INTRODUCTION:

In December 2019, a new strain of Corona virus called SARS-CoV-2 (COVID-19) has been emerged in Wuhan, China¹. On 1^st of January 2019, World Health Organization (WHO) announced the outbreak of COVID-19 and then declared it as a pandemic on 11^th March 2020². By now, it has been spread in around 230 countries with more than 359 000 000 confirmed cases and higher than 5 600 000 deaths as reported in Worldometer³. Fever, dry cough, and fatigue were the first common symptoms reported. Unfortunately, patients with COVID-19 can develop pneumonia, severe symptoms of acute respiratory distress syndrome, sepsis and multiple organ failure which are considered as the leading causes of morbidity and death amongst hospitalized patients with COVID-19⁴. The current COVID- 19 virus is different from other known corona viruses such as the Severe Acute Respiratory Syndrome (SARS) and the Middle East Respiratory Syndrome (MERS), caused by SARS-CoV and MERS-CoV, consecutively, in that it is highly contagious and easily transmitted from human to another through respiratory droplets, direct contact and close person-to-person contact which led to this enormous number of infected people⁵. It is characterized as a worldwide emergency where it is hitting the global population hard, restricting the freedom of movement and limiting nonemergency health care⁶.

Although information about COVID-19 is not enough, some COVID-19 vaccines are available today⁷, and the ongoing research is trying to find specific medications to combat COVID-19. However, some people during their infectious period use a few painkiller agents such as paracetamol to reduce the severity of COVID-19 symptoms and others may use some supplements, vitamins, or herbal medicines to enhance their immunity as protective or treatment tools⁸. Unfortunately, no sufficient data supporting this.

Therefore, the protective ways to avoid having COVID-19 are to reduce virus transmission as well as get vaccinations. The reduction of virus transmission should be by wearing masks, keeping at least one meter distance from other people, avoiding crowded places, and maintaining refresh air most of the time in public places and public transport as mentioned in Centers for disease Control and Prevention⁹. Moreover, people should do self-hygiene and wash their hands regularly with alcohol or with soap and water for at least 20 seconds⁹.

On the other hand, the effects of COVID-19 infection on pregnancy or fetus abortion and breastfeeding are still under investigation due to the absence of enough data. However, according to the newest findings, pregnant women have higher rates of COVID-19 incidence, hospitalizations, and poor in-hospital outcomes¹⁰. WHO also suggests that women with suspected or confirmed COVID-19 should consider initiating or continuing breastfeeding as its benefits are far greater than the risks of transmission¹¹.

Jordan, similar to other countries in the world, is suffering from an increasing number of COVID-19 since the first case was detected in March 2020. The knowledge, behaviour assessment, perceived severity and controllability of the COVID-19 among the communities living this pandemic is valuable, especially with misinformation and misconceptions that are provided by social media and adapted by the public and in the absence of specific defined treatment. Supportive therapy including administration of antipyretic and analgesic, maintenance of hydration, mechanical ventilation as respiratory support and uses of antibiotic in bacterial infections is the only treatment strategy followed by health professionals¹². Jordan is a developing country with limited resources, and with the COVID-19 pandemic, the Jordanian health infrastructure has been severely affected. It had been implemented a nationwide lockdown and gave the army and police the power to ensure the adherence of citizens to curfew laws. It had been notified that the people’s perceptions and knowledge about COVID-19 even people with different careers or medical knowledge have a significant impact on the spread of COVID-19 in their communities. Nevertheless, no sufficient research is focused on the knowledge of different categories of Jordanian people on the impact of the COVID-19 pandemic.

As a result, this study discusses the knowledge, behaviors, and health consequences of COVID-19 on Jordanian people having different demographic characteristics, in addition to pregnant and breastfeeding women. A cross-sectional study is designed using an online survey questionnaire during January 2021 and November 2021 to assess and evaluate the knowledge, attitudes, and practices of the Jordanian populations to combat the COVID-19 pandemic. It was used descriptive statistics and statistical analysis using SPSS.

METHOD:

The study was a cross-sectional survey using Google form targeting the Jordanian community. It was conducted from January 2021 and November 2021 and distributed electronically using social media (i.e., Facebook and WhatsApp). The first page of the questionnaire provides information to the participants about the aims of the study before the participants were asked if they would like to take part in it.

