Healthcare workers' and students' knowledge regarding the transmission, epidemiology and symptoms of COVID-19 in 41 cities of Bolivia and Colombia.

Dear Editor

Latin America has recently witnessed unprecedented challenges with emerging viral diseases, such as Chikungunya and Zika, and now the Coronavirus Disease 2019 (COVID-19) [[1], [2], [3]]. This situation brings complex epidemiological scenarios. In view of the challenge, it is important to assess the knowledge amongst healthcare students and workers about the epidemiology, symptoms and transmission of COVID-19 in cities of Bolivia and Colombia [4,5]. Particularly because no information about SARS-CoV-2, SARS or MERS, was available in national or local settings before 2020.

An observational cross-sectional study was performed among assistants who attended symposia on SARS-CoV-2/COVID-19 in February 2020, simultaneously in 41 cities of Bolivia and Colombia, before the arrival of SARS-CoV-2/COVID-19. The symposia, held in hospitals, universities and virtually (online), were organized by the Committee of Tropical Medicine, Zoonoses, and Travel Medicine, of the Colombian Association of Infectious Diseases (ACIN), the Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19), and the Ministry of Health of Bolivia.

Attendees who agreed to be part (convenience sample), filled out a written paper questionnaire (on site, before lockdowns; and online, thereafter) about basic knowledge on the epidemiology, symptoms and prevention of disease (five questions), before and after the meeting.

A total of 1165 questionnaires were completed (661 in Colombia and 504 in Bolivia). The mean age of participants was 33.5 year-old (±11.5; range 18–75, 61.9% female), 26.2% were medical students, 22.3% physicians, 16.7% nurses, 0.9% nursing students. Comparisons were made using the statistical chi-squared test, p significant <0.05 (Table 1 ).

Table 1

Results of questions about knowledge about transmission, epidemiology and symptoms of COVID-19 in 41 cities of Bolivia and Colombia.

	Countries
	Bolivia					Colombia					Countries comparison
	Pre training		Post training			Pre training		Post training			Pre	Post
	n	%	n	%	p	N	%	n	%	p	p	p
1. Coronavirus SARS-CoV-2 is transmitted mainly by? (answer: respiratory transmission)
Correct	247	92.5	227	95.8	0.09	138	87.9	474	94.0	0.01	0.08	0.214
Incorrect	20	7.5	10	4.2		19	12.1	30	6.0
Total	267	100.0	237	100.0		157	100.0	504	100.0
2. Regard symptoms, most patients present with? (answer: fever and cough)
Correct	260	97.4	231	97.5	0.588	146	93.0	495	98.2	0.002	0.0298	0.338
Incorrect	7	2.6	6	2.5		11	7.0	9	1.8
Total	267	100.0	237	100.0		157	100.0	504	100.0
3. Usual incubation period is? (answer: 7–14 days)
Correct	188	70.4	160	67.5	0.272	102	65.0	363	72.0	0.057	0.145	0.121
Incorrect	79	29.6	77	32.5		55	35.0	141	28.0
Total	267	100.0	237	100.0		157	100.0	504	100.0
4. The geographical origin of this pandemic is? (answer: China)
Correct	260	97.4	232	97.9	0.469	155	98.7	485	96.2	0.09	0.289	0.167
Incorrect	7	2.6	5	2.1		2	1.3	19	3.8
Total	267	100.0	237	100.0		157	100.0	504	100.0
5. In order to prevent disease spread in communities, is necessary to (answer: to washhandswith water and soap and use internal angle of elbow to sneeze or cough)
Correct	251	94.0	223	94.1	0.561	141	89.8	479	95.0	0.0178	0.084	0.353
Incorrect	16	6.0	14	5.9		16	10.2	25	5.0
Total	267	100.0	237	100.0		157	100.0	504	100.0

Knowledge about symptoms was significantly higher prior to the intervention in Bolivia (97.4%), but also high in Colombia (93.0%) (Table 1). In Bolivia, although in general terms, there was improvement in knowledge on all aspects, there were no significant differences comparing before and after. In Colombia, there was a significant increase in knowledge on transmission, symptoms, and prevention (Table 1).

Despite its limitations, this is the first study to measure the level of knowledge on transmission, epidemiology and symptoms of COVID-19 in Latin America. The disease arrived on February 25, 2020, after multiple trainings were held, there were no officially confirmed cases of COVID-19 in Bolivia nor Colombia, where this disease arrived on March 2 and 6, respectively [3,6]. Currently in these countries, up to April 28, 2020, there are 1053 and 5949 cases, respectively.

This course would have impacted on clinical and epidemiological suspicion, important for preparedness before the arrival of COVID-19 to these regions, in order to achieve a timely diagnosis and optimal disease management in endemic regions, but also for travelers returning from these areas. Other training in different knowledge areas, such as biosafety and biosecurity of healthcare workers and students, should be promoted in the current context of the pandemics in these countries in Latin America. Also, such training should be extended to other countries, especially those significantly affected by the SARS-CoV-2/COVID-19. Although there is no “standard” online course for COVID-19 targeted for healthcare workers from LANCOVID-19, we consider the videoconferences and related tools available in our web, www.lancovid.org, to be very useful for this target group.

Finally, in this period of pandemic, and physical distancing, e-learning is essential to educate in emerging diseases in a massive way, eliminating borders and reducing the time between the generation of knowledge and its application in clinical practice, even more so in low-income regions where the impact of the disease can be devastating. Now, the trainings continue using Google Hangouts®, Zoom®, Facebook Live® and Microsoft Teams®, among other.

Funding

None.

Declaration of competing interest

None of the authors report conflict of interests.