The knowledge about coronavirus (COVID-19) among populations in two different Arab countries

Abstract

COVID-19 is an infectious disease caused by a newly discovered coronavirus. Most patients infected with the COVID-19 virus experience mild to moderate respiratory symptoms and heal without any special treatment. This survey aimed to assess the knowledge of Syrian and Saudi populations about the general information, symptoms, and methods of prevention of coronavirus (COVID-19).

Materials and Methods:

A standardized questionnaire composed of four sections (demography, general information about COVID-19, symptoms of COVID-19 infection, and methods of prevention) including 34 questions divided between the four mentioned sections were sent online to different social media in the Syrian Arab Republic and Kingdom of Saudi Arabia as a Google drive form. The collected data were coded, computerized, and analyzed using methods of descriptive statistics by SPSS 25. A Chi-square test was done.

Results:

The total number of participants was 790; most of them were in the age group of 18–30 years (60.3%) wherein females formed about 59.2% of the whole sample. About 94.6% of the respondents from Syria agreed that several coronaviruses are known to cause respiratory infections while 45.6% of Saudi people knew that diarrhea is one of the symptoms of coronavirus (COVID-19). The good results of this current study were clear in the section of coronavirus (COVID-19) prevention as most of the information was correct in more than 60% of answers.

Conclusion:

The knowledge of Syrian and Saudi populations about the general information, symptoms, and methods of prevention of coronavirus COVID-19 was very good to excellent except in very limited points.

Introduction

In December 2019, several patients presented to hospitals with a diagnosis of pneumonia of unknown causes. These patients were depending on their food on seafood and wet animal wholesale market in Wuhan.[1,2] A lot of early reports predicted the onset of a potential coronavirus outbreak. The first cases were recorded in December 2019.[3] The time elapsed between the onset of COVID-19 symptoms to death is ranging between 6 to 41 days.[4] The shortest period until death was among patients more than 70- years of age.[4] The symptoms at the beginning of COVID-19 infection are fever, cough, and fatigue.[5] COVID-19 patients showed high leukocyte counts, abnormal respiratory findings, and also high levels of plasma pro-inflammatory cytokines. Mammals are the most possible mediator between COVID-19 and humans. Many studies suggested that person-to-person transmission is a probable way of the COVID-19 infection spreading. There was no proof that there is a transmission of COVID-19 from mom to child, but also it remains uncertain whether or not transmission can happen in the course of vaginal birth. A large number of countries have executed major prevention measures including travel screenings to control more spread of COVID-19. The current study was conducted as a step toward helping the health providers in taking a look at the society's level of knowledge about this new virus COVID-19.

Materials and Methods

A standardized questionnaire composed of four sections (demography, general information about COVID-19, symptoms of COVID-19 infection, and methods of prevention) including 34 close-ended questions divided between the four mentioned sections respectively (4,14,7,9) was sent online to different social media groups (Facebook, Whatsapp, and Snapchat) in the Syrian Arab Republic and Kingdom of Saudi Arabia as a Google drive form. The same person was not allowed to answer more than one time. The pilot study was performed on 20 persons from each country to evaluate the validity of the survey questions, and minor modifications were done. The collected data were coded in an Excel sheet, then computerized and analyzed using methods of descriptive statistics by SPSS 25. A Chi-square test was performed for qualitative data comparison. Results were evaluated at a significant level of P < 0.05.

Results

Section 1: Demographic distribution:

As depicted in Tables 1 and 2, exactly 790 participants answered the required questions of the survey completely and re-sent it. Nearly 577 persons (73.03%) were Syrian while 213 (26.97%) were from Saudi Arabia. About 60.3% of the respondents were aged between 18–30 years. Females formed about 59.2% of the whole studied sample. For the educational level, 665 participants (84.2%) were university educated. The average monthly income was dominant among all participants as reported by 513 (64.9%) participants.

Table 1.

Distribution of the participants according to age, gender, educational level, and monthly income

Age (Years)						Total		Gender				Total
n	%	n	%	n	%	n	%	n	%	n	%	n	%
18-30		31-42		>42				Male		Female
476	60.3	236	29.9	78	9.8	790	100	322	40.8	468	59.2	790	100

Table 2.

