Effect of facemask, handwashing, and social distancing on contracting COVID-19 infection in Saudi Arabia: a case-control study

Fahad M Alswaidi; Abdullah M Assiri; Muhra M Alalway; Haya H Alhaqbani; Haya H Alkahtani

doi:10.12688/f1000research.129255.1

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Research Article

Effect of facemask, handwashing, and social distancing on contracting COVID-19 infection in Saudi Arabia: a case-control study

[version 1; peer review: 1 approved]

Fahad M Alswaidi ¹, Abdullah M Assiri^1,2, Muhra M Alalway³, Haya H Alhaqbani¹, Haya H Alkahtani¹

Fahad M Alswaidi ¹, Abdullah M Assiri^1,2, [...] Muhra M Alalway³, Haya H Alhaqbani¹, Haya H Alkahtani¹

PUBLISHED 23 Mar 2023

Author details Author details

¹ Surveillance and Data Management Department, Saudi Ministry of Health, Riyadh, Saudi Arabia, 11176, Saudi Arabia
² Assistant deputy for preventive health, Saudi Ministry of health, Riyadh, Saudi arabia, 11176, Saudi Arabia
³ Public Health Authority department of occupational Health, Saudi Ministry of health, Riyadh, Saudi Arabia, 13354, Saudi Arabia

Fahad M Alswaidi
Roles: Conceptualization, Methodology, Software, Writing – Original Draft Preparation

Abdullah M Assiri
Roles: Validation, Writing – Review & Editing

Muhra M Alalway
Roles: Data Curation, Formal Analysis

Haya H Alhaqbani
Roles: Data Curation, Formal Analysis

Haya H Alkahtani
Roles: Visualization, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Emerging Diseases and Outbreaks gateway.

Abstract

Background: This study aimed to evaluate the impact of self-preventive measures (handwashing, mask-wearing, and social distancing) on preventing the Coronavirus Disease-2019 (COVID-19) infection in Saudi Arabia (KSA).
Methods: An unmatched case-control study (1 to 1 ratio) was conducted with a sample size of 1102. The researchers used descriptive, bivariate, and multivariate analyses to determine the effect of handwashing, mask-wearing behavior, and social gatherings on COVID-19 infection.
Results: The results evinced that participants who believed that the facemask was important for preventing COVID-19 infection were more likely protected against the disease (OR=0.450; 0.320—0.631). Using a facemask during social visits and shopping indicated a lower protective effect than using it at work (OR=1.299; 1.011—1.668). The type of mask (disposable versus cloth; OR=0.929; 0.590—0.1.462) and its wearing period (1< dayversus ≤1 day; OR=0.907; 0.662—1.243) showed an almost neutral statistical association with acquiring the infection. Contrarily, handwashing time for ≥20 seconds, compared to a shorter time, had a statistically significant protective association with the infection even after adjusting the odds ratio (OR=0.616; 0.4763—0.796). It was also noted that gathering with relatives and friends ≥4 times per month exhibited a higher and statistically significant association with the infection compared to the lower times (OR=1.347; 1.046—1.734). Furthermore, people who prayed five times a day at the mosque showed a higher risk of infection than those who prayed less than five times (adjusted OR=1.740; 1.152—2.626).
Conclusions: This study suggested that handwashing for more than 20 seconds is the most important preventive factor among all considerations investigated. Moreover, it was noticed that disposable and cloth facemasks may have the same effect regardless of the wearing period or sterilization status. Furthermore, gathering with relatives and friends, as well as praying five times a day at the mosque, were ascertained as significant social factors in acquiring the COVID-19 infection.

Keywords

COVID-19 in Saudi Arabia, Facemask, Handwashing, Social distancing

Corresponding author: Fahad M Alswaidi

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2023 M Alswaidi F et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: M Alswaidi F, M Assiri A, M Alalway M et al. Effect of facemask, handwashing, and social distancing on contracting COVID-19 infection in Saudi Arabia: a case-control study [version 1; peer review: 1 approved]. F1000Research 2023, 12:323 (https://doi.org/10.12688/f1000research.129255.1) First published: 23 Mar 2023, 12:323 (https://doi.org/10.12688/f1000research.129255.1) Latest published: 23 Mar 2023, 12:323 (https://doi.org/10.12688/f1000research.129255.1)

Introduction

Infection control strategies include blocking any stage of the infection pathway. In the case of airborne transmission, this means reducing spread of the pathogen from an infectious person, using disinfection techniques to kill pathogens released, or simply isolating infectious people in special rooms.¹ Infection controls generally constitute three categories: administrative, personal protection, and environmental. Administrative controls aim to keep infectious people away from vulnerable people while also ensuring that technical controls, such as personal protection, are used properly.² For the transmission pathway, personal protection usually involves masks to forestall pathogen distribution or inhalation. Environmental controls primarily intervene after pathogen leaves one person's breathing zone before entering the breathing zone of another.² The effectiveness of protective measures leans on the strength of surface disinfectants, hand sanitizers, and the materials used to make personal protective equipment. Adequate screening for some infectious diseases, which may be asymptomatic, can play an important role in controlling the transmission.²

Quarantine and isolation are critical public health strategies that frequently necessitate the use of the law to enforce.³^,⁴ Isolation of symptomatic individuals until they are no longer infectious is a common approach to combat viral illnesses, and has the potential to effectively interrupt the transmission and halt an outbreak.⁵ For instance, policies within healthcare organizations require that healthcare workers who contract influenza are not allowed to return to work until their symptoms have resolved. Another important public health strategy to cope with infections transmitted from person to person involves identifying contacts of infected individuals and providing them with either treatment or prophylaxis. Contact tracing is a crucial element of public health prevention approaches.⁴

The study of disease surveillance for the recognition and evaluation of disease patterns can provide information on the danger and magnitude of disease burden to individuals, people, institutions, subgroups of populations, and, therefore, the community at large.⁶ Effective communication of disease burden and the outcomes achievable through well-managed and effective control programs can be a powerful advocacy tool.² The challenge facing infectious disease control programs is to design an optimal set of interventions at the local, institutional, community, national, and international levels supported and accepted by the political leadership and the people to whom these measures are applied.⁷

When the COVID-19 pandemic broke out in 2020, without an effective treatment or vaccine and with new virus variants emerging, preventive measures were the only option to restrict its spread.⁷ Limiting the spread of COVID-19 necessitates the development of coordination mechanisms not only in health sectors but also in other departments, such as transportation, travel, commerce, finance, security, and others.⁸

Preventive measures are centered mainly on three practices that require individuals' commitment and willingness besides public enforcement. These personal protective measures include handwashing and facemask usage, social distancing, and quarantine.⁹ Since the beginning of the pandemic, Saudi Arabia implemented the most stringent preventive measures possible, which resulted in the reduction in the number of cases and deaths.¹⁰ The preventive measures began in Saudi Arabia on the February 2, 2020 when the government evacuated Saudi students from Wuhan city. Soon after, Saudi airlines suspended flights to China.⁶ Within weeks of the first confirmed cases, the ministry of health quarantined all visitors entering the country, instituted a contact tracing regimen, closed schools, suspended workplace attendance, prohibited prayers in mosques, and limited pilgrimage to only 50 thousand locals.¹¹ On May 7, 2020, the Ministry of the Interior approved regulations that restricted public gatherings and mandated temperature monitoring, hand sanitizer use, facemask use, and maintenance of a 2-meter distance at public places. Strict penalties against violators of these preventive measures are being imposed to date in some places.¹²

This study was initiated to evaluate the impact of self-preventive measures (handwashing, mask-wearing, and social distancing) in preventing the disease. The main aim was to provide a comparative analysis of these interventions and identify the most effective ones. This research will aid public health professionals in designing effective prevention and control policies.

