key: cord-0833849-sa5aeu9w
authors: Mansuri, Farah Muhammad Asad; Zalat, Marwa Mohammed; Khan, Adeel Ahmed; Alsaedi, Esraa Qabl; Ibrahim, Hanan Mosleh
title: Estimation of population’s response to mitigation measures and self-perceived behaviours against COVID-19 Pandemic
date: 2020-07-04
journal: J Taibah Univ Med Sci
DOI: 10.1016/j.jtumed.2020.06.003
sha: 05d70d66ef37d22d6c0cd48cc5bc8a0bdfc386e2
doc_id: 833849
cord_uid: sa5aeu9w

Abstract Objectives Since March 2020, a rapid increase has been observed in the prevalence of the COVID-19 pandemic, which has essentially resulted from increased disease transmission and intensified testing and reporting. The international guidelines for the prevention and treatment of the COVID-19 pandemic have been frequently updated. Such guidelines assist the governmental regulatory bodies in taking optimal measures and safeguarding their citizens against the pandemic. We conducted a short survey with a Saudi cohort to understand the awareness about COVID-19 and estimate the responses for mitigation strategies. Methods An electronic survey was conducted, and the first 388 responses were analysed for publishing an initial report. The questionnaire comprised 27 items and was divided into three sections, namely demographic, awareness, and response to mitigation strategies and participants’ self-perceived behaviours regarding COVID-19. The perceptions of the participants were compared with their responses to mitigation measures. Results In our study, 89.7% understood the meaning of pandemic, while 82.2% correctly identified that the elderly belonged to a high-risk group for the COVID-19 infection. As many as 96.1% agreed that staying at home was one of the mitigation strategies. Nearly 35% preferred self-medication. Higher educational level (OR: 2.09, 95% CI: 1.02- 4.29) and longer working hours were found to be significantly associated with a positive response to mitigation measures with p<0.04 and p<.02, respectively. Conclusions We report better understanding and appropriate response to mitigation measures towards the COVID-19 pandemic among the general population in Saudi Arabia. Nevertheless, the tendency towards self-medication was reported by one-third of the responders.

The COVID-19 outbreak was declared a worldwide pandemic by WHO on 11 March 2020, 2 with a 13-fold increase in the number of cases reported outside China, over a couple of 3 weeks. 1 It has affected more than 2.3 million people in 185 countries in the world. Out of the 4 total global burden, a little above 120 thousand confirmed cases and 5784 deaths were 5 reported in EMRO by 18 April 2020. 2 Saudi Arabia, with 7142 cases and 87 deaths, is the 6 third country in the region to be affected by the novel coronavirus or SARS-CoV-2 (severe 7 acute respiratory syndrome-CoV-2). 3

The overall case fatality rate (CFR) among all countries is 6.8%, but the highest is in Italy at 9 13.1%. 4,5 The COVID-19 pandemic may become a category 3 pandemic, depending on its 10 reproduction number (R 0 ) and overall fatality ratio thus far. 6,7

Furthermore, there is an absence of a specific treatment method or vaccine against the novel 12 coronavirus disease, which has enough potential of a pandemic. In such a situation, non-13 pharmaceutical interventions are the mainstay, such as community mitigation strategies and 14 suppression to slow down the transmission, particularly among the high-risk population. 8,9 15 An exploratory survey was conducted in the United States of America in 2006, to study the 16 expected public reaction to social distancing and other non-pharmaceutical interventions that 17 may be used during a pandemic. A total of 85 questions were developed to cover the 18 information on the acceptability of mitigation measures and about the problems that the 19 public would face while complying with the recommended measures towards preparedness to 20 a pandemic. It was found that 41% knew what the term 'pandemic' meant, while 25% had 21 never heard of this term. In addition, it was reported that 94% intended to stay at home, away 22 from work, while 85% said that they would be able to take care of sick persons in their 23 household. 9

The results of the same survey, published later in 2010, reported the ability to comply with 25 isolation recommendations and difficulties faced by low-income and urban populations. Of 26 the respondents, 28% reported that they might lose their job or business because of staying 27 away from work for 7-10 days, during an expected event of an influenza outbreak. 10

