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

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

• inequalities

Data availability statement

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

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

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

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Introduction

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

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

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

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

Social networks

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

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

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

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

Social support

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

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

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

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

Social and interactional norms

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

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

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

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

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

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

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

Recommendations and conclusions

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

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

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

Recommendation 2: intelligently balance online and offline ways of relating

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

Recommendation 3: build stronger and sustainable localised communities

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

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

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

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

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

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

Read the full text or download the PDF:

Coronavirus disease 2019 (COVID-19): A literature review

Affiliations.

• 1 Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. Electronic address: [email protected].
• 2 Division of Infectious Diseases, AichiCancer Center Hospital, Chikusa-ku Nagoya, Japan. Electronic address: [email protected].
• 3 Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. Electronic address: [email protected].
• 4 Department of Pulmonology and Respiratory Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. Electronic address: [email protected].
• 5 School of Medicine, The University of Western Australia, Perth, Australia. Electronic address: [email protected].
• 6 Siem Reap Provincial Health Department, Ministry of Health, Siem Reap, Cambodia. Electronic address: [email protected].
• 7 Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Warmadewa University, Denpasar, Indonesia; Department of Medical Microbiology and Immunology, University of California, Davis, CA, USA. Electronic address: [email protected].
• 8 Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Department of Clinical Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. Electronic address: [email protected].
• 9 Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, MI 48109, USA. Electronic address: [email protected].
• 10 Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. Electronic address: [email protected].
• PMID: 32340833
• PMCID: PMC7142680
• DOI: 10.1016/j.jiph.2020.03.019

In early December 2019, an outbreak of coronavirus disease 2019 (COVID-19), caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), occurred in Wuhan City, Hubei Province, China. On January 30, 2020 the World Health Organization declared the outbreak as a Public Health Emergency of International Concern. As of February 14, 2020, 49,053 laboratory-confirmed and 1,381 deaths have been reported globally. Perceived risk of acquiring disease has led many governments to institute a variety of control measures. We conducted a literature review of publicly available information to summarize knowledge about the pathogen and the current epidemic. In this literature review, the causative agent, pathogenesis and immune responses, epidemiology, diagnosis, treatment and management of the disease, control and preventions strategies are all reviewed.

Keywords: 2019-nCoV; COVID-19; Novel coronavirus; Outbreak; SARS-CoV-2.

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

Publication types

• Betacoronavirus
• Clinical Trials as Topic
• Coronavirus Infections* / epidemiology
• Coronavirus Infections* / immunology
• Coronavirus Infections* / therapy
• Coronavirus Infections* / virology
• Disease Outbreaks* / prevention & control
• Pneumonia, Viral* / epidemiology
• Pneumonia, Viral* / immunology
• Pneumonia, Viral* / therapy
• Pneumonia, Viral* / virology

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Open Access

Peer-reviewed

Research Article

The challenges arising from the COVID-19 pandemic and the way people deal with them. A qualitative longitudinal study

Contributed equally to this work with: Dominika Maison, Diana Jaworska, Dominika Adamczyk, Daria Affeltowicz

Roles Conceptualization, Funding acquisition, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing

Affiliation Faculty of Psychology, University of Warsaw, Warsaw, Poland

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

Roles Conceptualization, Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Roles Conceptualization, Formal analysis, Investigation, Methodology

• Dominika Maison, 
• Diana Jaworska, 
• Dominika Adamczyk, 
• Daria Affeltowicz

• Published: October 11, 2021
• https://doi.org/10.1371/journal.pone.0258133
• Peer Review
• Reader Comments

The conducted qualitative research was aimed at capturing the biggest challenges related to the beginning of the COVID-19 pandemic. The interviews were carried out in March-June (five stages of the research) and in October (the 6 th stage of the research). A total of 115 in-depth individual interviews were conducted online with 20 respondents, in 6 stages. The results of the analysis showed that for all respondents the greatest challenges and the source of the greatest suffering were: a) limitation of direct contact with people; b) restrictions on movement and travel; c) necessary changes in active lifestyle; d) boredom and monotony; and e) uncertainty about the future.

Citation: Maison D, Jaworska D, Adamczyk D, Affeltowicz D (2021) The challenges arising from the COVID-19 pandemic and the way people deal with them. A qualitative longitudinal study. PLoS ONE 16(10): e0258133. https://doi.org/10.1371/journal.pone.0258133

Editor: Shah Md Atiqul Haq, Shahjalal University of Science and Technology, BANGLADESH

Received: April 6, 2021; Accepted: September 18, 2021; Published: October 11, 2021

Copyright: © 2021 Maison 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 relevant data are within the manuscript and its Supporting Information files ( S1 Dataset ).

Funding: This work was supported by the Faculty of Psychology, University of Warsaw, Poland from the funds awarded by the Ministry of Science and Higher Education in the form of a subsidy for the maintenance and development of research potential in 2020 (501-D125-01-1250000). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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

Introduction

The coronavirus disease (COVID-19), discovered in December 2019 in China, has reached the level of a pandemic and, till June 2021, it has affected more than 171 million people worldwide and caused more than 3.5 million deaths all over the world [ 1 ]. The COVID-19 pandemic as a major health crisis has caught the attention of many researchers, which has led to the creation of a broad quantitative picture of human behavior during the coronavirus outbreak [ 2 – 4 ]. What has been established so far is, among others, the psychological symptoms that can occur as a result of lockdown [ 2 ], and the most common coping strategies [ 5 ]. However, what we still miss is an in-depth understanding of the changes in the ways of coping with challenges over different stages of the pandemic. In the following study, we used a longitudinal qualitative method to investigate the challenges during the different waves of the coronavirus pandemic as well as the coping mechanisms accompanying them.