Objectives

‐ To determine the associations between preventive measures (facemask, hand washing, and social distancing) and contracting COVID-19 infection in Saudi Arabia.
‐ To identify and recommend the most effective COVID-19 prevention practices in Saudi Arabia.

Methods

Ethics

Ethical approval was obtained from the Ministry of Health (MOH) Instituional Review Board (approval number: 20-213M).

Study design

An unmatched retrospective case–control study. Administrative proposal approval from MOH was obtained on 01/11/2020 while the remaining study steps took six months until the final report was formulated on 28/4/2021 (Extended data 1).

Study setting/data source

Potential participants were selected from the Health Electronic Surveillance System (HESN) database of all COVID-19 tested individuals with confirmed results (positive or negative) in October 2020 (15,215 cases). This is the most recent data available to minimize recall bias.

Case: Any confirmed COVID-19 case in the dataset with a positive PCR result and a phone number.

Control: Any case in the dataset with a confirmed negative PCR test result and an available phone number.

Sampling and data collection

After downloading the COVID-19 dataset for the assigned period, cleaning was performed to remove duplicates, outliers, and artifacts. Simple random sampling technique was used to select the samples. The required sample size was 386 under the assumptions of a 95% confidence level, alpha value of 0.05, and a COVID-19 infection proportion of 50%. However, since sufficient data were available and a low response rate was expected, we selected 6000 potential participants at random using online random number generator.¹³ Two frames for cases (2753) and controls (3247) were constructed containing names and phone numbers of the potential participants. After obtaining the appropriate IRB (20-213M) from the Ministry of Health (MOH), the questionnaire in Google forms was sent to all potential participants via the SMS services of MOH. With a response rate of 18.3%, a total of 1102 (551 cases and 551 controls) participants responded to the questionnaire completely. The case to control ratio was 1:1 (Extended data 2).

Before commencing the questionnaire, participants' consent was sought and documented on the answer form. The questionnaire consisted of five main parts: confirmation of result, i.e., (positive/case) or (negative/control), demographic data, facemask factors, handwashing factors, and social distancing factors (Extended data 3).

Data analysis

Data were managed and edited using Microsoft^® Excel^® (Microsoft^® Office 2016, Microsoft^® Corp USA). (Microsoft Excel, RRID:SCR_016137) Statistical analyses were performed using Statistical Package for the social Sciences (IBM SPSS statistics 25 USA) (SPSS, RRID:SCR_002865).

Central tendency and dispersion measures were calculated for the variables, and findings were presented in suitable descriptive tables according to the study objectives. Categorical data of independent variables were compared and tested against the identified dependent variable (outcome) using univariate analysis to obtain the odds ratio as a measure of association. As the final step in the data analysis, multivariate analysis using a binary logistic regression model was implemented to adjust for possible cofounders.

Results

The ≤40 years old age group represented 59.3% of all respondents, with a mean age of 37.7±12.6. Males accounted for 61.3%, Saudis for 63.6%, and those from the Central and Western regions for 40.6 and 21.5%, respectively (Table 1).

Table 1. Socio-demographic information of respondents in reference to cases and controls.

Study parameters	Study groups				Odds Ratio	95% CI
	Positive (Cases) (n=551)		Negative (Controls) (n=551)			95% CI
	Freq.	%	Freq.	%		Lower	Upper
1. Age (years)
≤40	354	54.1	300	45.9	1.503	1.181	1.915
<40	197	44.0	251	56.0
Mean age±SD (37.7 ±12.6)
2. Gender
Female	260	61.0	166	39.0	2.072	1.618	2.653
Male	291	43.0	385	57.0	2.072	1.618	2.653
3. Nationality
Saudi	434	61.9	267	38.1	3.946	3.031	5.137
Non-Saudi	117	29.2	284	70.8	3.946	3.031	5.137
4. Region
Central	151	33.7	297	66.3	0.367	0.279	0.484
Western	158	66.7	79	33.3	1.446	1.037	2.017
Others (East, South & North)	242	61.2	175	38.8	Ref
5. Education
High school and lower	204	56.4	158	43.6	1.462	1.135	1.883
University and higher	347	46.9	393	53.1	1.462	1.135	1.883
6. Occupation
Unemployed and students	246	64.6	135	35.4	2.485	1.923	3.213
Employed	305	42.3	416	57.7	2.485	1.923	3.213
7. Monthly income (Saudi riyals)
≤6000	294	55.1	240	44.9	1.482	1.169	1.880
>6000	257	45.2	311	54.8	1.482	1.169	1.880
8. Type of residence
Alone	98	32.2	206	67.8	0.362	0.274	0.479
Shared	453	56.8	345	43.2	0.362	0.274	0.479
9. Sharing residence with
Family	431	58.5	306	41.5	2.497	1.451	4.296
Friends	22	36.1	39	63.9	2.497	1.451	4.296
10. Number of persons sharing the residence
1-10	429	56.4	332	43.6	0.700	0.351	1.395
More than 10	24	64.9	13	35.1	0.700	0.351	1.395
11. Marital status
Single	166	54.1	141	45.9	1.254	0.963	1.633
Married	385	48.4	410	51.6	1.254	0.963	1.633

The data made it evident that the respondents younger than 40 years of age (OR=1.503; 1.181–1.915) and females (OR=2.072; 1.618–2.653) had a higher and statistically significant chance of contracting COVID-19 than others. Moreover, unemployment (OR=2.485; 1.923–3.213), monthly income less than SAR 6000 (OR=1.482; 1.169–1.880), and a low level of education (OR=1.462; 1.135–1.883) showed significant statistical associations with infection. In addition, living alone reduced the risk of infection by 64% than shared housing (OR=0.362; 0.274–0.479), whereas living with the family doubled the risk of infection compared to living with friends (OR=2.497; 1.451–4.296).

