Introduction
Lockdowns during the Coronavirus disease 2019 (Covid-19) outbreak include a range of largely non-pharmaceutical interventions to limit physical interactions and introduce social distancing [
1]. Although the introduction of a lockdown is an effective strategy to slow the spread of infection [
2], several studies pointed out its negative effects on mental health [
3‐
5], health behaviours [
6], social connectedness, and loneliness [
4]. A recent report presented by the Association of Schools of Public Health in the European Region found that lockdown restrictions contributed to an increase in problems such as addiction, poor diet, lack of physical activity, deteriorating mental health, and domestic violence [
7]. As these lockdowns have so negatively affected individuals in these ways and have had a devastating impact on economic growth, public debt and employment [
8], lockdown measures should be administered carefully and should be based on unbiased carefully collected data [
9,
10]. The adverse effects of the lockdowns should not be ignored and officials should take every measure to minimise the societal impact and ensure that this experience is as tolerable as possible for the general population [
11‐
14]. Therefore, the evaluation of lockdown strategies and containment policies is crucial. In a cross-sectional study, Sabat et al. found that citizens of seven European countries (Denmark, France, Germany, Italy, Portugal, the Netherlands, and the UK) were generally satisfied with their government’s responses to the Covid-19 outbreak [
15]. To the best of our knowledge, there are only a few studies published so far that assess policy responses and people’s perceptions of the implemented public health measures during the Covid-19 outbreak and their compliance with the government-advised preventive measures across several time-points.
Lockdowns in Austria
Austria initially reacted quickly to the Covid-19 pandemic and was praised for the policies it implemented to contain the virus [
16]. The first lockdown was introduced in March and the second one in November. Both required all non-essential business and schools to close and reduce social contacts. According to the Oxford Covid-19 government response stringency index, at the time of the first and the second lockdown, the score for Austria on a scale from 0 to 100 (100 = strictest) was 81.48 and 82.41, respectively [
17].
The first case of Covid-19 in Austria was diagnosed on 25 February 2020 [
18]. The first lockdown was imposed 20 days later on 16 March when the cases grew to 1192 [
19]. Stores selling non-essential goods as well as bars, restaurants, federal parks, sports facilities and public baths were forced to close. Supermarkets, chemist’s shops and pharmacies remained open. Air traffic was largely suspended. Strict contact regulations and curfews based on the Covid-19 law came into force [
20]. On 26 March a peak of new daily cases (1050 cases) was reported and a peak of daily deaths from Covid-19 followed on 6 April with 31 deaths reported [
19]. The number of active cases started to decrease after reaching its peak (8981 active cases) in the beginning of April 2020, which led to an easing of restrictions beginning 14 April.
After a summer with fairly low case numbers, a steeper growth curve was observed from September onwards with a dramatic increase in new daily cases in October [
16,
19]. While at the end of September 8602 active Covid-19 cases were reported in Austria, this number grew to 43,187 by 31 October [
19], an increase of 400%. On 11 November 2020 a peak of new daily infections was reported at 9216 confirmed cases.
Based on the success of the first lockdown in reducing the spread of the virus, the Austrian government implemented a second lockdown to hinder the rapidly growing pandemic curve. On 3 November a “light” lockdown was imposed which quickly turned into another “hard” national lockdown that began on 17 November. The restrictions included closure of cafes, restaurants, hairdressers and beauty salons, and all shops except those providing essential services and selling essential goods (e.g. grocery stores, pharmacies, post offices, gas stations, etc.) with an obligatory closing time of 7:00 pm. Primary schools joined secondary schools and universities in moving to distance learning. A 24-h curfew was introduced and people were allowed to leave their homes only for essential purposes such as: caring for other people or animals, family duties, outdoor exercise, and visiting religious institutions. Visits in hospitals and nursing homes were reduced to one visit per week. In public spaces, one meter distance between persons outside the same households was required as well as compulsory masks in indoor spaces and public transport. Only take-away and delivery was allowed for restaurants, and hotels and accommodation establishments closed, with an exception for business trips. Events were prohibited, and sports and leisure facilities were closed. Home office was recommended when possible but was not mandatory [
21]. This lockdown remained in effect until 6 December.
