impact of covid 19 on our lives essay

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Impact of COVID-19 on people's livelihoods, their health and our food systems

Joint statement by ilo, fao, ifad and who.

The COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems and the world of work. The economic and social disruption caused by the pandemic is devastating: tens of millions of people are at risk of falling into extreme poverty, while the number of undernourished people, currently estimated at nearly 690 million, could increase by up to 132 million by the end of the year.

Millions of enterprises face an existential threat. Nearly half of the world’s 3.3 billion global workforce are at risk of losing their livelihoods. Informal economy workers are particularly vulnerable because the majority lack social protection and access to quality health care and have lost access to productive assets. Without the means to earn an income during lockdowns, many are unable to feed themselves and their families. For most, no income means no food, or, at best, less food and less nutritious food. 

The pandemic has been affecting the entire food system and has laid bare its fragility. Border closures, trade restrictions and confinement measures have been preventing farmers from accessing markets, including for buying inputs and selling their produce, and agricultural workers from harvesting crops, thus disrupting domestic and international food supply chains and reducing access to healthy, safe and diverse diets. The pandemic has decimated jobs and placed millions of livelihoods at risk. As breadwinners lose jobs, fall ill and die, the food security and nutrition of millions of women and men are under threat, with those in low-income countries, particularly the most marginalized populations, which include small-scale farmers and indigenous peoples, being hardest hit.

Millions of agricultural workers – waged and self-employed – while feeding the world, regularly face high levels of working poverty, malnutrition and poor health, and suffer from a lack of safety and labour protection as well as other types of abuse. With low and irregular incomes and a lack of social support, many of them are spurred to continue working, often in unsafe conditions, thus exposing themselves and their families to additional risks. Further, when experiencing income losses, they may resort to negative coping strategies, such as distress sale of assets, predatory loans or child labour. Migrant agricultural workers are particularly vulnerable, because they face risks in their transport, working and living conditions and struggle to access support measures put in place by governments. Guaranteeing the safety and health of all agri-food workers – from primary producers to those involved in food processing, transport and retail, including street food vendors – as well as better incomes and protection, will be critical to saving lives and protecting public health, people’s livelihoods and food security.

In the COVID-19 crisis food security, public health, and employment and labour issues, in particular workers’ health and safety, converge. Adhering to workplace safety and health practices and ensuring access to decent work and the protection of labour rights in all industries will be crucial in addressing the human dimension of the crisis. Immediate and purposeful action to save lives and livelihoods should include extending social protection towards universal health coverage and income support for those most affected. These include workers in the informal economy and in poorly protected and low-paid jobs, including youth, older workers, and migrants. Particular attention must be paid to the situation of women, who are over-represented in low-paid jobs and care roles. Different forms of support are key, including cash transfers, child allowances and healthy school meals, shelter and food relief initiatives, support for employment retention and recovery, and financial relief for businesses, including micro, small and medium-sized enterprises. In designing and implementing such measures it is essential that governments work closely with employers and workers.

Countries dealing with existing humanitarian crises or emergencies are particularly exposed to the effects of COVID-19. Responding swiftly to the pandemic, while ensuring that humanitarian and recovery assistance reaches those most in need, is critical.

Now is the time for global solidarity and support, especially with the most vulnerable in our societies, particularly in the emerging and developing world. Only together can we overcome the intertwined health and social and economic impacts of the pandemic and prevent its escalation into a protracted humanitarian and food security catastrophe, with the potential loss of already achieved development gains.

We must recognize this opportunity to build back better, as noted in the Policy Brief issued by the United Nations Secretary-General. We are committed to pooling our expertise and experience to support countries in their crisis response measures and efforts to achieve the Sustainable Development Goals. We need to develop long-term sustainable strategies to address the challenges facing the health and agri-food sectors. Priority should be given to addressing underlying food security and malnutrition challenges, tackling rural poverty, in particular through more and better jobs in the rural economy, extending social protection to all, facilitating safe migration pathways and promoting the formalization of the informal economy.

We must rethink the future of our environment and tackle climate change and environmental degradation with ambition and urgency. Only then can we protect the health, livelihoods, food security and nutrition of all people, and ensure that our ‘new normal’ is a better one.

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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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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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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.

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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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8 Lessons We Can Learn From the COVID-19 Pandemic

BY KATHY KATELLA May 14, 2021

Note: Information in this article was accurate at the time of original publication. Because information about COVID-19 changes rapidly, we encourage you to visit the websites of the Centers for Disease Control & Prevention (CDC), World Health Organization (WHO), and your state and local government for the latest information.

The COVID-19 pandemic changed life as we know it—and it may have changed us individually as well, from our morning routines to our life goals and priorities. Many say the world has changed forever. But this coming year, if the vaccines drive down infections and variants are kept at bay, life could return to some form of normal. At that point, what will we glean from the past year? Are there silver linings or lessons learned?

“Humanity's memory is short, and what is not ever-present fades quickly,” says Manisha Juthani, MD, a Yale Medicine infectious diseases specialist. The bubonic plague, for example, ravaged Europe in the Middle Ages—resurfacing again and again—but once it was under control, people started to forget about it, she says. “So, I would say one major lesson from a public health or infectious disease perspective is that it’s important to remember and recognize our history. This is a period we must remember.”

We asked our Yale Medicine experts to weigh in on what they think are lessons worth remembering, including those that might help us survive a future virus or nurture a resilience that could help with life in general.

Lesson 1: Masks are useful tools

What happened: The Centers for Disease Control and Prevention (CDC) relaxed its masking guidance for those who have been fully vaccinated. But when the pandemic began, it necessitated a global effort to ensure that everyone practiced behaviors to keep themselves healthy and safe—and keep others healthy as well. This included the widespread wearing of masks indoors and outside.

What we’ve learned: Not everyone practiced preventive measures such as mask wearing, maintaining a 6-foot distance, and washing hands frequently. But, Dr. Juthani says, “I do think many people have learned a whole lot about respiratory pathogens and viruses, and how they spread from one person to another, and that sort of old-school common sense—you know, if you don’t feel well—whether it’s COVID-19 or not—you don’t go to the party. You stay home.”

Masks are a case in point. They are a key COVID-19 prevention strategy because they provide a barrier that can keep respiratory droplets from spreading. Mask-wearing became more common across East Asia after the 2003 SARS outbreak in that part of the world. “There are many East Asian cultures where the practice is still that if you have a cold or a runny nose, you put on a mask,” Dr. Juthani says.

She hopes attitudes in the U.S. will shift in that direction after COVID-19. “I have heard from a number of people who are amazed that we've had no flu this year—and they know masks are one of the reasons,” she says. “They’ve told me, ‘When the winter comes around, if I'm going out to the grocery store, I may just put on a mask.’”

Lesson 2: Telehealth might become the new normal

What happened: Doctors and patients who have used telehealth (technology that allows them to conduct medical care remotely), found it can work well for certain appointments, ranging from cardiology check-ups to therapy for a mental health condition. Many patients who needed a medical test have also discovered it may be possible to substitute a home version.

What we’ve learned: While there are still problems for which you need to see a doctor in person, the pandemic introduced a new urgency to what had been a gradual switchover to platforms like Zoom for remote patient visits. 

More doctors also encouraged patients to track their blood pressure at home , and to use at-home equipment for such purposes as diagnosing sleep apnea and even testing for colon cancer . Doctors also can fine-tune cochlear implants remotely .

“It happened very quickly,” says Sharon Stoll, DO, a neurologist. One group that has benefitted is patients who live far away, sometimes in other parts of the country—or even the world, she says. “I always like to see my patients at least twice a year. Now, we can see each other in person once a year, and if issues come up, we can schedule a telehealth visit in-between,” Dr. Stoll says. “This way I may hear about an issue before it becomes a problem, because my patients have easier access to me, and I have easier access to them.”

Meanwhile, insurers are becoming more likely to cover telehealth, Dr. Stoll adds. “That is a silver lining that will hopefully continue.”

Lesson 3: Vaccines are powerful tools

What happened: Given the recent positive results from vaccine trials, once again vaccines are proving to be powerful for preventing disease.

What we’ve learned: Vaccines really are worth getting, says Dr. Stoll, who had COVID-19 and experienced lingering symptoms, including chronic headaches . “I have lots of conversations—and sometimes arguments—with people about vaccines,” she says. Some don’t like the idea of side effects. “I had vaccine side effects and I’ve had COVID-19 side effects, and I say nothing compares to the actual illness. Unfortunately, I speak from experience.”

Dr. Juthani hopes the COVID-19 vaccine spotlight will motivate people to keep up with all of their vaccines, including childhood and adult vaccines for such diseases as measles , chicken pox, shingles , and other viruses. She says people have told her they got the flu vaccine this year after skipping it in previous years. (The CDC has reported distributing an exceptionally high number of doses this past season.)  

But, she cautions that a vaccine is not a magic bullet—and points out that scientists can’t always produce one that works. “As advanced as science is, there have been multiple failed efforts to develop a vaccine against the HIV virus,” she says. “This time, we were lucky that we were able build on the strengths that we've learned from many other vaccine development strategies to develop multiple vaccines for COVID-19 .” 

Lesson 4: Everyone is not treated equally, especially in a pandemic

What happened: COVID-19 magnified disparities that have long been an issue for a variety of people.

What we’ve learned: Racial and ethnic minority groups especially have had disproportionately higher rates of hospitalization for COVID-19 than non-Hispanic white people in every age group, and many other groups faced higher levels of risk or stress. These groups ranged from working mothers who also have primary responsibility for children, to people who have essential jobs, to those who live in rural areas where there is less access to health care.

“One thing that has been recognized is that when people were told to work from home, you needed to have a job that you could do in your house on a computer,” says Dr. Juthani. “Many people who were well off were able do that, but they still needed to have food, which requires grocery store workers and truck drivers. Nursing home residents still needed certified nursing assistants coming to work every day to care for them and to bathe them.”  

As far as racial inequities, Dr. Juthani cites President Biden’s appointment of Yale Medicine’s Marcella Nunez-Smith, MD, MHS , as inaugural chair of a federal COVID-19 Health Equity Task Force. “Hopefully the new focus is a first step,” Dr. Juthani says.

Lesson 5: We need to take mental health seriously

What happened: There was a rise in reported mental health problems that have been described as “a second pandemic,” highlighting mental health as an issue that needs to be addressed.

What we’ve learned: Arman Fesharaki-Zadeh, MD, PhD , a behavioral neurologist and neuropsychiatrist, believes the number of mental health disorders that were on the rise before the pandemic is surging as people grapple with such matters as juggling work and childcare, job loss, isolation, and losing a loved one to COVID-19.

The CDC reports that the percentage of adults who reported symptoms of anxiety of depression in the past 7 days increased from 36.4 to 41.5 % from August 2020 to February 2021. Other reports show that having COVID-19 may contribute, too, with its lingering or long COVID symptoms, which can include “foggy mind,” anxiety , depression, and post-traumatic stress disorder .

 “We’re seeing these problems in our clinical setting very, very often,” Dr. Fesharaki-Zadeh says. “By virtue of necessity, we can no longer ignore this. We're seeing these folks, and we have to take them seriously.”

Lesson 6: We have the capacity for resilience

What happened: While everyone’s situation is different­­ (and some people have experienced tremendous difficulties), many have seen that it’s possible to be resilient in a crisis.

What we’ve learned: People have practiced self-care in a multitude of ways during the pandemic as they were forced to adjust to new work schedules, change their gym routines, and cut back on socializing. Many started seeking out new strategies to counter the stress.

“I absolutely believe in the concept of resilience, because we have this effective reservoir inherent in all of us—be it the product of evolution, or our ancestors going through catastrophes, including wars, famines, and plagues,” Dr. Fesharaki-Zadeh says. “I think inherently, we have the means to deal with crisis. The fact that you and I are speaking right now is the result of our ancestors surviving hardship. I think resilience is part of our psyche. It's part of our DNA, essentially.”

Dr. Fesharaki-Zadeh believes that even small changes are highly effective tools for creating resilience. The changes he suggests may sound like the same old advice: exercise more, eat healthy food, cut back on alcohol, start a meditation practice, keep up with friends and family. “But this is evidence-based advice—there has been research behind every one of these measures,” he says.

But we have to also be practical, he notes. “If you feel overwhelmed by doing too many things, you can set a modest goal with one new habit—it could be getting organized around your sleep. Once you’ve succeeded, move on to another one. Then you’re building momentum.”

Lesson 7: Community is essential—and technology is too

What happened: People who were part of a community during the pandemic realized the importance of human connection, and those who didn’t have that kind of support realized they need it.

What we’ve learned: Many of us have become aware of how much we need other people—many have managed to maintain their social connections, even if they had to use technology to keep in touch, Dr. Juthani says. “There's no doubt that it's not enough, but even that type of community has helped people.”

Even people who aren’t necessarily friends or family are important. Dr. Juthani recalled how she encouraged her mail carrier to sign up for the vaccine, soon learning that the woman’s mother and husband hadn’t gotten it either. “They are all vaccinated now,” Dr. Juthani says. “So, even by word of mouth, community is a way to make things happen.”

It’s important to note that some people are naturally introverted and may have enjoyed having more solitude when they were forced to stay at home—and they should feel comfortable with that, Dr. Fesharaki-Zadeh says. “I think one has to keep temperamental tendencies like this in mind.”

But loneliness has been found to suppress the immune system and be a precursor to some diseases, he adds. “Even for introverted folks, the smallest circle is preferable to no circle at all,” he says.

Lesson 8: Sometimes you need a dose of humility

What happened: Scientists and nonscientists alike learned that a virus can be more powerful than they are. This was evident in the way knowledge about the virus changed over time in the past year as scientific investigation of it evolved.

What we’ve learned: “As infectious disease doctors, we were resident experts at the beginning of the pandemic because we understand pathogens in general, and based on what we’ve seen in the past, we might say there are certain things that are likely to be true,” Dr. Juthani says. “But we’ve seen that we have to take these pathogens seriously. We know that COVID-19 is not the flu. All these strokes and clots, and the loss of smell and taste that have gone on for months are things that we could have never known or predicted. So, you have to have respect for the unknown and respect science, but also try to give scientists the benefit of the doubt,” she says.

“We have been doing the best we can with the knowledge we have, in the time that we have it,” Dr. Juthani says. “I think most of us have had to have the humility to sometimes say, ‘I don't know. We're learning as we go.’"

