effect of coronavirus essay

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Effects of COVID-19 pandemic in daily life

Dear Editor,

COVID-19 (Coronavirus) has affected day to day life and is slowing down the global economy. This pandemic has affected thousands of peoples, who are either sick or are being killed due to the spread of this disease. The most common symptoms of this viral infection are fever, cold, cough, bone pain and breathing problems, and ultimately leading to pneumonia. This, being a new viral disease affecting humans for the first time, vaccines are not yet available. Thus, the emphasis is on taking extensive precautions such as extensive hygiene protocol (e.g., regularly washing of hands, avoidance of face to face interaction etc.), social distancing, and wearing of masks, and so on. This virus is spreading exponentially region wise. Countries are banning gatherings of people to the spread and break the exponential curve. 1 , 2 Many countries are locking their population and enforcing strict quarantine to control the spread of the havoc of this highly communicable disease.

COVID-19 has rapidly affected our day to day life, businesses, disrupted the world trade and movements. Identification of the disease at an early stage is vital to control the spread of the virus because it very rapidly spreads from person to person. Most of the countries have slowed down their manufacturing of the products. 3 , 4 The various industries and sectors are affected by the cause of this disease; these include the pharmaceuticals industry, solar power sector, tourism, Information and electronics industry. This virus creates significant knock-on effects on the daily life of citizens, as well as about the global economy.

Presently the impacts of COVID-19 in daily life are extensive and have far reaching consequences. These can be divided into various categories:

• • Challenges in the diagnosis, quarantine and treatment of suspected or confirmed cases
• • High burden of the functioning of the existing medical system
• • Patients with other disease and health problems are getting neglected
• • Overload on doctors and other healthcare professionals, who are at a very high risk
• • Overloading of medical shops
• • Requirement for high protection
• • Disruption of medical supply chain
• • Slowing of the manufacturing of essential goods
• • Disrupt the supply chain of products
• • Losses in national and international business
• • Poor cash flow in the market
• • Significant slowing down in the revenue growth
• • Service sector is not being able to provide their proper service
• • Cancellation or postponement of large-scale sports and tournaments
• • Avoiding the national and international travelling and cancellation of services
• • Disruption of celebration of cultural, religious and festive events
• • Undue stress among the population
• • Social distancing with our peers and family members
• • Closure of the hotels, restaurants and religious places
• • Closure of places for entertainment such as movie and play theatres, sports clubs, gymnasiums, swimming pools, and so on.
• • Postponement of examinations

This COVID-19 has affected the sources of supply and effects the global economy. There are restrictions of travelling from one country to another country. During travelling, numbers of cases are identified positive when tested, especially when they are taking international visits. 5 All governments, health organisations and other authorities are continuously focussing on identifying the cases affected by the COVID-19. Healthcare professional face lot of difficulties in maintaining the quality of healthcare in these days.

Declaration of competing interest

None declared.

How to Write About Coronavirus in a College Essay

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

Writing About COVID-19 in College Essays

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

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

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

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

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

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

Writing About COVID-19 for a College Application

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

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

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

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

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

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

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

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

Above all, she urges honesty.

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

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

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

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

Writing About Coronavirus in Main and Supplemental Essays

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• inequalities

Data availability statement

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

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

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

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Introduction

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

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

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

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

Social networks

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

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

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

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

Social support

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

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

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

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

Social and interactional norms

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

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

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

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

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

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

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

Recommendations and conclusions

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

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

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

Recommendation 2: intelligently balance online and offline ways of relating

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

Recommendation 3: build stronger and sustainable localised communities

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

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

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• Kriesler P , et al
• Mitchell R ,
• de Vries S , et al

Twitter @karenmaxSPHSU, @Mark_McCann, @Rwilsonlowe, @KMitchinGlasgow

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

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

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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• Review Article
• Published: 03 October 2022

How COVID-19 shaped mental health: from infection to pandemic effects

• Brenda W. J. H. Penninx   ORCID: orcid.org/0000-0001-7779-9672 1 , 2 ,
• Michael E. Benros   ORCID: orcid.org/0000-0003-4939-9465 3 , 4 ,
• Robyn S. Klein 5 &
• Christiaan H. Vinkers   ORCID: orcid.org/0000-0003-3698-0744 1 , 2  

Nature Medicine volume  28 ,  pages 2027–2037 ( 2022 ) Cite this article

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• Epidemiology
• Infectious diseases
• Neurological manifestations
• Psychiatric disorders

The Coronavirus Disease 2019 (COVID-19) pandemic has threatened global mental health, both indirectly via disruptive societal changes and directly via neuropsychiatric sequelae after SARS-CoV-2 infection. Despite a small increase in self-reported mental health problems, this has (so far) not translated into objectively measurable increased rates of mental disorders, self-harm or suicide rates at the population level. This could suggest effective resilience and adaptation, but there is substantial heterogeneity among subgroups, and time-lag effects may also exist. With regard to COVID-19 itself, both acute and post-acute neuropsychiatric sequelae have become apparent, with high prevalence of fatigue, cognitive impairments and anxiety and depressive symptoms, even months after infection. To understand how COVID-19 continues to shape mental health in the longer term, fine-grained, well-controlled longitudinal data at the (neuro)biological, individual and societal levels remain essential. For future pandemics, policymakers and clinicians should prioritize mental health from the outset to identify and protect those at risk and promote long-term resilience.

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In 2019, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO), with 590 million confirmed cases and 6.4 million deaths worldwide as of August 2022 (ref. 1 ). To contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) across the globe, many national and local governments implemented often drastic restrictions as preventive health measures. Consequently, the pandemic has not only led to potential SARS-CoV-2 exposure, infection and disease but also to a wide range of policies consisting of mask requirements, quarantines, lockdowns, physical distancing and closure of non-essential services, with unprecedented societal and economic consequences.

As the world is slowly gaining control over COVID-19, it is timely and essential to ask how the pandemic has affected global mental health. Indirect effects include stress-evoking and disruptive societal changes, which may detrimentally affect mental health in the general population. Direct effects include SARS-CoV-2-mediated acute and long-lasting neuropsychiatric sequelae in affected individuals that occur during primary infection or as part of post-acute COVID syndrome (PACS) 2 —defined as symptoms lasting beyond 3–4 weeks that can involve multiple organs, including the brain. Several terminologies exist for characterizing the effects of COVID-19. PACS also includes late sequalae that constitute a clinical diagnosis of ‘long COVID’ where persistent symptoms are still present 12 weeks after initial infection and cannot be attributed to other conditions 3 .

Here we review both the direct and indirect effects of COVID-19 on mental health. First, we summarize empirical findings on how the COVID-19 pandemic has impacted population mental health, through mental health symptom reports, mental disorder prevalence and suicide rates. Second, we describe mental health sequalae of SARS-CoV-2 virus infection and COVID-19 disease (for example, cognitive impairment, fatigue and affective symptoms). For this, we use the term PACS for neuropsychiatric consequences beyond the acute period, and will also describe the underlying neurobiological impact on brain structure and function. We conclude with a discussion of the lessons learned and knowledge gaps that need to be further addressed.

Impact of the COVID-19 pandemic on population mental health

Independent of the pandemic, mental disorders are known to be prevalent globally and cause a very high disease burden 4 , 5 , 6 . For most common mental disorders (including major depressive disorder, anxiety disorders and alcohol use disorder), environmental stressors play a major etiological role. Disruptive and unpredictable pandemic circumstances may increase distress levels in many individuals, at least temporarily. However, it should be noted that the pandemic not only resulted in negative stressors but also in positive and potentially buffering changes for some, including a better work–life balance, improved family dynamics and enhanced feelings of closeness 7 .

Awareness of the potential mental health impact of the COVID-19 pandemic is reflected in the more than 35,000 papers published on this topic. However, this rapid research output comes with a cost: conclusions from many papers are limited due to small sample sizes, convenience sampling with unclear generalizability implications and lack of a pre-COVID-19 comparison. More reliable estimates of the pandemic mental health impact come from studies with longitudinal or time-series designs that include a pre-pandemic comparison. In our description of the evidence, we, therefore, explicitly focused on findings from meta-analyses that include longitudinal studies with data before the pandemic, as recently identified through a systematic literature search by the WHO 8 .

Self-reported mental health problems

Most studies examining the pandemic impact on mental health used online data collection methods to measure self-reported common indicators, such as mood, anxiety or general psychological distress. Pooled prevalence estimates of clinically relevant high levels of depression and anxiety symptoms during the COVID-19 pandemic range widely—between 20% and 35% 9 , 10 , 11 , 12 —but are difficult to interpret due to large methodological and sample heterogeneity. It also is important to note that high levels of self-reported mental health problems identify increased vulnerability and signal an increased risk for mental disorders, but they do not equal clinical caseness levels, which are generally much lower.

Three meta-analyses, pooling data from between 11 and 61 studies and involving ~50,000 individuals or more 13 , 14 , 15 , compared levels of self-reported mental health problems during the COVID-19 pandemic with those before the pandemic. Meta-analyses report on pooled effect sizes—that is, weighted averages of study-level effect sizes; these are generally considered small when they are ~0.2, moderate when ~0.5 and large when ~0.8. As shown in Table 1 , meta-analyses on mental health impact of the COVID-19 pandemic reach consistent conclusions and indicate that there has been a heterogeneous, statistically significant but small increase in self-reported mental health problems, with pooled effect sizes ranging from 0.07 to 0.27. The largest symptom increase was found when using specific mental health outcome measures assessing depression or anxiety symptoms. In addition, loneliness—a strong correlate of depression and anxiety—showed a small but significant increase during the pandemic (Table 1 ; effect size = 0.27) 16 . In contrast, self-reported general mental health and well-being indicators did not show significant change, and psychotic symptoms seemed to have decreased slightly 13 . In Europe, alcohol purchase decreased, but high-level drinking patterns solidified among those with pre-pandemic high drinking levels 17 . When compared to pre-COVID levels, no change in self-reported alcohol use (effect size = −0.01) was observed in a recent meta-analysis summarizing 128 studies from 58 (predominantly European and North American) countries 18 .

What is the time trajectory of self-reported mental health problems during the pandemic? Although findings are not uniform, various large-scale studies confirmed that the increase in mental health problems was highest during the first peak months of the pandemic and smaller—but not fully gone—in subsequent months when infection rates declined and social restrictions eased 13 , 19 , 20 . Psychological distress reports in the United Kingdom increased again during the second lockdown period 15 . Direct associations between anxiety and depression symptom levels and the average number of daily COVID-19 cases were confirmed in the US Centers for Disease Control and Prevention (CDC) data 21 . Studies that examined longer-term trajectories of symptoms during the first or even second year of the COVID-19 pandemic are more sparse but revealed stability of symptoms without clear evidence of recovery 15 , 22 . The exception appears to be for loneliness, as some studies confirmed further increasing trends throughout the first COVID-19 pandemic year 22 , 23 . As most published population-based studies were conducted in the early time period in which absolute numbers of SARS-CoV2-infected individuals were still low, the mental health impacts described in such studies are most likely due to indirect rather than direct effects of SARS-CoV-2 infection. However, it is possible that, in longer-term or later studies, these direct and indirect effects may be more intertwined.

The extent to which governmental policies and communication have impacted on population mental health is a relevant question. In cross-country comparisons, the extent of social restrictions showed a dose–response relationship with mental health problems 24 , 25 . In a review of 33 studies worldwide, it was concluded that governments that enacted stringent measures to contain the spread of COVID-19 benefitted not only the physical but also the mental health of their population during the pandemic 26 , even though more stringent policies may lead to more short-term mental distress 25 . It has been suggested that effective communication of risks, choices and policy measures may reduce polarization and conspiracy theories and mitigate the mental health impact of such measures 25 , 27 , 28 .

In sum, the general pattern of results is that of an increase in mental health symptoms in the population, especially during the first pandemic months, that remained elevated throughout 2020 and early 2021. It should be emphasized that this increase has a small effect size. However, even a small upward shift in mental health problems warrants attention as it has not yet shown to be returned to pre-pandemic levels, and it may have meaningful cumulative consequences at the population level. In addition, even a small effect size may mask a substantial heterogeneity in mental health impact, which may have affected vulnerable groups disproportionally (see below).

Mental disorders, self-harm and suicide

Whether the observed increase in mental health problems during the COVID-19 pandemic has translated into more mental disorders or even suicide mortality is not easy to answer. Mental disorders, characterized by more severe, disabling and persistent symptoms than self-reported mental health problems, are usually diagnosed by a clinician based on the International Classification of Diseases, 10th Revision (ICD-10) or the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria or with validated semi-structured clinical interviews. However, during the COVID-19 pandemic, research systematically examining the population prevalence of mental disorders has been sparse. Unfortunately, we can also not strongly rely on healthcare use studies as the pandemic impacted on healthcare provision more broadly, thereby making figures of patient admissions difficult to interpret.

On a global scale and based on imputations and modeling from survey data of self-reported mental health problems, the Global Burden of Disease (GBD) study 29 estimated that the COVID-19 pandemic has led to a 28% (95% uncertainty interval (UI): 25–30) increase in major depressive disorders and a 26% (95% UI: 23–28) increase in anxiety disorders. It should be noted that these estimations come with high uncertainty as the assumption that transient pandemic-related increases in mental symptoms extrapolate into incident mental disorders remains disputable. So far, only four longitudinal population-based studies have measured and compared current mental (that is, depressive and anxiety) disorder prevalence—defined using psychiatric diagnostic criteria—before and during the pandemic. Of these, two found no change 30 , 31 , one found a decrease 32 and one found an increase in prevalence of these disorders 33 . These studies were local, limited to high-income countries, often small-scale and used different modes of assessment (for example, online versus in-person) before and during the pandemic. This renders these observational results uncertain as well, but their contrast to the GBD calculations 29 is striking.

Time-series analysis of monthly suicide trends in 21 middle-income to high-income countries across the globe yielded no evidence for an increase in suicide rates in the first 4 months of the pandemic, and there was evidence of a fall in rates in 12 countries 34 . Also in the United States, there was a significant decrease in suicide mortality in the first pandemic months but a slight increase in mortality due to drug overdose and homicide 35 . A living systematic review 36 also concluded that, throughout 2020, there was no observed increase in suicide rates in 20 studies conducted in North America, Europe and Asia. Analyses of electronic health record data in the primary care setting showed reduced rates of self-harm during the first COVID-19 pandemic year 37 . In contrast, emergency department visits for self-harm behavior were unchanged 38 or increased 39 . Such inconsistent findings across healthcare settings may reflect a reluctance in healthcare-seeking behavior for mental healthcare issues. In the living systematic review, eight of 11 studies that examined service use data found a significant decrease in reported self-harm/suicide attempts after COVID lockdown, which returned to pre-lockdown levels in some studies with longer follow-up (5 months) 36 .

In sum, although calculations based on survey data predict a global increase of mental disorder prevalence, objective and consistent evidence for an increased mental disorder, self-harm or suicide prevalence or incidence during the first pandemic year remains absent. This observation, coupled with the only small increase in mental health symptom levels in the overall population, may suggest that most of the general population has demonstrated remarkable resilience and adaptation. However, alternative interpretations are possible. First, there is a large degree of heterogeneity in the mental health impact of COVID-19, and increased mental health in one group (for example, due to better work–family balance and work flexibility) may have masked mental health problems in others. Various societal responses seen in many countries, such as community support activities and bolstering mental health and crisis services, may have had mitigating effects on the mental health burden. Also, the relationship between mental health symptom increases during stressful periods and its subsequent effects on the incidence of mental disorders may be non-linear or could be less visible due to resulting alternative outcomes, such as drug overdose or homicide. Finally, we cannot rule out a lag-time effect, where disorders may take more time to develop or be picked up, especially because some of the personal financial or social consequences of the COVID pandemic may only become apparent later. It should be noted that data from low-income countries and longer-term studies beyond the first pandemic year are largely absent.

Which individuals are most affected by the COVID-19 pandemic?

There is substantial heterogeneity across studies that evaluated how the COVID pandemic impacted on mental health 13 , 14 , 15 . Although our society as a whole may have the ability to adequately bounce back from pandemic effects, there are vulnerable people who have been affected more than others.

