ORIGINAL RESEARCH

published: 18 August 2020

doi: 10.3389/fpubh.2020.00482

Awareness and Preparedness of

COVID-19 Outbreak Among
Healthcare Workers and Other
Residents of South-West Saudi
Arabia: A Cross-Sectional Survey
Rina Tripathi 1 , Saad S. Alqahtani 1 , Ahmed A. Albarraq 1 , Abdulkarim M. Meraya 1 ,
Pankaj Tripathi 2*, David Banji 1 , Saeed Alshahrani 2 , Waquar Ahsan 3 and
Fatimah M. Alnakhli 1
1
Department of Clinical Pharmacy, Pharmacy Practice Research Unit (PPRU), College of Pharmacy, Jazan University, Jazan,
Saudi Arabia, 2 Department of Pharmacology, College of Pharmacy, Jazan University, Jazan, Saudi Arabia, 3 Department of
Pharmaceutical Chemistry, College of Pharmacy, Jazan University, Jazan, Saudi Arabia

Background: Coronavirus disease-2019 (COVID-19) was declared a “pandemic” by the

Edited by: World Health Organization (WHO) in early March 2020. Globally, extraordinary measures
Caterina Ledda, are being adopted to combat the formidable spread of the ongoing outbreak. Under
University of Catania, Italy
such conditions, people’s adherence to preventive measures is greatly affected by their
Reviewed by:
Emanuele Cannizzaro,
awareness of the disease.
University of Palermo, Italy
Aim: This study was aimed to assess the level of awareness and preparedness to fight
Yuke Tien Fong,
Singapore General against COVID-19 among the healthcare workers (HCWs) and other residents of the
Hospital, Singapore South-West Saudi Arabia.
*Correspondence:
Pankaj Tripathi
Methods: A community-based, cross-sectional survey was conducted using a
[email protected] self-developed structured questionnaire that was randomly distributed online among
HCWs and other residents (age ≥ 12 years) of South-West Saudi Arabia for feedback.
Specialty section:
The collected data were analyzed using Stata 15 statistical software.
This article was submitted to
Occupational Health and Safety, Results: Among 1,000 participants, 36.7% were HCWs, 53.9% were female,
a section of the journal
Frontiers in Public Health
and 44.1% were aged ≥ 30 years. Majority of respondents showed awareness of
Received: 15 May 2020
COVID-19 (98.7%) as a deadly, contagious, and life-threatening disease (99.6%) that
Accepted: 28 July 2020 is transmitted through human-to-human contact (97.7%). They were familiar with
Published: 18 August 2020 the associated symptoms and common causes of COVID-19. Health organizations
Citation: were chosen as the most reliable source of information by majority of the
Tripathi R, Alqahtani SS, Albarraq AA,
Meraya AM, Tripathi P, Banji D, participants (89.6%). Hand hygiene (92.7%) and social distancing (92.3%) were
Alshahrani S, Ahsan W and the most common preventive measures taken by respondents that were followed
Alnakhli FM (2020) Awareness and
Preparedness of COVID-19 Outbreak
by avoiding traveling (86.9%) to an infected area or country and wearing face
Among Healthcare Workers and Other masks (86.5%). Significant proportions of HCWs (P < 0.05) and more educated
Residents of South-West Saudi participants (P < 0.05) showed considerable knowledge of the disease, and all
Arabia: A Cross-Sectional Survey.
Front. Public Health 8:482. respondents displayed good preparedness for the prevention and control of COVID-19.
doi: 10.3389/fpubh.2020.00482 Age, gender, and area were non-significant predictors of COVID-19 awareness.

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Tripathi et al. Awareness and Preparedness About COVID-19 Outbreak

Conclusion: As the global threat of COVID-19 continues to emerge, it is critical

to improve the awareness and preparedness of the targeted community members,
especially the less educated ones. Educational interventions are urgently needed to reach
the targeted residents beyond borders and further measures are warranted. The outcome
of this study highlighted a growing need for the adoption of innovative local strategies
to improve awareness in general population related to COVID-19 and its preventative
practices in order to meet its elimination goals.

Keywords: COVID-19, coronavirus, outbreak, awareness, preparedness, healthcare, residents, questionnaire