Information provided in Yale Medicine articles is for general informational purposes only. No content in the articles should ever be used as a substitute for medical advice from your doctor or other qualified clinician. Always seek the individual advice of your health care provider with any questions you have regarding a medical condition.

More news from Yale Medicine

I Thought We’d Learned Nothing From the Pandemic. I Wasn’t Seeing the Full Picture

M y first home had a back door that opened to a concrete patio with a giant crack down the middle. When my sister and I played, I made sure to stay on the same side of the divide as her, just in case. The 1988 film The Land Before Time was one of the first movies I ever saw, and the image of the earth splintering into pieces planted its roots in my brain. I believed that, even in my own backyard, I could easily become the tiny Triceratops separated from her family, on the other side of the chasm, as everything crumbled into chaos.

Some 30 years later, I marvel at the eerie, unexpected ways that cartoonish nightmare came to life – not just for me and my family, but for all of us. The landscape was already covered in fissures well before COVID-19 made its way across the planet, but the pandemic applied pressure, and the cracks broke wide open, separating us from each other physically and ideologically. Under the weight of the crisis, we scattered and landed on such different patches of earth we could barely see each other’s faces, even when we squinted. We disagreed viciously with each other, about how to respond, but also about what was true.

Recently, someone asked me if we’ve learned anything from the pandemic, and my first thought was a flat no. Nothing. There was a time when I thought it would be the very thing to draw us together and catapult us – as a capital “S” Society – into a kinder future. It’s surreal to remember those early days when people rallied together, sewing masks for health care workers during critical shortages and gathering on balconies in cities from Dallas to New York City to clap and sing songs like “Yellow Submarine.” It felt like a giant lightning bolt shot across the sky, and for one breath, we all saw something that had been hidden in the dark – the inherent vulnerability in being human or maybe our inescapable connectedness .

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But it turns out, it was just a flash. The goodwill vanished as quickly as it appeared. A couple of years later, people feel lied to, abandoned, and all on their own. I’ve felt my own curiosity shrinking, my willingness to reach out waning , my ability to keep my hands open dwindling. I look out across the landscape and see selfishness and rage, burnt earth and so many dead bodies. Game over. We lost. And if we’ve already lost, why try?

Still, the question kept nagging me. I wondered, am I seeing the full picture? What happens when we focus not on the collective society but at one face, one story at a time? I’m not asking for a bow to minimize the suffering – a pretty flourish to put on top and make the whole thing “worth it.” Yuck. That’s not what we need. But I wondered about deep, quiet growth. The kind we feel in our bodies, relationships, homes, places of work, neighborhoods.

Like a walkie-talkie message sent to my allies on the ground, I posted a call on my Instagram. What do you see? What do you hear? What feels possible? Is there life out here? Sprouting up among the rubble? I heard human voices calling back – reports of life, personal and specific. I heard one story at a time – stories of grief and distrust, fury and disappointment. Also gratitude. Discovery. Determination.

Among the most prevalent were the stories of self-revelation. Almost as if machines were given the chance to live as humans, people described blossoming into fuller selves. They listened to their bodies’ cues, recognized their desires and comforts, tuned into their gut instincts, and honored the intuition they hadn’t realized belonged to them. Alex, a writer and fellow disabled parent, found the freedom to explore a fuller version of herself in the privacy the pandemic provided. “The way I dress, the way I love, and the way I carry myself have both shrunk and expanded,” she shared. “I don’t love myself very well with an audience.” Without the daily ritual of trying to pass as “normal” in public, Tamar, a queer mom in the Netherlands, realized she’s autistic. “I think the pandemic helped me to recognize the mask,” she wrote. “Not that unmasking is easy now. But at least I know it’s there.” In a time of widespread suffering that none of us could solve on our own, many tended to our internal wounds and misalignments, large and small, and found clarity.

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I wonder if this flourishing of self-awareness is at least partially responsible for the life alterations people pursued. The pandemic broke open our personal notions of work and pushed us to reevaluate things like time and money. Lucy, a disabled writer in the U.K., made the hard decision to leave her job as a journalist covering Westminster to write freelance about her beloved disability community. “This work feels important in a way nothing else has ever felt,” she wrote. “I don’t think I’d have realized this was what I should be doing without the pandemic.” And she wasn’t alone – many people changed jobs , moved, learned new skills and hobbies, became politically engaged.

Perhaps more than any other shifts, people described a significant reassessment of their relationships. They set boundaries, said no, had challenging conversations. They also reconnected, fell in love, and learned to trust. Jeanne, a quilter in Indiana, got to know relatives she wouldn’t have connected with if lockdowns hadn’t prompted weekly family Zooms. “We are all over the map as regards to our belief systems,” she emphasized, “but it is possible to love people you don’t see eye to eye with on every issue.” Anna, an anti-violence advocate in Maine, learned she could trust her new marriage: “Life was not a honeymoon. But we still chose to turn to each other with kindness and curiosity.” So many bonds forged and broken, strengthened and strained.

Instead of relying on default relationships or institutional structures, widespread recalibrations allowed for going off script and fortifying smaller communities. Mara from Idyllwild, Calif., described the tangible plan for care enacted in her town. “We started a mutual-aid group at the beginning of the pandemic,” she wrote, “and it grew so quickly before we knew it we were feeding 400 of the 4000 residents.” She didn’t pretend the conditions were ideal. In fact, she expressed immense frustration with our collective response to the pandemic. Even so, the local group rallied and continues to offer assistance to their community with help from donations and volunteers (many of whom were originally on the receiving end of support). “I’ve learned that people thrive when they feel their connection to others,” she wrote. Clare, a teacher from the U.K., voiced similar conviction as she described a giant scarf she’s woven out of ribbons, each representing a single person. The scarf is “a collection of stories, moments and wisdom we are sharing with each other,” she wrote. It now stretches well over 1,000 feet.

A few hours into reading the comments, I lay back on my bed, phone held against my chest. The room was quiet, but my internal world was lighting up with firefly flickers. What felt different? Surely part of it was receiving personal accounts of deep-rooted growth. And also, there was something to the mere act of asking and listening. Maybe it connected me to humans before battle cries. Maybe it was the chance to be in conversation with others who were also trying to understand – what is happening to us? Underneath it all, an undeniable thread remained; I saw people peering into the mess and narrating their findings onto the shared frequency. Every comment was like a flare into the sky. I’m here! And if the sky is full of flares, we aren’t alone.

I recognized my own pandemic discoveries – some minor, others massive. Like washing off thick eyeliner and mascara every night is more effort than it’s worth; I can transform the mundane into the magical with a bedsheet, a movie projector, and twinkle lights; my paralyzed body can mother an infant in ways I’d never seen modeled for me. I remembered disappointing, bewildering conversations within my own family of origin and our imperfect attempts to remain close while also seeing things so differently. I realized that every time I get the weekly invite to my virtual “Find the Mumsies” call, with a tiny group of moms living hundreds of miles apart, I’m being welcomed into a pocket of unexpected community. Even though we’ve never been in one room all together, I’ve felt an uncommon kind of solace in their now-familiar faces.

Hope is a slippery thing. I desperately want to hold onto it, but everywhere I look there are real, weighty reasons to despair. The pandemic marks a stretch on the timeline that tangles with a teetering democracy, a deteriorating planet , the loss of human rights that once felt unshakable . When the world is falling apart Land Before Time style, it can feel trite, sniffing out the beauty – useless, firing off flares to anyone looking for signs of life. But, while I’m under no delusions that if we just keep trudging forward we’ll find our own oasis of waterfalls and grassy meadows glistening in the sunshine beneath a heavenly chorus, I wonder if trivializing small acts of beauty, connection, and hope actually cuts us off from resources essential to our survival. The group of abandoned dinosaurs were keeping each other alive and making each other laugh well before they made it to their fantasy ending.

Read More: How Ice Cream Became My Own Personal Act of Resistance

After the monarch butterfly went on the endangered-species list, my friend and fellow writer Hannah Soyer sent me wildflower seeds to plant in my yard. A simple act of big hope – that I will actually plant them, that they will grow, that a monarch butterfly will receive nourishment from whatever blossoms are able to push their way through the dirt. There are so many ways that could fail. But maybe the outcome wasn’t exactly the point. Maybe hope is the dogged insistence – the stubborn defiance – to continue cultivating moments of beauty regardless. There is value in the planting apart from the harvest.

I can’t point out a single collective lesson from the pandemic. It’s hard to see any great “we.” Still, I see the faces in my moms’ group, making pancakes for their kids and popping on between strings of meetings while we try to figure out how to raise these small people in this chaotic world. I think of my friends on Instagram tending to the selves they discovered when no one was watching and the scarf of ribbons stretching the length of more than three football fields. I remember my family of three, holding hands on the way up the ramp to the library. These bits of growth and rings of support might not be loud or right on the surface, but that’s not the same thing as nothing. If we only cared about the bottom-line defeats or sweeping successes of the big picture, we’d never plant flowers at all.

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National Statistical

News and insight from the office for national statistics, exploring the changing impact of covid-19 on our lives.

• September 3, 2021

In March 2020, as the nation was urged to stay at home and only to leave for essential reasons, our lives were turned upside down.  At the ONS, most staff moved to homeworking, and those of us with children found ourselves, in common with millions of others, trying to combine childcare and home-schooling with working in new ways.  Here Tim Vizard looks back over the impact we’ve seen the pandemic having on people’s lives.

The word ‘unprecedented’ has been over-used to describe the past 18 months, but that was the position the ONS found itself in last March when the UK Government tasked us with providing real time statistics to understand how adults in Great Britain were coping as circumstances changed.

In a matter of days, we adapted our Opinions and Lifestyle survey to provide robust weekly estimates of the impacts living with COVID-19 were having on people’s daily lives.  Since March 2020, over 200,000 adults have taken part in our survey across Great Britain and to date, we have published weekly reports reflecting how people were feeling, and the evolving challenges they were facing.

Early priorities were to establish whether people understood how to protect themselves from the virus and if they were taking measures to do so, such as handwashing with soap and water. During these early days, wearing face coverings were not on the agenda in those first surveys of March and April 2020s.

TV and social media were playing important roles in providing information and it was clear that people were taking the coronavirus seriously, with 86% of adults worried that they or someone in their family would be infected. Despite this, many people were rallying round to help each other: 84% of people aged 70+ said someone had offered to organise or deliver food and essential items if they needed to self-isolate.

Yet in those early weeks of the first lockdown, half of adults thought life would return to normal within 6 months.  Last week, just 16% felt life would return to normal within 6 months, with “over a year” the view of 28% of adults.

The extent to which we have learned to “live with COVID” is seen in responses over time. Support for, and compliance with, protective measures such as hand-washing and wearing face coverings have remained high throughout.

People’s behaviour in each weekly report has reflected changing circumstances and the regulations in place over the past 18 months, from moves towards outdoor socialising and going to cafes and restaurants last summer to the growing restrictions towards the year’s end and then into early 2021.

Over time, worry about the impact of COVID-19 on our lives has fallen from 86% back in March 2020 to 48% at the end of August 2021.  We’ve been able to track the numbers of adults working from home and travelling to work throughout the pandemic, and provided insights into how many adults who would like to continue some form of hybrid working in the future. As young people are returning to schools and colleges, we’ve seen how concerned parents were about the effect that home-schooling had on their children’s wellbeing and the strain it placed on adults too.

Nevertheless, nearly half of adults are still ‘very or somewhat worried’ about the impacts of COVID-19.  Personal wellbeing across all measures is still worse than pre-pandemic. Seeing the nation’s wellbeing in real time have brought home the impact the pandemic has had on levels of anxiety in the population, particularly at the start of 2021. In the first three months of this year , more than one in five adults were experiencing some form of depression: double the rate found before the pandemic.

At the end of 2020, we also started watched with interest the roll out of COVID-19 vaccinations. We’ve seen people become increasingly positive about the COVID-19 vaccines, with 96% of adults saying they having already had it or would be likely if offered. Most recently, 94% of people who have received two doses of a COVID-19 vaccine said they would be very or fairly likely to have a booster vaccine if offered .

As someone who has worked on this survey since the start of 2020, I have found each week’s results fascinating, often resonating with my own experience and that of my colleagues. Delivering weekly results has required a hugely dedicated team across ONS, working long hours to provide timely estimates to our colleagues across Government.  As we move to a fortnightly survey, with the next results published on 10 September, we will continue to explore the impacts, old and new, that COVID-19 is having on our lives.  The fortnightly survey will give our participants more time to respond, and us more time to reflect on findings and incorporate new issues into the survey as life continues to change.

If you are one of the 200,000 people who have taken part in the survey – or any of the others we are conducting – I’d like to say thank you on behalf of all of us at ONS. Your responses have been hugely important in understanding the wide reaching impacts of COVID-19 has had on our lives.

Tim Vizard, Policy Evidence and Analysis Team at the ONS.

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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.

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• Policy and research
• The COVID Decade: understanding the long-term societal impacts of COV…

The COVID Decade: understanding the long-term societal impacts of COVID-19

The British Academy was asked by the Government Office for Science to produce an independent review on the long-term societal impacts of COVID-19. This report outlines the evidence across a range of areas, building upon a series of expert reviews, engagement, synthesis and analysis across the research community in the Social Sciences, Humanities and the Arts (SHAPE). It is accompanied by a separate report, Shaping the COVID decade , which considers how policymakers might respond. History shows that pandemics and other crises can be catalysts to rebuild society in new ways, but that this requires vision and interconnectivity between policymakers at local, regional and national levels.

With the advent of vaccines and the imminent ending of lockdowns, we might think that the impact of COVID-19 is coming to an end. This would be wrong. We are in a COVID decade: the social, economic and cultural effects of the pandemic will cast a long shadow into the future – perhaps longer than a decade – and the sooner we begin to understand, the better placed we will be to address them.

There are of course many impacts which flowed from lockdowns, including not being able to see family and friends, travel or take part in leisure activities. These should ease quickly as lockdown comes to an end. But there are a set of deeper impacts on health and wellbeing, communities and cohesion, and skills, employment and the economy which will have profound effects upon the UK for many years to come. In sum, the pandemic has exacerbated existing inequalities and differences and created new ones, as well as exposing critical societal needs and strengths. These can emerge differently across places, and along different time courses, for individuals, communities, regions, nations and the UK as a whole.

