key: cord-140847-d6w8fu3b authors: Venigalla, Akhila Sri Manasa; Vagavolu, Dheeraj; Chimalakonda, Sridhar title: SurviveCovid-19 -- A Game for Improving Awareness of Social Distancing and Health Measures for Covid-19 Pandemic date: 2020-04-21 journal: nan DOI: nan sha: doc_id: 140847 cord_uid: d6w8fu3b Pandemics have threatened human race many a times. One of the most important tasks during a pandemic is to bring awareness among people. Bringing awareness contributes a lot in controlling any pandemic. Covid-19 has been causing severe loss to the human race. Considering the mode of spread and the level of severity of this disease, it is extremely important to make people aware of various safety precautions such as using sanitizers and masks and maintaining social distancing, that are to be followed to prevent the disease and break the chain of spread. This mode of educating individuals about the disease is being widely carried out as announcements through online or physical awareness campaigns, advertisements in the media and so on. The younger generations in the present day spend considerably more time on mobile phones and games. However, there are very few mobile applications or games, aimed to bring awareness about a pandemic, which is much lesser in case of Covid-19. Also, considering the lockdown scenario across the world, games also act as a good pass time indoors. Hence, we propose a 2D survival based game, SurviveCovid-19, aimed to educate people about safety precautions to be taken for Covid-19 outside their homes, by incorporating social distancing and usage of masks and sanitizers in the game. SurviveCovid-19 has been designed as an Android based mobile game and has been evaluated through a remote qualitative user survey, with 20 volunteers. The results of the survey are promising with all the questions of survey having mean value greater than 3.6. Several diseases have proved to be a risk to people across the globe during many instances. Some of these diseases have qualified to be termed as epidemics and some to be termed as pandemics based on the speed and area of their spread. According to the guidelines specified by WHO 1 ((World Health Organization)), the pandemic phase of a disease, most commonly, influenza, begins when the same virus causes community level outbreaks in more than two countries, across different WHO regions. The world has witnessed several pandemics such as Cholera [Colwell (1996) ; Mutreja et al. (2011) ], H1N1 [Xu et al. (2010) ], Smallpox [Cunha (2004) ; Li et al. (2007) ], Ebola [Richard-son et al. (2016) ] and so on [Hays (2005) ]. One of the important lessons learned from these pandemics is the role of awareness campaigns. It has been observed that public awareness campaigns help in reducing the severity of the outcomes of disease, which include hospitalization and death [Mytton, Rutter, and Donaldson (2012) ]. Several governments across the world and researchers have highlighted the need for improvement of public health awareness and education campaigns, aimed towards improving health literacy among the people [Eastwood, Durrheim, Butler, and Jones (2010) ]. Health professionals across various nations have been advised to practice several control activities including basic sanitation facilities, identify and isolate suspected cases and educate general public through awareness campaigns [Sepulveda, Valdespino, and Garcia-Garcia (2006) ]. Along with the medical care required, it is important that all individuals across the world are aware of the safety precautions to be followed during the pandemic. A severe outbreak of pneumonia of a cause, initially unknown has occurred in Wuhan,China, in December,2019. This was later identified to be caused due to a novel coronavirus, severe acute respiratory syndrome coronavirus2 . This disease caused by SARS-Cov-2 has been named as Covid-19 by WHO in February,2020. Covid-19 has spread rapidly, affecting more than 1.9 million people, spread across several countries of the world, as reported by WHO, as of 16 April,2020 [Organization et al. (2020b) ]. It has spread on a large scale in a very short span of time, ranging from 0.16 million cases [Organization et al. (2020a) ] as of 16 March,2020 to 1.9 million cases [Organization et al. (2020b) ] as of 16 April,2020, resulting in a rise of 1087% cases in a span of one month (from 16 March,2020 to 16 April,2020). Symptoms of Covid-19 include fever, cough, dyspnoea, lymphocytopenia and fatigue [Zhou et al. (2020) ]. It is observed to weaken the immune system of victims and consequently increase the complications in patients suffering with diabetes, cardiovascular problems and chronic kidney diseases, leading to heart failures, kidney failures, respiratory failures and even death in some cases [Zhou et al. (2020) ] [Zheng, Ma, Zhang, and Xie (2020) ]. The number of deaths caused due to Covid-19 have increased from 6.6K to 130.8K during 16 March 2020 to 16 April 2020 2 . Several measures to control the Covid-19 pandemic are being taken by WHO and various nations across the world Sohrabi et al. (2020) . These measures include expediting diagnosis and contact tracing process, increasing health care facilities and scaling up health care equipment, encouraging the process of discovering drugs to treat Covid-19 and bringing awareness among the public 3 . Several governments in the world have issued lockdown instructions, to prevent spread of disease through public gatherings. Public Awareness programs about Covid-19 are being carried out in various ways across the globe. The public are being educated and repeatedly being reminded of safety measures to be followed, through telephonic and television advertisements, physical and online campaigns, flyer displays at public places and on many online websites and so on. Several websites