key: cord-0743092-0qb5ik3o authors: Mersha, A.; Shibiru, S.; Girma, M.; Ayele, G.; Bante, A.; Kassa, M.; Abebe, S.; Shewangizaw, M. title: Health professionals practice and associated factors towards precautionary measures for COVID-19 pandemic in public health facilities of Gamo zone, southern Ethiopia: a cross-sectional study date: 2020-09-07 journal: nan DOI: 10.1101/2020.09.05.20188805 sha: 976928f15dc08540f7793d5f28dbe109880bb298 doc_id: 743092 cord_uid: 0qb5ik3o Abstract Introduction Coronavirus disease-2019 (COVID-19) is a highly contagious acute respiratory disease, which caused by a novel coronavirus. The disease disrupts health systems and resulting in social, political, and economic crises. Health professionals are in front of this pandemic and always work in a high-risk environment. Currently, there is no vaccine or drug for the disease. Therefore, strictly practicing precautionary measures are the only option to save the life. Some studies reported health professional's practice of precautionary measures for COVID-19. Nevertheless, a few have identified factors affecting. As such, this study aimed to fill those research gaps in the study setting. Methods In this cross-sectional study, 428 health professionals were involved from the public health facilities of the Gamo zone, southern Ethiopia. A simple random sampling method was employed, and the data collected by the interviewer-administered Open Data Kit survey tool and observational checklist. The data analyzed in Stata version 15 and a binary logistic regression model used to identify factors. In this study, a statistically significant association was declared at P<0.05. Results In this study, 35{middle dot}3% (95%CI: 30{middle dot}7%, 39{middle dot}8%) of health professionals' had a good practice on precautionary measures for the COVID-19 pandemic. Use hand sanitizer or wash hands continuously with soap and water (68{middle dot}9%), cover nose and mouth with a tissue during sneezing or coughing (67{middle dot}3%), and use facemask in crowds (56{middle dot}8%) were the most common practice reported by study participants. Marital status, being married (AOR=1{middle dot}84, 95%CI: 1{middle dot}06, 3.18), good knowledge on the COVID-19 pandemic (AOR=2{middle dot}02, 95%CI: 1{middle dot}02, 3{middle dot}18), and positive attitude towards precautionary measures for COVID-19 were factors showed signification association with the practice. Conclusions The magnitude of good practice of precautionary measures for the COVID-19 pandemic among health professionals was low. As such, different interventions to improve the knowledge and attitude of health professionals in the health care system are highly needed to boost the practice and to advance service delivery. Coronavirus disease-2019 (COVID-19) is a highly contagious acute respiratory disease, which caused by a novel coronavirus. The disease disrupts health systems and resulting in social, political, and economic crises. Health professionals are in front of this pandemic and always work in a high-risk environment. Currently, there is no vaccine or drug for the disease. Therefore, strictly practicing precautionary measures are the only option to save the life. Some studies reported health professional's practice of precautionary measures for COVID-19. Nevertheless, a few have identified factors affecting. As such, this study aimed to fill those research gaps in the study setting. In this cross-sectional study, 428 health professionals were involved from the public health facilities of the Gamo zone, southern Ethiopia. A simple random sampling method was employed, and the data collected by the interviewer-administered Open Data Kit survey tool and observational checklist. The data analyzed in Stata version 15 and a binary logistic regression model used to identify factors. In this study, a statistically significant association was declared at P< 0.05. In this study, 35 .3% (95%CI: 30.7%, 39.8%) of health professionals' had a good practice on precautionary measures for the COVID-19 pandemic. Use hand sanitizer or wash hands continuously with soap and water (68.9%), cover nose and mouth with a tissue during sneezing or coughing (67.3%), and use facemask in crowds (56.8%) were the most common practice reported by study participants. Marital status, being married (AOR=1.84, 95%CI: 1.06, 3.18) , good knowledge on the COVID-19 pandemic (AOR=2.02, 95%CI: 1.02, 3.18) , and positive attitude towards precautionary measures for COVID-19 were factors showed signification association with the practice. The magnitude of good practice of precautionary measures for the COVID-19 pandemic among health professionals was low. As such, different interventions to improve the knowledge and attitude of health professionals in the health care system are highly needed to boost the practice and to advance service delivery. Coronavirus disease-2019 (COVID- 19) is an emerging respiratory disease caused by a novel coronavirus or severe acute respiratory syndrome coronavirus-2(SARS-CoV-2). The case was first identified in Wuhan province, China, and spread to other parts of the world within a short period. The disease is highly infectious, and clinical symptoms include fever, dry cough, fatigue, myalgia, and dyspnea [1] [2] [3] [4] [5] . The