Psychological responses, behavioral changes and public perceptions during the early phase of the COVID-19 outbreak in China: a population based cross-sectional survey

Mengcen Qian; Qianhui Wu; Peng Wu; Zhiyuan Hou; Yuxia Liang; Benjamin J Cowling; Hongjie Yu

Containment measures in the COVID-19 outbreak have focused on identifying, treating, and isolating infected people, tracing and quarantining their close contacts, and promoting precautionary behaviors among the general public. Therefore, the psychological and behavioral responses of the general population play an important role in the control of the outbreak. Previous studies have explored on this topic in various culture settings with SARS, 4, 5, 6 pandemic influenza A(H1N1), 7, 8, 9, 10 and influenza A(H7N9). 11, 12, 13 Cultural differences are evident in public responses. 14, 15 Behavioral changes are also associated with government involvement level, perceptions of diseases, and the stage of the outbreak, and these factors vary by diseases and settings. 4, 5, 8, 16 The current COVID-19 outbreak provides a unique platform to study behavioral changes for two main reasons. First, government engagement in the control of the outbreak has been unprecedented, for example, locking down Wuhan and surrounding cities, building new hospitals to treat infected patients in Wuhan within two weeks, extending holidays and school closure, deploying thousands of medical staff to heavily affected areas, and running intense public messaging campaigns. Second, the public are faced with rather mixed information, partly because knowledge of the newly emerging disease is evolving with the course of the outbreak. For example, the national technical protocols for COVID-19 released by the National Health Commission have been updated five times within a month. Both features might result in different public responses towards the outbreak. In this study, we aimed to investigate psychological and behavioral responses to the threat of COVID-19 outbreak and to examine public perceptions associated with the response outcomes in mainland China.