The questionnaire was developed, after an extensive review of the literature, by the Jordanian authors talking Arabic and English languages. The final version of the questionnaire was composed of five sections. The first section was composed of questions about participants’ demographics and health. The second section was about the general knowledge of COVID-19. The third section was aimed to collect participants’ beliefs and perceptions toward the COVID-19 outbreak. The fourth section was explored behavioral changes among participants during COVID-19. The final section was evaluated participants’ experiences, including pregnant and lactating mothers, with COVID-19 infection. The authors reviewed the questionnaire, piloted using a small group of participants, and finally amended it as required.

Percentages and frequencies were used to describe categorical data (i.e., participants’ characteristics). Chi-squared statistics (statistical significance was considered at a P-value<0.05) were calculated to examine differences between the survey cohorts and to examine potential associations between reported characteristics. The statistical package for social science (SPSS®) version 26 (SPSS® Inc., Chicago, IL, USA) was used to conduct statistical analyses.

The study protocol was approved by the institutional review board (IRB) committee at Yarmouk university, Irbid, Jordan, after supply the committee with the requested documents to ensure the protection of the human rights, confidentiality and privacy.

RESULTS:

The raw data were downloaded on 1^stDecember 2021; 1041 participants started filling the survey of whom 1015 consented and completed the questionnaire. Half of the participants (n= 524, 51.6%) were between 18 and 28 years old (Table 1). There were more females (n= 799, 78.7%) than males (n = 216, 21.3%). Around two-thirds of them has a graduate degree (n= 660, 65.0%), with approximately half of them having a health-related degree (n=480, 47.3%). Chronic diseases were reported by 271 participants (26.7%). Only 229 participants (22.6%) were received COVID-19 vaccines before filling up the survey and 14.0% received a previous vaccine as a protection against seasonal influenza (n=142).

Table 1: Demographic Characteristics of the Study Sample (N= 1015)

Character		Frequency (%)
Gender
	Male	216 (21.3%)
	Female	799 (78.7%)
Age (Year)
	18-28	524 (51.6%)
	29-39	290 (28.6%)
	40-50	159 (15.7%)
	51-61	34 (3.3%)
	>61	8 (0.8%)
Educational level
	Less than Secondary	26 (2.6%)
	Secondary or Diploma	162 (16.0%)
	Bachelor's	660 (65.0%)
	Postgraduate	167 (16.4%)
Employment status
	Employed in a health-related field	139 (13.7%)
	Employed in the non-health-related field	225 (22.2%)
	Student in a health-related field	341 (33.6%)
	Student in the non-health-related field	36 (3.5%)
	Not employed	274 (27.0%)
Monthly income
	Less than 500 JD	394 (38.8%)
	500-1000 JD	376 (37.0%)
	1000-1500 JD	151 (14.9%)
	More than 1500 JD	94 (9.3%)
Area of residence
	Urban	621 (61.2%)
	Rural	394 (38.8%)
Smoking status
	Non-smoker	872 (85.9%)
	Smoking less than 11 cigarettes daily	61 (6.0%)
	Smoking 11-19 cigarettes daily	37 (3.7%)
	Smoking more than 19 cigarettes daily	45 (4.4%)
Body mass index
	Underweight	51 (5.0%)
	Normal weight	597 (58.8%)
	Overweight	284 (28.0%)
	Obese	53 (5.2%)
	Do not know	30 (3.0%)
ABO group
	A+	387 (38.1%)
	A-	27 (2.7%)
	B+	104 (10.3%)
	B-	9 (0.9%)
	AB+	45 (4.4%)
	AB-	2 (0.2%)
	O+	245 (24.1%)
	O-	49 (4.8%)
	Do not know	147 (14.5%)
Have chronic disease
	Yes	271 (26.7%)
	No	744 (73.3%)
Had seasonal influenza vaccine
	Yes	142 (14.0%)
	No	873 (86.0%)
Had COVID-19 vaccine
	Yes	229 (22.6%)
	No	786 (77.4%)

KNOWLEDGE:

The knowledge of the participants about COVID-19, its route of transmission, and treatment options was inspected. Figure 1 is shown the points of participants’ views about the susceptible routes of COVID-19 transmission. Most of the participants shared a view that COVID-19 is transmitted through air droplets from infected persons via coughing or sneezing (86.5%) and through direct contact with them (84.3%).