We organised the evidence into three areas of societal effect. As we gathered evidence in these three areas, we continually assessed it according to five cross-cutting themes – governance, inequalities, cohesion, trust and sustainability – which the reader will find reflected across the chapters. Throughout the process of collating and assessing the evidence, the dimensions of place (physical and social context, locality), scale (individual, community, regional, national) and time (past, present, future; short, medium and longer term) played a significant role in assessing the nature of the societal impacts and how they might play out, altering their long-term effects. The three societal areas we chose to help structure our evidence collection and, ultimately, this report were:

• Health and wellbeing – covering physical and mental health (including young people and work), wellbeing, and the environment we live in
• Communities, culture and belonging – covering communities and civil society, cities and towns, family and kinship, and arts, media, culture, heritage and sport
• Knowledge, employment and skills – covering education (compulsory and tertiary), skills, knowledge and research, and work and employment

Below we provide a high-level summary across the three areas, but we encourage readers to dip into the detailed sections of the report, which contain a vast array of data not reproduced here.

Health and wellbeing

The impacts of COVID-19 on health and wellbeing have not been felt uniformly across society. COVID-19 has exacerbated existing structural and social inequalities, with particularly negative health outcomes for those already disadvantaged in society. In this chapter we identify seven areas where we expect there to be continuing challenges and opportunities: pre-existing health inequalities; mental health; social care; pandemic duration and ‘long COVID’; information and communication; data gathering and new health technologies; and environmental conditions, health and wellbeing.

Communities, culture and belonging

A central theme across the evidence is the vital importance of community-led responses that draw upon local knowledge and resources, and build capacity and channels of interconnectedness between government, community organisations and the public. The evidence clearly shows that those communities that entered the pandemic with such infrastructure have been best placed to respond. In this chapter we examine six areas where we expect there to be continued challenges and opportunities: community-level responses, volunteering and mutual aid; cohesion and solidarity; trust in government and media; place, cities and housing; race, ethnicity, immigration and prejudice; and arts, culture and sport.

Knowledge, employment and skills

COVID-19 has had significant and unequal effects depending on where in the UK people live, their level of education, socioeconomic and health status. Wider issues around the national economy, educational infrastructure and the social security system have compounded these impacts. In this chapter we examine five areas where we consider the challenges and opportunities of the pandemic on the experience of education and training; the sustainability of further and higher education; the stability of the economy; employment; and incomes.

Nine areas of long-term societal impact

Throughout this review, we have tried to retain a strict focus on the impacts caused by COVID-19 – but as we discovered, many impacts of the pandemic are an acceleration of existing trends. The evidence of impact pointed strongly to factors that preceded and will outlast the pandemic. This is to be expected, as it is also the pattern that pandemics and major crises throughout history have exhibited: pandemics are as much social and economic problems as medical and health ones. We conclude this review with a set of nine areas of long-term societal impact, which result from a synthesis and analysis of the effects, risks, challenges and opportunities outlined above. These nine areas of long-term impact are not exhaustive, but they will be significant, and we hope they provide a useful starting point for further engagement and understanding of how we will work together to address them.

1. Increased importance of local communities

Local communities have become more important than ever during the pandemic. Local and hyper-local charitable and voluntary organisations have been crucial to the response to COVID-19, but there are inequalities between communities based on the strength of community infrastructures. National capacity to respond to changing circumstances and challenges requires effort to sustain a strong web of communities and community engagement at local levels.

2. Low and unstable levels of trust in governance

Following a brief initial increase, trust in the UK Government and feelings of national unity are in decline. Trust in local government and feelings of local unity have been higher and steadier. Declining trust is a major challenge that needs to be addressed because it undermines the ability to mobilise public behaviour for wider social and health benefits.

3. Widening geographic inequalities

Geographic and spatial inequalities have widened. Health and wellbeing, local economic risk and resilience, poverty and deprivation, and response planning all have an important place dimension that has shaped the impact of the crisis. Attending to these inequalities is important because they expose ways in which the combination of geographical location, physical infrastructure and social conditions implies that different priorities may be needed in different places.

4. Exacerbated structural inequalities

COVID-19 and the government response to it have impacted different people in different ways, often amplifying existing structural inequalities in income and poverty, socioeconomic inequalities in education and skills, and intergenerational inequalities – with particular effects on children (including vulnerable children), families with children and young people. There are differential effects within these along dimensions of gender, race and ethnicity and social deprivation which have been both exposed and exacerbated, as well as effects related to social development, relationships and mental health which are all variably affected and interlinked. The evidence highlights that addressing the underlying interconnected propellants of inequality is a key challenge ahead.

5. Worsened health outcomes and growing health inequalities

Like structural inequalities, health outcomes for COVID-19 have followed patterns of existing health inequalities. There are ongoing health impacts from ‘long COVID’ as well as from delays in care seeking and reprioritisation of resources. Deficiencies in home and community care infection prevention and control measures, and  inequalities in the structure and funding of social care provision, have been laid bare. These are all areas that need significant attention to avoid critical gaps in the health system going forward.

6. Greater awareness of the importance of mental health

The pandemic and various measures taken to address it have resulted in differential mental health outcomes. Access to support for new cases and for those with pre-existing conditions has also been disrupted, in addition to services for children and young people. Both have the potential to result in long-term mental health impacts for particular groups if there is not a renewed focus on the causes and solutions for sustaining mental health across society, including by tackling the structural and root causes of inequality.

7. Pressure on revenue streams across the economy

Although detailed economic analyses were outside the scope of the report, there are likely to be additional pressures on government spending in the medium to long term, as a result of increasing levels of debt and possible falling tax revenues due to risks around unemployment, failing businesses, decreased consumption and significant shifts in the structure of the economy. It will be increasingly important to address the balance of revenue generation and weigh up expenditure against non-economic impacts, considering a diversity of mechanisms and actors to meet societal goals.

8. Rising unemployment and changing labour markets

Employment and household income levels have fallen and will likely worsen for the foreseeable future. This will lead to an increased dependency on social security, which the current system may be ill equipped to deal with effectively. This will matter not only for those who are (or will become) dependent on state social security support, but also because it may require significant adjustments to the social security system in order for it to keep pace with demand.

9. Renewed awareness of education and skills

The consequences of lost access to education at all levels, coupled with changes to assessments, will be felt for years to come, and wholly recovering lost education is unfeasible. This has exacerbated existing socioeconomic inequalities in attainment and highlighted digital inequality. Because a high-skill economy will be essential for future prosperity and for society to thrive, it will be vital to consider whether lifelong educational opportunities are sufficiently comprehensive, diverse and flexible.

This report draws together evidence across a wide range of areas on the societal impact of the pandemic. It shows that COVID-19 has generated a series of social, economic and cultural effects which will have long-term impacts. In particular, the pandemic has exposed, exacerbated and solidified existing inequalities in society. It has also made some individuals and groups living in particular places and communities even more vulnerable than before.

However, it is not just a case of the pandemic making existing problems worse. It has also exposed areas of strength, resilience, creativity and innovation. We hope this rich evidence base will prove a useful resource for policymakers, civil society, media and others who are trying to make sense of the changing landscape.

This evidence review is accompanied by a separate report, Shaping the COVID decade, outlining some potential options for policymakers to respond to the trends outlined in this review. History indicates that times of upheaval – such as the pandemic – can be opportunities to reshape society, but that this requires vision and for key decisionmakers to work together in concert.

The British Academy has begun the substantial task of exploring the long-term societal effects of COVID-19. Of course, the situation continues to evolve, and new evidence will help us to build a richer picture of the pandemic’s effects and how we might respond. What we offer here is a conceptual framework, a methodology and some core evidence that will allow both the British Academy and others to make progress on this urgent challenge. We look forward to opportunities to develop this programme in partnership with actors across all levels of government, with civil society and business sector leaders, and within communities.

Shaping the COVID decade: addressing the long-term societal impacts of COVID-19

Policy report

The British Academy has undertaken the substantial task of beginning to answer the longer-term question about what the societal impacts of COVID-19 will be and how we address them. This report sets out an interrelated set of nine areas of long-term impact, seven strategic policy goals and five key principles of a facilitative policy environment for 2030. We aim here to provide decision-makers with a sense of how to start to respond to these longer-term impacts based on the current evidence, and how to shape the COVID decade.

Evidence submissions

See all of the rapid response submissions to the British Academy’s call for evidence on the long-term societal effects and impacts of COVID-19.

‘Shaping the COVID Decade’, explained in two minutes

The key points from our reports on understanding and addressing the COVID decade, summarised by Professor Dominic Abrams FBA in just two minutes.

COVID-19 and Society: Shaping the COVID Decade

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• Open access
• Published: 17 April 2021

Impact of the COVID-19 crisis on work and private life, mental well-being and self-rated health in German and Swiss employees: a cross-sectional online survey

• Martin Tušl 1 ,
• Rebecca Brauchli 1 ,
• Philipp Kerksieck 1 &
• Georg Friedrich Bauer 1  

BMC Public Health volume  21 , Article number:  741 ( 2021 ) Cite this article

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The COVID-19 crisis has radically changed the way people live and work. While most studies have focused on prevailing negative consequences, potential positive shifts in everyday life have received less attention. Thus, we examined the actual and perceived overall impact of the COVID-19 crisis on work and private life, and the consequences for mental well-being (MWB), and self-rated health (SRH) in German and Swiss employees.

Cross-sectional data were collected via an online questionnaire from 2118 German and Swiss employees recruited through an online panel service (18–65 years, working at least 20 h/week, various occupations). The sample provides a good representation of the working population in both countries. Using logistic regression, we analyzed how sociodemographic factors and self-reported changes in work and private life routines were associated with participants’ perceived overall impact of the COVID-19 crisis on work and private life. Moreover, we explored how the perceived impact and self-reported changes were associated with MWB and SRH.

About 30% of employees reported that their work and private life had worsened, whereas about 10% reported improvements in work and 13% in private life. Mandatory short-time work was strongly associated with perceived negative impact on work life, while work from home, particularly if experienced for the first time, was strongly associated with a perceived positive impact on work life. Concerning private life, younger age, living alone, reduction in leisure time, and changes in quantity of caring duties were strongly associated with perceived negative impact. In contrast, living with a partner or family, short-time work, and increases in leisure time and caring duties were associated with perceived positive impact on private life. Perceived negative impact of the crisis on work and private life and mandatory short-time work were associated with lower MWB and SRH. Moreover, perceived positive impact on private life and an increase in leisure time were associated with higher MWB.

The results of this study show the differential impact of the COVID-19 crisis on people’s work and private life as well as the consequences for MWB and SRH. This may inform target groups and situation-specific interventions to ameliorate the crisis.

Peer Review reports

Key findings

31% of employees perceived a negative impact of the crisis on their work life. Mandatory short-time workers and those who lost their job felt the negative impact the most.

10% of employees perceived a positive impact of the crisis on their work life. Those working in home-office, particularly if experienced for the first time, felt the positive impact the most.

30% of employees perceived a negative impact of the crisis on their private life. Living in a single household, reduction in leisure time, and changes in quantity of caring duties (i.e., increase or decrease) were strongly associated with the negative impact.

13% of employees perceived a positive impact on their private life. Living with a partner or family, mandatory short-time work, increases in leisure time and caring duties were strongly associated with the positive impact.

Perceived negative impact of the crisis on work and private life and mandatory short-time work were strongly associated with lower mental well-being and self-rated health.

Perceived positive impact of the crisis on private life and an increase in leisure time were strongly associated with higher mental well-being and, for leisure time, also with higher self-rated health.

Targeted interventions for vulnerable groups should be established on a company/governmental levels such as psychological first aid accessible online or rapid financial aids for those who have lost their income partially or completely.

Companies may consider offering positive psychology trainings to employees to help them purposefully focus on and make use of the beneficial consequences of the crisis. Such trainings may also include workshops on optimal crafting of their work and leisure time during the pandemic.

On January 30, 2020, the World Health Organization (WHO) declared the outbreak of COVID-19 a Public Health Emergency of International Concern (PHEIC) [ 1 ]. In the following weeks, the virus quickly spread worldwide, forcing the governments of affected countries to implement lockdown measures to decrease transmission rates and prevent the overload of hospital emergency rooms. Switzerland entered full lockdown on March 16th, Germany followed 6 days later on March 22nd. Restrictive measures in both countries were comparable and included border controls, closing of schools, markets, restaurants, nonessential shops, bars, entertainment and leisure facilities, as well as ban on all public and private events and gatherings [ 2 , 3 ]. Such strict measures were in place until the end of April when both governments started to gradually ease the measures [ 4 , 5 ]. Consequently, much of the working population suddenly faced drastic changes to everyday life. People who commuted to work and had rich social lives outside their homes found themselves in a mandatory work from home (WFH) situation, many employees were furloughed or laid off as various businesses and industries had to shut down, and health workers in emergency rooms as well as supermarket staff and other essential employees were faced with a dramatic increase in workload and job strain [ 6 , 7 ].

Regarding the public health impact of the COVID-19 crisis, several studies suggest that working conditions have deteriorated and that employees are more likely to experience mental health problems, such as stress, depression, and anxiety [ 8 , 9 , 10 , 11 ]. In particular, women, young adults, people with chronic diseases, and those who have lost their jobs as a result of the crisis seem to be the most affected [ 11 , 12 , 13 , 14 ]. One of the common stressors that research has highlighted is the fear of losing one’s job and, consequently, one’s income [ 7 ]. Moreover, social isolation, conflicting messages from authorities, and an ongoing state of uncertainty have been described as some of the main factors contributing to emotional distress and negatively affecting mental health and well-being [ 8 , 14 , 15 , 16 , 17 , 18 ].

In the European context, Eurofound [ 12 ] released a report on research in April 2020 involving 85,000 participants across 27 EU member countries. The data indicate that the EU population experienced high levels of loneliness, low levels of optimism, insecurity regarding their jobs and financial future, as well as a decrease in well-being. Germany scored slightly below the EU27 average in well-being, and there is further evidence that it decreased significantly in the early stages of the COVID-19 pandemic, between March 2020 and May 2020 [ 19 ]. The Eurofound report does not discuss Switzerland; however, other studies suggest that there has been an increase in emotional distress in Swiss young adults [ 20 ] and that undergraduate students have experienced higher levels of stress, depression, anxiety, and loneliness compared to the time before the COVID-19 outbreak [ 14 ]. A Swiss social monitor study reports that over 40% of Swiss adults perceive a worsened quality of life compared to before the pandemic, 10% experience feelings of loneliness, 10% report fear of losing their job, and about 1% lost their job as a result of the pandemic. The report also indicates an increase in WFH by 29% compared to before the pandemic [ 21 ].