The respondents who said that the facemask is essential were more likely protected against the COVID-19 infection by nearly 55% (OR=0.450; 0.320–0.631; Table 2). Using the facemask during social visits and shopping indicated a lower protective effect than using it at work (OR=1.299; 1.011–1.668). There was no statistically significant difference between the effect of disposable versus cloth facemasks (OR=0.929; 0.590–0.1.462). Further, facemask wearing periods showed a negligible statistical difference (OR=0.907; 0.662–1.243).

Table 2. Factors of facemask and handwashing in reference to cases and controls.

Study parameters	Study groups				Odds Ratio	95% CI
	Positive (Cases) (n=551)		Negative (Controls) (n=551)			95% CI
	Freq.	%	Freq.	%		Lower	Upper
12. Is facemask important?
Yes	435	46.9	492	53.1	0.450	0.320	0.631
No	116	66.3	59	33.7	0.450	0.320	0.631
13. Do you use it?
Yes	529	50.1	526	49.9	1.143	0.636	2.052
No	22	46.8	25	53.2	1.143	0.636	2.052
14. Where do you use facemask most? (n=1055)
Social visits and shopping	349	52.6	315	47.4	1.299	1.011	1.668
Work	180	46.0	211	54.0	1.299	1.011	1.668
15. What type of mask do you use most? (n=1055)
Disposable	487	50.0	487	50.0	0.929	0.590	1.462
Cloth	42	51.9	39	48.1	0.929	0.590	1.462
16. For how long? (n=1055)
>one day	91	48.1	98	51.9	0.907	0.662	1.243
≤one day	438	50.6	428	49.4	0.907	0.662	1.243
17. Do you use face shield or goggles (n=1055)
Yes	37	41.1	53	58.9	0.671	0.433	1.040
No	492	51.0	473	49.0	0.671	0.433	1.040
18. If Yes, why? (n=90)
Nature of work	25	46.3	29	53.7	1.724	0.718	4.138
Over cautious	12	33.3	24	66.7	1.724	0.718	4.138
19. Do you think hand washing is important?
Yes	523	49.3	538	50.7	0.451	0.231	0.881
No	28	68.3	13	31.7	0.451	0.231	0.881
20. How frequent do you wash your hands?
>3 times/day	391	49.9	393	50.1	0.982	0.757	1.275
≤3 times/day	160	50.3	158	49.7	0.982	0.757	1.275
21. What type of material you use most?
Sanitizer or Soap	536	49.9	539	50.1	0.796	0.369	1.716
Water only	15	55.6	12	44.4	0.796	0.369	1.716
22. For how long do you wash your hands?
≥20 sec	350	46.2	407	53.8	0.616	0.4763	0.796
<20 sec	201	41.7	144	41.7	0.616	0.4763	0.796

The participants who believed that handwashing is important were 55% more likely to be protected against the infection (OR=0.451; 0.231–0.881). Handwashing frequency (three times per day) and the use of sanitizers showed minimal protective associations with the infection, but neither was statistically significant. In addition, handwashing for ≥20 seconds evinced a protective statistical association with the disease by 39% (OR=0.616; 0.4763–0.796), compared to the shorter handwashing time.

Respondents who believed that social distancing is important in combating the infection were 59% more likely to be protected than others (Table 3; OR=0.413; 0.241–0.709). Going to work or school (OR=0.353; 0.257–0.452), shopping four times a month (OR=0.506; 0.398–0.642), and visiting cafés and restaurants all had a statistically significant protective effect. Likewise, keeping a distance of ≤2 meters, shopping time for more than an hour, and spending more than an hour in a café or restaurant all showed no significant associations with the infection. Moreover, going to the mosque also did not have a statistically significant association with infection; however, the participants who prayed all five prayers per day at the mosque were at a higher risk of infection than those who prayed less than five times (OR=1.740; 1.152–2.626).

Table 3. Factors of social distancing one month prior to COVID-19 testing (in reference to cases and controls).

Study parameters	Study groups				Odds Ratio	95% CI
	Positive (Cases) (n=551)		Negative (Controls) (n=551)			95% CI
	Freq.	%	Freq.	%		Lower	Upper
23. Is keeping distance important?
Yes	505	48.7	531	51.3	0.413	0.241	0.709
No	46	69.7	551	30.3	0.413	0.241	0.709
24. Minimum distance
≤2 meters	382	50.3	377	49.7	1.043	0.808	1.346
>2 meters	169	49.2	174	50.8	1.043	0.808	1.346
25. Going to work or school
Yes	255	39.5	391	60.5	0.353	0.257	0.452
No	296	64.9	160	35.1	0.353	0.257	0.452
26. Shopping frequency per month
≥4 times	236	41.8	329	58.2	0.506	0.398	0.642
<4 times	315	58.7	222	41.3	0.506	0.398	0.642
27. Shopping time (n=920)
<one hour	164	45.6	196	54.4	1.008	0.772	1.315
≥one hour	254	45.4	306	54.6	1.008	0.772	1.315
28. Going to cafe and restaurant per month
≥4 times	107	42.6	144	57.4	0.681	0.513	0.905
<4 times	444	52.2	407	47.8	0.681	0.513	0.905
29. Time spent in cafe and restaurant (n=494)
>one hour	78	45.1	95	54.9	0.836	0.577	1.212
≤one hour	159	49.5	162	50.4	0.836	0.577	1.212
30. Gathering with friends and relatives per month
≥4 times	198	55.0	162	45.0	1.347	1.046	1.734
<4 times	353	47.6	389	52.4	1.347	1.046	1.734
31. Time spent with friends and relatives (n=662)
>one hour	237	53.3	208	46.7	1.238	0.894	1.713
≤one hour	104	47.9	113	52.1	1.238	0.894	1.713
32. Praying at Mosque
Yes	150	37.7	248	62.3	0.457	0.355	0.588
No	401	57.0	303	43.0	0.457	0.355	0.588
33. Praying frequency at mosque per day (n=398)
5 times	74	45.4	89	54.6	1.740	1.152	2.626
<5 times	76	32.3	159	67.6	1.740	1.152	2.626
34. Attending social occasions in the last month
Yes	196	60.7	125	39.3	1.848	1.418	2.407
No	356	45.6	425	54.4	1.848	1.418	2.407
35. Frequency of social occasions (n=321)
More than 1	75	57.3	56	42.7	0.770	0.488	1.214
One time	121	63.5	69	36.5	0.770	0.488	1.214
36. Number of occasion attendees (n=321)
>50 persons	32	60.7	20	39.3	1.04	0.565	1.915
≤50 persons	163	60.6	106	39.4	1.04	0.565	1.915
37. Are you aware of COVID-19 health messages in media?
Yes	490	48.9	512	51.1	0.612	0.402	0.932
No	61	61.0	39	39.0	0.612	0.402	0.932
38. If Yes, where did you see or hear it most? (n=1002)
Social media	379	52.4	344	47.6	1.668	1.259	2.208
Others	111	39.8	168	60.2	1.668	1.259	2.208

Social factors appeared to play a crucial role in spreading the COVID-19 infection. Our data depicted that gathering with relatives and friends (≥4 times a month) exhibited a significant statistical association with the chances of contracting the infection (OR=1.347; 1.046–1.734). Similarly, it was also noticed that the entrants who attended social occasions in the previous month were more likely to get infected compared to those who did not (OR=1.848; 1.418–2.407). Nevertheless, the number of events attended and the number of attendees had no significant statistical association with the infection.