In Poland, the first patient was diagnosed with COVID-19 on the 4 th March 2020. Since then, the number of confirmed cases has grown to more than 2.8 million and the number of deaths to more than 73,000 (June 2021) [ 1 ]. From mid-March 2020, the Polish government, similarly to many other countries, began to introduce a number of restrictions to limit the spread of the virus. These restrictions had been changing from week to week, causing diverse reactions in people [ 6 ]. It needs to be noted that the reactions to such a dynamic situation cannot be covered by a single study. Therefore, in our study we used qualitative longitudinal research in order to monitor changes in people’s emotions, attitudes, and behavior. So far, few longitudinal studies have been carried out that investigated the various issues related to the COVID-19 pandemic; however, all of them were quantitative [ 7 – 10 ]. The qualitative approach (and especially the use of enabling and projective techniques) allows for an in-depth exploration of respondents’ reactions that goes beyond respondents’ declarations and captures what they are less aware of or even unconscious of. This study consisted of six stages of interviews that were conducted at key moments for the development of the pandemic situation in Poland. The first stage of the study was carried out at the moment of the most severe lockdown and the biggest restrictions (March 2020) and was focused on exploration how did people react to the new uncertain situation. The second stage of the study was conducted at the time when restrictions were extended and the obligation to cover the mouth and nose everywhere outside the household were introduced (middle of April 2020) and was focused at the way how did people deal with the lack of family gatherings over Easter. The third stage of the study was conducted at the moment of announcing the four stages of lifting the restrictions (April 2020) and was focused on people’s reaction to an emerging vision of getting back to normalcy. The fourth stage of the study was carried out, after the introduction of the second stage of lifting the restrictions: shopping malls, hotels, and cultural institutions were gradually being opened (May 2020). The fifth stage of the study was conducted after all four stages of restriction lifting were in place (June 2020). Only the obligation to cover the mouth and nose in public spaces, an order to maintain social distance, as well as the functioning of public places under a sanitary regime were still in effect. During those 5 stages coping strategies with the changes in restrictions were explored. The sixth and last stage of the study was a return to the respondents after a longer break, at the turn of October and November 2020, when the number of coronavirus cases in Poland began to increase rapidly and the media declared “the second wave of the pandemic”. It was the moment when the restrictions were gradually being reintroduced. A full description of the changes occurring in Poland at the time of the study can be found in S1 Table .

The following study is the first qualitative longitudinal study investigating how people cope with the challenges arising from the COVID-19 pandemic at its different stages. The study, although conducted in Poland, shows the universal psychological relations between the challenges posed by the pandemic (and, even more, the restrictions resulting from the pandemic, which were very similar across different countries, not only European) and the ways of dealing with them.

Literature review

The COVID-19 pandemic has led to a global health crisis with severe economic [ 11 ], social [ 3 ], and psychological consequences [ 4 ]. Despite the fact that there were multiple crises in recent years, such as natural disasters, economic crises, and even epidemics, the coronavirus pandemic is the first in 100 years to severely affect the entire world. The economic effects of the COVID-19 pandemic concern an impending global recession caused by the lockdown of non-essential industries and the disruption of production and supply chains [ 11 ]. Social consequences may be visible in many areas, such as the rise in family violence [ 3 ], the ineffectiveness of remote education, and increased food insecurity among impoverished families due to school closures [ 12 ]. According to some experts, the psychological consequences of COVID-19 are the ones that may persist for the longest and lead to a global mental health crisis [ 13 ]. The coronavirus outbreak is generating increased depressive symptoms, stress, anxiety, insomnia, denial, fear, and anger all over the world [ 2 , 14 ]. The economic, social, and psychological problems that people are currently facing are the consequences of novel challenges that have been posed by the pandemic.

The coronavirus outbreak is a novel, uncharted situation that has shaken the world and completely changed the everyday lives of many individuals. Due to the social distancing policy, many people have switched to remote work—in Poland, almost 75% of white-collar workers were fully or partially working from home from mid-March until the end of May 2020 [ 15 ]. School closures and remote learning imposed a new obligation on parents of supervising education, especially with younger children [ 16 ]. What is more, the government order of self-isolation forced people to spend almost all their time at home and limit or completely abandon human encounters. In addition, the deteriorating economic situation was the cause of financial hardship for many people. All these difficulties and challenges arose in the aura of a new, contagious disease with unexplored, long-lasting health effects and not fully known infectivity and lethality [ 17 ]. Dealing with the situation was not facilitated by the phenomenon of global misinformation, called by some experts as the “infodemic”, which may be defined as an overabundance of information that makes it difficult for people to find trustworthy sources and reliable guidance [ 18 ]. Studies have shown that people have multiple ways of reacting to a crisis: from radical and even violent practices, towards individual solutions and depression [ 19 ]. Not only the challenges arising from the COVID-19 pandemic but also the ways of reacting to it and coping with it are issues of paramount importance that are worth investigating.

