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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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ABOUT PEW RESEARCH CENTER  Pew Research Center is a nonpartisan, nonadvocacy fact tank that informs the public about the issues, attitudes and trends shaping the world. It does not take policy positions. The Center conducts public opinion polling, demographic research, computational social science research and other data-driven research. Pew Research Center is a subsidiary of The Pew Charitable Trusts , its primary funder.

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Read these 12 moving essays about life during coronavirus

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

by Alissa Wilkinson

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

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

• The Vox guide to navigating the coronavirus crisis

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

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

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

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

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

• A syllabus for the end of the world

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

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

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

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

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

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

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

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

• What day is it today?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Writing about COVID-19 in a college admission essay

by: Venkates Swaminathan | Updated: September 14, 2020

Print article

For students applying to college using the CommonApp, there are several different places where students and counselors can address the pandemic’s impact. The different sections have differing goals. You must understand how to use each section for its appropriate use.

The CommonApp COVID-19 question

First, the CommonApp this year has an additional question specifically about COVID-19 :

Community disruptions such as COVID-19 and natural disasters can have deep and long-lasting impacts. If you need it, this space is yours to describe those impacts. Colleges care about the effects on your health and well-being, safety, family circumstances, future plans, and education, including access to reliable technology and quiet study spaces. Please use this space to describe how these events have impacted you.

This question seeks to understand the adversity that students may have had to face due to the pandemic, the move to online education, or the shelter-in-place rules. You don’t have to answer this question if the impact on you wasn’t particularly severe. Some examples of things students should discuss include:

• The student or a family member had COVID-19 or suffered other illnesses due to confinement during the pandemic.
• The candidate had to deal with personal or family issues, such as abusive living situations or other safety concerns
• The student suffered from a lack of internet access and other online learning challenges.
• Students who dealt with problems registering for or taking standardized tests and AP exams.

Jeff Schiffman of the Tulane University admissions office has a blog about this section. He recommends students ask themselves several questions as they go about answering this section:

• Are my experiences different from others’?
• Are there noticeable changes on my transcript?
• Am I aware of my privilege?
• Am I specific? Am I explaining rather than complaining?
• Is this information being included elsewhere on my application?

If you do answer this section, be brief and to-the-point.

Counselor recommendations and school profiles

Second, counselors will, in their counselor forms and school profiles on the CommonApp, address how the school handled the pandemic and how it might have affected students, specifically as it relates to:

• Grading scales and policies
• Graduation requirements
• Instructional methods
• Schedules and course offerings
• Testing requirements
• Your academic calendar
• Other extenuating circumstances

Students don’t have to mention these matters in their application unless something unusual happened.

Writing about COVID-19 in your main essay

Write about your experiences during the pandemic in your main college essay if your experience is personal, relevant, and the most important thing to discuss in your college admission essay. That you had to stay home and study online isn’t sufficient, as millions of other students faced the same situation. But sometimes, it can be appropriate and helpful to write about something related to the pandemic in your essay. For example:

• One student developed a website for a local comic book store. The store might not have survived without the ability for people to order comic books online. The student had a long-standing relationship with the store, and it was an institution that created a community for students who otherwise felt left out.
• One student started a YouTube channel to help other students with academic subjects he was very familiar with and began tutoring others.
• Some students used their extra time that was the result of the stay-at-home orders to take online courses pursuing topics they are genuinely interested in or developing new interests, like a foreign language or music.

Experiences like this can be good topics for the CommonApp essay as long as they reflect something genuinely important about the student. For many students whose lives have been shaped by this pandemic, it can be a critical part of their college application.

Want more? Read 6 ways to improve a college essay , What the &%$! should I write about in my college essay , and Just how important is a college admissions essay? .

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• Research article
• Open access
• Published: 04 June 2021

Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews

• Israel Júnior Borges do Nascimento 1 , 2 ,
• Dónal P. O’Mathúna 3 , 4 ,
• Thilo Caspar von Groote 5 ,
• Hebatullah Mohamed Abdulazeem 6 ,
• Ishanka Weerasekara 7 , 8 ,
• Ana Marusic 9 ,
• Livia Puljak   ORCID: orcid.org/0000-0002-8467-6061 10 ,
• Vinicius Tassoni Civile 11 ,
• Irena Zakarija-Grkovic 9 ,
• Tina Poklepovic Pericic 9 ,
• Alvaro Nagib Atallah 11 ,
• Santino Filoso 12 ,
• Nicola Luigi Bragazzi 13 &
• Milena Soriano Marcolino 1

On behalf of the International Network of Coronavirus Disease 2019 (InterNetCOVID-19)

BMC Infectious Diseases volume  21 , Article number:  525 ( 2021 ) Cite this article

18k Accesses

35 Citations

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Metrics details

Navigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging, and ongoing critical appraisal of this output is essential. We aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic.

Nine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO’s Global Research, LILACS, and Epistemonikos) were searched from December 1, 2019, to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory, and radiological findings), and quality assessment (AMSTAR 2). A meta-analysis was performed of the prevalence of clinical outcomes.

Eighteen systematic reviews were included; one was empty (did not identify any relevant study). Using AMSTAR 2, confidence in the results of all 18 reviews was rated as “critically low”. Identified symptoms of COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%) and gastrointestinal complaints (5–9%). Severe symptoms were more common in men. Elevated C-reactive protein and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. A frequent finding on chest imaging was uni- or bilateral multilobar ground-glass opacity. A single review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3 to 13.9%.

Conclusions

In this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic were of questionable usefulness. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards.

Peer Review reports

The spread of the “Severe Acute Respiratory Coronavirus 2” (SARS-CoV-2), the causal agent of COVID-19, was characterized as a pandemic by the World Health Organization (WHO) in March 2020 and has triggered an international public health emergency [ 1 ]. The numbers of confirmed cases and deaths due to COVID-19 are rapidly escalating, counting in millions [ 2 ], causing massive economic strain, and escalating healthcare and public health expenses [ 3 , 4 ].

The research community has responded by publishing an impressive number of scientific reports related to COVID-19. The world was alerted to the new disease at the beginning of 2020 [ 1 ], and by mid-March 2020, more than 2000 articles had been published on COVID-19 in scholarly journals, with 25% of them containing original data [ 5 ]. The living map of COVID-19 evidence, curated by the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), contained more than 40,000 records by February 2021 [ 6 ]. More than 100,000 records on PubMed were labeled as “SARS-CoV-2 literature, sequence, and clinical content” by February 2021 [ 7 ].

Due to publication speed, the research community has voiced concerns regarding the quality and reproducibility of evidence produced during the COVID-19 pandemic, warning of the potential damaging approach of “publish first, retract later” [ 8 ]. It appears that these concerns are not unfounded, as it has been reported that COVID-19 articles were overrepresented in the pool of retracted articles in 2020 [ 9 ]. These concerns about inadequate evidence are of major importance because they can lead to poor clinical practice and inappropriate policies [ 10 ].

Systematic reviews are a cornerstone of today’s evidence-informed decision-making. By synthesizing all relevant evidence regarding a particular topic, systematic reviews reflect the current scientific knowledge. Systematic reviews are considered to be at the highest level in the hierarchy of evidence and should be used to make informed decisions. However, with high numbers of systematic reviews of different scope and methodological quality being published, overviews of multiple systematic reviews that assess their methodological quality are essential [ 11 , 12 , 13 ]. An overview of systematic reviews helps identify and organize the literature and highlights areas of priority in decision-making.

In this overview of systematic reviews, we aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic.

Methodology

Research question.

This overview’s primary objective was to summarize and critically appraise systematic reviews that assessed any type of primary clinical data from patients infected with SARS-CoV-2. Our research question was purposefully broad because we wanted to analyze as many systematic reviews as possible that were available early following the COVID-19 outbreak.

Study design

We conducted an overview of systematic reviews. The idea for this overview originated in a protocol for a systematic review submitted to PROSPERO (CRD42020170623), which indicated a plan to conduct an overview.

Overviews of systematic reviews use explicit and systematic methods for searching and identifying multiple systematic reviews addressing related research questions in the same field to extract and analyze evidence across important outcomes. Overviews of systematic reviews are in principle similar to systematic reviews of interventions, but the unit of analysis is a systematic review [ 14 , 15 , 16 ].

We used the overview methodology instead of other evidence synthesis methods to allow us to collate and appraise multiple systematic reviews on this topic, and to extract and analyze their results across relevant topics [ 17 ]. The overview and meta-analysis of systematic reviews allowed us to investigate the methodological quality of included studies, summarize results, and identify specific areas of available or limited evidence, thereby strengthening the current understanding of this novel disease and guiding future research [ 13 ].

A reporting guideline for overviews of reviews is currently under development, i.e., Preferred Reporting Items for Overviews of Reviews (PRIOR) [ 18 ]. As the PRIOR checklist is still not published, this study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 statement [ 19 ]. The methodology used in this review was adapted from the Cochrane Handbook for Systematic Reviews of Interventions and also followed established methodological considerations for analyzing existing systematic reviews [ 14 ].

Approval of a research ethics committee was not necessary as the study analyzed only publicly available articles.

Eligibility criteria

Systematic reviews were included if they analyzed primary data from patients infected with SARS-CoV-2 as confirmed by RT-PCR or another pre-specified diagnostic technique. Eligible reviews covered all topics related to COVID-19 including, but not limited to, those that reported clinical symptoms, diagnostic methods, therapeutic interventions, laboratory findings, or radiological results. Both full manuscripts and abbreviated versions, such as letters, were eligible.

No restrictions were imposed on the design of the primary studies included within the systematic reviews, the last search date, whether the review included meta-analyses or language. Reviews related to SARS-CoV-2 and other coronaviruses were eligible, but from those reviews, we analyzed only data related to SARS-CoV-2.

No consensus definition exists for a systematic review [ 20 ], and debates continue about the defining characteristics of a systematic review [ 21 ]. Cochrane’s guidance for overviews of reviews recommends setting pre-established criteria for making decisions around inclusion [ 14 ]. That is supported by a recent scoping review about guidance for overviews of systematic reviews [ 22 ].

Thus, for this study, we defined a systematic review as a research report which searched for primary research studies on a specific topic using an explicit search strategy, had a detailed description of the methods with explicit inclusion criteria provided, and provided a summary of the included studies either in narrative or quantitative format (such as a meta-analysis). Cochrane and non-Cochrane systematic reviews were considered eligible for inclusion, with or without meta-analysis, and regardless of the study design, language restriction and methodology of the included primary studies. To be eligible for inclusion, reviews had to be clearly analyzing data related to SARS-CoV-2 (associated or not with other viruses). We excluded narrative reviews without those characteristics as these are less likely to be replicable and are more prone to bias.

Scoping reviews and rapid reviews were eligible for inclusion in this overview if they met our pre-defined inclusion criteria noted above. We included reviews that addressed SARS-CoV-2 and other coronaviruses if they reported separate data regarding SARS-CoV-2.

Information sources

Nine databases were searched for eligible records published between December 1, 2019, and March 24, 2020: Cochrane Database of Systematic Reviews via Cochrane Library, PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Sciences, LILACS (Latin American and Caribbean Health Sciences Literature), PDQ-Evidence, WHO’s Global Research on Coronavirus Disease (COVID-19), and Epistemonikos.

The comprehensive search strategy for each database is provided in Additional file 1 and was designed and conducted in collaboration with an information specialist. All retrieved records were primarily processed in EndNote, where duplicates were removed, and records were then imported into the Covidence platform [ 23 ]. In addition to database searches, we screened reference lists of reviews included after screening records retrieved via databases.

Study selection

All searches, screening of titles and abstracts, and record selection, were performed independently by two investigators using the Covidence platform [ 23 ]. Articles deemed potentially eligible were retrieved for full-text screening carried out independently by two investigators. Discrepancies at all stages were resolved by consensus. During the screening, records published in languages other than English were translated by a native/fluent speaker.

Data collection process

We custom designed a data extraction table for this study, which was piloted by two authors independently. Data extraction was performed independently by two authors. Conflicts were resolved by consensus or by consulting a third researcher.

We extracted the following data: article identification data (authors’ name and journal of publication), search period, number of databases searched, population or settings considered, main results and outcomes observed, and number of participants. From Web of Science (Clarivate Analytics, Philadelphia, PA, USA), we extracted journal rank (quartile) and Journal Impact Factor (JIF).

We categorized the following as primary outcomes: all-cause mortality, need for and length of mechanical ventilation, length of hospitalization (in days), admission to intensive care unit (yes/no), and length of stay in the intensive care unit.

The following outcomes were categorized as exploratory: diagnostic methods used for detection of the virus, male to female ratio, clinical symptoms, pharmacological and non-pharmacological interventions, laboratory findings (full blood count, liver enzymes, C-reactive protein, d-dimer, albumin, lipid profile, serum electrolytes, blood vitamin levels, glucose levels, and any other important biomarkers), and radiological findings (using radiography, computed tomography, magnetic resonance imaging or ultrasound).

We also collected data on reporting guidelines and requirements for the publication of systematic reviews and meta-analyses from journal websites where included reviews were published.

Quality assessment in individual reviews

Two researchers independently assessed the reviews’ quality using the “A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2)”. We acknowledge that the AMSTAR 2 was created as “a critical appraisal tool for systematic reviews that include randomized or non-randomized studies of healthcare interventions, or both” [ 24 ]. However, since AMSTAR 2 was designed for systematic reviews of intervention trials, and we included additional types of systematic reviews, we adjusted some AMSTAR 2 ratings and reported these in Additional file 2 .

Adherence to each item was rated as follows: yes, partial yes, no, or not applicable (such as when a meta-analysis was not conducted). The overall confidence in the results of the review is rated as “critically low”, “low”, “moderate” or “high”, according to the AMSTAR 2 guidance based on seven critical domains, which are items 2, 4, 7, 9, 11, 13, 15 as defined by AMSTAR 2 authors [ 24 ]. We reported our adherence ratings for transparency of our decision with accompanying explanations, for each item, in each included review.

One of the included systematic reviews was conducted by some members of this author team [ 25 ]. This review was initially assessed independently by two authors who were not co-authors of that review to prevent the risk of bias in assessing this study.

Synthesis of results

For data synthesis, we prepared a table summarizing each systematic review. Graphs illustrating the mortality rate and clinical symptoms were created. We then prepared a narrative summary of the methods, findings, study strengths, and limitations.

For analysis of the prevalence of clinical outcomes, we extracted data on the number of events and the total number of patients to perform proportional meta-analysis using RStudio© software, with the “meta” package (version 4.9–6), using the “metaprop” function for reviews that did not perform a meta-analysis, excluding case studies because of the absence of variance. For reviews that did not perform a meta-analysis, we presented pooled results of proportions with their respective confidence intervals (95%) by the inverse variance method with a random-effects model, using the DerSimonian-Laird estimator for τ 2 . We adjusted data using Freeman-Tukey double arcosen transformation. Confidence intervals were calculated using the Clopper-Pearson method for individual studies. We created forest plots using the RStudio© software, with the “metafor” package (version 2.1–0) and “forest” function.

