key: cord-0787574-d75wa9zd
authors: Mariano, Edward R.; Kou, Alex; Stiegler, Marjorie A.; Matava, Clyde
title: The rise and fall of the COVID-19 aerosol box through the lens of Twitter
date: 2020-11-19
journal: J Clin Anesth
DOI: 10.1016/j.jclinane.2020.110145
sha: 567499d0646eedffeefa40a88bc0ba5eecc0fdaa
doc_id: 787574
cord_uid: d75wa9zd

nan

box and eventual decline through the lens of Twitter (San Francisco, CA, USA) and research publications that lagged behind social media.

With IRB exemption (Stanford, CA USA), we accessed the Twitter public application programming interface and prospectively collected tweets and retweets from March through October 2020. We included tweets containing "intubation box(es)," "aerosol box(es)," or "intubation barrier(s)" and excluded all tweets missing at least of these search terms. Tweets were analyzed for frequency, type of tweet (original tweet, quoted tweet, a retweet of the original tweet, or retweet of quoted tweet), the number of unique users, and geographic location of users using R package "rtweet" version 0.6.9 [2] . However, enthusiasm quickly faded with the publication of more rigorous studies. Two key publications raised serious concerns about the box over airway management challenges [5] and J o u r n a l P r e -p r o o f increased exposure to airborne particles [6] . Citing these two studies [5, 6] , the FDA revoked the EUA for protective barrier enclosures on August 20, 2020 (https://www.fda.gov/media/141415/download). After the online publication of the Begley et al study on May 12 [5] , there were only two noteworthy Twitter spikes related to the aerosol box on June 14 and 29 (Figure 1) , and both were unrelated to new evidence. These tweets referenced aerosol box donations and were posted by influencers @DukeCondet and @GoenkaPK which were highly retweeted due to these users' large number of followers. There has been very little Twitter activity related to the aerosol box since the end of July.

Using Twitter data, we have shown the rapid rise and fall in popularity for the aerosol box which was designed to provide additional barrier protection for anesthesiologists who provide advanced airway management for COVID-19 patients. There is a substantial time lag between the initial social media dissemination of a popular concept and the publication of peer-reviewed research.

A limitation of our work is the inability to assess how often the aerosol box has actually been used among both users and non-users of social. However, we present this example to demonstrate the power of social media as a tool to share new ideas and inventions efficiently in an evolving crisis but also to advise clinicians and researchers to maintain equipoise until rigorous studies are published.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This material is the result of work supported with resources and the use J o u r n a l P r e -p r o o f 

Personal protective equipment (PPE) for both anesthesiologists and other airway managers: principles and practice during the COVID-19 pandemic

Collecting Twitter Data

Barrier Enclosure during Endotracheal Intubation

The aerosol box for intubation in coronavirus disease 2019 patients: an in-situ simulation crossover study

Measurement of airborne particle exposure during simulated tracheal intubation using various proposed aerosol containment devices during the COVID-19 pandemic