Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

In 1974 an article appeared in Science magazine with the dry-sounding title “Judgment Under Uncertainty: Heuristics and Biases” by a pair of psychologists who were not well known outside their discipline of decision theory. In it Amos Tversky and Daniel Kahneman introduced the world to Prospect Theory, which mapped out how humans actually behave when faced with decisions about gains and losses, in contrast to how economists assumed that people behave. Prospect Theory turned Economics on its head by demonstrating through a series of ingenious experiments that people are much more concerned with losses than they are with gains, and that framing a choice from one perspective or the other will result in decisions that are exactly the opposite of each other, even if the outcomes are monetarily the same. Prospect Theory led cognitive psychology in a new direction that began to uncover other human biases in thinking that are probably not learned but are part of our brain’s wiring.

Thinking fast and slow.

Following the 2016 U.S. presidential election, many have expressed concern about the effects of false stories (“fake news”), circulated largely through social media. We discuss the economics of fake news and present new data on its consumption prior to the election. Drawing on web browsing data, archives of fact-checking websites, and results from a new online survey, we find: (i) social media was an important but not dominant source of election news, with 14 percent of Americans calling social media their “most important” source; (ii) of the known false news stories that appeared in the three months before the election, those favoring Trump were shared a total of 30 million times on Facebook, while those favoring Clinton were shared 8 million times; (iii) the average American adult saw on the order of one or perhaps several fake news stories in the months around the election, with just over half of those who recalled seeing them believing them; and (iv) people are much more likely to believe stories that favor their preferred candidate, especially if they have ideologically segregated social media networks.

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Social Media and Fake News in the 2016 Election

NUDGE: IMPROVING DECISIONS ABOUT HEALTH, WEALTH, AND HAPPINESS by Richard H. Thaler and Cass R. Sunstein Penguin Books, 2009, 312 pp, ISBN 978-0-14-311526-7This book is best described formally as a general explanation of and advocacy for libertarian paternalism, a term coined by the authors in earlier publications. Informally, it is about how leaders, systems, organizations, and governments can nudge people to do the things the nudgers want and need done for the betterment of the nudgees, or of society. It is paternalism in the sense that "it is legitimate for choice architects to try to influence people's behavior in order to make their lives longer, healthier, and better", (p. 5) It is libertarian in that "people should be free to do what they like - and to opt out of undesirable arrangements if they want to do so", (p. 5) The built-in possibility of opting out or making a different choice preserves freedom of choice even though people's behavior has been influenced by the nature of the presentation of the information or by the structure of the decisionmaking system. I had never heard of libertarian paternalism before reading this book, and I now find it fascinating.Written for a general audience, this book contains mostly social and behavioral science theory and models, but there is considerable discussion of structure and process that has roots in mathematical and quantitative modeling. One of the main applications of this social system is economic choice in investing, selecting and purchasing products and services, systems of taxes, banking (mortgages, borrowing, savings), and retirement systems. Other quantitative social choice systems discussed include environmental effects, health care plans, gambling, and organ donations. Softer issues that are also subject to a nudge-based approach are marriage, education, eating, drinking, smoking, influence, spread of information, and politics. There is something in this book for everyone.The basis for this libertarian paternalism concept is in the social theory called "science of choice", the study of the design and implementation of influence systems on various kinds of people. The terms Econs and Humans, are used to refer to people with either considerable or little rational decision-making talent, respectively. The various libertarian paternalism concepts and systems presented are tested and compared in light of these two types of people. Two foundational issues that this book has in common with another book, Network of Echoes: Imitation, Innovation and Invisible Leaders, that was also reviewed for this issue of the Journal are that 1 ) there are two modes of thinking (or components of the brain) - an automatic (intuitive) process and a reflective (rational) process and 2) the need for conformity and the desire for imitation are powerful forces in human behavior. …

Nudge: Improving Decisions about Health, Wealth, and Happiness

The COVID-19 pandemic represents a massive global health crisis. Because the crisis requires large-scale behaviour change and places significant psychological burdens on individuals, insights from the social and behavioural sciences can be used to help align human behaviour with the recommendations of epidemiologists and public health experts. Here we discuss evidence from a selection of research topics relevant to pandemics, including work on navigating threats, social and cultural influences on behaviour, science communication, moral decision-making, leadership, and stress and coping. In each section, we note the nature and quality of prior research, including uncertainty and unsettled issues. We identify several insights for effective response to the COVID-19 pandemic and highlight important gaps researchers should move quickly to fill in the coming weeks and months.

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Using social and behavioural science to support COVID-19 pandemic response.

An increasingly common claim among cognitive psychologists is that the human mind is capable of two fundamentally different types of processes (Evans and Stanovich, 2013): Type 1 processing that is triggered autonomously by a stimulus and Type 2 processing that operates on a deliberate level via working memory and that allows for decoupling or override from default (Type 1) outputs. An article recently published in Nature Communications by Krajbich et al. (2015; hereafter, KBHF) focused on the use of response time (RT) differences as evidence for these dual-process theories (hereafter, DPT). KBHF outline how some dual-process theorists argue that if RTs are shorter for some response (“A”) than some other response (“B”), then this supports a DPT wherein Response A is intuitive and Response B is deliberative. Then, using economic games and intertemporal choice as examples, KBHF go on to argue that these RT differences can be better accounted for by sequential sampling models (SSM). Specifically, they argue that RT should increase when participants are presented options that are hard to discriminate (e.g., between two equally preferential choices). Thus, SSMs highlight the importance of conflict between choices as an explanation for RT differences. KBHF conclude by strongly cautioning against the use of RT differences to support DPTs.

