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In early 2020, over 80,000 cases of coronavirus disease (COVID-19) were confirmed in China. Public prevention and control measures, along with efforts from all sectors of society, were undertaken to control and eliminate disease transmission.
This paper describes Chinese citizens’ response to the epidemic, the preventive measures they implemented to avoid being infected, and the public strategies that were carried out by the government, health workers, etc. We also discuss the efficacy of these measures in controlling the epidemic in China.
Information on the responses and behaviors of Chinese citizens were collected through a cross-sectional, internet-based survey using Dingxiang Doctor’s public account on WeChat. Information on public strategies implemented by all sectors of society to control the epidemic and data on new COVID-19 cases were collected from the internet, mainly from government websites. Standard descriptive statistics and multivariate logistic regression analyses were conducted to analyze the data.
A total of 10,304 participants responded to the survey, with 10,198 valid responses; 74.1% (n=7557) were female and 25.9% (n=2641) were male. Overall, 98.2% (n=10,013) of participants paid high or very high attention to the epidemic, with WeChat being their main information source (n=9400, 92.2%). Over half the participants (n=5878, 57.7%) were confident that the epidemic could be curbed in China; 92.4% (n=9427) opened windows for ventilation more frequently than usual; 97.9% (n=9986) used masks in public; 95.7% (n=9759) avoided large crowds and stayed at home as much as possible; and 97.9% (n=9988) washed their hands more often than usual. Women were more likely to practice these behaviors than men (
The methods employed by Chinese citizens and authorities have effectively curtailed the spread of COVID-19, demonstrating that this pandemic can be brought under control as long as the right measures are taken.
In December 2019, an outbreak of pneumonia associated with the novel coronavirus disease (COVID-19) was reported in Wuhan, Hubei Province, China [
COVID-19 is a highly contagious disease. It mainly spreads from person to person through respiratory droplets, similar to the common cold and influenza viruses (ie, through face-to-face contact accompanied by a sneeze or cough). It can also be transmitted through contact with the secretions of infected individuals. The role of fecal–oral transmission is yet to be determined for COVID-19, but it was found to occur during the severe acute respiratory syndrome (SARS) outbreak [
Under such a situation, it is important to provide the public with adequate information on risks and precautions, like the proper use of masks, frequent handwashing, and the avoidance of large gatherings, to control the outbreak. From January 20, 2020, when person-to-person transmission was confirmed and made public in China by Dr Zhong Nanshan [
During the early part of the outbreak, genetic analyses conducted in China revealed that the virus was similar to, but distinct from, severe acute respiratory syndrome coronavirus (SARS-CoV). China’s emergency management of SARS was heavily criticized in 2003 [
This paper aimed to describe Chinese citizens’ responses to the epidemic, the preventive measures they implemented to avoid being infected, and public strategies carried out by the government, health workers, etc. We also discuss the efficacy of these measures in controlling the epidemic in China.
Data collection for our study comprised two parts. First, information on personal responses and preventive measures to avoid being infected with COVID-19 were collected through a cross-sectional, internet-based survey. The questionnaire collected sociodemographic data (sex, age, occupation, education level, marriage, etc); sources used to obtain information on COVID-19; the level of attention paid to the epidemic; respondents’ confidence in the curbing of the outbreak in China; places that participants had visited during the COVID-19 epidemic period prior to the survey; and preventive measures taken to avoid infection. A 5-point Likert scale (ie, very low=1 to very high=5) was used to evaluate the participants’ confidence in curbing the outbreak by China and their level of attention to the COVID-19 epidemic. The questions about preventive measures were as follows:
What did you do to protect your families and friends?
Did you open windows for ventilation more frequently than usual?
Did you wear a mask in public?
Did you avoid large crowds and stay at home as much as possible?
Did you wash your hands more often than usual?
Under the following circumstance, do you wash your hands after touching public goods, toilet use, returning home, coughing/sneezing, or before eating?
Do you wash your hands with soap and running water in most cases?
Do you cover your coughs/sneezes with tissue or your bent elbow in most cases?
Questions about COVID-19 were based on the latest official report from the WHO, the Chinese Center for Disease Control and Prevention, and scientific literature. The original questionnaire was developed in Chinese by research group members from the Zhejiang Provincial Center for Disease Control and Prevention and refined over two rounds of Delphi method collaboration. A pilot study was conducted to verify its reliability.
