key: cord-1049645-etjn043z authors: Peres, David; Monteiro, Jorge; Almeida, Miguel; Ladeira, Raquel title: Risk Perception of COVID-19 Among the Portuguese Healthcare Professionals and General Population date: 2020-05-30 journal: J Hosp Infect DOI: 10.1016/j.jhin.2020.05.038 sha: a114ddd7611e4e8ba7a9a1cd2dc4ee2c260597ff doc_id: 1049645 cord_uid: etjn043z Risk perception assessment of COVID-19 among Portuguese Healthcare Professionals (HCP) and General Population (GPop) was evaluated in a snowball 3 403 individual’s sample. 54.9% of HCP believed there is a high probability of becoming infected, in contrast with 24.0% of GPop (p <0.001) and, in more than 1/4, that this could happen to their family. Regarding prophylactic isolation, more than 70% agreed with its effectiveness. A large proportion perceived that health services are poorly prepared (50.1% GPop versus 63.5% HCP, p<0.001). Regarding Health Authorities’ communication, about 60% were “moderately” satisfied. 46.7% GPop and 52.8% HCP had the opinion the pandemic could be controlled in three to six months (p=0.01). (2) area of perception, assessed through 6 questions, Likert scale type. The questionnaire was developed using the Google Forms platform (©Google). Descriptive and analytical analysis was performed using software R 3.5.19. Considering continuous variables, the difference in means between the GPop and HCP was assessed using t-test for independent samples. A significance level of 5% was considered. Most of the 3403 participants were female (78.5%) and 35.1% were in the age group of 35-44 (Table I) . Regarding the likelihood of family and friends becoming infected, about 60% in both groups felt that there was a "moderate" probability. However, there was a large discrepancy regarding the probability of becoming infected themselves, namely, the majority of GPop accepted it as being "moderately likely" but, among HCP, their opinion is divergent (54.9% considers it to be "very likely" and 39% "moderately likely"). Regarding the perceived effectiveness of the quarantine measures, there was no significant difference between the two population groups, with more than 70% believing it to be "very effective". Most participants had the opinion that communication from the Health Authorities was "moderately adequate" (57.8% of GPop and 60.0% of the HCP). When asked about health services preparation to manage this pandemic, 63.5% of the HCP responded, "little prepared" (versus 50.1% of GPop who had the same opinion). Analyzing the answers given to the question "when will it be possible to control this pandemic at the European level?", 52.8% of HCP and 46,7% of GPop responded that this pandemic could be controlled within three to six months (Table I) . A recent publication, in which the opinion of several experts was explored, suggested that media coverage has prompted a significant level of fear of the virus. Many requests were received for SARS-CoV-2 testing based on perceived, but not actual, risk of exposure [3] . In another study, a sample of North-American and British individuals responded that it was probable that, by the end of 2020, about 60% and 70% of the population in their country would be COVID-19 positive, respectively [4] . On the other hand, during the SARS outbreak in 2003, there were several reports of nosocomial infection by this agent in healthcare professionals [3] . In this pandemic, there are reports of up to 10% of HCP infected in China [5] . In our questionnaire, 24.0% of GPop and 54.9% of HCP believed is "very likely" to become infected with SARS-CoV-2 (p <0.001) and, 25.2% of GPop and 29.7% of HCP, that this may happen to their family/ friends (p <0.01) ( Table I ). This indicates that HCP have the perception to be at higher risk than GPop, due to their close contact with suspected/ confirmed COVID-19 cases. As a public health measure, it is essential to limit cross-transmission and avoid amplification events. According to European Center for Disease Control and Prevention (ECDC), "quarantine" or "self-isolation" is supported by evidence from previous pandemics, in which isolation of exposed individuals contributed to delay the peak of the epidemic curve. There are considerable logistical, social and communication challenges in implementing quarantine measures and its efficiency is dependent on the definition and, in particular, the scale of exposure in the target population [6] . In our questionnaire, the vast majority of the respondents, faced with the question "how effective do you think quarantine is in controlling this virus?", answered "very effective" (72.2% of GPop and 73.9% of HCP), followed by "moderately effective" (26.8% and 25.5%, respectively) ( Table I) . This positive perception about the potential effectiveness of quarantine