Economic and social impacts of COVID-19 and public health measures: results from an anonymous online survey in Thailand, Malaysia, the UK, Italy and Slovenia

Objectives To understand the impact of COVID-19 and public health measures on different social groups, we conducted a mixed-methods study in five countries (‘SEBCOV—social, ethical and behavioural aspects of COVID-19’). Here, we report the results of the online survey. Study design and statistical analysis Overall, 5058 respondents from Thailand, Malaysia, the UK, Italy and Slovenia completed the self-administered survey between May and June 2020. Poststratification weighting was applied, and associations between categorical variables assessed. Frequency counts and percentages were used to summarise categorical data. Associations between categorical variables were assessed using Pearson’s χ2 test. Data were analysed in Stata 15.0 Results Among the five countries, Thai respondents reported having been most, and Slovenian respondents least, affected economically. The following factors were associated with greater negative economic impacts: being 18–24 years or 65 years or older; lower education levels; larger households; having children under 18 in the household and and having flexible/no income. Regarding social impact, respondents expressed most concern about their social life, physical health, mental health and well-being. There were large differences between countries in terms of voluntary behavioural change, and in compliance and agreement with COVID-19 restrictions. Overall, self-reported compliance was higher among respondents who self-reported a high understanding of COVID-19. UK respondents felt able to cope the longest and Thai respondents the shortest with only going out for essential needs or work. Many respondents reported seeing news perceived to be fake, the proportion varying between countries, with education level and self-reported levels of understanding of COVID-19. Conclusions Our data showed that COVID-19 and public health measures have uneven economic and social impacts on people from different countries and social groups. Understanding the factors associated with these impacts can help to inform future public health interventions and mitigate their negative consequences. Trial registration number TCTR20200401002.

I find the paper to be well written, organised and easy to read. In addition, although mainly descriptive and with a restrictive sample, it contains relevant information for the general public and policy implications.
I do have some minor comments/changes: -Either use % or "percent" when describing percentages through the paper; -Concepts as "least severe economic impacts" are not clear. What is considered severe? This concept may change according to the country.
-18-34 age group is a bit large to study labour market consequences is a bit wide, depending on the country. I would imagine that the percentage of young adults (with 18) working is much higher in Thailand then in the UK. This takes me to another point with is, people from the same age group in such different countries will probably have different percentages (maybe add to the limitations).
-Using the benchmark "households with 6 or more members", as shown in your tables, gives much more information on Thailand than on Italy. Even though you use weights, I would recommend to lower the threshold and see if there is more balance between countries for this variable.
-When you use the variable "Level of understanding" based on self-reported measures this is extremely biased by culture, age, context, income level, education (as you know). I believe in your limitations you should talk about this variable in particular since it has a lot of focus in your analysis. For the future, I would suggest to complement this question with some objective measures of understanding (maybe ask about how the virus spreads with multiple choice). Otherwise, this variable maybe an indicator of self confidence rather then understanding of the virus. (maybe add some references arguing for the accuracy of this question? if it exists) -Finally, I would welcome more context on the information channels of each country. This said, in section "Information about COVID-19, unclear information and fake news" I would appreciate some more information about how each country communicates, how much information does the population really has, is the media controlled by the government in some countries, how frequent? does every country has daily reports? This is important to interpret the results, including levels of compliance and confidence in the government.
Thank you, Sara Valente de Almeida

GENERAL COMMENTS
The reviewer also provided a marked copy with additional comments. Please contact the publisher for full details.

