effects of corona virus essay

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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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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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The impact of COVID-19 on global health goals

21 may 2021 | spotlight, covid-19 responsible for at least 3 million excess deaths in 2020.

As of 31 December 2020, COVID-19 had infected over 82 million people and killed more than 1.8 million worldwide. But preliminary estimates suggest the total number of global “excess deaths” directly and indirectly attributable to COVID-19 in 2020 amount to at least 3 million , 1.2 million higher than the official figures reported by countries to WHO.

With the latest COVID-19 deaths reported to WHO now exceeding 3.4 million, based on the estimates produced for 2020, we are likely facing a significant undercount of total deaths directly and indirectly attributed to COVID-19.

The term “excess deaths” describes deaths beyond what would have been expected under “normal” conditions. It captures not only confirmed deaths, but also COVID-19 deaths that were not correctly diagnosed and reported as well as deaths attributable to the overall crisis conditions. This provides a more comprehensive and accurate measure when compared with confirmed COVID-19 deaths alone.

For example, some countries only report COVID-19 deaths occurring in hospitals or the deaths of people who have tested positive for COVID-19. In addition, many countries cannot accurately measure or report cause of death due to inadequate or under-resourced health information systems.

The pandemic has likely increased deaths from other causes due to disruption to health service delivery and routine immunizations, fewer people seeking care, and shortages of funding for non-COVID-19 services. The second WHO “pulse survey” of 135 countries in March 2021 highlighted persistent disruptions at a considerable scale over one year into the pandemic, with 90% of countries reporting one or more disruptions to essential health services.

Real-time, quality data to track population health is critical for every country to improve health outcomes and eliminate health inequalities.

“Real-time, quality data to track population health is critical for every country to improve health outcomes and eliminate health inequalities", says Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. "WHO is committed to work with countries and partners to strengthen health information systems and support data-driven policies and interventions."

COVID-19 disproportionately impacts vulnerable populations

COVID-19 has exposed persistent inequalities by income, age, race, sex and geographic location. Despite recent global health gains, across the world people continue to face complex, interconnected threats to their health and well-being rooted in social, economic, political and environmental determinants of health.

The pandemic has also revealed significant gaps in country health information systems. While high-resource settings have faced challenges related to overstretched capacity and fragmentation, weaker health systems risk jeopardizing hard-won health and development gains made in recent decades.

Data from the COVID-19 World Symptoms survey shows a decline in preventive behaviours such as physical distancing, mask wearing and hand washing as household overcrowding increases. Among people living in uncrowded households, 79% reported trying to physically distance themselves compared with 71% in moderately overcrowded and 65% in extremely overcrowded households. Similar trends were observed for hand washing and mask-wearing, underscoring vulnerabilities due to socioeconomic status.

Source: WHO calculations using COVID-19 World Symptoms Survey data led by Facebook and the University of Maryland for 35 high-income countries, May 2020 – February 2021.

Irrespective of the pandemic, inequalities and data gaps impede targeted interventions. For example, a recent WHO global assessment of health information systems capacity found that only half of countries include disaggregated data in their published national health statistical reports. Investing in strong health information systems is vital to ensure disaggregated data reaches decision-makers and achieve equitable health outcomes.

With stronger, more equitable health information systems we can more accurately measure progress towards the health-related Sustainable Development Goals and WHO’s Triple Billion targets. “We are now less than nine years away from 2030”, says Dr Samira Asma, Assistant Director-General for the Division of Data, Analytics and Delivery for Impact at WHO. “We know where the gaps are, and we have the solutions to address them. What we need now is commitment and investment to accelerate progress and reach our goals.”

Before COVID-19 the world was making progress towards global health goals - but not fast enough

The World Health Statistics 2021 report presents the most up-to-date data and trends on more than 50 health-related indicators for the Sustainable Development Goal and WHO’s Triple Billion targets.

The data shows that global life expectancy at birth has increased from 66.8 years in 2000 to 73.3 years in 2019, and healthy life expectancy has increased from 58.3 years to 63.7 years. But even before the pandemic struck, progress was too slow and uneven to meet many targets including reduced premature mortality from noncommunicable diseases, tuberculosis and malaria incidence, and new HIV infections.

Chart showing where people living a higher proportion of years in good health

“Although we are living extended lives and more years in good health, these are no grounds for complacency”, says Dr Bochen Cao, Technical Officer in the Division of Data, Analytics and Delivery for Impact at WHO. “Many of the underlying health determinants still need critical improvements, and COVID-19 is yet another wake-up call to remind us that our health remains at risk unless urgent actions are taken to close the gaps.”

For instance, while global tobacco use has decreased by 33% since 2000 the prevalence of adult obesity is increasing, and in 2016 up to a quarter of the populations in high-income countries were obese. And although the prevalence of hypertension declined worldwide between 2000 and 2015, it is increasing slightly in low-income countries.

Children and women in low and lower-middle-income countries are also at higher risk of malnutrition including stunting, wasting, and anaemia during pregnancy, while people in upper-middle-income countries are more susceptible to being overweight.

Before COVID-19, many countries were making progress towards universal health coverage. Improvements in the coverage of essential health services were recorded in all income groups and across different types of services, despite persistent inequalities. But financial protection has been deteriorating. As of the latest figures, the proportion of the population spending more than 10% of their household budget on healthcare rose from 9% to 13% between 2000 and 2015, and almost 3% were spending more than 25% of their budget on health care.

Chart showing global progress towards triple billion targets

Health emergencies protection also requires urgent reform. Despite an increased focus on global health security, COVID-19 has revealed a critical need for a well-coordinated, multisectoral health emergency surge capacity and preparedness at all levels and within all countries. Continuing efforts are needed to improve and maintain early warning systems to mitigate and manage public health risks within the national context and to consider the worldwide pandemic contexts for national health emergency and operational preparedness planning.

World Health Data Hub to improve access to data

In addition to underscoring inequalities and data gaps, COVID-19 has highlighted the need for universal access to global health data. WHO’s new World Health Data Hub will provide an interactive digital platform and trusted source for all global health data, fulfilling WHO’s commitment to provide health data as a public good.

The Hub will provide easy access to powerful visualization tools that reveal trends, patterns and connections and draw insights. It will also allow Member States to upload and review their data in a secure environment, will be scalable to allow different varieties, volumes and velocities of data and will provide access to the latest predictive analytics technologies.

The Hub brings together all of WHO’s data assets including the Global Health Observatory , the GPW 13 Triple Billion dashboard , the health equity monitor , and the WHO Mortality Database .

Leveraging partnerships to get back on track

The World Health Data Hub is made possible through partnerships that combine digital technology and innovative solutions with the global convening capabilities of an organization like WHO. As key technology partners, Microsoft and Avanade are supporting WHO to deliver this ambitious end-to-end solution with a shared commitment to promote health data as a public good.

“This partnership was started to address a common goal not only to respond to the pandemic but to ensure that every person, every citizen and every country has a chance for a healthier life”, says Dr Samira Asma. “We have to be accountable for results, but that accountability can’t come if we don’t have underlying data systems and robust partnerships.”

Public-private partnerships like this one maximize the combined leadership, expertise, resources and reach of each organization to rapidly scale solutions and deliver measurable impact.

“It is our greatest ambition with the World Health Data Hub that we are more effective as a global community in making a difference in people’s lives because we have come together, building on our respective expertise, to bring to life that unified view that we've never had before,” says Justin Spelhaug, Vice President of Tech for Social Impact at Microsoft.

“At Avanade, our purpose is to make a genuine human impact,” adds Pam Maynard, CEO at Avanade. “The work our Tech for Social Good teams are doing to create scalable, repeatable and affordable solutions for the social sector is one way we bring that purpose to life every day.”

COVID-19 has underscored the need for efficient, multilateral cooperation that is responsive to country needs and reflects their unique priorities. WHO is committed to collaborating with all partners to support countries and get back on track towards the SDGs and Triple Billion targets. “There's no one organization, one nation or one group that's going to solve COVID-19”, says Spelhaug. “It requires full mobilization of the public and private sector at new levels of scale to empower countries, policymakers, and responders.”

“It’s been incredibly rewarding to see how the power of data and analytics can transform organizations, like the WHO, to accelerate from insights to action, allowing them to spend more time focusing on what matters most: improving the lives of people and communities around the world,” says Maynard.

With less than nine years to 2030, we have no time to lose.

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Introduction

Horrific history

The early days, health and medicine.

What was the impact of COVID-19?

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Table Of Contents

On February 25, 2020, a top official at the Centers for Disease Control and Prevention decided it was time to level with the U.S. public about the COVID-19 outbreak. At the time, there were just 57 people in the country confirmed to have the infection, all but 14 having been repatriated from Hubei province in China and the Diamond Princess cruise ship , docked off Yokohama , Japan .

The infected were in quarantine. But Nancy Messonnier, then head of the CDC’s National Center for Immunization and Respiratory Diseases, knew what was coming. “It’s not so much a question of if this will happen anymore but rather more a question of exactly when this will happen and how many people in this country will have severe illness,” Messonnier said at a news briefing.

“I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe,” she continued. “But these are things that people need to start thinking about now.”

Looking back, the COVID-19 pandemic stands as arguably the most disruptive event of the 21st century, surpassing wars, the September 11, 2001, terrorist attacks , the effects of climate change , and the Great Recession . It has killed more than seven million people to date and reshaped the world economy, public health , education, work, social interaction, family life, medicine, and mental health—leaving no corner of the globe untouched in some way. Now endemic in many societies, the consistently mutating virus remains one of the leading annual causes of death, especially among people older than 65 and the immunosuppressed.

“The coronavirus outbreak, historically, beyond a doubt, has been the most devastating pandemic of an infectious disease that global society has experienced in well over 100 years, since the 1918 influenza pandemic ,” Anthony Fauci , who helped lead the U.S. government’s health response to the pandemic under Pres. Donald Trump and became Pres. Joe Biden ’s chief medical adviser, told Encyclopædia Britannica in 2024.

“I think the impact of this outbreak on the world in general, on the United States, is really historic. Fifty years from now, 100 years from now, when they talk about the history of what we’ve been through, this is going to go down equally with the 1918 influenza pandemic , with the stock market crash of 1929 , with World War II —all the things that were profoundly disruptive of the social order.”

What few could imagine in the first days of the pandemic was the extent of the disruption the disease would bring to the everyday lives of just about everyone around the globe.

Within weeks, schools and child-care centers began shuttering, businesses sent their workforces home, public gatherings were canceled, stores and restaurants closed, and cruise ships were barred from sailing. On March 11, actor Tom Hanks announced that he had COVID-19, and the NBA suspended its season. (It was ultimately completed in a closed “bubble” at Walt Disney World .) On March 12, as college basketball players left courts mid-game during conference tournaments, the NCAA announced that it would not hold its wildly popular season-ending national competition, known as March Madness , for the first time since 1939. Three days later, the New York City public school system, the country’s largest, with 1.1 million students, closed. On March 19, all 40 million Californians were placed under a stay-at-home order.

By mid-April, with hospital beds and ventilators in critically short supply, workers were burying the coffins of COVID-19 victims in mass graves on Hart Island, off the Bronx . At first, the public embraced caregivers. New Yorkers applauded them from windows and balconies, and individuals sewed masks for them. But that spirit soon gave way to the crushing long-term reality of the pandemic and the national division that followed.

