Assessing the Impact of the COVID-19 Pandemic in Spain: Large-Scale, Online, Self-Reported Population Survey

Abstract

Background: Spain has been one of the countries most impacted by the COVID-19 pandemic. Since the first confirmed case was reported on January 31, 2020, there have been over 405,000 cases and 28,000 deaths in Spain. The economic and social impact is without precedent. Thus, it is important to quickly assess the situation and perception of the population. Large-scale online surveys have been shown to be an effective tool for this purpose.

Objective: We aim to assess the situation and perception of the Spanish population in four key areas related to the COVID-19 pandemic: social contact behavior during confinement, personal economic impact, labor situation, and health status.

Methods: We obtained a large sample using an online survey with 24 questions related to COVID-19 in the week of March 28-April 2, 2020, during the peak of the first wave of COVID-19 in Spain. The self-selection online survey method of nonprobability sampling was used to recruit 156,614 participants via social media posts that targeted the general adult population (age >18 years). Given such a large sample, the 95% CI was ±0.843 for all reported proportions.

Results: Regarding social behavior during confinement, participants mainly left their homes to satisfy basic needs. We found several statistically significant differences in social behavior across genders and age groups. The population's willingness to comply with the confinement measures is evident. From the survey answers, we identified a significant adverse economic impact of the pandemic on those working in small businesses and a negative correlation between economic damage and willingness to stay in confinement. The survey revealed that close contacts play an important role in the transmission of the disease, and 28% of the participants lacked the necessary resources to properly isolate themselves. We also identified a significant lack of testing, with only 1% of the population tested and 6% of respondents unable to be tested despite their doctor's recommendation. We developed a generalized linear model to identify the variables that were correlated with a positive SARS-CoV-2 test result. Using this model, we estimated an average of 5% for SARS-CoV-2 prevalence in the Spanish population during the time of the study. A seroprevalence study carried out later by the Spanish Ministry of Health reported a similar level of disease prevalence (5%).

Conclusions: Large-scale online population surveys, distributed via social media and online messaging platforms, can be an effective, cheap, and fast tool to assess the impact and prevalence of an infectious disease in the context of a pandemic, particularly when there is a scarcity of official data and limited testing capacity.

Keywords: COVID-19; SARS-CoV-2; disease prevalence; impact; infectious disease; large-scale online surveys; outbreak; perception; public engagement; public health; public health authorities; spain; survey.

Figure 1

Number of answers collected by the Covid19Impact survey in its first two days, reported in one hour intervals.

Figure 2

Reasons for leaving the home by gender and age.

Figure 3

Receiver operating characteristic of the symptom-only model (left) and full model (symptom, sex, age >70 years, and household infected member model; right). AUC: area under the curve.

Figure 4

Two methods for estimating the proportion of active coronavirus infections during the time of our study in relation to those identified by the seroprevalence study. Red dotted line based on the Mortality Monitoring System deaths, assuming infection started 2 weeks prior to death. Blue dotted line based on reported positive cases, assuming infection ended 2 weeks after the case was reported. Cases and deaths from the Carlos III Health Institute in Spain.