INTRODUCTION and people with chronic lung disease or moderate to severe

asthma, who are immunocompromised (due to cancer treatment,
An ongoing outbreak of infection by Severe Acute Respiratory bone marrow or organ transplant, AIDS, and prolonged use
Syndrome-Coronavirus-2 (SARS-CoV-2), termed as COVID-19, of corticosteroids or other medications), and those people with
aroused the attention of the entire world. The first infected severe obesity and chronic liver or kidney disease are at higher
case of coronavirus was reported on December 31, 2019, in risk of developing the COVID-19 severe illness (16–18).
Wuhan, China; within few weeks, infections spread across China Although, no specific vaccine or treatment is approved for
and to other countries around the world (1). On January 30, COVID-19, yet several treatment regimens prescribed under
2020, the World Health Organization (WHO) declared the novel different conditions are reported to control the severity and
coronavirus outbreak a public health emergency of international mortality rates up to some extent with few adverse effects, though
concern, which was the 6th declaration of its kind in WHO further evidence is needed (19). Recently, results of ongoing trials
history (2, 3). Surprisingly, during the first week of March 2020, aiming at drug repurposing for the disease have been reported,
devastating numbers of new cases were reported globally, and and several drugs have shown encouraging activity as far as
the WHO declared the COVID-19 outbreak a “pandemic” on reducing the viral load or the duration of therapy is concerned.
March 11 (4, 5). The outbreak has now spread to more than Remdesivir is one such antiviral drug, and it has reduced the
200 countries, areas, or territories beyond China (6). SARS-CoV- duration of therapy to 11 days in comparison to 15 days in
2 is a novel strain of the coronavirus family that has not been the case of patients receiving standard care only. Therefore, the
previously identified in humans (7). The disease spreads through USFDA has granted the emergency use authorization (EUA)
person-to-person contact, and the posed potential public health to Remdesivir for the treatment of suspected or confirmed
threat is very high. Estimates indicated that COVID-19 could COVID-19 cases (20, 21); however, further investigations are
cost the world more than $10 trillion, although considerable required to collect the sufficient data (22). Favipiravir (Avigan) is
uncertainty exists concerning the reach of the virus and the another drug that has exhibited promising activity in significantly
efficacy of the policy response (8). reducing the viral load in comparison to standard care in
The scientists still have limited information about COVID- several trials (23). Apart from antiviral drugs, convalescent
19, and as a result, the complete clinical picture of COVID- plasma for COVID-19 (as passive antibody therapy) has also
19 is not fully understood yet. Based on currently available been tested, proving to be of possible benefit in severely ill
information, COVID-19 is a highly contagious disease and its COVID-19 patients. However, it requires more clinical trials to
primary clinical symptoms include fever, dry cough, difficulty in be established for the optimal conditions of COVID-19 and as
breathing, fatigue, myalgia and dyspnea (9–11). This coronavirus antibody therapy in this disease (24–26). Mono, and Sarilumab
spreads primarily through respiratory droplets of >5–10 µm in which are immunosuppressants and are humanized antibodies
diameter, discharge from the mouth or nose, when an infected against the interleukin-6 receptor, were also tested on severely
person coughs or sneezes (12, 13). Reported illnesses range ill patients of COVID-19. They effectively improved the clinical
from very mild (including asymptomatic) to severe including symptoms and suppressed the worsening of acute COVID-19
illness resulting to death. However, the information so far patients and reduced the mortality rate (27, 28). Very recently,
suggested the symptoms as mild in almost 80% of the patients a corticosteroid, Dexamethasone, has been reported to be a
with lower death rates. People with co-morbidities, including life-saving drug that reduced the incidences of deaths by one-
diabetes and hypertension, who are treated with the drugs such third among patients critically ill with COVID-19 (29) requiring
as thiazolidinediones, angiotensin-converting enzyme (ACE) oxygen support.
inhibitors, and angiotensin-II receptor blockers (ARBs) have an So far, more than 9 million confirmed cases of COVID-
increased expression of angiotensin-converting enzyme-2 (ACE- 19 infections have been identified globally with more than
2). Since, SARS-CoV-2 binds to their target cells through ACE-2, 0.46 million confirmed deaths (as on June 21, 2020). Saudi
it was suggested that patients with cardiac disease, hypertension, Arabia has also been seriously affected by the COVID-19
and diabetes are at the higher risk of developing severe to fatal pandemic and reported its first confirmed case on March 3,
COVID-19 (14, 15). Moreover, elderly people (≥65 years), those 2020. The numbers are continuously increasing and reached

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Tripathi et al. Awareness and Preparedness About COVID-19 Outbreak

157,612 on June 21, 2020, with 1,267 confirmed deaths all over final sample size of 384 individuals. Therefore, to minimize the
the kingdom (30, 31) having reproduction number from 2.87 errors, the sample size taken for this study was 1,000.
to 4.9 (32). Before the emergence of COVID-19, Middle East
Respiratory Syndrome-coronavirus (MERS-CoV) was the major Outcome Measures
concern in 2012 (33), though it was successfully controlled in The present study examined the level of awareness and
Saudi Arabia. In response to the growing public health threat preparedness toward prevention of COVID-19 using area,
posed by COVID-19, the Saudi government adopted some gender, age, education level, and occupation as explanatory
unprecedented measures related to awareness and prevention in variables among the residents (HCWs and other community
order to control COVID-19 transmission in the country. These peoples) of South-West Saudi Arabia.
measures included the closure of schools, universities, public
transportation, and all public places as well as the isolation Study Tool
and care for infected and suspected cases (34). On March 9, Since this is a novel coronavirus with no such study having
2020, government authorities announced the lockdown of the been conducted before, a standardized (structured, pre-coded,
whole country and released advice for Saudi nationals and and validated) questionnaire was developed for this study by
residents present inside or outside of country to stay at home our co-authors, and it is based on frequently asked questions
and maintain social distancing. Moreover, the Saudi government (FAQ) found on Centers for Disease Control (CDC) and WHO
decided to suspend congregational prayers across all mosques in official websites (38, 39). The questions were multiple choice
the kingdom, including the two holy mosques in Makkah and and sought to gain insight into the respondent’s awareness
Madinah (35). and preparedness toward COVID-19. A pilot survey of 10
The fight against COVID-19 continues globally, and to individuals was undertaken first to ensure that the questions
guarantee success, people’s adherence to preventive measures elicited appropriate response and there were no problems with
is essential. It is mostly affected by their awareness and the entry of answers into the database. Since, it was not
preparedness toward COVID-19. Knowledge and attitudes feasible to conduct a community-based national sampling survey
toward infectious diseases are often associated with the level of during this critical period; we decided to collect the data online
panic among the population, which could further complicate the through a Google survey. The self-reported questionnaire is
measures taken to prevent the spread of the disease. As “natural divided into three sections. The first part is designed to obtain
hazards are inevitable; the disaster is not,” (36) to facilitate background information, including demographic characteristics
the management of the COVID-19 outbreak in Saudi Arabia, (nationality, age, gender, level of educational, and occupation).
there is an urgent need to understand the public’s awareness The second part of the survey consists of questions that
and preparedness for COVID-19 during this challenging time. address awareness concerning COVID-19 (reliable source of
The present study assessed the awareness and preparedness information, symptoms, mode of transmission, incubation
toward COVID-19 among South Western Saudi residents during period, complications, high-risk population, treatment, and
the early rapid rise of the COVID-19 outbreak. It included preventive measures). The third part of the survey consists
HCWs (doctors, nurses, and community pharmacists) and of questions that address the preparedness to fight against
other members of the community, including the employed, COVID-19. The questionnaire is designed in English, being
unemployed, as well as students. subsequently translated into Arabic for the convenience and ease
of understanding of the participants, and it was pre-tested to
ensure that it maintained its original meaning.
SUBJECTS AND METHODS
Setting and Population Data Collection and Analysis
Data were collected using a random sampling method and
A cross-sectional survey was conducted between March 18 and
analyzed using the statistical software Stata 15. For categorical
March 25—the week immediately after the announcement of
variables, data were presented as frequencies and percentages.
lockdown in Saudi Arabia. For this study, two highly populated
A chi-squared (χ 2 ) test was used to examine the association
regions (Jazan and Aseer) of South-West Saudi Arabia and
between each item in awareness and explanatory variable in
adjacent rural villages were selected. All Saudi citizens and
the bivariate analysis. Multivariable logistic regression was
residents, males and females of age 12 years or more (including
computed using each item in awareness and preparedness as
HCWs and other community peoples), who were willing to
an outcome separately to examine the relationships in the
participate in the study irrespective of COVID-19 infection status
adjusted analysis. Differences were considered to be statistically
were included in the study. People who did not meet the above
significant at P ≤ 0.05.
inclusion criteria were not eligible and were thus excluded from
the study.
Ethical Approval
The study protocol and procedures of informed consent were
Sample Size granted ethical approval by the “Institutional Research Review
The required sample size for this study was calculated using a and Ethics Committee (IRREC), College of Pharmacy, Jazan
Denial equation (37) where the significance level (alpha) was set University” before the formal survey was conducted. Since this
to 0.05 and power (1-β) was set to 0.80. It resulted in a required study was conducted during the lockdown period, a Google