Around the world, it was worse. On the day Messonnier spoke, the virus had spread from its origin point in Wuhan , China, to at least two dozen countries, sickening thousands and killing dozens. By April 4, more than one million cases had been confirmed worldwide. Some countries, including China and Italy, imposed strict lockdowns on their citizens. Paris restricted movement, with certain exceptions, including an hour a day for exercise, within 1 km (0.62 mile) of home.

In the United States , the threat posed by the virus did not keep large crowds from gathering to protest the May 25 slaying of George Floyd , a 46-year-old Black man, by a white police officer, Derek Chauvin. The murder, taped by a bystander in Minneapolis , Minnesota , sparked raucous and sometimes violent street protests for racial justice around the world that contributed to an overall sense of societal instability.

The official World Health Organization total of more than seven million deaths as of March 2024 is widely considered a serious undercount of the actual toll. In some countries there was limited testing for the virus and difficulty attributing fatalities to it. Others suppressed total counts or were not able to devote resources to compiling their totals. In May 2021, a panel of experts consulted by The New York Times estimated that India ’s actual COVID-19 death toll was likely 1.6 million, more than five times the reported total of 307,231.

An average of 3,100 people—one every 28 seconds—died of COVID-19 every day in the United States in January 2021.

When “ excess mortality”—COVID and non-COVID deaths that likely would not have occurred under normal, pre-outbreak conditions—are included in the worldwide tally, the number of pandemic victims was about 15 million by the end of 2021, WHO estimated.

Not long after the pandemic took hold, the United States, which spends more per capita on medical care than any other country, became the epicenter of COVID-19 fatalities. The country fell victim to a fractured health care system that is inequitable to poor and rural patients and people of color, as well as a deep ideological divide over its political leadership and public health policies, such as wearing protective face masks. By early 2024, the U.S. had recorded nearly 1.2 million COVID-19 deaths.

Life expectancy at birth plunged from 78.8 years in 2019 to 76.4 in 2021, a staggering decline in a barometer of a country’s health that typically changes by only a tenth or two annually. An average of 3,100 people—one every 28 seconds—died of COVID-19 every day in the United States in January 2021, before vaccines for the virus became widely available, The Washington Post reported.

The impact on those caring for the sick and dying was profound. “The second week of December [2020] was probably the worst week of my career,” said Brad Butcher, director of the medical-surgical intensive care unit at UPMC Mercy hospital in Pittsburgh , Pennsylvania. “The first day I was on service, five patients died in a shift. And then I came back the next day, and three patients died. And I came back the next day, and three more patients died. And it was completely defeating,” he told The Washington Post on January 11, 2021.

“We can’t get the graves dug fast enough,” a Maryland funeral home operator told The Washington Post that same day.

As the pandemic surged in waves around the world, country after country was plunged into economic recession , the inevitable damage caused by layoffs, business closures, lockdowns, deaths, reduced trade, debt repayment moratoriums , the cost to governments of responding to the crisis, and other factors. Overall, the virus triggered the greatest economic calamity in more than a century, according to a 2022 report by the World Bank .

“Economic activity contracted in 2020 in about 90 percent of countries, exceeding the number of countries seeing such declines during two world wars, the Great Depression of the 1930s, the emerging economy debt crises of the 1980s, and the 2007–09 global financial crisis,” the report noted. “In 2020, the first year of the COVID-19 pandemic, the global economy shrank by approximately 3 percent, and global poverty increased for the first time in a generation.”

A 2020 study that attempted to aggregate the costs of lost gross domestic product (GDP) estimated that premature deaths and health-related losses in the United States totaled more than $16 trillion, or roughly “90% of the annual GDP of the United States. For a family of 4, the estimated loss would be nearly $200,000.”

In April 2020, the U.S. unemployment rate stood at 14.7 percent, higher than at any point since the Great Depression. There were 23.1 million people out of work. The hospitality, leisure, and health care industries were especially hard hit. Consumer spending, which accounts for about two-thirds of the U.S. economy, plunged.

With workers at home, many businesses turned to telework, a development that would persist beyond the pandemic and radically change working conditions for millions. In 2023, 12.7 percent of full-time U.S. employees worked from home and 28.2 percent worked a hybrid office-home schedule, according to Forbes Advisor . Urban centers accustomed to large daily influxes of workers have suffered. Office vacancies are up, and small businesses have closed. The national office vacancy rate rose to a record 19.6 percent in the fourth quarter of 2023, according to Moody’s Analytics , which has been tracking the statistic since 1979.

Many hospitals were overwhelmed during COVID-19 surges, with too few beds for the flood of patients. But many also demonstrated their resilience and “surge capacity,” dramatically expanding bed counts in very short periods of time and finding other ways to treat patients in swamped medical centers. Triage units and COVID-19 wards were hastily erected in temporary structures on hospital grounds.

Still, U.S. hospitals suffered severe shortages of nurses and found themselves lacking basic necessities such as N95 masks and personal protective garb for the doctors, nurses, and other workers who risked their lives against the new pathogen at the start of the outbreak. Mortuaries and first responders were overwhelmed as well. The dead were kept in refrigerated trucks outside hospitals.

The country’s fragmented public health system proved inadequate to the task of coping with the outbreak, sparking calls for major reform of the CDC and other agencies. The CDC botched its initial attempt to create tests for the virus, leaving the United States almost blind to its spread during the early stages of the pandemic.

Beyond the physical dangers, mental health became a serious issue for overburdened health care personnel, other “essential” workers who continued to labor in crucial jobs, and many millions of isolated, stressed, fearful, locked-down people in the United States and elsewhere. Parents struggled to care for children kept at home by the pandemic while also attending to their jobs.

In a June 2020 survey, the CDC found that 41 percent of respondents said they were struggling with mental health and 11 percent had seriously considered suicide recently. Essential workers, unpaid caregivers , young adults, and members of racial and ethnic minority groups were found to be at a higher risk for experiencing mental health struggles, with 31 percent of unpaid caregivers reporting that they were considering suicide. WHO reported two years later that the pandemic had caused a 25 percent increase in anxiety and depression worldwide, young people and women being at the highest risk.

The rate of homicides by firearm in the United States rose by 35 percent during the pandemic to the highest rate in more than a quarter century.

A silver lining in the chaos of the pandemic’s opening year was the development in just 11 months of highly effective vaccines for the virus, a process that normally had taken 7–10 years. The U.S. government’s bet on unproven messenger RNA technology under the Trump administration’s Operation Warp Speed paid off, and the result validated the billions of dollars that the government pours into basic research every year.

On December 14, 2020, New York nurse Sandra Lindsay capped the tumultuous year by receiving the first shot of the vaccine that eventually would help end the public health crisis caused by COVID-19 pandemic.

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COVID-19 and Chronic Disease: The Impact Now and in the Future

ESSAY — Volume 18 — June 17, 2021

Karen A. Hacker, MD, MPH 1 ; Peter A. Briss, MD, MPH 1 ; Lisa Richardson, MD, MPH 1 ; Janet Wright, MD 1 ; Ruth Petersen, MD, MPH 1 ( View author affiliations )

Suggested citation for this article: Hacker KA, Briss PA, Richardson L, Wright J, Petersen R. COVID-19 and Chronic Disease: The Impact Now and in the Future. Prev Chronic Dis 2021;18:210086. DOI: http://dx.doi.org/10.5888/pcd18.210086 .

PEER REVIEWED

The Problem of COVID-19 and Chronic Disease

Raise awareness, collaborate on solutions and build trust, address long-term covid-19 sequelae, how will the national center for chronic disease prevention and health promotion contribute, acknowledgments, author information.

Chronic diseases represent 7 of the top 10 causes of death in the United States (1). Six in 10 Americans live with at least 1 chronic condition, such as heart disease, stroke, cancer, or diabetes (2). Chronic diseases are also the leading causes of disability in the US and the leading drivers of the nation’s $3.8 trillion annual health care costs (2,3).

The COVID-19 pandemic has resulted in enormous personal and societal losses, with more than half a million lives lost (4). COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can result in respiratory distress. In addition to the physical toll, the emotional impact has yet to be fully understood. For those with chronic disease, the impact has been particularly profound (5,6). Heart disease, diabetes, cancer, chronic obstructive pulmonary disease, chronic kidney disease, and obesity are all conditions that increase the risk for severe illness from COVID-19 (7). Other factors, including smoking and pregnancy, also increase the risk (7). Finally, in addition to COVID-19–related deaths since February 1, 2020, an increase in deaths has been observed among people with dementia, circulatory diseases, and diabetes among other causes (8). This increase could reflect undercounting COVID-19 deaths or indirect effects of the virus, such as underutilization of, or stresses on, the health care system (8).

Some populations, including those with low socioeconomic status and those of certain racial and ethnic groups, including African American, Hispanic, and Native American, have a disproportionate burden of chronic disease, SARS-CoV-2 infection, and COVID-19 diagnosis, hospitalization, and mortality (9). These populations are at higher risk because of exposure to suboptimal social determinants of health (SDoH). SDoH are factors that influence health where people live, work, and play, and can create obstacles that contribute to inequities. Education, type of employment, poor or no access to health care, lack of safe and affordable housing, lack of access to healthy food, structural racism, and other conditions all affect a wide range of health outcomes (10–12). The COVID-19 pandemic has exacerbated existing health inequities and laid bare underlying root causes.

The COVID-19 pandemic has had direct and indirect effects on people with chronic disease. In addition to morbidity and mortality, high rates of community spread and various mitigation efforts, including stay-at-home recommendations, have disrupted lives and created social and economic hardships (13). This pandemic has also raised concerns about safely accessing health care (14) and has reduced the ability to prevent or control chronic disease. This essay discusses the impact that these challenges have or could have on people with chronic disease now and in the future. Exploring the impact of COVID-19 should help the public health and health care communities effectively improve health outcomes.

The challenges we face as public health professionals are divided into 3 categories. The first category involves the current effects of COVID-19 on those with, or at risk for, chronic diseases and those at higher risk for severe COVID-19 illness. Inherent in this category is the need for balance between protecting people with chronic diseases from COVID-19 while assuring they can engage in disease prevention, manage their conditions effectively, and safely receive needed health care.

The second category is the postpandemic impact of COVID-19 on the prevention, identification, and management of chronic disease. COVID-19 has resulted in decreases of many types of health care utilization (15), ranging from preventive care to chronic disease management and even emergency care (16). As of June 2020, 4 in 10 adults surveyed reported delaying or avoiding routine or emergent medical care because of the pandemic (14). Cancer screenings, for example, dropped during the pandemic (17). Decreases in screening have resulted in the diagnoses of fewer cancers and precancers (18), and modeling studies have estimated that delayed screening and treatment for breast and colorectal cancer could result in almost 10,000 preventable deaths in the United States (19). We have lost ground in prevention across the chronic disease spectrum and in other areas, including pediatric immunization (20), mental health (21,22), and substance abuse (21,22).

Some challenges with health care utilization may be improving, but improvement has not been consistent across all health care visit types, providers, patients, or communities (15). Questions about the impact of the pandemic on chronic disease include:

What diseases have been missed or allowed to worsen?

What is the status of prevention and disease management efforts?

Have prevention and disease management efforts been affected by concerns such as job loss, loss of insurance, lack of access to healthy food, or loss of places and opportunities to be physically active?

How have effects of the pandemic on health care systems (staff reductions, health practice closures, disrupted services) (23) and public health organizations’ deployment of personnel away from ongoing chronic disease prevention efforts been experienced nationally?

