Public awareness of Coronavirus (COVID-2019) in Qassim Region Saudi Arabia

Abstract


Background
Coronavirus disease-19 (COVID- 19)is more commonly referred to then Coronavirus, the main causative agent of the newly emerged communicable disease that is brought about by a new strain of the coronavirus (1).It has been o cially named the Severe Acute Respiratory Syndrome Coronavirus 2, or SARS-CoV-2 (originally, this was called 2019-nCoV)(1) (2).In 2019, there was a spate of cases of respiratory illness that rapidly turned into an epidemic in Wuhan City, which is located in the Hubei Province of China (3).The rst report of this was made to the World Health Organization (WHO) on the 31 st of December of the same year (4).Approximately one month later, on the 30 th of January 2020, the WHO announced that the outbreak of COVID-19 was being proclaimed a global health emergency (4).In addition, since the 21 st of January 2020, the WHO has been publishing daily 'Situation Reports' on its website to update on the main facts, numbers (cases, deaths, and recoveries, by country), and other associated information about the disease (4).
The main symptoms of COVID-19 are fever, a cough, and shortness of breath, while the less common symptoms include muscle pain, anorexia, a general feeling of un wellness, sore throat, nasal congestion, dyspnea, and headache (5).Once an individual has been exposed to the disease, symptoms can manifest from anywhere between two and fourteen days (5).For the majority of individuals who contract COVID-19, only minor to middling cases of respiratory illness will be experienced, and they will not require any special medical interventions to recover.Conversely, a more severe illness has a high probability of developing if COVID-19 is contracted by the elderly or those with underlying medical conditions (such as cancer, cardiovascular disease, chronic respiratory disease, and diabetes) (5) The main way in which COVID-19 is transmitted is via saliva or nose discharge droplets that travel when an individual carrying the disease coughs or sneezes(1).In addition, individuals can acquire the disease if they touch a contaminated surface and subsequently touch their eyes, mouth, nose, or general face area (6).Although COVID-19 can be killed by disinfectants, it is believed that it will survive on un cleaned, contaminated surfaces for a couple of hours (6).Currently, there is no de nitive treatment or vaccine for COVID-19.Nevertheless, there are numerous clinical trials being conducted all over the world that are attempting to identify possible treatments for the disease.The WHO will report on clinical ndings as and when tangible results become available(1) (7).
In the light of the absence of any effective treatment for this disease and with clearly identi ed of the mode of transmission, information and detailed knowledge of this virus is the most powerful tool that individuals have to ght this disease.Being informed about the causes of COVID-19 and the manner in which it spreads is the optimum means of avoiding it and decreasing transmission rates.(2)The key advice from the WHO to prevent the spread of COVID-19 is that people should remain at home, ensure social distancing measures are being taken, wash their hands frequently with soap and water, and frequently clean objects and surfaces that are touched on a regular basis(6); therefore, effective awareness training in workplaces will be essential in the ght to halt the spread of the disease.
The rst step to raising peoples' defenses against COVID-19 is education (9).People must be informed about the symptoms of the disease, the actions they can take to protect themselves and the people they come into contact with, and what they can do if they themselves or someone they have been in contact with (such as a work colleague) have been exposed to the virus (9).
In Saudi Arabia, the Ministry of Health, in association with other organizations, has developed numerous programs to continuously educate the citizens and improve their level of awareness about COVID-19 (10).Indeed, they have also striven to enhance the knowledge and resources for healthcare providers and citizens in the country at this time of pandemic.As mentioned earlier, the general publics' awareness and knowledge of this disease is of utmost importance in terms of controlling the spread of this virus and nally overcoming it.To the best of our knowledge, there has yet to be a study conducted speci cally in this region on peoples' awareness of COVID-19.Therefore, in order to ll this research gap, the aim of this paper was to evaluate the knowledge and awareness of both the general public and healthcare providers in Qassim region in Saudi Arabia.