First, women have consistently reported larger increases in mental health problems in response to the COVID-19 pandemic than men 13 , 15 , 29 , 40 , with meta-analytic effect sizes being 44% 15 to 75% 13 higher. This could reflect both higher stress vulnerability or larger daily life disruptions due to, for example, increased childcare responsibilities, exposure to home violence or greater economic impact due to employment disruptions that all disproportionately fell to women 41 , thereby exacerbating the already existing pre-pandemic gender inequalities in depression and anxiety levels. In addition, adolescents and young adults have been disproportionately affected compared to younger children and older adults 12 , 15 , 29 , 40 . This may be the result of unfavorable behavioral and social changes (for example, school closure periods 42 ) during a crucial development phase where social interactions outside the family context are pivotal. Alarmingly, even though suicide rates did not seem to increase at the population level, studies in China 43 and Japan 44 indicated significant increases in suicide rates in children and adolescents.

Existing socio-cultural disparities in mental health may have further widened during the COVID pandemic. Whether the impact is larger for individuals with low socio-economic status remains unclear, with contrasting meta-analyses pointing toward this group being protected 15 or at increased risk 40 . Earlier meta-analyses did not find that the mental health impact of COVID-19 differed across Europe, North America, Asia and Oceania 13 , 14 , but data are lacking from Africa and South America. Nevertheless, a large-scale within-country comparison in the United States found that the mental health of Black, Hispanic and Asian respondents worsened relatively more during the pandemic compared to White respondents. Moreover, White respondents were more likely to receive professional mental healthcare during the pandemic, and, conversely, Black, Hispanic, and Asian respondents demonstrated higher levels of unmet mental healthcare needs during this time 45 .

People with pre-existing somatic conditions represent another vulnerable group in which the pandemic had a greater impact (pooled effect size of 0.25) 13 . This includes people with conditions such as epilepsy, multiple sclerosis or cardiometabolic disease as well as those with multiple comorbidities. The disproportionate impact may reflect this groupʼs elevated COVID-19 risk and, consequently, more perceived stress and fear of infection, but it could also reflect disruptions of regular healthcare services.

Healthcare workers faced increased workload, rapidly changing and challenging work environments and exposure to infections and death, accompanied by fear of infecting themselves and their families. High prevalences of (subthreshold) depression (13% 46 ), depressive symptoms (31% 47 ), (subthreshold) anxiety (16% 46 ), anxiety symptoms (23% 47 ) and post-traumatic stress disorder (~22% 46 , 47 ) have been reported in healthcare workers. However, a meta-analysis did not find a larger mental health impact of the pandemic as compared to the general population 40 , and another meta-analysis (of 206 studies) found that the mental health status of healthcare workers was similar to or even better than that of the general population during the first COVID year 48 . However, it is important to note that these meta-analyses could not differentiate between frontline and non-frontline healthcare workers.

Finally, individuals with pre-existing mental disorders may be at increased risk for exacerbation of mental ill-health during the pandemic, possibly due to disease history—illustrating a higher genetic and/or environmental vulnerability—but also due to discontinuity of mental healthcare. Already before the pandemic, mental health systems were under-resourced and disorganized in most countries 6 , 49 , but a third of all WHO member states reported disruptions to mental and substance use services during the first 18 months of the pandemic 50 , with reduced, shortened or postponed appointments and limited capacity for acute inpatient admissions 51 , 52 . Despite this, there is no clear evidence that individuals with pre-existing mental disorders are disproportionately affected by pandemic-related societal disruptions; the effect size for pandemic impact on self-reported mental health problems was similar in psychiatric patients and the general population 13 . In the United States, emergency visits for ten different mental disorders were generally stable during the pandemic compared to earlier periods 53 . In a large Dutch study 22 , 54 with multiple pre-pandemic and during-pandemic assessments, there was no difference in symptom increase among patients relative to controls (see Fig. 1 for illustration). In absolute terms, however, it is important to note that psychiatric patients show much higher symptom levels of depression, anxiety, loneliness and COVID-fear than healthy controls. Again, variation in mental health changes during the pandemic is large: next to psychiatric patients who showed symptom decrease due to, for example, experiencing relief from social pressures, there certainly have been many patients with symptom increases and relapses during the pandemic.

Trajectories of mean depressive symptoms (QIDS score), anxiety symptoms (BAI score), loneliness (De Jong questionnaire score) and Fear of COVID-19 score before and during the first year of the COVID-19 pandemic in healthy controls (blue line, n  = 378) and in patients with depressive and/or anxiety disorders (red line, n  = 908). The x -axis indicates time with one pre-COVID assessment (averaged over up to five earlier assessments conducted between 2006 and 2019) and 11 online assessments during April 2020 through February 2021. Symbols indicate the mean score during the assessment with 95% CIs. As compared to pre-COVID assessment scores, the figure shows a statistically significant increase of depression and loneliness symptoms during the first pandemic peak (April 2020) in healthy controls but not in patients (for more details, see refs. 22 , 54 ). Asterisks indicate where subsequent wave scores differ from the prior wave scores ( P  < 0.05). The figure also illustrates the stability of depressive and anxiety symptoms during the first COVID year, a significant increase in loneliness during this period and fluctuations of Fear of COVID-19 score that positively correlate with infection rates in the Netherlands. Raw data are from the Netherlands Study of Depression and Anxiety (NESDA), which were re-analyzed for the current plots to illustrate differences between two groups (healthy controls versus patients). BAI, Beck Anxiety Inventory; QIDS, Quick Inventory of Depressive Symptoms.

Impact of COVID-19 infection and disease on mental health and the brain

Not only the pandemic but also COVID-19 itself can have severe impact on the mental health of affected individuals and, thus, of the population at large. Below we describe acute and post-acute neuropsychiatric sequelae seen in patients with COVID-19 and link these to neurobiological mechanisms.

Neuropsychiatric sequelae in individuals with COVID-19

Common symptoms associated with acute SARS-CoV-2 infection include headache, anosmia (loss of sense of smell) and dysgeusia (loss of sense of taste). The broader neuropsychiatric impact is dependent on infection severity and is very heterogeneous (Table 2 ). It ranges from no neuropsychiatric symptoms among the large group of asymptomatic COVID-19 cases to milder transient neuropsychiatric symptoms, such as fatigue, sleep disturbance and cognitive impairment, predominantly occurring among symptomatic patients with COVID-19 (ref. 55 ). Cognitive impairment consists of sustained memory impairments and executive dysfunction, including short-term memory loss, concentration problems, word-finding problems and impaired daily problem-solving, colloquially termed ‘brain fog’ by patients and clinicians. A small number of infected individuals become severely ill and require hospitalization. During hospital admission, the predominant neuropsychiatric outcome is delirium 56 . Delirium occurs among one-third of hospitalized patients with COVID-19 and among over half of patients with COVID-19 who require intensive care unit (ICU) treatment. These delirium rates seem similar to those observed among individuals with severe illness hospitalized for other general medical conditions 57 . Delirium is associated with neuropsychiatric sequalae after hospitalization, as part of post-intensive care syndrome 58 , in which sepsis and inflammation are associated with cognitive dysfunction and an increased risk of a broad range of psychiatric symptoms, from anxiety to depression and psychotic symptoms with hallucinations 59 , 60 .

A subset of patients with COVID-19 develop PACS 61 , which can include neuropsychiatric symptoms. A large meta-analysis summarizes 51 studies involving 18,917 patients with a mean follow-up of 77 days (range, 14–182 days) 62 . The most prevalent neuropsychiatric symptom associated with COVID-19 was sleep disturbance, with a pooled prevalence of 27.4%, followed by fatigue (24.4%), cognitive impairment (20.2%), anxiety symptoms (19.1%), post-traumatic stress symptoms (15.7%) and depression symptoms (12.9%) (Table 2 ). Another meta-analysis that assessed patients 12 weeks or more after confirmed COVID-19 diagnosis found that 32% experienced fatigue, and 22% experienced cognitive impairment 63 . To what extent neuropsychiatric symptoms are truly unique for patients with COVID remains unclear from these meta-analyses, as hardly any study included well-matched controls with other types of respiratory infections or inflammatory conditions.

Studies based on electronic health records have examined whether higher levels of neuropsychiatric symptoms truly translate into a higher incidence of clinically overt mental disorders 64 , 65 . In a 1-year follow-up using the US Veterans Affairs database, 153,848 survivors of SARS-CoV-2 infection exhibited an increased incidence of any mental disorder with a relative risk of 1.46 and, specifically, 1.35 for anxiety disorders, 1.39 for depressive disorders and 1.38 for stress and adjustment disorders, compared to a contemporary group and a historical control group ( n  = 5,859,251) 65 . In absolute numbers, the incident risk difference attributable to SARS-CoV-2 for mental disorders was 64 per 1,000 individuals. Taquet et al. 64 analyzed electronic health records from the US-based TriNetX network with over 81 million patients and 236,379 COVID-19 survivors followed for 6 months. In absolute numbers, 6-month incidence of hospital contacts related to diagnoses of anxiety, affective disorder or psychotic disorder was 7.0%, 4.5% and 0.4%, respectively. Risks of incident neurological or psychiatric diagnoses were directly correlated with COVID-19 severity and increased by 78% when compared to influenza and by 32% when compared to other respiratory tract infections. In contrast, a medical record study involving 8.3 million adults confirmed that neuropsychiatric disorders were significantly elevated among COVID-19 hospitalized individuals but to a similar extent as in hospitalized patients with other severe respiratory disease 66 . In line with this, a study using language processing of clinical notes in electronic health records did not find an increase in fatigue, mood and anxiety symptoms among COVID-19 hospitalized individuals when compared to hospitalized patients for other indications and adjusted for sociodemographic features and hospital course 67 . It is important to note that research based only on hospital records might be influenced by increased health-seeking behavior that could be differential across care settings or by increased follow-up by hospitals of patients with COVID-19 (compared to patients with other conditions).

Consequently, whether PACS symptoms form a unique pattern due to specific infection with SARS-CoV-2 remains debatable. Prospective case–control studies that do not rely on hospital records but measure the incidence of neuropsychiatric symptoms and diagnoses after COVID-19 are still scarce, but they are critical for distinguishing causation and confounding when characterizing PACS and the uniqueness of neuropsychiatric sequalae after COVID-19 (ref. 68 ). Recent studies with well-matched control groups illustrate that long-term consequences may not be so unique, as they were similar to those observed in patients with other diseases of similar severity, such as after acute myocardial infarction or in ICU patients 56 , 66 . A first prospective follow-up study of COVID-19 survivors and control patients matched on disease severity, age, sex and ICU admission found similar neuropsychiatric outcomes, regarding both new-onset psychiatric diagnosis (19% versus 20%) and neuropsychiatric symptoms (81% versus 93%). However, moderate but significantly worse cognitive outcomes 6 months after symptom onset were found among survivors of COVID-19 (ref. 69 ). In line with this, a longitudinal study of 785 participants from the UK Biobank showed small but significant cognitive impairment among individuals infected with SARS-CoV-2 compared to matched controls 70 .

Numerous psychosocial mechanisms can lead to neuropsychiatric sequalae of COVID-19, including functional impairment; psychological impact due to, for example, fear of dying; stress of being infected with a novel pandemic disease; isolation as part of quarantine and lack of social support; fear/guilt of spreading COVID-19 to family or community; and socioeconomic distress by lost wages 71 . However, there is also ample evidence that neurobiological mechanisms play an important role, which is discussed below.

Neurobiological mechanisms underlying neuropsychiatric sequelae of COVID-19

Acute neuropsychiatric symptoms among patients with severe COVID-19 have been found to correlate with the level of serum inflammatory markers 72 and coincide with neuroimaging findings of immune activation, including leukoencephalopathy, acute disseminated encephalomyelitis, cytotoxic lesions of the corpus callosum or cranial nerve enhancement 73 . Rare presentations, including meningitis, encephalitis, inflammatory demyelination, cerebral infarction and acute hemorrhagic necrotizing encephalopathy, have also been reported 74 . Hospitalized patients with frank encephalopathies display impaired blood-brain barrier (BBB) integrity with leptomeningeal enhancement on brain magnetic resonance images 75 . Studies of postmortem specimens from patients who succumbed to acute COVID-19 reveal significant neuropathology with signs of hypoxic damage and neuroinflammation. These include evidence of BBB permeability with extravasation of fibrinogen, microglial activation, astrogliosis, leukocyte infiltration and microhemorrhages 76 , 77 . However, it is still unclear to what extent these findings differ from patients with similar illness severity due to acute non-COVID illness, as these brain effects might not be virus-specific effects but rather due to cytokine-mediated neuroinflammation and critical illness.

Post-acute neuroimaging studies in SARS-CoV-2-recovered patients, as compared to control patients without COVID-19, reveal numerous alterations in brain structure on a group level, although effect sizes are generally small. These include minor reduction in gray matter thickness in the various regions of the cortex and within the corpus collosum, diffuse edema, increases in markers of tissue damage in regions functionally connected to the olfactory cortex and reductions in overall brain size 70 , 78 . Neuroimaging studies of post-acute COVID-19 patients also report abnormalities consistent with micro-structural and functional alterations, specifically within the hippocampus 79 , 80 , a brain region critical for memory formation and regulating anxiety, mood and stress responses, but also within gray matter areas involving the olfactory system and cingulate cortex 80 . Overall, these findings are in line with ongoing anosmia, tremors, affect problems and cognitive impairment.

Interestingly, despite findings mentioned above, there is little evidence of SARS-CoV-2 neuroinvasion with productive replication, and viral material is rarely found in the central nervous system (CNS) of patients with COVID-19 (refs. 76 , 77 , 81 ). Thus, neurobiological mechanisms of SARS-CoV-2-mediated neuropsychiatric sequelae remain unclear, especially in patients who initially present with milder forms of COVID-19. Symptomatic SARS-CoV-2 infection is associated with hypoxia, cytokine release syndrome (CRS) and dysregulated innate and adaptive immune responses (reviewed in ref. 82 ). All these effects could contribute to neuroinflammation and endothelial cell activation (Fig. 2 ). Examination of cerebrospinal fluid in patients with neuroimaging findings revealed elevated levels of pro-inflammatory, BBB-destabilizing cytokines, including interleukin-6 (IL-6), IL-1, IL-8 and mononuclear cell chemoattractants 83 , 84 . Whether these cytokines arise from the periphery, due to COVID-19-mediated CRS, or from within the CNS, is unclear. As studies generally lack control patients with other severe illnesses, the specificity of such findings to SARS-CoV-2 also remains unclear. Systemic inflammatory processes, including cytokine release, have been linked to glial activation with expression of chemoattractants that recruit immune cells, leading to neuroinflammation and injury 85 . Cerebrospinal fluid concentrations of neurofilament light, a biomarker of neuronal damage, were reportedly elevated in patients hospitalized with COVID-19 regardless of whether they exhibited neurologic diseases 86 . Acute thromboembolic events leading to ischemic infarcts are also common in patients with COVID-19 due to a potentially increased pro-coagulant process secondary to CRS 87 .

(1) Elevation of BBB-destabilizing cytokines (IL-1β and TNF) within the serum due to CRS or local interactions of mononuclear and endothelial cells. (2) Virus-induced endotheliitis increases susceptibility to microthrombus formation due to platelet activation, elevation of vWF and fibrin deposition. (3) Cytokine, mononuclear and endothelial cell interactions promote disruption of the BBB, which may allow entry of leukocytes expressing IFNg into the CNS (4), leading to microglial activation (5). (6) Activated microglia may eliminate synapses and/or express cytokines that promote neuronal injury. (7) Injured neurons express IL-6 which, together with IL-1β, promote a ‘gliogenic switch’ in NSCs (8), decreasing adult neurogenesis. (9) The combination of microglial (and possibly astrocyte) activation, neuronal injury and synapse loss may lead to dysregulation of NTs and neuronal circuitry. IFNg, interferon-g; NSC, neural stem cell; NT, neurotransmitter; TJ, tight junction; TNF, tumor necrosis factor; vWF, von Willebrand factor.

It is also unclear whether hospitalized patients with COVID-19 may develop brain abnormalities due to hypoxia or CRS rather than as a direct effect of SARS-CoV-2 infection. Hypoxia may cause neuronal dysfunction, cerebral edema, increased BBB permeability, cytokine expression and onset of neurodegenerative diseases 88 , 89 . CRS, with life-threatening levels of serum TNF-α and IL-1 (ref. 90 ) could also impact BBB function, as these cytokines destabilize microvasculature endothelial cell junctional proteins critical for BBB integrity 91 . In mild SARS-CoV-2 infection, circulating immune factors combined with mild hypoxia might impact BBB function and lead to neuroinflammation 92 , as observed during infection with other non-neuroinvasive respiratory pathogens 93 . However, multiple studies suggest that the SARS-CoV-2 spike protein itself may also induce venous and arterial endothelial cell activation and endotheliitis, disrupt BBB integrity or cross the BBB via adoptive transcytosis 94 , 95 , 96 .