The effects of COVID-19, whether negative or positive, on health care and public health systems will certainly affect those with chronic disease. To fully understand the consequences of the pandemic, we need to assess its overall impact on incidence, management, and outcomes of chronic disease. This is particularly salient in communities where health inequities are already rampant or communities that are remote or underserved. Will our postpandemic response be strong enough to mitigate the exacerbation of inequities that have occurred? Can public health agencies effectively build trust in science and community health care systems where trust might never have been fully established or where it has been lost?

The third category relates to the long-term COVID-19 sequelae, both as a disease entity and from a population perspective. Has COVID-19 created a new group of patients with chronic diseases, neurologic or psychiatric conditions, diabetes, or effects on the heart, lungs, kidneys, or other organs (24)? Has it worsened existing conditions or caused additional chronic disease? And, at the population level, have the incidence and prevalence of chronic diseases increased because of pandemic-related health behaviors or other challenges, such as decreased food and nutrition security?

Given the rollout of COVID-19 vaccines and the coming end of the pandemic, this is an important time to examine the impact of COVID-19. Solutions at all levels are needed to improve health outcomes and lessen health inequities among people with or at risk for chronic disease. Solutions are likely to include increasing awareness about prevention and care during and after the pandemic, building or enhancing cross-organizational and cross-sector partnerships, innovating to address identified gaps, and addressing SDoH to improve health and achieve equity. So, what can be done?

Additional focus is required on several aspects of awareness about the impact of COVID-19. First, public health and health care practitioners need to allay people’s fears and help them safely return to health care. We need to reemphasize chronic disease prevention and care, explain how to safely access care, and convey the host of mitigation efforts made by health care systems, providers, and public health to ensure that environments are safe (eg, mask requirements, social distancing). Emphasis on safety and mitigation applies to both disease prevention (such as encouraging healthy nutrition and physical activity, screening for cancer and other conditions, and getting oral health care) and disease management (eg, educating patients about medications to control hypertension, diabetes, asthma, and other chronic conditions). Efforts must also include helping those with chronic diseases obtain access to and gain confidence in the COVID-19 vaccine. Given current community rates of COVID-19 and the need to reenter care after the height of the pandemic, information can help patients make informed choices about the need for in-person care, communication at a distance, or temporary delays in care that is more discretionary.

To garner support to help affected communities, there is a need to build awareness about how COVID-19 has disproportionately affected particular communities, including the unequal distribution of disease, morbidity, mortality, and resources, such as access to vaccines. Awareness is dependent on access to data at the granular geographic level, including information on the burden of chronic disease and the status of SDoH. Communities need data to effectively address health inequities in the aftermath of the pandemic.

Public health plays a significant role in addressing health behaviors (healthy eating, physical activity, avoiding tobacco and other substance use) and community solutions to address SDoH that impact prevention and control of chronic disease. Collaborations at both the individual and system levels, however, are required for success. Collaborative partners include other government and nongovernmental organizations, health care organizations, insurers, nonprofit organizations, community and faith-based groups, schools, businesses, and others. Coalitions and community groups are critical change agents. They have worked with local health departments and others to identify solutions, bring residents into discussions, and implement action. We can learn from them about how best to build trust and foster the innovation they are leading. Solutions must also include direct discussions with residents in affected communities to understand their priorities and effectively address their concerns. These relationships are particularly salient to address SDoH. These factors have been amplified as a direct consequence of COVID-19 and will require a multisector approach to problem solving.

To achieve this will require building trust in both the health care system and the public health system. The pandemic has taken a toll on an already fragile relationship between communities and public health and health care institutions where trust has been absent or insufficient. To begin to address the trust challenge will require investments in outreach, engagement, and transparency. Conversations need to be bidirectional, long-term, and conducted by people who are trusted, who are respectful, and who can identify with affected populations.

Creative solutions are needed to engage populations and promote resiliency among those who are disproportionately affected by COVID-19. Efforts that need to be further developed and brought to scale include the following:

Leveraging technology to expand the reach of health care and health promotion (eg, telemedicine, virtual program delivery, wearables, mobile device applications).

Providing more services in community settings, as is increasingly modeled in the National Diabetes Prevention Program (25).

Using community health workers to assist in assessing current conditions and connecting to community resources.

Further enhancing approaches to increase access to and convenience of services (eg, increasing access to home screenings, such as cancer screening) or monitoring (eg, home blood pressure monitoring) where appropriate.

Health care approaches, such as telemedicine, have expanded greatly during the pandemic and seem likely to continue expansion over time. As these and related efforts grow, practitioners will need to ensure that existing disparities are not magnified. Care is needed to ensure that those with the highest health needs can access services. For example, are technological solutions easily accessible, available in multiple languages, compatible with readily available hardware options, such as telephones rather than laptops? Are culturally appropriate resources available to help people use and value these technologies? In addition, computer availability and internet access will need to be expanded. Challenges such as unemployment, food insecurity, limited transportation, substance abuse, and social isolation will require a multisector effort uniquely adapted to local contexts. To begin, health equity–focused policy analyses and health impact assessments will help policy makers understand better how proposed SDoH-related action might either exacerbate or mitigate chronic disease inequities. These actions will help us develop a deeper understanding of what individual communities need to mobilize and build resilience for the future. We face serious public health and population health concerns that should be the focus in the near term — particularly as equitable access to COVID-19 vaccines is a consideration in every community across the nation. We clearly have an enormous amount of work to do as we enter recovery from the pandemic, but with recovery comes enormous opportunity.

A challenge related to long-term COVID-19 sequelae is that we do not know yet the extent that COVID-19 exacerbates chronic disease, causes chronic disease, or will be determined a chronic disease unto itself. Those interested in chronic disease prevention and management need to follow the research to understand better the role they will play with this emerging situation. Long-term studies and longitudinal surveillance will help clarify these issues, and there is much research to be done. The duty of the public health community is to help ensure that the most important issues from the perspectives of patients, providers, health care, and public health systems are addressed; that potential solutions are developed and tested; and that eventual solutions are delivered where they are needed most.

As the US enters the next phase of pandemic response, the work of National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) of the Centers for Disease Control and Prevention is evolving to address health inequities and drive toward health equity with a multipronged approach. This approach includes enhanced access to data at the local level, a focus on SDoH including a shift in the Notice of Funding Opportunity process that emphasizes a health equity lens, and an expansion of partnerships and communications.

Placing data in the hands of communities is critical for local coalitions to determine their burden of chronic disease and COVID-19, their access to resources, and the best policies and practices to implement. Data will be useful for local public health, governments, and health care systems, but can also help human services, planning, and economic development organizations. An initial step is making available data from the PLACES Project (26), which provides data on 27 chronic disease measures at the census tract level, allowing communities to understand their own chronic disease burden. In addition, modules on SDoH are in development to enhance NCCDPHP data surveillance systems. This will increase the ability to overlay chronic disease data and SDoH data at the community level. The need is also a great for core SDoH measures that allow comparisons of related outcomes across communities. NCCDPHP can augment this effort by contributing to and amplifying the SDoH measures identified for Healthy People 2030 (27).

NCCDPHP is focusing on supporting and stimulating SDoH efforts by concentrating on 5 major areas: built environment, social connectedness, food and nutrition security, tobacco policies, and connections to clinical care. For example, SDoH are the foci of recent Notices of Funding Opportunities (available at https://www.grants.gov). NCCDPHP supports multisector partnerships in numerous funding announcements and launched a joint effort with the Association of State and Territorial Health Officials and the National Association of County and City Health Officials to identify best practices in multisector collaboration to address SDoH (28). Evidence will help build a standard for success to support local coalitions in their work. States and local communities are sites of innovation, and promoting lessons learned can help build broader efforts. To address urgent needs and facilitate change, NCCDPHP must link with other sectors outside of public health and health care. The work to evaluate these efforts and determine the most effective strategies to address SDoH, therefore, will be integrated fully into NCCDPHP.

An expansion of the Racial and Ethnic Approaches to Community Health (REACH) Program (29) and other programs that address health inequities will help to target resources where they are needed most. REACH and a recently released investment in community health workers (30) demonstrate NCCDPHP’s commitment to connecting with populations that are disproportionately affected by chronic disease at the local level. These efforts are aimed at addressing the ramifications of COVID-19 while also amplifying chronic disease prevention efforts. NCCDPHP also intends to enhance the use of a health equity lens, among other approaches, to determine the best use of resources and to help assess outcomes in all programmatic activities.

Finally, communication about the impact of COVID-19 on chronic disease, returning to care, and the extent of health inequities is critical to building trust. Efforts under way include a television and digital media campaign aiming to encourage those with chronic disease to return safely to care (31). In addition to expanding work with partner organizations, both external and internal to government, NCCDPHP will embrace new ways of garnering input from affected communities. Successes and failures experienced by communities during the pandemic will continue to be of the utmost importance to NCCDPHP. In addition, important insights gained from working closely with affected communities will help NCCDPHP continually refine its national chronic disease prevention and control goals and objectives. Activities related to SDoH and health equity, data, and communication will address difficult questions now and into the future. These efforts can only be successful with collaboration and partnerships across multiple sectors.

The impact of SARS-CoV-2, the virus that causes COVID-19, on people with or at risk for chronic disease cannot be overstated. COVID-19 has impeded chronic disease prevention and disrupted disease management. The problems and solutions outlined here are critically important to help those committed to chronic disease prevention and intervention to identify ways forward.

NCCDPHP is adjusting, preparing, and implementing multiple strategies to address the future. Although the work will be challenging, opportunities abound. NCCDPHP is committed to working with the health care community and a variety of partners at federal, state, and local levels to help address the realities of the post-COVID era.

The authors have no conflicts of interest to report. No copyrighted materials were used in the preparation of this essay.

Corresponding Author: Karen A. Hacker, MD, MPH, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway NE, Atlanta, GA 30341. Telephone: 404-632-5062. Email: [email protected] .

Author Affiliations: 1 National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

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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 fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

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The positive effects...

The positive effects of covid-19

Read our latest coverage of the coronavirus pandemic.

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Bryn Nelson , science journalist
Seattle, WA, USA
bdnelson{at}nasw.org

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

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

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

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

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

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

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

Fewer cars, blue skies

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

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

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

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

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

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

Reassessing priorities

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

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

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

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

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

Long COVID: Lasting effects of COVID-19

Some people continue to experience health problems long after having COVID-19. Understand the possible symptoms and risk factors for post-COVID-19 syndrome.

After any coronavirus disease 2019 (COVID-19) illness, no matter how serious, some people report that symptoms stay for months. This lingering illness has often been called long COVID or post-COVID-19 syndrome. You might hear it called long-haul COVID or post-acute sequelae of SARS-CoV-2 (PASC).

There is no universal definition of long COVID right now.

In the U.S., some experts have defined long COVID as a long-lasting, called chronic, condition triggered by the virus that causes COVID-19. The medical term for this is an infection-associated chronic condition.

As researchers learn more about long COVID, this definition may change.

What are the most common symptoms of long COVID?

In research studies, more than 200 symptoms have been linked to long COVID. Symptoms may stay the same over time, get worse, or go away and come back.

Common symptoms of long COVID include:

Extreme tiredness, especially after activity.
Problems with memory, often called brain fog.
A feeling of being lightheaded or dizzy.
Problems with taste or smell.

Other symptoms of long COVID include:

Sleep problems.
Shortness of breath.
Fast or irregular heartbeat.
Digestion problems, such as loose stools, constipation or bloating.

Some people with long COVID may have other illnesses. Diseases caused or made worse by long COVID include migraine, lung disease, autoimmune disease and chronic kidney disease.