Response to reviewers
We would like to thank the reviewers for taking the time to read our manuscript, and for their constructive comments, which have helped to improve the manuscript. Please find our responses below.
Responses to Reviewer 1 1) Either use % or "percent" when describing percentages through the paper; We have revised the text and now use % consistently throughout the text.
2) Concepts as "least severe economic impacts" are not clear. What is considered severe? This concept may change according to the country.
We agree with this point. We used these phrases e.g. to express that fewer Slovenian respondents reported loss of job/loss of earnings compared to the overall cohort and the other countries. We have changed the manuscript to rephrase statements like "least severe impacts" or "worse economic impacts" (please see tracked changes).
3) 18-34 age group is a bit large to study labour market consequences is a bit wide, depending on the country. I would imagine that the percentage of young adults (with 18) working is much higher in Thailand then in the UK. This takes me to another point with is, people from the same age group in such different countries will probably have different percentages (maybe add to the limitations).
This is a fair point. We have re-analysed our data, breaking down the age group 18-34 years into 18-24 (final school years/University/junior professionals) and 25-34 (early career professionals). In our survey, we collected data on age in year groups (18-24, 25-34 etc), instead of individual ages, and therefore unfortunately we do not have data for 18 year olds only. We have updated Suppl. Table 1. and split up Suppl. Table 5 into 5a and 5b. 4) Using the benchmark "households with 6 or more members", as shown in your tables, gives much more information on Thailand than on Italy. Even though you use weights, I would recommend to lower the threshold and see if there is more balance between countries for this variable.
We have now reanalysed the data using "households with 1-4 members" and "households with 5 or more members". We chose 5 as the new cut-off for "large" households to reflect multigenerational households commonly found in Thailand and Malaysia. As result of the re-analysis, we also revised the paragraph on page 10 to improve clarity and presentation of our findings (e.g. 'living arrangements' was one area that larger households were significantly more concerned about). Thank you for this comment. Our intention was to determine peoples' own perception, as we think this will affect their behaviour. We did not include knowledge-based questions because it may deter some people from answering the survey. Also, at the time of the survey, there were many unknowns in COVID-19, and scientists were still actively determining its origins, how it spreads etc. It would have been challenging to design quiz-like questions then. Nevertheless, we have added this point in the limitation section. We have also added "perceived" in the relevant subtitle. It now reads "Selfperceived level of understanding of COVID-19".
6) Finally, I would welcome more context on the information channels of each country. This said, in section "Information about COVID-19, unclear information and fake news" I would appreciate some more information about how each country communicates, how much information does the population really has, is the media controlled by the government in some countries, how frequent? does every country has daily reports? This is important to interpret the results, including levels of compliance and confidence in the government. This is a valid point. We did some research on government communications during COVID-19. We found a few studies, which looked at media consumption of people during COVID-19 in more detailusually either at individual country level, or with a few selected countries [1,2]. To our knowledge, the Coronavirus Government Response Tracker, visualised via 'Our World in Data' [3], is the only aggregator that collected data on government/public health information campaigns from all countries throughout the course of the whole pandemic. We have included information on the coordination level of public health campaigns in form of a supplementary Figure 1. It shows that all five countries had coordinated public health campaigns from 1 st March throughout the time period of our study.
We agree with the reviewer's comments about the potential connection between countries' media landscapes and people's compliance and trust. However, we feel that this is out of scope for our study due to the complexity of the analysis needed, and because we are public engagement/science communication experts, not media/journalism experts. For example, when preparing our response to the reviewer's comments, we identified the levels of press freedom for each country, as indicated by the World Press Freedom Index (see Table 1 below). Malaysia and Thailand have a lower rank and a higher score compared to the European countries. Both countries have also managed the pandemic better than the European countries. Correlating compliance and confidence in government with the media landscape in each country is complex, and is being addressed in other studies [e.g. 1, 2].
Our main aim in this study was to capture people's communication needs and preferences, to provide guidance for organisations running public health communication campaigns, and to help improve communication efforts.
To acknowledge the reviewer's point, we have included the following sentences in the 'Strengths and limitations' section: "We were able to identify communication needs and preferences of our respondents, which can be used as guidance for organisations running public health communication initiatives. As the media landscapes vary among countries, other factors like freedom of press or the proportion of digital media consumption are likely to influence people's responses." 7) "at first study area " We have now included the study area.
8) "population of these countries" We have included the population of these countries in the section 'Study area', in Methods 9) "How did you calculate the sample size?" The following text was added to the section "Sample size": The following sample size formula was used where P is the anticipated prevalence, d is the margin of error, Z 1−a/2 is the standard normal value corresponding to the upper tail probability of α/2, α=0.05 (for a 95% confidence interval), n is the sample size. 10) (...%) for all results is necessary.
We have included percentages in the main text and in Supplementary Table 1. 11) Economic impacts of COVID-19 and public health measures should be calculate in before and after study.
Our study was designed to capture the views and perceptions of respondents on how COVID-19 impacted them socially and economically rather than actual social and economic impacts which was captured by other means such as by government agencies. We have included this in the limitations section. We have also edited the subtitles in the Results section to reflect this, i.e. "Views on economic impacts of COVID-19 and public health measures" and "Views on social impacts of COVID-19 and public health measures". Lastly, we added this limitation to the article summary at the start.
12) Social impacts of COVID-19 and public health measures should be calculate in before and after study.
As above.
13) "we do not have question sentence in the discussion." We have revised it to read "Groups most affected by COVID-19 public health measures".
14) "you should revised the conclusion. Conclusions should be written based on the knowledge of the authors themselves and you have no right to refer to this section." 15) "Conclusions should be written based on the results of the present study." The Conclusions section has been revised.
Other changes to the text  Changed sentence in the abstract and introduction (2 nd paragraph) to: "In the absence of widely available vaccines and pharmaceutical treatments…" (as vaccines are now being rolled out).
 Added clarification in the introduction (p4): "These data can be used to supplement quantitative/statistical data on economic and social impacts to provide a better understanding of the effects of COVID-19 and its related public health measures."  Summary section: we deleted one of the bullet points to keep the total number to 5.
In addition to the above, we have made minor changes throughout the text to improve its clarity.
As a result of responding to the reviewers' comments, our word count is now 5757.

REVIEWER
Valente de Almeida, Sara Universidade Nova de Lisboa Nova School of Business and Economics REVIEW RETURNED 29-Mar-2021

GENERAL COMMENTS
The authors addressed my previous comments very thoroughly. I find the paper quite interesting and with relevant and updated information.