ANALYSIS OF COVID-19 LOCKDOWN AND INCREASED HUNGER AMONGST CITIZENS

CHAPTER TWO

LITERATURE REVIEW

2.1 INTRODUCTION

Our focus in this chapter is to critically examine relevant literature that would assist in explaining the research problem and furthermore recognize the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps.

2.2 CONCEPTUAL FRAMEWORK

COVID-19

SARS-CoV-2 is a member of the family Coronaviridae and order Nidovirales. The family consists of two subfamilies, Coronavirinae and Torovirinaeand members of the subfamily Coronavirinae are subdivided into four genera: (a)Alphacoronavirus contains the human coronavirus (HCoV)-229E and HCoV-NL63; (b) Betacoronavirus includes HCoV-OC43, Severe Acute Respiratory Syndrome human coronavirus (SARS-HCoV), HCoV-HKU1, and Middle Eastern respiratory syndrome coronavirus (MERS-CoV); (c) Gammacoronavirus includes viruses of whales and birds and; (d) Deltacoronavirus includes viruses isolated from pigs and birds [Burrell C, et al.2016]. SARS-CoV-2 belongs to Betacoronavirus together with two highly pathogenic viruses, SARS-CoV and MERS-CoV. SARS-CoV-2 is an enveloped and positive-sense single-stranded RNA (+ssRNA) virus [Kramer A, et al.2006].

SARS-CoV-2 is considered a novel human-infecting Betacoro- navirus [Lu R,et al.2020]. Phylogenetic analysis of the SARS-CoV-2 genome indicates that the virus is closely related (with 88% identity) to two bat-derived SARS-like coronaviruses collected in 2018 in east- ern China (bat-SL-CoVZC45 and bat-SL-CoVZXC21) and genetically distinct from SARS-CoV (with about 79% similarity) and MERS-CoV [Lu R,et al.2020]. Using the genome sequences of SARS-CoV-2, RaTG13, and SARS-CoV [Zhou P,et al.2020], a further study found that the virus is more related to BatCoV RaTG13, a bat coronavirus that was previously detected in Rhinolophus affinis from Yunnan Province, with 96.2% overall genome sequence identity [Zhou P,et al.2020]. A study found that no evidence of recombination events detected in the genome of SARS-CoV-2 from other viruses originating from bats such as BatCoV RaTG13, SARS- CoV and SARSr-CoVs [Zhou P,et al.2020]. Altogether, these finding suggest that bats might be the original host of this virus.

However, a study is needed to elucidate whether any inter- mediate hosts have facilitated the transmission of the virus to humans. Bats are unlikely to be the animal that is directly responsi- ble for transmission of the virus to humans for several reasons [Lu R,et al.2020]:

1. there were various non-aquatic animals (including mammals) available for purchase in Huanan Seafood Wholesale Market but no bats were sold or found;
2. SARS-CoV-2 and its close relatives, bat- SL-CoVZC45 and bat-SL-CoVZXC21, have a relatively long branch (sequence identity of less than 90%), suggesting those viruses are not direct ancestors of SARS-CoV-2; and

(3) in other coronaviruses where bat is the natural reservoir such as SARS-CoV and MERS-CoV, other animals have acted as the intermediate host (civets and pos- sibly camels, respectively). Nevertheless, bats do not always need an intermediary host to transmit viruses to humans. For example, Nipah virus in Bangladesh is transmitted through bats shedding into raw date palm sap.