The reactions to unusual crisis situations may be dependent on dispositional factors, such as trait anxiety or perceived control [ 20 , 21 ]. A study on reactions to Hurricane Hugo has shown that people with higher trait anxiety are more likely to develop posttraumatic symptoms following a natural disaster [ 20 ]. Moreover, lack of perceived control was shown to be positively related to the level of distress during an earthquake in Turkey [ 21 ]. According to some researchers, the COVID-19 crisis and natural disasters have much in common, as the emotions and behavior they cause are based on the same primal human emotion—fear [ 22 ]. Both pandemics and natural disasters disrupt people’s everyday lives and may have severe economic, social and psychological consequences [ 23 ]. However, despite many similarities to natural disasters, COVID-19 is a unique situation—only in 2020, the current pandemic has taken more lives than the world’s combined natural disasters in any of the past twenty years [ 24 ]. It needs to be noted that natural disasters may pose different challenges than health crises and for this reason, they may provoke disparate reactions [ 25 ]. Research on the reactions to former epidemics has shown that avoidance and safety behaviors, such as avoiding going out, visiting crowded places, and visiting hospitals, are widespread at such times [ 26 ]. When it comes to the ways of dealing with the current COVID-19 pandemic, a substantial part of the quantitative research on this issue focuses on coping mechanisms. Studies have shown that the most prevalent coping strategies are highly problem-focused [ 5 ]. Most people tend to listen to expert advice and behave calmly and appropriately in the face of the coronavirus outbreak [ 5 ]. Problem-focused coping is particularly characteristic of healthcare professionals. A study on Chinese nurses has shown that the closer the problem is to the person and the more fear it evokes, the more problem-focused coping strategy is used to deal with it [ 27 ]. On the other hand, a negative coping style that entails risky or aggressive behaviors, such as drug or alcohol use, is also used to deal with the challenges arising from the COVID-19 pandemic [ 28 ]. The factors that are correlated with negative coping include coronavirus anxiety, impairment, and suicidal ideation [ 28 ]. It is worth emphasizing that social support is a very important component of dealing with crises [ 29 ].

Scientists have attempted to systematize the reactions to difficult and unusual situations. One such concept is the “3 Cs” model created by Reich [ 30 ]. It accounts for the general rules of resilience in situations of stress caused by crises, such as natural disasters. The 3 Cs stand for: control (a belief that personal resources can be accessed to achieve valued goals), coherence (the human desire to make meaning of the world), and connectedness (the need for human contact and support) [ 30 ]. Polizzi and colleagues [ 22 ] reviewed this model from the perspective of the current COVID-19 pandemic. The authors claim that natural disasters and COVID-19 pandemic have much in common and therefore, the principles of resilience in natural disaster situations can also be used in the situation of the current pandemic [ 22 ]. They propose a set of coping behaviors that could be useful in times of the coronavirus outbreak, which include control (e.g., planning activities for each day, getting adequate sleep, limiting exposure to the news, and helping others), coherence (e.g., mindfulness and developing a coherent narrative on the event), and connectedness (e.g., establishing new relationships and caring for existing social bonds) [ 22 ].

Current study

The issue of the challenges arising from the current COVID-19 pandemic and the ways of coping with them is complex and many feelings accompanying these experiences may be unconscious and difficult to verbalize. Therefore, in order to explore and understand it deeply, qualitative methodology was applied. Although there were few qualitative studies on the reaction to the pandemic [e.g., 31 – 33 ], they did not capture the perception of the challenges and their changes that arise as the pandemic develops. Since the situation with the COVID-19 pandemic is very dynamic, the reactions to the various restrictions, orders or bans are evolving. Therefore, it was decided to conduct a qualitative longitudinal study with multiple interviews with the same respondents [ 34 ].

The study investigates the challenges arising from the current pandemic and the way people deal with them. The main aim of the project was to capture people’s reactions to the unusual and unexpected situation of the COVID-19 pandemic. Therefore, the project was largely exploratory in nature. Interviews with the participants at different stages of the epidemic allowed us to see a wide spectrum of problems and ways of dealing with them. The conducted study had three main research questions:

• What are the biggest challenges connected to the COVID-19 pandemic and the resulting restrictions?
• How are people dealing with the pandemic challenges?
• What are the ways of coping with the restrictions resulting from a pandemic change as it continues and develops (perspective of first 6 months)?

The study was approved by the institutional review board of the Faculty of Psychology University of Warsaw, Poland. All participants were provided written and oral information about the study, which included that participation was voluntary, that it was possible to withdraw without any consequences at any time, and the precautions that would be taken to protect data confidentiality. Informed consent was obtained from all participants. To ensure confidentiality, quotes are presented only with gender, age, and family status.

The study was based on qualitative methodology: individual in-depth interviews, s which are the appropriate to approach a new and unknown and multithreaded topic which, at the beginning of 2020, was the COVID-19 pandemic. Due to the need to observe respondents’ reactions to the dynamically changing situation of the COVID-19 pandemic, longitudinal study was used where the moderator met on-line with the same respondent several times, at specific time intervals. A longitudinal study was used to capture the changes in opinions, emotions, and behaviors of the respondents resulting from the changes in the external circumstances (qualitative in-depth interview tracking–[ 34 ]).

The study took place from the end of March to October 2020. Due to the epidemiological situation in the country interviews took place online, using the Google Meets online video platform. The audio was recorded and then transcribed. Before taking part in the project, the respondents were informed about the purpose of the study, its course, and the fact that participation in the project is voluntary, and that they will be able to withdraw from participation at any time. The respondents were not paid for taking part in the project.

Participants.

In total, 115 interviews were conducted with 20 participants (6 interviews with the majority of respondents). Two participants (number 11 and 19, S2 Table ) dropped out of the last two interviews, and one (number 6) dropped out of the last interview. The study was based on a purposive sample and the respondents differed in gender, age, education, family status, and work situation (see S2 Table ). In addition to demographic criteria intended to ensure that the sample was as diverse as possible, an additional criterion was to have a permanent Internet connection and a computer capable of online video interviewing. Study participants were recruited using the snowball method. They were distant acquaintances of acquaintances of individuals involved in the study. None of the moderators knew their interviewees personally.

