The message that the government repeatedly emphasized at the outset of the Covid-19 pandemic, namely that people should wash or disinfect their hands regularly, has indeed sunk in.
But now it’s time for a new message that is in line with the latest research on how people contract the disease: by inhaling infected droplets. The best strategies to avoid this are to avoid large groups of people, apply physical distancing and wear masks.
This is the warning in a study on South Africans’ knowledge of Covid-19 and its prevention by Ronelle Burger of Stellenbosch University and Carmen Christian of the University of the Western Cape, as well as Brendan Maughan-Brown, Russell Rensburg and Laura Rossouw, all three from the University of the Witwatersrand. It is part of a series of studies by more than 30 researchers at South African and foreign universities known in their entirety as the Nids-Cram study (see box below) and was released on Wednesday.
The vast majority of people – 91% – say they have changed their behavior to prevent Covid-19 infection. The most common change was the washing or disinfection of hands, which 70% of people now do regularly.
However, only 35% made all three of the most effective preventative measures (avoid large groups, apply physical distancing, and wear masks) part of their behavior. Of the respondents, 53% now wear masks and 58% avoid people, either by staying at home or avoiding large groups. Only 25% of people apply physical distancing.
“Until a vaccine against Covid-19 is developed, governments will remain highly dependent on non-pharmaceutical interventions to control the spread of the pandemic and prevent the overloading of the health system,” the study warns.
The researchers say that complicating compliance with preventative measures is that people do not get any confirmation that it works. If they act safely, they may not get sick, but they do not have tangible evidence that it was precisely this behavior that prevented them from getting sick.
“The long time frame within which the preventive measures will have to be sustained is another challenge. Adaptation means that the power of our fears will weaken over time. Eventually we get used to living with risks and we stop being afraid. ”
The researchers also point out how difficult it is to apply preventive measures practically in poor residential areas. A study conducted in Cape Town shows that the distance between homes can be as small as 0.6 m. The homes themselves are full and in addition communities share amenities such as toilets. In addition, not everyone has access to clean, running water for washing hands or masks.
For restraint measures to be successful, high levels of trust are required. If leaders and the information they share are not trusted, few people will accept the restriction or comply with the regulations. The researchers refer to the deployment of the army and say it creates the danger of resistance and the destruction of trust. “In this context, co-operation can be more effective than punishment.”
Is people afraid (enough)?
Wealthy South Africans are very afraid that they will contract the virus Covid-19 as the poorest people in the population.
According to the researchers, 52% of the richest fifth of the population believe that they will contract the viral disease. Only 25% of the poorest fifth of the population believe they are susceptible.
It is worrying given that it is more affluent people who can protect themselves much more easily – they can probably work from home, do not have to use public transport and have contact with far fewer people per household. If people in less privileged positions are not so worried that they are going to get the disease, it helps explain why so many of the hotspots for Covid-19 distribution are poorer residential areas where people actually live closer to each other and use public transportation.
According to researchers, this is a double issue. On the one hand, too many people in poor neighborhoods think they are safe and therefore do not do the basic things they can to prevent the spread. On the other hand, regardless of their disposition, it is difficult to apply the best preventive measures – such as social distancing and disinfection.
Ignorance of Covid-19 symptoms
Coupled with the fact that many people may not be as worried about contracting the disease as they should be, people are not as aware of the major symptoms as health experts would like.
As many as 8% of people could not name a single symptom of Covid-19. Only 6% of people were able to identify all three of the most common symptoms of Covid-19, namely cough, fever and fatigue.
When respondents were asked what they think the symptoms are, 64% could list cough and 63% fever but only 11% fatigue.
“This implies that many South Africans will not be in a good position to make decisions about when to go into isolation and / or get Covid-19 symptoms. It is expected to have negative effects on individuals, but also more broadly for society because it means that the disease is not limited. ”
Even more worrying is the fact that the knowledge of symptoms and compliance with preventative behavior is not at all higher among high-risk groups such as the elderly and people with chronic health conditions.
Where can people get information about Covid-19?
The source most people (80%) use with confidence is news media, including radio and TV stations, newspapers and the internet. The government (14%), social media (14%) and conversations with health workers (11%) are also among the sources that people trust.
Interestingly, it is people who rely on health workers, social media and government resources who can respond more accurately to the symptoms of Covid-19 and who are more likely to follow the most effective prevention measures (distancing, masks, staying home) than people who only rely on the news media rely on.
The researchers’ recommendations to the government are:
- Communicate clearly, concisely and consistently.
- Give specific and feasible recommendations on preventative behavior – focusing on wearing masks and physical distancing.
- Use the media more efficiently to convey information.
- Rely more on government officials and health workers as a reliable source of information.
- Provide masks free of charge to ensure massage use.
- Restructure the delivery of services to promote physical distancing.
- Use “pre-fighters” – leaders in neighborhoods – to change social norms.
- Anchor messages in hope and a positive vision for the future.
About the study
The National Income Dynamics Study (Nids) Coronavirus Rapid Mobile Survey (Cram), or Nids-Cram, is the largest non-medical research project on Covid-19 to date. This is done by a consortium of more than 30 researchers from five South African and foreign universities.
More than 7,000 people were asked in 20-minute telephone interviews about aspects such as work, hunger in their household, migration, government grants, and their perceptions and behaviors regarding Covid-19. The calls were made by 50 call center agents who could work in ten languages.
The researchers will issue at least five phases of the research by December this year. Phase 1’s research was released on Wednesday.
The first phase’s poll was conducted from 7 May to 27 June. It questioned people about the period from February to April, with April in particular being particularly difficult given that the country then experienced the most severe level of restraint.
Nids is a separate study previously conducted by researchers at the University of Cape Town on behalf of the government. Nids-Cram measures the same group of individuals, which is composed in such a way that it represents the South African population.