2.1.1 Transmission

The role of the Huanan Seafood Wholesale Market in propagating disease is unclear. Many initial COVID-19 cases were linked to this market suggesting that SARS-CoV-2 was transmitted from animals to humans. However, a genomic study has provided evidence that the virus was introduced from another, yet unknown location, into the market where it spread more rapidly, although human-to-human transmission may have occurred earlier [Yu W,et al.2020]. Clusters of infected family members and medical workers have confirmed the presence of person-to-person transmission [Yu W,et al.2020]. After January 1, less than 10% of patients had market expo- sure and more than 70% patients had no exposure to the market [Yu W, et’al. 2020]. Person-to-person transmission is thought to occur among close contacts mainly via respiratory droplets produced when an infected person coughs or sneezes. Fomites may be a large source of transmission, as SARS-CoV has been found to persist on surfaces up to 96h [Kramer A, et al.2016] and other coronaviruses for up to 9 days.Whether or not there is asymptomatic transmission of disease is controversial. Findings about disease characteristics are rapidly changing and subject to selection bias. A study indicated the mean incubation period was 5.2 days (95% confidence interval [95%CI]: 4.1–7.0). The incubation period has been found to be as long as 19 or 24 days , although case definitions typically rely on a 14 day window (G.S 2020).

The basic reproductive number (R0) has been estimated with varying results and interpretations. R0 measures the average num- ber of infections that could result from one infected individual in a fully susceptible population. Studies from previous outbreaks found R0 to be 2.7 for SARS and 2.4 for 2009 pandemic H1N1 influenza. One study estimated that that basic reproductive number (R0) was 2.2 (95% CI: 1.4–3.9). However, later in a fur- ther analysis of 12 available studies found that R0 was 3.28. Because R0 represents an average value it is also important to consider the role of super spreaders, who may be hugely responsible for outbreaks within large clusters but who would not largely influence the value of R0. During the acute phase of an outbreak or prepandemic, R0 may be unstable .

In pregnancy, a study of nine pregnancy women who developed COVID-19 in late pregnancy suggested COVID-19 did not lead to substantially worse symptoms than in nonpregnant persons and there is no evidence for intrauterine infection caused by vertical transmission [Chen HEA 2020].

In hospital setting, a study involving 138 COVID-19 suggested that hospital-associated transmission of SARS-CoV-2 occurred in 41% of patients [Wang. D 2020 ].

2.1.2 Risk factors

The incidence of SARS-CoV-2 infection is seen most often in adult male patients with the median age of the patients was between 34 and 59 years. SARS-CoV-2 is also more likely to infect people with chronic comorbidities such as cardio- vascular and cerebrovascular diseases and diabetes. The highest proportion of severe cases occurs in adults 60 years of age, and in those with certain underlying conditions, such as cardiovascular and cerebrovascular diseases and diabetes. Severe manifestations maybe also associated with co-infections of bacteria and fungi [Chen N. et’al 2020].

Fewer COVID-19 cases have been reported in children less than 15 years [20,30,7,32]. In a study of 425 COVID-19 patients in Wuhan, published on January 29, there were no cases in children under 15 years of age. Nevertheless, 28 pediatric patients have been reported by January 2020. The clinical features of infected pediatric patients vary, but most have had mild symptoms with no fever or pneumonia, and have a good prognosis. Another study found that although a child had radiological ground-glass lung opacities, the patient was asymptomatic. In summary, children might be less likely to be infected or, if infected, present milder manifestations than adults; therefore, it is possible that their parents will not seek out treatment leading to underestimates of COVID-19 incidence in this age group.

Clinical manifestations

Clinical manifestations of 2019-nCoV infection have similarities with SARS-CoV where the most common symptoms include fever, dry cough, dyspnoea, chest pain, fatigue and myalgia [Huang C, et al.2020]. Less common symptoms include headache, dizziness, abdominal pain, diarrhoea, nausea, and vomiting [Huang C, et al.2020]. Based on the report of the first 425 confirmed cases in Wuhan, the common symptoms include fever, dry cough, myalgia and fatigue with less common are sputum production, headache, haemoptysis, abdominal pain, and diarrhoea. Approximately 75% patients had bilateral pneu- monia. Different from SARS-CoV and MERS-CoV infections, however, is that very few COVID-19 patients show prominent upper respiratory tract signs and symptoms such as rhinorrhoea, sneezing, or sore throat, suggesting that the virus might have greater preference for infecting the lower respiratory tract [Huang C, et al.2020]. Pregnant and non-pregnant women have similar characteristics. The common clinical presentation of 2019-nCoV infection are presented in Table 1.

