In early December 2019, a cluster of pneumonia-like cases were reported in Wuhan City of Hubei Province in central China [1]. Shortly after the onset of the epidemic, the disease was officially named as the Coronavirus Disease 2019 (COVID-19) by the World Health Organization (WHO) on February 11, 2020 and the severe acute respiratory syndrome coronavirus (SARS-CoV-2) was identified as the cause of the infection. On March 11, 2020, WHO declared COVID-19 a pandemic, pointing to the sustained risk of further global spread (https://www.who.int/news-room/detail/27-04-2020-who-timeline%2D%2D-covid-19).
Confronted with such a novel, highly contagious, and rapidly spreading virus, a need for compulsory isolation treatments and fears of cross-infection among a larger community and population prompted the Chinese government to lock down Wuhan City on January 23, 2020. It was the first time in Chinese history that a city with a population of more than 10 million was completely shut down. Many other cities in Hubei province as well as other provinces in China quickly followed and declared the first (and highest) level of public health response to the outbreak with a complete “lockdown” and nationwide travel bans, restricting all voluntary human movement to and from the cities by any means of public or private transportation. With the further outbreak of the infection, many cities in China have implemented similar controls on population movements by limiting voluntary traveling, public gathering and all entertainment and sports programs, and by delaying the normally scheduled reopening of all schools and factories after the traditional Chinese New Year holidays (which were initially scheduled to end on February 7, 2020). Many communities and neighborhoods also implemented “home-quarantines” where residents were typically permitted to leave their homes once or twice per week to purchase groceries or other essential items for living. Only those residents with valid identification, proof of residence, proof of being symptom-free, and an authorized pass were allowed to leave or enter their communities, neighborhoods, or villages. It was estimated that more than 150 million people were quarantined in China from late January through the middle of February 2020 [2]. In many regions of China, these mandatory measures have continued into the middle of March 2020. Both rapid spread of the virus and the accompanying drastic measures (e.g., nationwide lockdown) have resulted in multiple stressors such as the perceived severity of the infection and high infectability of the virus, interruption to their normal routine because of the lockdown, infection or suspected infection among family members or friends, family conflicts during the lockdown/quarantine, and many erroneous, inconsistent, unverified, and often conflicting news and messages (“information uncertainty”) during the outbreak [3, 4].
The unpredictable future of this pandemic has been exacerbated by information uncertainty, often driven by inconsistent, unverified, and sometimes conflicting news and messages from various governmental sources, social media outlets, and the Internet throughout China and abroad [5, 6]. Despite various measures taken by governmental and media sources to ease the concerns of communities, the lingering long-term outbreak, limited knowledge about this novel virus among both scientists and medical professionals, the inaccuracy of the information (e.g., origins of the virus, effectiveness of various control measures, number of people infected, the incubation period, and the mortality rate), the uncertainty about the pathogen and the transmission routes, are all contributing to intense stress among people living in China.
A vital aspect of crisis management and public health emergency response is the communication of timely and accurate information to the public, aimed to improve understanding of risks and to inform decision making [7]. Use of a primary source of information for the public during a disease outbreak can have great influence on perceptions of risk and people’s behaviors [8]. The information communicated can also influence perceptions of information certainty, self-efficacy, and intentions to follow guidelines from authoritative organizations [9]. Distrust of the messenger(s) or the sources of the information can affect people’s adoption of recommended behaviors especially if there exists uncertainty about the outbreak. As learned from other outbreak situations, clear, accurate, and timely communication to the public before and during an outbreak and clear inter-organization communication are critical [10]. While complete details about a public health crisis may not be known or available at the start of an outbreak, regular and cohesive communication from trusted leaders and organizations indicating that information is forthcoming is crucial. This is especially the case given the growing number of information outlets available to us, the potential for dissemination of misinformation by noncredible sources, and the rapid pace of messaging released to the public as experts gain a greater understanding about the outbreak [6]. This overload of quickly changing information, sometimes with questionable content and sources can be a contributor to the confusion, fear, and stress among the general population.
The rapid outbreak and spread of COVID-19 have affected many lives, created immense burden to healthcare systems, and resulted in huge economic losses on a global scale. Given the extent of questionable information that has emerged during this short period of time, we had a unique opportunity to examine the effects of information uncertainty on people’s psychological wellbeing during an outbreak. Therefore, we designed the current study to answer the following research questions: 1) Is information uncertainty prevalent during the outbreak? 2) Is information uncertainty a source of stress? 3) Is information uncertainty associated with acute stress disorder over and above other possible psychological stressors during the outbreak?