Managing overlapping systematic reviews

Some of the included systematic reviews that address the same or similar research questions may include the same primary studies in overviews. Including such overlapping reviews may introduce bias when outcome data from the same primary study are included in the analyses of an overview multiple times. Thus, in summaries of evidence, multiple-counting of the same outcome data will give data from some primary studies too much influence [ 14 ]. In this overview, we did not exclude overlapping systematic reviews because, according to Cochrane’s guidance, it may be appropriate to include all relevant reviews’ results if the purpose of the overview is to present and describe the current body of evidence on a topic [ 14 ]. To avoid any bias in summary estimates associated with overlapping reviews, we generated forest plots showing data from individual systematic reviews, but the results were not pooled because some primary studies were included in multiple reviews.

Our search retrieved 1063 publications, of which 175 were duplicates. Most publications were excluded after the title and abstract analysis ( n = 860). Among the 28 studies selected for full-text screening, 10 were excluded for the reasons described in Additional file 3 , and 18 were included in the final analysis (Fig. 1 ) [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Reference list screening did not retrieve any additional systematic reviews.

PRISMA flow diagram

Characteristics of included reviews

Summary features of 18 systematic reviews are presented in Table 1 . They were published in 14 different journals. Only four of these journals had specific requirements for systematic reviews (with or without meta-analysis): European Journal of Internal Medicine, Journal of Clinical Medicine, Ultrasound in Obstetrics and Gynecology, and Clinical Research in Cardiology . Two journals reported that they published only invited reviews ( Journal of Medical Virology and Clinica Chimica Acta ). Three systematic reviews in our study were published as letters; one was labeled as a scoping review and another as a rapid review (Table 2 ).

All reviews were published in English, in first quartile (Q1) journals, with JIF ranging from 1.692 to 6.062. One review was empty, meaning that its search did not identify any relevant studies; i.e., no primary studies were included [ 36 ]. The remaining 17 reviews included 269 unique studies; the majority ( N = 211; 78%) were included in only a single review included in our study (range: 1 to 12). Primary studies included in the reviews were published between December 2019 and March 18, 2020, and comprised case reports, case series, cohorts, and other observational studies. We found only one review that included randomized clinical trials [ 38 ]. In the included reviews, systematic literature searches were performed from 2019 (entire year) up to March 9, 2020. Ten systematic reviews included meta-analyses. The list of primary studies found in the included systematic reviews is shown in Additional file 4 , as well as the number of reviews in which each primary study was included.

Population and study designs

Most of the reviews analyzed data from patients with COVID-19 who developed pneumonia, acute respiratory distress syndrome (ARDS), or any other correlated complication. One review aimed to evaluate the effectiveness of using surgical masks on preventing transmission of the virus [ 36 ], one review was focused on pediatric patients [ 34 ], and one review investigated COVID-19 in pregnant women [ 37 ]. Most reviews assessed clinical symptoms, laboratory findings, or radiological results.

Systematic review findings

The summary of findings from individual reviews is shown in Table 2 . Overall, all-cause mortality ranged from 0.3 to 13.9% (Fig. 2 ).

A meta-analysis of the prevalence of mortality

Clinical symptoms

Seven reviews described the main clinical manifestations of COVID-19 [ 26 , 28 , 29 , 34 , 35 , 39 , 41 ]. Three of them provided only a narrative discussion of symptoms [ 26 , 34 , 35 ]. In the reviews that performed a statistical analysis of the incidence of different clinical symptoms, symptoms in patients with COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%), gastrointestinal disorders, such as diarrhea, nausea or vomiting (5.0–9.0%), and others (including, in one study only: dizziness 12.1%) (Figs. 3 , 4 , 5 , 6 , 7 , 8 and 9 ). Three reviews assessed cough with and without sputum together; only one review assessed sputum production itself (28.5%).

A meta-analysis of the prevalence of fever

A meta-analysis of the prevalence of cough

A meta-analysis of the prevalence of dyspnea

A meta-analysis of the prevalence of fatigue or myalgia

A meta-analysis of the prevalence of headache

A meta-analysis of the prevalence of gastrointestinal disorders

A meta-analysis of the prevalence of sore throat

Diagnostic aspects

Three reviews described methodologies, protocols, and tools used for establishing the diagnosis of COVID-19 [ 26 , 34 , 38 ]. The use of respiratory swabs (nasal or pharyngeal) or blood specimens to assess the presence of SARS-CoV-2 nucleic acid using RT-PCR assays was the most commonly used diagnostic method mentioned in the included studies. These diagnostic tests have been widely used, but their precise sensitivity and specificity remain unknown. One review included a Chinese study with clinical diagnosis with no confirmation of SARS-CoV-2 infection (patients were diagnosed with COVID-19 if they presented with at least two symptoms suggestive of COVID-19, together with laboratory and chest radiography abnormalities) [ 34 ].

Therapeutic possibilities

Pharmacological and non-pharmacological interventions (supportive therapies) used in treating patients with COVID-19 were reported in five reviews [ 25 , 27 , 34 , 35 , 38 ]. Antivirals used empirically for COVID-19 treatment were reported in seven reviews [ 25 , 27 , 34 , 35 , 37 , 38 , 41 ]; most commonly used were protease inhibitors (lopinavir, ritonavir, darunavir), nucleoside reverse transcriptase inhibitor (tenofovir), nucleotide analogs (remdesivir, galidesivir, ganciclovir), and neuraminidase inhibitors (oseltamivir). Umifenovir, a membrane fusion inhibitor, was investigated in two studies [ 25 , 35 ]. Possible supportive interventions analyzed were different types of oxygen supplementation and breathing support (invasive or non-invasive ventilation) [ 25 ]. The use of antibiotics, both empirically and to treat secondary pneumonia, was reported in six studies [ 25 , 26 , 27 , 34 , 35 , 38 ]. One review specifically assessed evidence on the efficacy and safety of the anti-malaria drug chloroquine [ 27 ]. It identified 23 ongoing trials investigating the potential of chloroquine as a therapeutic option for COVID-19, but no verifiable clinical outcomes data. The use of mesenchymal stem cells, antifungals, and glucocorticoids were described in four reviews [ 25 , 34 , 35 , 38 ].

Laboratory and radiological findings

Of the 18 reviews included in this overview, eight analyzed laboratory parameters in patients with COVID-19 [ 25 , 29 , 30 , 32 , 33 , 34 , 35 , 39 ]; elevated C-reactive protein levels, associated with lymphocytopenia, elevated lactate dehydrogenase, as well as slightly elevated aspartate and alanine aminotransferase (AST, ALT) were commonly described in those eight reviews. Lippi et al. assessed cardiac troponin I (cTnI) [ 25 ], procalcitonin [ 32 ], and platelet count [ 33 ] in COVID-19 patients. Elevated levels of procalcitonin [ 32 ] and cTnI [ 30 ] were more likely to be associated with a severe disease course (requiring intensive care unit admission and intubation). Furthermore, thrombocytopenia was frequently observed in patients with complicated COVID-19 infections [ 33 ].

Chest imaging (chest radiography and/or computed tomography) features were assessed in six reviews, all of which described a frequent pattern of local or bilateral multilobar ground-glass opacity [ 25 , 34 , 35 , 39 , 40 , 41 ]. Those six reviews showed that septal thickening, bronchiectasis, pleural and cardiac effusions, halo signs, and pneumothorax were observed in patients suffering from COVID-19.

Quality of evidence in individual systematic reviews

Table 3 shows the detailed results of the quality assessment of 18 systematic reviews, including the assessment of individual items and summary assessment. A detailed explanation for each decision in each review is available in Additional file 5 .

Using AMSTAR 2 criteria, confidence in the results of all 18 reviews was rated as “critically low” (Table 3 ). Common methodological drawbacks were: omission of prospective protocol submission or publication; use of inappropriate search strategy: lack of independent and dual literature screening and data-extraction (or methodology unclear); absence of an explanation for heterogeneity among the studies included; lack of reasons for study exclusion (or rationale unclear).

Risk of bias assessment, based on a reported methodological tool, and quality of evidence appraisal, in line with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method, were reported only in one review [ 25 ]. Five reviews presented a table summarizing bias, using various risk of bias tools [ 25 , 29 , 39 , 40 , 41 ]. One review analyzed “study quality” [ 37 ]. One review mentioned the risk of bias assessment in the methodology but did not provide any related analysis [ 28 ].

This overview of systematic reviews analyzed the first 18 systematic reviews published after the onset of the COVID-19 pandemic, up to March 24, 2020, with primary studies involving more than 60,000 patients. Using AMSTAR-2, we judged that our confidence in all those reviews was “critically low”. Ten reviews included meta-analyses. The reviews presented data on clinical manifestations, laboratory and radiological findings, and interventions. We found no systematic reviews on the utility of diagnostic tests.

Symptoms were reported in seven reviews; most of the patients had a fever, cough, dyspnea, myalgia or muscle fatigue, and gastrointestinal disorders such as diarrhea, nausea, or vomiting. Olfactory dysfunction (anosmia or dysosmia) has been described in patients infected with COVID-19 [ 43 ]; however, this was not reported in any of the reviews included in this overview. During the SARS outbreak in 2002, there were reports of impairment of the sense of smell associated with the disease [ 44 , 45 ].

The reported mortality rates ranged from 0.3 to 14% in the included reviews. Mortality estimates are influenced by the transmissibility rate (basic reproduction number), availability of diagnostic tools, notification policies, asymptomatic presentations of the disease, resources for disease prevention and control, and treatment facilities; variability in the mortality rate fits the pattern of emerging infectious diseases [ 46 ]. Furthermore, the reported cases did not consider asymptomatic cases, mild cases where individuals have not sought medical treatment, and the fact that many countries had limited access to diagnostic tests or have implemented testing policies later than the others. Considering the lack of reviews assessing diagnostic testing (sensitivity, specificity, and predictive values of RT-PCT or immunoglobulin tests), and the preponderance of studies that assessed only symptomatic individuals, considerable imprecision around the calculated mortality rates existed in the early stage of the COVID-19 pandemic.

Few reviews included treatment data. Those reviews described studies considered to be at a very low level of evidence: usually small, retrospective studies with very heterogeneous populations. Seven reviews analyzed laboratory parameters; those reviews could have been useful for clinicians who attend patients suspected of COVID-19 in emergency services worldwide, such as assessing which patients need to be reassessed more frequently.

All systematic reviews scored poorly on the AMSTAR 2 critical appraisal tool for systematic reviews. Most of the original studies included in the reviews were case series and case reports, impacting the quality of evidence. Such evidence has major implications for clinical practice and the use of these reviews in evidence-based practice and policy. Clinicians, patients, and policymakers can only have the highest confidence in systematic review findings if high-quality systematic review methodologies are employed. The urgent need for information during a pandemic does not justify poor quality reporting.

We acknowledge that there are numerous challenges associated with analyzing COVID-19 data during a pandemic [ 47 ]. High-quality evidence syntheses are needed for decision-making, but each type of evidence syntheses is associated with its inherent challenges.

The creation of classic systematic reviews requires considerable time and effort; with massive research output, they quickly become outdated, and preparing updated versions also requires considerable time. A recent study showed that updates of non-Cochrane systematic reviews are published a median of 5 years after the publication of the previous version [ 48 ].

Authors may register a review and then abandon it [ 49 ], but the existence of a public record that is not updated may lead other authors to believe that the review is still ongoing. A quarter of Cochrane review protocols remains unpublished as completed systematic reviews 8 years after protocol publication [ 50 ].

Rapid reviews can be used to summarize the evidence, but they involve methodological sacrifices and simplifications to produce information promptly, with inconsistent methodological approaches [ 51 ]. However, rapid reviews are justified in times of public health emergencies, and even Cochrane has resorted to publishing rapid reviews in response to the COVID-19 crisis [ 52 ]. Rapid reviews were eligible for inclusion in this overview, but only one of the 18 reviews included in this study was labeled as a rapid review.

Ideally, COVID-19 evidence would be continually summarized in a series of high-quality living systematic reviews, types of evidence synthesis defined as “ a systematic review which is continually updated, incorporating relevant new evidence as it becomes available ” [ 53 ]. However, conducting living systematic reviews requires considerable resources, calling into question the sustainability of such evidence synthesis over long periods [ 54 ].

Research reports about COVID-19 will contribute to research waste if they are poorly designed, poorly reported, or simply not necessary. In principle, systematic reviews should help reduce research waste as they usually provide recommendations for further research that is needed or may advise that sufficient evidence exists on a particular topic [ 55 ]. However, systematic reviews can also contribute to growing research waste when they are not needed, or poorly conducted and reported. Our present study clearly shows that most of the systematic reviews that were published early on in the COVID-19 pandemic could be categorized as research waste, as our confidence in their results is critically low.

Our study has some limitations. One is that for AMSTAR 2 assessment we relied on information available in publications; we did not attempt to contact study authors for clarifications or additional data. In three reviews, the methodological quality appraisal was challenging because they were published as letters, or labeled as rapid communications. As a result, various details about their review process were not included, leading to AMSTAR 2 questions being answered as “not reported”, resulting in low confidence scores. Full manuscripts might have provided additional information that could have led to higher confidence in the results. In other words, low scores could reflect incomplete reporting, not necessarily low-quality review methods. To make their review available more rapidly and more concisely, the authors may have omitted methodological details. A general issue during a crisis is that speed and completeness must be balanced. However, maintaining high standards requires proper resourcing and commitment to ensure that the users of systematic reviews can have high confidence in the results.

Furthermore, we used adjusted AMSTAR 2 scoring, as the tool was designed for critical appraisal of reviews of interventions. Some reviews may have received lower scores than actually warranted in spite of these adjustments.

Another limitation of our study may be the inclusion of multiple overlapping reviews, as some included reviews included the same primary studies. According to the Cochrane Handbook, including overlapping reviews may be appropriate when the review’s aim is “ to present and describe the current body of systematic review evidence on a topic ” [ 12 ], which was our aim. To avoid bias with summarizing evidence from overlapping reviews, we presented the forest plots without summary estimates. The forest plots serve to inform readers about the effect sizes for outcomes that were reported in each review.

Several authors from this study have contributed to one of the reviews identified [ 25 ]. To reduce the risk of any bias, two authors who did not co-author the review in question initially assessed its quality and limitations.

Finally, we note that the systematic reviews included in our overview may have had issues that our analysis did not identify because we did not analyze their primary studies to verify the accuracy of the data and information they presented. We give two examples to substantiate this possibility. Lovato et al. wrote a commentary on the review of Sun et al. [ 41 ], in which they criticized the authors’ conclusion that sore throat is rare in COVID-19 patients [ 56 ]. Lovato et al. highlighted that multiple studies included in Sun et al. did not accurately describe participants’ clinical presentations, warning that only three studies clearly reported data on sore throat [ 56 ].

In another example, Leung [ 57 ] warned about the review of Li, L.Q. et al. [ 29 ]: “ it is possible that this statistic was computed using overlapped samples, therefore some patients were double counted ”. Li et al. responded to Leung that it is uncertain whether the data overlapped, as they used data from published articles and did not have access to the original data; they also reported that they requested original data and that they plan to re-do their analyses once they receive them; they also urged readers to treat the data with caution [ 58 ]. This points to the evolving nature of evidence during a crisis.

Our study’s strength is that this overview adds to the current knowledge by providing a comprehensive summary of all the evidence synthesis about COVID-19 available early after the onset of the pandemic. This overview followed strict methodological criteria, including a comprehensive and sensitive search strategy and a standard tool for methodological appraisal of systematic reviews.

In conclusion, in this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all the reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic could be categorized as research waste. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards to provide patients, clinicians, and decision-makers trustworthy evidence.

Availability of data and materials

All data collected and analyzed within this study are available from the corresponding author on reasonable request.