Being informed about COVID-19 also seemed to be a major role player in contracting the virus. The incidence of infection showed a statistically significant protective association with awareness of COVID-19 health messages in the media (OR=0.612; 0.402–0.932). However, those who said that social media was their source of information were at a relatively higher risk of infection (OR=1.668; 1.259–2.208).

Out of all independent variables tested in the bivariate analysis (single variable association), 14 showed statistically significant associations with the outcome variable (positive versus negative). In the final step of the regression model, only eight variables exhibited significant statistical associations (Table 4). Briefly, praying at the mosque five times a day demonstrated a strong and significant statistical association with the chances of infection. While, on the other hand, the participants believing in the importance of handwashing and handwashing for more than 20 seconds indicated a substantial and statistically significant protective effect against the infection.

Table 4. Multivariate logistic regression analysis for the effect of socio-demographic factors, facemask, handwashing, and social distance on cases and controls (Enter Method).

Crude Odds Ratio	95% CI		Adjusted Odds Ratio	95% CI
Crude Odds Ratio	Lower	Upper	Adjusted Odds Ratio	Lower	Upper
Gender (Female vs. Male)
2.072	1.618	2.653	1.443	1.029	2.024
Nationality (Saudi vs. Non-Saudi)
3.946	3.031	5.137	2.933	1.930	4.457
Importance of handwashing (Yes vs. No)
0.451	0.231	0.881	0.485	0.247	0.954
Length of handwashing (>20 sec vs. ≤20 sec)
0.616	0.4763	0.796	0.638	0.236	0.591
Shopping frequency per month (≥4 times vs. <4 times)
0.506	0.398	0.642	0.234	0.067	0.819
Shopping time (<1 hr vs. ≥1 hr)
1.008	0.772	1.315	3.468	1.120	10.733
Praying at mosque frequency per day (5 times vs. <5 times)
1.74	1.152	2.626	3.363	1.044	10.827
Health awareness messages (Social media vs. Other media)
1.668	1.259	2.208	1.688	1.509	2.908

Discussion

This study was conducted to assess the effectiveness of self-preventive measures in reducing the risk of COVID-19 infection in the Saudi population. Since 2020, the COVID-19 pandemic has changed the face of the world and brought about significant changes to the lifestyle of people globally. Apart from governmental efforts to address this challenge at the policy level, self-preventive measures are also critical to preventing infection. Against this backdrop, the current study investigated the influence of handwashing, mask-wearing, and social distancing. The main findings support some other similar studies conducted in different parts of the world.

Demographic factors

In this study, younger respondents were found to be at a higher risk of contracting COVID-19 infection. This finding could be attributed to greater social activities among the young population, as documented in earlier COVID-19 studies from Saudi Arabia.¹⁴^,¹⁵ Studies from other countries like Italy, Brazil, and the USA also came to the same conclusion.¹⁶ Moreover, the female population in our study appeared to be at higher risk of contracting the disease. Despite the COVID-19 gathering prohibition rules, females in the Saudi community tend to congregate in large numbers in their homes on a regular basis. Hence, our results hinted at a potential role of this behavior in spreading the infection compared to the male population, a finding that contradicted the previous reports from Saudi Arabia.¹⁴^,¹⁵ However, the same finding was reported in seven European countries and the United States.¹⁷

The nationality of the respondents was also identified as an important demographic factor relevant to this study. The rate of infection was higher among the Saudi population than among non-Saudis. In general, gathering in large groups during social occasions is more common in Saudi culture. This social aspect may have increased the risk of infection among Saudis. Further, respondents with lower socioeconomic status were found to be at a higher risk of infection, which is concurrent with previous local and international studies.¹⁴^,¹⁵^,¹⁸^–²¹

Facemask factors

A positive attitude toward wearing a facemask is an important preventive factor. Despite the dispute on the effectiveness of facemasks at the beginning of the pandemic, their use turned to be a significant preventive factor in combating the infection worldwide.²² The type of facemask (disposable versus cloth) showed no difference in the protective effect. A systematic review by Chu et al.,²³ investigated the use of facemasks during the pandemic and illustrated that both the surgical/disposable and cloth types provide the same level of protection. In addition, using a disposable or cloth facemask for more than one day without sterilizing or changing it showed no protective difference compared with using it for shorter periods.

Many countries mandate universal masking, especially for healthcare workers. The Center for Disease Control (CDC) recommended the public to wear masks, particularly in crowded areas.⁷^,²⁴^,²⁵ Nonetheless, personal protective equipment is in short supply around the world, the efficacy of various types of masks, such as N95 respirators, surgical masks, and cloth masks, is still under investigation, and recommendations on the use, reuse, and sterilization of masks are inadequate.²⁴^,²⁵ One of the arguments regarding the facemask usage is that improper use of the mask increases the risk of COVID-19 infection by providing a false sense of protection.⁷ On the other hand, several randomized controlled trials conducted to examine the evidence for the community's use of masks and respirators suggested protection from the virus and the likely benefits of masks in this context.⁷

Due to strict preventive measures in work settings compared to social events and shopping places, the work environments seem to be safer regarding COVID-19 infection. Facemask use and compliance with other preventive strategies are generally taken more seriously by workplace managements. As a result, increased use of facemasks may help to slow the spread of the disease. There have been disparities in the usage of facemasks and their effectiveness against the pandemic;²⁴^,²⁵ however, this study supports the notion that using any type of proper facemask is effective in preventing the spread of infection regardless of its sterilization status and the period it is worn for.²²

Handwashing factors

Self-hygiene is critical to one's overall health. Handwashing has consistently been shown to be a critical factor in preventing the spread of communicable diseases. During a pandemic, the most crucial strategy for the population is to wash their hands and frequently use hand sanitizer while avoiding contact with their face and mouth after touching potentially contaminated surfaces⁷. This study confirms that people who have a positive attitude toward the importance of handwashing have a lower risk of contracting COVID-19. Handwashing for longer periods (≥20 seconds) appeared to be the most effective method of combating COVID-19 infection, among other investigated preventive measures. Handwashing for an extended period is inconvenient, but it is documented as the best way to sterilize the hand surface.⁷^,⁸ In this study, the frequency of handwashing per day and the type of sterilizer or soap used compared to only water had no effect on the infection acquisition. This finding contradicts previous research that suggests that using alcohol-based sanitizer or handwashing with soap has a positive effect on reducing the transmission of respiratory infections.⁷^,⁸

Social distancing factors

Maintaining safe distance in public places is a critical precaution as COVID-19 spreads via respiratory droplets. Several countries have implemented this strategy since the beginning of the pandemic to reduce the contact rate in the population and the potential contribution of asymptomatic and pre-symptomatic people to disease transmission.⁷ This study suggests that residents of Saudi Arabia are aware of the importance of keeping a safe distance as a precautionary measure. The distance itself (≥2 m versus <2 m) made no difference in acquiring the infection. This finding could be attributed to strict adherence to other preventive measures like wearing a facemask and handwashing.