Reducing neuropsychiatric sequelae of COVID-19

The increased risk of COVID-19-related neuropsychiatric sequalae was most pronounced during the first pandemic peak but reduced over the subsequent 2 years 64 , 97 . This may be due to reduced impact of newer SARS-CoV-2 strains (that is, Omicron) but also protective effects of vaccination, which limit SARS-CoV-2 spread and may, thus, prevent neuropsychiatric sequalae. Fully vaccinated individuals with breakthrough infections exhibit a 50% reduction in PACS 98 , even though vaccination does not improve PACS-related neuropsychiatric symptoms in patients with a prior history of COVID-19 (ref. 99 ). As patients with pre-existing mental disorders are at increased risk of SARS-CoV-2 infection, they deserve to be among the prioritization groups for vaccination efforts 100 .

Adequate treatment strategies for neuropsychiatric sequelae of COVID-19 are needed. As no specific evidence-based intervention yet exists, the best current treatment approach is that for neuropsychiatric sequelae arising after other severe medical conditions 101 . Stepped care—a staged approach of mental health services comprising a hierarchy of interventions, from least to most intensive, matched to the individual’s need—is efficacious with monitoring of mental health and cognitive problems. Milder symptoms likely benefit from counseling and holistic care, including physiotherapy, psychotherapy and rehabilitation. Individuals with moderate to severe symptoms fulfilling psychiatric diagnoses should receive guideline-concordant care for these disorders 61 . Patients with pre-existing mental disorders also deserve special attention when affected by COVID-19, as they have shown to have an increased risk of COVID-19-related hospitalization, complications and death 102 . This may involve interventions to address their general health, any unfavorable socioenvironmental factors, substance abuse or treatment adherence issues.

Lessons learned, knowledge gaps and future challenges

Ultimately, it is not only the millions of people who have died from COVID-19 worldwide that we remember but also the distress experienced during an unpredictable period with overstretched healthcare systems, lockdowns, school closures and changing work environments. In a world that is more and more globalized, connectivity puts us at risk for future pandemics. What can be learned from the last 2 years of the COVID-19 pandemic about how to handle future and longstanding challenges related to mental health?

Give mental health equal priority to physical health

The COVID-19 pandemic has demonstrated that our population seems quite resilient and adaptive. Nevertheless, even if society as a whole may bounce back, there is a large group of people whose mental health has been and will be disproportionately affected by this and future crises. Although various groups, such as the WHO 8 , the National Health Commission of China 103 , the Asia Pacific Disaster Mental Health Network 104 and a National Taskforce in India 105 , developed mental health policies early on, many countries were late in realizing that a mental health agenda deserves immediate attention in a rapidly evolving pandemic. Implementation of comprehensive and integrated mental health policies was generally inconsistent and suboptimal 106 and often in the shadow of policies directed at containing and reducing the spread of SARS-CoV-2. Leadership is needed to convey the message that mental health is as important as physical health and that we should focus specific attention and early interventions on those at the highest risk. This includes those vulnerable due to factors such as low socioeconomic status, specific developmental life phase (adolescents and young adults), pre-existing risk (poor physical or somatic health and early life trauma) or high exposure to pandemic-related (work) changes—for example, women and healthcare personnel. This means that not only should investment in youth and reducing health inequalities remain at the top of any policy agenda but also that mental health should be explicitly addressed from the start in any future global health crisis situation.

Communication and trust is crucial for mental health

Uncertainty and uncontrollability during the pandemic have challenged rational thinking. Negative news travels fast. Communication that is vague, one-sided and dishonest can negatively impact on mental health and amplify existing distress and anxiety 107 . Media reporting should not overemphasize negative mental health impact—for example, putative suicide rate increases or individual negative experiences—which could make situations worse than they actually are. Instead, communication during crises requires concrete and actionable advice that avoids polarization and strengthens vigilance, to foster resilience and help prevent escalation to severe mental health problems 108 , 109 .

Rapid research should be collaborative and high-quality

Within the scientific community, the topic of mental health during the pandemic led to a multitude of rapid studies that generally had limited methodological quality—for example, cross-sectional designs, small or selective sampling or study designs lacking valid comparison groups. These contributed rather little to our understanding of the mental health impact of the emerging crisis. In future events that have global mental health impact, where possible, collaborative and interdisciplinary efforts with well-powered and well-controlled prospective studies using standardized instruments will be crucial. Only with fine-grained determinants and outcomes can data reliably inform mental health policies and identify who is most at risk.

Do not neglect long-term mental health effects

So far, research has mainly focused on the acute and short-term effects of the pandemic on mental health, usually spanning pandemic effects over several months to 1 year. However, longer follow-up of how a pandemic impacts population mental health is essential. Can societal and economic disruptions after the pandemic increase risk of mental disorders at a later stage when the acute pandemic effects have subsided? Do increased self-reported mental health problems return to pre-pandemic levels, and which groups of individuals remain most affected in the long-term? We need to realize that certain pandemic consequences, particularly those affecting income and school/work careers, may become visible only over the course of several years. Consequently, we should maintain focus and continue to monitor and quantify the effects of the pandemic in the years to come—for example, by monitoring mental healthcare use and suicide. This should include specific at-risk populations (for example, adolescents) and understudied populations in low-income and middle-income countries.

Pay attention to mental health consequences of infectious diseases

Even though our knowledge on PACS is rapidly expanding, there are still many unanswered questions related to who is at risk, the long-term course trajectories and the best ways to intervene early. Consequently, we need to be aware of the neuropsychiatric sequelae of COVID-19 and, for that matter, of any infectious disease. Clinical attention and research should be directed toward alleviating potential neuropsychiatric ramifications of COVID-19. Next to clinical studies, studies using human tissues and appropriate animal models are pivotal to determine the CNS region-specific and neural-cell-specific effects of SARS-CoV-2 infection and the induced immune activation. Indeed, absence of SARS-CoV-2 neuroinvasion is an opportunity to learn and discover how peripheral neuroimmune mechanisms can contribute to neuropsychiatric sequelae in susceptible individuals. This emphasizes the importance of an interdisciplinary approach where somatic and mental health efforts are combined but also the need to integrate clinical parameters after infection with biological parameters (for example, serum, cerebrospinal fluid and/or neuroimaging) to predict who is at risk for PACS and deliver more targeted treatments.

Prepare mental healthcare infrastructure for pandemic times

If we take mental health seriously, we should not only monitor it but also develop the resources and infrastructure necessary for rapid early intervention, particularly for specific vulnerable groups. For adequate mental healthcare to be ready for pandemic times, primary care, community mental health and public mental health should be prepared. In many countries, health services were not able to meet the population’s mental health needs before the pandemic, which substantially worsened during the pandemic. We should ensure rapid access to mental health services but also address the underlying drivers of poor mental health, such as mitigating risks of unemployment, sexual violence and poverty. Collaboration in early stages across disciplines and expertise is essential. Anticipating disruption to face-to-face services, mental healthcare providers should be more prepared for consultations, therapy and follow-up by telephone, video-conferencing platforms and web applications 51 , 52 . The pandemic has shown that an inadequate infrastructure, pre-existing inequalities and low levels of technological literacy hindered the use and uptake of e-health, both in healthcare providers and in patients across different care settings. The necessary investments can ensure rapid upscaling of mental health services during future pandemics for those individuals with a high mental health need due to societal changes, government measures, fear of infection or infection itself.

Even though much attention has been paid to the physical health consequences of COVID-19, mental health has unjustly received less attention. There is an urgent need to prepare our research and healthcare infrastructures not only for adequate monitoring of the long-term mental health effects of the COVID-19 pandemic but also for future crises that will shape mental health. This will require collaboration to ensure interdisciplinary and sound research and to provide attention and care at an early stage for those individuals who are most vulnerable—giving mental health equal priority to physical health from the very start.

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Acknowledgements

The authors thank E. Giltay for assistance on data analyses and production of Fig. 1 . B.W.J.H.P. discloses support for research and publication of this work from the European Union’s Horizon 2020 research and innovation programme-funded RESPOND project (grant no. 101016127).

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Penninx, B.W.J.H., Benros, M.E., Klein, R.S. et al. How COVID-19 shaped mental health: from infection to pandemic effects. Nat Med 28 , 2027–2037 (2022). https://doi.org/10.1038/s41591-022-02028-2

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Read these 12 moving essays about life during coronavirus

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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How to Write About the Impact of the Coronavirus in a College Essay

U.S. News & World Report

October 21, 2020, 12:00 AM

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

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

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

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

[ Read: How to Write a College Essay. ]

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

Writing About COVID-19 for a College Application

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

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

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

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

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

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

[ Read: What Colleges Look for: 6 Ways to Stand Out. ]

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

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

Above all, she urges honesty.

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

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

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

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

Writing About Coronavirus in Main and Supplemental Essays

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

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

[ Read: The Common App: Everything You Need to Know. ]

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

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

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

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

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

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

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

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

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

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

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

Searching for a college? Get our complete rankings of Best Colleges.

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How to Write About the Impact of the Coronavirus in a College Essay originally appeared on usnews.com

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The positive effects of covid-19

Read our latest coverage of the coronavirus pandemic.

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

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

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

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

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

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

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

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

Fewer cars, blue skies

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

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

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

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

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

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

Reassessing priorities

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

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

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

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

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

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Covid 19 Essay in English

Essay on Covid -19: In a very short amount of time, coronavirus has spread globally. It has had an enormous impact on people's lives, economy, and societies all around the world, affecting every country. Governments have had to take severe measures to try and contain the pandemic. The virus has altered our way of life in many ways, including its effects on our health and our economy. Here are a few sample essays on ‘CoronaVirus’.

100 Words Essay on Covid 19

200 words essay on covid 19, 500 words essay on covid 19.

COVID-19 or Corona Virus is a novel coronavirus that was first identified in 2019. It is similar to other coronaviruses, such as SARS-CoV and MERS-CoV, but it is more contagious and has caused more severe respiratory illness in people who have been infected. The novel coronavirus became a global pandemic in a very short period of time. It has affected lives, economies and societies across the world, leaving no country untouched. The virus has caused governments to take drastic measures to try and contain it. From health implications to economic and social ramifications, COVID-19 impacted every part of our lives. It has been more than 2 years since the pandemic hit and the world is still recovering from its effects.

Since the outbreak of COVID-19, the world has been impacted in a number of ways. For one, the global economy has taken a hit as businesses have been forced to close their doors. This has led to widespread job losses and an increase in poverty levels around the world. Additionally, countries have had to impose strict travel restrictions in an attempt to contain the virus, which has resulted in a decrease in tourism and international trade. Furthermore, the pandemic has put immense pressure on healthcare systems globally, as hospitals have been overwhelmed with patients suffering from the virus. Lastly, the outbreak has led to a general feeling of anxiety and uncertainty, as people are fearful of contracting the disease.

My Experience of COVID-19

I still remember how abruptly colleges and schools shut down in March 2020. I was a college student at that time and I was under the impression that everything would go back to normal in a few weeks. I could not have been more wrong. The situation only got worse every week and the government had to impose a lockdown. There were so many restrictions in place. For example, we had to wear face masks whenever we left the house, and we could only go out for essential errands. Restaurants and shops were only allowed to operate at take-out capacity, and many businesses were shut down.

In the current scenario, coronavirus is dominating all aspects of our lives. The coronavirus pandemic has wreaked havoc upon people’s lives, altering the way we live and work in a very short amount of time. It has revolutionised how we think about health care, education, and even social interaction. This virus has had long-term implications on our society, including its impact on mental health, economic stability, and global politics. But we as individuals can help to mitigate these effects by taking personal responsibility to protect themselves and those around them from infection.

Effects of CoronaVirus on Education

The outbreak of coronavirus has had a significant impact on education systems around the world. In China, where the virus originated, all schools and universities were closed for several weeks in an effort to contain the spread of the disease. Many other countries have followed suit, either closing schools altogether or suspending classes for a period of time.

This has resulted in a major disruption to the education of millions of students. Some have been able to continue their studies online, but many have not had access to the internet or have not been able to afford the costs associated with it. This has led to a widening of the digital divide between those who can afford to continue their education online and those who cannot.

The closure of schools has also had a negative impact on the mental health of many students. With no face-to-face contact with friends and teachers, some students have felt isolated and anxious. This has been compounded by the worry and uncertainty surrounding the virus itself.

The situation with coronavirus has improved and schools have been reopened but students are still catching up with the gap of 2 years that the pandemic created. In the meantime, governments and educational institutions are working together to find ways to support students and ensure that they are able to continue their education despite these difficult circumstances.

Effects of CoronaVirus on Economy

The outbreak of the coronavirus has had a significant impact on the global economy. The virus, which originated in China, has spread to over two hundred countries, resulting in widespread panic and a decrease in global trade. As a result of the outbreak, many businesses have been forced to close their doors, leading to a rise in unemployment. In addition, the stock market has taken a severe hit.

Effects of CoronaVirus on Health

The effects that coronavirus has on one's health are still being studied and researched as the virus continues to spread throughout the world. However, some of the potential effects on health that have been observed thus far include respiratory problems, fever, and coughing. In severe cases, pneumonia, kidney failure, and death can occur. It is important for people who think they may have been exposed to the virus to seek medical attention immediately so that they can be treated properly and avoid any serious complications. There is no specific cure or treatment for coronavirus at this time, but there are ways to help ease symptoms and prevent the virus from spreading.

Explore Career Options (By Industry)

• Construction
• Entertainment
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• Information Technology

Data Administrator

Database professionals use software to store and organise data such as financial information, and customer shipping records. Individuals who opt for a career as data administrators ensure that data is available for users and secured from unauthorised sales. DB administrators may work in various types of industries. It may involve computer systems design, service firms, insurance companies, banks and hospitals.

Bio Medical Engineer

The field of biomedical engineering opens up a universe of expert chances. An Individual in the biomedical engineering career path work in the field of engineering as well as medicine, in order to find out solutions to common problems of the two fields. The biomedical engineering job opportunities are to collaborate with doctors and researchers to develop medical systems, equipment, or devices that can solve clinical problems. Here we will be discussing jobs after biomedical engineering, how to get a job in biomedical engineering, biomedical engineering scope, and salary. 

Ethical Hacker

A career as ethical hacker involves various challenges and provides lucrative opportunities in the digital era where every giant business and startup owns its cyberspace on the world wide web. Individuals in the ethical hacker career path try to find the vulnerabilities in the cyber system to get its authority. If he or she succeeds in it then he or she gets its illegal authority. Individuals in the ethical hacker career path then steal information or delete the file that could affect the business, functioning, or services of the organization.

GIS officer work on various GIS software to conduct a study and gather spatial and non-spatial information. GIS experts update the GIS data and maintain it. The databases include aerial or satellite imagery, latitudinal and longitudinal coordinates, and manually digitized images of maps. In a career as GIS expert, one is responsible for creating online and mobile maps.

Data Analyst

The invention of the database has given fresh breath to the people involved in the data analytics career path. Analysis refers to splitting up a whole into its individual components for individual analysis. Data analysis is a method through which raw data are processed and transformed into information that would be beneficial for user strategic thinking.

Data are collected and examined to respond to questions, evaluate hypotheses or contradict theories. It is a tool for analyzing, transforming, modeling, and arranging data with useful knowledge, to assist in decision-making and methods, encompassing various strategies, and is used in different fields of business, research, and social science.

Geothermal Engineer

Individuals who opt for a career as geothermal engineers are the professionals involved in the processing of geothermal energy. The responsibilities of geothermal engineers may vary depending on the workplace location. Those who work in fields design facilities to process and distribute geothermal energy. They oversee the functioning of machinery used in the field.

