Public perceptions and preventive behaviours during the early phase of the COVID-19 pandemic: a comparative study between Hong Kong and the United Kingdom

BackgroundIn the absence of treatments and vaccines, the mitigation of COVID-19 relies on population engagement in non-pharmaceutical interventions, which is driven by their risk perception, anxiety level and knowledge. There may also be regional discrepancies in these drivers due to different historical exposure to disease outbreaks, government responses and cultures. As such, this study compared psycho-behavioral responses in two regions during the early phase of the pandemic. MethodsComparable cross-sectional surveys were administered among adults in Hong Kong (HK) and the United Kingdom (UK) during the early phase of each respective epidemic. Explanatory variables included demographics, risk perception and knowledge of COVID-19, anxiety level and preventive behaviors. Responses were weighted according to census data. Logistic regression models, including interaction terms to quantify regional differences, were used to assess the association between explanatory variables and the adoption of social-distancing measures. ResultsData of 3431 complete responses (HK:1663; UK:1768) were analysed. Perceived severity differed by region (HK: 97.5%; UK: 20.7%). A large proportion of respondents were abnormally/borderline anxious (HK:64.8%; UK:45.9%) and regarded direct contact with infected individuals as the transmission route of COVID-19 (HK:94.0-98.5%; UK:69.2-93.5%), with HK identifying additional routes. HK reported high levels of adoption of social-distancing (HK:32.4-93.7%; UK:17.6-59.0%) and mask-wearing (HK:98.8%; UK:3.1%). The impact of perceived severity and perceived ease of transmission on the adoption of social-distancing varied by region. In HK, they had no impact, whereas in the UK, those who perceived severity as "high" were more likely to adopt social-distancing (aOR:1.58-3.01), and those who perceived transmission as "easy" were prone to both general social-distancing (aOR:2.00, 95% CI:1.57, 2.55) and contact avoidance (aOR:1.80, 95% CI: 1.41, 2.30). The impact of anxiety on adopting social-distancing did not vary by region. DiscussionThese results suggest that health officials should ascertain and consider baseline levels of risk perception and knowledge in the populations, as well as prior sensitisation to infectious disease outbreaks, during the development of mitigation strategies. Risk communication should be done through suitable media channels - and trust should be maintained - while early intervention remains the cornerstone of effective outbreak response.

Are we ready when COVID-19 vaccine is available? Study on nurses' vaccine hesitancy in Hong Kong

IntroductionNurses are considered a trustworthy source of vaccine-related information to build public confidence in vaccination. This study estimated nurses influenza vaccine uptake and intention to receive COVID-19 vaccine when available, and examined the corresponding psychological antecedents. MethodsA cross-sectional online survey among nurses was conducted during the main COVID-19 outbreak in Hong Kong between mid-March and late April 2020. Demographics, influenza vaccination, intention to have COVID-19 vaccine, the 5C vaccine hesitancy components (i.e., confidence, complacency, constraints, calculation, and collective responsibility), work stress and COVID-related work demands (i.e., insufficient supply of personal protective equipment, involvement in isolation rooms, and unfavorable attitudes towards workplace infection control policies) were reported. ResultsThe influenza vaccination coverage and the proportion intending to take COVID-19 vaccine were 49% and 63%, respectively, among 1205 eligible nurses. Influenza vaccine uptake was associated with working in public hospitals and all 5C constructs, whereas stronger COVID-19 vaccination intention was associated with younger age, more confidence, less complacency and more collective responsibility towards the vaccine. COVID-19-related demands were associated with greater work stress, and hence stronger COVID-19 vaccination intention. ConclusionVaccine uptake/intention was well predicted by the 5C constructs. With less work stress among nurses in the post-pandemic period, the intention to take COVID-19 vaccine will likely drop. The 5C constructs should be infused in vaccination campaigns. While a COVID-19 vaccine could be ready soon, communities are not ready to accept it. More research work is needed to boost the uptake.

