effect of covid 19 on our lives essay

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In Their Own Words, Americans Describe the Struggles and Silver Linings of the COVID-19 Pandemic

The outbreak has dramatically changed americans’ lives and relationships over the past year. we asked people to tell us about their experiences – good and bad – in living through this moment in history..

Pew Research Center has been asking survey questions over the past year about Americans’ views and reactions to the COVID-19 pandemic. In August, we gave the public a chance to tell us in their own words how the pandemic has affected them in their personal lives. We wanted to let them tell us how their lives have become more difficult or challenging, and we also asked about any unexpectedly positive events that might have happened during that time.

The vast majority of Americans (89%) mentioned at least one negative change in their own lives, while a smaller share (though still a 73% majority) mentioned at least one unexpected upside. Most have experienced these negative impacts and silver linings simultaneously: Two-thirds (67%) of Americans mentioned at least one negative and at least one positive change since the pandemic began.

For this analysis, we surveyed 9,220 U.S. adults between Aug. 31-Sept. 7, 2020. Everyone who completed the survey is a member of Pew Research Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories.  Read more about the ATP’s methodology . 

Respondents to the survey were asked to describe in their own words how their lives have been difficult or challenging since the beginning of the coronavirus outbreak, and to describe any positive aspects of the situation they have personally experienced as well. Overall, 84% of respondents provided an answer to one or both of the questions. The Center then categorized a random sample of 4,071 of their answers using a combination of in-house human coders, Amazon’s Mechanical Turk service and keyword-based pattern matching. The full methodology  and questions used in this analysis can be found here.

In many ways, the negatives clearly outweigh the positives – an unsurprising reaction to a pandemic that had killed  more than 180,000 Americans  at the time the survey was conducted. Across every major aspect of life mentioned in these responses, a larger share mentioned a negative impact than mentioned an unexpected upside. Americans also described the negative aspects of the pandemic in greater detail: On average, negative responses were longer than positive ones (27 vs. 19 words). But for all the difficulties and challenges of the pandemic, a majority of Americans were able to think of at least one silver lining. 

Both the negative and positive impacts described in these responses cover many aspects of life, none of which were mentioned by a majority of Americans. Instead, the responses reveal a pandemic that has affected Americans’ lives in a variety of ways, of which there is no “typical” experience. Indeed, not all groups seem to have experienced the pandemic equally. For instance, younger and more educated Americans were more likely to mention silver linings, while women were more likely than men to mention challenges or difficulties.

Here are some direct quotes that reveal how Americans are processing the new reality that has upended life across the country.

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• Volume 76, Issue 2
• COVID-19 pandemic and its impact on social relationships and health
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• http://orcid.org/0000-0003-1512-4471 Emily Long 1 ,
• Susan Patterson 1 ,
• Karen Maxwell 1 ,
• Carolyn Blake 1 ,
• http://orcid.org/0000-0001-7342-4566 Raquel Bosó Pérez 1 ,
• Ruth Lewis 1 ,
• Mark McCann 1 ,
• Julie Riddell 1 ,
• Kathryn Skivington 1 ,
• Rachel Wilson-Lowe 1 ,
• http://orcid.org/0000-0002-4409-6601 Kirstin R Mitchell 2
• 1 MRC/CSO Social and Public Health Sciences Unit , University of Glasgow , Glasgow , UK
• 2 MRC/CSO Social and Public Health Sciences Unit, Institute of Health & Wellbeing , University of Glasgow , Glasgow , UK
• Correspondence to Dr Emily Long, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow G3 7HR, UK; emily.long{at}glasgow.ac.uk

This essay examines key aspects of social relationships that were disrupted by the COVID-19 pandemic. It focuses explicitly on relational mechanisms of health and brings together theory and emerging evidence on the effects of the COVID-19 pandemic to make recommendations for future public health policy and recovery. We first provide an overview of the pandemic in the UK context, outlining the nature of the public health response. We then introduce four distinct domains of social relationships: social networks, social support, social interaction and intimacy, highlighting the mechanisms through which the pandemic and associated public health response drastically altered social interactions in each domain. Throughout the essay, the lens of health inequalities, and perspective of relationships as interconnecting elements in a broader system, is used to explore the varying impact of these disruptions. The essay concludes by providing recommendations for longer term recovery ensuring that the social relational cost of COVID-19 is adequately considered in efforts to rebuild.

• inequalities

Data availability statement

Data sharing not applicable as no data sets generated and/or analysed for this study. Data sharing not applicable as no data sets generated or analysed for this essay.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/ .

https://doi.org/10.1136/jech-2021-216690

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Introduction

Infectious disease pandemics, including SARS and COVID-19, demand intrapersonal behaviour change and present highly complex challenges for public health. 1 A pandemic of an airborne infection, spread easily through social contact, assails human relationships by drastically altering the ways through which humans interact. In this essay, we draw on theories of social relationships to examine specific ways in which relational mechanisms key to health and well-being were disrupted by the COVID-19 pandemic. Relational mechanisms refer to the processes between people that lead to change in health outcomes.

At the time of writing, the future surrounding COVID-19 was uncertain. Vaccine programmes were being rolled out in countries that could afford them, but new and more contagious variants of the virus were also being discovered. The recovery journey looked long, with continued disruption to social relationships. The social cost of COVID-19 was only just beginning to emerge, but the mental health impact was already considerable, 2 3 and the inequality of the health burden stark. 4 Knowledge of the epidemiology of COVID-19 accrued rapidly, but evidence of the most effective policy responses remained uncertain.

The initial response to COVID-19 in the UK was reactive and aimed at reducing mortality, with little time to consider the social implications, including for interpersonal and community relationships. The terminology of ‘social distancing’ quickly became entrenched both in public and policy discourse. This equation of physical distance with social distance was regrettable, since only physical proximity causes viral transmission, whereas many forms of social proximity (eg, conversations while walking outdoors) are minimal risk, and are crucial to maintaining relationships supportive of health and well-being.

The aim of this essay is to explore four key relational mechanisms that were impacted by the pandemic and associated restrictions: social networks, social support, social interaction and intimacy. We use relational theories and emerging research on the effects of the COVID-19 pandemic response to make three key recommendations: one regarding public health responses; and two regarding social recovery. Our understanding of these mechanisms stems from a ‘systems’ perspective which casts social relationships as interdependent elements within a connected whole. 5

Social networks

Social networks characterise the individuals and social connections that compose a system (such as a workplace, community or society). Social relationships range from spouses and partners, to coworkers, friends and acquaintances. They vary across many dimensions, including, for example, frequency of contact and emotional closeness. Social networks can be understood both in terms of the individuals and relationships that compose the network, as well as the overall network structure (eg, how many of your friends know each other).

Social networks show a tendency towards homophily, or a phenomenon of associating with individuals who are similar to self. 6 This is particularly true for ‘core’ network ties (eg, close friends), while more distant, sometimes called ‘weak’ ties tend to show more diversity. During the height of COVID-19 restrictions, face-to-face interactions were often reduced to core network members, such as partners, family members or, potentially, live-in roommates; some ‘weak’ ties were lost, and interactions became more limited to those closest. Given that peripheral, weaker social ties provide a diversity of resources, opinions and support, 7 COVID-19 likely resulted in networks that were smaller and more homogenous.

Such changes were not inevitable nor necessarily enduring, since social networks are also adaptive and responsive to change, in that a disruption to usual ways of interacting can be replaced by new ways of engaging (eg, Zoom). Yet, important inequalities exist, wherein networks and individual relationships within networks are not equally able to adapt to such changes. For example, individuals with a large number of newly established relationships (eg, university students) may have struggled to transfer these relationships online, resulting in lost contacts and a heightened risk of social isolation. This is consistent with research suggesting that young adults were the most likely to report a worsening of relationships during COVID-19, whereas older adults were the least likely to report a change. 8

Lastly, social connections give rise to emergent properties of social systems, 9 where a community-level phenomenon develops that cannot be attributed to any one member or portion of the network. For example, local area-based networks emerged due to geographic restrictions (eg, stay-at-home orders), resulting in increases in neighbourly support and local volunteering. 10 In fact, research suggests that relationships with neighbours displayed the largest net gain in ratings of relationship quality compared with a range of relationship types (eg, partner, colleague, friend). 8 Much of this was built from spontaneous individual interactions within local communities, which together contributed to the ‘community spirit’ that many experienced. 11 COVID-19 restrictions thus impacted the personal social networks and the structure of the larger networks within the society.

Social support

Social support, referring to the psychological and material resources provided through social interaction, is a critical mechanism through which social relationships benefit health. In fact, social support has been shown to be one of the most important resilience factors in the aftermath of stressful events. 12 In the context of COVID-19, the usual ways in which individuals interact and obtain social support have been severely disrupted.

One such disruption has been to opportunities for spontaneous social interactions. For example, conversations with colleagues in a break room offer an opportunity for socialising beyond one’s core social network, and these peripheral conversations can provide a form of social support. 13 14 A chance conversation may lead to advice helpful to coping with situations or seeking formal help. Thus, the absence of these spontaneous interactions may mean the reduction of indirect support-seeking opportunities. While direct support-seeking behaviour is more effective at eliciting support, it also requires significantly more effort and may be perceived as forceful and burdensome. 15 The shift to homeworking and closure of community venues reduced the number of opportunities for these spontaneous interactions to occur, and has, second, focused them locally. Consequently, individuals whose core networks are located elsewhere, or who live in communities where spontaneous interaction is less likely, have less opportunity to benefit from spontaneous in-person supportive interactions.

However, alongside this disruption, new opportunities to interact and obtain social support have arisen. The surge in community social support during the initial lockdown mirrored that often seen in response to adverse events (eg, natural disasters 16 ). COVID-19 restrictions that confined individuals to their local area also compelled them to focus their in-person efforts locally. Commentators on the initial lockdown in the UK remarked on extraordinary acts of generosity between individuals who belonged to the same community but were unknown to each other. However, research on adverse events also tells us that such community support is not necessarily maintained in the longer term. 16

Meanwhile, online forms of social support are not bound by geography, thus enabling interactions and social support to be received from a wider network of people. Formal online social support spaces (eg, support groups) existed well before COVID-19, but have vastly increased since. While online interactions can increase perceived social support, it is unclear whether remote communication technologies provide an effective substitute from in-person interaction during periods of social distancing. 17 18 It makes intuitive sense that the usefulness of online social support will vary by the type of support offered, degree of social interaction and ‘online communication skills’ of those taking part. Youth workers, for instance, have struggled to keep vulnerable youth engaged in online youth clubs, 19 despite others finding a positive association between amount of digital technology used by individuals during lockdown and perceived social support. 20 Other research has found that more frequent face-to-face contact and phone/video contact both related to lower levels of depression during the time period of March to August 2020, but the negative effect of a lack of contact was greater for those with higher levels of usual sociability. 21 Relatedly, important inequalities in social support exist, such that individuals who occupy more socially disadvantaged positions in society (eg, low socioeconomic status, older people) tend to have less access to social support, 22 potentially exacerbated by COVID-19.

Social and interactional norms

Interactional norms are key relational mechanisms which build trust, belonging and identity within and across groups in a system. Individuals in groups and societies apply meaning by ‘approving, arranging and redefining’ symbols of interaction. 23 A handshake, for instance, is a powerful symbol of trust and equality. Depending on context, not shaking hands may symbolise a failure to extend friendship, or a failure to reach agreement. The norms governing these symbols represent shared values and identity; and mutual understanding of these symbols enables individuals to achieve orderly interactions, establish supportive relationship accountability and connect socially. 24 25

Physical distancing measures to contain the spread of COVID-19 radically altered these norms of interaction, particularly those used to convey trust, affinity, empathy and respect (eg, hugging, physical comforting). 26 As epidemic waves rose and fell, the work to negotiate these norms required intense cognitive effort; previously taken-for-granted interactions were re-examined, factoring in current restriction levels, own and (assumed) others’ vulnerability and tolerance of risk. This created awkwardness, and uncertainty, for example, around how to bring closure to an in-person interaction or convey warmth. The instability in scripted ways of interacting created particular strain for individuals who already struggled to encode and decode interactions with others (eg, those who are deaf or have autism spectrum disorder); difficulties often intensified by mask wearing. 27

Large social gatherings—for example, weddings, school assemblies, sporting events—also present key opportunities for affirming and assimilating interactional norms, building cohesion and shared identity and facilitating cooperation across social groups. 28 Online ‘equivalents’ do not easily support ‘social-bonding’ activities such as singing and dancing, and rarely enable chance/spontaneous one-on-one conversations with peripheral/weaker network ties (see the Social networks section) which can help strengthen bonds across a larger network. The loss of large gatherings to celebrate rites of passage (eg, bar mitzvah, weddings) has additional relational costs since these events are performed by and for communities to reinforce belonging, and to assist in transitioning to new phases of life. 29 The loss of interaction with diverse others via community and large group gatherings also reduces intergroup contact, which may then tend towards more prejudiced outgroup attitudes. While online interaction can go some way to mimicking these interaction norms, there are key differences. A sense of anonymity, and lack of in-person emotional cues, tends to support norms of polarisation and aggression in expressing differences of opinion online. And while online platforms have potential to provide intergroup contact, the tendency of much social media to form homogeneous ‘echo chambers’ can serve to further reduce intergroup contact. 30 31

Intimacy relates to the feeling of emotional connection and closeness with other human beings. Emotional connection, through romantic, friendship or familial relationships, fulfils a basic human need 32 and strongly benefits health, including reduced stress levels, improved mental health, lowered blood pressure and reduced risk of heart disease. 32 33 Intimacy can be fostered through familiarity, feeling understood and feeling accepted by close others. 34

Intimacy via companionship and closeness is fundamental to mental well-being. Positively, the COVID-19 pandemic has offered opportunities for individuals to (re)connect and (re)strengthen close relationships within their household via quality time together, following closure of many usual external social activities. Research suggests that the first full UK lockdown period led to a net gain in the quality of steady relationships at a population level, 35 but amplified existing inequalities in relationship quality. 35 36 For some in single-person households, the absence of a companion became more conspicuous, leading to feelings of loneliness and lower mental well-being. 37 38 Additional pandemic-related relational strain 39 40 resulted, for some, in the initiation or intensification of domestic abuse. 41 42

Physical touch is another key aspect of intimacy, a fundamental human need crucial in maintaining and developing intimacy within close relationships. 34 Restrictions on social interactions severely restricted the number and range of people with whom physical affection was possible. The reduction in opportunity to give and receive affectionate physical touch was not experienced equally. Many of those living alone found themselves completely without physical contact for extended periods. The deprivation of physical touch is evidenced to take a heavy emotional toll. 43 Even in future, once physical expressions of affection can resume, new levels of anxiety over germs may introduce hesitancy into previously fluent blending of physical and verbal intimate social connections. 44

The pandemic also led to shifts in practices and norms around sexual relationship building and maintenance, as individuals adapted and sought alternative ways of enacting sexual intimacy. This too is important, given that intimate sexual activity has known benefits for health. 45 46 Given that social restrictions hinged on reducing household mixing, possibilities for partnered sexual activity were primarily guided by living arrangements. While those in cohabiting relationships could potentially continue as before, those who were single or in non-cohabiting relationships generally had restricted opportunities to maintain their sexual relationships. Pornography consumption and digital partners were reported to increase since lockdown. 47 However, online interactions are qualitatively different from in-person interactions and do not provide the same opportunities for physical intimacy.