A total of 10 men and 10 women participated in the study; their age range was: 25–55; the majority had higher education (17 respondents), they were people with different professions and work status, and different family status (singles, couples without children, and families with children). Such diversity of respondents allowed us to obtain information from different life perspectives. A full description of characteristics of study participants can be found in S2 Table .

Each interview took 2 hours on average, which gives around 240 hours of interviews. Subsequent interviews with the same respondents conducted at different intervals resulted from the dynamics of the development of the pandemic and the restrictions introduced in Poland by the government.

The interviews scenario took a semi-structured form. This allowed interviewers freely modify the questions and topics depending on the dynamics of the conversation and adapt the subject matter of the interviews not only to the research purposes but also to the needs of a given respondent. The interview guides were modified from week to week, taking into account the development of the epidemiological situation, while at the same time maintaining certain constant parts that were repeated in each interview. The main parts of the interview topic guide consisted of: (a) experiences from the time of previous interviews: thoughts, feeling, fears, and hopes; (b) everyday life—organization of the day, work, free time, shopping, and eating, etc.; (c) changes—what had changed in the life of the respondent from the time of the last interview; (d) ways of coping with the situation; and (e) media—reception of information appearing in the media. Additionally, in each interview there were specific parts, such as the reactions to the beginning of the pandemic in the first interview or the reaction to the specific restrictions that were introduced.

The interviews were conducted by 5 female interviewers with experience in moderating qualitative interviews, all with a psychological background. After each series of interviews, all the members of the research teams took part in debriefing sessions, which consisted of discussing the information obtained from each respondent, exchanging general conclusions, deciding about the topics for the following interview stage, and adjusting them to the pandemic situation in the country.

Data analysis.

All the interviews were transcribed in Polish by the moderators and then double-checked (each moderator transcribed the interviews of another moderator, and then the interviewer checked the accuracy of the transcription). The whole process of analysis was conducted on the material in Polish (the native language of the authors of the study and respondents). The final page count of the transcript is approximately 1800 pages of text. The results presented below are only a portion of the total data collected during the interviews. While there are about 250 pages of the transcription directly related to the topic of the article, due to the fact that the interview was partly free-form, some themes merge with others and it is not possible to determine the exact number of pages devoted exclusively to analysis related to the topic of the article. Full dataset can be found in S1 Dataset .

Data was then processed into thematic analysis, which is defined as a method of developing qualitative data consisting of the identification, analysis, and description of the thematic areas [ 35 ]. In this type of analysis, a thematic unit is treated as an element related to the research problem that includes an important aspect of data. An important advantage of thematic analysis is its flexibility, which allows for the adoption of the most appropriate research strategy to the phenomenon under analysis. An inductive approach was used to avoid conceptual tunnel vision. Extracting themes from the raw data using an inductive approach precludes the researcher from imposing a predetermined outcome.

As a first step, each moderator reviewed the transcripts of the interviews they had conducted. Each transcript was thematically coded individually from this point during the second and the third reading. In the next step, one of the researchers reviewed the codes extracted by the other members of the research team. Then she made initial interpretations by generating themes that captured the essence of the previously identified codes. The researcher created a list of common themes present in all of the interviews. In the next step, the extracted themes were discussed again with all the moderators conducting the coding in order to achieve consistency. This collaborative process was repeated several times during the analysis. Here, further superordinate (challenges of COVID-19 pandemic) and subordinate (ways of dealing with challenges) themes were created, often by collapsing others together, and each theme listed under a superordinate and subordinate category was checked to ensure they were accurately represented. Through this process of repeated analysis and discussion of emerging themes, it was possible to agree on the final themes that are described below.

Main challenges of the COVID-19 pandemic.

Challenge 1 –limitation of direct contact with people . The first major challenge of the pandemic was that direct contact with other people was significantly reduced. The lockdown forced many people to work from home and limit contact not only with friends but also with close family (parents, children, and siblings). Limiting contact with other people was a big challenge for most of our respondents, especially those who were living alone and for those who previously led an active social life. Depending on their earlier lifestyle profile, for some, the bigger problem was the limitation of contact with the family, for others with friends, and for still others with co-workers.

I think that because I can’t meet up with anyone and that I’m not in a relationship , I miss having sex , and I think it will become even more difficult because it will be increasingly hard to meet anyone . (5 . 3_ M_39_single) . The number In the brackets at the end of the quotes marks the respondent’s number (according to Table 1 ) and the stage of the interview (after the dash), further is information about gender (F/M), age of the respondent and family status. Linguistic errors in the quotes reflect the spoken language of the respondents.

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https://doi.org/10.1371/journal.pone.0258133.t001

Changes over time . Over the course of the 6 months of the study, an evolution in the attitudes to the restriction of face-to-face contact could be seen: from full acceptance, to later questioning its rationale. Initially (March and April), almost all the respondents understood the reasons for the isolation and were compliant. At the beginning, people were afraid of the unknown COVID-19. They were concerned that the tragic situation from Italy, which was intensively covered in the media, could repeat itself in Poland (stage 1–2 of the study). However, with time, the isolation started to bother them more and more, and they started to look for solutions to bypass the isolation guidelines (stage 3–4), both real (simply meeting each other) and mental (treating isolation only as a guideline and not as an order, perceiving the family as being less threatening than acquaintances or strangers in a store). The turning point was the long May weekend that, due to two public holidays (1 st and 3 rd May), has for many years been used as an opportunity to go away with family or friends. Many people broke their voluntary isolation during that time encouraged by information about the coming loosening of restrictions.