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Acknowledgments

We thank Catherine Henderson DPhil from Swanscoe Communications for pro bono medical writing and editing support. We acknowledge support from the Covidence Team, specifically Anneliese Arno. We thank the whole International Network of Coronavirus Disease 2019 (InterNetCOVID-19) for their commitment and involvement. Members of the InterNetCOVID-19 are listed in Additional file 6 . We thank Pavel Cerny and Roger Crosthwaite for guiding the team supervisor (IJBN) on human resources management.

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Israel Júnior Borges do Nascimento & Milena Soriano Marcolino

Medical College of Wisconsin, Milwaukee, WI, USA

Israel Júnior Borges do Nascimento

Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, College of Nursing, The Ohio State University, Columbus, OH, USA

Dónal P. O’Mathúna

School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland

Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany

Thilo Caspar von Groote

Department of Sport and Health Science, Technische Universität München, Munich, Germany

Hebatullah Mohamed Abdulazeem

School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia

Ishanka Weerasekara

Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka

Cochrane Croatia, University of Split, School of Medicine, Split, Croatia

Ana Marusic, Irena Zakarija-Grkovic & Tina Poklepovic Pericic

Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Ilica 242, 10000, Zagreb, Croatia

Livia Puljak

Cochrane Brazil, Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, Brazil

Vinicius Tassoni Civile & Alvaro Nagib Atallah

Yorkville University, Fredericton, New Brunswick, Canada

Santino Filoso

Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada

Nicola Luigi Bragazzi

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Contributions

IJBN conceived the research idea and worked as a project coordinator. DPOM, TCVG, HMA, IW, AM, LP, VTC, IZG, TPP, ANA, SF, NLB and MSM were involved in data curation, formal analysis, investigation, methodology, and initial draft writing. All authors revised the manuscript critically for the content. The author(s) read and approved the final manuscript.

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Supplementary Information

Additional file 1: appendix 1..

Search strategies used in the study.

Additional file 2: Appendix 2.

Adjusted scoring of AMSTAR 2 used in this study for systematic reviews of studies that did not analyze interventions.

Additional file 3: Appendix 3.

List of excluded studies, with reasons.

Additional file 4: Appendix 4.

Table of overlapping studies, containing the list of primary studies included, their visual overlap in individual systematic reviews, and the number in how many reviews each primary study was included.

Additional file 5: Appendix 5.

A detailed explanation of AMSTAR scoring for each item in each review.

Additional file 6: Appendix 6.

List of members and affiliates of International Network of Coronavirus Disease 2019 (InterNetCOVID-19).

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Borges do Nascimento, I.J., O’Mathúna, D.P., von Groote, T.C. et al. Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews. BMC Infect Dis 21 , 525 (2021). https://doi.org/10.1186/s12879-021-06214-4

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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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Read More: The Family Time the Pandemic Stole

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.

Read More: A Tool for Staying Grounded in This Era of Constant Uncertainty

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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• 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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Understanding COVID-19

How To Protect Yourself During the Pandemic

COVID-19 has claimed millions of lives around the world. But we learn more about this disease every day. Scientists are developing tools that promise to slow and eventu­ally help us overcome the pandemic.

COVID-19 is caused by a new coronavirus called SARS-CoV-2. There are many types of coronaviruses. Some cause the common cold. Others have led to fatal disease outbreaks. These include severe acute respiratory syndrome (SARS) in 2003, Middle East respiratory syndrome (MERS) in 2012, and now COVID-19.

Coronaviruses are named for the crown-like spikes on their surface. (Corona means crown.) The viruses use the spikes to help get inside your body’s cells. Once inside, they replicate, or make copies of themselves.

Scientists have learned how to turn these spikes against the virus through vaccines and treatments. They’ve also learned what you can do to protect yourself from the virus.

Protecting Yourself

You’re most likely to get COVID-19 through close contact with someone who’s infected. Coughing, sneezing, talking, and breathing produce small droplets of liquid. These are called respiratory droplets. They travel through the air and can be inhaled by someone else.

“COVID-19 is spread mainly through exposure to respiratory droplets that tend to drop within six feet,” says Dr. Anthony Fauci, director of NIH’s National Institute of Allergy and Infectious Diseases. That’s why it’s important to stay at least six feet (about two arm lengths) away from people who don’t live with you.

“Surfaces can be contaminated. But it is likely that this is a less common cause of infection rather than person-to-person directly,” Fauci says.

You can protect yourself and others by wearing a mask. Choose one that has at least two layers of fabric. Make sure that the mask covers your mouth and nose and doesn’t leak air around the edges.

“There’s very little transmission in places where masks are worn,” says Dr. Ben Cowling at the University of Hong Kong who studies how viruses spread. Cowling found that infections were most often spread in settings where masks aren’t worn.

“Masks work. But even with mandatory masking, you still need social distancing as well,” he says. You can lower your risk by avoiding crowds. Crowds increase the risk of coming in contact with someone who has COVID-19.

What to Look For

Common symptoms of COVID-19 include fever, cough, headaches, fatigue, and muscle or body aches. People with COVID-19 may also lose their sense of smell or taste. Symptoms usually appear two to 14 days after being exposed to the virus.

But even people who don’t seem sick can still infect others. The CDC estimates that 50% of infections are spread by people with no symptoms. While some with this virus develop life-threatening illness, others have mild symptoms, and some never develop any.

Catching the virus is more dangerous for some groups of people. This includes older adults and people with certain medical conditions. These medical conditions include obesity, diabetes, heart and lung disease, and asthma. About 40% of Americans have at least one of these risk factors.

Getting Treatment

Better COVID-19 treatments mean that fewer people now get severely sick if they catch the virus. Scientists have been working to test available drugs against the virus. They’ve found at least two that can help people who are hospitalized with the virus.

A drug called remdesivir can reduce the time a patient spends in the hospital. A steroid called dexamethasone helps stop the The system that protects your body from invading viruses, bacteria, and other microscopic threats. immune system from reacting too strongly to the virus. That can damage body tissues and organs.

Antibody treatments are also available. Antibodies are proteins that your body makes to fight germs. Scientists have learned how to make them in the lab. Antibody treatments can block SARS-CoV-2 to prevent the illness from getting worse. They seem to have the most benefit when given early in the disease.

“Antibody treatments really do have the potential to help people, especially for treating individuals who are not yet hospitalized,” says Dr. Mark Heise, who studies the genetics of viruses at the University of North Carolina at Chapel Hill. Heise is working to develop mouse models to test treatments and vaccines.

Studies are now testing combinations of treatments. “Combining drugs that target both the virus and the person’s immune response may help treat COVID-19,” says Heise. Scientists are also looking for new drugs that better target the virus.

A Shot of Hope: Vaccines

It used to take a decade or more to develop a new vaccine. In this pandemic, scientists created COVID-19 vaccines in less than a year.

The first two vaccines approved for emergency use are from Moderna and Pfizer/BioNTech. Moderna’s vaccine was co-developed with NIH scientists. Both are a new type of vaccine called mRNA vaccines. mRNA carries the genetic information for your body to make proteins.

The vaccines direct the body’s cells to make a piece of the virus called the spike protein. These proteins can’t cause illness by themselves. But they teach your immune system to make antibodies against the protein. If you encounter the virus later, the antibodies provide protection against it.

The mRNA vaccines now available were shown to be more than 90% effective in large clinical trials. They can cause side effects—such as fatigue, muscle aches, joint pain, and headache. But both vaccines were found to be safe in the clinical trials.

“Get vaccinated. The vaccines are safe. They’re incredibly effective,” says Dr. Jason McLellan, an expert on coronaviruses at the University of Texas at Austin. McLellan’s research was critical in developing these vaccines. His team, along with NIH scientists, figured out how to lock the shape of the spike protein to make the most effective antibodies.

As the pandemic has gone on, new versions of the virus, or variants, have appeared. “We’re all very confident that vaccines will continue to work well against these variants,” McLellan says. “Vaccination also helps stop the development of new variants, because it provides fewer opportunities for the virus to change as it replicates.”

Many people will need to be vaccinated for the pandemic to end. Fauci estimates that 70% to 85% of the U.S. population will need to be vaccinated to get “herd immunity.” That’s the point where enough people are immune to the virus to prevent its spread. That’s important because it protects vulnerable people who can’t get vaccinated.

“It is my hope that all Americans will protect themselves by getting vaccinated when the vaccine becomes available to them,” Fauci says. “That is how our country will begin to heal and move forward.”

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COVID‑19 Pandemic

By: History.com Editors

Updated: March 11, 2024 | Original: April 25, 2023

The outbreak of the infectious respiratory disease known as COVID-19 triggered one of the deadliest pandemics in modern history. COVID-19 claimed nearly 7 million lives worldwide. In the United States, deaths from COVID-19 exceeded 1.1 million, nearly twice the American death toll from the 1918 flu pandemic . The COVID-19 pandemic also took a heavy toll economically, politically and psychologically, revealing deep divisions in the way that Americans viewed the role of government in a public health crisis, particularly vaccine mandates. While the United States downgraded its “national emergency” status over the pandemic on May 11, 2023, the full effects of the COVID-19 pandemic will reverberate for decades.

A New Virus Breaks Out in Wuhan, China

In December 2019, the China office of the World Health Organization (WHO) received news of an isolated outbreak of a pneumonia-like virus in the city of Wuhan. The virus caused high fevers and shortness of breath, and the cases seemed connected to the Huanan Seafood Wholesale Market in Wuhan, which was closed by an emergency order on January 1, 2020.

After testing samples of the unknown virus, the WHO identified it as a novel type of coronavirus similar to the deadly SARS virus that swept through Asia from 2002-2004. The WHO named this new strain SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). The first Chinese victim of SARS-CoV-2 died on January 11, 2020.

Where, exactly, the novel virus originated has been hotly debated. There are two leading theories. One is that the virus jumped from animals to humans, possibly carried by infected animals sold at the Wuhan market in late 2019. A second theory claims the virus escaped from the Wuhan Institute of Virology, a research lab that was studying coronaviruses. U.S. intelligence agencies maintain that both origin stories are “plausible.”

The First COVID-19 Cases in America

The WHO hoped that the virus outbreak would be contained to Wuhan, but by mid-January 2020, infections were reported in Thailand, Japan and Korea, all from people who had traveled to China.

On January 18, 2020, a 35-year-old man checked into an urgent care center near Seattle, Washington. He had just returned from Wuhan and was experiencing a fever, nausea and vomiting. On January 21, he was identified as the first American infected with SARS-CoV-2.

In reality, dozens of Americans had contracted SARS-CoV-2 weeks earlier, but doctors didn’t think to test for a new type of virus. One of those unknowingly infected patients died on February 6, 2020, but her death wasn’t confirmed as the first American casualty until April 21.

On February 11, 2020, the WHO released a new name for the disease causing the deadly outbreak: Coronavirus Disease 2019 or COVID-19. By mid-March 2020, all 50 U.S. states had reported at least one positive case of COVID-19, and nearly all of the new infections were caused by “community spread,” not by people who contracted the disease while traveling abroad. 

At the same time, COVID-19 had spread to 114 countries worldwide, killing more than 4,000 people and infecting hundreds of thousands more. On March 11, the WHO made it official and declared COVID-19 a pandemic.

The World Shuts Down

Pandemics are expected in a globally interconnected world, so emergency plans were in place. In the United States, health officials at the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) set in motion a national response plan developed for flu pandemics.

State by state and city by city, government officials took emergency measures to encourage “ social distancing ,” one of the many new terms that became part of the COVID-19 vocabulary. Travel was restricted. Schools and churches were closed. With the exception of “essential workers,” all offices and businesses were shuttered. By early April 2020, more than 316 million Americans were under a shelter-in-place or stay-at-home order.

With more than 1,000 deaths and nearly 100,000 cases, it was clear by April 2020 that COVID-19 was highly contagious and virulent. What wasn’t clear, even to public health officials, was how individuals could best protect themselves from COVID-19. In the early weeks of the outbreak, the CDC discouraged people from buying face masks, because officials feared a shortage of masks for doctors and hospital workers.

By April 2020, the CDC revised its recommendations, encouraging people to wear masks in public, to socially distance and to wash hands frequently. President Donald Trump undercut the CDC recommendations by emphasizing that masking was voluntary and vowing not to wear a mask himself. This was just the beginning of the political divisions that hobbled the COVID-19 response in America.

When WWI, Pandemic and Slump Ended, Americans Sprang Into the Roaring Twenties

After enduring dark times, Americans were eager for a comeback.

Why the 1918 Flu Pandemic Never Really Ended

After infecting millions of people worldwide, the 1918 flu strain shifted—and then stuck around.

When Mask‑Wearing Rules in the 1918 Pandemic Faced Resistance

Most people complied, but some resisted (or poked holes in their masks to smoke).

Global Financial Markets Collapse

In the early months of the COVID-19 pandemic, with billions of people worldwide out of work, stuck at home, and fretting over shortages of essential items like toilet paper , global financial markets went into a tailspin.

In the United States, share prices on the New York Stock Exchange plummeted so quickly that the exchange had to shut down trading three separate times. The Dow Jones Industrial Average eventually lost 37 percent of its value, and the S&P 500 was down 34 percent.

Business closures and stay-at-home orders gutted the U.S. economy. The unemployment rate skyrocketed, particularly in the service sector (restaurant and other retail workers). By May 2020, the U.S. unemployment rate reached 14.7 percent, the highest jobless rate since the Great Depression . 

All across America, households felt the pinch of lost jobs and lower wages. Food insecurity reached a peak by December 2020 with 30 million American adults—a full 14 percent—reporting that their families didn’t get enough to eat in the past week.

The economic effects of the COVID-19 pandemic, like its health effects, weren’t experienced equally. Black, Hispanic and Native Americans suffered from unemployment and food insecurity at significantly higher rates than white Americans. 

Congress tried to avoid a complete economic collapse by authorizing a series of COVID-19 relief packages in 2020 and 2021, which included direct stimulus checks for all American families.

The Race for a Vaccine

A new vaccine typically takes 10 to 15 years to develop and test, but the world couldn’t wait that long for a COVID-19 vaccine. The U.S. Department of Health and Human Services (HHS) under the Trump administration launched “ Operation Warp Speed ,” a public-private partnership which provided billions of dollars in upfront funding to pharmaceutical companies to rapidly develop vaccines and conduct clinical trials.

The first clinical trial for a COVID-19 vaccine was announced on March 16, 2020, only days after the WHO officially classified COVID-19 as a pandemic. The vaccines developed by Moderna and Pfizer were the first ever to employ messenger RNA, a breakthrough technology. After large-scale clinical trials, both vaccines were found to be greater than 95 percent effective against infection with COVID-19.

A nurse from New York officially became the first American to receive a COVID-19 vaccine on December 14, 2020. Ten days later, more than 1 million vaccines had been administered, starting with healthcare workers and elderly residents of nursing homes. As the months rolled on, vaccine availability was expanded to all American adults, and then to teenagers and all school-age children.

By the end of the pandemic in early 2023, more than 670 million doses of COVID-19 vaccines had been administered in the United States at a rate of 203 doses per 100 people. Approximately 80 percent of the U.S. population received at least one COVID-19 shot, but vaccination rates were markedly lower among Black, Hispanic and Native Americans.

The First ‘Vaccine Passports’ Were Scars from Smallpox Vaccinations

When smallpox ravaged the United States at the turn of the 20th century, many public spaces required people to show their vaccine scars for entry.