Recommendations and conclusions

In the sections above we have outlined the ways in which COVID-19 has impacted social relationships, showing how relational mechanisms key to health have been undermined. While some of the damage might well self-repair after the pandemic, there are opportunities inherent in deliberative efforts to build back in ways that facilitate greater resilience in social and community relationships. We conclude by making three recommendations: one regarding public health responses to the pandemic; and two regarding social recovery.

Recommendation 1: explicitly count the relational cost of public health policies to control the pandemic

Effective handling of a pandemic recognises that social, economic and health concerns are intricately interwoven. It is clear that future research and policy attention must focus on the social consequences. As described above, policies which restrict physical mixing across households carry heavy and unequal relational costs. These include for individuals (eg, loss of intimate touch), dyads (eg, loss of warmth, comfort), networks (eg, restricted access to support) and communities (eg, loss of cohesion and identity). Such costs—and their unequal impact—should not be ignored in short-term efforts to control an epidemic. Some public health responses—restrictions on international holiday travel and highly efficient test and trace systems—have relatively small relational costs and should be prioritised. At a national level, an earlier move to proportionate restrictions, and investment in effective test and trace systems, may help prevent escalation of spread to the point where a national lockdown or tight restrictions became an inevitability. Where policies with relational costs are unavoidable, close attention should be paid to the unequal relational impact for those whose personal circumstances differ from normative assumptions of two adult families. This includes consideration of whether expectations are fair (eg, for those who live alone), whether restrictions on social events are equitable across age group, religious/ethnic groupings and social class, and also to ensure that the language promoted by such policies (eg, households; families) is not exclusionary. 48 49 Forethought to unequal impacts on social relationships should thus be integral to the work of epidemic preparedness teams.

Recommendation 2: intelligently balance online and offline ways of relating

A key ingredient for well-being is ‘getting together’ in a physical sense. This is fundamental to a human need for intimate touch, physical comfort, reinforcing interactional norms and providing practical support. Emerging evidence suggests that online ways of relating cannot simply replace physical interactions. But online interaction has many benefits and for some it offers connections that did not exist previously. In particular, online platforms provide new forms of support for those unable to access offline services because of mobility issues (eg, older people) or because they are geographically isolated from their support community (eg, lesbian, gay, bisexual, transgender and queer (LGBTQ) youth). Ultimately, multiple forms of online and offline social interactions are required to meet the needs of varying groups of people (eg, LGBTQ, older people). Future research and practice should aim to establish ways of using offline and online support in complementary and even synergistic ways, rather than veering between them as social restrictions expand and contract. Intelligent balancing of online and offline ways of relating also pertains to future policies on home and flexible working. A decision to switch to wholesale or obligatory homeworking should consider the risk to relational ‘group properties’ of the workplace community and their impact on employees’ well-being, focusing in particular on unequal impacts (eg, new vs established employees). Intelligent blending of online and in-person working is required to achieve flexibility while also nurturing supportive networks at work. Intelligent balance also implies strategies to build digital literacy and minimise digital exclusion, as well as coproducing solutions with intended beneficiaries.

Recommendation 3: build stronger and sustainable localised communities

In balancing offline and online ways of interacting, there is opportunity to capitalise on the potential for more localised, coherent communities due to scaled-down travel, homeworking and local focus that will ideally continue after restrictions end. There are potential economic benefits after the pandemic, such as increased trade as home workers use local resources (eg, coffee shops), but also relational benefits from stronger relationships around the orbit of the home and neighbourhood. Experience from previous crises shows that community volunteer efforts generated early on will wane over time in the absence of deliberate work to maintain them. Adequately funded partnerships between local government, third sector and community groups are required to sustain community assets that began as a direct response to the pandemic. Such partnerships could work to secure green spaces and indoor (non-commercial) meeting spaces that promote community interaction. Green spaces in particular provide a triple benefit in encouraging physical activity and mental health, as well as facilitating social bonding. 50 In building local communities, small community networks—that allow for diversity and break down ingroup/outgroup views—may be more helpful than the concept of ‘support bubbles’, which are exclusionary and less sustainable in the longer term. Rigorously designed intervention and evaluation—taking a systems approach—will be crucial in ensuring scale-up and sustainability.

The dramatic change to social interaction necessitated by efforts to control the spread of COVID-19 created stark challenges but also opportunities. Our essay highlights opportunities for learning, both to ensure the equity and humanity of physical restrictions, and to sustain the salutogenic effects of social relationships going forward. The starting point for capitalising on this learning is recognition of the disruption to relational mechanisms as a key part of the socioeconomic and health impact of the pandemic. In recovery planning, a general rule is that what is good for decreasing health inequalities (such as expanding social protection and public services and pursuing green inclusive growth strategies) 4 will also benefit relationships and safeguard relational mechanisms for future generations. Putting this into action will require political will.

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• ↵ (ONS), O.f.N.S., Domestic abuse during the coronavirus (COVID-19) pandemic, England and Wales . Available: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/domesticabuseduringthecoronaviruscovid19pandemicenglandandwales/november2020
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Twitter @karenmaxSPHSU, @Mark_McCann, @Rwilsonlowe, @KMitchinGlasgow

Contributors EL and KM led on the manuscript conceptualisation, review and editing. SP, KM, CB, RBP, RL, MM, JR, KS and RW-L contributed to drafting and revising the article. All authors assisted in revising the final draft.

Funding The research reported in this publication was supported by the Medical Research Council (MC_UU_00022/1, MC_UU_00022/3) and the Chief Scientist Office (SPHSU11, SPHSU14). EL is also supported by MRC Skills Development Fellowship Award (MR/S015078/1). KS and MM are also supported by a Medical Research Council Strategic Award (MC_PC_13027).

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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How to Write About Coronavirus in a College Essay

Students can share how they navigated life during the coronavirus pandemic in a full-length essay or an optional supplement.

Writing About COVID-19 in College Essays

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Experts say students should be honest and not limit themselves to merely their experiences with the pandemic.

The global impact of COVID-19, the disease caused by the novel coronavirus, means colleges and prospective students alike are in for an admissions cycle like no other. Both face unprecedented challenges and questions as they grapple with their respective futures amid the ongoing fallout of the pandemic.

Colleges must examine applicants without the aid of standardized test scores for many – a factor that prompted many schools to go test-optional for now . Even grades, a significant component of a college application, may be hard to interpret with some high schools adopting pass-fail classes last spring due to the pandemic. Major college admissions factors are suddenly skewed.

"I can't help but think other (admissions) factors are going to matter more," says Ethan Sawyer, founder of the College Essay Guy, a website that offers free and paid essay-writing resources.

College essays and letters of recommendation , Sawyer says, are likely to carry more weight than ever in this admissions cycle. And many essays will likely focus on how the pandemic shaped students' lives throughout an often tumultuous 2020.

But before writing a college essay focused on the coronavirus, students should explore whether it's the best topic for them.

Writing About COVID-19 for a College Application

Much of daily life has been colored by the coronavirus. Virtual learning is the norm at many colleges and high schools, many extracurriculars have vanished and social lives have stalled for students complying with measures to stop the spread of COVID-19.

"For some young people, the pandemic took away what they envisioned as their senior year," says Robert Alexander, dean of admissions, financial aid and enrollment management at the University of Rochester in New York. "Maybe that's a spot on a varsity athletic team or the lead role in the fall play. And it's OK for them to mourn what should have been and what they feel like they lost, but more important is how are they making the most of the opportunities they do have?"

That question, Alexander says, is what colleges want answered if students choose to address COVID-19 in their college essay.

But the question of whether a student should write about the coronavirus is tricky. The answer depends largely on the student.

"In general, I don't think students should write about COVID-19 in their main personal statement for their application," Robin Miller, master college admissions counselor at IvyWise, a college counseling company, wrote in an email.

"Certainly, there may be exceptions to this based on a student's individual experience, but since the personal essay is the main place in the application where the student can really allow their voice to be heard and share insight into who they are as an individual, there are likely many other topics they can choose to write about that are more distinctive and unique than COVID-19," Miller says.

Opinions among admissions experts vary on whether to write about the likely popular topic of the pandemic.

"If your essay communicates something positive, unique, and compelling about you in an interesting and eloquent way, go for it," Carolyn Pippen, principal college admissions counselor at IvyWise, wrote in an email. She adds that students shouldn't be dissuaded from writing about a topic merely because it's common, noting that "topics are bound to repeat, no matter how hard we try to avoid it."

Above all, she urges honesty.

"If your experience within the context of the pandemic has been truly unique, then write about that experience, and the standing out will take care of itself," Pippen says. "If your experience has been generally the same as most other students in your context, then trying to find a unique angle can easily cross the line into exploiting a tragedy, or at least appearing as though you have."

But focusing entirely on the pandemic can limit a student to a single story and narrow who they are in an application, Sawyer says. "There are so many wonderful possibilities for what you can say about yourself outside of your experience within the pandemic."

He notes that passions, strengths, career interests and personal identity are among the multitude of essay topic options available to applicants and encourages them to probe their values to help determine the topic that matters most to them – and write about it.

That doesn't mean the pandemic experience has to be ignored if applicants feel the need to write about it.

Writing About Coronavirus in Main and Supplemental Essays

Students can choose to write a full-length college essay on the coronavirus or summarize their experience in a shorter form.

To help students explain how the pandemic affected them, The Common App has added an optional section to address this topic. Applicants have 250 words to describe their pandemic experience and the personal and academic impact of COVID-19.

"That's not a trick question, and there's no right or wrong answer," Alexander says. Colleges want to know, he adds, how students navigated the pandemic, how they prioritized their time, what responsibilities they took on and what they learned along the way.

If students can distill all of the above information into 250 words, there's likely no need to write about it in a full-length college essay, experts say. And applicants whose lives were not heavily altered by the pandemic may even choose to skip the optional COVID-19 question.

"This space is best used to discuss hardship and/or significant challenges that the student and/or the student's family experienced as a result of COVID-19 and how they have responded to those difficulties," Miller notes. Using the section to acknowledge a lack of impact, she adds, "could be perceived as trite and lacking insight, despite the good intentions of the applicant."

To guard against this lack of awareness, Sawyer encourages students to tap someone they trust to review their writing , whether it's the 250-word Common App response or the full-length essay.

Experts tend to agree that the short-form approach to this as an essay topic works better, but there are exceptions. And if a student does have a coronavirus story that he or she feels must be told, Alexander encourages the writer to be authentic in the essay.

"My advice for an essay about COVID-19 is the same as my advice about an essay for any topic – and that is, don't write what you think we want to read or hear," Alexander says. "Write what really changed you and that story that now is yours and yours alone to tell."

Sawyer urges students to ask themselves, "What's the sentence that only I can write?" He also encourages students to remember that the pandemic is only a chapter of their lives and not the whole book.

Miller, who cautions against writing a full-length essay on the coronavirus, says that if students choose to do so they should have a conversation with their high school counselor about whether that's the right move. And if students choose to proceed with COVID-19 as a topic, she says they need to be clear, detailed and insightful about what they learned and how they adapted along the way.

"Approaching the essay in this manner will provide important balance while demonstrating personal growth and vulnerability," Miller says.

Pippen encourages students to remember that they are in an unprecedented time for college admissions.

"It is important to keep in mind with all of these (admission) factors that no colleges have ever had to consider them this way in the selection process, if at all," Pippen says. "They have had very little time to calibrate their evaluations of different application components within their offices, let alone across institutions. This means that colleges will all be handling the admissions process a little bit differently, and their approaches may even evolve over the course of the admissions cycle."

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Read these 12 moving essays about life during coronavirus

Artists, novelists, critics, and essayists are writing the first draft of history.

by Alissa Wilkinson

The world is grappling with an invisible, deadly enemy, trying to understand how to live with the threat posed by a virus . For some writers, the only way forward is to put pen to paper, trying to conceptualize and document what it feels like to continue living as countries are under lockdown and regular life seems to have ground to a halt.

So as the coronavirus pandemic has stretched around the world, it’s sparked a crop of diary entries and essays that describe how life has changed. Novelists, critics, artists, and journalists have put words to the feelings many are experiencing. The result is a first draft of how we’ll someday remember this time, filled with uncertainty and pain and fear as well as small moments of hope and humanity.

