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Given the extensive time needed to conduct a nationally representative household survey and the commonly low response rate of phone surveys, rapid online surveys may be a promising method to assess and track knowledge and perceptions among the general public during fast-moving infectious disease outbreaks.
This study aimed to apply rapid online surveying to determine knowledge and perceptions of coronavirus disease 2019 (COVID-19) among the general public in the United States and the United Kingdom.
An online questionnaire was administered to 3000 adults residing in the United States and 3000 adults residing in the United Kingdom who had registered with Prolific Academic to participate in online research. Prolific Academic established strata by age (18-27, 28-37, 38-47, 48-57, or ≥58 years), sex (male or female), and ethnicity (white, black or African American, Asian or Asian Indian, mixed, or “other”), as well as all permutations of these strata. The number of participants who could enroll in each of these strata was calculated to reflect the distribution in the US and UK general population. Enrollment into the survey within each stratum was on a first-come, first-served basis. Participants completed the questionnaire between February 23 and March 2, 2020.
A total of 2986 and 2988 adults residing in the United States and the United Kingdom, respectively, completed the questionnaire. Of those, 64.4% (1924/2986) of US participants and 51.5% (1540/2988) of UK participants had a tertiary education degree, 67.5% (2015/2986) of US participants had a total household income between US $20,000 and US $99,999, and 74.4% (2223/2988) of UK participants had a total household income between £15,000 and £74,999. US and UK participants’ median estimate for the probability of a fatal disease course among those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 5.0% (IQR 2.0%-15.0%) and 3.0% (IQR 2.0%-10.0%), respectively. Participants generally had good knowledge of the main mode of disease transmission and common symptoms of COVID-19. However, a substantial proportion of participants had misconceptions about how to prevent an infection and the recommended care-seeking behavior. For instance, 37.8% (95% CI 36.1%-39.6%) of US participants and 29.7% (95% CI 28.1%-31.4%) of UK participants thought that wearing a common surgical mask was “highly effective” in protecting them from acquiring COVID-19, and 25.6% (95% CI 24.1%-27.2%) of US participants and 29.6% (95% CI 28.0%-31.3%) of UK participants thought it was prudent to refrain from eating at Chinese restaurants. Around half (53.8%, 95% CI 52.1%-55.6%) of US participants and 39.1% (95% CI 37.4%-40.9%) of UK participants thought that children were at an especially high risk of death when infected with SARS-CoV-2.
The distribution of participants by total household income and education followed approximately that of the US and UK general population. The findings from this online survey could guide information campaigns by public health authorities, clinicians, and the media. More broadly, rapid online surveys could be an important tool in tracking the public’s knowledge and misperceptions during rapidly moving infectious disease outbreaks.
When faced with rapidly moving infectious disease outbreaks, such as the coronavirus disease 2019 (COVID-19), assessing knowledge and perceptions of relevant populations has to be accomplished in a short time frame if the findings are to be informative to the public health response. Population-representative household surveys generally take many months of preparation and data collection [
COVID-19 was first reported in Wuhan, China, in December 2019 [
The speed with which COVID-19 is spreading across the world calls for rapid assessments of the population’s knowledge and perceptions of this infection [
This is a cross-sectional online survey conducted on the research platform created and managed by Prolific Academic Ltd. Prolific is an online platform that connects researchers with individuals around the world who are interested in participating in online research studies [
For this study, Prolific established strata by age group (18-27, 28-37, 38-47, 48-57, or ≥58 years), sex (male or female) and ethnicity (white, black or African American, Asian or Asian Indian, mixed, or “other”) as well as all combinations of these strata. Using numbers from the latest census in the United States and the United Kingdom, a given number of places for taking the questionnaire were opened on the Prolific platform in each stratum to achieve the same distribution of participants by age, sex, and ethnicity as those in the general population. The targeted total sample size in each country was 1500 people. Participants’ eligibility for the open places in a particular stratum was determined based on the information they had entered in their profile when registering with Prolific. Eligible participants enrolled in the study on a first-come, first-served basis. The study was implemented in two rounds of 1500 participants each in the United States and the United Kingdom, such that the total target sample size in each country was 3000. Participants had to have indicated that they are fluent in English when registering with Prolific to be eligible for this study.