When the Supreme Court Ruled a Vaccine Could Be Mandatory

A 1905 decision provided a powerful and controversial precedent for the flexing of government authority.

4 Diseases You’ve Probably Forgotten About Because of Vaccines

Vaccines are so effective at fighting disease that sometimes it’s easy to forget their impact.

COVID-19 Deaths Heaviest Among Elderly and People of Color

In America, the COVID-19 pandemic impacted everyone’s lives, but those who died from the disease were far more likely to be older and people of color.

Of the more than 1.1 million COVID deaths in the United States, 75 percent were individuals who were 65 or older. A full 93 percent of American COVID-19 victims were 50 or older. Throughout the emergence of COVID-19 variants and the vaccine rollouts, older Americans remained the most at-risk for being hospitalized and ultimately dying from the disease.

Black, Hispanic and Native Americans were also at a statistically higher risk of developing life-threatening COVID-19 systems and succumbing to the disease. For example, Black and Hispanic Americans were twice as likely to be hospitalized from COVID-19 than white Americans. The COVID-19 pandemic shined light on the health disparities between racial and ethnic groups driven by systemic racism and lower access to healthcare.

Mental health also worsened during the COVID-19 pandemic. The anxiety of contracting the disease, and the stresses of being unemployed or confined at home, led to unprecedented numbers of Americans reporting feelings of depression and suicidal ideation.

A Time of Social & Political Upheaval

In the United States, the three long years of the COVID-19 pandemic paralleled a time of heightened political contention and social upheaval.

When George Floyd was killed by Minneapolis police on May 25, 2020, it sparked nationwide protests against police brutality and energized the Black Lives Matter movement. Because so many Americans were out of work or home from school due to COVID-19 shutdowns, unprecedented numbers of people from all walks of life took to the streets to demand reforms.

Instead of banding together to slow the spread of the disease, Americans became sharply divided along political lines in their opinions of masking requirements, vaccines and social distancing.

By March 2024, in signs that the pandemic was waning, the CDC issued new guidelines for people who were recovering from COVID-19. The agency said those infected with the virus no longer needed to remain isolated for five days after symptoms. And on March 10, 2024, the Johns Hopkins Coronavirus Resource Center stopped collecting data for its highly referenced COVID-19 dashboard.

Still, an estimated 17 percent of U.S. adults reported having experienced symptoms of long COVID, according to the Household Pulse Survey. The medical community is still working to understand the causes behind long COVID, which can afflict a patient for weeks, months or even years.

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“CDC Museum COVID Timeline.” Centers for Disease Control and Prevention . “Coronavirus: Timeline.” U.S. Department of Defense . “COVID-19 and Related Vaccine Development and Research.” Mayo Clinic . “COVID-19 Cases and Deaths by Race/Ethnicity: Current Data and Changes Over Time.” Kaiser Family Foundation . “Number of COVID-19 Deaths in the U.S. by Age.” Statista . “The Pandemic Deepened Fault Lines in American Society.” Scientific American . “Tracking the COVID-19 Economy’s Effects on Food, Housing, and Employment Hardships.” Center on Budget and Policy Priorities . “U.S. Confirmed Country’s First Case of COVID-19 3 Years Ago.” CNN .

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• COVID-19 and your mental health

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

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

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

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

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

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

Recognize what's typical and what's not

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

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

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

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

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

Get help when you need it

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

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

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

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

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

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

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

Self-care tips

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

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

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

Take care of your body

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

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

Take care of your mind

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

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

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

Other healthy self-care tips are:

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

Avoid stigma and discrimination

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

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

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

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

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

COVID-19 and health

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

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

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An Introduction to COVID-19

Simon james fong.

4 Department of Computer and Information Science, University of Macau, Taipa, Macau, China

Nilanjan Dey

5 Department of Information Technology, Techno International New Town, Kolkata, West Bengal India

Jyotismita Chaki

6 School of Information Technology and Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu India

A novel coronavirus (CoV) named ‘2019-nCoV’ or ‘2019 novel coronavirus’ or ‘COVID-19’ by the World Health Organization (WHO) is in charge of the current outbreak of pneumonia that began at the beginning of December 2019 near in Wuhan City, Hubei Province, China [1–4]. COVID-19 is a pathogenic virus. From the phylogenetic analysis carried out with obtainable full genome sequences, bats occur to be the COVID-19 virus reservoir, but the intermediate host(s) has not been detected till now.

A Brief History of the Coronavirus Outbreak

A novel coronavirus (CoV) named ‘2019-nCoV’ or ‘2019 novel coronavirus’ or ‘COVID-19’ by the World Health Organization (WHO) is in charge of the current outbreak of pneumonia that began at the beginning of December 2019 near in Wuhan City, Hubei Province, China [ 1 – 4 ]. COVID-19 is a pathogenic virus. From the phylogenetic analysis carried out with obtainable full genome sequences, bats occur to be the COVID-19 virus reservoir, but the intermediate host(s) has not been detected till now. Though three major areas of work already are ongoing in China to advise our awareness of the pathogenic origin of the outbreak. These include early inquiries of cases with symptoms occurring near in Wuhan during December 2019, ecological sampling from the Huanan Wholesale Seafood Market as well as other area markets, and the collection of detailed reports of the point of origin and type of wildlife species marketed on the Huanan market and the destination of those animals after the market has been closed [ 5 – 8 ].

Coronaviruses mostly cause gastrointestinal and respiratory tract infections and are inherently categorized into four major types: Gammacoronavirus, Deltacoronavirus, Betacoronavirus and Alphacoronavirus [ 9 – 11 ]. The first two types mainly infect birds, while the last two mostly infect mammals. Six types of human CoVs have been formally recognized. These comprise HCoVHKU1, HCoV-OC43, Middle East Respiratory Syndrome coronavirus (MERS-CoV), Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) which is the type of the Betacoronavirus, HCoV229E and HCoV-NL63, which are the member of the Alphacoronavirus. Coronaviruses did not draw global concern until the 2003 SARS pandemic [ 12 – 14 ], preceded by the 2012 MERS [ 15 – 17 ] and most recently by the COVID-19 outbreaks. SARS-CoV and MERS-CoV are known to be extremely pathogenic and spread from bats to palm civets or dromedary camels and eventually to humans.

COVID-19 is spread by dust particles and fomites while close unsafe touch between the infector and the infected individual. Airborne distribution has not been recorded for COVID-19 and is not known to be a significant transmission engine based on empirical evidence; although it can be imagined if such aerosol-generating practices are carried out in medical facilities. Faecal spreading has been seen in certain patients, and the active virus has been reported in a small number of clinical studies [ 18 – 20 ]. Furthermore, the faecal-oral route does not seem to be a COVID-19 transmission engine; its function and relevance for COVID-19 need to be identified.

For about 18,738,58 laboratory-confirmed cases recorded as of 2nd week of April 2020, the maximum number of cases (77.8%) was between 30 and 69 years of age. Among the recorded cases, 21.6% are farmers or employees by profession, 51.1% are male and 77.0% are Hubei.

However, there are already many concerns regarding the latest coronavirus. Although it seems to be transferred to humans by animals, it is important to recognize individual animals and other sources, the path of transmission, the incubation cycle, and the features of the susceptible community and the survival rate. Nonetheless, very little clinical knowledge on COVID-19 disease is currently accessible and details on age span, the animal origin of the virus, incubation time, outbreak curve, viral spectroscopy, dissemination pathogenesis, autopsy observations, and any clinical responses to antivirals are lacking among the serious cases.

How Different and Deadly COVID-19 is Compared to Plagues in History

COVID-19 has reached to more than 150 nations, including China, and has caused WHO to call the disease a worldwide pandemic. By the time of 2nd week of April 2020, this COVID-19 cases exceeded 18,738,58, although more than 1,160,45 deaths were recorded worldwide and United States of America became the global epicentre of coronavirus. More than one-third of the COVID-19 instances are outside of China. Past pandemics that have existed in the past decade or so, like bird flu, swine flu, and SARS, it is hard to find out the comparison between those pandemics and this coronavirus. Following is a guide to compare coronavirus with such diseases and recent pandemics that have reformed the world community.

Coronavirus Versus Seasonal Influenza

Influenza, or seasonal flu, occurs globally every year–usually between December and February. It is impossible to determine the number of reports per year because it is not a reportable infection (so no need to be recorded to municipality), so often patients with minor symptoms do not go to a physician. Recent figures placed the Rate of Case Fatality at 0.1% [ 21 – 23 ].

There are approximately 3–5 million reports of serious influenza a year, and about 250,000–500,000 deaths globally. In most developed nations, the majority of deaths arise in persons over 65 years of age. Moreover, it is unsafe for pregnant mothers, children under 59 months of age and individuals with serious illnesses.

The annual vaccination eliminates infection and severe risks in most developing countries but is nevertheless a recognized yet uncomfortable aspect of the season.

In contrast to the seasonal influenza, coronavirus is not so common, has led to fewer cases till now, has a higher rate of case fatality and has no antidote.

Coronavirus Versus Bird Flu (H5N1 and H7N9)

Several cases of bird flu have existed over the years, with the most severe in 2013 and 2016. This is usually from two separate strains—H5N1 and H7N9 [ 24 – 26 ].

The H7N9 outbreak in 2016 accounted for one-third of all confirmed human cases but remained confined relative to both coronavirus and other pandemics/outbreak cases. After the first outbreak, about 1,233 laboratory-confirmed reports of bird flu have occurred. The disease has a Rate of Case Fatality of 20–40%.

Although the percentage is very high, the blowout from individual to individual is restricted, which, in effect, has minimized the number of related deaths. It is also impossible to monitor as birds do not necessarily expire from sickness.

In contrast to the bird flu, coronavirus becomes more common, travels more quickly through human to human interaction, has an inferior cardiothoracic ratio, resulting in further total fatalities and spread from the initial source.

Coronavirus Versus Ebola Epidemic

The Ebola epidemic of 2013 was primarily centred in 10 nations, including Sierra Leone, Guinea and Liberia have the greatest effects, but the extremely high Case Fatality Rate of 40% has created this as a significant problem for health professionals nationwide [ 27 – 29 ].

Around 2013 and 2016, there were about 28,646 suspicious incidents and about 11,323 fatalities, although these are expected to be overlooked. Those who survived from the original epidemic may still become sick months or even years later, because the infection may stay inactive for prolonged periods. Thankfully, a vaccination was launched in December 2016 and is perceived to be effective.

In contrast to the Ebola, coronavirus is more common globally, has caused in fewer fatalities, has a lesser case fatality rate, has no reported problems during treatment and after recovery, does not have an appropriate vaccination.

Coronavirus Versus Camel Flu (MERS)

Camel flu is a misnomer–though camels have MERS antibodies and may have been included in the transmission of the disease; it was originally transmitted to humans through bats [ 30 – 32 ]. Like Ebola, it infected only a limited number of nations, i.e. about 27, but about 858 fatalities from about 2,494 laboratory-confirmed reports suggested that it was a significant threat if no steps were taken in place to control it.

In contrast to the camel flu, coronavirus is more common globally, has occurred more fatalities, has a lesser case fatality rate, and spreads more easily among humans.

Coronavirus Versus Swine Flu (H1N1)

Swine flu is the same form of influenza that wiped 1.7% of the world population in 1918. This was deemed a pandemic again in June 2009 an approximately-21% of the global population infected by this [ 33 – 35 ].

Thankfully, the case fatality rate is substantially lower than in the last pandemic, with 0.1%–0.5% of events ending in death. About 18,500 of these fatalities have been laboratory-confirmed, but statistics range as high as 151,700–575,400 worldwide. 50–80% of severe occurrences have been reported in individuals with chronic illnesses like asthma, obesity, cardiovascular diseases and diabetes.

In contrast to the swine flu, coronavirus is not so common, has caused fewer fatalities, has more case fatality rate, has a longer growth time and less impact on young people.

Coronavirus Versus Severe Acute Respiratory Syndrome (SARS)

SARS was discovered in 2003 as it spread from bats to humans resulted in about 774 fatalities. By May there were eventually about 8,100 reports across 17 countries, with a 15% case fatality rate. The number is estimated to be closer to 9.6% as confirmed cases are counted, with 0.9% cardiothoracic ratio for people aged 20–29, rising to 28% for people aged 70–79. Similar to coronavirus, SARS had bad results for males than females in all age categories [ 36 – 38 ].

Coronavirus is more common relative to SARS, which ended in more overall fatalities, lower case fatality rate, the even higher case fatality rate in older ages, and poorer results for males.

Coronavirus Versus Hong Kong Flu (H3N2)

The Hong Kong flu pandemic erupted on 13 July 1968, with 1–4 million deaths globally by 1969. It was one of the greatest flu pandemics of the twentieth century, but thankfully the case fatality rate was smaller than the epidemic of 1918, resulting in fewer fatalities overall. That may have been attributed to the fact that citizens had generated immunity owing to a previous epidemic in 1957 and to better medical treatment [ 39 ].

In contrast to the Hong Kong flu, coronavirus is not so common, has caused in fewer fatalities and has a higher case fatality rate.

Coronavirus Versus Spanish Flu (H1N1)

The 1918 Spanish flu pandemic was one of the greatest occurrences of recorded history. During the first year of the pandemic, lifespan in the US dropped by 12 years, with more civilians killed than HIV/AIDS in 24 h [ 40 – 42 ].

Regardless of the name, the epidemic did not necessarily arise in Spain; wartime censors in Germany, the United States, the United Kingdom and France blocked news of the disease, but Spain did not, creating the misleading perception that more cases and fatalities had occurred relative to its neighbours

This strain of H1N1 eventually affected more than 500 million men, or 27% of the world’s population at the moment, and had deaths of between 40 and 50 million. At the end of 1920, 1.7% of the world’s people had expired of this illness, including an exceptionally high death rate for young adults aged between 20 and 40 years.

In contrast to the Spanish flu, coronavirus is not so common, has caused in fewer fatalities, has a higher case fatality rate, is more harmful to older ages and is less risky for individuals aged 20–40 years.

Coronavirus Versus Common Cold (Typically Rhinovirus)

Common cold is the most common illness impacting people—Typically, a person suffers from 2–3 colds each year and the average kid will catch 6–8 during the similar time span. Although there are more than 200 cold-associated virus types, infections are uncommon and fatalities are very rare and typically arise mainly in extremely old, extremely young or immunosuppressed cases [ 43 , 44 ].

In contrast to the common cold, coronavirus is not so prevalent, causes more fatalities, has more case fatality rate, is less infectious and is less likely to impact small children.

Reviews of Online Portals and Social Media for Epidemic Information Dissemination

As COVID-19 started to propagate across the globe, the outbreak contributed to a significant change in the broad technology platforms. Where they once declined to engage in the affairs of their systems, except though the possible danger to public safety became obvious, the advent of a novel coronavirus placed them in a different interventionist way of thought. Big tech firms and social media are taking concrete steps to guide users to relevant, credible details on the virus [ 45 – 48 ]. And some of the measures they’re doing proactively. Below are a few of them.

Facebook started adding a box in the news feed that led users to the Centers for Disease Control website regarding COVID-19. It reflects a significant departure from the company’s normal strategy of placing items in the News Feed. The purpose of the update, after all, is personalization—Facebook tries to give the posts you’re going to care about, whether it is because you’re connected with a person or like a post. In the virus package, Facebook has placed a remarkable algorithmic thumb on the scale, potentially pushing millions of people to accurate, authenticated knowledge from a reputable source.

