key: cord-324725-6xu7q927 authors: Bhagavathula, Akshaya Srikanth; Aldhaleei, Wafa Ali; Rahmani, Jamal; Mahabadi, Mohammadjavad Ashrafi; Bandari, Deepak Kumar title: Novel Coronavirus (COVID-19) Knowledge and Perceptions: A Survey of Healthcare Workers date: 2020-03-13 journal: nan DOI: 10.1101/2020.03.09.20033381 sha: doc_id: 324725 cord_uid: 6xu7q927 Background: During the first week of March, the surge of coronavirus disease 2019 (COVID-19) cases reached over 100 countries with more than 100,000 cases. Healthcare authorities have already initiated awareness and preparedness activities beyond borders. A poor understanding of the disease among healthcare workers (HCWs) may result in delayed treatment and the rapid spread of infection. This study aimed to investigate the knowledge and perceptions of HCWs about COVID-19. Methods: A cross-sectional, web-based study was conducted among HCWs about COVID-19 during the first week of March 2020. A 23-item survey instrument was developed and distributed randomly to HCWs using social media; it required 5 minutes to complete. A chi-square test was used to investigate the level of association among variables at the significance level of p<0.05. Results: Of 529 participants, a total of 453 HCWs completed the survey (response rate: 85.6%); 51.6% were males, 32.1% were aged 25-34 years, and most were doctors (30.2%) and medical students (29.6%). Regarding COVID-19, most of the participants used social media to obtain information (61%), and a significant proportion of HCWs had poor knowledge of its transmission (61%) and symptom onset (63.6%) and showed positive perceptions of COVID-19 prevention and control. Factors such as age and profession were associated with inadequate knowledge and poor perception of COVID-19. Conclusion: As the global threat of COVID-19 continues to emerge, it is critical to improve the knowledge and perceptions of HCWs. Educational interventions are urgently needed to reach HCWs beyond borders, and further studies are warranted. Coronaviruses (CoV) infections are emerging respiratory viruses and known to cause illness ranging from the common cold to severe acute respiratory syndrome (SARS) [1] . CoV is zoonotic pathogens that can be transmitted via animal-to-human and human-to-human [2] . (WHO) declared COVID-19 as a public health emergency of international concern (PHEIC) [5] . Astonishingly, in the first week of March, a devastating number of new cases have been reported globally, emerging as a pandemic. As of 9 March 2020, more than 110,000 confirmed cases across 105 countries and more than 3800 deaths have been reported [6] . The COVID-19 is spread by human-to-human through droplets, feco-oral, and direct contact, with an incubation period of 2-14 days [6] . So far, no antiviral treatment or vaccine has been recommended explicitly for COVID-19. Therefore, applying the preventive measure to control COVID-19 infection is the utmost critical intervention. Healthcare workers (HCWs) are the primary section in contact with patients and are an important source of exposure to the infected cases in the healthcare settings, thus, expected to be at a high risk of infections. By the end of January, the WHO and CDC (Centers for Disease Control and Prevention) have published recommendations for the prevention and control of COVID-19 for HCWs [8, 9] . Indeed, the WHO also initiated several online training sessions and materials on in various languages to strengthen the preventive strategies, including raising awareness, and training HCWs preparedness activities [10] . In several instances, misunderstandings of HCWs delayed controlling efforts to provide necessary treatment [11] , implicate rapid spread . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 13, 2020. . https://doi.org/10.1101/2020.03.09.20033381 doi: medRxiv preprint of infection in hospitals [12, 13] , and also may put the patients' lives at risk. In this regard, the COVID-19 epidemic offers a unique opportunity to investigate the level of knowledge, and perceptions of HCWs during this global health crisis. Besides, we also explored the role of different information sources in shaping HCWs knowledge and perceptions on COVID-19 during this peak period. A prospective Web-based cross-sectional study was conducted using a survey instrument to obtain responses from HCWs globally during the first week of March 2020. A 23-item survey instrument was developed using WHO course materials on Emerging respiratory viruses, including COVID-19 [14] , and covered the domains of HCWs characteristics, awareness, information sources, knowledge and perceptions related to COVID-19. The developed draft survey instrument was distributed to ten randomly selected faculty members to assess the readability and validity before pretesting among 20 randomly selected HCWs for clarity, relevancy, and acceptability. The developed comprehensive and well organized questionnaire was distributed to the study population. The survey instrument constituted 23-close ended questions and took approximately 3 minutes to complete. The 23-item questionnaire was divided into three parts including is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 