During the summer (stage 5 of the survey), practically no one was fully compliant with the isolation recommendations anymore. At that time, a growing familiarity could be observed with COVID-19 and an increasing tendency to talk about it as “one of many diseases”, and to convince oneself that one is not at risk and that COVID-19 is no more threatening than other viruses. Only a small group of people consciously failed to comply with the restrictions of contact with others from the very beginning of the pandemic. This behavior was mostly observed among people who were generally less anxious and less afraid of COVID-19.

I’ve had enough. I’ve had it with sitting at home. Okay, there’s some kind of virus, it’s as though it’s out there somewhere; it’s like I know 2 people who were infected but they’re still alive, nothing bad has happened to anyone. It’s just a tiny portion of people who are dying. And is it really such a tragedy that we have to be locked up at home? Surely there’s an alternative agenda there? (17.4_F_35_Adult and child)

Ways of dealing . In the initial phase, when almost everyone accepted this restriction and submitted to it, the use of communication platforms for social meetings increased (see Ways of dealing with challenges in Table 1 ) . Meetings on communication platforms were seen as an equivalent of the previous face-to-face contact and were often even accompanied by eating or drinking alcohol together. However, over time (at around stage 4–5 of the study) people began to feel that such contact was an insufficient substitute for face-to-face meetings and interest in online meetings began to wane. During this time, however, an interesting phenomenon could be seen, namely, that for many people the family was seen as a safer environment than friends, and definitely safer than strangers. The belief was that family members would be honest about being sick, while strangers not necessarily, and—on an unconscious level—the feeling was that the “family is safe”, and the “family can’t hurt them”.

When it became clear that online communication is an insufficient substitute for face-to-face contacts, people started to meet up in real life. However, a change in many behaviors associated with meeting people is clearly visible, e.g.: refraining from shaking hands, refraining from cheek kissing to greet one another, and keeping a distance during a conversation.

I can’t really say that I could ‘feel’ Good Friday or Holy Saturday. On Sunday, we had breakfast together with my husband’s family and his sister. We were in three different places but we connected over Skype. Later, at noon, we had some coffee with my parents, also over Skype. It’s obvious though that this doesn’t replace face-to-face contact but it’s always some form of conversation. (9.3_F_25_Couple, no children)

Challenge 2 –restrictions on movement and travel . In contrast to the restrictions on contact with other people, the restrictions on movement and the closing of borders were perceived more negatively and posed bigger challenges for some people (especially those who used to do a lot of travelling). In this case, it was less clear why these regulations were introduced (especially travel restrictions within the country). Moreover, travel restrictions, particularly in the case of international travels, were associated with a limitation of civil liberties. The limitation (or complete ban) on travelling abroad in the Polish situation evoked additional connotations with the communist times, that is, with the fact that there was no freedom of movement for Polish citizens (associations with totalitarianism and dictatorship). Interestingly, the lack of acceptance of this restriction was also manifested by people who did not travel much. Thus, it was not just a question of restricting travelling abroad but more of restricting the potential opportunity (“even if I’m not planning on going anywhere, I know I still can”).

Limitations on travelling around the country were particularly negatively felt by families with children, where parents believe that regular exercise and outings are necessary for the proper development of their children. For parents, it was problematic to accept the prohibition of leaving the house and going to the playground (which remained closed until mid-May). Being outdoors was perceived as important for maintaining immunity (exercise as part of a healthy lifestyle), therefore, people could not understand the reason underlying this restriction and, as a consequence, often did not accept it.

I was really bothered by the very awareness that I can’t just jump in my car or get on a plane whenever I want and go wherever I want. It’s not something that I have to do on a daily basis but freedom of movement and travelling are very important for me. (14.2_M_55_Two adults and children)

Changes over time . The travel and movement limitations, although objectively less severe for most people, aroused much greater anger than the restrictions on social contact. This was probably due to a greater sense of misunderstanding as to why these rules were being introduced in the first place. Moreover, they were often communicated inconsistently and chaotically (e.g., a ban on entering forests was introduced while, at the same time, shopping malls remained open and masses were allowed to attend church services). This anger grew over time—from interview to interview, the respondents’ irritation and lack of acceptance of this was evident (culminating in the 3 rd -4 th stage of the study). The limitation of mobility was also often associated with negative consequences for both health and the economy. Many people are convinced that being in the open air (especially accompanied by physical activity) strengthens immunity, therefore, limiting such activity may have negative health consequences. Some respondents pointed out that restricting travelling, the use of hotels and restaurants, especially during the holiday season, will have serious consequences for the existence of the tourism industry.

I can’t say I completely agree with these limitations because it’s treating everything selectively. It’s like the shopping mall is closed, I can’t buy any shoes but I can go to a home improvement store and buy some wallpaper for myself. So I don’t see the difference between encountering people in a home improvement store and a shopping mall. (18.2_F_48_Two adults and children)

Ways of dealing . Since the restriction of movement and travel was more often associated with pleasure-related behaviors than with activities necessary for living, the compensations for these restrictions were usually also from the area of hedonistic behaviors. In the statements of our respondents, terms such as “indulging” or “rewarding oneself” appeared, and behaviors such as throwing small parties at home, buying better alcohol, sweets, and new clothes were observed. There were also increased shopping behaviors related to hobbies (sometimes hobbies that could not be pursued at the given time)–a kind of “post-pandemic” shopping spree (e.g., a new bike or new skis).

Again, the reaction to this restriction also depended on the level of fear of the COVID-19 disease. People who were more afraid of being infected accepted these restrictions more easily as it gave them the feeling that they were doing something constructive to protect themselves from the infection. Conversely, people with less fears and concerns were more likely to rebel and break these bans and guidelines.

