After several months of the course of the epidemic process, specialists naturally forecast and build models for the development of a pandemic in various regions of the world. There are demographic, social, medical, and other differences that significantly affect the incidence of COVID-19. Severe infections and deaths are observed mainly at the age of 60 and older. When developing preventive measures for the spread of COVID-19, an integrated approach is needed that considers the epistemic, psychological, and behavioral attitudes of the public towards the virus.
This paper reviews eight articles and groups them into four major topics. First, the author considers articles reporting the studies on the epidemiology of COVID-19. The second and third sections present the reviews of research on the knowledge regarding the infection among public and attitudes regarding COVID-19, respectively. The final part of the paper discusses behaviors and their adequacy. The review makes a particular focus on community-dwelling individuals defined as older people living individually.
Epidemiology of COVID-19
Currently, the primary infection source is an infected person, including those at the end of the incubation, prodromal period (the beginning of virus isolation from target cells), and during clinical manifestations. Rothan and Byrareddy (2020) provide a report of the epidemiology and pathogenesis of the COVID-19 outbreak. The transmission mechanism is an aspiration, and its roots are airborne (virus release when coughing, sneezing, talking) upon contact at close range. The contact-household route is realized through transmission factors: water, food products, and objects (door handles, smartphone screens) contaminated with the pathogen. The risk of transmission of the virus from the hands to the mucous membranes of the eyes, nose, and mouth has been proven. It is also possible that a fecal-oral route of transmission exists since SARS-CoV-2 nucleic acids are found in stool samples from pneumonia patients with abdominal symptoms. The study also reports on nosocomial roots of the most cases registered among medical workers (for instance, assisting patients with COVID-19).
Susceptibility to the pathogen is high among all population groups. Li et al. (2020) present the meta-analysis of clinical characteristics and risk factors of the COVID-19. The risk groups for a severe course of the disease and the risk of death include people over 60 years old and patients with chronic diseases (diseases of the respiratory system, cardiovascular system, diabetes mellitus, or oncological diseases). The mortality rate reported in their study is 5.6%, and it is higher than usually reported. Li et al. (2020) state that the primary infection sources are sick people, asymptomatic carriers, and those in the incubation period. They also second Rothan and Byrareddy (2020), saying that transmission’s main routes are airborne and contact. The researchers also suggest that infection can enter the body through the conjunctiva of the eye.
The severity and threat of an epidemic depend on the number of infected, the degree of infectiousness of the virus, and the spectrum of clinical manifestations. Lipsitch et al. (2020) suggest four critical questions for further studies of the disease epidemiology. First, “what is the full spectrum of disease severity (which can range from asymptomatic, to symptomatic-but-mild, to severe, to requiring hospitalization, to fatal)?” (Lipsitch et al., 2020, p.1195). The second question should tackle the transmissibility of the virus. Third, researchers should focus on studying the infectors: “how do the infected person’s age, the severity of illness, and other characteristics of a case affect the risk of transmitting the infection to others?” (Lipsitch et al., 2020, p.1195). Finally, epidemiologists should identify the most susceptible groups at danger and develop the most suitable preventive strategies.
Knowledge Regarding COVID-19 Infection Among Public
A significant proportion of older people lack the skills to work with the latest technologies, which leads to the fact that for this population group, access to information on measures to protect against coronavirus and to many necessary services is limited. Generally, this can also lead to an increase in isolation or marginalization of the community dwellers. Ibrahim and Mahmoud (2020) conducted a descriptive cross-sectional correlational research, revealing that more than one-third of older people exhibit a satisfactory level of knowledge about the roots and preventive mechanisms of COVID-19. Patkar and Berry (2020) made a particular focus on the absence of any medical background among participants included in their sample. Their results show that the participants demonstrated a good level of awareness about the pandemic, preventive tactics, and ways to enhance immunity. However, there are still some weak spots: mask disposal technique, over the counter medication, and affection of pets. Although both studies’ results are inspiring, it is necessary to bear in mind that the elderly community dwellers are less able to keep up with the latest information circulation and dissemination. Thus, there is a need for careful development of awareness-increasing nursing programs.