Database Architect

If you are intrigued by the programming world and are interested in developing communications networks then a career as database architect may be a good option for you. Data architect roles and responsibilities include building design models for data communication networks. Wide Area Networks (WANs), local area networks (LANs), and intranets are included in the database networks. It is expected that database architects will have in-depth knowledge of a company's business to develop a network to fulfil the requirements of the organisation. Stay tuned as we look at the larger picture and give you more information on what is db architecture, why you should pursue database architecture, what to expect from such a degree and what your job opportunities will be after graduation. Here, we will be discussing how to become a data architect. Students can visit NIT Trichy , IIT Kharagpur , JMI New Delhi . 

Remote Sensing Technician

Individuals who opt for a career as a remote sensing technician possess unique personalities. Remote sensing analysts seem to be rational human beings, they are strong, independent, persistent, sincere, realistic and resourceful. Some of them are analytical as well, which means they are intelligent, introspective and inquisitive. 

Remote sensing scientists use remote sensing technology to support scientists in fields such as community planning, flight planning or the management of natural resources. Analysing data collected from aircraft, satellites or ground-based platforms using statistical analysis software, image analysis software or Geographic Information Systems (GIS) is a significant part of their work. Do you want to learn how to become remote sensing technician? There's no need to be concerned; we've devised a simple remote sensing technician career path for you. Scroll through the pages and read.

Budget Analyst

Budget analysis, in a nutshell, entails thoroughly analyzing the details of a financial budget. The budget analysis aims to better understand and manage revenue. Budget analysts assist in the achievement of financial targets, the preservation of profitability, and the pursuit of long-term growth for a business. Budget analysts generally have a bachelor's degree in accounting, finance, economics, or a closely related field. Knowledge of Financial Management is of prime importance in this career.

Underwriter

An underwriter is a person who assesses and evaluates the risk of insurance in his or her field like mortgage, loan, health policy, investment, and so on and so forth. The underwriter career path does involve risks as analysing the risks means finding out if there is a way for the insurance underwriter jobs to recover the money from its clients. If the risk turns out to be too much for the company then in the future it is an underwriter who will be held accountable for it. Therefore, one must carry out his or her job with a lot of attention and diligence.

Finance Executive

Product manager.

A Product Manager is a professional responsible for product planning and marketing. He or she manages the product throughout the Product Life Cycle, gathering and prioritising the product. A product manager job description includes defining the product vision and working closely with team members of other departments to deliver winning products.  

Operations Manager

Individuals in the operations manager jobs are responsible for ensuring the efficiency of each department to acquire its optimal goal. They plan the use of resources and distribution of materials. The operations manager's job description includes managing budgets, negotiating contracts, and performing administrative tasks.

Stock Analyst

Individuals who opt for a career as a stock analyst examine the company's investments makes decisions and keep track of financial securities. The nature of such investments will differ from one business to the next. Individuals in the stock analyst career use data mining to forecast a company's profits and revenues, advise clients on whether to buy or sell, participate in seminars, and discussing financial matters with executives and evaluate annual reports.

A Researcher is a professional who is responsible for collecting data and information by reviewing the literature and conducting experiments and surveys. He or she uses various methodological processes to provide accurate data and information that is utilised by academicians and other industry professionals. Here, we will discuss what is a researcher, the researcher's salary, types of researchers.

Welding Engineer

Welding Engineer Job Description: A Welding Engineer work involves managing welding projects and supervising welding teams. He or she is responsible for reviewing welding procedures, processes and documentation. A career as Welding Engineer involves conducting failure analyses and causes on welding issues. 

Transportation Planner

A career as Transportation Planner requires technical application of science and technology in engineering, particularly the concepts, equipment and technologies involved in the production of products and services. In fields like land use, infrastructure review, ecological standards and street design, he or she considers issues of health, environment and performance. A Transportation Planner assigns resources for implementing and designing programmes. He or she is responsible for assessing needs, preparing plans and forecasts and compliance with regulations.

Environmental Engineer

Individuals who opt for a career as an environmental engineer are construction professionals who utilise the skills and knowledge of biology, soil science, chemistry and the concept of engineering to design and develop projects that serve as solutions to various environmental problems. 

Safety Manager

A Safety Manager is a professional responsible for employee’s safety at work. He or she plans, implements and oversees the company’s employee safety. A Safety Manager ensures compliance and adherence to Occupational Health and Safety (OHS) guidelines.

Conservation Architect

A Conservation Architect is a professional responsible for conserving and restoring buildings or monuments having a historic value. He or she applies techniques to document and stabilise the object’s state without any further damage. A Conservation Architect restores the monuments and heritage buildings to bring them back to their original state.

Structural Engineer

A Structural Engineer designs buildings, bridges, and other related structures. He or she analyzes the structures and makes sure the structures are strong enough to be used by the people. A career as a Structural Engineer requires working in the construction process. It comes under the civil engineering discipline. A Structure Engineer creates structural models with the help of computer-aided design software. 

Highway Engineer

Highway Engineer Job Description:  A Highway Engineer is a civil engineer who specialises in planning and building thousands of miles of roads that support connectivity and allow transportation across the country. He or she ensures that traffic management schemes are effectively planned concerning economic sustainability and successful implementation.

Field Surveyor

Are you searching for a Field Surveyor Job Description? A Field Surveyor is a professional responsible for conducting field surveys for various places or geographical conditions. He or she collects the required data and information as per the instructions given by senior officials. 

Orthotist and Prosthetist

Orthotists and Prosthetists are professionals who provide aid to patients with disabilities. They fix them to artificial limbs (prosthetics) and help them to regain stability. There are times when people lose their limbs in an accident. In some other occasions, they are born without a limb or orthopaedic impairment. Orthotists and prosthetists play a crucial role in their lives with fixing them to assistive devices and provide mobility.

Pathologist

A career in pathology in India is filled with several responsibilities as it is a medical branch and affects human lives. The demand for pathologists has been increasing over the past few years as people are getting more aware of different diseases. Not only that, but an increase in population and lifestyle changes have also contributed to the increase in a pathologist’s demand. The pathology careers provide an extremely huge number of opportunities and if you want to be a part of the medical field you can consider being a pathologist. If you want to know more about a career in pathology in India then continue reading this article.

Veterinary Doctor

Speech therapist, gynaecologist.

Gynaecology can be defined as the study of the female body. The job outlook for gynaecology is excellent since there is evergreen demand for one because of their responsibility of dealing with not only women’s health but also fertility and pregnancy issues. Although most women prefer to have a women obstetrician gynaecologist as their doctor, men also explore a career as a gynaecologist and there are ample amounts of male doctors in the field who are gynaecologists and aid women during delivery and childbirth. 

Audiologist

The audiologist career involves audiology professionals who are responsible to treat hearing loss and proactively preventing the relevant damage. Individuals who opt for a career as an audiologist use various testing strategies with the aim to determine if someone has a normal sensitivity to sounds or not. After the identification of hearing loss, a hearing doctor is required to determine which sections of the hearing are affected, to what extent they are affected, and where the wound causing the hearing loss is found. As soon as the hearing loss is identified, the patients are provided with recommendations for interventions and rehabilitation such as hearing aids, cochlear implants, and appropriate medical referrals. While audiology is a branch of science that studies and researches hearing, balance, and related disorders.

An oncologist is a specialised doctor responsible for providing medical care to patients diagnosed with cancer. He or she uses several therapies to control the cancer and its effect on the human body such as chemotherapy, immunotherapy, radiation therapy and biopsy. An oncologist designs a treatment plan based on a pathology report after diagnosing the type of cancer and where it is spreading inside the body.

Are you searching for an ‘Anatomist job description’? An Anatomist is a research professional who applies the laws of biological science to determine the ability of bodies of various living organisms including animals and humans to regenerate the damaged or destroyed organs. If you want to know what does an anatomist do, then read the entire article, where we will answer all your questions.

For an individual who opts for a career as an actor, the primary responsibility is to completely speak to the character he or she is playing and to persuade the crowd that the character is genuine by connecting with them and bringing them into the story. This applies to significant roles and littler parts, as all roles join to make an effective creation. Here in this article, we will discuss how to become an actor in India, actor exams, actor salary in India, and actor jobs. 

Individuals who opt for a career as acrobats create and direct original routines for themselves, in addition to developing interpretations of existing routines. The work of circus acrobats can be seen in a variety of performance settings, including circus, reality shows, sports events like the Olympics, movies and commercials. Individuals who opt for a career as acrobats must be prepared to face rejections and intermittent periods of work. The creativity of acrobats may extend to other aspects of the performance. For example, acrobats in the circus may work with gym trainers, celebrities or collaborate with other professionals to enhance such performance elements as costume and or maybe at the teaching end of the career.

Video Game Designer

Career as a video game designer is filled with excitement as well as responsibilities. A video game designer is someone who is involved in the process of creating a game from day one. He or she is responsible for fulfilling duties like designing the character of the game, the several levels involved, plot, art and similar other elements. Individuals who opt for a career as a video game designer may also write the codes for the game using different programming languages.

Depending on the video game designer job description and experience they may also have to lead a team and do the early testing of the game in order to suggest changes and find loopholes.

Radio Jockey

Radio Jockey is an exciting, promising career and a great challenge for music lovers. If you are really interested in a career as radio jockey, then it is very important for an RJ to have an automatic, fun, and friendly personality. If you want to get a job done in this field, a strong command of the language and a good voice are always good things. Apart from this, in order to be a good radio jockey, you will also listen to good radio jockeys so that you can understand their style and later make your own by practicing.

A career as radio jockey has a lot to offer to deserving candidates. If you want to know more about a career as radio jockey, and how to become a radio jockey then continue reading the article.

Choreographer

The word “choreography" actually comes from Greek words that mean “dance writing." Individuals who opt for a career as a choreographer create and direct original dances, in addition to developing interpretations of existing dances. A Choreographer dances and utilises his or her creativity in other aspects of dance performance. For example, he or she may work with the music director to select music or collaborate with other famous choreographers to enhance such performance elements as lighting, costume and set design.

Social Media Manager

A career as social media manager involves implementing the company’s or brand’s marketing plan across all social media channels. Social media managers help in building or improving a brand’s or a company’s website traffic, build brand awareness, create and implement marketing and brand strategy. Social media managers are key to important social communication as well.

Photographer

Photography is considered both a science and an art, an artistic means of expression in which the camera replaces the pen. In a career as a photographer, an individual is hired to capture the moments of public and private events, such as press conferences or weddings, or may also work inside a studio, where people go to get their picture clicked. Photography is divided into many streams each generating numerous career opportunities in photography. With the boom in advertising, media, and the fashion industry, photography has emerged as a lucrative and thrilling career option for many Indian youths.

An individual who is pursuing a career as a producer is responsible for managing the business aspects of production. They are involved in each aspect of production from its inception to deception. Famous movie producers review the script, recommend changes and visualise the story. 

They are responsible for overseeing the finance involved in the project and distributing the film for broadcasting on various platforms. A career as a producer is quite fulfilling as well as exhaustive in terms of playing different roles in order for a production to be successful. Famous movie producers are responsible for hiring creative and technical personnel on contract basis.

Copy Writer

In a career as a copywriter, one has to consult with the client and understand the brief well. A career as a copywriter has a lot to offer to deserving candidates. Several new mediums of advertising are opening therefore making it a lucrative career choice. Students can pursue various copywriter courses such as Journalism , Advertising , Marketing Management . Here, we have discussed how to become a freelance copywriter, copywriter career path, how to become a copywriter in India, and copywriting career outlook. 

In a career as a vlogger, one generally works for himself or herself. However, once an individual has gained viewership there are several brands and companies that approach them for paid collaboration. It is one of those fields where an individual can earn well while following his or her passion. 

Ever since internet costs got reduced the viewership for these types of content has increased on a large scale. Therefore, a career as a vlogger has a lot to offer. If you want to know more about the Vlogger eligibility, roles and responsibilities then continue reading the article. 

For publishing books, newspapers, magazines and digital material, editorial and commercial strategies are set by publishers. Individuals in publishing career paths make choices about the markets their businesses will reach and the type of content that their audience will be served. Individuals in book publisher careers collaborate with editorial staff, designers, authors, and freelance contributors who develop and manage the creation of content.

Careers in journalism are filled with excitement as well as responsibilities. One cannot afford to miss out on the details. As it is the small details that provide insights into a story. Depending on those insights a journalist goes about writing a news article. A journalism career can be stressful at times but if you are someone who is passionate about it then it is the right choice for you. If you want to know more about the media field and journalist career then continue reading this article.

Individuals in the editor career path is an unsung hero of the news industry who polishes the language of the news stories provided by stringers, reporters, copywriters and content writers and also news agencies. Individuals who opt for a career as an editor make it more persuasive, concise and clear for readers. In this article, we will discuss the details of the editor's career path such as how to become an editor in India, editor salary in India and editor skills and qualities.

Individuals who opt for a career as a reporter may often be at work on national holidays and festivities. He or she pitches various story ideas and covers news stories in risky situations. Students can pursue a BMC (Bachelor of Mass Communication) , B.M.M. (Bachelor of Mass Media) , or  MAJMC (MA in Journalism and Mass Communication) to become a reporter. While we sit at home reporters travel to locations to collect information that carries a news value.  

Corporate Executive

Are you searching for a Corporate Executive job description? A Corporate Executive role comes with administrative duties. He or she provides support to the leadership of the organisation. A Corporate Executive fulfils the business purpose and ensures its financial stability. In this article, we are going to discuss how to become corporate executive.

Multimedia Specialist

A multimedia specialist is a media professional who creates, audio, videos, graphic image files, computer animations for multimedia applications. He or she is responsible for planning, producing, and maintaining websites and applications. 

Quality Controller

A quality controller plays a crucial role in an organisation. He or she is responsible for performing quality checks on manufactured products. He or she identifies the defects in a product and rejects the product. 

A quality controller records detailed information about products with defects and sends it to the supervisor or plant manager to take necessary actions to improve the production process.

Production Manager

A QA Lead is in charge of the QA Team. The role of QA Lead comes with the responsibility of assessing services and products in order to determine that he or she meets the quality standards. He or she develops, implements and manages test plans. 

Process Development Engineer

The Process Development Engineers design, implement, manufacture, mine, and other production systems using technical knowledge and expertise in the industry. They use computer modeling software to test technologies and machinery. An individual who is opting career as Process Development Engineer is responsible for developing cost-effective and efficient processes. They also monitor the production process and ensure it functions smoothly and efficiently.

AWS Solution Architect

An AWS Solution Architect is someone who specializes in developing and implementing cloud computing systems. He or she has a good understanding of the various aspects of cloud computing and can confidently deploy and manage their systems. He or she troubleshoots the issues and evaluates the risk from the third party. 

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The Impact of COVID-19 Pandemic

The year 2019 will forever be engraved in many people’s hearts and minds as the time when a deadly virus known as the coronavirus disease 2019 (COVID-19) invaded almost all the sectors, thereby disrupting daily activities. It is described as a communicable respiratory illness which is triggered by a new strain of coronavirus which leads to various ailments in human beings. There is currently no known cure or vaccine for the virus as scientists worldwide are still trying to learn about the illness to respond appropriately through research (Goodell, 2020). This paper aims at exploring the effects that the pandemic has had on society regarding the economy, social life, education, religion, and family.

The emergence of the pandemic, which began in China-2019, quickly spread to other nations across the world with devastating effects on their economies As a way of containing the disease, many countries instituted strict measures, such as curfews, the mandatory wearing of masks, and social distancing of 1 meter apart (Goodell, 2020). Covid-19 has significantly changed the way these preventive methods relate with each concerning trade matters. The majority of the states affected opted to close their borders as fear among the citizens increased. The implementation of the strict rules interfered with the business operations of many nations. It became difficult for international trade to continue as a result of the closed borders. Most businesses have also had to close due to financial constraints.

When it comes to socialization, people have been forced to use other means to meet their friends and families across the world. Social media platforms have seen an increased usage during this difficult time as people try to find new ways of socializing. It has happened especially in such countries as Australia, where the restrictions were extreme as it enforced a lockdown for close to a hundred days (Goodell, 2020). The use of masks is also quickly becoming the new norm across numerous states. Unlike in developed countries where the governments have offered their citizens some aid mostly in terms of cash transfers, developing countries have struggled to balance between the people’s livelihood and the containment of the Covid-19. As such, most people have turned to social media platforms as a medium of communication and socialization due to lockdowns.