In Saudi Arabia, a cross-sectional study was conducted in 2015, which showed high levels of 1 concern and widespread utilisation of precautionary measures against MERS-CoV by most 2 participants. The results revealed that gender and knowledge were the predictors of the level 3 of concern. 11 For the current pandemic, mitigation measures have been implemented from 27 The questionnaire comprised 27 questions and was divided into three sections, namely 30 demographic, awareness, and response to mitigation strategies and participants' self-31 perceived behaviours regarding COVID-19. The questions were developed by consulting and reviewing currently available international guidelines [Annex: Report of Systematic 1 Literature Reviews pages 2-4]. The tool was designed in English and translated to Arabic by 2 a bilingual co-investigator and back-translated by another bilingual expert. The questions 3 have undergone necessary modifications and corrections to ensure their clarity and ease of 4 understanding. The questionnaire has been tested on 12 persons. The reliability coefficient 5 test (Cronbach's alpha) was high for all questions. The results of the pilot study were 6 consistent with the study results; therefore, it was included in the main survey.

In this survey, we estimated an optimal sample size of 385 participants by using OpenEpi 8 software version 3.01 (https://www.openepi.com/SampleSize/SSPropor.htm). Invitations to 9 participate in the survey were sent to 1925 individuals, and an accepted minimal response 10 rate of 20% was used while keeping a 5% margin of error. This quick survey was the first 11 phase of a longitudinal mixed method study funded by Taibah University. Approximately 60.8% of the participants were younger than 40 years of age, and 60.3% were 29 females. They were mostly residents of Makah (39.7%), Madinah (24.2%), and Riyadh 30 (18.6%). Nearly half of the participants were of Saudi nationality (50.3%), and most of them were University graduates or above (59.5%). The majority (95.9%) reported that they have 1 travelled in or out of SA, more than two weeks ago. The mean number of family members in 2 the house was 5.13±3.16 persons, with approximately two children per household, on an 3 average.

While 44% of the participants were working inside the health sector, 26.5% were working 5 outside the health sector, and nearly a third of them were not working (including 6 homemakers/retired). Further, 51% were government employees, and 33% were working in 7 the private sector. Of the respondents, 60.3% reported that their overall work duration was 8 ≤10 years, and 39.7% were working for more than 10 years, with an average of 7.61±2.09 9 work hours/day. Table 4 shows the socio-demographic and occupational characteristics modelled by using 6 multivariate logistic regression for independent association with response to mitigation 7 measures. Only educational level showed a significant independent association with response 8 to mitigation measures (OR: 2.09, 95% CI: 1.02-4.29, p=0.04). However, nationality, 9 residence, and gender did not show any independent association with response to mitigation 10 measures. Among occupational characteristics, longer working hours (OR: 1.5, 95% CI: 1.02-11 2.39, p=0.02) were independently associated with higher odds of positive response to 12 mitigation measures, but neither with a type of occupation nor the work sector. It was also 13 found that participants identified children younger than five years of age as the only high-risk 14 group, which was significantly associated with response to mitigation measures (p=0.03). Most participants (82%) were aware that senior citizens are more at risk; however, the other 3 high-risk groups, such as those with co-morbidities, like smokers, asthmatics, and diabetics 4 (50-60%) were not that well known to a majority of the population. Thus, this information 5 must be provided to the people to protect the high-risk groups from the infection. This is akin 6 to the findings of the study conducted among healthcare providers in the Qassim region, 7 which reported that approximately 76% of the participants knew that people with co- Written consent was obtained from all the participants at the start of the online survey, after 27 clarification was provided regarding the study's aim and the privacy of personal data.

Authors contributions: 29 FAM conceived and designed the study, conducted research, and provided research materials. collected and interpreted data. EQA wrote the introduction and collected data. HMI obtained 1 ethical approval and wrote results. All authors wrote the manuscript, contributed to data 2 extraction, critically reviewed and approved the final draft, and are responsible for the 3 content and similarity index of the manuscript. The authors would like to thank all participants of this study for sharing their knowledge, 6 perceptions, and experiences. As the corresponding author, I had full access to all the data in 7 the study and take responsibility for the integrity of the data and the accuracy of the data 8 analysis. 

Only heard the term pandemic • Understand the meaning of pandemic • Heard but don't know what it is • Don't know at all

Which of the following are at a greater risk of coronavirus infection?* • Elderly of age >60ys

This study was approved by the Taibah University College of Dentistry Research Ethics committee. Informed consent was obtained from all participants electronically before participating in the research. All procedures of the research were according to the World Medical Association (WMA) Declaration of Helsinki on ethical principles for medical research involving human subjects

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