Severe complications such as hypoxaemia, acute ARDS, arry- thmia, shock, acute cardiac injury, and acute kidney injury have been reported among COVID-19 patients [Huang C, et al.2020]. A study among 99 patients found that approximately 17% patients developed ARDS and, among them, 11% died of multiple organ failure. The median duration from first symptoms to ARDS was 8 days .

Diagnosis

Efforts to control spread of COVID-19, institute quarantine and isolation measures, and appropriately clinically manage patients all require useful screening and diagnostic tools. While SARS-CoV- 2 is spreading, other respiratory infections may be more common in a local community. The WHO has released a guideline on case surveillance of COVID-19 on January 31, 2020. For a person who meets certain criteria, WHO recommends to first screen for more common causes of respiratory illness given the season and location. If a negative result is found, the sample should be sent to referral laboratory for SARS-CoV-2 detection.

Case definitions can vary by country and will evolve over time as the epidemiological circumstances change in a given location. In China, a confirmed case from January 15, 2020 required an epidemiological linkage to Wuhan within 2 weeks and clinical features such as fever, pneumonia, and low white blood cell count. On January 18, 2020 the epidemiological criterion was expanded to include con- tact with anyone who had been in Wuhan in the past 2 weeks [50]. Later, the case definitions removed the epidemiological linkage.

The WHO has put forward case definitions [23]. Suspected cases of COVID-19 are persons (a) with severe acute respiratory infections (history of fever and cough requiring admission to hospital) and with no other aetiology that fully explains the clinical presentation and a history of travel to or residence in China during the 14 days prior to symptom onset; or (b) a patient with any acute respiratory illness and at least one of the following during the 14 days prior to symptom onset: contact with a confirmed or probable case of SARS-CoV-2 infection or worked in or attended a health care facility where patients with confirmed or probable SARS-CoV-2 acute respiratory disease patients were being treated. Probable cases are those for whom testing for SARS-CoV-2 is inconclusive or who test positive using a pan-coronavirus assay and without laboratory evidence of other respiratory pathogens. A confirmed case is one with a laboratory confirmation of SARS-CoV-2 infection, irrespective of clinical signs and symptoms.

For patients who meet diagnostic criteria for SARS-CoV-2 testing, the CDC recommends collection of specimens from the upper respiratory tract (nasopharyngeal and oropharyngeal swab) and, if possible, the lower respiratory tract (sputum, tracheal aspirate, or bronchoalveolar lavage). In each country, the tests are per- formed by laboratories designated by the government.

Treatments

Similar to MERS-CoV and SARS-CoV, there is still no specific antiviral treatment for COVID-19. Isolation and supportive care including oxygen therapy, fluid management, and antibiotics treatment for secondary bacterial infections is recommended. Some COVID-19 patients progressed rapidly to ARDS and septic shock, which was eventually followed by multiple organ failure [Huang C, et al.2020]. Therefore, the effort on initial management of COVID-19 must be addressed to the early recognition of the suspect and contain the disease spread by immediate isolation and infection control measures .

Currently, no vaccination is available, but even if one was avail- able, uptake might be suboptimal. A study of intention to vaccinate during the H1N1 pandemic in the United States was around 50% at the start of the pandemic in May 2009 but had decreased to 16% by January 2010.

Neither is a treatment available. Therefore, the management of the disease has been mostly supportive referring to the disease severity which has been introduced by WHO. If sepsis is identi- fied, empiric antibiotic should be administered based on clinical diagnosis and local epidemiology and susceptibility information. Routine glucocorticoids administration are not recommended to use unless there are another indication. Clinical evidence also does not support corticosteroid treatment. Use of intravenous immunoglobulin might help for severely ill patients .

