Demographics for each cohort are shown in the Table 2 below. Participants were mostly young adults (ages 18–34, 61.1%), who were well educated (bachelor’s or higher degree, 90.2%), with above average self-identified social standing (6.13 out of 10).

Table 2 Demographic characteristics of the study participants in China and U.SBarriers to following health recommendations

While quantitatively, most participants from both countries were willing to follow COVID-19 related health recommendations, different barriers were identified in qualitative analysis.

Qualitative findings

Some Chinese respondents mentioned limited physical space in public areas, ‘交通工具上难以保持距离. (It is hard to keep the distance on public transportation.)’ Further, individuals noted that changing social behaviors was challenging, e.g., ‘以前的生活, 社交习惯 (Hard to change lifestyle and social habits)’ particularly since they did not feel their safety was imminently threatened. A Chinese participant (28 years old, male, bachelor’s degree, Jiangxi) wrote:

‘如果是疫情最严重的时候自然会遵守, 甚至不会出门, 但现在中国江西几乎没有了, 所以便不会那么注意. (It's natural to follow the rules when the pandemic was at the worst situation, I wouldn't even go out of my home. But currently Jiangxi barely has cases, so I am not being so careful now.)’

Meanwhile, U.S. participants reported their biggest concern was others not following public health recommendations. One stated (35 years old, female, Massachusetts), ‘I am worried about people not taking it seriously or not being as careful, especially as the weather gets warmer. I am also worried about people becoming over-confident and cavalier.’

Quantitative findings

Due to a low number of responses received for the last three items (48.7% missingness for each item), the mean score for each respondent was only aggregated based on the first five survey items. U.S. participants had higher aggregate compliance intent. However, this aggregate difference was driven primarily by a marked difference in item 4, cough etiquette. Results from item-wise comparison are shown in the Table 3 below.

Table 3 Comparison of intent to comply by questionSkepticism about the COVID-19 vaccine

Both groups indicated a willingness to take a COVID-19 vaccine, but also noted skepticism stemming from the vaccine’s rapid development. Interestingly, their skepticism led to different concerns.

Qualitative findings

Chinese participants expected that a COVID-19 vaccine would eventually be successfully developed but were concerned that rapid development might compromise the vaccine’s safety. One respondent (38 years old, male, graduate degree) wrote,

‘希望在保证安全和质量的前提下尽快研制成功. (Hope vaccines can be successfully developed as soon as possible with the assurance of safety and quality.)’

In contrast, U.S. participants focused primarily on concern that rapid development might compromise vaccine efficacy. One participant (25 years old, female, graduate degree, Illinois) said, ‘I want there to be a vaccine, but worry that it is so fast tracked that it could have side effects or be ineffective.’

Quantitative findings

A reduced sample size was observed for these four items given the fact that disclosing personal vaccination preferences might be a sensitive topic for participants from both countries. Both groups indicated high overall tendency towards COVID-19 vaccination, with no significant difference between them (China: n = 22, Mean = 4.25, SD = 0.36; U.S.: n = 21, Mean = 4.43, SD = 0.79; p = 0.343).

Perspectives on reopening

At the time of survey (April-July 2020), reopening of the U.S. was under consideration in many states [36]. In contrast, China just lifted its lockdown on Wuhan city, and people started to follow more global news on the pandemic. Neither cohort supported reopening.

Qualitative findings

Chinese respondents’ expressed concerns about the global impact of reopening – particularly driving war and international discontent. One participant (39 years old, female, graduate degree) wrote,

‘死亡, 治愈后遗症, 次生灾难, 如经济衰退, 失业, 战争, 心理疾病等. (Deaths, post covid19 syndrome, second-order damages such as economic recession, unemployment, war, and mental disorders).’

Another (44 years old, graduate degree) worried that reopening would lead to, ‘世界互相指责和分裂. (a blame game that makes the world divided)’, and some (30 years old, male, associate degree) worried that uncoordinated reopening would undermine success, noting,

‘在其他国家已经控制住疫情漫延的情况下, 很多国家放弃控制, 那么之前的所有努力都会付诸东流. (In the situation where the outbreak is under control in some countries while many other countries give up responding to COVID-19, all the efforts done previously will come to naught).’

