Use of Rapid Online Surveys to Assess People's Perceptions During Infectious Disease Outbreaks: A Cross-sectional Survey on COVID-19

Abstract

Background: Given the extensive time needed to conduct a nationally representative household survey and the commonly low response rate of phone surveys, rapid online surveys may be a promising method to assess and track knowledge and perceptions among the general public during fast-moving infectious disease outbreaks.

Objective: This study aimed to apply rapid online surveying to determine knowledge and perceptions of coronavirus disease 2019 (COVID-19) among the general public in the United States and the United Kingdom.

Methods: An online questionnaire was administered to 3000 adults residing in the United States and 3000 adults residing in the United Kingdom who had registered with Prolific Academic to participate in online research. Prolific Academic established strata by age (18-27, 28-37, 38-47, 48-57, or ≥58 years), sex (male or female), and ethnicity (white, black or African American, Asian or Asian Indian, mixed, or "other"), as well as all permutations of these strata. The number of participants who could enroll in each of these strata was calculated to reflect the distribution in the US and UK general population. Enrollment into the survey within each stratum was on a first-come, first-served basis. Participants completed the questionnaire between February 23 and March 2, 2020.

Results: A total of 2986 and 2988 adults residing in the United States and the United Kingdom, respectively, completed the questionnaire. Of those, 64.4% (1924/2986) of US participants and 51.5% (1540/2988) of UK participants had a tertiary education degree, 67.5% (2015/2986) of US participants had a total household income between US $20,000 and US $99,999, and 74.4% (2223/2988) of UK participants had a total household income between £15,000 and £74,999. US and UK participants' median estimate for the probability of a fatal disease course among those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 5.0% (IQR 2.0%-15.0%) and 3.0% (IQR 2.0%-10.0%), respectively. Participants generally had good knowledge of the main mode of disease transmission and common symptoms of COVID-19. However, a substantial proportion of participants had misconceptions about how to prevent an infection and the recommended care-seeking behavior. For instance, 37.8% (95% CI 36.1%-39.6%) of US participants and 29.7% (95% CI 28.1%-31.4%) of UK participants thought that wearing a common surgical mask was "highly effective" in protecting them from acquiring COVID-19, and 25.6% (95% CI 24.1%-27.2%) of US participants and 29.6% (95% CI 28.0%-31.3%) of UK participants thought it was prudent to refrain from eating at Chinese restaurants. Around half (53.8%, 95% CI 52.1%-55.6%) of US participants and 39.1% (95% CI 37.4%-40.9%) of UK participants thought that children were at an especially high risk of death when infected with SARS-CoV-2.

Conclusions: The distribution of participants by total household income and education followed approximately that of the US and UK general population. The findings from this online survey could guide information campaigns by public health authorities, clinicians, and the media. More broadly, rapid online surveys could be an important tool in tracking the public's knowledge and misperceptions during rapidly moving infectious disease outbreaks.

Keywords: COVID-19; SARS-CoV-2; coronavirus; infectious disease; knowledge; outbreak; pandemic; perceptions; public health; rapid online surveys; survey.

Figure 1

Time at which participants started the questionnaire. Dates and times are given in Pacific Standard Time. Bins have a width equal to 30 minutes.

Figure 2

Proportion of participants who selected each category for their estimate of the number of COVID-19 deaths in their country by the end of 2020.

Figure 3

Distribution of responses to the question, “What percent of people who get infected with the new coronavirus die from this infection?”.

Figure 4

Proportion of participants who replied with “yes” to whether each of seven symptoms or signs were common for COVID-19. The horizontal black bars represent the 95% CIs calculated using the Wilson method [14].

Figure 5

Responses to the question “If you have a fever or cough and recently visited China, or spent time with someone who did, what would be the best course of action?” GP: general practitioner; A&E: accident and emergency (department).

Figure 6

Proportion of participants who replied with “yes” to whether each of 11 actions help prevent an infection with SARS-CoV-2. The horizontal black bars represent the 95% CIs calculated using the Wilson method [14].

Figure 7

Proportion of participants who replied with “yes” to each government action in response to the question “At this point in the coronavirus epidemic, do you think your government should implement the following measures to prevent spreading of the virus?” The horizontal black bars represent the 95% CIs calculated using the Wilson method [14].

Figure 8

Distribution of the responses to questions on COVID-19 prevalence among individuals of East-Asian ethnicity. Of the total, 32 and 129 participants estimated a prevalence greater than 50% for the prevalence among East-Asian individuals in their country and East-Asian individuals wearing a face mask in their community, respectively. The responses from these individuals are not shown in the histogram below.

Figure 9

Distribution of responses to the question “If you were an Uber driver today, would you try to reject ride requests from people with East Asian-sounding names (or a profile photo of East-Asian ethnicity) to reduce your risk of getting infected with the new coronavirus?”.