ORIGINAL RESEARCH published: 09 July 2021 doi: 10.3389/fpsyt.2021.648569 An Ethnography Study of a Viral YouTube Educational Video in Ecuador: Dealing With Death and Grief in Times of COVID-19 Lydia Giménez-Llort 1,2* 1 Medical Psychology Unit, Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain, 2 Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain In Western societies, death is a social and educational taboo. Poor education about death and mourning processes and overprotective family and social attitudes move children away from death to avoid “unnecessary suffering.” The COVID-19 outbreak highlighted these shortcomings and the difficult management of grief’s complexity under sudden and unexpected scenarios. The need for immediate and constant updates related to COVID-19 benefited from social media coverage’s immediacy. The use of Edited by: YouTube as a digital platform to disseminate/search for knowledge exploded, raising Christos Theleritis, the need to conduct ethnographic studies to describe this community’s people and National and Kapodistrian University culture and improve the booming social media’s educational capacity and quality. The of Athens, Greece present virtual ethnography studied 255,862 YouTube views/users and their behavior Reviewed by: Lucas Borrione, related to “Vuela Mariposa, Vuela,” a children’s story available online since 2009 (not University of São Paulo, Brazil monetized) about the cycle of life, death, and disenfranchised grief (not acknowledged Panagiotis Pentaris, University of Greenwich, by society) that went viral (+ >999%) on May. To our knowledge, this case study is the United Kingdom first original research that explores the ethnography of (i) a viral video, (ii) on death and *Correspondence: grief taboo topics, (iii) for prescholars, and (iv) before and during the COVID pandemic. Lydia Giménez-Llort The quantitative and qualitative analyses identified a change in the users’ profiles, lidia.gimenez@uab.cat engagement, and feedback. During the previous 11 years, the users were 35–44 years Specialty section: old Mexican and Spanish women. Those in grief used narrative comments to explain their This article was submitted to vital crisis and express their sorrow. In the pandemic, the analysis pointed to Ecuador Public Mental Health, a section of the journal as the virality geographical niche in a moment when the tragic scenarios in its streets Frontiers in Psychiatry were yet unknown. The timeline match with the official records confirmed the severity Received: 26 January 2021 of their pandemic scenario. The viral video reached a broad population, with normal Accepted: 25 May 2021 Published: 09 July 2021 distribution for age, and including male gender. Engagement by non-subscribers, direct Citation: search (traffic sources), and mean visualization times suggested educational purposes Giménez-Llort L (2021) An as confirmed by the users’ feedback with critical thinking referring to the cycle of life’s Ethnography Study of a Viral YouTube meaning and societal mourning. For the youngest users, the video was part of academic Educational Video in Ecuador: Dealing With Death and Grief in Times of assignments. The ethnography pointed at YouTube as a flexible education resource, COVID-19. immediately reaching diverse users, and being highly sensitive to critical events. Front. Psychiatry 12:648569. doi: 10.3389/fpsyt.2021.648569 Keywords: pre-school education, death, grief, disenfranchised grief, youtube, ethnography, COVID-19 Frontiers in Psychiatry | www.frontiersin.org 1 July 2021 | Volume 12 | Article 648569 Giménez-Llort Ethnography of Death-Grief in YouTube INTRODUCTION instead of letting it be a natural part of the child’s psychology and maturational development. More recently, among health In many Western societies, focused on youth and productivity, promotion perspectives, digital storytelling (21) and children’s after a century of health and social advances increasing life literature have been foreseen to promote students’ global expectancy by half a century, death is a taboo (1–3). Most people development and well-being (22). The approach of death and prefer not to think about it unless it is necessary. They behave as mourning process through tales is a common educational if death will exclusively be the endpoint of old age, and the “word resource used since prescholar times (23–25) similarly to taboo” forces the use of euphemisms. Talking about death is occasional “teachable moments” where children are in contact considered inappropriate or offensive outside normative settings with the presence of finitude (26). Under a psychosocial nursing restricted to figurative scenarios, the religious doctrine, or when perspective, the most recent work also refers to the relevance its use is unavoidable in medical situations. The taboo on the dead of using storytelling with grief reactions in children during the includes naming the deceased person, touching the dead, those COVID-19 pandemic (27). Experts consider that death education encompassing them, and anything related to it. Grief that does programs are a kind of intervention program to learn coping not align with social norms, the so-called disenfranchised grief, is strategies to deal with the fear of death and manage loss and not acknowledged by society and even denied. In other societies, anxiety (28), which are important to incorporate also into school indigenous ceremonies and rituals like those of Mexicans or curricula (29). Australian aborigines provide the opposite scenario, where the The present work is presented as a case study aimed to celebration of death and dead people are intrinsic to their culture determine the ethnographic profile of 255,862 YouTube users (4, 5). (as estimated from visualizations) and their behavior related The emerging, rapidly evolving nature of the COVID-19 to “Vuela Mariposa, Vuela,” a children’s story available online scenario results in a strong need for fast and freely accessible since 2009 (not monetized) about the cycle of life, death, medical information resources to spread recommendations, and disenfranchised grief (not acknowledged by society) that guidelines, and constantly updated advice (6). Internet was went viral (+ >999%) on May 2020. To our knowledge, already a popular source of healthcare information for both this brief report is the first original research that explores patients and professionals through not only different “social the ethnography describing the YouTube community’s people media” formats, such as blogs, microblogs (Twitter), and and culture associated with (i) a viral video, (ii) dealing with forums in medical websites, but also social networking sites death and grief taboo topics, (iii) created as a material for (i.e., LinkedIn and Facebook) and communities (YouTube) prescholars, and (iv) quantifying the change in the ethnography (General Medical Council UK (https://www.gmc-uk.org) (7)). profile before and during the COVID-19 pandemic. The In particular, YouTube is the second most popular website in children’s story was first published open access in Encuentos.com, the world, and its use as a digital platform to disseminate a digital editorial before the illustrated book, which also includes knowledge in the health field is on the rise, along with its a guide for parents and teachers, was published in an independent ability to be a disinformation niche (8). The increased use editorial. The story is also part of a scholarly book for American of YouTube has highlighted the importance of conducting students. Its professional use is cited in a doctoral thesis and ethnographic studies to describe this community’s culture. This several professional websites and blogs of Spanish and Latino– research approach can be defined as studying social interactions, American psychologists specialized in managing children’s grief. behaviors, and perceptions within groups and communities (9). It is characterized by exploring the nature of a particular social phenomenon rather than testing a hypothesis about it. This MATERIAL research model applied in virtual education aims to improve the educational capacity and quality of the booming social The material consists of two videos hosted on a non-monetized media (10). YouTube channel. They present a Spanish children’s story on the Thanatology and current practice in death education are cycle of life, death, and disenfranchised grief entitled “¡Vuela, an emerging field in postmodern Western societies, using mariposa! ¡Vuela!” (30) and its English version “Fly, Butterfly, interdisciplinary approaches (11) to counteract the social taboo Fly!” (31), both original works of the author of the present report. of death (12). Poor education about death and mourning The original version was published on June 23, 2009, and in its processes, together with overprotective family and social English version 2 days later, on June 25 of the same year. attitudes, moves children away from death to avoid what is considered an “unnecessary suffering” (13, 14). The COVID- Participants 19 pandemic has highlighted these shortcomings (15, 16) and This study’s participants are constituted by an independent, the severe difficulties that individuals, but mostly society, have anonymous sample of 255,862 YouTube users, an estimated to manage grief ’s complexity under adverse scenarios (17–19) number by YouTube Analytics based on the number of views and chronosystem pressure (20). The situation is worsened by from their publication dates (June 23 and 25, 2009) until August multiple mourning, as to the loss of the loved ones, individuals 31, 2020. In each ethnography analysis (Tables 1–6), the number add other material, economic, and social losses that increase of estimated users (views) is indicated. The sample of interest the meaning and impact. In children, the protective attitudes refers to the time frames where the virality of the video occurred. postpone their “confrontation” with the concept of death, It is focused on the 96,019 YouTube views in the 174 days since Frontiers in Psychiatry | www.frontiersin.org 2 July 2021 | Volume 12 | Article 648569 Giménez-Llort Ethnography of Death-Grief in YouTube TABLE 1 | Comparative analysis on the use of the children’s story on cycle of life, death, and grief—indicators and traffic sources. !Vuela Mariposa, Vuela! Fly, butterfly, Fly! (A) Historic (B) Pandemic (A) Historic (B) Pandemic 2009 to March 10, 2020 March 11 to August 31, 2020 2009 to March 10, 2020 March 11 to August 31, 2020 Indicator n n n n Visualizations (total: 255,592) 159,573 96,019 1,203 67 Impressions (total: 336,980) 218,892 118,088 398 243 Time (h) of visualization (total: 13,454) 6,662.3 6,791.7 8.1 0.7 Mean duration of the visualizations 3:01 4:14 1:39 1:27 Subscribers (total: 624) 200 424 0 0 Percentage of clicks (%) 5.6 10.0 1.0 1.2 Traffic source n (%) n (%) n (%) n (%) External source 55,220 (34.6) 32,702 (34.1) 104 (8.2) 3 (4.5) Direct or unknown 19,628 (12.3) 46,615 (48.6)*** 286 (23.8) 26 (38.8)* YouTube search 44,080 (27.6) 11,738 (12.2) 286 (23.8) 2 (3.0) Suggested videos 20,399 (12.8) 2,312 (2.4) 175 (14.6) 33 (49.3)*** Inserted 7,085 (4.4) — 94 (7.8) — Other YouTube functions 2,920 (1.8) 1,749 (1.8) 50 (4.2) 2 (3.0) Google search 3,487 (2.2) — 11 (0.9) — Promotion for YouTube partners 2,268 (1.4) — 162 (13.5) — Data for (A) Spanish version and (B) English version of the children’s story are expressed as real numbers (n) and percentages (%). In bold, the highest percentages are indicated. The symbol “—” is meant for absence or data not reported or quantifiable, according to YouTube analytics. Statistics: χ2 , *p = 0.05, ***p = 0.0001 vs. pre-pandemic period. TABLE 2 | Comparative analysis on the use of the children’s story on cycle of life, death, and grief—age and sex. !Vuela Mariposa, Vuela! Fly, butterfly, Fly! (A) Historic (B) Pandemic (A) Historic (B) Pandemic 2009 to March 10, 2020 March 11 to August 31, 2009 to March 10, 2020 March 11 to August 31, 2020 2020 Age % Users, mean duration of % Users, mean duration of %, Mean, % %, Mean, % visualization and (%) visualization and (%) 13–17 years old — 4.1%, 3:46 (47.0) — — 18–24 years old — 14.3%,*** 4:06 (51.1) — — 25–34 years old — 25.8%,*** 4:13 (52.6) — — 35–44 years old 100%, 2:51 (35.5) 24.8%,*** 4:22 (54.4) — — 45–54 years old — 19.9%,*** 4:31 (56.4) — — 55–64 years old — 10.1%,** 4:39 (57.9) — — +65 years old — 1.0%, 4:27 (55.6) — — Sex Women 100%, 2:51 (35.5) 69.1%,*** 4:17 (53.5) — — Men — 30.9%,*** 4:21 (54.2) — — Data for (A) Spanish version and (B) English version of the children’s story are expressed as a percentage of users, mean duration of visualizations expressed as (minute: seconds), and as a percentage. In bold, the main contributors are indicated. The symbol “—” is meant for absence or data not reported or quantifiable, according to YouTube analytics. Statistics: Fisher exact test, **p < 0.01; ***p = 0.0001 vs. pre-pandemic period. the start of the official declaration of the pandemic (WHO, March video’s engagement indicators (Table 4). Service used to share 11, 2020) until August 