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Tripathi et al. Awareness and Preparedness About COVID-19 Outbreak

survey was prepared with an online informed consent form on symptoms of infection and complications, its perceived threat,
the first page. Participants are informed about the contents of and high-risk population. Respondents were allowed to choose
the questionnaire, and they have to answer a yes/no question more than one option from the choices given according to
to confirm their willingness to participate voluntarily. In case their understanding and conscience. The results indicated
of minors (participants below 16 years of age), they are asked that majority of respondents had heard of and were aware of
to show the form to their parents/guardians before selecting COVID-19 disease. Most of the participants (97.7%) correctly
their answer. The patients/participants or their legal guardians identified human-to-human transmission (contaminated person
have to provide their written informed consent to participate
in this study. After an affirmative response of the question, the
participant is directed to complete the self-report questionnaire.
All responses are anonymous. TABLE 2 | Awareness about COVID-19, its symptoms, transmission, and
complications.

RESULTS Variable Count (n) Percentage

n = 1,000 (%)
Demographic Characteristics
Respondents’ demographic descriptions are summarized in 1. Heard of COVID Yes 987 98.7
19
Table 1. A total of 1,000 participants completed the survey
No 13 1.3
questionnaire, the split being 46.1% male and 53.9% female.
The majority of participants are from Jazan region (74.8%) 2. COVID 19 is Yes 996 99.6
contagious life No 4 0.4
compared to 25.2% from Aseer province. More than half (55.9%) threatening disease
of the participants are of <30 years of age, and 44.1% are 3. Incubation period 2–14 days 957 95.7
aged ≥ 30 years. Around 79.5% respondents are university
3 weeks 63 6.3
graduates holding a bachelor’s degree or higher, whereas 20.5%
≥1 month 11 1.1
of participants possess educational qualifications of secondary
Don’t know 32 3.2
school or lower (non-graduates). HCWs make up 36.7% of
4. Reliable source of Health organization 896 89.6
participants, and 63.3% of participants are classified as other. information* Healthcare professionals 579 57.9
Social media 155 15.5
Knowledge of COVID-19 Disease and Television/you tube 124 12.4
Personal Protection Measures Newspaper/Poster 30 3.0
Table 2 displays respondents’ knowledge about COVID- Family/friends 27 2.7
19, reliable sources of information, modes of transmission, Don’t know 9 0.9
5. Mode of Human-to-human 977 97.7
transmission* transmission
Animals contact 229 22.9
TABLE 1 | Socio-demographic characteristics of participants.
Sea food and live animal 128 12.8
Variable Count (n) Percentage Fast food 93 9.3
n = 1,000 (%) Domestic animal 45 4.5
Don’t know 24 2.4
Region Jazan 748 74.8 6. Symptoms of Difficulty in breathing 909 90.9
Asser 252 25.2 COVID 19* High temperature/Fever 898 89.8
Gender Male 461 46.1 Cough 839 83.9
Female 539 53.9 Sore throat 542 54.2
Age groups <30 years 559 55.9 Tiredness 531 53.1
≥30 years 441 44.1 Pain in the muscles 343 34.3
Education Middle school or less 26 2.6 Runny nose 217 21.7
High School 179 17.9 Common cold 203 20.3
Bachelor Degree 634 63.4 Nausea/Vomiting 179 17.9
Master/Ph.D./above 161 16.1 Don’t know 20 2.0
Occupation Doctor 76 7.6 7. Complications* Pneumonia 794 79.4
Nurse 51 5.1 Kidney failure 228 22.8
Pharmacist 240 24.0 Sepsis and septic shock 76 7.6
Other Employed 238 23.8 Visual/Memory loss 18 1.8
Unemployed 123 12.3 Death 549 54.9
Students 272 27.2 Don’t know 123 12.3

n, Number of participants. *Multiple answers were possible; n, Number of participants.