three modes of transmissions are droplets (when an infected person coughs or sneezes), contact (subject touches a surface or object contaminated with the virus and subsequently touch their mouth, nose, or eyes), and aerosol (respiratory droplets) [6, 7] . However, a few studies indicated the digestive system as a potential transmission route for COVID-19 infection [8] . The nucleic acid of SARS-CoV-2 detects in the real-time fluorescence-polymerase chain reaction (RT-PCR) [7, 9, 10] . Currently, there are no drugs or vaccines approved to prevent or treat COVID-19. The best prevention is avoiding exposure to the virus [11] [12] [13] [14] [15] [16] [17] [18] [19] . Health care professionals (HCPs) are at the front line of the COVID-19 outbreak response. Preventing intra-hospital transmission of contagious disease is, therefore, a priority [20, 21] . Because of their direct contact with patients, health workers play critical roles in the prevention of the COVID-19 outbreak. A combination of standards, airborne and droplet precautions should practice for all COVID-19 cases. They must use personal protective equipment (PPE) such as a glove, gown or apron, and surgical mask [16, 22, 23] . World Health Organization (WHO) declared the 2019-nCoV outbreak as a public health emergency of international concern (PHEIC) and as a global pandemic [24] [25] [26] . Several thousand healthcare workers have already infected with COVID-19, and there is a report of deaths in China, Italy, Spain, Pakistan, the UK, and other countries [21, [27] [28] [29] [30] [31] . According to the Chinese Red Cross Foundation, the National Health Commission (NHC) of the People's Republic of China, and public media, a total of 23 of the health care professionals among these 3387 persons had died from COVID-19 after they became infected during the practice of medicine in Wuhan and elsewhere in China [28] . The contained outbreak could significantly influence the global economy in the short run. The scale of costs might be reduced by investment in public health systems in all economies but particularly in less developed economies where health care systems are less developed, and population density is high [32] . The public health systems in Africa are coming under severe strain as the unprecedented COVID-19 pandemic persists [33, 34] . Hospital associated transmission is suspected as the presumed mechanism of infection for affected health professionals (29%) and hospitalized patients (12.3%) [35] . A study conducted in Washington State reported that due to ineffective precautionary measures, 81 of the residents, 34 staff members, and 14 visitors infected and died with COVID-19 [36] . Therefore, universal source control, early identification, and isolation of patients with suspected disease, the use of appropriate personal protective equipment (PPE) when caring for patients with COVID-19, and environmental disinfection are obligatory in the health care settings [37] . The practice of precautionary measures for coronavirus (CoVs) among HCPs was 89.7% in a study conducted in China [38] , 87.9% in the Kingdom of Saudi Arabia [39] , and 70.12% Iran [40] . To control the COVID-19 pandemic, 96.10% of HCPs had washing hands with soap or cleaning with sanitizers, and 84.30% had avoided to touching of eyes, nose, or mouth in the study from Pakistan [41] , and 24.2% used facemask in the crowds in the study from Saudi Arabia [42] . Another study from the Kingdom of Saudi Arabia showed PPE used when seeing suspected cases CoV infection was mainly the mask (94.1%), gloves (78.8%), the gown (60%), goggles (31.8%), and the cap (22.4%) [43] . Different works of the literature indicated that age, gender, knowledge level, attitude, work experience and job category, working hours, educational attainment were factors associated with HCWs' practice of precautionary measures towards COVID-19 [38] [39] [40] . During this time, many studies are emerging by scholars regarding the COVID-19 pandemic. Nevertheless, health care professionals' practice of precautionary measures towards the COVID-19 takes the lion share and vital to save the life of professionals and others. Presently, a few studies assessed practice and factors affecting precautionary measures for the COVID-19 pandemic among health professionals. Besides, there are limited studies in country Ethiopia. Therefore, this study aimed to assess the health professional's practice and associated factors towards precautionary measures for the COVID-19 pandemic in public health facilities of the Gamo zone, southern Ethiopia. In this study, health professionals working in public health facilities of the Gamo zone, southern Ethiopia, were involved, from June 10-19, 2020. Gamo zone is one of the administrative zones in Ethiopia. It bordered with Wolayta, Dawro, and Gofa zones in the North, on the northeast by the Lake Abaya and the southeast by the Amaro special woreda, and Dirashe special woreda, and on the southwest by South Omo. The administrative center of the Gamo zone is Arba Minch town. Arba Minch town, located 505 km southwest from Addis Ababa, the capital city of Ethiopia, and 275 km southwest of Hawassa, the capital city of southern Ethiopia. Gamo zone has one administrative town and 13 woredas. It hosted five hospitals (one