• The Vox guide to navigating the coronavirus crisis

At the New York Review of Books, Ali Bhutto writes that in Karachi, Pakistan, the government-imposed curfew due to the virus is “eerily reminiscent of past military clampdowns”:

Beneath the quiet calm lies a sense that society has been unhinged and that the usual rules no longer apply. Small groups of pedestrians look on from the shadows, like an audience watching a spectacle slowly unfolding. People pause on street corners and in the shade of trees, under the watchful gaze of the paramilitary forces and the police.

His essay concludes with the sobering note that “in the minds of many, Covid-19 is just another life-threatening hazard in a city that stumbles from one crisis to another.”

Writing from Chattanooga, novelist Jamie Quatro documents the mixed ways her neighbors have been responding to the threat, and the frustration of conflicting direction, or no direction at all, from local, state, and federal leaders:

Whiplash, trying to keep up with who’s ordering what. We’re already experiencing enough chaos without this back-and-forth. Why didn’t the federal government issue a nationwide shelter-in-place at the get-go, the way other countries did? What happens when one state’s shelter-in-place ends, while others continue? Do states still under quarantine close their borders? We  are  still one nation, not fifty individual countries. Right?

• A syllabus for the end of the world

Award-winning photojournalist Alessio Mamo, quarantined with his partner Marta in Sicily after she tested positive for the virus, accompanies his photographs in the Guardian of their confinement with a reflection on being confined :

The doctors asked me to take a second test, but again I tested negative. Perhaps I’m immune? The days dragged on in my apartment, in black and white, like my photos. Sometimes we tried to smile, imagining that I was asymptomatic, because I was the virus. Our smiles seemed to bring good news. My mother left hospital, but I won’t be able to see her for weeks. Marta started breathing well again, and so did I. I would have liked to photograph my country in the midst of this emergency, the battles that the doctors wage on the frontline, the hospitals pushed to their limits, Italy on its knees fighting an invisible enemy. That enemy, a day in March, knocked on my door instead.

In the New York Times Magazine, deputy editor Jessica Lustig writes with devastating clarity about her family’s life in Brooklyn while her husband battled the virus, weeks before most people began taking the threat seriously:

At the door of the clinic, we stand looking out at two older women chatting outside the doorway, oblivious. Do I wave them away? Call out that they should get far away, go home, wash their hands, stay inside? Instead we just stand there, awkwardly, until they move on. Only then do we step outside to begin the long three-block walk home. I point out the early magnolia, the forsythia. T says he is cold. The untrimmed hairs on his neck, under his beard, are white. The few people walking past us on the sidewalk don’t know that we are visitors from the future. A vision, a premonition, a walking visitation. This will be them: Either T, in the mask, or — if they’re lucky — me, tending to him.

Essayist Leslie Jamison writes in the New York Review of Books about being shut away alone in her New York City apartment with her 2-year-old daughter since she became sick:

The virus.  Its sinewy, intimate name. What does it feel like in my body today? Shivering under blankets. A hot itch behind the eyes. Three sweatshirts in the middle of the day. My daughter trying to pull another blanket over my body with her tiny arms. An ache in the muscles that somehow makes it hard to lie still. This loss of taste has become a kind of sensory quarantine. It’s as if the quarantine keeps inching closer and closer to my insides. First I lost the touch of other bodies; then I lost the air; now I’ve lost the taste of bananas. Nothing about any of these losses is particularly unique. I’ve made a schedule so I won’t go insane with the toddler. Five days ago, I wrote  Walk/Adventure!  on it, next to a cut-out illustration of a tiger—as if we’d see tigers on our walks. It was good to keep possibility alive.

At Literary Hub, novelist Heidi Pitlor writes about the elastic nature of time during her family’s quarantine in Massachusetts:

During a shutdown, the things that mark our days—commuting to work, sending our kids to school, having a drink with friends—vanish and time takes on a flat, seamless quality. Without some self-imposed structure, it’s easy to feel a little untethered. A friend recently posted on Facebook: “For those who have lost track, today is Blursday the fortyteenth of Maprilay.” ... Giving shape to time is especially important now, when the future is so shapeless. We do not know whether the virus will continue to rage for weeks or months or, lord help us, on and off for years. We do not know when we will feel safe again. And so many of us, minus those who are gifted at compartmentalization or denial, remain largely captive to fear. We may stay this way if we do not create at least the illusion of movement in our lives, our long days spent with ourselves or partners or families.

• What day is it today?

Novelist Lauren Groff writes at the New York Review of Books about trying to escape the prison of her fears while sequestered at home in Gainesville, Florida:

Some people have imaginations sparked only by what they can see; I blame this blinkered empiricism for the parks overwhelmed with people, the bars, until a few nights ago, thickly thronged. My imagination is the opposite. I fear everything invisible to me. From the enclosure of my house, I am afraid of the suffering that isn’t present before me, the people running out of money and food or drowning in the fluid in their lungs, the deaths of health-care workers now growing ill while performing their duties. I fear the federal government, which the right wing has so—intentionally—weakened that not only is it insufficient to help its people, it is actively standing in help’s way. I fear we won’t sufficiently punish the right. I fear leaving the house and spreading the disease. I fear what this time of fear is doing to my children, their imaginations, and their souls.

At ArtForum , Berlin-based critic and writer Kristian Vistrup Madsen reflects on martinis, melancholia, and Finnish artist Jaakko Pallasvuo’s 2018 graphic novel  Retreat , in which three young people exile themselves in the woods:

In melancholia, the shape of what is ending, and its temporality, is sprawling and incomprehensible. The ambivalence makes it hard to bear. The world of  Retreat  is rendered in lush pink and purple watercolors, which dissolve into wild and messy abstractions. In apocalypse, the divisions established in genesis bleed back out. My own Corona-retreat is similarly soft, color-field like, each day a blurred succession of quarantinis, YouTube–yoga, and televized press conferences. As restrictions mount, so does abstraction. For now, I’m still rooting for love to save the world.

At the Paris Review , Matt Levin writes about reading Virginia Woolf’s novel The Waves during quarantine:

A retreat, a quarantine, a sickness—they simultaneously distort and clarify, curtail and expand. It is an ideal state in which to read literature with a reputation for difficulty and inaccessibility, those hermetic books shorn of the handholds of conventional plot or characterization or description. A novel like Virginia Woolf’s  The Waves  is perfect for the state of interiority induced by quarantine—a story of three men and three women, meeting after the death of a mutual friend, told entirely in the overlapping internal monologues of the six, interspersed only with sections of pure, achingly beautiful descriptions of the natural world, a day’s procession and recession of light and waves. The novel is, in my mind’s eye, a perfectly spherical object. It is translucent and shimmering and infinitely fragile, prone to shatter at the slightest disturbance. It is not a book that can be read in snatches on the subway—it demands total absorption. Though it revels in a stark emotional nakedness, the book remains aloof, remote in its own deep self-absorption.

• Vox is starting a book club. Come read with us!

In an essay for the Financial Times, novelist Arundhati Roy writes with anger about Indian Prime Minister Narendra Modi’s anemic response to the threat, but also offers a glimmer of hope for the future:

Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next. We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it. 

From Boston, Nora Caplan-Bricker writes in The Point about the strange contraction of space under quarantine, in which a friend in Beirut is as close as the one around the corner in the same city:

It’s a nice illusion—nice to feel like we’re in it together, even if my real world has shrunk to one person, my husband, who sits with his laptop in the other room. It’s nice in the same way as reading those essays that reframe social distancing as solidarity. “We must begin to see the negative space as clearly as the positive, to know what we  don’t do  is also brilliant and full of love,” the poet Anne Boyer wrote on March 10th, the day that Massachusetts declared a state of emergency. If you squint, you could almost make sense of this quarantine as an effort to flatten, along with the curve, the distinctions we make between our bonds with others. Right now, I care for my neighbor in the same way I demonstrate love for my mother: in all instances, I stay away. And in moments this month, I have loved strangers with an intensity that is new to me. On March 14th, the Saturday night after the end of life as we knew it, I went out with my dog and found the street silent: no lines for restaurants, no children on bicycles, no couples strolling with little cups of ice cream. It had taken the combined will of thousands of people to deliver such a sudden and complete emptiness. I felt so grateful, and so bereft.

And on his own website, musician and artist David Byrne writes about rediscovering the value of working for collective good , saying that “what is happening now is an opportunity to learn how to change our behavior”:

In emergencies, citizens can suddenly cooperate and collaborate. Change can happen. We’re going to need to work together as the effects of climate change ramp up. In order for capitalism to survive in any form, we will have to be a little more socialist. Here is an opportunity for us to see things differently — to see that we really are all connected — and adjust our behavior accordingly.  Are we willing to do this? Is this moment an opportunity to see how truly interdependent we all are? To live in a world that is different and better than the one we live in now? We might be too far down the road to test every asymptomatic person, but a change in our mindsets, in how we view our neighbors, could lay the groundwork for the collective action we’ll need to deal with other global crises. The time to see how connected we all are is now.

The portrait these writers paint of a world under quarantine is multifaceted. Our worlds have contracted to the confines of our homes, and yet in some ways we’re more connected than ever to one another. We feel fear and boredom, anger and gratitude, frustration and strange peace. Uncertainty drives us to find metaphors and images that will let us wrap our minds around what is happening.

Yet there’s no single “what” that is happening. Everyone is contending with the pandemic and its effects from different places and in different ways. Reading others’ experiences — even the most frightening ones — can help alleviate the loneliness and dread, a little, and remind us that what we’re going through is both unique and shared by all.

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How COVID Changed the World

Lessons from two years of emergency science, upheaval and loss

Olena Shmahalo

Pandemic-Era Research Will Pay Off for Years

The COVID research infrastructure will help fight all sorts of pathogens

Britt Glaunsinger

Introducing 21 Ways COVID Changed the World

The pandemic didn’t bring us together, but it did show us what we need to change the most

Jen Schwartz

COVID Pushed Global Health Institutions to Their Limits

The need to reinvent the World Health Organization has become abundantly clear

Lawrence O. Gostin

COVID Has Made Global Inequality Much Worse

The poor, no matter where they live, will suffer the greatest lasting toll

Joseph E. Stiglitz

COVID Changed the World of Work Forever

People realized their jobs don’t have to be that way

Christina Maslach, Michael P. Leiter

The Pandemic Set Off a Boom in Diagnostics

COVID accelerated the development of cutting-edge PCR tests—and made the need for them urgent

Roxanne Khamsi

A High-Speed Scientific Hive Mind Emerged from the COVID Pandemic

The pandemic pushed researchers into new forms of rapid communication and collaboration

Joseph Bak-Coleman, Carl T. Bergstrom

COVID’s Uneven Toll Captured in Data

Visualizing ongoing stories of loss, adaptation and inequality

Amanda Montañez, Jen Christiansen, Sabine Devins, Mariana Surillo, Ashley P. Taylor

COVID Revealed the Fragility of American Public Health

What happens when a deadly virus hits a vulnerable society

Wendy E. Parmet

The Pandemic Showed the Promise of Cities with Fewer Cars

Residents learned what was possible. Some politicians fought to keep it that way

Andrea Thompson

How a Virus Exposed the Myth of Rugged Individualism

Humans evolved to be interdependent, not self-sufficient

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The Pandemic Deepened Fault Lines in American Society

COVID energized the Black Lives Matter movement—and provoked a dangerous backlash

Aldon Morris

• COVID-19 and your mental health

Worries and anxiety about COVID-19 can be overwhelming. Learn ways to cope as COVID-19 spreads.

At the start of the COVID-19 pandemic, life for many people changed very quickly. Worry and concern were natural partners of all that change — getting used to new routines, loneliness and financial pressure, among other issues. Information overload, rumor and misinformation didn't help.

Worldwide surveys done in 2020 and 2021 found higher than typical levels of stress, insomnia, anxiety and depression. By 2022, levels had lowered but were still higher than before 2020.

Though feelings of distress about COVID-19 may come and go, they are still an issue for many people. You aren't alone if you feel distress due to COVID-19. And you're not alone if you've coped with the stress in less than healthy ways, such as substance use.

But healthier self-care choices can help you cope with COVID-19 or any other challenge you may face.

And knowing when to get help can be the most essential self-care action of all.

Recognize what's typical and what's not

Stress and worry are common during a crisis. But something like the COVID-19 pandemic can push people beyond their ability to cope.

In surveys, the most common symptoms reported were trouble sleeping and feeling anxiety or nervous. The number of people noting those symptoms went up and down in surveys given over time. Depression and loneliness were less common than nervousness or sleep problems, but more consistent across surveys given over time. Among adults, use of drugs, alcohol and other intoxicating substances has increased over time as well.

The first step is to notice how often you feel helpless, sad, angry, irritable, hopeless, anxious or afraid. Some people may feel numb.

Keep track of how often you have trouble focusing on daily tasks or doing routine chores. Are there things that you used to enjoy doing that you stopped doing because of how you feel? Note any big changes in appetite, any substance use, body aches and pains, and problems with sleep.

These feelings may come and go over time. But if these feelings don't go away or make it hard to do your daily tasks, it's time to ask for help.

Get help when you need it

If you're feeling suicidal or thinking of hurting yourself, seek help.

• Contact your healthcare professional or a mental health professional.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline , available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential.

If you are worried about yourself or someone else, contact your healthcare professional or mental health professional. Some may be able to see you in person or talk over the phone or online.

You also can reach out to a friend or loved one. Someone in your faith community also could help.

And you may be able to get counseling or a mental health appointment through an employer's employee assistance program.

Another option is information and treatment options from groups such as:

• National Alliance on Mental Illness (NAMI).
• Substance Abuse and Mental Health Services Administration (SAMHSA).
• Anxiety and Depression Association of America.