dedicated to Covid-19 are being developed, to provide information about precautions to be taken and the status of Covid-19. In many countries across the world, lockdown instructions are eased for a specific time slot, to enable buying of daily essentials, when people are allowed to come outdoors. It is extremely necessary to follow safety precautions when people are in public places. The younger generation of the present day spend a lot of time with their mobile phones, on various mobile apps and mobile games [Chan, Kow, and Cheng (2017) ]. Also, it has been observed that games have the ability to affect players behaviour and attitude [Orji, Vassileva, and Mandryk (2013) ]. In spite of the large scale public health awareness programs being carried out, we are not aware of any mobile games that are aimed to educate people about the safety measures to be taken against Covid-19. Thus, we propose SurviveCovid-19, a survival theme based 2D mobile game, with an aim to educate players about various safety measures to be followed against Covid-19 when in outdoors. Bringing out awareness among public with respect to various diseases plays a primary role in keeping people healthy. With the increase in use of mobile and web applications, several health care mobile apps and websites are being developed. Mobile apps to support prevention of various diseases such as obesity, cardiovascular diseases, chronic diseases such as skin cancer and so on have been developed [Brinker et al. (2018) ] [Sindi et al. (2015) ] [Kong and Tan (2012) ] [Matsumura and Yamakoshi (2013) ]. Brinker et al., have presented a facial-aging mobile app, SunFace, aimed to prevent skin cancer [Brinker et al. (2018) ]. SunFace encourages users to click a selfie and view changes induced due to 5 and 25 years of skin aging with and without sun protection. It also provides information about most commonly caused skin cancers due to UV rays and displays odds ratio of skin cancer based on various behaviors [Brinker et al. (2018) ]. A study conducted to evaluate SunFace app with around 350 Brazilian secondary school students has shown increased considerations for UV protective behaviours [Brinker et al. (2018) ] [Brinker et al. (2017) ]. CAIDE Dementia Risk Score App has been developed by Sindi et al. to predict risk of dementia based on the profile of individuals [Sindi et al. (2015) ]. It also provides guidance to individuals to reduce the risk of dementia. The "medical history, health status and current health behaviour" of individuals is taken as input, through a questionnaire and risk score is calculated based on this information. It also provides a platform for medical practitioners to monitor risk of dementia of an individual and provide necessary guidance [Sindi et al. (2015) ]. Kong et al. have developed DietCam, a mobile phone based application that aims to reduce obesity [Kong and Tan (2012) ]. It assesses the food intake of users based on three images, clicked from three different perspectives, or a short video of the food being consumed. The type of food in the image or video is classified by comparing result of feature matching with different types of food stored in food and nutrition database. The volume of the food is identified through geometry calibration and 3D reconstruction. An estimation of number of calories being consumed based on the type of food and volume generated, is presented to the users, which helps them in assessing the calorie intake, and consequently manage their diet [Kong and Tan (2012) ]. Studies also reveal that more than 70% of users, using weight loss reduction mobile applications show successful weight reduction [Chin et al. (2016) ]. These studies thus imply the positive outcomes of using mobile applications in health care. iPhysioMeter has been proposed as a smartphone program (on iPhone 4 , 4S and 5) to measure heart rate(HR) and normalized pulse volume(NPV) [Matsumura and Yamakoshi (2013) ]. The HR and NPV values are calculated by the program when users tap on the iPhone home screen and cover the flash LED and CMOS camera with their left index finger. The results of measurements are sent to the users' email [Matsumura and Yamakoshi (2013) ]. Several mobile games have also been developed to promote self health monitoring for various diseases [Birn, Holzmann, and Stech (2014) ] [Park, Koo, Cho, and Bae (2015) ] [Baghaei, Nandigam, Casey, Direito, and Maddison (2016) ] [Bin Hussein et al. (2019) ]. MobileQuiz has been developed as a mobile game, to promote both physical and cognitive skill among older adults and is to be played outdoors [Birn et al. (2014) ]. It assigns tasks to users in view of the physical distance and direction to be covered by the user, which when accomplished, users are rewarded with points and are provided with a questionnaire related to the location or surrounding regions [Birn et al. (2014) ]. Park et al. have proposed SnackBeaker, a mobile game, aimed to promote healthy food choices among the players [Park et al. (2015) ]. It presents a quiz that can be answered based on elimination of one among two choices, in terms of nutritional values provided by the two alternatives, thus educating users about the nutritional value of different snacks and consequently helping them choose snacks with high nutritional values [Park et al. (2015) ]. A mario style based mobile game, Diabetic mario, was introduced to help in understanding ways to manage diabetes [Baghaei et al. (2016) ]. The player is assigned with the task of managing blood sugar level of Diabetic Mario by selectively choosing the food items provided in the game console and eventually save the princess [Baghaei et al. (2016) ]. Considering the importance of Automated External Defibrillators(AED) in cases of out-of-hospital cardiac arrests, a crowdsource based mobile