Abstract
BackgroundSo far, there have been no published population studies on the relationship between a COVID-19 infection and public risk perception, information source, knowledge, attitude, and behaviors during the COVID-19 outbreak in China.ObjectiveThis study aims to understand the relationships between COVID-19 infection; four personal nonpharmaceutical interventions (NPIs; handwashing, proper coughing habits, social distancing, and mask wearing); and public risk perception, knowledge, attitude, and other social demographic variables.MethodsAn online survey of 8158 Chinese adults between February 22 and March 5, 2020, was conducted. Bivariate associations between categorical variables were examined using Fisher exact test. We also explored the determinants of four NPIs as well as their association with COVID-19 infection using logistic regression.ResultsOf 8158 adults included, 57 (0.73%) were infected with COVID-19. The overwhelming majority of respondents showed a positive attitude (n=8094, 99.2%), positive risk perception (n=8146, 99.9%), and high knowledge levels that were among the strongest predictors of the four adopted NPIs (handwashing: n=7895, 96.8%; proper coughing: 5997/6444, 93.1%; social distancing: n=7104/8158, 87.1%; and mask wearing: 5011/5120, 97.9%). There was an increased risk of COVID-19 infection for those who did not wash their hands (2.28% vs 0.65%; risk ratio [RR] 3.53, 95% CI 1.53-8.15; P=.009), did not practice proper coughing (1.79% vs 0.73%; RR 2.44, 95% CI 1.15-5.15; P=.03), did not practice social distancing (1.52% vs 0.58%; RR 2.63, 95% CI 1.48-4.67; P=.002), and did not wear a mask (7.41% vs 0.6%; RR 12.38, 95% CI 5.81-26.36; P<.001). For those who did practice all other three NPIs, wearing a mask was associated with a significantly reduced risk of infection compared to those who did not wear a mask (0.6% vs 16.7%; P=.04). Similarly, for those who did not practice all or part of the other three NPIs, wearing a mask was also associated with a significantly reduced risk of infection. In a penalized logistic regression model including all four NPIs, wearing a mask was the only significant predictor of COVID-19 infection among the four NPIs (odds ratio 7.20, 95% CI 2.24-23.11; P<.001).ConclusionsWe found high levels of risk perception, positive attitude, desirable knowledge, as well as a high level of adopting the four NPIs. The relevant knowledge, risk perception, and attitude were strong predictors of adapting the four NPIs. Mask wearing, among the four personal NPIs, was the most effective protective measure against COVID-19 infection, with added preventive effect among those who practiced all or part of the other three NPIs.
Highlights
The unprecedented COVID-19 global pandemic [1] has changed the way our society operates
We explored the risk between a COVID-19 infection and the four nonpharmaceutical interventions (NPIs) using a similar approach but excluded knowledge, attitude, and risk perception of the four NPIs based on a penalized maximum likelihood function logistic regression [8,9], which provides consistent estimates in situations of sparse event and total separation
Over 54% (n=4439) were from the area outside Hubei Province, which had fewer than 100 cases; 42% (n=3400) from the areas outside Hubei Province, which had more than 100 infected cases; and 4% (n=319) from Hubei Province, the epicenter of the Chinese COVID-19 epidemic (Table 1)
Summary
The unprecedented COVID-19 global pandemic [1] has changed the way our society operates. Since the lockdown of Wuhan City on January 23, 2019, China was the first country to introduce NPIs with strict measures such as the lockdown of cities and counties; compulsory mask wearing; isolation of suspicious cases; screening and contact tracing; quarantining people from high risk areas for 14 days; as well as promoting handwashing, proper coughing habits, social distancing, and self-isolation. There was no published evidence on relationships between a COVID-19 infection, the Chinese public risk perception, information source, knowledge, attitude, and personal NPIs during the middle to the end of the epidemic. There have been no published population studies on the relationship between a COVID-19 infection and public risk perception, information source, knowledge, attitude, and behaviors during the COVID-19 outbreak in China
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