general and four primary hospitals), 56 health centers, and 299 health posts, which serve the community by providing preventive and curative services. There are 2570 (1096 male and 1474 female) health professionals who are working in those institutions [44] . The institution-based cross-section study design was employed to meet study objectives. The source population for this study was all health professionals who work in public health facilities of the Gamo zone, southern Ethiopia. The study population for this study was all health professionals who were working in selected health facilities of the Gamo zone, southern Ethiopia, during the study period. All health professionals who were staff and working at least for six months in selected health facilities recruited in this study, whereas those health professionals who were sick and on annual leave at the time of data collection were not involved in this study. Epi info 7 StatCalc software used to estimate the sample sizes. For the first specific objective, a single population proportion was used by considering the following assumption: P=0.897 from the study conducted in China [38] , 95% level of confidence, and 3% margin of error. Therefore, based on this assumption, the calculated sample size was 394. To determine the sample size for the second objective two-sample comparison proportion was used by considering the following assumptions: work experience of less than one year (P 1 ) =82.7%, and >5 years (P 2 ) =95.7% from the study in Pakistan [41] , 95% level of confidence, Power of 90%, and Ratio:1:1. Based on this assumption, the estimated sample size was 266. As such, the final sample size came up by adding a non-response rate of 10% to the larger sample size, which was 394 that estimated by the first objective. Therefore, the calculated sample size for this study was 434. Currently, there are five fully functional hospitals and fifty-six health centers in the Gamo zone. A simple random sampling method was employed to select three hospitals and fifteen health centers from them ( Figure 1 ). Then, the calculated sample size, proportionally allocated to those health facilities based on the number of health professionals who were working. Finally, a simple random sampling method after generating a table of random numbers used to select health professionals based on proportions allocated to each health facility (Table 1) . Interviewer-administered Open Data Kit (ODK) survey tool and observational checklist were employed to collect the data. The survey tool and observational checklist were adapted by reviewing different works of literature, WHO, and national guidelines related to COVID-19 precautionary measures [41, [45] [46] [47] . Eight data collectors and three supervisors were involved. Before starting data collection, both the data collectors and supervisors trained on data collection ways and overall procedure and ODK survey tool by experts for one day. The data collectors gave information about the study's aim before interviewing the study participants. Then those participants who were willing and signed in the voluntary consent interviewed. The dependent variable for this study was the health care professionals' practice of precautionary measures for COVID-19. Socio-demographic and professional-related characteristics (age, sex, education level, job category, working hours, and work experience, knowledge about COVID-19, and attitude towards precautionary measures for COVID-19 were the independent variables for this study. The measurements of the outcome variable and some of the explanatory variables, stated below (Table 2) . The total score of HCPs practice of precautionary measures for COVID-19 assessment items ranged from 0-6, and a score of ≥ 4 reported as good practice, and a score of <4 indicated as poor practice toward precautionary measures for COVID-19 [41] . The total score of HCPs knowledge regarding COVID-19 assessment items ranged from 0-14, and a score of ≤ 10 reported as Poor, and a score of ≥ 11 (more than 75%) indicated a Good level [41] . The response of each item of HCPs attitude towards precautionary measures for COVID-19 recorded on a 5-point Likert scale; strongly agree (1-point), agree (2-point), undecided (3-point), disagree (4-point), and strongly disagree (5-point). Then, the total score ranges from 7 to 35, with an overall lower than mean score indicated a positive attitude toward COVID-19 [41] . The tools that were validated by scholars were employed to collect the information, and it was pre-tested in setting with similar characteristics. Extensive training gave for both data collectors and supervisors to maintain consistency and to standardize the data collection techniques. The training focused on the objectives of the study, data collection tool, data collection methods, ways of checking the completeness of data, ways of maintaining the confidentiality of the data. The survey template uploaded to the ODK cloud server (ODK Aggregate platform of AMU), then the survey template was download to individual data collector's smartphone for data collection. After completing the data of each study participant, the data collectors sent the data to the ODK cloud server after confirmed by supervisors. After cessation of the data collection, the