Similar initiatives have been adopted by Twitter. Searching for COVID-19 will carry you to a page highlighting the latest reports from public health groups and credible national news outlets. The search also allows for common misspellings. Twitter has stated that although Russian-style initiatives to cause discontent by large-scale intelligence operations have not yet been observed, a zero-tolerance approach to network exploitation and all other attempts to exploit their service at this crucial juncture will be expected. The problem has the attention of the organization. It also offers promotional support to public service agencies and other non-profit groups.

Google has made a step in making it better for those who choose to operate or research from home, offering specialized streaming services to all paying G Suite customers. Google also confirmed that free access to ‘advanced’ Hangouts Meet apps will be rolled out to both G Suite and G Suite for Education clients worldwide through 1st July. It ensures that companies can hold meetings of up to 250 people, broadcast live to up to about 100,000 users within a single network, and archive and export meetings to Google Drive. Usually, Google pays an additional $13 per person per month for these services in comparison to G Suite’s ‘enterprise’ membership, which adds up to a total of about $25 per client each month.

Microsoft took a similar move, introducing the software ‘Chat Device’ to help public health and protection in the coronavirus epidemic, which enables collaborative collaboration via video and text messaging. There’s an aspect of self-interest in this. Tech firms are offering out their goods free of charge during periods of emergency for the same purpose as newspapers are reducing their paywalls: it’s nice to draw more paying consumers.

Pinterest, which has introduced much of the anti-misinformation strategies that Facebook and Twitter are already embracing, is now restricting the search results for ‘coronavirus’, ‘COVID-19’ and similar words for ‘internationally recognized health organizations’.

Google-owned YouTube, traditionally the most conspiratorial website, has recently introduced a connection to the World Health Organization virus epidemic page to the top of the search results. In the early days of the epidemic, BuzzFeed found famous coronavirus conspiratorial videos on YouTube—especially in India, where one ‘explain’ with a false interpretation of the sources of the disease racketeered 13 million views before YouTube deleted it. Yet in the United States, conspiratorial posts regarding the illness have failed to gain only 1 million views.

That’s not to suggest that misinformation doesn’t propagate on digital platforms—just as it travels through the broader Internet, even though interaction with friends and relatives. When there’s a site that appears to be under-performing in the global epidemic, it’s Facebook-owned WhatsApp, where the Washington Post reported ‘a torrent of disinformation’ in places like Nigeria, Indonesia, Peru, Pakistan and Ireland. Given the encrypted existence of the app, it is difficult to measure the severity of the problem. Misinformation is also spread in WhatsApp communities, where participation is restricted to about 250 individuals. Knowledge of one category may be readily exchanged with another; however, there is a considerable amount of complexity of rotating several groups to peddle affected healing remedies or propagate false rumours.

Preventative Measures and Policies Enforced by the World Health Organization (WHO) and Different Countries

Coronavirus is already an ongoing epidemic, so it is necessary to take precautions to minimize both the risk of being sick and the transmission of the disease.

WHO Advice [ 49 ]

• Wash hands regularly with alcohol-based hand wash or soap and water.
• Preserve contact space (at least 1 m/3 feet between you and someone who sneezes or coughs).
• Don’t touch your nose, head and ears.
• Cover your nose and mouth as you sneeze or cough, preferably with your bent elbow or tissue.
• Try to find early medical attention if you have fatigue, cough and trouble breathing.
• Take preventive precautions if you are in or have recently go to places where coronavirus spreads.

The first person believed to have become sick because of the latest virus was near in Wuhan on 1 December 2019. A formal warning of the epidemic was released on 31 December. The World Health Organization was informed of the epidemic on the same day. Through 7 January, the Chinese Government addressed the avoidance and regulation of COVID-19. A curfew was declared on 23 January to prohibit flying in and out of Wuhan. Private usage of cars has been banned in the region. Chinese New Year (25 January) festivities have been cancelled in many locations [ 50 ].

On 26 January, the Communist Party and the Government adopted more steps to contain the COVID-19 epidemic, including safety warnings for travellers and improvements to national holidays. The leading party has agreed to prolong the Spring Festival holiday to control the outbreak. Universities and schools across the world have already been locked down. Many steps have been taken by the Hong Kong and Macau governments, in particular concerning schools and colleges. Remote job initiatives have been placed in effect in many regions of China. Several immigration limits have been enforced.

Certain counties and cities outside Hubei also implemented travel limits. Public transit has been changed and museums in China have been partially removed. Some experts challenged the quality of the number of cases announced by the Chinese Government, which constantly modified the way coronavirus cases were recorded.

Italy, a member state of the European Union and a popular tourist attraction, entered the list of coronavirus-affected nations on 30 January, when two positive cases in COVID-19 were identified among Chinese tourists. Italy has the largest number of coronavirus infections both in Europe and outside of China [ 51 ].

Infections, originally limited to northern Italy, gradually spread to all other areas. Many other nations in Asia, Europe and the Americas have tracked their local cases to Italy. Several Italian travellers were even infected with coronavirus-positive in foreign nations.

Late in Italy, the most impacted coronavirus cities and counties are Lombardia, accompanied by Veneto, Emilia-Romagna, Marche and Piedmonte. Milan, the second most populated city in Italy, is situated in Lombardy. Other regions in Italy with coronavirus comprised Campania, Toscana, Liguria, Lazio, Sicilia, Friuli Venezia Giulia, Umbria, Puglia, Trento, Abruzzo, Calabria, Molise, Valle d’Aosta, Sardegna, Bolzano and Basilicata.

Italy ranks 19th of the top 30 nations getting high-risk coronavirus airline passengers in China, as per WorldPop’s provisional study of the spread of COVID-19.

The Italian State has taken steps like the inspection and termination of large cultural activities during the early days of the coronavirus epidemic and has gradually declared the closing of educational establishments and airport hygiene/disinfection initiatives.

The Italian National Institute of Health suggested social distancing and agreed that the broader community of the country’s elderly is a problem. In the meantime, several other nations, including the US, have recommended that travel to Italy should be avoided temporarily, unless necessary.

The Italian government has declared the closing (quarantine) of the impacted areas in the northern region of the nation so as not to spread to the rest of the world. Italy has declared the immediate suspension of all to-and-fro air travel with China following coronavirus discovery by a Chinese tourist to Italy. Italian airlines, like Ryan Air, have begun introducing protective steps and have begun calling for the declaration forms to be submitted by passengers flying to Poland, Slovakia and Lithuania.

The Italian government first declined to permit fans to compete in sporting activities until early April to prevent the potential transmission of coronavirus. The step ensured players of health and stopped event cancellations because of coronavirus fears. Two days of the declaration, the government cancelled all athletic activities owing to the emergence of the outbreak asking for an emergency. Sports activities in Veneto, Lombardy and Emilia-Romagna, which recorded coronavirus-positive infections, were confirmed to be temporarily suspended. Schools and colleges in Italy have also been forced to shut down.

Iran announced the first recorded cases of SARS-CoV-2 infection on 19 February when, as per the Medical Education and Ministry of Health, two persons died later that day. The Ministry of Islamic Culture and Guidance has declared the cancellation of all concerts and other cultural activities for one week. The Medical Education and Ministry of Health has also declared the closing of universities, higher education colleges and schools in many cities and regions. The Department of Sports and Culture has taken action to suspend athletic activities, including football matches [ 52 ].

On 2 March 2020, the government revealed plans to train about 300,000 troops and volunteers to fight the outbreak of the epidemic, and also send robots and water cannons to clean the cities. The State also developed an initiative and a webpage to counter the epidemic. On 9 March 2020, nearly 70,000 inmates were immediately released from jail owing to the epidemic, presumably to prevent the further dissemination of the disease inside jails. The Revolutionary Guards declared a campaign on 13 March 2020 to clear highways, stores and public areas in Iran. President Hassan Rouhani stated on 26 February 2020 that there were no arrangements to quarantine areas impacted by the epidemic and only persons should be quarantined. The temples of Shia in Qom stayed open to pilgrims.

South Korea

On 20 January, South Korea announced its first occurrence. There was a large rise in cases on 20 February, possibly due to the meeting in Daegu of a progressive faith community recognized as the Shincheonji Church of Christ. Any citizens believed that the hospital was propagating the disease. As of 22 February, 1,261 of the 9,336 members of the church registered symptoms. A petition was distributed calling for the abolition of the church. More than 2,000 verified cases were registered on 28 February, increasing to 3,150 on 29 February [ 53 ].

Several educational establishments have been partially closing down, including hundreds of kindergartens in Daegu and many primary schools in Seoul. As of 18 February, several South Korean colleges had confirmed intentions to delay the launch of the spring semester. That included 155 institutions deciding to postpone the start of the semester by two weeks until 16 March, and 22 institutions deciding to delay the start of the semester by one week until 9 March. Also, on 23 February 2020, all primary schools, kindergartens, middle schools and secondary schools were declared to postpone the start of the semester from 2 March to 9 March.

South Korea’s economy is expected to expand by 1.9%, down from 2.1%. The State has given 136.7 billion won funding to local councils. The State has also coordinated the purchase of masks and other sanitary supplies. Entertainment Company SM Entertainment is confirmed to have contributed five hundred million won in attempts to fight the disease.

In the kpop industry, the widespread dissemination of coronavirus within South Korea has contributed to the cancellation or postponement of concerts and other programmes for kpop activities inside and outside South Korea. For instance, circumstances such as the cancellation of the remaining Asian dates and the European leg for the Seventeen’s Ode To You Tour on 9 February 2020 and the cancellation of all Seoul dates for the BTS Soul Tour Map. As of 15 March, a maximum of 136 countries and regions provided entry restrictions and/or expired visas for passengers from South Korea.

The overall reported cases of coronavirus rose significantly in France on 12 March. The areas with reported cases include Paris, Amiens, Bordeaux and Eastern Haute-Savoie. The first coronaviral death happened in France on 15 February, marking it the first death in Europe. The second death of a 60-year-old French national in Paris was announced on 26 February [ 54 ].

On February 28, fashion designer Agnès B. (not to be mistaken with Agnès Buzyn) cancelled fashion shows at the Paris Fashion Week, expected to continue until 3 March. On a subsequent day, the Paris half-marathon, planned for Sunday 1 March with 44,000 entrants, was postponed as one of a series of steps declared by Health Minister Olivier Véran.

On 13 March, the Ligue de Football Professional disbanded Ligue 1 and Ligue 2 (France’s tier two professional divisions) permanently due to safety threats.

Germany has a popular Regional Pandemic Strategy detailing the roles and activities of the health care system participants in the case of a significant outbreak. Epidemic surveillance is carried out by the federal government, like the Robert Koch Center, and by the German governments. The German States have their preparations for an outbreak. The regional strategy for the treatment of the current coronavirus epidemic was expanded by March 2020. Four primary goals are contained in this plan: (1) to minimize mortality and morbidity; (2) to guarantee the safety of sick persons; (3) to protect vital health services and (4) to offer concise and reliable reports to decision-makers, the media and the public [ 55 ].

The programme has three phases that may potentially overlap: (1) isolation (situation of individual cases and clusters), (2) safety (situation of further dissemination of pathogens and suspected causes of infection), (3) prevention (situation of widespread infection). So far, Germany has not set up border controls or common health condition tests at airports. Instead, while at the isolation stage-health officials are concentrating on recognizing contact individuals that are subject to specific quarantine and are tracked and checked. Specific quarantine is regulated by municipal health authorities. By doing so, the officials are seeking to hold the chains of infection small, contributing to decreased clusters. At the safety stage, the policy should shift to prevent susceptible individuals from being harmed by direct action. By the end of the day, the prevention process should aim to prevent cycles of acute treatment to retain emergency facilities.

United States

The very first case of coronavirus in the United States was identified in Washington on 21 January 2020 by an individual who flew to Wuhan and returned to the United States. The second case was recorded in Illinois by another individual who had travelled to Wuhan. Some of the regions with reported novel coronavirus infections in the US are California, Arizona, Connecticut, Illinois, Texas, Wisconsin and Washington [ 56 ].

As the epidemic increased, requests for domestic air travel decreased dramatically. By 4 March, U.S. carriers, like United Airlines and JetBlue Airways, started growing their domestic flight schedules, providing generous unpaid leave to workers and suspending recruits.

A significant number of universities and colleges cancelled classes and reopened dormitories in response to the epidemic, like Cornell University, Harvard University and the University of South Carolina.

On 3 March 2020, the Federal Reserve reduced its goal interest rate from 1.75% to 1.25%, the biggest emergency rate cut following the 2008 global financial crash, in combat the effect of the recession on the American economy. In February 2020, US businesses, including Apple Inc. and Microsoft, started to reduce sales projections due to supply chain delays in China caused by the COVID-19.

The pandemic, together with the subsequent financial market collapse, also contributed to greater criticism of the crisis in the United States. Researchers disagree about when a recession is likely to take effect, with others suggesting that it is not unavoidable, while some claim that the world might already be in recession. On 3 March, Federal Reserve Chairman Jerome Powell reported a 0.5% (50 basis point) interest rate cut from the coronavirus in the context of the evolving threats to economic growth.

When ‘social distance’ penetrated the national lexicon, disaster response officials promoted the cancellation of broad events to slow down the risk of infection. Technical conferences like E3 2020, Apple Inc.’s Worldwide Developers Conference (WWDC), Google I/O, Facebook F8, and Cloud Next and Microsoft’s MVP Conference have been either having replaced or cancelled in-person events with internet streaming events.

On February 29, the American Physical Society postponed its annual March gathering, planned for March 2–6 in Denver, Colorado, even though most of the more than 11,000 physicist attendees already had arrived and engaged in the pre-conference day activities. On March 6, the annual South to Southwest (SXSW) seminar and festival planned to take place from March 13–22 in Austin, Texas, was postponed after the city council announced a local disaster and forced conferences to be shut down for the first time in 34 years.

Four of North America’s major professional sports leagues—the National Hockey League (NHL), National Basketball Association (NBA), Major League Soccer (MLS) and Major League Baseball (MLB) —jointly declared on March 9 that they would all limit the media access to player accommodations (such as locker rooms) to control probable exposure.

Emergency Funding to Fight the COVID-19

COVID-19 pandemic has become a common international concern. Different countries are donating funds to fight against it [ 57 – 60 ]. Some of them are mentioned here.

China has allocated about 110.48 billion yuan ($15.93 billion) in coronavirus-related funding.

Foreign Minister Mohammad Javad Zarif said that Iran has requested the International Monetary Fund (IMF) of about $5 billion in emergency funding to help to tackle the coronavirus epidemic that has struck the Islamic Republic hard.

President Donald Trump approved the Emergency Supplementary Budget Bill to support the US response to a novel coronavirus epidemic. The budget plan would include about $8.3 billion in discretionary funding to local health authorities to promote vaccine research for production. Trump originally requested just about $2 billion to combat the epidemic, but Congress quadrupled the number in its version of the bill. Mr. Trump formally announced a national emergency that he claimed it will give states and territories access to up to about $50 billion in federal funding to tackle the spread of the coronavirus outbreak.

California politicians approved a plan to donate about $1 billion on the state’s emergency medical responses as it readies hospitals to fight an expected attack of patients because of the COVID-19 pandemic. The plans, drawn up rapidly in reaction to the dramatic rise in reported cases of the virus, would include the requisite funds to establish two new hospitals in California, with the assumption that the state may not have the resources to take care of the rise in patients. The bill calls for an immediate response of about $500 million from the State General Fund, with an additional about $500 million possible if requested.

