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The Perception of Infection Risks during the Early and Later Outbreak of COVID-19 in Germany: Consequences and Recommendations

14 May 2020-

TL;DR: Individuals showed biases in their risk perception concerning overconfidence and the underestimation of exponential growth of infection cases in the early phase of the pandemic, and adherence to governmental recommendations increased with perceived personal consequences of infection and decreased with negative expected short-term consequences of these measures.
Abstract: In three studies (N = 1,055), we investigated the determinants and consequences of the perception of infection risks during the early and later outbreak of COVID-19 in Germany. Individuals’ perceived COVID-19 infection risk was reasonably in line with experts’ assessment but changed over time. The probability of the rare event of getting severely sick and hospitalized was overestimated. Overestimation increased in the exponential growth phase of the pandemic and later on decreased again, showing an inverse U-shaped pattern. Individuals showed biases in their risk perception concerning overconfidence and the underestimation of exponential growth of infection cases in the early phase of the pandemic. Forecasts were more accurate after the growth curve had flattened. Risk perceptions increased with perceived dread and tended to increase with perceived control over infection, the evaluation of scientific and own knowledge about the pandemic. Approval for the introduction of stricter governmental measures and acceptance of future vaccination measures was mainly influenced by rational utilitarian factors of risk perception (probabilities and utilities of outcomes). These rational influences were mediated by dread, but dread had an additional potentially irrational effect. Adherence to governmental recommendations was mainly driven by dread and positive expected long-term consequences of the measures. To a smaller degree, adherence increased with perceived personal consequences of infection and decreased with negative expected short-term consequences of these measures. Implications for theory development are discussed and recommendations to handle virus outbreaks are derived.
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Running head: PERCEPTION OF COVID-19 INFECTION RISKS
The Perception of Infection Risks during the Early and Later Outbreak of COVID-19 in
Germany: Consequences and Recommendations
Andreas Glöckner
1,2
, Angela Dorrough
1
, Tobias Wingen
1
, & Simone Dohle
1
1
University of Cologne
2
Max Planck Institute for Research on Collective Goods, Bonn
This is an unedited manuscript (that has been or will be) submitted for publication. The
manuscript will undergo a review process and subsequent copyediting, typesetting, and
review before it is published in its final form.
Author’s note: Correspondence should be addressed to Andreas Glöckner, University of
Cologne, Department of Psychology, Richard-Strauss-Str. 2, D-50931 Cologne, Germany,
phone +49-221 470 7916, email: andreas.gloeckner@uni-koeln.de

PERCEPTION OF COVID-19 INFECTION RISKS 2
Abstract
In three studies (N = 1,055), we investigated the determinants and consequences of the
perception of infection risks during the early and later outbreak of COVID-19 in Germany.
Individuals’ perceived COVID-19 infection risk was reasonably in line with experts’
assessment but changed over time. The probability of the rare event of becoming severely ill
and hospitalized was overestimated. Overestimation increased in the exponential growth
phase of the pandemic before decreasing at a later stage, thus indicating an inverse U-shaped
pattern. Individuals showed biases in their risk perceptions concerning overconfidence and the
underestimation of exponential growth of infection cases in the early phase of the pandemic.
Forecasts were more accurate after the growth curve had flattened. Risk perceptions increased
with perceived dread and tended to increase with perceived control over infection, the
evaluation of scientific and one’s own knowledge about the pandemic. Approval for the
introduction of stricter governmental measures and acceptance of future vaccination measures
was mainly influenced by rational utilitarian factors of risk perception (probabilities and
utilities of outcomes). These rational influences were mediated by dread, but dread had an
additional, potentially irrational effect. Adherence to governmental recommendations was
mainly driven by dread and positive expected long-term consequences of the measures. To a
smaller degree, adherence increased with perceived personal consequences of infection and
decreased with negative expected short-term consequences of these measures. Implications
for theory development are discussed and recommendations for dealing with virus outbreaks
are derived.
Keywords
risk perception; overweighting of rare events; heuristics and biases; judgment; forecast;
overconfidence; COVID-19

PERCEPTION OF COVID-19 INFECTION RISKS 3
The outbreak of the COVID-19 pandemic starting in December 2019 has caused a
global major economic and societal crisis. Countries applied various measures to address the
threat. Most measures aimed at reducing the speed of the virus spread to avoid a potential
overload and collapse of the health system. These “flatten the curve” measures involved
governmental orders and recommendations including (a) reducing the number of direct
contacts, (b) social distancing to avoid transmission in case of contact, (c) increased hygiene
measures (e.g., hand washing, not touching the face, sufficient ventilation of rooms) and (d)
various quarantine measures for infected persons, particularly vulnerable persons or even
entire communities. Over time additional measures, for example to mitigate the consequences
of quarantine (Brooks et al., 2020), also became increasingly important.
Investigations of previous outbreaks of infectious diseases such as H1N1 (swine flu)
revealed that various factors influence the magnitude and speed of the spread of viruses (e.g.,
Poletti, Ajelli, & Merler, 2011; Rudisill, 2013). Some of these factors – such as characteristics
of the pathogen as well as the sociodemographic structure of the population – must be taken
as given. Behavioral factors, however, such as mobility patterns, adherence to governmental
recommendations, and voluntary vaccination can be influenced. The behavioral and social
sciences provide important insights for effective responses to induce large-scale behavior
changes and to reduce the significant psychological burdens for individuals (Betsch, 2020;
Chater, 2020; Van Bavel et al., 2020).
Of crucial importance in this context are individuals’ risk perception, which
determines cognitive, affective, and behavioral responses (e.g., Brewer et al., 2007). Classic
work on risk perception (Slovic, 1987) indicated that perceived risks are influenced by
various characteristics (7 to 18 are considered by Slovic) that typically load on two main
factors. Risk perception increases with perceived dread (the degree to which the negative
consequences are dreaded “on the level of a gut reaction”) and lack of control about the
consequences. Together with additional characteristics (i.e. catastrophic potential,