Non-pharmaceutical behavioural measures for droplet-borne biological hazards prevention: Health-EDRM for COVID-19 (SARS-CoV-2) pandemic

IntroductionNon-pharmaceutical interventions to facilitate response to the COVID-19 pandemic, a disease caused by novel coronavirus SARS-CoV-2, are urgently needed. Using the WHO health emergency and disaster risk management (health-EDRM) framework, behavioural measures for droplet-borne communicable disease, with their enabling and limiting factors at various implementation levels were evaluated. Sources of dataKeyword search was conducted in PubMed, Google Scholar, Embase, Medline, Science Direct, WHO and CDC online publication database. Using OCEBM as review criteria, 105 English-language articles, with ten bottom-up, non-pharmaceutical prevention measures, published between January 2000 and May 2020 were identified and examined. Areas of AgreementEvidence-guided behavioural measures against COVID-19 transmission for global at-risk communities are identified. Area of ConcernStrong evidence-based systematic behavioural studies for COVID-19 prevention are lacking. Growing pointsVery limited research publications are available for non-pharmaceutical interventions to facilitate pandemic response. Areas timely for researchResearch with strong implementation feasibility that targets resource-poor settings with low baseline Health-EDRM capacity is urgently need.

Community responses during the early phase of the COVID-19 epidemic in Hong Kong: risk perception, information exposure and preventive measures

BackgroundCommunity responses are important for outbreak management during the early phase when non-pharmaceutical interventions are the major preventive options. Therefore, this study aims to examine the psychological and behavioral responses of the community during the early phase of the COVID-19 epidemic in Hong Kong. MethodA cross-sectional online survey was launched within 36 hours after confirmed COVID-19 cases were first reported. Councilors of all 452 district council constituency areas were approached for survey dissemination. Respondent demographics, anxiety level, risk perception, sources to retrieve COVID-19 information, actual adoption and perceived efficacy of precautionary measures were collected. ResultAnalysis from 1715 complete responses indicated high perceived susceptibility (89%) and high perceived severity (97%). Most respondents were worried about COVID-19 (97%), and had their daily routines disrupted (slightly/greatly: 98%). The anxiety level, measured by the Hospital Anxiety and Depression Scale, was borderline abnormal (9.01). Nearly all respondents were alert to the disease progression (99.5%). The most trusted information sources were doctors (84%), followed by broadcast (57%) and newspaper (54%), but they were not common information sources (doctor: 5%; broadcast: 34%; newspaper: 40%). Only 16% respondents found official websites reliable. Enhanced personal hygiene practices and travel avoidance to China were frequently adopted (>77%) and considered effective (>90%). The adoption of social-distancing measures was lower (39%-88%), and their drivers for greater adoption include: being female (adjusted odds ratio [aOR]:1.27), living in the New Territories (aOR:1.32-1.55), perceived as having good understanding of COVID-19 (aOR:1.84) and being more anxious (aOR:1.07). DiscussionRisk perception towards COVID-19 in the community was high. Most respondents are alert to the disease progression, and adopt self-protective measures. This study contributes by examining the psycho-behavioral responses of hosts, in addition to the largely studied mechanistic aspects, during the early phase of the current COVID-19 epidemic. The timely psychological and behavioral assessment of the community is useful to inform subsequent interventions and risk communication strategies as the epidemic progresses.