Accordingly, the data from Eurofound [ 12 ] also suggest that European employees have experienced a dramatic increase in WFH. About 37% of the EU working population transitioned to WFH as a result of the pandemic, and 24% WFH for the first time. Before the pandemic, employees had considered remote working a benefit when it followed their preferences. However, the COVID-19 lockdown changed this by forcing many employees into mandatory WFH [ 6 ]. This posed various challenges for employees without prior WFH experience, such as organizing the workspace, establishing new communication channels with colleagues, coping with work isolation, or managing boundaries between work and non-work [ 22 , 23 , 24 ]. Without proper support from the employer or insufficient resources to manage these challenges, mandatory WFH may become a burden that negatively affects employees’ well-being [ 8 ] and, in turn, their performance [ 22 ]. Furthermore, the increase in WFH has been highlighted as a potential threat to parents with small children at home, as this group is likely to experience difficulties in combining work duties with home schooling and household chores [ 12 , 23 ].

Indisputably, the COVID-19 pandemic has had a strong impact on many aspects of our lives and will continue to do so for months and years to come. However, the consequences of the crisis and societal reactions to the challenges posed by the virus are not deemed solely negative. The new situation also holds opportunities for positive shifts in our work and private lives that were impossible before the COVID-19 crisis. Many may see this crisis as an opportunity to learn how to cope with profound changes in everyday life and even to adopt new pro-active behaviors. For instance, some employees may discover that the new ways of working (e.g., WFH) facilitate more productivity and are more satisfying compared to working in an office [ 25 ]. Data collected from employees in Denmark and Germany between March and May 2020 [ 26 ] suggest that 71% of respondents felt informed and well prepared for the changing work situation and WFH. Participants also reported several advantages of working from home, such as perceived control over the workday, working more efficiently, or saving time previously spent commuting. In contrast, some reported disadvantages of WFH included social isolation, loss of the value of work, and a lack of important work equipment. Nonetheless, respondents reported overall relatively more positive experiences of WFH than negative ones. Thus, we argue that more balanced studies are needed that examine both the negative and positive impact of the COVID-19 crisis on peoples’ lives, health, and well-being, considering differential effects in diverse subgroups. Such studies have the potential to conclude how to diminish the negative and enhance the positive outcomes of the current and future pandemic-related crises in the working population.

Aim and objectives

The overall aim of the present study was to examine the actual and perceived overall impact of the COVID-19 crisis on employees’ work and private life, along with its consequences for mental well-being (MWB) and self-rated health (SRH) in the German and Swiss working populations. Specifically, we pursued the following objectives:

To investigate the perceived positive and negative impact of the COVID-19 crisis on work and private life as well as to assess the self-reported changes in work and private life routines induced by the crisis.

To examine which sociodemographic variables and which self-reported changes in work and private life routines are associated with perceived positive and negative impact of the COVID-19 crisis on work and private life.

To investigate how the self-reported changes and perceived overall impact of the COVID-19 crisis on work and private life are associated with MWB and SRH as relevant health outcomes.

Although SRH has been identified as a relevant predictor of mental distress during the COVID-19 pandemic [ 10 , 27 ], to our knowledge, it has not been studied as an outcome variable in combination with MWB indicators as in our study.

The present study used a cross-sectional online survey design. We report our study following the STROBE guidelines for cross-sectional studies [ 28 ], and the checklist for reporting results of internet e-surveys (CHERRIES) [ 29 ], see ‘Additional file  1 .pdf’ in supplementary material.

Participants were recruited through a panel data service Respondi ( respondi.com ). Cross-sectional data were collected from employees in Germany and Switzerland via an online questionnaire using a web-based survey provider SurveyGizmo. The questionnaire was tested and checked by senior researchers from the field for face validity prior to the administration. The period of data collection was from 9th to 22nd April 2020, when both countries were in full lockdown as part of the control measures relating to COVID-19. Participants received a minimal incentive for completing the survey (i.e., points which could be redeemed towards a given service after participating in several surveys). Participation was voluntary and participant anonymity and confidentiality of their data were assured and emphasized. Each participant in the online panel service database had a unique code which ensured anonymity and prevented multiple submissions from one participant. Important items in the survey were mandatory and participants were informed if they accidently skipped an item. Further, the questionnaire used a logic to avoid asking redundant or non-applicable questions (e.g., participants who indicated that they lost their job were not asked about the change in working time or home-office). Moreover, we included several disqualifying items (i.e., “Please choose number three as an answer to this item”) as a quality check to exclude participants who would give random answers. Participants were able to go back in the survey and review or change their answers.

The eligibility criteria were: being employed (not self-employed), working more than 20 h per week, and being within the age range of 18 to 65 years. The final sample included 2118 participants. Figure  1 shows a flow diagram describing how the final sample was achieved.

Sample flow diagram

Sociodemographic characteristics of the sample are shown in Table  1 : the mean age was 46.51 years ( SD  = 11.28), 5% completed primary, 58% secondary, and 37% tertiary education, Footnote 1 55% were male, 77% were from Germany, and 72% were living with a partner, family, or in a shared housing.

Overall, in terms of age, education, and living situation (i.e., single households), the study sample seems to be a good representation of the target of the working population in Germany ( www.destatis.de ) and Switzerland ( www.bfs.admin.ch ). In general, males were slightly overrepresented in our sample (56%) compared to the general population (52%); however, the proportion of males in both countries did not differ significantly (56% from Germany, 52% from Switzerland), χ 2 (1) = 1.63, p  = 0.201.

Perceived overall impact of COVID-19 on work and private life

Assuming that both improvements and deteriorations can simultaneously occur due to COVID-19, we designed four separate items (see ‘Additional file  2 .pdf’ in supplementary material) to assess participants’ subjective evaluation of the overall impact of the COVID-19 crisis on their work and private lives: “The Corona-crisis has (a) worsened my work life; (b) improved my work life; (c) worsened my private life; (d) improved my private life.” The response scale ranged from 1 =  strongly disagree to 5 =  strongly agree . As a primer to this question, we defined the Corona-crisis as follows:

“The following questions deal directly with the current COVID-19 (Corona) pandemic and the consequent regulations from the government (i.e., business closures, school closures, event bans, contact reduction in public spaces, etc.). Hereafter, we refer to this collectively as the Corona-crisis. Please compare your current situation with the situation as it was before the government regulations.”

Changes in work and private life routines

The following items examined qualitative and quantitative changes in participants’ work and private life routines resulting from the COVID-19 crisis: (a) change in employment contract ( no change ; short-time work Footnote 2 with a reduced contract ; short-time work with a contract reduced to 0 h ; job loss ); (b) proportion of WFH before and after COVID-19 ( 0 to 100% ; participants were grouped into three categories according to their answers: None , Experienced , New Footnote 3 ); (c) changes in quantity of working time,; (d) changes in quantity of leisure time; and (e) changes in quantity of caring duties. The response scale for items c, d, and e ranged from 1 =  strongly decreased to 5 =  strongly increased . For the statistical analysis, responses were grouped into three categories: decreased (1 + 2), unchanged (3), increased (4 + 5).

• Mental well-being

MWB was assessed with the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) [ 30 ]. Specifically, we used the German translation of the 7-item short version of the WEMWBS [ 31 ]. WEMWBS is a measure of MWB capturing the positive aspects of mental health, namely, positive affect (feelings of optimism, relaxation), satisfying interpersonal relationships, and positive functioning (clear thinking, self-acceptance, competence, autonomy). The response scale ranged from 1 =  never to 5 =  all the time . For the statistical analysis (i.e., ordinal logistic regression model), we grouped participants into six categories according to their overall score in percentiles (10, 25, 50, 75, 90, 99%).

• Self-rated health

SRH was assessed with a single item: “In general, how would you evaluate your health?” [ 32 ]. The response scale ranged from 1 =  very bad to 5 =  very good . The application of single-item measures for self-evaluated health is a gold standard in public health research [ 33 ].

Statistical analysis

Data analysis was carried out using R version 4.0.2. In the first step, four ordinal logistic regression models using polr from the MASS R package [ 34 ] were fitted to assess associations of the perceived overall impact of COVID-19 on work and private life as outcome variables with sociodemographic factors (gender, age, country, living situation) and factors related to changes in work and private life routines (changes in employment contract, WFH, work time, leisure time, caring duties) as independent variables. To verify that there was no multicollinearity, the variables were tested a priori using the variance inflation factor tested vif from the car R package [ 35 ] (VIF < 2). The results are presented as adjusted odds ratio (OR) with 95% confidence intervals (95% CI) interpreted as the OR of reporting a higher level of the impact compared to the reference category.

Further, two additional ordinal logistic regression models were fitted to investigate the association between the perceived overall impact of COVID-19 on work and private life Footnote 4 and the self-reported changes in work and private life routines as independent variables and MWB with SRH as outcome variables. In both models, we also controlled for possible confounders (gender, age, country, living situation). The results are presented as adjusted OR with 95% CI interpreted as the OR of reporting a higher level of MWB/SRH compared to the reference category.

Figure  2 displays the correlations between the analyzed variables. Education was not included in the regression models due to missing data (see details in the Methods section).

Correlation matrix of the analyzed variables. Note: Only correlations with p  < 0.01 displayed; Gender (1 = Female, 2 = Male); Country (1 = Germany, 2 = Switzerland); Education (1 = Primary, 2 = Secondary, 3 = Tertiary); Living situation (1 = Alone, 2 = With partner/family); Contract change (1 = No change, 2 = Short-time reduced, 3 = Short-time 0, 4 = Job loss); Home-office (1 = None, 2 = Experienced, 3 = New)

Perceived overall impact of COVID-19 crisis and self-reported changes in work and private life routines

Figure  3 shows the results for the four items related to the perceived overall impact of the COVID-19 crisis on work and private life. Thirty-one percent of participants (strongly) agreed that their work life had worsened and 30% (strongly) agreed that their private life had worsened. In contrast, 10% (strongly) agreed that their work life had improved and 13% (strongly) agreed that their private life had improved as a result of the COVID-19 crisis.

Perceived impact on work and private life and self-reported changes in work time, leisure time, and caring duties. Note: Total percentage does not always equal 100% due to rounding error

Further, Fig.  3 shows self-reported changes with regard to the quantity of time actually spent in work and private life. Work time decreased for 38%, leisure time increased for 36%, while the amount of caring duties changed for 26% of participants.

Figures  4 and 5 show self-reported changes with regard to contracted working hours and home-office. Twenty-eight percent of participants experienced a change in their employment contract, while 27% were affected by mandatory short-time work, 1% lost their job as a result of the COVID-19 crisis. Fifty-one percent reported to WFH and of those, 20% reported doing so for the first time.

Self-reported changes in home-office. Note: None = 0% WFH before COVID-19, 0% after; Experienced = at least 10% WFH before and at least 10% after COVID-19; New = 0% WFH before and at least 10% after COVID-19

Self-reported changes in contracted working hours. Note: Short-time reduced = work hours temporarily partly reduced by employer; Short time 0 = work hours temporarily reduced to 0 by employer

Factors associated with perceived impact on work life

Table  2 shows OR comparisons between different subgroups concerning their evaluation of the degree to which their work life had worsened or improved due to the COVID-19 crisis, assessed by two separate dependent variables. Regarding perceived negative impact on work life, change in employment contract demonstrated the highest OR of reporting a deterioration of work life. The association was particularly strong in participants who had their contract reduced to mandatory short-time work with 0 working hours (OR = 9.72) and in those who had lost their job (OR = 35.07). Further, participants who reported a change in their work time had a significantly higher OR of reporting a deterioration of work life (OR = 2.95; 2.06). Finally, changes in leisure time and increased caring duties were significantly associated with perceived deterioration of work life. This association was particularly strong for a decrease in leisure time (OR = 1.62) and an increase in caring duties (OR = 1.58).

Regarding perceived positive impact of COVID-19 on work life, WFH had the highest OR of reporting an improvement in work life. The association was particularly strong in those who had started to WFH for the first time (OR = 2.77). Increase in leisure time was also significantly associated with a positive impact on work life. Further, older employees in the 51–60 and 61–65 age groups had significantly lower odds of reporting a positive impact of COVID-19 on work life (OR = 0.71; 0.61), as well as short-time employees, in particular those with a contract reduced to 0 working hours (OR = 0.53), and those who reported a decrease in work time (OR = 0.61).

Factors associated with perceived impact on private life

Table 2 further shows OR comparisons within different subgroups concerning their evaluation of the degree to which their private life had worsened or improved due to the COVID-19 crisis, assessed by two separate dependent variables. Regarding perceived negative impact on private life, the subgroup of participants living with a partner, family, or in a shared housing had significantly lower odds of reporting the deterioration of their private life compared to those living alone (OR = 0.41). The odds of reporting deterioration of private life were lower also for the 61–65 age group (OR = 0.58). Finally, changes in the quantity of leisure time and quantity of caring duties were associated with perceived deterioration of private life, and this association was particularly strong for a decrease in leisure time (OR = 2.62) and a decrease in caring duties (OR = 1.62).

Regarding perceived positive impact on private life, the strongest association was with an increase in leisure time (OR = 2.25), followed by living with a partner, family, or in a shared housing (OR = 1.74); WFH, particularly among those with prior WFH experience (OR = 1.72); and with an increase in caring duties (OR = 1.33). Short-time workers had significantly higher odds of reporting a positive impact on their private life compared to workers without any change, especially those with a contract reduced to 0 working hours (OR = 1.57).

