Covid-19 control training required for all med students: Jaffna Teaching Hospital study

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Students show reliance on social media as source of information, researchers note

By Ruwan Laknath Jayakody Since accurate information is a major and vital requirement in the early phases of a public health emergency, rather than reliance on social media it is important to ensure that medical students are guided to appropriate sources to obtain information and be given adequate training to reduce gaps in knowledge. This observation was made in a research article on “A cross-sectional survey of the knowledge and practices toward Covid-19 among medical students in Northern Sri Lanka” which was authored by A. Paramanantham and M. Luxman (attached to the Jaffna Teaching Hospital’s Accident and Emergency Department), N. Suganthan (attached to the same Hospital’s Jaffna University Medical Unit), and N. Rajeshkannan (attached to the Civic Park Medical Centre of New South Wales, Australia) and published in the Sri Lanka Journal of Infectious Diseases 11 (2) in October 2021. Covid-19 is a respiratory illness caused by a novel Coronavirus, namely the Severe Acute Respiratory Syndrome related Coronavirus Two (SARS-Cov-2). The World Health Organisation (WHO) declared this outbreak as a public health emergency of international concern on 30 January 2020 and a pandemic on 11 March 2020. In Sri Lanka, the first imported case of Covid-19 was identified on 27 January 2020 and on 10 March 2020, a Sri Lankan national was confirmed with Covid-19 for the first time. The dominant mode of transmission of this virus is through respiratory droplets and an infected person can spread the virus while coughing, sneezing, or talking. The incubation period of Covid-19 is two to 14 days, with 80% of the infected persons developing mild or no symptoms. The main symptoms are cough, fever, shortness of breath, tiredness, body ache, loss of taste and smell, and loose bowel movements. More adversely, infection leads to respiratory failure, sepsis, and kidney failure (per P.H. Tsai, W.Y. Lai, Y.Y. Lin, Y.H. Luo, Y.T. Lin, H.K. Chen, Y.M. Chen, Y.C. Lai, L.C. Kuo, S.D. Chen, K.J. Chang, C.H. Liu, S.C. Chang, F.D. Wang, and Y.P. Yang’s “Clinical manifestation and Disease progression in the Covid-19 infection”, and the Centes for Disease Control and Research [CDC]). There is no proven antiviral treatment. However, since December 2020, newly developed vaccines were introduced and Sri Lanka too started to provide the same to the population. Since assessing the knowledge and practices among various subgroups, including medical students, regarding Covid-19, is needed, Paramanantham et al. conducted a descriptive, cross-sectional study amongst undergraduate medical students at the Jaffna University from August to September 2020. The stratified random sampling method was used to select 431 students from all six batches at the Medical Faculty. A self administered questionnaire was used for data collection. Questions covered the assessment of knowledge (16 questions) and practices regarding the Covid-19 pandemic (20 questions). The knowledge-related questions included those on virology and transmission (Covid-19 is caused by the novel Coronavirus named SARS-Cov-2; the incubation period for the disease is two to 14 days; Covid-19 spreads via respiratory droplets of infected persons; eating or contact with animals would not result in contracting Covid-19; and asymptomatic carriers will not transmit the disease), the clinical features (the main clinical symptoms are fever, fatigue, dry cough, and myalgia [pain in a muscle or a group of muscles]; the majority develop only mild symptoms; and severe disease is mainly detected in patients who are elderly, having chronic illnesses or are obese), and treatment and prevention (there is currently no effective antiviral treatment; wearing a facemask helps to prevent infection transmission; effective hand washing practices prevent the spread of the infection; and social distancing prevents transmission). The knowledge level was compared between the students according to the different stages in their career (pre-clinical [students of the first two years who are not required to attend teaching hospitals, and only follow basic subjects such as anatomy, physiology, and biochemistry], para-clinical [those who do their clinical clerkship in hospitals in the morning, have community-based field visits, and follow para-clinical subjects such as pathology, microbiology, parasitology, and community medicine], and clinical [those who spend majority of the time in wards and clinics and have direct contact with patients]). Correct knowledge meant being correct more than 80% of the time. On adherence to selected practices to prevent the spread of Covid-19, correct practices included key practices (such as wearing a facemask and always maintaining the recommended social distance), hand hygiene (washing hands regularly with soap and water and using disinfectants such as hand sanitisers with an alcohol content of 60% or above), cough etiquette and respiratory hygiene (covering the cough and sneeze with a tissue, handkerchief, or into the elbow), isolation (avoiding contact with persons under self-isolation), wearing appropriate personal protective equipment when examining a suspected or confirmed case and staying at home as much as possible, especially when sick. Other practices included the frequent cleaning and disinfection of high touch