Method
Descriptive, cross-sectional, and randomized study was conducted in Qassim region inside shopping malls from 10 February 2020 to 10 March 2020.All participants were recruited from Qassim province.
Qassim is located in the center of Saudi Arabia, and it has more than 1.5 million inhabitants.
The following inclusion criteria were applied in this study: rstly, participants had to be adults (i.e., older than 17 years of age); secondly, participants had to reside in the Qassim region; and thirdly, participants needed to provide voluntary and informed consent prior to participating.Participants who did not satisfy these criteria were excluded from the study.Data were obtained in-person using a structured questionnaire.A pilot study was undertaken to validate the questionnaire, and a panel of three domain-speci c experts was used to test the data collection instrument.
Microsoft Excel was used to analyze data from 130 participants, as well as version 25 of the Statistical Package for the Social Sciences (SPSS).Excel was used for data entry and data representation purposes, and different categorical and quantitative variables were identi ed.Data were cleansed before running statistical analyses, and missing data and typographical errors were checked.Using SPSS, counts and percentages were examined for the categorical variables, and descriptive statistics were undertaken for the quantitative variables.Inferential statistics were also used to address the study's main research questions.The parametric assumptions associated with all variables were tested.Different comparisons were performed using the Mann-Whitney U test for independent two-group variables, while for more than two groups, the Kruskal-Wallis signed rank test was employed.Throughout this study, data are presented as median and quartiles, and P-values are considered statistically signi cant at < 0.05.

Result Demographic characters
A total of 130 participants have answered the designed questionnaire, out of which 67participants were males and 54 were female with percentage of 58.5% and 41.5% respectively.Four age groups have been identi ed among the 130 participants (<20, 20-40, 40-6, >60), with around 75 % of the second age group from 20-40.Educational level varied from intermediate education to postgraduate studies while the majority (66 %) had BA or BSc.Profession showed variation between private, governmental, health and other sectors.The participants demographics is presented in (Table1).

General knowledge awareness of COVID-19
Results showed that 129 out of the 130 participants are aware of COVID-19, while 4.5 % of the participants didn't know what it is, and 90% have recognize it as a respiratory disease and around 6% have identi ed it as SARS2 and 100 % have recognized it as a contagious disease.
Participants have been asked to response if the COVID-19 is similar to the SARS virus and the responses varied where the participants have been divided into three similar groups with three different answers between yes and no and I don't know.94 % of the participants were able to recognize the correct incubation period of the virus while only 6 % have chosen a wrong answer.Around 84% of the participants have considered the risk of COVID-19 is high while the rest have underestimated the risk of it.Out of the 130 participants, 125 were aware of the situation of the COVID-19 in the Saudi Arabia.Almost half of the participants asked for more information about COVID-19.basic information awareness about COVID-19 (Table 2 and Figs.2-4).

