Situational pathogen avoidance mediates the impact of social connectedness on preventive measures during the COVID-19 pandemic.

During the COVID-19 pandemic, physical distancing was one of the more important behaviours for reducing the spread of the virus. The present study investigated the influence on pathogen avoidance of familiarity with other people at private gatherings. Based on the social identity model of risk taking and the theory of the behavioural immune system, we assumed that greater familiarity with others would make people feel more connected with one another and decrease situational pathogen avoidance. This could result in lower perceptions of the risk of contracting COVID-19 and fewer protective behaviours. Two experiments (n1 = 1022, n2 = 994) showed that the negative influence of greater familiarity on the perceived risk of infection and protective behaviour is explained by an increased feeling of connectedness and less feeling of situational pathogen avoidance. In an additional survey, the participants (n = 23,023) rated the quality of their past social contacts. The correlational analyses showed that the familiarity of the other person was more important in explaining variance in protective behaviours than attitudes toward those behaviours or the pandemic situation itself. Understanding the process that result in an explosive increase in infection after social gatherings can improve infection control in the future.

[Attitudes Toward Influenza Vaccination in Fall/Winter 2021: Results of the COSMO Study]. / Einstellung zur Grippeimpfung im Herbst/Winter 2021: Ergebnisse der COSMO-Studie.

AIM OF THE STUDY: There is a lack of knowledge about attitudes to influenza vaccination in Germany in 2021/2022. Based on the COSMO survey ("COVID-19 Snapshot Monitoring"), the aim of this study was to shed some light on this topic. METHODS: Wave 49 (August 10 and 11, 2021) of the COSMO survey (n=967; Germany-wide non-probabilistic quota sample; 18 to 74 years). RESULTS: This year, about one-third of respondents (and health care workers) plan to get a flu shot, and among the at-risk group of people aged 60 and older (up to 74 years in our sample), more than half. Correlates (such as gender: women with a lower likelihood of a planned flu shot) were identified. CONCLUSION: Physicians should inform women in particular about the advantages of influenza vaccination, especially during the pandemic, and communicate data on the proven protective effect of influenza vaccination as convincingly as possible (e. g., using existing brochures).

A lay perspective on prioritization for intensive care in pandemic times: Vaccination status matters

During a pandemic, demand for intensive care often exceeds availability. Experts agree that allocation should maximize benefits and must not be based on whether patients could have taken preventive measures. However, intensive care units (ICUs) are often overburdened by individuals with severe COVID-19 who have chosen not to be vaccinated to prevent the disease. This article reports an experiment that investigated the German public's prioritization preferences during the fourth wave of the coronavirus pandemic (N?=?1014). In a series of scenarios, participants were asked to decide on ICU admission for patients who differed in terms of health condition, expected treatment benefits, and vaccination status. The results reveal an in-group bias, as vaccinated individuals preferred to allocate more resources to the vaccinated than to the unvaccinated. Participants also favored admitting a heart attack patient rather than a COVID-19 patient with the same likelihood of benefiting from ICU admission, indicating a preference for maintaining regular ICU services rather than treating those with severe COVID-19. Finally, participants were more likely to admit a patient to intensive care when this meant withholding rather than withdrawing care from another patient. The results indicate that lay prioritizations violate established allocation principles, presaging potential conflicts between those in need of intensive care and those who provide and allocate it. It is therefore recommended that allocation principles should be explained to enhance public understanding. Additionally, vaccination rates should be increased to relieve ICUs and reduce the need for such triage decisions.

Emotional Situation of Children and Adolescents during the COVID-19 Pandemic in Germany: Results from the COVID-19 Snapshot Monitoring Study (COSMO).

The COVID-19 pandemic led to numerous restrictions in daily life that had a significant impact on the well-being and mental health of the population. Among others, children and adolescents were particularly affected, being a vulnerable group at risk. The aim of this study was to assess the emotional situation of children and adolescents during different phases of the pandemic and to identify modifying factors. Data from the serial cross-sectional COVID-19 Snapshot Monitoring (COSMO) survey in Germany were used for this study. The survey waves 12 (19th/20th May 2020) and 21 (15th/16th September 2020) were investigated as examples of two different pandemic phases. The psychosocial and emotional situation and well-being of children were measured with the emotional subscale of the Strengths and Difficulties Questionnaire (SDQ) assessed by parents. Descriptive analyses and logistic regressions were calculated. In total, a third of the participating parents in wave 12 and in wave 21 reported having children and adolescents with emotional symptoms. Especially children with younger parents seemed to be more affected by emotional symptoms. Sociodemographic aspects, such as household language, showed a significant association with reported emotional symptoms in children (Wave 12: OR = 2.22; 95% CI: 1.20-4.09). Reported prevalences of emotional symptoms in children did not differ between the pandemic phases. In conclusion, the pandemic had negative influences on the emotional symptoms of children and adolescents in COVID-19 pandemic waves in 2020, indicating a forecasted reoccurrence and need for preventive measures for upcoming waves and other pandemics in the future.

