Humor

42. Legionnaires’ Outbreak
(2015)

43. Outbreak Summary
• Type of pneumonia caused by legionella bacteria
• Worst legionella outbreak in NYC’s history
• 128 cases, 120 hospitalized and 12 deaths
• July – September 2015 (Activation continued after outbreak contained)
• Required massive response that leveraged innovative detection
capabilities and ability to quickly identify the source and halt the
outbreak
• Resulted in new legislation requiring registration of cooling towers
• NYC DOHMH:
– Investigated 361 cases and tested approximately 450 samples.
– Received and reviewed documentation to register 3,600+ buildings
with cooling towers.
– Inspected 170+ buildings with cooling towers
– Trained 46 NYC staff to conduct sampling and disinfection.
– Conducted 47 community events and distributed approximately
8,000 pieces of literature.

44. DOHMH Press Release - July 29th
Standard Local Press Coverage

45. Initial Messaging

47. Misinformation / Rumors

48. Replying to Specific Misinformation

49. Countering Rumors

50. Confirming Water Safety

51. Confirming Cooling Tower Disinfection

52. Anxiety / Concern / Mistrust

53. Conspiracy

54. Monitoring for Reaction to Community Outreach

55. SM Sit Rep Summary Reports

56. Legionnaires’ Monitoring
Summary
• Alleviated public concern regarding
rumors, misinformation and
confusion about the disease
• Monitored and engaged @nycHealthy
Twitter mentions
• Included social media summaries /
stats in situational reports

57. Zika Virus

58. Zika Issues to Monitor
• Local Fear, Misinformation, Rumors
• Activity related to Agency Communications
– Press Releases and FAQs
– Lab Testing / Call Center Instructions
• National and International News
– Policy
– Reproductive Health
– Latest Scientific Research
During Mosquito Season in NYC
• Public Sentiment on Additional Mosquito Control
Strategies
• Issues will depend on local transmission

60. Social Media Monitoring:
Tools & Techniques

61. Tools DOHMH Uses

62. Zika Dataminr Alerts

64. Twitter Boolean Operators

65. Boolean Queries
(ebola OR #ebola OR #ebolavirus OR #stopebola OR
#EbolainNYC) AND ("new york" OR "new york city"
OR NY OR NYC OR Brooklyn OR Queens OR Bronx OR
Manhattan OR "Staten Island" OR SI OR BK OR BX OR
astoria)
zika OR #zika OR #zikavirus OR #virusdelzika
near:"Queens, NY" within:15mi
"legionella" OR "legionella" OR "legionnaire" OR
"legionnaires" OR "legionnaire's" OR "Legionaire's"
OR "legionaires'" OR "#Legionnaires" OR
"#legionnairesdisease" OR "legionario" OR
"Legionelosis" OR "legionellosis"

66. VOST Consideration
• VOST = Virtual Operations Support Team
• External to agency
• Team of volunteers activated to perform specific
social media functions in support of an affected
organization and/or jurisdiction
• Each VOST has Team Leader that reports directly to
the affected organization/agency
• Future Project - DOHMH may train group of NYC
MRC volunteers to assist w/ monitoring, but also:
– Message amplification
– Use their language skills
– Other platforms

67. Value of Social Media Monitoring
• Real-time situational awareness
• Get a feel for public sentiment
• Good way to get feedback on
public messaging
• Informs your message
development
• Combat major rumors and
misinformation by public and news
media

68. Acknowledgement
Social Media Monitoring Team Leaders
Keren Fleshler (Ebola)
Jennifer MacGregor (Legionnaires’ & Current Zika)

69. Contact Information
Tamer Hadi
thadi@health.nyc.gov
347.396.2769
@tamer_hadi (opinions my own!)
http://www.linkedin.com/in/tamerhadi
Questions & Discussion