Data were collected using the online questionnaire shown in
For binary and categorical response options, the percentage of participants who selected each response was computed. For binomial proportions, two-sided 95% confidence intervals using the Wilson score interval were calculated [
Three types of data quality checks were performed. First, participants who took less than 2 minutes to complete the questionnaire were excluded from the analysis because this indicated random clicking. This resulted in the exclusion of 2 participants. Second, if some respondents used random clicking to obtain the US $1.50 reward as fast as possible, a bimodal distribution in the time taken to complete the survey might be expected (with one group clicking as fast as possible and one reading the questions). I, therefore, plotted a histogram of the time taken to complete the survey. Third, participants were asked, at the end of the questionnaire, whether they looked up any answers online (
Time at which participants started the questionnaire. Dates and times are given in Pacific Standard Time. Bins have a width equal to 30 minutes.
Of 3000 adults residing in the United States and 3000 adults residing in the United Kingdom who could participate, 2986 and 2988, respectively, completed the questionnaire. Approximately two-thirds (1924/2986, 64.4%) of US participants and half (1540/2988, 51.5%) of UK participants had a tertiary education degree (
Sample characteristics.
Characteristics | US | UK | |
Number of participants | 2986 | 2988 | |
Female, n (%) | 1519 (50.9) | 1531 (51.2) | |
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18-27 | 655 (21.9) | 550 (18.4) |
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28-37 | 687 (23.0) | 557 (18.6) |
|
38-47 | 531 (17.8) | 563 (18.8) |
|
48-57 | 493 (16.5) | 480 (16.1) |
|
≥58 | 620 (20.8) | 838 (28.0) |
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Less than a high school diploma/A-levels | 24 (0.8) | 396 (13.3) |
|
High school degree/Completed A-levels | 334 (11.2) | 682 (22.8) |
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Some undergraduate education (no degree) | 704 (23.6) | 370 (12.4) |
|
Associate degree | 322 (10.8) | N/Aa |
|
Bachelor’s degree | 1068 (35.8) | 1030 (34.5) |
|
Master’s degree | 405 (13.6) | 330 (11.0) |
|
Professional degree | 63 (2.1) | 100 (3.3) |
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Doctorate | 66 (2.2) | 80 (2.7) |
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<US $10,000/<£7500 | 165 (5.5) | 172 (5.8) |
|
US $10,000-US $19,000/£7500-£14,999 | 222 (7.4) | 333 (11.1) |
|
US $20,000-US $29,000/£15,000-£22,499 | 342 (11.5) | 463 (15.5) |
|
US $30,000-US $39,000/£22,500 - £29,999 | 325 (10.9) | 473 (15.8) |
|
US $40,000-US $49,000/£30,000-£37,499 | 280 (9.4) | 358 (12.0) |
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US $50,000-US $59,000/£37,500-£44,999 | 304 (10.2) | 312 (10.4) |
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US $60,000-US $69,000/£45,000-£52,499 | 230 (7.7) | 242 (8.1) |
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US $70,000-US $79,000/£52,500-£59,999 | 242 (8.1) | 156 (5.2) |
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US $80,000-US $89,000/£60,000-£67,499 | 138 (4.6) | 121 (4.0) |
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US $90,000-US $99,000/£67,500-£74,999 | 154 (5.2) | 98 (3.3) |
|
US $100,000-US $149,000/£75,000-£99,999 | 401 (13.4) | 168 (5.6) |
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≥US $150,000/≥£100,000 | 183 (6.1) | 92 (3.1) |
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White | 2269 (76.0) | 2540 (85.0) |
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Black or African American | 392 (13.1) | 110 (3.7) |
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Asian or Asian Indian | 191 (6.4) | 227 (7.6) |
|
Mixed | 74 (2.5) | 62 (2.1) |
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Other | 60 (2.0) | 49 (1.6) |
Current student, n (%) | 516 (17.3) | 409 (13.7) | |
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Born in China | 11 (0.4) | 15 (0.5) |
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Parents or grandparents born in China | 57 (1.9) | 27 (0.9) |
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Nurse | 33 (1.1) | 44 (1.5) |
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Physician | 5 (0.2) | 15 (0.5) |
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Pharmacist | 10 (0.3) | 6 (0.2) |
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Other | 102 (3.4) | 118 (3.9) |
aAssociate degrees are not awarded in the UK.
