Journal of Preventive Medicine

Introduction
Misconceptions about the infection and the health-related consequences of contact with patients recovered from COVID-19 can lead to fear, social avoidance, and discriminatory attitudes towards them. A previous study reported that SARS survivors were stigmatized by the general public [7]. SARS survivors had significant problems in resuming their normal lives due to public discrimination [4]. Thus, public attitudes play a vital role in encouraging infection survivors to reintegrate into society. Therefore, it is necessary to know the public attitude towards patients recovered from COVID-19. Most of the previous studies have examined the knowledge and attitude of the general population towards COVID-19 and the acceptance of its vaccines [10, 11]. Few studies have addressed the issue of social stigma in COVID-19 patients, including a study by Cassiani-Miranda et al. that focused on the relationship between stigma and fear of contracting COVID-19 in the general population of Colombia [12]. A study focused on people's experiences of discrimination related to COVID-19 [13]. Only two studies with goals, tools, methods, and sample sizes different from our study have addressed the issue of discriminatory attitudes towards COVID-19 recovered patients [3, 4]. On the other hand, it seems that the social avoidance of the general population towards COVID-19 recovered patients varies from one country to another according to the prevailing culture, the prevalence of the disease, and the amount of vaccine coverage. Therefore, the present study aims to investigate social avoidance and workplace discrimination in the general population of Iran related to COVID-19 recovered patients and find the related demographic factors.

Methods
A web-based cross-sectional study was conducted on 3836 Iranian people over 15 years of age in 2020, who were selected using a convenience sampling method. The data was collected using a valid and reliable researcher-made questionnaire using a Likert scale and Yes/No answers for rating. Each questionnaire took about 15 minutes to complete. The questionnaire surveys demographic information, perceptions of COVID-19 recovered patients, avoiding COVID-19 recovered patients, and workplace discriminatory attitudes. A score less than the average score was considered as low social avoidance or discriminatory attitude and a score equal to or greater than the average score was considered as high social avoidance or discriminatory attitude at the workplace. Mean±SD were used to describe quantitative variables and frequency and percentage were used to describe qualitative variables. For statistical analysis, to determine the relationship between dependent and independent variables, univariate analysis was first performed, and then variables whose odds ratio was less than 0.25 were entered into the multiple logistic regression model. Data analysis was done in SPSS software, version 21. P<0.05 was considered statistically significant.

Results
In total, 56.72% and 49.06% of the general population of Iran had social avoidance and workplace discriminatory attitudes towards COVID-19 recovered patients, respectively. Social avoidance was higher in the age group 45-64 compared to the age group 18-29 (AOR=1.10; 95% CI, 1.04%-2.93%), urban people compared to rural people (AOR=1.23; 95% CI, 1.3%-28.95%), people with high school diploma compared to people with primary education (AOR=1.42; 95% CI, 1.13%-2.71%), people with university education compared to people with primary education (AOR=2.19; 95% CI, 1.15%-3.36%), college/school students compared to unemployed people (AOR=2.32; 95% CI, 1.81%-3.50%), employed people compared to unemployed people (AOR=1.51; 95% CI, 1.20%-2.64%), and people who had a recovered person at home compared to other people (AOR=2.35; 95% CI, 1.28%-6.51%) had higher social avoidance. Men had lower social avoidance compared to women (AOR=0.63; 95% CI, 0.54%-0.88%). Moreover, workplace discriminatory attitudes were higher in the age group 45-64 compared to the age group 18-29 (AOR=1.21; 95% CI, 1.05%-2.29%), single people compared to married people (AOR=1.15; 95% CI, 1.09%-2.02%), urban people compared to rural people (AOR=1.90; 95% CI, 1.68%-2.99%), people with high economic status compared to those with low economic status (AOR=1.20; 95% CI, 1.05%-1.79%), and people who had a recovered person at home compared to other people (AOR=1.33; 95% CI, 1.15%-1.89%). On the other hand, men compared to women (AOR=0.84; 95% CI, 0.58%-0.96%) and people with high school education (AOR=0.61; 95% CI, 0.37%-0.75%), high school diploma (AOR=0.75; 95% CI, 0.00%-61.97%), and university degree (AOR=0.51; 95% CI, 0.43%-0.77%) compared to those with primary school education, had lower discriminatory attitudes.

Conclusion
Social avoidance and workplace discriminatory attitudes towards COVID-19 recovered patients in the general population of Iran is a major concern, since about half of them showed social avoidance and workplace discrimination behaviors related to the recovered patients. Providing accurate and transparent information about the physical conditions of recovered patients by the medical department, focusing on city residents, women, and families with a history of COVID-19 patients, as well as supporting measures related to employment by government or private organizations and strengthening the relationship between general population and recovered patients are recommended to reduce social avoidance and workplace discriminatory attitudes towards COVID-19 recovered patients

Ethical Considerations
Compliance with ethical guidelines
All methods were performed in accordance with the Declaration of Helsinki. The All ethical considerations such as preserving the dignity of individuals, clearly and clearly stating the purpose of the research, informed consent and presenting the results to the stakeholders in order to make appropriate decisions were observed  Hormozgan University of Medical Sciences approved the study (Code: IR.HUMS.REC.1399.061) .

Funding
This project was funded by Hormozgan University of Medical Sciences. 

Authors' contributions
Study design and writing the manuscript: Sara Dadipoor and Nahid Shahabi; Data analysis and data interpretation: Shokrollah Mohseni; Study protocol and supervision of data collection: Nahid Shahabi, Vahid Ranaei; Data collection and data curation: Sara Dadipoor and Hadi Eshaghi Sani Kakhaki; Design online questionnaire: Hesamaddin Kamalzadeh Takhti, Hossein Montazereghaem; Final approval: All authors.

Conflicts of interest
The authors declared no conflicts of interest.

Acknowledgements
The authors would like to thank Hormozgan University of Medical Science as their financial support. The authors would also like to express their gratitude to the participants for their sincere cooperation in this study.


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