The U.S. cohort primarily considered reopening within their country, with many expressing concerns that premature reopening without a robust protective strategy would be disastrous. One U.S. participant (28, female, bachelor’s degree, Illinois) said:

‘Am very stressed about it. I feel like we all know how this ends. History and science have told us these things. Unfortunately, it seems that our country has chosen profit over people. The whole world is watching as our curve never flattens, and we prepare for what is likely another wave later in the year.’

Quantitative findings

With regards to trust in government, Chinese participants reported higher trust compared to the U.S. cohort, both at a national (China: n = 56, Mean = 4.30, SD = 0.89; U.S.: n = 57, Mean = 2.39, SD = 1.1; p < 0.001) and local level (China: n = 54, Mean = 4.17, SD = 1; U.S.: n = 57, Mean = 3.53, SD = 0.97; p < 0.001).

Change of COVID-19-related information consumption

Both samples reported that the internet was their primary information source and that their change in news consumption was based on a perceived need to diversify information sources to get the ‘real’ news.

Qualitative findings

Both samples noted that distrust of information led them to increase and diversify information sources for improved accuracy (i.e., more use of government tracking sites, ‘疫情图 (COVID-19 tracking map)’, and social media, ‘社交媒体 (social media)’. Participants also attempted to identify more personally relevant information. For example, a U.S. participant (30, female, bachelor’s degree) wrote,

‘I started paying attention more closely to my local newspapers because I needed to stay up to date on local and state ordinances - learning which businesses would remain open, what reopening meant, case numbers in my area, whether testing was available, and so on. Also, I started paying more attention to more scientific journals or science-focused publishing, which had less of a political focus.’

Quantitative findings

U.S. respondents were more likely to report that they had changed their consumption of news because of COVID-19 (54% versus 19%, p < 0.001). Over half of both samples got their health-related news from news websites, government websites, and other internet sites (social media excluded, see Fig. 1 below). Both samples showed similar high trust in health professionals, including personal health providers (China: n = 48, Mean = 4.08, SD = 1.07; U.S.: n = 54, Mean = 4.2, SD = 0.66; p = 0.501) and WHO (China: n = 55, Mean = 4.13, SD = 1.04; U.S.: n = 56, Mean = 3.96, SD = 1.01; p = 0.403).

Fig. 1

COVID-19 news sources between China and U.S. samples, April- July 2020

COVID-19 pandemic related information

Qualitative analysis showed differences in perceptions about the origins of COVID-19. U.S. respondents answered more questions correctly than the Chinese cohort.

Qualitative findings

In the free-text responses about the origin of COVID-19, answers from the Chinese cohort were vague and indirect. One response (38 years old, male, graduate degree) wrote,

‘病毒溯源是非常艰难的科学问题, 该病毒有可能是多个源头几乎同时爆发, 中间宿主也尚不明确 (Tracing the source of virus is a difficult scientific problem. SARS-CoV-2 might originate from and cause the outbreak at multiple places simultaneously. Intermediate hosts for the virus are still undetermined.)’

In contrast, U.S. respondents were clear in their free-text responses about the origin of COVID-19, using key words like ‘Wuhan, China’, ‘wet market’, and ‘zoonotic transmission.’

Quantitative findings

U.S. respondents answered more of the seven knowledge questions correctly (range: 0–7, 7 = all questions correctly answered; China: n = 34, Mean = 4.68, SD = 1.55; U.S.: n = 24, Mean = 5.42, SD = 0.78; p = 0.021). This difference appears primarily driven by Question 7, with no significant difference between groups on answers to the other questions (See Table 4 below). Remarkably, more than 2/3 of participants from both groups did not know that the public health recommendations from WHO, European Commission, and U.S. CDC were different.

Table 4 Comparison of COVID-19 knowledge by question