Diseases that people may be diagnosed with due to long COVID include:

Heart disease.
Mood disorders.
Stroke or blood clots.
Postural orthostatic tachycardia syndrome, also called POTS.
Myalgic encephalomyelitis-chronic fatigue syndrome, also called ME-CFS.
Mast cell activation syndrome.
Fibromyalgia.
Hyperlipidemia.

People can get long COVID symptoms after catching the COVID-19 virus even if they never had COVID-19 symptoms. Also, long COVID symptoms can show up weeks or months after a person seems to have recovered.

And while the COVID-19 virus spreads from person to person, long COVID is not contagious and doesn't spread between people.

Why does COVID-19 cause ongoing health problems?

Current research has found that long COVID is a chronic condition triggered by the virus that causes COVID-19. The medical term for this is an infection-associated chronic condition.

Researchers don't know exactly how COVID-19 causes long-term illness, but they have some ideas. Theories include:

The virus that causes COVID-19 upsets immune system communication. This could lead immune cells to mistake the body's own cells as a threat and react to them, called an autoimmune reaction.
Having COVID-19 awakens viruses that haven't been cleared out of the body.
The coronavirus infection upsets the gut's ecosystem.
The virus may be able to survive in the gut and spread from there.
The virus affects the cells that line blood vessels.
The virus damages communication in the brain stem or a nerve that controls automatic functions in the body, called the vagus nerve.

Because the virus that causes COVID-19 continues to change, researchers can't say how many people have been affected by long COVID. Some researchers have estimated that 10% to 35% of people who have had COVID-19 went on to have long COVID.

What are the risk factors for long COVID?

Risk factors for long COVID are just starting to be known. In general, most research finds that long COVID is diagnosed more often in females of any age than in males. The long COVID risk also may be higher for people who have cardiovascular disease before getting sick.

Some research also shows that getting a COVID-19 vaccine may help prevent long COVID.

Many other factors may raise or lower your risk of long COVID, but research is still ongoing.

What should I do if I have long COVID symptoms?

See a healthcare professional if you have long COVID symptoms. Part of long COVID's definition is symptoms that last for three months.

But at this time, no test can say whether you have long COVID. Since you may not have symptoms if you have an infection with the COVID-19 virus, you may not know you had it. Some people have mild symptoms and don't take a COVID-19 test. Others may have had COVID-19 before testing was common.

Long COVID symptoms may come and go or be constant. They also can start any time after you had COVID-19. But symptoms still need to be documented for at least three months in order for a health care professional to diagnose long COVID.

Healthcare professionals may treat your symptoms or conditions before a long COVID-19 diagnosis. And they may work to rule out other conditions over the time you start having symptoms.

Your healthcare team might do lab tests, such as a complete blood count or liver function test. You might have other tests or procedures, such as chest X-rays, based on your symptoms.

The information you give and any test results can help your healthcare professional come up with a treatment plan.

Care for long COVID

It can be hard to get care for long COVID. Treatment may be delayed while you work with healthcare professionals. And people with long COVID may have their health problems dismissed by others, including healthcare professionals, family members or employers.

For people with cultural or language barriers, getting a long COVID diagnosis can be even harder. Pulling together information about symptoms and timing can be a challenge too. This is especially true when medical history is fragmented or when someone is managing symptoms related to memory or that affect the thought process.

Underdiagnosis may be more common among people who have less access to healthcare or who have limited financial resources.

If you're having long COVID symptoms, talk with your healthcare professional. It can help to have your medical records available before the appointment if you are starting to get care at a new medical office.

To prepare for your appointment, write down:

When your symptoms started and if they come and go.
What makes your symptoms worse.
How your symptoms affect your activities.
Questions you have about your illness.

List medicines and anything else you take, including nutrition supplements and pain medicine that you can get without a prescription. Some people find it helpful to bring a trusted person to the appointment to take notes.

Keep visit summaries and your notes in one place. That can help you track what actions you need to take or what you've already tried to treat your symptoms.

Also, you might find it helpful to connect with others in a support group and share resources.

How long can long COVID last?

The conditions linked as part of long COVID may get better over months or may last for years.

What treatment is available for long COVID?

Healthcare professionals treat long COVID based on the symptoms. For tiredness, your healthcare professional may suggest that you be active only as long as your symptoms stay stable. If you start to feel worse, rest and don't push through your tiredness.

For symptoms of pain, breathlessness or brain fog, work with your healthcare professional to find a treatment plan that works for you. That may include medicine you can get without a prescription for pain, prescription medicine, supplements and referrals to other healthcare team members.

For loss of taste or smell, a process to retrain the nerves involved in those processes may help some people. The process is called olfactory training. For people with POTS or a fast heartbeat, the healthcare professional may suggest prescription medicine as well as a plan to stay hydrated.

Treatment for other long COVID symptoms may be available so contact your healthcare professional for options.

Next steps for Long COVID

Long COVID makes life more difficult for many people. To provide better options for care, research is going on to better understand this illness. In the meantime, adults or children with long COVID may be able to get support for daily activities affected by the illness.

National Academies of Sciences, Engineering, and Medicine. A Long COVID Definition: A Chronic, Systemic Disease State with Profound Consequences. National Academies Press; 2024. https://nap.nationalacademies.org/catalog/27768/a-long-covid-definition-a-chronic-systemic-disease-state-with. Accessed Aug. 7, 2024.
Oelsner EC, et al. Epidemiologic features of recovery from SARS-CoV-2 infection. JAMA Network Open. 2024; doi:10.1001/jamanetworkopen.2024.17440
Long COVID basics. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html. Accessed June 19, 2024.
Living with long COVID. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/care-post-covid.html. Accessed June 19, 2024.
Post-COVID syndrome. AskMayoExpert. 2023.

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Essay On Covid-19: 100, 200 and 300 Words

Updated on
Apr 30, 2024

COVID-19, also known as the Coronavirus, is a global pandemic that has affected people all around the world. It first emerged in a lab in Wuhan, China, in late 2019 and quickly spread to countries around the world. This virus was reportedly caused by SARS-CoV-2. Since then, it has spread rapidly to many countries, causing widespread illness and impacting our lives in numerous ways. This blog talks about the details of this virus and also drafts an essay on COVID-19 in 100, 200 and 300 words for students and professionals.

Table of Contents

1 Essay On COVID-19 in English 100 Words
2 Essay On COVID-19 in 200 Words
3 Essay On COVID-19 in 300 Words
4 Short Essay on Covid-19

Essay On COVID-19 in English 100 Words

COVID-19, also known as the coronavirus, is a global pandemic. It started in late 2019 and has affected people all around the world. The virus spreads very quickly through someone’s sneeze and respiratory issues.

COVID-19 has had a significant impact on our lives, with lockdowns, travel restrictions, and changes in daily routines. To prevent the spread of COVID-19, we should wear masks, practice social distancing, and wash our hands frequently.

People should follow social distancing and other safety guidelines and also learn the tricks to be safe stay healthy and work the whole challenging time.

Also Read: National Safe Motherhood Day 2023

Essay On COVID-19 in 200 Words

COVID-19 also known as coronavirus, became a global health crisis in early 2020 and impacted mankind around the world. This virus is said to have originated in Wuhan, China in late 2019. It belongs to the coronavirus family and causes flu-like symptoms. It impacted the healthcare systems, economies and the daily lives of people all over the world.

The most crucial aspect of COVID-19 is its highly spreadable nature. It is a communicable disease that spreads through various means such as coughs from infected persons, sneezes and communication. Due to its easy transmission leading to its outbreaks, there were many measures taken by the government from all over the world such as Lockdowns, Social Distancing, and wearing masks.

There are many changes throughout the economic systems, and also in daily routines. Other measures such as schools opting for Online schooling, Remote work options available and restrictions on travel throughout the country and internationally. Subsequently, to cure and top its outbreak, the government started its vaccine campaigns, and other preventive measures.

In conclusion, COVID-19 tested the patience and resilience of the mankind. This pandemic has taught people the importance of patience, effort and humbleness.

Essay On COVID-19 in 300 Words

COVID-19, also known as the coronavirus, is a serious and contagious disease that has affected people worldwide. It was first discovered in late 2019 in Cina and then got spread in the whole world. It had a major impact on people’s life, their school, work and daily lives.

COVID-19 is primarily transmitted from person to person through respiratory droplets produced and through sneezes, and coughs of an infected person. It can spread to thousands of people because of its highly contagious nature. To cure the widespread of this virus, there are thousands of steps taken by the people and the government.

Wearing masks is one of the essential precautions to prevent the virus from spreading. Social distancing is another vital practice, which involves maintaining a safe distance from others to minimize close contact.

Very frequent handwashing is also very important to stop the spread of this virus. Proper hand hygiene can help remove any potential virus particles from our hands, reducing the risk of infection.

In conclusion, the Coronavirus has changed people’s perspective on living. It has also changed people’s way of interacting and how to live. To deal with this virus, it is very important to follow the important guidelines such as masks, social distancing and techniques to wash your hands. Getting vaccinated is also very important to go back to normal life and cure this virus completely.

Also Read: Essay on Abortion in English in 650 Words

Short Essay on Covid-19

Please find below a sample of a short essay on Covid-19 for school students:

Also Read: Essay on Women’s Day in 200 and 500 words

to write an essay on COVID-19, understand your word limit and make sure to cover all the stages and symptoms of this disease. You need to highlight all the challenges and impacts of COVID-19. Do not forget to conclude your essay with positive precautionary measures.

Writing an essay on COVID-19 in 200 words requires you to cover all the challenges, impacts and precautions of this disease. You don’t need to describe all of these factors in brief, but make sure to add as many options as your word limit allows.

The full form for COVID-19 is Corona Virus Disease of 2019.

Simran Popli

An avid writer and a creative person. With an experience of 1.5 years content writing, Simran has worked with different areas. From medical to working in a marketing agency with different clients to Ed-tech company, the journey has been diverse. Creative, vivacious and patient are the words that describe her personality.

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The pandemic has had devastating impacts on learning. What will it take to help students catch up?

Subscribe to the brown center on education policy newsletter, megan kuhfeld , megan kuhfeld senior research scientist - nwea jim soland , jim soland assistant professor, school of education and human development - university of virginia, affiliated research fellow - nwea karyn lewis , and karyn lewis director, center for school and student progress - nwea emily morton emily morton research scientist - nwea.

March 3, 2022

As we reach the two-year mark of the initial wave of pandemic-induced school shutdowns, academic normalcy remains out of reach for many students, educators, and parents. In addition to surging COVID-19 cases at the end of 2021, schools have faced severe staff shortages , high rates of absenteeism and quarantines , and rolling school closures . Furthermore, students and educators continue to struggle with mental health challenges , higher rates of violence and misbehavior , and concerns about lost instructional time .

As we outline in our new research study released in January, the cumulative impact of the COVID-19 pandemic on students’ academic achievement has been large. We tracked changes in math and reading test scores across the first two years of the pandemic using data from 5.4 million U.S. students in grades 3-8. We focused on test scores from immediately before the pandemic (fall 2019), following the initial onset (fall 2020), and more than one year into pandemic disruptions (fall 2021).

Average fall 2021 math test scores in grades 3-8 were 0.20-0.27 standard deviations (SDs) lower relative to same-grade peers in fall 2019, while reading test scores were 0.09-0.18 SDs lower. This is a sizable drop. For context, the math drops are significantly larger than estimated impacts from other large-scale school disruptions, such as after Hurricane Katrina—math scores dropped 0.17 SDs in one year for New Orleans evacuees .