Self-care tips

Some people may use unhealthy ways to cope with anxiety around COVID-19. These unhealthy choices may include things such as misuse of medicines or legal drugs and use of illegal drugs. Unhealthy coping choices also can be things such as sleeping too much or too little, or overeating. It also can include avoiding other people and focusing on only one soothing thing, such as work, television or gaming.

Unhealthy coping methods can worsen mental and physical health. And that is particularly true if you're trying to manage or recover from COVID-19.

Self-care actions can help you restore a healthy balance in your life. They can lessen everyday stress or significant anxiety linked to events such as the COVID-19 pandemic. Self-care actions give your body and mind a chance to heal from the problems long-term stress can cause.

Take care of your body

Healthy self-care tips start with the basics. Give your body what it needs and avoid what it doesn't need. Some tips are:

• Get the right amount of sleep for you. A regular sleep schedule, when you go to bed and get up at similar times each day, can help avoid sleep problems.
• Move your body. Regular physical activity and exercise can help reduce anxiety and improve mood. Any activity you can do regularly is a good choice. That may be a scheduled workout, a walk or even dancing to your favorite music.
• Choose healthy food and drinks. Foods that are high in nutrients, such as protein, vitamins and minerals are healthy choices. Avoid food or drink with added sugar, fat or salt.
• Avoid tobacco, alcohol and drugs. If you smoke tobacco or if you vape, you're already at higher risk of lung disease. Because COVID-19 affects the lungs, your risk increases even more. Using alcohol to manage how you feel can make matters worse and reduce your coping skills. Avoid taking illegal drugs or misusing prescriptions to manage your feelings.

Take care of your mind

Healthy coping actions for your brain start with deciding how much news and social media is right for you. Staying informed, especially during a pandemic, helps you make the best choices but do it carefully.

Set aside a specific amount of time to find information in the news or on social media, stay limited to that time, and choose reliable sources. For example, give yourself up to 20 or 30 minutes a day of news and social media. That amount keeps people informed but not overwhelmed.

For COVID-19, consider reliable health sources. Examples are the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).

Other healthy self-care tips are:

• Relax and recharge. Many people benefit from relaxation exercises such as mindfulness, deep breathing, meditation and yoga. Find an activity that helps you relax and try to do it every day at least for a short time. Fitting time in for hobbies or activities you enjoy can help manage feelings of stress too.
• Stick to your health routine. If you see a healthcare professional for mental health services, keep up with your appointments. And stay up to date with all your wellness tests and screenings.
• Stay in touch and connect with others. Family, friends and your community are part of a healthy mental outlook. Together, you form a healthy support network for concerns or challenges. Social interactions, over time, are linked to a healthier and longer life.

Avoid stigma and discrimination

Stigma can make people feel isolated and even abandoned. They may feel sad, hurt and angry when people in their community avoid them for fear of getting COVID-19. People who have experienced stigma related to COVID-19 include people of Asian descent, health care workers and people with COVID-19.

Treating people differently because of their medical condition, called medical discrimination, isn't new to the COVID-19 pandemic. Stigma has long been a problem for people with various conditions such as Hansen's disease (leprosy), HIV, diabetes and many mental illnesses.

People who experience stigma may be left out or shunned, treated differently, or denied job and school options. They also may be targets of verbal, emotional and physical abuse.

Communication can help end stigma or discrimination. You can address stigma when you:

• Get to know people as more than just an illness. Using respectful language can go a long way toward making people comfortable talking about a health issue.
• Get the facts about COVID-19 or other medical issues from reputable sources such as the CDC and WHO.
• Speak up if you hear or see myths about an illness or people with an illness.

COVID-19 and health

The virus that causes COVID-19 is still a concern for many people. By recognizing when to get help and taking time for your health, life challenges such as COVID-19 can be managed.

• Mental health during the COVID-19 pandemic. National Institutes of Health. https://covid19.nih.gov/covid-19-topics/mental-health. Accessed March 12, 2024.
• Mental Health and COVID-19: Early evidence of the pandemic's impact: Scientific brief, 2 March 2022. World Health Organization. https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1. Accessed March 12, 2024.
• Mental health and the pandemic: What U.S. surveys have found. Pew Research Center. https://www.pewresearch.org/short-reads/2023/03/02/mental-health-and-the-pandemic-what-u-s-surveys-have-found/. Accessed March 12, 2024.
• Taking care of your emotional health. Centers for Disease Control and Prevention. https://emergency.cdc.gov/coping/selfcare.asp. Accessed March 12, 2024.
• #HealthyAtHome—Mental health. World Health Organization. www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome---mental-health. Accessed March 12, 2024.
• Coping with stress. Centers for Disease Control and Prevention. www.cdc.gov/mentalhealth/stress-coping/cope-with-stress/. Accessed March 12, 2024.
• Manage stress. U.S. Department of Health and Human Services. https://health.gov/myhealthfinder/topics/health-conditions/heart-health/manage-stress. Accessed March 20, 2020.
• COVID-19 and substance abuse. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/covid-19-substance-use#health-outcomes. Accessed March 12, 2024.
• COVID-19 resource and information guide. National Alliance on Mental Illness. https://www.nami.org/Support-Education/NAMI-HelpLine/COVID-19-Information-and-Resources/COVID-19-Resource-and-Information-Guide. Accessed March 15, 2024.
• Negative coping and PTSD. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/gethelp/negative_coping.asp. Accessed March 15, 2024.
• Health effects of cigarette smoking. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm#respiratory. Accessed March 15, 2024.
• People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed March 15, 2024.
• Your healthiest self: Emotional wellness toolkit. National Institutes of Health. https://www.nih.gov/health-information/emotional-wellness-toolkit. Accessed March 15, 2024.
• World leprosy day: Bust the myths, learn the facts. Centers for Disease Control and Prevention. https://www.cdc.gov/leprosy/world-leprosy-day/. Accessed March 15, 2024.
• HIV stigma and discrimination. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/basics/hiv-stigma/. Accessed March 15, 2024.
• Diabetes stigma: Learn about it, recognize it, reduce it. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/features/diabetes_stigma.html. Accessed March 15, 2024.
• Phelan SM, et al. Patient and health care professional perspectives on stigma in integrated behavioral health: Barriers and recommendations. Annals of Family Medicine. 2023; doi:10.1370/afm.2924.
• Stigma reduction. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/od2a/case-studies/stigma-reduction.html. Accessed March 15, 2024.
• Nyblade L, et al. Stigma in health facilities: Why it matters and how we can change it. BMC Medicine. 2019; doi:10.1186/s12916-019-1256-2.
• Combating bias and stigma related to COVID-19. American Psychological Association. https://www.apa.org/topics/covid-19-bias. Accessed March 15, 2024.
• Yashadhana A, et al. Pandemic-related racial discrimination and its health impact among non-Indigenous racially minoritized peoples in high-income contexts: A systematic review. Health Promotion International. 2021; doi:10.1093/heapro/daab144.
• Sawchuk CN (expert opinion). Mayo Clinic. March 25, 2024.

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• The positive effects...

The positive effects of covid-19

Read our latest coverage of the coronavirus pandemic.

• Related content
• Peer review
• Bryn Nelson , science journalist
• Seattle, WA, USA
• bdnelson{at}nasw.org

As the coronavirus pandemic continues its deadly path, dramatic changes in how people live are reducing some instances of other medical problems. Bryn Nelson writes that the irony may hold valuable lessons for public health

Doctors and researchers are noticing some curious and unexpectedly positive side effects of the abrupt shifts in human behaviour in response to the covid-19 pandemic. Skies are bluer, fewer cars are crashing, crime is falling, and some other infectious diseases are fading from hospital emergency departments.

Other changes are unquestionably troubling. American doctors have expressed alarm over a nosedive in patients presenting to emergency departments with heart attacks, strokes, and other conditions, leading to fears that patients are too afraid of contracting covid-19 to seek necessary medical care. 1 Calls to poison control centres are up by around 20%, attributed to a rise in accidents with cleaners and disinfectants even before President Trump questioned whether injected disinfectants might stop the virus. 2 Calls to suicide prevention lines are skyrocketing, while health experts are fretting about signs of rising alcohol and drug use, poorer diets, and a lack of exercise among those cooped-up at home. 3 Millions of people are hungry and unemployed.

But doctors, researchers, and public health officials say the pandemic is also providing a unique window through which to view some positive health effects from major changes in human behaviour. And the pandemic may lead to a public more willing to accept and act on public health messages.

Alice Pong, a paediatric infectious disease physician and the medical director for infection control at Rady Children’s Hospital in San Diego, California, said the hospital has seen a sharp decline in paediatric admissions for respiratory illnesses. These include diseases such as influenza, parainfluenza, respiratory syncytial virus, and human metapneumovirus.

“We track positive viral tests through our hospital lab and those numbers have gone down dramatically since everybody went into quarantine,” Pong told The BMJ . “We do think that’s a reflection of kids not being in day care or school.” The hospital is testing fewer patients, she said, which could be because more children might be staying home with respiratory symptoms. But more serious cases and intensive care unit admissions are down as well, suggesting a true decline in life threatening illnesses.

Beyond the disease reducing effects of social distancing, Pong said she believes children and families are taking advice on hand washing, personal hygiene, and other prevention measures seriously. “I think this is going to be a good lesson for everybody,” she said. ‘‘The public is seeing why public health officials have advised them stay home when they feel sick, for example, and why they’ve emphasised hand washing and covering a cough or sneeze. Kids growing up now will know this is how germs are spread,” Pong said. That message could spread to their families and broaden awareness.

Fewer cars, blue skies

With covid-19 shutting down economic activity in most parts of the world and people staying closer to home, street crimes like assault and robbery are down significantly, though domestic violence has increased. 4 Traffic has plummeted as well. As a result, NASA satellites have documented significant reductions in air pollution—20-30% in many cases—in major cities around the world. 5 Based on those declines, Marshall Burke, an environmental economist at Stanford University, predicted in a blog post that two months’ worth of improved air quality in China alone might save the lives of 4000 children under the age of 5 and 73 000 adults over the age of 70 (a more conservative calculation estimated about 50 000 saved lives). 6

Although baseline pollution levels in the US are lower, Burke said a similar 20-30% reduction in pollution would still likely yield significant health benefits. “A pandemic is a terrible way to improve environmental health,” he emphasised. It may, however, provide an unexpected vantage to help understand how environmental health can be altered. “It may help bring into focus the effect of business as usual on health outcomes that we care about,” he told The BMJ . “In some sense, it helps us imagine the future.” Getting there, he says, could instead come through better regulation and technology.

A separate report coauthored by Fraser Shilling, director of the Road Ecology Center at the University of California at Davis, found that highway accidents—including those involving an injury or fatality—fell by half after the state’s shelter-in-place order on 19 March. 7 “The reduction in traffic accidents is unparalleled,” and yielded an estimated $40m (£32m; €37m) in public savings every day, the report asserted.

Whereas average traffic speeds increased by only a few miles per hour, traffic volume fell by 55%. Hospitals in the Sacramento region reported fewer trauma related admissions while other reports indicated fewer car collisions with pedestrians and cyclists.

In Washington, collisions on state highways fell even further—by 62%—in the month after the state’s stay-at-home order went into effect on 23 March, compared with the previous year, according to the Washington State Patrol. The question, Shilling said, is whether researchers can learn from the information to design safer transportation patterns. “We’re not going to be guessing anymore about what happens when you take half the cars away,” he said.

Emptier highways, though, may be triggering reckless driving that could undo the mortality reductions. Washington State Patrol spokesperson Darren Wright said that troopers are seeing a “scary trend” of more drivers travelling at extreme speeds—a phenomenon also observed in Missouri. “We’re seeing speeds in the 120 and 130 miles per hour range,” Wright said. One motorcyclist was clocked at more than 150 miles per hour.

Reassessing priorities

If the pandemic has prompted risky behaviour for some, it has encouraged others to embrace preventive measures. Randy Mayer, chief of the Bureau of HIV, STD, and Hepatitis at the Iowa Department of Public Health, said the public has become more responsive to calls from the department’s partner services, which perform contact tracing for people who test positive for HIV, gonorrhoea, and syphilis. “People are really interested in calling us back and finding out what information we have for them,” he said. That increased cooperation, Mayer said, may be a benefit of people associating public health departments with trying to keep them safe from covid-19.

Even so, he worries that a noticeable reduction in the number of new HIV diagnoses may partially reflect a reduction in available testing with many clinics open for limited hours, if not completely closed. But growing evidence suggests that more people are also heeding recent pleas by public health officials and even dating apps to reduce the risk of covid-19 infection by avoiding casual sex with new partners. Researchers in Portugal and the UK told The BMJ that they were beginning to see shifts in the incidence of sexually transmitted infections but were still collecting data to support their observations.

Miguel Duarte Botas Alpalhão, a dermatovenereologist and invited lecturer in the Faculty of Medicine at the University of Lisbon, said that he expects to see a lower rate of sexually transmitted infections during the lockdown. The crisis has caused people to question their priorities “and how much they are willing to give up to protect their lives and those of their loved ones,” he said. “People are now more aware that nothing really matters when health is lacking, and this raised awareness may be the driving force towards healthier habits. We will have to wait and see.”

Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

• ↵ Grady D. The pandemic’s hidden victims: sick or dying, but not from the virus. New York Times. 20 April 2020. www.nytimes.com/2020/04/20/health/treatment-delays-coronavirus.html .
• Schnall AH ,
• ↵ Bharath D. Suicide, help hotline calls soar in Southern California over coronavirus anxieties. Orange County Register. 19 April 2020. www.ocregister.com/2020/04/19/suicide-help-hotline-calls-soar-in-southern-california-over-coronavirus-anxieties .
• ↵ Dazio S, Briceno F, Tarm M. Crime drops around the world as covid-19 keeps people inside. Associated Press. 11 April 2020. https://apnews.com/bbb7adc88d3fa067c5c1b5c72a1a8aa6 .
• ↵ NASA. Airborne nitrogen dioxide plummets over China. 2 March 2020. www.earthobservatory.nasa.gov/images/146362/airborne-nitrogen-dioxide-plummets-over-china .
• ↵ Burke M. Covid-19 reduces economic activity, which reduces pollution, which saves lives. G-FEED.org. 8 March 2020. www.g-feed.com/2020/03/covid-19-reduces-economic-activity.html .
• ↵ Shilling F, Waetjen D. Special report (update): impact of covid-19 mitigation on numbers and costs of California traffic crashes. 15 April 2020. https://roadecology.ucdavis.edu/files/content/projects/COVID_CHIPs_Impacts_updated_415.pdf .

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‘When Normal Life Stopped’: College Essays Reflect a Turbulent Year

This year’s admissions essays became a platform for high school seniors to reflect on the pandemic, race and loss.

By Anemona Hartocollis

This year perhaps more than ever before, the college essay has served as a canvas for high school seniors to reflect on a turbulent and, for many, sorrowful year. It has been a psychiatrist’s couch, a road map to a more hopeful future, a chance to pour out intimate feelings about loneliness and injustice.

In response to a request from The New York Times, more than 900 seniors submitted the personal essays they wrote for their college applications. Reading them is like a trip through two of the biggest news events of recent decades: the devastation wrought by the coronavirus, and the rise of a new civil rights movement.

In the wake of the high-profile deaths of Black people like George Floyd and Breonna Taylor at the hands of police officers, students shared how they had wrestled with racism in their own lives. Many dipped their feet into the politics of protest, finding themselves strengthened by their activism, yet sometimes conflicted.

And in the midst of the most far-reaching pandemic in a century, they described the isolation and loss that have pervaded every aspect of their lives since schools suddenly shut down a year ago. They sought to articulate how they have managed while cut off from friends and activities they had cultivated for years.

To some degree, the students were responding to prompts on the applications, with their essays taking on even more weight in a year when many colleges waived standardized test scores and when extracurricular activities were wiped out.

This year the Common App, the nation’s most-used application, added a question inviting students to write about the impact of Covid-19 on their lives and educations. And universities like Notre Dame and Lehigh invited applicants to write about their reactions to the death of George Floyd, and how that inspired them to make the world a better place.

The coronavirus was the most common theme in the essays submitted to The Times, appearing in 393 essays, more than 40 percent. Next was the value of family, coming up in 351 essays, but often in the context of other issues, like the pandemic and race. Racial justice and protest figured in 342 essays.

“We find with underrepresented populations, we have lots of people coming to us with a legitimate interest in seeing social justice established, and they are looking to see their college as their training ground for that,” said David A. Burge, vice president for enrollment management at George Mason University.

Family was not the only eternal verity to appear. Love came up in 286 essays; science in 128; art in 110; music in 109; and honor in 32. Personal tragedy also loomed large, with 30 essays about cancer alone.

Some students resisted the lure of current events, and wrote quirky essays about captaining a fishing boat on Cape Cod or hosting dinner parties. A few wrote poetry. Perhaps surprisingly, politics and the 2020 election were not of great interest.

Most students expect to hear where they were admitted by the end of March or beginning of April. Here are excerpts from a few of the essays, edited for length.

Nandini Likki

Nandini, a senior at the Seven Hills School in Cincinnati, took care of her father after he was hospitalized with Covid-19. It was a “harrowing” but also rewarding time, she writes.

When he came home, my sister and I had to take care of him during the day while my mom went to work. We cooked his food, washed his dishes, and excessively cleaned the house to make sure we didn’t get the disease as well.

It was an especially harrowing time in my life and my mental health suffered due to the amount of stress I was under.

However, I think I grew emotionally and matured because of the experience. My sister and I became more responsible as we took on more adult roles in the family. I grew even closer to my dad and learned how to bond with him in different ways, like using Netflix Party to watch movies together. Although the experience isolated me from most of my friends who couldn’t relate to me, my dad’s illness taught me to treasure my family even more and cherish the time I spend with them.

Nandini has been accepted at Case Western and other schools.

Grace Sundstrom

Through her church in Des Moines, Grace, a senior at Roosevelt High School, began a correspondence with Alden, a man who was living in a nursing home and isolated by the pandemic.

As our letters flew back and forth, I decided to take a chance and share my disgust about the treatment of people of color at the hands of police officers. To my surprise, Alden responded with the same sentiments and shared his experience marching in the civil rights movement in the 1960s.

Here we were, two people generations apart, finding common ground around one of the most polarizing subjects in American history.

When I arrived at my first Black Lives Matter protest this summer, I was greeted by the voices of singing protesters. The singing made me think of a younger Alden, stepping off the train at Union Station in Washington, D.C., to attend the 1963 March on Washington.

Grace has been admitted to Trinity University in San Antonio and is waiting to hear from others.

Ahmed AlMehri

Ahmed, who attends the American School of Kuwait, wrote of growing stronger through the death of his revered grandfather from Covid-19.

Fareed Al-Othman was a poet, journalist and, most importantly, my grandfather. Sept. 8, 2020, he fell victim to Covid-19. To many, he’s just a statistic — one of the “inevitable” deaths. But to me, he was, and continues to be, an inspiration. I understand the frustration people have with the restrictions, curfews, lockdowns and all of the tertiary effects of these things.

But I, personally, would go through it all a hundred times over just to have my grandfather back.

For a long time, things felt as if they weren’t going to get better. Balancing the grief of his death, school and the upcoming college applications was a struggle; and my stress started to accumulate. Covid-19 has taken a lot from me, but it has forced me to grow stronger and persevere. I know my grandfather would be disappointed if I had let myself use his death as an excuse to slack off.

Ahmed has been accepted by the University of California, Irvine, and the University of Miami and is waiting to hear from others.

Mina Rowland

Mina, who lives in a shelter in San Joaquin County, Calif., wrote of becoming homeless in middle school.

Despite every day that I continue to face homelessness, I know that I have outlets for my pain and anguish.

Most things that I’ve had in life have been destroyed, stolen, lost, or taken, but art and poetry shall be with me forever.

The stars in “Starry Night” are my tenacity and my hope. Every time I am lucky enough to see the stars, I am reminded of how far I’ve come and how much farther I can go.

After taking a gap year, Mina and her twin sister, Mirabell, have been accepted at the University of Maryland Eastern Shore and are waiting on others.

Christine Faith Cabusay

Christine, a senior at Stuyvesant High School in New York, decided to break the isolation of the pandemic by writing letters to her friends.

How often would my friends receive something in the mail that was not college mail, a bill, or something they ordered online? My goal was to make opening a letter an experience. I learned calligraphy and Spencerian script so it was as if an 18th-century maiden was writing to them from her parlor on a rainy day.

Washing lines in my yard held an ever-changing rainbow of hand-recycled paper.

With every letter came a painting of something that I knew they liked: fandoms, animals, music, etc. I sprayed my favorite perfume on my signature on every letter because I read somewhere that women sprayed perfume on letters overseas to their partners in World War II; it made writing letters way more romantic (even if it was just to my close friends).

Christine is still waiting to hear from schools.

Alexis Ihezue

Her father’s death from complications of diabetes last year caused Alexis, a student at the Gwinnett School of Mathematics, Science and Technology in Lawrenceville, Ga., to consider the meaning of love.

And in the midst of my grief swallowing me from the inside out, I asked myself when I loved him most, and when I knew he loved me. It’s nothing but brief flashes, like bits and pieces of a dream. I hear him singing “Fix You” by Coldplay on our way home, his hands across the table from me at our favorite wing spot that we went to weekly after school, him driving me home in the middle of a rainstorm, his last message to me congratulating me on making it to senior year.

It’s me finding a plastic spoon in the sink last week and remembering the obnoxious way he used to eat. I see him in bursts and flashes.

A myriad of colors and experiences. And I think to myself, ‘That’s what it is.’ It’s a second. It’s a minute. That’s what love is. It isn’t measured in years, but moments.

Alexis has been accepted by the University of North Carolina at Chapel Hill and is waiting on others.

Ivy Wanjiku

She and her mother came to America “with nothing but each other and $100,” writes Ivy, who was born in Kenya and attends North Cobb High School in Kennesaw, Ga.

I am a triple threat. Foreign, black, female. From the dirt roads and dust that covered the attire of my ancestors who worshiped the soil, I have sprouted new beginnings for generations.

But the question arises; will that generation live to see its day?

Melanin mistaken as a felon, my existence is now a hashtag that trends as often as my rights, a facade at best, a lie in truth. I now know more names of dead blacks than I do the amendments of the Constitution.

Ivy is going to Emory University in Atlanta on full scholarship and credits her essay with helping her get in.

Mary Clare Marshall

The isolation of the pandemic became worse when Mary Clare, a student at Sacred Heart Greenwich in Connecticut, realized that her mother had cancer.

My parents acted like everything was normal, but there were constant reminders of her diagnosis. After her first chemo appointment, I didn’t acknowledge the change. It became real when she came downstairs one day without hair.

No one said anything about the change. It just happened. And it hit me all over again. My mom has cancer.

Even after going to Catholic school for my whole life, I couldn’t help but be angry at God. I felt myself experiencing immense doubt in everything I believe in. Unable to escape my house for any small respite, I felt as though I faced the reality of my mom’s cancer totally alone.

Mary Clare has been admitted to the University of Virginia and is waiting on other schools.

Nora Frances Kohnhorst

Nora, a student at the High School of American Studies at Lehman College in New York, was always “a serial dabbler,” but found commitment in a common pandemic hobby.

In March, when normal life stopped, I took up breadmaking. This served a practical purpose. The pandemic hit my neighborhood in Queens especially hard, and my parents were afraid to go to the store. This forced my family to come up with ways to avoid shopping. I decided I would learn to make sourdough using recipes I found online. Initially, some loaves fell flat, others were too soft inside, and still more spread into strange blobs.

I reminded myself that the bread didn’t need to be perfect, just edible.

It didn’t matter what it looked like; there was no one to see or eat it besides my brother and parents. They depended on my new activity, and that dependency prevented me from repeating the cycle of trying a hobby, losing steam, and moving on to something new.

Nora has been admitted to SUNY Binghamton and the University of Vermont and is waiting to hear from others.

Gracie Yong Ying Silides

Gracie, a student at Greensboro Day School in North Carolina, recalls the “red thread” of a Chinese proverb and wonders where it will take her next.

Destiny has led me into a mysterious place these last nine months: isolation. At a time in my life when I am supposed to be branching out, the Covid pandemic seems to have trimmed those branches back to nubs. I have had to research colleges without setting foot on them. I’ve introduced myself to strangers through essays, videos, and test scores.

I would have fallen apart over this if it weren’t for my faith.

In Hebrews 11:1, Paul says that “faith is the substance of things hoped for, the evidence of things not seen.” My life has shown me that the red thread of destiny guides me where I need to go. Though it might sound crazy, I trust that the red thread is guiding me to the next phase of my journey.

Gracie has been accepted to St. Olaf College, Ithaca College and others.

Levi, a student at Westerville Central High School in Ohio, wrestles with the conflict between her admiration for her father, a police officer, and the negative image of the police.

Since I was a small child I have watched my father put on his dark blue uniform to go to work protecting and serving others. He has always been my hero. As the African-American daughter of a police officer, I believe in what my father stands for, and I am so proud of him because he is not only my protector, but the protector of those I will likely never know. When I was young, I imagined him always being a hero to others, just as he was to me. How could anyone dislike him??? However, as I have gotten older and watched television and social media depict the brutalization of African-Americans, at the hands of police, I have come to a space that is uncomfortable.

I am certain there are others like me — African-Americans who love their police officer family members, yet who despise what the police are doing to African-Americans.

I know that I will not be able to rectify this problem alone, but I want to be a part of the solution where my paradox no longer exists.

Levi has been accepted to the University of North Carolina at Chapel Hill and North Carolina Agricultural and Technical State University, and is waiting to hear from others.

Henry Thomas Egan

When Henry, a student at Creighton Preparatory School in Omaha, attended a protest after the death of George Floyd, it was the words of a Nina Simone song that stayed with him.

I had never been to a protest before; neither my school, nor my family, nor my city are known for being outspoken. Thousands lined the intersection in all four directions, chanting, “He couldn’t breathe! George Floyd couldn’t breathe!”

In my head, thoughts of hunger, injustice, and silence swirled around.

In my ears, I heard lyrics playing on a speaker nearby, a song by Nina Simone: “To be young, gifted, and Black!” The experience was exceptionally sad and affirming and disorienting at the same time, and when the police arrived and started firing tear gas, I left. A lot has happened in my life over these last four years. I am left not knowing how to sort all of this out and what paths I should follow.

Henry has not yet heard back from colleges.

Anna Valades

Anna, a student at Coronado High School in California, pondered how children learned racism from their parents.

“She said I wasn’t invited to her birthday party because I was black,” my sister had told my mom, devastated, after coming home from third grade as the only classmate who had not been invited to the party. Although my sister is not black, she is a dark-skinned Mexican, and brown-skinned people in Mexico are thought of as being a lower class and commonly referred to as “negros.” When my mom found out who had been discriminating against my sister, she later informed me that the girl’s mother had also bullied my mom about her skin tone when she was in elementary school in Mexico City.

Through this situation, I learned the impact people’s upbringing and the values they are taught at home have on their beliefs and, therefore, their actions.

Anna has been accepted at Northeastern University and is waiting to hear from others.

Research was contributed by Asmaa Elkeurti, Aidan Gardiner, Pierre-Antoine Louis and Jake Frankenfield.