game has been designed to make users vary of AED locations and also to motivate them to report condition of AEDs [Bin Hussein et al. (2019)]. Considering the importance of public awareness towards a pandemic and the importance of research in view of planning and response to curb the pandemic, few online websites and telephonic lines have also been developed. ISIS has been developed as a web framework to help in planning and response against pandemics by analyzing multiple simulations of possible interventions, including "administering a vaccine to a part of population, using antivirals as treatment, closing schools and work places and instituting social distancing" [Beckman et al. (2014) ]. WHO also lists out various safety measures on the WHO website to enable public awareness during pandemics. Few web based applications and websites are also being developed to help in tracking Covid-19 reported cases and in bringing public awareness towards Covid-19. Dong et al have developed web-based dashboard that displays visualizations of Covid-19 reported cases from time to time [Dong, Du, and Gardner (2020) ]. It "reports cases of the Covid-19 pandemic at level of cities in USA, Australia and Canada, province level in China and country level in other cases" [Dong et al. (2020) ]. Few governments across the world have also promoted use of various mobile based applications 4567 that are aimed to bring awareness among people about risks, best practices and relevant advisories regarding Covid-19. Considering the positive impact of mobile games and apps [Orji et al. (2013) ] in the area of health care and the proven usefulness in bringing awareness about various diseases through mobile games and apps, designing mobile games to help in public awareness in the context of Covid-19 pandemic could be useful. However, inspite of the availability of mobile applications towards containment of Covid-19, we are not aware of any mobile games that promote public awareness with respect to Covid-19. Hence, we present SurviveCovid-19, a survival based 2D game, aimed to educate users about various safety measures to be followed against Covid-19 pandemic. Covid-19 is severely affecting various nations across the world, at a rapid rate in the present day. It has been observed to spread through physical contact and respiratory droplets. Hence, several countries have issued lockdown instructions so as to prevent public gatherings and consequently, flatten the curve. Maintaining physical distance, using masks to cover nose and mouth and frequently using sanitizers to keep palms clean and visiting a doctor when symptoms of cough and fever are observed, help in reducing the risk of contracting the virus. It is important to educate the public to follow the measures mentioned above. SurviveCovid-19 is an educational game that helps people in understanding the importance of masks and sanitizers to keep themselves and people in their surroundings safe from Covid-19. This game is inspired by a simple pixel-based top-down style design where people navigate the city with safety and health measures. The game begins by showing a landing screen. As the game starts, the player sees a short video depicting a simple story-line of a person who needs to get essential items from the city during lock down for his family while following proper health measures and avoid spreading the virus. It is then followed by a screen showing the specific instructions to complete the game. The goal of the player is to collect the allotted number of groceries and medicines while navigating the city. While doing so, the player also has to make use of face masks and sanitizers to avoid getting infected or infecting other people. To make the game challenging and fun for the players, both of these utilities have been given a timer. The player has to make use of them strategically to win. The game finishes when the player collects all the required items and reaches home, as shown on the map. The game also keeps in check the number of people getting affected because of the user's action in terms of people being infected directly and indirectly. This prompts the player to tread the path with caution and by taking proper health measures throughout the game. We have developed SurviveCovid, as an educational game to learn the importance of following proper health measures against Covid-19 using the Unity 3D game engine. We followed a step by step approach to develop the game as shown in Figure 2 . We then used the Android SDK module provided by Unity to export the game for android based mobile devices. We have used 2d tiles from the standard assets pack provided by Unity to define most of the game objects. The rest have been created using Photoshop software. The tiles are first imported into Unity and then using the tile-map feature of Unity, we design the game. In this way, the map of the city in which the player has to navigate is created. A mask and a Sanitizer object are created and have been placed at strategic positions on the map. These utilities are meant to help the player to complete the level. All the events in the game are controlled using scripts written in CSharp programming language. A mechanism to simulate the spread of disease through touch has been implemented using CSharp scripts. This spread can be prevented by taking appropriate measures like using the mask and the sanitizer. Many obstacles, such as infected people and monsters which spread the virus on touch, are placed on the map. The people are positioned such that they mimic real crowds and queues of people. A single script keeps track of the groceries and medicine that have been collected by the player. A Quota is assigned to the player automatically to collect groceries and medicine. Only on completing the assigned quota, the player may