The impact of COVID-19 on the RSVs of conspiracy-related queries was evident (Figure 1); in particular, all considered infodemic queries underwent a significant level-shift during the Codogno, Italy, outbreak at the end of February 2020, signaling an immediate increase in fake news with the arrival of the pandemic in Italy (∆_1%=+102.5, t₁=6.3; ∆_2%=+288.2, t₂=11.5; ΔΑ_3%=+10.2; Δ_4%=+60.6, t₄=6.2).

It is relevant that the COVID-19 national outbreak has influenced the RSV trend even after the end of the first lockdown (May 2020). Indeed, Figure 1 shows a permanent level-shift for all of the investigated web queries.

Regional interest in conspiracy-related keyword 1 decreased, on average, during the 2016-2020 time-lapse period, from 71 (SEM 4.2) to 52 (SEM 4.1) (Table 1). From 2020 to 2021, the increase in RSV was manifest and common to all regions (=80 ± 2.8, t_min=1.8, Δ_min%=+12.4; t_max=5.7, Δ_max%=+54.6). Over the 2016-2020 period, the percentage standard deviation ranged from 22.1 to 32.6, while it reached an absolute minimum of 14.4 during the COVID-19 pandemic. This fact shows that web interest in conspiracies has also become more homogeneous across regions. No correlation was sought, as data were subject to a strong dependence on the day of collection [24]; however, the mean values and standard deviations never changed significantly (t_max=0.4).

On the contrary, web interest in the ByoBlu disinformation channel has always been compatible during the 2016-2021 period (t ∈ [–1.3, 1.1], Δ_% ∈ [–16.3, 21.8]; t_20-21=–0.1, Δ_20-21=–1.0; Multimedia Appendix 2).

Figure 1 shows a substantial increase in national searches, and it is evident that the query “byoblu” was searched more in some regions than others. By analyzing the regional trends one by one, it can be observed that web interest in “byoblu” has increased over time, except for in Basilicata and Molise (Figure 2). Although a growing trend was already present, the novel coronavirus seems to have strongly impacted RSVs in Campania (Δ_20-21%=+93.3 vs Δ_19-20%=+63.8), Friuli-Venezia Giulia (Δ_20-21%=+187.6 vs Δ_19-20%=+59.0), Lazio (Δ_20-21%=+95.7 vs Δ_19-20%=+15.8), Trentino-Alto Adige (Δ_20-21%=+173.2 vs Δ_19-20%=+4.5, and Valle d’Aosta (Δ_20-21%=+199.2 vs Δ_19-20%=+86.2).

A fraction of the users seemed aware of the danger inherent in COVID-19 fake news circulating on the web and tried to limit its effects by relying on antihoax websites (Figure 3). Nevertheless, the impact of COVID-19 was more incisive for conspiracy hypotheses (t₁=11.3 vs t₂=4.5; Δ_1%=+157.6 vs Δ_2%=+84.7), so much so that it is possible to observe a greater level-shift in the trend of infodemic web queries. This worsening was homogeneous on a national scale (Figure 4).

With the announcement of the discovery of COVID-19 vaccines, web interest in side effects immediately soared (t_27.1=10.3, Δ_%=+905.2 from October 2020 to April 2021). Although health authorities reported rare side effects of adenoviral vector vaccines only, web interest in this topic exceeded interest in pollution and climate change (SS_vaccines=1.2, P<.001 vs SS_pollution=0.81, P<.001; Δ_%=+44.0; Figure 5), which are much more urgent issues. Queries related to the effects of pollution and climate change returned negligible RSVs.

When considering queries related to vaccine names, the gap between the RSVs further widened; specifically, the discrepancy between the SS values of the two graphs was substantial, which underlines the unjustified disproportion in risk perception between these two topics (SS_vaccines=0.22, P<.001 vs SS_pollution=0.05, P<.001; Δ_%=+296.4). As observable in Figure 6, the risk perception in vaccines has surpassed that in pollution and climate change in a homogeneous way throughout Italy.