Association between the perceived impact, self-reported changes, mental well-being and self-rated health

Table  3 shows the results of the associations between perceived overall impact, the self-reported changes in work and private life routines, and relevant health outcomes in terms of MWB and SRH, controlled for various sociodemographic variables. Regarding the perceived overall impact, participants who (strongly) agreed that COVID-19 had worsened their work life reported significantly lower MWB (OR = 0.61) compared to those who (strongly) disagreed. In addition, participants who neither agreed nor disagreed that their work life had worsened reported lower MWB (OR = 0.71) compared to those who (strongly) disagreed. A strong negative association could also be seen regarding perceived negative impact on private life: participants who (strongly) agreed that their private life had worsened reported lower MWB (OR = 0.62) and SRH scores (OR = 0.67) compared to those who (strongly) disagreed. Both outcomes were also negatively associated with employees who neither agreed nor disagreed that their private life had worsened (OR = 0.80; 0.66) compared to those who (strongly) disagreed. Finally, participants who (strongly) agreed that their private life had improved as a result of the COVID-19 crisis had higher odds of reporting a higher MWB score (OR = 1.39) compared to those who (strongly) disagreed.

Regarding the impact of the self-reported changes in work and private life routines, mandatory short-time workers with a contract reduced to 0 working hours reported significantly lower MWB (OR = 0.57) and SRH (OR = 0.49) compared to participants without any change in their employment contract. In contrast, an increase in leisure time was positively associated with both better MWB (OR = 1.23) and SRH (OR = 1.45).

The present study aimed to examine the impact of the COVID-19 crisis on employees’ work and private life and the consequences for MWB and SRH in German and Swiss employees. The first objective of the study was to assess the perceived impact and self-reported changes related to COVID-19. Although the research has thus far mostly emphasized the negative impact of the COVID-19 crisis [ 9 , 10 , 11 , 12 , 36 ], our data show that more than 40% of participants perceived no negative changes and over 10% even positive shifts in both life domains. This can be partly explained by the experienced changes in daily routines: 28% of participants were affected by a change in their employment contract and 49% by changes in the quantity of work time, confirming almost identical findings for Germany in the Eurofound report [ 12 ]. Also, quantity of leisure time and of caring duties changed for 58 and 26% respectively. The finding that about half WFH at least part of their working time, and 20% for the first time is also in line with Eurofound’s data where 24% reported WFH for the first time [ 12 ]. Overall, the proportion of people affected by changes in work and private life is comparable but hardly exceeds 50%, similar to the proportion of participants who reported a deterioration in their work and private life.

The second objective was to explore the factors associated with perceived impact on work and private life. A change in contracted work hours (i.e., mandatory short-time work, job loss), and changes in work time were strongly associated with reporting deterioration of work life. Those affected by short-time work experienced a significant disruption in their work routine as well as fear of losing the job, factors associated with increased level of distress and low MWB [ 7 ]. In consequence, employees whose contract had been reduced or terminated due to the lockdown measures are particularly vulnerable to developing mental health problems [ 11 , 13 ]. Further, an increase in caring duties, and, perhaps more surprisingly, increase and decrease in leisure time were strongly associated with perceived deterioration of work life. Such changes in private life routines may require efforts for readjustments that can interfere with work and work-life balance. These readjustments may be particularly difficult for older employees (i.e., age group 61–65) who were more likely to report deterioration of their work life. They may be particularly sensitive to changes in daily structure and less flexible in adapting to a new situation, such as mandatory WFH, less personal contact with colleagues, and an increase in the use of digital technology.

WFH was most strongly associated with perceived positive impact of the COVID-19 crisis on work life, particularly in those reporting WFH for the first time, supporting evidence from Ipsen and colleagues [ 26 ]. This positive impact of WFH may be explained by a reduction or absence of commute time, more job autonomy, more flexible workdays, and ultimately, extra time for leisure. In fact, increased leisure time was another important factor associated with perceived positive impact of the COVID-19 crisis on work life. More time for leisure may allow for better recovery from work and rebuilding of personal resources [ 37 , 38 ], which can then help an individual deal with work demands. In contrast, a change in contracted working hours and a decrease in work time were negatively associated with perceived positive impact on work life. A reduction in work time may not only cause financial problems, but also reduces important daily routines and social interactions at work, and may trigger fear of losing one’s job. Again, older employees may struggle more with the new situation and may be less successful in transforming it to their benefit, explaining why the oldest age groups, 54–60 and 61–65 years, were less likely to report an improvement in their work life.

Regarding the perceived impact on private life, participants living alone were more likely to report a deterioration and less likely to report an improvement of their private life compared to those living with a partner, family, or in a shared housing. The COVID-19 lockdown substantially restricted possibilities for social interactions beyond one’s own household, particularly affecting people living alone. For individuals who live alone, this may lead to feelings of loneliness [ 12 ], which in turn, threatens their MWB [ 39 ], highlighting the importance of having opportunities for direct exchange in such a crisis situation. This could also explain that an increase in caring duties, allowing for more exchange with family members, was associated with perceived positive shifts in private life. Further, an increase in WFH showed to be beneficial also to the private life, particularly to those experienced in WFH who did not need to first establish their workspace and new routines. Increase in leisure time and, more surprisingly, mandatory short-time work were also associated with positive impact on private life, as employees can engage more freely in activities they value. Interestingly, participants over 60 years old were less likely to report a deterioration of their private life. Older employees may be less dependent on the number of social contacts beyond their household, and they may have more mature emotion regulation strategies than the younger generations [ 40 ]. Indeed, mental well-being of the German elderly population (65+) remained largely unaltered during the early COVID-19 lockdown [ 41 ].

Finally, our third objective was to investigate how the perceived overall impact and self-reported changes induced by the crisis were associated with MWB and SRH. Low SRH has been associated with increased odds of depression [ 27 ], displaying the relevance of SRH for psychologically demanding situations, such as the COVID-19 pandemic. Our results suggest a strong negative association between the perceived negative impact on work and private life, MWB and SRH, indicating that this perception by itself is of relevance. It is of note that the perceived negative impact, particularly in private life, had such a strong association with SRH, which is more stable over time than MWB. In contrast, perceived positive impact on private life was associated with higher MWB. It seems that those who were able to cope with the COVID-19 crisis and translate the lockdown measures into some positive shifts in their private life, also benefited in terms of increased MWB.

Looking at the impact of the self-reported changes on MWB and SRH, mandatory short-time work with 0 contracted working hours was strongly associated with a lower MWB and SRH. Short-time work leads to significant losses of financial security and of daily structure and routines. Conversely, an increase in leisure time was positively associated with MWB, and the link was even stronger with SRH. More time for leisure gives extra opportunities for individuals to engage in meaningful activities that provide them with important resources that benefit their MWB and SRH. The overall strength of the associations indicates that MBW may be more affected by the perceived impact, as both are cognitive-emotional domains and are more dependent on the cognitive appraisal of one’s situation and emotional experience. SRH, on the other hand, may be more affected by actual changes in work and private life that increase or decrease opportunities to engage in activities that are perceived as beneficial to health.

Limitations and strengths

A major limitation is the cross-sectional design, which allowed only to infer associations between variables but did not provide evidence of the directions of the associations or potential causality. Furthermore, the online survey created timely data on the immediate impact of the COVID-19 crisis situation. However, the self-reported data may be influenced by common method biases [ 42 ], such as social desirability bias [ 43 ] or self-selection bias, posing potential threats to the validity of our findings. Thus, we hired a professional panel data service that guarantees collection of high quality data. Moreover, we implemented various strategies in the questionnaire such as using disqualifying items to prevent invalid answers. The sociodemographic characteristics of our sample indicate a good representation of the target population. Finally, we did not control for all variables that might have affected the results. For instance, coping with a crisis and MWB differ individually and may be influenced by variables such as personality traits, resilience, or coping style [ 44 , 45 , 46 , 47 ]. However, our study aimed to provide a broad picture of both the negative and positive impacts of the COVID-19 crisis on a large, diverse sample of the working population. Thus, it was beyond the scope of this study to investigate individual differences and characteristics. In addition, a more complete, lengthy survey would have likely reduced the participation rate.

A strength of the present study is the relatively large and heterogeneous sample size that allowed us to conduct a detailed analysis and explore different subgroups within the sample. Another strength is the time point of the data collection launched at the beginning of April 2020, close to the first peak of the COVID-19 outbreak in Germany and Switzerland and onset of the related lockdown measures. This enabled us to capture a valid picture of the immediate impact of the lockdown measures. Moreover, the survey assessed the present situation, adding to the validity compared to a retrospective survey design. Finally, the combination of a subjective evaluation of the impact of the crisis with relevant, standardized public health indicators of MWB and SRH increases the relevance of the results to public health research and for policymaking.

Conclusion and policy recommendations

The present study contributes to our understanding of the impact of the COVID-19 crisis on work and private life. It provides evidence on the covariates of a more negative/positive perceived impact and on the associations with MWB and SRH in the German and Swiss working populations. Employees whose employment contract was affected by the crisis seem to have felt the greatest negative impact on their work life. This highlights the crucial role of (un−/under-)employment in a crisis, as employment is associated with several health-promoting factors that cannot be substituted in any other way [ 48 ]. Moreover, the private life of employees living alone has been affected most negatively due to social isolation. Thus, psychological first aid also accessible online should be established particularly for these vulnerable groups [ 49 ]. Employers need to assure that they keep close social ties with and emotionally support employees with reduced contract or working hours. Moreover, rapid financial aids are needed to those who have lost their income partially or completely.

Nevertheless, we should also foster positive consequences of the crisis. In general, it seems that an increase in WFH was positive for work life. Learning from the beneficial effects of WFH in a crisis can inform future organizational and legislative policies to support this form of working. As employees experienced with WFH had a stronger positive impact on private life than first-timers, future WFH policies should include offering training and exchange of experience between employees on how to establish positive routines compatible with their private life. This will help employees to proactively identify their preferences and craft their work environment accordingly [ 50 ]. Further, an increase in leisure time was particularly positive for private life. More leisure time allows for dedicating extra time to activities one enjoys, and this may be beneficial also for recovery and detachment from work [ 51 ] and for mental health in general [ 52 ]. Thus, employees could also be trained in optimal crafting of their leisure time to strengthen these beneficial effects [ 53 , 54 ].

Finally, we saw that besides the reported actual changes in work and private life, also the perception of the overall positive or negative impact is related to the health outcomes. This suggests to offer positive psychology trainings to employees helping them to purposefully focus on and make use of potential positive consequences of the crisis [ 55 , 56 , 57 ]. From a longitudinal research perspective, it would be interesting to further examine how the actual and perceived impact of the ongoing crisis as well as the associated health outcomes change over time and whether some of the new routines developed during the pandemic will be maintained in the long term.

To conclude, our study adds to recent evidence [ 58 ] that the Covid-19 crisis and related lockdown measures do not have solely negative impact. Rather, it affects vulnerable groups of individuals who need targeted support, while the majority of the population remain healthy or even experience positive shifts in their daily life.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. The R code used for the statistical analysis is available in the GitHub repository: https://github.com/jesuismartin/covid

Education estimates are based on data from n  = 1194 participants who took part in a subsequent wave of data collection (December 2020), missing values ( n  = 924) were imputed using mice R package (for details see supplementary material). Education was not included in the regression models as the imputed data could potentially threaten the validity of our conclusions.

Short-time work is defined as “public programs that allow firms experiencing economic difficulties to temporarily reduce the hours worked while providing their employees with income support from the State for the hours not worked” (European Commission, 2020, Retrieved from: https://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1587138033761&uri=CELEX%3A52020PC0139 ).

None  = 0% WFH before COVID-19, 0% after; Experienced  = at least 10% WFH before and at least 10% after COVID-19; New  = 0% WFH before and at least 10% after COVID-19.

Participants were grouped into three categories according to their answers: disagree (1 + 2), neither/nor (3), agree (4 + 5).

Abbreviations

World Health Organization

Public Health Emergency of International Concern

Work from home

European Union

Confidence interval

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Acknowledgements

The authors would like to thank to Roald Pijpker from Wageningen University for his helpful comments during the final editing of the manuscript.

MT received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 801076, through the SSPH+ Global PhD Fellowship Programme in Public Health Sciences (GlobalP3HS) of the Swiss School of Public Health. RB, PK, and GB received funding from the University of Zurich Foundation. Beyond providing the funding, these funding bodies were not involved at any stage of the study.

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MT planned and carried out data collection and analysis, interpretation of the results, writing and reviewing the manuscript in collaboration with the co-authors. RB contributed to the research concept, data collection, data analysis, and review of the manuscript. PK was involved with the conceptualization of the research, interpretation of the results, writing, and review of the manuscript. GB contributed to the conceptualization of the research, interpretation of results, writing, and review of the manuscript. All authors read and approved the final manuscript before submission.

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Informed consent was obtained from all participants, the study included adult participants (18+ years) only. Participants voluntarily completed the questionnaires, guaranteeing their anonymity. For anonymous surveys on working/living conditions and self-reported mental well-being and health no ethical review was necessary under national, university, or departmental rules (Department of Data Protection at the University of Zurich, www.dsd.uzh.ch/en/ ). The study was conducted under strict observation of ethical and professional guidelines. The study was not registered prior to the start of the data collection as this is not common in the field of occupational health psychology where this study originated. The study is part of a larger longitudinal data collection on occupational health and individual strategies employee use to craft their work, started already before the Covid-19 pandemic. When the pandemic started, we decided to add the study aim to explore the immediate impact of the Covid-19 crisis on Swiss and German working population presented in this paper. The manuscript is an accurate and transparent account of the study, and no important aspects of the study or any analyses conducted have been omitted.

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Tušl, M., Brauchli, R., Kerksieck, P. et al. Impact of the COVID-19 crisis on work and private life, mental well-being and self-rated health in German and Swiss employees: a cross-sectional online survey. BMC Public Health 21 , 741 (2021). https://doi.org/10.1186/s12889-021-10788-8

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COVID-19: Where we’ve been, where we are, and where we’re going

One of the hardest things to deal with in this type of crisis is being able to go the distance. Moderna CEO Stéphane Bancel

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Living with covid-19, people & organizations, sustainable, inclusive growth, related collection.

The Next Normal: Emerging stronger from the coronavirus pandemic

Two Years In: How the Pandemic Changed Our Lives

From remote work to major life developments, the COVID-19 era left its mark on Duke staff and faculty

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Two years ago this week, the novel coronavirus fully took hold in the United States. While it had been in the country earlier, the second week of March 2020 was when cases spiked, and soon after, Duke University President Vincent E. Price announced in an “urgent message” that faculty and staff who could work from home should do so. 

Masking and social distancing policies became the norm while businesses, schools and offices went quiet.

As some  safety measures ease , COVID-19 has infected nearly 80 million Americans and left nearly 970,000 dead. As the pandemic raged with variants, education, research and health care continued across Duke University and Duke University Health System at a high level. 

