key: cord-0698522-eagirsni authors: Thang, T. V.; Nguyen, N. P. T.; Hoang, T. D.; Tran, V. T.; Vu, C. T.; Nelson Siewe, J.; Colebunders, R.; Dunne, M. title: Preventive behavior of Vietnamese people in response to the COVID-19 pandemic date: 2020-05-20 journal: nan DOI: 10.1101/2020.05.14.20102418 sha: ebb4cc6bd76954734e09e8e69bb08de0b8efc5ed doc_id: 698522 cord_uid: eagirsni We sought to evaluate the adherence of Vietnamese adults to COVID-19 preventive measures, and gain insight into the effects of the epidemic on the daily lives of Vietnamese people. An online questionnaire survey was organized from March 31 to April 6, 2020. The questionnaire assessed preventive behavior using multiple answer responses to indicate the extent of adherence. In total, 2175 respondents completed the questionnaire (age range: 18-69 years). The mean adherence scores for personal and community preventive measures were 7.23 {+/-} 1.63 (range 1-9) and 9.57 {+/-} 1.12 (range 1-11), respectively. Perceived adaptation of the community to lockdown ({beta}=2.64, 95% CI 1.25 -4.03), fears/worries concerning one's health ({beta}=2.87, 95% CI 0.04-5.70), residing in large cities ({beta}=19.40, 95% CI 13.78-25.03), access to official COVID19 information sources ({beta}=16.45, 95% CI 6.82-26.08), and belonging to the healthcare sector ({beta}=22.53, 95% CI 16.00-29.07) were associated with a higher adherence score to anti -COVID instructions. The study indicates excellent preventive behavior of the Vietnamese population which explains the low number of COVID-19 infections and zero recorded mortality up to the first week of May 2020. Further monitoring is recommended to assess the sustainability of COVID-19 prevention via behavior change in the medium and long-term. This led to an increase in domestic transmission of COVID-19, thus ushering in the second stage 59 of the epidemic. Fortunately, the government and health agencies had pandemic preparedness and 60 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. non-essential business activities and services, only allow essential services such as food 69 distribution, non-elective medical procedures, pharmacies store and the fuel supply. In addition, 70 gatherings of more than 2 people were prohibited (5) . The primary purpose of this study was to assess how well the people have adhered to these 72 instructions because they are crucial in preventing the spread of the virus. We also sought to 73 investigate the effects of the epidemic on the daily lives of Vietnamese people. Study design 76 We conducted a descriptive cross-sectional survey during which we received voluntary 77 responses continuously for seven consecutive days (from March 31 st to April 6 th , 2020). Data were collected through an online survey initiated by the ICPcovid consortium 80 (https://www.icpcovid.com/). A secure website was used to design and host an online 81 questionnaire, which was adapted to local Vietnamese context. The research team translated the 82 English questionnaire into Vietnamese, conducted a pilot test and improved the questionnaire 83 before official use. It took about 10 minutes to complete the questionnaire. The web link to the 84 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.14.20102418 doi: medRxiv preprint online questionnaire was disseminated via various social media platforms, and consenting 85 volunteers submitted their information anonymously. The data became available immediately 86 upon submission. The online questionnaire was kept open for one week (recruitment period) after 87 which it was closed and inaccessible. Sample size and sampling 89 Sampling was done using the snow-ball approach: as more persons completed the online 90 questionnaire, they were encouraged to share the survey web link to their contacts. Only data from 91 respondents who self-identified as being at least 18 years old, who were Vietnamese citizens, Given that our study sought to evaluate the level of adherence to the preventive measures 99 recommended by the government, our study outcomes included the proportions of participants 100 who reported following the lockdown instructions against COVID-19 Yes or No answers were 101 given to show whether the person had followed each guideline during the previous week. Overall 102 adherence was assessed by summing the answers with higher scores reflected higher adherence. 103 We also asked participants to self-report their difficulty in staying home as required during the 104 lockdown, using a 5-point Likert scale (1=not difficult at all to 5 =extremely difficult). Adherence to personal preventive measures was assessed by using 9 questions, covering 106 the following aspects: following the 1.5-2m meters social distance rule; wearing a face mask when 107 outside; avoiding touching the face; covering of mouth and nose when coughing/sneezing; hand 108 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.14.20102418 doi: medRxiv preprint 6 hygiene via regular hand washing and/or disinfection with sanitizer; frequency of body 109 temperature check; disinfecting mobile phone frequently. Adherence to community preventive measures was assessed with 11 questions with a 111 focus on the following strategies: avoiding meetings/gatherings; avoiding being in a vehicle/bus 112 with more than 10 persons; avoiding going to crowded entertainment venues/ public gym/ beauty 113 salon; avoiding funeral attendance; avoiding going to a fresh food market; usage of individual 114 spoons and plates when eating together with family/non-family members; avoiding travel to 115 another province/country during the lockdown period. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.14.20102418 doi: medRxiv preprint Multiple linear regression model was used to analyze which independent variables associated with 133 squared-transformed adherence scores. 95% confidence intervals and a p-value of less than 0.05 134 were used for significance testing. women. The characteristics of our study participants are summarized in Table 1 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. 99.5%, "regular hand washing with soap and water during the day" and "covering of mouth and 164 nose with a tissue paper when coughing or sneezing" ranked in the next position, with 97.4% and 165 94.9%, respectively. The least compliance was found for "measuring body temperature at least 166 twice a week" with 45.1% (Table 3 ). Using a 9-item score, the mean level of personal adherence 167 to preventive measures was 7.23 ± 1.63; range: 1 to 9. 