Even more concerning, test-score gaps between students in low-poverty and high-poverty elementary schools grew by approximately 20% in math (corresponding to 0.20 SDs) and 15% in reading (0.13 SDs), primarily during the 2020-21 school year. Further, achievement tended to drop more between fall 2020 and 2021 than between fall 2019 and 2020 (both overall and differentially by school poverty), indicating that disruptions to learning have continued to negatively impact students well past the initial hits following the spring 2020 school closures.

These numbers are alarming and potentially demoralizing, especially given the heroic efforts of students to learn and educators to teach in incredibly trying times. From our perspective, these test-score drops in no way indicate that these students represent a “ lost generation ” or that we should give up hope. Most of us have never lived through a pandemic, and there is so much we don’t know about students’ capacity for resiliency in these circumstances and what a timeline for recovery will look like. Nor are we suggesting that teachers are somehow at fault given the achievement drops that occurred between 2020 and 2021; rather, educators had difficult jobs before the pandemic, and now are contending with huge new challenges, many outside their control.

Clearly, however, there’s work to do. School districts and states are currently making important decisions about which interventions and strategies to implement to mitigate the learning declines during the last two years. Elementary and Secondary School Emergency Relief (ESSER) investments from the American Rescue Plan provided nearly $200 billion to public schools to spend on COVID-19-related needs. Of that sum, $22 billion is dedicated specifically to addressing learning loss using “evidence-based interventions” focused on the “ disproportionate impact of COVID-19 on underrepresented student subgroups. ” Reviews of district and state spending plans (see Future Ed , EduRecoveryHub , and RAND’s American School District Panel for more details) indicate that districts are spending their ESSER dollars designated for academic recovery on a wide variety of strategies, with summer learning, tutoring, after-school programs, and extended school-day and school-year initiatives rising to the top.

Comparing the negative impacts from learning disruptions to the positive impacts from interventions

To help contextualize the magnitude of the impacts of COVID-19, we situate test-score drops during the pandemic relative to the test-score gains associated with common interventions being employed by districts as part of pandemic recovery efforts. If we assume that such interventions will continue to be as successful in a COVID-19 school environment, can we expect that these strategies will be effective enough to help students catch up? To answer this question, we draw from recent reviews of research on high-dosage tutoring , summer learning programs , reductions in class size , and extending the school day (specifically for literacy instruction) . We report effect sizes for each intervention specific to a grade span and subject wherever possible (e.g., tutoring has been found to have larger effects in elementary math than in reading).

Figure 1 shows the standardized drops in math test scores between students testing in fall 2019 and fall 2021 (separately by elementary and middle school grades) relative to the average effect size of various educational interventions. The average effect size for math tutoring matches or exceeds the average COVID-19 score drop in math. Research on tutoring indicates that it often works best in younger grades, and when provided by a teacher rather than, say, a parent. Further, some of the tutoring programs that produce the biggest effects can be quite intensive (and likely expensive), including having full-time tutors supporting all students (not just those needing remediation) in one-on-one settings during the school day. Meanwhile, the average effect of reducing class size is negative but not significant, with high variability in the impact across different studies. Summer programs in math have been found to be effective (average effect size of .10 SDs), though these programs in isolation likely would not eliminate the COVID-19 test-score drops.

Figure 1: Math COVID-19 test-score drops compared to the effect sizes of various educational interventions

$Figure 1 – Math COVID-19 test-score drops compared to the effect sizes of various educational interventions$

Source: COVID-19 score drops are pulled from Kuhfeld et al. (2022) Table 5; reduction-in-class-size results are from pg. 10 of Figles et al. (2018) Table 2; summer program results are pulled from Lynch et al (2021) Table 2; and tutoring estimates are pulled from Nictow et al (2020) Table 3B. Ninety-five percent confidence intervals are shown with vertical lines on each bar.

Notes: Kuhfeld et al. and Nictow et al. reported effect sizes separately by grade span; Figles et al. and Lynch et al. report an overall effect size across elementary and middle grades. We were unable to find a rigorous study that reported effect sizes for extending the school day/year on math performance. Nictow et al. and Kraft & Falken (2021) also note large variations in tutoring effects depending on the type of tutor, with larger effects for teacher and paraprofessional tutoring programs than for nonprofessional and parent tutoring. Class-size reductions included in the Figles meta-analysis ranged from a minimum of one to minimum of eight students per class.

Figure 2 displays a similar comparison using effect sizes from reading interventions. The average effect of tutoring programs on reading achievement is larger than the effects found for the other interventions, though summer reading programs and class size reduction both produced average effect sizes in the ballpark of the COVID-19 reading score drops.

Figure 2: Reading COVID-19 test-score drops compared to the effect sizes of various educational interventions

Source: COVID-19 score drops are pulled from Kuhfeld et al. (2022) Table 5; extended-school-day results are from Figlio et al. (2018) Table 2; reduction-in-class-size results are from pg. 10 of Figles et al. (2018) ; summer program results are pulled from Kim & Quinn (2013) Table 3; and tutoring estimates are pulled from Nictow et al (2020) Table 3B. Ninety-five percent confidence intervals are shown with vertical lines on each bar.

Notes: While Kuhfeld et al. and Nictow et al. reported effect sizes separately by grade span, Figlio et al. and Kim & Quinn report an overall effect size across elementary and middle grades. Class-size reductions included in the Figles meta-analysis ranged from a minimum of one to minimum of eight students per class.

There are some limitations of drawing on research conducted prior to the pandemic to understand our ability to address the COVID-19 test-score drops. First, these studies were conducted under conditions that are very different from what schools currently face, and it is an open question whether the effectiveness of these interventions during the pandemic will be as consistent as they were before the pandemic. Second, we have little evidence and guidance about the efficacy of these interventions at the unprecedented scale that they are now being considered. For example, many school districts are expanding summer learning programs, but school districts have struggled to find staff interested in teaching summer school to meet the increased demand. Finally, given the widening test-score gaps between low- and high-poverty schools, it’s uncertain whether these interventions can actually combat the range of new challenges educators are facing in order to narrow these gaps. That is, students could catch up overall, yet the pandemic might still have lasting, negative effects on educational equality in this country.

Given that the current initiatives are unlikely to be implemented consistently across (and sometimes within) districts, timely feedback on the effects of initiatives and any needed adjustments will be crucial to districts’ success. The Road to COVID Recovery project and the National Student Support Accelerator are two such large-scale evaluation studies that aim to produce this type of evidence while providing resources for districts to track and evaluate their own programming. Additionally, a growing number of resources have been produced with recommendations on how to best implement recovery programs, including scaling up tutoring , summer learning programs , and expanded learning time .

Ultimately, there is much work to be done, and the challenges for students, educators, and parents are considerable. But this may be a moment when decades of educational reform, intervention, and research pay off. Relying on what we have learned could show the way forward.

Science News

New covid-19 booster shots have been approved. when should you get one.

The vaccines target the omicron variants currently circulating in the United States

The FDA has now approved updated COVID-19 vaccines that are formulated to more closely target the omicron variants currently circulating.

How are the updated vaccines different from last year’s version?

They’re the exact same vaccine save for one difference, Talaat says — the viral strain that’s targeted. Last year’s jabs were aimed at the omicron XBB.1.5 variant that caused the majority of cases in late winter 2022 and spring 2023.

The new mRNA boosters target the omicron KP.2 variant (also called JN.1.11.1.2), which accounted for an estimated 3.2 percent of cases in the United States from August 4 to 17. Two other omicron variants, KP.3 and KP3.1.1, together make up nearly 54 percent of cases during the same period. Another variant known as LB.1 caused 14 percent of cases. And there is an alphabet soup of other variants circulating, too.

Novavax’s updated vaccine targets the JN.1 variant. That is the parent variant of KP.2, KP.3 and LB.1. The variants differ at only a few spots on their spike proteins, the knobby protein that the coronavirus uses to latch onto and enter cells. But the KP and LB.1 offspring may be a little bit more transmissible because those changes help the newer variants evade immunity from older versions of the vaccine and from infection with earlier coronavirus variants. It takes longer to reconfigure protein vaccines than it does for mRNA vaccines, so Novavax needed to go with the older version of the virus. In other countries, Moderna is making a JN.1 version of the vaccine , the company said in a statement.

This is the third time the vaccines have gotten updates to more closely match versions of the virus that are circulating. Each time the virus has been several steps ahead, but the shots have provided protection against severe disease, especially for older people and people with health conditions that put them at increased risk.

Infectious diseases physician Carlos del Rio says he’d like to see high vaccination rates in everybody over 65 years old because those people are at higher risk for hospitalization and severe disease. “Vaccination continues to be one of our major strategies in [managing] COVID,” says del Rio, of Emory University School of Medicine in Atlanta. “And keeping immunity up is important.”

When should I get the new COVID-19 booster?

Maximum protection against the virus lasts for several months after getting boosted, Talaat says. So “even if you get the vaccine now, you’re likely to have some protection at Thanksgiving and Christmas.”

The U.S. Centers for Disease Control and Prevention recommends getting the shot at some point in September or October, depending on what works best for people, agency director Mandy Cohen said in an August 23 call with reporters. “The important part is getting it done.”

People who were infected in this summer’s surge are probably still protected from repeat infections, Talaat says, and can wait until the fall to get their updated shot. While it’s hard to predict exactly how long the current surge will last, test positivity rates and waste water levels of the virus are still rising ( SN: 9/20/23) . “COVID is still killing lots of people ,” she says. “We may not hear about it any longer, but it hasn’t gone away.”

Children returning to school could lead to a fresh round of infections. Just 14 percent of children ages 6 months to 17 years are up-to-date with the 2023–2024 COVID-19 booster, according to the CDC. And though more than 80 percent of adults 18 and over have received at least one shot, the number of people continuing to receive boosters has dropped steeply. Just 22 percent of people in this age group received a 2023–2024 COVID-19 vaccine dose , the CDC reported in data last updated in May.

How long does the shot’s protection last?

Many scientists have investigated that question. One large study examining evidence of antibodies against the coronavirus found that by the fall of 2022 more than 96 percent of people in the United States had immunity from vaccination, prior infection or both.

But immunity can wane. For instance, last year, people who got the XBB.1.5 vaccine in Europe had pretty good protection against hospitalization from COVID-19 in the first month or so after getting the shot. The vaccines were about 69 percent effective 14 to 29 days after inoculation, researchers reported August 15 in Influenza and Other Respiratory Viruses . Effectiveness dropped to 40 percent 60 to 105 days after vaccination. Part of the drop in effectiveness was because of the rise of the new JN.1 variants.

But protection doesn’t just fall off a cliff. New work offers evidence that the shots actually provide long-lasting benefits . Scientists performed an in-depth analysis of some 500 people’s immune responses over three years. Their results suggest that while the vaccine spurs an initial antibody boost that tends to fade rapidly, after a few months, antibody levels then stabilize, researchers reported in Immunity in March.

Updated versions of the vaccines may up that protection further. Pfizer submitted data to the FDA showing that its updated KP.2 version of the vaccine increased antibody production in mice and provided better protection against JN.1 and its offspring than last year’s version of the vaccine does.

Will the booster protect against infection or long COVID?

One of the biggest misconceptions about these vaccines is that they prevent infection, del Rio says. A common refrain is: “Well, they don’t work because I still got COVID.” It’s true they’re not great at preventing infection, he says, but that doesn’t mean the vaccines aren’t working. “They’re very good at preventing severe disease and mortality.”

It’s still not clear if getting the vaccines will protect people from getting long COVID , del Rio says ( SN: 7/17/24 ). Some data suggest yes, some suggest no. But, he says, “I think it’s a good idea to get vaccinated if you are worried.”