Interestingly, the results of this study hinted that going to school or work during the pandemic had a significant protective effect against infection. Adequate preventive measures are probably better practiced at work and school than at home; however, this point requires further investigation. Gathering with relatives and friends seems to be an important factor in acquiring the infection. This supports the Saudi MOH's claims that most of the community-acquired COVID-19 cases were from family gatherings.²⁶ Therefore, strict penalties were imposed on those who gather in a group of more than 20 persons.¹² Despite the negative impact of social distance on mental health, many countries, including KSA, enforced it to reduce disease transmission and protect the vulnerable population.²⁷ Mitigating these mental health effects necessitates daily routines that include a healthy lifestyle, hobbies, virtual social interactions, and mindfulness.²⁷

Routine social activities like shopping and visits to cafés and restaurants were supposed to be associated with a higher risk of acquiring the infection; however, the results of this study showed that they have preventive effects, probably due to strict preventive precautions at these places. The association between the risk of infection and visits to these locations may be highly dependent on adherence to disease prevention measures and designated Standard Operating Procedures (SOPs). Therefore, more research is needed on this subject. Contrarily, praying at the mosque five times a day seemed to contribute significantly to the spread of the infection. Despite strict preventive measures implemented in mosques, MOH reports revealed that mosques are potential sites of spreading the infection.²⁶ During the curfew at the start of the pandemic, all mosques in the Kingdom, including the two holy mosques in Makkah and Madina, were closed for three months for the first time in the Kingdom's history. That was a difficult decision for both the government and the public, but it indicates commitment and seriousness of the health authority in enforcing preventive precautions against the current pandemic.

Our results evinced that COVID-19 educational messages in the media played an important role in prevention efforts. However, social media appeared to play a misleading role in this context. Because of a lack of checks and users' differing opinions, social media is a source of false and incorrect data about COVID-19. The false messages and conspiracy theories were well received by the general public, posing a significant challenge to the health authorities in KSA as well as around the world.²⁸

Conclusion

Saudi residents seem to be aware of the significance of precautionary measures in combating COVID-19 spread. This study suggests that handwashing for more than 20 seconds is the most important preventive factor among all factors investigated. Regarding the use of facemasks, it was noticed that disposable and cloth facemasks may have the same preventive effect regardless of the wearing period or their sterilization status. Moreover, common social activities like going to work or school, frequent shopping, and visits to cafés and restaurants showed preventive effects when compared to the homestay, which could be attributed to the strict preventive precautions at these places. However, gathering with relatives and friends and praying five times a day at the mosque were recognized as important factors in acquiring the COVID-19 infection.

Limitations

A worth mentioning limitation of this study is that it lacks questions on whether the cases or contacts were subject to isolation or quarantine as an important preventive measure.

Data availability

Underlying data

Figshare: Unmatched case-control dataset (precautionary practices & Covid19 infection) (1).sav, https://doi.org/10.6084/m9.figshare.22258849.v1.²⁹

The project contains the following underlying data:

• Unmatched case-control dataset (precautionary practices & Covid19 infection) (1).sav

Extended data

Figshare: Study timeline.pdf, https://doi.org/10.6084/m9.figshare.21952853.v2.³⁰

This project contains the following extended data:

• Study timeline.pdf

Figshare: Sampling flowchart.pdf, https://doi.org/10.6084/m9.figshare.21952838.v2.³¹

This project contains the following extended data:

• Sampling flowchart.pdf

Figshare: The questionnaire, https://doi.org/10.6084/m9.figshare.21973142.v2.³²

This project contains the following extended data:

• The questionnaire.docx

Reporting guidelines

Figshare: STROBE checklist for ‘Effect of facemask, handwashing, and social distancing on contracting COVID-19 infection in Saudi Arabia: a case-control study’, https://doi.org/10.6084/m9.figshare.21959579.v2.³³

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgments

We are thankful to our colleagues in the Health Electronic Surveillance System and the General Directorate for the Electronic Applications in Ministry of Health (MOH) for their support in providing raw data of this study and distributing the questionnaire through the MOH short messages services (SMS).

