On 31st December 2019, a cluster of cases of pneumonia of unknown aetiology in Wuhan City, Hubei Province, China were reported to WHO (World Health Organization, 2020a). On 9th January 2020, the causative pathogen was identified as a new coronavirus (Cyranoski, 2020) which was later named SARS-CoV-2 (severe acute respiratory syndrome, coronavirus 2) with the disease called coronavirus disease 19 (COVID-19) (Coronaviridae Study Group of the International Committee on Taxonomy of, 2020). The most commonly reported symptoms are fever and cough with headache, myalgia or fatigue .
An epidemic in China then ensued with transmission to countries across the world with this being declared a Public Health Emergency of International Concern on 30 January 2020 (World Health, Organization, 2020b). As of 23 March 2020 there have been 332935 cases confirmed globally with 14510 deaths (World Health Organization, 2020c). A number of public health measures to control the epidemic have been implemented internationally including travel and visa restrictions, quarantine, screening on entry, and self-isolation (World Health Organization, 2020d). Due to large numbers of cases, a number of European countries have imposed lockdown measures whereby the population are only allowed to leave their homes for essential purposes. In the United Kingdom such stringent policies are not currently in place however, there has been extensive public health advocacy for ‘social distancing’ e.g. avoid places where large crowds gather such as bars and restaurants and working from home, particularly for those in groups more susceptible to severe symptoms associated with the virus including those aged 70 years or over and those with chronic medical conditions; and also pregnant women (Public Health England, 2020). This sudden and unprecedented change to lifestyles has resulted in behaviours ranging from stockpiling food and medicines (Bachelor, 2020, Murray and Busby, 2020), the dissemination of rumours and misinformation (Department for International Development, 2020) and increased anxiety with regard to health and also the economic situation (Saner, 2020 and Cosslett, 2020) with some attributing this situation to being similar to that of a war (Giuffrida, 2020).
Behaviours and attitudes
Prior to the H1N1 Influenza A pandemic in Hong Kong, a telephone survey found that frequent hand-washing was associated with perceptions including the unavailability of a vaccine and threat of a large scale local outbreak. Similarly, wearing a face mask in public areas was associated with perceptions including fatality (Lau et al., 2010). Bish and Michie (2010) conducted a review of the attitudes towards protective behaviours during a respiratory pandemic. The study found that adoption of preventive behaviours such as hand washing, coughing or sneezing into a hand or tissue and cleaning surfaces was associated with being older, female and more educated or non-White. Precautionary behaviours were also more likely to be adopted by those who believed that the authorities were open with communication or had greater trust in authorities (Quah and Hin-Peng, 2004, Tang and Wong, 2005) with compliance with quarantine affected by inconsistent information from authorities (Cava et al., 2005).
Brooks et al. 2020 conducted a review of the psychological impact of quarantine under epidemics including SARS, Middle-Eastern Respiratory Syndrome (MERS) and Ebola virus. Longer quarantine duration, fear of infection, financial loss, frustration and boredom were cited as stressors causing negative psychological effects. The current outbreak of COVID-19 is predominantly more severe in the elderly and those with co-morbidities (Centers for Disease Control and Prevention, 2020, Chen et al. 2020). As a result this population are strongly advised to avoid social mixing/contact which can have an impact on daily activities in addition to the ability to carry out daily activities (Public Health England, 2020).
An online survey (https://enketo.lshtm.ac.uk/::wsqM5QPj) was developed and tested by the research team and includes questions relating to the knowledge of the COVID-19 pandemic, where information is obtained and attitudes and behaviours towards the public health response. The survey was developed using the open source software, Enketo (enketo.org).
The URL for an online survey will be disseminated to the general public (aged 13 years and over) in the UK using a variety of methods aimed to include a target audience from as many socio-demographic and economic groups as possible. This would include (but is not exclusive to), via social media platforms such as Twitter and Facebook, those included in mailing lists e.g. within academic institutes, and via personal contacts.
Non-personally identifiable information from the survey will be collected only. On completion of the survey, an encrypted form will be sent to a secure server hosted at LSHTM only accessible to members of study team. The data will be decrypted and analysed by the study team. Aggregated data, stratified by geolocation, age and socio-demographics, showing the results of the survey will be made available on an open access online dashboard. The link for this (https://chrissyhroberts.github.io/csedk/) will be provided to all participants at the end of the survey. More detailed analyses will be published here and on medRxiv.
The survey will initially be conducted in the UK with potential expansion to other countries if feasible.
We aim to conduct the survey over the course of the pandemic, evaluating changes in responses over time and how these relate to the implementation and possible retraction of public health control measures.
Reports of the results will be shared with national public health agencies to help inform responses.
The co-investigators on this work are Dr Hannah Brindle (LSHTM), Dr Luisa Enria (The University of Bath), Dr Shelley Lees (LSHTM, Co-PI), Dr Chrissy h Roberts (LSHTM, Co-PI) and Dr Nina Rogers (University College London),
Contact : The research team can be contacted here
The primary investigators can also be reached by mail at
Dr Chrissy h Roberts / Dr Shelley Lees
London School of Hygiene and Tropical Medicine