A snapshot of public knowledge of novel coronavirus disease 2019: a web-based national survey

On 31 January 2020, the World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19) to be a public health emergency of international concern and the risk assessment was very high at both the Chinese and global level [1]. According to the COVID-19 situation report of the WHO, as of 29 February 2020, there were 79,394 confirmed cases across China and 85,403 confirmed cases globally [2]. The number of existing cases in China began to decrease on 19 February 2020, however, the number of confirmed cases abroad has surged since late February.

The first case of this pneumonia was diagnosed on 8 December 2019 with an unknown pathogen in Wuhan, Hubei, China [3]. One month later, the novel coronavirus was identified as the pathogen leading to the pandemic. In the following days, a great amount of massive news appeared in the media. The epidemiological and clinical characteristics of COVID-19 were released by the Chinese Center for Disease Control and Prevention through various social media channels, such as web pages on cellphones and computers, Television news, and real-time radio broadcasts [4]. To draw more public attention, great efforts were made by the government. News about COVID-19 was broadcast all day and night. The front-line situation of the COVID-19 pandemic in Wuhan was even broadcast on the most important traditional Television shows—the Spring Festival Gala of China Central Television. These shows used the most serious language to arouse people’s attention and to urge the whole nation to unite together to win the battle against COVID-19. Grassroots cadres patrolled in the streets and towns to tell people to stay home and not gather outside.

To control the pandemic, the General office of the State Council announced the prolongation of the Spring Festival holiday [4]. All restaurants, shopping malls, cinemas, and entertainment venues were closed in many cities during the Spring Festival. Mass events were cancelled. Companies delayed the resumption of work and schools delayed the start of the spring semester. Numerous cities and towns were shut down. Body temperature screenings were requested at the entrances of train stations, bus stations and airports. Quarantine for at least 14 days was compulsory for people from other cities.

Improving public knowledge of the disease, its transmission patterns and effective protective measures is the foundation for the control and prevention of the disease. However, discrepancies may exist in the knowledge held by people of varying socioeconomic levels or ages. In addition, the pandemic may have negative effects on individuals’ psychological state. Therefore, investigating the public’s awareness of COVID-19 and its psychological state could help in identifying the public knowledge gap and potential psychological disorders so that more targeted efforts could be made to increase public awareness and decrease the risk of psychological disorders.

This study aimed to determine the China’s public knowledge of COVID-19 and psychological state as well as attitudes towards control measures via a quick online survey.

A cross-sectional study was conducted over 48 h from 22:30 29 February 2020 to 22:30 2 March 2020 based on a self-administered questionnaire. The questionnaire was created and released based on the Sojump (Changsha Ranxing Information Technology Co., Ltd., Changsha, China, http://​www.​sojump.​com) online survey tool and distributed to participants via WeChat (Tencent Inc., Shenzhen, China, Version 7.0.12), a popular social media platform.

This study investigated the current Chinese public knowledge of COVID-19 via a 48-h Web survey. More than ten thousand people in China and elsewhere participated. Most of the participants had overall good knowledge of the disease, yet a knowledge gap was noticed in people of varying ages and educational levels. Residents of Hubei were more anxious than those of other regions. Highly agreement with the effectiveness of overall control measures was negatively correlated with the number of regional existing confirmed cases.

The overall knowledge of COVID-19 was satisfactory, which can be attributed to the broadcasting of the latest situation and scientific research. The media played a pivotal role in raising public awareness and improving people’s knowledge of COVID-19. According to our data, 82.4% of the participants learned about COVID-19 from the Internet. With the wide use of smartphones, the information that people obtained was abundant and updated in a timely manner [8, 9]. For example, people could gain access to real-time data on the number of confirmed cases reported by authorities and know what happened to a person in Wuhan, Hubei as soon as this information was posted on the web. With social media, the spread of information was explosive, in both speed and scale. Chinese Internet users spend more than 5 h online each day [10]. There is no doubt that people could gain more knowledge about the controlling and preventing of COVID-19. However, some information on social media was unverified and even consisted of rumors, which may mislead receivers and cause panic. Seniors and people without tertiary education may have more difficulty accepting scientific information and identifying rumors, contributing to the discrepancies in the knowledge obtained. The awareness of Hubei participants was not as good as that of participants from other regions, and the lower percentage of healthcare workers among Hubei participants could be the reason. In addition, compared to participants from other regions, the awareness of Hubei residents more often originated from personal experience, leading to subjective opinions about the disease.