India committed about $10 million to the COVID-19 Emergency Fund and said it was setting up a rapid response team of physicians for the South Asian Association for Regional Cooperation (Saarc) countries.

South Korea unveiled an economic stimulus package of about 11.7 trillion won ($9.8 billion) to soften the effects of the biggest coronavirus epidemic outside China as attempts to curb the disease exacerbate supply shortages and drain demand. Of the 11,7 trillion won expected, about 3.2 trillion won would cover up the budget shortfall, while an additional fiscal infusion of about 8.5 trillion won. An estimated 10.3 trillion won in government bonds will be sold this year to fund the extra expenditure. About 2.3 trillion won will be distributed to medical establishments and would support quarantine operations, with another 3.0 trillion won heading to small and medium-sized companies unable to pay salaries to their employees and child care supports.

The Swedish Parliament announced a set of initiatives costing more than 300 billion Swedish crowns ($30.94 billion) to help the economy in the view of the coronavirus pandemic. The plan contained steps like the central government paying the entire expense of the company’s sick leave during April and May, and also the high cost of compulsory redundancies owing to the crisis.

In consideration of the developing scenario, an updating of this strategy is planned to take place before the end of March and will recognize considerably greater funding demands for the country response, R&D and WHO itself.

Artificial Intelligence, Data Science and Technological Solutions Against COVID-19

These days, Artificial Intelligence (AI) takes a major role in health care. Throughout a worldwide pandemic such as the COVID-19, technology, artificial intelligence and data analytics have been crucial in helping communities cope successfully with the epidemic [ 61 – 65 ]. Through the aid of data mining and analytical modelling, medical practitioners are willing to learn more about several diseases.

Public Health Surveillance

The biggest risk of coronavirus is the level of spreading. That’s why policymakers are introducing steps like quarantines around the world because they can’t adequately monitor local outbreaks. One of the simplest measures to identify ill patients through the study of CCTV images that are still around us and to locate and separate individuals that have serious signs of the disease and who have touched and disinfected the related surfaces. Smartphone applications are often used to keep a watch on people’s activities and to assess whether or not they have come in touch with an infected human.

Remote Biosignal Measurement

Many of the signs such as temperature or heartbeat are very essential to overlook and rely entirely on the visual image that may be misleading. However, of course, we can’t prevent someone from checking their blood pressure, heart or temperature. Also, several advances in computer vision can predict pulse and blood pressure based on facial skin examination. Besides, there are several advances in computer vision that can predict pulse and blood pressure based on facial skin examination.

Access to public records has contributed to the development of dashboards that constantly track the virus. Several companies are designing large data dashboards. Face recognition and infrared temperature monitoring technologies have been mounted in all major cities. Chinese AI companies including Hanwang Technology and SenseTime have reported having established a special facial recognition system that can correctly identify people even though they are covered.

IoT and Wearables

Measurements like pulse are much more natural and easier to obtain from tracking gadgets like activity trackers and smartwatches that nearly everybody has already. Some work suggests that the study of cardiac activity and its variations from the standard will reveal early signs of influenza and, in this case, coronavirus.

Chatbots and Communication

Apart from public screening, people’s knowledge and self-assessment may also be used to track their health. If you can check your temperature and pulse every day and monitor your coughs time-to-time, you can even submit that to your record. If the symptoms are too serious, either an algorithm or a doctor remotely may prescribe a person to stay home, take several other preventive measures, or recommend a visit from the doctor.

Al Jazeera announced that China Mobile had sent text messages to state media departments, telling them about the citizens who had been affected. The communications contained all the specifics of the person’s travel history.

Tencent runs WeChat, and via it, citizens can use free online health consultation services. Chatbots have already become important connectivity platforms for transport and tourism service providers to keep passengers up-to-date with the current transport protocols and disturbances.

Social Media and Open Data

There are several people who post their health diary with total strangers via Facebook or Twitter. Such data becomes helpful for more general research about how far the epidemic has progressed. For consumer knowledge, we may even evaluate the social network group to attempt to predict what specific networks are at risk of being viral.

Canadian company BlueDot analyses far more than just social network data: for instance, global activities of more than four billion passengers on international flights per year; animal, human and insect population data; satellite environment data and relevant knowledge from health professionals and journalists, across 100,000 news posts per day covering 65 languages. This strategy was so successful that the corporation was able to alert clients about coronavirus until the World Health Organization and the Centers for Disease Control and Prevention notified the public.

Automated Diagnostics

COVID-19 has brought up another healthcare issue today: it will not scale when the number of patients increases exponentially (actually stressed doctors are always doing worse) and the rate of false-negative diagnosis remains very high. Machine learning therapies don’t get bored and scale simply by growing computing forces.

Baidu, the Chinese Internet company, has made the Lineatrfold algorithm accessible to the outbreak-fighting teams, according to the MIT Technology Review. Unlike HIV, Ebola and Influenza, COVID-19 has just one strand of RNA and it can mutate easily. The algorithm is also simpler than other algorithms that help to determine the nature of the virus. Baidu has also developed software to efficiently track large populations. It has also developed an Ai-powered infrared device that can detect a difference in the body temperature of a human. This is currently being used in Beijing’s Qinghe Railway Station to classify possibly contaminated travellers where up to 200 individuals may be checked in one minute without affecting traffic movement, reports the MIT Review.

Singapore-based Veredus Laboratories, a supplier of revolutionary molecular diagnostic tools, has currently announced the launch of the VereCoV detector package, a compact Lab-on-Chip device able to detect MERS-CoV, SARS-CoV and COVID-19, i.e. Wuhan Coronavirus, in a single study.

The VereCoV identification package is focused on VereChip technology, a Lab-on-Chip device that incorporates two important molecular biological systems, Polymerase Chain Reaction (PCR) and a microarray, which will be able to classify and distinguish within 2 h MERS-CoV, SARS-CoV and COVID-19 with high precision and responsiveness.

This is not just the medical activities of healthcare facilities that are being charged, but also the corporate and financial departments when they cope with the increase in patients. Ant Financials’ blockchain technology helps speed-up the collection of reports and decreases the number of face-to-face encounters with patients and medical personnel.

Companies like the Israeli company Sonovia are aiming to provide healthcare systems and others with face masks manufactured from their anti-pathogenic, anti-bacterial cloth that depends on metal-oxide nanoparticles.

Drug Development Research

Aside from identifying and stopping the transmission of pathogens, the need to develop vaccinations on a scale is also needed. One of the crucial things to make that possible is to consider the origin and essence of the virus. Google’s DeepMind, with their expertise in protein folding research, has rendered a jump in identifying the protein structure of the virus and making it open-source.

BenevolentAI uses AI technologies to develop medicines that will combat the most dangerous diseases in the world and is also working to promote attempts to cure coronavirus, the first time the organization has based its product on infectious diseases. Within weeks of the epidemic, it used its analytical capability to recommend new medicines that might be beneficial.

Robots are not vulnerable to the infection, and they are used to conduct other activities, like cooking meals in hospitals, doubling up as waiters in hotels, spraying disinfectants and washing, selling rice and hand sanitizers, robots are on the front lines all over to deter coronavirus spread. Robots also conduct diagnostics and thermal imaging in several hospitals. Shenzhen-based firm Multicopter uses robotics to move surgical samples. UVD robots from Blue Ocean Robotics use ultraviolet light to destroy viruses and bacteria separately. In China, Pudu Technology has introduced its robots, which are usually used in the cooking industry, to more than 40 hospitals throughout the region. According to the Reuters article, a tiny robot named Little Peanut is distributing food to passengers who have been on a flight from Singapore to Hangzhou, China, and are presently being quarantined in a hotel.

Colour Coding

Using its advanced and vast public service monitoring network, the Chinese government has collaborated with software companies Alibaba and Tencent to establish a colour-coded health ranking scheme that monitors millions of citizens every day. The mobile device was first introduced in Hangzhou with the cooperation of Alibaba. This applies three colours to people—red, green or yellow—based on their transportation and medical records. Tencent also developed related applications in the manufacturing centre of Shenzhen.

The decision of whether an individual will be quarantined or permitted in public spaces is dependent on the colour code. Citizens will sign into the system using pay wallet systems such as Alibaba’s Alipay and Ant’s wallet. Just those citizens who have been issued a green colour code will be permitted to use the QR code in public spaces at metro stations, workplaces, and other public areas. Checkpoints are in most public areas where the body temperature and the code of individual are tested. This programme is being used by more than 200 Chinese communities and will eventually be expanded nationwide.

In some of the seriously infected regions where people remain at risk of contracting the infection, drones are used to rescue. One of the easiest and quickest ways to bring emergency supplies where they need to go while on an epidemic of disease is by drone transportation. Drones carry all surgical instruments and patient samples. This saves time, improves the pace of distribution and reduces the chance of contamination of medical samples. Drones often operate QR code placards that can be checked to record health records. There are also agricultural drones distributing disinfectants in the farmland. Drones, operated by facial recognition, are often used to warn people not to leave their homes and to chide them for not using face masks. Terra Drone uses its unmanned drones to move patient samples and vaccination content at reduced risk between the Xinchang County Disease Control Center and the People’s Hospital. Drones are often used to monitor public areas, document non-compliance with quarantine laws and thermal imaging.

Autonomous Vehicles

At a period of considerable uncertainty to medical professionals and the danger to people-to-people communication, automated vehicles are proving to be of tremendous benefit in the transport of vital products, such as medications and foodstuffs. Apollo, the Baidu Autonomous Vehicle Project, has joined hands with the Neolix self-driving company to distribute food and supplies to a big hospital in Beijing. Baidu Apollo has also provided its micro-car packages and automated cloud driving systems accessible free of charge to virus-fighting organizations.

Idriverplus, a Chinese self-driving organization that runs electrical street cleaning vehicles, is also part of the project. The company’s signature trucks are used to clean hospitals.

This chapter provides an introduction to the coronavirus outbreak (COVID-19). A brief history of this virus along with the symptoms are reported in this chapter. Then the comparison between COVID-19 and other plagues like seasonal influenza, bird flu (H5N1 and H7N9), Ebola epidemic, camel flu (MERS), swine flu (H1N1), severe acute respiratory syndrome, Hong Kong flu (H3N2), Spanish flu and the common cold are included in this chapter. Reviews of online portal and social media like Facebook, Twitter, Google, Microsoft, Pinterest, YouTube and WhatsApp concerning COVID-19 are reported in this chapter. Also, the preventive measures and policies enforced by WHO and different countries such as China, Italy, Iran, South Korea, France, Germany and the United States for COVID-19 are included in this chapter. Emergency funding provided by different countries to fight the COVID-19 is mentioned in this chapter. Lastly, artificial intelligence, data science and technological solutions like public health surveillance, remote biosignal measurement, IoT and wearables, chatbots and communication, social media and open data, automated diagnostics, drug development research, robotics, colour coding, drones and autonomous vehicles are included in this chapter.

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• Review Article
• Published: 27 September 2021

Why lockdown and distance learning during the COVID-19 pandemic are likely to increase the social class achievement gap

• Sébastien Goudeau   ORCID: orcid.org/0000-0001-7293-0977 1 ,
• Camille Sanrey   ORCID: orcid.org/0000-0003-3158-1306 1 ,
• Arnaud Stanczak   ORCID: orcid.org/0000-0002-2596-1516 2 ,
• Antony Manstead   ORCID: orcid.org/0000-0001-7540-2096 3 &
• Céline Darnon   ORCID: orcid.org/0000-0003-2613-689X 2  

Nature Human Behaviour volume  5 ,  pages 1273–1281 ( 2021 ) Cite this article

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The COVID-19 pandemic has forced teachers and parents to quickly adapt to a new educational context: distance learning. Teachers developed online academic material while parents taught the exercises and lessons provided by teachers to their children at home. Considering that the use of digital tools in education has dramatically increased during this crisis, and it is set to continue, there is a pressing need to understand the impact of distance learning. Taking a multidisciplinary view, we argue that by making the learning process rely more than ever on families, rather than on teachers, and by getting students to work predominantly via digital resources, school closures exacerbate social class academic disparities. To address this burning issue, we propose an agenda for future research and outline recommendations to help parents, teachers and policymakers to limit the impact of the lockdown on social-class-based academic inequality.

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The widespread effects of the COVID-19 pandemic that emerged in 2019–2020 have drastically increased health, social and economic inequalities 1 , 2 . For more than 900 million learners around the world, the pandemic led to the closure of schools and universities 3 . This exceptional situation forced teachers, parents and students to quickly adapt to a new educational context: distance learning. Teachers had to develop online academic materials that could be used at home to ensure educational continuity while ensuring the necessary physical distancing. Primary and secondary school students suddenly had to work with various kinds of support, which were usually provided online by their teachers. For college students, lockdown often entailed returning to their hometowns while staying connected with their teachers and classmates via video conferences, email and other digital tools. Despite the best efforts of educational institutions, parents and teachers to keep all children and students engaged in learning activities, ensuring educational continuity during school closure—something that is difficult for everyone—may pose unique material and psychological challenges for working-class families and students.

Not only did the pandemic lead to the closure of schools in many countries, often for several weeks, it also accelerated the digitalization of education and amplified the role of parental involvement in supporting the schoolwork of their children. Thus, beyond the specific circumstances of the COVID-19 lockdown, we believe that studying the effects of the pandemic on academic inequalities provides a way to more broadly examine the consequences of school closure and related effects (for example, digitalization of education) on social class inequalities. Indeed, bearing in mind that (1) the risk of further pandemics is higher than ever (that is, we are in a ‘pandemic era’ 4 , 5 ) and (2) beyond pandemics, the use of digital tools in education (and therefore the influence of parental involvement) has dramatically increased during this crisis, and is set to continue, there is a pressing need for an integrative and comprehensive model that examines the consequences of distance learning. Here, we propose such an integrative model that helps us to understand the extent to which the school closures associated with the pandemic amplify economic, digital and cultural divides that in turn affect the psychological functioning of parents, students and teachers in a way that amplifies academic inequalities. Bringing together research in social sciences, ranging from economics and sociology to social, cultural, cognitive and educational psychology, we argue that by getting students to work predominantly via digital resources rather than direct interactions with their teachers, and by making the learning process rely more than ever on families rather than teachers, school closures exacerbate social class academic disparities.

First, we review research showing that social class is associated with unequal access to digital tools, unequal familiarity with digital skills and unequal uses of such tools for learning purposes 6 , 7 . We then review research documenting how unequal familiarity with school culture, knowledge and skills can also contribute to the accentuation of academic inequalities 8 , 9 . Next, we present the results of surveys conducted during the 2020 lockdown showing that the quality and quantity of pedagogical support received from schools varied according to the social class of families (for examples, see refs. 10 , 11 , 12 ). We then argue that these digital, cultural and structural divides represent barriers to the ability of parents to provide appropriate support for children during distance learning (Fig. 1 ). These divides also alter the levels of self-efficacy of parents and children, thereby affecting their engagement in learning activities 13 , 14 . In the final section, we review preliminary evidence for the hypothesis that distance learning widens the social class achievement gap and we propose an agenda for future research. In addition, we outline recommendations that should help parents, teachers and policymakers to use social science research to limit the impact of school closure and distance learning on the social class achievement gap.

Economic, structural, digital and cultural divides influence the psychological functioning of parents and students in a way that amplify inequalities.