Distribution of the participants according to (age, gender, educational level, and monthly income) depending on the nationality

	Age (Years)								Total				Gender						Total
	n		%	n	%		n	%	n		%		n	%		n	%		n	%
	18-30			31-42			>42						Male			Female
	Syrian	332		57.5	174	30.2		71	12.3	577		100		243	42.1		334	57.9		577	100
Saudi	144		67.6	62	29.1		7	3.3	213		100		79	37.1		134	62.9		213	100
Educational Level									Total		Monthly Income								Total
	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
	Pri. s		Prep. s		Sec. s		Uni				low		Average		High		V. High
Syrian	5	0.9	21	3.6	64	11.1	487	84.4	577	100	151	26.4	380	65.8	44	7.5	2	0.3	577	100
Saudi	1	0.5	1	0.5	33	15.5	178	83.5	213	100	51	23.9	133	62.4	26	12.2	3	1.5	213	100

([Educational Level; Pri: Primary school, Prep: Preparatory school, Sec: Secondary school, Uni: University], [Monthly Income; V.: Very])

Educational Level								Total		Monthly Income								Total
n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Pri. s		Prep. s		Sec. s		Uni				low		Average		High		V. High
6	0.8	22	2.7	97	12.3	665	84.2	790	100	202	25.6	513	64.9	70	8.9	5	0.6	790	100

([Educational Level; Pri: Primary school, Prep: Preparatory school, Sec: Secondary school, Uni: University], [Monthly Income; V.: Very])

Section 2: The knowledge about general information of coronavirus (COVID-19)

Tables 3 and 4 showed that 71.8% of the participants agreed that coronavirus (COVID-19) can affect animals and humans and 59.4% of all respondents went with the information saying coronavirus (COVID-19) is common among bats and other animals.

Table 3.

Assessment of the knowledge of citizens of general information about coronaviruses (COVID-19)

Yes		No		I do not know		Total
n	%	n	%	n	%	n	%
Coronaviruses (COVID-19) are a large family of viruses which may cause illness in animals or humans
567	71.8	169	21.4	54	6.8	790	100
Coronaviruses are a large group of viruses common among bats and animals
469	59.4	190	24.1	131	16.6	790	100
Several coronaviruses are known to cause respiratory infections
734	92.9	40	5.1	16	2	790	100
Several coronaviruses are known to cause Severe Acute Respiratory Syndrome (SARS)
306	38.7	266	33.7	218	27.6	790	100
Some people become infected but only have very mild symptoms
683	86.5	80	10.1	27	3.4	790	100
Most people recover from the disease without needing hospital treatment
461	58.4	238	30.1	91	11.5	790	100
The disease caused by infection with the coronavirus (COVID-19) is generally mild, especially in children and young adults
470	59.5	253	32	67	8.5	790	100
The disease spreads primarily from person to person through small droplets from the nose or mouth, which are expelled when a person with COVID-19 coughs, sneezes, or speaks
773	97.8	8	1	9	1.1	790	100
It is possible to catch COVID-19 from someone who has just a mild cough and does not feel ill.
597	75.6	103	13	90	11.4	790	100
The risk of transmission of coronavirus COVID-19 through the faeces of an infected person is limited
302	38.2	188	23.8	300	38	790	100
COVID-19 virus can survive for up to many days on surfaces
490	62	240	30.4	60	7.6	790	100
The time between exposure to COVID-19 and the moment when symptoms start is commonly around 5 to 6 days but can range from 1-14 days.
745	94.3	14	1.8	31	3.9	790	100
Antibiotics should not be used as a means of prevention or treatment of COVID-19
633	80.1	55	7	102	12.9	790	100
There is no vaccine and no specific antiviral medicines against COVID-19
697	88.2	37	4.7	56	7.1	790	100

Table 4.