168 Table 3 . Adherence to personal preventive measures for COVID-19 169 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. Avoided meeting or gathering with more than 10 persons in last seven days 1791 82.3 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. professional role in the health sector (worker or student) were associated with higher adherence 191 scores. Conversely, people with higher perceived difficulty in obeying lockdown order to stay at 192 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. proper social distancing. Probably as a consequence of this early intervention and high uptake of 203 protective behaviors, up to the first week of May 2020 the spread has been minimised with only 204 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.14.20102418 doi: medRxiv preprint 13 63 new cases since the implementation of strategies for the whole population, and no new cases 205 detected in the community since April 16 th , 2020 (6) . 206 Most companies/organizations have applied unprecedented working methods in 207 accordance with national efforts to promote working from home. This study found that 48.2% of 208 workers were obliged to work from home during the COVID-19 confinement. Although negative 209 effects of social distancing on people's jobs and lives might emerge if sustained for long periods, 210 the participants in this study indicated relatively few difficulties in the short term, such as meeting 211 daily needs for food. Respondents' adherence to social distancing measures 213 The survey revealed that many people were moderately to severely worried or afraid about 214 the health risks for family members (42.3%) and this was more than the level of concern about 215 their own health (30.0%). This may reflect the mean age of participants; as most were young adults, 216 they may be concerned about risks to older family members, which is particularly relevant in 217 Vietnam where many people live in multi-generational extended family households. It is common and easy to apply measures such as wearing a mask, washing hands frequently 219 with soap or disinfectant solutions. Although the efficacy of non-medical masks in preventing 220 COVID-19 spread is currently subject to debate, mask use among infected persons can limit the 221 spread of the virus to the outside environment (7) (8) (9) . The rate of wearing masks when going out in 222 this study was 99.5%, similar to an estimate of 98% in a Chinese study but higher than 70.1% 223 observed in Japan (9, 10) Two reasons for such high mask use are the fact that the Vietnamese government made 225 mask use mandatory from April 1 st , and that in many parts of the country, a majority of the people 226 have a habit of wearing masks to cope with air pollution (5, 11) . Although negative social 227 interactions regarding face mask usage have been reported in some parts of the World (12), in 228 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.14.20102418 doi: medRxiv preprint Vietnam and some East Asian countries such as China, Japan, and Korea, wearing face masks is 229 ubiquitous (13). It has been practiced for health and cultural reasons (7, 13) , so the transition to 230 more widespread mask wearing in response to COVID-19 appears not to have caused a conflict 231 that can sometimes arise if people are forced to change cultural norms. The implementation of community prevention measures was applied very early in response 233 to a localized outbreak in a northern province, and this was re-enforced from April 1 st with official 234 implementation of nationwide social distancing. The shutdown nationally has been unprecedented, 235 with all except essential businesses closed (5) . People were advised to stay at home as a patriotic healthcare professionals or were medical students, so they may tend to be more adherent to health 247 protection efforts. Age and gender were not significantly associated with adherence score in this 248 study (Table 5) . The high adherence to state recommendations has proven extremely important in the fight 250 against COVID-19 infection. Positive attitudes and compliant behavior indicate that most people 251 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.14.20102418 doi: medRxiv preprint measures were stopped and life is gradually returning to normal in Vietnam, albeit with a stronger 275 than usual emphasis on personal protection during social interactions. Careful monitoring for 276 potential new imported COVID infections and community transmission will be needed to prevent 277 a resurgence of the epidemic. Acknowledgements 279 We are grateful to the respondents for their participation. The authors would also like to (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.14.20102418 doi: medRxiv preprint Clinical features of patients infected 298 with 2019 novel coronavirus in Wuhan Going global -Travel and the 2019 novel coronavirus. Travel Medicine and Infectious Disease WHO. WHO Director-General's remarks at the media briefing on 2019-nCoV on 11 303 Covid-19 updates as of April 10th On Implementation of Urgent Measures for Prevention and Control of Covid-19 Timeline of Covid-19 in Vietnam Face masks for the public 315 during the covid-19 crisis Knowledge, attitudes, 321 and practices towards COVID-19 among Chinese residents during the rapid rise COVID-19 outbreak: a quick online cross-sectional survey Japanese citizens; behavioral 325 changes and preparedness against COVID-19: How effective is Japan's approach of self-restraint? Risk, ritual and health responsibilisation: Japan's 'safety blanket' of 328 surgical face mask-wearing Understanding 330 the Impact of Face Mask Usage Through Epidemic Simulation of Large Social Networks. Theories 331 and Simulations of Complex Social Systems Rational use of 333 face masks in the COVID-19 pandemic. The Lancet Respiratory Medicine Vietnamese Ministry of Health. Initially identify the main source of infection in Bach 335 Mai Hospital 2020 Vietnamese Ministry of Health. The Prime Minister chaired a Government meeting on 339 All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.14.20102418 doi: medRxiv preprint