Learning institutions have also not been spared by the Covid-19 pandemic. Most countries affected by the spread of the virus were forced to suspend their educational curriculum calendar to allow children and university students to stay home until the time when the disease is finally neutralized (Goodell, 2020). However, students and parents have been pushing the governments to resume schools with clear protocols which ensure that both the students and the teachers follow the rules, including the mandatory wearing of masks. Religion has also been significantly affected as it has become difficult for people to seek for spiritual nourishment (Goodell, 2020). Many religious leaders have had to devise other ways of reaching out to the congregates. For example, many churches now have to move their services online by using such platforms as YouTube, Facebook, Zoom, among others to convey essential teachings.

Covid-19 has also directly affected many families across the world, as the majority have succumbed to the disease. The United States of America and Italy are some of the pandemic’s worst casualties, where many people were killed by the lethal virus (Goodell, 2020). Some people have in the end lost more than one member of the family because of the disease, and in some worse case scenarios, the illness has claimed a whole family.

In conclusion, this paper has highlighted the impacts of the Covid-19 pandemic on the economy, social life, education, religion, and family units. Many countries and businesses had underestimated the disease’s impact before they later suffered from the consequences. Therefore, international bodies, such as the World Health Organization, need to help developing countries establish critical management healthcare systems, which can help to deal with the future pandemics.

Goodell, J. W. (2020). COVID-19 and finance: Agendas for future research. Finance Research Letters , 35 , 101512. Web.

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

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

March 3, 2022

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Essay on COVID-19 Pandemic

As a result of the COVID-19 (Coronavirus) outbreak, daily life has been negatively affected, impacting the worldwide economy. Thousands of individuals have been sickened or died as a result of the outbreak of this disease. When you have the flu or a viral infection, the most common symptoms include fever, cold, coughing up bone fragments, and difficulty breathing, which may progress to pneumonia. It’s important to take major steps like keeping a strict cleaning routine, keeping social distance, and wearing masks, among other things. This virus’s geographic spread is accelerating (Daniel Pg 93). Governments restricted public meetings during the start of the pandemic to prevent the disease from spreading and breaking the exponential distribution curve. In order to avoid the damage caused by this extremely contagious disease, several countries quarantined their citizens. However, this scenario had drastically altered with the discovery of the vaccinations. The research aims to investigate the effect of the Covid-19 epidemic and its impact on the population’s well-being.

There is growing interest in the relationship between social determinants of health and health outcomes. Still, many health care providers and academics have been hesitant to recognize racism as a contributing factor to racial health disparities. Only a few research have examined the health effects of institutional racism, with the majority focusing on interpersonal racial and ethnic prejudice Ciotti et al., Pg 370. The latter comprises historically and culturally connected institutions that are interconnected. Prejudice is being practiced in a variety of contexts as a result of the COVID-19 outbreak. In some ways, the outbreak has exposed pre-existing bias and inequity.

Thousands of businesses are in danger of failure. Around 2.3 billion of the world’s 3.3 billion employees are out of work. These workers are especially susceptible since they lack access to social security and adequate health care, and they’ve also given up ownership of productive assets, which makes them highly vulnerable. Many individuals lose their employment as a result of lockdowns, leaving them unable to support their families. People strapped for cash are often forced to reduce their caloric intake while also eating less nutritiously (Fraser et al, Pg 3). The epidemic has had an impact on the whole food chain, revealing vulnerabilities that were previously hidden. Border closures, trade restrictions, and confinement measures have limited farmer access to markets, while agricultural workers have not gathered crops. As a result, the local and global food supply chain has been disrupted, and people now have less access to healthy foods. As a consequence of the epidemic, many individuals have lost their employment, and millions more are now in danger. When breadwinners lose their jobs, become sick, or die, the food and nutrition of millions of people are endangered. Particularly severely hit are the world’s poorest small farmers and indigenous peoples.

Infectious illness outbreaks and epidemics have become worldwide threats due to globalization, urbanization, and environmental change. In developed countries like Europe and North America, surveillance and health systems monitor and manage the spread of infectious illnesses in real-time. Both low- and high-income countries need to improve their public health capacities (Omer et al., Pg 1767). These improvements should be financed using a mix of national and foreign donor money. In order to speed up research and reaction for new illnesses with pandemic potential, a global collaborative effort including governments and commercial companies has been proposed. When working on a vaccine-like COVID-19, cooperation is critical.

The epidemic has had an impact on the whole food chain, revealing vulnerabilities that were previously hidden. Border closures, trade restrictions, and confinement measures have limited farmer access to markets, while agricultural workers have been unable to gather crops. As a result, the local and global food supply chain has been disrupted, and people now have less access to healthy foods (Daniel et al.,Pg 95) . As a consequence of the epidemic, many individuals have lost their employment, and millions more are now in danger. When breadwinners lose their jobs, the food and nutrition of millions of people are endangered. Particularly severely hit are the world’s poorest small farmers and indigenous peoples.

While helping to feed the world’s population, millions of paid and unpaid agricultural laborers suffer from high levels of poverty, hunger, and bad health, as well as a lack of safety and labor safeguards, as well as other kinds of abuse at work. Poor people, who have no recourse to social assistance, must work longer and harder, sometimes in hazardous occupations, endangering their families in the process (Daniel Pg 96). When faced with a lack of income, people may turn to hazardous financial activities, including asset liquidation, predatory lending, or child labor, to make ends meet. Because of the dangers they encounter while traveling, working, and living abroad; migrant agricultural laborers are especially vulnerable. They also have a difficult time taking advantage of government assistance programs.

The pandemic also has a significant impact on education. Although many educational institutions across the globe have already made the switch to online learning, the extent to which technology is utilized to improve the quality of distance or online learning varies. This level is dependent on several variables, including the different parties engaged in the execution of this learning format and the incorporation of technology into educational institutions before the time of school closure caused by the COVID-19 pandemic. For many years, researchers from all around the globe have worked to determine what variables contribute to effective technology integration in the classroom Ciotti et al., Pg 371. The amount of technology usage and the quality of learning when moving from a classroom to a distant or online format are presumed to be influenced by the same set of variables. Findings from previous research, which sought to determine what affects educational systems ability to integrate technology into teaching, suggest understanding how teachers, students, and technology interact positively in order to achieve positive results in the integration of teaching technology (Honey et al., 2000). Teachers’ views on teaching may affect the chances of successfully incorporating technology into the classroom and making it a part of the learning process.

In conclusion, indeed, Covid 19 pandemic have affected the well being of the people in a significant manner. The economy operation across the globe have been destabilized as most of the people have been rendered jobless while the job operation has been stopped. As most of the people have been rendered jobless the living conditions of the people have also been significantly affected. Besides, the education sector has also been affected as most of the learning institutions prefer the use of online learning which is not effective as compared to the traditional method. With the invention of the vaccines, most of the developed countries have been noted to stabilize slowly, while the developing countries have not been able to vaccinate most of its citizens. However, despite the challenge caused by the pandemic, organizations have been able to adapt the new mode of online trading to be promoted.

Ciotti, Marco, et al. “The COVID-19 pandemic.”  Critical reviews in clinical laboratory sciences  57.6 (2020): 365-388.

Daniel, John. “Education and the COVID-19 pandemic.”  Prospects  49.1 (2020): 91-96.

Fraser, Nicholas, et al. “Preprinting the COVID-19 pandemic.”  BioRxiv  (2021): 2020-05.

Omer, Saad B., Preeti Malani, and Carlos Del Rio. “The COVID-19 pandemic in the US: a clinical update.”  Jama  323.18 (2020): 1767-1768.

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Your Doctor’s Words Could Make You Sick

Blease, Ph.D., . Bernstein, Ph.D., Locher, Ph.D., and Brown, M.D. are authors of the book The Nocebo Effect: When Words Make You Sick

“You may feel a sharp pinch, but it will all be over quickly.”

Before the COVID-19 jab was plunged into our arms, most of us probably heard words similar to these. After the anticipated pinch, the nurse or doctor likely told us something about possible vaccine side effects. For one of us, the nurse’s forewarning was rather specific: “Around 12 hours from now you may experience a pain in your arm or feel flu symptoms. But don’t worry,” the nurse aimed to reassure. “This can be easily managed by Tylenol.”

Sure enough, like clockwork, 12 hours later, the symptoms manifested.

An estimated 30% of people who received the COVID-19 vaccine also reported nasty side effects. Making matters worse, like a nightmarish self-fulfilling prophecy, the very words used by clinicians might well have caused some of this harm. Of course, doctors and nurses do not deliberately set out to hurt patients—far from it. They want to ensure that patients are fully informed. However, as our research shows, their words might unintentionally ramp up the effects of a psychological phenomenon that operates under the radar. This phenomenon is called the “nocebo effect.”

Characterized as the “evil-twin” of the placebo effect, nocebo effects are harms that arise from negative expectations. While placebo effects are those beneficial outcomes that arise when we expect to feel better and, as a result, do , nocebo effects are what happen when we expect to feel worse.

Read More: The Placebo Effect Is Real, and Scientists May Be Able To Predict Who Responds

Today, we expect our doctors to give information to us straight. Gone are the days when doctors could wilfully withhold information from patients, even if they believed doing so would make patients feel better. Yet, the best-known phrase from medicine’s oldest creed, the Hippocratic Oath, is “First, do no harm.” Nocebo effects are one of medicine’s natural disruptors: they present a challenging scenario because, sometimes, information may be bad for our health. Balancing honesty against the risks of harm is no easy feat and is one area where medical ethicists, health researchers, patients, and clinicians need to put their heads together.

COVID-19 offered an unprecedented global experiment into the size and significance of this effect. In 2022, placebo researcher Julia Haas led a review of COVID vaccine clinical trial data and concluded that the nocebo phenomenon could account for as much as three quarters of the side effects associated with the jabs. The evidence for this startling finding comes by comparing side effects between patients allocated to the placebo shot versus those allocated to the real shot in the vaccine trials. Those receiving only a saline injection with no effect on the body still reported many unwanted side effects. It is possible that some of these effects might have been due to “symptom misattribution.” At any given time, some of us may experience low grade aches and pains, such as headaches, or fatigue, and knowledge that the vaccine causes these effects might draw our attention to symptoms we’re already experiencing. Alternatively, some negative symptoms might have been caused, or worsened, by nocebo effects. 

Beyond COVID-19, a growing body of research shows that nocebo effects may be commonplace in medicine and that the verbal suggestions uttered by clinicians really do matter. In one experimental study in 2004, radiology professor Dr. Elvira Lang and her colleagues found that warning or even sympathizing with patients about painful or undesirable experiences following an intervention increased pain and anxiety. In another 2003 study of beta-blockers for cardiac disease and hypertension, telling patients that treatment side effects might include erectile dysfunction (ED) led to a doubling of patients reporting this problem compared with those not given information about ED risk.

In 2010, Dr. Dirk Varelmann, a specialist in anesthesia and pain management at Beth Israel Deaconess Medical Center in Boston, wanted to explore whether the way in which a local anesthetic injection was described to patients would influence pain. Varelmann led a study where one group was told, “You will feel a big bee sting; this is the worst part;” the other group was informed, “We are going to give you a local anesthetic that will numb the area, and you will be comfortable during the procedure.” Those who were told they would feel a sting—that is, the patients receiving a negative suggestion— reported significantly more pain after the injection even though both groups got the same anesthetic. Varelmann’s conclusion was that, “using gentler, more reassuring words” could improve patients’ experience during invasive medical procedures.

Studies like this expose the ethical dilemma that nocebo effects invite. Since April 2021 , patients in the U.S. have had the right to read their online medical records. Access rights include test results, medication lists, and the very words written by clinicians. Patients appreciate this. Surveys in the U.S. and other countries where access has been rolled out reveal patients who read their electronic medical records feel more in control of their care, and report better understanding and recall about their treatment plans. People who poke their noses into their records also report better understanding of the side effects of the medications they are prescribed.

However, there is a catch. In a study one of us conducted in 2021, some enlightened patients said they worried more about their medications after reading their clinical records. And while the connection has only been hypothesized , we shouldn’t be surprised if the language doctors use in our records gives nocebo effects unfettered free reign. In fact, as many as half of all patients in the U.S. who are prescribed medications for chronic conditions fail to take their meds leading to an estimated 100,000 preventable deaths and $100 billion in costs every year. Side effects are one of the main reasons patients discontinue treatments. If we can solve the nocebo problem, we might do a better job of keeping more people on their medications and staying healthy.

Nocebo effects are relevant even beyond the doctor’s office. They invite challenging questions about how governments should frame public health information, and how advertisers ought to sell their drugs on TV. The free press is a pillar of democratic societies, but even here the nocebo phenomenon raises interesting novel concerns. If journalists reporting on health veer into sensationalism and scaremongering, and this literally causes readers harm, was their choice of words unethical?

This brings us back to coronavirus. An estimated 70% of the world’s population received at least one COVID-19 jab. But many skipped their second shot, some because of fears about the vaccine’s side effects . Perhaps not even the most ardent conspiracy theorist could have imagined that a humble mind-body effect might have played a role in the pandemic’s gloomy story. But they should think again.

Knowledge is power, but it’s as equally important to remember that words matter. Let us not delay the “nocebo” conversation any longer.

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Research Article

Effect of face-covering use on adherence to other COVID-19 protective behaviours: A systematic review

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Visualization, Writing – original draft, Writing – review & editing

Affiliation Behavioural Science and Insights Unit, UK Health Security Agency, London, United Kingdom

Roles Formal analysis, Visualization, Writing – original draft, Writing – review & editing

Roles Formal analysis, Project administration, Supervision, Visualization, Writing – review & editing

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Supervision, Writing – review & editing

* E-mail: [email protected]

• Adam Millest, 
• Sidra Saeed, 
• Charles Symons, 
• Holly Carter

• Published: April 11, 2024
• https://doi.org/10.1371/journal.pone.0284629
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During the COVID-19 pandemic, concerns were raised that face covering use may elicit risk compensation; a false sense of security resulting in reduced adherence to other protective behaviours such as physical distancing. This systematic review aimed to investigate the effect of face covering use on adherence to other COVID-19 related protective behaviours. Medline, Embase, PsychInfo, EmCare, medRxiv preprints, Research Square and WHO COVID-19 Research Database were searched for all primary research studies published from 1 st January 2020 to 17 th May 2022 that investigated the effect of face covering use on adherence to other protective behaviours in public settings during the COVID-19 pandemic. Papers were selected and screened in accordance with the PRISMA framework. Backwards and forwards citation searches of included papers were also conducted on 16 th September 2022, with eligible papers published between 1 st January 2020 and that date being included. A quality appraisal including risk of bias was assessed using the Academy of Nutrition and Dietetics’ Quality Criteria Checklist. This review is registered on PROSPERO, number CRD42022331961. 47 papers were included, with quality ranging from low to high. These papers investigated the effects of face covering use and face covering policies on adherence to six categories of behaviour: physical distancing; mobility; face-touching; hand hygiene; close contacts; and generalised protective behaviour. Results reveal no consistent evidence for or against risk compensation, with findings varying according to behaviour and across study types, and therefore confident conclusions cannot be made. Any policy decisions related to face coverings must consider the inconsistencies and caveats in this evidence base.

Citation: Millest A, Saeed S, Symons C, Carter H (2024) Effect of face-covering use on adherence to other COVID-19 protective behaviours: A systematic review. PLoS ONE 19(4): e0284629. https://doi.org/10.1371/journal.pone.0284629

Editor: Wondwossen Amogne Degu, Addis Ababa University, College of Health Sciences, ETHIOPIA

Received: March 22, 2023; Accepted: March 23, 2024; Published: April 11, 2024

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

Data Availability: All data that were used for synthesis are available in the data extraction table. This table can be found in the file titled ' S3_Appendix ' in the Supporting information zip file. Please note that we did not have access to the original raw data for each individual study included in our review. The data that were synthesised in our analysis were extracted from the results sections of each paper.

Funding: The authors received no specific funding for this work.

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

1. Introduction

The COVID-19 pandemic highlighted the important role that public behaviour can play in the control of infectious disease. Prior to the introduction of vaccination, measures to control the spread of COVID-19 consisted primarily of non-pharmaceutical interventions (NPIs) (e.g., hand cleaning; reducing contact with others; staying at home), which included the use of face-coverings [ 1 ]. Over 160 governments mandated or recommended face-coverings during the pandemic [ 2 ], and their use was seen as crucial to controlling the spread of COVID-19.