Assessment of the knowledge of citizens of general information about coronaviruses (COVID-19) depending on nationality

Syrian								Saudi
Yes		No		I do not know		Total		Yes		No		I do not know		Total
n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Coronaviruses (COVID-19) are a large family of viruses which may cause illness in animals or humans
411	71.2	130	22.5	36	6.3	577	100	156	73.2	39	18.3	18	8.5	213	100
Coronaviruses are a large group of viruses common among bats and animals
345	59.8	143	24.8	89	15.4	577	100	124	58.2	47	22.1	42	19.7	213	100
Several coronaviruses are known to cause respiratory infections
546	94.6	19	3.3	12	2.1	577	100	188	88.2	21	9.9	4	1.9	213	100
Several coronaviruses are known to cause Severe Acute Respiratory Syndrome (SARS)
235	40.8	194	33.6	148	25.6	577	100	71	12.3	72	12.5	70	12.2	213	100
Some people become infected but only have very mild symptoms
503	87.2	58	10	16	2.8	577	100	180	84.5	22	10.3	11	5.2	213	100
Most people recover from the disease without needing hospital treatment
355	61.5	159	27.6	63	10.9	577	100	106	49.8	79	37.1	28	13.1	213	100
The disease caused by infection with the coronavirus (COVID-19) is generally mild, especially in children and young adults
356	61.7	172	29.8	49	8.5	577	100	114	53.5	81	38	18	8.5	213	100
The disease spreads primarily from person to person through small droplets from the nose or mouth, which are expelled when a person with COVID-19 coughs, sneezes, or speaks
564	97.7	8	1.4	5	0.9	577	100	209	98.1	0	0	4	1.9	213	100
It is possible to catch COVID-19 from someone who has just a mild cough and does not feel ill.
453	78.5	70	12.1	54	9.4	577	100	144	67.5	33	15.5	36	17	213	100
The risk of transmission of coronavirus COVID-19 through the feces of an infected person is limited
250	43.3	136	23.6	191	33.1	577	100	52	24.4	52	24.4	109	51.2	213	100
COVID-19 virus can survive for up to many days on surfaces
357	61.9	182	31.5	38	6.6	577	100	133	62.4	58	27.2	22	10.3	213	100
The time between exposure to COVID-19 and the moment when symptoms start is commonly around 5 to 6 days but can range from 1-14 days.
545	94.5	12	2.1	20	3.4	577	100	200	93.9	2	0.9	11	5.2	213	100
Antibiotics should not be used as a means of prevention or treatment of COVID-19
480	83.1	38	6.7	59	10.2	577	100	153	71.8	17	8	43	20.2	213	100
There is no vaccine and no specific antiviral medicines against COVID-19
519	89.9	24	4.2	34	5.9	577	100	178	83.6	13	6.1	22	10.3	213	100

Notably, most of the people in these two studied countries (92.9%) were familiar with the ability of coronavirus (COVID-19) to cause respiratory infections. On the other side, only 306 (38.7%) knew that some coronaviruses can cause severe acute respiratory syndrome (SARS). About 86.5% had information that the patient infected with coronavirus (COVID-19) could have only mild symptoms. More than half (58.4%) of the recent studied respondents believed that there is a possibility of patients recovering without the need for hospital treatment while approximately the same percentage (59.5%) assured that this kind of disease is mild in children and young adults. Nearly 97.8% were aware that the infection of coronavirus (COVID-19) can spread from person to person through small droplets from the mouth or nose while speaking, sneezing, or coughing. It is possible to catch coronavirus (COVID-19) infection from a person who has just a mild cough and does not feel ill as mentioned by 75.6% of respondents. A low percentage of 38.2% of the whole sample declared that coronavirus (COVID-19) can be transmitted through the feces of infected people. Coronavirus (COVID-19) can survive for many days on surfaces as reported by 62% of participants. The time between exposure to COVID-19 and the moment of symptoms arising is commonly around 5 to 6 days and can reach up to 14 days; 94.3% of respondents were aware of this truth. More than 80% of participants had the knowledge of the insignificance of antibiotics intake in such cases (coronavirus [COVID-19]) and the unavailability of any effective vaccine or antiviral medicine against this new virus.