31, 2020 (Tables 1–3). After that, the was determined from the behavior of 6,949 users, from whom 23,246 users (views) on the day that went viral determine the viral 3,944 users belong to the historic pre-pandemic period and 3,005 Frontiers in Psychiatry | www.frontiersin.org 3 July 2021 | Volume 12 | Article 648569 Giménez-Llort Ethnography of Death-Grief in YouTube TABLE 3 | Comparative analysis on the use of the children’s story on the cycle of life, death, and grief—geographic areas. !Vuela Mariposa, Vuela! Fly, butterfly, Fly! (A) Historic (B) Pandemic (A) Historic (B) Pandemic 2009 to March 10, 2020 March 11 to August 31, 2020 2009 to March 10, 2020 March 11 to August 31, 2020 Geographical area n (%) n (%) n (%) n (%) Total visualizations 159,573 (100) 96,019 (100) 1,203 (100) 67 (100) Mexico 46,577 (29.2) 3,644*** (3.8) 13 (1.0) — Spain 14,268 (8.9) 1,210* (1.3) 10 (0.8) — Colombia 4,608 (2.9) 1,062 (1.1) — — Argentina 3,049 (1.9) 569 (0.6) — — Chile 1,354 (0.9) 312 (0.3) — — Peru 359 (0.2) 302 (0.3) — — Ecuador 272 (0.2) 81,524 (84.9)*** — 16 (23.9)*** USA 252 (0.2) 354 (0.4) — — Costa Rica 219 (0.1) — — — a b Other Latino—American countries 313 (0.1) 48 (0.05) — — Data for (A) Spanish version and (B) English version of the children’s story are expressed as real numbers (n) and percentages (%). In bold, the highest percentages are indicated. The symbol “—” is meant for absence or data not reported or quantifiable, according to YouTube analytics. Statistics: Fisher exact test, *p < 0.05 and ***p = 0.0001 vs. pre-pandemic period. a Other Latino–American countries: Guatemala (95), Uruguay (62), Paraguay (41), Puerto Rico (37), Venezuela (35), Filipinas (20), El Salvador (12), Panamá (11). b Other Latino–American countries: Nicaragua (13), Bolivia (12), Panamá (12), El Salvador (11). users to the pandemic (Table 5). Finally, a total sample of 90 view duration (estimated average minutes viewed per replay), users interacted in the YouTube channel to write commentaries impressions (number of times video thumbnails have been shown to the video, thus providing feedback during the pre-pandemic to viewers), and impressions CTR (click-through rate; views by (33 users) and the pandemic (57 users) periods. impressions shown). Instruments and Procedure Ethnography of the Virality—Timeline, Engagement, Ethnography—Analytics of the Children’s Story Sharing, and Users’ Feedback Videos The data to elaborate the two videos’ comparative temporal All the data from the video publication date until August maps were obtained through YouTube’s analytical engine. Total 31, 2020, were considered for the comparative analysis. As dates were defined from June 25, 2009, to August 31, 2020. The the two versions of the story’s publication dates differ in 3 temporal map of the evolution of COVID-19 for Ecuador was days, the publication date of June 25, 2009, was taken as a taken from the official source of COVID-19 alerts in Google, as standard reference. It was verified that this did not affect the offered as of September 1 (the latest to collect data possible for total computations. The data were obtained for three time this publication) cites Wikipedia as a source, Creative Commons, intervals: the total and the two periods that comprise the free to use. historic or pre-pandemic period (from the beginning to March Analytics of the viral video’s engagement indicators measured 10, 2020, inclusive) and the first 174 days of the COVID- by the number of views, time of visualization, and the mean 19 pandemic (from March 11 to August 31, 2020). After duration of visualization was obtained from YouTube Analytics that, the data of the viral version were analyzed on the day for the day the video went viral. In addition, sharing was it went viral. measured by the service used to share, for both periods, the The virtual ethnographic analysis was made through three historical and the pandemic. instruments. First, YouTube Analytics provides the traffic sources Finally, for the users’ feedback, content analysis on the used to watch the video, geographical areas, sex and age of comments posted by users in the viral video was performed. the users, and other social engagement indicators. The concepts Based on the user profile, three participations or user’s typologies behind the different variables are obvious or intuitive, but some were considered: E, entities; W, women; and M, men. Content may need to be defined. These are Traffic sources (the origin analysis was done on users’ comments to the video for both through which people found the site. YouTube traffic sources periods (historic and COVID-19). The presence of grief was include search, browse features, playlists, and suggested videos, recorded and qualified in five typologies as follows: personal all power to varying degrees by the YouTube algorithm. Other loss (of a child, husband, father), loss of a friend, loss of a sources include direct URL or external), viewing time (estimated person in the school, societal loss (referred to COVID-19), total hours of viewing of the content by the audience), average and disenfranchised grief (loss of a pet). The content analysis Frontiers in Psychiatry | www.frontiersin.org 4 July 2021 | Volume 12 | Article 648569 Giménez-Llort Ethnography of Death-Grief in YouTube TABLE 4 | Analytics of the viral video’s engagement indicators. Engagement’s indicators Source Visualizations Time of visualization (h) Mean duration of visualizations n (%) n (%) n (%) Total 23,246 2,069.1 5:20 (66.5) Subscription status Non-subscriber 23,161 (99.6) 2,064.7 (99.8) 5:20 (66.5) Subscriber 85 (0.4) 4.3 (0.2) 3:04 (38.3) Type of device Computer 16,439 (70.7) 1,628.7 (78.7) 5:56 (74.0) Mobile pone 6,473 (27.9) 408.8 (19.8) 3.47 (47.2) Tablet 161 (0.7) 13.1 (0.6) 4:52 (60.7) TV 109 (0.5) 11.6 (0.6) 6:23 (79.6) Video game console 1 (0.0) 0.1 (0.0) 8:01 (100) Traffic source Direct or unknown 14,453 (62.2) 1,436.7 (69.4) 5:57 (74.2) External sources 147 (28.5) 462.8 (22.4) 4:11 (52.1) YouTube search 62 (6.5) 125.2 (12.0) 4:56 (61.5) Other YouTube functions 36 (1.4) 24.2 (5.1) 4:24 (54.8) Suggested videos 22 (1.1) 16.5 (3.9) 3:59 (49.8) Exploration functions 11 (0.2) 1.9 (1.6) 2:39 (33.1) Page of reproduction list 11 (0.1) 0.8 (2.0) 4:21 (54.2) Reproduction lists 7 (0.0) 0.9 (1.1) 5:28 (68:2) Channel’s pages 1 (0.0) 0.0 (0) 0:27 (5.7) Geographic area Ecuador 22,903 (98.5) 2,047.5 (99.0) 5:21 (66.8) United States 117 (0.5) 10.0 (0.5) 5:07 (63.7) Mexico 42 (0.2) 1.8 (0.1) 2:34 (49.1) Colombia 35 (0.2) 0.9 (0.1) 1.36 (42.6) Spain 18 (0.1) 0.7 (0.0) 