surfaces such as the phone screen, door knobs, desks, switches, elevator buttons, and other belongings, avoiding public gatherings, eating outside, shaking hands, and using public transport when possible, and keeping a helpline number to contact if one suspects oneself or someone one knows of having symptoms. In terms of their background, the majority of the students were female (54.6%) and belonged to the Hindu religion (52%). There were 76 (17.6%) students in their first year of training and 15.1% in the final year. The majority (64.5%) had not attended any lectures or discussions on the Covid-19 pandemic and only 37.1% had received any kind of infection control training. In terms of their knowledge, the majority (81.4%) answered more than 80% of the questions correctly. The median (value at the midpoint of a distribution of values) number for correctly answered questions to assess knowledge was 14 (87.5%), out of the 16 questions. The majority (67.5%) correctly identified the name of the virus causing Covid-19 and the majority (62.2%) stated that the infection can be transmitted by eating or through contact with animals. This proportion was however less among para-clinical students (51.5%) when compared to pre-clinical students (71%), but increased again in the clinical years (66.9%). In terms of the source of information, all four main sources – news media, social media, health professionals, and health organisations such as the Medical Officer of Health (MOH) and Regional Director of Health Services offices and family and friends were used by 120 students (27.8%); with the most popular source being social media (86.3%), followed by the news media (63.8%), family and friends (54.5%), and Government health organisations websites and relevant scientific articles (52.2%). In terms of the assessment of the 20 preventive practices, the majority (85.4%) adhered to more than 80% of the correct practices (a high figure) with 97% wearing facemasks, 96.1% washing hands regularly with soap and water, 92.6% following respiratory etiquette practice, 94.8% staying at home when sick, and 94.4% social distancing. This study showed that the majority of medical students had adequate knowledge about and followed correct practices concerning the Covid-19 pandemic. However, even after vaccination, continued adherence to correct practices is essential to prevent the spread of Covid-19 and therefore, the assessment of knowledge, attitude, and practices among the public and healthcare personnel is vital to improve pandemic control. The involvement of medical students in patient care and clinical activities causes a significant risk of disease transmission among them and therefore clinical students who have direct contact with patients should have adequate knowledge to educate them. However, Paramanantham et al. found that only 37.5% had attended Covid-19 education programmes while only 37.1% had had infection control training even though infection prevention control guidelines are a part of their curriculum during the para-clinical years (two-thirds had therefore not attended any Covid-19-related training). Over 80% responded correctly to the questions on the mode of transmission and incubation period. Only 67.5% knew the name of the virus. Knowledge on clinical features, treatment, and prevention was higher at 70-95%. The current study showed that 96.1% of medical students avoided public gatherings to reduce the risk of infection. When comparing medical students at different stages of their training, more clinical students (96%) answered correctly for the availability of antiviral treatment compared to pre-clinical (87.5%) or para-clinical students (95.5%). However, with regard to hand washing and wearing facemasks, more pre-clinical students answered correctly compared to para-clinical and clinical students. Student responses towards correct practices were also very positive, with the majority practicing appropriate measures to prevent the spread of the infection. The majority (86.3%) had used social media as their main source of information on the pandemic. Even though the majority reported overall positive knowledge, 273 students (62.2%) responded that those who eat, or have contact with animals can contract the Covid-19 infection. The proportion who believed this and was thus confused was significantly higher among the pre-clinical students (71%), compared with para-clinical students (51.5%), and clinical students (66.9%). Paramanantham et al. explained that this confusion could be due to confusing messages in social media. Social media users who post messages have a responsibility to communicate correct facts while national or country-level regulators and owners of social media platforms should ensure the accuracy of such posts, they noted. As explained by S.F. Tsao, H. Chen, T. Tisseverasinghe, Y. Yang, L. Li, and Z.A. Butt in “What social media told us in the time of Covid-19: A scoping review”, it is also crucial that government responses use social media platforms to counteract inaccurate information and to spread accurate and reliable facts. Paramanantham et al. elaborated that such beliefs and gaps in knowledge can be rectified through organised training or lectures regarding Covid-19, in addition to infection control training in the early stages of a pandemic. In conclusion, Paramanantham et al. urged that further studies on the assessment of students’ attitudes and practices, in particular concerning practices such as avoiding public transport, should be assessed.