Anemona Hartocollis is a national correspondent, covering higher education. She is also the author of the book, “Seven Days of Possibilities: One Teacher, 24 Kids, and the Music That Changed Their Lives Forever.” More about Anemona Hartocollis

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New study highlights significant health impacts three years after COVID-19 infection

Benjamin mateus 30 may 2024.

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Amid the complete blackout by governments and public health officials on the true state of the ongoing COVID-19 pandemic, a study just published in the journal Nature Medicine by Dr. Ziyad Al-Aly and colleagues reaffirms in the negative the detriments to our health posed by allowing SARS-CoV-2 to infect and reinfect populations under the stated policy of “forever COVID.”

One of the most pernicious lies about COVID-19 is that mild or asymptomatic infections cause no damage to the body and are therefore of little concern. Following up on their prior groundbreaking studies , Al-Aly and colleagues address this fallacy head-on and, in distinction to the laissez-faire attitude of the Centers for Disease Control and Prevention (CDC) and the Biden administration, make a cogent warning on the significant long-term damage COVID-19 can wreak on the body.

Regardless of how mild the acute course of the disease may be, the sustained impact to numerous organ systems may greatly impede our long-term well-being. The studies led by Al-Aly force the medical sciences to rethink the genesis of chronic diseases and for stewards of public health to accept prevention as a necessary first measure in defending societies from these pathogens.

In attempting to understand the chronicity of post-acute sequelae of COVID-19 (PASC), the authors of the study explained, “Addressing this knowledge gap is important to deepen understanding of the post-acute and long-term health trajectories of people who had SARS-CoV-2 infection and will inform care of people with these conditions.”

As with their prior studies, the authors utilize the expansive databases of the US Department of Veterans Affairs. The participants of the present study included a cohort of 135,161 US veterans (114,864 non-hospitalized (NH) and 20,297 hospitalized (H)) who survived the first 30 days of their COVID-19 infections and were followed for three full years to estimate their risk of death and incident of PASC throughout the follow-up period. The comparison group consisted of more than 5 million users of the VA healthcare system without any evidence of prior SARS-CoV-2 infection.

Results of death and PASC in NH and H participants

With respect to death, NH participants only saw an increased risk of death in the first year after the acute phase of their infection compared to controls. This amounted to an excess mortality burden of 16.2 per 1,000 persons.

However, H participants continued to see their risk of death climb even into the third year from their initial infection. In the first year, these participants saw an excess mortality burden of 58.85 per 1,000 persons compared to non-infected people. That rate continued climbing with an additional 14.15 excess deaths per 1,000 persons in the second year and then 8.16 excess deaths per 1,000 persons in the third year, for a cumulative rate of over 80 excess deaths per 1,000 persons.

Translating this, H participants with just one prior infection compared to non-infected controls can expect to see 8 percent more die after three years. Given that estimates place the number of people hospitalized from May 2020 to April 2021 at between 3.25 to 3.95 million people, that would lead to a considerable undercounting of COVID deaths.

With respect to PASC (Long COVID), among NH participants the three-year cumulative number reached 378.7 per 1,000 persons. The highest rate occurred in the first year at 212.3, then 125.0 in the second year and 41.2 in the third year. Additionally, the authors found that the cumulative burden of disability-adjusted-life-years (DALYs) due to PASC reached 91.2 per 1,000 persons. Although declining each year, it remained statistically significant and elevated.

By comparison, for H participants, the three-year cumulative number of post-acute sequelae reached 2,392 per 1,000 persons and the burden of DALYs due to PASC had reached 766.2 per 1,000 persons or 8.4 times higher than among NH participants.

DALYs are used by researchers to capture the impact a disease has on people’s lives above and beyond mortality rates. These are time-based measures that combine years of life lost due to premature death (Years of Life Lost—YLL) and years of life lost due to time lived in states of less than full health, or years of healthy life lost due to disability (YLD). Statistically, one DALY represents the loss of the equivalent of one year of full health.

Dr. Al-Aly wrote to the World Socialist Web Site ,

Risk of new onset sequelae (PASC/Long Covid) declines over time in both non-hospitalized and hospitalized patients. But risk remains in the third year after infection causing 10 DALYs per 1000 persons in non-hospitalized and 90 DALYs per 1000 persons who were hospitalized during acute COVID. The organ systems where the risk persists in non-hospitalized include neurologic, gastro-intestinal (GI), and pulmonary. Viruses are known to have long-term neurologic impacts (e.g. Epstein-Barr Virus/Multiple Sclerosis) and the gut may serve as a long-term reservoir for the virus. Cumulatively, at three years, Long Covid contributes 91.2 DALYs per 1000 persons – higher than cancer and heart disease. For context heart disease and cancer cause about 50 DALYs per 1000 persons in the population. Stroke generates about 10 DALYs per 1000 persons.

Mechanisms for Long COVID need to be further elucidated but are thought to include viral persistence, chronic inflammation, immune dysregulation or a combination of these.

When the PASC data were analyzed by organ systems, among NH participants compared to controls without infection, there was an increased risk of organ damage in all 10 “organ systems”—cardiovascular, coagulation, fatigue, gastrointestinal, kidney, mental, metabolic, musculoskeletal, neurologic and pulmonary—in the first year after infection, nine in the second year (all except kidney), and three in the third year that include the three organ systems mentioned above by Dr. Al-Aly.

For H participants, all ten organ systems reviewed were at risk in years one and two, while seven (all except kidney, metabolic, and musculoskeletal) exhibited increased risks in the third year.

When these were further subcategorized by actual disease states [ See figure 2 below from the study ], the real impact of Long COVID on the health of these participants became obviously evident. Using the statistical term incidence rate ratio (IRR) to demonstrate the increased burden of disease, one quickly observes that H participants have significantly higher rates of acute coronary disease. Rates of pulmonary embolism remain elevated for these patients throughout the study period. Risk of acute kidney injury persists. The rates of loss of smell are astronomical. They are also at higher risk of opioid abuse, sleep disorders, and suicidal ideations. These issues, although at lower rates, also impact NH participants.

The authors warned that even though those with severe COVID face the harshest long-term consequences, the absolute burden of Long COVID remains highest among those with mild disease, writing,

According to an analysis by the Global Burden of Disease (GBD) collaborators, about 90 percent of people with PASC had mild COVID-19, suggesting that, although preventing severe disease is important, strategies to reduce the risk of post-acute and long-term health loss in people with mild COVID-19 are also needed.

Al-Aly wrote to the WSWS:

We are used to thinking about infections as acute events with health effects that manifest around the time of infection. The data shows that Covid can cause health effects even 3 years later. I think this challenges the classic notion of infections causing acute health events. I feel Covid continues to teach us, and this is an important new lesson.

He concluded,

The story in hospitalized people is starker – they have greater risk and longer risk horizon with resultant burden of disease that is astronomically much higher than non-infected people and higher than non-hospitalized individuals. This places emphasis on prevention of hospitalization via vaccination, antivirals, etc. Hospitalization can have huge and wide-ranging effects on people’s lives for years if not more. Preventing hospitalization is very important.

But as Al-Aly had noted in a January 2024 Congressional hearing on Long COVID, “The best way to prevent Long COVID is to prevent COVID in the first place. There is no Long COVID without COVID.”

The results of this latest study reaffirm the need to prevent the ongoing transmission of SARS-CoV-2 globally and underscore the malign neglect that has punctuated the response by the capitalist ruling elites to the ongoing COVID-19 pandemic. The powers-that-be have inflicted this “mass disabling event” on the world’s population, with potential health ramifications for every life on this planet.

• Interview with Dr. Ziyad Al-Aly on the COVID pandemic and Long COVID 6 January 2023
• Interview with Dr. Ziyad Al-Aly on the COVID pandemic and Long COVID: Part two 8 January 2023
• New study proves that COVID-19 is far more harmful and deadly than the flu 17 December 2023
• Preeminent COVID-19 scientists urge action to confront Long COVID 22 February 2024

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The global impact of the coronavirus pandemic

John hiscott.

a Pasteur Laboratory, Istituto Pasteur Italia - Fondazione Cenci Bolognetti, Rome, 00161 Italy

Magdalini Alexandridi

Michela muscolini, evelyne tassone, enrico palermo, maria soultsioti.

b Molecular Virology Laboratory, Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands

Alessandra Zevini

The coronavirus pandemic has engulfed the nations of the world for the first five months of 2020 and altered the pace, fabric and nature of our lives. In this overview accompanying the Special Issue of Cytokine & Growth Factor Reviews , we examine some of the many social and scientific issues impacted by SARS-CoV2 – personal lives, economy, scientific communication, the environment. International members of Istituto Pasteur in Rome and INITIATE, the Marie Curie Training Network reflect on the lasting global impact of the coronavirus pandemic.

1. Introduction

The World Health Organization (WHO) officially declared the SARS-CoV-2 outbreak a Public Health Emergency of International Concern on January 30, 2020 and a global pandemic on March 11, 2020. Countries were urged by WHO to adopt strict social distancing and quarantine measures to avoid virus spread and to protect public health [ 1 ]. Despite fragmented international efforts to contain the spread, SARS-CoV2 has spread to 213 countries, resulting in more than 5 million cases and deaths approaching 400,000 since its formal identification in Wuhan China in December 2019. This issue of Cytokine & Growth Factor Reviews is devoted to reviews from around the globe, describing the rapidly accumulating knowledge about the virus, the immunopathogenic consequences of severe disease, the consequences of the cytokine storm and potential therapeutic interventions that could improve morbidity and mortality until a vaccine can be developed and made available. Below, members of Istituto Pasteur in Rome and the Marie Curie ITN INITIATE ( https://initiate-itn.eu ) reflect on the lasting global impact of the coronavirus pandemic.

2. Warning signs

“ Pestilence is in fact very common, but we find it hard to believe in a pestilence when it descends upon us. There have been as many plagues as wars in history; yet always plagues and wars take people equally by surprise .”

- Albert Camus, The Plague

‘How quickly it hit us’ – this is one of the most common sentiments about the Covid-19 pandemic. We were all caught off guard in one way or another; in an instant, an obscure outbreak of pneumonia in an exotic foreign locale - in the next, a viral outbreak jumping from China to the heart of Italy, then to all of Europe, on to America - finally a plague that stopped the world. As the pandemic hit all countries of the globe, it became indisputably clear that everyone was connected - united against a viral scourge [ 2 ].

Despite the shock, there were plenty of warning signs. Since the beginning of the 21st century, recurring outbreaks and epidemics presaged what was coming - there was the first SARS outbreak in 2003, H1N1 influenza pandemic in 2009, MERS coronavirus in 2011, Ebola in 2014−16; mosquito-borne Zika in 2016. A collage of news magazines ( Fig. 1 ) screamed out warnings of an impending pandemic but the clichéd phrase ‘it’s not a matter of if, but when’ continued to be ignored. Even the messages from political leaders (Presidents Barak Obama and George W. Bush) and scientific leaders (NIAID Director Anthony Fauci) went unheard. Below are links to their statements from 2005 to 2017.

Magazine covers from recent years announcing the arrival of new virus outbreaks around the globe.

https://edition.cnn.com/videos/politics/2020/04/10/barack-obama-2014-pandemic-comments-sot-ctn-vpx.cnn

https://abcnews.go.com/Politics/george-bush-2005-wait-pandemic-late-prepare/story?id=69979013

https://www.sciencealert.com/niaid-director-warned-us-government-of-a-surprise-outbreak-in-2017

International cooperation and a unified strategy of pandemic preparedness were not a priority. In the end, there was no united response - a global leadership void painfully revealed at a moment when it was most needed. What resulted was an international cacophony of last moment efforts, strategies and opinions to suppress the viral pandemic - after it was already upon the world.

3. Global scientific response

“ I have no idea what's awaiting me, or what will happen when this all ends. For the moment I know this: there are sick people and they need curing .”

In order to tackle the Covid-19 crisis, an unparalleled international scientific response has been launched with the goal to understand viral genetics, immunopathogenesis, and therapeutic strategies. Public and private funders across the globe have launched an unprecedented number of initiatives to support multidisciplinary projects addressing the detection, treatment and prevention of SARS-CoV2 infections. Most of the calls encourage collaboration between international scientists, industry, healthcare community, and government policy makers, to facilitate a well-integrated COVID-19 response. The dramatic effects of COVID-19 outbreak taught us that similar pandemics cannot be managed solely at the national level. For this reason, alliances, consortia and networks have emerged on every continent, to connect experts in different research areas of fundamental science, clinical trials, social and behavioural sciences, engineering, and bioinformatics [ 3 ].

In the same context, it has been remarkable how research groups and companies from all over the world have been “repurposing” equipment, facilities and product lines in a joint effort for a rapid response against the ongoing pandemic. Companies that were once producing perfume switched gears to production of much-needed hand sanitizers and disinfectants; industrial companies switched to making face masks which were in short supply in many countries, and automotive companies started production of medical devices, such as ventilators. Scientists in non-virology research fields, who were required to halt their research indefinitely due to the lockdowns, turned their laboratories into diagnostic testing facilities for SARS-CoV-2 and organized into volunteer groups to help researchers on the front lines with their skills and expertise [ [4] , [5] , [6] , [7] ].

This pandemic has also brought to light the importance of open science, data-sharing and new means of communication among members of the scientific community [ [7] , [8] , [9] , [10] ]. Numerous data sets are available publicly, alongside literature reviews and preprint articles in bioarxiv and medarxiv portals. This openness has resulted in a massive amount of information spreading swiftly, which is an important driving force moving COVID-19 research forward in a short time. Of course, such openness comes with a cost: the surge of preprints available in bioarxiv and medarxiv has made it harder to keep up with the screening process of articles to be published in the preprint repositories. More than ever before, information needs to be scrutinized before going public to avoid the danger of inaccuracies, misinformation or even conspiracy theories. Such a situation is unprecedented, as no other pandemic in human history has been tackled in this way. Many scientists all over the world welcome this new form of communication and data-sharing and believe that eventually there will be a balance between good-quality information spreading quicker versus perfect-quality information that is unavailable until much later [ 8 ].

