What had people in China done as early as Day 5-12 since the Wuhan lockdown to control COVID-19 effectively: a national population-based cross-sectional study of 23,863 university students.

Lau, Joseph; Yu, Yanqiu; Xin, Meiqi; She, Rui; Luo, Sitong; Li, Lijuan; Wang, Suhua; Ma, Le; Tao, Fangbiao; Zhang, Jianxin; Zhao, Junfeng; Li, Liping; Hu, Dongsheng; Zhang, Guohua; Gu, Jing; Lin, Danhua; Wang, Hongmei; Cai, Yong; Wang, Zhaofen; You, Hua; Hu, Guoqing

BACKGROUND The outbreak of the Coronavirus Disease 2019 (COVID-19) in China occurred around the Chinese New Year (CNY, January 25, 2020), and dropped continuously afterwards. Adoption of preventive measures during the CNY period was crucial in driving the decline. It is imperative to investigate preventive behaviors among Chinese university students, as they might spread COVID-19 when travelling home during the CNY. OBJECTIVE This study investigated the levels of COVID-19-related personal measures (frequent face-mask wearing, frequent handwashing, frequent home-staying) and an indicator combining the three behaviors taken up during the 7-day CNY holidays by university students in China, and associated COVID-19-related cognitive factors. METHODS A cross-sectional anonymous online survey was conducted during February 1-10, 2020. Data of 23,863 students of 26 universities of 16 cities in 13 provincial-level regions were analyzed (overall response rate=70%). Multi-level multiple logistic regression analysis was performed. RESULTS Only 28.0% of the participants had left home for >4 hours (49.3% had never left home) during the 7-day CNY period; 79.7% always used face-masks in public areas. Frequency of handwashing with soap was relatively low (26.9% for >5 times/day); 72.4% had frequently taken up ≥2 of these three measures. COVID-19-related cognitive factors (perceptions on modes of transmission, permanent bodily damage, efficacy of personal/governmental preventive measures, non-availability of vaccines/treatments) were significantly associated with the preventive measures. The associations of frequent face-mask wearing were stronger than those of frequent home-staying. CONCLUSIONS The levels of personal prevention, especially frequent home-staying and face-mask wearing, were high. Health promotion may modify the cognitive factors. Some structural factors (e.g., social distancing policy) might explain why the frequency in home-staying were higher than handwashing. University students had made strong behavioral responses during the very early phase of the COVID-19 outbreak. Other populations might have behaved similarly. It, however, remains uncertain, as such data are not available.