It should be noted that more than half of the participants that there was fecal-oral transmission and agreed with the efficacy of plasma antibodies, which have not been verified with solid proof [3, 11‐14]. The overreporting of related studies and specific cases made people too concerned about being infected. More than half of the participants believed that COVID-19 could be transmitted through talking with others or shaking hands with others. The overwhelming information on social media, the inability to distinguish between good information and bad information and the exaggerated reporting of specific cases contributed to these cognitive biases. These results suggest that the accuracy of media information during the spread of information should be improved.

Residents of Hubei were more anxious than those of other regions; however, the degree of anxiety had no correlation with the number of existing cases. The reasons for this result are as follows. First, the prevalence of COVID-19 in Hubei (32,959/59.17 million) was nearly 70 times that in the Hong Kong Special Administrative Region (60/7.45 million), a municipality with the second highest prevalence on 29 February, 2020. It was very likely that a resident in Hubei had relatives or acquaintances with COVID-19, which would greatly increase anxiety. For residents of other regions, infected people may just appear in the news. Second, the enormous medical burden in Hubei raised concerns about not being diagnosed and treated in a timely manner when people were sick. Third, people in Hubei were at the forefront of the pandemic and were the focus of people all around the world. The overwhelming online news and rumors about Hubei and even regional discrimination in China and elsewhere led to great anxiety.

The number of participants with highly agreement with the effectiveness of the overall control measures was moderately negatively correlated with the number of regional existing confirmed cases. Approximately 90% of the participants considered social distancing policies necessary and effective. However, there was a significant difference in highly agreement with the effectiveness of the overall control measures between the participants from Hubei and those from other regions. This result may be attributed to the extreme shortage of medical resources in Hubei when the outbreak occurred. In addition, the huge number of confirmed and suspected cases in Hubei upset residents, particularly the reports that the quarantine and control measures may have been initiated too late [15, 16]. According to a study on the prediction of the pandemic trend after public health interventions in mainland China, if control measures were implemented 5 days later, the scale of the outbreak might have tripled and if they were implemented 5 days earlier, the scale of the pandemic may have decreased to one-third [17].

This study has some limitations. The questionnaire was first released by the authors in a WeChat friends circle and then, the link was voluntarily forwarded by the authors’ friends. Thus, most participants were from Shanghai, where the study group was located, followed by cities around Shanghai in southern China. As a result, the percentages of healthcare workers and participants with tertiary education were much higher than the average level in China. In addition, some special questions related to the pandemic were not included in the questionnaire to avoid negative effects on the participants.

The current survey was initiated at the end of February and finished in 48 h. With the dynamic changes and information updatation in the pandemic situation in China and abroad, knowledge of and attitudes towards COVID-19 may change [18‐21]. Moreover, our knowledge of the disease will improve as more researches are conducted. Further studies should be conducted to explore changes in public knowledge and attitudes in the future. The media have a great room to publicize knowledge of infectious diseases such as COVID-19 and prevention and control measures in the future to promote physical and psychological health, halt the spread of infectious diseases and conduct epidemiological studies. Nevertheless, the overwhelming information on social media, the inability to distinguish between good information and bad information and the exaggerated reporting of specific cases could contribute to cognitive bias and psychological disorders among members of the public. Thus, the accuracy of media information during the spread of the information should be improved.

In conclusion, the survey revealed that the Chinese public had overall good knowledge of COVID-19 except for those indeterminate knowledges, which still needs to be elucidated. With dynamic changes in the global pandemic situation and more researches, further studies are needed to explore changes in public knowledge of and attitudes towards COVID-19 in the future. The media can be used in a strict and regular manner to improve people’s knowledge of epidemics, promote physical and psychological health, halt the spread of future epidemics and conduct epidemiological studies.