The EU joined forces to coordinate a common response against the coronavirus pandemic. On 30th January 2020, when the pandemic was not declared yet, European Commission mobilized a budget of €10 million for research, that was subsequently increased to €47.5 million [ 11 ]; later on, the Innovative Medicines Initiative (IMI), a partnership between the European Commission and the pharmaceutical industry, invested a total of 90 € million for research proposals to combat the COVID-19 emergency [ 12 ]. During the Coronavirus Global Response pledging event organized by the EU together with WHO (May 4th), €7.4 billion was raised from donors worldwide, to be used “for developing, producing and deploying a vaccine for all”, the European Commission President von der Leyen said [ 13 ]. In the UK, Government invested £20 million to fund new studies against coronavirus, including studies to sequence the different virus isolates as a tool to understand virus behaviour, mutation frequency, virus spread and emergence of new strains [ 14 , 15 ].

Part of these funds will be also used to allow the rapid, large scale production of a vaccine. With more than 100 research laboratories conducting vaccine development research, and with eight vaccine candidates already moving to clinal trials, the race to develop an effective prophylactic vaccine is on [ 16 , 22 ]. Since the biotech firm Moderna announced plans to launch vaccine trials in humans, the US government has invested $483 million to scale up that company’s vaccine production [ 17 ]. Meanwhile, the National Institutes of Health (NIH), together with other government organizations and biotech companies, set up a partnership to coordinate efforts against the COVID-19 pandemic, giving priority to the development of an efficient vaccine and therapeutic drugs [ 18 ]. Days ago, Moderna announced the results of a small eight-person phase I trial of their spike mRNA vaccine candidate, and the preliminary results indicate that all subjects developed antibodies, even at the lowest dose of inoculum [ 19 ], encouraging the company to proceed with a phase II clinical trial that will involve 600 participants. However, scientists are cautious over the successes of such vaccine candidates since the levels of the immune response needed to grant protection against SARS-CoV-2 are not yet well understood [ 8 ].

European biotech companies are also working to develop a potential COVID-19 vaccine. In Germany, BioNTech has designed four vaccine candidates that deliver mRNA encoding four different viral antigens [ 20 ]; ReiThera in Rome, Leukocare in Munich, and Univercells in Brussels have announced the creation of a European consortium that will start the clinical trials of a COVID-19 vaccine. The two pharma giants Sanofi and GSK have recently started a collaboration finalized to the development of an adjuvanted COVID-19 vaccine [ 21 22 ]

To contribute to the pandemic effort, the COVID-19 High Performance Computing (HPC) Consortium demonstrates cooperation amongst global high tech giants Google, Microsoft, Amazon, and IBM; the HPC Consortium offers services, resources and expertise to support molecular modelling projects as the simulation of SARS-CoV2 entering in a host cell, the high throughput screening of drug candidates, and the evaluation of patients’ genomic features with prognostic values [ 23 ].

4. Lockdown & social distance

“The public lacked, in short, standards of comparison. It was only as time passed and the steady rise in the death-rate could not be ignored that public opinion became alive to the truth.”

A. Europe. As the pandemic spread throughout the world, countries took drastic measures to protect their citizens. These measures focused on achieving a fragile balance between limiting virus spread from person to person and maintaining economic activity. It was an impossible balance, although the timing of the implementation of these measures proved to be crucial, both for public health and SARS-CoV2 spread, as well as the economic impact on each country. Early lockdown and strict enforcement were the most effective strategies available to limit virus spread [ 24 , 25 ]. In an accompanying article in this issue, Olagnier & Mogensen describe the implementation of lockdown procedures in Denmark, a country with a remarkably rapid and effective response. The trilogy - social distance, personal hygiene, protective mask – became the mantra throughout Europe and the world.

Follow the spread of Covid-19 in a worldwide cases timeline ( Fig. 2 ): ( https://www.worldometer.info/coronavirus/worldwide-graphs ).

Global distribution of the Covid-19 cases.

Working in close cooperation with the WHO and EU Member States, the European Union took clear, strict measures, based on the best available scientific expertise. Some member countries faced a significantly limited availability of personal protective equipment (PPE) and the public health systems came close to collapse from the ever-increasing number of severe cases requiring emergency intensive care and ventilation [ 26 ]. In some cases, medical equipment destined for other countries was confiscated [ 27 ]. On the 20th of March, the EU announced a funding scheme of 1,3 billion euro for bulk purchase of PPE [ 28 ]; unfortunately, the UK missed the opportunity to join that funding scheme [ 29 ].

In Europe, health systems adapted to the crisis by mobilizing staff, increasing pharmaceutical spending on vaccine development, and optimizing space with the aim to increase the number and availability of intensive care beds capacity. The European average is currently 11.5 critical care beds per 100.000 capita of population [ 30 ]; in addition to the shortage of ICU beds and ventilators, the lack of health workers to staff the new units became critical. Countries such as France used army forces and camps to transport patients and optimize care bed capacity [ 31 ]. Germany, with the highest proportion of ICU beds per capita of population and one of the best European health systems, campaigned to obtain the medical help of foreign doctors who were living in Germany but did not yet have a license to practice medicine [ 32 ]. In Italy, the Netherlands, France and the UK, retired doctors, nurses and medical students were recruited to help [ 33 ].

Rather than impose a lockdown of its population, the UK initially followed a mitigation strategy to build population immunity but abandoned this plan after realizing it would result in ‘hundreds of thousands of deaths,’ as noted in a report from the Imperial College's COVID-19 response team [ 34 ]. The subsequent illness of the Prime Minister and his transfer to intensive care further contributed to the realization that strict lockdown measures were necessary. Despite ongoing restrictions in the UK, the number of cases continues to rise, the death rate is the highest in Europe and the curve of infections has yet to plateau – a reflection of the lag time before the start of the lockdown.

The Johns Hopkins University (JHU) Coronavirus Resource Center ( http//:coronavirus.jhu.edu ) provides an important live global update of the spread of SARS-CoV2 that includes world map, US map and critical trends. As of 20th May 2020, the total reported cases in Europe were 1,909,592, and the total deaths are 167,538. The UK currently has the highest number of cases & deaths (250,138 & 35,169), followed by Italy (226, 699 & 32,169), Spain (232,037 & 27,778) and France (180,933 & 25,025).

Sweden similarly followed a plan of ‘voluntary’ social distancing, with the country remaining open. With a population of 10 million, the country remains amongst the top 25 in the world in terms of total number of cases, even though testing is reserved only for those with severe symptoms. These measures have not proved to be effective, and altogether the country has registered 5–10 times more deaths than neighboring Scandinavian countries. The above examples again demonstrate that fast response and strict lockdown saved lives.

JHU lists Sweden with 30,799 cases and 3743 deaths, compared to Denmark (11,315 & 551), Finland (6399 & 301) and Norway (8267 & 233).

Moreover, results from a recent antibody testing study across Spain showed that only 5% of the total number of participants tested positive for exposure to the virus and developed some level of immunity [ 35 , 36 ]. A modelling study, based on data obtained from French hospitals, has shown that by the 11th of May only 4.4 % of the French population had developed potential immunity against SARS-CoV-2 [ 37 ] Such numbers, even if remotely accurate, make it clear that letting the infection run its natural course will not result in protection levels high enough to satisfy the criteria of herd-immunity. On the other hand, if such data are interpreted as a low percentage of the population exposed to SARS-CoV-2 in two of the most affected countries in Europe, this showcases a massive positive impact of lockdown measures in containing the spread of the virus.

Lockdowns were not the only measures taken to protect public health. Asian countries which had experience with other viral outbreaks rapidly implemented strict movement restrictions and suspended all unnecessary activities, but in parallel ramped up testing for virus, as well as tracking and isolating cases and contacts [ 38 ]. At the same time, China in response to the surge of cases, built new, specially equipped hospitals to increase the number of intensive care beds, while in Korea, hotels were repurposed as care units exclusively for patients suffering from Covid-19. These countries were also the first to ban flights to and from other countries; borders were closed and open only for cargo trade [ 39 , 40 ].

JHU: Many months after the start of the outbreak in China the number of confirmed cases is more than 84,063 and the deaths are 4638; the case fatality ratio is close to 5,5%. As stated on numerous occasions, it is not clear how accurate the Chinese numbers are. Remarkably, in South Korea, the number of cases is 11,110, with only 263 deaths, numbers that reflect the positive impact of in depth efforts in testing, contact tracing and social distancing.

In the pandemic emergency, the lack of PPE and supplies like disinfectants created fear among frontline medics and staff. To draw attention to this aspect, German medical practitioners posed naked on a Twitter page; this protest was inspired by the French doctor Alain Colombié, who affirmed that doctors were being asked “to go to the front without weapons and no defences.” [ 41 ]. For the same reason protest marches involving doctors, nurses and paramedics took place in many countries - in Pakistan, they evolved into violent clashes between police and doctors, in Italy, silent flash-mobs protested the government response [ 42 , 43 ]

“Many continued hoping that the epidemic would soon die out and they and their families be spared. Thus, they felt under no obligation to make any change in their habits, as yet. Plague was an unwelcome visitant, bound to take its leave one day as unexpectedly as it had come.”

B. America. The first case of Covid-19 was confirmed in America on January 21 st and a few days later the White House Coronavirus Task Force was established. But with government inaction about the pandemic, weeks were lost when the government could have prepared its own response, informed the public and identified necessary medical supplies. New York City, with its dense population and hundreds of flights a day from Europe, became the epicenter of the pandemic in America. The first New York case was recognized on March 1, 2020, although reports now indicate that by March 1, there may have been as many as 10,000 cases in the state, imported from Italy and elsewhere. Mixed messages from city and state officials, essentially claiming ‘go on with your lives’ at the beginning of March further confused the response. Additional delays in announcing a lockdown and containment practices (the New York Pause was issued March 22) guaranteed the firm establishment of the virus in the city and state. New York Governor Andrew Cuomo became a daily fixture on the news, providing daily updates on the number of cases, the search for proper medical equipment and the courageous efforts of medical front line personnel. However, with more than 15,000 deaths in New York City, the critical need to recognize and respond swiftly to the virus was once again sadly reinforced by the staggering numbers. In contrast, California reacted more swiftly to the emergence of SARS-CoV2, and issued a ‘stay-at-home’ order on March 19, an important decision when hours and days mattered.

JHU: As of May 21st, New York state listed 354,370 cases with 28,636 deaths, while California registered 85,997 cases and 3497 deaths. For comparison the number of cases/deaths in New York City are 194,550 and 15,789, while in San Francisco, there are 2179 cases and 36 deaths.

By the end of March, all 50 states of the USA reported cases of Covid-19. A few weeks after the first Covid-19 case, the hospitals began reporting supply shortages - both for testing and personal protective equipment, a severe safety issue for frontline medical staff that was never addressed nationally. Rather, it was left to state governors to grapple with the purchase supplies on the international market [ 44 ]. In mid-March the army started constructing new hospital facilities [ 45 ]. As in Europe, large-scale gatherings were prohibited, schools and other educational institutions were closed, businesses shuttered and restrictions on movement were imposed.

JHU: As of 20 May 2020, the total reported cases in USA is 1,528,661, the number of deaths is more than 91,938.

5. Impact on economy

“The truth is that everyone is bored and devotes himself to cultivating habits. Our citizens work hard, but solely with the object of getting rich. Their chief interest is commerce, and their chief aim in life is, as they call it, 'doing business.'”

A. Europe. The eurozone was experiencing poor economic growth even before the shock of the pandemic, with an expansion of just 0.1% for the last three months of 2019. The economic productivity of the 19 countries of the Eurozone decreased by 3.8 % for the first three months of 2020, in the shadow of the spread of coronavirus throughout Europe. Analysts now say it is certain that the entire eurozone will experience the largest recession since its creation in the late 1990s. Germany, France and Italy, the three largest economies in the monetary union, have all entered into economic recession, with Eurostat recording an even bigger drop in gross national product (GDP) compared to what markets expected. Although countries have published data only for the first quarter of 2020, analysts predict an even greater recession for the second and third quarters of the year [ [46] , [47] , [48] ].

Of the individual Eurozone countries that published relevant data, France reported that after a recession of 0.1 % for the last quarter of 2019, its economy shrank by 5.8 % for the first 3 months of 2020, the largest recession since the country began recording data in the late 1940s. Italy has also experienced recession for the first half of the year, with the economy shrinking to 4.7 % after falling 0.3 % at the end of 2019. The effects of coronavirus pandemic on an already weak economy were enough to squash it. Spain, one of the countries hit hardest by the pandemic, reported a 5.2 % drop in the first quarter the year, while GDP in Belgium and Austria fell 3.9 % and 2.5 % respectively [ 46 , 47 ].

Germany’s economy shrank by 2.2 % in the first quarter of 2020, as the coronavirus pandemic pushed the eurozone's strongest economy into recession; the seasonally adjusted number of unemployed in Germany jumped by 373,000–2.64 million in April. The jobless rate climbed to 5.8 % from a low of 5% the previous month. The government also increased the number of ‘underemployed’ workers to 10.1 million during April; these part-time employment measures helped to maintain the overall employment figures in Germany [ 49 ].

