Knowledge, Attitude and Practice of Techniques of Face-mask Usage and Hand Hygiene among COVID-19 Positive Individuals at a COVID Care Centre in Central India: A Cross-sectional Comparative Study.

Most of the published reports of Knowledge, Attitude and Practice (KAP) surveys with regard to the COVID-19 pandemic are on healthy population or selective groups. We hypothesised that knowledge gap regarding COVID-appropriate behaviour (face-mask use technique and hand hygiene) was responsible for the spread of COVID-19 infection. The participants of our study were unique in the sense that they were already afflicted with COVID-19 infection before getting enrolled in the study. We conducted an online questionnaire-based survey among the COVID-19 positive patients admitted at the district COVID Care Centre at Vidisha, Madhya Pradesh, India to study the KAP of COVID-appropriate behaviour of individuals already afflicted with COVID-19. Two-hundred COVID-19 positive patients were approached, out of which 175 consented and participated in the survey, a response rate of >85.0%. The average knowledge score was 3.21±1.85 (out of 5). The average attitude score was 9.51±4.94 (out of 35). The average practice score was 12.4 (out of 72). Knowledge, attitude as well as practice scores were higher for the participants who were young (18 to 37 years of age), had higher education (university) and those with higher monthly income (>?10,000 per month). No significant difference was noted in these scores based on gender, and on the place of residence (rural vs. urban). Positive correlation was noted using Spearman's rank correlation coefficient for the practice of COVID-appropriate behaviour with higher knowledge and attitude scores. Overall, the KAP scores of our study participants were poor. Low knowledge scores were associated with still lower attitude scores for COVID-appropriate behaviour. The strong positive correlation was noted between knowledge, attitude and practice. The results of this KAP survey suggest the need to improve dissemination of knowledge and suitable modification of messaging strategies to improve attitude as well as practice of COVID-appropriate behaviour among the population.

Potential complications and sequelae of SARS-CoV-2 infection

COVID-19 disease caused by the SARS-CoV-2 virus affects almost all the organ systems of the body leading to multisystemic morbidities and typical complications hitherto unheard of in seasonal "flu" or SARS-CoV-1 epidemic. Acute life-threatening complications range from unabated pneumonia and respiratory failure to "cytokine release syndrome" or "cytokine storm," cardiovascular and cerebrovascular morbidities leading to multiorgan failure, followed by death. The prepathogenesis, pathogenesis, and the clinico-demographic characteristics of SARS-CoV-2 infection have shown a wide variation across different populations, geographical regions, race, and ethnicities. While there are some commonalities, there continues to be a lack of consensus on several aspects of this infection such as its natural history, infectivity, transmission, and its mutagenic strains. Further, newer aspects of the disease have continued to emerge with passing time since its first appearance in December 2019 in Wuhan, China. The initial case descriptions varied from asymptomatic to mild illness requiring minimal monitoring and support to severe COVID-19 disease requiring admission to intensive care facilities and a higher morbidity and mortality. Only subsequently it was recognized that even after the clinical recovery from illness, the infection may persist for a longer time, with continuing damage to some organ systems and sequelae that compromise the quality of life. These have been called the long-term complications or "chronic COVID" infection, and they may be noted even months after recovery from the acute form of disease. While thus far the global efforts have been rightfully directed at combating the acute illness in the pandemic and maximizing recovery, it is possible that we may soon be faced with the challenge of a "secondary pandemic" with a significant burden of chronic COVID and sequelae. This will be a strain on the palliative care, rehabilitative care, and domiciliary care network essentially supported by the primary health-care providers or first-contact physicians worldwide. This approach is in alignment with an emphasis that the WHO placed on the third clinical outcome indicator "functioning" in addition to the two indicators "cure" and "death." The present review discusses the pathophysiology, clinical aspects, and implications of long-term effects of SARS-CoV-2 infection. It is expected to help in sensitizing the health-care workers and policymakers for preparing adequately and timely for dealing with these effects.