In view of the rapid spread of COVID-19 and the increase in the number of cases in Pakistan, it is necessary to have a clear picture of the state of public awareness and their practices in the context of the precautionary measures. In addition, Pakistan is a populous country and is facing enormous pressure on non-communicable diseases . Both factors increase the country’s vulnerability to this deadly infection and results in higher mortality and morbidity. Moreover, Pakistan's history of dealing with epidemics required a high level of preparedness by government as well as masses. Global efforts have been made to reduce the transmission of this contagious infection. These efforts include political efforts by the governments, together with personal attitudes and behaviors, which depend on the awareness of the general public about the disease.
Findings revealed that almost half of the population had good knowledge, and 80% had a precautionary approach. News channels such as the internet and social media platforms had become commonly used information sources compared to traditional channels such as newspapers etc. Social media was the primary source of information to be used by the general public (66.62%) in Pakistan to obtain information on COVID-19. This could be explained by the fact that most study participants were under 30 years of age and had university level education. This stratum is the main user of the Internet in Pakistan, according to a recent survey by the Pakistan Telecommunications Authority (PTA), 63% of the 76 million people who have access to the Internet are under 30 years of age .
This finding has implications that although social media platforms could be an easily accessible source of information, there is a potential risk of misinformation. As with this pandemic of COVID-19, there is also a pandemic of misinformation on the Internet that leads to negative reactions from the public . Mainly, false information regarding the potential benefits of certain drugs such as hydroxychloroquine stimulated the irrational use of this drug by masses, and this results in a shortage of these medicines and becomes unavailable to patients who need .
Results show that 48.19% (n = 332) of the population had good knowledge of the nature, transmission, risk groups and precautionary measures of COVID-19. This rate of good knowledge is lower as reported in a Pakistani study (64.8%) , a Malaysian study (80.5%)  and a Chinese study (90%) . However, this is in agreement with the findings of Abdelhafiz et al., who reported Egyptians had average (16.39 ± 2.63, range: 7–22) knowledge regarding COVID-19 . A possible reason for less knowledge reported in this study could be explained by the fact that most respondents attained COVID-19 related information from social media. Owing to unauthenticated and the use of social media to get information can explain the existence of myths and misinformation among the general public.
Of note that more than half (55.6%, n = 383) of the study population incorrectly reported that COVID-19 directly leads to death. While wolf et al. reported that only 14.2% of US adults think that COVID-19 may cause death . Possible speculation is that factors such as the outbreak itself and consequential lockdown result in severe psychological impact as khan et al. reported 87.73% of the studied population feared the current situation, which leads to fatigue, anxiety, and depression . Additionally, misinformation surging on the internet and related economic pressure also put immense pressure and creates negative feelings about the situation .
The adjusted regression model revealed that higher education and monthly income are substantial predictors of good knowledge (P < 0.05). These results are in line with an Egyptian study which also stated that public awareness was important in terms of its socioeconomic status and level of education (P < 0.002) . A Chinese study concluded that higher education (middle school or lower vs. Master β: 1.346, P < 0.001) played a significant role in increasing good knowledge . While an American study didn’t found any difference in respondents' knowledge regarding symptoms by poverty level (68.5% vs. 73.1%, P > 0.05) , this finding is of particular importance for the Government and the authorities concerned to focus on the less privileged stratum of society to ensure the effective implementation of precautionary measures.
Findings indicated that 80% of participants had positive practices in following precautionary measures. This is in line with the results of Zhong et al., who also reported that the majority (> 90%) of participants were following precautionary measures . Possible speculation of a higher rate of good practices depsite of only 50% population had good knowledge could be that of campaigns lauched by Government describing causes, symptoms, and route but these awareness campaigns primarily focused on highlighting precautionary measures such as wearing a facemask, social distancing, and hand hygiene practices.
Note that 20.2% of the participants did not wear a face mask when they left their homes. This poroprtion is much higher than the chineese study, which reported that only 2% of the population studied did not wear a face mask. . While Pakistani study reported that 14.2% of the people surveyed did not wear a face mask. Despite the vigorous broadcast of precautionary measures, this risk of taking action could be attributed to the younger age of the participants. Additionally, this might be because face mask shortage in different parts of the country due to high demand as well as price hiking also affects the affordability of the less income stratum. The government had taken several measures to ensure the availability and price control of all personal protective equipment (PPEs) (Pakistan Medical Workers Score Win as Gov’t Says It Will Ensure PPE | Democracy Now! ).
The adjusted multivariable logistic regression model demonstrated that older age, higher education, and knowledge regarding COVID-19 are the factors that substantially related to the positive attitude among the general public in Pakistan. Zhong et al. found that knowledge was significantly associated with positive practices as Chinese individuals with higher education regarding COVID-19 were less likely to visit crowded places (OR:0.90, p = 0.001) and not wearing a face mask (OR:0.78, p < 0.001) . While a Pakistani study also concluded that younger age (vs. 30 years; OR = 3.08, p < 0.001) and lower education (matriculation vs. Master degree, OR = 6.829, p < 0.001) were the characteristics potentially associated with poor practices regarding COVID-19 .
To control the pandemic, there is a need for continuous monitoring of the implementation of preventive measures, the review of existing interventions and the updating of such responses. This study helps to inform the current state of awareness and practices of preventive measures and adds to the findings of a previously conducted study in Pakistan .
There are a number of implicit limitations to the study. First, as this is an online survey design, the response depends primarily on honesty and partly on the ability to recall and may, therefore, be subject to bias recall. However, due to a policy of lockdown and social distancing, the survey hand filling was not possible. Second, the sample size is not large enough, and most of the respondents were from one province (Punjab), which limits the generalizability of the population in the whole Pakistan. Potential sample clustering, as the majority (> 60%) of participants were young and students, may also limit the generalizability of the study.