References

1. Morens DM, Folkers GK, Fauci AS: The challenge of emerging and re-emerging infectious diseases. Nature. 2004; 430(6996): 242–249. PubMed Abstract | Publisher Full Text | Free Full Text
2. Eyler AA, Chriqui JF, Moreland-Russell S, et al.: Prevention, policy, and public health. Oxford University Press; 2016. Publisher Full Text
3. Nsubuga P, White ME, Thacker SB, et al.: Public health surveillance: a tool for targeting and monitoring interventions. Disease Control Priorities in Developing Countries. 2nd ed.2006.
4. Detels R: Epidemiology: the foundation of public health. Oxford textbook of public health. 1st ed.2009; pp. 485–491. Publisher Full Text
5. Dowdle WR: The principles of disease elimination and eradication. Bull. World Health Organ. 1998; 76 Suppl 2(Suppl 2): 22–25. PubMed Abstract | Free Full Text
6. Alboaneen D, Pranggono B, Alshammari D, et al.: Predicting the epidemiological outbreak of the coronavirus disease 2019 (COVID-19) in Saudi Arabia. Int. J. Environ. Res. Public Health. 2020; 17(12): 4568. PubMed Abstract | Publisher Full Text | Free Full Text
7. Güner HR, Hasanoğlu İ, Aktaş F: COVID-19: Prevention and control measures in community. Turkish. J. Med. Sci. 2020; 50(SI-1): 571–577. PubMed Abstract | Publisher Full Text | Free Full Text
8. Pradhan D, Biswasroy P, Naik PK, et al.: A review of current interventions for COVID-19 prevention. Arch. Med. Res. 2020; 51(5): 363–374. PubMed Abstract | Publisher Full Text | Free Full Text
9. Nussbaumer-Streit B, Mayr V, Dobrescu AI, et al.: Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. Cochrane Database Syst. Rev. 4(9). PubMed Abstract | Publisher Full Text | Free Full Text
10. Almutairi AF, BaniMustafa A, Alessa YM, et al.: Public trust and compliance with the precautionary measures against COVID-19 employed by authorities in Saudi Arabia. Risk Manag. Healthc. Policy. 2020; 13(753): 753–760. PubMed Abstract | Publisher Full Text | Free Full Text
11. Saudi Press Agency: Interior minister approves regulation to limit gatherings and classifies violations and penalties.2020. (7 May 2020). Reference Source Reference Source
12. Saudi Press Agency: Ministry of interior approves revising regulations on limiting gatherings, updating violations classification schedule.2020. (30 May 2020). Reference Source
13. Furey E: Random Number Generator. CalculatorSoup- Online Calculators. Reference Source Reference Source
14. Alswaidi FM, Assiri AM, Alhaqbani HH, et al.: Characteristics and outcome of COVID-19 cases in Saudi Arabia: review of six-months of data (March-August 2020). Saudi Pharm J. 2021; 29: 682–691. PubMed Abstract | Publisher Full Text | Free Full Text
15. Alsofayan YM, Althunayyan SM, Khan AA, et al.: Clinical characteristics of COVID-19 in Saudi Arabia: A national retrospective study. J. Infect. Public Health. 2020; 13(7): 920–925. PubMed Abstract | Publisher Full Text | Free Full Text
16. Onder G, Rezza G, Brusaferro S: Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020; 323(18): 1775–1776. PubMed Abstract | Publisher Full Text
17. Parker A, Maree G, Götz G, et al.: Women and COVID-19 in Gauteng, South Africa.2020. (31 August 2020). Publisher Full Text Reference Source
18. Boehmer TK, DeVies J, Caruso E, et al.: Changing age distribution of the COVID-19 pandemic—United States, May–August 2020. Morb. Mortal. Wkly Rep. 2020; 69(39): 1404–1409. PubMed Abstract | Publisher Full Text | Free Full Text
19. Zhao W, Zhong Z, Xie X, et al.: Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: a multicenter study. Am. J. Roentgenol. 2020; 214(5): 1072–1077. PubMed Abstract | Publisher Full Text
20. Conti P, Younes A: Coronavirus COV-19/SARS-CoV-2 affects women less than men: Clinical response to viral infection. J. Biol. Regul. Homeost. Agents. 2020; 34(2): 339–343. PubMed Abstract | Publisher Full Text
21. European Centre for Disease Prevention and Control: Coronavirus disease 2019 (COVID-19) in the EU/EEA and the UK–eleventh update: resurgence of cases.2020. Reference Source
22. Brooks JT, Butler JC: Effectiveness of mask wearing to control community spread of SARS-CoV-2. JAMA. 2021; 325(10): 998–999. PubMed Abstract | Publisher Full Text | Free Full Text
23. Chu DK, Akl EA, Duda S, et al.: Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020; 395(10242): 1973–1987. PubMed Abstract | Publisher Full Text | Free Full Text
24. MacIntyre CR, Chughtai AA: A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. Int. J. Nurs. Stud. 2020; 108: 103629. PubMed Abstract | Publisher Full Text | Free Full Text
25. Tirupathi R, Bharathidasan K, Palabindala V, et al.: Comprehensive review of mask utility and challenges during the COVID-19 pandemic. Infez. Med. 2020; 28(suppl 1): 57–63. PubMed Abstract
26. Ministry of Health Saudi Arabia: Curve still going up in some KSA regions.2021. Reference Source
27. Teslya A, Pham TM, Godijk NG, et al.: Impact of self-imposed prevention measures and short-term government-imposed social distancing on mitigating and delaying a COVID-19 epidemic: A modelling study. PLoS Med. 2020; 17(7): e1003166. PubMed Abstract | Publisher Full Text | Free Full Text
28. Hammad MA, Alqarni TM: Psychosocial effects of social media on the Saudi society during the Coronavirus Disease 2019 pandemic: A cross-sectional study. PLoS One. 2021; 16(3): e0248811. PubMed Abstract | Publisher Full Text | Free Full Text
29. Alswaidi F, et al.: Unmatched case-control dataset (precautionary practices & Covid19 infection) (1).sav. Dataset. figshare. 2023. Publisher Full Text
30. Alswaidi F, Assiri AM, et al.: Study timeline.pdf. Dataset. figshare. 2023. Publisher Full Text
31. Alswaidi F, Assiri AM, et al.: Sampling flowchart.pdf. Dataset. figshare. 2023. Publisher Full Text
32. Alswaidi F, Assiri AM, et al.: The questionnaire. Dataset. figshare. 2023. Publisher Full Text
33. Alswaidi F, Alalawi M, et al.: STROBE-case-control checklist 26.01.2023.pdf. Dataset. figshare. 2023. Publisher Full Text

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Author details Author details

¹ Surveillance and Data Management Department, Saudi Ministry of Health, Riyadh, Saudi Arabia, 11176, Saudi Arabia
² Assistant deputy for preventive health, Saudi Ministry of health, Riyadh, Saudi arabia, 11176, Saudi Arabia
³ Public Health Authority department of occupational Health, Saudi Ministry of health, Riyadh, Saudi Arabia, 13354, Saudi Arabia

Fahad M Alswaidi
Roles: Conceptualization, Methodology, Software, Writing – Original Draft Preparation

Abdullah M Assiri
Roles: Validation, Writing – Review & Editing

Muhra M Alalway
Roles: Data Curation, Formal Analysis

Haya H Alhaqbani
Roles: Data Curation, Formal Analysis

Haya H Alkahtani
Roles: Visualization, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

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M Alswaidi F, M Assiri A, M Alalway M et al. Effect of facemask, handwashing, and social distancing on contracting COVID-19 infection in Saudi Arabia: a case-control study [version 1; peer review: 1 approved]. F1000Research 2023, 12:323 (https://doi.org/10.12688/f1000research.129255.1)

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Reviewer Report 27 May 2024

Joyzy Pius Egunjobi, Psycho-Spiritual Institute, Abuja, Nigeria; Counseling Psychology, The Catholic University of Eastern Africa (Ringgold ID: 107856), Nairobi, Nairobi County, Kenya

Approved

https://doi.org/10.5256/f1000research.141924.r233152

The study analyzed the effectiveness of self-preventive measures in reducing COVID-19 infection in Saudis. Demographic factors, such as younger respondents, females, and nationality, were identified as significant contributors to infection risk. Facemasks were reported to have a significant preventive factor, ... Continue reading

The study analyzed the effectiveness of self-preventive measures in reducing COVID-19 infection in Saudis. Demographic factors, such as younger respondents, females, and nationality, were identified as significant contributors to infection risk. Facemasks were reported to have a significant preventive factor, with both disposable and cloth types providing protection. Work environments were reported to be safer due to strict preventive measures. Longer handwashing periods were reported to be the most effective method of combating infection. Social distancing did not significantly affect infection acquisition. School or work were found to be protective, while gathering with relatives and friends was a significant factor. Media education messages were also important in prevention efforts.