2:17 (32.1) Chile 13 (0.1) 0.9 (0.0) 3:56 (28.5) Peru 12 (0.1) 0.7 (0.0) 3:25 (20.0) Age 13–17 years old — (2.1) — (25.9) 5:08 (63.9) 18–24 years old — (11.1) — (10.9) 4:59 (62.1) 25–34 years old — (24.9) — (24.7) 5:00 (62.3) 35–44 years old — (25.5) — (25.9) 5:08 (63.9) 45–54 years old — (22.9) — (23.0) 5:04 (63.2) 55–64 years old — (12.3) — (12.4) 5:95 (63.3) +65 years old — (1.2) — (1.2) 5:01 (62.5) Sex Woman — (69.7) — (69.0) 5:01 (62.5) Man — (30.3) — (31.0) 5:10 (64.4) Data for engagement indicators on the viral children’s story are expressed as real numbers (n) and percentages (%). In bold, the highest percentages are indicated. The symbol “—” is meant for absence or data not reported or quantifiable, according to YouTube analytics. searched for several items related to the video and the story, Data Analysis the emotions, and feelings raised; the cognitive aspects such as The data are presented and analyzed using quantitative and critical thoughts; a summary of the video and its interpretation, qualitative descriptive methods. Differences were analyzed with providing new opinions; consideration of its use; and the Student t test, χ 2 test, or Fisher exact test. p < 0.05 value was target population. considered statistically significant. Frontiers in Psychiatry | www.frontiersin.org 5 July 2021 | Volume 12 | Article 648569 Giménez-Llort Ethnography of Death-Grief in YouTube TABLE 5 | Service used to share. in 174 days. The percentage of clicks during the pandemic was twice those of the previous years (10.0 vs. 5.5%). Compared to Service (A) Historic (B) Pandemic videos with the same duration, YouTube Analytics scored the 2009 to March 10, March 11 to August 31, audience’s relative retention as “high” until minute 2:50 and “over 2020 2020 the mean” until minute 6:05. The video received 892 likes vs. 51 dislikes and recorded a 94.6% active response to satisfaction, n (%) n (%) similar to the mean 94.4% given to the channel. The main traffic Total 3,944 (100) 3,005 (100) source changed during the pandemic with “director unknown” WhatsApp 1,958 (49.7) 1,803 (60.0) n.s. (48.6%) showing a statistically significant increase (χ 2 = 30.570, Copy to Clipboard 788 (20.0) 315 (11.1) 1 dg, p = 0.0001), as compared to historical, and leading the Facebook 708 (18.0) 334 (11.1) traffic, ahead of “external source” (34.1%) and “YouTube search” Other services 207 (5.3) 437 (14.5) (12.2%), the main sources during the previous years (34.6 and Facebook Messenger 120 (3.0) 64 (2.1) 27.6%, respectively). Gmail 69 (1.8) 27 (0.9) As a comparison, the indicators and traffic sources of the E-mail 24 (0.6) 4 (0.1) English version Fly, Butterfly! Fly! is indicated in Table 1. Since its publication in 2009, this version has obtained 1,270 total Google+ 18 (0.5) — views and 641 total impressions, representing 0.05 and 0.19% of Text message 16 (0.4) 3 (0.1) the original story’s total activity, respectively. The 5.3% of total Twitter 12 (0.3) 6 (0.2) views were done during the pandemic, although views had a Pinterest 12 (0.3) 3 (0.1) similar mean duration (1:27 vs. 1:39) and percentage of clicks Blogger 5 (0.1) 1 (0.0) (1.2 vs. 1.0) than the previous years. In contrast, the number of Hangouts 3 (0.1) 1 (0.0) impressions was maintained relatively high, with 243 compared Reddit 1 (0.0) 7 (0.2) to 398 in previous years. Still, these indicators were small as Tuenti 1 (0.0) — compared to the viral video. From its publication, traffic sources LinkedIn 1 (0.0) — were quite diversified, with 23.8% being “direct or unknown” and Embed 1 (0.0) — 23.8% “YouTube search,” followed by “suggested videos” (14.6%), Data for service used to share the viral children’s story are expressed as real numbers (n) “promotion of YouTube partners” (13.5%), or “external sources” and percentages (%). In bold, the highest percentages are indicated. The symbol “—” is (8.2%). During the pandemic, the “main traffic sources” also meant for absence or data not reported or quantifiable, according to YouTube analytics. changed, as they were found concentrated on “suggested videos” Statistics: χ2 = 1.636, 1 df (degrees of freedom), p = 0.2008, n.s. (not statistically significant) vs. pre-pandemic period. (49.3%) and “direct or unknown” (38.8%) that significantly increased (χ 2 = 25.023, 1 dg, p = 0.0001; 4.542, 1 dg, p = 0.0331, respectively) as compared to the historic. RESULTS Age and Sex Ethnography—Analytics of the Children’s Since its publication, the age and sex of the audience have been Story Videos very uniform, with 100% of visits being 35–44-year-old women, The video statistics provided by YouTube Studio for the video who spend a mean of 2:51 min in the visualizations, a 35.5% and its English version in the two periods of time, the pandemic of the video duration. During the pandemic, the audience was and the history of the previous 11 years, are depicted in three broader, showing a normal distribution with the maximum in the tables according to three main analytical domains: (1) indicators 25–34 year (25.8%) and 35–44 year (24.8%) ranges, an increase and traffic sources (Table 1); (2) age and sex (Table 2); (3) that reached statistical significance except at the two tails of the geographical areas (Table 3). curve (χ 2 s, age intervals from 18 to 54 years, p = 0.0001; 55– 64 years old, p = 0.0015). The mean duration of visualizations Indicators and Traffic Sources per age group was similar, covering ∼50% of the video duration, The database of indicators and traffic sources for “¡Vuela with the lowest time (3:46, 47.0%) in the youngest age group Mariposa!¡Vuela!” (Table 1) showed that from its publication (13–17 years old) and the highest (4:39, 57.9%) in those 55–64 in 2009 until August 31, 2020, a total of 255,592 visualizations years old. Men also viewed the video, with a 30.9% participation, and 336,980 impressions were recorded. The 37.6% (96,019) and spending 4:21 min (54.2%) of visualization time than 69.1% of 35.0% (118,088) of them, respectively, were done during the women, who spent 4:17 min (53.5%). No data were available for 174 days of the pandemic period recorded. 