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Tripathi et al. Awareness and Preparedness About COVID-19 Outbreak

with virus) as the primary mode of transmission. Furthermore, countries (86.9%). However, importantly, 63.8% participants
fever, cough, and difficulty in breathing were stated as the most believe in avoiding raw and under-cooked animal products,
common COVID-19 symptoms by 89.8, 83.9, and 90.9% of 16.2% choose to avoid purchasing products made in China,
respondents, respectively. The frequently reported complications and 1.7% have knowledge of proper prevention methods.
of COVID-19 were pneumonia (79.4%), kidney failure (22.8%), Approximately, half of the respondents (42.4%) report that they
and death (54.9%) by the respondents. seek more information on COVID-19.
Participants’ knowledge of personal protection against
COVID-19 is summarized in Table 3. The majority of Preparedness to Fight Against COVID-19
respondents (76.4%) believe that there is no treatment available Results of participants’ preparedness against COVID-19 are
for COVID-19 to date, 47.1% report supportive care, and 45.8% summarized in Table 3. Over one-third of participants are well-
state personal safety as the only treatment option. The most prepared and adopt various methods for the current situation.
common personal protection practices adopted by participants The majority of participants stat that they avoid crowded places,
are washing hands (92.7%), social distancing (92.3%), using mass gatherings, or traveling to suspected areas (95.1%), and
a face mask (86.5%), and avoiding travel to infected areas or 82.7% wear face masks when going outside and have increased

TABLE 3 | Awareness about personal protection and preparedness against COVID-19.

Variables Count (n) Percentage

(n = 1,000) (%)

What is the current situation in Saudi Arabia regarding COVID-19

Many cases have been reported till date 967 96.7%
No case have been reported till date 8 0.8%
Don’t know 25 2.5%
Population at high risk*
Elderly age ≥ 65 years 745 74.5
People with comorbid conditions 686 68.6
Health care workers or other who cares infected patient 560 56.0
Live animal market workers 240 24.0
Personal protection measures*
Social distancing (avoid personal contact) 923 92.3
Hand hygiene (washing hands more often) 927 92.7
Use face mask (cover nose) 865 86.5
Avoid travel to infected area or country 869 86.9
Avoid visiting wet markets, raw and under cooked animal products 638 63.8
Avoid sea food and live animals etc. 200 20.0
Use different chopping board and knives for raw meat and other food 183 18.3
Avoid purchasing things made in china 162 16.2
Avoid vegetarian food 32 3.2
Don’t know 17 1.7
Treatment available for COVID-19*
No treatment/vaccine till date 764 76.4
Supportive treatment 471 47.1
Just keep yourself safe 458 45.8
Vaccination 17 1.7
Don’t know 86 8.6
Preparedness to fight against COVID-19*
Avoiding mass gathering and traveling to suspected area 951 95.1
Using hand sanitizer, face mask, home cleaning materials recent days 827 82.7
Spending 20 s thoroughly for washing hands now a days 768 76.8
Maintaining food hygiene 611 61.1
Stored food items and basic required things in home as its lockdown 447 44.7
Ready to visit hospital immediately if needed 555 55.5
Do you need more information about prevention of COVID 19?
Yes 424 42.4

*Multiple answers were possible; n, Number of participants.

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Tripathi et al. Awareness and Preparedness About COVID-19 Outbreak

the use of hand sanitizers and home cleaning materials. Many of as compared to the Aseer region. There were no significant
them (76.8%) now spend 20 seconds washing their hands using differences found in knowledge level between gender (male vs.
soap multiple times a day. However, it could be assumed from the female) and age groups.
survey that a considerable percentage of the participants do not Significant differences were observed in awareness about
find the protective measures necessary, visit crowded places, and protective measures between educational groups and
do not wear face masks when leaving home. occupational groups (Tables 4, 5). The survey shows that
On the other hand, HCWs also reported their preparedness the educated participants (Bachelors or more) and HCWs
on different areas to fight against COVID-19 (Figure 1). All consider the use of face masks, frequent washing of hands, social
367 (100%) HCWs who participated in this study say that they distancing, and avoid traveling to an infected area or country
checked adequate supplies of goggles, masks, and gowns on as preventive measures, more so than their counter group (P
hand for emergencies, 99.7% say they prepared links or are in < 0.05). However, gender, age, and area comparisons on these
contact with External Resource Centers for COVID-19 such as measures were non-significant. Moreover, the survey exhibited
the CDC or WHO, 98% evaluated the patient care equipment, no significant differences regarding preparedness to fight against
including portable ventilators (preparation and patient handling COVID-19 level between areas, age, gender, and educational and
checklists), and 83.4% checked and prepared alternative suppliers occupational groups.
list of certain personal protective equipment etc. Surprisingly,
18.3% of the respondents are unaware of any preparation, and Multivariable Logistic Regressions
4.5% do not find it necessary. It was found that HCWs were more likely to be aware of
COVID-19 symptoms (fever: OR = 2.15, P = 0.008; cough:
Bivariate Analysis OR = 1.66, P = 0.018 etc.), complications (pneumonia: OR
The comparison between educational groups and occupational = 2.37, P = 0.001; kidney failure: OR = 1.54, P = 0.013 etc.),
groups (HCWs vs. other residents) demonstrated significant populations at high risk, available treatment, and preventive
differences in the level of knowledge and preventive measures measures compared to the other community members who
for COVID-19 disease (Tables 4, 5). The survey shows educated were non-HCWs. On the other hand, less-educated participants
participants (bachelors or more) and HCWs were more aware (≤secondary schooling) were more likely to have knowledge
about COVID-19 symptoms (P ≤ 0.001), incubation period (P about COVID-19 symptoms (fever: OR = 4.24, P = 0.014;
≤ 0.001), complications (P ≤ 0.001), high-risk populations (P breathing difficulty: OR = 2.94, P = 0.043 etc.), high-risk
≤ 0.01), and available treatment (P ≤ 0.05) compared to less- population (OR = 3.29, P = 0.001), complications, and
educated (≤high school) ones and other residents (non HCWs). preventive measures (social distancing: OR = 2.08, P = 0.008;
Jazan area participants heard about (P ≤ 0.002), and showed avoid traveling to infected area or country: OR = 2.01, P =
more awareness regarding COVID-19 symptoms (fever: P ≤ 0.002 etc.) compared to the higher-educated participants, as
0.001), and available treatment (supportive care: P ≤ 0.001) shown in Tables 6, 7. Tables displayed outcomes with statistically