Attitudes Regarding COVID19 Infection Among Public
Community dwellers today face increased not only health risks but also great difficulties related to self-isolation. While social distancing is necessary to reduce the spread of disease, if not applied correctly, it can also lead to the increased social isolation of older people when they most need support. Ibrahim and Mahmoud (2020) studied the presence of fear among the aged population and have concluded that this group exhibits this emotion the most. The findings of Biswas and Sen (2020) suggest that the emotional stress related to COVID-19 and social isolation worsens pre-existing mental issues and psychological problems. Czeisler et al. (2020) have found that US adults living in urban areas start feeling more unsafe when the restrictions are strengthened. However, the authors suggest that people generally support the mitigation guidelines.
Behaviors Regarding COVID-19 Infection Among Public
The support of the preventive strategies does not necessarily involve compliance with them. As Ibrahim and Mahmoud (2020) state, the aged adults tended to exhibit more deficient preventive practices. An interesting insight of their findings is the negative correlation between fear from COVID-19 and COVID-19 knowledge and preventive practices when comparing middle-aged and older adults. Lemke and Lemke (2020) implicitly support these findings by stating that age 65+ and clinical risk factors were not positive predictors of increased preventive behaviors. At the same time, when estimated in general, the mitigation practices have increased strongly. However, the authors distinguish between urban and rural community dwellers. The former tends to exhibit preventive behaviors significantly more than the latter. Czeisler et al. (2020) second their findings by stating that people located in non-urban areas tend to neglect mitigation strategies.
Summary
The reviewed articles suggest that community dwellers are at the most risk from COVID-19 and, at the same time, exhibit less adequate epistemological, psychological, and behavioral practices related to the disease. Although people generally tend to support mitigation strategies and guidelines, older adults have significantly less appropriate knowledge about the infection, its roots, and prevention mechanisms. It is partly explained by their exclusion from social networks due to isolation and their inability to engage with digital technologies. Similarly, the aged population does not tend to follow behavioral guidelines and adopt a more deficient set of preventive practices towards COVID-19. At the same time, community dwellers are at the most psychological risk related to the mitigation strategies.
References
Biswas, R., & Sen, S. (2020). Urban eco-psychological attitude during COVID-19 ‘lockdown’: A survey. International Journal of Creative Research Thoughts, 8(7).
Czeisler, M. É., Tynan, M. A., Howard, M. E., Honeycutt, S., Fulmer, E. B., Kidder, D. P.,… & Rajaratnam, S. M. Public attitudes, behaviors, and beliefs related to COVID-19, stay-at-home orders, nonessential business closures, and public health guidance—United States, New York City, and Los Angeles, May 5–12, 2020. Morbidity and Mortality Weekly Report, 69(24), 751-758.
Ibrahim, S. M. E., & Mahmoud, M. A. M. (2020). Relationship between knowledge, preventive practices and fear from COVID-19 among middle aged and older adults: During the novel coronavirus outbreak. American Journal of Nursing, 9(5), 338-351. Web.
Lemke, D., & Lemke, K. (2020). Factors associated with COVID-19 mitigation behavior among US adults. medRxiv.
Li, J., Huang, D. Q., Zou, B., Yang, H., Hui, W. Z., Rui, F.,… & Teng, M. L. P. (2020). Epidemiology of COVID‐19: A systematic review and meta‐analysis of clinical characteristics, risk factors, and outcomes. Journal of Medical Virology. Web.
Lipsitch, M., Swerdlow, D. L., & Finelli, L. (2020). Defining the epidemiology of Covid-19—studies needed. New England Journal of Medicine, 382(13), 1194-1196.
Patkar, A., & Berry, A. K. (2020). Awareness of COVID-19, preventive strategies for the same and factors affecting immunity in adult community dwellers with no medical background-A questionnaire based study. International Journal of Health Sciences and Research 10(7), 287-295.
Rothan, H. A., & Byrareddy, S. N. (2020). The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of Autoimmunity. Web.