6,791.7 h, half of the English version. the total visualization time (13,454 h) was accumulated during the pandemic, which was as much as the 6,662.3 accumulated hours during the previous 11 years since its publication. The Geographical Areas visualizations’ mean duration was 4:14, a 52.8% of its total 8:01 The description of the geographical areas unveiled a key aspect duration, while the that of the previous years was 3:01, 37.6%. since the video, which was popular among Mexicans (29.2%) and During the preceding 11 years, the video captured 624 Spaniards (8.9%), became viral during the pandemic in another subscribers, 200 before the pandemic and 64.1% (400) of them location, Ecuador (84.9%). The few data registered for the English Frontiers in Psychiatry | www.frontiersin.org 6 July 2021 | Volume 12 | Article 648569 Giménez-Llort Ethnography of Death-Grief in YouTube TABLE 6 | Content analysis of comments of users. (A) Historic (B) Pandemic 2009 to March 10, 2020 March 11 to August 31, 2020 Statistics n (E:W:M) (%) n (E:W:M) (%) P Participants 33 (4:26:3) (100) 57 (0: 44:13) (100) Grief 13 (0:11:2) (39.4) 5 (0:3:2) (8.8) *** Personal loss 8 (0:6.2) (24.2) 1 (0:0:1) (1.8) Loss of a friend 2 (0:2:0) (6.0) 1 (0:0:1) (1.8) Loss at the school 3 (0:3:0) (9.0) 0 Societal loss 0 2 (0:2:0) (3.5) Disenfranchised grief 0 1 (0:0:1) (1.8) Expressivity (use of emoji or emoticons) In grief 0 0 Not in grief 0 11 (0:7:4) (21) ** Expressivity (number of words) n, Mean ± SEM n, Mean ± SEM In grief 13, 37.5 ± 7.0 5, 17.0 ± 5.44 (*) Not in grief 20, 9.8 ± 2.3 GGG 52, 16.1 ± 2.03 (*) Data for content analysis of comments of users on the viral children’s story are expressed as real numbers (n); ratio of E, entities; W, women; M, men; and percentages (%). In bold, the highest percentages are indicated. The symbol “—” is meant for absence or data not reported or quantifiable, according to YouTube analytics. Statistics: Student t test of Fisher exact test; p < 0.001 vs. the comments not referring to grief; *p < 0.05, one-tailed; **p < 0.01; ***p < 0.001 vs. the historic. version also pointed at Ecuador (23.9%) as a geographical area, was the “main source” of the audience. Geographical areas also whereas no information was available for the other areas. pointed at Ecuador as 98.5% of visitors with high retention times of 5:21 (66.8%). While the United States represented only 0.5% Ethnography of the Virality—Timeline, of the audience of that day, the retention was 5:07 (63.7%). Engagement, Sharing, and User’s The age and sex distribution replicated that described for the Feedback pandemic period, except for 13–17-year-old visitors who spent Timeline 63.9% (5:08 min). Figure 1 illustrates the temporal map of the video’s virality provided by YouTube analytics and plots the views per day of Sharing the English version (hardly detectable) for comparison. During The “service used to share” analytics is depicted in Table 5. the pandemic, March 11 to August 31, 2020, YouTube referred to Since its publication, WhatsApp was the “main service” (49.78%) viral (+ >999%) engagement, and May 19, 2020, as the day with a used to share the video, followed by “Copy to Clipboard” maximum of 23,246 visualizations and a retention time of 66.5% (20%) and Facebook (18.0%). During the pandemic, the sharing (5:20 min). Evident synchronicity is shown with Google COVID- through WhatsApp was increased (60.0%) whereas the other two 19 alert statistics for Ecuador during the same period, March 11 devices reduced their use to 11.1% in favor of “other services” and August 31, 2020. Total cases, cured, and deaths in the world, (14.5%). The use of Facebook Messenger represented 3.0% of the Ecuador, and different Ecuadorian areas are depicted. shares since 2009, or 2.1% during the pandemic. Gmail, emails, Google+, text message, Twitter, Pinterest, Blogger, Hangouts, Engagement Indicators Reddit, Tuenti, LinkedIn, and Embed were minor. Viral video’s engagement indicators (Table 4) show that 99.6% of views on May 19, 2020, were from non-subscribers, with a User’s Feedback as Commentaries computer (70.7%) being the main type of device used to watch Before the pandemic, the feedback from users recorded as the video, and the mean duration was as high as 5:56 min commentaries to the video was low but increased with time, (74.0%). Those who were already subscribers showed a lower 3:04 reaching a total number of 33 comments (Figure 2A). According retention time. Access through mobile phones was 27.9%, and to the user’s profiles and written comments, the 33 comments the mean duration was 3:47 (47.2%). Despite that tablets and TV were written by four bereavement counseling entities, 26 women were used in a hundred persons, the mean duration increased and 3 men (Table 6). The exponential growth of comments was to 4:52 (60.7%) and 6:23 (79.6%), respectively. Only one user recorded during the 174 days of the pandemic studied, with viewed the video from a video game console but saw it during 57 new commentaries of 44 women and 13 men. No entities its complete duration. Traffic source was direct (62.2%) followed contributed with comments. by “External sources” (28.5%) with high visualization rates of The content analysis allowed us to identify eight topics 74.2% of video duration. Reproduction lists, while representing (Figure 2B). During the years before the pandemic, the only seven visualizations, had a 68.2% retention time. Ecuador commentaries referred to the beauty of the video/story (42.4%) Frontiers in Psychiatry | www.frontiersin.org 7 July 2021 | Volume 12 | Article 648569 Giménez-Llort Ethnography of Death-Grief in YouTube FIGURE 1 | Time lines. (A) Temporal map of ’1Vuela mariposa, Vuela! video’s virality provided by YouTube analytics and views per day of the English version. (B) Synchronicity of the children’s story virality (red icon) shown with Google COVID-19 alert statistics for Ecuador during the same period, March 11 and August 31, 2020. Right table: Total cases, cured and deads in the world, Ecuador and different Ecuadorian areas are depicted. and/or described personal details about grief experiences (39.4%, averaged number per year was 1.18 ± 0.23 over 3.0 ± 0.47 13 persons: 11 women, 2 men), primarily personal loss (24.2%) participants per year (64.8%), 13 over 33 participants (39.4%) but also loss of friends (6.1%) or in the schools (9.1%). Those in during the whole period (Fisher exact test, p = 0.0008). Societal grief wrote longer texts to express themselves (37.5 ± 7 words) loss, related to the current situation, was referred to in two of five than those not referring to grief, who used shorter texts (9.8 comments. Evocation of the grief for the loss of a pet (considered ± 2.3 words, Student t test, p = 0.0001). One-third of users disenfranchised grief) was also mentioned here for the first time. (30.3%) found the video “helpful” for themselves or those who The other two explicit comments were for a personal loss and the had lost a loved one, and they thanked for