FIGURE 1 | HCWs preparedness to fight against COVID 19. P1, Check adequate supplies of goggles, masks, and gowns on hand for emergencies. P2, Links to or
contact External Resource Centers for COVID-19 (Coronavirus) (CDC, WHO etc.). P3, Check patient care equipment, including portable ventilators. P4,
Recommendations for infection control to help biomedical and clinical engineers. P5, Check alternative suppliers of certain personal protective equipment. P6,
Prepared the list to supply chain professionals. P7, Do not need any preparation. P8, I don’t know.

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Tripathi et al. Awareness and Preparedness About COVID-19 Outbreak

TABLE 4 | Awareness of COVID-19 stratified by occupation groups among the study participants (n = 1,000).

Knowledge Occupation groups P-value

Total HCWs Other residents

n= 1,000 n = 367 n = 633

Incubation period : 2–14 days 957 362 (98.64%) 595 (94%) 0.001
Symptoms
Difficulty in breathing 909 349 (95.1%) 560 (88.47%) 0.001
High temperature/Fever 898 349 (95.1%) 549 (86.73%) 0.001
Cough 839 327 (89.1%) 512 (80.88%) 0.001
Sore throat 542 215 (58.88%) 327 (51.66%) 0.034
Tiredness 531 225 (61.31%) 306 (48.34%) 0.001
Pain in the muscles 343 166 (45.23%) 177 (27.96%) 0.001
Runny nose 217 106 (28.88%) 111 (17.54%) 0.001
Complications
Pneumonia 794 327 (89.1%) 467 (73.78%) 0.001
Kidney failure 228 108 (29.43%) 120 (18.96%) 0.001
Sepsis and septic shock 76 41 (11.17%) 35 (5.53%) 0.001
Population at high risk
Elderly age ≥ 65 years 745 292 (79.56%) 453 (71.56%) 0.005
People with comorbid conditions 560 238 (64.85%) 322 (50.87%) 0.001
Health care workers 686 277 (75.48%) 409 (64.61%) 0.000
Personal protection measures
Social distancing 923 347 (94.55%) 576 (91%) 0.042
Use face mask 867 331 (90.19%) 534 (84.36%) 0.009
Avoid purchasing things made in china 162 41 (11.17%) 121 (19.12%) 0.001
Treatment available for COVID 19
No treatment till date 764 299 (81.47%) 465 (73.46%) 0.004
Supportive treatment 471 229 (62.4%) 242 (38.23%) 0.001

P < 0.05 is considered statistically significant (Chi square test), n, Number of participants; HCWs, health care workers (including doctors, nurses, and pharmacist), Other residents
including employed, unemployed, and students.

significant association only with explanatory variable. Area be stopping the spread of disease effectively among the people.
(Jazan vs. Aseer), gender (male vs. female), and age group (age Hence, the main focus of this research was to assess the awareness
< 30 years vs. ≥30 years) were not associated significantly of people, particularly among HCWs as well as other residents,
with COVID-19 knowledge. Surprisingly, no difference about the disease, how they prepared themselves to fight against
was reported for preparedness to fight against COVID-19 it, and whether they are participating in the eradication of the
among participants. infection or not. We are aware that COVID-19 had taken the
nation by surprise when they were least prepared to face the
DISCUSSION pandemic. To the best of our knowledge, this is the first study
of its kind, conducted in Saudi Arabia that is assessing the
As the outbreak of COVID-19 is expanding exponentially, awareness and preparedness toward COVID-19 among HCWs
spreading beyond borders and spreading across continents, it and other residents.
has been classified as a “pandemic.” It created havoc and dismay Our survey of HCWs and other residents of the study region
among all nations. This new viral infection is successful in was well-received. People of different educational backgrounds
inducing restlessness, confusion, and fear among the people. The and employments participated in the survey. The majority of
uniqueness of this infection is that it shows little or no symptoms them are graduates, followed by people who had education
in the beginning, and many do not even know they are infected. up to high school. Similarly, among different employment
It does not induce any severe change or indication in the infected backgrounds, HCWs make up more than one-third of the sample
person so that he can seek medical attention at an early stage. size. In the first place, HCWs and graduates should be aware of
By the time infected persons realize that they are infected, they the disease profile, so that they can quickly spread the message
might have spread the disease to a large number of people without among their family members, their neighbors, and all those who
their knowledge and any ulterior motives. Therefore, the first are within their contact. Analysis of the study results showed
and foremost strategy to win the battle over COVID-19 shall that both HCWs and the graduates possess adequate knowledge

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Tripathi et al. Awareness and Preparedness About COVID-19 Outbreak

TABLE 5 | Awareness of COVID-19 stratified by educational groups among the study participants (n = 1,000).

