Since the declaration of the first case on February 21st,2020, a great public health concern emerged in Lebanese public and governmental institutions. Until this date, no definitive treatment was recommended, and physicians are expected to play an important role in the detection and management of cases of COVID-19. In addition, they are carrying the burden to prevent further spreading of the disease. Thus, lack of their knowledge regarding transmission and clinical manifestations of the disease as well as inadequate preventive practices could lead to misdiagnosis of the case and increase the risk of infection.
This study was conducted during the early stage of the COVID-19 outbreak in Lebanon to provide insight into the knowledge and practices of physicians. Results of our survey revealed that the majority of Lebanese physicians had good knowledge about the disease while only half of the respondents adopted good preventive practices. Our results also showed that frontline physicians who had been practicing medicine for more than 10 years, and with a good level of knowledge had good practice compared to their counterparts.
Our finding of a good level of knowledge among physicians is in line with that of Minghe Zhou et al., who reported that 89.7% of HCWs have sufficient knowledge regarding COVID-19 with doctors showing higher scores compared to nurses and paramedics [15]. When looking at the dimensions of knowledge, we found that most participants were aware of the nature of the disease (93.5%) and its treatment (75.6%). However, a poor level of knowledge was clearly shown in response to the questions regarding the transmission of the disease (31.5%), similarly for the actions when dealing with COVID-19 cases (37.3%) and precautionary measures by health care providers (42.2%). Consistent with our findings, Akshaya Srikanth Bhagavathula et al., [16] reported a poor level of knowledge among HCWs concerning the transmission of the disease (39%). This could be attributed to the scientific dilemma proposed by the experts regarding this topic. Logistic regression analysis showed that the age of the participants was the only significant predictor of good knowledge. This comes inconsistency with the study conducted in Pakistan to evaluate knowledge, attitude, practice, and perceived barriers among HCWs regarding COVID-19 by Saqlain et al. [17].
We also found that physicians used official international and governmental websites such as WHO (85.0%), MOPH (70.5%), CDC (41.0%), and (IDSA) (31%) as main sources of information about COVID-19. This indicates that physicians utilize reliable sources to acquire information regarding COVID-19 and reflect their good level of knowledge. It is also worth mentioning that some physicians used TV (18.4%) and Facebook (16.3%) as sources of information. Although these platforms provide an easy way to get the information, they can also be a source of fake news. Thus, it is highly recommended for physicians to seek information from scientific and authentic platforms.
Concerning practice, approximately half of the respondents (49.7%) followed infection control practices. These include regular hand hygiene (97%), wearing a face mask (89%), and gloves (65%). Only half of our participants can maintain a social distancing of at least 1.5 m from colleagues (55%). This could be to overcrowding or small surfaces in health care settings. In addition, only 77.5 and 61.8% of the physicians were aware of the proper donning and doffing PPE. A recent study conducted in Pakistan showed that 91.4% of physicians had good practices in following precautions to avoid COVID-19 [18].
Limited resources in the institution, the lack of experience, the poor level of knowledge regarding mode of transmission of the disease, actions are taken when dealing with cases and precautionary measures could partly explain the poor preventive practices of physicians. The Lebanese order of physicians (LOP), the syndicate of hospitals, and the scientific societies have conducted many online training sessions for HCWs mainly physicians. In addition, several protocols and memo regarding SARS-Cov-2 were issued. Despite all of this, a significant number of HCWs have been infected due to misdiagnosis of the cases and inadequate preventive practices. Thus, continued professional education and training are advised to empower physicians by supporting their ability to acquire and use evidence-based information. This imposes an action plan from LOP and syndicate of hospitals to enhance the actions and preventive measures that should be implemented when confronting a novel virus.
Similar to the findings of Zhang et al., [15], results of our survey showed that frontline physicians who had been practicing medicine for more than 10 years had better practice compared to their counterparts. This indicates that frontline physicians’ with more than 10 years of experience had skills to deal with public health emergencies and are confident in their ability to defeat the virus. A finding of considerable concern in this survey is that more than 30% of the respondents expressed their fear towards treating a patient with COVID-19 which in turn was associated with poor practice. Indeed, SARS-COV-2 is highly contagious which could explain the reluctance of physicians to treat patients with COVID-19. Thus, psychological interventions to improve physicians’ mental health and to enhance confidence in their ability to treat patients are needed. With a deeper understanding of COVID-19, we believe that physicians’ fear will decrease and the number of physicians who are willing to treat these patients would gradually increase.
Interestingly, the majority of participants (80.3%) declared that the policies/actions implemented by the MOPH are adequate. The Lebanese governments have set early lockdown measures such as the closure of all educational institutions, international airport, and its sea borders in addition to the nighttime curfew. All these measures have contributed, till the time of the writing, to the success in slowing the pace of COVID-19 progression. However, only 63.9% revealed that the policies/actions implemented by their health care facilities were adequate in fighting COVID-19. This could be due to the poor infection control practices implemented in the health care facilities and the shortage of available PPE for all HCWs. Thus, increasing the preparedness of all health care facilities is vital to increase the confidence of physicians so to improve their work.
The findings of the present study should be considered in light of several limitations. Firstly, no validated tool for the assessment of the knowledge and practices of HCWs was available. We have adapted and modified tools used for the assessment of knowledge, attitude, and practice toward MERS-COV [9,10,11,12] in addition some items were formulated from WHO and CDC guidelines. Secondly, due to the lockdown, we did not design the sample to statistically represent the Lebanese population of physicians and make rigid extrapolations, but to offer for the first time, useful insights of the knowledge and practices towards COVID-19. Thirdly, only physicians who publicly shared their phone numbers were eligible to participate; this could have led to selection bias. Therefore, assessment of knowledge and practices of a significant proportion of physicians and their opinions might be missed in this analysis. Fourth, some participants might have provided socially desirable responses rather than their actual opinions.