Social Attitudes of People Towards Adhering to Health Protocols to Prevent Covid-19 Infection

Background: The use of masks is effective in reducing the incidence of covid-19 and can reduce the risk of transmission of Covid-19 disease through carriers or those who have not yet been diagnosed with symptoms. In some societies, however, it is common culture that only sick people wear masks. In addition to the mask, the World Health Organization has proposed two alcohol-based formulations for hand hygiene and reducing the prevalence and contamination of coronavirus in health care, but why do people not follow the health protocols regularly and seriously, despite having enough information about the conditions and dangers of this virus?


Introduction
According to the World Health Organization, the first human infection related to Covid-19 was registered in Wuhan, China in early December 2019 [1]. The World Health Organization, on the recommendation of IHR Emergency Committee on January 30, 2020, declared the outbreak as "public health emergencies of international concern (PHEIC) [2]. The disease spread rapidly and spread to most parts of the world, affecting almost all public places and different strata. Places that are considered high-risk areas for disease and have less health facilities include shops, sports clubs, exhibitions, nursing homes, prisons and psychiatric hospitals. It is estimated that about 14 million elderly people over 65 years in nursing homes and 10.74 million inmates in prisons [3,4], who are at higher risk due to fewer facilities. Also on February 8, 2020, in a report in a Chinese hospital, at least 50 patients with psychiatric disorders and 30 mental health professionals were infected with the virus [5], one of the reasons could be the irregular mental state of these people, which in itself reduces the observance of health protocols.
According to research conducted in the United States, the virus has threatened many patients and operating room therapists and caused many problems for surgeons [6]. There are also many other such cases in various fields that have been studied by researchers. Following the outbreak of this disease, extensive research has been done to find a way to prevent and treat this disease. No vaccine is currently available, and treatment is mainly supportive. Measures should include avoiding unnecessary travel, identifying and isolating patients in the early stages, hand hygiene, respiratory hygiene, environmental hygiene, and social distance. The World Health Organization (WHO) has stated that SARS-Cov-2 is transmitted through airborne particles [7]. Van Doremalen et al. Stated that SARS-Cov-2 could survive for 3 hours in an aerosol less than 5 mm [8]. Due to the similar transmission characteristics between influenza and Covid-19, researchers consider the use of masks and hand hygiene to be the most effective way to prevent the disease [9][10][11]. In a research conducted in Taiwan, the use of masks has been shown to be effective in reducing the incidence of Covid-19 [12]. The use of masks was also effective in reducing the incidence of SARS 2003 [13,14]. Currently, the use of masks can reduce the risk of transmission of Covid-19 disease through carriers or those who have not yet been diagnosed with symptoms [15].
Indirect effects of mask use also include creating a social norm in society and increasing the level of risk perception, which can ultimately improve personal hygiene behaviors [16,17]. At one point, Us Surgeon General urged people to stop buying masks [18].
In addition, one of the reasons why people in some countries do not use masks is the limited supply of masks in health centers [19]. The shortage of supply of masks and the increase in demand has led to a significant increase in its price. This leads to the repeated use In some societies, it is common culture for only sick people to wear masks. In these societies, people are reluctant to wear masks and avoid wearing masks in order not to be identified as sick [21,22].
The World Health Organization has proposed two alcohol-based formulations for hand hygiene and reducing the prevalence and contamination caused by the Corona virus. These recommendations are based on rapid and effective antimicrobial activity as well as their widespread effectiveness [23].
However, some research shows that the use of disinfectants to prevent covid-19 is dangerous to the health of the environment and humans, and it is recommended that hands be washed frequently with soap and water to prevent possible contamination and infection [24]. Excessive ethanol consumption can cause Irritation, dryness or cracking of the skin, leading to symptoms such as redness and itching of the skin. It can also cause skin cancer [25,26]. It is worth noting that in winter, many people may confuse the disease with the cold, which can lead to an arbitrary increase in antibiotic use [27].
Adherence to health protocols by people in different social classes can have a great impact on preventing or controlling the disease.
But why do people not follow the health protocols regularly and seriously, despite having enough information about the conditions and dangers of this virus? In this article, we examine people's social perspectives on the use of masks and disinfectants, as well as the role of factors such as income level, age and gender in people's perspectives.

