An Assessment of Healthcare Workers Knowledge about COVID-19

Introduction: Coronavirus disease 2019 (COVID-19) is caused by a viral infection and considered the third coronavirus emerging among human beings over the past two decades. Healthcare Workers (HCWs) are at high risk of acquiring this serious infection during providing care to patients. Therefore, it’s crucial to assess the knowledge of the HCWs about COVID-19. Methods: A multicenter cross-sectional study was conducted on HCWs working at public hospitals and Primary Healthcare (PHC) centers in the Najran region, KSA to evaluate the staff’s knowledge toward COVID-19. The questionnaire consisted of two parts, the first part included the demographic data, and the second part involved questions related to the COVID-19. Results: 451 HCWs participated in this study and the median of overall knowledge score was 67%. Most HCWs properly identified symptoms (82.9%), mode of transmission (78.5%), the incubation period (96.4%), the way of preventing the infection (91.5%), the COVID-19 is not same as MERS-CoV (74.3%) and availability of a vaccine against the COVID-19 (82%). However, HCWs were less likely to identify the source of COVID-19 when it was discovered in China (22.5%), the mortality rate (44.6%), and the presence of treatment (32.1%). Overall knowledge score was statistically significantly associated with profession (P = 0.034), educational level (P = 0.033), and availability of the infection control in the workplace (P = 0.006). Conclusion: The findings of this study demonstrated an intermediate level of knowledge of HCWs about COVID-19. Intervention programs are urgently needed to raise the knowledge of HCWs about this global public health issue.


Introduction
The human coronavirus (HCoV) was discovered in 1965 and was named as B814 [1]. HCoVs are classified within the family Coronaviridae (genus, Coronavirus) in the order Nidovirales. They are the largest RNA viruses, enveloped, nonsegmented, positive-sense, single-stranded RNA viruses, and named after their corona-like or crown-like surface projections seen on electron microscopy that correspond to large surface spike proteins [2] [3] [4].
HCoVs are widely distributed among birds and mammals as well as humans [5] [6]. There are six species of coronavirus that cause human illness. 229E, OC43, NL63, and HKU1 are typically associated with common cold symptoms [7]. The other two species are originally zoonotic, including severe acute respiratory syndrome (SARS-CoV) which was the related pathogen for SARS-CoV in Guangdong Province, China in 2002 and 2003 [8] [9] [10], and the Middle East respiratory syndrome (MERS-CoV) that was the causative agent for MERS-CoV in the Middle East, which was first diagnosed in Saudi Arabia in 2012 [11] [12].
In late December 2019, clusters of sick people with pneumonia of unknown reasons were discovered in Wuhan, Hubei Province, China. These cases were epidemiologically linked to the seafood wholesale market in Wuhan [13]. A new virus was identified and initially called the 2019 novel coronavirus (2019-nCoV) [6].
International Committee on Taxonomy of Viruses eventually changed the name of the virus to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [14]. On January 30, 2020, the World Health Organization (WHO) named the disease as "COVID-19" which is coronavirus disease 2019 [15]. Although COVID-19 outbroke in December 2019 in Wuhan (China), soon it spreads worldwide and in a couple of weeks the number of confirmed cases was reported by the majority of countries around the world, therefore, on March 11, 2020, the WHO officially described the COVID-19 outbreak as a pandemic [16].
In the Kingdome of Saudi Arabia (KSA), the first confirmed COVID-19 case was reported on 2nd March 2020 from Qatif, eastern region, a Saudi national person coming back from Iran across Bahrain. His companion was reported the second case on the 4th of March 2020 [17]. Since then and till now, about 35 Despite the availability of an enormous amount of information from different resources to community members as well as HCWs, a huge volume of this information is not evidence-based nor the best available resources. Therefore, it becomes very important to assess HCWs' knowledge of the pandemic against the best available information.
This study aims to assess the knowledge of HCWs in Najran, KSA about COVID-19.

Methods
A multicenter cross-sectional study conducted over 15  Participants' knowledge was evaluated against published evidence and guidelines [17]- [22]. We calculated a total score for each participant according to their response. The total score was 12.
Statistical analysis: Median (inter-quartile range) and frequency (percent) were used to present the data. Mann-Whitney test and Kruskal Wallis were used to compare the data.
Robust regression analysis was used to identify the factors associated with the overall knowledge score. For analyzing the data, statistical packages IBMSPSS (Version 20) was employed.

