problem solving in covid 19

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The Coronavirus Crisis

How 6 problem-solvers tackled pandemic challenges in their neighborhoods.

Left: Tech entrepreneur Ruchit Garg is helping farmers connect to customers in India. Center: A mariachi band brings music and joy to the streets of Colombia during lockdown. Right: Designer Rhea Shah created an affordable cardboard bed for health facilities in India. Rohit Garg; Jorge Calle; Pritesh Prajapati hide caption

Left: Tech entrepreneur Ruchit Garg is helping farmers connect to customers in India. Center: A mariachi band brings music and joy to the streets of Colombia during lockdown. Right: Designer Rhea Shah created an affordable cardboard bed for health facilities in India.

Cardboard beds. Urban farms. Roving mariachi bands.

These are some of the ways that regular folks are solving problems and spreading happiness during the pandemic.

The solutions aren't perfect — public health experts have some critiques and suggestions. But at the same time, they applaud the ingenuity and positive vibes.

Read the stories of six grassroots change-makers — then nominate your own at the bottom of this story.

Urban farmer gives greens to the poor

Left: Urban farmer Victor Edalia (in white shirt) with three beneficiaries of his free veggies (left to right): Sheila Musimbi, a single mom; Celine Oinga, who comes from a family of 9 siblings; and Jackline Oyamo, jobless due to the pandemic. Right: Edalia uses modern urban farming methods, including this spiral planter that holds up to 100 seedlings. Thomas Bwire hide caption

In April, Jackline Oyamo, 31, was laid off from her job as an electronic sales assistant at a shop in Kibera, one of the world's largest slums on the outskirts of Nairobi, Kenya. The curfews to control the pandemic meant fewer customers – and staff cutbacks. "After losing my job, it was extremely difficult to keep feeding myself after I exhausted my small savings," she says.

But Oyamo is able to get fresh produce for free from Victor Edalia, a 30-year-old urban farmer in her neighborhood. Last November, Edalia, who works as a driver by day, converted a trash dump site in the slum into an urban garden. He signed an agreement with a local chief to use the land. Now, the plot, about a quarter of an acre, grows vegetables such as kale, onions and spinach.

Edalia originally started the farm to boost his income. The idea was to sell vegetables to hotels. But once the pandemic hit, he changed the plan. He wanted to find a way to "give back," he says.

So throughout the pandemic, Edalia has been providing free supplies of vegetables to 10 needy families and individuals in Kibera. They include young people who lost their jobs in the pandemic, like Oyamo, as well as single mothers and families with households of more than seven people. They can drop by the farm up to three times a week to pick up a supply of vegetables.

"I saw needy families get food donations, mostly comprising of dry foods but without any vegetables," says Edalia.

Oyamo says the veggies supplement other food donations she receives from charities and people in the community.

Moses Omondi, team leader of Adopt a Family, a local nonprofit that's been providing dry food donations – like maize flour — to 500 families in Kibera, thinks Edalia's program is promising.

Providing veggies to families who receive food packs – "I think it's a pretty smart approach," he says. "In addition to supporting struggling families during these tough times that face starvation while at home, it helps to reduce anxiety and helplessness of a Kibera family."

Thomas Bwire is a digital and radio journalist from Kibera, Kenya.

App maker helps churches go virtual

Houses of worship had to close their doors because of the pandemic. And even now, with some reopening, there may be limits on how many congregants are allowed in.

Nnamdi Udeh, 29, a tech entrepreneur in Nigeria, came up with OSanctus, an app that offers some solutions: easy access to virtual worshipping options and a reservations system so there won't be crowding at reopened churches.

Churches can use the app to stream mass online and share community announcements. Parishioners can book a virtual consultation with a priest — and send in a digital donation. And in Nigeria, where houses of worship have capped attendance at 50% of capacity, folks can use the app to register for a spot instead of showing up to church in the hope of being let in.

"It helps the priests manage their time schedule, know how many persons they are expecting on a particular day, all the appointments and masses booked and other activities that they want," says Udeh.

Harvard Medical School physician Dr. Abraar Karan says indoor churches are high risk. "There is singing usually and close face-to-face contact between participants. While the app is probably trying to reduce crowding outside the church, it is unclear if it will achieve that."

But, he adds, "if the church is going to open either way, the app could help ensure that only a certain number of people come at a time."

So far, it's been helpful to parishioners. "It is user-friendly and helps us to resolve church registration issues. Parishioners can easily access the parish office and we can also reach out to them," says Father Paul Akin-Otiko, a pastor at a Catholic-run chaplaincy . "It came in handy during this pandemic."

The app runs in six parishes in Lagos and has been downloaded about 500 times. It is now under trial in other parishes across the country. But it's not 100% altruistic. As everyone struggles to earn a living in these times, the app maker plans to charge the churches an annual fee, based on the size of the parish.

Patrick Egwu is a Nigerian freelance journalist currently based in Johannesburg, where he is an Open Society Foundations fellow on Investigative Reporting at the University of the Witwatersrand.

Designer makes recyclable cardboard beds for patients

Left: Designer Rhea Shah, right, and her colleagues assemble a cardboard bed at her family's paper factory in the western Indian state of Gujarat. Right: Shah poses for a photo with family members and colleagues who helped manufacture the cardboard bed. Pritesh Prajapati hide caption

As the coronavirus surges in India, authorities are converting dozens of convention centers in major cities into temporary COVID-19 wards, some equipped with rather unusual beds — made entirely of cardboard.

The beds can be assembled in minutes and hold a load of more than 400 pounds. They're made of tough corrugated cardboard that's been chemically treated to make it waterproof, so they can be sprayed with disinfectant and wiped clean. They cost about $13 each – roughly half the price of the cheapest metal beds, says architect and designer Rhea Shah , who specializes in urban resilience.

Shah came up with the concept for the bed while under lockdown at her family's home in western India.

"I was grappling with helplessness, thinking about what I could do with my talent and the resources available," Shah says.

Her family runs a paper factory and is selling the beds at cost, without profit. They've shipped about 15,000 units to isolation wards set up by the Indian Navy, government hospitals and a school in Mumbai's Dharavi slum – a recent COVID-19 hotspot.

"The cardboard bed was really a great help because it can be disposed of easily," says city official Kiran Dighavkar, who oversees Dharavi. Once they are no longer needed, they can be recycled.

Dighavkar says it wasn't economical to buy thousands of metal beds, which would only be used during the peak of the pandemic.

Cardboard furniture isn't new. Cardboard desks and beds are popular in Europe because they're recyclable. With the high death toll from COVID-19 in Latin America, designers there have come up with cardboard beds that turn into coffins .

Other Indian manufacturers are adapting Shah's design. One company supplied 10,000 cardboard beds to a makeshift hospital in New Delhi , one of the largest COVID-19 facilities in the world.

"It's heartwarming to know that in spaces where it was most needed, it was useful," says Shah.

Sushmita Pathak is a producer for NPR India.

'Commander Safeguard' brings COVID-19 messages to remote areas

Left: Rehmat Ali Dost makes an announcement at the village of Kushum in the Upper Chitral district of Pakistan. Right: Using a loudspeaker, Dost shares information about COVID-19 in the village of Rech Torkhow. Afzal Wali Badakhsh hide caption

Rehmat Ali Jaffar Dost, 43, is known as "Commander Safeguard" for his clean-up and anti-littering campaigns in Chitral, a remote district of Pakistan on the border of Afghanistan. Now he's adding to his agenda: informing citizens about COVID-19.

In the area where Dost lives, fewer than 20% of residents have basic 2G internet and there are still some villages with no electricity, according to the Aga Khan Rural Support Program, a nonprofit operating in rural parts of Pakistan. And government officials and nonprofit organizations have been slow to spread crucial COVID-19 messaging to remote areas of the country. But the virus itself is spreading. In the district of Upper Chitral, with a population of nearly 200,000, there are more than 110 confirmed cases.

On March 17, Dost went on a 40-day journey across the Upper Chitral region to share information about the pandemic. He borrowed a friend's car and covered other expenses with the help of friends and donations. Dost is the founder of Chitral Heritage and Environment Protection Society, a student volunteer organization.

In open spaces, Dost organized small group meetings with community members and leaders to answer questions and bust rumors and misconceptions. "A majority of the people did not know what a virus was," he says, "and some thought people in developing countries are already immune to every kind of virus."

"In order to respond with concrete and factual information, I have involved community leaders, religious clerics, educated people and health professionals [to answer their questions]," adds Dost.

Dost also trained people to sew their own face masks, which he learned how to do by watching YouTube videos.

In some parts of Upper Chitral, he was not able to meet face-to-face interactions with women. "Chitral is highly divided in terms of religious sects and extremely conservative," he says So, he came up with a solution. Standing in the street, he uses "a loudspeaker to reach out to Chitrali sisters and mothers," politely requesting that people stay home, wear masks, don't shake hands and wash their hands.

Government officials such as Shah Saud, deputy commissioner of Upper Chitral, is grateful for Dost's involvement. "We totally support and appreciate this initiative. Volunteers like Rehmat Ali can help stop or slow down the spread of this contagious disease."

Benazir Samad is a lead multimedia journalist at Voice of America's Pakistan desk in Washington, D.C.

Roving mariachi musicians uplift locked-down neighbors

Left: Since lockdown, the band has been going out to busk in different neighborhoods. Right: Antonio Cartagena, an accordion player in a mariachi group meets his bandmates on the street in Medelli­n, Colombia. Jorge Calle hide caption

Medellin's mariachi and folk music bands are usually booked up with performances at parties, weddings and birthdays. But since mandatory stay-home orders were enforced on March 20, they have been out of work.

Equipped with masks, some Colombian musical groups are helping others and themselves by walking the streets and busking.

These public mini-concerts cheer up the city's residents stuck at home.

Jairo Muriel, 56, has seen four live performances outside his apartment in Bello, a suburb of Medellin. "It's really enjoyable," he says. People come out on their balconies to savor the music and sing along.

Then they lower tips in a basket. "People are very good to us. They help us," says Antonio Cartagena, 66, an accordion player from a mariachi band.

The money is far from normal wages. Depending on how successful a band is, an 8- to 10-piece group can earn up to $1,100 to divvy up for one night's work. Cartagena says his share of the daily tips in the pandemic is $13 on average. Although it's not much, he says it's enough for him to buy food for his family each day.

Not everyone likes the music. Muriel has heard at least one person in the surrounding buildings telling the groups to move along. But the bands, he says, "don't stay very long, they're not annoying."

And the city's secretary for culture Lina Gaviria is a fan. Entertainment can "transmit a message of hope during these difficult times," she says.

Sophie Foggin is a journalist based in Medellin, Colombia, covering politics, human rights, history and justice in Latin America.

Tech entrepreneur connects farmers to customers

Left: Ruchit Garg, founder of the Harvesting Farmer Network, and a farmer near Bhopal, Madhya Pradesh, India, in 2018. Right: Garg on a tractor during a visit with farmers. Rohit Garg hide caption

In early April, Justin Stephen, a 36-year-old farmer from Udhagamandalam, a town nestled in south India's Niligiri mountains, was distressed.

As India's lockdown came into effect on the midnight of March 25, the prime season for harvesting avocados was just beginning. Every month, from February to September, the trees on Stephen's two-acre farmlands yielded a rich harvest of roughly 4,000 avocados. The fruit stays fresh only three days after being picked. So getting the produce to market as quickly as possible is a priority.

Even in previous years, Stephen had difficulty connecting with key retail markets in Indian cities and transporting the avocados on time because his farm, bordering a jungle, wasn't as accessible. There wasn't a reliable network of trucks to transport the products. And transport costs were high.

Now, with lockdown restrictions on travel, getting his avocados to market "seemed impossible," he says.

In mid-April, when he was staring at mounting financial losses and crop wastage, a friend suggested that he contact Harvesting Farmer Network (HFN), a website run by Ruchit Garg , a tech entrepreneur. Garg runs a tech company called Harvesting , which uses satellite data and artificial intelligence to identify, measure and monitor cropland.

When social media erupted with videos of distraught farmers flinging produce into rivers and onto streets, frustrated and unable to sell because of the pandemic travel restrictions, Garg's heart went out to them. "I could feel their pain. I knew I had to do something," he says.

Garg launched HFN on April 12 to address some of the farmers' challenges. With many shops being shut down, some farmers only lacked customers. Farmers can join HFN free of charge and display their fresh produce to customers across India. If a customer is interested in buying, they place their order on the site.

Once farmers receive their orders, they can coordinate deliveries to the customers themselves. For farmers unable to arrange for transport, Garg has arranged for buses and lorries and HFN vehicles to transport produce from the farms to the customers.

So far, he says that HFN has helped deliver over one million pounds of fresh fruits and vegetables from over 2,000 farmers to customers across the country.

Stephen's avocados have been popular on HFN. In a single day, he delivered about 3,600 avocados, and some of his delighted customers tweeted their thanks. "I was overjoyed that people appreciated my fresh produce, and that I could connect with customers in these difficult times."

So far, he's sold nearly 15,000 avocados. "In a country hit by COVID, we found kindness and a way to look to the future with hope," he says.

Kamala Thiagarajan is a freelance journalist based in Madurai, India, who has written for The International New York Times, BBC Travel and Forbes India. You can follow her @kamal_t .

Nominate a problem-solver

We'd like to tell more stories about inventive ways that people are using their talents and skills to address COVID-19 challenges in their community.

If you have any suggestions, send an email to [email protected] with your nomination, with "Problem Solver" in the subject line. We may feature them in a future story on NPR.org.

Americans coped with pandemic using problem solving, emotional support

Alessandro Biascioli / iStock

A survey of 1,000 Americans assessing positive and negative coping skills during the pandemic shows that people fared better when focused on problem solving and planning during times of uncertainty.

As part of the study, published yesterday in PLOS One , participants engaged in an online survey to assess how they dealt with stressful life events (SLEs), coping strategies, and the physical and psychological health domains of quality of life (QOL) during COVID-19. The 25- to 30-minute survey was conducted in August 2021 on Prolific, a web-based survey recruitment platform.

Survey respondents were mostly White (73%), equally divided among men and women, with a mean age of 44. Half were married or cohabitating.

More stressors led to more avoidance behaviors

Using 16 questions, the authors identified three patterns for coping with SLEs: problem-focused coping, emotional-focused coping, and avoidant coping.

Problem-focused coping included four items relating to the use of informational support. Emotion-focused coping included six items using emotional support, humor, and religion. And avoidant coping had six items relating to self-distraction, substance use, and behavioral disengagement.

Respondents answered the coping questions using a 5-point Likert scale, noting how they had coped with particular stressors over the last year.

The mean number of SLEs reported by respondents was 1.6, with a range of 0 to 18. The three most common SLEs reported in the sample were a decrease in financial status, followed by personal injury or illness, and a change in living conditions.

Problem- and emotional-focused coping helped

For all respondents, problem-focused coping and emotion-focused coping were significantly related to higher levels of QOL, whereas avoidant coping was associated with lower QOL, the authors said. More life stressors correlated to using more avoidant coping skills.

As the pandemic instigated or exacerbated a wide range of unexpected and unpredictable stressors, such as personal illness, illness and deaths of loved ones, and unemployment, we posit that the use of emotion-focused coping was likely helpful in navigating these situations.

"Previous research, most of which was conducted pre-pandemic, has demonstrated inconsistent findings regarding the relationship between emotion-focused coping and QOL, with many studies pointing to a negative association between these two constructs," the authors said. They hypothesize that emotional coping served people well during the pandemic because it helped them handle uncertainty.

"As the pandemic instigated or exacerbated a wide range of unexpected and unpredictable stressors, such as personal illness, illness and deaths of loved ones, and unemployment, we posit that the use of emotion-focused coping was likely helpful in navigating these situations," the authors said.

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• COVID-19 and your mental health

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

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

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

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

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

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

Recognize what's typical and what's not

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

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

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

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

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

Get help when you need it

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

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

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

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

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

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

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

Self-care tips

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

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

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

Take care of your body

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

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

Take care of your mind

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

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

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

Other healthy self-care tips are:

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

Avoid stigma and discrimination

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

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

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

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

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

COVID-19 and health

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

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• Mental Health and COVID-19: Early evidence of the pandemic's impact: Scientific brief, 2 March 2022. World Health Organization. https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1. Accessed March 12, 2024.
• Mental health and the pandemic: What U.S. surveys have found. Pew Research Center. https://www.pewresearch.org/short-reads/2023/03/02/mental-health-and-the-pandemic-what-u-s-surveys-have-found/. Accessed March 12, 2024.
• Taking care of your emotional health. Centers for Disease Control and Prevention. https://emergency.cdc.gov/coping/selfcare.asp. Accessed March 12, 2024.
• #HealthyAtHome—Mental health. World Health Organization. www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome---mental-health. Accessed March 12, 2024.
• Coping with stress. Centers for Disease Control and Prevention. www.cdc.gov/mentalhealth/stress-coping/cope-with-stress/. Accessed March 12, 2024.
• Manage stress. U.S. Department of Health and Human Services. https://health.gov/myhealthfinder/topics/health-conditions/heart-health/manage-stress. Accessed March 20, 2020.
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• People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed March 15, 2024.
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• World leprosy day: Bust the myths, learn the facts. Centers for Disease Control and Prevention. https://www.cdc.gov/leprosy/world-leprosy-day/. Accessed March 15, 2024.
• HIV stigma and discrimination. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/basics/hiv-stigma/. Accessed March 15, 2024.
• Diabetes stigma: Learn about it, recognize it, reduce it. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/features/diabetes_stigma.html. Accessed March 15, 2024.
• Phelan SM, et al. Patient and health care professional perspectives on stigma in integrated behavioral health: Barriers and recommendations. Annals of Family Medicine. 2023; doi:10.1370/afm.2924.
• Stigma reduction. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/od2a/case-studies/stigma-reduction.html. Accessed March 15, 2024.
• Nyblade L, et al. Stigma in health facilities: Why it matters and how we can change it. BMC Medicine. 2019; doi:10.1186/s12916-019-1256-2.
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• Yashadhana A, et al. Pandemic-related racial discrimination and its health impact among non-Indigenous racially minoritized peoples in high-income contexts: A systematic review. Health Promotion International. 2021; doi:10.1093/heapro/daab144.
• Sawchuk CN (expert opinion). Mayo Clinic. March 25, 2024.

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• Published: 30 June 2021

The COVID-19 wicked problem in public health ethics: conflicting evidence, or incommensurable values?

• Federica Angeli   ORCID: orcid.org/0000-0003-4010-3103 1 ,
• Silvia Camporesi   ORCID: orcid.org/0000-0003-4135-1723 2 &
• Giorgia Dal Fabbro 3  

Humanities and Social Sciences Communications volume  8 , Article number:  161 ( 2021 ) Cite this article

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While the world was facing a rapidly progressing COVID-19 second wave, a policy paradox emerged. On the one side, much more was known by Autumn 2020 about the mechanisms underpinning the spread and lethality of Sars-CoV-2. On the other side, how such knowledge should be translated by policymakers into containment measures appeared to be much more controversial and debated than during the first wave in Spring. Value-laden, conflicting views in the scientific community emerged about both problem definition and subsequent solutions surrounding the epidemiological emergency, which underlined that the COVID-19 global crisis had evolved towards a full-fledged policy “ wicked problem ”. With the aim to make sense of the seemingly paradoxical scientific disagreement around COVID-19 public health policies, we offer an ethical analysis of the scientific views encapsulated in the Great Barrington Declaration and of the John Snow Memorandum, two scientific petitions that appeared in October 2020. We show that how evidence is interpreted and translated into polar opposite advice with respect to COVID-19 containment policies depends on a different ethical compass that leads to different prioritization decisions of ethical values and societal goals. We then highlight the need for a situated approach to public health policy, which recognizes that policies are necessarily value-laden, and need to be sensitive to context-specific and historic socio-cultural and socio-economic nuances.

Competing goals and conflicting values in the COVID-19 wicked problem

At the time of writing (November 2020), while the world is facing a rapidly progressing COVID-19 second wave, and governments are rushing towards the reintroduction of restrictive measures, the consensus that almost monolithically surrounded the lockdown decisions—or slight variations of the same formula—in Spring 2020, is visibly breaking apart. Roughly 6 months into the pandemic, a paradox emerges. On the one hand, we have more evidence about the mechanisms underpinning the transmission, morbidity and mortality related to Sars-CoV-2. On the other hand, how such knowledge should be translated into containment policies is subject of fierce debates. In particular, a polarization of views started to emerge within the scientific community, vividly illustrated by the Great Barrington Declaration (Kulldorff et al., 2020 ; Lenzer, 2020 ) on the one side and the John Snow Memorandum (Alwan et al., 2020 ; John Snow Memorandum, 2020 ) on the other side. The Great Barrington Declaration was authored by Dr. Sunetra Gupta (University of Oxford), Dr. Jay Bhattacharya (Stanford University), and Dr. Martin Kulldorff (Harvard University), and was written and signed at the American Institute for Economic Research in Great Barrington, Massachusetts, on October 4th 2020. The document is co-signed by a further 44 medical and public health scientists and medical practitioners working in the US, Canada, Israel, Germany, India, New Zealand, and Sweden. The declaration advocates against lockdown measures to favor a containment approach based on a focused protection of the vulnerable, whilst allowing the segments of the population nominally at lower risk of COVID-related complications to resume normal life, thus favouring population-level natural immunity. The John Snow Memorandum was published in the Lancet on October 15th, 2020 as a reaction to the Great Barrington declaration, and was authored by a team of 31 scientists from the UK, Switzerland, US, Canada, Germany, France, Australia. The memorandum’s aim was to lay out empirical evidence to justify restrictive lockdown-like measures to prevent the uncontrolled spread of the virus and the subsequent collapse of healthcare systems.

Such value-laden, conflicting views about both problem definition and problem solution are typical of policy “ wicked problems ” (Alford and Head, 2017 ), a construct that increasingly applies to the COVID-19 global crisis. The pandemic has created a context in which multiple urgent, interdependent societal goals simultaneously exist, which generates a fundamental problem of prioritization of one aspect over another (Camporesi and Mori, 2020 ). Such goals can be identified in the short-term reduction of COVID-19 morbidity and mortality, the mitigation of long-term social repercussions of containment policies (rising social inequalities, mental health issues due to social isolation, intergenerational conflicts) and financial adverse consequences, in the form of severe economic recessions, and subsequent rise in unemployment, poverty levels, and social tensions (Angeli and Montefusco, 2020 ; Camporesi, 2020 ). We are currently witnessing how such prioritization choices generate conflicting stakeholder views about what the problem is (e.g., catastrophic death toll vs potential economic meltdown) and the related solutions (e.g., lockdown measures vs softer mechanisms of virus control). A full-fledged wicked problem has now arisen. However, while wicked problems are normally associated with policy choices, the polarization of views has now permeated the scientific community and the very process of translation of evidence into policy advice, therefore illustrating—perhaps more than ever before—the evolution from value-free to value-laden science.