Methods and Materials
The present study is a cross sectional descriptive-analytical study that was conducted in the fall of 1399 (October and   According to our results, older people use masks more, so that 96% of people over 40 use masks. This is while the rate of mask use in the age group of 20 to 29 years is about 84% (Table 3). According to the study, 360 people wore masks while away from home.
However, 63 people used the mask only when crowded and 51 people only when they entered the closed space ( Table 4). The main reason for not using the mask was "breathing hard while masking" and also the belief that "masking has no effect on preventing Corona disease". According to the data presented in Table 5 believe that the use of disinfectants causes skin problems. After that, the main reasons for not using disinfectants, respectively, are "expensive disinfectants" and the idea that "hand washing alone is sufficient" ( Table 5). Table 3: Different reasons why people in the community do not use masks.

Makes breathing difficult
It has no effect on prevention Its price is high It is difficult to access Disinfectants alone are sufficient    [28]. It is better for people to use mild detergents as much as possible and without chemical and nonaromatic dyes. It is also recommended to use moisturizing or moisturizing creams after consuming these substances so that the destruction of skin tissue occurs less quickly.
Also, due to the fact that Covid 19 was not anticipated and considered, the increase in demand and lack of resources has led to an increase in prices, which also leads to a decrease in the purchasing power of people in the community. On the other hand, 37% of the participants believed that using a mask and hand washing alone would suffice, which would increase the level.
Clarifies information and awareness in the community.
According to studies, there are several reasons for not using a mask. For example, some people with a degree below the diploma, scientific and medical aspects do not understand the need to use a mask to prevent the spread of the virus in the environment and disease transmission. They avoid wearing masks, believing that most people they meet and interact with on a daily basis in different places are in seemingly healthy physical condition, but may in fact be carriers of the disease. Of course, a large percentage of the participants had a relatively good awareness, which could indicate that the government and the media have done some good work in raising public awareness. Also, according to the results, it was observed that about 3.3% of people, regardless of any level of science, finance, age, etc. do not use any masks and disinfectants.
Two women and 15 men (when talking to these people, it became clear that they were mostly young people in the community and believed that due to having a strong immune system, if infected, they would have a mild form of the disease and their serious risks However, these people should be aware that in case of infection they may not have any symptoms and by not following the protocols, they may spread the disease.
However, this percentage will be a little worrying in larger statistical populations. Adequate information, information and education about the disease and methods of prevention and transmission should be given to the people so that changing the attitudes of those few people will eventually lead to a change in their behavior and encourage them to follow health protocols. In this way, in addition to their own health, the health of others is largely guaranteed. In the meantime, special attention should be paid to the cultural factor. In societies where it is believed that only suspicious and carriers or patients wear masks and there is stigma and discrimination, many people avoid wearing masks [29]. Even in studies [30,31] it has been stated that some employers in highrisk environments such as grocery stores, etc., stop their employees from wearing masks. Another reason for not using a mask, especially for older people who also have underlying diseases, is shortness of breath and the general belief that it has no effect on prevention. However, according to the results recorded in related articles, the use of masks in older people has been reported more than young people.
In our study, people 40 years old about 4% more than people between 20-40 years old use masks This statistic can be partly due to the fact that older people are at higher risk due to diseases and weakened immune systems. Of course, we know that the use of masks in all age groups, especially indoors is essential [32].
According to the statistical studies and calculations obtained from the questionnaire, similar to the results of most other articles, we find that women are more likely than men to use masks and disinfectants [33]. Our statistics show 220 people make up more than 50% of women who use both masks and disinfectants, and women have a higher rate of menopause than ever before. It can be due to the normalization of the condition and more inattention of men to the disease. If we want to find out more precisely and psychologically the cause of this issue, we can refer to research done in previous pandemics such as SARS and H1N1 These studies showed that men try to overcome their fears and do not wear masks because of social and psychological taboos and with the view that masking is a sign of weakness and fear [34,35]. According to the results of some studies, it can be said that blood type A should follow health protocols more than others [36].

Conclusion
The incidence of covid-19 is increasing daily around the world, and one of the most important reasons is the lack of compliance with health protocols by people in the community. In Iran, most people use both masks and disinfectants, but the number of patients is still high, which can be due to various reasons such as "the quality of the masks" and "lack of proper use of how to put and remove the mask" and so on which needs more research. The main reason why people in the community do not use the mask is that "wearing a mask makes it harder to breathe", as well as this believe that the use of disinfectants can cause skin problems. It is suggested that the media place more serious emphasis on this disease and increase the level of public awareness in the field so that this disease is taken more seriously and health protocols are followed in the right way.