**1. Introduction**

Since the first report of an emerging coronavirus in Wuhan, China, in December 2019, the virus has spread rapidly worldwide [1]. In South Korea, the first confirmed case of COVID-19 occurred on 19 January 2020 [2]. In February of the same year, beginning with a

**Citation:** Lee, Y.; Kim, B.-W.; Kim, S.-W.; Son, H.; Park, B.; Lee, H.; You, M.; Ki, M. Precautionary Behavior Practices and Psychological Characteristics of COVID-19 Patients and Quarantined Persons. *Int. J. Environ. Res. Public Health* **2021**, *18*, 6070. https://doi.org/10.3390/ ijerph18116070

Academic Editors: Paolo Roma, Merylin Monaro and Cristina Mazza

Received: 10 May 2021 Accepted: 31 May 2021 Published: 4 June 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

cluster infection among Shincheonji Church members, the number of COVID-19 cases rose sharply in the city of Daegu and Gyeongsangbuk Province, followed by ongoing sporadic group infections occurring nationwide [2]. To date, domestic outbreaks continue to appear, and the virus continues to spread globally.

COVID-19 symptoms include fever, cough, fatigue, body aches, headache, sore throat, diarrhea, loss of taste, and loss of smell [3]. It is reported that, in most persons infected with SARS-CoV-2, the symptoms are mild or moderate, and approximately 30% of cases are asymptomatic [4,5]. In comparison to SARS and MERS, COVID-19 has a lower mortality rate, but its basic reproduction number (R0) is reported to be as high as 2.87 (95% CI, 2.39–3.44) [5]. As it is hard to implement pharmaceutical interventions, such as vaccines and anti-viral medications, in the pandemic, non-pharmaceutical interventions have been emphasized to prevent the spread of infection [6]. Public health authorities and experts have informed the public (and shared guidelines) on the importance of precautionary practices. A large number of countries have used interventions, such as restricting the use of public and multi-purpose facilities, prohibiting large gatherings, closing borders, and/or practicing lockdowns, although the extent of these interventions has varied across countries.

Persons confirmed with COVID-19 (or suspected of being exposed) are isolated from others and restricted in their movements in order to inhibit person-to-person transmission [7]. In South Korea, patients with moderate to critical cases are admitted to hospitals for treatment, while patients with asymptomatic or mild cases are isolated in residential treatment centers where they receive healthcare services and their symptoms are monitored. In addition, regardless of the presence or absence of symptoms, close contacts of COVID-19 patients, and anyone traveling from abroad, are required to quarantine in a residential treatment center or at home, for a period of two weeks [8].

A pandemic affects the public's physical and mental health; these health effects were also identified during the 2019 coronavirus outbreak [9–12]. In the early stage of a pandemic, people feel fear, anxiousness, and helplessness due to the lack of information and uncertainty about the new risks (as well as fear of death) [13,14]. Anxiety regarding an emerging infectious disease can lead to suspicion and distrust of others, and people often blame those who are believed to have spread the disease [13]. Therefore, isolation and quarantine are effective at reducing the number of confirmed cases and mortality, but at the same time, they have negative psychological impacts on confirmed patients and quarantined persons [15,16]. Isolated or quarantined persons may face undesirable experiences and feelings, such as guilt, embarrassment, and social stigma, during and after the isolation or quarantine period [16,17]. They may suffer from social rejection and excessive blame, as well as fear of infection [13].

As confirmed, quarantined persons are exposed to various stresses in a COVID-19 outbreak; thus, investigating their isolation/quarantine experiences and mental health statuses is important for pandemic recovery and preparedness. Previous studies on quarantine/isolation experience assessed the mental health of members of the general public who were under mass quarantine due to COVID-19, which is different from the situation of Korea [18,19]. Studies conducted in Korea assessed the mental health status of (i) caregivers at a children's hospital who were quarantined due to contact with a case of COVID-19 [20], and (ii) isolated patients in residential treatment centers [21]. To our knowledge, this paper is the first to report on the precautionary behavior practices and mental health of confirmed patients and quarantined persons, and identify the needs for improvement regarding isolation or quarantine during the early stage of the COVID-19 outbreak in Korea.

We investigated precautionary behavior practices (hygiene-related behavior and social distancing) for the two weeks before they had been confirmed or quarantined, since it is widely accepted that these practices may contribute to inhibiting the infection [22,23]. We investigated the psychological states of persons who experienced COVID-19-related isolation or quarantine, and the areas that needed improvement (in regards to isolation/quarantine); this is important to improve the care of persons in isolation or quarantine, to assist in

their psychological recovery. This study was performed after the first wave of COVID-19 in South Korea, which occurred from February to March 2020, and was conducted with patients confirmed to have COVID-19 and quarantined persons in the regions where a high number of confirmed cases were initially reported (Daegu, Busan, Korea).

The study findings are expected to provide government organizations and healthcare professionals with basic data to improve policies that support persons who experience isolation or quarantine. An additional purpose of the current study is to increase public health emergency preparedness (PHEP) by promoting effective communication and emphasizing social solidarity during the persistent COVID-19 pandemic.
