The First 60 Days: American Public Health Agencies' Social Media Strategies in the Emerging COVID-19 Pandemic

In this paper, we capture, identify, and describe the patterns of longitudinal risk communication from public health communicating agencies on Twitter during the first 60 days of the response to the novel coronavirus disease 2019 (COVID-19) pandemic. We collected 138,546 tweets from 696 targeted accounts from February 1 to March 31, 2020, employing term frequency-inverse document frequency to identify keyword hashtags that were distinctive on each day. Our team conducted inductive content analysis to identify emergent themes that characterize shifts in public health risk communication efforts. As a result, we found 7 distinct periods of communication in the first 60 days of the pandemic, each characterized by a differing emphasis on communicating information, individual and collection action, sustaining motivation, and setting social norms. We found that longitudinal risk communication in response to the COVID-19 pandemic shifted as secondary threats arose, while continuing to promote pro-social activities to reduce impact on vulnerable populations. Identifying patterns of risk communication longitudinally allows public health communicators to observe changes in topics and priorities. Observations from the first 60 days of the COVID-19 pandemic prefigures ongoing messaging needs for this event and for future disease outbreaks.