Knowledge Total Educational groups P-value

N = 1,000

≤High school Bachelor degree Master/Ph.D.

n = 205 n = 634 or above
n = 161

Incubation period : 2–14 days 957 183 (89.27%) 616 (97.16%) 158 (98.14%) 0.001
Symptoms
Difficulty in breathing 909 172 (83.9%) 582 (91.8%) 155 (96.27%) 0.001
High temperature/Fever 898 170 (82.93%) 571 (90.06%) 157 (97.52%) 0.001
Cough 839 158 (77.07%) 533 (84.07%) 148 (91.93%) 0.001
Sore throat 542 101 (49.27%) 325 (51.26%) 116 (72.05%) 0.001
Tiredness 531 83 (40.49%) 351 (55.36%) 97 (60.25%) 0.001
Complications
Pneumonia 794 136 (66.34%) 515 (81.23%) 143 (88.82%) 0.001
Kidney failure 228 32 (15.61%) 136 (21.45%) 60 (37.27%) 0.001
Sepsis and septic shock 76 6 (2.93%) 49 (7.73%) 21 (13.04%) 0.001
Population at high risk
Elderly age ≥ 65 years 745 141 (68.78%) 471 (74.29%) 133 (82.61%) 0.010
People with comorbid conditions 686 111 (54.15%) 444 (70.03%) 131 (81.37%) 0.001
Health care workers 560 94 (45.85%) 364 (57.41%) 102 (63.35%) 0.002
Personal protection measures
Social distancing 923 178 (86.83%) 595 (93.85%) 150 (93.17%) 0.004
Avoid travel to infected area or country 869 165 (80.49%) 564 (88.96%) 140 (86.96%) 0.008
Avoid things made in china 162 51 (24.88%) 102 (16.09%) 9 (5.59%) 0.001
Treatment available for COVID 19
No treatment till date 764 138 (67.32%) 487 (76.81%) 139 (86.34%) 0.001
Supportive treatment 471 61 (30.24%) 317 (50%) 92 (55.14%) 0.001

P < 0.05 is considered statistically significant (Chi square test), n, Number of participants; HCWs, health care workers (including doctors, nurses, and pharmacist), other residents:
including employed, unemployed, and students.

about the infection. It was a significant finding of our study that transmission. They were aware that the infection is related to
they can not only protect themselves against the disease but also the respiratory system, and there could be some difficulties in
help others to stay away from the infection by creating awareness breathing with high temperatures accompanied by dry cough.
for it. As the results suggested, health organizations (89.6%) Furthermore, it might lead to pneumonia, organ failure, and
and healthcare professionals (57.9%) are able to communicate death. Indeed, COVID-19 induces these symptoms after the log
effectively to the participants in convincing and making them period (40), although in some cases. Also, HCWs keenly follow
understand the patterns and phases of the infection. This study the situation in the regions and the countries regarding the
also revealed that some people showed little trust in social number of cases of infected and fresh cases reported daily. It
media and other sources of communications such as television, perhaps helps them in getting prepared physically to manage
newspaper, posters, etc. They were not convinced or accepting the situation by acquiring the important things that are required
of the facts disseminated to them initially. It is probably for in combating the disease, and it might also help them to get
this reason that few people showed reluctance in following the prepared mentally. They were aware of the social distancing,
guidelines given through these channels and kept ignoring them. hand hygiene, using face masks, and avoiding traveling. These
This lack of acceptance might have accelerated the spread of this are the desired activities, which are expected to be practiced
disease among the public. strictly in order to stop the spread of the disease (41–44). Our
Our study revealed that HCWs and people with a higher study revealed that HCWs and educated residents were following
educational background (graduation or more) were more aware it meticulously. It was also known to them that no specific
of the symptoms and the complications of COVID-19. It is and effective treatment is available for COVID-19 to date, and
spread via human-to-human transmission through droplet, feco- whatever therapy is available at the designated centers is non-
oral, and direct contact and has an incubation period of 2–14 specific and treats only symptoms. They are sufficient enough to
days (13). The majority of the participants (97.7%) mentioned relieve the symptoms of the infection, to overcome difficulties
human-to-human contact as the primary cause of COVID-19 in breathing, and to boost the immunity of the individuals. A

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Tripathi et al. Awareness and Preparedness About COVID-19 Outbreak

TABLE 6 | Multivariable logistic regression on factors significantly associated with awareness toward COVID-19.

Explanatory variable Odds ratio P-value Odds ratio P-value Odds ratio P-value
(CI 95 %) (CI 95 %) (CI 95 %)

Outcome: Symptoms High temperature (Fever) Cough Difficulty in breathing

Area Asser [1] Reference NS – NS –
Jazan 1.61(1.02–2.53) 0.040 – – – –
Education level ≤High school [1] Reference [1] Reference [1] Reference
Bachelor degree 1.44(0.90–2.31) 0.126 1.33(0.89–2.01) 0.164 1.88(1.15–3.06) 0.011
Master/PhD/above 4.24(1.34–13.43) 0.014 2.33(1.08–5.00) 0.030 2.94(1.03–8.40) 0.043
Occupation Other residents [1] Reference [1] Reference [1] Reference
HCWs 2.15(1.22–3.79) 0.008 1.66(1.09–2.53) 0.018 1.92(1.08–3.43) 0.026
Outcome: Complication Pneumonia Kidney Failure Sepsis
Education level ≤High school [1] Reference [1] Reference [1] Reference
Bachelor degree 1.72(1.19–2.48) 0.004 1.31(0.85–2.04) 0.224 2.34(0.97–5.68) 0.060
Master/Ph.D./above 2.68(1.36–5.32) 0.004 2.41(1.31–4.44) 0.005 3.42(0.03–1.15) 0.027
Occupation Other residents [1] Reference [1] Reference [1] Reference
HCWs 2.37(1.58–3.57) 0.001 1.54(1.09–2.16) 0.013 1.68(1.00–2.82) 0.049
Outcome: Treatment available Supportive care only Just keep safe No treatment
Education level ≤High school [1] Reference [1] Reference [1] Reference
Bachelor degree 1.73(1.22–2.47) 0.002 0.79(0.57–1.11) 0.184 1.54(1.07–2.22) 0.019
Master/Ph.D./above 1.89(1.10–3.23) 0.020 0.55(0.32–0.93) 0.027 3.27(1.67–6.41) 0.001
Occupation Other residents [1] Reference – – – –
HCWs 2.26(1.68–3.03) 0.001 NS – NS –
Outcome: High risk population Patients with comorbidities Health care professional
Education level ≤High school [1] Reference NS –
Bachelor degree 1.81(1.29–2.54) 0.001 – –
Master/Ph.D./above 3.29(1.83–5.90) 0.001 – –
Occupation Other residents [1] Reference [1] Reference
HCWs 1.36(0.99–1.87) 0.001 1.61(1.20–2.16) 0.001