Second, information on public strategies carried out by government, health workers, companies, etc, to protect citizens from being infected were sourced from official government websites, national and local health commission websites, national and local centers for disease control and prevention websites, and official papers [
Participants were recruited via Dingxiang Doctor, a WeChat public account with 35 million users in China, used to disseminate health knowledge to the general population. A message stating “COVID-19, have you done enough to prevent it?” was created on the site, with a link to the questionnaire. Users who viewed the message could share it through the internet, allowing for news and information to spread quickly to many people. The study period was from January 31 to February 2, 2020.
The study was approved by the Ethics Committee at Zhejiang Provincial Center for Disease Control and Prevention. Informed consent was obtained from all participants before their information was collected.
Data were exported from Dingxiang Doctor to Microsoft Excel and analyzed using SPSS, version 19.0 (IBM Corporation). Standard descriptive statistics were used to summarize the data. Multivariate logistic regression analyses were conducted to explore differences in the practice of preventive behaviors between men and women.
A total of 58,000 Dingxiang Doctor users visited the study page, 17.8% (n=10,304) of whom completed the questionnaire; 106 participants outside of China were excluded and 10,198 responses were included in the study.
Among the participants, 74.1% (n=7557) were female and 25.9% (n=2641) were male; 47.4 (n=4770) were single, divorced, or widowed; 52.6% (n=5364) were married. The proportion of participants in the age groups <30 years, 30-49 years, and ≥50 years were 55.4% (n=5653), 39.8% (n=4059), and 4.8% (n=486), respectively. Most participants had an undergraduate degree (n=7179, 70.4%), while participants with primary or lower, secondary, and postgraduate education comprised 5.1% (n=524), 10.8% (n=1105), and 13.6% (n=1390) of the sample, respectively. A total of 40.1% (n=4089) participants worked in the business and service industry, 17.7% (n=1809) worked in government institutions, 18.1% (n=1844) were students, 6.5% (n=666) were health workers, 7.3% (n=745) were housewives or househusbands, and 10.3% (n=1045) indicated “other” occupational statuses (retired, unemployed, etc).
Survey respondents’ sociodemographic characteristics (N=10,198).
Characteristic | Respondents, n (%) | |
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Male | 2641 (25.9) |
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Female | 7557 (74.1) |
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<30 | 5653 (55.4) |
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30-49 | 4059 (39.8) |
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≥50 | 486 (4.8) |
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Primary or less (≤9 years) | 524 (5.1) |
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Secondary (10-12 years) | 1105 (10.8) |
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Undergraduate (13-16 years) | 7179 (70.4) |
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Postgraduate (>16 years) | 1390 (13.6) |
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Staff of government institutions | 1809 (17.7) |
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Staff of business and service industry | 4089 (40.1) |
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Students | 1844 (18.1) |
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Health workers | 666 (6.5) |
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Housewives or househusbands | 745 (7.3) |
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Others (retired, unemployed, etc) | 1045 (10.3) |
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Single/divorced/widowed | 4770 (47.4) |
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Married | 5364 (52.6) |
Using a 5-point Likert scale, most participants indicated that they paid high attention to the epidemic. As seen in
Chinese citizens’ level of attention to the coronavirus disease (COVID-19) epidemic and their main information sources.
Variables | Total responses (N=10,198), n (%) | |
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Very high | 8035 (78.8) |
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High | 1978 (19.4) |
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Neutral | 170 (1.7) |
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Low | 11 (0.1) |
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Very low | 4 (0.04) |
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9400 (92.2) | |
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News and information applications | 4529 (44.4) |
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Microblogs | 4154 (40.7) |
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Television or radio | 4042 (39.6) |
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Family members/friends/colleagues | 2417 (23.7) |
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Websites | 2167 (21.3) |
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Short video applications | 1606 (15.8) |
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SMS | 1110 (10.9) |
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Community advocacy | 1069 (10.5) |
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Paper media (newspaper, magazine, etc) | 671 (6.6) |
Most participants followed the recommendations of the public health authority.
Gender differences existed in the practice of all preventive behaviors, with women being more compliant with all hygiene measures than men. Except for differences in “washing hands after coughing/sneezing or before eating” and “told friends and family to avoid large gatherings,” all differences were statistically significant (
Preventive measures taken by participants to avoid being infected with coronavirus disease (COVID-19), grouped by gender.
