International citizen project to assess adherence to public health measures and their impact on the COVID-19 outbreak

In December 2019, an unknown viral pneumonia outbreak occurred in the Hubei Province of China. This disease was later found to be caused by the Severe Acute Respiratory Syndrome Coronavirus-2, which was declared recognized as a pandemic by the World Health Organization (WHO) in March 2020 [1,2]. The disease, now called Coronavirus Disease 2019 (COVID-19), has spread to 200 countries and caused more than 465, 000 infections and at least 21,000 deaths as of March 26th 2020 [3]. COVID-19 mostly causes benign symptoms in adults, although some cases may become severely ill and require hospitalization with respiratory support [4].

Human-to-human transmission of COVID-19 occurs through respiratory droplets, contaminated objects, and direct physical contact with infected people [5]. Once infected, both asymptomatic and symptomatic persons can transmit the disease [6]. In the absence of effective treatments or vaccines, the WHO has strongly recommended countries to implement interventions to curb the rapid spread of COVID-19 through minimizing contact between infected and uninfected persons. Suggested measures include lockdowns, closing schools and public places, and stringent personal methods of hand hygiene and social distancing [7]. Governments are increasingly implementing more stringent measures of social distancing to stall the transmission of COVID-19. For the first time on a global scale, people are faced with travel restrictions, school closure, and forbiddance of social gatherings of any kind.

Because such measures had never been implemented before at this scale, it is unclear to what degree people will adhere to them, which factors determine adherence, what the durability of adherence is, and what the effectiveness of the combined intervention and its components is in reducing COVID-19 transmission [8].

We hypothesize that the level of adherence to the prescribed measures as recommended by the government will initially be high, that adherence will not be durable, and that the level of adherence is associated with the incidence of severe COVID-19 disease. The study aims are:

  1. To describe the level of adherence to the current measures recommended by governments and during the first 6 months following implementation
  2. To describe the determinants of adherence to the measures recommended by governments (baseline covariates and time-varying covariates)
  3. To assess the overall effectiveness of adherence to the measures recommended by governments on the incidence of severe COVID-19 disease
  4. To identify the most effective measure (or combination of measures) to reduce the incidence of severe COVID-19 disease

Understanding the feasibility of adherence to, and durability of public health measures will be essential to public health officials in choosing the most effective strategy for reducing transmission, reducing the COVID-19 burden on the healthcare system, and “flattening the curve” until a vaccine or treatment is licensed. Moreover, if the current containment measures for the outbreak are successful, herd immunity will not be reached. Therefore lessons learned from the current outbreak will be important to tackle potential recurrent episodes and will better prepare us for future pandemics. By performing the study in different countries the most effective strategies will be identified. For objectives 3 and 4 the data obtained with the questionnaire will be combined to local COVID-19 incidence data.

What will be measured?

The primary outcome measure will be adherence to the interventions recommended by the government which include, staying at home, social distancing, hygiene measures, staying away from healthcare workers except for corona-related urgency, avoiding generation mixing, self-quarantine when experiencing symptoms, avoidance of unessential travel. Information will also be obtaining concerning relevant covariates such as: rural/urban residence, housing details, age, education level, size and composition of household, gender, health condition (co-morbidities), pregnancy, smoking status, income, travel history, belief in science, belief in social responsibility, belief in government, and risk perception.

How frequently will the measurement take place?

Participants will be asked to complete the survey at regular time intervals. Certain questions will be repeated but other questions may be modified and new questions may be added depending on the preliminary results.

How will the questionnaire be distributed?

The questionnaire will be distributed using a secure study website https://www.icpcovid.com/ mainly by submitting answers using mobile phones.

What stimulates people to participate?

People contribute to science (a better understanding of virus outbreaks and pandemic management) and therefore have the feeling they can contribute positively to society (in a time when society is put under stress).

How will the information be used?

Indicators of poor adherence overall or in specific population groups will be communicated to the health authorities within the days after distribution of the questionnaire so that targeted interventions can be developed and implemented.

Who is organizing the study?

An international consortium of scientists from Asia, Africa, South America, United States and Europe. The protocol and questionnaire for this survey is largely based on the citizen science Corona survey first launched in Belgium by the University of Antwerp (team: Philippe Beutels, Niel Hens, Koen Pepermans & Pierre Van Damme) on 17th March.2020, which is repeated every Tuesday throughout the COVID-19 epidemic in Belgium.