Attitude toward a mandatory COVID-19 vaccination policy and its determinants: Evidence from serial cross-sectional surveys conducted throughout the pandemic in Germany.

BACKGROUND: Mandating vaccination against COVID-19 is often discussed as a means to counter low vaccine uptake. Beyond the potential legal, ethical, and psychological concerns, a successful implementation also needs to consider citizens' support for such a policy. Public attitudes toward vaccination mandates and their determinants might differ over time and, hence, should be monitored. METHODS: Between April 2020 and April 2021, we investigated public support for mandatory vaccination policies in Germany and examined individual correlates, such as vaccination intentions, confidence in vaccine safety, and perceived collective responsibility, using a series of cross-sectional, quota-representative surveys (overall N = 27,509). RESULTS: Support for a vaccination mandate declined before the approval of the first vaccine against COVID-19 in December 2020 and increased afterwards. However, at the end of April 2021, only half of respondents were in favor of mandatory regulations. In general, mandates were endorsed by those who considered the vaccines to be safe, anticipated practical barriers, and felt responsible for the collective. On the contrary, perceiving vaccination as unnecessary and weighing the benefits and risks of vaccination was related to lower support. Older individuals and males more often endorsed vaccination mandates than did younger participants and females. Interestingly, there was a gap between vaccination intentions and support for mandates, showing that the attitude toward mandatory vaccination was not only determined by vaccination-related factors such as vaccine safety or prosocial considerations. CONCLUSIONS: Because of low public support, mandatory vaccination against COVID-19 should be considered a measure of last resort in Germany. However, if removing barriers to vaccination and educational campaigns about vaccine safety and the societal benefits of high vaccination uptake are not sufficient for increasing vaccination uptake to the required levels, mandates could be introduced. In this case, measures to ensure and increase acceptance and adherence should be taken.

Money is not everything: experimental evidence that payments do not increase willingness to be vaccinated against COVID-19.

Rapid, large-scale uptake of new vaccines against COVID-19 will be crucial to decrease infections and end the pandemic. In a recent article in this journal, Julian Savulescu argued in favour of monetary incentives to convince more people to be vaccinated once the vaccine becomes available. To evaluate the potential of his suggestion, we conducted an experiment investigating the impact of payments and the communication of individual and prosocial benefits of high vaccination rates on vaccination intentions. Our results revealed that none of these interventions or their combinations increased willingness to be vaccinated shortly after a vaccine becomes available. Consequently, decision makers should be cautious about introducing monetary incentives and instead focus on interventions that increase confidence in vaccine safety first, as this has shown to be an especially important factor regarding the demand for the new COVID-19 vaccines.

The four weeks before lockdown during the COVID-19 pandemic in Germany: a weekly serial cross-sectional survey on risk perceptions, knowledge, public trust and behaviour, 3 to 25 March 2020.

BackgroundDuring the COVID-19 pandemic, public perceptions and behaviours have had to adapt rapidly to new risk scenarios and radical behavioural restrictions.AimTo identify major drivers of acceptance of protective behaviours during the 4-week transition from virtually no COVID-19 cases to the nationwide lockdown in Germany (3-25 March 2020).MethodsA serial cross-sectional online survey was administered weekly to ca 1,000 unique individuals for four data collection rounds in March 2020 using non-probability quota samples, representative of the German adult population between 18 and 74 years in terms of age × sex and federal state (n = 3,910). Acceptance of restrictions was regressed on sociodemographic variables, time and psychological variables, e.g. trust, risk perceptions, self-efficacy. Extraction of homogenous clusters was based on knowledge and behaviour.ResultsAcceptance of restrictive policies increased with participants' age and employment in the healthcare sector; cognitive and particularly affective risk perceptions were further significant predictors. Acceptance increased over time, as trust in institutions became more relevant and trust in media became less relevant. The cluster analysis further indicated that having a higher education increased the gap between knowledge and behaviour. Trust in institutions was related to conversion of knowledge into action.ConclusionIdentifying relevant principles that increase acceptance will remain crucial to the development of strategies that help adjust behaviour to control the pandemic, possibly for years to come. Based on our findings, we provide operational recommendations for health authorities regarding data collection, health communication and outreach.

