COVID-19 is rapidly changing: Examining public perceptions and behaviors in response to this evolving pandemic

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Abstract

Background

Since the emergence of SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) in late 2019, communities have been required to rapidly adopt community mitigation strategies rarely used before, or only in limited settings. This study aimed to examine the attitudes and beliefs of Australian adults towards the COVID-19 pandemic, and willingness and capacity to engage with these mitigation measures. In addition, we aimed to explore the psychosocial and demographic factors that are associated with adoption of recommended hygiene-related and avoidance-related behaviors.

Methods

A national cross-sectional online survey of 1420 Australian adults (18 years and older) was undertaken between the 18 and 24 March 2020. The statistical analysis of the data included univariate and multivariate logistic regression analysis.

Findings

The survey of 1420 respondents found 50% (710) of respondents felt COVID-19 would ‘somewhat’ affect their health if infected and 19% perceived their level of risk as high or very high. 84·9% had performed ≥1 of the three recommended hygiene-related behaviors and 93·4% performed ≥1 of six avoidance-related behaviors over the last one month. Adopting avoidance behaviors was associated with trust in government/authorities (aOR: 6.0, 95% CI 2.6–11·0), higher perceived rating of effectiveness of behaviors (aOR: 4·0, 95% CI: 1·8–8·7), higher levels of perceived ability to adopt social distancing strategies (aOR: 5.0, 95% CI: 1·5–9.3), higher trust in government (aOR: 6.0, 95% CI: 2.6–11.0) and higher level of concern if self-isolated (aOR: 1.8, 95% CI: 1.1–3.0).

Interpretation

In the last two months, members of the public have been inundated with messages about hygiene and social (physical) distancing. However, our results indicate that a continued focus on supporting community understanding of the rationale for these strategies, as well as instilling community confidence in their ability to adopt or sustain the recommendations is needed.

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Most cited references 21

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia

Arina Azlan, Mohammad Rezal Hamzah, Tham Sern … (2020)

In an effort to mitigate the outbreak of COVID-19, many countries have imposed drastic lockdown, movement control or shelter in place orders on their residents. The effectiveness of these mitigation measures is highly dependent on cooperation and compliance of all members of society. The knowledge, attitudes and practices people hold toward the disease play an integral role in determining a society’s readiness to accept behavioural change measures from health authorities. The aim of this study was to determine the knowledge levels, attitudes and practices toward COVID-19 among the Malaysian public. A cross-sectional online survey of 4,850 Malaysian residents was conducted between 27th March and 3rd April 2020. The survey instrument consisted of demographic characteristics, 13 items on knowledge, 3 items on attitudes and 3 items on practices, modified from a previously published questionnaire on COVID-19. Descriptive statistics, chi-square tests, t-tests and one-way analysis of variance (ANOVA) were conducted. The overall correct rate of the knowledge questionnaire was 80.5%. Most participants held positive attitudes toward the successful control of COVID-19 (83.1%), the ability of Malaysia to conquer the disease (95.9%) and the way the Malaysian government was handling the crisis (89.9%). Most participants were also taking precautions such as avoiding crowds (83.4%) and practising proper hand hygiene (87.8%) in the week before the movement control order started. However, the wearing of face masks was less common (51.2%). This survey is among the first to assess knowledge, attitudes and practice in response to the COVID-19 pandemic in Malaysia. The results highlight the importance of consistent messaging from health authorities and the government as well as the need for tailored health education programs to improve levels of knowledge, attitudes and practices.

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Data-based analysis, modelling and forecasting of the COVID-19 outbreak

Cleo Anastassopoulou, Lucia Russo, Athanasios Tsakris … (2020)