Section 3: The knowledge about symptoms of coronavirus (COVID-19) infection

More than 70% of people participating in the current study were familiar with most of the coronavirus (COVID-19) infection symptoms (fever, tiredness, dry cough, aches and pains, and sore throat) except for nasal congestion which was known among only (39.6%) and diarrhea among (44.3%) [Tables 5 and 6].

Table 5.

Assessment of the knowledge of citizens of the signs and symptoms of coronaviruses (COVID-19) infection

Yes		No		I do not know		Total
n	%	n	%	n	%	n	%
Fever
770	97.5	9	1.1	11	1.4	790	100
Tiredness
715	90.5	33	4.2	42	5.3	790	100
Dry cough
765	96.8	9	1.1	16	2	790	100
Aches and pains
679	85.9	57	7.2	54	6.8	790	100
Nasal congestion
313	39.6	352	44.6	125	15.8	790	100
Sore throat
578	73.2	148	18.7	64	8.1	790	100
Diarrhea
350	44.3	289	36.6	151	19.1	790	100

Table 6.

Assessment of the knowledge of citizens of the signs and symptoms of coronaviruses (COVID-19) infection depending on nationality

Syrian								Saudi
Yes		No		I do not know		Total		Yes		No		I do not know		Total
n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Fever
565	97.9	5	0.9	7	1.2	577	100	205	96.2	4	1.9	4	1.9	213	100
Tiredness
538	93.3	22	3.8	17	2.9	577	100	177	83.1	11	5.2	25	11.7	213	100
Dry cough
560	97.1	6	1	11	1.9	577	100	205	96.2	3	1.4	5	2.3	213	100
Aches and pains
500	86.7	43	7.4	34	5.9	577	100	179	84	14	6.6	20	9.4	213	100
Nasal congestion
217	37.6	268	46.4	92	16	577	100	96	45.1	84	39.4	33	15.5	213	100
Sore throat
426	73.8	111	19.2	40	7	577	100	152	71.4	37	17.4	24	11.2	213	100
Diarrhea
253	43.8	228	39.5	96	16.7	577	100	97	45.6	61	28.6	55	25.8	213	100

Section 4: The knowledge about coronaviruses (COVID-19) infection’ prevention methods

About 77% of correspondents and more were familiar with the prevention methods of coronavirus (COVID-19) infection. Only 60.5% realized the necessity of wearing masks only in cases of having coronavirus (COVID-19) infection symptoms [Tables 7 and 8].

Table 7.

Assessment of the knowledge of citizens about coronaviruses (COVID-19) infection prevention methods

Yes		No		I do not know		Total
n	%	n	%	n	%	n	%
It is important to stay at least 1 m (3 feet) away from others
713	90.3	40	5.1	37	4.7	790	100
Regularly and thoroughly clean your hands with an alcohol-based hand rub.
636	80.5	126	15.9	28	3.5	790	100
Washing your hands with soap and water.
775	98.1	7	0.9	8	1	790	100
Avoid touching eyes, nose, and mouth.
776	98.2	8	1	6	0.8	790	100
Covering your mouth and nose with your bent elbow or tissue when you cough or sneeze.
765	96.8	16	2	9	1.1	790	100
Stay home and self-isolate even with minor symptoms such as cough, headache, mild fever, until you recover.
760	96.2	25	3.2	5	0.6	790	100
If you have a fever, cough, and difficulty breathing, seek medical attention, but call by telephone in advance if possible.
767	97.1	16	2	7	0.9	790	100
You do not need to wear a mask unless you have symptoms of Covid.19 disease (especially coughing).
478	60.5	282	35.7	30	3.8	790	100
Avoid direct contact with animals and surfaces in contact with animals
608	77	108	13.7	74	9.4	790	100

Table 8.

