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Introduction

19^th and 20^th centuries have witnessed quite a few pandemics, from the cholera pandemic of 1910-1911 to H1N1 in 2009 to present day coronavirus 2019 (COVID-19). Millions of people have succumbed to these diseases [1]. Just over a decade after handling the H1N1-2009, the world is now facing the challenge of a newly emerged corona virus strain i.e. nCoV-19 [2].

Within 3 months after the initial outbreak in Wuhan province, China, the virus had spread rapidly to various countries. In view of this, the World Health Organization (WHO) declared the outbreak a pandemic [3].

COVID-19 and its pandemic nature caused widespread concern, fear, and anxiety among all the individuals [4]. The risk of getting infected increased fear among the general public [5]. Constant exposure to the news about fatalities or infection rate of the pandemic further exacerbated fear, anxiety, and depression too [6]. Uninfected people are afraid of contacting the virus from COVID-19 infected individuals. Fear can lead to stigma, and social exclusion of confirmed patients, survivors, their families, and health care providers. This may increase the risk of depression and adjustment disorder [7].

Lin et al. [5] observed that fear of COVID-19 lead to irrational and unclear thoughts and correlated positively with depression, anxiety, stress and negatively with life satisfaction.

On 30th January 2020 the first corona virus case was confirmed in India. India imposed a nation-wide lockdown from 24th March to 29th May 2020 which restricted public movement for all activities except for essential services [8]. As a result, the country had come to a pause. Many were struck at places far off and many had lost their livelihood. High infectivity and relatively deadly nature of the corona virus along with unexpected measures taken by the government for its containment posed high risks to the psychological wellbeing.

Current management of COVID-19 focusses on infection control, development of a vaccine and treatment of the patients [1, 9]. There is little emphasis on the psychosocial aspects [1, 10-12]. The aim of the current study is to assess the prevalence of fear of COVID -19 and variables associated with it.

At the time of initiation of the study, i.e. on 24th April 2020, India had recorded 23,452 cases and 723 deaths with a mortality rate of 3.1% [13].

Subjects and methods

The current study was an online, cross- sectional study conducted across general population. Institutional ethics committee approval was obtained for the study. A survey form comprising a semi-structured questionnaire on the socio-demographic data, COVID-19 specific variables, ways of coping with the situation and fear of COVID-19 scale was created using Google forms, and was shared via various social networking platforms. Participants included population belonging to various sections of the society.

Participation was voluntary. An informed consent was taken from the participants. The responses were recorded online. All the participants who completed the survey from 24th April 2020 to 7th May 2020 were included in the study and only the incomplete responses were excluded. Population was described using descriptive statistics. Chi-square test was used for the assessment of categorical data. Student t-test was used for the evaluation of continuous data. SPSS version 26 was used for statistical analysis.

Tools

The Fear of COVID-19 Scale developed [14] is a seven item scale. The participants score their responses on a five-item Likert type scale from “strongly disagree,” “disagree,” “neither agree nor disagree,” “agree,” to “strongly agree”. The scores range from 1-5. A total score is calculated by adding up each item score. Score ranges from 7 to 35. Higher scores indicated a greater fear of COVID-19.

It has an internal consistency (α = 0.82) and test–retest reliability (ICC = 0.72). It has concurrent validity with the perceived vulnerability to disease scale (with perceived infectability, r = 0.483 and germ aversion, r = 0.459) and the hospital anxiety and depression scale (with depression, r = 0.425 and anxiety, r = 0.511) [4].

Results

A total of 1090 members participated in the study. Among them, 88 members gave incomplete responses and hence were excluded from the data analysis. A total of 1002 members were included in the data analysis. The mean age of population was 32.29 and SD 14.17 (student t-test) with an age range of 12 to 84 years. Of the total population, 54.1% were males and 45.9% were females. 88.9% were staying with family. 60% of the population was from metros. 16% of the population had comorbidities and 6.5% were tested for COVID-19 (Tables 1 & 2).

Table 1: Socio-demographic profile of the population.

Table 2: COVID-19 specific variables.

17% were working from home, 39% of the population spent time with their families, 5.6% pursued their hobbies during lockdown. 53.4% were unhappy with the progression of the situation (Table 3).

Table 3: Coping with COVID-19 lockdown.

33.4% were very afraid of coronavirus. 31.7 % were uncomfortable to think of corona virus, 14.7% had fear of losing their life to corona virus. 18.4% were anxious about the news on corona (emotional fear reaction). 3.8% had disturbed sleep, 10% had clammy hands and 7.2% had palpitations (symptomatic expression of fear) (Table 4).

Table 4: Population responses on each item of fear of COVID-19 scale (score 1-5).

Higher scores on fear of COVID 19 scale indicate higher fear. The total score was summed. Based on the mean Likert scale classification [15] the population was divided into 4 groups as No fear (8-14), Mild fear (15-21), Moderate fear (22-28) and Severe fear (29-35).