On a 7-point Likert scale ranging from “extremely unlikely” to “extremely likely,” 23.9% (95% CI 22.4%-25.5%) of US participants and 18.4% (95% CI 17.1%-19.9%) of UK participants selected “slightly likely,” “moderately likely,” or “extremely likely” when asked whether SARS-CoV-2 is a bioweapon developed by a government or terrorist organization (
Proportion of participants who selected each category for their estimate of the number of COVID-19 deaths in their country by the end of 2020.
When asked what percent of individuals infected with COVID-19 experience a fatal disease course, the median estimate given by participants was 5.0% (IQR 2.0%-15.0%) among US participants and 3.0% (IQR 2.0%-10.0%) among UK participants. The full distribution of responses as well as a magnification of the distribution of responses among those who estimated a risk of death ≤10% is shown in
When asked “when they have been infected, what age groups are most likely to die from the illness caused by the new coronavirus” and presented with the option to select “children,” “young adults,” or “older adults” (selecting more than option was possible), 96.3% (95% CI 95.6%-96.9%) of participants in the United States and 98.3% (95% CI 97.7%-98.7%) of participants in the United Kingdom selected “older adults.” However, 53.8% (95% CI 52.1%-55.6%) in the United States and 39.1% (95% CI 37.4%-40.9%) in the United Kingdom also thought that children were at a high risk of death when infected. Almost all participants in both countries (96.3%, 95% CI 95.6%-97.0% in the United States and 97.5%, 95% CI 96.9%-98.0% in the United Kingdom) responded that adults with other health problems were more likely to experience a fatal disease course than those without any other health problems.
Distribution of responses to the question, “What percent of people who get infected with the new coronavirus die from this infection?”.
Most participants in both the United States and the United Kingdom recognized fever, cough, and shortness of breath as three common symptoms and signs of COVID-19 (
When asked
Proportion of participants who replied with “yes” to whether each of seven symptoms or signs were common for COVID-19. The horizontal black bars represent the 95% CIs calculated using the Wilson method [
Responses to the question “If you have a fever or cough and recently visited China, or spent time with someone who did, what would be the best course of action?” GP: general practitioner; A&E: accident and emergency (department).
A total of 92.6% (95% CI 91.6%-93.4%) of US participants and 86.0% (95% CI 84.7%-87.2%) of UK participants selected each of the following three responses as effective measures for preventing infection with SARS-CoV-2: washing your hands; avoiding close contact with people who are sick; and avoiding touching your eyes, nose, and mouth with unwashed hands (
A total of 74.8% (95% CI 73.2%-76.4%) of US participants and 81.2% (95% CI 79.8%-82.6%) of UK participants correctly selected
Proportion of participants who replied with “yes” to whether each of 11 actions help prevent an infection with SARS-CoV-2. The horizontal black bars represent the 95% CIs calculated using the Wilson method [
Proportion of participants who replied with “yes” to each government action in response to the question “At this point in the coronavirus epidemic, do you think your government should implement the following measures to prevent spreading of the virus?” The horizontal black bars represent the 95% CIs calculated using the Wilson method [
When asked about the prevalence of an infection with SARS-CoV-2 among East-Asian individuals in their country, the median estimate among US and UK participants was 0.5% (IQR 0.0%-2.0%) and 0.5% (IQR 0.0%-1.0%), respectively (
A total of 25.6% (95% CI 24.1%-27.2%) of US participants and 29.6% (95% CI 28.0%-31.3%) of UK participants responded with “yes” to the question,
Distribution of the responses to questions on COVID-19 prevalence among individuals of East-Asian ethnicity. Of the total, 32 and 129 participants estimated a prevalence greater than 50% for the prevalence among East-Asian individuals in their country and East-Asian individuals wearing a face mask in their community, respectively. The responses from these individuals are not shown in the histogram below.