And many of us are forever changed.

“I think we, as a people, are different,” said Duke Associate Professor of Medicine Jon Bae, a co-convener for the mental and emotional well-being portion of Healthy Duke. “In the last two years, people have learned different ways of working, different ways of living and different ways to take appreciation for things.”

Jon Boylan is one of those. 

The past two years have drawn Boylan closer to his wife, Katie, a steadying influence during uncertain times. But starting a family against the backdrop of a global pandemic has given him a deeper respect for how forces outside of our control can alter plans.

“I wasn’t one of those people who had time to learn how to bake bread or anything,” Boylan said. “But I think in terms of personal growth, a lot happened.”

We caught up with some Duke colleagues to hear how their lives are different two years into the pandemic.

Committing to Self-Care

“For me, I thought, ‘How do I have a rich, full life amid all of this and keep a positive attitude?’” Thomas said.

She decided that she needed a goal that she could work toward until the world opened up. Already with a long list of outdoors adventures under her belt, Thomas decided to plan a summer 2021 trip to Nepal to hike the summit of the 21,247-foot Mera Peak.

For the next several months, Thomas began running, working out at a socially distanced gym, and incorporating as many walks as possible into her day. While the trip to Nepal was the goal, the exercise to prepare for it became a central piece of her self-care routine.

“I just love being outside, it’s very restorative,” Thomas said. “And I like physical challenges, I get the rush of endorphins from that. So putting those two things together just helps me out mentally. Even just a short walk can help me focus.”

Eventually, travel complications required Thomas to postpone the trip to Nepal. Instead, she flew to Spain and, over three weeks in September and October of 2021, she hiked 335 miles on the Camino de Santiago pilgrim trail.

“It was basically like a walking meditation for three weeks,” said Thomas, who is now exercising with an eye toward a 2023 Nepal trip. “It’s really an incredible experience.”

Defining Your Purpose

But she said COVID-19 tested everyone’s resolve.

“You just don’t know how you’re going to react to something until you’re in it,” Casey said.

In March 2020, Casey was the clinical team lead for Duke Raleigh’s ICU, a managerial role with less hands-on patient care. But it wasn’t far into the pandemic before Casey’s desire to help patients led her to return to a clinical nurse role.

There, she saw the virus’ danger up close. At one point in the summer of 2020, 13 of the 15 beds in the ICU were occupied by COVID-19 patients on ventilators. With no visitors allowed for COVID-19 patients, Casey witnessed several wrenching goodbyes said over cellphone.

Her challenges didn’t end when she left work. With four children and a husband who’s a police officer in Durham, at home, Casey faced stress from home schooling and a spouse also on COVID-19’s front lines.

While many ICU nurses ask to be transferred to different units due to the emotional strain, Casey was inspired by seeing colleagues bravely push forward, giving comfort and dignity to patients facing dire situations. She also said that, as the pandemic wore on, the bond between ICU nurses grew stronger. 

As hard as these past two years have been, Casey, who still serves in the ICU and recently began working toward an Acute Care Nurse Practitioner certificate through the Duke University School of Nursing , said the pandemic experience has only deepened her connection to her work.

“We all faced this as a challenge, personally, emotionally and professionally, and hopefully learned to grow through it and be better if this ever happens again,” Casey said.

Taking Charge of Physical Health

After the pandemic required many Duke staff and faculty members to work remotely , sending Carbuccia from working in the bustling Smith Warehouse to his Mebane home, the IT Analyst with  Duke’s Office of Information Technology  found himself making healthier choices without even thinking. 

Instead of eating lunch out or grabbing meals from events in his on-campus workspace, Carbuccia found himself eating homemade breakfasts, lunches and dinners. Scrambled eggs with vegetables, or simply prepared salmon filets are some of current favorites.

And without a commute, he has time for walks around his neighborhood before and after work.

Carbuccia saw the result of these changes a few months into the pandemic when he stepped on the scale and saw that he’d lost 26 pounds.

“When I stepped on the scale, I said, ‘Holy Moses! I lost a lot of weight, and I wasn’t even planning to!’” Carbuccia said.

A Better Mental Space

And each day also involved a roughly 30-minute commute along I-85 to her home in Graham, where the heavy traffic made her feel especially anxious, leaving her tense when she arrived at work or home.

But the past two years saw her work go fully remote, and now a move to a hybrid arrangement featuring one day of on-site each week. She cherishes the time she can spend working from home, often with her two dogs – Marx, a Boston Terrier, and Duke, a rescue – lounging at her feet.

“Working at home, I feel like my mental health is in a better place,” said Herrera, a wife and mother of three.

Herrera isn’t alone in her appreciation of remote work.  According to a Pew Research Center  report  from February 2022, approximately six in 10 workers who can do their jobs from home are working remotely most or all of the time.  

Herrera said her hybrid schedule leaves her feeling mentally fresh when she begins her workday and better able to transition between work and personal life. 

“I’m happier,” Herrera said. “I’m more at ease.”

Learning on the Fly

“Even though some of us had experience working remotely, it was still new,” said Roberts, who’s worked at Duke for nearly a decade. “Regardless of how much experience you had, I don’t think we were mentally or technologically ready for that quick of a transition.”

Roberts recalls PRMO leaders moving quickly to get desktops, monitors, laptops, cameras and headsets in the hands of team members. She also recalls many of her colleagues working diligently to familiarize themselves with new tools and programs, such as the collaboration platform Jabber, that were different from what was used in the PRMO offices on South Alston Avenue in Durham. 

Roberts and her colleagues also had to learn how to collaborate with one another when communication came by email and chat messages instead of a quick face-to-face conversation.

Working each day from her home in Franklinton, Roberts continues to help Duke Health patients with billing concerns. She’s part of a large team that gelled amid the pandemic and kept the pace of customer support high.

With PRMO keeping colleagues connected with department meetings and team-building Zoom events, Roberts said these past two years have given her a new appreciation of the resilience of her colleagues.

“It made me proud because nobody skipped a beat,” Roberts said. “Everybody took accountability. While some of our thinking and the logic behind how we normally do things had to change, I’m proud that it was still a really seamless transition for us.”

Finding Flexibility

“This is something that would have never happened before the pandemic,” said Atkinson, a regulatory coordinator with the  Duke Department of Surgery .

Like many administrators in Duke’s research areas, Atkinson has been working fully remote since the pandemic began, trading in her fourth-floor workspace in Erwin Terrace for a spot at home. The change reshaped Atkinson’s day-to-day routine in a drastic way, ridding her of a commute that ate up two hours each day.

Now, with more time to spend with her son, West, born before the pandemic, and her 10-month-old daughter, Iris, Atkinson, who has worked for Duke for nearly seven years, has the flexibility that allows her to feel rooted. And with more balance, she hopes to let the roots of her family, as well as the cucumbers, tomatoes and peppers that will be in the ground soon, grow strong.

“I’ve attempted a very small garden each year, but we have a very shady lot,” Atkinson said. “But this year, we’re putting it in the front, where we get a lot of sun, and West is helping me, so it’s going to work.”

A World of Change

In late 2019, she met Neil Gallagher at a party and hit it off. The pair dated for the next few months and, when the pandemic forced everyone to limit contact with others, they decided to keep each other in their quarantine bubble.

“It was one of those easy connections where we were really comfortable with each other,” said Meyer, who shared the  story of her mental health journey  with Working@Duke just before the coronavirus outbreak.

Over the next several months, the pair grew closer and, by the end of 2020, they’d begun talking about getting engaged and starting a family. Those plans hit warp speed when they found out Meyer was pregnant in early 2021. Not long after, they were engaged and later married in a small ceremony in Raleigh in July of last year.

And over a few hectic days in early October, the pair closed on a house together in Raleigh and Meyer gave birth to a healthy baby girl named Maggie.

Now in a very different spot in life from where she was when the pandemic began, Meyer said she greets each day with a new feeling of purpose and strong sense of gratitude.

“I think my husband and I have been keenly aware of how odd it’s been and how many blessing we’ve had at a time when life has been really hard for a lot of people,” Meyer said.

How has the pandemic changed your life? Send us your story and photographs through  our story idea form  or write  [email protected] .

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Research Article

Impact of COVID-19 on psychological distress in subsequent stages of the pandemic: The role of received social support

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Writing – original draft

* E-mail: [email protected]

Affiliations Department of Psychology, Indiana University of Pennsylvania, Indiana, PA, United States of America, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland

Roles Conceptualization, Formal analysis, Methodology, Writing – original draft

Affiliation Academy of Health and Social Studies, NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands

• Krzysztof Kaniasty, 
• Erik van der Meulen

• Published: September 25, 2024
• https://doi.org/10.1371/journal.pone.0310734
• Reader Comments

This longitudinal study examined a sample of adult Poles (N = 1245), who were interviewed three times from July 2021 to August 2022, during the later stages of the COVID-19 pandemic. The study had two primary objectives. The first was to assess the impact of the pandemic on psychological distress, measured through symptoms of depression and anxiety. The pandemic’s effects were evaluated using three predictors: direct exposure to COVID-19, COVID-19 related stressors, and perceived threats from COVID-19. The second objective was to investigate the role of received social support in coping with the pandemic’s hardships. Receipt of social support was measured by both the quantity of help received and the perceived quality of that support. A Latent Growth Curve Model (LGCM) was employed to analyze psychological distress across three waves, controlling for sociodemographic variables, non-COVID life events, coping self-efficacy, and perceived social support. Findings indicated that COVID-19 stressors and COVID-19 threats were strongly and consistently associated with greater psychological distress throughout the study period. The impact of direct COVID-19 exposure was limited. The quantity of received support predicted higher distress, whereas higher quality of received support was linked to better mental health. Crucially, the relationship between the quantity of support and distress was moderated by the quality of support. Effective social support was associated with the lowest distress levels, regardless of the amount of help received. Conversely, receiving large amounts of low-quality support was detrimental to psychological health. In summary, the ongoing psychosocial challenges of COVID-19 significantly eroded mental health, highlighting the importance of support quality over quantity in coping with significant life adversities.

Citation: Kaniasty K, van der Meulen E (2024) Impact of COVID-19 on psychological distress in subsequent stages of the pandemic: The role of received social support. PLoS ONE 19(9): e0310734. https://doi.org/10.1371/journal.pone.0310734

Editor: Ali B. Mahmoud, St John’s University, UNITED STATES OF AMERICA

Received: December 18, 2023; Accepted: September 5, 2024; Published: September 25, 2024

Copyright: © 2024 Kaniasty, van der Meulen. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are publicly available from the OSF repository ( http://osf.io/xmzw8 ).

Funding: Funding preparation of this paper was supported by Grant OPUS-19 grant No. 2020/37/B/HS6/02957 awarded to Krzysztof Kaniasty from the Polish National Science Centre (Narodowe Centrum Nauki). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

It is reasonable to assert that the COVID-19 pandemic, like no other collective crisis in the world’s history, prompted an unprecedented number of research studies, reviews and meta-analyses attempting to assess its impact on mental health. Many quantitative and qualitative syntheses documented that the heaviest mental health toll on general public, most frequently assessed as symptoms of depression, anxiety, PTSD, or psychological distress, occurred in the early months of the pandemic [ 1 – 4 ]. Similar patterns of findings emerged within different subgroups, such as COVID-19 patients [ 5 ], children and adolescents [ 6 ], college students [ 7 ], elderly [ 8 ] or healthcare workers [ 9 ]. Evidence concerning whether in later months of the first year of the pandemic mental health problems decreased [ 1 , 4 ] or remained stable at moderately elevated levels [ 2 , 3 ] is not yet conclusive.

It is also reasonable to assert that the psychological impact of the SARS-CoV-2 virus would persist through subsequent phases of the pandemic. Few, thus far published, longitudinal investigations with mental health assessments conducted after July 2021 [ 10 – 15 ], evidenced overall improvements in psychological health in various populations since the onset of the pandemic. Nevertheless, mental health issues appear elevated as compared to pre-pandemic times [ 16 ].

The COVID-19 experience should be regarded as a disaster or catastrophe that set off a prolonged series of diverse and stressful hardships. The pandemic encompassed all possible classes of stressors [ 17 ]: traumas (e.g., death, injuries), life events (e.g., lockdowns, job interruptions/loss), daily hassles (e.g., social distancing, mask-wearing), macro-system events (e.g., economic downturns, societal protests/disputes), nonevents (e.g., postponements/cancellations of expected life milestones such as graduations and weddings), and chronic stressors (e.g., ongoing life hardships such as caregiving, environmental challenges). Each of these facets of the COVID-19 catastrophe independently impacted psychological and social well-being, capturing different aspects of the comprehensive spectrum of stress processes [ 17 , 18 ].

The present longitudinal study had two major goals. First, it aimed to assess the impact of the pandemic in its later phases (July 2021—August 2022) on psychological distress assessed as combined symptoms of depression and anxiety. The ongoing presence of the pandemic in people’s lives was measured using three predictor variables. COVID-19 direct exposure for individuals and their significant others was evaluated as probable encounters with the virus. This assessment encompassed a range of experiences from simple testing or mild infection to severe illness, including hospitalization or the death of a significant person. Several COVID-19 studies have documented the association between direct exposure to the SARS-CoV-2 virus and psychological health [ 19 , 20 ]. The second measure, COVID-19 stressors, included a series of significant secondary stressors such as occupational disruptions, financial insecurity, and delays or cancellations. These stressors have also been shown to adversely impact mental health [ 21 , 22 ]. Finally, COVID-19 threats, likely the most frequently assessed indicator of the pandemic’s adversities, evaluated people’s concerns and fears for their own health and the health of their families [ 21 , 23 ].

The second goal of the present study was to investigate the role of social support in the ongoing process of coping with COVID-19 adversities. Social support is a multifaceted construct that encompasses social interactions providing actual assistance and embedding individuals in a network of relationships perceived as loving, caring, and readily available in times of need [ 24 ]. The most central distinction between different forms of social support lies between perceived social support and received social support. Perceived social support refers to subjective appraisals of being reliably connected to others, such as believing that "If I needed it, I can easily find someone to talk to about my troubles, worries, or concerns." In contrast, received social support pertains to the actual support received, such as "How often did someone give, loan, or offer you money?"

