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
Authors: Hou Zhiyuan , Lin Leesa , Liang Lu , Du Fanxing , Qian Mengcen , Liang Yuxia , Zhang Juanjuan , Yu Hongjie 
Published: February 2020

SummaryBackgroundIn 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.MethodsA 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.FindingsProportion 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.InterpretationThe 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.FundingNational Science Fund for Distinguished Young Scholars, H2020 MOOD project.Research in contextEvidence before this studyOn 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 studyWe 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 evidenceWe 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.