Figure 1. Route of COVID-19 transmission

Regards scoring of participant’s knowledge, each correct response was given a mark of 1 but an incorrect response or a response of “Not sure” was given a score of 0. The overall median knowledge score for the included participants was 4 (range, 0-6). Table 2 is shown that there was no difference in the knowledge score based on age, gender, employment status, residency, smoking status, body mass index (BMI), having seasonal influenza vaccine, or having chronic diseases. However, higher educated participants (p=0.009) and those with higher income (p=0.003) had better knowledge about COVID-19. Results regarding the knowledge section are portrayed in Table 2.

Table 2: Participants knowledge about COVID-19

Item	Yes n (%)	No n (%)	Not sure n (%)
Death is a common complication of COVID-19	533 (52.5%)	205 (20.2%)	277 (27.3%)
Elderly, pregnant, breastfeeding mothers and immunocompromised people are at higher exposure risk for being infected	800 (78.8%)	83 (8.2%)	132 (13.0%)
Seasonal influenza vaccine can prevent COVID-19 infection	143 (14.1%)	528 (52.0%)	344 (33.9%)
The home isolation period is 14 days on average	799 (78.7%)	67 (6.6%)	149 (14.7%)
Until now, no medication is found to kill the virus	734 (72.3%)	79 (7.8%)	202 (19.9%)
Supportive therapy has a positive effect on alleviating COVID-19 symptoms	540 (53.2%)	89 (8.8%)	386 (38.0%)

Due to using some home remedies, vitamins, and medications by some people in treating COVID-19 infection, the participants were asked about using these supplements (Figure 2).

Figure 2. Knowledge about COVID-19 treatment options

On the other hand, the most common sources used to get information about COVID-19 by the respondents were social media as reported by 67.9%, followed by the Jordanian Ministry of Health and official sites (65.8%), websites (58.9%), television news (47.9%), and friends, relatives, and colleagues (33.8%).

BELIEFS:

Around 83.7% believes that anxiety and depression levels among the Jordanian community have been increased because of the pandemic, and about 60.4% have concerns about being infected. Although of this, only half of the participants (49.4%) agreed to be vaccinated against COVID-19.

EXPERIENCES:

It was reported that 36.7% of the participants were being infected with COVID-19. About57.5% of them had moderate symptoms, and 3.3%were admitted to the hospital, including 1.6% were admitted to the ICU department. The most common symptoms of those infected participants as reported by them are pointed out in Figure 3. Around 79.0% of the infected participants (n= 294) were fully adherent to home isolation and 1.9% (n= 7) were not adherent at all.

Figure 3. Symptoms of COVID-19 infection reported by participants

When the general treatment options during the illness were assessed (Figure 4), most of infected participants reported to use paracetamol (n= 296, 79.6%), citrus fruit (n= 315, 84.7%), zinc (n= 231, 62.1%) and vitamin C (n= 225, 60.5%).

Figure 4. Remedies used by infected participants for COVID-19 treatment

BEHAVIORAL CHANGES:

Overall, participants adopted several behavioral changes depending on preventive and avoidant measures, owing to the COVID-19 pandemic (Table 3). The most notable changes were washing hands more frequently, using sanitizer, making a distance from the public at least 1 meter, and wearing a face mask. The reasons behind changing these habits as provided by participants were to protect their families (89.4%), themselves (82.2%), and others (69.6%), as well as commit to the Jordanian official rules (57.6%).

Table 3: Participants’ behavior changes during COVID-19

Behavior	Frequency n (%)
Washing hands more frequently/using sanitizer	852 (83.9%)
Distanced from people at least 1 meter	804 (79.2%)
Avoiding touching face	640 (63.1%)
Avoiding touching surfaces	647 (63.7%)
Covering mouth and nose during cough/sneeze	733 (72.2%)
Stayed home more than usual	699 (68.9%)
Reduced/stopped smoking	219 (21.6%)
Increased physical activity	292 (28.8%)
Wore a face mask	794 (78.2%)
Wore gloves	365 (36.0%)
Ate healthier diet	516 (50.8%)
Reduced fast food	321 (31.6%)
Increased water and fluid consumption	593 (58.4%)
Supplement and vitamin consumption	538 (53.0%)
My habits did not change	51 (5.0%)

PREGNANCY:

A total of 34 respondents were pregnant who were being infected with COVID-19, 23.5% (n=8) were in their first trimester, 50.0% (n=17) were in their second trimester, and 26.5% (n=9) were in their third trimester. The infected pregnant women with COVID-19 had some concerns, as expected, and these concerns were reported and highlighted in Table 4.

