The impact of the COVID-19 pandemic on quality of life and well-being in Morocco

Two months after the declaration of quarantine in Morocco following the Covid-19 epidemic, we carried out a descriptive cross-sectional study of 279 Moroccan citizens. We used the Short Form Health Survey (SF-12) as a determinant of quality of life, which is based on eight dimensions of health. The data were collected using an electronic questionnaire distributed online. The participants also indicated their socio-demographic data, their knowledge and practices regarding the Covid-19 pandemic and whether they had chronic health problems.


Introduction
The appearance of a new coronavirus disease  was first reported in December 2019 in Wuhan, China [1]. The Moroccan health authorities announced the first confirmed case of Covid-19 on March 2, 2020. COVID-19 was officially declared a pandemic by the world health organization on March 11, 2020 [2]. From December 2019 until the time of writing this article, 7,000,000 cases of COVID-19 have been confirmed worldwide and more than 400,000 people have died [3]. This pandemic has put global public health institutions on alert [4,5,6]. Morocco, like many countries in the world, declared a state of health emergency and quarantine on March 20, 2020.
Admittedly, quarantine and the state of health emergency have a great interest in controlling the spread of the pandemic [7]. However, it is also important to understand the implications of these restrictions on the health and well-being of the community.
We hypothesized that health-related quality of life is more likely to be affected during the COVID-19 pandemic.
Therefore, we aim in this study to provide an analysis of the health and well-being of a sample of the general population during the quarantine period.

Characteristics of the participants:
We conducted a descriptive cross-sectional online survey about two months after the declaration of quarantine and the COVID-19 state of emergency in Morocco. All participants were adults over the age of 18, resident in Morocco who were not epidemiologically infected with the virus, but they lived in places affected by COVID-19. To have a representative national sample and cover people in areas of varying severity of COVID-19, we interviewed citizens across the 12 regions of Morocco.

Study procedure:
Given the circumstances of the quarantine, the study announcements, containing brief information about the study and a link to a web page, were shared by e-mail (to personal and professional networks), and published on Facebook and other popular social media websites, including Twitter and Instagram. The online survey was administered by Google Forms to ensure wide reach and easy access. Participants were asked to share the survey with their families and acquaintances. Responses to all elements of the questionnaire were required, and respondents could only submit their responses if all questions were answered. The data reported in this study was collected between May 25 and June 6, 2020.
Participation was voluntary and all participants gave informed consent electronically and without any remuneration for their participation. No identifying information was collected to protect the anonymity of participants.

Variables studied:
Participants provided their socio-demographic characteristics, such as gender, age, education and residence (region and city) as well as their knowledge and practices regarding the Covid-19 pandemic. Given that COVID-19 is more dangerous for people with co-morbidities [8], so we asked if the participants had a chronic disease.
We assessed individual health using the Short Form-12 (SF12). We used a Moroccan version The eight dimensions form two physical and mental subscores (PCS and MCS), with a possible total score ranging from 0 to 100 [11]. A higher SF12 score indicates better health.

Statistical analyzes:
We report descriptive statistics of the study variables. The analyzes were performed by IBM SPSS Statistics v 21. We used the t-student test to compare the means of the summary physical and mental scores of the SF-12, after having checked the normality of the distribution of the two scores. The materiality threshold was set at 0.05.

Results:
279 participants responded to the survey. The majority of participants (96.77%) report that they follow the health recommendations for coronavirus and 75.95% comply with the quarantine recommendations in more than 80% ( Figure 1). 90.32% of the respondents report that they always wear the mask when leaving the house. 97.50% of participants wash their hands daily at least with soap and water.
Participants' fear of catching the coronavirus was assessed using an increasing numerical scale from 1 to 10 ( Figure 2). 60.6% of the participants reported a fear less than or equal to 5 degrees. diseases were 32.51 (± 7.14) and 29.28 (± 1.23), respectively (Table 4).
Overall, the participants' PCS and MCS scores suffered from chronic diseases and the elderly participants were lower than those of young participants without comorbidities ( Figure 3).  Restrictive measures applied in several countries around the world appear to be effective in containing the spread of COVID-19 [7]. However, these measures have disrupted people's daily employment and daily activities and can therefore have important implications for their health and well-being. [12] As was the case previously with the Middle East respiratory syndrome coronavirus (MERS-CoV) [13,14], the COVID-19 pandemic also causes panic and mental health problems for the general population [15 , 16.17]. In addition, quarantine could affect the psychological health of the public [18,19]. This can influence the general health and quality of life of people. An article published on Lancet pointed out that people in quarantine have reported a high prevalence of symptoms of distress and psychological disorders and some of these symptoms seem to persist long after quarantine [22].
We may need to pay more attention to those affected and those with co-morbidities, but also physically active people, who may be more frustrated with the quarantine restrictions. Such identification can help health systems prioritize those who may have more impact during this health crisis.
We present this data on general quality of life disruptions to provide evidence on the health of the community during this Covid-19 crisis.
The study has certain limitations. First of all, this study was based on a cross-sectional observation survey. The data do not allow conclusions to be drawn about the nature or the orientation of the associations examined. We also do not know whether this lower quality of life existed before COVID-19.
Likewise, online self-assessment questionnaires may be influenced by the difficulty of completing them. This could affect the validity of the data provided.
Given our recruitment methods and our sample size, the results may not be generalized to the entire population of Morocco and other countries. Nevertheless, the hypotheses reported could be targets for future studies.

Conclusion
The results underscore the importance of social ties to mitigate the negative consequences of the COVID-19 pandemic on mental health and physical well-being. Policymakers managing the COVID-19 pandemic can benefit from understanding these implications for the health and well-being of the population, especially the elderly and those with chronic diseases.

Conflict of Interest Statement
We declare no competing interests.