Talaat doesn’t see any real downsides to getting the latest booster. “All vaccines have some side effects,” she says. People may see the same types of symptoms they experienced with previous versions of the vaccine. Those can include sore arms, headache, joint pain and fatigue. She points out that billions of vaccine doses have made it into the arms of people worldwide. “They’re very safe,” she says.

Even if you’re young, healthy and at relatively low risk, Talaat still recommends getting boosted. “We need to do what we can to protect ourselves and our loved ones,” she says. Talaat plans to vaccinate her two teenagers “because their grandparents are in their 80s,” she says, “and I want to make sure that they stay safe as well.”

As for herself, Talaat says, “I’m seriously thinking about getting it next week.”

Erin Garcia de Jesús contributed to the reporting of this story.

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The CDC says COVID is endemic. That doesn't mean the danger is past

Regina Barber, photographed for NPR, 6 June 2022, in Washington DC. Photo by Farrah Skeiky for NPR.

Regina G. Barber

Rob Stein, photographed for NPR, 22 January 2020, in Washington DC.

Rachel Carlson

Rebecca Ramirez

At this point, public health officials generally agree that COVID is endemic, meaning it is here to stay in predictable ways. Peter Zelei Images/Getty Images hide caption

At this point, public health officials generally agree that COVID is endemic, meaning it is here to stay in predictable ways.

U.S. health officials now say COVID-19 is an endemic disease. That means it's here to stay – circulating regularly like the flu. Even though that changes how public health officials think about managing the virus, they say it doesn't mean being less cautious or vigilant during surges, like the current one this summer. COVID still poses significant risks for older individuals and those with underlying conditions — and anyone who gets COVID is at risk of developing long COVID.

Ashish Jha is the dean of the Brown University School of Public Health who served as President Biden's COVID-19 response coordinator. He encourages people to to do what they can to protect themselves.

"If we just say OK, 'Learning to live with it means we're just going to let it do what it's doing,' the burden on our society is going to be very high," he says. "We're going to see, you know, a majority of Americans get infected every year. We're going to see a lot of older Americans die unnecessarily ... We can do better. And we should demand and expect that we do better than that."

People can protect themselves and others by masking in crowded spaces and around high-risk individuals and getting updated vaccines – like the updated one the FDA is expected to greenlight later this week.

Read more of science correspondent Rob Stein 's story here .

Interested in hearing more health news? Email us at [email protected] .

Listen to Short Wave on Spotify , Apple Podcasts and Google Podcasts .

This episode was produced by Rachel Carlson, edited by Rebecca Ramirez and fact-checked by Rob Stein. The audio engineer was Robert Rodriguez.

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Australia's new 'right to disconnect' law goes into effect

A new law went into effect in Australia on Monday allowing employees to ignore employer phone calls and other digital messages during off hours. File Photo by John Angelillo/UPI

Aug. 26 (UPI) -- A new Australian law went into effect on Monday that protects workers from being contacted by their employers outside of their work hours via phone calls and emails.

Under what is dubbed as the "right to disconnect" law, employees can refuse contact from work unless that refusal is "unreasonable." The law is meant to curb employee contact with employers through the Internet, which has grown over the years. Advertisement

Ubiquitous contact means through social media and cell phones after being described by workers and employee rights experts as "digital leashes" for employers. Some have complained the constant contact has made unpaid work commonplace in Australia.

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A company could face fines of up to $64,000 for violating the new law.

"Unions welcome the new right-to-disconnect laws coming into effect today as a cost-of-living win for working people," the Australian Council of Trade Unions said in a statement . Advertisement

"Today's new rights will empower workers to refuse unreasonable out-of-hours work contact, enabling greater work-life balance and reducing the burden of unpaid labor while families face cost-of-living pressures."

Academic Gabrielle Golding told Australian Broadcasting Corp. that the COVID-19 pandemic ushered in work-at-home with employers using email, social media and text methods to reach employees. But when workers returned to the office, she said the employer's digital contact with employees did not subside after hours, opening the door for the new law.

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FDA Approves and Authorizes Updated mRNA COVID-19 Vaccines to Better Protect Against Currently Circulating Variants

FDA News Release

Today, the U.S. Food and Drug Administration approved and granted emergency use authorization (EUA) for updated mRNA COVID-19 vaccines (2024-2025 formula) to include a monovalent (single) component that corresponds to the Omicron variant KP.2 strain of SARS-CoV-2. The mRNA COVID-19 vaccines have been updated with this formula to more closely target currently circulating variants and provide better protection against serious consequences of COVID-19, including hospitalization and death. Today’s actions relate to updated mRNA COVID-19 vaccines manufactured by ModernaTX Inc. and Pfizer Inc.

In early June, the FDA advised manufacturers of licensed and authorized COVID-19 vaccines that the COVID-19 vaccines (2024-2025 formula) should be monovalent JN.1 vaccines. Based on the further evolution of SARS-CoV-2 and a rise in cases of COVID-19, the agency subsequently determined and advised manufacturers that the preferred JN.1-lineage for the COVID-19 vaccines (2024-2025 formula) is the KP.2 strain, if feasible.

“Vaccination continues to be the cornerstone of COVID-19 prevention,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “These updated vaccines meet the agency’s rigorous, scientific standards for safety, effectiveness, and manufacturing quality. Given waning immunity of the population from previous exposure to the virus and from prior vaccination, we strongly encourage those who are eligible to consider receiving an updated COVID-19 vaccine to provide better protection against currently circulating variants.”

The updated mRNA COVID-19 vaccines include Comirnaty and Spikevax, both of which are approved for individuals 12 years of age and older, and the Moderna COVID-19 Vaccine and Pfizer-BioNTech COVID-19 Vaccine, both of which are authorized for emergency use for individuals 6 months through 11 years of age.

What You Need to Know

Unvaccinated individuals 6 months through 4 years of age are eligible to receive three doses of the updated, authorized Pfizer-BioNTech COVID-19 Vaccine or two doses of the updated, authorized Moderna COVID-19 Vaccine.
Individuals 6 months through 4 years of age who have previously been vaccinated against COVID-19 are eligible to receive one or two doses of the updated, authorized Moderna or Pfizer-BioNTech COVID-19 vaccines (timing and number of doses to administer depends on the previous COVID-19 vaccine received).
Individuals 5 years through 11 years of age regardless of previous vaccination are eligible to receive a single dose of the updated, authorized Moderna or Pfizer-BioNTech COVID-19 vaccines; if previously vaccinated, the dose is administered at least 2 months after the last dose of any COVID-19 vaccine.
Individuals 12 years of age and older are eligible to receive a single dose of the updated, approved Comirnaty or the updated, approved Spikevax; if previously vaccinated, the dose is administered at least 2 months since the last dose of any COVID-19 vaccine.
Additional doses are authorized for certain immunocompromised individuals ages 6 months through 11 years of age as described in the Moderna COVID-19 Vaccine and Pfizer-BioNTech COVID-19 Vaccine fact sheets.

Individuals who receive an updated mRNA COVID-19 vaccine may experience similar side effects as those reported by individuals who previously received mRNA COVID-19 vaccines and as described in the respective prescribing information or fact sheets. The updated vaccines are expected to provide protection against COVID-19 caused by the currently circulating variants. Barring the emergence of a markedly more infectious variant of SARS-CoV-2, the FDA anticipates that the composition of COVID-19 vaccines will need to be assessed annually, as occurs for seasonal influenza vaccines.

For today’s approvals and authorizations of the mRNA COVID-19 vaccines, the FDA assessed manufacturing and nonclinical data to support the change to include the 2024-2025 formula in the mRNA COVID-19 vaccines. The updated mRNA vaccines are manufactured using a similar process as previous formulas of these vaccines. The mRNA COVID-19 vaccines have been administered to hundreds of millions of people in the U.S., and the benefits of these vaccines continue to outweigh their risks.

On an ongoing basis, the FDA will review any additional COVID-19 vaccine applications submitted to the agency and take appropriate regulatory action.

The approval of Comirnaty (COVID-19 Vaccine, mRNA) (2024-2025 Formula) was granted to BioNTech Manufacturing GmbH. The EUA amendment for the Pfizer-BioNTech COVID-19 Vaccine (2024-2025 Formula) was issued to Pfizer Inc.

The approval of Spikevax (COVID-19 Vaccine, mRNA) (2024-2025 Formula) was granted to ModernaTX Inc. and the EUA amendment for the Moderna COVID-19 Vaccine (2024-2025 Formula) was issued to ModernaTX Inc.

Related Information

Comirnaty (COVID-19 Vaccine, mRNA) (2024-2025 Formula)
Spikevax (COVID-19 Vaccine, mRNA) (2024-2025 Formula)
Moderna COVID-19 Vaccine (2024-2025 Formula)
Pfizer-BioNTech COVID-19 Vaccine (2024-2025 Formula)
FDA Resources for the Fall Respiratory Illness Season
Updated COVID-19 Vaccines for Use in the United States Beginning in Fall 2024
June 5, 2024, Meeting of the Vaccines and Related Biological Products Advisory Committee

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Elsevier - PMC COVID-19 Collection

The Effect of COVID-19 on Education

Jacob hoofman.

a Wayne State University School of Medicine, 540 East Canfield, Detroit, MI 48201, USA

Elizabeth Secord

b Department of Pediatrics, Wayne Pediatrics, School of Medicine, Pediatrics Wayne State University, 400 Mack Avenue, Detroit, MI 48201, USA

COVID-19 has changed education for learners of all ages. Preliminary data project educational losses at many levels and verify the increased anxiety and depression associated with the changes, but there are not yet data on long-term outcomes. Guidance from oversight organizations regarding the safety and efficacy of new delivery modalities for education have been quickly forged. It is no surprise that the socioeconomic gaps and gaps for special learners have widened. The medical profession and other professions that teach by incrementally graduated internships are also severely affected and have had to make drastic changes.

• Virtual learning has become a norm during COVID-19.
• Children requiring special learning services, those living in poverty, and those speaking English as a second language have lost more from the pandemic educational changes.
• For children with attention deficit disorder and no comorbidities, virtual learning has sometimes been advantageous.
• Math learning scores are more likely to be affected than language arts scores by pandemic changes.
• School meals, access to friends, and organized activities have also been lost with the closing of in-person school.

The transition to an online education during the coronavirus disease 2019 (COVID-19) pandemic may bring about adverse educational changes and adverse health consequences for children and young adult learners in grade school, middle school, high school, college, and professional schools. The effects may differ by age, maturity, and socioeconomic class. At this time, we have few data on outcomes, but many oversight organizations have tried to establish guidelines, expressed concerns, and extrapolated from previous experiences.