We further categorized no and mild fear as Group 1. Moderate and severe fear were categorized as Group 2. Accordingly, 151(15.06%) subjects had higher levels of fear and 851(84.94%) had low levels of fear. The two groups were compared with respect to various variables and the data is presented as under (Tables 5-7).

Table 5 compares the socio-demographic data of the two groups. A comparison was done between the variables of the two groups using Chi-square test and there was a statistically significant difference between the two groups in variables like education, income and stay.

Table 5: Comparison of two groups -Socio- demographic variables.  

Note: Statistical test used Chi square test α =0.05; X2 Degree of freedom.

Table 6 compares the COVID-19 specific parameters of the two groups. A comparison was done between the variables of the two groups using Chi-square test and there was a statistically significant difference between the two groups in people who were tested for COVID-19.

Table 6: Comparison of two groups - COVID19 specific parameters.  

Note: Statistical test used chi square test α 0.05

Table 7 compares the coping of the two groups to COVID 19 lockdown. A comparison was done between the variables of the two groups using Chi-square test and there was a statistically significant difference between the two groups in all the variables except hoarding of food, medicines and essentials.

Table 7: Comparison of two groups– Coping with COVID-19 lockdown. 

 Note: Statistical test- chi square test

Discussion

The current study is a comprehensive study on the prevalence of fear of corona virus in the population and its associated factors. 1002 subjects participated in the study. 15.06% reported higher levels of fear and 84.94% had low levels of fear. 14.7% are fearful of losing their life to corona virus which was quite high.

15% of the total population scored high on fear of COVID-19 scale indicating anxiety and depression in the population [4]. This focusses the need for targeted assessment and management of mental health issues at a population level.

In a study done by Reznik et al., mean scores observed in Russia were 17.4 with a SD of 4.7 and in Belarus were 16.6 with a SD of 4.5 [16]. A study done by Doshi et al., in Indian population using Fear of COVID-19 scale observed that the study population had an overall mean score of 18.00 with a SD of 5.68 [17]. Mean score on fear of COVID-19 scale in this study was 14.93 with SD of 6.27, indicating lower levels of fear among the study population.

Primary and secondary schooled individuals had more fear than those with higher education. This could be due to better access to credential information for the more educated sections of the society and thus not falling prey to the various myths circulated in social network and media.

Fear in low income group (Income <20000) and in persons with perceived financial burden may be attributed to the financial troubles caused by COVID-19 or lockdown. However, this is in contrast to a study done by Gaur et al. [18], in Indian population which showed no significant difference in the fear among different income groups.

Staying with family protected from fear. Family offers support system and is protective from a variety of psychological impacts which was evident from the current study. During the study period, those who stayed alone had more fear as they had a poor support system. Strong possibilities of being stranded at a place away from home town, lack of facilities for transportation and food might have contributed to heightened fear (Table 5).

People who underwent testing for COVID-19 had more fear. The status of their report was not included in the study. Waiting period during report and a positive report both contributed to the fear (Table 6).

Study done by Gaur et al. [18] also observed that approximately, 42% of respondents were nervous after watching news/social media posts about COVID 19. Our study also observed that people with higher levels of fear watched corona news most of the times, forwarded messages related to COVID-19 always even without checking the source and credibility of information. This could also lead to increasing panic among others.

They were satisfied with the current scenario as the lockdown was strictly being followed. This reflected the pro-activeness of the study population in putting up efforts for pandemic control (Table 7).

No significance was seen with respect to gender, urban- rural residence, occupation, comorbidities and quarantine status. Gender had no effect on fear in the current study. But studies from Eastern Europe [16] and Israel [6] showed that females had more fear than males. In Israeli population people with comorbidities had more fear than those without comorbidities.

Mental well-being plays an important role in coping with unprecedented times like the COVID-19 pandemic. Even though there are several factors that pose problems in the COVID-19 pandemic, fear and some of its causative factors were explored in this study. Identifying factors that lead to fear of COVID-19 and preventing them could help in better coping with the pandemic. Further studies are needed for a better understanding on the pattern of fear and its consequences on mental and physical health.

Conclusions

Fear of COVID-19 pandemic is universally present in the study population, with a high fear of losing their life. Fear was due to concerns regarding health, social and economic crises. False reports on social media, television media and print media play a crucial role in spreading the fear associated with pandemic. Access to credential information regarding the COVID-19 pandemic helps in reducing the fear of pandemic. Support system is highly helpful in reducing the fear associated with pandemic.

Limitations

Cross sectional study design. Online study design - so people who use smart phones and had access to internet facility only were included in the study. People with previous mental illnesses were not excluded. Various phases of corona and lockdown will have various reactions from the people. So these may not be generalized to the pandemic as such but to the time frame of data collection. Sample contained data only from the Indian population. Global information about COVID-19 is varied, and hence, while interpreting and extrapolating the study results on fear and its impact, caution should be exercised.

Future directions

Studies focused on neuropsychiatric aspects of COVID-19 and long-term mental health consequences of COVID-19 will throw further insights.

Conflicts of interest

Authors declare no conflicts of interest.