Unprecedented measures have been adopted to control the rapid spread of the ongoing COVID-19 epidemic in China. People's adherence to control measures is affected by their knowledge, attitudes, and practices (KAP) towards COVID-19. In this study, we investigated Chinese residents' KAP towards COVID-19 during the rapid rise period of the outbreak. An online sample of Chinese residents was successfully recruited via the authors' networks with residents and popular media in Hubei, China. A self-developed online KAP questionnaire was completed by the participants. The knowledge questionnaire consisted of 12 questions regarding the clinical characteristics and prevention of COVID-19. Assessments on residents' attitudes and practices towards COVID-19 included questions on confidence in winning the battle against COVID-19 and wearing masks when going out in recent days. Among the survey completers (n=6910), 65.7% were women, 63.5% held a bachelor degree or above, and 56.2% engaged in mental labor. The overall correct rate of the knowledge questionnaire was 90%. The majority of the respondents (97.1%) had confidence that China can win the battle against COVID-19. Nearly all of the participants (98.0%) wore masks when going out in recent days. In multiple logistic regression analyses, the COVID-19 knowledge score (OR: 0.75-0.90, P<0.001) was significantly associated with a lower likelihood of negative attitudes and preventive practices towards COVID-2019. Most Chinese residents of a relatively high socioeconomic status, in particular women, are knowledgeable about COVID-19, hold optimistic attitudes, and have appropriate practices towards COVID-19. Health education programs aimed at improving COVID-19 knowledge are helpful for Chinese residents to hold optimistic attitudes and maintain appropriate practices. Due to the limited sample representativeness, we must be cautious when generalizing these findings to populations of a low socioeconomic status.
On 11 March 2020, the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic 1. The strategies based on non-pharmaceutical interventions that were used to contain the outbreak in China appear to be effective 2 , but quantitative research is still needed to assess the efficacy of non-pharmaceutical interventions and their timings 3. Here, using epidemiological data on COVID-19 and anonymized data on human movement 4,5 , we develop a modelling framework that uses daily travel networks to simulate different outbreak and intervention scenarios across China. We estimate that there were a total of 114,325 cases of COVID-19 (interquartile range 76,776-164,576) in mainland China as of 29 February 2020. Without non-pharmaceutical interventions, we predict that the number of cases would have been 67-fold higher (interquartile range 44-94-fold) by 29 February 2020, and we find that the effectiveness of different interventions varied. We estimate that early detection and isolation of cases prevented more infections than did travel restrictions and contact reductions, but that a combination of non-pharmaceutical interventions achieved the strongest and most rapid effect. According to our model, the lifting of travel restrictions from 17 February 2020 does not lead to an increase in cases across China if social distancing interventions can be maintained, even at a limited level of an on average 25% reduction in contact between individuals that continues until late April. These findings improve our understanding of the effects of non-pharmaceutical interventions on COVID-19, and will inform response efforts across the world.
Socioeconomic status (SES) refers to an individual's social position relative to other members of a society. Low SES is associated with large increases in cardiovascular disease (CVD) risk in men and women. The inverse association between SES and CVD risk in high-income countries is the result of the high prevalence and compounding effects of multiple behavioral and psychosocial risk factors in people of low SES. However, strong and consistent evidence shows that parental SES, childhood and early-life factors, and inequalities in health services also contribute to elevated CVD risk in people of low SES who live in high-income countries. In addition, place of residence can affect CVD risk, although the data on the influence of wealth distribution and work-related factors are inconsistent. Studies on the effects of SES on CVD risk in low-income and middle-income countries is scarce, but evidence is emerging that the increasing wealth of these countries is beginning to lead to replication of the patterns seen in high-income countries. Clinicians should address the association between SES and CVD by incorporating SES into CVD risk calculations and screening tools, reducing behavioral and psychosocial risk factors via effective and equitable primary and secondary prevention, undertaking health equity audits to assess inequalities in care provision and outcomes, and by use of multidisciplinary teams to address risk factors over the life course.
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