At the onset of the pandemic however, concerns were raised that the use of face coverings may provide a false sense of security, leading to lower adherence to other protective measures such as hand hygiene and physical distancing; a phenomenon known as ‘risk compensation’ [ 3 , 4 ] that has its theoretical origins in both economonics and psychology. Peltzman [ 4 ], for example, proposes that each individual has a targeted level of risk. If a person feels that they have taken an action to reduce their risk in a particular context, they may feel able to take greater risks in other areas in order to maintain their targeted risk level. People therefore compensate for the perceived decline in risk by taking other risky behaviours; this is known as the Peltzman effect. For example, in the case of driving cars, the Peltzman effect predicts that safer cars will prompt riskier driving as drivers increase their driving intensity to offset their reduced risk [ 5 ]. According to this effect, face-coverings may provide a level of safety that exceeds a targeted level, and people may compensate through a reduction in other COVID-19-related safety measures. Wilde [ 6 ] predicts such behaviour through a phenomenon he refers to as ‘risk homeostasis.’ Wilde posits that, just as our bodies have a certain biological balance that we unconsciously look to maintain, psychologically we have an optimum level of risk that we also seek to maintain, and that, depending on the circumstances we find ourselves in, we will look to make risk-related adjustments. As such if we find ourselves in circumstances in which our level of risk is below this optimum level, we will look to increase it through our behaviour. In the case of face-covering use, these theories would predict that by wearing face-coverings our perceived risk of catching or transmitting a virus may decrease to below our optimum level, and so we compensate by reducing other COVID-19-related safety behaviours, such as physical distancing. In summary, though these two theories take a slightly different angle, both predict that when our behaviour or circumstances reduce the level of risk we are subjected to, we look to compensate for that risk by undertaking behaviour that has an equal and opposite effect.

The literature on risk compensation during COVID-19 has found mixed results [ 7 , 8 ]. One review was carried out early in the pandemic to examine the extent to which risk compensation may affect public behaviour [ 9 ], however, given the paucity of research into COVID-19 specifically at the time, this review necessarily relied on research into risk compensation in other contexts (such as the wearing of bike or ski helmets, the use of pre-exposure prophylaxis for HIV, and the use of the HPV vaccination). In a study in Germany, Henk et al. [ 10 ] found that self-reported adherence to protective behaviours was significantly lower after the implementation of two policies: mandatory quarantine for visitors to the country and mandatory face-covering use in shops and on public transport. Similarly, Jones Ritten et al. [ 11 ] investigated the risk compensating effect of COVID-19 testing by surveying students at two large universities in the US and found a positive association between testing behaviour and the number of risky events attended (e.g., large indoor gatherings). Moreover, it was found that those who participated in the testing programme perceived that doing so reduced their risk of contracting COVID-19, and further, that there was a positive association in the perceived risk-reducing effect of the testing programme and frequency of attending risky events; that is, the more respondents believed that testing reduced their risk of contracting COVID-19, the more likely they were to attend risky events. In contrast, Ludema et al. [ 12 ], used a randomised controlled trial to investigate risk compensation and anti-body testing and found that, irrespective of whether the result was positive or negative, receiving antibody test results did not lead to significant changes in adherence to COVID-19 protective behaviours. The extent to which risk compensation has occurred during the COVID-19 pandemic is therefore unclear.

There is now a substantial body of research investigating risk compensation in relation to face-covering use in the context of COVID-19. The aim of this systematic review was therefore to identify, summarise and assess the findings from studies examining the effect of face covering use on adherence to other protective behaviours in the context of COVID-19.

Details of the protocol for this systematic review were registered on PROSPERO before screening took place. The protocol’s number is CRD42022331961 and can be accessed at https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=331961 [ 13 ]. It can also be seen in S1 Appendix .

2.1 Eligibility criteria

Studies were eligible if they reported primary quantitative or qualitative research relating to the impact of face covering use on adherence to other protective behaviours during the COVID-19 pandemic. Protective behaviours of interest included but were not limited to: COVID-19 physical/social distancing, hygiene (e.g., avoidance of face-touching, regular handwashing), staying at home, and reducing travel. Studies that examined the effectiveness and/or efficacy of wearing face coverings or factors related to adherence to face covering use were excluded. Published research and pre-publication articles were included. Reviews, position/discussion papers, conference abstracts, protocol papers, modelling studies, case reports and studies published in languages other than English were excluded (see Table 1 ).

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https://doi.org/10.1371/journal.pone.0284629.t001

2.2 Search strategy

A systematic search was conducted by UKHSA researchers on 17 th May 2022 for papers from January 2020 until the date of searches. Sources searched included Ovid Medline, Ovid Embase, Ovid PsychInfo, Ovid EmCare, medRxiv preprints, Research Square and WHO COVID-19 Research Database. Search terms included terms related to COVID-19 (e.g., COVID-19, coronavirus, Sars-COV2), face coverings (e.g., mask, face cover, mouth covers) and protective behaviours (e.g., social distancing, handwashing, face-touching). A complete list of search terms is available in S2 Appendix .

Forward and backward citation searches of included papers were also conducted on 16 th September 2022, and eligible papers from 1 st January 2020 to that date were also included.

2.3 Study identification

Selection and screening of papers followed a systematic search method following a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework [ 14 ]. The study identification process is detailed in Fig 1 and contains full details of papers included and excluded at each stage. Papers were initially title- and abstract-screened (decisions were made as to the eligibility of each paper following a review of their title and abstract alone). In the first stage of title and abstract screening, 10% of records were assessed in duplicate by two reviewers, and disagreements were resolved by discussion and consensus. In the second stage of title and abstract screening one reviewer assessed the remaining 90% of records. The screening tool Rayyan [ 15 ] was used for both these first and second stages. All relevant records were then screened by full text by one reviewer (decisions were made as to the eligibility of each paper following a review of the paper in full). These decisions were then checked by a second reviewer. There were five reasons for exclusion: (i) The direction of analysis was incorrect e.g., the study investigated behavioural predictors of face-covering use rather than vice versa (n = 5), (ii) the independent variables or outcome variables were not relevant to the research question (n = 14), (iii) the study did not comprise primary empirical research (n = 6), (iv) the paper was a previously undetected duplicate (n = 5), and (v) the paper was not written in English (n = 1). By the end of this process, 47 papers were deemed eligible and included in the review.

https://doi.org/10.1371/journal.pone.0284629.g001

2.4 Data extraction and synthesis

Findings related to any relevant COVID-19 protective behaviours were extracted; at the completion of extraction, these comprised the following behavioural outcomes: physical distancing, mobility, face-touching, hand hygiene, close contacts, and generalised measures of protective behaviour. All results from selected papers were included. The following information was then collated for each study: country, publication status, population and sample size, methods, key outcome variables and main results. Data were initially collated into one table which included an outcome variable column. This table was then divided by outcome variable into six smaller data extraction tables, and a narrative summary of results was produced, structured by these six outcome variable categories.

Data extraction was completed for each included study by one reviewer and independently checked by a second reviewer, with discrepancies resolved by discussion. Any evidence that was not directly relevant to the review question was not extracted.

2.5 Quality assessment

Quality of the selected articles, including risk of bias, was evaluated by one reviewer using the Quality Criteria Checklist (QCC) tool which can be used to assess the methodological quality of a study [ 16 ]. Using the QCC, studies were characterized as high, medium, or low quality.

This checklist tool is composed of ten questions, 4 of which are considered critical (questions on selection bias, group comparability, description of exposure/assessment of transmission routes, and validity of outcome measurements); full details can be seen in S3 Appendix .

A study was rated as high methodological quality if the answers were yes to the four critical questions plus at least one of the remaining questions. A study was rated as low methodological quality if answers were no to more than half of the 10 questions. Otherwise, a study was rated as medium methodological quality. In line with a systematic review that found that self-report methods of capturing adherence to protective behaviours can over-estimate objectively observed adherence by up to a factor of five [ 17 ], any studies which employed a self-report methodology were deemed not to satisfy the validity of outcome criterion, and so were necessarily limited to a quality score of medium or below. An additional reviewer independently assessed five of the studies, and conflicting findings were discussed. Following discussions, a potential source of bias was identified in the first reviewer’s application of one of the tool’s questions, and all studies were subsequently re-evaluated to correct for this bias.

3.1 Overview of search results

The initial searches generated 12,662 articles. After de-duplication, 7,980 records remained, and title and abstract screening resulted in 70 papers being accepted for full text screening. Following full text screening, 39 papers were accepted for inclusion in the review. Backwards and forwards citation searches were conducted that yielded a further 8 papers for inclusion, meaning the total number of papers included in the review was 47. Quality appraisal of the articles revealed that nine were of a high quality, 33 of a medium quality, and five of a low quality. Of the papers included nine were pre-prints, 35 were peer-reviewed publications, and three were published conference papers. Finally, it was found that some papers included more than one methodology, intervention, or protective behaviour and thus, the number of studies described for each of these categories may exceed the total number of papers.

All studies included used quantitative methods, and none used qualitative methods. Methods included field experiments (n = 7), natural experiments (n = 14), lab experiments (n = 14), observational studies (n = 10) and cross-sectional studies (n = 9). Of these, 30 studies measured behaviour through observation, and 22 measured behaviour through self-report. Of the self-report studies, 10 were concerned with current or previous behaviour, and 12 with expected or intended behaviour. Though all included papers necessarily investigated the effect of face covering use on protective behaviours, the exact intervention of focus in each case was varied and fit into one of five categories: face covering use (self) i.e., the act of wearing a face covering oneself (n = 21); face covering use (other) i.e., in some way interacting with someone else wearing a face covering (n = 18); face covering use (self and other) i.e., in some way interacting with someone else who is wearing a face covering whilst also wearing a face covering oneself (n = 1); face covering policy i.e., the implementation of a face covering mandate (n = 19); and face covering intervention package i.e., a community programme designed to increase uptake of face covering usage (n = 1). The protective behaviour(s) in each case also varied, and in each case fit into one of 6 categories: physical distancing i.e., interpersonal distance (n = 30); mobility i.e., the extent to which people leave their home and visit public or residential spaces (n = 13); face-touching (n = 7); hand hygiene e.g., hand washing, avoidance of handshakes (n = 5); close contacts i.e., the extent to which people have close and extended interactions with people outside of their household (n = 4); and generalised protective behaviour i.e., a single measure to encapsulate two or more COVID-19 protective behaviours other than face-covering use, e.g., hand-washing, physical distancing and staying at home (n = 2). Full details on each paper can be seen in the data extraction tables in S4 Appendix .

Some studies initially appeared to meet the inclusion criteria but were ultimately excluded. For example, one study investigated how face covering use affected perceptions of physical distance between oneself and another person, however, since it did not investigate how face covering use affected distancing behaviour, it was not deemed to be eligible for inclusion [ 18 ]. Similarly, another study investigated participants’ judgements on how face covering use moderates the relationship between a given physical distance and transmission risk and was not included since, although its focus was related to the review’s objectives, it did not directly address it, in that it did not investigate how face covering use directly impacted adherence to protective behaviours [ 19 ].

The section below presents findings in relation to each of these six behaviours and describes the extracted data in terms of the effect that face covering use has on each type of behaviour, also exploring any patterns with regards to how the effect of face covering use varies by the type of intervention, and the type of study design.

3.2 Physical distancing (see table 2a in S4 Appendix for full details)

Outcomes in relation to the impact of face covering use on physical distancing were mixed and varied depending on the type of study. Findings from the majority of lab experiments (10 of 13) indicated that physical distancing was lower in conditions where a face covering was used by another person compared with conditions where it was not [ 20 – 27 ], [ 28 : two different studies], and two of these studies also found that physical distancing was lower when a face covering was used by the self [ 28 : two different studies]. Additionally, one of these studies investigated how physical distancing in conditions with and without face covering use compared with a baseline measure (that is, physical distancing outside the context of face covering use) [ 20 ]. It was found that physical distancing was significantly greater than the baseline in conditions without face covering use, but not significantly different in conditions with face covering use, potentially suggesting that differences between conditions is driven by participants moving away from people without face coverings (relative to where they would normally position themselves), rather than towards people with face coverings. Of the remaining three studies, one found that physical distancing was lower in conditions of face covering use (other), but that this effect was conditional on situational factors such as effort required to maintain physical distance, and age of the other person [ 29 ], and two found that distancing was greater in the case of face covering use (other) [ 30 ], [ 31 : Study 2].

In contrast, the majority of field experiments (5 of 6) found that physical distancing was either greater or not significantly different in conditions where face coverings were used, compared to conditions where they were not. Two studies found that physical distancing was greater in conditions where face coverings (self or other) were used compared to when they were not [ 31 : Study 1], [ 32 ], with a third study finding that physical distancing was greater in areas where a face covering intervention package had been implemented compared to those where it had not [ 33 ]. One study found mixed effects: face covering use (self) had no effect on distancing, but distancing was greater in conditions of face covering use (other) [ 34 ]. Another study found no differences in distancing between conditions of face covering use (self and other) and conditions without face covering use [ 35 ]. A minority of field experiments (1 of 6) found that physical distancing was lower in conditions of face covering use (other), but that this effect was conditional on gender of participant, race, and social status of confederate (a member of the research team acting as a participant), and face covering policy implemented at the time [ 36 ]. Additionally, three of the above studies also investigated through a natural design whether the effect of face covering use on physical distancing differed between different time periods that varied by the face covering policy (mandatory or voluntary) implemented at the time. One study found that face-covering use by others significantly reduced physical distancing adherence amongst men only, both in mandatory and in voluntary face covering policy contexts; the effect was slightly more pronounced in the mandatory context [ 36 ]. The two other studies found no difference between policy contexts; both found that face covering use (other) increased physical distancing both when it was mandated and when it was voluntary [ 32 , 34 ].

The four natural experiments explored the impact of face covering policy on physical distancing. Three of these found that physical distancing did not significantly differ according to whether face covering wearing was voluntary or mandatory [ 28 : Study 2], [ 34 ], [ 37 : Study 2], while a third found that the impact of face covering policy on physical distancing was dependent on context; attention given to physical distancing decreased when a face covering mandate was introduced on public transport, but increased when the mandate was expanded to bars and restaurants, and again when expanded to all public spaces [ 38 ].

The four observational studies found either a positive or a neutral relationship between face covering use or face covering policy and physical distancing. Three observational studies found no significant relationship between face covering use (self) or face covering policy and physical distancing [ 37 : two studies], [ 39 ], while the fourth observational study found that physical distancing was greater in those who wore face coverings, and also that it was greater when a face covering mandate was implemented [ 40 ].

Four of the six correlational studies found that as self-reported face covering use (self or other) increased, so did self-reported physical distancing [ 41 – 44 ]. One study showed mixed results for the relationship between face covering use and physical distancing, finding that those who reported wearing face coverings all the time were more likely to report adherence to physical distancing compared with those who reported never doing so, but those who reported wearing face coverings sometimes were more likely to report having reduced distancing with people than those who reported never doing so [ 45 ]. The final correlational study found no relationship between face covering use (self) and physical distancing [ 46 ].

3.3 Mobility (see table 2b in S4 Appendix for full details)

Of the 10 natural experiments, five found that when face covering policies were in place mobility increased (i.e., people were less likely to stay at home) [ 47 – 51 ], four found that mobility was unchanged [ 52 – 55 ], and one found that mobility decreased (i.e., people were more likely to stay at home) [ 56 ]. The only lab experiment found that mobility is likely to increase when policies are in place, as participants reported being more willing to use the London Underground when a face covering mandate was in operation [ 57 ].

Of the two cross-sectional studies, one found that self-reported adherence to personal protective behaviours, which included face covering use (self), predicted self-reported frequency of going out in public, and that this relationship was mediated by belief in ‘substitution myths’; the belief that one protective behaviour can be substituted for another, with risk staying constant [ 46 ]. The second cross-sectional study found that those who reported always wearing a face covering outside their home were less likely to report visiting a friend, neighbour, bar or club, compared with those who did not report always wearing a face covering outside their home [ 44 ].

