Regional Disparities in Information-Seeking Response to the COVID-19 Pandemic in China

Abstract

Background: In late December 2019, a newly coronavirus disease, later named as COVID-19, emerged in China. This unknown coronavirus and the subsequent official announcement of human-to-human transmission of COVID-19 alarmed the public and initiated the uptake of preventive measures. However, the manner in which the public responded to these announcements, and whether individuals from different provinces, responded similarly during the COVID-19 pandemic in China, remains unknown. To assess public reactions, we examined search interests during the COVID-19 epidemic in China. This study aimed to investigate how information seeking changed over time and how changes in information seeking varied across regions in China. 

Methods: We used an interrupted time-series analysis to examine the Baidu Search Index and selected COVID-19 related terms associated with the COVID-19 derived exposure variables. We analyzed the search index daily using segmented log-normal regressions with data from Jan 1, 2017 to Mar 15, 2021, and derived relative risk (RR) estimates representing relative daily changes associated with exposure. Analyses were stratified by the provincial Human Index (HDI)- an area-level measure of socioeconomic status- and were conducted to assess regional heterogeneity in information-seeking responses.  

Findings: Synchronous increases in COVID-19 related searches on the index were observed in the initial stage of the COVID-19 epidemic in all provinces regardless of the number of confirmed cases. The most precipitous increase occurred in the week following the announcement of human-to-human transmission (Jan 18 to Jan 25 2020), when most provinces had activated their highest level of response to public health emergencies. Search patterns increased more as the HDI level increased, with a 105·8 (95% CI: 99·1-113·0), 123·6 (95% CI: 116·6 -130·9) and 124·3 (95% CI: 115·5-133·8) fold increase in regions with low, middle and high HDI, respectively.  Searches on the index began to decline nationwide after the initiation of mass-scale lockdowns and travel restrictions, but statistically significant increases continued to occur in conjunction with the confirmation and report of major sporadic local outbreaks, including the outbreaks in Beijing (June, 2020), Qingdao (October, 2020) and Shijiazhuang (January, 2021). The relative increase in searches on the index was statistically significantly higher in regions with higher HDI in each outbreak. 

Interpretation: Using search index data of nearly one billion internet users in China, we found that changes in the patterns of search interest in COVID-19 in each province of China occurred in a synchronous fashion during the first wave of the COVID-19 pandemic and at the time of subsequent local outbreaks, irrespective of the location of the epicenter of each outbreak and the variation in pandemic severity across the country. However, inequalities in the magnitude of public response to and awareness of COVID-19 were evident, with lower-levels of information seeking regarding COVDI-19 in less developed areas compared with developed areas.

Funding Information: National Natural Science Foundation of China (72074130) Spring Breeze Foundation of Tsinghua University (20203080035)

Declaration of Interests: The authors declare no competing interests related to the study.