There is no doubt that these measures have been reported in many studies to prevent the spread of COVID-19 (Chiu et al., 2021[1]; Dearling et al., 2021[2]; Kwon et al., 2021[3]; Egunjobi, 2020[4] , Egunjobi, 2020 [5]) A critical review of the data between those who tested positive and negative revealed that the gap between those who considered facemasks important or not is slightly different (between nearly average [45%] and slightly above average [55%]). This reflects, in part, the researchers’ bias, which may partly affect the significance of the conclusion of the study.

Notwithstanding my observation, the study is consistent with previous studies that found that facemasks, handwashing, and social distance were truly preventive. So, according to the 1500 Dutch philosopher Desiderius Erasmus, 'prevention is better than cure' (Royal College of Nursing, n.d.- https://www.rcn.org.uk/Get-Involved/Campaign-with-us/Prevention-is-better-than-cure#:~:text=Promotion%20of%20healthy%20lifestyles%20and,Desiderius%20Erasmus%20in%20around%201500.), and prevention costs less than treatment (Egunjobi, 2020[4]).

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

References

1. Chiu NC, Chi H, Tai YL, Peng CC, et al.: Impact of Wearing Masks, Hand Hygiene, and Social Distancing on Influenza, Enterovirus, and All-Cause Pneumonia During the Coronavirus Pandemic: Retrospective National Epidemiological Surveillance Study.J Med Internet Res. 2020; 22 (8): e21257 PubMed Abstract | Publisher Full Text
2. Dearling JLJ, van Dam EM, Harris MJ, Packard AB: Detection and therapy of neuroblastoma minimal residual disease using [64/67Cu]Cu-SARTATE in a preclinical model of hepatic metastases.EJNMMI Res. 2021; 11 (1): 20 PubMed Abstract | Publisher Full Text
3. Kwon S, Joshi AD, Lo CH, Drew DA, et al.: Association of social distancing and face mask use with risk of COVID-19.Nat Commun. 2021; 12 (1): 3737 PubMed Abstract | Publisher Full Text
4. Egunjobi ,J.P: Effectiveness of Hand Washing, Face Masking, Social Distancing, and Lockdown in preventing the Spread of Covid-19. ResearchGate. 2020.
5. Egunjobi J.P.: BIOPSYCHOSOCIOTECHNO-SPIRITUAL SELFCARE DURING COVID-19 LOCKDOWN April 2020. ResearchGate. 2020.

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: psychology, psycho-spiritual therapy, neuropsychology, marriage and family, addictive disorders

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Joyzy Pius Egunjobi, Psycho-Spiritual Institute, Abuja, Nigeria; The Catholic University of Eastern Africa (Ringgold ID: 107856), Nairobi, Kenya

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Reviewer Report

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27 May 2024 | for Version 1

Joyzy Pius Egunjobi, Psycho-Spiritual Institute, Abuja, Nigeria; Counseling Psychology, The Catholic University of Eastern Africa (Ringgold ID: 107856), Nairobi, Nairobi County, Kenya

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Approved

The study analyzed the effectiveness of self-preventive measures in reducing COVID-19 infection in Saudis. Demographic factors, such as younger respondents, females, and nationality, were identified as significant contributors to infection risk. Facemasks were reported to have a significant preventive factor, with both disposable and cloth types providing protection. Work environments were reported to be safer due to strict preventive measures. Longer handwashing periods were reported to be the most effective method of combating infection. Social distancing did not significantly affect infection acquisition. School or work were found to be protective, while gathering with relatives and friends was a significant factor. Media education messages were also important in prevention efforts.

There is no doubt that these measures have been reported in many studies to prevent the spread of COVID-19 (Chiu et al., 2021[1]; Dearling et al., 2021[2]; Kwon et al., 2021[3]; Egunjobi, 2020[4] , Egunjobi, 2020 [5]) A critical review of the data between those who tested positive and negative revealed that the gap between those who considered facemasks important or not is slightly different (between nearly average [45%] and slightly above average [55%]). This reflects, in part, the researchers’ bias, which may partly affect the significance of the conclusion of the study.

Notwithstanding my observation, the study is consistent with previous studies that found that facemasks, handwashing, and social distance were truly preventive. So, according to the 1500 Dutch philosopher Desiderius Erasmus, 'prevention is better than cure' (Royal College of Nursing, n.d.- https://www.rcn.org.uk/Get-Involved/Campaign-with-us/Prevention-is-better-than-cure#:~:text=Promotion%20of%20healthy%20lifestyles%20and,Desiderius%20Erasmus%20in%20around%201500.), and prevention costs less than treatment (Egunjobi, 2020[4]).

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

References

1. Chiu NC, Chi H, Tai YL, Peng CC, et al.: Impact of Wearing Masks, Hand Hygiene, and Social Distancing on Influenza, Enterovirus, and All-Cause Pneumonia During the Coronavirus Pandemic: Retrospective National Epidemiological Surveillance Study.J Med Internet Res. 2020; 22 (8): e21257 PubMed Abstract | Publisher Full Text
2. Dearling JLJ, van Dam EM, Harris MJ, Packard AB: Detection and therapy of neuroblastoma minimal residual disease using [64/67Cu]Cu-SARTATE in a preclinical model of hepatic metastases.EJNMMI Res. 2021; 11 (1): 20 PubMed Abstract | Publisher Full Text
3. Kwon S, Joshi AD, Lo CH, Drew DA, et al.: Association of social distancing and face mask use with risk of COVID-19.Nat Commun. 2021; 12 (1): 3737 PubMed Abstract | Publisher Full Text
4. Egunjobi ,J.P: Effectiveness of Hand Washing, Face Masking, Social Distancing, and Lockdown in preventing the Spread of Covid-19. ResearchGate. 2020.
5. Egunjobi J.P.: BIOPSYCHOSOCIOTECHNO-SPIRITUAL SELFCARE DURING COVID-19 LOCKDOWN April 2020. ResearchGate. 2020.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

psychology, psycho-spiritual therapy, neuropsychology, marriage and family, addictive disorders

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (0)

[1] 1. Morens DM, Folkers GK, Fauci AS: The challenge of emerging and re-emerging infectious diseases. Nature. 2004; 430(6996): 242–249. PubMed Abstract | Publisher Full Text | Free Full Text

[2] 2. Eyler AA, Chriqui JF, Moreland-Russell S, et al.: Prevention, policy, and public health. Oxford University Press; 2016. Publisher Full Text

[3] 3. Nsubuga P, White ME, Thacker SB, et al.: Public health surveillance: a tool for targeting and monitoring interventions. Disease Control Priorities in Developing Countries. 2nd ed.2006.