Aim of the study
Studies conducted in Austria reported many negative impacts of the Covid-19 lockdowns including increased loneliness [
22], worsening of mental health [
23‐
26], decreased quality of life [
24], and decreased engagement in sports [
27]. In terms of the long-term impacts, one study reported that depression did not improve in the weeks after lifting lockdown measures [
28]. The Austrian Corona Panel Project showed further negative effects of the Covid-19 lockdowns [
29] in terms of the economic, political and health aspects such as loss of income especially among low income households, loss of trust in the parliament and the federal government, and an increase in the cigarette and alcohol consumption during the first lockdown [
30‐
33]. Due to the negative consequences of the lockdowns and of the pandemic, nuanced evaluation of policies is crucial for the design of future restrictions implemented to contain the spread of Covid-19. In this study, the aim was to assess and compare the general population’s experiences of the Covid-19 situation and their attitudes towards public health measures during the two lockdowns in spring and fall of 2020 in Austria.
Methods
Recruitment of study participants
Study participants were recruited using convenience sampling, i.e. people who self-selected to become part of a study when responding to an advert. Any adult over 18 years with sufficient German knowledge and main residency in Austria was able to participate.
The first wave of the survey was conducted between 27 May and 16 June 2020, with all questions referring to the one-month lockdown period in Austria between 16 March and 15 April 2020. The weblink for the online survey was distributed via social media platforms (Facebook and Twitter) and by directly contacting several institutions across Austria (e.g. universities, sport clubs, the Red Cross, non-profit mental health organisations such as pro mente). Information about the study was shared on the Facebook and Twitter sites of the Medical University of Vienna and through various Facebook groups related to Covid-19 (e.g. Coronavirus Österreich, Coronavirus Österreich Info, Das Coronavirus (Covid-19) Hilfe & Erfahrungen & Austausch). To reach a more diverse study sample, information about the study was posted to the comments sections under Covid-19-related articles on Facebook that were shared by the most popular newspapers in Austria (e.g. Der Standard, Die Presse, Ö24, Heute and local online newspapers). As part of the first wave of data collection, all recruited participants were invited to provide their e-mail addresses at the end of the survey and agree to be contacted for follow-up data collection.
The second wave of the study was conducted between 2 December and 9 December 2020 with questions referring to the second national lockdown in Austria between 17 November and 6 December 2020. Those participants, who provided their e-mail addresses in the first round of data collection, were contacted and a link to the second survey was provided.
Survey design
The survey was developed in the SoSci online survey platform [
34]. The survey was conducted in German and consisted of questions about socio-demographics, Covid-19-related questions (including information about Covid-19 infections), lockdown-related questions (including the perceptions of the public health measures in place during the lockdown in Austria). The questionnaire used in the study (translated to English) is provided in Supplementary file
1. Further details of the study design and recruitment can be found in Simon et al. [
26].
Data analysis
Collected data were checked for inconsistencies. Any entry with time of completion below 7 min was deleted from the dataset. Data were analysed primarily using descriptive statistics. Mean values and standard deviation were reported for continuous variables and frequencies were reported for categorical variables.
Data related to the personal experience of the Covid-19 lockdowns were collected on a five-point Likert scale (1 – Strongly disagree, 2 – Slightly disagree, 3 – Neutral, 4 – Slightly agree, 5 – Strongly agree) with higher scores presenting higher level of agreement with the statement presented to the study participants. Data were summarised using means and standard deviations for ease of comparison of the answers between the two lockdowns. Differences between the two lockdowns were assessed using the chi-square test for categorical variables.