P < 0.05 is considered statistically significant, HCWs, health care workers (including doctors, nurses, and pharmacist), other residents: including employed, unemployed, and students;
NS, Non-significant result.

similar level of awareness was reported in recent studies in China increase. This is genuinely desirable and precautionary in a
(10) and the UAE (45). This may be attributed to continuous situation like COVID-19, as coming closer to or violating social
practice of raising awareness about COVID-19 in communities distancing is risky. Perhaps this preparedness is a reflection
about health issues by healthcare organizations and Saudi health of steps taken by government authorities, as Saudi Arabia can
extension workers, which has been effectively implemented in control the spread of COVID-19 in South-West region. When the
recent days (46). whole world is struggling to control COVID-19 spreading, Saudi
Previously, MERS-CoV was a major global concern after Arabia has reported 1,155 positive cases (as of June 21, 2020)
it was first identified in 2012 in Saudi Arabia (33). Many in Jazan and Aseer region (313 and 842, respectively) among
awareness studies reported different levels of knowledge about 157,612 positive cases the entire country (50).
MERS disease among Saudi HCWs and residents after the MERS Also, our study confirmed that nearly half of the participants
outbreak (47–49). Present findings showed that the awareness were ready to visit the hospital immediately if needed. The
regarding COVID-19 disease was higher compared to MERS. WHO recommends that identification of the infected individual
This can be ascribed to the global reach of COVID-19, as it is is the first and essential step required in combating COVID-
more serious than MERS owing to its high rate of transmission, 19. It also advises nations to allow citizens to get tested and
alarming number of cases, and the continued global death count. put them in quarantine if they are infected. It is a significant
As far as preparedness to fight against COVID-19 is step, as nearly 50% of the people are aware of the importance
concerned, our study showed that all the participants were aware of testing in suspected cases but the remaining 50% of the
of avoiding mass gathering, avoiding traveling to suspected areas, participants are not. Doubts or fears about quarantine can make
the use of face masks and hand sanitizers, and maintaining proper the public hide behind closed doors. This behavior of theirs could
food hygiene. During the lockdown period, the majority of the be dangerous, as it not only puts them in a difficult situation,
people who participated in our study stockpiled sufficient food but is risks their entire family and neighbors. Surprisingly, nearly
items, and the frequency of going out to buy groceries and other 42.4% of the participants have asked for more information about
food items can thus be avoided. According to them, a large COVID-19 so that they can take sufficient precautions and
number of people at supermarkets do not practice appropriate prepare themselves to avoid contracting the disease. These are
social distancing, and chances of contracting the infection might the participants who had fewer opportunities to access healthcare

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Tripathi et al. Awareness and Preparedness About COVID-19 Outbreak

TABLE 7 | Multivariable logistic regression analysis on factors significantly associated with preventive measures toward COVID-19.

Explanatory variable Odds ratio (CI 95%) P-value

Outcome: Preventive measures

Wash hand frequently
Education level ≤High school [1] Reference
Bachelor degree 1.75(1.15–2.66) 0.009
Master/Ph.D./above 4.15(1.67–10.33) 0.002
Occupation Other residents [1] Reference
HCWs 1.90(1.17–3.09) 0.010
Use face mask
Occupation Other residents [1] Reference
HCWs 1.55(0.99–2.43) 0.055
Avoid personal contact with infected peoples
Education level ≤High school [1] Reference
Bachelor degree 2.08(1.21–3.59) 0.008
Master/Ph.D./above 1.41(0.57–3.50) 0.457
Avoid travel to infected area or country
Education level ≤High school [1] Reference
Bachelor degree 2.01(1.29–3.16) 0.002
Master/Ph.D./above 1.43(0.69–2.96) 0.334
Avoid purchasing things made in China
Education level ≤High school
Bachelor degree 0.64(0.43–0.95) 0.028
Master/Ph.D./above 0.26(0.11–0.62) 0.002

P < 0.05 is considered statistically significant, HCWs, health care workers (including doctors, nurses, and pharmacist), other residents: including employed, unemployed, and students.