Table 4: Pregnant women concerns due to COVID-19 infection (n= 34)

Concern	Agree n (%)	Disagree n (%)	Not sure n (%)
The possibility of natural birth is decreased	5 (14.7%)	22 (64.7%)	7 (20.6%)
Infected pregnant should undergo cesarean delivery	4 (11.8%)	23 (67.6%)	7 (20.6%)
COVID-19 can be transmitted from mother to baby by the placenta	2 (5.9%)	23 (67.6%)	9 (26.5%)
Baby is at increased risk for medical illnesses	18 (52.9%)	9 (26.5%)	7 (20.6%)
The baby is at increased risk for congenital disorders	11 (32.4%)	15 (44.1%)	8 (23.5%)
Increased risk for abortion	12 (35.3%)	12 (35.3%)	10 (29.4%)

LACTATION:

Thirty-two of the respondents were lactating mothers who were being infected with COVID-19. During illness, 81.3% of them (n=26) continued direct breastfeeding, 12.5% (n=4) reduced breastfeeding times, 3.1% (n=1) used pumped milk instead of direct feeding, and 3.1% (n=1) stopped breastfeeding and moved toward formula. Because of their concerns, lactating mothers practice several preventive measures to protect their babies from getting an infection as shown in Table 5.

Table 5: Lactating mothers’ practices due to COVID-19 infection(n= 32)

Practice	Agree n (%)	Disagree n (%)	Not sure n (%)
Wearing a face mask and washing hands before and after feeding	24 (75.0 %)	4 (12.5%)	4 (12.5%)
Washing breasts before each lactating time	16 (50.0%)	9 (28.1%)	7 (21.9%)
Increasing breastfeeding to transfer antibodies to the baby	30 (93.8%)	1 (3.1%)	1 (3.1%)
Providing good home ventilation during feeding time	23 (71.9%)	2 (6.3%)	7 (21.9%)

DISCUSSION:

The emerging COVID-19 pandemic since the first case was reported in Jordan on 3^rd of March, 2020. As an exceptional worldwide pandemic it sweeps the globe and affects every individual on this earth in a variety of aspects such as mentally, physically and economically¹³.

An adequate level of COVID-19-related awareness is essential to containing the spread of the virus and setting up realistic expectations regarding the disease’s future course. The current study was conducted to assess the knowledge, perceptions, and attitudes of the public in Jordan towards COVID-19. Participants were found to have good levels of knowledge about COVID-19. However, higher educated participants and those with higher incomes were found to have better knowledge.

This viral disease is transmitted very rapidly form individual to another as the close contact with the symptomatic patient is now the primary way of transmission of COVID-19 via respiratory droplets, which are spread by breathing, speaking, coughing, and sneezing^14,15,16,17. The other route of infection is through handshakes with the asymptomatic patient or touching contaminated surfaces¹⁸. In our study, the majority of participants knew that COVID-19 could be transmitted through air droplets from infected persons via coughing or sneezing (86.5%) and through direct contact with them (84.3%). Additionally, 24.2% and 18.1% of participants were aware of the possible transmission of the COVID-19 virus through blood transfusion and unprotected contact with animals respectively. These routes of transmission are not frequently discussed because of the low risk of blood transfusion transmission of SARS-CoV-2¹⁹and the low rate of spreading of the virus through animals to people²⁰. This study also revealed an increase in awareness regarding the transmission of SARS-CoV-2 from mother to child. Approximately, 15.4% of the participants answered that a pregnant woman can transmit the virus to a fetus, compared to 23% of the medical students in a study performed in March 2020²¹. When participants were also asked if the virus could be transferred through breastfeeding, 12.2% agreed with this route of transmission. Although limited data are available, many studies have reported that there is not enough evidence on the vertical transmission of the virus from mother to child²².

More than three-quarters of participants (78.8%) knew that the elderly, pregnant and immunocompromised people are at higher risk for being infected with SARS-CoV-2, which is in agreement with the currently available data about mortality risks from COVID-19²³. Generally this viral disease is mild in most cases, however it can end with pneumonia, ARDS (acute respiratory distress syndrome), and multi-organ failure in some cases as in elderly patients with comorbidities²⁴.