data were downloaded from ODK aggregate and then exported to Stata version 15 for analysis. The univariate analysis such as; proportions, frequency, and summary statistics computed. The bivariate analysis used to see the association between each independent variable and the outcome variable by using binary logistic regression. The assumptions for binary logistic regression checked, and the goodness of fit-tested by the log-likelihood ratio (LR). All 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 September 7, 2020. . variables with P<0.25 in the bivariate analysis included in the final model to control all possible confounders. A Multi-collinearity test ran to see the correlation between independent variables by using collinearity statistics, and Variance inflation factor (VIF) >10 and tolerance (T) <0.1 considered as suggestive of the existence of multi-collinearity. A crude and adjusted odds ratio (OR) with 95%CI estimated, to identify factors affecting HCPs practice of precautionary measures for COVID-19. In this study, P-value, <0.05 was considered to declare a result as statistically significant. Ethical clearance obtained from Arba Minch University, College of Medicine and Health Sciences, Institutional Research Ethics Review Board (IRB) with reference number: IRB/408/12. Written and signed voluntary consent obtained from all study participants before recruiting the health professionals into the study. The concealment of the participants kept via the use of codes. The respondents also informed that the information obtained from them kept with the utmost confidentiality. In this study, 428 health professionals were involved, which gave a response rate of 98.6%. The mean and standard deviation of the age of study participants was 33.2±8.2 years old. Of the participants, 240 (56.1%) were male, and 215 (50.2%) had an educational level of Diploma. One hundred thirty-one (30.6%) of participants have health professional qualifications of nurses, and 270 (63.1%) had work experience of six or more years (Table 3) . (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 September 7, 2020. Figure 3) . Overall, 84.1% (95%CI: 80.6%, 87.6%) of health professionals had good knowledge about the COVID-19 pandemic. 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 September 7, 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 September 7, 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 September 7, 2020. . https://doi.org/10.1101/2020.09.05.20188805 doi: medRxiv preprint Out of study participants, 309 (72.2%) strongly agreed that gowns, gloves, masks, and goggles must use when dealing with the COVID-19 patients, and 161 (37.6%) agreed that healthcare workers must acknowledge themselves with all the information about the COVID-19 (Table 4 ). Overall, 53% (95%CI: 48.3%, 57.8%) of HCPs had a positive attitude towards precautionary measures for the COVID-19 pandemic. Of the health facilities, in eight (44.4%), a team of HCWs should always bed signaled to care exclusively for suspected or confirmed cases to reduce the risk of transmission. In fourteen (77.8%) health facilities, all persons entering the patients' room never recorded (Table 5 ). 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 September 7, 2020. . Of the study participants, 295 (68.9%) wash hands continuously with water and soap or use hand sanitizer, and 220 (51.4%) sometimes educate their patients about the COVID-19 ( Figure 4) . Overall, 35.3% (95%CI: 30.7%, 39.8%) of health professionals had a good practice on precautionary measures for the COVID-19 pandemic. In a multivariable model, marital status (being married), good knowledge about COVID-19, and a positive attitude towards precautionary measures had shown a significant association with health professionals' practice of precautionary measures for the COVID-19 pandemic. (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 September 7, 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 September 7, 2020. . https://doi.org/10.1101/2020.09.05.20188805 doi: medRxiv preprint This survey aimed to fill a research gap in Ethiopia by assessing health professionals' practice of precautionary measures for COVID-19 in public health facilities. In this study, 2/3 rd of health professionals' had knowledgeable about the COVID-19 pandemic, 1/2 nd were a positive attitude towards precautionary measures for COVID-19, and only 1/3 rd had a good practice on precautionary measures in public health facilities. Marital status, knowledge about COVID-19, and attitude towards precautionary measures were factors identified in this study that showed significant association with good practice of precautionary measures for the COVID-19 pandemic. In this study, the magnitude of good practice of precautionary measures for COVID-19 was 35.3% (95%CI: 30.7%, 39.8%). These were very low as compared to studies conducted in Iran (70.12%) [40] , in China (89.7%) [38] , the Kingdom of Saudi Arabia (87.9%) [39] , Uganda (74%) [48] , and Ethiopia (62%) [49] . The finding of this study indicated that 50.5% of health professionals avoided touching mouse, eyes, and noses, and 68.9% had wash hands continuously with water, soap, or use hand sanitizer. These were incongruent with studies conducted in Pakistan (84.3% for