[4] 4. Detels R: Epidemiology: the foundation of public health. Oxford textbook of public health. 1st ed.2009; pp. 485–491. Publisher Full Text

[5] 5. Dowdle WR: The principles of disease elimination and eradication. Bull. World Health Organ. 1998; 76 Suppl 2(Suppl 2): 22–25. PubMed Abstract | Free Full Text

[6] 6. Alboaneen D, Pranggono B, Alshammari D, et al.: Predicting the epidemiological outbreak of the coronavirus disease 2019 (COVID-19) in Saudi Arabia. Int. J. Environ. Res. Public Health. 2020; 17(12): 4568. PubMed Abstract | Publisher Full Text | Free Full Text

[7] 7. Güner HR, Hasanoğlu İ, Aktaş F: COVID-19: Prevention and control measures in community. Turkish. J. Med. Sci. 2020; 50(SI-1): 571–577. PubMed Abstract | Publisher Full Text | Free Full Text

[8] 8. Pradhan D, Biswasroy P, Naik PK, et al.: A review of current interventions for COVID-19 prevention. Arch. Med. Res. 2020; 51(5): 363–374. PubMed Abstract | Publisher Full Text | Free Full Text

[9] 9. Nussbaumer-Streit B, Mayr V, Dobrescu AI, et al.: Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. Cochrane Database Syst. Rev. 4(9). PubMed Abstract | Publisher Full Text | Free Full Text

[10] 10. Almutairi AF, BaniMustafa A, Alessa YM, et al.: Public trust and compliance with the precautionary measures against COVID-19 employed by authorities in Saudi Arabia. Risk Manag. Healthc. Policy. 2020; 13(753): 753–760. PubMed Abstract | Publisher Full Text | Free Full Text

[11] 11. Saudi Press Agency: Interior minister approves regulation to limit gatherings and classifies violations and penalties.2020. (7 May 2020). Reference Source Reference Source

[12] 12. Saudi Press Agency: Ministry of interior approves revising regulations on limiting gatherings, updating violations classification schedule.2020. (30 May 2020). Reference Source

[13] 13. Furey E: Random Number Generator. CalculatorSoup- Online Calculators. Reference Source Reference Source

[14] 14. Alswaidi FM, Assiri AM, Alhaqbani HH, et al.: Characteristics and outcome of COVID-19 cases in Saudi Arabia: review of six-months of data (March-August 2020). Saudi Pharm J. 2021; 29: 682–691. PubMed Abstract | Publisher Full Text | Free Full Text

[15] 15. Alsofayan YM, Althunayyan SM, Khan AA, et al.: Clinical characteristics of COVID-19 in Saudi Arabia: A national retrospective study. J. Infect. Public Health. 2020; 13(7): 920–925. PubMed Abstract | Publisher Full Text | Free Full Text

[16] 16. Onder G, Rezza G, Brusaferro S: Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020; 323(18): 1775–1776. PubMed Abstract | Publisher Full Text

[17] 17. Parker A, Maree G, Götz G, et al.: Women and COVID-19 in Gauteng, South Africa.2020. (31 August 2020). Publisher Full Text Reference Source

[18] 18. Boehmer TK, DeVies J, Caruso E, et al.: Changing age distribution of the COVID-19 pandemic—United States, May–August 2020. Morb. Mortal. Wkly Rep. 2020; 69(39): 1404–1409. PubMed Abstract | Publisher Full Text | Free Full Text

[19] 19. Zhao W, Zhong Z, Xie X, et al.: Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: a multicenter study. Am. J. Roentgenol. 2020; 214(5): 1072–1077. PubMed Abstract | Publisher Full Text

[20] 20. Conti P, Younes A: Coronavirus COV-19/SARS-CoV-2 affects women less than men: Clinical response to viral infection. J. Biol. Regul. Homeost. Agents. 2020; 34(2): 339–343. PubMed Abstract | Publisher Full Text

[21] 21. European Centre for Disease Prevention and Control: Coronavirus disease 2019 (COVID-19) in the EU/EEA and the UK–eleventh update: resurgence of cases.2020. Reference Source

[22] 22. Brooks JT, Butler JC: Effectiveness of mask wearing to control community spread of SARS-CoV-2. JAMA. 2021; 325(10): 998–999. PubMed Abstract | Publisher Full Text | Free Full Text

[23] 23. Chu DK, Akl EA, Duda S, et al.: Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020; 395(10242): 1973–1987. PubMed Abstract | Publisher Full Text | Free Full Text

[24] 24. MacIntyre CR, Chughtai AA: A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. Int. J. Nurs. Stud. 2020; 108: 103629. PubMed Abstract | Publisher Full Text | Free Full Text

[25] 25. Tirupathi R, Bharathidasan K, Palabindala V, et al.: Comprehensive review of mask utility and challenges during the COVID-19 pandemic. Infez. Med. 2020; 28(suppl 1): 57–63. PubMed Abstract

[26] 26. Ministry of Health Saudi Arabia: Curve still going up in some KSA regions.2021. Reference Source

[27] 27. Teslya A, Pham TM, Godijk NG, et al.: Impact of self-imposed prevention measures and short-term government-imposed social distancing on mitigating and delaying a COVID-19 epidemic: A modelling study. PLoS Med. 2020; 17(7): e1003166. PubMed Abstract | Publisher Full Text | Free Full Text

[28] 28. Hammad MA, Alqarni TM: Psychosocial effects of social media on the Saudi society during the Coronavirus Disease 2019 pandemic: A cross-sectional study. PLoS One. 2021; 16(3): e0248811. PubMed Abstract | Publisher Full Text | Free Full Text

[29] 29. Alswaidi F, et al.: Unmatched case-control dataset (precautionary practices & Covid19 infection) (1).sav. Dataset. figshare. 2023. Publisher Full Text

[30] 30. Alswaidi F, Assiri AM, et al.: Study timeline.pdf. Dataset. figshare. 2023. Publisher Full Text

[31] 31. Alswaidi F, Assiri AM, et al.: Sampling flowchart.pdf. Dataset. figshare. 2023. Publisher Full Text

[32] 32. Alswaidi F, Assiri AM, et al.: The questionnaire. Dataset. figshare. 2023. Publisher Full Text

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Effect of facemask, handwashing, and social distancing on contracting COVID-19 infection in Saudi Arabia: a case-control study

Abstract

Keywords

Introduction

Objectives

Methods

Ethics

Study design

Study setting/data source

Sampling and data collection

Data analysis

Results

Table 1. Socio-demographic information of respondents in reference to cases and controls.

Table 2. Factors of facemask and handwashing in reference to cases and controls.

Table 3. Factors of social distancing one month prior to COVID-19 testing (in reference to cases and controls).

Table 4. Multivariate logistic regression analysis for the effect of socio-demographic factors, facemask, handwashing, and social distance on cases and controls (Enter Method).

Discussion

Demographic factors

Facemask factors

Handwashing factors

Social distancing factors

Conclusion

Limitations

Data availability

Underlying data

Extended data

Reporting guidelines

Acknowledgments

References

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