The digital divide

Unequal access to digital resources.

Although the use of digital technologies is almost ubiquitous in developed nations, there is a digital divide such that some people are more likely than others to be numerically excluded 15 (Fig. 1 ). Social class is a strong predictor of digital disparities, including the quality of hardware, software and Internet access 16 , 17 , 18 . For example, in 2019, in France, around 1 in 5 working-class families did not have personal access to the Internet compared with less than 1 in 20 of the most privileged families 19 . Similarly, in 2020, in the United Kingdom, 20% of children who were eligible for free school meals did not have access to a computer at home compared with 7% of other children 20 . In 2021, in the United States, 41% of working-class families do not own a laptop or desktop computer and 43% do not have broadband compared with 8% and 7%, respectively, of upper/middle-class Americans 21 . A similar digital gap is also evident between lower-income and higher-income countries 22 .

Second, simply having access to a computer and an Internet connection does not ensure effective distance learning. For example, many of the educational resources sent by teachers need to be printed, thereby requiring access to printers. Moreover, distance learning is more difficult in households with only one shared computer compared with those where each family member has their own 23 . Furthermore, upper/middle-class families are more likely to be able to guarantee a suitable workspace for each child than their working-class counterparts 24 .

In the context of school closures, such disparities are likely to have important consequences for educational continuity. In line with this idea, a survey of approximately 4,000 parents in the United Kingdom confirmed that during lockdown, more than half of primary school children from the poorest families did not have access to their own study space and were less well equipped for distance learning than higher-income families 10 . Similarly, a survey of around 1,300 parents in the Netherlands found that during lockdown, children from working-class families had fewer computers at home and less room to study than upper/middle-class children 11 .

Data from non-Western countries highlight a more general digital divide, showing that developing countries have poorer access to digital equipment. For example, in India in 2018, only 10.7% of households possessed a digital device 25 , while in Pakistan in 2020, 31% of higher-education teachers did not have Internet access and 68.4% did not have a laptop 26 . In general, developing countries lack access to digital technologies 27 , 28 , and these difficulties of access are even greater in rural areas (for example, see ref. 29 ). Consequently, school closures have huge repercussions for the continuity of learning in these countries. For example, in India in 2018, only 11% of the rural and 40% of the urban population above 14 years old could use a computer and access the Internet 25 . Time spent on education during school closure decreased by 80% in Bangladesh 30 . A similar trend was observed in other countries 31 , with only 22% of children engaging in remote learning in Kenya 32 and 50% in Burkina Faso 33 . In Ghana, 26–32% of children spent no time at all on learning during the pandemic 34 . Beyond the overall digital divide, social class disparities are also evident in developing countries, with lower access to digital resources among households in which parental educational levels were low (versus households in which parental educational levels were high; for example, see ref. 35 for Nigeria and ref. 31 for Ecuador).

Unequal digital skills

In addition to unequal access to digital tools, there are also systematic variations in digital skills 36 , 37 (Fig. 1 ). Upper/middle-class families are more familiar with digital tools and resources and are therefore more likely to have the digital skills needed for distance learning 38 , 39 , 40 . These digital skills are particularly useful during school closures, both for students and for parents, for organizing, retrieving and correctly using the resources provided by the teachers (for example, sending or receiving documents by email, printing documents or using word processors).

Social class disparities in digital skills can be explained in part by the fact that children from upper/middle-class families have the opportunity to develop digital skills earlier than working-class families 41 . In member countries of the OECD (Organisation for Economic Co-operation and Development), only 23% of working-class children had started using a computer at the age of 6 years or earlier compared with 43% of upper/middle-class children 42 . Moreover, because working-class people tend to persist less than upper/middle-class people when confronted with digital difficulties 23 , the use of digital tools and resources for distance learning may interfere with the ability of parents to help children with their schoolwork.

Unequal use of digital tools

A third level of digital divide concerns variations in digital tool use 18 , 43 (Fig. 1 ). Upper/middle-class families are more likely to use digital resources for work and education 6 , 41 , 44 , whereas working-class families are more likely to use these resources for entertainment, such as electronic games or social media 6 , 45 . This divide is also observed among students, whereby working-class students tend to use digital technologies for leisure activities, whereas their upper/middle-class peers are more likely to use them for academic activities 46 and to consider that computers and the Internet provide an opportunity for education and training 23 . Furthermore, working-class families appear to regulate the digital practices of their children less 47 and are more likely to allow screens in the bedrooms of children and teenagers without setting limits on times or practices 48 .

In sum, inequalities in terms of digital resources, skills and use have strong implications for distance learning. This is because they make working-class students and parents particularly vulnerable when learning relies on extensive use of digital devices rather than on face-to-face interaction with teachers.

The cultural divide

Even if all three levels of digital divide were closed, upper/middle-class families would still be better prepared than working-class families to ensure educational continuity for their children. Upper/middle-class families are more familiar with the academic knowledge and skills that are expected and valued in educational settings, as well as with the independent, autonomous way of learning that is valued in the school culture and becomes even more important during school closure (Fig. 1 ).

Unequal familiarity with academic knowledge and skills

According to classical social reproduction theory 8 , 49 , school is not a neutral place in which all forms of language and knowledge are equally valued. Academic contexts expect and value culture-specific and taken-for-granted forms of knowledge, skills and ways of being, thinking and speaking that are more in tune with those developed through upper/middle-class socialization (that is, ‘cultural capital’ 8 , 50 , 51 , 52 , 53 ). For instance, academic contexts value interest in the arts, museums and literature 54 , 55 , a type of interest that is more likely to develop through socialization in upper/middle-class families than in working-class socialization 54 , 56 . Indeed, upper/middle-class parents are more likely than working-class parents to engage in activities that develop this cultural capital. For example, they possess more books and cultural objects at home, read more stories to their children and visit museums and libraries more often (for examples, see refs. 51 , 54 , 55 ). Upper/middle-class children are also more involved in extra-curricular activities (for example, playing a musical instrument) than working-class children 55 , 56 , 57 .

Beyond this implicit familiarization with the school curriculum, upper/middle-class parents more often organize educational activities that are explicitly designed to develop academic skills of their children 57 , 58 , 59 . For example, they are more likely to monitor and re-explain lessons or use games and textbooks to develop and reinforce academic skills (for example, labelling numbers, letters or colours 57 , 60 ). Upper/middle-class parents also provide higher levels of support and spend more time helping children with homework than working-class parents (for examples, see refs. 61 , 62 ). Thus, even if all parents are committed to the academic success of their children, working-class parents have fewer chances to provide the help that children need to complete homework 63 , and homework is more beneficial for children from upper-middle class families than for children from working-class families 64 , 65 .

School closures amplify the impact of cultural inequalities

The trends described above have been observed in ‘normal’ times when schools are open. School closures, by making learning rely more strongly on practices implemented at home (rather than at school), are likely to amplify the impact of these disparities. Consistent with this idea, research has shown that the social class achievement gap usually greatly widens during school breaks—a phenomenon described as ‘summer learning loss’ or ‘summer setback’ 66 , 67 , 68 . During holidays, the learning by children tends to decline, and this is particularly pronounced in children from working-class families. Consequently, the social class achievement gap grows more rapidly during the summer months than it does in the rest of the year. This phenomenon is partly explained by the fact that during the break from school, social class disparities in investment in activities that are beneficial for academic achievement (for example, reading, travelling to a foreign country or museum visits) are more pronounced.

Therefore, when they are out of school, children from upper/middle-class backgrounds may continue to develop academic skills unlike their working-class counterparts, who may stagnate or even regress. Research also indicates that learning loss during school breaks tends to be cumulative 66 . Thus, repeated episodes of school closure are likely to have profound consequences for the social class achievement gap. Consistent with the idea that school closures could lead to similar processes as those identified during summer breaks, a recent survey indicated that during the COVID-19 lockdown in the United Kingdom, children from upper/middle-class families spent more time on educational activities (5.8 h per day) than those from working-class families (4.5 h per day) 7 , 69 .

Unequal dispositions for autonomy and self-regulation

School closures have encouraged autonomous work among students. This ‘independent’ way of studying is compatible with the family socialization of upper/middle-class students, but does not match the interdependent norms more commonly associated with working-class contexts 9 . Upper/middle-class contexts tend to promote cultural norms of independence whereby individuals perceive themselves as autonomous actors, independent of other individuals and of the social context, able to pursue their own goals 70 . For example, upper/middle-class parents tend to invite children to express their interests, preferences and opinions during the various activities of everyday life 54 , 55 . Conversely, in working-class contexts characterized by low economic resources and where life is more uncertain, individuals tend to perceive themselves as interdependent, connected to others and members of social groups 53 , 70 , 71 . This interdependent self-construal fits less well with the independent culture of academic contexts. This cultural mismatch between interdependent self-construal common in working-class students and the independent norms of the educational institution has negative consequences for academic performance 9 .

Once again, the impact of these differences is likely to be amplified during school closures, when being able to work alone and autonomously is especially useful. The requirement to work alone is more likely to match the independent self-construal of upper/middle-class students than the interdependent self-construal of working-class students. In the case of working-class students, this mismatch is likely to increase their difficulties in working alone at home. Supporting our argument, recent research has shown that working-class students tend to underachieve in contexts where students work individually compared with contexts where students work with others 72 . Similarly, during school closures, high self-regulation skills (for example, setting goals, selecting appropriate learning strategies and maintaining motivation 73 ) are required to maintain study activities and are likely to be especially useful for using digital resources efficiently. Research has shown that students from working-class backgrounds typically develop their self-regulation skills to a lesser extent than those from upper/middle-class backgrounds 74 , 75 , 76 .

Interestingly, some authors have suggested that independent (versus interdependent) self-construal may also affect communication with teachers 77 . Indeed, in the context of distance learning, working-class families are less likely to respond to the communication of teachers because their ‘interdependent’ self leads them to respect hierarchies, and thus perceive teachers as an expert who ‘can be trusted to make the right decisions for learning’. Upper/middle class families, relying on ‘independent’ self-construal, are more inclined to seek individualized feedback, and therefore tend to participate to a greater extent in exchanges with teachers. Such cultural differences are important because they can also contribute to the difficulties encountered by working-class families.

The structural divide: unequal support from schools

The issues reviewed thus far all increase the vulnerability of children and students from underprivileged backgrounds when schools are closed. To offset these disadvantages, it might be expected that the school should increase its support by providing additional resources for working-class students. However, recent data suggest that differences in the material and human resources invested in providing educational support for children during periods of school closure were—paradoxically—in favour of upper/middle-class students (Fig. 1 ). In England, for example, upper/middle-class parents reported benefiting from online classes and video-conferencing with teachers more often than working-class parents 10 . Furthermore, active help from school (for example, online teaching, private tutoring or chats with teachers) occurred more frequently in the richest households (64% of the richest households declared having received help from school) than in the poorest households (47%). Another survey found that in the United Kingdom, upper/middle-class children were more likely to take online lessons every day (30%) than working-class students (16%) 12 . This substantial difference might be due, at least in part, to the fact that private schools are better equipped in terms of online platforms (60% of schools have at least one online platform) than state schools (37%, and 23% in the most deprived schools) and were more likely to organize daily online lessons. Similarly, in the United Kingdom, in schools with a high proportion of students eligible for free school meals, teachers were less inclined to broadcast an online lesson for their pupils 78 . Interestingly, 58% of teachers in the wealthiest areas reported having messaged their students or their students’ parents during lockdown compared with 47% in the most deprived schools. In addition, the probability of children receiving technical support from the school (for example, by providing pupils with laptops or other devices) is, surprisingly, higher in the most advantaged schools than in the most deprived 78 .

In addition to social class disparities, there has been less support from schools for African-American and Latinx students. During school closures in the United States, 40% of African-American students and 30% of Latinx students received no online teaching compared with 10% of white students 79 . Another source of inequality is that the probability of school closure was correlated with social class and race. In the United States, for example, school closures from September to December 2020 were more common in schools with a high proportion of racial/ethnic minority students, who experience homelessness and are eligible for free/discounted school meals 80 .

Similarly, access to educational resources and support was lower in poorer (compared with richer) countries 81 . In sub-Saharan Africa, during lockdown, 45% of children had no exposure at all to any type of remote learning. Of those who did, the medium was mostly radio, television or paper rather than digital. In African countries, at most 10% of children received some material through the Internet. In Latin America, 90% of children received some remote learning, but less than half of that was through the internet—the remainder being via radio and television 81 . In Ecuador, high-school students from the lowest wealth quartile had fewer remote-learning opportunities, such as Google class/Zoom, than students from the highest wealth quartile 31 .

Thus, the achievement gap and its accentuation during lockdown are due not only to the cultural and digital disadvantages of working-class families but also to unequal support from schools. This inequality in school support is not due to teachers being indifferent to or even supportive of social stratification. Rather, we believe that these effects are fundamentally structural. In many countries, schools located in upper/middle-class neighbourhoods have more money than those in the poorest neighbourhoods. Moreover, upper/middle-class parents invest more in the schools of their children than working-class parents (for example, see ref. 82 ), and schools have an interest in catering more for upper/middle-class families than for working-class families 83 . Additionally, the expectation of teachers may be lower for working-class children 84 . For example, they tend to estimate that working-class students invest less effort in learning than their upper/middle-class counterparts 85 . These differences in perception may have influenced the behaviour of teachers during school closure, such that teachers in privileged neighbourhoods provided more information to students because they expected more from them in term of effort and achievement. The fact that upper/middle-class parents are better able than working-class parents to comply with the expectations of teachers (for examples, see refs. 55 , 86 ) may have reinforced this phenomenon. These discrepancies echo data showing that working-class students tend to request less help in their schoolwork than upper/middle-class ones 87 , and they may even avoid asking for help because they believe that such requests could lead to reprimands 88 . During school closures, these students (and their families) may in consequence have been less likely to ask for help and resources. Jointly, these phenomena have resulted in upper/middle-class families receiving more support from schools during lockdown than their working-class counterparts.

Psychological effects of digital, cultural and structural divides

Despite being strongly influenced by social class, differences in academic achievement are often interpreted by parents, teachers and students as reflecting differences in ability 89 . As a result, upper/middle-class students are usually perceived—and perceive themselves—as smarter than working-class students, who are perceived—and perceive themselves—as less intelligent 90 , 91 , 92 or less able to succeed 93 . Working-class students also worry more about the fact that they might perform more poorly than upper/middle-class students 94 , 95 . These fears influence academic learning in important ways. In particular, they can consume cognitive resources when children and students work on academic tasks 96 , 97 . Self-efficacy also plays a key role in engaging in learning and perseverance in the face of difficulties 13 , 98 . In addition, working-class students are those for whom the fear of being outperformed by others is the most negatively related to academic performance 99 .

The fact that working-class children and students are less familiar with the tasks set by teachers, and less well equipped and supported, makes them more likely to experience feelings of incompetence (Fig. 1 ). Working-class parents are also more likely than their upper/middle-class counterparts to feel unable to help their children with schoolwork. Consistent with this, research has shown that both working-class students and parents have lower feelings of academic self-efficacy than their upper/middle-class counterparts 100 , 101 . These differences have been documented under ‘normal’ conditions but are likely to be exacerbated during distance learning. Recent surveys conducted during the school closures have confirmed that upper/middle-class families felt better able to support their children in distance learning than did working-class families 10 and that upper/middle-class parents helped their children more and felt more capable to do so 11 , 12 .