Another way of dealing with this challenge was making plans for interesting travel destinations for the post-pandemic period. This was especially salient in respondents with an active lifestyle in the past and especially visible during the 5 th stage of the study.

Today was the first day when I went to the store (due to being in quarantine after returning from abroad). I spent loads of money but I normally would have never spent so much on myself. I bought sweets and confectionery for Easter time, some Easter chocolates, too. I thought I’d do some more baking so I also bought some ingredients to do this. (1.2_ F_25_single)

Challenge 3 –necessary change in active lifestyle . Many of the limitations related to COVID-19 were a challenge for people with an active lifestyle who would regularly go to the cinema, theater, and gym, use restaurants, and do a lot of travelling. For those people, the time of the COVID constraints has brought about huge changes in their lifestyle. Most of their activities were drastically restricted overnight and they suddenly became domesticated by force, especially when it was additionally accompanied by a transition to remote work.

Compulsory spending time at home also had serious consequences for people with school-aged children who had to confront themselves with the distance learning situation of their children. The second challenge for families with children was also finding (or helping find) activities for their children to do in their free time without leaving the house.

I would love to go to a restaurant somewhere. We order food from the restaurant at least once a week, but I’d love to go to the restaurant. Spending time there is a different way of functioning. It is enjoyable and that is what I miss. I would also go to the cinema, to the theater. (13.3_M_46_Two adults and child.)

Changes over time . The nuisance of restrictions connected to an active lifestyle depended on the level of restrictions in place at a given time and the extent to which a given activity could be replaced by an alternative. Moreover, the response to these restrictions depended more on the individual differences in lifestyle rather than on the stage of the interview (except for the very beginning, when the changes in lifestyle and everyday activities were very sudden).

I miss that these restaurants are not open . And it’s not even that I would like to eat something specific . It is in all of this that I miss such freedom the most . It bothers me that I have no freedom . And I am able to get used to it , I can cook at home , I can order from home . But I just wish I had a choice . (2 . 6_F_27_single ).

Ways of dealing . In the initial phase of the pandemic (March-April—stage 1–3 of the study), when most people were afraid of the coronavirus, the acceptance of the restrictions was high. At the same time, efforts were made to find activities that could replace existing ones. Going to the gym was replaced by online exercise, and going to the cinema or theater by intensive use of streaming platforms. In the subsequent stages of the study, however, the respondents’ fatigue with these “substitutes” was noticeable. It was then that more irritation and greater non-acceptance of certain restrictions began to appear. On the other hand, the changes or restrictions introduced during the later stages of the pandemic were less sudden than the initial ones, so they were often easier to get used to.

I bought a small bike and even before that we ordered some resistance bands to work out at home, which replace certain gym equipment and devices. […] I’m considering learning a language. From the other online things, my girlfriend is having yoga classes, for instance. (7.2_M_28_Couple, no children)

Challenge 4 –boredom , monotony . As has already been shown, for many people, the beginning of the pandemic was a huge change in lifestyle, an absence of activities, and a resulting slowdown. It was sometimes associated with a feeling of weariness, monotony, and even of boredom, especially for people who worked remotely, whose days began to be similar to each other and whose working time merged with free time, weekdays with the weekends, and free time could not be filled with previous activities.

In some way, boredom. I can’t concentrate on what I’m reading. I’m trying to motivate myself to do such things as learning a language because I have so much time on my hands, or to do exercises. I don’t have this balance that I’m actually doing something for myself, like reading, working out, but also that I’m meeting up with friends. This balance has gone, so I’ve started to get bored with many things. Yesterday I felt that I was bored and something should start happening. (…) After some time, this lack of events and meetings leads to such immense boredom. (1.5_F_25_single)

Changes over time . The feeling of monotony and boredom was especially visible in stage 1 and 2 of the study when the lockdown was most restrictive and people were knocked out of their daily routines. As the pandemic continued, boredom was often replaced by irritation in some, and by stagnation in others (visible in stages 3 and 4 of the study) while, at the same time, enthusiasm for taking up new activities was waning. As most people were realizing that the pandemic was not going to end any time soon, a gradual adaptation to the new lifestyle (slower and less active) and the special pandemic demands (especially seen in stage 5 and 6 of the study) could be observed.

But I see that people around me , in fact , both family and friends , are slowly beginning to prepare themselves for more frequent stays at home . So actually more remote work , maybe everything will not be closed and we will not be locked in four walls , but this tendency towards isolation or self-isolation , such a deliberate one , appears . I guess we are used to the fact that it has to be this way . (15 . 6_M_43_Two adults and child) .

Ways of dealing . The answer to the monotony of everyday life and to finding different ways of separating work from free time was to stick to certain rituals, such as “getting dressed for work”, even when work was only by a computer at home or, if possible, setting a fixed meal time when the whole family would gather together. For some, the time of the beginning of the pandemic was treated as an extra vacation. This was especially true of people who could not carry out their work during the time of the most severe restrictions (e.g., hairdressers and doctors). For them, provided that they believed that everything would return to normal and that they would soon go back to work, a “vacation mode” was activated wherein they would sleep longer, watch a lot of movies, read books, and generally do pleasant things for which they previously had no time and which they could now enjoy without feeling guilty. Another way of dealing with the monotony and transition to a slower lifestyle was taking up various activities for which there was no time before, such as baking bread at home and cooking fancy dishes.

