Public Exposure to Live Animals, Behavioural Change, and Support in Containment Measures in response to COVID-19 Outbreak: a population-based cross sectional survey in China

  1. Zhiyuan Hou
  2. Leesa Lin
  3. Lu Liang
  4. Fanxing Du
  5. Mengcen Qian
  6. Yuxia Liang
  7. Juanjuan Zhang
  8. Hongjie Yu

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Abstract

Background

In response to the COVID-19 outbreak, we aimed to investigate behavioural change on exposure to live animals before and during the outbreak, and public support and confidence for governmental containment measures.

Methods

A population-based cross-sectional telephone survey via random dialing was conducted in Wuhan (the epicentre) and Shanghai (an affected city with imported cases) between 1 and 10 February, 2020. 510 residents in Wuhan and 501 residents in Shanghai were randomly sampled. Differences of outcome measures were compared before and during the outbreak, and between two cities.

Findings

Proportion of respondents visiting wet markets at usual was 23.3% (119/510) in Wuhan and 20.4% (102/501) in Shanghai. During the outbreak, it decreased to 3.1% (16) in Wuhan (p<0·001), and 4.4% (22) in Shanghai (p<0·001). Proportion of those consuming wild animal products declined from 10.2% (52) to 0.6% (3) in Wuhan (p<0·001), and from 5.2% (26) to 0.8% (4) in Shanghai (p<0·001). 79.0% (403) of respondents in Wuhan and 66.9% (335) of respondents in Shanghai supported permanent closure of wet markets (P<0.001). 95% and 92% of respondents supported banning wild animal trade and quarantining Wuhan, and 75% were confident towards containment measures. Females and the more educated were more supportive for the above containment measures.

Interpretation

The public responded quickly to the outbreak, and reduced exposure to live animals, especially in Wuhan. With high public support in containment measures, better regulation of wet markets and healthy diets should be promoted.

Funding

National Science Fund for Distinguished Young Scholars, H2020 MOOD project.

Research in context

Evidence before this study

On February 19, 2020, we searched PubMed for papers published after January 1, 2020, containing the following terms: “2019 nCoV” or “COVID-19”. We identified 179 studies, most of which are research on clinical and epidemiological characteristics of COVID-19. To date there is no primary research to quantify public behavioural response and support in containment measures in response to the outbreak. Only four commentaries mentioned the influence of the outbreak on mental health. One commentary introduced the habit of consuming wild animal products in China. Another commentary briefly introduced isolation, quarantine, social distancing and community containment as public health measures in the outbreak. The Chinese government has introduced a series of strict containment measures, and societal acceptability of these measure is important for effective and sustained response. Evidence is urgently needed to help policy makers understand public response to the outbreak and support for the containment measures, but no evidence available to date.

Added value of this study

We conducted a population-based cross-sectional telephone survey via random digital dialing in Wuhan (the epicentre) and Shanghai (an affected city with imported cases) between 1 and 10 February, 2020. To date, this is the only few analyses on behavioural response to the outbreak and societal acceptability of governmental containment measures, which has been listed as the current priority of China CDC. We provide an assessment of behavioural change on exposure to live animals during the outbreak, by comparison before and during the outbreak, and between two cities with diverse exposure intensities to COVID-19. We also provide evidence on public support in governmental containment measures, including strict regulation on wet markets to reduce animal-to-human transmission and city quarantine to reduce human transmission.

Implications of all the available evidence

We found that wild animal consumption was more prevalent in Wuhan (10.2%) than in Shanghai (5.2%). The public responded quickly to the outbreak, and significantly reduced exposure to live animals and stopped wild animal consumption, especially in Wuhan. They were very supportive of governmental containment measures. With high public support, wet markets should be better regulated, and healthy diets, including changing the traditional habit of eating wild animal products, should be promoted. This can inform policy makers in China and other countries to implement and adjust containment strategies in response to the outbreak in the future.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.02.21.20026146: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were performed using Stata 14.0 (StataCorp LP, College Station, TX).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. First, there may be recall bias. We aimed to identify behavioral changes in a cross-sectional survey, and outcomes before the outbreak were measured based on participant recall. Second, our results may be affected by selection bias from telephone survey. We did attempt multiple calls to unanswered numbers to mitigate this bias, and quota sampling was introduced to get a representative sample. The anonymous phone interview addressed the concern of response bias due to fear of being seen as criticizing the government. Third, a cross-sectional design prevents us from assessing how long the effect on behavioral/intention change demonstrated in this study will last, when the outbreak is no longer fresh in people’s minds. Thus, we plan to conduct a second-round survey at the end of the outbreak to track the long-term changes. In conclusion, exposure to live animals was common before the COVID-19 outbreak. The public responded quickly to this outbreak, and significantly reduced their exposure to live animals and stopped wild animal consumption, especially in Wuhan. They were very supportive and confident for current mitigating measures. With high public support, wet markets should be better regulated, and healthy diets, including changing the habit of wild animal consumption, should be promoted, especially for male, the less educated and those exposing to live animals at usual.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.02.21.20026146 on medRxiv