  • Brazil: Federal University of Jataí, School of Medicine, Health Sciences Unit
  • Cameroon: Brain Research Africa Initiative (BRAIN)
  • Ecuador: Universidad de Cuenca, Facultad de Ciencias Medicas
  • Peru : Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt
  • Mali: University of Bamako, Faculty of Medicine and Odontostomatology, International Center of Excellence in Research
  • Ghana: University of Ghana, Department of Population, Family & Reproductive Health
  • The Gambia: MRC Unit The Gambia at LSHTM Fajara
  • Democratic Republic of Congo: University of Kinshasa, Department of Tropical Medicine
  • South-Sudan: AMREF Health Africa
  • Uganda: Makerere University, College of Health Sciences, School of Public Health
  • Tanzania: National Institute for Medical Research Tanga
  • Burundi: University of Burundi, Faculty of Medecine
  • Zambia: University of Zambia, School of Public Health, Tropical Diseases Research Centre
  • Malawi: UNC Project Lilongwe & University of North Carolina (USA), School of Medicine
  • Mozambique: Institutio Nacional de Saúde
  • South Africa: University of Witwatersrand, Ezintsha
  • India: Shiv Nadar University, School of Natural Sciences, Dept. of Mathematics
  • Thailand: Mahidol University, ASEAN Institute for Health Development
  • Taiwan: National Taiwan University College of Medicine, Taipei
  • Vietnam: Hue University of Medicine and Pharmacy, Faculty of Public Health, Institute for Community Health Research
  • Benin: Ecole Polytechnique d'Abomey-Calavi, Université d'Abomey-Calavi, Bénin
  • Belgium: Institute of Tropical Medicine, Antwerp
  • Belgium: Global Health Institute, University of Antwerp

Countries

Benin

Introduction The coronavirus

Gambia

Introduction The Gambian

Rwanda

Introduction With COVID-19

Somalia

Introduction/Hordhac The

South Africa

Introduction The government

Myanmar (Burma)

Introduction The coronavirus

Tunisia

Introduction The coronavirus

Tanzania

Introduction The coronavirus

Burundi

Introduction The coronavirus

Ethiopia

Introduction The coronavirus

Taiwan

Introduction The coronavirus

Congo - Kinshasa

Introduction The coronavirus

Gambia

Introduction The coronavirus

Ghana

Introduction The government

Thailand

คำนำ

Mozambique

Introdução O novo coronavírus

Peru

Introducción El nuevo

Zambia

Introduction The coronavirus

Malawi

Introduction The government

Uganda

Introduction The severe acute

Mali

Introduction The coronavirus

Ecuador

Presione el botón verde al

Vietnam

Giới thiệu Virus corona (còn

India

Introduction The coronavirus

Brazil

Introduction The coronavirus

Cameroon

Introduction The coronavirus

Collaborators:

Prof. Dr. Robert Colebunders, Prof. Dr. Jean-Pierre Van geertruyden (GHI, Belgium); Prof. Marc-Alain Widdowson (ITM, Belgium); Dr. Bernardo Jose Vega Crespo (Ecuador); Prof. Dr. Edlaine Faria de Moura Villela (Brazil); Prof. Dr. Theresa Ochoa, Takashi Watanabe (Peru); Dr Philippe Sessou (Bénin); Prof. Dr. Alfred K. Njamnshi, Dr. Joseph Nelson Siewe Fodjo (Cameroon); Dr. Dolo Housseini (Mali); Prof. Dr. Kwasi Torpey (Ghana); Prof. Dr. Umberto Dalessadro (The Gambia); Prof. Dr. Hypolite Muhindo (DR Congo); Dr. Jane Carter (South Sudan); Prof. Dr. Rhoda Wanyenze (Uganda); Prof. Dr. John Lusingu (Tanzania); Dr. Zacharie Ndizeye (Burundi); Dr. Gershom Chongwe (Zambia); Prof. Dr. Mina Hosseinipour (Malawi & USA); Dr. Janet Dula, Dr. Jani Ilesh (Mozambique); Mohammed Majam (South Africa); Prof. Samit Bhattacharyya (India); Prof. Dr. Supa Pengpid (Thailand); Prof. Dr. Thang Vo Van (Vietnam); Prof. Dr. Chien-Ching Hung (Taiwan).

Team for statistical support:

Steven Abrams (GHI, University of Antwerp, CenStat, UHasselt); Thomas Neyens (L-BioStat, KU Leuven, CenStat, UHasselt); Jonas Crevecoeur (LRisk, KU Leuven); Katrien Antonio (LStat and LRisk, KU Leuven); Liesbeth Bruckers (CenStat, UHasselt); Lisa Hermans (CenStat, UHasselt); Anna Ivanova (L-BioStat, KU Leuven, CenStat, UHasselt).

References

1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Feb 20;382(8):727–33.

2. World Health Organisation. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020 [Internet]. 2020 [cited 2020 Mar 20]. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020

3. World Health Organisation. Coronavirus pandemic [Internet]. 2020 [cited 2020 Mar 26]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

4. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Feb 28;NEJMoa2002032.

5. Chan JF-W, Yuan S, Kok K-H, To KK-W, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. The Lancet. 2020 Feb;395(10223):514–23.

6. Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA [Internet]. 2020 Feb 21 [cited 2020 Mar 18]; Available from: https://jamanetwork.com/journals/jama/fullarticle/2762028

7. European Centre for Disease Prevention and Control. Algorithm for the management of contacts of probable or confirmed COVID-19 cases [Internet]. European Centre for Disease Prevention and Control. 2020 [cited 2020 Mar 18]. Available from: https://www.ecdc.europa.eu/en/publications-data/algorithm-management-contacts-probable-or-confirmed-covid-19-cases

8. Gershon RR, Zhi Q, Chin AF, Nwankwo EM, Gargano LM. Adherence to Emergency Public Health Measures for Bioevents: Review of US Studies. Disaster med public health prep. 2018 Aug;12(4):528–35.