Perceived social support, regarded as the principal facet of social support, has consistently been shown to be advantageous for better postcrisis outcomes [see 25 , 26 ]. Conversely, studies assessing received social support have produced inconsistent findings. Some investigations have documented a clear benefit of greater received support in reducing distress. However, many other studies have found no effects, or worse, have shown positive associations between received support and increased mental health problems [ 27 , 28 ]. Accordingly, the stress and coping literature consistently highlights the benefits of social support for psychological adjustment, with an emphasis on perceived social support rather than received support. This focus poses challenges for public health professionals and practitioners who provide aid, support, and psychological interventions to communities recovering from disasters. It also presents difficulties for countless individuals worldwide who have been striving to offer actual support to one another during the challenging times of the COVID-19 pandemic.

The reasons why the efficacy of received social support may be undermined during times of coping with stressors are extensive [ 27 , 29 , 30 ]. Providing and receiving help in times of crisis, whether through personal, charitable, or professional relationships, is a complex and challenging process. Good intentions and sincere concerns often mix with confusion, skepticism, and psychological threats. Simply put, while the desire to relieve the suffering of others is commendable, not all forms of social support prove to be helpful.

A number of recommendations can be found in the social support literature that offer ideas for identifying theoretical pathways, along with empirical and practical prerequisites for detecting the genuinely helpful influence of received social support [ 27 , 30 ]. Rini and Dunkel Schetter [ 31 ] proposed a comprehensive theoretical framework for investigating the efficacy of received social support, which they labeled the “ social support effectiveness model ” (SSE). The SSE model delineates the joint influence of the “ quantity ” and “ quality ” of received social support and the extent to which helping provisions meet recipients’ expectations, needs and demands from the stressors they face.

The quantity dimension of support receipt is determined by the match between the recipient’s needs and the amount of help received, ensuring the support is neither too little nor too much. The quality dimension involves more complex practical and psychological dynamics, including: a) “functional fit”—the type of help aligns with what is needed; b) “skillfulness and sensitivity”–support is delivered in ways that minimize the recipient’s feelings of being a burden; c) “ease of access”–help is not difficult to get; and d) “impact on self-concept”–the support received does not reflect poorly on one’s self-esteem, avoiding blame, feelings of incompetence, or a sense of indebtedness.

Rini and her colleagues [ 32 ] provided strong empirical evidence for the SSE model in a sample of hematopoietic stem cell transplant survivors. When examined together, the quantity of support received was predictive of more distress experienced by survivors, whereas favorable appraisals of the effectiveness of support received were associated with better mental health. Most critically, the two operationalizations of received social support statistically interacted with each other producing a disconcerting pattern revealing that when support was judged as being low in quality, receiving greater quantities of it predicted elevated distress. However, recipients of effective support reported the lowest levels of distress, regardless of the amount of help received. The importance of assessing both the amount and quality of postcrisis received social support for psychological functioning was also evidenced among survivors of disasters [ 33 – 35 ]. Altogether, these findings highlight the importance of enhancing the quality of help provided to people coping with life difficulties. Simply providing "more" support is not necessarily better and can potentially be detrimental if offered in substandard ways. This underscores the need for support that is provided in the right amount and type, delivered with skill and sensitivity, easily accessible, and without negative repercussions for the recipient’s self-image.

In addition to reliance on social support, theory and research on coping with stressful life events repeatedly emphasize the importance of self-efficacy as a critical factor influencing adaptation to significant life challenges, threats, and losses [ 36 , 37 ]. Confidence in one’s own coping abilities and social support resources dynamically influence each other. Received social support may enhance self-efficacy (i.e., enabling path), whereas self-efficacy may mobilize (i.e., cultivation path) social networks to action [ 38 ].

The present study examined the role of social support receipt, measured in terms of both quantity and quality, on psychological distress. The analyses accounted for the influence of sociodemographic factors, perceived social support, and beliefs in coping self-efficacy, which are two crucial resources that routinely promote successful coping with stressors. The uniqueness of the COVID-19 catastrophe for studying received social support stems from the fact that everyone has been subjected to its threats, disruptions, and losses. Nearly everyone has needed support at some point, and nearly everyone has provided support at some point.

Sample and procedure

Wave 1 sample was recruited between July 6 and 19, 2021, from an online survey panel (“Ariadna,” a Polish online research panel with over 150,000 registered and verified users) to be representative of Polish adults in terms of gender, age, and size of municipality. It originally consisted of 3074 respondents who met all quality control requirements established for the study based on answers to attention questions, and times of completion of surveys (i.e., participants with completion times faster than 1 SD from the sample mean were eliminated). Wave 2 data were collected in February 2022, and Wave 3 followed six months later in August 2022.

The sample analyzed in this study comprised 1,245 respondents who completed all three waves of data assessments and met subsequent (Wave 2 and 3) quality control requirements. A comparison of these participants with those who dropped out after earlier waves of assessments ( N = 1829, 59.4%) on Wave 1 variables revealed some significant differences. The drop-out participants were younger, less educated, and more likely to live in villages or smaller towns. They were also less likely to be in relationships and had higher scores on the psychological distress measure.

The study was approved by the Institutional Review Board of the Institute of Psychology, Polish Academy of Sciences (Approvals # Wave 1-13/V/2021, Wave 2-01/1/2022, Wave 3-17/VII/2022). All participants provided written consent prior to each wave of assessments.

Outcome variable—psychological distress.

Symptoms of psychological distress were assessed with 8 items from the Patient Health Questionnaire (PHQ-8) [ 39 ], and 7 items from the Generalized Anxiety Disorder scale (GAD-7) [ 40 ]. These self-reports have been frequently used to assess depressive (e.g., “Little interest or pleasure in doing things”) and anxiety symptoms (e.g., “Feeling nervous, anxious or on edge”). In order to keep our measures consistent across all surveys’ administrations with regards to time frames of responding and response opinions, both instruments asked respondents about how often they were bothered by these symptoms in the last 30 days (instead of the typical for these instruments time frames of “the past two weeks”), with the following five answer choices: 0 ( Never ), 1 ( Rarely ), 2 ( Sometimes ), 3 ( Often ), and 4 ( Very often ). These options were recoded to a four-point scale of the standard PHQ-8 and GAD-7’s response sets (range 0 to 3, with answers “rarely” and “sometimes” both coded as 1). Cronbach’s α reliability coefficients of the PHQ-8 and GAD-7 scores computed as sums were high at all assessment times (0.92–0.94).

The PHQ-8 and GAD-7 are often combined into a single measure of general distress [ 41 ], consequently the total score of psychological distress used in the present analyses was a sum of all 15 items. Confirmatory factor analyses using a Diagonally Weighted Least Square Estimator on the present data showed excellent fit for single factor solutions (see S1 Table ). Cronbach’s alphas of the psychological distress total scores at each measurement wave were all high (> 0.95).

Measurement of focal predictors.

COVID-19 direct exposure index was based on a sum of answers to 11 questions that asked about exposure to SARS-CoV-2 in the past 16 (Wave 1) or 6 months (Waves 2 and 3). Questions referred to the participant (e.g., being tested for the virus, if positive how severe was the illness, hospitalization) and to the family and friends (including deaths). Different answer options were used depending on the content of the question, but all responses were recoded as 0 ( No or minimal exposure ) or 1 ( Moderate to severe exposure ).

COVID-19 stressors was derived from the average of items that evaluated the extent to which pandemic-specific events (i.e., decline in household budget, irreversible cancellation of important personal events, postponement of important events, new/additional burdens with care for children, new/additional burdens with care of elderly) negatively influenced respondents’ lives in the past 16 months (Wave 1, 10 items) or 6 months (Waves 2 and 3, 6 items; 0 = Did not happen or not at all , 4 = To a great extent ). One additional item was included that asked whether a participant and/or someone in their household experienced COVID-19 related job loss that had negative consequences.

COVID-19 threats involved 12 questions asking the participants about their fears and concerns regarding current threats associated with the continuing pandemic (e.g., “I am concerned that someone close to me will get sick with COVID-19, even if it would be a subsequent infection,” “I am worried about difficulties with access to medical personnel with issues not related to COVID-19”). Items were answered using a 7-point Likert-type response option format anchored with 1 ( Definitely disagree ) and 7 ( Definitely agree ). Reliability coefficients of the scores were high at each assessment (>.92).

Quantity of received social support was measured by the Inventory of Postdisaster Social Support [ 42 ]. Respondents were asked to estimate how often they received different types of help within the timeframe of the past 16 (Wave 1) and 6 months (Waves 2 and 3). For example, a question at Wave 1 asked: “How often, in the last 16 months (i.e., since the beginning of the pandemic), did family members give, loan or offer you money? Regardless of the reason, did this happen…? (1 = never , 2 = rarely , 3 = sometimes 4 = quite often , 5 = very often ). Another example question, from Wave 3 (August 2022), read: How often, in the past 6 months (i.e., from the beginning of February until today), did friends help you understand the situation you were in?

Three types of received support were assessed: emotional (4 items), informational (4 items), and tangible (8 items) support [ 43 ]. Each of these 16 items was asked two times to gage amounts of support received from two sources: family/relatives and friends/close acquittances. Thus, the total scale score was an average of 32 items. Reliability coefficients of the scores were high at each assessment wave (>. 96).

Quality of received social support was assessed with 12 items modeled on the instrument developed by Rini and Dunkel Schetter [ 31 , 32 ] based on their SSE model. The same six questions, with varying Likert-type five answer options (all coded 1 thru 5), asked respondents for their appraisals of the support received from family/relatives and friends/close acquittances. Respondents judged the help they received along the following dimensions: quantity (“When family members tried to help you, how well did the amount of help you received match the amount of help you wanted?”), functional fit with needs (“How often have you found yourself wishing the help you received had been different—for instance, a different type of help, or offered in a different way or at a different time?), skillfulness of support delivery (“How often did your friends who gave you help provide it skillfully?), ease of getting help (“When you needed help from family members, how often was it difficult to obtain?”; “How often did friends offer you support without you having to ask for it?”), and the overall appraisal of effectiveness of received help (“Broadly speaking, how effective or useful was the help you received from your family?”). Cronbach’s alphas of average scores computed on 12 items were high at each assessment wave (> .85).

Measurement of additional predictors.

Normative life events index was a sum of answers (0 = No , 1 = Yes ) to questions asking whether, in the past 16 (Wave 1) and past 6 months (Waves 2 and 3), respondents experienced any of 19 major life events (e.g., change in marital status, birth of a child/grandchild, other than COVID-19 illness of self or family, not COVID-19 bereavements). The count of non-COVID events was recoded to range from 0 to 9.

Coping self-efficacy was measured with six items modeled on the Trauma Self-Efficacy scale [ 44 ]. At Wave 1 and 2 the items referred to participants’ perceived capability to cope with challenges and uncertainties of the COVID-19 pandemic (e.g., “Today, how capable are you to successfully deal with your emotions [ anxiety , sadness , disaffection , anger ] related to the pandemic?”; 1 = Not capable , 7 = Very capable ). At Wave 3, the same items were asked about participants’ appraisals of their capability to cope with serious negative life events that might happen to them in the future (e.g., “In the future, when faced with a difficult life circumstance, how capable will you be to successfully deal with emotions [ anxiety , sadness , disaffection , anger ] that you might experience at that time?”). Confirmatory factor analyses with scale items showed acceptable fit for single factor solutions [ 45 ]. Internal reliability coefficients of average scores of this scale were high at each wave (> .93).

Perceived social support was assessed with 12 items from the Interpersonal Support Evaluation List [ 46 ] and 3 items from the Social Provision Scale [ 47 ] that asked about an overall perceived availability of emotional (5 items), informational (4 items) and tangible (6 items) social support (e.g., “If I were sick and needed someone to take me to the doctor, I would have no trouble finding that person;” “I have close relationships that provide me with a sense of emotional security and well-being;”1 = definitely false ; 4 = definitely true ). Cronbach’s alphas of average scores of this 15-item instrument were high at each wave (> .92).

Sense of danger due to the war was also assessed because during the course of this longitudinal research Russia attacked Ukraine (February 24, 2022), a country bordering with Poland. To account for this additional life stressor, participants were asked at Wave 3 (August 2022) to what extent, in the past 30 days, they were afraid, worried, and/or concerned about their own, their family, and the entire country’s safety and welfare due to the ongoing armed conflict (e.g., “To what extent have you felt that life of your family members and relatives were in danger because of the war in Ukraine?”; 1 = Not at all , 5 = To a very great extent; α = .85) [ 48 ].

Sociodemographic variables.

Five sociodemographic factors were also included in all analyses. Participants’ gender and their marital status were scored as dichotomous variables. Age was scored in years, respondents’ educational attainment was classified into four levels and size of municipality was grouped into five categories.

Statistical analysis

The lavaan package (version 0.6–9) [ 49 ] for R was used to conduct latent growth curve modelling (LGCM) with psychological distress at three waves as an outcome. The latent growth was modelled to be a linear process. Distress was normally distributed (skewness < 0.630 and kurtosis < 0.720 at all three measurement waves) making it feasible to use maximum likelihood estimation for our models.

Three models with increasing complexity were fitted. First, a model with only the psychological distress latent intercept and slope without any predictors was tested. In the next model, the time-invariant predictors of age, gender, educational level, marital status and municipality size were added as predictors of the psychological distress latent intercept and slopes.

The final model of interest in was a model with a latent intercept and slope (using psychological distress measured at three waves), and included time-invariant predictors of the latent intercept and slope (gender, age, educational level, marital status, and municipality size), and time-varying predictors that were measured at all three waves predicting trajectory deviations either only concurrently (COVID-19 exposure, COVID-19 stressors, COVID-19 threat, Non-COVID events), and both concurrently and prospectively (coping self-efficacy, perceived social support, received support-quantity, and received support-quality). Fig 1 gives a full overview of the study model.

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https://doi.org/10.1371/journal.pone.0310734.g001

A stepwise approach was used to successively fitting models leading up to more complex models, running from a growth curve model only to the addition of both time-invariant and time-varying predictors. First, we fitted a model with only the growth curve, which included a latent intercept and slope. Next, we enhanced the model by adding the time-invariant predictor. Finally, we further refined the model by incorporating the time-varying predictors. All variables were mean-centered before being entered into the conditional models. The following model fit statistics were used: χ 2 (and its significance), RMSEA (and its confidence interval), CFI, NFI and SRMR. Using Hu and Bentler’s [ 50 ] criteria, a CFI and NFI close to .95, an SRMR close to .06 and an RMSEA close to 0.08 were indications of adequate fit.