The prioritization of the shorter-term goals of reduction of COVID-19-related morbidity and mortality in the Spring of 2020 first wave resulted in a multiplicity of policy interventions’ bundles in different countries. These interventions shared similarities in the way they restricted individual freedoms (Camporesi, 2020 ) and varied in their combination of school closures, limitations on pubs’ and restaurants’ opening times, use of face coverings, restrictions of socialization opportunities or individual mobility (Angeli and Montefusco, 2020 ). Now, as evidence about modes of contagion and manifestations of the disease accumulates, the debate about how to use the scientific evidence to inform policy has reached the stage of a polarized conflict. The shift away in narrative from the “we are all in this together” (United Nations, 2020 ), to the “focused protection” (Kulldorff et al., 2020 ) shows that the COVID -19 wicked policy problem requires more in-depth ethical considerations. In this piece, we offer an ethics-driven view of scientific advice for COVID-19 policy formulation, to illustrate how specific ethical prisms can lead to different—even polar opposite—views on containment policies. In this sense, we highlight the importance of ethics in decision-making and in the process of translating evidence into policy design (Oliver and Boaz, 2019 ). Our analysis also aims to provide an interdisciplinary interpretative lens, as it addresses the problem of how decision-makers attend to multiple objectives in space and time—a well-known area of research in management studies (Cyert and March, 1963 ; Ocasio, 1997 ; Rerup, 2009 ), by theoretically drawing on the field of public health ethics (Abbasi et al., 2018 ), and public policy formulation in the context of wicked problems (Head, 2008 ; Waddell, 2016 ).

Conflicting policy viewpoints: different priorities to different values

Conflicting values are commonplace in the context of managerial decision-making (e.g., Levinthal and Marengo, 2020 ) and in public health, especially in relation to the management of infectious diseases (Ortmann et al., 2016 ). Compulsory vaccination represents one emblematic example, in which individual freedom is restricted to favor the public good, by way of boosting heard immunity towards specific pathogens (Dawson et al., 2007 ). Public health policies revolve, although often implicitly, around a compass of three key values, namely utility, liberty, and equity/equality. The principle of utility aims at maximizing a certain value “X” for the greatest number of people. Public health policies aim at maximizing population health. In the context of measures aimed at the containment of disease outbreak, ensuring population health translates into reducing the disease transmission, morbidity and mortality, whether through vaccination, natural herd immunity, or restrictive measures aimed at reducing/modifying citizens’ socialization and interaction patterns, mobility and hygiene practices. Liberty is generally understood as the freedom to live one’s own life free from interference from others. Although there are two main understandings of liberty, a negative (liberty to act free from interference), and a positive one (liberty to shape one’s own life according to one’s own values, and to have the opportunity to do so beyond and above the lack of others’ interference) (Berlin, 1969 ) in the context of public health, liberty is generally conceptualized as negative liberty. Equity/equality is a value that is recognized as salient for public health policies, but also of difficult operationalization and implementation. Egalitarianism is the theory that aims at ensuring a fair distribution of benefits and harms across a given population, and hence to maintain distributive justice. Equity and equality are often used as synonyms in public health ethics, however, they point to different—even opposite—concepts. Equity is a normative concept, grounded in distributive justice, while that is not necessarily the case for equality (i.e. not all health inequalities are unfair) (Braveman and Gruskin, 2003 ). In the context of public health policies, equity means equal opportunity and implies that resources should be distributed in ways most likely to produce a fair distribution of harms and benefits across all segments of the population. This often implies that societal groups should not be offered the same services (as it would be in the case of equal treatment) but rather should receive differential care according to their differential needs. We will focus in this piece on equity rather than equality.

Even if not explicitly acknowledged, the values of utility, liberty and equity underpin any public (health) policy decision, including those aimed at containing the COVID-19 emergency. According to a pluralistic approach to public health policy (Selgelid, 2009b , 2009a ) these three values should all be considered as independent, socially legitimate public goals. Effective public health policies are then tasked to find creative ways to pursue all of them at the same time, through trade-offs that are socially and culturally acceptable. This is naturally easier said, than done. What creates a broad spectrum of public policy approaches in response to the COVID-19 pandemic is the different weight associated by different decision-makers—and also by scientists—to the three value dimensions of the ethical compass, resulting in different trade-off points. The recently published Great Barrington Declaration and John Snow Memorandum exemplify two situations in which, provided the same available scientific evidence, this is interpreted and translated by scientists into polar opposite advice with respect to COVID-19 containment policies. We argue that such views can be best understood in light of a different ethical compass that leads to different prioritization decisions. We can assume that signatories to both memoranda obviously want to reduce COVID-19 morbidity and mortality, want to mitigate its socio-economic repercussions, are concerned about restrictions of personal freedom and increasing surveillance, appreciate the differential impact of the policies across the population. However, the signatories assign a different weight to each of the three values of utility, liberty and equity, hence appraising the available scientific evidence with a different, value-laden ethical prism. The fact that the process of normative weighting assigned to empirical data remains implicit creates a polarization that is only apparently based on disagreements about empirical evidence.

The Great Barrington declaration takes a stance against restrictive measures aimed at controlling the community spread of the virus and instead proposes to focus policies and societal resources towards “focused protection” of the older demographics—notably those who are several times more likely to die from COVID-19 or to suffer from long-lasting complications. According to the signatories, this approach would also favor the development of herd immunity, hence further shielding the older people from the possibility of contracting the disease. This position has sparked a strong reaction from the signatories of the John Snow Memorandum, which highlights instead that the herd immunity arguments based on the assumption that natural infection from the virus will boost lasting protective immunity are flawed and lack supporting evidence. Moreover, the uncontrolled spread of Sars-CoV-2 within communities would lead to an excessive burden on healthcare systems and workers, and compromise the diagnosis and treatment of several acute and chronic conditions, with long-lasting-negative repercussions. As a consequence, the John Snow Memorandum argues that it is important to extend social distancing, targeted restrictions of mobility and socialization, face coverings and strengthened hygiene practices to the whole population.

With its emphasis on “focused protection” the Great Barrington declaration prioritizes values of liberty and equity, as it views the wide imposition of restrictive measures as violating individual freedom in a way that is unfair to the less vulnerable individuals, such as the young generations. The herd immunity argument—widely decried by the scientific community (Aschwanden, 2020 ) and public opinion alike (The Guardian, 2020 )—is highly controversial, and mostly for an ethical rather than a scientific reason. The technical possibility that a population develops natural protection from the infection exists, however, for Sars-CoV-2 it is unclear what the threshold is as this depends on the transmission rate and how long the immunity could last (Fontanet and Cauchemez, 2020 ). Although from a technical point of view the pursuit of (short-term) herd immunity is not, in theory, an unattainable policy goal, there is widespread societal consensus that it would be an unacceptable policy goal from an ethical point of view, in the absence of improved patient management and in the absence of optimal shielding of individuals at risk of severe complications. In the absence of these two key factors, current modeling of transmission dynamics predict that letting Sars-CoV-2 epidemic run its course without non-pharmaceutical interventions (i.e., social distancing, facemasks, heightened hygiene measures) would lead to catastrophic consequences in terms of death toll, both direct from COVID-19, and indirect, due to the overwhelming burden on the healthcare systems (hospital capacity) (Brett and Rohani, 2020 ).

The signatories of the John Snow Memorandum are in fact more concerned with utility, namely the short-term reduction of COVID-19-induced mortality and morbidity and the long-term health outcomes of delayed treatments. Interestingly, by problematizing the definition of “vulnerable” individuals, John Snow supporters implicitly defend the egalitarianism of their position, as evidence is still scant around the reasons underpinning the wide individual variation in COVID-19 adverse outcomes—with some developing grave complications until death and other showing only mild symptoms or remaining completely asymptomatic. Concluding that everyone is equally at risk, the John Snow Memorandum implicitly assumes that it is fair for restrictive measures to be applied to everyone, therefore leaning towards a solution geared towards equality rather than equity. Instead, the Great Barrington Declaration implicitly proffers that vulnerability to the virus is only one aspect that should be taken into account. Vulnerabilities within the population instead should be specified taking into account vulnerability towards negative repercussion of the economic recessions—such as BAME minorities in the UK (Institute for Fiscal Studies, 2020 ), as well vulnerability towards the negative effects of lockdown-induced isolation and alienation, as in adolescents (Lee, 2020 ). The prioritization of short-term gains in terms of physical health with respect to impeding longer term socio-economic disadvantage and mental health consequences therefore becomes less straightforward.

Contextualizing values and policies in time and space

In dealing with a highly complex situation—a wicked problem—such as the COVID-19 pandemic, it is important to understand how values—hence societal goals—are formulated and understood, and the influence of temporality. The value of utility can be specified short-term, as the reduction in the number of COVID-19-related deaths at a given time. However, a more encompassing, forward-looking view will also consider the total number of COVID-19-induced deaths in the medium-long run. The need to prioritize COVID patients in the hospital will necessarily lead to other collateral deaths because of missed appointments and delayed surveillance or surgeries (Maringe et al., 2020 ). Economic recession is widening inequalities and increasing poverty levels (Kirby, 2020 ; Van Lancker and Parolin, 2020 ), while the mental health repercussions induced by isolation especially in young people might lead to forms of addiction and depression (Lee, 2020 ). While deaths from the infectious disease are short-term, indirect casualties that will occur down the line need to be taken into account. Public health policies cannot afford the myopic mistake of discounting the future, a well-known individual cognitive bias (Trout, 2007 ). The public health ethics framework also demands that the management of infectious diseases outbreaks follows the key principle of proportionality in restricting individual freedoms to promote the public good (World Health Organization, 2020 ). This means that, as epidemiological and clinical evidence becomes more conclusive on the disease’s transmission, prevention and diagnosis patterns (Manigandan et al., 2020 ), on the variability of health outcomes (Chen et al., 2020 ), on the effect of non-pharmaceutical interventions to reduce community spread (Li et al., 2020 ), and on the long-term consequences of lockdown measures such as school closures (Bayham and Fenichel, 2020 ; Viner et al., 2020 ), the same restrictive policies might not be as suitable, justified or acceptable as they were in the early stage of the pandemic. This principle is implicit in the Great Barrington declaration.

What degree of personal infringement of liberty is justified? This is where ethics comes in. Expert groups will offer a range of possible ethically justified policies, but, we argue, it is the policymakers’ task to do the normative weighting and to decide which policy approach is best suited to the local socio-economic, socio-cultural and socio-political context (Angeli and Montefusco, 2020 ). While in some national settings the Great Barrington Declaration proposal could be more attuned to the existing social dynamics, individual mindsets, healthcare infrastructure and economic development, in other contexts the prescription of the very same proposal would not be applicable nor recommended, while the solutions proposed by the polar opposite John Snow Memorandum could be more suitable. For example, a policy of focused protection is not practical in settings—such as Italy—where intergenerational exchange is very high, grandparents often babysit grandchildren and even share living space with younger generations. A focused protection approach, which also aims at achieving high levels of community spread of the disease in less vulnerable societal segments, will likely lead to higher burden on the healthcare system, which is only sustainable in settings where healthcare infrastructures are strong and widely accessible, and focused protection of vulnerable segments of the population (i.e shielding) is feasible. In a similar way, restrictions to individual freedom are more difficult to implement in countries where personal liberty is culturally highly valued, and where utility—intended as the public good—comes second. A case in point is the use of face coverings, which, despite mounting evidence related to the importance of the measure to prevent COVID-19 transmission (Cheng et al., 2020 ; Lyu and Wehby, 2020 ), remains highly debated (Martin et al., 2020 ). It is not by chance that more individualistic cultures such as the United States, the United Kingdom or the Netherlands (Hofstede, 1983 ), have seen a more patchy and less widespread imposition of such measures (Royal Society, 2020 ; Statista, 2020 ), combined with higher societal resistance and rising social tensions (CNN, 2020 ).

Finally, questions of equity and justice. Public health measures aimed at containing an infectious disease outbreak should take into account to what degree the measures are disproportionately affecting certain groups of the population. This is where the concept of vulnerability comes in and where it can be used to operationalize the equity principle. Defining who qualifies as vulnerable is difficult, but by no means impossible, as research ethics literature demonstrates. One approach that we think could be well suited here is the layered approach to vulnerability (Luna, 2019 , 2014), which is context dependent, and dynamic. One could identify, for example, the following three layers of COVID-19 related vulnerability:

A biological axis: likelihood of developing severe/critical symptoms after contracting COVID-19. Evidence widely supports that older people and people with pre-existing co-morbidities are at higher risk of COVID complications;

Socio-economic axis: likelihood of being severely affected by restrictive measures. Studies have highlighted how disadvantaged groups and communities (such as BAME minorities in the UK) are disproportionally more severely hit by the economic crisis ensuing from lockdown measures;

Mental health axis: likelihood of developing severe mental health repercussions related to containment policies. School closures and extended lockdown periods have increased mental health issues in the population, with children and adolescents at particularly high risk.

Age, gender and race remain transversal axes here, as the approach rejects applying the label of vulnerability to specific groups. That does not mean that is impossible to define who is vulnerable, contrary to the John Snow memorandum positions. However, who counts as vulnerable to COVID-19 will change depending on the context, over time and through what layers one decides to look at this question. While in the first COVID-19 wave the priority has been given to the biological axis, the attention is, in the second COVID-19 wave, importantly shifting towards socio-economic and mental health aspects.

With the purpose of illustrating the longitudinal evolution over time of value prioritization, and its cross-sectional, cross-country variation, we have selected a number of containment measures that can reflect how the values of liberty, equality and utility are incorporated into scientific advice and then translated into policy. Restrictions to individual freedom can be appreciated for example through the presence of restrictions to jogging activities; the presence of a ban on amatorial sports activities; the extent of face coverings obligations, the restrictions on household mixing, and whether a social bubble is allowed. The value of equity can be operationalized into whether the measures have been prescribed to the whole population indistinctively or whether there has been a differential application to more or less vulnerable sub-groups, or taking into account the different morbidity and mortality levels across regions. This aspect can be appreciated by considering whether restrictions have been imposed nationally or following a regionalization rationale; whether face coverings have been prescribed also to children under 11, notably less amenable to infect, get infected and develop severe symptoms from COVID-19; whether specific measures have been adopted to strengthen protection of older demographics; whether youth sport activities have been allowed; whether business closures have been imposed indistinctively or have instead followed an occupational health risk assessment. Finally, utility can reflect into governments’ advocacy practices, namely the presence of a stay-at-home advice, the emphasis of COVID-19 as a burden for healthcare workers and systems, the clear and frequent communication of COVID-19 epidemic progression, the level of surveillance and sanctioning of non-compliant individual behaviors. We have considered the presence/absence as well as the strength of the above aspects at the highest point of first and second wave of COVID-19, in Italy and in the United Kingdom. As restriction levels, timing and the combination varied across England, Scotland, Wales and Northern Italy, we focused on England.

Table 1 represents the comparison of measures between COVID-19 first and second wave in the two countries, as derived from the original policy documents. Based on the nature of the containment measures, and the effect to which they reflected values of equity, utility and liberty, we computed scores on each dimension, for each country across the two waves, on a total of 20 points for each value dimension.

We then plotted the results in Fig. 1 . The graphs highlight how values are differentially embedded into containment policies trough context- and time-specific trade-offs. The figure highlights how two countries started from very different positions, with measures in Italy in the first wave almost entirely guided by utility (public health) considerations, with strong restrictions of individual freedoms and little appreciation of differences in vulnerability levels across populations and regions. In the second wave, we notice the evolution of Italian policies towards more consideration for liberty and equity value dimensions. England has experienced a similar evolution, albeit starting from a much more libertarian stance. Its policies show an evolution towards liberty and equity considerations against a slight reduction of utility-focused measures.

Evolution of the value trade-off embedded in the COVID-19 containment policies promulgated in Italy and in England, during the first and the second pandemic wave (until December 2020).

Conclusions

Public health policies—and particularly those aimed at the containment of a highly infectious disease such as COVID-19—revolve around a compass of moral values, which are often implicitly given different weights by both policymakers and scientific advisors. Both the understanding of these values, and the normative weighing of the values will always necessarily be context dependent, and dynamic. Public health policies should aim to consider to what degree the proposed measures aimed to preserve the public good are socio-culturally acceptable in restricting individual freedom, in what way they disproportionately affect certain groups of the population, according to what aspect of vulnerability is most relevant. An approach of situated policy is therefore most salient, which promotes policymaking that is attuned with idiosyncrasies that are both spatial (the socio-cultural and socio-economic local context) and temporal (given the rapid evolution of COVID-related scientific evidence). A situated approach to policymaking in the context of wicked problems reflects that there cannot be a one-size-fits-all approach to COVID-19 public health policies.

Our analysis has aimed to propose an ethics-driven perspective to better comprehend how evidence is used to inform policymaking and how disagreement on policy can emerge within scientific communities. In doing so, we have offered an interdisciplinary view at the intersection between management studies, public policy and bioethics disciplinary boundaries. Whilst the debate around evidence-based policymaking has been a core focus of science and technology studies (Frickel and Moore, 2006 ), this commentary offers an alternative perspective that is less concerned with the politics of science—hence the influence on knowledge production of socio-political factors and power dynamics (Hoppe, 2005 )—and is instead more focused on how evidence is filtered through a situated ethical prism to inform policymakers’ prioritization decisions. The recognition that policymaking is shaped by socio-contextual factors and that policymakers engage into processes of interpretation of evidence in light of their knowledge, norms and values and towards their economic and political goals is not new (Sohn, 2018 ). This commentary suggests, however, that an ethical perspective is salient to understand such processes, that interestingly affect not only policymakers but also prominent representatives of the scientific community. Our analysis thus highlighted how evidence-based public health containment measures to address the pandemic can be ethically justifiable and understood through a clear and transparent understanding of the values underpinning policy decisions, and the evolution of acceptable trade-offs over time.

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Angeli, F., Camporesi, S. & Dal Fabbro, G. The COVID-19 wicked problem in public health ethics: conflicting evidence, or incommensurable values?. Humanit Soc Sci Commun 8 , 161 (2021). https://doi.org/10.1057/s41599-021-00839-1

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Infectious disease

How COVID-19 has changed the culture of science

C&EN spoke to researchers and scientific leaders about the good, the bad, and the uncertain ways that life has changed because of the pandemic, in the lab and beyond

By bethany halford , laura howes , andrea widener, january 25, 2021 | a version of this story appeared in volume 99, issue 3.

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The pandemic has cost lives and livelihoods, but many scientists C&EN spoke to were positive about the future. Here are some of the reasons why.

Science and scientists in the spotlight

Support nonprofit science journalism C&EN has made this story and all of its coverage of the coronavirus epidemic freely available during the outbreak to keep the public informed. To support us: Donate Join Subscribe

Ever since the first genome sequence of the novel coronavirus was released to the world in February 2020, science has been supercharged. The speed and volume of discovery over the past year have been remarkable, with researchers managing to unravel the molecular details of the virus, understand how it spreads and who is most at risk, and invent tests, drugs, and vaccines to tackle it. The public has seen what scientists can do under pressure.

Throughout 2020, clinical trial data regularly garnered headlines, and certain academics emerged as authoritative voices of the pandemic.

“There’s a group of people who have become almost household names,” says Holden Thorp, chemist and editor in chief of the Science family of journals. Early on, Pall Thordarson, a chemist at the University of New South Wales in Sydney, became a viral sensation for explaining how something as simple as washing your hands can protect against infections. In Germany, podcasts about the pandemic by virologist Christian Drosten, who developed the first diagnostic test for SARS-CoV-2, became must-listens for the German-speaking public. And Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, emerged as the steady source of advice in the US and overseas—he also became a popular icon, with his image appearing on T-shirts, socks, and coffee mugs.

Scientists who spoke to C&EN believe that the reputation of the pharmaceutical industry, in particular, has improved during the pandemic, as the public closely followed the development of vaccines. Companies’ rapid mobilization also highlighted that science is collaborative, works across borders, and is performed by diverse teams. “Hopefully, this will be seen more unambiguously as a triumph for science,” Thorp says.

And the public has gotten an up-close view of the people who do science, says Freeman Hrabowski III , president of the University of Maryland, Baltimore County. “This is a chance for the world, but particularly for those of us in American society, to see people who are from working- and middle-class families going to the top in science and helping humankind. This is an opportunity for our chemists and life scientists to be making the point that this work is for all of us—for women, for people of color, for first-generation college students—and you can make a difference.” The attention could inspire the next generation of scientists—hopefully a more diverse one.

People are influenced by their life experiences and what excites them, says Malika Jeffries-EL, a chemistry professor and associate dean of the Graduate School of Arts and Sciences at Boston University. “We’re going to have a huge surge of interest in things like immunology and fields related to viruses and vaccine development.”

Science itself has advanced dramatically in the last year, with discoveries rolling out at breathtaking speed. Terms like “space race” have been used to describe the rapid development of vaccines, but Francis Collins, director of the US National Institutes of Health, points out that scientists also made impressive strides in developing diagnostics , establishing testing capacity, and expanding our fundamental understanding of the virus.

“We did science in ways that people did not think we could, driven by this sense of urgency, which we all say that every day counts,” Collins says. “This is a pandemic that is taking lives and destroying economies, and there’s no excuse for anybody arguing for delay.”

Collaborations and data sharing

The year 2020 also saw more scientists embrace preprints—articles published before peer review—and data sharing across borders and disciplines.

“The preprint server business has been given a giant boost from this,” says Derek Lowe, a pharmaceutical chemist and author of the popular In the Pipeline blog.

According to the Dimensions COVID-19 data set , researchers have published over 38,000 SARS-CoV-2 preprints since the beginning of 2020. James Wilsdon, a professor of research policy at the University of Sheffield, says the pandemic has shown that when “the stakes are really high,” researchers can work quickly and create better systems for disseminating data. The real question, he says, is whether those changes in publishing behavior will remain postpandemic.

More generally, researchers see the way that scientists have cooperated as a huge positive. Moderna’s COVID-19 vaccine , for example, could not have been developed so quickly—it went from discovery to distribution in a mere 11 months—had the company not had a long-standing partnership with researchers at the NIH. And big pharma firms have been collaborating with one another to find novel antivirals for this pandemic and the next one, sharing expertise and data in unprecedented ways. Open-science collaborations have also sprung up between academic groups, such as the COVID Moonshot effort, which is screening potential antivirals at facilities in England and Israel.

