cross country comparison of public awareness rumors and behavioral responses to the CORD-Papers-2022-06-02 (Version 1)

Title: Cross-Country Comparison of Public Awareness Rumors and Behavioral Responses to the COVID-19 Epidemic: Infodemiology Study
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.
Published: 2020-08-03
Journal: J Med Internet Res
DOI: 10.2196/21143
Author Name: Hou Zhiyuan
Author link:
Author Name: Du Fanxing
Author link:
Author Name: Zhou Xinyu
Author link:
Author Name: Jiang Hao
Author link:
Author Name: Martin Sam
Author link:
Author Name: Larson Heidi
Author link:
Author Name: Lin Leesa
Author link:
license: cc-by
source_x: Medline; PMC
pubmed_id: 32701460
pmcid: PMC7402643
has_full_text: TRUE
Keywords Extracted from PMC Text: [17-19] Multimedia Appendix 3 people patients [6,7] Tibet Wuhan purchased [1-3 radix isatidis PHEIC line 127,336 Figure 2 China's National Health face hydroxychloroquine coronavirus chloroquine [16] Multimedia Appendix 4 COVID-19 's contact/case Shuanghuanglian [4] garlic Figure 1 [12] " radix isatidis against Eve People's
Extracted PMC Text Content in Record: First 5000 Characters:In early December 2019, the then-unnamed novel coronavirus disease (COVID-19) emerged in Wuhan City and spread rapidly across China [1,2]. On January 23, 2020, the Chinese government placed Wuhan and several nearby cities under quarantine and implemented containment measures to slow community transmission [3]. The World Health Organization (WHO) declared the outbreak to be a public health emergency of international concern (PHEIC) on January 30, when there were almost 8000 confirmed cases worldwide; all but 98 of these cases, along with all 170 COVID-19–related deaths, were in China. The PHEIC declaration stressed the risk the virus posed to countries beyond China and the need for a more coordinated international response to the outbreak. On March 11, the WHO declared COVID-19 a global pandemic, with a worldwide confirmed case count of 118,000 in 114 countries and the death toll reaching more than 4200. At that time, more than 90% of cases were localized in four countries, including China and South Korea, where local epidemics had significantly declined [4]. By the end of April, the epidemic had spread to 213 countries with more than 3.02 million confirmed cases, leading to at least 208,000 deaths [5]. The United States reported the highest numbers of confirmed cases and deaths, followed by Spain, Italy, the United Kingdom, Germany, and France; all these countries reported over 120,000 cases and 24,000 deaths except for Germany, which reported approximately 6000 deaths [5]. During an epidemic, it is crucial to understand how critical information about the health threat is disseminated and how the public processes and responds to this information [6,7]. The risks and uncertainties of emerging infectious diseases may arouse public awareness and prompt either constructive behavior (eg, employing personal hand hygiene and avoiding mass gatherings) or disruptive behavior (eg, panic buying and adopting unproven treatments) [7,8]. COVID-19 has triggered the spread of rumors and misinformation through social media regarding unproven remedies, which has induced public stress and panic [9,10]. In addition, the public may respond differently to an epidemic across countries. In the early stage of the COVID-19 epidemic, people in Asian countries immediately began to wear face masks; however, Europeans and North Americans opposed this practice [11]. Messages from health authorities and evidence of the effectiveness of masks against COVID-19 are conflicting [12]. It is necessary to understand why and how the public responds to COVID-19–related information, which will further inform government risk communication and appropriate official guidelines [13]. The power of internet search data is being increasingly recognized in public health emergencies [14,15]. In contrast with traditional surveys, internet surveillance can systematically track public responses to epidemics in real time and is less likely to be affected by recall bias [16]. Despite these benefits, the role of internet surveillance (also called infoveillance or infodemiology) in monitoring public behavioral responses and rumors during an epidemic is still underexplored [17-19]. Using internet surveillance data from China and worldwide, this study aimed to assess the public awareness and behavioral responses in real time during the first 100 days of the COVID-19 epidemic. This study compares the governmental and public responses across selected countries and provides insights on the control of COVID-19 and future epidemics. In this study, we conducted internet surveillance in 12 countries. In addition to China, three countries in East and Southeast Asia that were affected by the first wave of the pandemic were selected, namely Japan, South Korea, and Singapore, followed by four European countries (Italy, France, Spain, and the United Kingdom) and the United States. Additionally, Brazil, South Africa, and India, where internet surveillance data (Google Trends) are available, were selected from Latin America, Africa, and South Asia, respectively. All data are publicly available. Google Trends can provide insight into the relative search volumes of search terms on Google on a daily basis [20]. Depending on the source of the search, Google Trends can be further divided into web search trends and Google Shopping trends, and these trends were highly correlated (Multimedia Appendix 1). The Google Trends index (web search) on the topic of coronavirus was used to assess the awareness of COVID-19 among the general public, whereas the Google Shopping indices on two topics, mask and hand sanitizer, were used to assess the adoption of personal protection measures. In countries where Google Shopping data were limited for assessing public purchasing behavior (including Japan, Singapore, South Korea, Italy, and Spain), Google web search data were used as an alternative. Google Trends presents relative search volumes ranging from 0 to 100 (the maximum daily search volume on speci
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