Awareness of COVID-19 detailed information
This part of the questionnaire composed of nine checkbox questions and responders should select as much correct choices as possible.Number of correct choices for each participant and number of participants who choose every choice within each question were used to represent the awareness of COVID-19 detailed information (Table 3).
The highest awareness rate was recorded in the question of the reliable source of information where 64% of the participants have recognized all reliable sources while only 4% have not recognized any reliable source (Table 3).A total 92 % of participant have recognized WHO as the most reliable source of information about COVID-19 while Healthcare professionals came at second with 68%.Other options were selected with less than 15% of the participants (Fig. 5).Participants showed the second-high awareness towards the recognition of the high-risk groups with 46% of participants have chosen all highrisk groups, while only 5% of the participants have not recognized any group.Elderly people, Patients with chronic conditions, health care workers, was the arrangement of the high-risk groups with around 77%, 69%, 63% of selection respectively (Table 3 and Fig. 6).
Mode of transmission was only recognized through human to human transmission with 96% while on other side no participant has recognized contacting contaminated surfaces as a transmission mode (Table 3 and Fig. 7).Responses varied towards the recognition of disease symptoms were out of the eight known symptoms, only 2% were able to choose all symptoms while 5% where able to recognize seven of them and the highest rate was between 3 and 5 symptoms with around 60% of participants.A total of 87% have marked fever and shortness of breath to be the most common symptoms followed by cough (75%), sore throat (63%), tiredness (46%), muscle pain (39), the rest symptoms were chosen by less than 20 % (Table 3 and Fig. 8).The lowest awareness rate was towards the long term complications of the disease where 20% of the participants have recognized none of the long term complications while 64% were able to recognize only one complication out of the three listed complications.Pneumonia was the highest marked complication by 78%, followed by death with 50%, while kidney failure was recognized by only 15% of the participants (Table 3 and Fig. 9).
Out of six measures to prevent COVID-19 spread, 36% of the participants have denoted the six measures followed by 38% with ve measures recognized.The highest recognized measures among the participants were avoid travelling and gathering, sanitizers and cleaning materials usage, washing hands with soap for 20 seconds with 94%, 79%, 78% respectively (Table 3 and Fig. 10).Preparation to ght the COVID-19 showed a moderate awareness about possible options where over 80% were able to nd more than two measures out of the six correct measures.Only 18% were able to identify the six measures correctly followed by 17% with ve measures identi ed.It is noteworthy that this question in line with the spread prevention question showed 0% of participants failed to recognize at least one correct choice.General hygiene rules was the most marked measure with 95% of participants, followed by cover when coughing and sneezing and avoid contact with sick people with 88%, avoid travelling to infected areas with 84%, frequent hand wash 82%.It is worth mentioning that avoid raw animals was marked by 30% of participants, while avoid places handling animals was marked by 46% of participants (Table 3 and Fig. 11).
Responses towards the treatment for COVID-19 showed that 14% were not able recognize the proper handling of the disease while 60% were able to check one measure and 29% were able to nd the two correct measures listed in the questionnaire.It is noteworthy to mention that all participants were aware of the fact that there is no vaccination yet for COVID-19 and 80% knew that there is no treatment as well while only 38% were able to recognize supportive treatment as a method to control or improve chances of disease control (Table 3 and Fig. 12).
Preparation of ghting COVID-19 among medical workers showed that 58% were non health workers while among medical workers, results showed that 70% were able to recognize the six important measures for preparation against the virus while around 6% of medical workers were not able to recognize any correct measures.Out of the 54 medical workers who responded to our questionnaire, 85% has recognized check supplies for emergencies as the rst priority followed by contact international centers as CDC and WHO followed by evaluation of equipment and ventilators as the highest priority while alternative supplying checking came at last position with 48% (Table 3 and Fig. 13).

Awareness level of COVID-19 among different groups
Investigating differences among different groups of the participants was done for sex, age, educational level and profession.Parametric assumptions were tested, and data showed signi cant violation against assumptions.Differences between different genders were examined using Mann-Whitney Signed rank test while differences among age, education, profession groups were tested using Kruskal-Wallis one way signed rank test.Results showed that there were no signi cant differences among different groups for all questions except for two questions.There were signi cant differences of awareness levels among different groups of age and profession in response to the identi cation of the high risk groups.Participants of the age group 20-40 showed higher awareness than other age groups while government employees showed higher awareness level than other profession groups.Results showed that there were signi cant differences of awareness levels among different groups of age and sex in response to the identi cation of COVID-19 treatment.Participants of the age group 20-40 showed higher awareness than other age groups while females showed higher awareness level than males in response to the treatment of COVID-19 (Table 4).

Correlation among awareness levels of COVID-19 detailed information.
As parametric assumptions have been violated, non-parametric spearman correlation was investigated among awareness levels of COVID-19 speci cs.Results showed signi cant positive correlation between high risk groups recognition, reliable source of information, infection symptoms, disease spread prevention and COVID_19 available treatments.While the reliable source of information awareness was positively correlated with all other questions except for the long term complications awareness.The lowest correlations were found between the awareness level of the long term complications and the available COVID-19 treatment in one side and all other questions on the other side.Long term complications awareness level was only correlated to the awareness level of disease symptoms while treatment awareness level was correlated to high risk group, information source and disease spread prevention (Table 5).

