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Comparative Study
. 2020 Aug 3;22(8):e21143.
doi: 10.2196/21143.

Cross-Country Comparison of Public Awareness, Rumors, and Behavioral Responses to the COVID-19 Epidemic: Infodemiology Study

Zhiyuan Hou  1   2 , Fanxing Du  1 , Xinyu Zhou  1 , Hao Jiang  1 , Sam Martin  3 , Heidi Larson  4   5 , Leesa Lin  4
Affiliations
Comparative Study

Cross-Country Comparison of Public Awareness, Rumors, and Behavioral Responses to the COVID-19 Epidemic: Infodemiology Study

Zhiyuan Hou et al. J Med Internet Res. .

Abstract

Background: Understanding public behavioral responses to the coronavirus disease (COVID-19) epidemic and the accompanying infodemic is crucial to controlling the epidemic.

Objective: The aim of this study was to assess real-time public awareness and behavioral responses to the COVID-19 epidemic across 12 selected countries.

Methods: Internet surveillance was used to collect real-time data from the general public to assess public awareness and rumors (China: Baidu; worldwide: Google Trends) and behavior responses (China: Ali Index; worldwide: Google Shopping). These indices measured the daily number of searches or purchases and were compared with the numbers of daily COVID-19 cases. The trend comparisons across selected countries were observed from December 1, 2019 (prepandemic baseline) to April 11, 2020 (at least one month after the governments of selected countries took actions for the pandemic).

Results: We identified missed windows of opportunity for early epidemic control in 12 countries, when public awareness was very low despite the emerging epidemic. China's epidemic and the declaration of a public health emergency of international concern did not prompt a worldwide public reaction to adopt health-protective measures; instead, most countries and regions only responded to the epidemic after their own case counts increased. Rumors and misinformation led to a surge of sales in herbal remedies in China and antimalarial drugs worldwide, and timely clarification of rumors mitigated the rush to purchase unproven remedies.

Conclusions: Our comparative study highlights the urgent need for international coordination to promote mutual learning about epidemic characteristics and effective control measures as well as to trigger early and timely responses in individual countries. Early release of official guidelines and timely clarification of rumors led by governments are necessary to guide the public to take rational action.

Keywords: COVID-19; Google Trends; behavior; infodemic; infodemiology; infoveillance; internet; public response; rumor; surveillance; trend.

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Conflict of interest statement

Conflicts of Interest: HL is on the Merck Vaccine Confidence Advisory Board. Her research group, the Vaccine Confidence Project, received research grants from GSK and Merck on vaccine confidence issues. None of those research grants are related to this paper.

Figures

Figure 1
Figure 1
Public awareness and searches related to COVID-19 by Baidu Index in China and Google Trends worldwide from December 2019 to April 2020. PHEIC: public health emergency of international concern; PHER: public health emergency response.
Figure 2
Figure 2
Trends of Baidu and Ali indices for recommended personal protection measures in China from December 2019 to April 2020: A. Face mask. B. Hand sanitizer. C. Disinfectant. D. Thermometer.
Figure 3
Figure 3
Cross-country comparison of Google Trends data for mask and hand sanitizer with numbers of COVID-19 cases from December 2019 to April 2020.
Figure 4
Figure 4
Trends of Baidu indices for rumors related to herbal remedies in China from December 2019 to April 2020.
Figure 5
Figure 5
Google Trends data on rumors related to antimalarial drugs worldwide from December 2019 to April 2020.
See this image and copyright information in PMC

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