Collins at the NIH says most of his time last year was spent “trying to bring together all of the partners that could accelerate progress, and making sure that any of the barriers to those kinds of partnerships got knocked down.” And researchers from all sectors “were completely willing to share and work together in fashions that traditionally have been more difficult.”

Related: Chemists rethink work travel

“I’m hoping that this emphasis on international collaborations will continue in the research community,” says Magdalena Skipper, editor in chief of Nature . “But I hope it will also be taken up as an example beyond the research community itself,” she adds, noting that while scientists have collaborated on a global scale, policy makers have worked much more locally.

Much of that collaboration has naturally occurred in the virtual world, opening up opportunities for partnerships that otherwise might not have materialized. As Marie Heffern of the University of California, Davis, points out, setting up a cross-institutional collaboration is now just a matter of arranging a video call. Group leaders can meet and discuss projects or take part in conferences they normally couldn’t have attended. At the same time, postdocs and students have been able to interact more readily with big-name academics through online meetings.

University of Michigan chemistry professor Alison Narayan points to a virtual biocatalysis meeting she set up with researchers at Merck & Co. and the University of Manchester. The regular meeting has grown to include almost 500 people and is “a wonderful platform for students to present their science,” Narayan says, adding that she wants to continue these meetings after the pandemic.

“When you have a pressing need, like the worst pandemic in 102 years, it does require organizing science in new, creative, and productive ways,” the NIH’s Collins says. “And that has been amazing to see happening and to have some role pushing forward.”

Flexibility and support at work

Stay-at-home orders forced a marked increase in flexible working, which in turn showed that work can still be accomplished when people are not in the lab. In the face of these challenges, scientists got creative about keeping up their work.

For some, working from home has increased productivity and raised awareness of other people’s personal challenges. “When you’re on a Zoom call, you see someone’s whole world,” Narayan says. That experience can be eye opening for mentors and colleagues and bring a person’s needs to the forefront.

Merck & Co. chemist Rebecca Ruck says flexible working has taught her and her colleagues how to be more creative. “I hope that affords people—men, women, everybody—greater flexibility in how they work,” she says. Luis Echegoyen, president of the American Chemical Society in 2020, says the productivity of his team at the University of Texas at El Paso actually increased, as members finally had the time for papers and review articles that had been waiting for someone to write them (ACS publishes C&EN). His small group published 15 articles or reviews in 2020, including 3 in the Journal of the American Chemical Society . “That’s an immediate, positive consequence of the pandemic in our group,” Echegoyen says.

Professors are also learning how to use technology to support student learning and to train the next generation of researchers. Where some in-person teaching was allowed, many universities prioritized lab sessions over classroom seminars or lectures, moving more instruction online. Where all teaching went remote, science departments adapted by designing lab work that could be done at home. Other professors built online versions of practical experiments.

Moving classes online with short notice was a daunting challenge that made building rapport and community more difficult—particularly for newer students who may have met their teachers only virtually. Professors say some students have understandably struggled with this shift, but online instruction can improve digital literacy and time management , thus helping prepare students for work after university.

Many teachers are taking a more “flipped classroom” approach by asking students to watch videos and read specific texts before class. The class is then used for active learning and problem solving rather than a lecture, says Mary Boyd, provost and chemistry professor at Berry College. She praises the community of educators that has built up to support best practices and online teaching strategies. “That’s been pretty great,” Boyd says.

Some of the pandemic’s negative impacts may be short lived, while others are likely to reverberate for years.

Science has long struggled to reflect the diversity of the world it serves. Less than 5% of people who earned PhDs in chemistry in the US in 2018 were Black, according to the Open Chemistry Collaborative in Diversity Equity. And recent data show a dearth of people of color and women working as professors in chemistry departments at top schools. The pandemic has only amplified those problems. Because COVID-19 has disproportionately affected communities of color, many worry that it will prevent people from those communities from getting college or advanced degrees. And more women than men have been sidelined in their education and careers as they took on the lion’s share of extra childcare duties associated with lockdowns.

“The pandemic has been a magnifier of inequality,” Berry College’s Boyd says. Challenges range from finding a quiet workspace in small or overcrowded households to having to defer education altogether to help with family or to earn money, as many lost jobs. While much of the world has moved online for classes and conferences, those without reliable internet access or technology have often been left behind.

Zakiya S. Wilson-Kennedy, the assistant dean for diversity and inclusion and a chemistry education professor at Louisiana State University, agrees that the pandemic has magnified inequities. “The transition to online learning has offered this opportunity for disruptive innovation, but the ability to take advantage of this time is very economically driven,” she says

When Wilson-Kennedy considers the ways 2020 affected the culture of science, she points to not just the pandemic but the Black Lives Matter movement and the increase of deadly hurricanes resulting from climate change. “Black and Brown communities, economically disadvantaged folks, and our working poor are disproportionately impacted by all of these,” she says. Because of that, Wilson-Kennedy wonders how we will “cultivate the talents of young people who are passionate about answering these challenges, knowing that even right now, we have a host of folks who have talent but who have different levels of access to education.” If we are going to have sustainable change around supporting diversity in the scientific workforce and in academia, she says, “we have to be extremely intentional about it.”

“Universities were already starting to have a slow awakening about the fact that the status quo is not effectively serving everybody,” Boston University’s Jeffries-EL says. “I think people are starting to have an honest conversation about what is really the issue in the pipeline,” she adds. Sara D. Leonhardt, a professor of chemical ecology at Technical University of Munich, says, “The problems we had before—which were always there—will be even more severe in the future because of the pandemic. I think that’s the really ugly part.” Leonhardt organized an open letter signed by researchers in Germany who argue that the German government needs to support early-career researchers by listening to more-diverse sources of advice, prioritizing opening childcare, and committing to extra financial support in the wake of the pandemic. She is concerned there has been little awareness of how unequally the pandemic has affected different groups—specifically women, those with child- or elder-care duties, and people of color.

Even if the obvious effects of the pandemic on these scientists last only a year—fewer publications or grants, for instance—the impact could be dramatic, Science ’s Thorp says. As an example, he cites the 2008 recession , which derailed careers for years and pushed many out of science entirely. “Almost every time we’ve had some kind of severe problem, it’s always magnified whatever inequities were there to start.”

The next generation of scientists

Anyone who works at the bench knows that there’s just no way to make up for the time lost in the lab during this pandemic. And while that reality is tough on all bench scientists, the situation is particularly acute for assistant professors just starting their labs, postdoctoral scholars with contracts that are just a year or two long, and undergraduates who are missing out on laboratory experiences.

Heffern at UC Davis worries about how the pandemic lockdowns have upset her lab’s momentum. When you’re working toward tenure, such interruptions in research and creating a team can set back early-career researchers .

Related: International students deserve recognition and support

“Postdocs are all about productivity in a short period of time,” UTEP’s Echegoyen says. With such short contracts, these scientists are losing some of the most important years for establishing their careers. “The most disruptive part that I can see of this for science is the future,” he says.

Some fear that pandemic-related productivity gaps will be perceived poorly by funding agencies. “In the short term, obviously funders and others need to make sure we’re not unfairly discriminating against those who haven’t been pumping out grant proposals,” the University of Sheffield’s Wilsdon says.

Another fear is that budgets will shrink because of economic factors and that much of the remaining funding will be funneled into COVID-19-related work. “You can sort of frame the challenge now in terms of the dangers of COVID-ization of research funding,” Wilsdon says. There are questions about how to fund research as well as how to balance the funding so that important areas don’t lose out.

With summer research experiences and internships for undergraduate and high school students canceled for 2020 and likely for 2021, several researchers point to the lasting impact those lost opportunities for research experience will have on the chemistry pipeline. “That’s usually where the premed students decide they actually want to be chemists,” the University of Michigan’s Narayan says.

Merck’s Ruck echoes that concern. “Without that hands-on experience, will these students ever fall in love with chemistry?” she says. “I worry that that will have implications for the overall talent flow into the field.”

Politicization of science

Followers of the climate change movement know that politicization of science isn’t new. But the pandemic has made the human toll of this phenomenon much more immediate, with people refusing to wear masks on the advice of politicians and the White House suppressing scientific discourse.

“By politicizing science, we denied the fundamental tools that we needed to tackle a biological and social problem,” says Jeremy Levin, CEO of Ovid Therapeutics and chairman of the Biotechnology Innovation Organization. We’re now seeing the consequence in loss of life, economic upheaval, and other untold suffering, he says. “I think the denial of the validity of science and the politicization of it will be held against us for decades to come.”

Thorp at Science says researchers haven’t done a good job of describing the scientific process to the public, which is why it’s been so easy for science to become politicized . Take the shifting guidance on face masks. Officials first advised against wearing them out of concern that supplies would become stretched and that the priority should be that health-care workers get masks. Then, as scientists learned more about the airborne transmission of COVID-19 and the ability for asymptomatic people to spread the disease, they urged people to wear masks to protect others. Later, scientists learned that masks also provide protection to the wearer.

“If you’re a scientist, that makes perfect sense,” Thorp says. “If you’re out there in the public, just consuming sound bites, that makes it look like we don’t know what we’re talking about. And that’s a product of the fact that it’s much easier to just tell people that science is this textbook full of stuff that you have to memorize and not a process and a way of thinking that’s carried out by people.”

Scientists haven’t done the hard work of explaining how the scientific method is connected to important scientific advances, Thorp says. Instead, he adds, “we bring them their new drug or their better Wi-Fi or their profitable companies.”

The Unknown

Not all the dramatic changes—positive or negative—might last. Experts weighed in on the biggest uncertainties.

Travel and meetings

Prepandemic, many principal investigators were rarely in the lab; they were often on the road, giving talks or attending meetings. The pandemic stopped travel overnight.

The University of Michigan’s Narayan had given 17 talks in the first 2 months of 2020 as part of her “tenure tour”—visiting schools before she applied for tenure. “What this has taught me is that I don’t need to be traveling constantly,” says Narayan, who now expects to be more selective about her travel. “That’s maybe better for me personally, and better for my family and my research group.”

Virtual talks have many advantages. More people can attend, including those who might not otherwise get to hear from a Nobel Prize winner or other high-profile scientists. They make it easier for smaller schools to get big-name speakers, are a vast saving for cash-strapped organizations, and are much better for the environment.

“In South America, we are far from everywhere,” says Ana Flávia Nogueira, a chemistry professor at the University of Campinas. So the move to virtual conferences has widened access for her students because they don’t have to pay for travel, and fees for online meetings tend to be lower. At the same time, she says, the most important aspect of attending conferences for her is the ability to make personal connections with other scientists with whom she might collaborate. That’s tough to do online. Nogueira thinks that the investments made in online meetings mean that many future conferences will be a hybrid of virtual and in-person events.

But “there are certain aspects of collaboration and connection that are much, much harder to achieve purely through online interaction,” the University of Sheffield’s Wilsdon says.

You can rarely see your audience on Zoom, and you can’t make the same personal connections with potential students or collaborators. That’s especially concerning for early-career scientists, who are supposed to be meeting people and building their lab’s reputation. “COVID has really made that quite difficult,” UC Davis’s Heffern says.

Online meetings are so easy to schedule that everyone does it. “In June and July it was an invitation a day,” Echegoyen at UTEP says. “You realize that all of a sudden people have gotten trigger happy.”

Lack of travel has also been a mixed bag for scientists who have family responsibilities—especially women. Less travel can mean more time with your family, but it can also make working harder if you are expected to do childcare. “If you are still at home, you’re expected to do all the home things even while you’re technically working because you’re at a conference,” Berry College’s Boyd says. “You don’t get the separation that you would get.”

So what is the fate of conferences? Boyd has yet to see a way to do virtual conferences well. The talks themselves are just as good—maybe better, she admits—but sitting in front of a screen all day is tiring. And “we miss the important part of attending a conference, which is the networking and getting to know other people,” she says.

But Merck’s Ruck says that in many cases, what individual scientists lose online is made up for by increased access for people who might not be able to travel.

In 2019, the Empowering Women in Organic Chemistry conference had 180 attendees at its inaugural, in-person event. In 2020, the online version attracted 800 people from all over the globe. Ruck, who helps organize that meeting, thinks that most conferences will be a hybrid of in-person and online going forward.

“I’m going to be very content to give many more talks from my living room,” Ruck says.

Echegoyen says it’s going to take a long time before people feel comfortable going to an event with 15,000 to 20,000 people, like a typical ACS meeting. But he thinks some new technology will make virtual meetings more palatable. “I think we’re going to come out of it changed, that’s for sure.”

Distanced lab culture

Almost all faculty and students were hit hard by the pandemic, but the work and productivity of lab scientists probably suffered most. Research labs worldwide shut down or at a minimum operated on vastly altered schedules. At some universities and research centers, only lab work directly related to COVID-19 was allowed to continue.

“We had to redirect a lot of the scientific energy towards this pressing global pandemic,” while at the same time keeping safe those who remained in person, Collins says. That was true at the NIH’s Maryland campus, where most labs, including Collins’s, shut down. “And that doesn’t turn out so well if you’re somebody who needs a lab bench, so we did lose momentum for things that weren’t directly related to COVID,” he says.

When labs did open, it was often in small groups with distance required between lab members. Normally bustling benches were limited to one or two people. And lab mates couldn’t run into each other in the hallway or share their latest successes and failures as they happened.

That has removed a lot of the spontaneity that is a regular part of making discoveries, Heffern says.

But limited time in the lab has forced people to think carefully about how they’re using that time. “My students are getting a lot better at planning experiments and analyzing their data,” she says.

Shifts have also made research teams work together more closely—you have to carefully plan to hand off an experiment to a colleague at the end of your day, according to the University of Michigan’s Narayan. “Ultimately, I think those skills are going to serve people really well in their training and launching into different careers,” she says. This will also help move chemistry away from the idea that “you should be chained to your hood 24 hours a day, 7 days a week,” she adds.

Stability of schools

Academic institutions worldwide have undoubtedly been changed by the pandemic. Beyond shutting down labs, many moved classes online as the pandemic spread and remained completely or partially remote for the rest of the year. That put many US schools that were no longer getting fees for residence halls or meal plans in a financially precarious position.

If schools can open their campuses in fall 2021, “the ones that had money will probably be OK,” Thorp says. “And the ones that ran out of money? A lot of those are going to have a hard time recovering.”

Schools with endowments or consistent government support should be able to cover losses. But those that rely on tuition to pay salaries and fund their day-to-day operations don’t have that safety net.

Many students dropped out or deferred enrollment, which put tuition-reliant schools in a tough position. The enrollment decline has been especially precipitous among international students, who often pay full tuition but have no way to get to the US during a pandemic. At the same time, universities have had to shut down medical services, facility rentals, sports events, and other revenue streams that keep their campuses functioning.

In addition, Echegoyen says, students are questioning paying the same tuition and fees when classes are fully or partially online. “Will a whole new economic model evolve for universities?” he wonders.

No matter what happens, “there’s going to be a lot of belt tightening” at tuition-driven universities, Echegoyen says. In many cases, administrators and lab technicians were the first to face furloughs and cuts. But prolonged hiring freezes will mean that many graduate students and postdocs won’t be able to find their first academic positions. “A lot of people are going to find themselves without jobs,” Echegoyen says.

Most at risk for job losses and cuts might be universities that rely on their medical schools and associated hospitals for support. The pandemic has caused many to curtail outpatient clinical and elective procedures, the NIH’s Collins says. “No question about it, it is going to take a long time for universities to recover.”

This story was updated on Feb. 1, 2021, to correct the affiliation of Pall Thordarson. He works at the University of New South Wales in Sydney, not the University of Sydney.

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Human Resource Management Research

p-ISSN: 2169-9607    e-ISSN: 2169-9666

2020;  10(2): 33-39

doi:10.5923/j.hrmr.20201002.02

Characteristics of ‘Problem-Based Learning’ in Post-COVID-19 Workplace

Mohamed Buheji 1 , Aisha Buheji 2

1 International Inspiration Economy Project, Bahrain

2 Researcher, Bahrain

Copyright © 2020 The Author(s). Published by Scientific & Academic Publishing.

The COVID-19 pandemic forced many workplaces to adapt to drastic changes in the work environment around the world. Despite the changes in the previous years in relevance to new technologies and digitisation, the abrupt changes of the pandemic require steep-learning. As the world emerges from the lockdown, more collaborative approaches to solving complex problems are needed. Therefore, this paper investigates the requirements of Problem-based Learning (PBL) in the new normal; an era expected in the post-COVID-19 pandemic. This research uses the dimensions of both the new normal demands and the competency to be learned through the analysis of a questionnaire that investigates the need for PBL. The authors illustrate how the utilisation of PBL helps in the selective approach of the types of possible problems to be solved. The implication of this paper is that it shed light into the rising need for PBL as an attitude after COVID-19 and establish early tools to encourage further more in-depth research on the subject.

Keywords: COVID-19, New Normal, Problem-based Learning, Workplace, Problem-Solving

Cite this paper: Mohamed Buheji, Aisha Buheji, Characteristics of ‘Problem-Based Learning’ in Post-COVID-19 Workplace, Human Resource Management Research , Vol. 10 No. 2, 2020, pp. 33-39. doi: 10.5923/j.hrmr.20201002.02.

Article Outline

1. introduction, 2. literature review, 2.1. definition of problem based learning (pbl), 2.2. describing the new normal, 2.3. understanding the challenges of the new normal, 2.4. requirements of problem solving in post-covid-19 & new normal, 2.5. type of problems that would enhance the learning capacity, 2.6. new normal attitudes and pbl, 2.7. importance of mentors during problem solving journeys, 2.8. untapped covid-19 pandemic problems that await solutions, 2.9. role of pbl in covid-19 problems containment, 2.10. coming technology role in spreading pbl in the new normal, 2.11. role of pbl to validate permanent solutions, 3. methodology, 3.1. dimensions of pbl, 3.1.1. dimension of new normal demands (5rs), 3.1.2. dimension of competency to be learned (5ps), 3.2. analysis of questionnaire approach, 3.3. analysis of iiep research conducted based on pbl approach, 4. data analysis, 4.1. the need of pbl after covid-19, 4.2. the pbl influence on selecting research of the covid-19 pandemic, 5. discussion and conclusions, 5.1. the value of pbl to life and livelihood, 5.2. limitation and implications of this research.

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Original research article, going viral: how fear, socio-cognitive polarization and problem-solving influence fake news detection and proliferation during covid-19 pandemic.

• 1 Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Austin, TX, United States
• 2 Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy

In times of uncertainty, people often seek out information to help alleviate fear, possibly leaving them vulnerable to false information. During the COVID-19 pandemic, we attended to a viral spread of incorrect and misleading information that compromised collective actions and public health measures to contain the spread of the disease. We investigated the influence of fear of COVID-19 on social and cognitive factors including believing in fake news, bullshit receptivity, overclaiming, and problem-solving—within two of the populations that have been severely hit by COVID-19: Italy and the United States of America. To gain a better understanding of the role of misinformation during the early height of the COVID-19 pandemic, we also investigated whether problem-solving ability and socio-cognitive polarization were associated with believing in fake news. Results showed that fear of COVID-19 is related to seeking out information about the virus and avoiding infection in the Italian and American samples, as well as a willingness to share real news (COVID and non-COVID-related) headlines in the American sample. However, fear positively correlated with bullshit receptivity, suggesting that the pandemic might have contributed to creating a situation where people were pushed toward pseudo-profound existential beliefs. Furthermore, problem-solving ability was associated with correctly discerning real or fake news, whereas socio-cognitive polarization was the strongest predictor of believing in fake news in both samples. From these results, we concluded that a construct reflecting cognitive rigidity, neglecting alternative information, and black-and-white thinking negatively predicts the ability to discern fake from real news. Such a construct extends also to reasoning processes based on thinking outside the box and considering alternative information such as problem-solving.

Introduction

“If it bleeds, it leads” cites a well-known mantra of journalism. When a story involves deaths or injury of some kind, it is more likely to be discussed on the media, to receive a higher number of clicks on the internet and be shared. News stories are often reported in a sensationalist form tailored to trigger an emotional response which can influence our ability to reason. Recent studies on the impact of misinformation during the COVID-19 pandemic highlight how unreliable and inflammatory information ( Gallotti et al., 2020 ) may have threatened public health in several countries by altering individuals' perception of risk behaviors ( Oh et al., 2020 ). For example, it appears that at the beginning of the pandemic the population was divided between those who were seriously concerned and reacted by seeking information and those who thought that COVID-19 was “no more than the flu” and thus resisted taking safety measures. Stanley et al. (2020) found that analytic thinking, measured via the Cognitive Reflection Test (CRT: Frederick, 2005 ), was a predictor of believing the pandemic was a hoax and resisting the adoption of safety measures like social-distancing and hand-washing to mitigate spread. A pandemic is a prototypical situation wherein collective behavior directly impacts the health and safety of every member of the group. Consequently, the belief in and proliferation of fake news during a global pandemic is a significant concern that can exacerbate a public health emergency. Indeed, misinformation has been instrumentalized by pushing divisive political ideologies with the consequence of preventing cooperation among individuals ( Stella et al., 2018 ). In the present investigation, we attempted to gain a better understanding of specific social, cognitive, and emotional factors that contribute to individuals' tendency to believe in and share fake news during the early height of the COVID-19 pandemic in Italy and the United States.

Why does negative news echo faster than positive news? To answer this question, we highlight two components of news that contribute to its appeal: alertness , and informativeness . A first component that may explain why people are so attracted to negative news, whether it is fake or real, is that news tends to be alerting by inducing fear. From an evolutionary framework, fear makes people more sensitive to potential threats ( Ohman and Mineka, 2001 ; Schaller et al., 2003 ; Balzarotti and Ciceri, 2014 ). Our cognitive system is particularly tuned toward potential sources of threat such as negative events, which, in most situations, are “more salient, and generally efficacious than positive events” ( Rozin and Royzman, 2001 , p. 297). Given its specific relevance to survival, human cognitive processing of negative stimuli is more elaborate, detailed, and complex compared to positive stimuli [i.e., negativity bias, see Rozin and Royzman (2001) ]. Moreover, memories for negative information form more quickly and are more easily retrieved ( Kensinger et al., 2006 , 2007 ). A pandemic is a prototypical scenario that engenders a great deal of unresolved fear and anxiety that can leave people in a constant state of high alert. In parallel to the immune system, animal species have developed specific cognitive and behavioral responses that help us avoid infections ( Schaller and Park, 2011 ). This disease-avoidance system drives both explicit and implicit safety measures against infection (e.g., increased hand-washing; Fleischman et al., 2011 ). For example, in response to fear people tend to be socially avoidant and less tolerant of foreigners, and are in general more xenophobic ( Navarrete et al., 2007 ; Mortensen et al., 2010 ; Schaller and Park, 2011 ). Following this perspective, we predicted that fear of COVID-19 should relate to seeking out information about the disease, proactively taking actions to reduce the chances of being infected, and sharing as much information as possible.