Variables related to the perceptions of the necessity of imposed public health measures and compliance with the public health measures were collected on a scale from 1 to 10 (ranging from 1 ‘Completely unnecessary’ to 10 ‘Absolutely essential’; and from 1 ‘Not complying at all’ to 10 ‘Complying completely’). These data were re-coded to a 5-point scale: 1 – Completely unnecessary (answers 1, 2), 2 – Unnecessary (answers 3, 4), 3 – Neutral (answers 5, 6), 4 – Necessary (answers 7, 8), 5 – Absolutely essential (answers 9, 10); and 1 – Not complying at all (answers 1, 2), 2 – Not always complying (answers 3, 4), 3 – Neutral (answers 5, 6), 4 – Complying most of the time (answers 7, 8), 5 – Complying completely (answers 9, 10) and presented as frequencies.
Variables related to the impact of Covid-19 on different areas of life were collected on a 1 to 10 scale (1 ‘No disruption at all, 10 ‘Serious disruption’) and the differences in answers between the two lockdowns were assessed using a two-sample t-test with unequal variances.
We used an alpha level of 0.05 for all statistical tests. All analyses were performed in Stata v.16. The graphs were created in Stata v.16 and Python.
Discussion
The study offers a comprehensive insight into experiences of the Covid-19 pandemic situation as well as perceptions and attitudes towards imposed public health measures of the general population during the two lockdowns in Austria. More specifically, the study provides a snapshot of people’s opinions, concerns, personal experiences and perceptions of and compliance with preventive measures throughout the Covid-19 pandemic in Austria during the two lockdowns in March/April and November/December 2020. Based on the collected data, we can draw conclusions from the two confinement stages in the Covid-19 pandemic that can facilitate the discussion around the design of future lockdown strategies and confinement policies.
Our findings suggest that, compared to the first lockdown in March/April, the time period during the second lockdown in November/December appeared to have significantly more negative effects in terms of personal experiences of attachment to the local community, appreciation of healthcare workers and people around, and feeling of understanding better what really matters in life. It also caused more disruption to friendships, leisure activities, and community and family lives. Furthermore, compliance with the government-imposed restrictions reduced between the two lockdowns, except for the use of masks and face coverings in indoor public spaces. For instance, we observed the reduction in compliance with restrictions on leaving private dwellings during the second lockdown. This result confirms the analysis of the mobile phone mobility data during the two lockdowns in Austria which showed that there was a clear change from lockdown to lockdown. While the observed reduction in mobility across nine federal states varied between − 57% and − 80% during the first lockdown in March/April, the reduction observed during the lockdown in November/December was lower and ranged from − 30% to − 50%, as compared to the weeks preceding the introduction of restrictions [
39]. Moreover, the perceived necessity and compliance with some of the public health measures was different among age groups, gender and regions of Austria. For instance, our study found that the compliance with the Covid-19 lockdown measures was lower among men compared to women. These results are consistent with similar international studies [
35,
36].
The findings on the high support with the mandatory face mask use in public spaces observed in our study is in line with the findings of the Austrian Corona Panel Project which also showed the highest support for this public health measure. In our study, 80% of study participants saw this measure as absolutely essential during the second lockdown, compared to 72% participants of the Austrian Corona Panel Project during a comparable time period [
30]. The compliance to this measure was the highest of all presented measures in our study during both lockdowns which can be explained by an increased police presence and fines for not wearing a mask.
In the second wave of the study, more respondents indicated that the Covid-19 lockdown did not pose any threat to their livelihood/income as compared to the first wave of data collection. This could be associated with the characteristics of study participants who, in comparison to the general population in Austria, were more educated (54% in the study sample in the first wave of data collection and 63% in the second wave of data collection, compared to 13% in the general population [
37]). A recent study from Austria showed that the negative effects of the Covid-19 pandemic were most notable in lower socio-economic groups especially in the case of job loss, decrease in financial stability, and declining mental health [
40]. A smaller proportion of respondents felt more isolated since the beginning of the second lockdown in November/December, when compared to the first lockdown. This may be related to the slightly different regulations during the second lockdown in Austria which allowed for visitation of close relatives and important caregivers as well as partners who do not live in the same household which was not officially allowed during the first lockdown.