Assessment of the knowledge of citizens about coronaviruses (COVID-19) infection prevention methods depending on nationality

Syrian								Saudi
Yes		No		I do not know		Total		Yes		No		I do not know		Total
n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
It is important to stay at least 1 m (3 feet) away from others.
529	91.7	26	4.5	22	3.8	577	100	184	86.4	14	6.6	15	7	213	100
Regularly and thoroughly clean your hands with an alcohol-based hand rub.
572	99.1	87	15.1	18	3.1	577	100	164	77	39	8.3	10	4.7	213	100
Washing your hands with soap and water.
567	98.3	4	0.7	6	1	577	100	208	97.7	3	1.4	2	0.9	213	100
Avoid touching eyes, nose, and mouth.
568	98.4	4	0.7	5	0.9	577	100	208	97.7	4	1.9	1	0.5	213	100
Covering your mouth and nose with your bent elbow or tissue when you cough or sneeze.
558	96.7	12	2.1	7	1.2	577	100	207	97.2	4	1.9	2	0.9	213	100
Stay home and self-isolate even with minor symptoms such as cough, headache, mild fever, until you recover.
556	96.4	17	2.9	4	0.7	577	100	204	95.8	8	3.8	1	0.5	213	100
If you have a fever, cough, and difficulty breathing, seek medical attention, but call by telephone in advance if possible.
559	96.9	13	2.3	5	0.9	577	100	208	97.7	3	1.4	2	0.9	213	100
You do not need to wear a mask unless you have symptoms of Covid-19 disease (especially coughing).
342	59.3	214	37.1	21	3.6	577	100	136	63.8	68	31.9	9	4.3	213	100
Avoid direct contact with animals and surfaces in contact with animals
443	76.8	83	14.4	51	8.8	577	100	165	77.5	25	18.7	23	10.8	213	100

Discussion

In late December 2019, the first cases of coronavirus disease (COVID-19) appeared in Wuhan, China and during less than 3 months it became a widespread pandemic around the world. This disease shocked the entire world and caused a major shift in the lifestyle of humans worldwide. For these reasons, it has received a great deal of attention from organizations, governments, and decision-makers. It was also the number one topic on global newscasts and social media. Therefore, this study was conducted as a step to help health providers to take a look at the society's level of knowledge about this new disease. This survey aimed to assess the knowledge about coronavirus disease (COVID-19) in two important countries in the Middle East, Syria, and Saudi Arabia.

The total number of participants in this survey were 790. Syrians participants (577) were significantly more than Saudis (213) (P > 0.05). Most of the participants were females (59.2%), in the age group of 18–30 (60.3%), had university educational level (84.2%), and were average monthly income earners (64.9%).

This survey compromised questions to evaluate the knowledge level about general information, symptoms, and methods of prevention of new coronavirus disease (COVID-19).

For general information, according to WHO, the following facts were noted: (https://www.who.int/ar/emergencies/diseases/novel-coronavirus-2019/advice-for-public/q-a-coronaviruses)[6]

-Coronavirus (COVID-19) is a large family of viruses that may cause illness in animals or humans.

-Coronaviruses are a large group of viruses common among bats and animals.

-Several coronaviruses are known to cause respiratory infections.

-Several coronaviruses are known to cause Severe Acute Respiratory Syndrome (SARS).

-Some people become infected but only have very mild symptoms.

-Most people recover from the disease without needing hospital treatment.

-The disease caused by infection with the coronavirus (COVID-19) is generally mild, especially in children and young adults.

-The disease spreads primarily from person to person through small droplets from the nose or mouth, which are expelled when a person with COVID-19 coughs, sneezes or speaks.

-It is possible to catch COVID-19 from someone who has just a mild cough and does not feel ill.

-The risk of transmission of coronavirus (COVID-19) through the feces of an infected person is limited.

-COVID-19 virus can survive for up to many days on surfaces.

-The time between exposure to COVID-19 and the moment when symptoms start is commonly around 5 to 6 days but can range from 1–14 days.

-Antibiotics should not be used as a means of prevention or treatment of COVID-19.

-There is no vaccine and no specific antiviral medicines against COVID-19.

Although statistically, there was no significant difference in the accuracy of most answers about general information between Syrian and Saudis, male and female, age groups, educational level, and monthly income (P < 0.05), the university educational participants were statistically better when compared to the rest of the age groups (P > 0.05).