A second factor involved in the proliferation of news is the need for information , which is especially pertinent during global crises such as the COVID-19 pandemic. Confirmed coronavirus (COVID-19) cases increased exponentially first in China, followed by Italy, Spain, central Europe, and then the United States, culminating in a worldwide public health emergency. From the earliest days of the outbreak, misinformation about COVID-19 circulated widely across social media, radio, talk shows, and national news media ( Frenkel et al., 2020 ; Pennycook et al., 2020 ). Seeking out information can help resolve uncertainty during a time of heightened anxiety (e.g., Webster and Kruglanski, 1994 ; Kossowska and Bukowski, 2015 ). The limited amount of reliable scientific information during the beginning of the COVID-19 outbreak likely encouraged people to search for explanations that did not yet exist as the science underlying the biology and spread of the virus was still being investigated. This void of scientific consensus may have opened a wide avenue for the spread of pseudo-scientific and outright false information. In the context of threat, where feelings of uncertainty and fear make it difficult to anticipate or plan actions, people compulsively search for explanations and tend to base them on readily accessible pieces of information ( Hogg and Adelman, 2013 ; Kossowska and Bukowski, 2015 ). Such a lack of reliable information, together with the fear of infection, might have compelled people toward pseudo-profound existential beliefs, as well as overclaiming confidence in unreliable information to make up for a lack of reliable information and overcome uncertainty-induced anxiety. Therefore we hypothesized that fear of COVID-19 should predict a greater likelihood of believing fake news, in particular COVID-related fake news; second we predict it would relate to individual's propensity to judge pseudo-profound statements as profound (measured by the Bullshit Receptivity Questionnaire; Pennycook et al., 2015 ) and the tendency for people to “self-enhance” when asked about their familiarity with general knowledge questions ( Pennycook and Rand, 2017 ) assessed using the overclaiming scale ( Paulhus et al., 2003 ). Moreover, we predicted that those with higher bullshit receptivity and worse overclaiming accuracy would be more likely to believe in fake news.

From the existing literature, we know that individual differences in thinking and reasoning modulate individuals' propensity to believe in fake news. Specifically, there is a positive correlation between solving the CRT and discerning fake from real news (e.g., Pennycook and Rand, 2017 ). Dispositionally analytical thinkers are, indeed, more resistant to believing fake news (e.g., Pennycook and Rand, 2017 , 2019 ), but were also more likely to avoid safety measures at the beginning of the COVID-19 pandemic ( Stanley et al., 2020 ). Stupple et al. (2017) examined the role of “cognitive miserliness” as a determinant of poor performance on the CRT. According to the cognitive miserliness perspective, people often respond incorrectly on CRT items because they are “unwilling to go beyond the default, heuristic processing and invest time and effort in analytic, reflective processing” (p. 1). Additionally, reduced inhibitory control is found to be associated with lower CRT performances ( Oldrati et al., 2016 ). Solving a problem entails being able to go beyond the first interpretation of a problem, accrue information, and incubate with potential solutions until the most appropriate solution is reached. The ability to detect fake from real news might also rely on mechanisms involved in problem-solving. This perspective finds support in a recent demonstration that people share false information about COVID-19 because they fail to think sufficiently about the accuracy of news content ( Pennycook et al., 2020 ). In light of previous studies showing that stress, high risk-taking and anxiety of running out of time deteriorate creativity, and problem-solving performance ( Salvi et al., 2016a ; Salvi and Bowden, 2019 ; Duan et al., 2020 ) we hypothesized that the problem-solving performance would relate to a greater likelihood of detecting fake news, whereas fear of COVID-19 would lead to worse problem-solving performance.

To date, research on fake news has focused predominately around the 2016 US presidential election. Liberals and conservatives differ in cognitive style and the latter appear to fail at discerning fake from real news within a political context ( Pennycook and Rand, 2017 ; Pennycook et al., 2018 ). There is scientific literature showing that political ideology is associated with cognitive rigidity/flexibility and different problem-solving styles, where liberalism is associated with a problem-solving style oriented toward insight, and conservatism toward step-by-step processing ( Salvi et al., 2016b ). Interestingly, insight problem-solving appears to lead to higher accuracy on problem-solving tasks, rely on brain regions responsible for novel and original associations and may also be involved in fake news detection (e.g., Salvi et al., 2016a , 2020 ; Shen et al., 2017 ; Cristofori et al., 2018 ; Danek and Salvi, 2018 ; Laukkonen et al., 2020 ). Additionally, there is evidence that conservatives and liberals differ in creativity ( Dollinger, 2007 ). Overall, conservatives appear to be more structured, rigid, and prefer more direct answers, whereas liberals have more tolerance for ambiguity and complexity and tend to show greater openness ( Jost et al., 2003 ). Conservatives present higher perceptual rigidity for example and appear to be more influenced by figures' global shapes as well as contextual information than liberals ( Caparos et al., 2015 ). This difference is also reflected in neurocognitive functioning: Liberalism is associated with stronger anterior cingulate activity suggesting that liberals have a higher sensitivity for monitoring response conflict, whereas right-wing orientation is associated with greater neural sensitivity to fear and larger amygdala volume ( Amodio et al., 2007 ; Jost and Amodio, 2011 ). These differences in problem-solving accuracy and the capacity to handle complexity may help explain people's ability to assess conflicting information provided by media outlets.

Recent studies investigating social media content have demonstrated that accounts with a high “bot score” (indexing the likelihood of being a bot, or fake account) promulgate conspiratorial narratives charged with alt-right ideology and are specifically oriented toward hateful and polarizing political ideologies ( Stella et al., 2018 ; Ferrara, 2020 ). During the COVID-19 pandemic, hateful bots have been found to be more successful in attracting followers compared to counter-hate bots. Hateful and counter-hate bots appeared to interact and engage extensively with one another, promoting a culture of racism against Asians ( Ziems et al., 2020 ). Because of the association between conservatism, rigidity in overall reasoning, and previous evidence on believing in fake news, we hypothesized that conservatism would predict fake news beliefs also in our dataset.

Tolerance of ambiguity is a well-established trait of personality known to predict creativity and problem-solving ( Merrotsy, 2013 ). The Multidimensional Attitude Toward Ambiguity Scale ( Lauriola et al., 2016 ) detects three different dimensions of intolerance for ambiguity: the affective (Discomfort with Ambiguity), cognitive (Moral Absolutism/Splitting), and epistemic (Need for Complexity and Novelty) components. Budner (1962) defined ambiguous situations or contexts as those which “cannot be adequately structured or categorized by an individual because of the lack of sufficient cues” ( Budner, 1962 , p. 30). Ambiguous situations are those which could be unclear, confusing, or interpreted in more than one way. Those who are intolerant of ambiguity tend to resort to black-or-white solutions and are distinguished for their quick and overconfident judgment, even at the neglect of reality ( Frenkel-Brunswik, 1949 ). By contrast, those who are tolerant of ambiguity are attracted to situations they find ambiguous, challenging, and interesting. They are also individuals who score highly on the openness to experience and sensation-seeking behavior scales ( McLain, 1993 , 2009 ; Caligiuri et al., 2000 ; Lauriola et al., 2007 ). Individuals with low tolerance of ambiguity present an aversive reaction to ambiguous situations because the lack of information makes it difficult to evaluate risk and thus make decisions. These scenarios are perceived as a source of discomfort and people react to a perceived threat with stress, avoidance, delay, suppression, and denial ( Budner, 1962 ; MacDonald, 1970 ; McLain, 1993 ; Furnham and Ribchester, 1995 ; Iannello et al., 2017 ). The tolerance of ambiguity scale negatively correlates with authoritarianism ( MacDonald, 1970 ) and ethnocentrism ( O'Connor, 1952 ) and positively with openness ( Bardi et al., 2009 ) extraversion, and “novelty-seeking” ( Rajagopal and Hamouz, 2009 ). Therefore, we hypothesized that intolerance of ambiguity, specifically captured by absolutism, could be associated with believing in fake news.

Xenophobia, specifically toward patients and Chinese visitors, is a final factor linked to the recent spread of anti-Asian hate seen during the COVID-19 pandemic ( Ziems et al., 2020 ). On January 24, 2020, the fake news that “Chinese passengers from Wuhan with fever escaped the quarantine at Kansai International Airport” ( Kansai International Airport., 2020 ) was spread through multiple social media channels. Despite Kansai International Airport denying that took place, xenophobia against Chinese people rapidly spread in Japan and all around the world. #ChineseDon'tComeToJapan started trending on Twitter, while “Chinese visitors [were being] tagged as dirty, insensitive, and even bioterrorists” ( Shimizu, 2020 ). Xenophobia has never been studied concerning fake news. Considering its relation to fear (see above) and potentially cognitive rigidity, we hypothesized xenophobia may play a part in the discernment of fake from real news, particularly COVID-19 news.

The shared literature on emotional, social, and cognitive factors underlying, political conservatism, intolerance for ambiguity, and xenophobic reactions suggest that people who score higher in these measures may be less likely to handle complexity and thus fail to seek out alternative explanations when assessing news. As such, we believe these factors share a common theoretical ground and belong to the same construct which we define as Socio-Cognitive Polarization (SCP; a factor capturing absolutism/intolerance of ambiguity, xenophobia, and conservative political ideology). Therefore, we hypothesized that they would be highly correlated to each other and would negatively predict the ability to discern fake from real news.

In sum, in this study, we sought to understand the potential role of a range of emotional, social, and cognitive factors underlying the infodemic during the early height of the COVID-19 pandemic. To this end, we investigated how fear of the COVID-19 pandemic is related to information seeking and proactive health behavior, fake news detection and sharing, propensity toward pseudo-profound beliefs, overclaiming false information, and problem-solving. We also investigated how these factors uniquely predict participants' ability to discern fake from real news. In particular, we expected that fear of COVID-19, problem-solving, and Socio-Cognitive Polarization would uniquely predict fake news detection and sharing. We administered a survey to participants from two countries that registered the highest case and death counts associated with COVID-19 during the early peak of the pandemic: Italy and the United States. The participants included a set of news headlines split by news-type (COVID-19-related or neutral) and veracity (fake or real); a series of questions to assess COVID-related fear and information-seeking proactivity; problem-solving tasks including the CRT and a set of visual and semantic puzzles (i.e., Rebus puzzles: MacGregor and Cunningham, 2008 ; Salvi et al., 2015a , b ); and a series of scales measuring bullshit receptivity, propensity toward overclaiming, political ideology, xenophobia, and absolutism (See Figure 1 for a summary of the experimental hypotheses).

Figure 1 . Summary of our hypotheses and results. **significance at p < 0.01; ***significance at p < 0.001.

Pre-registration

We report materials used, our target sample size, how we determined data exclusions, our primary hypotheses, and our plan for primary analyses in our OSF preregistration available online ( https://osf.io/tsvg5 ). Our materials and datasets can be found at our OSF preregistered project online ( https://osf.io/4pd2u ). In this paper we discuss only the first hypothesis of the preregistered study. Results of hypothses number two and three will be published separately.

Participants

Five hundred and sixty-five Italian and American volunteers participated in the study and completed the news and problem-solving portions of the survey (excluding outliers). The complete demographic characteristics of the respondents are available in the Supplementary Table 1 . The two samples did not differ for age ( t (560) = 0.43; p = 0.669) and gender (X 2 = 0.03; p = 0.985), yet differed significantly in marital status and level of education ( Supplementary Table 1 ). Because these differences suggest our samples reflect different populations, we decided to analyze and report the results of the two samples separately.

Italian Sample

Out of three-hundred and twelve participants who completed at least 50% of the study, three-hundred native Italian speakers completed all news and problem-solving items. Eight outliers were removed for performing three standard deviations away from the mean on our fake news variables, leaving us with a final sample of two-hundred-and-ninety-two participants (210 females, average age = 37.79, SD = 16.06). Missing values for nineteen participants (who failed to complete at least one item of the remaining scales) were imputed using the mean values across subjects for the respective variable. Participants were distributed as follows: 51.7% from Milan; 18.8% from Bergamo city 1 ; 14.8% from other cities in the Lombardy region; 10.2% from other northern and central regions (Emilia Romagna, Liguria, Piemonte, Toscana, Trentino Alto Adige, Veneto); 2.8% from southern regions (Calabria, Campania, Sicilia).

American Sample

Out of three-hundred and forty-three participants who completed at least 50% of the study, two-hundred and seventy-five native American English speakers completed the news and problem-solving items. Two outliers were removed for performing at least three standard deviations away from the mean on our fake news variables, leaving us with a final sample of two-hundred and seventy-three participants (198 females, average age = 38.8, SD = 16.38). Missing values for twenty-one participants (who failed to complete at least one item of the remaining scales) were imputed using the mean values across subjects for the respective variable. Participants were distributed as follows: 35.2% from the state of Texas; 12.8% from the state of New York; 15.5% from Midwestern states (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin); 13.6% from Western states (Arizona, California, Colorado, Hawaii, Idaho, New Mexico, Oregon, Utah, Washington), 13.2% from other Southern states (Arkansas, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Virginia, West Virginia); 9.9% from other Northeastern states (Connecticut, Maine, Massachusetts, New Jersey, Pennsylvania, Rhode Island).

Sample Size Estimation

Based on data from previous studies investigating the relationship between fake news discernment and social and cognitive variables ( Pennycook and Rand, 2019 ), we performed statistical power analyses for sample size estimation. Power analysis (at an alpha = 0.05 and power = 0.90) revealed that our final sample of participants (273 Americans; 292 Italians) is higher than the projected sample size ( N = 255) needed to obtain the meaningful effect size for weak correlations ( r = 0.20; GPower 3.1 software), as well as the projected sample size ( N = 247) needed to obtain the meaningful effect size for weak to moderate increase in R 2 for fixed multiple linear regression with 8 tested predictors ( f 2 = 0.08; G Power 3.1 software).

Data were collected in Italy and the US during the COVID-19 pandemic peaks (Italy: 3–24 April 2020; US: 14–28 April 2020). Qualtrics online survey platform ( www.qualtrics.com ), hosted on the University of Texas at Austin and Università Cattolica del Sacro Cuore of Milan servers, was used to distribute the survey. Participants were recruited via email invitations, advertisements on social media platforms, as well as psychology and creativity associations' websites. Participation was voluntary. All participants gave written informed consent. Each session lasted ~40 min.

After providing information about demographics (age, gender), marital status, level of education, type of news sources they consulted to seek information about COVID-19 ( Supplementary Table 1 ), and political orientation, participants completed the online survey, which assessed fake news discernment, COVID-19-related fear and proactivity, bullshit receptivity, overclaiming tendencies, problem-solving, and socio-cognitive polarization. Clusters of individual sub-measures, which were theoretically similar and moderately to highly correlated ( r ≥ 0.2), were collapsed into higher-order factors by z-scoring individual measures and averaging across a specific factor. Our factor reduction procedure left us with a total of 10 predictor variables for our primary analyses: 3 demographic factors (age, sex, and level of education); 3 COVID-19 factors (COVID-19 fear, proactivity, and city case count); and 4 socio-cognitive factors (bullshit receptivity, overclaiming, problem-solving and socio-cognitive polarization). Correlation matrices for each collapsed factor can be found in the ( Supplementary Table 2 ).

Fake-News Discernment

To measure the ability to judge the accuracy of COVID-19-related and neutral news headlines, 12 legitimate-looking news articles, inspired by news and titles found online, were created from scratch following the methodology of Pennycook and Rand (2017 , 2019) (see Figure 2 ). The news articles were presented in a dedicated section of the survey. Six news headlines were factually accurate (real news) and six were false (fake news). The articles covered COVID-19-related news 50% of the time, whereas in the other 50% they covered more general topics, namely technology, nature, and employment (COVID-19 vs . neutral content). The news articles were balanced for credibility, plausibility, and sensationalism, through preliminary testing on a sample of 24 participants. Each headline was presented in the format of online newspaper headlines and it included a sensationalist headline, a thumbnail image, and a preview text from the article, while the sources were identical for each headline to control for source-bias.

Figure 2 . Examples of fake news headlines presented to participants. We report one example for each type: Top left, COVID-19-related fake news; top right, COVID-19-related real news; bottom left, neutral fake news; bottom right, neutral real news. ©Images purchased from shutterstock.com . **significance at p < 0.01; ***significance at p < 0.001.

For each news article, participants were asked: (1) if they were familiar with the article (response options: “No”; “Unsure”; “Yes”); (2) how accurate they believed the article was (a 5 points scale ranging from “Not at all accurate” to “Very accurate” was used); and (3) if they would share that article on social media (response options: “I would never share it online” (these data were removed from the analyses); “No”; “Maybe”; “Yes”). To make sure participants would not use any internet source to search for the answers, the news articles appeared on the screen for a maximum of 45 s. A discernment index, representing the ability to discern fake from real news, was calculated, following Pennycook and Rand's (2019) procedure, by subtracting the perceived accuracy of fake news from perceived accuracy of real news and dividing by 4. The discernment index ranges from −1 (i.e., complete belief in fake news and disbelief in real news) to 1 (i.e., complete belief in real news and disbelief in fake news), with 0 indicating no discernment between fake and real news. Similarly, a social-media sharing discernment index was calculated by subtracting willingness to share fake news from the willingness to share real news and dividing by 3. Individual discernment indices were computed for COVID-19-related news and neutral news.

COVID-19 Variables

Information about the type of news sources participants normally consulted to learn about COVID-19 was collected using a multiple answer question (options: daily or online newspapers, TV news, social media or news aggregates, government websites, radio, or podcasts).

Participants answered 6 questions about their perception, emotions, and behaviors toward COVID-19. More precisely, they were asked to rate, on a scale from 0 (low) to 100 (high), the perceived severity of COVID-19, the negative arousal associated with the possibility of being infected, and the perceived likelihood to be infected. Participants were also asked to evaluate the frequency of their proactive information-seeking behaviors to face the pandemic (i.e., search for more information and take actions to reduce their chances of infection) on a 7-point Likert scale. Individual Perceived Severity and Arousal scores were collapsed into one “COVID-19 fear” factor in the analysis, whereas proactivity scores were treated as a separate “proactivity” factor in the analysis.

Data about the spread of COVID-19 during the studied period (March 27–April 28, 2020), and more precisely country, state, and city-specific confirmed case and death counts, were retrieved from the Italian Civil defense COVID-19 database ( GitHub, 2020b ) and the New York Times COVID-19 database ( GitHub, 2020a ). On the last day of data collection, death counts reached 25,969 for Italy and 53,034 for the U.S. Daily counts of positive cases in each city were used as the “cases” factor in the analyses since we expected a local index of COVID-19 would be the best metric of environmental severity (see Supplementary Table 1 ).

Bullshit Receptivity Score (BRS)

The propensity to judge pseudo-profound statements as profound was measured using the Bullshit Receptivity Questionnaire by Pennycook et al. (2015) . Pseudo-profound bullshit is defined by the authors as seemingly impressive assertions, which are presented as true and meaningful but are actually vacuous sentences with no discernible meaning (e.g., “Interdependence is rooted in ephemeral actions”). The scale includes actual profound statements (e.g., “All endings are also beginnings. We just don't know it at the time”) and non-profound, mundane statements, which reported simple facts (e.g., “Some things have distinct smells”). An Italian version of the scale was created by translating the original statements and then verifying them with a back translation. Participants were asked to rate each statement on their profundity on a 5-point Likert scale (1 = Not at all profound; 5 = Very profound). Individual scores for bullshit, profound and mundane statements were computed (For the Italian translation see Appendix 1 ).

Overclaiming

Overclaiming is considered the tendency for people to “self-enhance” when asked about their familiarity with general knowledge questions ( Pennycook and Rand, 2017 ). A shortened version of the Paulhus et al. (2003) overclaiming questionnaire was included in the survey. We administered a list of 13 different items with which participants had to rate their familiarity on a 7-point Likert scale (1 = Never heard of it; 7 = Very familiar). While 11 items indicated factual physical sciences topics, historical events, or historical figures, 2 foils were designed to detect if participants lied about their knowledge or overclaim. The items of the original scale were translated into Italian. To avoid participants researching the items on the Internet, the 13 questions were timed 60 s. A general knowledge score, consisting of the number of real items that received a score ≥ 4 (i.e., hits) and an overclaiming score, consisting of the number of foils which received a score ≥4 (i.e., false alarms), were computed. Finally, an accuracy score was calculated by subtracting the number of false alarms from the number of hits ( Paulhus et al., 2003 ). A higher accuracy score indicates a lower tendency to overclaim.

Problem-Solving

The problem-solving measures the performance of two cognitive tasks: a rebus puzzle-solving task ( MacGregor and Cunningham, 2008 ; Salvi et al., 2015b ) and four problems from the CRT ( Frederick, 2005 ; Thomson and Oppenheimer, 2016 ).

Rebus Puzzles

Participants were administered 20 rebus puzzles taken from MacGregor and Cunningham (2008) and Salvi et al. (2015b) . To solve each rebus puzzle, subjects had to merge verbal and visual clues to make a common phrase, such as: “Cycle, Cycle, Cycle”; solution: “Tricycle.” These problems are solved through either insight or a step-by-step process. Subjects were asked to produce a text string response for each rebus and to self-report the problem-solving method they used to solve each rebus. The results on insight problem-solving during the COVID-19 pandemic will be reported separately from the present report.

Participants were administered four Cognitive Reflection Test problems (CRT; Frederick, 2005 ). CRTs are deceiving problems that are designed to elicit an immediate, yet incorrect, response. After further consideration, the correct solution becomes more apparent. The four problems were taken from Frederick (2005) and Thomson and Oppenheimer (2016) , and more precisely the “bat and ball,” “machines,” “lily pads,” and “Emily's” problem were selected. The Italian version of the problems was taken from Baldi et al. (2013) . Each participant's percentage of correctly answered CRT items was calculated.

Socio-Cognitive Polarization (SCP)

The SCP factor included measures of absolutism ( Lauriola et al., 2016 ), xenophobia ( van der Veer et al., 2013 ), and conservatism ( Robinson et al., 1999 ; Salvi et al., 2016b ).