3.4 Face-touching (see table 2c in S4 Appendix for full details)

The only field experiment found that face covering use (self) resulted in less face-touching; there was a significant increase in the number of individuals who touched their eyes or hair when they were not wearing a face covering, and, when investigating areas not covered by a face covering (hair, forehead, eyes, and ears) the absolute number of total touches was significantly higher in those not wearing one [ 58 ]. Two of the six observational studies found similar results; those who wore face coverings were less likely to touch their face [ 59 , 60 ]. Two more observational studies found that results were dependent on the operationalisation of face-touching; when face-touching was defined as making contact with any part of the face (including touches to the mask), there was no significant relationship between face covering use (self) and face-touching, but when it was defined as making contact with specific parts of the face (not including touches to the mask), those who wore face coverings touched their faces less frequently [ 61 : two studies]. A minority of observational studies (1 of 6) found a greater frequency of face-touching in those who wore coverings compared with those who did not [ 62 ]. The final observational study found that face covering policy had no impact on face-touching; there was no statistically significant association between the face covering policy in operation and frequency of face-touching [ 63 ].

3.5 Hand hygiene (see table 2d in S4 Appendix for full details)

The only natural experiment found that face covering policy had no impact on hand hygiene; attention paid to hygiene practices was not significantly different according to the implementation of different face covering policies (38). The three cross-sectional studies found that those who reported wearing face coverings more often were more likely to report also adhering to hand hygiene practices [ 41 , 44 , 45 ].

3.6 Close contacts (see table 2e in S4 Appendix for full details)

One of the two natural experiments found that the number of close contacts a person had was significantly lower when a face covering mandate was expanded from public transport to include restaurants and bars, and lower again when expanded to all public spaces [ 38 ]. The other natural experiment found that a face covering mandate did not affect whether participants cancelled or postponed personal or social activities [ 55 ].

One of the three cross-sectional studies found that the relationship between face covering use (self) and number of close contacts was mixed; those who reported wearing face coverings all the time were more likely to report spending less than 15 minutes in close contact with someone compared with those who reported never wearing face coverings, while those who reported sometimes wearing face coverings were more likely to report spending over 60 minutes in close contact with someone compared with those who reported never doing so [ 45 ]. The second cross-sectional study found that those who did not always wear face coverings were more likely than those who always wore face coverings to have close contact with people they do not live with [ 44 ], whilst the final cross-sectional study found that workers who self-reported wearing a face covering outside of work reported more daily contacts than those who did not wear a mask outside work [ 64 ].

3.7 Generalised protective behaviour (see table 2f in S4 Appendix for full details)

The term ‘generalised protective behaviour’ was used to categorise any studies whose outcome variable was a single measure which encapsulated two or more other COVID-19 protective behaviours besides face covering use e.g., hand washing, physical distancing and staying at home. Two studies examined generalised protective behaviour, and both found that self-reported face covering use (self) was associated with self-reported behaviours that are likely to reduce the spread of COVID-19. In one study the majority of participants reported that their adherence to other protective behaviours was either unchanged or greater when they wore a face covering compared with when they did not [ 65 ], while the other study found that self-reported face covering use (self) was associated with self-reported reduced engagement with COVID-19 related risky behaviour [ 66 ].

3.8 Quality assessment

Few clear patterns were found when analysing the results of studies cross-sectionally by quality. With the exception of face-touching, for all behaviours (physical distancing, mobility, hand hygiene, close contacts and generalised protective behaviour), there was no apparent association between quality of the study and the results. For face-touching, studies were either of a low or medium quality, with all four studies of medium quality finding the same result: a negative effect of (or association with) face covering use. The three studies of low quality were mixed: one found a positive association, one found a negative association, and one found a nonsignificant association.

4. Discussion

Concerns have been raised about the potential impact of face covering use on adherence to other COVID-19 protective behaviours. While several studies that explore this issue have been conducted, they had not previously been brought together in a review. This systematic review has identified and summarised the findings of 47 papers that collectively investigate the effect of face covering use on other COVID-19-related protective behaviours, namely, physical distancing, mobility, face-touching, hand hygiene, close contacts and generalised protective behaviour. Findings showed that results varied considerably, and that the nature of the variation often depended upon the specific behaviour investigated and the type of study employed to investigate it. The sections below, organised by behaviour, summarise and discuss the findings.

4.1 Physical distancing

One of the clearest patterns emerging from the studies relating to physical distancing was the distinction between the respective findings of lab experiments and field experiments. The majority of lab experiments found that physical distancing was lower in conditions of face covering use (compared with conditions without face covering use), whereas the majority of field experiments found that physical distancing was either greater or unchanged in conditions of face covering use.

A number of considerations should be made when interpreting these results, starting with the respective merits of field and lab experiments. There are three main advantages of lab experiments. First, the majority of the lab experiments employed a within-subjects design, meaning that individual differences that may impact physical distancing (e.g., age, gender, risk perception, conscientiousness) are essentially controlled for in a way that cannot be done with between-subjects field experiments [ 67 ] (although estimates of such variables, e.g., age, were in some cases recorded and controlled for in the field experiments). Second, the lab experiments typically allowed for more precision in data collection. The majority of lab experiments used an on-screen slider for participants to indicate their preferred distances, or a virtual reality environment in which computers captured the distances participants maintained from virtual agents. In contrast, some of the field experiments employed human judgement to determine whether a physical distancing guideline had been violated, increasing the risk of bias. However, four of the six field experiments used some form of electronic sensor to collect data (all of which found that physical distancing was greater or unchanged in conditions of face covering use). Third, lab experiments are able to examine the impact of face covering use on physical distancing in a context which is agnostic of face covering policy (mandatory vs voluntary), in contrast to field experiments which are necessarily conducted under periods of either mandatory or voluntary face covering wear (the potential for an interaction between face covering use and face covering policy is discussed in more detail in subsection 4.7).

However, whilst field experiments are less controlled than lab experiments, they are more ecologically valid [ 68 ]. A key advantage of field experiments compared to lab experiments is that the disease transmission risk is real, not hypothetical; therefore, a person’s approach to physical distancing has a real impact on their own risk and on others’ risk of contracting and spreading COVID-19. In all but one of the six field experiments not only were participants blinded to the experimental condition they were assigned to, but they were also unaware that they were taking part in an experiment at all, and so responses were unlikely to be biased by, for example, demand characteristics. Behaviour captured in field experiments may therefore be more representative of, and generalisable to, wider populations than that collected during lab experiments, in which participants could second-guess research objectives, potentially causing demand effects [ 67 ]. Additionally, in the majority of lab experiments, rather than being measured for actual behaviour, participants were asked to indicate distances they would prefer from the avatars or characters, allowing them to make a conscious decision which may or may not be indicative of how they might behave in real-life scenarios.

In addition to the lab and field experiments, the effect of face covering use on physical distancing was also investigated through a number of different methodologies; the majority of natural and observational studies tended not to find any significant associations between face covering use (or face covering policy) and physical distancing, and cross-sectional studies tended to find positive associations between self-reported face covering-wearing and physical distancing. These different study types also have their respective strengths and weaknesses that should be considered when interpreting the results. The observational studies are necessarily high in ecological validity, however, are less controlled [ 69 ]. As such, the means of measurement (human judgement) may be lacking in precision and subject to bias, and furthermore, only claims of association (and not causality) can be made [ 70 ]. For example, it is likely that relationships between face covering wearing and physical distancing are driven by confounding variables (e.g., risk perception, age, conscientiousness) impacting both behaviours. The natural experiments, though again high in validity, are types of observational studies and so are subject to the same qualifications. Cross-sectional studies are also unable to draw claims of causality due to the likely impact of confounding variables [ 70 ] and may also be limited in their precision since measures are self-reported and not necessarily indicative of real-life behaviour [ 17 ].

A final consideration that should be made when interpreting the results is to consider the nature of the intervention in each case. Specifically, consideration should be given to: whether the independent variable (IV) is face covering condition of the self, face covering condition of another person, face covering policy, or some combination of any of the three; and the way in which physical distancing is operationalised in each case. Whilst there is no clear pattern with regards to how these different interventions and operationalisations of distancing impact outcomes, it is important to consider such differences when interpreting findings. Overall, it is clear that there is no consensus in relation to the impact of face covering use on physical distancing. Further research is therefore required to bring the merits of different study types together and capture more reliable, and perhaps more consistent, findings with regards to the effect of face covering use on physical distancing.

4.2 Mobility

The findings on mobility are also inconclusive, although there is more evidence to suggest that face covering policies increase mobility than there is to suggest that they decrease mobility. Natural experiments tended to compare changes in mobility from a baseline between areas and periods of time that varied according to the face covering policy implemented. The findings arising from such studies are therefore likely to be confounded by any number of other variables which are likely to impact upon mobility (e.g., other COVID-19 public health measures, rate of infection at time/area of data collection) and claims of causality must be made with caution. Generally speaking, however, these studies employ rich data sources and complex statistical models to account for these variables as far as is possible, and so conclusions made from these studies can be arrived at with a certain level of confidence. If it is the case that implementing face covering policies increases mobility, a plausible explanation may be that a mandate instils confidence in people that if they are to leave home others are more likely to wear a face covering, leading to a greater sense of security; this is therefore a potential example of the Peltzman Effect [ 4 ]. Further qualitative work could be conducted to investigate how face covering policies impact upon people’s decision to leave home and move around their communities.

Two cross-sectional self-report studies which investigated how face covering use by the self impacted mobility were inconclusive, with relationships found in both directions [ 44 , 46 ]. Interestingly however, in one case it was found that a positive relationship between self-reported adherence to personal protective behaviour (including wearing a face covering) and going out in public with people outside ones’ household was mediated by a belief that one protective behaviour can be safely substituted for another [ 46 ], providing evidence in favour of the risk compensation hypothesis.

4.3 Face-touching

The impact of face covering use on face-touching was the most consistent of all the behavioural outcomes, with a general trend for face-touching to be lower in conditions of face covering use than in conditions without. This result was found in a field experiment [ 58 ] and four of six observational studies investigating the relationship between face covering use by the self and face-touching [ 59 , 60 ], [ 61 : two studies]. Whilst observational studies are subject to the same caveats described in the physical distancing subsection the general pattern of a negative relationship between face touching and face covering use suggests that even if risk compensation is at play, it is not strong enough to result in a positive relationship. Furthermore, that this pattern is corroborated by the experimental study boosts the claim that face covering use might reduce face touching behaviour. Additionally, all of the relatively higher-quality studies investigating face-touching (which were all of a medium, as opposed to a low quality) found face covering use to have a negative effect on (or a negative association with) face-touching. It should however be noted that different operationalisations of face-touching were employed across face-touching studies, and that in cases where significant effects or associations were found, they did not always apply to all parts of the face. Further research using experimental designs is required in this area, but on the basis of the studies reviewed to date, it seems reasonable to conclude that face covering use reduces instances of face-touching.

4.4 Hand hygiene

Across four studies (one natural experiment and three cross-sectional studies), three studies found a positive relationship between either face-covering use or face-covering policy and hand hygiene practices and a fourth found no significant relationship. The three studies which found positive relationships were cross-sectional [ 41 , 44 , 46 ] and based on self-report surveys; findings therefore show that those who report wearing face coverings are more likely to also report practicing good hand hygiene, but the cross-sectional nature of the studies means a causal relationship cannot be established. Furthermore, these studies can only inform us on how the isolated practices of wearing a face covering and practising hand hygiene relate to one another and cannot tell us whether hand hygiene is affected whilst wearing a face covering. The natural experiment [ 38 ], which employed face covering policies as an IV and found no significant effect on self-reported attention paid to hygiene practices may be more informative, suggesting that implementing a face covering mandate has no ‘collateral’ effect on hand hygiene practices. It should be noted however that the natural experiment is also subject to the caveats around accuracy associated with self-report data. In summary, the literature on the effect of face covering use on hand hygiene is limited and relies on self-report data, possibly because hand hygiene is a relatively private practice that is difficult to investigate using an experimental or observational design. On the basis of the literature reviewed however, it can be said that there is no evidence thus far to suggest that face covering use causes a reduction in hand hygiene practices.

4.5 Close contacts

There was little consensus in the literature on close contacts. Across two natural experiments, it was found that face covering mandates either had no effect on close contacts, or that they reduced them [ 38 , 55 ]. Across three cross-sectional studies the results were mixed with both positive and negative relationships found [ 44 , 45 , 64 ]. It is therefore difficult to draw robust conclusions about the impact of face covering use on close contacts.

4.6 Generalised protective behaviour

Two cross-sectional studies [ 65 , 66 ] investigated the relationship between face covering use by the self and generalised adherence to other protective behaviours and found a relationship between face covering use and increased adherence to other protective behaviours (or reduced undertaking of risky behaviours). As previously discussed, cross-sectional studies do not allow for claims of causality to be made, and confounding variables are likely to influence any relationships.

4.7 Risk compensation outcomes under different policies

An area for consideration is whether risk compensation behaviour varies according to whether face covering use is voluntary or mandatory. For example, it might be expected that when face covering use is voluntary, there is a stronger relationship between face covering use (i.e., self-selected face covering use) and adherence to other protective behaviours given that the decision to wear a face covering is more likely to be driven by one’s own risk perception rather than the extrinsic factor of the mandatory face covering policy. Equally, when face covering use is voluntary, their use may serve as a stronger social signal as to the preferences or condition of the person using them since others know that they are doing so despite the lack of a mandate. For example, voluntary use may signal that the user is particularly risk-averse and therefore others may be more likely to keep their distance out of consideration and respect. Alternatively, voluntary use may signal that the user is more likely to be infectious, and so others may be more likely to keep their distance for self-protective reasons.

In the present review, only three included studies [ 32 , 34 , 36 ] compared the effect of face covering use across different face covering policies (mandatory or voluntary) and only through a natural design and for one protective behaviour (physical distancing). In all three studies, the effect of face covering use by others on physical distancing adherence was not influenced by policy context, although in one study the effect was reportedly slightly more pronounced in the mandatory than in the voluntary context. There were also 17 studies in which, although the authors did not assess impact of face covering policy, they did provide information on the real-world policy implemented during the time of study; that is whether face covering use was mandatory, voluntary or whether the policy was varied (i.e., that for some of the duration of the study it was mandatory, and for some of the time it was voluntary). Of the 17, thirteen studies focused on physical distancing (five carried out in a mandatory face covering context, six in a voluntary face covering context, and two in contexts where the policy varied between the two) and results across studies were mixed in all three contexts [ 28 : two studies, 29 , 31 : two studies, 33 , 35 , 37 , 40 , 41 , 44 – 46 ]. Two focused on mobility, and in both cases face covering use was voluntary but a positive association was found in one [ 46 ] and a negative association in the other [ 44 ]. There were three studies focused on face-touching [ 58 , 59 , 61 : study two] and three on hand hygiene [ 41 , 44 , 45 ]. For both protective behaviours face covering policy varied across studies but the face-touching studies all reported negative effects or associations and the hand hygiene studies all reported positive effects or associations. Two studies were focused on close contacts, one of which was conducted under mandated face covering use and found the association to be equivocal [ 45 ], and one of which was conducted when face covering use was voluntary and found the association to be negative [ 44 ]. A final study that focused on generalised protective behaviour was conducted under varied policies and found a positive association [ 65 ].

It is difficult to draw robust conclusions about any interaction between face covering use and face covering policy from studies included in this review. A particular limitation of the literature is that no study to date has applied type of face covering policy (mandatory or voluntary) as an independent variable to assess its interaction with face covering use on risk compensation for other protective behaviours. This is an evidence gap that should be addressed in future research.

4.8 Limitations

This review is novel in drawing together current literature on the impact of face covering use on other protective behaviours during the COVID-19 pandemic and contributing to an understanding of risk compensation in this context. However, some limitations should be acknowledged when considering this review’s findings. First, despite every attempt to apply the inclusion and exclusion criteria systematically and objectively, it is likely that some level of subjectivity may have impacted on paper screening and selection. To mitigate against this, 10% of the title and abstract screening was undertaken by two researchers, and any disagreements resolved by discussion and consensus. The full-text screening was also checked by a second researcher. Second, due to resource constraints (namely, the linguistic limitations of the researchers), only papers published in English were included in the review, inevitably creating a geographical bias. For example, 32 of the 47 papers described studies carried out in the UK, Western Europe, Canada, North America, or Australia. An additional consideration relates to the potential to conduct a meta-analysis of the included studies. Given the heterogeneity of the included studies (both in terms of clinical heterogeneity and methodological heterogeneity), a decision was taken not to carry out a meta-analysis. This is in line with Cochrane guidance on heterogeneity within meta-analysis, which states that meta-analysis should only be undertaken if studies are considered to be sufficiently similar to ensure a meaningful outcome and avoid drawing potentially misleading conclusions. However, as further research is conducted in this area, potentially resulting in more clinically and methodologically similar studies, future studies could build on this review by carrying out a meta-analysis.

