Disinformation influencers in the spanish flu and covid-19 pandemics: a documentary study

Introduction: As fast and destructive as the pandemic disease is the spread of untruths in pandemic scenarios, which led to many deaths. Therefore, counter-infodemic interventions are currently one of the biggest challenges for the health sector. Objective: To understand the convergence of disinformation on the Spanish Flu and COVID-19 and how fake news influencers act in the Brazilian health field. Method: this is a documentary study with a qualitative approach, carried out through the triangulation of data from different sources and in the periods of the Spanish Influenza (1918 to 1920) and COVID-19 (2020 to 2021). Result: It was observed that the pandemics were and continue to be fertile scenarios for the production and dissemination of disinformation influencers and that it is necessary to problematize the challenges of worker training in times of liquid modernity and in contexts of infodemics, since the professional discourses have been weakened bydisinformation. Conclusion: the study allowed us to understand the convergence of disinformation between the Spanish Flu and COVID-19 and the role of health education when facing the mass dissemination of fake news in the Brazilian health field.


INTRODUCTION
When delving intothe past, one can see that pandemics remain fertile scenarios for the spread of untruths. All one needs is torecall the Spanish Flu pandemic that arrived in Brazil in 1918 and one will realize that history is alive and reverberates into the future.
And the future is here! After 100 years, we are facing the COVID-19 pandemic and, with it, the reappearance of old disinformationproblems, such as: rumors, miraculous recipes, medicationsthat lack scientific proof, conspiracy theories, among others 1 . Therefore, it can be observed that the false contents generated by disinformation influencers in Brazil have long been determinants of life or death.
Hence, although many years have passed since the Spanish Flu pandemic, it is observed that the strategy for the circulation of disinformation in health has not changed much, with the verisimilitude, i.e., the communication of a lie whose appearance is of a truth,being one of the biggest challenges when confronting it 2 . Added to this, we have the social networks that have been vehicles of fast and accessible information, but also scenarios conducive to decontextualized and misinformative content 3 .
Thus, we have seen many changes that have occurred in communication patterns regarding matters of health interest 4 . Bauman namedthese changes "liquid modernity" and points to a new way to inform based on the speed of the electronic signal 5 . The COVID-19 pandemic arrived precisely at the generation of instantaneity and the circulation of a new power to inform and/ or misinform by the so-called digital influencers.
In this train of thought, the study points to the urgent need for the health sector to understand the phenomenon of disinformation in the past in order to understand in the present which concrete educational intervention measures should be taken, since such informationdisorders generate a problem of mistrust, that is, generate confusion for the population, who do not know what to believe and who they should believe 6 . All this poses an analysis of the existing training process, since workers need to act on a new reality that is rapidly changing. Therefore, we have the following research problem: how have the disinformationinfluencers affected the field of health and challenged the training of workers in times of pandemics?
In view of this, this article aims to understand the convergence of disinformation in the Spanish Flu and COVID-19 pandemics and how fake news influencers act in the Brazilian health field.

METHOD
This is a documentary study with a qualitative approach, carried out by triangulating data from two different periods of pandemics and from different sources. It is noteworthy that in the news collections, it was not possible to use the feature of finding words, and so, it was necessary to search in each issue.
After collecting the data, they were organized into thematic categories that were later substantiated by the

RESULTS
When searching for news records in the issues of Correio Regarding the news that minimized the impact and severity of the pandemic or that produced untrue and sensationalist information, the following stand out: It is important to emphasize that the news had as influencers an association between the press, pharmacies, doctors and the government that, even without proof, disseminated such information to the population. The use of medical references, for instance, aimed to give greater credibility and legitimacy to the news, as shown below: Regarding the news items that produced untrue and sensationalist information, the following stand out: The COVID-19 virus can be transmitted through mosquito bites (WORLD HEALTH ORGANIZATION, 2021). (WORLD HEALTH ORGANIZATION, 2021).

Study in Nature journal proves that ivermectin cures COVID-19 and we donot need vaccines (BOATOS.ORG, 2021). The American and Japanese Red Cross do not accept blood donations from people vaccinated against COVID-19 (BOATOS.ORG, 2021).
Regarding vaccines against COVID-19, the produced disinformation was aimed at causing fear and discouraging people from getting the vaccine, as shown by the following news items:

Vaccines approved for COVID-19 contain graphene oxide and can make a person to become magnetized (FATO OU FAKE, 2021)
Those immunized with mRNA vaccines will not be able to travel by plane due to the risk of blood clots (FATO OU FAKE, 2021