The Multidimensional Attitude Toward Ambiguity Scale (MAAS; Lauriola et al., 2016 ), which measures individual differences in tolerance vs . intolerance of perceived ambiguous stimuli, was administered to the participants. The 30-item version of the scale, which had both an Italian and American adaptation ( Lauriola et al., 2016 ), was used. Responses were provided on a 7-point Likert scale (1 = Strongly disagree; 7 = Strongly agree). The Moral Absolutism/Splitting subscale, a measure of rigid and stereotyped “black-and-white” thinking (e.g., “There's a right way and a wrong way to do almost everything”), was of primary interest in the present investigation.

Hostility and fear toward immigrants were assessed using the 14-item Xenophobia Scale created by van der Veer et al. (2013) . Participants indicated their level of agreement with statements such as “Interacting with immigrants makes me uneasy” on a 7-point Likert scale (1 = Strongly disagree; 7 = Strongly agree). The items of the scale were translated in Italian and then verified by a back-translation.

Conservatism

Political ideology was measured by two 7-point Likert scales ( Robinson et al., 1999 ; Salvi et al., 2016b ). Participants were asked to indicate their level of agreement with the following statements: “I endorse many aspects of conservative political ideology” and “I endorse many aspects of liberal political ideology.” The conservatism score was calculated by subtracting the score for liberalism from the score for conservatism.

Statistical Analyses

Our primary analyses investigate the relationship across our COVID-19-related factors (fear of COVID, COVID-19 information proactivity, city case count at the time of taking the survey), demographic factors (age, sex, education), cognitive factors (BRS, overclaiming accuracy, and problem-solving), and fake news factors (discernment, familiarity, and sharing). Secondary analyses probe the relation between problem-solving and SCP on fake news discernment in the context of the COVID-19 pandemic. Because we had reason to suspect our samples represented different populations (i.e., large differences in the level of education and in the type of news sources where they sought information about COVID-19; see Supplementary Table 1 ), separate correlations and regressions were performed for each sample.

COVID-19 and Socio-Cognitive Analyses

To test our series of hypotheses relating fear of COVID-19 to fake news discernment, sharing, proactive behaviors, BRS, and overclaiming, we initially performed correlations across COVID-19 factors (fear, proactivity, and city case count), fake news factors (discernment, familiarity, and sharing), and BRS and overclaiming factors. We tested our hypotheses that fear of COVID-19 would predict worse performance on problem-solving tasks by conducting a univariate regression between COVID-19 fear and problem-solving (with age, sex, and education as covariates) in each sample. The effect of type of news on discernment was analyzed through planned pairwise t -tests in each sample.

Fake News Discernment Regressions

To test our hypotheses that fear of COVID-19, problem-solving, and SCP would uniquely predict fake news discernment in each sample, we broadened our analyses with a series of planned univariate and multivariate regressions. Our reasoning for implementing multivariate regressions is to capture the strongest and most unique predictors of fake news discernment among the variables of interest by taking into account covariance and collinearity across all factors. We first performed bivariate correlations between each predictor and type of news discernment before fitting linear regressions using the generalized linear model glm() function in R3.6.3 ( R Development Core Team., 2008 ) to determine how well each factor predicts fake news discernment. Our rationale for presenting correlations and univariate results is to illustrate the strength of each predictor when other factors are not taken into account. This was followed by a multiple stepwise regression in which fake and neutral discernment were separately regressed onto all COVID-19-related and cognitive factors, again using the glm() function with forward and backward selection in R3.6.3 ( R Development Core Team., 2008 ). All regressions included sex, age, and education as covariates.

Given the widely recognized limitations of stepwise regression ( Whittingham et al., 2006 ), we sought to isolate the most unique predictors of fake news discernment by fitting a cross-validated LASSO, or penalized regression, using the cv.glmnet() function ( Friedman et al., 2010 ) in R3.6.3 ( R Development Core Team., 2008 ). This method works by adding a L1-penalization term to the regression equation ( Tibshirani, 1996 ), where larger λ-values correspond to the shrinking of more regression coefficients to zero. LASSO regression penalizes collinear coefficients and retains variables that most uniquely predict the outcome variable, thereby avoiding overfitting and multicollinearity [for a broader overview, see Gillespie et al. (2018) , Yankov et al. (2019) ]. We bootstrapped the cv.glmnet() function 1,000 times and extracted the λ with the smallest error deviance between predicted and actual observations. We applied each unique λ to final penalized regressions to identify the subset of factors most strongly predictive of fake news discernment. We executed this procedure four times, once for each unique fake news discernment variable (news type x country).

In support of our hypothesis that COVID-19 fear would predict likelihood to share news, we found that COVID-19 fear positively correlates with willingness to share both COVID-19 [ r = 0.15, 95% CI = (−0.05, 0.35), p = 0.01] and neutral [ r = 0.17, 95% CI = (0.07, 0.45), p = 0.01] news in the American sample (see Table 1 ). Importantly, the positive correlation indicates that COVID-19 fear relates specifically to willingness to share real news above and beyond fake news, contrary to our hypothesis that fear would make people more likely to share fake news. Additionally, in support of our hypothesis that proactivity (i.e., seeking information and taking safety measures) would relate to better discernment of fake news, we find that proactivity positively correlates with fake news discernment for COVID-19 [ r = 0.15, 95% CI = (– 0.05, 0.34), p < 0.05) and neutral [ r = 0.15, 95% CI = (–.06, 0.34), p < 0.05] news, as well as fear of COVID-19 [ r = 0.31, 95% CI = (0.16, 0.42), p < 0.01] in the American sample. As predicted, BRS negatively correlates with both fake news discernment for COVID-19 [ r = −0.13, 95% CI = (– 0.32, 0.07), p < 0.05) and neutral [ r = −0.14, 95% CI = (−0.34, 0.06), p < 0.05] news, as well as positively correlates with COVID-19 fear [ r = 0.16, 95% CI = (−0.04, 0.36), p < 0.05] in the American sample. This finding is in support of our hypothesis that those who score higher on BRS would in turn be less likely to detect fake news and that fear would be positively related to bullshit receptivity. BRS negatively correlates with overclaiming accuracy [ r = −0.18, 95% CI = (−0.37, 0.02), p < 0.05] in the American sample, suggesting those who are more likely to appraise pseudo-profound beliefs as profound are also more likely to overclaim the accuracy of unreliable information. Finally, overclaiming accuracy positively correlates with fake news discernment for COVID-19 [ r = 0.20, 95% CI = (0.0, 0.39), p < 0.05] in the American sample, suggesting a relationship between two variables that rely on scrutizing potentially false information.

Table 1 . Absolute correlation coefficients (Pearson's r ) for fake news and covid factors for the USA (lower diagonal) and ITA (upper diagonal) samples.

In the Italian sample, proactivity positively correlates with fake news discernment [ r = 0.18, 95% CI = (−0.03, 0.36), p < 0.01] and sharing [ r = 0.18, 95% CI = (0.07, 0.44), p < 0.01] of COVID-19 news. Interestingly, COVID-19 fear positively correlates with proactivity in both the American sample [ r = 0.31, 95% CI = (0.19, 0.41), p < 0.001] and the Italian sample [ r = 0.36, 95% CI = (0.18, 0.52), p < 0.001], highlighting a potentially beneficial role of COVID-19 fear on COVID-19-related information seeking. Similarly to the American sample, BRS positively correlates with COVID-19 fear [ r = 0.17, 95% CI = (−0.03, 0.36), p < 0.05] in the Italian sample, supporting our hypothesis that fear would be positively related to receptivity of pseudo-profound statements. In the Italian sample BRS also correlates with proactivity [ r = 0.17, 95% CI = (−0.07, 0.33), p < 0.05). From our results fear and fake news discernment did not significantly correlate in either sample. Contrary to our hypothesis that COVID-19 fear would be related to worse fake news discernment, there was no significant correlation in either sample between COVID-19 fear and fake news discernment variables. Notably, participants were more likely to discern COVID-19 fake news than neutral fake news in both samples (USA: t (269) = 10.524, p = 0.001; Italy: t (299) = 18.554, p < 0.001), suggesting a greater awareness of COVID-19 vs. neutral content during the pandemic.

COVID-19 and Problem-Solving

In support of our hypothesis COVID-19 fear negatively predicted performance on problem-solving tasks in both the American [β = −0.20, 95% CI = (−0.3, −0.1), p < 0.01] and Italian [β = −0.24, 95% CI = (−0.33, −0.14), p < 0.001] samples, while other predictors (age, education, number of cases) were insignificant (see Figure 3 ).

Figure 3 . Fear of getting COVID-19 negatively predicts problem-solving in the USA and ITA samples. Bands indicate 95% CI. **significance at p < 0.01; ***significance at p < 0.001.

In the American sample, COVID-19 fake news discernment significantly correlated with all the cognitive factors in the hypothesized directions ( Table 2 ). In both the univariate and multiple stepwise regressions, the most unique cognitive predictors of COVID-19 discernment were SCP [β = −0.22, 95% CI = (−0.3, −0.1), p < 0.001] and overclaiming [β = 0.16, 95% CI = (0.06, 0.26), p = 0.01] and the most unique COVID-19 predictor was proactivity [β = 0.13, 95% CI = (0.03, 0.23), p < 0.01]. The LASSO identified SCP as the most unique (negative) predictor of COVID-19 discernment. In both univariate and multiple stepwise regressions, the most unique cognitive predictors of neutral discernment were SCP [β = −0.13, 95% CI = (−0.22, 0.02), p < 0.05] and problem-solving accuracy [β = 0.24, 95% CI = (0.14, 0.35), p < 0.001], the most unique COVID-19 predictor was proactivity [β = 0.14, 95% CI = (0.05, 0.26), p < 0.05], and the most unique demographic predictor was age [β = 0.18, 95% CI = (0.08, 0.28), p < 0.01]. The LASSO identified problem-solving as the most unique (positive) predictor of neutral discernment. In support of our hypotheses, these results suggest that while BRS and overclaiming accuracy are both related to how likely participants were to detect fake news, SCP and problem-solving ability are the strongest predictors of participants' ability to detect fake news. Specifically, SCP predicts believing in fake news headlines, whereas problem-solving predicts fake news detection in the American sample.

Table 2 . Correlation, standardized univariate regression, multiple stepwise, and Lease Absolute Shrinkage and Selection Operator (LASSO) coefficients for the American sample.

In the Italian sample, the factors that predict COVID-19 discernment were proactivity [β = 0.19, 95% CI = (0.1, 0.29), p < 0.01] and age [β = 0.14, 95% CI = (0.04, 0.23), p < 0.05], with the LASSO identifying proactivity as the most unique (positive) predictor (see Table 3 ). The sole factor that predicted neutral discernment is SCP [β = −0.21, 95% CI = (−0.31, −0.11), p < 0.001], which the LASSO identified as the most unique (negative) predictor. These result suggest that, similarly to the American sample, SCP predicts believing in fake news headlines (specifically neutral fake news) in the Italian sample.

Table 3 . Correlation, univariate regression, multiple stepwise regression, and Lease Absolute Shrinkage and Selection Operator (LASSO) coefficients for the Italian sample.

The COVID-19 pandemic provided a natural context to study the critical impact of fear on how people seek, believe, and share information. Several aspects of human interaction with the media exacerbated fear during the COVID-19 pandemic. When the infection started to spread in Europe, especially in Italy, media reports adopted sensationalistic titles that tend to attract the most attention [e.g., on February 26, 2020 CNN titles “CDC official warns Americans it's not a question of if coronavirus will spread, but when” ( McLaughlin and Almasy, 2020 ); or “Like a wartime curfew: Inside Italy's coronavirus quarantine zone,” The Telegraph, on February 24 ( Oliphant et al., 2020 ); “There is no truce,” La Repubblica, on March 13, 2020 ( Bocci et al., 2020 )]. Even if little was known about the virus, such titles may have contributed to a state of alertness that drove people's behavior. The circulation of fake news and misleading information accelerated right after the beginning of the coronavirus outbreak ( Chakravorti et al., 2020 ; Cinelli et al., 2020 ; Taylor, 2020 ). This spread of false narratives (e.g., implausible cures; Sommer, 2020 ), conspiracy theories ( Ellis, 2020 ), and hate ( Ferrara, 2020 ) favored attitudes and behaviors that undermine the governments' efforts to implement prevention measures ( Abd-Alrazaq et al., 2020 ). The rapid and massive spread of misinformation has grown to such an extent that it has been referred to it as an “infodemic” (“We're not just fighting an epidemic; we're fighting an infodemic” - Word Health Organization., 2020 ), underlining the serious consequences of misinformation during the management of the viral outbreak. Information reliability becomes crucial when events that threaten many human lives take place (such as a pandemic or a natural catastrophe) since they impact the effectiveness of adopted safety measures ( Zarocostas, 2020 ). The case of the COVID-19 pandemic is a clear example of such an event. Our theoretical background frames the belief in and sharing of fake news in the context of individuals' need to resolve uncertainty during a time of heightened anxiety where people may be more vulnerable to fake news. This need has been exacerbated in a global pandemic, where scientific consensus and certainty was particularly elusive in the early days of the outbreak. During events like pandemics, fear-driven and instinctive behaviors activate promptly and people may develop more sensitivity to negative and overall novel information to help resolve uncertainty. This natural inclination toward information seeking may become problematic when sources of information contain misleading or outright false news stories.

Within this context, we investigated emotional, social, and cognitive factors that may influence fake news discernment and sharing, specifically the roles of COVID-19-related fear, seeking out information, BRS, overclaiming accuracy, problem-solving accuracy, and socio-cognitive polarization.

Our results showed that fear of COVID-19 is associated with proactive behaviors oriented toward seeking out information about the disease, taking actions to reduce the chances of being infected, and sharing real above and beyond fake news (despite the news sources consulted to gather information about the pandemic). As suggested by the literature, fear alters decision-making processes, and pushes people toward seeking information ( Allen et al., 2014 ; Lin et al., 2014 ). We believe that the circumstantial lack of knowledge at the beginning of the COVID-19 pandemic did not just push people to seek information, but may have also increased their willingness to share this information over social media. We speculate that people share information because they believe that specific information would be interesting or useful to others. Thus, we conclude that people who took the risk of infection and severity of COVID-19 more seriously felt the urgency to seek out information related to COVID-19 and share real news above and beyond fake news, hoping that circulating information may be helpful to others. This might illustrate a protective benefit to those who appraise the gravity of the pandemic by leading individuals to search for reliable sources of information. This result is in line with intuitive model of prosociality, which suggests that prosocial and helping behaviors often arises from intuitive, yet impulsive system 1 preferences ( Shi et al., 2020 ). However, our results also reveal that fear of COVID-19 positively correlates with believing in pseudo-profound bullshit and negatively predicts problem-solving ability, which may illustrate adverse effects of fear induced by the distressing context of a pandemic. Although we cannot speculate a causal relationship between the two in our results the link between fear and believing in pseudo-profound statements may suggest that sensitivity to fear is paralleled with believing in meaningless claims, which extends to forms of misinformation outside of the context of our fake news sample. Contrary to our prediction, the relation between fear and BRS seemed to be unique and independent from variables that have been hypothesized to be related to fear such as fake news discernment and overclaiming.

While we know that people acquire information to reduce fear and anxiety, our study provides evidence that fear leads also to sharing information and overestimating pseudo-profound statements. The relationship between fear, sharing, and bullshit receptivity may be explained by a desire to control the destabilizing lack of meaningful information. This effect might reflect the attitude toward creating spiritual meanings to explain, predict, and have an impression of control during unpredictable catastrophic events. The downside of these circumstances is that such a state reduces analytical thinking and our ability to solve problems. This result is in line with previous studies showing that stress, high risk-taking and anxiety of running out of time deteriorate creativity and problem-solving performance ( Salvi et al., 2016a ; Shen et al., 2018 ; Salvi and Bowden, 2019 ; Duan et al., 2020 ). Our results showed that problem-solving accuracy (as measured by both CRT and Rebus puzzles) correlates positively with a discerning fake from real news, indicating that an individual's willingness to engage in analytic and reflective thinking is associated with a reduced belief in fake news. In line with other studies, we found that individuals who perform better on the CRT ( Bronstein et al., 2019 ; Pennycook and Rand, 2019 ), and visual-semantic puzzles ( Sindermann et al., 2020 ) are better able to discern fake from real news. Tackling complicated problems requires continuous reframing and changing the initial representation of a problem to see it under a new light. We speculate that such mental exercise impacts other information processing skills. Thus, the relationship between being a good problem solver and detecting fake news may be explained by the willingness to invest time and effort in going beyond the default information. Problem-solving capacity may engender a greater tendency to question the information in news by investigating its accuracy further.

Our results replicate Pennycook and Rand (2020) findings that overclaiming accuracy and bullshit receptivity positively and negatively predict fake news discernment, respectively—but only in the American sample. This replication underscores a potential underlying feature of analytic thinking across our primary predictors (problem-solving and SCP) and supports our interpretation that those who are more willing to question default narratives, critically appraise a problem, and seek for new information are better suited to discern fake from real news. Finally, while problem-solving positively predicted fake news in the American sample, problem-solving was not a unique predictor of either neutral or COVID-19-related fake news in the Italian sample. Moreover, COVID-19-related fear only correlated with sharing real above and beyond fake news in the American sample. We have reason to believe our two samples represented populations with wide differences in their level of education (with the American sample scoring higher), which may explain the null relationship between problem-solving and fake news discernment in the Italian sample. Interestingly, the Italian sample scored much higher than the American sample on fear of COVID-19 (see Supplementary Table 1 ), which may have resulted in a ceiling effect, therefore preventing the detection of a relationship between fear and fake news variables in the Italian sample.

Our data indicate that higher levels of SCP (absolutism, conservatism, xenophobia) are associated with reduced fake news discernment. Absolutism refers to an individual's preference for rigid dichotomizations into fixed categories, which results in black-and-white thinking. People who score high in absolutism tend to have a polarized way of thinking by splitting representations of reality into opposite concepts that cannot coexist as distinct features of the same object (i.e., good-bad/right-wrong with no middle ground) ( Frenkel-Brunswik, 1951 ; Budner, 1962 ; Lauriola et al., 2016 ). Verifying the news' reliability requires the willingness to go beyond a readily available piece of information, the motivation to search for alternative views on the same issue, and the conviction that beliefs should change according to evidence ( Bronstein et al., 2019 ). Thus, when there are incongruencies within the news they are reading, it behooves individuals to seek more information in external resources for assessment ( Edgerly et al., 2020 ). Following this logic, people who are high on absolutism tend to stick to a single view ( Lewandowsky et al., 2012 ), maintain pre-existing established beliefs when presented with new information ( Kruglanski et al., 1993 ), and are less likely search for alternative information ( Ford and Kruglanski, 1995 ), which is likely to hinder the detection of fake news. Previous research suggests that intolerance for ambiguity is positively related to conservatism ( Jost et al., 2003 ; Jost, 2017 ). Conservative ideology tends to correlate with preferences toward certainty, simplicity, and closure, and avoidance of uncertainty, novelty, and complexity. Other studies also suggest that conservatives may engage in heuristic/automatic thinking more often than liberals ( Jost, 2017 ), and conservatism is positively related to lower mental effort ( Eidelman et al., 2012 ; Van Berkel et al., 2015 ). Our results indicate that people who subscribe to conservative viewpoints were more likely to believe fake news, which replicates prior research suggesting that belief in incorrect information is prevalent among conservatives ( Kull et al., 2003 ; Travis, 2010 ).

Xenophobia is also associated with the tendency to believe in fake news. To the best of our knowledge, there are no studies that demonstrate a relationship between xenophobic attitudes and fake news discernment. However, dogmatism, ethnocentrism, and intolerance for ambiguity are positively correlated [see Furnham and Marks (2013) ]. Thus, it is plausible to assume that people reporting a high level of xenophobia are those who tend to be more dogmatic, rigid, and who are less open to considering alternative views, and thus are worse at fake news discernment ( Bronstein et al., 2019 ).

We can conclude that the construct we named socio-cognitive polarization, which reflects cognitive rigidity, neglecting alternative information, and black-and-white thinking negatively predicts the ability to discern fake from real news. Such a construct extends also to reasoning processes, such as problem-solving, where thinking outside the box and consider alternative information is fundamental.

Limits of the Study

A major strength of this study is that data were collected during the critical early stages of the COVID-19 outbreak in two countries with the highest reported cases and deaths from the disease. However, the samples might not fully representative of the demographics of Italian and US populations. Nevertheless, it is worth noting that the two subsamples were well-balanced in terms of gender and age. The differences between the two subsamples are limited to education level, which, in any case, turned out to be a non-significant predictor of fake news discernment and information sharing, and to the type of news sources most frequently consulted to gather information about COVID-19. On the one hand, it can be argued that different media platforms would vary in terms of effort and actions directed to warn the readers about the potential threat of misinformation. On the other hand, even though Italian participants trusted TV news, whereas American participants preferred social media, predictions about fake news discernment were similar between samples, suggesting different media's responses to the threat of fake news during the pandemic was not a confounding variable in our study. Another limitation is that by administering the study online, we necessarily lose tight experimental control, which can introduce potentially confounding variables (e.g., impossible to know if each subject is fully attending to the experiment while in their home environment). Such caveats are of course true for online studies in general, and not unique to the present study. Another important issue is the current socio-cultural environment independent of the pandemic that could affect people's behavior, such as the impending 2020 US political election. Finally, as every subject is living through the same global pandemic, we do not have a putatively “pandemic free” sample to compare our results. Furthermore, in the present study, we did not measure trait and state levels of non-specific fear, and therefore our analyses regarding fear and fake news discernment, sharing, and problem-solving are limited to COVID-19 specific appraisals. To better understand how fear (or lack thereof) influences peoples' capacity to discriminate fake and real news stories, further research should also compare individuals with high vs. low levels of state or trait fear.

Data Availability Statement

All data and analysis code are available on our OSF project page ( https://osf.io/4pd2u/ ).

Ethics Statement

The studies involving human participants were reviewed and approved by IRB at The University of Texas at Austin. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

This study is the result of 2.5 months of uninterrupted work of all the researchers involved, while they were quarantined for COVID-19. All the researchers contributed with continuous daily work to finish the study in time and publish the results as soon as possible. This work was possible thanks to the collaborative effort of everyone who was involved in the project and understood the importance of supporting science during the pandemic. CS contributed in work coordination, conceptualization, methodology, and writing. PI contributed in conceptualization, methodology, and writing. AC contributed in conceptualization, methodology, data curation, and writing. MM contributed in conceptualization, methodology, data analysis, data interpretation, and writing. SR contributed with creating and translating the questionnaires, data cleaning, formatting, and bibliography. JD and AA contributed in supervision, writing, reviewing, and final editing.