PERCEPTION OF COVID-19 INFECTION RISKS 4
involuntariness, inequity, globality of the catastrophe, fatality of the consequences, risk to
future generations, (unstoppable) increase of risk over time), these variables constitute the
factor dread risk. Furthermore, risk perception increases with a second factor, unknown risk,
which includes characteristics such as novelty and lack of scientific evidence as well as
individual knowledge about the risk, non-observable risks, and risks with delayed effects.
Other decision-theoretical theories, such as the Conjoint Expected Risk model
postulate that risk perceptions are determined by the probabilities of gains and losses, the
status quo, and the utility of gains and losses (Luce & Weber, 1986). Hence, the Conjoint
Expected Risk model postulates that individuals’ risk perceptions are determined by the
factors that are in line with normative standards of rationality (von Neumann & Morgenstern,
1947). In some contexts of health risks, the postulated factors by Slovic (1987; see above) did
not have predictive power beyond the rational utilitarian factors postulated by the Conjoint
Expected Risk model, whereas they did so in the financial domain (Holtgrave & Weber,
1993). Holtgrave and Weber (1993) suggest a hybrid model that takes into account rational
factors and some risk factors suggested by Slovic (1987) such as dread. Other research
identified general trust and general confidence as important predictors of perceived risk
(Siegrist, Gutscher, & Earle, 2005). In the current research, we investigated (i) risk
perceptions in a pandemic, including and combining influence factors identified in previous
work as well as (ii) their connection with adherence to governmental recommendations,
approval of governmental measures, and vaccination.
Risk perceptions have a substantial influence on behavior, particularly if individuals
have a high self-efficacy and believe that the protective measures are effective (Maddux &
Rogers, 1983; Rogers, 1975; Witte, 1994). Threatening communication and fear appeals that
influence risk perception, for example, are particularly effective in changing behavior in
combination with high efficacy (Peters, Ruiter, & Kok, 2013); in its absence, they may lead to
defensive behavior (Witte & Allen, 2000). According to a meta-analysis (Brewer et al., 2007),

PERCEPTION OF COVID-19 INFECTION RISKS 5
vaccination behavior increased with perceived probability of the negative outcome of the
disease (likelihood of risk), a particular susceptibility of the individual, and assumed negative
utility of consequences (severity). A second meta-analysis that contained various kinds of risk
behavior found small to medium effects for experimental manipulations of risk perceptions on
intentions and behavior (Sheeran, Harris, & Epton, 2014). Furthermore, risk perceptions (in
the form of beliefs) have been shown to influence health behavior in reasoned action
approaches (Ajzen, Albarracin, & Hornik, 2007). Thus, because risk perception is an import
prerequisite for various health-related behaviors (including vaccination), it is important to
better understand risk perception in respect to COVID-19 and investigate whether it is based
on a rational decision process.
Persons’ risk perceptions and responses to the COVID-19-pandemic have been
investigated in various surveys. A study conducted in China (Li et al., 2020, February 28)
found that the perceived severity of the COVID-19 outbreak was the risk factor that was most
widely associated with emotional and behavioral reactions. Perceived controllability of the
COVID-19 outbreak was the strongest protective factor against emotional problems. Self-
assessed knowledge about COVID-19 was unrelated to emotional and behavioral changes,
whereas social participation and precautionary measures increased with knowledge. A study
in Hong Kong (Kwok et al., 2020, February 27) found that persons reacted to the first
infection cases with an anxiety level that was borderline abnormal and that persons with a
better understanding of COVID-19 and higher anxiety levels were more likely to follow
social distancing measures. Wise et al. (2020, March 19) found that persons in the US had
relatively high estimates concerning their risk of being infected with the novel coronavirus
1
(i.e., mean rating of 43 on an analog scale from 0 (very unlikely) to 100 (very likely),which
implies a mean probabilities < .50). These estimates are, however, still substantially lower
1
In the following, we will use the term coronavirus to refer to the Severe Acute Respiratory Syndrome Coronavirus
2 (SARS-CoV-2) that causes the coronavirus disease 2019 (COVID-19)

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