13, 2020. The obtained data were coded, validated, and analyzed using SPSS, version 24 (IBM, Armonk, NY, USA). Descriptive analysis was applied to calculate the frequencies and proportions. The Chi-square test was used to investigate the level of association among variables. A p-value of less than 0.05 was considered statistically significant. A total of 529 HCWs participated, of which 453 completed the study questionnaire (85.6% response rate), including 234 (51.6%) men and 219 (48.3%) women, and most of them are below 44 years of age (82.4%). Majority of respondents are doctors (n=137, 30.2%), and medical students (n=134, 29.6%), and from Asia (68%). Table 1 shows the sociodemographic characteristics of the respondents. Almost every one of the participants agreed that they heard about COVID-19 (97.8%), but only 44.1% of them got the opportunity to attend lectures/discussions about COVID-19. . CC-BY-NC-ND 4.0 International license It is made available under a 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 March 13, 2020. When we asked about their source of reliable information about COVID-19, the primary source of information that they obtain about COVID-19 was through official government websites and social media ( Figure 1 ). Around 30% of the respondents reported they use news media (TV/video, magazines, newspapers, and radio) and social media (Facebook, Twitter, Whatsapp, YouTube, Instagram, Snapchat) to obtain information about COVID-19. Moreover, nearly 40% of the respondents sometimes discussed COVID-19 related topics with family and friends. Table 2 shows the knowledge about COVID-19 among HCWs. We identified significant knowledge gaps between doctors and other HCWs. For instance, around two-third of doctors and half of the allied health workers thought that the origin of COVID-19 was from bats (65.7% vs. 55.7%, p<0.05). A high majority of the HCWs (85.6%) agreed that maintaining hand hygiene, covering nose and mouth while coughing, and avoiding sick patients can help to prevent COVID-19 transmission. A majority of the doctors agreed that COVID-19 can leads to pneumonia, respiratory failure, and death (84%, p<0.05), and supportive care is the only treatment option that is currently available (83.2%, p<0.05). However, the participants' knowledge about questions related to mode of transmission and incubation period of COVID-19 was poor (p<0.05). Over 78% of the HCWs exhibited a positive perception of COVID-19. A high majority of the HCWs knew that sick patients should share their recent travel history (92.7%), flu vaccination is not enough to prevent (90.7%), and COVID-19 is not fatal (88.5%). Besides, 87% felt that washing hands with soap and water could help to prevent COVID-19 transmission; symptoms of it will appear in 2-14 days (84.3%) and agreed that all the . CC-BY-NC-ND 4.0 International license It is made available under a 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 March 13, 2020. . https://doi.org/10.1101/2020.03.09.20033381 doi: medRxiv preprint equipments used in the wet markets should be cleaned every day (85.6%). However, around 20% of HCWs were not clear about eating well-cooked meat during the outbreak [ Table 3 ]. Items related to COVID-19 related perception among HCWs in the study were analyzed using χ 2 test to assess their association with age, sex, and across different categories of HCWs [ Table 4 ]. Nearly ninety percent of the youngsters (<25 years) and 92% of the doctors perceived that the symptoms of COVID-19 appear as early as 2 to 14 days; the differences among the respondent groups were statistically significant (p<0.05). Moreover, a significant proportion of the doctors perceived that eating well-cooked/handled meat is safe (83.2%) (p<0.05). Medical students found to have an association with the perception that flu vaccination is not sufficient to prevent COVID-19 transmission (88%, p<0.05). A large number of allied health workers wrongly perceived that it is not safe to eat well-processed meat during COVID-19 outbreak (25.3%, p<0.05), COVID-19 is fatal (21.5%); delay in symptoms (19.8%), and flu vaccination is sufficient (19.8%; p<0.05) than other respondents in respective groups, respectively. Currently, COVID-19 is a global discussion topic in the media and among the public, 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 March 13, 2020. . https://doi.org/10.1101/2020.03.09.20033381 doi: medRxiv preprint perceptions to prevent COVID-19 transmission. We also found that more than 33% of the HCWs use official government websites as a primary source of information about COVID-19. This indicates the COVID-19 related updates posted online by the official government health authorities had shown to have a positive implication for improving HCWs knowledge levels. Relying on authentic sources is a key factor to believe the transparent information about the emerging COVID-19 infection and is essential for HCWs preparedness and response. However, a finding of considerable concern that most of HCWs (60%) also used social media as a major source of information. Nowadays, a vast diversity of the information available through the internet and this unverified malicious