JD and CS were supported by the NSF CAREER Award # 1844792 (PI J.E.D.).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We thank all the volunteers that supported our project and took the questionnaire without being paid, just under the commitment of supporting science. A special thanks go to Sam Cooper for the crucial help and advice he gave us on the statistical analysis. An infinite thanks go to Milena Fisher and the Creativity Post, AIRIcerca association of Italian researchers in the world, and the Italian Psychology Association (Associazione Italiana Psicologia, AIP) to promptly and enthusiastically share the link for taking the questionnaire.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fcomm.2020.562588/full#supplementary-material

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Keywords: COVID-19, fake news, problem-solving, fear, xenophobia, overclaiming, bullshit receptivity, socio-cognitive polarization

Citation: Salvi C, Iannello P, Cancer A, McClay M, Rago S, Dunsmoor JE and Antonietti A (2021) Going Viral: How Fear, Socio-Cognitive Polarization and Problem-Solving Influence Fake News Detection and Proliferation During COVID-19 Pandemic. Front. Commun. 5:562588. doi: 10.3389/fcomm.2020.562588

Received: 18 May 2020; Accepted: 04 December 2020; Published: 12 January 2021.

Reviewed by:

Copyright © 2021 Salvi, Iannello, Cancer, McClay, Rago, Dunsmoor and Antonietti. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Carola Salvi, carola.salvi@austin.utexas.edu

This article is part of the Research Topic

Coronavirus Disease (COVID-19): Pathophysiology, Epidemiology, Clinical Management and Public Health Response

Preparing for the next health crisis: COVID-19 showed the importance of community-engaged research

Research Associate, Health Sciences, Simon Fraser University

Assistant Professor, Faculty of Health Sciences, Simon Fraser University

Disclosure statement

Julia Smith receives funding from the Canadian Institutes of Health Research and Health Research BC.

Simran Purewal does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Simon Fraser University provides funding as a member of The Conversation CA.

Simon Fraser University provides funding as a member of The Conversation CA-FR.

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Community-engaged research involves the active and meaningful involvement of people directly affected by a research problem. Like most activities that require personal interaction, this type of research was disrupted by the restrictions of the COVID-19 pandemic.

This research approach is intended to build trustworthy relationships and yield mutual benefits. Community-engaged projects have garnered attention over the past two decades as they focus on tackling inequities , which often arise during public health crises.

Conducting community-engaged research has several benefits, like increasing the relevancy of studies , incorporating lived experience , and supporting the sharing of findings back to affected communities. Community engagement also plays an important role in emergency responses. Community-engaged emergency responses can promote the uptake of public health interventions and bolster advocacy efforts.

Community-engaged research during the pandemic

Researchers’ ability to engage with communities was impacted by the COVID-19 pandemic. Public health measures focused on preventing the spread of COVID-19 (such as limits on in-person gatherings) halted traditional forms of fieldwork. For example, researchers could not safely host in-person interviews. They were forced to quickly adapt to unfamiliar virtual teaching and learning platforms.

At the same time, civil society organizations (CSOs), non-profit agencies operating separately from government and business, were stretched thin as their demand soared. These organizations are sought after as community research partners since they are embedded in the communities they serve and provide crucial services to community members. Examples include the United Way BC and Sources Community Resource Centre , which provide direct services, support and relief to communities across B.C.

In 2023, the Pacific Institute on Pathogens, Pandemics, and Society ( PIPPS ) hosted a roundtable with community-engaged researchers at Simon Fraser University to learn about their experiences engaging with communities amid the pandemic. Findings from our roundtable, supplementing this article, have also been included in our Community-Engaged Research during Health Crises: Engaging with Civil Society Organizations handbook published by PIPPS and SFU Community Engaged Research Initiative .

Barriers to conducting community-engaged research

Roundtable attendees first discussed the challenges of conducting research remotely, with one noting how their research plans were put on pause for more than three months because of pandemic-related restrictions. Attendees also highlighted how managing multiple forms of online communication disrupted their work-life balance.

Several attendees found it difficult to recruit research participants; they discussed the challenges of the digital divide , referring to the gap between communities’ access to information and communication technologies.

Researchers faced challenges with ethics review boards, which did not consider the risks and unique considerations of engaging communities in a public health crisis. While ethics applications were expedited, researchers felt they lacked guidance for community-engaged research during the pandemic.

Researchers also found it hard to maintain relationships with communities amidst the pandemic. Some key ways researchers connect with communities are through sharing findings and hosting food-sharing events, such as lunch and learns. These opportunities were not available during the pandemic. In addition, many of their long-standing relationships with CSOs were strained as they experienced layoffs and increased demand. Researchers did not want to impede on CSOs’ frontline pandemic-related efforts.

Opportunities emerging from the pandemic

Despite the challenges they faced, researchers identified a range of opportunities that emerged as a result of the pandemic. They noted how they could increase the scope of their projects since virtual tools, like Zoom, allowed them to reach rural and remote communities. These platforms also provided low-barrier forms of participation for participants with accommodation needs.

Researchers also discussed how the pandemic forced the “professional veneers to slip away.” Over time, researchers connected on a more vulnerable level with their community partners, as they all attempted to get through the pandemic. Collectively, they showed up in their most authentic way and practised humility in their partnerships. Moreover, research teams emphasized the importance of building community, which reinforced their commitment to mutual benefit .

Through their community-engaged work, some researchers hired people with lived experience of the research problem of interest. This opportunity emerged during the pandemic. Compensating members of the research team for their knowledge strengthened the relevancy of their findings as they directly learned how the pandemic was impacting distinct groups.

Lessons learned: Conducting community-engaged research in future crises

Participants were asked what they would do differently in future health crises. Some discussed the significance of holding informal check-ins with their teams to openly discuss professional and personal challenges. Others pointed to the need for knowledge and resource sharing with other community-engaged researchers, to break down silos.

Additionally, attendees underscored the benefits of interdisciplinary research teams , bringing together diverse skills and expertise. In health crises, they aim to work collaboratively with academics and service providers from CSOs.

Based on the key themes of the roundtable, three recommendations emerged to support community-engaged research in future public health crises:

1) Post-secondary institutions should develop guidance for community-engaged research in health emergencies

Since post-secondary institutions increasingly recognize the importance of community-university partnerships , institutions should create protocols to support community-engaged research in public health crises. Attention should be paid to crisis-related considerations, including funding sources, resource challenges and ethics.

2) Develop targeted funding opportunities for community-engaged research partnerships

During the pandemic, research unrelated to COVID-19 faced funding drawbacks and resource constraints . This may have secondary effects in the “ post-pandemic era ,” especially for projects addressing health inequities. To avoid these unintended consequences, partnerships should be proactively supported by post-secondary institutions and funding agencies, to provide research partners with honoraria for their time and insights shared, and to help academic researchers build networks for engagement.

3) Prioritize capacity-building in partnerships

Mutual benefit is a guiding principle of community-engaged research . In partnerships, academic researchers often benefit through career advancement and a sense of fulfillment . Yet, community partners are not always assured the same benefits. To ensure mutual benefit, capacity building , referring to the process of building skills, abilities and resources, should guide community-engaged research partnerships. Both academic researchers and community partners bring significant assets to projects; these assets and training gaps should be uncovered at the outset of projects and considered throughout the partnership.

In addition to these recommendations, a repeated theme for participants was how community-engaged research should be viewed as a fundamental component of their work, as opposed to an afterthought. Rather than treating community-engaged research as a “ peripheral activity ,” the principles of community engagement should be embedded in research, teaching and learning.

• Public health
• Online communication
• Community engagement
• Public health crisis
• Civil society organizations
• Pandemic restrictions

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Teamworking in Healthcare during the COVID-19 Pandemic: A Mixed-Method Study

Associated data.

The data presented in this study are available on request from the corresponding author.

The widespread impact of COVID-19 on healthcare has demanded new ways of working across many organisation types and many forms of healthcare delivery while at the same time endeavouring to place minimal, or no, additional burden on already strained healthcare teams. This is a cross-sectional mixed-method study which captured the experiences of teamwork during the COVID-19 pandemic contributing to successful collaboration. We hypothesised that work engagement and psychological safety separately contribute to collective leadership and organisational citizenship behaviours. Participants were healthcare staff on active duty during the COVID-19 pandemic in Ireland ( n = 152) who responded to our social media (Twitter) invitation to participate in this study. Survey and free-text responses were collected through an online platform. Structural equation modelling examined the relationships between work engagement and psychological safety, and collective leadership and OCBs. Open text responses relating to experiences of teamworking during the pandemic were analysed for latent themes. From the survey data, the structural model demonstrated excellent statistical fit indicating that psychological safety, but not work engagement, was predictive of collective leadership and OCBs. From the qualitative data, two key themes were generated: (1) Contrasting experiences of working in a team during the pandemic; and (2) The pandemic response: a tipping point for burnout. This study offers a valuable starting point to explore the factors driving change and the shift to more collective ways of working observed in response to COVID-19. Future studies should use longitudinal data to capture the temporal relationship of these variables which could be moderated by prolonged pressure to healthcare staff during the pandemic.

1. Introduction

The COVID-19 pandemic elicited an extraordinary response from healthcare teams. To reduce the transmission of the virus and to ensure the safe continuity of services, changes were rapidly implemented across all levels of health systems globally [ 1 ]. Despite the typically slow pace of change in healthcare pre-pandemic [ 2 , 3 ], new initiatives have been rapidly approved and implemented. The widespread impact of COVID-19 on healthcare has demanded quicker designing, implementing, and learning about innovations across many organisation types and many forms of healthcare delivery while at the same time endeavouring to place minimal, or no, additional burden on already strained healthcare staff [ 4 ]. Whilst there is considerable variety of new initiatives introduced during the pandemic, such as the use of tablets to allow the family of patients in critical care to see their loved ones, common characteristics can be identified including the emergence of enhanced interprofessional collaboration and trust within healthcare teams and empowerment and autonomy to cultivate change [ 5 ]. Against the backdrop of intense pressure to maintain quality standards while keeping themselves safe, how did healthcare staff experience teamwork during the pandemic response? What were the factors that supported healthcare teams to deliver rapid changes in service delivery? This cross-sectional study explored the association between collective leadership, psychological safety, work engagement, and organisational citizenship behaviours during this time of exceptional transformation in healthcare.

1.1. Theoretical Approaches

During the pandemic, researchers have reported softer hierarchies and greater staff autonomy within multidisciplinary teams MDTs; [ 6 , 7 ]. This approach to patient care aligns with a shift away from traditional ‘command and control’ leadership styles to a more collaborative and collective leadership approach. While there have been many studies on traditional, formal leadership roles and how they influence the team environment, there is a paucity of research looking into collective leadership. Collective leadership is characterised by all team members jointly participating in decision-making processes and fulfilling tasks traditionally reserved for a hierarchical leader [ 8 ]. In the understanding of collective leadership, even those without formal leadership roles could contribute to the team’s decision-making processes. This differs from teamwork, which is generally understood as the activity of working together in a group with other people. One can have teamwork despite being in a team controlled by an authoritative leader.

Approaches such as collective leadership (e.g., shared or distributed leadership) emphasise the relational aspects of leadership, conceptualising leadership as a dynamic, interactive group-level phenomenon rather than the responsibility of one formal ‘heroic’ leader [ 9 ]. A recent meta-analysis by Wu et al. [ 8 ] has shown the positive relationship between shared leadership and group behaviour processes (e.g., problem solving), attitudinal outcomes (e.g., team satisfaction), team cognition (e.g., team creativity), and team performance (e.g., team productivity). Although research in other fields has begun to investigate the antecedents that support the emergence of collective leadership [ 10 , 11 , 12 ], our understanding of the factors that positively influence and enable collective leadership in healthcare teams is still developing. A recent systematic review of the literature found that internal team environment (i.e., shared purpose, voice and social support) and team heterogeneity are antecedents that are positively related to the emergence of shared approaches to leadership [ 8 ] Building on Carson et al.’s [ 10 ] work, we predicted that the internal team environment will support the emergence of collective leadership in healthcare teams.

One of the key characteristics of a positive team environment is one that promotes psychological safety [ 10 ]. To actively participate in patient care decision-making, staff must perceive that their work setting accepts and encourages collaboration and feedback [ 13 ]. Psychological safety refers to the shared belief that a work setting is a safe place to take interpersonal risks such as speaking up, asking questions, and sharing ideas and opinions [ 14 ]. The importance of psychological safety in healthcare teams is emphasised by the ongoing, global response to COVID-19; the continuous adaptation and redesign of services has required enhanced collaboration, engagement, creativity, innovation, and knowledge sharing across teams and across organisations. Newman et al. [ 15 ] identify these factors as key outcomes observed when working within psychologically safe environments. Previous research suggests that psychological safety enhances the adoption of leadership roles within MDTs by enabling involvement and voice in decision-making [ 16 ]. We acknowledge that it is also plausible that collective leadership would contribute to psychological safety within the team.

For healthcare staff to adopt leadership roles, they must be engaged and motivated to do so. Researchers conceptualise work engagement as a cognitive state in which individuals invest their personal resources and energies into their work roles and tasks [ 17 , 18 ]. Schaufeli et al. [ 19 ] consider vigour (e.g., high levels of energy and mental resilience while working), dedication (e.g., sense of enthusiasm or pride in one’s work), and absorption (e.g., being deeply engrossed in one’s work) as key characteristics of work engagement. The extant literature suggests that engagement is essential for overcoming the complex barriers associated with healthcare provision, for instance excessive workloads and inadequate staffing levels, and enables employees to feel attachment and engagement to their work roles [ 13 , 17 , 20 ]. When a psychologically safe environment exists, employees perceive greater self-determination and interest in their work, leading to improved innovation and shared learning [ 21 ]. Bakker and Albrecht [ 22 ] also suggest that because engaged employees are open to new experiences, staff are more inclined to help their colleagues. Similarly, Kahn [ 17 ] suggests that engaged individuals are more likely to step outside the formal boundaries of their role to assist their colleagues and support the goals of their team or organisation. Although research has examined the association between transformational leadership (which focuses on the behaviour of a designated leader) and work engagement [ 23 , 24 ], the relationship between work engagement, collective leadership and extra-role behaviours remains unclear, requiring further investigation.

Organisational citizenship behaviour (OCB) is a term used to describe these extra-role behaviours which include helping colleagues, encouraging others, and volunteering to take on additional responsibilities [ 25 , 26 ]. In addition to work engagement and collective leadership, psychological safety has also been positively associated with OCBs [ 20 ]. When healthcare staff feel comfortable taking interpersonal risks, they actively engage as part of the MDT and therefore we propose that staff may subsequently participate in extra-role behaviours to support their colleagues.

1.2. Hypotheses

This study aims to capture the experiences of teamwork during the COVID-19 pandemic, exploring factors which contribute to successful collaboration. We hypothesise that psychological safety is a pre-requisite conditions that promote collective leadership and OCBs in healthcare teams. Acknowledging that psychological safety can also contribute to work engagement [ 21 ], we additionally hypothesise that work engagement (even in the absence of psychological safety) promotes collective leadership and OCBs in healthcare teams during the pandemic, given the needs of the health service. As of the writing of this paper, no peer-reviewed studies have examined the four constructs together in the context of healthcare, especially with the lens of teamworking during the COVID-19 pandemic.

2. Materials and Methods

2.1. design, participants and recruitment strategy.

This is a cross-sectional mixed-method study. Given the growing complexity of healthcare, we hoped to capture the richness of contextual perspectives and relationships that exist between the four constructs (psychological safety, work engagement, collective leadership, OCBs) beyond numerical data. To capture the corresponding circumstances of collaboration, we added open-ended questions to the survey. To ensure neutrality and provide a safe space for participants, we recruited through social media rather than healthcare institutions.

Participants ( n = 152) in this study consisted of healthcare professionals who were working during the COVID-19 pandemic (from March 2020) in Ireland. They included clinical, administrative, and support staff. Participants were recruited using an online survey, completed via Qualtrics.com. The survey link was published on Twitter once a week during the study period, starting on 7 September 2020, and re-tweeted 230 times by Twitter users. Participants accessed the online survey using their own personal computer (desktop/laptop/tablet) or smartphone. Those clicking on the link were taken to an information and consent page. The survey was conducted entirely online with a median completion time of 15 min. This study received an exemption from full ethical review due to the low-risk nature of the work, from the research ethics committee at University College Dublin, Ireland.

2.2. Materials

This research employed four standardised scales and a series of open text questions relating to participants’ experiences of teamworking in healthcare during COVID-19. In addition, there was an optional section on demographic information. As Ireland has a relatively small population size and considering the self-reporting of racial data, to protect the anonymity of participants, age was reported in bands.

2.2.1. Collective Leadership

Collective leadership was assessed using the Collective Leadership Scale [ 27 ]. This is a 25-item instrument which assesses four domains of collective leadership: planning and organizing (six items); problem solving (seven items); support and consideration (six items); and development and mentoring (six items). However, given the considerable time pressures on healthcare staff and to reduce participant response burden, only the first three domains were retained, totalling 19 items. The development and mentoring subscale had items pertaining to skills acquisition and exchanging career-related advice, which the researchers were aware would be difficult to do as non-essential in-person interactions were severely limited in the early stages of pandemic response. To avoid contaminating the integrity of the responses, we omitted this subscale. Items prompted participants to consider how often their team shared in tasks including ‘Planning how the work gets done’ and ‘Finding solutions to problems affecting team performance’. All items were rated using a seven-point Likert scale (‘rarely’ = 0, ‘always’ = 7), with higher scores reflecting higher levels of collective leadership. The psychometric properties of this measure have previously been supported [ 27 ]. Similarly, the internal consistency (Cronbach’s alpha) for the full scale (α = 0.98) and each individual subscale (planning and organising = 0.95; problem solving = 0.95; support and consideration = 0.95) in the current sample demonstrated high levels of consistency.

2.2.2. Utrecht Work Engagement

Work engagement was measured using the Utrecht Work Engagement Scale UWES [ 19 ]. The UWES is comprised of 17 items that measure three dimensions of work engagement: vigour (six items), dedication (five items), and absorption (six items). Sample items include ‘When I get up in the morning, I feel like going to work’ and ‘At my job, I always persevere, even when things do not go well’. All items were rated using a seven-point Likert scale (‘rarely’ = 0, ‘always’ = 7), with higher scores reflecting increased work engagement. The psychometric properties of this measure have previously been supported [ 28 ]. Moreover, the internal consistency of the full scale (α = 0.95) and individual subscales (vigour = 0.90; dedication = 0.90; absorption = 0.83) were excellent in the current sample.

2.2.3. Organisational Citizenship Behaviour

OCB was measured using the Organisational Citizenship Behaviour Scale [ 29 ]. This is a 24-item scale which assesses five domains of organisational citizenship behaviour: altruism; conscientiousness; sportsmanship; courtesy; and civic virtue. However, to minimise participant response burden and avoid overlap with UWES, only three domains were retained, namely altruism (five items), courtesy (five items), and civic virtue (four items), totalling 14 items. Items were rated using a seven-point Likert scale (‘strongly disagree’ = 0, ‘strongly agree’ = 7), with higher scores reflecting higher levels of OCB. Sample items on this scale prompted participants to consider whether team members ‘are mindful of how their behaviour affects other people’s jobs’ and ‘keep abreast of changes in the organisation’. The psychometric properties of this measure have previously been supported [ 29 ]. Moreover, the internal consistency of the full scale (α = 0.96) and individual subscales (altruism = 0.83; courtesy = 0.95; civic virtue = 0.95) were satisfactory in the current sample.

2.2.4. Psychological Safety

Psychological safety was assessed using the 19-item Psychological Safety Scale [ 30 ]. This recently developed measure is designed to target psychological safety among healthcare professionals in relation to their team leader (nine items), fellow team members (seven items), and the whole team (three items). All items were rated using a seven-point Likert scale (‘strongly disagree’ = 0, ‘strongly agree’ = 7), with higher scores being indicative of higher psychological safety. Sample items included ‘I can speak up with recommendations/ideas for new projects or changes in procedures to my peers’ and ‘If I made a mistake on this team, I would feel safe speaking up to my peers’. The internal consistency of the full scale (α = 0.97) and individual subscales (team leader = 0.97; team members = 0.94; whole team = 0.95) were satisfactory in the current sample.

2.2.5. Open-Ended Questions

A series of eight open-ended questions ( Appendix A ) were embedded between the above standardised scales to capture the nuances of participants’ experiences working as part of a healthcare team during the COVID-19 pandemic. These questions were designed to elicit perceived changes in how teams worked together during the pandemic, and how the participant felt about these changes.

2.2.6. Covariates

A number of covariates were assessed including age (18–29, 30–39, 40–49, 50–59, 60+), sex (0 = male, 1 = female), self-reported ethnicity (0 = ethnicity other than White Irish, 1 = White Irish), length of time employed in healthcare, and whether or not the participant was redeployed due to the COVID-19 pandemic. Non-white Irish participants were grouped together for our data analysis due to the small sample size. In addition, due to small sample sizes in the 18–29 and 60+ age groups, the 18–29 and 30–39 groups were collapsed together, and the 50–59, and 60+ groups were collapsed together. This resulted in three age groups: 18–39, 40–49, 50+. These covariates were selected, following the guidelines set forth by VanderWeele [ 31 ], to ensure that the observed effects were not the result of differences among sociodemographic variables or additional work-related factors. For example, time employed in healthcare and/or being redeployed during the COVID-19 pandemic might impact an individual’s level of work engagement and/or psychological safety.

2.3. Data Analysis

2.3.1. quantitative data.

Structural equation modelling (SEM) was used to examine the relationships between work engagement and psychological safety, and collective leadership and organisation citizenship behaviours, while adjusting for several exogenous covariates (age, sex, self-reported ethnicity, length of time working in healthcare, and redeployment status). SEM is advantageous as it parses out measurement error, thus leading to more accurate parameter estimates [ 32 ]. It was necessary to first evaluate the fit of the measurement model (i.e., a model consisting of just the latent variables), prior to fitting the structural model [ 33 ]. Model fit was assessed using several goodness-of-fit indices [ 34 ]: Non-significant χ 2 , Comparative Fit Index CFI; [ 35 ] and Tucker–Lewis Index TLI; [ 36 ] values ≥ 0.90; Root Mean Square Error of Approximation RMSEA; [ 37 ] and Standardised Root-Mean-Square Residual SRMR; [ 38 ] values < 0.08 suggest adequate model fit.