General educational losses and disparities

Many researchers are examining how the new environment affects learners’ mental, physical, and social health to help compensate for any losses incurred by this pandemic and to better prepare for future pandemics. There is a paucity of data at this juncture, but some investigators have extrapolated from earlier school shutdowns owing to hurricanes and other natural disasters. 1

Inclement weather closures are estimated in some studies to lower middle school math grades by 0.013 to 0.039 standard deviations and natural disaster closures by up to 0.10 standard deviation decreases in overall achievement scores. 2 The data from inclement weather closures did show a more significant decrease for children dependent on school meals, but generally the data were not stratified by socioeconomic differences. 3 , 4 Math scores are impacted overall more negatively by school absences than English language scores for all school closures. 4 , 5

The Northwest Evaluation Association is a global nonprofit organization that provides research-based assessments and professional development for educators. A team of researchers at Stanford University evaluated Northwest Evaluation Association test scores for students in 17 states and the District of Columbia in the Fall of 2020 and estimated that the average student had lost one-third of a year to a full year's worth of learning in reading, and about three-quarters of a year to more than 1 year in math since schools closed in March 2020. 5

With school shifted from traditional attendance at a school building to attendance via the Internet, families have come under new stressors. It is increasingly clear that families depended on schools for much more than math and reading. Shelter, food, health care, and social well-being are all part of what children and adolescents, as well as their parents or guardians, depend on schools to provide. 5 , 6

Many families have been impacted negatively by the loss of wages, leading to food insecurity and housing insecurity; some of loss this is a consequence of the need for parents to be at home with young children who cannot attend in-person school. 6 There is evidence that this economic instability is leading to an increase in depression and anxiety. 7 In 1 survey, 34.71% of parents reported behavioral problems in their children that they attributed to the pandemic and virtual schooling. 8

Children have been infected with and affected by coronavirus. In the United States, 93,605 students tested positive for COVID-19, and it was reported that 42% were Hispanic/Latino, 32% were non-Hispanic White, and 17% were non-Hispanic Black, emphasizing a disproportionate effect for children of color. 9 COVID infection itself is not the only issue that affects children’s health during the pandemic. School-based health care and school-based meals are lost when school goes virtual and children of lower socioeconomic class are more severely affected by these losses. Although some districts were able to deliver school meals, school-based health care is a primary source of health care for many children and has left some chronic conditions unchecked during the pandemic. 10

Many families report that the stress of the pandemic has led to a poorer diet in children with an increase in the consumption of sweet and fried foods. 11 , 12 Shelter at home orders and online education have led to fewer exercise opportunities. Research carried out by Ammar and colleagues 12 found that daily sitting had increased from 5 to 8 hours a day and binge eating, snacking, and the number of meals were all significantly increased owing to lockdown conditions and stay-at-home initiatives. There is growing evidence in both animal and human models that diets high in sugar and fat can play a detrimental role in cognition and should be of increased concern in light of the pandemic. 13

The family stress elicited by the COVID-19 shutdown is a particular concern because of compiled evidence that adverse life experiences at an early age are associated with an increased likelihood of mental health issues as an adult. 14 There is early evidence that children ages 6 to 18 years of age experienced a significant increase in their expression of “clinginess, irritability, and fear” during the early pandemic school shutdowns. 15 These emotions associated with anxiety may have a negative impact on the family unit, which was already stressed owing to the pandemic.

Another major concern is the length of isolation many children have had to endure since the pandemic began and what effects it might have on their ability to socialize. The school, for many children, is the agent for forming their social connections as well as where early social development occurs. 16 Noting that academic performance is also declining the pandemic may be creating a snowball effect, setting back children without access to resources from which they may never recover, even into adulthood.

Predictions from data analysis of school absenteeism, summer breaks, and natural disaster occurrences are imperfect for the current situation, but all indications are that we should not expect all children and adolescents to be affected equally. 4 , 5 Although some children and adolescents will likely suffer no long-term consequences, COVID-19 is expected to widen the already existing educational gap from socioeconomic differences, and children with learning differences are expected to suffer more losses than neurotypical children. 4 , 5

Special education and the COVID-19 pandemic

Although COVID-19 has affected all levels of education reception and delivery, children with special needs have been more profoundly impacted. Children in the United States who have special needs have legal protection for appropriate education by the Individuals with Disabilities Education Act and Section 504 of the Rehabilitation Act of 1973. 17 , 18 Collectively, this legislation is meant to allow for appropriate accommodations, services, modifications, and specialized academic instruction to ensure that “every child receives a free appropriate public education . . . in the least restrictive environment.” 17

Children with autism usually have applied behavioral analysis (ABA) as part of their individualized educational plan. ABA therapists for autism use a technique of discrete trial training that shapes and rewards incremental changes toward new behaviors. 19 Discrete trial training involves breaking behaviors into small steps and repetition of rewards for small advances in the steps toward those behaviors. It is an intensive one-on-one therapy that puts a child and therapist in close contact for many hours at a time, often 20 to 40 hours a week. This therapy works best when initiated at a young age in children with autism and is often initiated in the home. 19

Because ABA workers were considered essential workers from the early days of the pandemic, organizations providing this service had the responsibility and the freedom to develop safety protocols for delivery of this necessary service and did so in conjunction with certifying boards. 20

Early in the pandemic, there were interruptions in ABA followed by virtual visits, and finally by in-home therapy with COVID-19 isolation precautions. 21 Although the efficacy of virtual visits for ABA therapy would empirically seem to be inferior, there are few outcomes data available. The balance of safety versus efficacy quite early turned to in-home services with interruptions owing to illness and decreased therapist availability owing to the pandemic. 21 An overarching concern for children with autism is the possible loss of a window of opportunity to intervene early. Families of children and adolescents with autism spectrum disorder report increased stress compared with families of children with other disabilities before the pandemic, and during the pandemic this burden has increased with the added responsibility of monitoring in-home schooling. 20

Early data on virtual schooling children with attention deficit disorder (ADD) and attention deficit with hyperactivity (ADHD) shows that adolescents with ADD/ADHD found the switch to virtual learning more anxiety producing and more challenging than their peers. 22 However, according to a study in Ireland, younger children with ADD/ADHD and no other neurologic or psychiatric diagnoses who were stable on medication tended to report less anxiety with at-home schooling and their parents and caregivers reported improved behavior during the pandemic. 23 An unexpected benefit of shelter in home versus shelter in place may be to identify these stressors in face-to-face school for children with ADD/ADHD. If children with ADD/ADHD had an additional diagnosis of autism or depression, they reported increased anxiety with the school shutdown. 23 , 24

Much of the available literature is anticipatory guidance for in-home schooling of children with disabilities rather than data about schooling during the pandemic. The American Academy of Pediatrics published guidance advising that, because 70% of students with ADHD have other conditions, such as learning differences, oppositional defiant disorder, or depression, they may have very different responses to in home schooling which are a result of the non-ADHD diagnosis, for example, refusal to attempt work for children with oppositional defiant disorder, severe anxiety for those with depression and or anxiety disorders, and anxiety and perseveration for children with autism. 25 Children and families already stressed with learning differences have had substantial challenges during the COVID-19 school closures.

High school, depression, and COVID-19

High schoolers have lost a great deal during this pandemic. What should have been a time of establishing more independence has been hampered by shelter-in-place recommendations. Graduations, proms, athletic events, college visits, and many other social and educational events have been altered or lost and cannot be recaptured.

Adolescents reported higher rates of depression and anxiety associated with the pandemic, and in 1 study 14.4% of teenagers report post-traumatic stress disorder, whereas 40.4% report having depression and anxiety. 26 In another survey adolescent boys reported a significant decrease in life satisfaction from 92% before COVID to 72% during lockdown conditions. For adolescent girls, the decrease in life satisfaction was from 81% before COVID to 62% during the pandemic, with the oldest teenage girls reporting the lowest life satisfaction values during COVID-19 restrictions. 27 During the school shutdown for COVID-19, 21% of boys and 27% of girls reported an increase in family arguments. 26 Combine all of these reports with decreasing access to mental health services owing to pandemic restrictions and it becomes a complicated matter for parents to address their children's mental health needs as well as their educational needs. 28

A study conducted in Norway measured aspects of socialization and mood changes in adolescents during the pandemic. The opportunity for prosocial action was rated on a scale of 1 (not at all) to 6 (very much) based on how well certain phrases applied to them, for example, “I comforted a friend yesterday,” “Yesterday I did my best to care for a friend,” and “Yesterday I sent a message to a friend.” They also ranked mood by rating items on a scale of 1 (not at all) to 5 (very well) as items reflected their mood. 29 They found that adolescents showed an overall decrease in empathic concern and opportunity for prosocial actions, as well as a decrease in mood ratings during the pandemic. 29

A survey of 24,155 residents of Michigan projected an escalation of suicide risk for lesbian, gay, bisexual, transgender youth as well as those youth questioning their sexual orientation (LGBTQ) associated with increased social isolation. There was also a 66% increase in domestic violence for LGBTQ youth during shelter in place. 30 LGBTQ youth are yet another example of those already at increased risk having disproportionate effects of the pandemic.

Increased social media use during COVID-19, along with traditional forms of education moving to digital platforms, has led to the majority of adolescents spending significantly more time in front of screens. Excessive screen time is well-known to be associated with poor sleep, sedentary habits, mental health problems, and physical health issues. 31 With decreased access to physical activity, especially in crowded inner-city areas, and increased dependence on screen time for schooling, it is more difficult to craft easy solutions to the screen time issue.

During these times, it is more important than ever for pediatricians to check in on the mental health of patients with queries about how school is going, how patients are keeping contact with peers, and how are they processing social issues related to violence. Queries to families about the need for assistance with food insecurity, housing insecurity, and access to mental health services are necessary during this time of public emergency.

Medical school and COVID-19

Although medical school is an adult schooling experience, it affects not only the medical profession and our junior colleagues, but, by extrapolation, all education that requires hands-on experience or interning, and has been included for those reasons.

In the new COVID-19 era, medical schools have been forced to make drastic and quick changes to multiple levels of their curriculum to ensure both student and patient safety during the pandemic. Students entering their clinical rotations have had the most drastic alteration to their experience.

COVID-19 has led to some of the same changes high schools and colleges have adopted, specifically, replacement of large in-person lectures with small group activities small group discussion and virtual lectures. 32 The transition to an online format for medical education has been rapid and impacted both students and faculty. 33 , 34 In a survey by Singh and colleagues, 33 of the 192 students reporting 43.9% found online lectures to be poorer than physical classrooms during the pandemic. In another report by Shahrvini and colleagues, 35 of 104 students surveyed, 74.5% students felt disconnected from their medical school and their peers and 43.3% felt that they were unprepared for their clerkships. Although there are no pre-COVID-19 data for comparison, it is expected that the COVID-19 changes will lead to increased insecurity and feelings of poor preparation for clinical work.

Gross anatomy is a well-established tradition within the medical school curriculum and one that is conducted almost entirely in person and in close quarters around a cadaver. Harmon and colleagues 36 surveyed 67 gross anatomy educators and found that 8% were still holding in-person sessions and 34 ± 43% transitioned to using cadaver images and dissecting videos that could be accessed through the Internet.

Many third- and fourth-year medical students have seen periods of cancellation for clinical rotations and supplementation with online learning, telemedicine, or virtual rounds owing to the COVID-19 pandemic. 37 A study from Shahrvini and colleagues 38 found that an unofficial document from Reddit (a widely used social network platform with a subgroup for medical students and residents) reported that 75% of medical schools had canceled clinical activities for third- and fourth-year students for some part of 2020. In another survey by Harries and colleagues, 39 of the 741 students who responded, 93.7% were not involved in clinical rotations with in-person patient contact. The reactions of students varied, with 75.8% admitting to agreeing with the decision, 34.7% feeling guilty, and 27.0% feeling relieved. 39 In the same survey, 74.7% of students felt that their medical education had been disrupted, 84.1% said they felt increased anxiety, and 83.4% would accept the risk of COVID-19 infection if they were able to return to the clinical setting. 39

Since the start of the pandemic, medical schools have had to find new and innovative ways to continue teaching and exposing students to clinical settings. The use of electronic conferencing services has been critical to continuing education. One approach has been to turn to online applications like Google Hangouts, which come at no cost and offer a wide variety of tools to form an integrative learning environment. 32 , 37 , 40 Schools have also adopted a hybrid model of teaching where lectures can be prerecorded then viewed by the student asynchronously on their own time followed by live virtual lectures where faculty can offer question-and-answer sessions related to the material. By offering this new format, students have been given more flexibility in terms of creating a schedule that suits their needs and may decrease stress. 37

Although these changes can be a hurdle to students and faculty, it might prove to be beneficial for the future of medical training in some ways. Telemedicine is a growing field, and the American Medical Association and other programs have endorsed its value. 41 Telemedicine visits can still be used to take a history, conduct a basic visual physical examination, and build rapport, as well as performing other aspects of the clinical examination during a pandemic, and will continue to be useful for patients unable to attend regular visits at remote locations. Learning effectively now how to communicate professionally and carry out telemedicine visits may better prepare students for a future where telemedicine is an expectation and allow students to learn the limitations as well as the advantages of this modality. 41

Pandemic changes have strongly impacted the process of college applications, medical school applications, and residency applications. 32 For US medical residencies, 72% of applicants will, if the pattern from 2016 to 2019 continues, move between states or countries. 42 This level of movement is increasingly dangerous given the spread of COVID-19 and the lack of currently accepted procedures to carry out such a mass migration safely. The same follows for medical schools and universities.