Pandemic disparity, future directions and recommendations

The research reviewed thus far suggests that children and their families are highly unequal with respect to digital access, skills and use. It also shows that upper/middle-class students are more likely to be supported in their homework (by their parents and teachers) than working-class students, and that upper/middle-class students and parents will probably feel better able than working-class ones to adapt to the context of distance learning. For all these reasons, we anticipate that as a result of school closures, the COVID-19 pandemic will substantially increase the social class achievement gap. Because school closures are a recent occurrence, it is too early to measure with precision their effects on the widening of the achievement gap. However, some recent data are consistent with this idea.

Evidence for a widening gap during the pandemic

Comparing academic achievement in 2020 with previous years provides an early indication of the effects of school closures during the pandemic. In France, for example, first and second graders take national evaluations at the beginning of the school year. Initial comparisons of the results for 2020 with those from previous years revealed that the gap between schools classified as ‘priority schools’ (those in low-income urban areas) and schools in higher-income neighbourhoods—a gap observed every year—was particularly pronounced in 2020 in both French and mathematics 102 .

Similarly, in the Netherlands, national assessments take place twice a year. In 2020, they took place both before and after school closures. A recent analysis compared progress during this period in 2020 in mathematics/arithmetic, spelling and reading comprehension for 7–11-year-old students within the same period in the three previous years 103 . Results indicated a general learning loss in 2020. More importantly, for the 8% of working-class children, the losses were 40% greater than they were for upper/middle-class children.

Similar results were observed in Belgium among students attending the final year of primary school. Compared with students from previous cohorts, students affected by school closures experienced a substantial decrease in their mathematics and language scores, with children from more disadvantaged backgrounds experiencing greater learning losses 104 . Likewise, oral reading assessments in more than 100 school districts in the United States showed that the development of this skill among children in second and third grade significantly slowed between Spring and Autumn 2020, but this slowdown was more pronounced in schools from lower-achieving districts 105 .

It is likely that school closures have also amplified racial disparities in learning and achievement. For example, in the United States, after the first lockdown, students of colour lost the equivalent of 3–5 months of learning, whereas white students were about 1–3 months behind. Moreover, in the Autumn, when some students started to return to classrooms, African-American and Latinx students were more likely to continue distance learning, despite being less likely to have access to the digital tools, Internet access and live contact with teachers 106 .

In some African countries (for example, Ethiopia, Kenya, Liberia, Tanzania and Uganda), the COVID-19 crisis has resulted in learning loss ranging from 6 months to more 1 year 107 , and this learning loss appears to be greater for working-class children (that is, those attending no-fee schools) than for upper/middle-class children 108 .

These findings show that school closures have exacerbated achievement gaps linked to social class and ethnicity. However, more research is needed to address the question of whether school closures differentially affect the learning of students from working- and upper/middle-class families.

Future directions

First, to assess the specific and unique impact of school closures on student learning, longitudinal research should compare student achievement at different times of the year, before, during and after school closures, as has been done to document the summer learning loss 66 , 109 . In the coming months, alternating periods of school closure and opening may occur, thereby presenting opportunities to do such research. This would also make it possible to examine whether the gap diminishes a few weeks after children return to in-school learning or whether, conversely, it increases with time because the foundations have not been sufficiently acquired to facilitate further learning 110 .

Second, the mechanisms underlying the increase in social class disparities during school closures should be examined. As discussed above, school closures result in situations for which students are unevenly prepared and supported. It would be appropriate to seek to quantify the contribution of each of the factors that might be responsible for accentuating the social class achievement gap. In particular, distinguishing between factors that are relatively ‘controllable’ (for example, resources made available to pupils) and those that are more difficult to control (for example, the self-efficacy of parents in supporting the schoolwork of their children) is essential to inform public policy and teaching practices.

Third, existing studies are based on general comparisons and very few provide insights into the actual practices that took place in families during school closure and how these practices affected the achievement gap. For example, research has documented that parents from working-class backgrounds are likely to find it more difficult to help their children to complete homework and to provide constructive feedback 63 , 111 , something that could in turn have a negative impact on the continuity of learning of their children. In addition, it seems reasonable to assume that during lockdown, parents from upper/middle-class backgrounds encouraged their children to engage in practices that, even if not explicitly requested by teachers, would be beneficial to learning (for example, creative activities or reading). Identifying the practices that best predict the maintenance or decline of educational achievement during school closures would help identify levers for intervention.

Finally, it would be interesting to investigate teaching practices during school closures. The lockdown in the spring of 2020 was sudden and unexpected. Within a few days, teachers had to find a way to compensate for the school closure, which led to highly variable practices. Some teachers posted schoolwork on platforms, others sent it by email, some set work on a weekly basis while others set it day by day. Some teachers also set up live sessions in large or small groups, providing remote meetings for questions and support. There have also been variations in the type of feedback given to students, notably through the monitoring and correcting of work. Future studies should examine in more detail what practices schools and teachers used to compensate for the school closures and their effects on widening, maintaining or even reducing the gap, as has been done for certain specific literacy programmes 112 as well as specific instruction topics (for example, ecology and evolution 113 ).

Practical recommendations

We are aware of the debate about whether social science research on COVID-19 is suitable for making policy decisions 114 , and we draw attention to the fact that some of our recommendations (Table 1 ) are based on evidence from experiments or interventions carried out pre-COVID while others are more speculative. In any case, we emphasize that these suggestions should be viewed with caution and be tested in future research. Some of our recommendations could be implemented in the event of new school closures, others only when schools re-open. We also acknowledge that while these recommendations are intended for parents and teachers, their implementation largely depends on the adoption of structural policies. Importantly, given all the issues discussed above, we emphasize the importance of prioritizing, wherever possible, in-person learning over remote learning 115 and where this is not possible, of implementing strong policies to support distance learning, especially for disadvantaged families.

Where face-to face teaching is not possible and teachers are responsible for implementing distance learning, it will be important to make them aware of the factors that can exacerbate inequalities during lockdown and to provide them with guidance about practices that would reduce these inequalities. Thus, there is an urgent need for interventions aimed at making teachers aware of the impact of the social class of children and families on the following factors: (1) access to, familiarity with and use of digital devices; (2) familiarity with academic knowledge and skills; and (3) preparedness to work autonomously. Increasing awareness of the material, cultural and psychological barriers that working-class children and families face during lockdown should increase the quality and quantity of the support provided by teachers and thereby positively affect the achievements of working-class students.

In addition to increasing the awareness of teachers of these barriers, teachers should be encouraged to adjust the way they communicate with working-class families due to differences in self-construal compared with upper/middle-class families 77 . For example, questions about family (rather than personal) well-being would be congruent with interdependent self-construals. This should contribute to better communication and help keep a better track of the progress of students during distance learning.

It is also necessary to help teachers to engage in practices that have a chance of reducing inequalities 53 , 116 . Particularly important is that teachers and schools ensure that homework can be done by all children, for example, by setting up organizations that would help children whose parents are not in a position to monitor or assist with the homework of their children. Options include homework help groups and tutoring by teachers after class. When schools are open, the growing tendency to set homework through digital media should be resisted as far as possible given the evidence we have reviewed above. Moreover, previous research has underscored the importance of homework feedback provided by teachers, which is positively related to the amount of homework completed and predictive of academic performance 117 . Where homework is web-based, it has also been shown that feedback on web-based homework enhances the learning of students 118 . It therefore seems reasonable to predict that the social class achievement gap will increase more slowly (or even remain constant or be reversed) in schools that establish individualized monitoring of students, by means of regular calls and feedback on homework, compared with schools where the support provided to pupils is more generic.

Given that learning during lockdown has increasingly taken place in family settings, we believe that interventions involving the family are also likely to be effective 119 , 120 , 121 . Simply providing families with suitable material equipment may be insufficient. Families should be given training in the efficient use of digital technology and pedagogical support. This would increase the self-efficacy of parents and students, with positive consequences for achievement. Ideally, such training would be delivered in person to avoid problems arising from the digital divide. Where this is not possible, individualized online tutoring should be provided. For example, studies conducted during the lockdown in Botswana and Italy have shown that individual online tutoring directly targeting either parents or students in middle school has a positive impact on the achievement of students, particularly for working-class students 122 , 123 .

Interventions targeting families should also address the psychological barriers faced by working-class families and children. Some interventions have already been designed and been shown to be effective in reducing the social class achievement gap, particularly in mathematics and language 124 , 125 , 126 . For example, research showed that an intervention designed to train low-income parents in how to support the mathematical development of their pre-kindergarten children (including classes and access to a library of kits to use at home) increased the quality of support provided by the parents, with a corresponding impact on the development of mathematical knowledge of their children. Such interventions should be particularly beneficial in the context of school closure.

Beyond its impact on academic performance and inequalities, the COVID-19 crisis has shaken the economies of countries around the world, casting millions of families around the world into poverty 127 , 128 , 129 . As noted earlier, there has been a marked increase in economic inequalities, bringing with it all the psychological and social problems that such inequalities create 130 , 131 , especially for people who live in scarcity 132 . The increase in educational inequalities is just one facet of the many difficulties that working-class families will encounter in the coming years, but it is one that could seriously limit the chances of their children escaping from poverty by reducing their opportunities for upward mobility. In this context, it should be a priority to concentrate resources on the most deprived students. A large proportion of the poorest households do not own a computer and do not have personal access to the Internet, which has important consequences for distance learning. During school closures, it is therefore imperative to provide such families with adequate equipment and Internet service, as was done in some countries in spring 2020. Even if the provision of such equipment is not in itself sufficient, it is a necessary condition for ensuring pedagogical continuity during lockdown.

Finally, after prolonged periods of school closure, many students may not have acquired the skills needed to pursue their education. A possible consequence would be an increase in the number of students for whom teachers recommend class repetitions. Class repetitions are contentious. On the one hand, class repetition more frequently affects working-class children and is not efficient in terms of learning improvement 133 . On the other hand, accepting lower standards of academic achievement or even suspending the practice of repeating a class could lead to pupils pursuing their education without mastering the key abilities needed at higher grades. This could create difficulties in subsequent years and, in this sense, be counterproductive. We therefore believe that the most appropriate way to limit the damage of the pandemic would be to help children catch up rather than allowing them to continue without mastering the necessary skills. As is being done in some countries, systematic remedial courses (for example, summer learning programmes) should be organized and financially supported following periods of school closure, with priority given to pupils from working-class families. Such interventions have genuine potential in that research has shown that participation in remedial summer programmes is effective in reducing learning loss during the summer break 134 , 135 , 136 . For example, in one study 137 , 438 students from high-poverty schools were offered a multiyear summer school programme that included various pedagogical and enrichment activities (for example, science investigation and music) and were compared with a ‘no-treatment’ control group. Students who participated in the summer programme progressed more than students in the control group. A meta-analysis 138 of 41 summer learning programmes (that is, classroom- and home-based summer interventions) involving children from kindergarten to grade 8 showed that these programmes had significantly larger benefits for children from working-class families. Although such measures are costly, the cost is small compared to the price of failing to fulfil the academic potential of many students simply because they were not born into upper/middle-class families.

The unprecedented nature of the current pandemic means that we lack strong data on what the school closure period is likely to produce in terms of learning deficits and the reproduction of social inequalities. However, the research discussed in this article suggests that there are good reasons to predict that this period of school closures will accelerate the reproduction of social inequalities in educational achievement.

By making school learning less dependent on teachers and more dependent on families and digital tools and resources, school closures are likely to greatly amplify social class inequalities. At a time when many countries are experiencing second, third or fourth waves of the pandemic, resulting in fresh periods of local or general lockdowns, systematic efforts to test these predictions are urgently needed along with steps to reduce the impact of school closures on the social class achievement gap.

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Acknowledgements

We thank G. Reis for editing the figure. The writing of this manuscript was supported by grant ANR-19-CE28-0007–PRESCHOOL from the French National Research Agency (S.G.).

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Goudeau, S., Sanrey, C., Stanczak, A. et al. Why lockdown and distance learning during the COVID-19 pandemic are likely to increase the social class achievement gap. Nat Hum Behav 5 , 1273–1281 (2021). https://doi.org/10.1038/s41562-021-01212-7

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Outbreaks have been reported in places where people have gather, often in crowded indoor settings and where they talk loudly, shout, breathe heavily or sing such as restaurants, choir practices, fitness classes, nightclubs, offices and places of worship.

To make your environment as safe as possible:

• Avoid the 3Cs: spaces that are c losed, c rowded or involve c lose contact.
• Meet people outside. Outdoor gatherings are safer than indoor ones, particularly if indoor spaces are small and without outdoor air coming in.
• If you can’t avoid crowded or indoor settings, take these precautions:
• Open a window to increase the amount of natural ventilation when indoors.
• Wear a mask (see above for more details).
• Small public gatherings
• Ventilation and air conditioning (for the general public)
• Ventilation and air conditioning (for people who manage public spaces and buildings) 

Keep good hygiene

By following good respiratory hygiene you protect the people around you from viruses that cause colds, flu and COVID-19. 

To ensure good hygiene you should:

• Regularly and thoroughly clean your hands with either an alcohol-based hand rub or soap and water. This eliminates germs that may be on your hands, including viruses.
• Cover your mouth and nose with your bent elbow or a tissue when you cough or sneeze. Dispose of the used tissue immediately into a closed bin and wash your hands.
• Clean and disinfect surfaces frequently, especially those which are regularly touched, such as door handles, faucets and phone screens.

What to do if you feel unwell

If you feel unwell, here’s what to do. 

• If you have a fever, cough and difficulty breathing, seek medical attention immediately. Call by telephone first and follow the directions of your local health authority.
• Know the full range of symptoms of COVID-19. The most common symptoms of COVID-19 are fever, dry cough, tiredness and loss of taste or smell. Less common symptoms include aches and pains, headache, sore throat, red or irritated eyes, diarrhoea,  a skin rash or discolouration of fingers or toes.
• Stay home and self-isolate for 10 days from symptom onset, plus three days after symptoms cease. Call your health care provider or hotline for advice. Have someone bring you supplies. If you need to leave your house or have someone near you, wear a properly fitted mask to avoid infecting others.
• Keep up to date on the latest information from trusted sources, such as WHO or your local and national health authorities. Local and national authorities and public health units are best placed to advise on what people in your area should be doing to protect themselves.

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12 Ideas for Writing Through the Pandemic With The New York Times

A dozen writing projects — including journals, poems, comics and more — for students to try at home.

By Natalie Proulx

The coronavirus has transformed life as we know it. Schools are closed, we’re confined to our homes and the future feels very uncertain. Why write at a time like this?

For one, we are living through history. Future historians may look back on the journals, essays and art that ordinary people are creating now to tell the story of life during the coronavirus.

But writing can also be deeply therapeutic. It can be a way to express our fears, hopes and joys. It can help us make sense of the world and our place in it.

Plus, even though school buildings are shuttered, that doesn’t mean learning has stopped. Writing can help us reflect on what’s happening in our lives and form new ideas.

We want to help inspire your writing about the coronavirus while you learn from home. Below, we offer 12 projects for students, all based on pieces from The New York Times, including personal narrative essays, editorials, comic strips and podcasts. Each project features a Times text and prompts to inspire your writing, as well as related resources from The Learning Network to help you develop your craft. Some also offer opportunities to get your work published in The Times, on The Learning Network or elsewhere.

We know this list isn’t nearly complete. If you have ideas for other pandemic-related writing projects, please suggest them in the comments.

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