Data were analysed using Mplus 8.2 [ 39 ] and the models were estimated using the robust maximum likelihood (MLR) estimator. There was a substantial proportion of missing data on certain variables of the survey. Although 100% ( n = 152) completed the Collective Leadership Scale, 68.4% ( n = 104) completed the UWES, 65.8% ( n = 100) completed the Organisational Citizenship Behaviour Scale, 60.5% ( n = 92) completed the Psychological Safety Scale, and 43.4–50% ( n = 66–76) completed the remaining demographic questions. However, the missing data were found to be missing completely at random (MCAR), as indicated by Little’s MCAR test ( χ 2 [30, n = 152] = 18.39, p = 0.952).

Missing data were handled using the robust full information maximum likelihood procedure, which allows parameters to be estimated using all information available. To reduce model complexity, the latent variables (i.e., work engagement, psychological safety, collective leadership, and OCBs) were created using parcels consisting of the summed scores of each subscale within the latent variable’s respective scale. Moreover, the default procedure for using maximum likelihood estimation removes exogenous covariates using listwise deletion before the model is estimated. As such, we brought all variables, including the exogeneous covariates, into the model [ 39 ] to use all information available and thus model covariate missingness. This process makes distributional assumptions (i.e., multivariate normality) about the nature of the covariates. However, the MLR estimator was used as this estimator is robust to non-normally distributed data and can account for concerns of such multivariate non-normality.

2.3.2. Qualitative Data

The eight open-ended questions included in this survey generated text responses. The qualitative data were analysed using Braun and Clarke’s [ 40 ] 6-step thematic analysis framework. This process involved repeatedly reading the data, generating initial codes and developing, refining and naming broader themes. Rather than applying a prescriptive list of codes, a bottom-up inductive approach to coding was applied which ensured themes strongly reflected the data collected. Using NVivo11 software, an experienced qualitative researcher trained in advanced qualitative design and analysis conducted line-by-line thematic coding. As themes emerged, they were deliberated and refined through discussions with the research team who were familiar with the data set. The dependability of the findings was further enhanced through deviant case analysis. By recognizing alternative viewpoints and contradicting data, a more holistic understanding of the data was achieved. Through this process, we identified patterns in the data, interpreted them, and explained their latent ideas. In total, 96 survey participants provided responses to the open-ended questions. These data provided greater insight into the experiences of teamwork during COVID-19 enhancing our understanding of the relationship between psychological safety, work engagement, collective leadership, and OCBs.

3.1. Descriptive Statistics

Table 1 summarises the sample characteristics for the current study. The majority of participants who responded to the demographic questions are female (84%). Three quarters identified as White Irish (75%). We also note that approximately a third of our participants who responded to the demographic questions experienced redeployment to a different healthcare team during the pandemic (31.6%).

Sample characteristics and descriptive statistics of the current study.

3.2. Measurement Model

The measurement model consisting of four latent variables (work engagement, psychological safety, collective leadership, and OCBs) demonstrated excellent statistical fit ( χ 2 (48) = 70.46, p = 0.019; CFI = 0.983; TLI = 0.976; RMSEA = 0.055 [90% CI 0.023, 0.082]), SRMR = 0.035. Although a significant χ 2 indicates poor model fit, this fit statistic can often reject the postulated model for trivial misspecifications [ 41 , 42 ]. As such, it is generally recommended to consult additional fit statistics. As the CFI, TLI, and RMSEA indicated satisfactory statistical fit, it is likely that the proposed model provided adequate fit to the data. All factor loadings were positive and significant ( p < 0.001) ranging from 0.78–0.97 and inter-factor correlation ranged from 0.68–0.94. For individual factor loadings and inter-factor correlations see Appendix B , Table A2 and Table A3 ).

Structural Model

The SEM model (see Figure 1 ) demonstrated satisfactory fit to the data ( χ 2 (96) = 129.30, p = 0.001; CFI = 0.978; TLI = 0.969; RMSEA = 0.048 [90% CI 0.023, 0.068]), SRMR = 0.041 and explained 80.7% of the variance in collective leadership scores and 94.1% of the variance in OCBs.

Structural model illustrating the relationship (standardised estimates) between work engagement and psychological safety, and collective leadership and organisational citizenship behaviours. Note: Individual exogenous covariate pathways are omitted for visual clarity. Statistical significance: *** p < 0.001.

While adjusting for the exogenous covariates (see Table 2 for all parameter estimates), increased psychological safety (β = 0.90, p < 0.001) and self-reported ethnicity (ethnicity other than White Irish) (β = −0.31, p < 0.001) were associated with increased collective leadership. Similarly, psychological safety (β = 1.13, p < 0.001) and self-reported ethnicity (ethnicity other than White Irish) (β = −0.25, p < 0.001) were associated with increased OCBs. Although this standardised regression coefficient (OCBs regressed on psychological safety) may appear quite large, it is important to note that standardised coefficients can exceed a value of one if there are multiple, correlated, predictors [ 43 , 44 ]. It is also argued that one should not modify a model for the purpose of reducing large coefficients as this can lead to biased estimates [ 43 ]. Moreover, the model converged without any indicators of improper solutions, such as negative residual variances. There was no association between work engagement and either collective leadership (β = −0.01, p = 0.918) or OCBs (β = −0.24, p = 0.055).

SEM model of work engagement, psychological safety, collective leadership, and organisational citizenship behaviours.

Note: B = unstandardised estimates; β = standardised estimates; SE = standard error; a = sex coded as 0 = male, 1 = female; b = self-reported ethnicity coded as 0 = ethnicity other than White Irish, 1 = White Irish. Statistical significance: *** p < 0.001.

3.3. Qualitative Findings

Two key themes were generated from the inductive qualitative analysis of open-ended responses: (1) Contrasting experiences of working in a team during the pandemic; and (2) The pandemic response: a tipping point for burnout.

3.3.1. Contrasting Experiences of Working in a Team during the Pandemic

Participants described greater collaboration as one of the most significant changes to occur as a result of COVID-19. Staff discussed the removal of organisational barriers and “red tape” (COV217) which commonly hindered the implementation of change. This greater autonomy resulted in enhanced innovation and implementation: “less bureaucracy and more action” (COV148). In addition to more bottom-up decision-making, participants also reported enhanced interdisciplinary teamworking characterised by improved communication and the development of “supportive networks” (COV103). Some participants described “working together as one team” rather than within discipline specific silos (e.g., medicine, nursing, allied health) (COV021), which is consistent with a shift towards a collective approach to leadership. The shared goal and challenge of responding to COVID-19 encouraged staff to “pull together” (COV 209), which increased compassion and the sense of “solidarity” (COV027) in teams. Informal ‘check-ins’ were a common support mechanism identified by participants. Many staff emphasised their desire to sustain the interprofessional teamworking that emerged during the pandemic response. Some suggested that by experiencing the benefits of collective decision-making (e.g., in service redesign), greater collaboration among team members may be sustainable. However, others questioned whether “going the extra mile” for colleagues would continue (COV104), with one participant noting that the “sense of being in this together has gone” as the pandemic continued (COV015).

Other respondents, however, described a very different experience of working in healthcare during the pandemic response. In some instances, the strictures of the traditional hierarchy and power dynamics were not only evident, but reinforced, and this was universally reported as a negative, even damaging experience for staff. Some participants outlined experiences of hierarchical decision-making in which decisions were imposed and frontline staff were expected to “follow them unquestionably like school children” (COV010). One participant emphasised the fear associated with this model of leadership: “they were working in situations of fear of the management as well as fear of the virus” (COV097). While another stressed their “frustration” at the “command and control pressures on the team” (COV094). Many staff described how this sense of powerlessness made them feel “taken for granted, not important” (COV118) and simply “just a number” (COV029). Although some participants provided examples of formal wellbeing services, others felt organisational support for frontline staff was limited or “superficial” (COV130). Some staff also described poor interpersonal relationships within their frontline team. Some explained how a “blame culture” exists (COV030), while others simply mentioned feeling “let down” (COV029). These participants suggested that COVID-19 restrictions may have strengthened the hierarchical culture that exists within their workplace. Due to social distancing precautions, some staff described how there are “less people having [a] voice at the table” (COV026). Frontline staff also recognised that personal protective equipment has impacted the informal relationships within their teams as there are “few opportunities to have chats and coffee” (COV070). For others, redeployment exacerbated the fragmented nature of teamworking: “you did what you were told without question” (COV016).

3.3.2. The Pandemic Response: A Tipping Point for Burnout

Although some staff accredited greater commitment, pride and meaning to their work following their initial involvement in the pandemic response, as the pandemic continued many participants emphasised increasing levels of burnout. Burnout was illustrated in the evocative language used by participants. Staff described working on the frontline as “hell” (COV190), “unrelenting” (COV27), “exhausting, draining, and upsetting” (COV22). Some staff described feeling “shattered, shellshocked, and traumatised” (COV97) as they had “passed the novelty of being heroes” (COV143). Despite public recognition for their work, many participants felt underappreciated by their health system:

“I am working in an industry that has a small heart and little respect” (COV143).

Many participants associated burnout to their growing workloads and diminishing resources; “extra work piled on without any support” (COV005). Some described how a “get on with it” attitude exists within their organisation (COV022). However, due to the ongoing demands one participant questioned “how am I going to do this for another 20 years” (COV156). Due to their negative experiences, some staff suggested a “massive increase in anxiety related illnesses” (COV19) for healthcare staff. Others implied possibly leaving the health service because of feeling unappreciated by their organisation and the wider health system: “I’m looking for other opportunities where I’m valued more” (COV118). Despite the increased risk associated with their role (in which many contracted COVID-19), some staff felt unprotected by their health service, explaining how “no one could care less about [their] experience” (COV016). Some participants suggested that insufficiencies in organisational and wider health service leadership have left staff feeling “forgotten” on the frontline (COV019).

4. Discussion

This study, conducted in 2020 during the COVID-19 pandemic, aimed to capture the experiences of teamwork during the pandemic response. While previous research harnessing media and social media narratives has demonstrated that the health system can transform rapidly when presented with a single focus or threat [ 5 ], our research has used social media (Twitter) to recruit participants to a study exploring factors driving this shift towards collaborative and collective approaches to teamworking and leadership. Specifically, we hypothesised that work engagement and psychological safety would be associated with collective leadership and OCBs. Our results partially supported these hypotheses, with psychological safety, but not work engagement, predictive of collective leadership and OCBs. Qualitative analysis of text responses offered valuable contextual insight to help explain these findings.

As predicted, we found that psychological safety was associated with collective leadership behaviours. Previous research has found that the key drivers of psychological safety and its outcomes include the level of interaction between, and familiarity among, team members [ 45 ] and the quality of social relationships between team members, indicated by trust and collective thinking [ 46 ]. Where it exists, the interprofessional collaboration reported during the COVID-19 response enabled an atmosphere of psychological safety and creativity, where ideas and innovations were actively sought and developed collectively. Previous work has similarly found that inclusive approaches are associated with enhanced psychological safety and creativity [ 47 , 48 ]. As a result, team members were empowered to adopt leadership roles and responsibilities, effectively leveraging and contributing their expertise to support the operation and functioning of the team. Consistent with previous research [ 10 ], the qualitative findings demonstrate that the levels of peer support and the positive internal environment reported by participants promoted through this collaborative approach to change facilitated the emergence of collective leadership. This collaborative approach to change suggests a more collective mindset and coalescing around a shared goal, promoting a sense of team and collective identity [ 49 ].

In this study, psychological safety also predicted organisational citizenship behaviours. When staff feel psychologically safe in taking interpersonal risks, such as adopting a new role or responsibility, they are more willing to venture outside their own professional domain or comfort zone to support colleagues, engaging in extra-role behaviours including helping colleagues, encouraging others, and volunteering to take on additional responsibilities. However, our qualitative findings highlight the potential risk of burnout from engagement in extra-role behaviours. Organ and Ryan [ 50 ] found that individuals who engaged in high levels of OCB might feel overloaded and be at higher risk of role fatigue. Indeed, excessive levels of engagement in OCBs, such as those that were observed during the pandemic response, may contribute to burnout and ultimately disengagement in work.

Contrary to our prediction, work engagement did not predict collective leadership or OCB. Work engagement is often considered the opposite of burnout. In contrast to those who suffer from burnout, engaged employees are those who experience a sense of energetic and effective connection with their work and perceive themselves as capable of managing the demands of their role [ 19 ]. Given work engagement is defined as a positive, fulfilling work-related outlook, this experience may not be generally representative of healthcare workers perceptions during this time of unprecedented pressure on health services. Our qualitative findings offer some potential explanations into why a relationship between work engagement and collective leadership, or OCB was not observed. Firstly, this study took place several months into the onset of the global pandemic and participants in our qualitative analysis conveyed either a largely positive or a very negative experience of their work. The latter group reported higher levels of stress, burnout, and fatigue. Those who perceived more hierarchical working environments tended to report greater levels of burnout. These polarised experiences may explain why no relationship between work engagement and collective leadership and OCBs was observed. Future research should investigate this further. Secondly, whilst psychological safety and work engagement both represent positive, motivational states toward one’s work, work engagement tends to reflect cognitive appraisal of the job, whereas psychological safety is more reflective of the perceptions one holds of the work environment. This disparity may explain the current findings. Furthermore, employees tend to report high levels of work engagement when they perceive higher levels of control over their work environment [ 51 ]. In the context of an unpredictable, rapidly evolving, high-stress pandemic, it is not surprising that healthcare staff may not have the same personal resources and perceptions of control that are associated with higher levels of work engagement.

Finally, our model found that self-reported ethnicity predicted both collective leadership and OCBs. It is well-established in the literature that cross-cultural differences exist in both the meaning and perceptions of leadership and in the degree of individualism or collectivism [ 52 ]. As Friedrich et al. highlight [ 53 ], research on teams often assumes homogeneity in teams and fails to attend to this diversity. A recent meta-analysis found a positive relationship between team heterogeneity and shared leadership, suggesting the importance of diversity among team members as an antecedent condition to support collective leadership [ 8 ]. Team diversity warrants further exploration, specifically the impact of culturally diverse teams and the emergence of collective leadership and OCBs.

4.1. Theoretical and Practical Implications

This research delivered snapshots of healthcare workers’ experiences of teamworking during the COVID-19 pandemic to explore factors contributing to collaboration and successful initiatives during a crisis. At the point this manuscript was submitted, no peer-reviewed studies have examined the psychological safety, work engagement, collective leadership, and OCBs together in the context of healthcare, especially with the lens of teamworking during the COVID-19 pandemic. The majority of existing research in this field have examined the outcome variables separately through either a quantitative or qualitative approach, but seldom both. This study offers the evidence to support psychological safety as a precondition for collective leadership and OCBs even during a national crisis—that ‘necessity’ alone cannot force collaboration and force an environment of innovation to take place. There is considerable scope for learning how teams are adapting to the COVID-19 crisis and the factors that are promoting effective teamworking and outcomes. To date, a relatively narrow range of outcomes have been measured and there is opportunity to understand other antecedents and outcomes related to collective leadership, including aspects of workplace culture and the impact on burnout. The latter is attracting more attention recently due to the impact of the on-going COVID-19 pandemic on healthcare staff. These avenues for future research will prove fruitful in informing how we can train and develop teams to ensure the appropriate interventions to enable collective ways of working to harness intelligence and leverage skills and knowledge from the whole team to ensure optimal care delivery.

Practically, this study shows that recruitment of research participants through social media is possible, although not without its limitations. For healthcare teams, this study’s findings further underline the need to deliberately establish a psychologically safe environment, where individuals will not be humiliated for speaking up with ideas, questions, concerns, or observations. Risk-taking attitudes which are traditionally associated with innovation, requires an environment that is open to experimentation and welcoming of ideas even from the lowest ranks. Our study further shows that without such an environment, healthcare professionals are unlikely to go the extra mile. Several strategies have been identified to support healthcare teams foster psychological safety in daily practice [ 48 , 54 ]. Firstly, encouraging all team members to engage in more inclusive behaviours by establishing a daily multidisciplinary huddle will likely improve staff perceptions relating to the value of their role, promoting voice behaviours and staff contributions. Rather than only focusing on operational issues, protecting time monthly to reflect together as a team on more personal experiences may enhance familiarity and trust within teams. In addition to enabling team reflections, one-on-one interactions between staff have been shown to facilitate discussions on more difficult subjects [ 54 ]. Therefore, adopting an approach such as a buddy system in practice where staff are paired with a peer or more senior colleague may further strengthen interpersonal relationships promoting greater openness and ultimately psychological safety within healthcare teams.

4.2. Limitations

Whilst the research offers valuable insights to help us understand these rapid changes, the limitations of the work must also be acknowledged. In our attempt to be neutral, recruitment was through an academic social media channel. Even though the recruitment links were replicated over 200 times, we acknowledge that many healthcare workers without a Twitter account might not have been exposed to our study. As in all studies of this nature, we are aware that there is potentially a self-selection bias of healthcare workers who chose to participate. Those who are engaged in their work, have very positive or very negative stories to share, or feel they have the agency to make a difference are more likely to participate in this type of study.

Given the considerable burden already on healthcare staff, we deliberately adopted a design approach to minimise response burden. We designed the demographics section optional, and right at the end of the survey. Age was reported in bands, to minimise the possibility of identifying respondents from their demographics, as Ireland has a relatively small population. This resulted in participants only completing the substantive part of the survey and dropping out when they reach demographics section. The missing data observed in responses suggests the use of shortened scales through administration of only the most relevant sub-scales was warranted. Procedures to account for missing data using all information available, together with the analytical approach adopted, enabled robust analyses and inferences based on this data set and helped to ensure that this limitation was mitigated. Finally, causality cannot be inferred in cross-sectional research of this nature and the focus on staff in one national healthcare system may limit the generalisability of the findings. Future studies should use longitudinal data to capture the temporal relationship of these variables which could be moderated by prolonged pressure to healthcare staff during the COVID-19 pandemic.

5. Conclusions

This study explored experiences of teamworking during the COVID-19 pandemic. Structural equation modelling indicated that psychological safety, but not work engagement, was predictive of collective leadership and OCBs. Further qualitative analysis found contrasting experiences of working as part of a healthcare team during the pandemic; and initial evidence of the pandemic representing a tipping point for burnout. These findings require further investigation to clarify how the pandemic has impacted individuals and teams in the long term. Meanwhile, this research offers a valuable starting point to explore the factors driving change and the shift to more collective ways of working observed in response to demands presented as a result of the COVID-19 pandemic.

Open-Ended Questions. The following questions intend to capture attitudes towards, and motivations driving, new ways of working during COVID-19.

Standardised factor loadings of all latent variables.

Note: β = standardised estimates; SE = standard error. Statistical significance: All p < 0.001.

Inter-factor correlations of all latent variables.

Note: Statistical significance: *** p < 0.001.

Author Contributions

Conceptualization, S.A., A.D.B. and E.M.; methodology, S.A., A.D.B., L.R., R.F. and E.M.; formal analysis, S.A, R.F., L.R.; writing—original draft preparation, S.A., A.D.B., L.R., R.F; writing—review and editing, S.A., A.D.B., L.R., R.F. and E.M.; funding acquisition, E.M. All authors have read and agreed to the published version of the manuscript.

This work is funded by the Irish Health Research Board (RL-2015-1588) and the Health Service Executive.

Institutional Review Board Statement

This study received an exemption from full ethical review due to the low-risk nature of the work, from the research ethics committee at University College Dublin, Ireland.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

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Do You Understand the Problem You’re Trying to Solve?

To solve tough problems at work, first ask these questions.

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Problem solving skills are invaluable in any job. But all too often, we jump to find solutions to a problem without taking time to really understand the dilemma we face, according to Thomas Wedell-Wedellsborg , an expert in innovation and the author of the book, What’s Your Problem?: To Solve Your Toughest Problems, Change the Problems You Solve .

In this episode, you’ll learn how to reframe tough problems by asking questions that reveal all the factors and assumptions that contribute to the situation. You’ll also learn why searching for just one root cause can be misleading.

Key episode topics include: leadership, decision making and problem solving, power and influence, business management.

HBR On Leadership curates the best case studies and conversations with the world’s top business and management experts, to help you unlock the best in those around you. New episodes every week.

• Listen to the original HBR IdeaCast episode: The Secret to Better Problem Solving (2016)
• Find more episodes of HBR IdeaCast
• Discover 100 years of Harvard Business Review articles, case studies, podcasts, and more at HBR.org .

HANNAH BATES: Welcome to HBR on Leadership , case studies and conversations with the world’s top business and management experts, hand-selected to help you unlock the best in those around you.

Problem solving skills are invaluable in any job. But even the most experienced among us can fall into the trap of solving the wrong problem.

Thomas Wedell-Wedellsborg says that all too often, we jump to find solutions to a problem – without taking time to really understand what we’re facing.

He’s an expert in innovation, and he’s the author of the book, What’s Your Problem?: To Solve Your Toughest Problems, Change the Problems You Solve .

  In this episode, you’ll learn how to reframe tough problems, by asking questions that reveal all the factors and assumptions that contribute to the situation. You’ll also learn why searching for one root cause can be misleading. And you’ll learn how to use experimentation and rapid prototyping as problem-solving tools.

This episode originally aired on HBR IdeaCast in December 2016. Here it is.

SARAH GREEN CARMICHAEL: Welcome to the HBR IdeaCast from Harvard Business Review. I’m Sarah Green Carmichael.

Problem solving is popular. People put it on their resumes. Managers believe they excel at it. Companies count it as a key proficiency. We solve customers’ problems.

The problem is we often solve the wrong problems. Albert Einstein and Peter Drucker alike have discussed the difficulty of effective diagnosis. There are great frameworks for getting teams to attack true problems, but they’re often hard to do daily and on the fly. That’s where our guest comes in.

Thomas Wedell-Wedellsborg is a consultant who helps companies and managers reframe their problems so they can come up with an effective solution faster. He asks the question “Are You Solving The Right Problems?” in the January-February 2017 issue of Harvard Business Review. Thomas, thank you so much for coming on the HBR IdeaCast .

THOMAS WEDELL-WEDELLSBORG: Thanks for inviting me.

SARAH GREEN CARMICHAEL: So, I thought maybe we could start by talking about the problem of talking about problem reframing. What is that exactly?

THOMAS WEDELL-WEDELLSBORG: Basically, when people face a problem, they tend to jump into solution mode to rapidly, and very often that means that they don’t really understand, necessarily, the problem they’re trying to solve. And so, reframing is really a– at heart, it’s a method that helps you avoid that by taking a second to go in and ask two questions, basically saying, first of all, wait. What is the problem we’re trying to solve? And then crucially asking, is there a different way to think about what the problem actually is?