Sociodemographic characteristics determine download and use of a Corona contact tracing app in Germany-Results of the COSMO surveys.

During the SARS-CoV-2 pandemic mobile health applications indicating risks emerging from close contacts to infected persons have a large potential to interrupt transmission chains by automating contact tracing. Since its dispatch in Germany in June 2020 the Corona Warn App has been downloaded on 25.7 Mio smartphones by February 2021. To understand barriers to download and user fidelity in different sociodemographic groups we analysed data from five consecutive cross-sectional waves of the COVID-19 Snapshot Monitoring survey from June to August 2020. Questions on the Corona Warn App included information on download, use, functionality, usability, and consequences of the app. Of the 4,960 participants (mean age 45.9 years, standard deviation 16.0, 50.4% female), 36.5% had downloaded the Corona Warn App. Adjusted analysis found that those who had downloaded the app were less likely to be female (Adjusted Odds Ratio for men 1.16 95% Confidence Interval [1.02;1.33]), less likely to be younger (Adjusted Odds Ratio for age 18 to 39 0.47 [0.32;0.59] Adjusted Odds Ratio for age 40 to 64 0.57 [0.46;0.69]), less likely to have a lower household income (AOR 0.55 [0.43;0.69]), and more likely to live in one of the Western federal states including Berlin (AOR 2.31 [1.90;2.82]). Willingness to disclose a positive test result and trust in data protection compliance of the Corona Warn App was significantly higher in older adults. Willingness to disclose also increased with higher educational degrees and income. This study supports the hypothesis of a digital divide that separates users and non-users of the Corona Warn App along a well-known health gap of education, income, and region.

Good night: Experimental evidence that nighttime curfews may fuel disease dynamics by increasing contact density.

BACKGROUND: Nighttime curfews have been discussed and implemented in many countries as a means of controlling the COVID-19 pandemic. However, there is evidence that such curfews have little or no effect on disease dynamics when other measures such as bans on gatherings or business and school closures are already in place. There are two possible explanations for this. First, nighttime curfews may elicit reactance-a feeling of anger that drives non-adherence; second, nighttime curfews may motivate people to shift activities from night to daytime, thereby increasing contact density. METHODS: A survey experiment was conducted with German participants (N = 997) to investigate public perceptions of nighttime curfews and possible detrimental effects on contact behaviors. RESULTS: Most participants perceived nighttime curfews as ineffective. The introduction of a hypothetical curfew did not affect intentions to reduce private contacts but instead elicited reactance, motivating participants to violate curfew hours or to shift a fictitious dinner meeting to an earlier time rather than cancelling it. CONCLUSIONS: When people do not support nighttime curfews or do not understand the rationale behind them, introduction of this measure may fuel the spread of the disease. For that reason, nighttime curfews should be a measure of last resort and should be accompanied by a public communication campaign explaining the importance of contact reduction during both nighttime and daylight hours.

Empirical evidence to understand the human factor for effective rapid testing against SARS-CoV-2.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapid antigen point-of-care and home tests are available to laypeople. In four cross-sectional mixed-methods data collections conducted between December 2020 and March 2021 (n = 4,026), we showed that a majority of subjects were willing to test despite mistrust and ignorance regarding rapid tests' validity. Experimental evidence shows that low costs and access to events could increase testing intentions. Mandatory reporting and isolation after positive results were not identified as major barriers. Instead, assuming that testing and isolation can slow down the pandemic and the possibility to protect others were related to greater willingness to get tested. While we did not find evidence for risk compensation for past tests, experimental evidence suggests that there is a tendency to show less mask wearing and physical distancing in a group of tested individuals. A short communication intervention reduced complacent behavior. The derived recommendations could make rapid testing a successful pillar of pandemic management.

Allocation of COVID-19 vaccination: when public prioritisation preferences differ from official regulations.

As vaccines against COVID-19 are scarce, many countries have developed vaccination prioritisation strategies focusing on ethical and epidemiological considerations. However, public acceptance of such strategies should be monitored to ensure successful implementation. In an experiment with N=1379 German participants, we investigated whether the public's vaccination allocation preferences matched the prioritisation strategy approved by the German government. Results revealed different allocations. While the government had top-prioritised vulnerable people (being of high age or accommodated in nursing homes for the elderly), participants preferred exclusive allocation of the first available vaccines to medical staff and personnel caring for the elderly. Interestingly, allocation preferences did not change when participants were told how many individuals were included in each group. As differences between allocation policies and public preferences can affect trust in the government and threaten the social contract between generations, we discuss possible strategies to align vaccination prioritisations.

School opening during the SARS-CoV-2 pandemic: Public acceptance of wearing fabric masks in class.