avoiding touching eyes, nose and mouth, and 96.1% for hand washing and use sanitizer) [41] , in two studies from Saudi Arabia, 24.2% [42] , and 94.1% [43] use facemask in crowds. The observational finding of this study also indicated that a gap in applying droplet and contact precautions (using PPEs), routinely cleaning and disinfecting surfaces with which the patient contact and equipment used, and controlling visitors (there is overcrowding) in the health facility. This discrepancy may be due to differences in socio-demographic and economic characteristics, technological advancement and health care system, and social-cultural factors. The other factor may be methodological aspects (the majority of previous studies were an online survey (using email, Facebook, and telegram) that may overestimate the practice). The health professionals' marital status was significantly associated with good practice of precautionary measures for COVID-19. However, other socio-demographic and professional factors (sex, age, educational attainment, job category/profession, and work experience) had not shown significant association. These were not in line with studies conducted in China [38] , the Kingdom of Saudi Arabia [39] , Iran [40] , Pakistan [41] , and Uganda [48] . This difference might related to sampling variation or sample clustering that previous studies mainly based on an online survey, and participants are only those who access the internet service during the data collection period. Besides, a health professional who continuously manages patients with COVID-19 might not involve in that study due to time shortage. Coronavirus disease-2019 is a global pandemic that all the information sources (mass media, stream media, social media, and others) and all the government sectors give focus on this issue, and health professionals seek information utmost an equal level. Therefore, the practice of precautionary measures for COVID-19 in health facilities does not that much vary with sex, age category, educational level, job category, and work experience difference. In this study, knowledge of health professionals' on the COVID-19 had shown a significant association with a good practice of precautionary measures in health facilities. These were in line with studies conducted in Pakistan [41] , Iran [40] , the Kingdom of Saudi Arabia [39] , China [38] , Ethiopia [49, 50] , and Uganda [48] . Similarly, the attitude of the health professionals' towards precautionary measures had shown a significant association with practice in the health facility. These were in line with the study conducted in Pakistan [41] . These are facts that health professionals who are knowledgeable about the pandemic and positive attitude towards precautionary measures are more likely to put in practice. In general, the positive attitude of the health professional is a base to seeking information about the pandemic from different sources and concerning bodies to build knowledge and resulted in behavioral change and to put the practice in the ground. The main strength of this study was that it assessed the health professionals' practice and factors affecting precautionary measures for the COVID-19 pandemic in the health facilities with limited previous studies. It also used validated Open Data Kit survey tools to collect the information. The limitation of this study was the study might subject to recall and social desirability biases. The study, conducted in a very constrained environment that different activities controlled by the national emergency team due to the pandemic. The study was cross-sectional that the causal relationship was under caution. Therefore, those issues must consider while interpreting the study findings. The implication of this study is; it involved health professionals in health facilities and health professionals are in the front line to this pandemic, and different interventions are needed in the ground route to improve service quality and to stable the health care system. Currently, millions of individuals are infected, and thousands died with this evil disease. The pandemic disrupts the health care system. Therefore, assessing the practice and identifying the factors affect is very important to intervene urgently to squeal the consequence within a short period. The finding of this study can urge different stakeholders, task forces, and public health emergency teams to design strategies for intervention. In summary, there are limited studies that showed the health professionals' practice and factors affecting precautionary measures for the COVID-19 pandemic. Therefore, this study aimed to fill these research gaps in Ethiopia. This study identified that there was a gap in the practice of precautionary measures for COVID-19 among health professionals, and knowledge and attitude towards precautionary measures were the most determinate factors. The observational finding also supplementary for the results indicated based on interviewed data. This study had its limitation, and the results must interpret by considering those limitations. These results of this study can be input for different stakeholders and task forces to design specific strategies for intervention. This study showed that the practice of precautionary measures for the COVID-19 