Two-thirds (66%) of respondents in our study agreed that the government provided sufficient information about the Covid-19 pandemic situation in March/April, compared to nearly 68% of respondents of the Austrian Corona Panel Project who reported in March that they were very or somewhat satisfied with the work of the government. When compared to other countries, during a similar time period, 45 and 61% of study respondents in Norway and Sweden, respectively, strongly agreed or agreed that they trusted their government during the first wave of the pandemic in March and April 2020 [
41]. In our study the proportion of respondents who agreed that the government provided sufficient Covid-19 advice decreased by 18% between the first and the second lockdown. At the same time, the Austrian Corona Panel Project reported almost 50% decrease in satisfaction with the government’s work between March and December 2020 [
42]. Together these findings suggest a negative trend over time in relation to the perceived effectiveness and transparency of the government actions taken during the pandemic.
Our study showed that during the first lockdown people rated their experiences related to the attachment to the local community, appreciation of life and healthcare workers, and people around being more friendly higher, compared to 7 months later during the second lockdown. Similarly, in the Austrian Corona Panel Project, the initially very positive assessment of the development of social cohesion continued to decline with each wave of surveys since March 2020 [
43]. It is not clear whether this decline is related to the general decrease in the perceived social cohesion and solidarity, or the fact that the prolongation of the pandemic and recurring lockdowns made people lose hope and confidence that the situation would resolve and holding together as a community could end this crisis sooner.
Since the Covid-19 pandemic is far from being over and future lockdowns are inevitable, there are a few lessons we can learn from this study that may be useful in future planning of confinement policies. Firstly, our findings show that the compliance with certain restrictions decreased between the first and the second lockdown which raises a question about the effectiveness of future lockdown measures due to declining compliance. A study from the United States also found that as the pandemic progressed, both younger and older people tended to resume potentially risky social behaviours, especially in terms of visiting friends and family [
44]. This aspect should be considered when designing new measures as well as the timing and length of future lockdowns in addition to certain support measures (e.g. availability of free testing, psychological and financial support services) that could improve compliance and lessen social and economic disruption. Secondly, according to our data, closure of schools had a very low approval among study participants, especially among women. This indicates an increased burden related to childcare and home-schooling during the pandemic experienced by women. This should be taken into account when planning further school and childcare facility closures. As outlined by Power (2020), specific policies during the Covid-19 pandemic should focus on support and protection for unpaid care-givers, including subsidies to replace pay for workers who are unable to work due to the closure of schools and daycare facilities, expanding access to paid family leave and paid sick leave, and extending benefits to those resigning from employment to provide child care due to the pandemic [
undefined]. Thirdly, we observed that people felt that they did not receive sufficient information about the Covid-19 situation from the government during the second lockdown, when compared to the first lockdown. This is concerning as this finding might also indicate that also the trust in the information received from the government decreased as the pandemic progressed. Studies indicate associations between the political trust and social distancing practices by members of the general population [
46] and overall compliance with restrictions during the Covid-19 pandemic [
47]. Trust in official governmental media proved to be an independent predictor of protective behaviours in a study from China [
48]. Since adherence to government-imposed restrictions by the general population is key in containing Covid-19, the focus should be on restoring political trust of the general population.
Some limitations of this study need to be considered. The study sample was collected via online adverts and the responses may not be generalizable to the whole Austrian population. The majority of the participants were women, and there was an overrepresentation of the age group 30 to 49 years and underrepresentation of the age group above 65 years [
35] as well as overrepresentation of people with higher education [
37], compared to the general population. This is a common limitation observed in online surveys. Previous research has shown that younger age [
49,
50] and higher education [
50,
51] predict higher willingness to participate in online surveys. Furthermore, the presented analysis is mostly descriptive and any tests of differences are conducted on unadjusted data. However, since the survey in the second wave of the study was conducted on a sub-group of participants from the first wave, and there were no significant differences between the two groups in terms of participant characteristics, the presented results outlining differences observed between the two lockdowns are robust for this sample.
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