Post-hoc analyses on the interaction effects were conducted by categorizing the quality of received support into three levels (< - 1 SD , -1 SD to + 1 SD , > + 1 SD ). Subsequently, a simple regression of predicted distress scores (retrieved from the most complex LGCM) on the quantity of received support for each category were conducted.

Table 1 provides an overview of descriptive statistics and S2 Table provides correlations for all variables ( N = 1047; participants who reported receiving no support at any of three measurement times were excluded).

https://doi.org/10.1371/journal.pone.0310734.t001

In total three models were tested (unconditional model, conditional model with only time-invariant predictors and conditional model with time-invariant and time-varying covariates). Before we modelled our intended model, we assessed: 1) potential multicollinearity among predictors and 2) potential overfit of the model (given the number of predictors). Multicollinearity was assessed by examining correlations among the predictor variables. Of the 528 correlations possible among all predictors, 24 were larger than 0.5 or smaller than -0.5 (4.5%).

These stronger correlations existed among the same variables measured at different times and between COVID-19 coping self-efficacy and psychological distress. To determine whether these correlations raised multicollinearity issues in the LGCM, three multiple regression models were run with the predicted distress scores at each wave as dependent variables and the LGCM-corresponding time-varying covariates as independent variables. Independent variable’s variance inflation factors (VIFs) of these models never exceeded values of 2.871 which was well under the threshold of 5 and, thus, signaling no obvious multicollinearity problems.

Overfit of the model was assessed by changes in the Akaike’s Information Criterion (AIC) of the predictors in relation to a model without predictors—a decrease of the AIC was indicative of an enhanced model fit when the particular predictor was added to the model. We examined both the bivariate decreases in AIC for each predictor (i.e. differences in AIC between every predictor separately to a model without any predictors) and hierarchical decreases in AIC (i.e. successively adding predictors and determining the decrease in AIC after each addition). Some variables appeared to add little to the model and caused a slight increase in the AIC. However, these decreases were relatively small and their negative impact on model fit, thereby, was rather minor. For reasons of completeness, these variables were kept in the model, nonetheless. S3 Table gives a full overview of overfit assessment. An additional consideration for overfit is the adequacy of the sample size in relation to model complexity. This can be captured by the ratio of estimated parameters to the number of respondents [ 51 , 52 ]; a minimum is 1 to 5 (i.e. 5 respondents for every estimated parameter), for the current study this was 1 to 18.70 highlighting an exceedingly sufficient sample size. Therefore, our modelling approaches were deemed valid.

Latent growth

All models, one unconditional and two conditional models, yielded significant latent intercepts and non-significant latent slopes. The first rows of Table 2 indicate the latent growth factors (intercept and slope) for each model. The non-significant slopes in all three models reflect a general absence of change over time. Only in the unconditional model, the latent intercept and slope were associated; individuals with higher initial starting values showed a higher decline over time ( cov = .177). In both conditional models, the latent intercept and slope were unrelated ( cov = .113 and .001, respectively).

https://doi.org/10.1371/journal.pone.0310734.t002

Time-invariant predictors.

In the model with only time-invariant predictors (Model 2; see Table 2 ), the latent intercept was associated with gender and age; women and younger respondents were more distressed initially. None of the time-invariant predictors were predictive of the latent slope.

Time-varying predictors: COVID-19 variables, non-COVID life events, and sense of danger due to the war.

The last column of Table 2 (Model 3) conveys the outcomes of time-varying predictors. The COVID-19 experiences variables (COVID-19 exposure, stressors and threats) and the experience of non-COVID events were assessed as concurrent predictors (i.e. i th wave to i th wave) of distress at each wave. Of these variables, the COVID-19 stressors and COVID-19 threats, and non-COVID events were significantly associated with distress at each wave. Higher levels of stressors, threats and other life events were associated with more symptoms of distress. COVID-19 exposure was only significantly positively associated with distress at Wave 2; i.e., more virus exposure was predictive of with more distress. Sense of danger due to the Russian-Ukrainian war significantly predicted higher levels of symptom at Wave 3.

Time-varying predictors: Coping self-efficacy, perceived social support, quantity and quality of received social support.

Coping self-efficacy ratings were strongly both concurrently and prospectively (i.e. i th wave to i+1 th wave) associated with lower distress scores at all waves. Perceived social support was concurrently associated with lower levels of distress symptoms, but never prospectively.

Quantity and quality of received support were concurrently associated with distress at all three measurement moments. Prospectively, both Wave 1 quantity and quality of received support were predictive of later distress only at Wave 2. Received support quantity was positively associated with psychological distress, such that greater amounts of support were associated with more distress. However, appraisals of the quality of received support were negatively associated with distress, such that greater quality of received support was associated with lower levels of distress symptoms.

The interaction between Wave 1 quantity of received support by Wave 1 quality of received support was statistically significant predicting Wave 1 distress. Fig 2 presents the plots of this interaction associated with observed (left panel) and predicted distress scores (right panel). Persons who judged support received as low in quality reported the highest levels of distress, and greater amounts of received help were strongly associated with higher levels of distress (post-hoc slope analyses, B = 1.810, p = .030). The slope for the average quality of received support group was also statistically significant ( B = 0.737, p = .020) but the adverse effect of the amount of received support was less pronounced. Most importantly, however, persons who received most efficacious support reported lowest levels of symptoms compared to the other two groups, and the amount of help they actually received did not influence of their experience of distress (B = 0.607, p = .207). No other quantity by quality interactions were statistically significant.

Interaction Effect of Received Support Quantity with Quality on Observed (left pane) and Predicted Distress Scores (right pane). Predicted scores were retrieved from the Latent Growth Curve Model including all time-invariant and time-varying predictors.

https://doi.org/10.1371/journal.pone.0310734.g002

Fundamentally, the experience of COVID-19 could be considered a total catastrophic event because the pandemic spurred all possible classes of stressors [ 17 ]. It has been a traumatic and/or major life changing event, it created daily hassles, it caused macro-system turbulences, generated a surplus of disappointing nonevents, and many of its repercussions have evolved into identifiable chronic stressors. All these facets of the COVID-19 pandemic represent separate parts of the overall universe of stress processes, each potentially adversely influencing mental health.

The present study examined psychological distress trajectories a sample of adult Poles who were interviewed three times from July 2021 to August 2022, thus during later stages of the pandemic. A Latent Growth Curve Model (LGCM) revealed that respondents differed in their level of psychological distress, although changes in these trajectories were generally absent. In other words, individual growth trajectories only differed in the level of distress, but all trajectories were horizontal. Relative stability of the pandemic-related symptomatology was also documented in the meta-analysis of prevalences of depression reported by studies conducted during the first year of the pandemic [ 2 ]. Similarly to prior COVID-19 studies, the levels of mental health were dependent on gender and age with women and younger respondents exhibiting more symptoms [ 2 , 3 , 6 , 7 , 9 ].

COVID-19 stressors and COVID-19 threats were both strongly and consistently associated with greater distress throughout the study. The influence of COVID-19 direct exposure was limited to one assessment period. Notwithstanding the overall traumatic and grave consequences of the SARS-CoV-2 virus, it can be said that the pandemic’s psychosocial challenges and disturbances have most forcefully eroded mental health [ 21 , 22 ]. Continuing effect of COVID-19 pandemic on distress in the present sample was observed controlling for harmful influences of other normative life events and sense of danger associated with Russia’s invasion of Ukraine [ 48 , 53 ].

There are many psychological and social resources that empower humans to show resilience and recover successfully from adversity. Chief among them are survivors’ sense of trust in their own ability to face demands/losses posed by the stressor [see 36 , 37 , 54 ] and perceptions of being supported [see 55 , 56 ]. In accord with other investigations of the pandemic, results of the present study showed that higher levels of coping self-efficacy [ 57 – 59 ] and perceived social support [ 60 – 63 ] were consistently associated with lower levels of distress symptomatology.

The main interest of this research was focused on mental health influence of the amount of received social support and appraisals of its quality. The few available COVID-19 studies that investigated the quantity of actual receipt of help have produced mixed findings, yielding very limited beneficial effects [ 64 , 65 ], or no effects at all [ 59 , 66 ]. Contradictory evidence was also reported suggesting that the amount of received support was associated with lower distress [ 67 , 68 ], or with greater distress [ 69 ]. On the one hand, the results of the present analyses showing adverse psychological effects of receiving greater levels of support could just add to this confusion. However, more favorable appraisals of effectiveness of received support showed a protective function and, with equal consistency, were associated with lower levels of psychological distress. The pattern of the received support quantity by its quality interaction offers a reasonable and theory-based (SSE model) [ 31 ] interpretation of this apparent inconsistency. Persons who received effective social support exhibited the lowest levels of distress symptoms, irrespective of the amount of help. On the other hand, receiving large amounts of ineffective social support appeared to be detrimental to mental health. These results replicated an interaction pattern reported by Rini et al.’s [ 32 ] and should warn potential social support providers that if they cannot help smart , they should not attempt to help that hard . In other words, as long as it is delivered in an efficacious manner, received social support protects mental health in the context of stressful circumstances [ 33 – 35 ].

Strengths and limitations

The use of LGCM allowed to model psychological distress trajectories and predicting distress trajectory deviations from factors that were both stable and changed over time. In other words, the model depicted individuals’ typical distress trajectories and identified why and when individual’s had a-typical distress levels influenced by a comprehensive set of (possible) experiences along the trajectory, most notably: COVID-19 experiences and received support. Conservative analyses included, as control factors, relevant sociodemographic variables, potentially stressful life events not related to the pandemic, and participants’ concerns about the ongoing war in neighboring Ukraine. The study’s sample was large and randomly selected from a nationally representative internet panel. However, across the study’s three assessments, close to 60% of the initial sample was not retained due to attrition and strict data quality control procedures. In addition, all typical disadvantages associated with longitudinal online surveys apply. Finally, although the quantity by quality of received support interaction was consistent with theoretical underpinnings of the study it reached statistical reliability only one time. Thus, this interactive effect should be viewed with prudence as it requires additional examinations.

Although the rates of severe illness and deaths due to infections with variants of the coronavirus SARS-CoV-2 have gradually decreased and vaccination campaigns continue to reach more and more people, it is not unreasonable to assert that adverse mental health impact of the COVID-19 pandemic will persist. Results of the present study suggest that the ongoing presence of COVID-19 concerns, disturbances and losses have become chronic stressors. Citizens of the world may have to “domesticate” these challenges along with mastering personal and collective strategies to prevent and mitigate harmful psychological consequences of the pandemic. Clearly, beliefs in coping self-efficacy and sense of being reliably connected to others serve as robust contributors to successful coping and adaptation. The conditions under which actually receiving social support are less straightforward, particularly in the context of community-wide emergencies that routinely call for considerable amounts of help and assistance. What appears decisive when aiding people in times of coping with a variety of stressors is the quality, not necessarily quantity, of support provided. In our private as well as professional roles as helpers, it is worth remembering that the benefits of support provided to others may be achieved more readily if we attempt to help smarter rather than harder .

Supporting information

S1 table. confirmatory analysis of single factor distress scale composed of gad-7 and phq-8..

https://doi.org/10.1371/journal.pone.0310734.s001

S2 Table. Correlations among study variables (n = 1047).

https://doi.org/10.1371/journal.pone.0310734.s002

S3 Table. Assessment of model overfit and incremental value of predictors.

https://doi.org/10.1371/journal.pone.0310734.s003

Acknowledgments

The authors would like to thank the members of our research team: Maria Baran, Marta Boczkowska, Katarzyna Hamer, and Beata Urbańska.

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Psychological impact of COVID-19

Know the signs of anxiety, panic attacks, depression, and suicide.

• Disasters and Response

The coronavirus pandemic is an epidemiological and psychological crisis. The enormity of living in isolation, changes in our daily lives, job loss, financial hardship, and grief over the death of loved ones has the potential to affect the mental health and well-being of many.

Even in this time of physical distancing, it’s critical to seek social support and connection with others. It’s also important to know the signs of anxiety, panic attacks, depression, and suicide so you can easily identify them, not just among your family, friends, and neighbors, but for yourself.

Signs of anxiety

• Persistent worry or feeling overwhelmed by emotions.
• Excessive worry about a number of concerns, such as health problems or finances, and a general sense that something bad is going to happen.
• Restlessness and irritability.
• Difficulty concentrating, sleep problems and generally feeling on edge.

Signs of a panic attack

• Sweating, trembling, shortness of breath or a feeling of choking.
• A pounding heart or rapid heart rate, and feelings of dread.
• Such attacks often happen suddenly, without warning.
• People who experience panic attacks often become fearful about when the next episode will occur, which can cause them to change or restrict their normal activities.

Signs of depression

• A lack of interest and pleasure in daily activities.
• Significant weight loss or gain.
• Insomnia or excessive sleeping.
• Lack of energy or an inability to concentrate.
• Feelings of worthlessness or excessive guilt.
• Recurrent thoughts of death or suicide.

Risk factors for suicide

• Talking about dying or harming oneself.
• Recent loss through death, divorce, separation, even loss of interest in friends, hobbies and activities previously enjoyed.
• Changes in personality like sadness, withdrawal, irritability or anxiety.
• Changes in behavior, sleep patterns and eating habits.
• Erratic behavior, harming self or others.
• Low self-esteem including feelings of worthlessness, guilt or self-hatred.
• No hope for the future, believing things will never get better or nothing will change.

Help is available

If you or someone you care about is exhibiting these signs, help is available. Use the links on this page to access prevention and crisis resources.

• 988 Suicide and Crisis Lifeline 988
• Crisis hotlines and resources
• APA COVID-19 information and resources

Related Resources

• Panic Disorder: Answers to your most important questions 

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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.

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CDC Supports Kenya's COVID-19 Surveillance

What to know.

When the COVID-19 pandemic began, Kenya was able to adapt foundational surveillance and laboratory platforms. CDC leveraged technical skills and trusted partnerships to build sustainable public health capacity at the national and county levels. The U.S. government donated 10 million vaccines to Kenya through the COVID-19 Vaccines Global Access (COVAX) initiative. The collaboration between CDC and the Kenyan government is instrumental to scaling up capacity to respond to serious public health threats.

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