Results
There was a total of 451 participants in this study. The majority of the respondents were male (61.2%), and 47% of the total participants were 25 to 34 years old, however, no one of them was 65+ years old. Most of the respondents were nurses (40.5%) while the least were IPC staff. The median of the participant's experience was 9 (5 -14) years, and nearly 86% of respondents reported that they work at the hospital. Roughly 50% of the study respondents hold a bachelor's degree and only 2.2% of them had Ph.D. While 91.3% of participants reported that the IPC department is available at their workplace, about 5% of them did not know. The demographic data of the respondents are presented in Table   1.
Responses of HCWs about the COVID-19 are presented in Table 2  Respondents were asked about the source of COVID-19 when it was discovered in China and over 55% of them reported Bats. The HCWs were also asked regarding the way of prevention and the vast majority of them (91.5%) mentioned washing hands with alcohol-based hand sanitizer, cover nose and mouth with a tissue when coughing or sneezing, and avoiding personal contact is the ways to prevent the infection.
Regarding similarity between COVID-19 and MERS-CoV, 25% of the respondents stated that both viruses are same. The HCWs showed a variation with respect to mortality rate caused by COVID-19.
In terms of availability of treatment and vaccination, 48.1 said there is a treatment and 82% stated that there is no vaccination against COVID-19. Correct answers on the different questions regarding the HCWS knowledge about COVID-19 are shown in Table 3. The HCWs have rarely considered coronavirus disease 2019 and viral respiratory illness are denoted the meaning COVID-19 (27.3%). However, coronavirus disease 2019 had the highest percentage (68.5%) as solely the meaning of COVID-19. 78.5% of the HCWs identified the mode of transmission. Most HCWs were able to identify the correct answers to the symptoms and incubation period of the virus 82.9% and 96.4%, respectively. Only 22.5% of participants reported the correct source of COVID-19 when discovered in China, Seafood wholesale market. The participants identified correctly the way of prevention, availability of vaccine against COVID-19, and COVID-19 is the same as MERS-CoV, in a percent of 91.5%, 82%, and 74.3% respectively. Table 4 demonstrates the difference in the median of the overall score for correct responses of the HCWs knowledge about COVID-19 by demographic factors. The median of the overall score varied significantly by Profession (P.   Variables associated with an overall score of knowledge were analyzed using Robust regression analysis, Table 5  Compared with a score of HCWs who hold diploma degree, HCWs who have fellowship were 6.66 higher (B = 6.66, CI = 0.51 -12.81, P = 0.034). The score of HCWs who have the IPC department and aware about it was 10.92 times higher than those who either didn't have or didn't know (B = 10.92, CI = 3.20 -18.65, P = 0.006). The source of information where the respondents heard about COVID-19 is demonstrated in Figure 1. Approximately 33.2% of the HCWs have heard about COVID-19 from MOH information channels, which represent the majority. Media (30.5%) ranked the second more source of information about COVID-19. Social media and place of work showed 22.9% and 12.2%, respectively as another source of information. However, only 1.1% of the respondents reported the source of the information was from their colleagues.

Discussion
To the best of our knowledge, this is the first study that evaluates the knowledge level of HCWs regarding the current public health issue COVID-19 in Najran city, the southern province of Saudi Arabia. Our study found that the overall   HCWs (67%). HCWs who had post-graduate qualifications showed better knowledge than those who had a bachelor or diploma degree. Furthermore, the median scores of HCWs who knew availability of IPC department in their settings were higher than those who reported that they did not have IPC department in their working place and those who had not known If the IPC available at their settings, 75%, 58%, and 58%, respectively. Similar findings have been reported before [39].
It is important to ensure the availability of the HCWs mentioned above during implementation of the intervention programs.
In terms of demographic variables that were statistically significantly associated with an overall median score of healthcare staff's knowledge toward the COVID-19; profession, educational level, and availability of the IPC department in the workplace were the only three significant variables. A study conducted in the Al Jouf region reported similar variables (gender, educational level, and occupation) associated with an overall score [46]. However, Khan et al. stated that gender and experience were the only two statistically significant demographic variables associated with the overall mean score of the knowledge of the HCWs. [44]. Although other research does not support the association of gender with the knowledge and attitude of HCWs [47], which agrees with our results.
This study has some limitations. First, the possibility of recall and misclassification bias, because it was questionnaire based study. Second, this study was conducted in a single region in the KSA, thus we can't generalize our findings to the entire KSA.

Conclusion
The and ensuring the HCWs are receiving the information from MOH which is evidence-based source.