Influencers and disinformation in the Spanish Flu pandemic scenario in Brazil (1918 to 1920)
The Spanish Flu was considered the biggest epidemic in the world between 1918 and 1920 due to severe respiratory infections that caused more than twenty million deaths, affecting about 90% of the planet 8 .
In Brazil, the Spanish flu arrived around September 1918.
At first, the population did not show much concern about its arrival, not believing that it could spread in Brazil due to the country's distance from the European territory 9 . However, when it arrived here, it was seen as an unnecessary commotion for what would be a simple "get-rid-of-elderly-people" disease, as the then director of the General Directorate of Public Health, Carlos Seidl, thought 10,11 .
According to the results, the disinformationinfluencers were those whose discourses had greater legitimacy with the Brazilian population. They were: the press (daily and weekly newspapers), government officials, doctors, pharmacists and even those responsible for public health services. It is noteworthy that the news used the corroboration of medical discourse to sell miraculous products for the prevention, cure and rehabilitation of the Spanish flu.
In this scenario of disinformation, the denial of the disease lethality caused the Brazilian authorities to delay adopting precautionary measures against the disease, such as social distancing, which greatly contributed to the population becoming ill.
There is no doubt that this was a scenario of precarious information and the health workers'knowledge was not enough to face the pandemic, as they did not understand the causative agent.However, it was clear from the records that a large epidemic of disinformation was installed in the country, through those who held the power of communication and gave Advice to the People 12,13 .
Hence, the collected news records showed that the health field was a territory of pharmaceutical dispute for the treatment of the Spanish Flu. These agents advertised medications, purgative waters, disinfectants, alcoholic beverages, fortifiers, oils and even chocolates that, according to them, were efficient in curing this flu 14 . It should be noted that in 1918, there were no surgical masks or alcohol gel, so people raced to the pharmacies in search of these miraculousproducts, and this was encouraged by advertisements in newspapers and magazines at the time.
When we look at the news published during the Spanish flu, the question that arises is whether these ads were not the beginning of what we now call fake news, since there was no guarantee of cure for the flu that these advertisements promoted. Thus, even though there was no proof of therapeutic value, the newspapers of the time insistently publicized miraculous formulas, often coming from the Health Service itself, which were thus passed on by word of mouth 12 .
The disinformationinfluencers at the time were successful, as the general population was in a condition of spectatorsof news events, without resources to verify the veracity of these news. Therefore, disinformation generated economic gains for a minority and indelible losses for a large part of society, as Orsi 15 states "[...] every time a useless therapy is promoted in the news, a charlatan gets rich and a citizen is affected".

Influencers and disinformation in the COVID-19 pandemic in Brazil (2019-2021)
The COVID-19 pandemic was decreed by the World Health Organization (WHO) on March 11, 2020, and in Brazil, the first record of the disease took place on February 26, 2020 16 . It is a severe respiratory disease caused by SARS-CoV-2 17 . By February 2022, approximately 388 million cases and more than 5 million deaths have been recorded worldwide.
Along with the pandemic severity, came a range of disinformation and fake news, which could be considered an infodemic 18 . Therefore, we have seen a legion of fake news influencers who minimized the pandemic by reducing it to a little flu, encouraging the population to abandon measures recommended by the health sector.
Disinformation influencers in times of COVID-19 have shown themselves as an association between agents and platforms. The agents have been the government, politicians, companies, journalists, Youtubers, bloggers, social boats, conservative religious groups, artists, scientists and even health workers. The platforms distributing thedisinformationincluded Amazon, Apple, Google, Facebook, blogs, Pinterest, YouTube, WhatsApp, Twitter, Instagram, Telegram and Tumblr, not to mention conventional vehicles such as television, radio and part of the press 4 .
In this context, it is worth considering that among the aforementioned influencing agents, it is not uncommon in the COVID-19 pandemic to finddoctors, nurses and other health professionals. As an example, there is a group called'Doctors for Life' that circulates on social media with a manifesto defending the early treatment of COVID-19,by using drugs such as hydroxychloroquine, ivermectin, bromhexine, azithromycin, zinc, vitamin D, anticoagulants, among others proven to be ineffective 19 . This has greatly confused the population, which sees these actors in lab coats as a source of information credibility.
According to a study, the disinformation produced by By observing the news facts in the course of the COVID-19 pandemic, one can say that this is a problem that the health area needs to take care of, as disinformation reduces trust in the professionals, institutions and science. Another point that needs to be considered is that, if the disinformation is greater and more substantial than the true information as stated by Hezrom 2 , health workers and institutions are somehow failing and this is a problem for professional training in the sense of modernizing it to meet the new demands of the media ecosystem.
However, in view of the results, one can observe that the health field is an excellent culture medium for fake news influencers and this demonstrates the need to strengthen the educational processes 24 .
Hence, training should be seen as a central pillar of foundation for health education actions and as a response to the contemporary information crisis, since it puts the problem under analysis and helps workers to take a stand against disinformation in health.