I generally do have a set schedule. I begin work at eight. Well, and what’s changed is that I can get up last minute, switch the computer on and be practically making my breakfast and coffee during this time. I do some work and then print out some materials for my younger daughter. You know, I have work till four, I keep on going up to the computer and checking my emails. (19.1_F_39_Two adults and children)

Challenge 5 –uncertainty about the future . Despite the difficulties arising from the circumstances and limitations described above, it seems that psychologically, the greatest challenge during a pandemic is the uncertainty of what will happen next. There was a lot of contradictory information in the media that caused a sense of confusion and heightened the feeling of anxiety.

I’m less bothered about the changes that were put in place and more about this concern about what will happen in the future. Right now, it’s like there’s these mood swings. […] Based on what’s going on, this will somehow affect every one of us. And that’s what I’m afraid of. The fact that someone will not survive and I have no way of knowing who this could be—whether it will be me or anyone else, or my dad, if somehow the coronavirus will sneak its way into our home. I simply don’t know. I’m simply afraid of this. (10.1_F_55_Couple, no children)

Changes over time . In the first phase of the pandemic (interviews 1–3), most people felt a strong sense of not being in control of the situation and of their own lives. Not only did the consequences of the pandemic include a change in lifestyle but also, very often, the suspension of plans altogether. In addition, many people felt a strong fear of the future, about what would happen, and even a sense of threat to their own or their loved ones’ lives. Gradually (interview 4), alongside anxiety, anger began to emerge about not knowing what would happen next. At the beginning of the summer (stage 5 of the study), most people had a hope of the pandemic soon ending. It was a period of easing restrictions and of opening up the economy. Life was starting to look more and more like it did before the pandemic, fleetingly giving an illusion that the end of the pandemic was “in sight” and the vision of a return to normal life. Unfortunately, autumn showed that more waves of the pandemic were approaching. In the interviews of the 6 th stage of the study, we could see more and more confusion and uncertainty, a loss of hope, and often a manifestation of disagreement with the restrictions that were introduced.

This is making me sad and angry. More angry, in fact. […] I don’t know what I should do. Up until now, there was nothing like this. Up until now, I was pretty certain of what I was doing in all the decisions I was making. (14.4_M_55_Two adults and children)

Ways of dealing . People reacted differently to the described feeling of insecurity. In order to reduce the emerging fears, some people searched (sometimes even compulsively) for any information that could help them “take control” of the situation. These people searched various sources, for example, information on the number of infected persons and the number of deaths. This knowledge gave them the illusion of control and helped them to somewhat reduce the anxiety evoked by the pandemic. The behavior of this group was often accompanied by very strict adherence to all guidelines and restrictions (e.g., frequent hand sanitization, wearing a face mask, and avoiding contact with others). This behavior increased the sense of control over the situation in these people.

A completely opposite strategy to reducing the feeling of uncertainty which we also observed in some respondents was cutting off information in the media about the scale of the disease and the resulting restrictions. These people, unable to keep up with the changing information and often inconsistent messages, in order to maintain cognitive coherence tried to cut off the media as much as possible, assuming that even if something really significant had happened, they would still find out.

I want to keep up to date with the current affairs. Even if it is an hour a day. How is the pandemic situation developing—is it increasing or decreasing. There’s a bit of propaganda there because I know that when they’re saying that they have the situation under control, they can’t control it anyway. Anyhow, it still has a somewhat calming effect that it’s dying down over here and that things aren’t that bad. And, apart from this, I listen to the news concerning restrictions, what we can and can’t do. (3.1_F_54_single)

Discussion and conclusions

The results of our study showed that the five greatest challenges resulting from the COVID-19 pandemic are: limitations of direct contact with people, restrictions on movement and travel, change in active lifestyle, boredom and monotony, and finally uncertainty about the future. As we can see the spectrum of problems resulting from the pandemic is very wide and some of them have an impact on everyday functioning and lifestyle, some other influence psychological functioning and well-being. Moreover, different people deal with these problems differently and different changes in everyday life are challenging for them. The first challenge of the pandemic COVID-19 problem is the consequence of the limitation of direct contact with others. This regulation has very strong psychological consequences in the sense of loneliness and lack of closeness. Initially, people tried to deal with this limitation through the use of internet communicators. It turned out, however, that this form of contact for the majority of people was definitely insufficient and feelings of deprivation quickly increased. As much data from psychological literature shows, contact with others can have great psychological healing properties [e.g., 29 ]. The need for closeness is a natural need in times of crisis and catastrophes [ 30 ]. Unfortunately, during the COVID-19 pandemic, the ability to meet this need was severely limited by regulations. This led to many people having serious problems with maintaining a good psychological condition.

Another troubling limitation found in our study were the restrictions on movement and travel, and the associated restrictions of most activities, which caused a huge change in lifestyle for many people. As shown in previous studies, travel and diverse leisure activities are important predictors of greater well-being [ 36 ]. Moreover, COVID-19 pandemic movement restrictions may be perceived by some people as a threat to human rights [ 37 ], which can contribute to people’s reluctance to accept lockdown rules.

The problem with accepting these restrictions was also related to the lack of understanding of the reasons behind them. Just as the limitation in contact with other people seemed understandable, the limitations related to physical activity and mobility were less so. Because of these limitations many people lost a sense of understanding of the rules and restrictions being imposed. Inconsistent communication in the media—called by some researchers the ‘infodemic’ [ 18 ], as well as discordant recommendations in different countries, causing an increasing sense of confusion in people.