Interestingly, half of the participants thought that the seasonal influenza vaccine would not protect them from being infected with COVID-19. Although the available results have been conflicting, influenza vaccination is associated with potential protection against COVID-19, improved clinical outcomes, and a significant reduction in COVID-19 death rate in the elderly²⁵.

Self-medication practice is frequently used in Jordan and other countries ²⁶ in addition to the increased number of Google searches worldwide since the pandemic started²⁷. So, participants were asked about medication, home remedies, and vitamins who think may treat COVID-19 and about the options for the infected ones used during the infection period. Approximately, 80% of the participants answered that they should be treated, if they get infected, or used paracetamol for treating COVID-19, while a third of them believed that they should take antibiotics and be treated with an antibiotic (37.9%, 29.3% respectively). Paracetamol was the most commonly used treatment for COVID-19 in Jordan and the Middle East^26,28. More than 80% of the respondents selected citrus fruits as the most frequent home remedy for treating COVID-19. When asked about other remedies, there was a decrease in response between participants who suffered from COVID-19 compared to others. For example, 52.4% and 42.2% of infected participants consumed honey and ginger, respectively, whereas participants who thought that ginger and honey will alleviate COVID-19 symptoms in case of infection were 68.2% and 63.9%, respectively. This is supports the results in which home remedies can to boost the immune system, such as taking garlic, clove, ginger and others²⁹. This study also reported that zinc was the product most consumed (62.1%) followed by vitamin C (60.5%) and vitamin D (55.6%). These views correspond with other studies about self-medication practiced in Jordan which described that participants tended to use high doses of vitamin C and D and Zinc as a potential effect treatment²⁶. Herbs, minerals, and vitamins can enhance the body immunity and decrease the possibility of viral infections in human, also they have role in the primary stage of corona infection³⁰.

This study also found out the most common source of information during the pandemic. Non-medical sources, such as social media were the most influential source of information about COVID-19 (67.9%). Jordanian Ministry of Health option official website was the second source for seeking information (65.8%) followed by other websites (58.9%), television news (47.9%), and friends, relatives, and colleagues (33.8%). People tend to receive information from media, friends, and family since they are often first-hand information³¹.

Another aspect covered by this study was mental health; according to literature COVID-19 had substantial impact on human in regards to anxiety, stress and depression and affects ability of well-being³². In this study the majority of the participants (83.7%) experienced anxiety and depression because of the pandemic and more than half (60.4%) displayed concerns from being infected. This new pandemic caused great mental disorders and a high level of stress and worries worldwide due to the unspecified isolation, contagious disease, and with no sign of returning to normal life soon, especially, during the acute phase of the pandemic when the data was collected³³. However, only half of the participants (49.4%) intended to be vaccinated against COVID-19 which is lower than the percentage reported in other countries (almost 90% in China to almost 57% in the USA)³⁴. According to a Jordanian study published in February 2021, the concerns about safety and efficacy were the main reasons for participants' refusal of vaccination or hesitation³⁵.

In this study, about one-third of the participants were infected with COVID-19. The most common symptoms they experienced were fatigue, headache, loss of taste and smell, pain, cough, fever, and sore throat, while only a few of the participants reported that they had conjunctivitis, otitis media, movement, and/or speaking disability and dermatitis. This aligns with studies that have found fatigue, pain, loss of taste and/or smell fever, and cough to be the dominant symptoms^36,17., while conjunctivitis, otitis media, neuropathy, skin lesions, and urticaria were rarely presented by patients^36-37 For those diagnosed with Covid-19, the high prevalence with 79% followed the protocol and adhered to self-isolation at home.

It is also important to control the spread of the SARS-CoV2 virus, some of the latest virological studies propose potential agents as a good candidates for COVID-19 treatment, however until now no effective therapeutic treatment is available³⁸. Accordingly, standard procedures including isolation of infected patients, regular hand hygiene practice, social distance one-two meter rule, and wearing a mask, in addition to changing negative lifestyle behaviors are recommended by WHO and other major authorities to control this epidemics^2,39. These recommendations are simple, effective, but require people’s cooperation. In this study, approximately 80% of the participants adhered to washing their hands regularly, using sanitizer, keeping a distance of one meter, and wearing masks. Two-thirds of the responders were also aware of the importance of staying at home, covering coughs and sneezes, and avoiding touching the face and surfaces, This lines up with studies that found that this viral pandemic disease has changed people lifestyle by being aware of the importance of hygiene practices⁴⁰.The majority of participants reported that they maintained these precautions for family and self-protection (89.4%, 82.2% respectively). However, 5% of the sample population excluded all the habitual protective practices. The reason behind the high percentage of implementing behaviors according to health protocols may be explained by the influence of social media. Media exposure and social media both showed great impact on providing health education and increasing knowledge about the prevention of covid-19 transmission. Accordingly, it has an impact on good behavior in preventing the spread of covid-19⁴¹. This pandemic changes many people lifestyle, as most of the people use sanitizers as well different masks for prevention from Covid-19.