SARAH GREEN CARMICHAEL: So, I feel like so often when this comes up in meetings, you know, someone says that, and maybe they throw out the Einstein quote about you spend an hour of problem solving, you spend 55 minutes to find the problem. And then everyone else in the room kind of gets irritated. So, maybe just give us an example of maybe how this would work in practice in a way that would not, sort of, set people’s teeth on edge, like oh, here Sarah goes again, reframing the whole problem instead of just solving it.

THOMAS WEDELL-WEDELLSBORG: I mean, you’re bringing up something that’s, I think is crucial, which is to create legitimacy for the method. So, one of the reasons why I put out the article is to give people a tool to say actually, this thing is still important, and we need to do it. But I think the really critical thing in order to make this work in a meeting is actually to learn how to do it fast, because if you have the idea that you need to spend 30 minutes in a meeting delving deeply into the problem, I mean, that’s going to be uphill for most problems. So, the critical thing here is really to try to make it a practice you can implement very, very rapidly.

There’s an example that I would suggest memorizing. This is the example that I use to explain very rapidly what it is. And it’s basically, I call it the slow elevator problem. You imagine that you are the owner of an office building, and that your tenants are complaining that the elevator’s slow.

Now, if you take that problem framing for granted, you’re going to start thinking creatively around how do we make the elevator faster. Do we install a new motor? Do we have to buy a new lift somewhere?

The thing is, though, if you ask people who actually work with facilities management, well, they’re going to have a different solution for you, which is put up a mirror next to the elevator. That’s what happens is, of course, that people go oh, I’m busy. I’m busy. I’m– oh, a mirror. Oh, that’s beautiful.

And then they forget time. What’s interesting about that example is that the idea with a mirror is actually a solution to a different problem than the one you first proposed. And so, the whole idea here is once you get good at using reframing, you can quickly identify other aspects of the problem that might be much better to try to solve than the original one you found. It’s not necessarily that the first one is wrong. It’s just that there might be better problems out there to attack that we can, means we can do things much faster, cheaper, or better.

SARAH GREEN CARMICHAEL: So, in that example, I can understand how A, it’s probably expensive to make the elevator faster, so it’s much cheaper just to put up a mirror. And B, maybe the real problem people are actually feeling, even though they’re not articulating it right, is like, I hate waiting for the elevator. But if you let them sort of fix their hair or check their teeth, they’re suddenly distracted and don’t notice.

But if you have, this is sort of a pedestrian example, but say you have a roommate or a spouse who doesn’t clean up the kitchen. Facing that problem and not having your elegant solution already there to highlight the contrast between the perceived problem and the real problem, how would you take a problem like that and attack it using this method so that you can see what some of the other options might be?

THOMAS WEDELL-WEDELLSBORG: Right. So, I mean, let’s say it’s you who have that problem. I would go in and say, first of all, what would you say the problem is? Like, if you were to describe your view of the problem, what would that be?

SARAH GREEN CARMICHAEL: I hate cleaning the kitchen, and I want someone else to clean it up.

THOMAS WEDELL-WEDELLSBORG: OK. So, my first observation, you know, that somebody else might not necessarily be your spouse. So, already there, there’s an inbuilt assumption in your question around oh, it has to be my husband who does the cleaning. So, it might actually be worth, already there to say, is that really the only problem you have? That you hate cleaning the kitchen, and you want to avoid it? Or might there be something around, as well, getting a better relationship in terms of how you solve problems in general or establishing a better way to handle small problems when dealing with your spouse?

SARAH GREEN CARMICHAEL: Or maybe, now that I’m thinking that, maybe the problem is that you just can’t find the stuff in the kitchen when you need to find it.

THOMAS WEDELL-WEDELLSBORG: Right, and so that’s an example of a reframing, that actually why is it a problem that the kitchen is not clean? Is it only because you hate the act of cleaning, or does it actually mean that it just takes you a lot longer and gets a lot messier to actually use the kitchen, which is a different problem. The way you describe this problem now, is there anything that’s missing from that description?

SARAH GREEN CARMICHAEL: That is a really good question.

THOMAS WEDELL-WEDELLSBORG: Other, basically asking other factors that we are not talking about right now, and I say those because people tend to, when given a problem, they tend to delve deeper into the detail. What often is missing is actually an element outside of the initial description of the problem that might be really relevant to what’s going on. Like, why does the kitchen get messy in the first place? Is it something about the way you use it or your cooking habits? Is it because the neighbor’s kids, kind of, use it all the time?

There might, very often, there might be issues that you’re not really thinking about when you first describe the problem that actually has a big effect on it.

SARAH GREEN CARMICHAEL: I think at this point it would be helpful to maybe get another business example, and I’m wondering if you could tell us the story of the dog adoption problem.

THOMAS WEDELL-WEDELLSBORG: Yeah. This is a big problem in the US. If you work in the shelter industry, basically because dogs are so popular, more than 3 million dogs every year enter a shelter, and currently only about half of those actually find a new home and get adopted. And so, this is a problem that has persisted. It’s been, like, a structural problem for decades in this space. In the last three years, where people found new ways to address it.

So a woman called Lori Weise who runs a rescue organization in South LA, and she actually went in and challenged the very idea of what we were trying to do. She said, no, no. The problem we’re trying to solve is not about how to get more people to adopt dogs. It is about keeping the dogs with their first family so they never enter the shelter system in the first place.

In 2013, she started what’s called a Shelter Intervention Program that basically works like this. If a family comes and wants to hand over their dog, these are called owner surrenders. It’s about 30% of all dogs that come into a shelter. All they would do is go up and ask, if you could, would you like to keep your animal? And if they said yes, they would try to fix whatever helped them fix the problem, but that made them turn over this.

And sometimes that might be that they moved into a new building. The landlord required a deposit, and they simply didn’t have the money to put down a deposit. Or the dog might need a $10 rabies shot, but they didn’t know how to get access to a vet.

And so, by instigating that program, just in the first year, she took her, basically the amount of dollars they spent per animal they helped went from something like $85 down to around $60. Just an immediate impact, and her program now is being rolled out, is being supported by the ASPCA, which is one of the big animal welfare stations, and it’s being rolled out to various other places.

And I think what really struck me with that example was this was not dependent on having the internet. This was not, oh, we needed to have everybody mobile before we could come up with this. This, conceivably, we could have done 20 years ago. Only, it only happened when somebody, like in this case Lori, went in and actually rethought what the problem they were trying to solve was in the first place.

SARAH GREEN CARMICHAEL: So, what I also think is so interesting about that example is that when you talk about it, it doesn’t sound like the kind of thing that would have been thought of through other kinds of problem solving methods. There wasn’t necessarily an After Action Review or a 5 Whys exercise or a Six Sigma type intervention. I don’t want to throw those other methods under the bus, but how can you get such powerful results with such a very simple way of thinking about something?

THOMAS WEDELL-WEDELLSBORG: That was something that struck me as well. This, in a way, reframing and the idea of the problem diagnosis is important is something we’ve known for a long, long time. And we’ve actually have built some tools to help out. If you worked with us professionally, you are familiar with, like, Six Sigma, TRIZ, and so on. You mentioned 5 Whys. A root cause analysis is another one that a lot of people are familiar with.

Those are our good tools, and they’re definitely better than nothing. But what I notice when I work with the companies applying those was those tools tend to make you dig deeper into the first understanding of the problem we have. If it’s the elevator example, people start asking, well, is that the cable strength, or is the capacity of the elevator? That they kind of get caught by the details.

That, in a way, is a bad way to work on problems because it really assumes that there’s like a, you can almost hear it, a root cause. That you have to dig down and find the one true problem, and everything else was just symptoms. That’s a bad way to think about problems because problems tend to be multicausal.

There tend to be lots of causes or levers you can potentially press to address a problem. And if you think there’s only one, if that’s the right problem, that’s actually a dangerous way. And so I think that’s why, that this is a method I’ve worked with over the last five years, trying to basically refine how to make people better at this, and the key tends to be this thing about shifting out and saying, is there a totally different way of thinking about the problem versus getting too caught up in the mechanistic details of what happens.

SARAH GREEN CARMICHAEL: What about experimentation? Because that’s another method that’s become really popular with the rise of Lean Startup and lots of other innovation methodologies. Why wouldn’t it have worked to, say, experiment with many different types of fixing the dog adoption problem, and then just pick the one that works the best?

THOMAS WEDELL-WEDELLSBORG: You could say in the dog space, that’s what’s been going on. I mean, there is, in this industry and a lot of, it’s largely volunteer driven. People have experimented, and they found different ways of trying to cope. And that has definitely made the problem better. So, I wouldn’t say that experimentation is bad, quite the contrary. Rapid prototyping, quickly putting something out into the world and learning from it, that’s a fantastic way to learn more and to move forward.

My point is, though, that I feel we’ve come to rely too much on that. There’s like, if you look at the start up space, the wisdom is now just to put something quickly into the market, and then if it doesn’t work, pivot and just do more stuff. What reframing really is, I think of it as the cognitive counterpoint to prototyping. So, this is really a way of seeing very quickly, like not just working on the solution, but also working on our understanding of the problem and trying to see is there a different way to think about that.

If you only stick with experimentation, again, you tend to sometimes stay too much in the same space trying minute variations of something instead of taking a step back and saying, wait a minute. What is this telling us about what the real issue is?

SARAH GREEN CARMICHAEL: So, to go back to something that we touched on earlier, when we were talking about the completely hypothetical example of a spouse who does not clean the kitchen–

THOMAS WEDELL-WEDELLSBORG: Completely, completely hypothetical.

SARAH GREEN CARMICHAEL: Yes. For the record, my husband is a great kitchen cleaner.

You started asking me some questions that I could see immediately were helping me rethink that problem. Is that kind of the key, just having a checklist of questions to ask yourself? How do you really start to put this into practice?

THOMAS WEDELL-WEDELLSBORG: I think there are two steps in that. The first one is just to make yourself better at the method. Yes, you should kind of work with a checklist. In the article, I kind of outlined seven practices that you can use to do this.

But importantly, I would say you have to consider that as, basically, a set of training wheels. I think there’s a big, big danger in getting caught in a checklist. This is something I work with.

My co-author Paddy Miller, it’s one of his insights. That if you start giving people a checklist for things like this, they start following it. And that’s actually a problem, because what you really want them to do is start challenging their thinking.

So the way to handle this is to get some practice using it. Do use the checklist initially, but then try to step away from it and try to see if you can organically make– it’s almost a habit of mind. When you run into a colleague in the hallway and she has a problem and you have five minutes, like, delving in and just starting asking some of those questions and using your intuition to say, wait, how is she talking about this problem? And is there a question or two I can ask her about the problem that can help her rethink it?

SARAH GREEN CARMICHAEL: Well, that is also just a very different approach, because I think in that situation, most of us can’t go 30 seconds without jumping in and offering solutions.

THOMAS WEDELL-WEDELLSBORG: Very true. The drive toward solutions is very strong. And to be clear, I mean, there’s nothing wrong with that if the solutions work. So, many problems are just solved by oh, you know, oh, here’s the way to do that. Great.

But this is really a powerful method for those problems where either it’s something we’ve been banging our heads against tons of times without making progress, or when you need to come up with a really creative solution. When you’re facing a competitor with a much bigger budget, and you know, if you solve the same problem later, you’re not going to win. So, that basic idea of taking that approach to problems can often help you move forward in a different way than just like, oh, I have a solution.

I would say there’s also, there’s some interesting psychological stuff going on, right? Where you may have tried this, but if somebody tries to serve up a solution to a problem I have, I’m often resistant towards them. Kind if like, no, no, no, no, no, no. That solution is not going to work in my world. Whereas if you get them to discuss and analyze what the problem really is, you might actually dig something up.

Let’s go back to the kitchen example. One powerful question is just to say, what’s your own part in creating this problem? It’s very often, like, people, they describe problems as if it’s something that’s inflicted upon them from the external world, and they are innocent bystanders in that.

SARAH GREEN CARMICHAEL: Right, or crazy customers with unreasonable demands.

THOMAS WEDELL-WEDELLSBORG: Exactly, right. I don’t think I’ve ever met an agency or consultancy that didn’t, like, gossip about their customers. Oh, my god, they’re horrible. That, you know, classic thing, why don’t they want to take more risk? Well, risk is bad.

It’s their business that’s on the line, not the consultancy’s, right? So, absolutely, that’s one of the things when you step into a different mindset and kind of, wait. Oh yeah, maybe I actually am part of creating this problem in a sense, as well. That tends to open some new doors for you to move forward, in a way, with stuff that you may have been struggling with for years.

SARAH GREEN CARMICHAEL: So, we’ve surfaced a couple of questions that are useful. I’m curious to know, what are some of the other questions that you find yourself asking in these situations, given that you have made this sort of mental habit that you do? What are the questions that people seem to find really useful?

THOMAS WEDELL-WEDELLSBORG: One easy one is just to ask if there are any positive exceptions to the problem. So, was there day where your kitchen was actually spotlessly clean? And then asking, what was different about that day? Like, what happened there that didn’t happen the other days? That can very often point people towards a factor that they hadn’t considered previously.

SARAH GREEN CARMICHAEL: We got take-out.

THOMAS WEDELL-WEDELLSBORG: S,o that is your solution. Take-out from [INAUDIBLE]. That might have other problems.

Another good question, and this is a little bit more high level. It’s actually more making an observation about labeling how that person thinks about the problem. And what I mean with that is, we have problem categories in our head. So, if I say, let’s say that you describe a problem to me and say, well, we have a really great product and are, it’s much better than our previous product, but people aren’t buying it. I think we need to put more marketing dollars into this.

Now you can go in and say, that’s interesting. This sounds like you’re thinking of this as a communications problem. Is there a different way of thinking about that? Because you can almost tell how, when the second you say communications, there are some ideas about how do you solve a communications problem. Typically with more communication.

And what you might do is go in and suggest, well, have you considered that it might be, say, an incentive problem? Are there incentives on behalf of the purchasing manager at your clients that are obstructing you? Might there be incentive issues with your own sales force that makes them want to sell the old product instead of the new one?

So literally, just identifying what type of problem does this person think about, and is there different potential way of thinking about it? Might it be an emotional problem, a timing problem, an expectations management problem? Thinking about what label of what type of problem that person is kind of thinking as it of.

SARAH GREEN CARMICHAEL: That’s really interesting, too, because I think so many of us get requests for advice that we’re really not qualified to give. So, maybe the next time that happens, instead of muddying my way through, I will just ask some of those questions that we talked about instead.

THOMAS WEDELL-WEDELLSBORG: That sounds like a good idea.

SARAH GREEN CARMICHAEL: So, Thomas, this has really helped me reframe the way I think about a couple of problems in my own life, and I’m just wondering. I know you do this professionally, but is there a problem in your life that thinking this way has helped you solve?

THOMAS WEDELL-WEDELLSBORG: I’ve, of course, I’ve been swallowing my own medicine on this, too, and I think I have, well, maybe two different examples, and in one case somebody else did the reframing for me. But in one case, when I was younger, I often kind of struggled a little bit. I mean, this is my teenage years, kind of hanging out with my parents. I thought they were pretty annoying people. That’s not really fair, because they’re quite wonderful, but that’s what life is when you’re a teenager.

And one of the things that struck me, suddenly, and this was kind of the positive exception was, there was actually an evening where we really had a good time, and there wasn’t a conflict. And the core thing was, I wasn’t just seeing them in their old house where I grew up. It was, actually, we were at a restaurant. And it suddenly struck me that so much of the sometimes, kind of, a little bit, you love them but they’re annoying kind of dynamic, is tied to the place, is tied to the setting you are in.

And of course, if– you know, I live abroad now, if I visit my parents and I stay in my old bedroom, you know, my mother comes in and wants to wake me up in the morning. Stuff like that, right? And it just struck me so, so clearly that it’s– when I change this setting, if I go out and have dinner with them at a different place, that the dynamic, just that dynamic disappears.

SARAH GREEN CARMICHAEL: Well, Thomas, this has been really, really helpful. Thank you for talking with me today.

THOMAS WEDELL-WEDELLSBORG: Thank you, Sarah.  

HANNAH BATES: That was Thomas Wedell-Wedellsborg in conversation with Sarah Green Carmichael on the HBR IdeaCast. He’s an expert in problem solving and innovation, and he’s the author of the book, What’s Your Problem?: To Solve Your Toughest Problems, Change the Problems You Solve .

We’ll be back next Wednesday with another hand-picked conversation about leadership from the Harvard Business Review. If you found this episode helpful, share it with your friends and colleagues, and follow our show on Apple Podcasts, Spotify, or wherever you get your podcasts. While you’re there, be sure to leave us a review.

We’re a production of Harvard Business Review. If you want more podcasts, articles, case studies, books, and videos like this, find it all at HBR dot org.

This episode was produced by Anne Saini, and me, Hannah Bates. Ian Fox is our editor. Music by Coma Media. Special thanks to Maureen Hoch, Adi Ignatius, Karen Player, Ramsey Khabbaz, Nicole Smith, Anne Bartholomew, and you – our listener.

See you next week.

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Covid vaccines not linked to fatal heart problems in young people, CDC finds

There is no evidence that mRNA Covid vaccines cause fatal cardiac arrest or other deadly heart problems in teens and young adults, a Centers for Disease Control and Prevention report published Thursday shows.

Ever since the vaccines from Pfizer and Moderna were authorized in late 2020, anti-vaccination groups in the U.S. have blamed the shots for fatal heart problems in young athletes.

One of the most notorious examples of vaccine misinformation involves Buffalo Bills safety Damar Hamlin , 26, who in 2023 collapsed on “Monday Night Football” as a result of cardiac arrest. Hamlin was resuscitated on the field and eventually recovered. He returned to play for the Bills last season. 

“When Damar Hamlin went down, immediately comments were getting made that it was possibly vaccine-related,” said study co-author Dr. Paul Cieslak, the medical director of communicable diseases and immunizations at Oregon Health Authority’s public health division. “This is kind of what we were trying to address with this analysis.”

The findings in the new report come from the  analysis of nearly 1,300 death certificates of Oregon residents ages 16 to 30 who died from any heart condition or unknown reasons between June 1, 2021, and Dec. 31, 2022.

During this time period, nearly 1 million teens and young adults in the state had gotten a Covid vaccine, the authors wrote.

The authors refined their focus to people who got an mRNA Covid vaccine from Pfizer or Moderna and died within 100 days of being vaccinated.

Out of 40 deaths that occurred among people who got an mRNA Covid vaccine, three occurred within that time frame.

Two of the deaths were attributed to chronic underlying health conditions. 

The third death was recorded as an “undetermined natural cause,” with toxicology tests returning negative for alcohol, cannabis, methamphetamine or other illicit substances. 

The medical examiner could neither confirm nor exclude Covid vaccination as the cause of death; however, none of the death certificates attributed the fatalities to the vaccines.

While it remains unclear whether the vaccine caused the third death, Cieslak noted that the analysis showed that 30 people died from Covid during the time frame, the majority of whom were not vaccinated.

“When you’re balancing risks and benefits, you have to look at that and go, ‘You got to bet on the vaccine,’” he said. 

Dr. Leslie Cooper, chair of the cardiology department at the Mayo Clinic, who was not involved in the study, said the researchers were actually “quite generous” in their analysis, adding that the 100-day time frame following vaccination was a large one.

“They went above and beyond to try and capture any possible cardiac death from vaccinations,” he said.

Cardiac arrest occurs when the heart stops beating and pumping blood to the rest of the body. It’s not the same as a heart attack, which happens when blood flow to the heart’s muscle becomes limited or blocked, or myocarditis, which is an inflammation of the heart muscle. 

For people under 35, the causes of cardiac arrest are often unclear. It could be the result of genetic defects or heart malfunctions, such as problems with the valves of the heart. 

Even with the lengthy time frame, Cooper added, the analysis shows that the risk of sudden death in young adults after being vaccinated is significantly lower than the risk of sudden cardiac death from all causes — about 1 in 500,000 per year, compared to 1 in 100,000 per year, according to his estimates.

The data shows “no signal for any elevation in cardiac deaths associated with the Covid mRNA vaccines,” he said. “Their conclusions are quite reasonable.”

No vaccine has ever been conclusively linked to sudden cardiac death, said Dr. Ofer Levy, the director of the Precision Vaccines Program at Boston Children’s Hospital.

Although the mRNA vaccines have been linked to a small risk of myocarditis , the heart condition tends to be much milder than what is typically seen with traditional myocarditis from Covid infection, he added, and most people fully recover within a few days . 

“This adds to evidence that people don’t drop dead from getting their mRNA Covid vaccines,” Levy said of the study.

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.

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No link between sudden cardiac deaths and COVID vaccine, CDC says

The CDC says "the data do not support an association of COVID-19 vaccination with sudden cardiac death among previously healthy young persons."

New research from the Centers for Disease Control and Prevention says COVID vaccines don't have any link to heart problems that can kill younger people.

The top line, the CDC says, is that "the data do not support an association of COVID-19 vaccination with sudden cardiac death among previously healthy young persons."

The CDC  investigated data  on COVID vaccinations and heart-related deaths after reports of myocarditis affecting young men following vaccination for COVID-19.

The agency collected death records and vaccine status from 1,292 cases of death in Oregon in which people between 16 and 30 years old had died from "cardiac or undetermined" causes between June 2021 and December 2022.

COVID was shown to have killed 30 of the people.

A total of 101 people who died had experienced cardiac events that "could not be excluded" as the cause of death. The CDC found three of these people had received a COVID-19 shot within 100 days of death.

Among 40 people who had died and also received COVID vaccinations, three of them got their shots within 100 days of death. Two of those people were reported to have died from chronic underlying conditions, and one had an undetermined cause of death.

COVID-19 vaccination was not listed as a cause of death in any of the cases.

The CDC also noted that for those 5 years or older, "the risk for cardiac complications was significantly higher after COVID-19 infection than after mRNA COVID-19 vaccination."

Man vaccinated 217 times against COVID shows no side effects

Researchers studied the man and determined he had more COVID antibodies but experienced no side effects from being hypervaccinated.

In early 2023, Buffalo Bills defensive back Damar Hamlin  suffered a cardiac arrest  on the field after being tackled.

Study co-author Dr. Paul Cieslak  told NBC News  there had been unfounded discussion that Hamlin's collapse was related to the COVID-19 vaccine. Cieslak said the new analysis was meant to address such conspiracy theories.

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