The COVID-19 pandemic is continuing to spread across the USA, even as the government continues to tries to put measures in place to limit the spread of the virus at state and federal levels. As of now, this country has seen the highest number of cases and deaths in the world. The former accounts for approximately 2% of the total population of the USA, at above 5.8 million. In a new study published on the preprint server medRxiv*, researchers from the Yale Institute for Global Health analyzed the shift in COVID-19 risk perception, behavior, knowledge, and attitude across the U.S. from February to May 2020 by surveying 672 adults.
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
Preventive Behavior and Health Communications
Many Americans have adopted containment measures such as wearing masks when in contact with people from outside their household, washing their hands after touching any potentially contaminated surface, and physical distancing. However, there is a sizable number who refuse to do so, putting themselves and others at risk. The decision is made based on their risk: benefit assessment, which in turn requires that public health authorities recognize the trends in COVID-19 risk perception across the country. This need is highlighted by the fact that sociocultural factors play a leading role in defining such risk perceptions and the health outcomes associated with it.
In previous pandemics, it has been shown that following recommended health behaviors are crucial to changing the course of viral transmission. This emphasizes further the need to understand how the public understands the risk of viral transmission and illness. In addition, it has become clear that all populations of the American society are not at equal risk, since the overcrowding and underlying chronic disease states commonly encountered in the underprivileged segments of society are pushing up their risk far beyond average levels. This includes the poor of any race, and also Black, Hispanic, and Native Americans. Thus, the risk perception must be shaped sensitively, knowing that such communities have historically been at risk of unethical research methodologies and are therefore understandably suspicious of the medical establishment.
Higher Risk Perception Among Older People
The study was made up of 672 adults, mostly white, with a college or graduate degree. On average, the risk perception was 5.9 and was higher compared with that calculated from an earlier February survey.
The researchers found that people above the age of 55 years from Native American, Native Alaskan, or Asian ethnicities, perceived higher COVID-19 risk. Increased risk perception was also found in those who had already got the infection or knew someone who had it. Blacks, however, did not share this elevated risk perception.
About 93% of the participants said they knew of the pandemic, about 72% rating their knowledge as good or very good. This was up from 39% in February. This self-assessed rating was confirmed by a calculated knowledge score, in which May participants scored better than those who participated in the February survey.
Over 80% correctly stated that there was no vaccine or cure for the illness at present, but 9% and 4% thought there was a cure or vaccine, respectively. Over half of this misinformation came from the media.
Prevention of Infection
Most participants agreed with policies that restrict physical mobility for those likely to carry infection, including quarantine, travel bans, closure of common community facilities, and event cancelations. The greater the risk perception, the higher was the risk score. The release of non-violent prisoners as part of such containment measures was a “Yes” for 36%, again following the same trend. Risk perception was also more significant for the third of participants who thought temporary discrimination against an ethnic group was reasonable under pandemic conditions (this figure was 38% when adjusted by age, sex, and race). The fuel for this type of discrimination, typically being experienced by Asians, is fear based on the false belief that this ethnic group is more likely to transmit the virus.
Almost 60% of participants reported it was easy to follow the CDC public health recommendations. For the 17% who said that they were difficult, the most common rationales were lack of clarity on the duration of the pandemic and being an essential worker. Still, 85% said they used face masks following CDC guidelines reported it was hard to follow the CDC guidelines, while over 90% said they followed CDC guidelines other once face masks were excluded. Those who reported the highest risk perception typically had or planned to buy reserves of medicine, food, and other stocks of daily necessities.
Economic Perceptions
Most participants said they felt the pandemic had caused a huge economic impact, but that containment measures were rightly prioritized over economic health, at 84% and 70%, respectively. This is in contrast to media reports that ‘most’ Americans oppose lockdown measures, and may indicate that the media is propagating a false picture of what Americans feel about the pandemic.
Confidence in Official Information and Action
Overall, healthcare professionals and health officials enjoyed the trust of the participants, but not social media. However, health organizations such as the CDC, DHHS, NIH, and the AMA suffered a significant loss of trust. About 35% said they wanted the U.S. President to lead the initiative against the pandemic, significantly higher than the 13% of the February survey. Less than 20% of people favored a leading role for the CDC in contrast to the 53% who wanted this in February.
Need for Trust-Building and Sensitivity
The researchers found that risk perception was variable among demographic groups in the USA. While more people are currently aware of the illness, over 15% still reported false beliefs about it, perhaps due to misinformation and contradictory messages from different sources. This may help public health agencies to understand why some people are likely to resist taking preventive action.
They conclude, “Our study demonstrates the continued need for targeted messaging about appropriate infection prevention and protective measures.”
When information about an ongoing crisis is not forthcoming, it may breed suspicion and fear. The current study bears this out, with many participants saying they trusted information on the pandemic from the White House or Congress least of all, compared to that from doctors and other healthcare professionals. This may be due to contradictory and delayed communications from these bodies.
The researchers comment, “The White House, Congress, and public health organizations, especially the CDC, must agree on the information being communicated to the public and be transparent with the American people to ensure trust in public health and governmental authorities.”
Currently, Asians are often discriminated against as the source of the virus, with Asian-owned restaurants experiencing a decline in takeout orders and Asian communities a fall in the number of visitors from other races. This is only exacerbated by the labeling of the virus as the ‘China virus.’
Implications
The study is limited by the need for all participants to have a CloudResearch account as well as the use of a smartphone or computer to participate in the survey. However, it is important to recognize that this examines in detail the risk perceptions of COVID-19 during the pandemic, as well as changes over time.
The study concludes with the need for leadership in clear and competent health messaging that will also be evidence-based and sensitive to community cultures, to promote the adoption of preventive measures as reopening strategies are being implemented across the country.
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
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