This study also, according to our knowledge, is the first study directed to infected pregnant and breastfeeding women in Jordan. It is important to evaluate the fears and perceptions of both categories about COVID-19.

Pregnant women, in particular, may be at increased risk of complications associated with COVID-19, since pregnancy alters the immune response which makes them more vulnerable to respiratory infections including COVID- 19⁴². This aligns with the results obtained by a study by Yee Mon et al, in which a valuable information on pregnancy risk is indicated; where a similarity in the pathphysiological conditions between COVID-19 and pregnancy is notice as in both cases the lymphocytes are reduced and selected proinflammatory cytokines are increased⁴³. More than 17% of pregnant women with COVID-19 were hospitalized in the United States since 22 January 2020, as reported by the Centre for Disease Control and Prevention (CDC)^10b. The effects of SARS-CoV-2 infection throughout pregnancy range from mild immunological response, additive or synergistic risk factors for thrombosis, and higher rates of preeclampsia to severe respiratory infections⁴⁴.

Around 18% of the infected participated sample, were pregnant and lactating mothers. The participants demonstrated adequate knowledge of COVID-19. More than 67% of pregnant women who experienced COVID-19 infection believed in the possibility of vaginal delivery. Similarly, 67.6% knew that fetuses were at low risk of being infected with SARS‐Cov‐2. Almost half of them had a perception that their infants are at increased risk for medical illnesses (52.9%) and one-third of them showed fears of congenital disorders (32.4%) and risk of abortion (35.3%). Around 20% of the participants answered (I am not sure) for all the presented concerns. There is some suggestion of vertical transmission of COVID-19, but many clinical studies have suggested that vaginal delivery is associated with a low risk of COVID -19 transmission to the newborn^22,45. The virus is also not significantly linked to be associated with lower birth weight, miscarriage, premature birth, and teratogenicity⁴⁶.

In our study, almost all the nursing mothers were aware of the advantages of breastfeeding milk on the lifelong health and development of newborns⁴⁷, and so 96.8% of them continued breastfeeding during infection COVID-19 infection whether directly or using pumped milk. Mothers also adopted appropriate hygiene measures to decrease the risk of SARS‐Cov‐2 transmission to their infants. More than 70% of them reported that they used to wearing face masks and washing hands before and after feeding, in addition to providing adequate home ventilation during feeding time. Half of the responders washed the breast before every breastfeed, while 21.9% answered (Not sure). The different responses between nursing mothers could be explained by the lack of information provided by healthcare providers⁴⁸.

According to the WHO¹¹, nursing mothers should continue breastfeeding with prudent precautions including hygiene measures such as wearing a medical mask, washing hands, and gentle washing of breast with soap and warm water for at least 20 seconds before feeding. IgM and IgG antibodies to SARS-CoV-2 were found in breast milk while the SARS-CoV-2 genome was not detected⁴⁹. Accordingly, global and governmental guidelines, also recommend breastfeeding or using expressed milk when mothers are infected⁵⁰.

CONCLUSION:

The authors were able to develop an investigation of the knowledge, perceptions, and attitudes of the Jordanians towards COVID-19. The results of this study suggest that the public has good levels of knowledge about COVID-19 regardless of their educational levels. In addition, the Jordanian try always to protect themselves and their close-contact families in this pandemic situation through wearing masks and gloves, keeping a distance from others, and using some vitamins and medications to boost their immunity. The international significance of this work is evident, as Jordan has reopened its economy completely, resumed in-person learning on September 2021, following an aggressive lockdown during the beginning of the pandemic (March 2020–September 2020), and used a comprehensive COVID-19 vaccination program.

ACKNOWLEDGMENTS:

We would like to thank the Jordanian Ministry of Health for their help in this project

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Received on 11.03.2022 Modified on 21.04.2022

Research J. Pharm. and Tech 2022; 15(9):4119-4127.

DOI: 10.52711/0974-360X.2022.00692