Most participants showed good level of knowledge about coronavirus disease (COVID-19) for general information, especially in ways of transmission of coronavirus disease (COVID-19). Besides, most of the participants realized that antibiotics are not helpful for treatment and there is no vaccine and no specific antiviral medicines against COVID-19. These results could be due to widespread interest in the media and social media about coronavirus disease (COVID-19). The symptoms of COVID-19 infection appear after an incubation period of approximately 5.2 days.[7] The period from the onset of COVID-19 symptoms to death ranged from 6 to 41 days with a median of 14 days. This period is dependent on the age of the patient and the status of the patient's immune system. It was shorter among patients above 70-years of age compared with those under the age of 70.[4] The most common symptoms at the onset of COVID-19 disease are fever, cough, and fatigue, in addition to other symptoms as sputum production, headache, hemoptysis, diarrhea, dyspnea, and lymphopenia.[4,8] Clinical features revealed by a chest computed tomography (CT) scan presented as pneumonia. On the other hand, we can find abnormal features such as RNAaemia, acute respiratory distress syndrome, acute cardiac injury, and incidence of grand-glass opacities that led to death.[9] In some cases, the multiple peripheral ground-glass opacities were observed in subpleural regions of both lungs that likely induced both systemic and localized immune response that led to increased inflammation [10] COVID-19 illness also showed some unique clinical features that include the targeting of the lower airway as evident by upper respiratory tract symptoms such as rhinorrhea, sneezing, and sore throat.[11,12] Besides, chest radiographs in some cases showed an infiltrate in the upper lobe of the lung associated with increased dyspnea and hypoxemia.[13] COVID-19 patients also developed gastrointestinal symptoms like diarrhea, Therefore, it is important to test fecal and urine samples to exclude a potential alternative route of transmission, specifically through healthcare workers, patients, etc.[11,12]

The result of this survey revealed good knowledge among participants about the symptoms of coronavirus disease (COVID-19) since more than 85% of participants confirmed that fever; tiredness, dry cough, aches, and pains are explicit symptoms of coronavirus disease (COVID-19). While less than half of the participants (44.3%) confirmed that diarrhea is a symptom in this illness since these symptoms were related to gastrointestinal disorders and COVID-19 is related to the respiratory system.

The World Health Organization reported on its web site many steps and methods to keep people safe and far away from the new virus (COVID-19), these recommendations can be summarized as follows [6]:

-It is important to stay at least 1 m (3 feet) away from others.

-Regularly and thoroughly clean your hands with an alcohol-based hand rub.

-Washing your hands with soap and water.

-Avoid touching eyes, nose, and mouth.

-Covering your mouth and nose with your bent elbow or tissue when you cough or sneeze.

-Stay home and self-isolate even with minor symptoms such as cough, headache, mild fever, until you recover.

-If you have a fever, cough, and difficulty breathing, seek medical attention, but call by telephone in advance if possible.

-You do not need to wear a mask unless you have symptoms of COVID-19 disease (especially coughing).

-Avoid direct contact with animals and surfaces in contact with animals.

The knowledge of the people about measures of safety and prevention in the two studied countries was very good to excellent.

However, only 59.3% agreed with the necessity of wearing masks by health people. As the matter remains controversial; best practices should be followed about how to wear, remove, and dispose them and how to maintain hand hygiene after removal.[14]

There was a statistical effect of gender on the importance of wearing the mask by healthy people (P = 001), also this measure was clear to be statistically affected by educational level (P = 0.013) and monthly income (P = 0.000).

Conclusion

-The level of knowledge about the studied points relating to coronavirus disease (COVID-19) ranged from very good to excellent except very limited points which should be made clear through the TV, newspapers, and social media.

-The updated information about coronavirus disease (COVID-19) should be provided to people as soon as possible to keep them aware of the measures to be followed to protect themselves and their communities.

-Cross-sectional studies should be made everywhere to know exactly where the people are standing from the current pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.