Drugs are being evaluated in line with past investigations into therapeutic treatments for SARS and MERS. Overall, there is not robust evidence that these antivirals can significantly improve clinical outcomes A. Antiviral drugs such as oseltamivir combined with empirical antibiotic treatment have also been used to treat COVID- 19 patients [Huang C, et al.2020]. Remdesivir which was developed for Ebola virus, has been used to treat imported COVID-19 cases in US [Holshue ML, 2020]. A brief report of treatment combination of Lopinavir/Ritonavir, Arbidol, and Shufeng Jiedu Capsule (SFJDC), a traditional Chinese medicine, showed a clinical benefit to three of four COVID-19 patients [Holshue ML, 2020]. There is an ongoing clinical trial evaluating the safety and efficacy of lopinavir-ritonavir and interferon-α 2b in patients with COVID- 19 [Huang C, et al.2020]. Ramsedivir, a broad spectrum antivirus has demonstrated in vitro and in vivo efficacy against SARS-CoV-2 and has also initiated its clinical trial. In addition, other potential drugs from existing antiviral agent have also been proposed.

Control and prevention strategies

COVID-19 is clearly a serious disease of international concern. By some estimates it has a higher reproductive number than SARS, and more people have been reported to have been infected or died from it than SARS. Similar to SARS-CoV and MERS-CoV, disrupting the chain of transmission is considered key to stopping the spread of disease. Different strategies should be implemented in health care settings and at the local and global levels.

To prevent further spread of the virus, civil societies, and government agencies-initiated awareness programs for promotions of several preventive measures. Body temperature screening was conducted at airports and those returning from countries with a high number of confirmed cases of COVID-19 were advised to self-isolate. The Nigeria Center for Disease Control in collaboration with State governments also initiated tracing and tracking of victims and their contacts. On 18th March 2020, the Nigerian government prohibited all gatherings of fifty people or above for four weeks and ordered a stay-at-home (Ewodage, 2020). Similarly, the Nigerian government, on 30th March 2020 introduced various containment plan such as the closing of the national borders and airspace, schools, worship centers, and other public places, canceling of public gathering events, the complete lockdown of the Federal Capital Territory, Lagos and Ogun states for fourteen days initially (Radio Nigeria, 2020).Body temperature screening was conducted at airports and those returning from countries with a high number of confirmed cases of COVID-19 were advised to self-isolate.

Some stipulated COVID 19 preventive measures are listed as follows:

1. Social distance
2. Self-isolation
3. Washing of hands with detergent or use of alcohol based sanitizers 4. Putting on a face mask in public places

COVID-19 LOCKDOWN

Due to the COVID-19 pandemic, a number of non-pharmaceutical interventions colloquially known as lockdowns (encompassing stay-at-home orders, curfews, quarantines, cordons sanitaires and similar societal restrictions) have been implemented in numerous countries and territories around the world. These restrictions were established to reduce the spread of SARS-CoV-2, the virus that causes COVID-19.

By April 2020, about half of the world's population was under some form of lockdown, with more than 3.9 billion people in more than 90 countries or territories having been asked or ordered to stay at home by their governments. Although similar disease control measures have been used for hundreds of years, the scale seen in the 2020s is thought to be unprecedented.

Research and case studies have shown that lockdowns are effective at reducing the spread of COVID-19, therefore flattening the curve. The World Health Organization's recommendation on curfews and lockdowns is that they should be short-term measures to reorganize, regroup, rebalance resources, and protect health workers who are exhausted. To achieve a balance between restrictions and normal life, the WHO recommends a response to the pandemic that consists of strict personal hygiene, effective contact tracing, and isolating when ill.

Countries and territories around the world have enforced lockdowns of varying stringency. Some include total movement control while others have enforced restrictions based on time.