Variable | Gender | Total, n (%) | |||
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Male, n (%) | Female, n (%) |
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Told them to avoid large gatherings | 2194 (83.1) | 6458 (85.5) | 8652 (84.8) | .07 |
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Persuaded them to stay at home as much as possible | 2276 (86.2) | 6761 (89.5) | 9037 (88.6) | <.001 |
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Shared epidemic information with them | 2062 (78.1) | 6207 (82.1) | 8269 (82.0) | <.001 |
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Told them to use a mask in public | 2205 (83.5) | 6517 (86.2) | 8722 (85.5) | <.001 |
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.003 | ||||
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Yes | 2394 (90.6) | 7033 (93.1) | 9427 (92.4) |
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No | 247 (9.4) | 524 (6.9) | 771 (7.6) |
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.001 | ||||
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Yes | 2563 (97.0) | 7423 (98.2) | 9986 (97.9) |
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No | 78 (3.0) | 134 (1.8) | 212 (2.1) |
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<.001 | ||||
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Yes | 2488 (94.2) | 7271 (96.2) | 9759 (95.7) |
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No | 153 (5.8) | 286 (3.8) | 439 (4.3) |
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<.001 | ||||
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Yes | 2557 (96.8) | 7431 (98.3) | 9988 (97.9) |
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No | 84 (3.2) | 126 (1.7) | 210 (2.1) |
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After touching public goods | 2262 (85.7) | 6718 (88.9) | 8980 (88.1) | .001 |
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After toilet use | 2424 (91.8) | 7241 (95.8) | 9665 (94.8) | <.001 |
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After returning home | 2330 (88.2) | 7001 (92.6) | 9331 (91.5) | <.001 |
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After coughing/sneezing | 1706 (64.6) | 5076 (67.2) | 6782 (66.5) | .06 |
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Before eating | 2279 (86.3) | 6644 (87.9) | 8923 (87.5) | .11 |
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<.001 | ||||
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Yes | 2196 (83.2) | 6646 (87.9) | 8842 (86.7) |
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No | 445 (16.8) | 911 (12.1) | 1356 (13.3) |
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.01 | ||||
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Yes | 1451 (54.9) | 4438 (58.7) | 5889 (57.8) |
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No | 1190 (45.1) | 3119 (41.3) | 4309 (42.3) |
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aMultivariate logistic regression, adjusted for age, education level, occupation, marital status, and region.
From January 20, 2020, when person-to-person transmission was confirmed and made public in China, social distancing policies were advocated for among the public. As shown in
Places that participants had been to during the coronavirus disease (COVID-19) epidemic period prior to taking the survey.
Place | Total responses (N=10,198), n (%) |
Supermarket or shopping mall | 5109 (50.1) |
Always at home | 2648 (26.0) |
Gathering with friends or family members | 1755 (17.2) |
Farmer’s market | 1427 (14.0) |
Public transport areas | 1120 (11.0) |
Workplace | 898 (8.8) |
Over half the participants were confident that the COVID-19 epidemic would be curbed in China, among whom 29.6% (n=3014) participants were strongly confident, and 28.1% (n=2864) were confident. A total of 30.1% (n=3073) participants were neutral, 10.0% (n=1022) lacked confidence, and 2.2% (n=225) strongly lacked confidence (
Participants’ confidence in curbing the COVID-19 epidemic in China.
Confidence level | Total responses (N=10,198), n (%) |
Strongly confident | 3014 (29.6) |
Confident | 2864 (28.1) |
Neutral | 3073 (30.1) |
Lack of confidence | 1022 (10.0) |
Strong lack of confidence | 225 (2.2) |
Since January 20, 2020, a series of strategies were implemented to curb the spread of the virus to the wider community.
Main public strategies that responded to coronavirus disease 2019 (COVID-19) epidemic in China.