cross the finish line. All the media, such as videos and photos in the game, are made using Windows Video Maker and photoshop softwares. Consider Moksha, an individual staying indoors due to lockdown instructions in her locality, interested to play games and to gain awareness against Covid-19. She considers playing SurviveCovid-19, to pass her time and also to be vary of safety measures to SurviveCovid-19 has been developed to educate public about safety measures to be taken to control Covid-19 pandemic, as an Android based mobile game. Though we could not find games developed to support public health awareness towards pandemics, several health care related games have been evaluated based on similar factors such as learning outcomes, usability, user experience and so on. Also, several educational games have been evaluated based on usability and player experience. Hence, we have evaluated SurviveCovid-19 to understand its usability, usefulness and player experience. We considered 20 volunteers in the age group of 17-25 years and conducted a remote qualitative user survey based on usability, usefulness and player experience factors. The volunteers were requested to download the SurviveCovid-19 application and install the same on their Android mobile phones. A 5-point Likert Scale based questionnaire as shown in Table 1 , has been sent to all the participants as a user survey. The participants were asked to play the game and provide their feedback by answering the questionnaire presented in the user survey. Table 1 indicates the results of user survey in terms of mean and standard deviation of each question in the questionnaire. It can be observed that the mean for all the questions is greater than 3.5, indicating the positive experience of users. Figure 9 , depicts the mean and standard deviation values for each of the three quality factors. Mean value of 3.7 for Usability indicates that most of the volunteers found SurviveCovid-19 easy and attractive. The mean value for Usefulness is greater than 4, indicating that most of the volunteers intended to follow the safety measures against Covid-19 while playing the game. Player Experience factor having mean value greater than 3.9 reveals that majority of the volunteers found SurviveCovid-19 to be interesting to play and were willing to recommend SurviveCovid-19 to their peers. Participants also suggested that : • Control sensitivity for navigation buttons could be improved. • Way to home and to hospitals could be indicated in the game. SurviveCovid-19 is based on survival theme, where the storyline deals with a person who needs to go outdoors to purchase daily essentials and medicine during Covid-19 situation. The game has been designed in a way to enforce the players follow safety measures to stay safe from Covid-19 when outdoors. Thus, the developed prototype version of SurviveCovid-19 aims to educate players about precautions to be taken towards Covid-19 and also serves as a pass time during the lockdown situations that are prevailed due to Covid-19. Though this game has been developed to address the younger generations of society, it can be played by a wide range audience, irrespective of any social or educational backgrounds. The only requirement of the game is that the players are expected to be equipped with using a mobile phone. The current version of SurviveCovid-19 being a basic prototype, has only one level. However, further levels can easily be added to the game and difficulty level could also be increased with every level being added. Also, the existing SurviveCovid-19 application can be played only on Android based mobile devices. The future versions of the game could be made compatible to mobile devices operating on other operating systems such as Apple and Windows. In this paper, we presented the prototype version of SurviveCovid-19, a survival based 2D mobile game 8 , aimed to bring awareness about safety measures to be followed against Covid-19. Public Awareness Campaingns are considered as one of the most important measures to be taken across the world in cases of a pandemic or a disease outbreak [Mytton et al. (2012) , Eastwood et al. (2010) ]. The current outbreak of Covid-19 pandemic requires all individuals across the world to be aware of precautions to be followed to prevent the spread of Covid-19. Large scale public health awareness campaigns are being carried out by almost all the governments and various organizations across the world, including WHO to control Covid-19. Considering the large amount of time spent by younger generations on mobile apps and games in the present day, and the effect of games on players' attitude [Chan et al. (2017) , Orji et al. (2013) ], it could be useful to introduce mobile games that contribute towards public health awareness. SurviveCovid-19 aims to educate people about the safety measures to be followed during Covid-19 and motivates them to follow the precautions in real time. We have evaluated SurviceCovid-19 based on usability, usefulness and player experience quality factors. The evaluation was done through a remote qualitative user survey with 20 volunteers, and obtained positive feedback with 80% of volunteers willing to recommend SurviveCovid-19 to their peers. The game currently supports Android mobile devices. It can further be extended to support mobile devices running on other operating systems. We plan to improve the game by increasing number of levels in the game and difficulty of the levels. Also, future versions of the game can include online and multiplayer features unlike the current offline and single player version of the game. We also plan to modify the game controls by improving the sensitivity of the control keys, as suggested by the participants in the survey. 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