According to Reuters, experts from the World Bank, the World Resources Institute (WRI) and other organizations warn that the coronavirus pandemic will leave behind about 100 million 'new poor’ living in cities around the world due to job losses and income [ 50 , 51 ]. In this scenario, another sad truth must be faced: coronavirus pandemic is widening the gap dividing rich and poor. As for any epidemic, poverty and inequality can exacerbate rates of transmission and mortality. The main factors that sentence poor people to illness are the lack of access to health care, plus poor and crowded living conditions. In the context of the current pandemic, a key mitigating factor in infection risk is the possibility of working remotely, but this is a luxury that a large segment of the workforce doesn’t have. For people who work outside home, the choice is between lose job, lose salary - or keep going out to work amid the pandemic. And because their financial position is more precarious, the only option is to continue to work, travelling in most cases by public transportation, despite the risk of infection for themselves and their families. A primary consequence of this phenomenon is the racial disproportion in sickness and death percentages in the US: African Americans are contracting SARS-CoV2 and dying for it at significantly higher rates compared to white Americans, and this has nothing to do with a biological or genetic predisposition toward coronavirus infection, but is more likely due to a "social predisposition” [ 52 ].

In the European Union, it was decided to provide financial assistance of 5% of its GDP to its member states [ 53 , [ 54 ]. The worst affected countries can use the funds to alleviate the financial burden of the immediate response measures, including assistance to the population, medical assistance and equipment, support to vulnerable groups, and measures to contain the spread of the disease, strengthen preparedness and communication. Among the various fiscal measures adopted to contain the economic fallout, several governments have decided to defer certain payments, including taxes, loans or utility bills, to improve the liquidity positions of individuals and companies facing difficulties. But, in many cases, those measures are not sufficient.

In Italy, the EU country worst affected by coronavirus, economy has been damaged in such a severe manner that people in some regions are running short of food and money. Many of these “new poor” have turned to charities for help, and several cases of looting at supermarkets have been reported. This critical situation encouraged Italians to give a new twist to an old custom known as “suspended coffee”. In this centuries-old Neapolitan tradition, bar customers pay in advance a coffee for someone who can't afford it. The same concept is being applied to “suspended grocery shopping”: customers buy food with a long shelf-life for the needy - such as pasta and canned goods. "Those who can, put something in, those who can't, help yourself": this is the slogan written on solidarity baskets that appeared in supermarkets, local grocery shops and even on the streets throughout Italy [ 55 ]. Beyond these acts of charity, an important help will come from the government, which has designated €400 m for food vouchers to those who can no longer afford groceries [ 56 ].

“He knew quite well that it was plague and, needless to say, he also knew that, were this to be officially admitted, the authorities would be compelled to take very drastic steps. This was, of course, the explanation of his colleagues' reluctance to face the facts.”

B. America. The country with the greatest wealth and medical minds in the world failed to heed warnings from China and then Italy; refused to acknowledge the ‘emergency of international concern’ from the World Health Organization on January 31, 2020; and lacked a pandemic preparedness plan that would have mobilized the American health system to respond to the coming viral pandemic as early as February. A failure of national leadership, compounded by the political divisions, and a fragmented state by state response guaranteed the numbers - more than 1.5 million cases and counting, deaths approaching 100,000. It is impossible to imagine that the United States will emerge from this pandemic with the same perspective on its historic economic inequality.

The coronavirus pandemic has already triggered the sharpest recession in the United States since the Great Depression. For the first 2 1/2 months of 2020, the economy continued to grow at a steady pace, but suddenly halted in mid-March - when businesses, travel industries, restaurants and retail shops were abruptly closed, and tens of millions of Americans were ordered to stay home in an effort to slow the spread of SAR-CoV2.More than 35 million people were suddenly out of work and have filed unemployment claims in recent weeks. The spread of the coronavirus has threatened the social and economic fabric of American communities and revealed in a striking way the inequities of the American system – a single event threw more that 35,000,000 people into joblessness and a step closer to poverty. Expanded unemployment benefits and a one-time stimulus package were forthcoming from the US House and Senate, but these are temporary solutions to a much larger structural inequality that the pandemic has exposed. The Covid-19 pandemic highlighted the flaws in the system and revealed two economic conditions that have been left unchecked: poverty and economic insecurity. An inclusive social safety net that includes a basic income and health coverage may be the only solution to ensure that its citizens have a strong foundation for preparedness for the next pandemic.

6. Psychological impact

“Thus, each of us had to be content to live only for the day, alone under the vast indifference of the sky.”

The measures taken to avoid the spread of the new coronavirus have left their mark on the psyche of citizens around the world. At its peak, an estimated 2.6 billion people – or a third of the world’s population – was living under some kind of lockdown or quarantine, arguably the largest psychological experiment ever conducted [ 57 ]. Adapting to new, unprecedented conditions brought a change in our daily routine and our habits, and imposed adverse effects on citizens at multiple levels. Fear of death and the end of humanity, loneliness and isolation at home, sadness and anxiety for the next day and the future of our loved ones are the grounds for psychological disorders. Increases in firearm and alcohol sales have been registered in the US over the last two months, clear signs of the stress and anxiety generated by coronavirus pandemic among people [ 58 , 59 ]. Since the onset of social distancing, calls to domestic abuse helplines or suicide hotlines have intensified all over the world [ 60 , 61 ]. France offered free accommodation to victims of violence in the home and encouraged people to ask for help in pharmacies [ 62 ]. Australia announced a special phone line named “coronavirus wellbeing support line.” [ 63 ]

In late February 2020, before European countries mandated various forms of lockdown, The Lancet published a review documenting the psychological impact of quarantine (the “restriction of movement of people who have potentially been exposed to a contagious disease”). In short, and perhaps unsurprisingly, people who are quarantined are likely to develop a wide range of symptoms of psychological stress and disorder, including low mood, insomnia, stress, anxiety, anger, irritability, emotional exhaustion, depression and post-traumatic stress symptoms [ 64 ]. In China, these expected mental health effects are already being reported in the first research papers about the lockdown [ 65 ]. A study reporting on the long-term effects of SARS quarantine among healthcare workers found a long-term risk for alcohol abuse, self-medication and long-lasting “avoidance” behavior - where some hospital workers avoid being in close contact with patients by simply not showing up for work. Scientists predict that, if the pandemic continues, psychological and social effects of Covid-19 will worsen and create the “perfect storm” of conditions for suicide, especially in the most vulnerable categories, like the elderly, poor and people suffering from previous mental problems [ 66 ].

“Well, personally, I've seen enough of people who die for an idea. I don't believe in heroism; I know it's easy and I've learned that it can be murderous. What interests me is living and dying for what one loves.”

Widespread measures adopted by governments facing the pandemic crisis were social distancing, country-wide lockdown, and restriction of traffic. Numerous constitutionalists have argued that such measures violate human rights, as freedom of movement is a fundamental right directly linked to human nature. However, international human rights law does recognize that during serious public health threats and public emergencies that threaten the life of a nation, restrictions on some rights can be justified.

Various measures have been taken by the majority of the countries to protect human rights in these difficult times. Countries like Ireland, Austria and Argentina have banned the evictions and have announced measures to protect housing, recognizing its role in the crisis response. Portugal announced that people with pending residency and asylum applications will be treated as permanent residents, giving them equal access to free health care [ 67 ]. Initially several incidents of racism and xenophobia were reported towards people of Chinese and Asian descent all over the world [ 68 ]. Some politicians started to use the term “Chinese Virus” to describe the SARS-Cov-2 pandemic and received criticism for their statements. As the virus spread into European countries and Italy became an epicenter, Italians were also subjected to racism. Unfortunately, such incidents are neither extraordinary nor isolated. Socioeconomic and anthropological/archaeological studies have shown that past pandemics, like the 1918 Spanish Flu and the Black Death in the 14th century, affected societies disproportionally [ 69 ]. People at the lower end of the socioeconomic spectrum were more likely to die from infectious diseases due to different treatment practices (or lack thereof) based on their societal status. African Americans, Latinos and indigenous populations have also faced health care inequalities and discriminations during the course of past pandemics. Since the current pandemic does not yet belong to the past, it is a pivotal moment in history to prevent such discriminations and racial inequalities from leaving their social stigma in the years to come.

7. Misinformation

“There comes a time in history when the man who dares to say that two and two do make four is punished with death.”

WHO has repeatedly stated the urgency of adhering to the measures and positions of the scientific community – social distance, personal hygiene and the use of protective masks. But such invasive measures also opened the floodgates of misinformation, with social and mass media spreading a range of questionable information; conspiracy theories, misinformation or non-scientific views regarding the virus, its origin and spread that endanger public health have acquired a criminal character in several countries.

One of the most difficult issues concerned reports that U.S. officials were investigating the possibility that the coronavirus was secretly ‘manufactured’ and/or ‘escaped’ from a Chinese lab in Wuhan, specifically the Wuhan Institute of Virology. There is no scientific evidence to support these theories. The sequencing and analysis of coronavirus genomes have already dispelled these rumors and instead demonstrate that bats are the likeliest source, suggesting that COVID-19 was created by nature, not humans. At its molecular level, the viral genome most closely resembles an isolate that already exists in horseshoe bats in Hunan province. Supported by several studies, bats have an unusually high capacity to harbor viruses and have been linked to past outbreaks, including SARS, MERS and Ebola. The virus may have spread from bats to an intermediary animal before infecting humans; this remains unclear. The fact that the earliest cases of COVID-19 were linked to a live animal market in Wuhan that sold exotic species only bolsters these observations.

In a recent study from Nature Medicine, researchers concluded "Our analyses clearly show that SARS-CoV-2 is not a laboratory construct or a purposefully manipulated virus” [ 70 ]. It is well known that the Wuhan Institute of Virology and other Institutes have been studying coronaviruses and bats ever since the SARS outbreak of the early 2000s, but there is no evidence that this research was malicious, rather it was a response to the need to understand the pathogenesis and epidemiology of SARS. High containment research was essential, given earlier outbreaks, as well as warnings from former Presidents and scientific leaders (see above).

In 2003 the Chinese government was legitimately criticized for their attempted cover-up of the original SARS outbreak, leading to skepticism amongst its critics about the openness of its response to the SARS-CoV2 outbreak of 2019. Calls from over 100 nations for an investigation into the origins of SARS-CoV2 and the pandemic have been recognized by Premier Xi of China, with his qualification that the review take place ‘after the virus is under control’. There remains much to learn from the early days of the pandemic and the Chinese response, as well as the pandemic response of other countries. From an epidemiologic perspective, these were critical days; understanding the nature and necessity of the immediate response will only prepare the global community for the next outbreak.

8. An environmental surprise

“What’s true of all the evils in the world is true of plague as well. It helps men to rise above themselves.”

The massive shutdown of industry, business, global travel, farming and personal movement produced an unanticipated beneficial effect on the environment. All over the world, the levels of air pollution dropped [ 71 ]; in China, a 25 % reduction in carbon emissions has been reported [ 72 ], while in New York, air pollution dropped by 50 %. In northern Italy and central Europe, nitrogen dioxide (NO2) emissions decrease by 5o% ( Fig. 3 ) [ 73 , 74 ].

Reduction of NO2 emissions over Northern Italy – January (left) & March (right). https://www.esa.int/ESA_Multimedia/Videos/2020/03/Coronavirus_nitrogen_dioxide_emissions_drop_over_Italy .

To observe statistics and videos of the impact of the coronavirus lockdown on environmental emissions, please visit: https://www.visualcapitalist.com/coronavirus-lockdowns-emissions/

And, in perhaps the most symbolic evidence of the impact of the global pause on the environment, the canals of Venice have cleared; in this video [ 75 ] a jelly fish swims in the canal, while Venetian buildings are reflected in the clear water.

https://www.youtube.com/watch?v=5zDqYvjld18

9. Conclusion

We have reached May 2020 and the lockdown efforts in most countries are winding down. At the time of writing, the population in Italy has moved forward with re-opening the economy; restaurants, stores and businesses are active once again, although the tourists have yet to return. Germany, Spain and France are moving forward with the re-opening their countries after reducing the number of cases and deaths through strict lockdown enforcement. The United States pushes ahead with re-opening business, travel, beaches and bars, despite the continued rise in cases and deaths. And new regions of concern are emerging; Brazil and Russia report massive daily increases in the number of cases and are now becoming the new epicenters, with the second and third highest rates of infection in the world. Singapore and China are carefully evaluating spikes in new cases - using testing, contact tracing and isolation to prevent a ‘second wave’ of coronavirus cases. Research and vaccine development are moving at ‘warp speed’ in the hopes of finding a treatment that will restore us to a new normal. In the first four months of 2020, Covid-19 has engulfed the world; it remains to be seen if global efforts during the next four months will unwrap our planet ( Fig. 4 ).

Wrapped in Corona. A schematic view of the world as SARS-CoV-2 engulfs the planet.

The pandemic continues. Although it is not clear whether the virus will continue to smolder and ignite in different global regions during the summer, or perhaps retreat, only to return to new peaks in the fall and winter, most experts agree that Covid-19 is not going away anytime soon, and will probably be with us for the next two years [ 76 ]. On May 21st, the WHO reported 106,000 new cases of Covid-19 globally, the highest one day total since the pandemic began. As new knowledge about the virus accumulates, new complications of the disease arise, including the recent recognition of a serious Kawasaki-like disorder in children, termed multi-system inflammatory syndrome (MIS). And new modelling research states that had the lockdown of America been imposed two weeks earlier - March 9 vs March 23 - over 80 % of the cases and deaths could have been prevented. This sobering estimate brings us to another unsettling fact; throughout this crisis, efforts have been made to mute and even ridicule the response of scientific leadership to the pandemic. If Covid-19 ushers in a ‘new normal’ for citizens around the world, we hope that new reality will include the recognition that the voice of science, reason and experience must be heard.

Acknowledgements

The authors wish to thank Michaela Muscolini, Evelyne Tassone and Enrico Palermo for critical reading and comments. The authors also thank the students of INITIATE, the Marie Curie International Training Network for their scientific perspectives and writings during this pandemic period. Quotations in italics from Albert Camus, The Plague. This project was supported by funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 813343 for the Marie Curie ITN INITIATE program.