JMIR Publications

ABSTRACT

Background:

Spain has been one of the most impacted countries by the COVID-19 pandemic. Since the first confirmed case of COVID-19 reported on January 31st, 2020, over 240,000 cases have been reported in Spain, resulting in over 27,000 deaths. The economic and social impact of the COVID-19 pandemic is without precedent. In this context, it is of paramount importance to quickly assess the situation and perception of citizens during the pandemic. Large-scale, online surveys have been shown to be an effective tool to carry out such rapid assessments.

Objective:

The objective of the research described in this paper is to quickly assess the Spanish citizens’ situation and perception on four areas related to the COVID-19 pandemic: their social contact behavior during the confinement, their personal economic impact, their workplace situation and their health status. We report overall statistics, carry out bi-variate statistical analysis and identify significant age and gender differences in people’s situations and behavior during the COVID-19 pandemic in Spain. Moreover, we perform multi-variate logistic regression models and build a linear regression COVID-19 prevalence model using two of the questions of the survey and validate it with data from a seroprevalence study in Spain.

Methods:

We obtained a large sample using an online survey with 24 questions related to COVID-19 for rapid and effective distribution. The self-selection online survey method of nonprobability sampling was used to recruit 156,614 participants via social media posts that targeted the general adult population (aged > 18 years old).

Results:

Regarding the social behavior during confinement, we found that participants mainly left their homes to satisfy basic needs, such as go to the pharmacy, supermarket, and bakery (47.8%) and to go to work (31.3%). On average, 10.1% of respondents did not leave their homes and stayed at home during their confinement. We identified several statistically significant (P<.001) differences in the social behavior across genders and age groups: 14.8% of female respondents vs 6.5% of male respondents reported not leaving their home; 26% of female participants vs 36.7% of male participants reported leaving to go to work and respondents aged 60 and older were almost twice as likely to stay home than younger participants (14.9% vs 7.6%). Individual transportation was largely preferred over other means of transportation (84.5%). The citizens’ solidarity with the measures and resilience regarding the confinement is evident: most respondents (46.6%) believed that the government should implement more measures and 44.1% of participants reported being able to remain in confinement for one additional month. The survey answers reveal a significant economic impact of the pandemic in small businesses: 47.3% of respondents working in small (1-9 workers) companies reported having been financially affected and 19.4% reported facing bankruptcy at their work. We also find that economic impact is a key driver for resilience towards the confinement measures: a multi-variate logistic regression model reveals that those who report not having enough money to buy food have more than twice the probability of reporting that they could not stay in confinement for more than 1 week (OR=2.23, 95%CI[1.81, 2.77]). In terms of the ability to implement an effective quarantine, 27.2% of participants reported not having the necessary resources to isolate themselves. Regarding symptom prevalence, 16.8% of respondents reported having at least one COVID-19-related symptom and 7.1% reported having at least one of the most severe symptoms (fever, dry cough and difficulty breathing). The answers to the survey also point out to a lack of tests, with 6.1% of participants reporting that their doctors recommended they get tested, but no tests were available. From the symptoms and social contact behavior, we built a regression model to infer COVID-19 prevalence in Spain and report prevalence figures that are near or within the margin of error of a recent seroprevalence study carried out by the Spanish Ministry of Health. Moreover, a large portion of respondents who had tested positive (80.9%) reported having had close contact with an infected individual (e.g. friend or relative, patient, colleague, or client). Given such a large sample, the C.I. for a 95% confidence level is of ±0.843 for all reported proportions.

Conclusions:

The Spanish population has shown high levels of compliance with confinement measures and resilience during the confinement period. In fact, at the time when the survey was deployed, most of the population demanded more measures. Close contacts play an important role in the transmission of the disease, particularly during confinement. The economic impact of the pandemic is evident in small companies. Gender and age matter regarding the social contact behavior, the economic and labor impact, and the ability to self-isolate. Quarantine infrastructure might be needed as over one quarter of the population reports lacking the necessary means to isolate themselves. The number of COVID-19 infected individuals is larger than the officially reported figures and can be estimated from the answers to our survey. During the early period of the pandemic, our survey also reveals a lack of tests and a significant difference (P<.001) in attitudes towards testing availability between those with symptoms vs those without.