We need to accept and prepare for the fact that medial students as well as other learners who require in-person training may lack some skills when they enter their profession. These skills will have to be acquired during a later phase of training. We may have less skilled entry-level resident physicians and nurses in our hospitals and in other clinical professions as well.

The COVID-19 pandemic has affected and will continue to affect the delivery of knowledge and skills at all levels of education. Although many children and adult learners will likely compensate for this interruption of traditional educational services and adapt to new modalities, some will struggle. The widening of the gap for those whose families cannot absorb the teaching and supervision of education required for in-home education because they lack the time and skills necessary are not addressed currently. The gap for those already at a disadvantage because of socioeconomic class, language, and special needs are most severely affected by the COVID-19 pandemic school closures and will have the hardest time compensating. As pediatricians, it is critical that we continue to check in with our young patients about how they are coping and what assistance we can guide them toward in our communities.

Clinics care points

• Learners and educators at all levels of education have been affected by COVID-19 restrictions with rapid adaptations to virtual learning platforms.
• The impact of COVID-19 on learners is not evenly distributed and children of racial minorities, those who live in poverty, those requiring special education, and children who speak English as a second language are more negatively affected by the need for remote learning.
• Math scores are more impacted than language arts scores by previous school closures and thus far by these shutdowns for COVID-19.
• Anxiety and depression have increased in children and particularly in adolescents as a result of COVID-19 itself and as a consequence of school changes.
• Pediatricians should regularly screen for unmet needs in their patients during the pandemic, such as food insecurity with the loss of school meals, an inability to adapt to remote learning and increased computer time, and heightened anxiety and depression as results of school changes.

The authors have nothing to disclose.

FDA approves the new Covid vaccine. Here's the best time to get it.

The Food and Drug Administration on Thursday approved the new Covid vaccines from Pfizer and Moderna.

It’s the third time the vaccines have been updated to match circulating strains since the original series. The shots should be available within days. The agency hasn't yet approved a third vaccine, from drugmaker Novavax.

The timing of the new vaccines — last year's rollout was in mid-September — is significant, since most of the U.S. is still caught in the summer wave of Covid illness. As of Monday, the Centers for Disease Control and Prevention reported, the number of people testing positive for Covid keeps rising and emergency room visits for Covid have been increasing since mid-May. Hospitalizations are rising , too.

Here’s what to know about the updated vaccines.

How are the new Covid vaccines different?

The new shots from Pfizer and Moderna are designed to target the KP.2 strain, a descendant of the highly contagious JN.1 variant that began circulating widely in the U.S. last winter. The drugmakers started making the new doses in June after the FDA advised them to freshen the formulas to match the version of the virus that was gaining ground in the U.S.

A third vaccine, from drugmaker Novavax, has been updated to target the JN.1 strain. JN.1 and KP.2 have largely faded from circulation, according to the CDC.

As of Saturday, a sister strain called KP.3.1.1 accounted for about 36% of all new Covid cases, while another sister strain, KP.3, accounted for about 17%.

It’s unclear exactly how effective the vaccines will be against the newer strains, but experts expect that they will protect against severe illness.

A spokesperson from Pfizer told NBC News that data submitted to the FDA shows that its vaccine generates a “substantially improved” immune response against multiple currently circulating variants, including KP.3, compared to earlier versions of the vaccine.

There are “very minor sequence differences” between the variants, said John Moore, a professor of microbiology and immunology at Weill Cornell Medical College.

A paper published this month in the journal Infectious Diseases found that KP.3.1.1 shares similarities with JN.1 and KP.2, although it has a few additional mutations that may help it spread more easily.

“All these changes are incremental. They do not change the overall big picture,” Moore said. “KP.3.1.1 is just another step in the road that the overall omicron lineage is taking towards greater transmissibility.”

Who should get the new Covid vaccine?

In an earlier interview, Dr. Ashish Jha, dean of the Brown University School of Public Health and a former White House Covid-19 response coordinator, said Covid is most likely endemic in the U.S., meaning the virus is following “a relatively predictable pattern that will last a very long time.”

That means we’ll be getting a yearly updated Covid vaccine to protect against mutations and waning immunity, just like annual flu shots.

As of May 11, only 22.5% of adults got last year’s updated Covid vaccine, according to data from the CDC . Only 14.4% of children ages 6 months through 17 years got vaccinated.

For this fall, the CDC recommended that all Americans ages 6 months and older get the new shots.

But Dr. Isaac Bogoch, an infectious disease specialist at the University of Toronto, said it’s challenging to make a one-size-fits-all recommendation on who should get the vaccine, especially for healthy, young adults.

“It’s fair to say that the vaccines are still helpful, certainly at an individual level, and to some extent at a community level,” he said.

It’s critically important that people at the highest risk of a severe Covid infection — including people over 65 or with weakened immune systems or underlying health conditions, such as heart disease or obesity — get the vaccine, Bogoch said

“The heavy lifting of the vaccine is really in protecting the most vulnerable people from severe outcomes, like hospitalization and death,” he said.

When should I get the new Covid vaccine?

Millions of people in the U.S. have had Covid within the last few weeks and months. An advantage of the summer wave is that people who have recently recovered have an immune boost to fight off future infections.

Because the vaccines will be available earlier this year than last, the question of timing for the most protection through the winter is more urgent. According to CDC guidance, if you’ve recently had Covid , “you may consider delaying your vaccine dose by 3 months.”

For people at high risk of severe illness, experts say get the vaccine when it becomes available. That's because infection may not provide as much protection as vaccination, said Dr. Ofer Levy, the director of the Precision Vaccines Program at Boston Children’s Hospital.

Protection from infection can vary based on the severity of infection, the strain, as well as a person’s age and health.

For the young and healthy, it may not be as beneficial to get the vaccine so close to recovery from infection, said Akiko Iwasaki, professor of immunology at the Yale School of Medicine. High levels of antibodies present from recent infection may prevent the vaccine from stimulating new immune cells.

“If there’s a lot of antibodies already circulating, those antibodies are going to block the [vaccine] from doing its job,” she said. “That’s one reason why it’s not recommended to get the vaccine immediately after you’ve had Covid.”

Dr. Paul Sax, clinical director of the division of infectious diseases at Brigham and Women’s Hospital in Boston, said there’s no harm in getting the vaccine now, although it may make more sense to wait since Covid cases tend to pick up around November.

“Assuming that’s the case again this year, I would say sometime in October when people get their flu shot would be perfect,” Sax said.

There’s not a risk to getting it right away, but the initial protection from the vaccine may not last through an expected winter wave, Sax said.

“The good thing is that all of us with our immunity from prior vaccines or getting Covid or both don’t have as much of a risk of severe disease,” he said. “But if you want to really completely avoid getting infected it’s that antibody spike after the vaccine that happens one to three weeks after that’s most protective.”

Dr. Manisha Juthani, commissioner of the Connecticut Department of Public Health, said that people who recently had Covid can wait a few months before they get their updated vaccine.

“Immunity does wane from having had Covid or getting the vaccine,” Juthani said Wednesday during a media briefing with the Association of State and Territorial Health Officials ahead of the winter respiratory virus season. “If you don’t feel strongly about getting the vaccine right away, then waiting about three months from when you had Covid, and particularly, so that as we’re approaching the holidays, that you get that shot before the big holidays and when you may be gathering with people.”

“If you feel strongly that you really want to get the shot as soon as it’s available, even if you had Covid this summer, then of course you can get that,” she added. “There’s nothing to say that you can’t in September or October.”

Data from prior Covid vaccines suggests that the initial protection against infection peaks about a month after the shot and starts to wane over the next several months, even when the vaccine is well matched to the circulating strains.

Fortunately protection against severe disease remains robust for much longer, Iwasaki said.

Ultimately you never know when you may become infected with the virus, she said.

“It’s kind of a risky calculation because waves just means that there is a large number of infections in the population, but at the individual level you can get infected tomorrow,” she said. “So it’s very difficult to predict what is the best time to get it.”

Iwasaki plans to get the vaccine herself sooner rather than later since she has not been infected or had a booster in some time.

Sax recommends that his patients wait two to three months after recovering before getting another shot.

“The reality is, your infection gives you some boost of your own immunity,” he said.

What are side effects of the new Covid vaccines?

Like other versions of the Covid vaccines and similar to flu shots, the most common reaction is some pain at the injection site. Other side effects include :

Muscle pain

The CDC says the side effects typically resolve after a few days. Serious side effects , such as the life-threatening allergic reaction called anaphylaxis, are rare.

Pfizer and Moderna’s vaccines have been associated with a small but increased risk of myocarditis , the inflammation of the heart muscle, mostly in young men. Most people make a full recovery.

How much will it cost?

Pfizer, Moderna and Novavax are charging up to $150 per dose for a Covid vaccine , according to data from the Centers for Medicare and Medicaid Services.

The vast majority of people with public and private health insurance should pay nothing out of pocket for the updated Covid vaccines —as long as they stick with an in-network provider, said Jennifer Kates, director of the Global Health & HIV Policy Program.

Medicare and Medicaid require that the vaccines are free for patients. The Affordable Care Act, also known as Obamacare, requires private insurers to cover all vaccines that are recommended by the CDC’s vaccine committee and director.

However, Kates added that the ACA’s requirement does not apply to grandfathered plans — plans that existed before the ACA was signed into law — and short-term health plans.

“People enrolled in these plans may face cost sharing for the Covid vaccine, or the vaccine may not be covered at all,” she said.

Children without insurance can get free vaccines through the government-run Vaccines for Children Program.

For adults without health insurance, the situation is a bit different. The CDC’s Bridge Access Program — which has been paying for shots for uninsured adults — is expected to shut down in August because of a lack of funding.

Once the funding runs out, uninsured individuals may be able to access free Covid vaccines through community health centers and other safety net providers that participate in the Section 317 vaccine program for adults, Kates said. Section 317 is a federal initiative that gives funding to states to provide vaccines for uninsured and underinsured adults.

“Some state and local health departments may also have a limited supply for people without insurance, but any supply will be very limited,” Kates said.

Berkeley Lovelace Jr. is a health and medical reporter for NBC News. He covers the Food and Drug Administration, with a special focus on Covid vaccines, prescription drug pricing and health care. He previously covered the biotech and pharmaceutical industry with CNBC.

Akshay Syal, M.D., is a medical fellow with the NBC News Health and Medical Unit.

IMAGES

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