services. They indeed need more information on COVID-19 HCWs in preparedness activities (53). In several instances,
to stay away from the deadly disease. This is the substantial misunderstandings among HCWs have delayed controlling
finding of our study: nearly half of the participants did not have efforts to provide necessary treatment (44), which led to the rapid
detailed information or a desire to gain more knowledge about spread of infection in hospitals (33, 49) and putting patients’
the disease. The focus of the administrators should be on this lives at risk. The present study also analyzed the preparedness
category of people—the common man—so that they too can of HCWs to fight against COVID-19 and found all participated
prepare themselves to fight the disease. Overall, the reported HCWs were well prepared and ready for the current outbreak.
preparedness could be because the healthcare authorities have All participating HCWs report that they have adequate
already initiated awareness and preparedness activities beyond supplies of personal protective equipment’s (PPEs), such as
their own borders. Every country around the world is being goggles, masks, and gowns, to manage emergencies, 99.72% of
encouraged to draft a preparedness plan as per the WHO’s HCWs depend on an external resource center like CDC and
global guidelines: “The ‘COVID-19’ Strategic Preparedness and WHO for the required emergency materials, and 98% HCWs
Response Plan” (SPRP). The SPRP outlines the public health say that they have already checked their hospitals equipped
measures that are needed to be taken to support countries to with patient care equipment, including portable ventilators.
prepare for and respond to COVID-19 (51, 52). Surprisingly, few respondents (18.26%) say they were unaware
It was observed that the educational background plays of any preparation, and very few (4.36%) say that there is no
a significant role in understanding the infection quickly. need for any preparation. In general, our study indicated that the
This survey showed that HCWs and people with higher HCWs have well equipped themselves to fight against COVID-
education have a better understanding of the disease than their 19. Although, hospitals and HCWs are fully geared up to face
counterparts. Even though all the groups showed almost identical the pandemic situation, the best national option available is to
knowledge about the primary information of the disease, in spread awareness in order to stop the spread of disease. We have
some areas, such as disease complications, high-risk populations, no other way but to educate our fellow citizens to not indulge in
personal protection measures, and treatment availability, a clear any activities that could lead them being a part of the problem.
distinction exists. For example, only 68.78% of the less educated Instead, they should be encouraged to be the part of the solution.
showed awareness of the high risk of contracting the infection of The WHO has published guidance for public health and social
older people. measures at the workplace within the context of COVID-19. This
The WHO have initiated several online training sessions included the standards for all workplaces and specific criteria
and materials on COVID-19 in various languages to strengthen for workplaces and jobs at medium risk and high risk. The
preventive strategies, including raising awareness and training guidance suggested to adapt the essential preventive measures

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Tripathi et al. Awareness and Preparedness About COVID-19 Outbreak

for all workplaces, including practicing hand hygiene, respiratory well-educated people, including healthcare workers, and those
hygiene, physical distancing (avoid direct physical contact by who have access to computers and the internet. Hence it may
hugging, touching, or shaking hands), reducing and otherwise not truly represent the entire population of the study region.
managing work-related travel, regular environmental cleaning Therefore, the generalization of the findings may suffer from
and disinfection, risk communication, training and education, reporting bias.
and management of people with COVID-19 or their contacts. In
addition, specific measures for workplaces and jobs at medium CONCLUSION
risk included frequent cleaning and disinfection of objects and
surfaces that are touched regularly (fomites). In such places The present study sheds light on the current level of awareness
where physical distancing of 1 meter cannot be maintained regarding COVID 19, including knowledge, preventative
for a particular activity, all mitigating actions possible should practices, and preparedness in the South-West region of Saudi
be taken to reduce the risk of transmission between workers, Arabia, which is still struggling to achieve its target of total
clients or customers, contractors, and visitors, and these include COVID-19 eradication. The results of this survey indicated
staggered activities, minimizing face-to-face and skin-to-skin that the majority of respondents were aware of the knowledge,
contact, ensuring workers work side-by-side or facing away preventive measures and well prepared to fight against COVID-
from each other rather than face-to-face, and assigning staff 19. It was evident that the community’s overall COVID-19
to the same shift teams to limit social interaction. Along with awareness and their preparedness among educated and HCWs
that, such workplaces must be well-ventilated with a natural air populations were fairly satisfactory. However, there were few
of artificial ventilation without re-circulation of air for high- misconceptions regarding the mode of COVID-19 transmission
risk work activities and jobs. The WHO have advised that among the participants, which need to be addressed. Knowledge
we find possibilities to suspend operations or adhere to the and preparedness do translate into improved practices toward
hygiene measures before and after contact with or suspicion of COVID-19 prevention and the same was reflected in this study.
COVID-19. In such cases, workers must comply with the use of In order to achieve complete control over COVID-19, it would
medical masks, disposable gowns, gloves, and eye protection for also be worthwhile to invest in various COVID-19 prevention
workers and use of protective equipment when in contact with efforts, including health education and innovative strategies
COVID-19 patients, their respiratory secretions, body fluids, and based on local evidences to raise the community’s awareness and
highly contaminated waste. HCWs must be trained in infection to improve its preventative practices.
prevention and control practices and use of PPEs to handle such
situations (54, 55). DATA AVAILABILITY STATEMENT
The knowledge and awareness of the disease are important
parameters for the adoption of protective measures that The raw data supporting the conclusions of this article will be
minimize the exposure risk of the illness. Our findings suggest made available by the authors, without undue reservation.
that residents who are less educated and who are non-healthcare
professionals possess less knowledge of COVID-19 disease AUTHOR CONTRIBUTIONS
and preventive measures than their counterparts. Therefore,
health promotion and awareness programs are warranted to RT and PT: conceptualization, methodology, writing of the
address these particular sections of the population. Thus, original draft, investigation, project administration, and final
COVID-19 awareness programs and other educating strategies editing. SSA and AA: supervision, co-project administration,
should be developed and implemented more effectively to data collection, feedback, and making substantive changes. AM:
eradicate this disease and increase the breadth of knowledge software, validation, and formal analysis. SA: visualization and
of rurally and minimally educated populations. These findings investigation. WA and DB: data collection and calculations,
are useful for public health policymakers and health workers writing, reviewing, editing of the manuscript, and formal
to recognize target populations for COVID-19 prevention and analysis. FA: preparation of Google form and Arabic translation.
health education. All authors participated in the distribution of the survey.
The strength of the study lies in its large sample size,
recruited during a crucial period—the early stage of the ACKNOWLEDGMENTS
COVID-19 outbreak in Saudi Arabia. Nevertheless, this was
an online self-reported survey conducted during lockdown due We wish to acknowledge Deanship of Scientific Research, Jazan
to pandemic, and this affected our outreach to the general University, Jazan, Saudi Arabia, for their continuous support
population. Our sample was obviously over-representative of throughout the study.

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Frontiers in Public Health | www.frontiersin.org 13 August 2020 | Volume 8 | Article 482