The COVID-19 pandemic is potentially catastrophic and destroying, in order minimize it effect, as no current vaccine or drugs to the cure of the crises, as at the time of compiling this paper, the government at both federal and state level introduced a lockdowns strategically plan which present an opportunity to slow the spread of the pandemic. However ,such stay-at-home policies planted the seeds of recession in developed countries, and there was a general consensus among economists that the coronavirus pandemic would plunged the world into a global recession which in turn affect the global food security (Financial Times, 2020).

According to (WHO, 2020; NCDC, 2020). Lockdown Measures (common prevention tips) to Covid-19 in Nigeria are as follows:

1. Listen for instructions from your local government about staying home.
2. Keep a safe distance from others
3. Clean hands often and disinfect frequently touched surfaces at home. IV. Don’t touch eyes, nose or mouth.
4. Cover coughs and sneezes with your elbow or tissue Source:

FOOD INSECURITY AS A PREDICTOR TO HUNGER

,Food insecurity has emerged as one of the key problems for development which poses challenge to the society. Food insecurity exists when people do not have adequate physical, social or economic access to food as defined above the food security situation must be urgently assessed to address any potential need for assistance. There are two kinds of food insecurity:

1. chronic and B. transitory.

Chronic food insecurity is characterized by a continuously inadequate diet, caused by the incapacity to produce, purchase, or otherwise obtain sufficient food (Matemilola and Elegbede, 2017).

Transitory food insecurity is a temporary decline in a household‟s access to sufficient food, stemming from fluctuations in production or incomes. The most common causes of food insecurity in African and other third world countries were; drought and other extreme weather events, pests, livestock diseases and other agricultural problems, climate change, military conflicts, lack of emergency plans, corruption and political instability, cash crops dependence, aids and rapid population growth (AFI, 2012).

Food insecurity does not only describe situations where current food intake is inadequate, it also covers the potential for future food intake to be inadequate. This is apparent from the phrase “at all times”in most standard definitions of food security (Sphere Project 2004). Therefore, this study aimed at providing further evidence on transitory food insecurity and the impact of covid-19 outbreak and lockdown on household food security. The study also divulge on the remedial option to reduce such circumstance. Transitory food insecurity as mention earlier exists when people do not have adequate physical, social or economic access to food as defined above the food security situation. “A sudden (and often precipitous) drop in the ability to purchase or grow enough food to meet physiological requirements for good health and activity”. “The sudden reduction of a household’s access to food to below the nutritionally adequate level” (IFAD, 1997). “Transitory food insecurity concerns shocks that briefly push the level of food consumption below the requirements” (IFAD, 1997). “Transitory vulnerability to food insecurity involves a temporary inability to meet food needs or smooth consumption levels” (WFP, 2005). “Transitory food insecurity affects households that are able to meet their minimum food needs at normal times, but are unable to do so after a shock” (WFP 2005). “Transitory food insecurity occurs when there is a temporary inability to meet food needs, usually associated with a specific shock or stress such as drought, floods or civil unrest” (DFID 2002). “Transitory food insecurity: being unable to meet the food intake needs when specific fluctuations or shocks affect income or means to access food, without sacrificing productive assets or undermining the human capital” (Dhur, 2005).

The experience from previous disease outbreaks such as Ebola, Lassa fever etc. as provides valuable information on how to think about the implications of COVID-19 to transitory food insecurity.