Date | Main strategies implemented by the government, health workers, factories, companies, and media |
January 20 | Person-to-person transmission is officially announced to the public. Nationwide health education campaign is initiated. People are encouraged to stay at home, avoid gatherings, wear protective masks when they need to move in public, etc. |
January 23 | The government extends Chinese Lunar New Year holiday. Museums, libraries, shopping malls, etc, are closed. Large public events are canceled or postponed. Chinese authorities place a lockdown on Wuhan, the epicenter of COVID-19, and traffic in Wuhan and cities across Hubei Province is restricted and monitored. Transportation is subsequently restricted at a national level. |
January 24 | The first batch of medical teams from outside Hubei arrive in Wuhan. More medical staff continue to arrive, totaling over 40,000 individuals. Chinese companies are ordered to build a 1000-bed hospital within 10 days. Work on a second facility with 1300 beds follows 2 days later. To plug the shortage of protective suits, masks, and other medical supplies, Chinese manufacturers from various industries are mobilized, including those that normally manufacture cars and cellphones. |
January 27 | The Examine and Approve Policy on resumption of work is initiated. Factories, companies, etc, begin to collect the travel history and health status of staff members. |
February 3 | Psychological service is provided nationally. A training program is set up on the National Health Commission website for continuing medical education [ |
February 4 | Close management of communities, villages, and workplaces to curb COVID-19 begins in Hangzhou and is later implemented nationally. Community screening is initiated. |
February 10 | China urges efforts to ensure orderly resumption of work to provide sufficient material support for epidemic control. The health status of workers is examined and recorded before they resume work and monitored twice a day during work. |
February 11 | A health QRa code system is developed by Alibaba Company, and implemented to control the spread of COVID-19 in Hangzhou. People traveling to Hangzhou must report their travel history and health conditions in advance online and are issued with green, yellow, or red QR codes, based on the information they had provided. A green code holder, rated as having little chance of being infected, can visit public areas and take public transport normally after taking their temperatures. Those with yellow and red codes, however, must be quarantined for 14 days and report their health information every day, or be sent to a hospital if necessary, before they may travel. Subsequently, the system is implemented nationally. |
February 24 | With the decrease in new cases, shopping malls, libraries, museums, etc, are reopened in succession. |
February 28 | The government publicly announces that the COVID-19 epidemic in Wuhan is controllable and is heading in a good direction. |
aQR: Quick Response.
Daily new cases of coronavirus disease (COVID-19) in China since January 20, 2020.
This is the first large-scale, nationwide study to report on the comprehensive preventive measures taken by Chinese citizens and strategies implemented by the government, health workers, factories, etc, to combat COVID-19 at a national level. We found that Chinese citizens responded quite well to the COVID-19 epidemic, by strictly following the recommendations of health authorities. The frequency of taking preventive measures by participants was high, with 92.4% of participants opening windows for ventilation more often than usual, 99.4% of participants using masks in public, 95.7% of participants avoiding large crowds and staying at home as much as possible, and 97.9% of participants washing hands more often than usual. However, responses varied among participants, and women showed higher compliance with all hygiene measures than men—a phenomenon that was also found in other studies [
Compared with measures taken to prevent the transmission of SARS in 2003 [
WeChat, the largest standalone social media mobile app in China, was found to be one of the main sources of information on the COVID-19 epidemic for over 90% participants. In China, over 95% of adults own a mobile phone and over 1 billion access WeChat at least once a day. The app has become an integral part of Chinese daily life, with citizens using it to send messages, share updates, and access the latest news from the government, celebrities, enterprises, and so on [
Our findings showed that over 80% participants had tried to influence their families and friends by telling them to avoid large gatherings and stay at home as much as possible, sharing epidemic information with them, and telling them to use masks when necessary. This finding supports previous findings that participants who lived with their families were more likely to use a higher number of precautionary measures than those who did not live with their families during the SARS outbreak in 2003 [
Innovative measures combined with traditional strategies have facilitated China’s response to COVID-19. Traditional strategies, including active contact tracing, isolation and quarantine, a series of social distancing policies, and community containment were reinforced at a national level. China’s emergency management of SARS was heavily criticized in 2003 [
This study has some limitations. First, selection bias might exist. Intrinsic limits, such as partial coverage of the population and missing responses from interviewees, are also present in our study, like other internet-based surveys [
Our study provided a broad description of preventive measures taken by Chinese citizens to avoid being infected with the novel coronavirus and the main strategies implemented by the government, health workers, factories, companies, and media to protect citizens. Chinese citizens followed the hygiene recommendations of health authorities very well; however, further education on practicing respiratory hygiene is still needed in China. In addition to traditional response strategies, an innovative health QR code system based on big data and mobile internet technologies has helped to prevent the spread of COVID-19 and facilitate the resumption of work and production. Online education has enhanced the capacity of health workers on the prevention, diagnosis, and treatment of COVID-19 in a safe and efficient way. With daily decreases in the number of new cases, we conclude that Chinese measures to curb the spread of COVID-19 has been effective. Our findings suggest that an epidemic of COVID-19 can be brought under control as long as the right measures are taken.
coronavirus disease 2019
Quick Response
severe acute respiratory syndrome
severe acute respiratory syndrome coronavirus
World Health Organization
We are grateful to the staff of Ding Xiang Doctor WeChat platform for their help in conducting the study and for the support by Zhejiang Medicine and Health Technology project (2018KY335).
None declared.