Discussion
The purpose of this study was to evaluate the awareness of healthcare professionals and the general public regarding the coronavirus in Saudi Arabia's (KSA), Qassim region, focusing on both general awareness of COVID-19 and an awareness of detailed information about COVID-19.Although the rst patient with coronavirus was diagnosed in Qassim region on 22 March 2020, the COVID-19 dashboard of the Saudi Ministry of Health indicates that Qassim has the lowest coronavirus prevalence across the country (10).
Regarding the general awareness of COVID-19 in the Al-Qassim region, almost every participant, whether a healthcare professional or a member of the general public, knew about the disease and the viral agent that causes it.This is consistent with the fact that many media organizations, due to the pandemic status of the coronavirus, frequently disseminate information, which has contributed to growing public awareness globally (11).For 95% of this study's participants, hygiene practices were considered the main way to prevent the transmission of COVID-19, which re ects the e cacy of the Saudi government's public health education initiatives, many of which have used digital technologies to spread essential information to the country's inhabitants.Furthermore, this awareness is consistent with the World Health Organization's (WHO) emphasis on the importance of regular, thorough, and well-timed hand washing (12).
Regarding the participants' awareness of detailed information about COVID-19, only 2% of the participants correctly identi ed the eight known symptoms of the disease, while 5% recognized seven of the eight symptoms.Most participants, approximately 60%, identi ed between three and ve symptoms.These varying levels of awareness about the symptoms of COVID-19 may be linked to knowledge de cits, but they can also be accounted for by referencing the fact that, in different countries, different symptoms have been associated with the disease (13,14).This variation in awareness of recognized symptoms may be too many change of WHO detection, especially at the beginning (11,13).
The lowest level of awareness was associated with the long-term complications of COVID-19, as well as the disease's transmission mechanisms.The only mechanism of transmission identi ed by the participants was human-to-human, which 96% were aware of.However, contact with contaminated surfaces was not identi ed by any of the participants.Of the six measures mentioned in the questionnaire to prevent the transmission of COVID-19, only 36% identi ed all six, while 38% identi ed ve of the six measures.One way to account for the participants' knowledge de cits regarding the possibility of transmitting COVID-19 by contact with contaminated surfaces relates to the fact that this study was conducted early on in the coronavirus crisis.As such, it is possible that the participants lacked access to much of the information we have today.As for the lack of awareness about long-term complications, this could stem from the same reason, or it could be due to the fact that not much information has been disseminated about these complications.As such, more information is required for public education about transmission mechanisms and possible complications.
Awareness of COVID-19 management was high in the participants, and although no treatment has yet been proposed for the disease, a range of medications, including antimalarial and antiviral drugs, are being examined in clinical trials (15,16 and 17).For example, evidence indicates that COVID-19 may be amenable to treatment with hydroxychloroquine, an antimalarial, and clinical trials are currently being conducted to see if this existing pharmaceutical can alleviate the symptoms of COVID-19 (e.g., pneumonia) (15,16 and 17).
Subgroup analysis revealed that no signi cant differences existed between the different groups for every question, with the exception of two questions.Firstly, a signi cant difference was identi ed based on age group, and secondly, a signi cant difference was also identi ed for profession.Speci cally, young individuals who worked in professional positions were associated with a greater awareness of the complications of COVID-19.
To the best of our knowledge, this is the rst study that has sought to evaluate COVID-19 awareness in Saudi healthcare professionals and the general public in the Qassim region.In healthcare professionals, the results indicate that most are aware of the critical details that will aid in the ght against the pandemic.These results were consistent with a Najran-based cross-sectional study of the knowledge and attitudes towards the Middle East Respiratory System coronavirus (MERS-CoV) in healthcare professionals in primary healthcare centers and hospitals (18).Speci cally, the study noted that healthcare professionals had a satisfactory level of knowledge about the disease (18).However, other KSA-based studies have been conducted in which it has been found that awareness for emerging infectious diseases is low, which highlights the importance of examining this issue further (19).
Finally, a noteworthy limitation of this study is that the sample group may not have been representative.For example, most of the participants were members of the young generation, meaning that the generalizability of these results to other parts of the KSA is low.

Figure 2 Percentage
Figure 2

Figure 5 Percentage
Figure 5

Figure 6 Percentage
Figure 6

Figure 10 Percentage
Figure 10

Figure 11 Percentage
Figure 11

Figure 12 Percentage
Figure 12