Distribution of responses to the question “If you were an Uber driver today, would you try to reject ride requests from people with East Asian-sounding names (or a profile photo of East-Asian ethnicity) to reduce your risk of getting infected with the new coronavirus?”.
It was possible to conduct an in-depth online assessment of knowledge and perceptions of COVID-19 among the general public in the United States and the United Kingdom in a short time frame. It took 2-3 days to obtain a completed questionnaire of 22 knowledge and perception questions from 1500 adults in each the United States and the United Kingdom, when allowing enrollment only in relatively granular strata by age, sex, and ethnicity (and each of these variables’ combinations). Importantly, the distribution of participants by education and household income in this sample, although not part of the enrollment criteria, was similar to that of the general population in the United States and the United Kingdom [
Regarding the survey findings, the general public in both the United States and the United Kingdom held several important misconceptions about COVID-19. Participants in both countries likely overestimated the probability of a fatal disease course among those infected with SARS-CoV-2 (while plagued by uncertainty, the case fatality rate is currently believed to lie below 1% [
This study’s findings on the levels of knowledge and prevalence of misconceptions regarding COVID-19 could inform relevant information campaigns by public health authorities and the media as well as communication of health care workers with patients. For instance, such information provision may highlight the comparatively low case fatality rate, the low risk posed by individuals of East-Asian ethnicity living in the United States and the United Kingdom, and that children do not appear to be at a heightened risk of dying from COVID-19. In addition, a substantial proportion of participants appeared to believe that common surgical masks are highly effective in protecting the wearer from infection with SARS-CoV-2. Information campaigns may, therefore, want to emphasize the comparative effectiveness of common surgical masks versus other methods of prevention, particularly frequent and thorough handwashing and avoiding close contact with people who are sick. Lastly, it is important to note that while the general public appeared to be well informed about the common symptoms of COVID-19, over one-fourth of the participants selected a health care–seeking option that could lead to further transmission of SARS-CoV-2. Thus, clear messaging on the recommended care-seeking action when experiencing some of the core symptoms of COVID-19 will be crucial.
Public health information campaigns may also want to directly target some of the mis- and disinformation that has circulated on social media [
Participants did not expect a large number of individuals to die from COVID-19 in their country by the end of 2020. This finding may be surprising considering that fear-inducing headlines in the media may (at least up to a certain extent [
This study has several limitations. First, although the sample of participants is representative of the US and UK general population by age, sex, and ethnicity, and the distribution of participants by household income and education was similar to that in the US and UK general population, participants may still differ from the general population on a variety of other characteristics. These characteristics may be both correlated with their knowledge and perceptions of COVID-19 as well as with their decision to participate in the study or to create a profile with Prolific. Second, the estimates of discrimination against individuals of East-Asian ethnicity may be an underestimation because some participants may not have wanted to volunteer their discriminating tendencies to themselves or the researcher. However, I, as the researcher, had no access to any identifying information about the research participants, and participants were reminded of this fact prior to answering the question. In addition, such social desirability bias has been found to be lower in online surveys than in telephone or in-person surveys [
Rapid online surveys are a promising method to assess and track knowledge and perceptions in the midst of rapidly evolving infectious disease outbreaks. Such assessments are crucial because ensuring that the general public is well informed about a condition like COVID-19 could reduce unnecessary anxiety as well as reduce disease transmission and thus ultimately save lives.
Supplementary appendix.
coronavirus disease 2019
Middle East respiratory syndrome
severe acute respiratory syndrome coronavirus 2
World Health Organization
PG conceived of the study, designed the questionnaire, conducted the data analysis, and wrote the manuscript. PG is the guarantor of the work. PG was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR003143. The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report. PG had full access to all the data in the study and had final responsibility for the decision to submit for publication.
I would like to thank all participants and the team at Prolific Academic Ltd. for their time and effort.
None declared.