In this commentary we will briefly discuss two important questions that arise from KBHF's important contribution: (1) Are all cases in which researchers have used RTs to support DPTs undermined by KBHF's analysis? and (2) Are there any RT differences that are more easily explained under DPT than by SSMs? Our overarching goal is to illustrate that the scope of KBHF's analysis is far more limited than would be reasonable surmised by their original article.

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Commentary: Rethinking fast and slow based on a critique of reaction-time reverse inference.

Conspiracy theories tend to involve doubt and skepticism, but are conspiracy believers really more deliberative? We review recent research that investigates the relative roles of intuition and reason in conspiracy belief and find that the preponderance of evidence indicates that conspiracy belief is linked to an overreliance on intuition and a lack of reflection. This research, in addition to work investigating the broader influence of misinformation, indicates that people may believe conspiracies partly because they fail to engage in analytic thinking and rely too much on their intuitions. However, we also note that research in this area lacks in experimental studies and that work focusing on underlying cognitive mechanisms is needed. 

Intuition, reason, and conspiracy beliefs.

A meaningful portion of online misinformation sharing is likely attributable to Internet users failing to consider accuracy when deciding what to share. As a result, simply redirecting attention to the concept of accuracy can increase sharing discernment. Here we discuss the importance of accuracy and describe a limited-attention utility model that is based on a theory about inattention to accuracy on social media. We review research that shows how a simple nudge or prompt that shifts attention to accuracy increases the quality of news that people share (typically by decreasing the sharing of false content), and then discuss outstanding questions relating to accuracy nudges, including the need for more work relating to persistence and habituation as well as the dearth of cross-cultural research on these topics. We also make several recommendations for policy-makers and social media companies for how to implement accuracy nudges.

Nudging Social Media toward Accuracy

Simply failing to consider accuracy when deciding what to share on social media has been shown to play an important role in the spread of online misinformation. Interventions that shift users’ attention towards the concept of accuracy – accuracy prompts or nudges – are a promising approach to improve the quality of news content that users share and therefore reduce misinformation online. Here we test the replicability and generalizability of this effect among American participants by conducting a meta-analysis of all 20 accuracy prompt survey experiments (total N=26,863) completed by our group between 2017 and 2020. This approach avoids common meta-analysis pitfalls by including all studies regardless of outcome (avoiding selection bias) and using identical analyses across all studies (avoiding researcher degrees of freedom and p-hacking). The experiments used a wide range of different accuracy prompts tested using a large variety of headline sets and with participants recruited from qualitatively different subject pools. We find that overall, accuracy prompts increased sharing discernment (difference in sharing intentions for true relative to false headlines) by 72% relative to the control, and that this effect was primarily driven by reducing sharing intentions for false headlines (10% reduction relative to the control). These effects were not unique to a particular implementation of accuracy prompt, and were roughly twice as large when multiple accuracy prompts were combined. The magnitude of the accuracy prompt effect on sharing discernment did not significantly differ for headlines about politics versus COVID-19, and was larger for headline sets where users were less likely to distinguish between true and false headlines at baseline. With respect to individual-level variables, the treatment effect on sharing discernment was not robustly moderated by gender, race, political ideology, education, or value explicitly placed on accuracy, and was significantly larger for participants who were older, higher on cognitive reflection, and who passed more attention check questions. These results suggest that accuracy prompt effects are replicable and generalize across prompts and headlines, and thus offer a promising approach for fighting against misinformation.

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Reducing the spread of fake news by shifting attention to accuracy: Meta-analytic evidence of replicability and generalizability

Why is disbelief in anthropogenic climate change common despite broad scientific consensus to the contrary? A widely-held explanation involves politically motivated (“System 2”) reasoning: Rather than helping uncover truth, people use their reasoning abilities to protect their partisan identities and reject beliefs that threaten those identities. Despite the popularity of this account, the evidence supporting it (i) does not account for the fact that partisanship is confounded with prior beliefs about the world, and (ii) is entirely correlational with respect to the effect of reasoning. Here, we address these shortcomings by (i) measuring prior beliefs and (ii) experimentally manipulating participants’ extent of reasoning using cognitive load and time pressure while they evaluate arguments for or against anthropogenic global warming. The results challenge the politically motivated system 2 reasoning account: Rather than exacerbating the impact of partisanship per se, engaging in more reasoning led people to have greater coherence between judgments and their prior beliefs about climate change - a process that can be consistent with rational (unbiased) Bayesian reasoning. Thus, we challenge the dominant cognitive account of climate disbelief, and suggest that interventions aimed at providing accurate information about climate change may be effective in the long run.

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Gordon Pennycook

Papers

Commentary: Rethinking fast and slow based on a critique of reaction-time reverse inference.

Intuition, reason, and conspiracy beliefs.

Nudging Social Media toward Accuracy

Reducing the spread of fake news by shifting attention to accuracy: Meta-analytic evidence of replicability and generalizability

Reasoning about Climate Change