Received: 14 June 2020 Accepted: 28 June 2020

DOI: 10.1002/kjm2.12276

CORRESPONDENCE

Perceived confidence of the local governments in controlling

the COVID-19 pandemic

Dear Editor, must shoulder the responsibility of assisting the public with their
The decisions made by a country's central government in urgent financial and medical needs during the pandemic. It is reason-
response to coronavirus disease 2019 (COVID-19) outbreaks must be able to hypothesize that the pandemic-prevention confidence of local
implemented by local governments. Furthermore, local governments governments may affect public concerns regarding contracting

T A B L E 1 Associations between the respondents' perception of the confidence of their local government in coping with COVID-19 and
predictors, examined using univariate and multivariate linear regressions (N = 1954)

Univariate regression Multivariate regression

Predictors Mean SD Wals χ 2

P OR 95% CI of OR Wals χ 2 P OR 95% CI of OR
Age (years) 37.9 10.8 6.144 .013 1.014 1.003-1.024 7.586 .006 1.017 1.005-1.029
n % Wals χ 2 P OR 95% CI of OR Wals χ 2 P OR 95% CI of OR
Sex
Female 1305 66.8 1.722 .189 1.175 .923-1.495
Male 649 33.2
Education level
High (college or above) 1736 88.8 .000 .993 .998 .701-1.422
Low (high school or below) 218 11.2
Self-confidence in coping with COVID-19
Low 268 13.7 278.272 <.001 11.373 8.547-15.133 222.427 <.001 9.638 7.156-12.981
High 1686 86.3
Basic epidemic-prevention materials
Insufficient 530 27.1 33.243 <.001 1.997 1.579-2.527 .057 .811 .962 .699-1.324
Sufficient 1424 72.9
Information about COVID-19
Insufficient 191 9.8 28.141 <.001 2.390 1.732-3.298 .023 .880 1.033 .674-1.584
Sufficient 1763 90.2
Financial sources
Insufficient 500 25.6 43.717 <.001 2.223 1.754-2.817 .664 .415 1.139 .833-1.558
Sufficient 1454 74.4
Medical resources
Insufficient 421 21.5 76.632 <.001 2.965 2.324-3.781 5.957 .015 1.576 1.094-2.270
Sufficient 1533 78.5
Mental support sources
Insufficient 405 20.7 63.546 <.001 2.724 2.129-3.486 6.497 .011 1.532 1.104-2.127
Sufficient 1549 79.3

Abbreviations: CI, Confidence interval; COVID-19, coronavirus disease 2019; OR, Odds ratio; SD, standard deviation.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2020 The Authors. The Kaohsiung Journal of Medical Sciences published by John Wiley & Sons Australia on behalf of Kaohsiung Medical University.

Kaohsiung J Med Sci. 2020;36:763–764. wileyonlinelibrary.com/journal/kjm2 763

764
COVID-19. However, neither this hypothesis nor the factors that pre-
dict public perceptions of local government confidence have been
investigated.
The Online Survey Study on COVID-19 in Taiwan recruited par-
ticipants aged ≥20 years by using a Facebook advertisement from
April 10 to 20, 2020. We investigated respondents' perception of self-
confidence in coping with COVID-19,1 their local governments' confi-
dence in coping with COVID-19, susceptibility to COVID-19,2 and the
adequacy of resources and support during the COVID-19 pandemic.3
We also collected participants' demographic characteristics.
Data from 1954 respondents were analyzed. Of all respondents,
385 (19.7%) perceived that their local government had a low level of
confidence regarding coping with COVID-19 and 346 (17.7%) per-
ceived that they were highly susceptible to COVID-19. After demo-
graphic characteristic and self-confidence in coping with COVID-19
were controlled for, respondents who perceived their local govern-
ment to be highly confident were more likely to perceive low suscep-
tibility to COVID-19 (Wals χ 2 = 11.106; P = .001; odds ratio
[OR] = 0.603, 95% confidence interval: 0.447-0.812).
The results of the univariate multivariate linear regression indi-
cated that older age, high self-confidence in coping with COVID-19,
sufficient basic epidemic-prevention materials (eg, face masks and
disinfecting alcohol), epidemic-related information, financial resources,
medical resources, and mental support resources were significantly
associated with high perceived confidence in the local government
(Table 1). These significant factors were selected for a multivariate lin-
ear regression, and the results indicated that older age, high self-
confidence in coping with COVID-19, sufficient medical resources,
and sufficient mental support resources were significantly associated
with high perceived confidence among the local government regard-
ing coping with the COVID-19 pandemic.
A study reported that possessing sufficient basic epidemic-
prevention materials and epidemic-related information reduced public
concerns regarding the epidemic.4 However, the present study indi-
cated that the public's assessment of the adequacy of medical and
mental support resources was significantly correlated with their per-
ception of the local government's epidemic-prevention confidence.
Different levels of governments provide different resources and sup-
port during the various stages of the COVID-19 pandemic.5 Local gov-
ernments have instructed medical institutions under their jurisdiction
to offer the required medical and mental support resources, which
ultimately became indicators of the local governments' epidemic-
prevention confidence.
Local governments that display active and effective epidemic-
prevention efforts during the COVID-19 pandemic may provide clear
CORRESPONDENCE
directions for the public to follow, thus reducing panic. We suggest
that local governments should use the experience gained from the
COVID-19 pandemic to establish effective epidemic-prevention strat-
egies and regular drills, to enable them to guide the public successfully
during the next epidemic or pandemic.
CONFLIC T OF INT ER E ST
The author declares that he has no competing interests.
Cian-Ruei Jian1
Chia-Fen Wu1
Yu-Ping Chang2
Cheng-Fang Yen1,3
1
Department of Psychiatry, Kaohsiung Medical University Hospital,
Kaohsiung, Taiwan
2
School of Nursing, The State University of New York, University at
Buffalo, New York, New York
3
Department of Psychiatry, School of Medicine, and Graduate Institute of
Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung,
Taiwan
Correspondence
Cheng-Fang Yen, Department of Psychiatry, Kaohsiung Medical
University Hospital, 100 Tzyou 1 Road, Kaohsiung 80703, Taiwan.
Email: chfaye@cc.kmu.edu.tw
OR CID
Cheng-Fang Yen https://orcid.org/0000-0003-1156-4939
RE FE RE NCE S
1. Effective Communication in Outbreak Management for Europe. Stan-
dard questionnaire on risk perception of an infectious disease out-
break. Netherlands: Municipal Public Health Service Rotterdam-
Rijnmond and National Institute for Public Health and the Environ-
ment. 2015 [Accessed 2020 Mar 13]. Available from: http://ecomeu.
info/wp-content/uploads.
2. Liao Q, Cowling BJ, Lam WW, Ng DMW, Fielding R. Anxiety, worry
and cognitive risk estimate in relation to protective behaviors during
the 2009 influenza A/H1N1 in Hong Kong: Ten cross-sectional sur-
veys. BMC Infect Dis. 2014;14:169.
3. World Health Organization (WHO). Pandemic influenza preparedness
and response: A WHO guidance document. Geneva: WHO: WHO,
2009.
4. Choi EPH, Hui BPH, Wan EYF. Depression and anxiety in Hong Kong
during COVID-19. Int J Environ Res Public Health. 2020;17:e3740.
5. Haffajee RL, Mello MM. Thinking globally, acting locally - the
U.S. response to Covid-19. N Engl J Med. 2020;382:e75.