Perceived risk of COVID-19 in Central Indian population

Background: risk perception inuences the behavior of the people. With gradual unlocking in India it is important to understand the perceived risk of people for COVID-19 issue as it might inuence number of new positive cases in India. Material and method: this was an online survey which measured the perceived risk under two domain, risk perception of disease and trust people have in authorities and themselves to ght against COVID-19. SPSS 23.0 was used for data analysis. Result: Total sample size is 797. Only participants above age of 60 have high risk perception. But overall risk perception is low. All have high trust in scientist to develop an effective vaccine soon. The overall trust of participants is high which resulted in low risk perception. According to our study participants have low perceived risk. Conclusion: with low perceived risk, there and chances of increase of cases in COVID-19 positive patients. And people should not be misled by false sense of immunity and authorities should be prepared for second wave.


Introduction
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease , was rst identi ed in December 2019 in Wuhan city China, which latter spread globally. The rst SARS-CoV-2 positive case in India was reported on January 30 th , on same day the WHO declared COVID-19 a Public Health Emergency of International Concern 1 .
India implemented a complete national lockdown on March 25 2020. The lockdown continued till 68 days.
But this lockdown has severely affected everyone emotionally, as well as nancially. Hence on June 1, 2020, the complete lockdown was lifted and relaxations provided through federal (union) directives to the states and union territories (UT). During this period the COVID-19 cases were on rise, but instead going for lockdown 2.0 India went for unlocks 2.0 and 3.0 with restriction. This was be followed by unlock 4.0 in September. Now the fate of COVID-19 is in hands of people and how they adapt to this new normal. Preventive behavior developed by the population is essential in the face of the risk of COVID-19 infection. However, preventive measures will depend on the risk perception acquired 2 .
Risk perceptions refer to people's beliefs and feelings about the possibility of disease or other harms to health. Perceived risk is a key predictor of both motivation to take protective action, and subsequent performance of health behaviors geared at alleviating the threat 3 . From the previous pandemic, we have learned that people's behavior can fundamentally in uence and alter the spread of a pandemic which is in uenced by the public having accurate perceptions of personal and societal risk factors 4 .
The literature has shown that in times of the COVID-19 people may behave so differently than their normal behaviors. Thus, risk perception of COVID-19 is potentially a signi cant determinant of the pandemic evolution, as it could in uence the number of new positive cases 5 . Hence accurate public risk perceptions are critical to effectively managing public health risks. In this study, we tried to nd out the perceived risk of the general public by checking two parameters their risk perception and their trust in agencies to ght COVID-19 infection.

Sample
The survey was conducted in Maharashtra state using convenience sampling method. The original perceived risk questionnaire was modi ed according to Indian population, and was validated a pilot study was conducted to test its readability and content validity. Sample size was 797

Measure
Questionnaire was divided into three domains. First Domain consisted demographic data of participants.

Statistical analysis
Descriptive statistics, frequency, mean and standard deviation were used to describe the data. ANOVA was used to examine the difference between variables. P-value of <0.05 was considered statistically signi cant. Spss 23.0 was used for data analysis.

Result
Out of 797 responses, majority were male graduates between age group 20-40. Of all respondents 21% of participants, either they themselves or theirs family members have suffered from COVID-19 infection. To analyze the risk perception towards COVID-19, the score of 1-3 was considered as low risk and 4-5 were considered high risk perceived.    Table 2 shows distribution of total perceived risk and demographic data. There is statistical signi cance in perceived risk and age (p-value 0.001) participants above 60 have higher perceived risk as compared to others. There is also statistical signi cance in group who has suffered from COVID-19 before and total perceived risk (0.008). However no statistical signi cance was seen in gender and education with total perceived risk. Table 3 shows distribution of trust and demographic data. Statistical signi cance was seen only between education and over all trust (0.001). No statistical signi cance was seen between age, gender or previous history of COVID-19 infection and total trust.

Discussion
By now almost everybody is aware of the COVID-19 issue and acquired enough knowledge to prevent the spread of disease, the government has made various law like mandatorily wearing a mask in public places, and penalties for violating the terms of quarantine or not wearing a mask when in public or other such advisories like frequently washing hands. But now what is needed from the public is a change in attitude which in uences precautionary behavior. Risk perception is a feature of protection-motivation theory 6 . That might in uence the public's willingness to adopt health-protective behaviors during pandemics, including frequent hand washing, physical distancing, avoiding public places, and wearing face masks.
The worry of acquiring a disease can in uence the perceived risk of a pandemic. It is a response to a threat, which can predict perceived risk in uencing protective behaviors 7 . According to our study, the majority are not worried about the COVID-19 issue. the majority are not worried that they themselves or their family member may be infected by the virus. Our nding does not match with previous studies which state that people are worried about getting infected by COVID-19 8 . According to our study, people think that getting infected by COVID-19 cannot be serious, this may be because the majority of our participants were of age group 20-40 and the symptoms of corona are not too severe in the young age group. An ironic nding of our study is the majority feel that many people of their city may get infected by the COVID-19 virus but they themselves or their friends and family cannot get infected by the virus. With this attitude, people are less likely to adopt self-protective behavior.
Trust is one major factor that contributes to shaping an accurate risk perception of the disease. According to the Trust and Con dence Model, trust plays an important part in managing a threat by affecting the person's judgments about the risks and the related bene ts. Trust can in uence the behavior for adopting recommended measures 9 . In our study majority of participants have shown trust in the government to deal effectively with the pandemic. Participants have a huge amount of trust in scientists to develop an effective vaccine soon. Our ndings are consistent with previous studies where people have a positive attitude towards the COVID-19 vaccine 10 .
Previously researchers have found that in the past few weeks, doctors across India have been experiencing a lot of unsolicited behavior from the general population 11 . But in our study, we found that people have trust in doctors and nurses to provide proper treatment for corona patients. The majority of people feel that the personal actions taken to prevent the spread of COVID-19 are enough but as compare to this the trust in Actions taken by the city are not enough to prevent the spread of COVID-19. The overall trust in government, scientists, doctors, city administrative, people, and themselves is high. Previous studies have shown that the more general trust the less is perceived risk of the person 4 . With low risk perception and high trust, it can be said that total perceived risk is low among people. Similarly he study conducted in Europe also suggested that the perceived risk for COVID-19 2 .

Conclusion
According to our study, the total perceived risk is less and the trust domain is high this shows that the overall perceived risk is very low in people, during unlocking. Hence it will be di cult to observe the precautionary behavior of people. Since major coronavirus outbreaks often occur in waves, surviving the primary wave could also be amid a misleading sense of immunity. So the only hope in the near future is developing herd immunity and the development of a vaccine. Otherwise, the rise in COVID positive patients will be uncontrollable.

Limitation
As the study was online, and the questionnaire was in English we could not reach to masses especially the vulnerable class of less educated and aged people.

Declarations
Ethics: This study was approved by ethical committee of V.S.P.M DCRC. As the study is questionnaire based study no approval letter was given.
Consent: As far statement of participants consent is concern, there was a short message attached with questionnaires that agree to ll the form is giving consent.
Competing Interest: Authors declare no competing interests.