The causes of transitory food insecurity in Nigeria

Transitory Food insecurity has been observed to be rampart in less developed countries with Nigeria as no exception. The causes of transitory food insecurity includes but not limited to:

1. Disease and infection: The current Covid-19 Pandemic continues to plague in Nigeria. First, the spread of the virus encouraged social distancing which led to the shutdown of food markets, restaurants, financial institutions, Agri-businesses & business units, events centres and even borders. COVID-19 and other infectious diseases such as Lassa fever not only reduce the man-hours available to agriculture and household food acquisition but also increase the burden of household in acquiring food.
2. Increase in food prices: Ensuring food security is currently one of the greatest challenges facing Nigerian community because food prices continue to soar in many states thereby causing low purchasing power on the part of household. A rising price indicator may reflect supply deficits due to lower production (labour shortage, shortage of inputs in affected and production areas), lower food imports and increasing demand. Civil insecurity: The rise in food prices is also related to the persistent and widespread conflict between farmers and herdsmen.
3. Movement and trade restrictions: The movement and trade restrictions that have been imposed by the government in order to limit the transmission of the disease have seriously disrupted the economic activities. This economic slowdown has hit all areas in Nigeria as well as neighbouring countries, irrespective of the magnitude of the COVID-19 outbreak. Certain groups have been disproportionally affected by loss of income, namely informal and agricultural workers. Also the border closures endorse since have also led to reduced income for cash crop producers due to missed export opportunities. In a similar vein on the study of Ebola outbreak, FEWS NET.2017., Stress that weekly or monthly market closures can compromise household capacity to both purchase food and to sell other goods to earn money to buy food, with some implications for overall food security.
4. Handicapping policies: The current lockdown policies have greatly affected the food security in Nigeria. The problem arises because the focus of the policy structures is put above that of the people expectation as majority of the household earn their living through hand to mouth i.e what they earn on daily basis is what they spent to carter for their family, which lockdown policy as disrupted.
5. Low technology for processing and storage: The use of modern technologies in the production and distribution of agricultural products is very low in Nigeria, these along with other factors made the sector to be more depended on manual labour for farming activities. Also, lack of processing facilities to preserved food items of classes of fruits and vegetables, cereals, legumes, etc. which also result in wastage thereby further deepening the insecurity level of food.
6. Others causes of food insecurity as stressed includes; insufficient production, Gender inequalities, Conflict and civil insecurity and climate change & Natural disasters (Matemilola and Elegbede, 2017).

COVID-19 LOCKDOWN AND HUNGER

Since food insecurity is a predictor to hunger, suffice to say that when food crops are affected due to covid lockdown, hunger will have its own toll on the masses.

The full impacts of COVID-19 lockdown on food security are difficult to predict and will be context-specific. However, lessons can be learned from past crises which are important to bear in mind today. The 2014 West Africa EVD outbreak had important implications for food security in that region. The measures to contain the outbreak – in particular the quarantines and restrictions to public gatherings and movements of goods and persons – disrupted agricultural market supply chains, and many farmers were unable to grow or sell crops due to lack of inputs and labour. These factors considerably impacted food production. For example in Liberia, 47percent of farmers reported they were unable to cultivate farmland due to the outbreak. Furthermore, travel restrictions and suspension of operations of periodic markets disrupted trade flows of food commodities and other necessities. Due to the disruption of markets, in particular international flows due to border controls, there were shortages of goods on the market and this led to an increase in prices of key commodities (FAO, 2020). Some of the impact of COVID-19 and lockdown to transitory food insecurity in Nigeria include but not limited to: 1. Significant Post-harvest losses: The difficulty for producers and traders to sell surpluses to neighbouring states has led to significant spoilage and post-harvest losses. Situational report from Yankaba and Yanlemo market in Kano state in Nigeria, were large amount of fruits and vegetable such as watermelon, orange, pear, tomato, fresh onion, pepper etc. get spoiled every day until the recent ease on lockdown by the state government.