Since the first suspected case of coronavirus disease-2019 (COVID-19) on December 1st, 2019, in Wuhan, Hubei Province, China, a total of 40,235 confirmed cases and 909 deaths have been reported in China up to February 10, 2020, evoking fear locally and internationally. Here, based on the publicly available epidemiological data for Hubei, China from January 11 to February 10, 2020, we provide estimates of the main epidemiological parameters. In particular, we provide an estimation of the case fatality and case recovery ratios, along with their 90% confidence intervals as the outbreak evolves. On the basis of a Susceptible-Infectious-Recovered-Dead (SIDR) model, we provide estimations of the basic reproduction number (R 0), and the per day infection mortality and recovery rates. By calibrating the parameters of the SIRD model to the reported data, we also attempt to forecast the evolution of the outbreak at the epicenter three weeks ahead, i.e. until February 29. As the number of infected individuals, especially of those with asymptomatic or mild courses, is suspected to be much higher than the official numbers, which can be considered only as a subset of the actual numbers of infected and recovered cases in the total population, we have repeated the calculations under a second scenario that considers twenty times the number of confirmed infected cases and forty times the number of recovered, leaving the number of deaths unchanged. Based on the reported data, the expected value of R 0 as computed considering the period from the 11th of January until the 18th of January, using the official counts of confirmed cases was found to be ∼4.6, while the one computed under the second scenario was found to be ∼3.2. Thus, based on the SIRD simulations, the estimated average value of R 0 was found to be ∼2.6 based on confirmed cases and ∼2 based on the second scenario. Our forecasting flashes a note of caution for the presently unfolding outbreak in China. Based on the official counts for confirmed cases, the simulations suggest that the cumulative number of infected could reach 180,000 (with a lower bound of 45,000) by February 29. Regarding the number of deaths, simulations forecast that on the basis of the up to the 10th of February reported data, the death toll might exceed 2,700 (as a lower bound) by February 29. Our analysis further reveals a significant decline of the case fatality ratio from January 26 to which various factors may have contributed, such as the severe control measures taken in Hubei, China (e.g. quarantine and hospitalization of infected individuals), but mainly because of the fact that the actual cumulative numbers of infected and recovered cases in the population most likely are much higher than the reported ones. Thus, in a scenario where we have taken twenty times the confirmed number of infected and forty times the confirmed number of recovered cases, the case fatality ratio is around ∼0.15% in the total population. Importantly, based on this scenario, simulations suggest a slow down of the outbreak in Hubei at the end of February.

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Author and article information

Contributors

Holly Seale:

ORCID: http://orcid.org/0000-0002-1877-5395

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draft

Anita E. Heywood: Role: Formal analysisRole: MethodologyRole: Writing – original draft

Julie Leask: Role: MethodologyRole: Writing – original draft

Meru Sheel:

ORCID: http://orcid.org/0000-0001-5453-070X

Role: MethodologyRole: Writing – original draft

Susan Thomas: Role: MethodologyRole: ResourcesRole: Writing – original draft

David N. Durrheim: Role: MethodologyRole: Writing – original draft

Katarzyna Bolsewicz: Role: MethodologyRole: Writing – original draft

Rajneesh Kaur: Role: Formal analysisRole: MethodologyRole: Writing – original draft

Wen-Jun Tu: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 23 June 2020

Publication date Collection: 2020

Publication date PMC-release: 23 June 2020

Volume: 15

Issue: 6

Electronic Location Identifier: e0235112

Affiliations

[1 ] School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia

[2 ] Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

[3 ] National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children’s Hospitals Network, Westmead, NSW, Australia

[4 ] National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Health and Medicine, The Australian National University, Acton, ACT, Australia

[5 ] School of Medicine and Public Health, University of Newcastle, Wallsend, NSW, Australia

[6 ] Office of Medical Education, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia

Chinese Academy of Medical Sciences and Peking Union Medical College, CHINA

Author notes

Competing Interests: The authors have read the journal's policy and the authors of this paper have the following competing interests: HS has previously received funding from drug companies for investigator driven research and consulting fees to present at conferences/workshops and develop resources (bio-CSL/Sequiris, GSK and Sanofi Pasteur). She has also participated in advisory board meeting for Sanofi Pasteur. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.

* E-mail: h.seale@ 123456unsw.edu.au

Author information

Holly Seale http://orcid.org/0000-0002-1877-5395

Meru Sheel http://orcid.org/0000-0001-5453-070X

Article

Publisher ID: PONE-D-20-09891

DOI: 10.1371/journal.pone.0235112

PMC ID: 7310732

PubMed ID: 32574184

SO-VID: 2699db0e-71b2-42c5-96c8-42da8b7075e3

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 6 April 2020

Date accepted : 2 June 2020

Page count

Figures: 1, Tables: 3, Pages: 13

Funding

No funding was received for this specific study. MS is supported by a fellowship from the Westpac Scholars Trust.

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Data Availability The data is available at https://figshare.com/articles/COVID-19_AustSurvey_xlsx/12298844.

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COVID-19 is rapidly changing: Examining public perceptions and behaviors in response to this evolving pandemic

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Abstract

Background

Methods

Findings

Interpretation

Related collections

PLOS: COVID-19 pandemic

Most cited references 21

Clinical Characteristics of Coronavirus Disease 2019 in China

Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia

Data-based analysis, modelling and forecasting of the COVID-19 outbreak

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Cited by 122

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