Coronavirus disease 2019 (COVID-19) was first noticed in Wuhan city of Hubei Province, China in late December 2019 (1). On March 11, 2020, the World Health Organization (WHO) declared it a pandemic (2, 3). The pandemic paralyzed the healthcare system in many countries due to its rapid spread (4). On July 11, 2021, the disease infected ~190 million people and caused more than four million deaths across the globe (5). Both the developed and developing parts of the world were hit hard by the pandemic and resultantly huge mortalities were reported in the United States of America (USA), India, and Brazil (6, 7). The overall number of confirmed cases in low-resource or developing nations is projected to rise dramatically shortly. COVID-19 was discovered to be a growing threat to the global economy, particularly China's surrounding developing nations, including Pakistan, India, Iran, Afghanistan, and Bangladesh (8). It is reported that developed countries have defined health care systems and public education programs as compared to low- and middle-income countries (LMICs). It is crucial for LMICs, including Pakistan, to strengthen their healthcare systems to save lives, ensure patients' quality of life, and assure patient safety and well-being of the general population (9).

Pakistan is a densely populated country with around 197 million people having a low to the medium-level economy. It comprises four provinces i.e., Punjab, Sindh, Khyber Pakhtunkhwa (KP), Balochistan, and three territories that include Islamabad Capital Territory, Gilgit–Baltistan, Azad Jammu, and Kashmir (10). The bell for the approaching storm was rung out on 26 February 2020, when the first two cases of COVID-19 were reported in Pakistan (11). There were 973,284 confirmed COVID-19 cases and 22,582 deaths across the country when writing this article (12, 13). The COVID-19 outbreak harshly hit Punjab province as it has the highest number of COVID-19 cases (with 348,000 cases as of 11 July 2021) (12, 13).

The government of Pakistan devised strategies such as partial lockdown, social distancing, closure of schools, colleges, and universities across the country, travel restrictions, suspension of general populations transportation, quarantine centers, isolation wards, and diagnostics laboratories, among others, to deal with the pandemic and contain the contagion. Despite these controls, COVID-19 instances continued to be reported regularly. These control mechanisms are said to work because of the general population's knowledge, behavior, and compliance. With the massive distribution of misinformation and falsehoods about COVID-19 on various online networking and social media platforms, the pandemic became more infodemic, making it difficult for the general population to know which sources to believe. To forestall individuals' misconception about this viral malady, the WHO needed to dispatch a page entitled “Myth busters” on their website page (14). The adequacy of government-run data campaigns fundamentally relies upon what individuals see, anticipate, and think about COVID-19. Therefore, it is critical to teach the general population in general about cleanliness standards, the spread of sicknesses, and potential alternatives to treat them; thus making the control measures work well. Following other countries, The government of Pakistan must analyze the general population's knowledge, attitude, and practice or perceptions (KAP) and then develop strategies and standard operating procedures (SOPs) to effectively combat the epidemic (15, 16). Therefore, an online survey was performed to determine KAPs of the Pakistani population toward COVID-19.

COVID-19 is a new, fast-evolving worldwide health concern that affects all areas of society. It is critical to persuade the general population to adopt precautionary measures, which are completely dependent on accurate information of the pandemic and appropriate general populations reaction. Numerous researches have been performed out to assess the level of KAP concerning infectious disease epidemics and pandemics including Severe acute respiratory syndrome (SARS), Influenza, Swine Flu, and Middle East respiratory syndrome (MERS). Recent studies on KAP toward COVID-19 among people in China (19), the United States (20), Tanzania (21), Kenya (22), Ethiopia (23), Saudi Arabia (24), and Nepal (25) have been reported.

Jilani et al. conducted a study to research the impact of information sharing on long-term performance in Bangladesh and concluded that knowledge concealment did not affect the impact of knowledge sharing on employees' ambidexterity (26). As a result, the purpose of this research was to explore the general population's knowledge, attitudes, practices, and anxiety about COVID-19 in Pakistan. This research also revealed several demographic factors linked to KAP's response to the COVID-19 pandemic. This research might give information to help healthcare officials and policymakers in establishing policies and awareness programs to limit the spread of the new COVID-19 pandemic.

Several web KAP studies have been done in Pakistan, with a focus on the educated population, including healthcare workers and university graduates. The results of previous studies found that participants were well-versed on common signs and symptoms (84–93%) and COVID-19 prevention measures (72–92%) (1). However, according to our findings, more than 90% of participants were aware of the common signs and symptoms Another community-based survey revealed relatively inadequate illness awareness, with just 45.3 %of the sample group viewing close physical contact as a risk factor for virus spread (27).