Incidence and Risk Factors for Implant Failure in Spinal Metastasis Surgery

Methods@#This study recruited 88 patients who received surgical stabilization with instrumentation for the treatment of spinal metastasis. Their medical records and postoperative X-rays were reviewed for evidence of implant failure. Statistical analysis with logistic regression was performed to assess nine potential risk factors for the development of implant failure, including patient’s age at operation, gender, survival, primary tumor, spinal level involved, construct length, decompression levels, fusion material utilization, and radiotherapy application either before or after surgery, to identify potential contributing risk factors. @*Results@#Implant failure was identified in nine out of 88 cases (10.2%) with two cases requiring implant removal: one case included a progressive kyphosis that resulted in nonhealing sore and the other involved a deep-seated wound infection that spread to the implants. Another case required wound debridement due to superficial wound infection. The remaining six cases were asymptomatic, despite postoperative X-rays demonstrating evidence of implant failure. No patient required implant revision. Logistic regression analysis demonstrated that patients who received radiotherapy either before or after surgery were less likely to develop implant failure. @*Conclusions@#The development of radiological implant failure following surgical treatment of spinal metastasis is common. However, symptomatic implant failure leading to revision surgery is uncommon. Our findings suggest that radiotherapy, either before or after spinal surgery, is not associated with the development of implant failure.

Incidence and Risk Factors for Implant Failure in Spinal Metastasis Surgery

Methods@#This study recruited 88 patients who received surgical stabilization with instrumentation for the treatment of spinal metastasis. Their medical records and postoperative X-rays were reviewed for evidence of implant failure. Statistical analysis with logistic regression was performed to assess nine potential risk factors for the development of implant failure, including patient’s age at operation, gender, survival, primary tumor, spinal level involved, construct length, decompression levels, fusion material utilization, and radiotherapy application either before or after surgery, to identify potential contributing risk factors. @*Results@#Implant failure was identified in nine out of 88 cases (10.2%) with two cases requiring implant removal: one case included a progressive kyphosis that resulted in nonhealing sore and the other involved a deep-seated wound infection that spread to the implants. Another case required wound debridement due to superficial wound infection. The remaining six cases were asymptomatic, despite postoperative X-rays demonstrating evidence of implant failure. No patient required implant revision. Logistic regression analysis demonstrated that patients who received radiotherapy either before or after surgery were less likely to develop implant failure. @*Conclusions@#The development of radiological implant failure following surgical treatment of spinal metastasis is common. However, symptomatic implant failure leading to revision surgery is uncommon. Our findings suggest that radiotherapy, either before or after spinal surgery, is not associated with the development of implant failure.

An international collaborative study on influenza viruses antibody titers and contact patterns of individuals in rural and urban household of Guangzhou / 中华流行病学杂志

<p><b>OBJECTIVE</b>To describe the influenza viruses antibody levels and contact patterns of individuals in rural and urban regions of Guangzhou and to understand how contact patterns and other factors would correlate with the levels on the titers of antibody.</p><p><b>METHODS</b>"Google Map" was used to randomly select the study points from the administrative areas in Guangzhou region. Each participant was required to provide 5 ml blood serum sample to be tested against different strains of H1N1 and H3N2 influenza viruses.</p><p><b>RESULTS</b>1) Using "Google map", 50 study points were selected but only 40 study points would meet the inclusion criteria. The cohort of this study consisted 856 households with 2 801 individuals. 1 821 participants (65% of the total number individuals in the cohort) completed the questionnaires. Among the 1 821 participants, 77.3% (1 407/1 821) and 22.7% (414/1 821) of them were from rural and urban areas respectively. There were more male participants in the rural but more female participants in the urban regions. Majority of the participants were from age group 18-59 followed by group 60 with aged 2-17 the least, in both rural and urban areas. 2) 78.1% (1 423/1 821) of the participants provided their serum samples. There appeared a strong correlation between age of the participants and the strength of their antibodies against that strain when a strain first circulated. In particular, seroprevalence was the highest at the age group 2-17. 3) 'Contact' was defined as persons having physical touch or/and conversation within one meter with the participants. Participants reported all having had large number of contacts. The proportion of participants having contacts with ten persons or above was the highest, ranging from 49.8% to 72.6%, particularly in age group 6-17. Compared to weekdays, participants had fewer contact persons on weekends.</p><p><b>CONCLUSION</b>There was a strong correlation between the age of participants at the time when the strains first circulated and the seroprevalence against influenza virus strains of H1N1 and H3N2. Also, age of the participants and the frequencies of their contacts to people, was also correlated.</p>