OBJECTIVES: Policy decisions regarding mask wearing in schools in times of the SARS-CoV-2 pandemic will likely be made despite a lack of scientific data. Public acceptance is therefore an important indicator to inform the communication activities that accompany the introduction of a new policy. The goal was to assess acceptance and relevant target groups for communication activities. STUDY DESIGN: Cross-sectional online survey embedded in the regular German COVID-19 monitoring. METHODS: Besides sociodemographic information, trust in institutions, knowledge about COVID-19 and protective behaviors, as well as risk perceptions, we assessed public acceptance of school-related mask policies of parents and non-parents (total N â€‹= â€‹957). RESULTS: In the absence of mandatory mask policies in schools in Germany in August 2020, the general agreement with mask wearing in school was low. Those living in bigger cities or communities - where class sizes are usually larger - agreed more with mask wearing in class; those who felt a greater risk, had greater trust in institutions, or felt higher self-efficacy in fighting the outbreak also wanted children to wear a mask in class. Women were more likely than men to disagree with mask wearing in class. Agreement was highest that policies should uniformly apply for all institutions within a state/province and should not be regulated at the school level or federal/country level. CONCLUSIONS: Implementing mask policies in school will require intense communication. Acceptance of these policies from teachers and pupils should be considered as well. Women seem to be an important target group as they supported mask wearing in class less than men. Women's roles in controlling infectious diseases in school should therefore receive special attention and support.

[Public trust in institutions in the first half of the Corona pandemic: findings from the COVID-19 Snapshot Monitoring (COSMO) project]. / Vertrauen der Bevölkerung in staatliche Institutionen im ersten Halbjahr der Coronapandemie: Erkenntnisse aus dem Projekt COVID-19 Snapshot Monitoring (COSMO).

BACKGROUND: In the coronavirus pandemic, two institutions play a central role in the evidence-based classification of events for politics and the population. The Robert Koch Institute (RKI) coordinates the fight against the pandemic, prepares well-founded recommendations for medical professionals, the media and the population, and advises politicians. The Federal Centre for Health Education (BZgA) informs the population and institutions. GOALS: The COVID-19 Snapshot Monitoring (COSMO) project monitors whether and how trust in institutions changes over the pandemic. Which population groups show trust and how this is related to attitudes, risk perception and behaviour are analysed. METHODS: Cross-sectional studies with approximately N = 1000 respondents per survey were conducted since March 2020 to investigate risk perception, behaviour, acceptance of measures and trust in institutions. RESULTS: Trust in the RKI and BZgA was generally high but declined over the course of the pandemic. Higher trust for both institutions was associated with higher age of respondents, higher education, higher risk perception and higher acceptance of measures. Behaviours such as physical distancing and handwashing were shown more frequently. Men and the chronically ill showed lower trust. DISCUSSION: The results show that trust should be further promoted. This could be achieved, among other things, by taking into account the population's perspective (e.g. through COSMO) in the development and justification of strategies and measures. Communication strategies and recommendations for action should aim to support and relieve people with high-risk perceptions.

Social and behavioral consequences of mask policies during the COVID-19 pandemic.

Mandatory and voluntary mask policies may have yet unknown social and behavioral consequences related to the effectiveness of the measure, stigmatization, and perceived fairness. Serial cross-sectional data (April 14 to May 26, 2020) from nearly 7,000 German participants demonstrate that implementing a mandatory policy increased actual compliance despite moderate acceptance; mask wearing correlated positively with other protective behaviors. A preregistered experiment (n = 925) further indicates that a voluntary policy would likely lead to insufficient compliance, would be perceived as less fair, and could intensify stigmatization. A mandatory policy appears to be an effective, fair, and socially responsible solution to curb transmissions of airborne viruses.

Ten considerations for effectively managing the COVID-19 transition.

Governments around the world have implemented measures to manage the transmission of coronavirus disease 2019 (COVID-19). While the majority of these measures are proving effective, they have a high social and economic cost, and response strategies are being adjusted. The World Health Organization (WHO) recommends that communities should have a voice, be informed and engaged, and participate in this transition phase. We propose ten considerations to support this principle: (1) implement a phased approach to a 'new normal'; (2) balance individual rights with the social good; (3) prioritise people at highest risk of negative consequences; (4) provide special support for healthcare workers and care staff; (5) build, strengthen and maintain trust; (6) enlist existing social norms and foster healthy new norms; (7) increase resilience and self-efficacy; (8) use clear and positive language; (9) anticipate and manage misinformation; and (10) engage with media outlets. The transition phase should also be informed by real-time data according to which governmental responses should be updated.