By temporarily excluding vaccines, web interest in COVID-19–related fake news reached its peak during the first wave of the pandemic and then declined, as of April 2021 (Δ_% ∈ [–86.1, –73.7], t ∈ [–5.7, –2.3]). However, as observable in Figure 7, the trend of keywords related to the engineered novel coronavirus and unproven COVID-19 remedies had stabilized at values significantly far from 0 ( = 4.8 ± 0.4, = 3.8 ± 0.4, respectively). By restricting the domain from January to June 2021—so as to obtain daily RSVs instead of weekly RSVs—a level-shift of web interest in the manufactured origin of SARS-CoV-2 was evident (comparison between May 1 to 22 and May 23 to June 1; Δ_%=+119.1, t_10.3=2.5). Through the iterative comparison of RSVs, it was possible to estimate that, in the last 12 months, this query represented about 0.04% of COVID-19–related web searches. Regarding vaccines, the highest RSV peak was reached in the week of May 16 to 22, 2021. Such a surge was mainly due to the query “vaccino calamita” (vaccine magnet). By comparing the time-lapse periods of January 1 to May 22, 2021, and May 22 to 31, 2021, a 761% increase in infodemic searches on vaccines was found (t_9.5=6.1).

At the regional level (Table 2), from the beginning of the pandemic, web interest in COVID-19–related fake news was not equally distributed (SD% ∈ [21.4, 33.2]), as opposed to that of generic news (SD%=9.4). Furthermore, Tables 2 and 3 testify to the absence of a regional predisposition for fake news in general and, at the same time, prove a diffused interest in specific topics. Indeed, all of the keywords were low or noncorrelated to each other (|r| ∈ [0.01, 0.39], P ∈ [.13, .97]).

To the best of the author’s knowledge, this is the first study to investigate the impact of COVID-19 on pre-existing fake news and the risk perception of Italian web users. These findings show that the pandemic— understood as a set of different situations, such as a health crisis, an economic crisis, lockdowns, disease, and an infodemic—has significantly increased the phenomenon of conspiracies and interest in them. This influence not only caused a marked initial growth of RSV during the first lockdown (March to May 2020) but also generated a pronounced level-shift in web interest that has persisted until at least April 2021. Regional web interest in conspiracy hypotheses during the pre–COVID-19 2016-2020 period had assumed a clear negative trend and was more noticeable in some areas than in others. However, with the advent of the novel coronavirus, interest has increased to reach the highest level in the last 5 years, becoming even more homogeneous across regions. Due to the high dependence of the RSV on the day of gathering, it was not possible to search for correlations with the regional numbers of COVID-19 cases; nevertheless, the mean values and the sample variances have always remained similar. On the contrary, when analyzing the data year by year, no change in average interest in the infodemic YouTube channel ByoBlu, which had over 500,000 subscribers, was observed between the regions. Since a strong increase was highlighted nationwide, some regions must have contributed far more than others to the jump in total RSV. Specifically, as shown in Figure 2, Campania, Lazio, Friuli-Venezia Giulia, Trentino-Alto Adige, and Valle d’Aosta experienced a much higher increase than the other regions. Moreover, a growing trend in RSV during the last 5 years involved all regions except Basilicata and Molise. Finally, web interest in fake news sources has increased more than interest in antihoax services. These results are not to be underestimated; indeed, the Ministry of Health, various online platforms such as YouTube and Twitter, and social networks such as Facebook and Instagram have declared war without borders against the rampant infodemic. Specifically, under each video relating to the pandemic, YouTube has affixed a warning bar that offers users the opportunity to read the latest COVID-19 news on the Ministry of Health official website, complete with a button to access it. A similar procedure has been adopted by Facebook and Instagram. All of these companies have banned accounts and channels that are protagonists of the spread of fake news, including ByoBlu [32-36]. This approach is partly consistent with the procedure proposed by the WHO to deal with the infodemic but was not enough to contain disinformation in Italy. Among the problems that have undermined the effectiveness of these strategies, there is the resonance given by newspapers and television channels to unreliable or misleading information [37-40]. Beyond the mere disinformation contribution, this can foster distrust toward mass media, making the information campaign even more complex during times of crisis [41]. Furthermore, despite all of the countermeasures adopted, social networks and messaging apps, such as WhatsApp, are fake news vehicles [37,38,41].