1. There was an overall loss of household income and purchasing power: This is related to the difficulties in trading produces but also to a broader decline in economic activity.
2. Changes in Household Spending Patterns: The restrictions on movements and market closures led to temporary price spikes and slumps as goods became unavailable. Some reported price peaks were large; for example, price of 50kg bag of sugar rise from N15,000 to N22,000, a Mudu of local rice increase in cost from N840 to N1,400, price of Garri per Mudu skyrocketed to N1,000 as for it early price of N400. These and other conditions have made household families to shift their demands to a cheaper package for livelihood. (e.g. Rice substituted with Garri, and to other low key foods of cereals and leguminous classes).
3. Disruption of food supply chains: COVID-19 has the potential to severely disrupt critical food supply chains, including between rural and urban areas. Movement or import/ export restrictions has result challenges to transport key food items and access processing units and markets, affecting both producers and consumers. This has led to reduced farmers’ incomes and instability of food prices deviating from geographical and seasonal patterns, thus creating uncertainty for both producers and consumers. This is likely to have significant adverse effects in particular on the most vulnerable actors, such as informal labourers, vulnerable urban populations, displaced populations and others that rely heavily on the market to meet their food needs. Reduced or lost wages, unstable prices, and haphazard availability of essential food items would have serious implications for acute food security and malnutrition levels in these populations. 5. Other impacts includes: Families lost their love ones, some police harass, road closed linking communities, man-labour work reduce, social tension, problems in accessing financial services and difficulties in transportation.

HUNGER SURVIVAL STRATEGY DURING COVID-19 LOCKDOWN

Different causal factors imply differentiated policy responses. If food insecurity is a result of disrupted food systems, then restoring access to food is the most appropriate response. There is a range of policy instruments for achieving this imperative:

1. Food-based (food transfers, food for work) - food transfer such as palliatives food for vulnerable people introduce by Nigerian government at both state and federal levels. Others include Food donations from stakeholders, private individuals, corporates, donor agencies etc.
2. Cash-based (cash transfers, cash for work), such as cash transfer measures taken by Ministry of Humanitarian Affairs, Disaster management and Social Development. Palliatives stipend from others aids bodies such as foundation, women organisation, youth development agencies etc.
3. Market-based (open market operations, food price subsidies).
4. IV. Market mechanism (Price flow and price ceiling)

Others are mechanisms by which households or community members meet their relief and recovery needs and adjust to future disaster- related risks termed as ‘Coping strategies’.

1. Change in consumption patterns.
2. Sale of assets such as livestock to food grain purchase from the local markets.
3. Borrowing grains from other farmers.
4. Support from relatives and friends.

2.2 THEORTICAL FRAMEWORK

The theory used for this study is the Health Belief Model and theory of Planned behavior theory.

The Health Belief Model (HBM) was developed to help understand why people did or did not use preventive services offered by public health departments in the 1950’s, and has evolved to address newer concerns in prevention and detection (e.g., mammography screening, influenza vaccines) as well as lifestyle behaviors such as sexual risk behaviors and injury prevention. The HBM theorizes that people’s beliefs about whether or not they are at risk for a disease or health problem, and their perceptions of the benefits of taking action to avoid it, influence their readiness to take action. Core constructs of the HBM: • Perceived susceptibility and perceived severity • Perceived benefits and perceived barriers • Cues to action • Self-efficacy (added more recently) The HBM has been most-often applied for health concerns that are prevention-related and asymptomatic, such as early cancer detection and hypertension screening – where beliefs are as important or more important than overt symptoms. The HBM is also clearly relevant to interventions to reduce risk factors for cardiovascular disease.

Source: Becker, M. H. & Maiman, L. A., (1975). Socio-behavioral determinants of compliance with health and medical care recommendations. Medical Care, 134(1), 10-24.

The theory of planned behavior (TPB) is a psychological theory that links beliefs to behavior. The theory maintains that three core components, namely, attitude, subjective norms, and perceived behavioral control, together shape an individual's behavioral intentions. In turn, a tenet of TPB is that behavioral intention is the most proximal determinant of human social behavior.

2.3 Summary of Literature

The novel Corona Virus has been described by WHO as an infectious disease. The above reviewed literature explained its classification origin, clinical manifestations,symptoms and preventive strategies.To prevent further spread of the virus, civil societies, and government agencies-initiated awareness programs for promotions of several preventive