information can spread quickly and can also misguide the HCWs. The health authorities and scientists particularly warned the wide-spreading misinformation of COVID-19 as a serious concern causing xenophobia across the world [4,16-18]. In this regard, HCWs are should practice with careful evaluation of COVID-19 related information and should use scientific and authentic content of information sources. The findings of this study suggest significant knowledge gaps between the amount of information available about COVID-19 and the depth of knowledge among HCWs, particularly about the mode of transmission and incubation period of COVID-19. Also, many allied health workers had inadequate knowledge, thought that COVID-19 can be treated with antivirals, and there is a vaccine available. This is unfortunate, as the surge of COVID-19 is devastating globally, and a large number of resources are provided by the healthcare authorities to educate HCWs to improve their knowledge about COVID-19 was immense. As a result, our findings were disappointing. Nevertheless, greater encouragement from the health authorities is needed to assimilate COVID-19 related knowledge among HCWs, including doctors. . CC-BY-NC-ND 4.0 International license It is made available under a 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 March 13, 2020. . https://doi.org/10.1101/2020.03.09.20033381 doi: medRxiv preprint Generally, most participants had a positive perception of prevention and control of COVID-19. However, discrepancies were identified across different categories of HCWs in their perceptions. For instance, only half (52%) of the HCWs aged between 45-65 years old perceived that the symptoms of COVID-19 appear as early as 2 to 14 days (p<0.05) and more than a quarter of the medical students though that eating meat during the outbreak is not safe. Around 20% of the allied health workers believed that the flu vaccine is sufficient for COVID-19 prevention. Finally, a vast majority of HCWs strongly agreed that maintaining hygiene activities, reporting the recent travel history when individuals are sick, and cleaning the equipment used in the wet markets are strongly recommended. We used WHO training material for detection, prevention, response, and control of COVID-19 to develop a validated questionnaire. The developed questionnaire was pilot tested, and open-ended questions were limited to reduce information bias. However, the study has some limitations that should be considered. This is a cross-sectional study conducted online among HCWs during alarming cases reported globally in the first week of March 2020. Besides, the data presented in this study are self-reported partly depending on respondents' honesty and ability to recall. This may subject to recall bias. We identified a significant gap constituting the source of information, poor knowledge levels, and discrepancies in the perceptions about COVID-19 among our study participants. As the . CC-BY-NC-ND 4.0 International license It is made available under a 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 March 13, 2020. . https://doi.org/10.1101/2020.03.09.20033381 doi: medRxiv preprint global threat of COVID-19 continues to emerge, greater efforts through educational campaigns that targeting HCWs and a wide reach population beyond the borders are urgently needed. We thank all the study participants for their voluntary participation and providing the essential information. ASB designed the study, developed the questionnaire, collected the data, analyzed the data, prepared the manuscript. WAA designed the questionnaire, conducted pilot test, and literature review. MMJ and JR distributed the questionnaire, filtered, and analyzed the data. All the author read and approved the final manuscript. All the materials are attached as supplementary and information related to the study are in the manuscript. . CC-BY-NC-ND 4.0 International license It is made available under a 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 March 13, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a 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 March 13, 2020. . 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 March 13, 2020. . . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 13, 2020. . https://doi.org/10.1101/2020.03.09.20033381 doi: medRxiv preprint SARS and other coronaviruses as causes of pneumonia Note from the editors: World Health Organization declares novel coronavirus (2019-nCoV) sixth public health emergency of international concern Novel coronavirus (COVID-19) situation Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China Infection prevention and control during health care when novel coronavirus ( nCoV) infection is suspected: interim guidance Centers for disease control and prevention. Update and interim guidelines on outbreak of 2019 Novel coronavirus (2019-nCoV). Available online Responding to COVID-19: Real-time training for the coronavirus disease outbreak Delays in Global Disease Outbreak Responses: Lessons from H1N1, Ebola, and Zika Infection Rates and Risk Factors for Infection Among Health Workers During Ebola and Marburg Virus Outbreaks: A Systematic Review