Alongside this, the influence of newspapers and television news on the risk perception related to COVID-19 vaccines was evident. Although the trend has been on the rise since early October 2020, the headlines of online, printed, and television news publications have often been the subject of criticism from the scientific community as sensationalistic and far from the scientific evidence [42-44]. Distrust of vaccines is a growing issue that raises a serious public health question [45-47]. Although most vaccine-related fake news circulates on social networks, the national mass media must attend to the evidence presented in the scientific literature with appropriate and thoughtful language. In particular, the effect of deliberately misleading titles linked to secondary aspects of the article can have serious consequences [48]. In such an intricate scenario, web interest in vaccine side effects has overtaken interest in pollution and climate change. Notwithstanding that the author of this paper loudly supports the pharmacovigilance process and is aware of the existence of numerous studies on the possible causal link between adenoviral vector COVID-19 vaccines and thrombotic events [49-51], it is necessary to consider that pollution and climate change constitute one of the major global threats today, claiming millions of victims every year [27,52]. Since Janssen and Vaxzevria vaccines have very rare side effects [28,52-55], it is reasonable to conclude that the risk perception of Italian users is distorted and disconnected from the real dangers that menace them. This is even more true when considering the incidence of COVID-19 itself in this type of event [56,57].

Finally, COVID-19 and the crisis it caused have generated fertile ground for new conspiracy hypotheses. While some of these, such as the link between 5G and the spread of the epidemic, have waned over time, others, including the human engineering of the virus in a Wuhan laboratory, phantom infection remedies with no scientific basis, and intentionally altered vaccines, have persisted until today. To further complicate the scenario, the spread of COVID-19–related fake news has not been uniform among the regions; indeed, the RSV groups showed low multicollinearity and vast discrepancies (eg, Abruzzo, Puglia, Calabria, Friuli-Venezia Giulia, and Veneto showed a high interest in the vaccine infodemic and a significantly lower interest in unproven remedies). As a conclusive consideration, the author of this paper emphasizes that it is correct to use the term “infodemic” to describe news that supports any hypotheses without supporting evidence [58]. At the same time, science needs to continue to investigate any possible leads [59].

There are no guarantees that Google Trends is sufficient for investigating the totality of the interests of the Italian public. In particular, internet penetration in Italy is equal to about 74% of the population [60]. Of this fraction, almost 96% use Google as their default online search engine [61]. Therefore, 29% of the Italian population is not considered in this survey. Furthermore, it is not certain that the keywords used in this research included all the terms related to the topics investigated. Indeed, the algorithm with which Google selects the most relevant related queries is unknown (ie, it may not consider web searches pertinent to the discussion). Finally, some relevant keywords may not have been selected for the analysis. Future research could rely on machine learning algorithms for textual analysis to derive the topics of interest to search for on Google Trends.

COVID-19 has given a significant boost to web interest in conspiracy hypotheses and has made it more uniform across regions. The pandemic accelerated an already-growing trend in users’ interest toward some fake news sources, including the 500,000-subscriber YouTube channel ByoBlu, which was removed from the platform by YouTube for disinformation in March 2021. The risk perception related to COVID-19 vaccines has been so distorted that vaccine side effect–related queries outweighed those relating to pollution and climate change, which are much more urgent issues. Moreover, a large amount of fake news circulated about COVID-19 vaccines, remedies, and origin. Based on these findings, it is recommended that the Italian authorities implement more effective infoveillance systems, and that communication by the mass media be less sensationalistic and more consistent with the available scientific evidence. In this context, Google Trends can be used to monitor the users’ response to specific infodemiological countermeasures. Further research is needed to understand the psychological mechanisms that regulate risk perception.