sharing (21.2%). loss of a friend. The length of comments with explicit reference Users qualified the video as touching or evoking their sadness to a grief experience was as long as those that did not (17.0 ± 5.44 (18.2%), whereas others referred to it as inviting to do reflections vs. 16.1 ± 2.03) (vs. the previous years, one-tailed Student t test, and/or expressed their opinion (18.2%). Thus, some users used in grief, p = 0.05; not in grief p = 0.04, respectively). Also, the use the comments to summarize the story. Others extracted one of emoticons was observed in the comments (Fisher exact test, or several messages regarding human qualities, existence, or p = 0.006). The content analysis confirmed the categorization values such as friendship, acceptance, and immortality of love. of topics but changed their incidence. Thus, while the video’s Other users used the commentary to provide their point of beauty was one of the two most common observations (40.4%), view and perspective. Finally, a few (9%) used or added an “I there was an increase in the number of users referring to critical love it” to their commentary. This pattern was changed during thinking elicitation; users summarized the messages and some the pandemic. The ratio of users referring to be in grief or added opinions (43.9%). Some comments explicitly referred to evoking their grief during the semester of the pandemic was 5 (3 watching the video as an assignment from their teacher or as women, 2 men) over 57 participants (8.8%), whereas the previous docents, and these comments received positive reinforcement Frontiers in Psychiatry | www.frontiersin.org 8 July 2021 | Volume 12 | Article 648569 Giménez-Llort Ethnography of Death-Grief in YouTube FIGURE 2 | User’s feedback as commentaries. (A) Time line, Statistics: Time line regression analysis. (B) Content analysis identifying 8 topics as described in the legend. Statistics: Chi-square, *p < 0.05; **p < 0.01; ***p < 0.001 vs. historic (2009-March 10, 2020). Frontiers in Psychiatry | www.frontiersin.org 9 July 2021 | Volume 12 | Article 648569 Giménez-Llort Ethnography of Death-Grief in YouTube from others (up to 35 likes). The comments also qualified the where monarch butterflies are a symbol of the deceased who are video as helpful for their new role as bereavement counselors to present on the Day of the Dead (4), was reported as the primary help others. geographical location. Altogether, the geographic analysis was key for the ethnographic analysis, corroborated by the timeline and the users’ feedback, unveiling the user’s needs and use of the DISCUSSION video to manage the mourning process, as will be later discussed. In a formal comparative analysis, results obtained in a period The present study prompted by a children’s story about the cycle are contrasted against a similar period immediately before or the of life, death, and grief hold in a YouTube channel for more same time frame in the previous year. In the present work, the than 11 years, suddenly becoming viral (+ >999% increase of idiosyncrasy of virality is significantly different from precedent views) in May 2020, 3 months after the pandemic was declared data, at least for the number of visualizations. As the standard (32). Therefore, because of its nature and singularity, this work basal levels of the video were trimmed, the analysis was done is presented as a case study. To our knowledge, this report is the compared to (1) the English version during the same period of first original research that explores the ethnography of (i) a viral the pandemic and (2) the historical records obtained during the video, (ii) on death and grief taboo topics, (iii) for prescholars, previous 11 years. and (iv) the change in the ethnography profile before and during The indicators showed that virality allowed to achieve, in the COVID-19 pandemic. a brief time, approximately half of the amount of activity There is abundant literature about the role of social media accumulated during the precedent years, as measured by the and death and grief since the 1980s that emphasizes many of the number of visualizations and impressions. Viewing times of arguments presented in the discussion of this work. New reports virtual social media are usually very short and, in most cases, emerging in the advent of COVID-19 pandemic regarding crisis rarely exceed 3 min. Therefore, the average viewing duration management, mental health challenges, and implications are of the video was greater than the standard and may support also noteworthy (33). The original contribution of the present its educational use/purpose. Besides, the fact that the time of case study’s analysis relies on the viral, exponential interest visualization was equal to pre-pandemic and the mean duration in this children’s story in the specific scenario of COVID-19, of the visualizations was longer talks in favor of the video’s presenting a different ethnographic profile compared to before potential impact at the educational level. It also helps to discard the pandemic. The virality per se recognized a need for users that the virality resulted in a sudden but short exposure to the to find and visualize material related to death and mourning video content, which would reduce this potential. The 2-fold processes that, as confirmed through the temporal overlapping increase in the number of subscribers and the percentage of with the tragic events in Ecuador and the user’s feedback, mainly clicks, which are relevant to measure the impact and quality of was aimed to help manage the sudden and dramatic number the materials, suggests that the viral video was translated into of deaths and consequent difficulties of the mourning process. the channel’s adherence. Here it is important to note that, as The time when the video went viral was also determinant a comparison, these variables were not modified in the English because time is considered a critical factor to help disrupt version. It would have been interesting to compare the profiles grief ’s vulnerability and support other protective factors (17). with those of another contemporary children’s story addressing However, the most important finding was that the quantitative other physical changes or loss in the natural life cycle, such and qualitative ethnographic analysis allowed identifying a yet as the first tooth loss. Other interesting comparisons could be unknown severity of the pandemic situation in Ecuador that made with virtual material about fear of death when experiencing later could be confirmed by the timeline