In our study, 95.5% of the respondents were hopeful that the fight against the COVID-19 pandemic would be successfully won and controlled in Pakistan through mitigation and prevention efforts. A significant proportion was revealed in China's recent survey, with 90.8% believing that COVID-19 will be successfully managed and 97.1% believing that China can win the battle against the SARS-CoV-2 (19). While according to another study in Pakistan, 67.3 % were confident that COVID-19 would be effectively managed; nevertheless, this was very low in comparison to our study (28).

In our study, the predominant portion (80%) were male participants which were similar to the studies conducted by other researchers (1), while some studies recruited more female participants (19, 21). The symptoms of the SARS-CoV-2 were investigated in this work, similar to the one conducted by others (1). In our study, 98.0% of participants reported that they avoided gathering in groups and eating or drinking in a public place throughout COVID-19, COVID-19, which was comparable to the research carried out by (1). We observed that 90.5% cleaned their hands regularly. Our findings are consistent with research done in Jordan, and Pakistan which found that frequent handwashing and mask-wearing are preventive measures used by the Jordanian and Pakistani population (29, 30). Another study from China found that participants had higher information, a positive attitude, and excellent health habits to prevent fatal infectious illnesses (31). In our study, the majority of participants (about 99.0%) used facemasks in public places and did not share personal items, which was higher than the findings of other studies (19, 25). In our study, a high proportion of the respondents (89%) thought that media coverage of this disease is exaggerated. A recent study in Karachi found that a large number of people (84 percent) think that false news about COVID-19, circulating on social media, is generating fear in the general population (32). These aspects of human life are governed by the trinity of general populations KAP, and the three components work together to form the complex system of life. As a result, they are all linked together in such a way that evidence of increased knowledge, changes in attitudes, and standard practices can all be traced back to pandemic impact prevention.

Concerns were expressed by more than half of the participants (52.5%), who were concerned about getting the disease; this ratio is a bit lower as compared to the Chinese population which is 54% in a recent report (33). There was a higher level of anxiety and susceptibility to getting and spreading the infection to oneself and family members in our study population. One possible explanation is that the general population did not fully comply with the government's preventive procedures, which resulted in the spread of COVID-19 fear.

The government of Pakistan responded well to the pandemic and succeeded in minimizing the losses. These preventive precautions may largely be ascribed to the government of Pakistan's stringent preventative and control measures, including banning of general populations gatherings and, a tight lockdown to stop the spread of COVID-19. The suspension of all incoming flights at airports, the closure of educational institutions, and the importation of 1,000 ventilators until the end of June 2020 are all significant steps (34). The success of the government of Pakistan in containing the contagion might also be the result of the people's thorough understanding of the COVID-19 virus's high virulence and speed of transmission. A tiny portion of the respondents (0.5%) reported that they do not wear face masks and 1.5% of participants gather in groups and do not avoid eating or drinking in a general population's place throughout COVID-19. Around 0.1% of participants mentioned that they do not wash their hands and stopped shaking their hands during the pandemic. These figures are a bit lower than the findings of the recent study (23). In research on KAP toward COVID-19, similar results were observed among the Nepalese population (25). Prevention is the best way to mitigate the effects of the COVID-19 pandemic, and general populations aware of the importance of SARS-CoV-2 preventive measures is critical, disseminating accurate information to the general populations about the situation of COVID-19 in Pakistan is critical for spreading awareness of the possible risks and the best code of behavior throughout COVID-19. Because of a lack of internet access and online health information, vulnerable populations in Pakistan affected by the COVID-19 epidemic, such as senior citizens and rural residents, are more likely to have low knowledge, negative attitudes, and ineffective prevention during the pandemic. As a result, in Pakistan today, KAP toward COVID-19 among the vulnerable population requires special attention. Furthermore, the study's sample was not representative. Another limitation was the lack of a detailed evaluation of KAP toward COVID-19, which could have been accomplished through focus group interviews and in-depth interviews for a more in-depth understanding.

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding authors.

All the authors contributed to the preparation of this manuscript. SK, MK, TU, JA, DW, MJ, KH, MAR, KS, and DW wrote the article, final editing, and preparation of the manuscript for submission. SK, DW, and XJ revised the manuscript. All authors read and approved the final article.

This work was supported by the National Natural Science Foundation of China (Nos. 81802718 and U1504817), the Foundation of Science and Technology Department of Henan Province, China (Nos. 192102310151 and 202102310480), and the training Program for Young Backbone Teachers of Institution of Higher Learning in Henan Province, China (No. 2020GGJS038).

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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