This study was a large-scale survey from 19,113 samples and 12,254 individuals over 9 weeks. Although low levels of crisis awareness in younger age groups have been reported in media coverage and other small-scale awareness surveys, this was the first objective prospective survey to investigate this topic. We found that the increasing spread of COVID-19 throughout Japan more strongly correlated with an increased potentially awareness of prevention and treatment for COVID-19 than the spread of COVID-19 worldwide. Additionally, a deeper awareness of treatment further increased with the reported death of a famous Japanese celebrity comedian on March 30 (Wk7.3). Reports on the rise of individuals who were positive for COVID-19 test from the Diamond Princess cruise line from February 5 to March 1 (Wk1-3) temporarily resulted in increased crisis awareness. In these periods, there were no significant differences in crisis awareness and the cost of hypothetical vaccine and drugs showed almost flat trend in not only the younger age group but also the elderly.
In Japan, as there was no significant rise in the number of infected individuals in these survey time, there seemed to be a sense of security in individuals. This more individuals, combined with the fact that it was also cherry blossom viewing season, more individuals ventured outside during the long weekend from March 20–22. In this study, the prices allocated for the hypothetical prophylactic vaccine and other therapeutic drugs were also reduced on March 20 (Wk6), and the survey seemed capable of reflecting crisis awareness in Japanese individuals. Moreover, an additional survey conducted at the time of the reported death of a famous comedian in Japan showed a sharp rise in awareness.
Differences in crisis awareness between the younger age group and the elderly were believed to result from age-related differences, such as the increase in severity of symptoms and higher mortality rates related to age. Mortality rates associated with COVID-19 increased with age, with 0.2% deaths in those in the 20 s or 30 s, 0.4% in those in the 40 s, 1.3% in those in the 50 s, 3.6% in those in the 60 s, 8.0% in those in the 70 s, and 14.8% in those 80 years or older [5]. For this reason, the assumption is that the younger age group is less aware of the crisis and consequently has lower compliance rates to governmental directives, such as bans on going outside. However, the percentage of cases who were not willing to pay for the prevention and treatment was reduced correlating with increases in the number of COVID-19 positivity in Japan. The proportions of participants who were willing to pay for the treatment more than the standard price for the influenza drugs in any phase were similar in all age groups and were increased with widespread of COVID-19.
In this study, crisis awareness was evaluated based on a comparison of the cost for prophylactic and treatments with that for influenza. There are currently no questionnaires that assess awareness of treatment and sense of crisis that are validated in the Japanese language. It is currently unknown whether questionnaires would be suitable for this infectious disease. In this regard, the idea was that performing a comparison to those of influenza, an infectious disease for which prophylactic vaccination and treatment were provided in about 50% of individuals in Japan would be convenient. Japan ranks 16th in the Organisation for Economic Co-operation and Development members in influenza vaccination rate in those aged 65, with the Republic of Korea ranking highest at 83%, followed by Australia, the United Kingdom, and the United States [7]. Specifically, in 2020, the percentage of people vaccinated for influenza was 58.5% in the elderly, 28.6% in adults, and 59.2% in children [6]. It is also considered easy to assess the number of infected individuals since there has been a constant frequency of 200–300 million individuals in Japan each year [8]. Thus, we used this influenza comparing questionnaire due to the popular disease in Japan. Conversely, the mean cost of a hypothetical prophylactic vaccine and other hypothetical prophylactic drugs were 2876.3 JPY (26.9 USD) and 3357.4 JPY (31.4 USD) at Wk9, respectively, and considerably lower in situations where the government declared an emergency comparing to seasonal influenza.
This study evaluated the potentially demand for medical care in healthy individuals. In particular, in patients with severe symptoms of COVID-19, the medical load is higher with measures in place such as ventilator management and this higher load can lead to a higher burden on medical workers. Consequently, it may also be the cause of medical disruption which can lead to higher mortality rates. Since Japan, in particular, still has lower morbidity and mortality rather compared to those of Western countries at the time of this study, the belief is that raising awareness in individuals without symptoms will be necessary. This study might be clue to evaluate the potential crisis awareness for COVID-19.
This study had the following limitations: the validity of the questionnaire itself, lack of detailed evaluations including the ability to perform evaluations over time despite issues with awareness remaining. But this simple survey, could evaluate the results regardless of final educational attainment.
The study revealed a change in crisis awareness in all age groups, which was associated with an increasing awareness of infected individuals. Moreover, crisis awareness was lower in the younger age group than in the elderly, whereas crisis awareness in the middle-aged group fluctuated between high and low levels. Meanwhile, females, married persons, and those with child(ren) showed higher crisis awareness.