matches with the natural disasters. Recent reports on higher acute grief after death official records. The main port of Ecuador and the second most due to COVID-19 compared to natural loss allow the researchers populated city, Guayaquil, was between April and May 2020, to predict that pandemic-related increases in pathological grief which experienced community contagion at an increasing rate. are foreseen as a worldwide public health concern (35). Reports referred to people suddenly collapsing and the deceased’s Traffic sources were also informative about the way the video bodies lying in the streets covered with white sheets because went viral. During the pandemic, the access to the video was of the inability to be buried at once. In summer, Quito D.M., direct, in contrast to external sources or YouTube search as the country’s capital, surpassed Guayaquil with the number of main sources used during the previous years. Incoming traffic confirmed cases and became the new epicenter of the nation’s channeled through websites or direct recommendations via pandemic (34). The geographic area analysis pointing to Ecuador links means that other people participate in the election. These as the video’s virality’s primary geographical location was also indicators suggest a goal-directed behavior of users compatible confirmed in the English version, in contrast to precedent with educational purposes. The posterior analysis of sharing was Mexican and Spanish geographical locations during the historic. also illustrative and confirmed that WhatsApp’s direct links were This indication is important since, despite the current devastating the most used service to spread the word. scenarios worldwide, the virality of a video on death and grief is a Apart from the geographical area, age, and sex were two singular phenomenon in the context of the social and educational relevant socio-demographic factors to identify the audience’s taboo of death. Here, it is interesting to note that during the profile, which expanded from all cases being “35–44 year-old previous years, Mexico, with a cultural syncretist tradition of women” user profile to a broader normal distribution of ages, indigenous rituals commemorating the dead and dead people, also including the presence of men. Age and sex factors are Frontiers in Psychiatry | www.frontiersin.org 10 July 2021 | Volume 12 | Article 648569 Giménez-Llort Ethnography of Death-Grief in YouTube critical to determine the users’ profile and elucidate the potential resistance or resilience (19, 35, 44, 45). Thematic content analysis needs of users covered by the material. Thus, during the historic, of Twitter data from bereaved family members and friends (46) the adult female profile would respond to mothers confronting or national newspapers (28) has also reported the complexity and the grief process or women in parenting or professional roles difficulty of the current bereavement scenarios. toward pre-scholars, as confirmed in the content analysis of In the present work, the comparative content analysis the user’s feedback. Similarly, the broader coverage of ages and highlighted a change in the user’s profile concerning the sexes during the pandemic was informative of new use of the mourning process. This aspect is important as listening and pre-scholar material among teenagers as academic assignments understanding the user’s opinions must improve the cultural or men as fathers/docents. This information helped define and pedagogic quality of death education (47). In the precedent subsequent actions for the audience, as a target population, years since the publication of the children’s story, users referred in agreement with other efforts to elaborate and share action to the personal loss of a child, another family member, or a lines for death in preschool education (14). Thus, a YouTube student wrote narrative comments to explain the vital crisis they video call in the channel offered a guide for education on were confronting and expressed their depth sorrow. In addition, death and mourning for adults (parents and docents) and some comments were provided by entities specialized in grief organized a webinar on this topic. The resulting survey’s management, providing support to bereaved families. In this ethnographic analysis allowed defining potential professional latter case, users’ written comments giving spontaneous feedback users’ sociodemographic and socioecologic profiles (20). These to the video could be understood as a kind of virtual grief group data were valuable to address their needs on this topic in an where bereaved people amenably expressed their loss personally immediate and personalized manner. Still, in future lines of and socially. analysis and study, within the most rigorous field of education The content analysis of the comments written during through the use of audiovisual elements, it would be interesting the pandemic indicated societal mourning and included to qualify the video using DISCERNMENT score, a content disenfranchised grief. The broader range of age of users, reliability index, or PEMAT, another evaluation instruments of including the youth, would also explain the use of emoji educational materials for patients for audiovisual materials (8). and emoticons to express emotions among those not in grief. The level of comprehensibility and the capacity for action the However, the most relevant difference was that, in agreement video may allow could be assessed using these scales. with the current situation, most of the comments reflected The temporal maps showed that the video became viral critical thinking and provided a space for users to summarize immediately after the most severe days of the pandemic outbreak the meaning of the children’s story. They were also used in Ecuador. Among the engagement indicators on the day the to provide their own opinion on the scale of values and video went viral, it is noteworthy that non-subscription as the other important issues related to the cycle of life, death, and majoritarian status, the direct traffic source indicating direct mourning. In this sense, this change of expressivity patterns connection, and the use of a computer as a device instead of suggests that the material covered the personal needs of mobile phones, despite WhatsApp was identified as the service bereaved mothers/professionals during the historic, whereas the used for sharing using the Share on YouTube button. The educational purpose and use of the video were more evident in overrepresentation of females in the