4.9 Conclusion

Overall, findings relating to the impact of face covering use or policy on other protective behaviours are inconsistent, varying both according to the particular behaviour in question, and by study type. For some behavioural outcomes, it is possible to draw tentative conclusions regarding the impact of face coverings on behaviour. For example, evidence suggests that wearing a face covering reduces the amount that an individual touches their face; face coverings may therefore have a positive impact on face touching behaviours. Conversely, evidence suggests that the introduction of face mask mandates may increase mobility; face coverings may therefore have a negative impact on mobility-related behaviours. Some studies suggest that there may be a relationship between wearing a face covering and other protective behaviours (such as increased hand hygiene). However, these studies are predominately cross-sectional and rely on self-report measures; they therefore do not allow conclusions to be drawn about the impact of face covering use on adherence to these behaviours. Evidence relating to the impact of face covering use on physical distancing and close contacts is mixed. Findings are particularly inconsistent in relation to physical distancing, with considerable discrepancy found between study types. Whilst assessments of behaviour in real-life settings tend to find that face covering use either increases or has no impact upon physical distancing, lab experiments tend to suggest that physical distancing decreases in conditions of face covering use. There is some suggestion that the impact of face covering use on physical distancing could be affected by whether or not mandatory face covering policies are in effect (which would indicate that conclusions drawn from a voluntary context should not be directly applied to a mandatory context and vice versa) but further assessment of this potential moderating effect is warranted. Evidence relating to the potential impact of risk compensation is also inconsistent; while some studies suggest risk compensation may play a role in shaping behaviour, others suggest it has no impact.

Overall, this review highlights that the impact of face covering use on other protective behaviours is likely to vary based on the behaviour under investigation. While for some behaviours the evidence suggests a positive impact (e.g., face coverings may result in reduced face touching), for other behaviours the evidence suggests a negative impact (e.g., increased mobility), or provides no clear consensus (e.g., physical distancing, close contacts, and adherence to other protective behaviours). There are two key recommendations that can be made from this review: 1) further research, using more robust research designs, is needed to establish whether face covering use affects different types of protective behaviours; and 2) any policy decisions made in relation to recommended or mandatory face covering use must take into account the inconsistencies and caveats in the evidence base, recognising that current evidence does not allow firm conclusions to be drawn about the potential impact of face covering use on adherence to other protective behaviours. Recommendations for future research are summarised below.

4.9.1 Recommendations for future research.

• Differing effects of face covering use by the self and face covering use by another person
• How different face covering policies might moderate the relationship between face covering use and physical distancing. For example, a field experiment could be conducted whereby two manipulations occur; one whereby the setting varies according to the face covering policy implemented (mandatory or voluntary), and one whereby a confederate appears either wearing or not wearing a face covering. Physical distancing from the confederate would then be measured. This would allow for the direct comparison between the moderating effects of voluntary and mandatory settings with more control over extraneous factors.
• How effects might vary according to the operationalisation of distancing; for example, whether the absolute distance is measured, or whether a binary variable capturing whether or not a particular distance or guideline is adhered to is captured
• Lab experiments replicating those cited in this review, but that vary by the framing of physical distancing (i.e., self-protective or prosocial)
• Qualitative research investigating how differing face covering policies affect attitudes towards leaving the home and moving around the community
• Experimental studies, including lab, natural, or field experiments, investigating the effect of face covering use and face covering policies on face-touching, hand hygiene and close contacts

Supporting information

S1 appendix. protocol..

https://doi.org/10.1371/journal.pone.0284629.s001

S2 Appendix. Search strategies.

https://doi.org/10.1371/journal.pone.0284629.s002

S3 Appendix. Quality criteria checklist.

https://doi.org/10.1371/journal.pone.0284629.s003

S4 Appendix. Data extraction tables.

https://doi.org/10.1371/journal.pone.0284629.s004

S5 Appendix. PRISMA 2020 checklist.

https://doi.org/10.1371/journal.pone.0284629.s005

S6 Appendix. PRISMA 2020 abstract checklist.

https://doi.org/10.1371/journal.pone.0284629.s006

Acknowledgments

The authors thank Dr Joanna Milward for contributing to the development of the protocol and search terms, Nicola Pearce-Smith for creating the search strategies and running the searches themselves, as well as providing guidance on screening, and Megan Phillips for contributing to the quality appraisal as a second reviewer.

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Does nothing stop a bullet like a job? The effects of income on crime

Do jobs and income-transfer programs affect crime? The answer depends on why one is asking the question, which shapes what one means by “crime.” Many studies focus on understanding why overall crime rates vary across people, places, and time; since 80% of all crimes are property offenses, that’s what this type of research typically explains. But if the goal is to understand what to do about the crime problem, the focus will instead be on serious violent crimes, which account for the majority of the social costs of crime. The best available evidence suggests that policies that reduce economic desperation reduce property crime (and hence overall crime rates) but have little systematic relationship to violent crime. The difference in impacts surely stems in large part from the fact that most violent crimes, including murder, are not crimes of profit but rather crimes of passion – including rage. Policies to alleviate material hardship, as important and useful as those are for improving people’s lives and well-being, are not by themselves sufficient to also substantially alleviate the burden of crime on society.

When citing this paper, please use the following: “Ludwig, J, Schnepel, K. 2024. Does nothing stop a bullet like a job? The effects of income on crime. Annual Review of Criminology. Submitted.” Thanks to Shawn Bushway, Jillian Carr, Aaron Chalfin and Philip Cook for helpful comments, and to Maggi Ibis, Javier Lopez, Biz Rasich and Alejandro Roemer for outstanding assistance. All opinions and any errors are of course our own. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

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The physical sensations of watching a total solar eclipse

Regina G. Barber

Science writer David Baron witnesses his first total solar eclipse in Aruba, 1998. He says seeing one is "like you've left the solar system and are looking back from some other world." Paul Myers hide caption

Science writer David Baron witnesses his first total solar eclipse in Aruba, 1998. He says seeing one is "like you've left the solar system and are looking back from some other world."

David Baron can pinpoint the first time he got addicted to chasing total solar eclipses, when the moon completely covers up the sun. It was 1998 and he was on the Caribbean island of Aruba. "It changed my life. It was the most spectacular thing I'd ever seen," he says.

Baron, author of the 2017 book American Eclipse: A Nation's Epic Race to Catch the Shadow of the Moon and Win the Glory of the World , wants others to witness its majesty too. On April 8, millions of people across North America will get that chance — a total solar eclipse will appear in the sky. Baron promises it will be a surreal, otherworldly experience. "It's like you've left the solar system and are looking back from some other world."

Baron, who is a former NPR science reporter, talks to Life Kit about what to expect when viewing a total solar eclipse, including the sensations you may feel and the strange lighting effects in the sky. This interview has been edited for length and clarity.

Baron views the beginning of a solar eclipse with friends in Western Australia in 2023. Baron says getting to see the solar corona during a total eclipse is "the most dazzling sight in the heavens." Photographs by David Baron; Bronson Arcuri, Kara Frame, CJ Riculan/NPR; Collage by Becky Harlan/NPR hide caption

Baron views the beginning of a solar eclipse with friends in Western Australia in 2023. Baron says getting to see the solar corona during a total eclipse is "the most dazzling sight in the heavens."

What does it feel like to experience a total solar eclipse — those few precious minutes when the moon completely covers up the sun?

It is beautiful and absolutely magnificent. It comes on all of a sudden. As soon as the moon blocks the last rays of the sun, you're plunged into this weird twilight in the middle of the day. You look up and the blue sky has been torn away. On any given day, the blue sky overhead acts as a screen that keeps us from seeing what's in space. And suddenly that's gone. So you can look into the middle of the solar system and see the sun and the planets together.

Can you tell me about the sounds and the emotions you're feeling?

A total solar eclipse is so much more than something you just see with your eyes. It's something you experience with your whole body. [With the drop in sunlight], birds will be going crazy. Crickets may be chirping. If you're around other people, they're going to be screaming and crying [with all their emotions from seeing the eclipse]. The air temperature drops because the sunlight suddenly turns off. And you're immersed in the moon's shadow. It doesn't feel real.

Everything you need to know about solar eclipse glasses before April 8

In your 2017 Ted Talk , you said you felt like your eyesight was failing in the moments before totality. Can you go into that a little more?

The lighting effects are very weird. Before you get to the total eclipse, you have a progressive partial eclipse as the moon slowly covers the sun. So over the course of an hour [or so], the sunlight will be very slowly dimming. It's as if you're in a room in a house and someone is very slowly turning down the dimmer switch. For most of that time your eyes are adjusting and you don't notice it. But then there's a point at which the light's getting so dim that your eyes can't adjust, and weird things happen. Your eyes are less able to see color. It's as if the landscape is losing its color. Also there's an effect where the shadows get very strange.

Crescent-shaped shadows cast by the solar eclipse before it reaches totality appear on a board at an eclipse-viewing event in Antelope, Ore., 2017. Kara Frame and CJ Riculan/NPR hide caption

You see these crescents on the ground.

There are two things that happen. One is if you look under a tree, the spaces between leaves or branches will act as pinhole projectors. So you'll see tiny little crescents everywhere. But there's another effect. As the sun goes from this big orb in the sky to something much smaller, shadows grow sharper. As you're nearing the total eclipse, if you have the sun behind you and you look at your shadow on the ground, you might see individual hairs on your head. It's just very odd.

Some people might say that seeing the partial eclipse is just as good. They don't need to go to the path of totality.

A partial solar eclipse is a very interesting experience. If you're in an area where you see a deep partial eclipse, the sun will become a crescent like the moon. You can only look at it with eye protection. Don't look at it with the naked eye . The light can get eerie. It's fun, but it is not a thousandth as good as a total eclipse.

A total eclipse is a fundamentally different experience, because it's only when the moon completely blocks the sun that you can actually take off the eclipse glasses and look with the naked eye at the sun.

And you will see a sun you've never seen before. That bright surface is gone. What you're actually looking at is the sun's outer atmosphere, the solar corona. It's the most dazzling sight in the heavens. It's this beautiful textured thing. It looks sort of like a wreath or a crown made out of tinsel or strands of silk. It shimmers in space. The shape is constantly changing. And you will only see that if you're in the path of the total eclipse.

Shots - Health News

Watching a solar eclipse without the right filters can cause eye damage. here's why.

So looking at a partial eclipse is not the same?

It is not at all the same. Drive those few miles. Get into the path of totality.

This is really your chance to see a total eclipse. The next one isn't happening across the U.S. for another 20 years.

The next significant total solar eclipse in the United States won't be until 2045. That one will go from California to Florida and will cross my home state of Colorado. I've got it on my calendar.

The digital story was written by Malaka Gharib and edited by Sylvie Douglis and Meghan Keane. The visual editor is Beck Harlan. We'd love to hear from you. Leave us a voicemail at 202-216-9823, or email us at [email protected].

Listen to Life Kit on Apple Podcasts and Spotify , and sign up for our newsletter .

NPR will be sharing highlights here from across the NPR Network throughout the day Monday if you're unable to get out and see it in real time.

Correction April 3, 2024

In a previous audio version of this story, we made reference to an upcoming 2025 total solar eclipse. The solar eclipse in question will take place in 2045.

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CDC Redacted Study on Myocarditis After COVID-19 Vaccination?

The redacted document, released as part of a foia request, was not a study., anna rascouët-paz, published april 8, 2024.

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In April 2024, a rumor circulated claiming that the U.S. Centers for Disease Control and Prevention had released a 148-page, completely redacted study the previous month on myocarditis following COVID-19 mRNA vaccination. One user shared the claim without context on X (formerly Twitter), garnering more than 18,000 views:

Another X user  linked to a YouTube video of "The Jimmy Dore Show," posted at the end of March 2024, which discussed the topic at length and had received 13,000 likes and 124,000 views:

This YouTube channel had 1.34 million subscribers at the time of this writing.

The document had been the subject of discussions during a hearing of the Novel Coronavirus Southwestern Intergovernmental Committee on March 15, 2024, which was  livestreamed . 

"One hundred and forty eight pages," said Arizona state Sen. Janae Shamp as she held up blank pages during the hearing. "The entire thing is redacted. What good does a study do if there's nothing there?"

Peter McCullough, a cardiologist who contributed to the spread of misinformation during the COVID-19 pandemic, also was at the hearing. "We're witnessing an active cover-up of a colossal consumer safety debacle that is basically affecting the entire world," he said. He then accused the CDC and the FDA, as well as the U.K., European and Australian medicine regulation agencies, of being complicit in this alleged cover-up. 

As we will demonstrate below, the redacted document was not in any sense a "study."

A clip of the intergovernmental committee's hearing was shared on X  ( archived ) on March 18, 2024, and was viewed 4 million times and amplified more than 20,000 times.

The CDC's Redacted Pages

The CDC did release 148 redacted pages following a Freedom of Information Act request by The Epoch Times concerning "MOVING" (Myocarditis outcomes after mRNA COVID-19 vaccination) surveys. These pages, however, were not a study. Zachary Stieber, the Epoch Times reporter who made the FOIA request, posted on X that he had noticed "confusion" about the document: 

The post ( archived ) to which he replied included the 148 blank pages. Clicking on the linked document and zooming in, a small inscription appears in the upper left corner of the first page: 

The inscription (b)(5), seen above, is repeated on every page of the document. This refers to information that is exempted from FOIA requests. According to the U.S. Justice Department :

Exemption 5 of the FOIA protects "inter-agency or intra-agency memorandums or letters which would not be available by law to a party other than an agency in litigation with the agency."

This detail confirms that the 148 redacted pages did not constitute a study, but were instead communications within the CDC or between the CDC and other agencies. We contacted the CDC asking for more details on the reason for the redaction and will update this story if we receive an answer.

Stieber, in his post, added that the CDC team in charge of studying myocarditis outcomes following COVID-19 vaccinations has already shared several studies on the topic. He links to one of them, published in 2022 in The Lancet, which concludes :

After at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination, most individuals in our cohort were considered recovered by health-care providers, and quality of life measures were comparable to those in pre-pandemic and early pandemic populations of a similar age. 

The paper also recommends further study into the topic.

More Studies on Myocarditis Outcomes After COVID-19 mRNA Vaccine

The CDC and other research institutions have indeed released several studies on the link between the COVID-19 vaccine and both myocarditis, which is an inflammation of the heart muscle, and pericarditis, which is an inflammation of the thin tissue that lines the heart. The CDC website links to 10 studies on myocarditis after the vaccine carried out between 2021 and 2022. As Stieber indicated in his post, the MOVING team told him it plans to publish another study with updated findings.

Several studies found that while myocarditis and pericarditis can follow mRNA vaccination, the data show vaccination protects against complications. For example, a study from Germany showed that the risk of dying from myocarditis from a COVID-19 infection is much higher than the risk of dying from myocarditis not caused by COVID-19. 

Bemtgen, Xavier, et al. 'Myocarditis Mortality with and without COVID-19: Insights from a National Registry'. Clinical Research in Cardiology , vol. 113, no. 2, 2024, pp. 216–22. PubMed Central , https://doi.org/10.1007/s00392-022-02141-9.

Kracalik, Ian, et al. ' Ian Kracalik, PhD   • Matthew E Oster, MD • Karen R Broder, MD • Margaret M Cortese, MD • Maleeka Glover, ScD • Karen Shields, BS • et al. Show All Authors Published:September 21, 2022•DOI:Https://Doi.Org/10.1016/S2352-4642(22)00244-9• PlumX Metrics'. The Lancet , vol. 6, no. 11, Nov. 2022, pp. 788–99, https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00244-9/fulltext.

Office of Information Policy | FOIA Guide, 2004 Edition: Exemption 5 . 23 July 2014, https://www.justice.gov/archives/oip/foia-guide-2004-edition-exemption-5.

Vaccine Safety Publications | Research | Vaccine Safety | CDC . 27 Feb. 2024, https://www.cdc.gov/vaccinesafety/research/publications/index.html.

Video Player . https://www.azleg.gov/videoplayer/?clientID=6361162879&eventID=2024031052. Accessed 22 Mar. 2024.

By Anna Rascouët-Paz

Anna Rascouët-Paz is based in Brooklyn, fluent in numerous languages and specializes in science and economic topics.

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