Top

BMC Public Health

Published in:

Open Access 01-12-2021 | COVID-19 | Research article

Effectiveness of personal protective health behaviour against COVID-19

Authors: Chon Fu Lio, Hou Hon Cheong, Chin Ion Lei, Iek Long Lo, Lan Yao, Chong Lam, Iek Hou Leong

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

Novel coronavirus disease 2019 (COVID-19) has become a pandemic, and over 80 million cases and over 1.8 million deaths were reported in 2020. This highly contagious virus is spread primarily via respiratory droplets from face-to-face contact and contaminated surfaces as well as potential aerosol spread. Over half of transmissions occur from presymptomatic and asymptomatic carriers. Although several vaccines are currently available for emergency use, there are uncertainties regarding the duration of protection and the efficacy of preventing asymptomatic spread. Thus, personal protective health behaviour and measures against COVID-19 are still widely recommended after immunization. This study aimed to clarify the efficacy of these measures, and the results may provide valuable guidance to policymakers to educate the general public about how to reduce the individual-level risk of COVID-19 infection.

Methods

This case-control study enrolled 24 laboratory-confirmed COVID-19 patients from Centro Hospitalar Conde de São Januário (C.H.C.S.J.), which was the only hospital designated to manage COVID-19 patients in Macao SAR, China, and 1113 control participants who completed a 14-day mandatory quarantine in 12 designated hotels due to returning from high-risk countries between 17 March and 15 April 2020. A questionnaire was developed to extract demographic information, contact history, and personal health behaviour.

Results

Participants primarily came from the United Kingdom (33.2%), followed by the United States (10.5%) and Portugal (10.2%). Independent factors for COVID-19 infection were having physical contact with confirmed/suspected COVID-19 patients (adjusted OR, 12.108 [95% CI, 3.380–43.376], P < 0.005), participating in high-risk gathering activities (adjusted OR, 1.129 [95% CI, 1.048–1.216], P < 0.005), handwashing after outdoor activity (adjusted OR, 0.021 [95% CI, 0.003–0.134], P < 0.005), handwashing before touching the mouth and nose area (adjusted OR, 0.303 [95% CI, 0.114–0.808], P < 0.05), and wearing a mask whenever outdoors (adjusted OR, 0.307 [95% CI, 0.109–0.867], P < 0.05). The daily count of handwashing remained similar between groups. Only 31.6% of participants had a sufficient 20-s handwashing duration.

Conclusions

Participating in high-risk gatherings, wearing a mask whenever outdoors, and practising hand hygiene at key times should be advocated to the public to mitigate COVID-19 infection.

Available only for authorised users

WHO. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020: World Health Organization; 2020 [13 April 2020]. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19%2D%2D-11-march-2020.

WHO. Weekly epidemiological update - 5 January 2021. World Health Organization. Available from: https://www.who.int/publications/m/item/weekly-epidemiological-update%2D%2D-5-january-2021.

Wolfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Muller MA, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020. Available from: https://doi.org/10.1038/s41586-020-2196-x.

Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA. 2020;324(8):782–93. Available from: https://doi.org/10.1001/jama.2020.12839.

Ganyani T, Kremer C, Chen D, Torneri A, Faes C, Wallinga J, et al. Estimating the generation interval for coronavirus disease (COVID-19) based on symptom onset data, March 2020. 2020;25(17):2000257. Available from: https://doi.org/10.2807/1560-7917.ES.2020.25.17.2000257.

Haynes BF, Corey L, Fernandes P, Gilbert PB, Hotez PJ, Rao S, et al. Prospects for a safe COVID-19 vaccine. Science translational medicine. 2020;12(568). Available from: https://doi.org/10.1126/scitranslmed.abe0948.

Gostin LO, Wiley LF. Governmental Public Health Powers During the COVID-19 Pandemic: Stay-at-home Orders, Business Closures, and Travel Restrictions. JAMA. 2020. Available from: https://doi.org/10.1001/jama.2020.5460.

Colbourn T. COVID-19: extending or relaxing distancing control measures. Lancet Public Health. 2020;5(5):e236–7. https://doi.org/10.1016/S2468-2667(20)30072-4.CrossRefPubMedPubMedCentral

Klompas M, Morris CA, Sinclair J, Pearson M, Shenoy ES. Universal masking in hospitals in the Covid-19 era. N Engl J Med. 2020;382(21):e63. https://doi.org/10.1056/NEJMp2006372.CrossRefPubMed

10.

Phelan AL, Katz R, Gostin LO. The novel coronavirus originating in Wuhan, China: challenges for Global Health governance. JAMA. 2020;323(8):709–10. Available from: https://doi.org/10.1001/jama.2020.1097.

11.

The Lancet Respiratory M. COVID-19: delay, mitigate, and communicate. Lancet Respir Med. 2020;8(4):321. Available from: https://doi.org/10.1016/S2213-2600(20)30128-4.

12.

Norman P, Conner M. Health Behavior. Reference Module in Neuroscience and Biobehavioral Psychology: Elsevier. 2017. p. 1–37.

13.

Tian H, Liu Y, Li Y, Wu C-H, Chen B, Kraemer MUG, et al. An investigation of transmission control measures during the first 50 days of the COVID-19 epidemic in China. Science. 2020:eabb6105. Available from: https://doi.org/10.1126/science.abb6105.

14.

CDC. Prevent Getting Sick, How COVID-19 Spreads: Centers for Disease Control and Prevention. 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html.

15.

Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020;395(10242):1973–87. Available from: https://doi.org/10.1016/S0140-6736(20)31142-9.

16.

WHO. Advice on the use of masks in the context of COVID-19. 2020 [13 April 2020]. Available from: https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak.

17.

Offeddu V, Yung CF, Low MSF, Tam CC. Effectiveness of masks and respirators against respiratory infections in healthcare workers: a systematic review and meta-analysis. Clin Infect Dis. 2017;65(11):1934–42. Available from: https://doi.org/10.1093/cid/cix681.

18.

Seto WH, Tsang D, Yung RWH, Ching TY, Ng TK, Ho M, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). The lancet. 2003;361(9368):1519-20. Available from: 2003. https://doi.org/10.1016/s0140-6736(03)13168-6.

19.

Chughtai AA, Stelzer-Braid S, Rawlinson W, Pontivivo G, Wang Q, Pan Y, et al. Contamination by respiratory viruses on outer surface of medical masks used by hospital healthcare workers. BMC Infect Dis. 2019;19(1):491. Available from: https://doi.org/10.1186/s12879-019-4109-x.CrossRefPubMedPubMedCentral

20.

Ranney ML, Griffeth V, Jha AK. Critical supply shortages — the need for ventilators and personal protective equipment during the Covid-19 pandemic. N Engl J Med. 2020;382(18):e41. https://doi.org/10.1056/NEJMp2006141.CrossRefPubMed

21.

Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med. 2020. Available from: https://doi.org/10.1056/NEJMsb2005114.

22.

Lamptey E, Serwaa D. The use of Zipline drones technology for COVID-19 samples transportation in Ghana. HighTech Innov J. 2020;1(2):67–71. Available from: https://doi.org/10.28991/HIJ-2020-01-02-03.

23.

Parenteau CI, Bent S, Hossain B, Chen Y, Widjaja F, Breard M, et al. COVID-19 Related Challenges and Advice from Parents of Children with Autism Spectrum Disorder. SciMed J. 2020;2:73–82. Available from: https://doi.org/10.28991/SciMedJ-2020-02-SI-6.

24.

Tipaldi MA, Lucertini E, Orgera G, Zolovkins A, Lauirno F, Ronconi E, et al. How to Manage the COVID-19 Diffusion in the Angiography Suite: Experiences and Results of an Italian Interventional Radiology Unit. SciMed J. 2020;2:1–8. Available from: https://doi.org/10.28991/SciMedJ-2020-02-SI-1.

25.

Hanscom D, Clawson DR, Porges SW, Bunnage R, Aria L, Lederman S, et al. Polyvagal and global cytokine theory of safety and threat Covid-19 – plan B. SciMed J. 2020;2:9–27. Available from: https://doi.org/10.28991/SciMedJ-2020-02-SI-2.

26.

Aiello AE, Coulborn RM, Perez V, Larson EL. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health. 2008;98(8):1372-81. Available from: https://doi.org/10.1001/jamanetworkopen.2020.35057.

27.

van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564–7. https://doi.org/10.1056/NEJMc2004973.

28.

Chia PY, Coleman KK, Tan YK, Ong SWX, Gum M, Lau SK, et al. Detection of air and surface contamination by SARS-CoV-2 in hospital rooms of infected patients. Nat Commun. 2020;11(1):2800. Available from: https://doi.org/10.1038/s41467-020-16670-2.

29.

van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. 2020;382(16):1564-7. Available from: https://doi.org/10.1056/NEJMc2004973.

30.

Trampuz A, Widmer AF. Hand hygiene: a frequently missed lifesaving opportunity during patient care. Mayo Clin Proc. 2004;79(1):109–16. Available from: https://doi.org/10.4065/79.1.109.

31.

Beiu C, Mihai M, Popa L, Cima L, Popescu MN. Frequent hand washing for COVID-19 prevention can cause hand dermatitis: management tips. Cureus. 2020;12(4):e7506. Available from: https://doi.org/10.7759/cureus.7506.CrossRefPubMedPubMedCentral

32.

Pang J, Chua SWJL, Hsu L. Current knowledge, attitude and behaviour of hand and food hygiene in a developed residential community of Singapore: a cross-sectional survey. BMC Public Health. 2015;15(1):577. Available from: https://doi.org/10.1186/s12889-015-1910-3.

33.

Wong T-W, Tam WW-S. Handwashing practice and the use of personal protective equipment among medical students after the SARS epidemic in Hong Kong. Am J Infect Control. 2005;33(10):580–6. Available from: https://doi.org/10.1016/j.ajic.2005.05.025.

Title: Effectiveness of personal protective health behaviour against COVID-19
Authors: Chon Fu Lio
Hou Hon Cheong
Chin Ion Lei
Iek Long Lo
Lan Yao
Chong Lam
Iek Hou Leong
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: COVID-19
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-10680-5

At a glance: The STEP trials

Springer Medicine

Effectiveness of personal protective health behaviour against COVID-19

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross-sectional analysis of three million individuals

Key stakeholder perspectives on the development and real-world implementation of a home-based physical activity program for mothers at risk of postnatal depression: a qualitative study

Workplace sitting is associated with self-reported general health and back/neck pain: a cross-sectional analysis in 44,978 employees

The estimated effect of graphic warning labels on smoker’s intention to quit in Shanghai, China: a cross-sectional study

Resilience mediates the association between self-harm and suicidal ideation in Chinese left-behind children

Sugar-sweetened beverages consumption among New Zealand children aged 8-12 years: a cross sectional study of sources and associates/correlates of consumption