two studied periods is the new context of COVID-19. As mentioned in some comments, common and agrees with bereavement research using voluntary- the video was promoted from educative scenarios as an academic response sampling and is considered that it may reflect a more assignment for teenagers. Similar to grief support being part vital need for women to share their feelings (19). In this respect, of health education (48), the educative areas also showed a therefore, in the present work, the emergence of masculine strong need to train their fellows. Besides, the commentary participation in the users’ profiles and the users’ feedback forum worked as a scenario to establish symbolic family bonds is noteworthy. among unknown people worldwide, similarly to what has been The user’s feedback to the video can be considered an recently described in the organizational ethnography of charities important exercise to deal with the “word taboo” (verbal in crisis times (49). In addition, recent grief research using omissions related to a taboo topic) (1–3). Despite the low voluntary recruitment before and during the pandemic showed translation of the video virality into written comments, the no significant differences in socio-demographic and loss-related exponential increase shown in the timeline was noticeable. This variables (19). However, in the present work, a singular change is important because the taboo of death also extends to “words in the ethnography profile before and during the outbreak was taboo” and strongly contributes to grief stigmatization and determined by viewers’ spontaneous and voluntary enrolment. disenfranchised grief symptoms. Also, although death rituals and Understanding the nature and pattern of misinformation mourning practices are highly dependent on the cultural context infodemic during large-scale disease outbreaks deserves special (5, 36), the COVID-19 pandemic has created a global scenario attention (50). When referring to social media as a source with commonalities for people in all nations [i.e., (19, 37–42)]. and resource of health information, the topic is controversial, The most important commonalities are the psychological burden under constant evaluation and debate. This is primarily due to associated with confinement (43), the inability to say goodbye the worrisome number of videos found to present medically or to perform rituals according to believes and culture, and misleading information and some patients’ abusive behavior the measures of physical distancing, all of them considered risk using these resources (8, 51). In recent medical online education factors for traumatic and disenfranchised grief in people with low reports, social media as a medical information source during Frontiers in Psychiatry | www.frontiersin.org 11 July 2021 | Volume 12 | Article 648569 Giménez-Llort Ethnography of Death-Grief in YouTube the COVID-19 pandemic is critically analyzed (6). Furthermore, coverage of all age ranges and the inclusion of male gender the infodemics of the COVID-19 pandemic are also found talk favoring this virtual resource’s potential and flexibility among healthcare students and professionals (52). Despite these allowed an immediate switch of users’ profiles responding aspects, the analysis of engagement on social media networks to their vital crisis needs. Thus, the ethnography pointed at and digital newspapers shows that good practices may find YouTube as a flexible education resource, immediately reaching a promising scenario for the new native digital generations diverse users and being highly sensitive to critical events. Good (46, 53, 54) and can be even foreseen as a palliative social practices on using YouTube as a source and resource of health media (55). The present report supports the emerging studies education can make it a promising tool for native-digital users in this pandemic, showing that goal-directed social networks’ and precedent generations. More importantly, it talks in favor engagement in health media and healthcare professionals plays of good practices in this popular social media as eligible as an important role (6, 8, 51, 56). “palliative social media,” helping to mitigate the death taboo The most important limitation to this work is intrinsic to the in the current Western societies in a world devastated by the virality nature of the material and that the ethnographic analysis COVID-19 pandemic. focused on a case study. Besides, the singularity video’s virality associated with a specific scenario could also be considered DATA AVAILABILITY STATEMENT a limitation. Other limitations include those related to the sources provided by the analytics of this social media, the The original contributions presented in the study are included spontaneous and voluntary-response sampling, and self-reports in the article/Supplementary Material, further inquiries can be in the user’s feedback. directed to the corresponding authors. In summary, this ethnographic analysis on a case study provided evidence that, under singular circumstances, a ETHICS STATEMENT YouTube video dealing with the idea of death, a taboo topic even in its most censored forms such as disenfranchised grief Ethical review and approval was not required for the presented in the children’s story, was able to go viral. The study on human participants in accordance with the quantitative and qualitative analyses identified a change in the local legislation and institutional requirements. Written users’ profiles, engagement, and feedback. The analysis pointed informed consent for participation was not required for this to Ecuador as the geographical niche of the viral virus before study in accordance with the national legislation and the the severity of the nation’s pandemic scenarios was known. institutional requirements. 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Caring for terms of the Creative Commons Attribution License (CC BY). The use, distribution end-of-life patients and their families, during life, and mourning, or reproduction in other forums is permitted, provided the original author(s) and in the COVID-19 era-the experience of a palliative care team in the copyright owner(s) are credited and that the original publication in this journal Portugal. Front Psychiatry. (2021) 12:624665. doi: 10.3389/fpsyt.2021. is cited, in accordance with accepted academic practice. No use, distribution or 624665 reproduction is permitted which does not comply with these terms. Frontiers in Psychiatry | www.frontiersin.org 13 July 2021 | Volume 12 | Article 648569