pandemic was low. Even if, majority of the health professionals know about COVID-19, there was a gap. Marital status, knowledge about COVID-19, and attitude towards the precautionary measures identified as factors. Therefore, the investigators recommended that the ministry of health and other concerning task forces should provide capacity-building activities such as inservice training, motivate and recognize staffs to improve the knowledge, and to change the behavior or attitude of the health professionals. Statement Regarding Cluster of Pneumonia Cases in Wuhan, China Experts say that the pathogenic identification of the novel coronavirus of unknown cause in Wuhan has made preliminary progress Novel-2019 Coronavirus Genome Severe acute respiratory syndrome coronavirus 2 isolate Wuhan-Hu-1, complete genome Coronavirus disease 2019 (COVID-19)Situation Report -10 National Health Commission of the People's Republic of China. Prevent guidelines of 2019-nCoV National Health Commission of the People's Republic of China. Pneumonia diagnosis and treatment of 2019-nCoV infection from Chinese NHC and CDC 2020 The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes Beijing Union Medical College Hospital on "pneumonia of novel coronavirus infection Union Med Coll Hosp The medical expert group of Tongji hospital. A quick guide to the diagnosis and treatment of pneumonia for novel coronavirus infections Considerations in adjusting public health and social measures in the context of COVID-19, Interim guidance Novel coronavirus Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review Disinfection measures for pneumonia foci infected by a novel coronavirus in 2019 Coronavirus disease 2019 (COVID-19)Situation Report -72 Advice on the use of masks in the community, during home care and in health care settings in the context of the novel coronavirus 2019-nCoV outbreak (Interim guidance). 2020. Available at: WHO/novel Cov/IPC_Masks/2020. Access date National Health Commission of the People's Republic of China. Guidelines for public protection against novel coronavirus infection Information for Clinicians on Investigational Therapeutics for Patients with COVID-19 Countermeasures for the rapid spread of new coronavirus pneumonia in Wuhan. Chin General Pract Nurs COVID-19) outbreak: rights, roles, and responsibilities of health workers, including key considerations for occupational safety and health Preventing intra-hospital infection and transmission of COVID-19 in healthcare workers. Safety and health at work National Institute for Communicable Disease. Clinical Management of Suspected or Confirmed COVID-19 Diseases Access date WHO Declares COVID-19 a Pandemic. (2531-6745 (Electronic)) World Health Organization. The 2019-nCoV outbreak is an emergency of international concern Infection prevention partners up with psychology in a Danish Hospital successfully addressing staffs fear during the COVID-19 pandemic Death from Covid-19 of 23 Health Care Workers in China Gujrat hospital isolation ward nurse dies of coronavirus Doctors, nurses, porters, volunteers: the UK health workers who have died from Covid-19 Coronavirus: Remembering 100 NHS and healthcare workers who have died The Global Macroeconomic Impacts of COVID-19: Seven Scenarios WHO urges countries not to let COVID-19 eclipse other health issues Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan COVID-19 in a Long-Term Care Facility Coronavirus disease 2019 (COVID-19): Infection control in health care and home settings Knowledge, attitude and practice regarding COVID-19 among health care workers in Henan Knowledge, attitude, and practices of healthcare providers towards MERS-CoV infection at Makkah hospitals, KSA Knowledge, perceptions, and practices of healthcare workers regarding the use of respiratory protection equipment at Iran hospitals Journal of Infection Prevention Attitude and Practice among Healthcare Professionals regarding COVID-19: A cross-sectional survey from Pakistan Middle East Respiratory Syndrome (MERS): Comparing the knowledge, attitude, and practices of different health care workers Knowledge and practices of primary health care physicians regarding updated guidelines of MERS-CoV infection in Abha city. Journal of family medicine and primary care infectionprevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infectionis-suspected-20200125 National Institute of Health (NIH), Pakistan-COVID-19 Hospital Readiness Checklist for COVID-19 Coronavirus Disease-2019: Knowledge, Attitude, and Practices of Health Care Workers at Makerere University Teaching Hospitals, Uganda. Frontiers in Public Health Factors determining the knowledge and prevention practice of healthcare workers towards COVID-19 in Amhara region, Ethiopia: a cross-sectional survey. Tropical Medicine and Health Knowledge and Precautionary Behavioral Practice Toward COVID-19 Among Health Professionals Working in Public University Hospitals in Ethiopia: A Web-Based Survey Our heartfelt thanks go to the Gamo zone health department, Chief executive officers in the hospitals, health center heads, task force leaders who gave support during data collection, data collectors, and study participants. Finally, yet importantly, we would like to say thank you for all peoples who support directly or indirectly.