measures is important to understand and predict population behavior, when deciding to implement this measure. In healthcare settings there is the risk that nosocomial outbreaks can work as local amplifiers. are several lessons to be learned, namely the need for consistent management choices and a strong political commitment to create a long-term sustainable system [8] . Regarding the question, "in your opinion, how ready are health services to deal with this virus?", 50.1% of GPop and 63.5% of HCP defended they are "badly prepared" (Table I) . Interestingly, it was the HCP that felt most the lack of preparation of the health services, perhaps because they have better knowledge of its weaknesses. Health authorities are often involved in damage control caused by several kinds of risks (including pathogens). One of the challenges in risk communication is the different perception of distinct population groups (such as legislators, researchers, health professionals, etc). Given the current situation, Portuguese Health Authorities implemented a risk communication strategy, which included: daily communications; press conferences; online information for different audiences; technical guidelines for HCP; adaptation and adoption of the international recommended guidelines ( ECDC and WHO), in accordance with the national risk assessment level and institutional partners involvement. In this study, most participants are of the opinion that the health authorities communication with the population has been "moderately adequate" (57.8% of GPop and 60.0% of HCP) and, 22.2% of GPop and 13.0% of HCP, responded "very adequate" (p < 0.001) (Table I) . These results could be explained by the anxiety created in the whole population, due to the uncertainty of the pandemic scenario and its intensive media coverage. Regarding the participants perception about the time horizon for the pandemic control in Europe, the prevailing opinion is between three and six months (46.7% of GPop vs. 52.8% of HCP, p=0.01). Considering the "basic reproduction number" (R 0 ), as the average number of secondary infection cases generated by a primary case in a susceptible population, Liu et al. conclude that it's between In recent decades, new infectious agents have emerged, some of which have become major global threats. The new SARS-CoV-2 pandemic is an example of an international public health emergency. Considering the international epidemiological scenario, exceptional public health measures were taken (which include isolation and social distance), which have considerable logistical, social, economic and communication challenges. In this study, we assessed the risk perception of a snowball sample of GPop and HCP. The results obtained showed a significant proportion of HCP (versus Gop) who believed there is a high probability of being infected with SARS-CoV-2 and that this may happen to their family/ friends. Regarding prophylactic isolation, a significant majority relied on its effectiveness to control this virus. On the other hand, many were of the opinion that the health services are little prepared to deal with this pandemic (interestingly, more HCP). In terms of the adequacy of the communication from the Health Authorities, the majority were "moderately satisfied", leaving room for improvement in this area. Finally, most respondents believed that it could be possible to control the situation within six months. ECDC. Event background COVID-19. Stockholm: European Center for Disease Control and Prevention Communicable Disease Control and Health Protection Handbook The SARS-CoV-2 Outbreak: Diagnosis, Infection Prevention, and Public Perception Knowledge and Perceptions of COVID-19 Among the General Public in the United States and the United Kingdom: A Cross-sectional Online Survey Report of the WHO-China Joint Mission on Coronavirus Disease Guidelines for the use of non-pharmaceutical measures to delay and mitigate the impact of 2019-nCoV. Stockholm: European Centre for Disease Prevention and Control Emerging infectious diseases: Focus on infection control issues for novel coronaviruses (Severe Acute Respiratory Syndrome-CoV and Middle East Respiratory Syndrome-CoV), hemorrhagic fever viruses (Lassa and Ebola), and highly pathogenic avian influenza viruses, A(H5N1) and A(H7N9) The Italian health system and the COVID The reproductive number of COVID-19 is higher compared to SARS coronavirus Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts The authors would like to thank and encourage the general population collaboration in the pursuit of public health measures, instituted by the Health Authorities. of health. Aware of the great effort and risk they are subject to, they also pay tribute to the performance and perseverance of healthcare professionals.