Another huge challenge posed by the current pandemic is the feeling of uncertainty about the future. This feeling is caused by constant changes in the rules concerning daily functioning during the pandemic and what is prohibited and what is allowed. People lose their sense of being in control of the situation. From the psychological point of view, a long-lasting experience of lack of control can cause so-called learned helplessness, a permanent feeling of having no influence over the situation and no possibility of changing it [ 38 ], which can even result in depression and lower mental and physical wellbeing [ 39 ]. Control over live and the feeling that people have an influence on what happens in their lives is one of the basic rules of crisis situation resilience [ 30 ]. Unfortunately, also in this area, people have huge deficits caused by the pandemic. The obtained results are coherent with previous studies regarding the strategies harnessed to cope with the pandemic [e.g., 5 , 10 , 28 , 33 ]. For example, some studies showed that seeking social support is one of the most common strategies used to deal with the coronavirus pandemic [ 33 , 40 ]. Other ways to deal with this situation include distraction, active coping, and a positive appraisal of the situation [ 41 ]. Furthermore, research has shown that simple coping behaviors such as a healthy diet, not reading too much COVID-19 news, following a daily routine, and spending time outdoors may be protective factors against anxiety and depressive symptoms in times of the coronavirus pandemic [ 41 ].

This study showed that the acceptance of various limitations, and especially the feeling of discomfort associated with them, depended on the person’s earlier lifestyle. The more active and socializing a person was, the more restrictions were burdensome for him/her. The second factor, more of a psychological nature, was the fear of developing COVID-19. In this case, people who were more afraid of getting sick were more likely to submit to the imposed restrictions that, paradoxically, did not reduce their anxiety, and sometimes even heightened it.

Limitations of the study.

While the study shows interesting results, it also has some limitations. The purpose of the study was primarily to capture the first response to problems resulting from a pandemic, and as such its design is not ideal. First, the study participants are not diverse as much as would be desirable. They are mostly college-educated and relatively well off, which may influence how they perceive the pandemic situation. Furthermore, the recruitment was done by searching among the further acquaintances of the people involved in the study, so there is a risk that all the people interviewed come from a similar background. It would be necessary to conduct a study that also describes the reaction of people who are already in a more difficult life situation before the pandemic starts.

Moreover, it would also be worthwhile to pay attention to the interviewers themselves. All of the moderators were female, and although gender effects on the quality of the interviews and differences between the establishment of relationships between women and men were not observed during the debriefing process, the topic of gender effects on the results of qualitative research is frequently addressed in the literature [ 42 , 43 ]. Although the researchers approached the process with reflexivity and self-criticism at all stages, it would have seemed important to involve male moderators in the study to capture any differences in relationship dynamics.

Practical implications.

The study presented has many practical implications. Decision-makers in the state can analyze the COVID-19 pandemic crisis in a way that avoids a critical situation involving other infectious diseases in the future. The results of our study showing the most disruptive effects of the pandemic on people can serve as a basis for developing strategies to deal with the effects of the crisis so that it does not translate into a deterioration of the public’s mental health in the future.

The results of our study can also provide guidance on how to communicate information about restrictions in the future so that they are accepted and respected (for example by giving rational explanations of the reasons for introducing particular restrictions). In addition, the results of our study can also be a source of guidance on how to deal with the limitations that may arise in a recurrent COVID-19 pandemic, as well as other emergencies that could come.

The analysis of the results showed that the COVID-19 pandemic, and especially the lockdown periods, are a particular challenge for many people due to reduced social contact. On the other hand, it is social contacts that are at the same time a way of a smoother transition of crises. This knowledge should prompt decision-makers to devise ways to ensure pandemic safety without drastically limiting social contacts and to create solutions that give people a sense of control (instead of depriving it of). Providing such solutions can reduce the psychological problems associated with a pandemic and help people to cope better with it.

Conclusions

As more and more is said about the fact that the COVID-19 pandemic may not end soon and that we are likely to face more waves of this disease and related lockdowns, it is very important to understand how the different restrictions are perceived, what difficulties they cause and what are the biggest challenges resulting from them. For example, an important element of accepting the restrictions is understanding their sources, i.e., what they result from, what they are supposed to prevent, and what consequences they have for the fight against the pandemic. Moreover, we observed that the more incomprehensible the order was, the more it provoked to break it. This means that not only medical treatment is extremely important in an effective fight against a pandemic, but also appropriate communication.

The results of our study showed also that certain restrictions cause emotional deficits (e.g., loneliness, loss of sense of control) and, consequently, may cause serious problems with psychological functioning. From this perspective, it seems extremely important to understand which restrictions are causing emotional problems and how they can be dealt with in order to reduce the psychological discomfort associated with them.

Supporting information

S1 table. a full description of the changes occurring in poland at the time of the study..

https://doi.org/10.1371/journal.pone.0258133.s001

S2 Table. Characteristics of study participants.

https://doi.org/10.1371/journal.pone.0258133.s002

S1 Dataset. Transcriptions from the interviews.

https://doi.org/10.1371/journal.pone.0258133.s003

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• Published: 05 August 2020

Impact of the COVID-19 pandemic on clinical research

• Katherine R. Tuttle   ORCID: orcid.org/0000-0002-2235-0103 1 , 2  

Nature Reviews Nephrology volume  16 ,  pages 562–564 ( 2020 ) Cite this article

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• Acute kidney injury
• Clinical trials
• Infectious diseases

The COVID-19 pandemic has placed a tremendous strain on sustaining the clinical research enterprise and will also likely affect key study outcomes; these effects must be considered during data analysis and interpretation. Nevertheless, the responses to the pandemic have also introduced innovations that will advance the conduct of clinical research.

The first recognized case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leading to coronavirus disease 2019 (COVID-19) in the USA occurred during late January 2020 in the state of Washington 1 . Our state was hit hard by the outbreak that followed, as hospitals and emergency medical services became overwhelmed by severely ill patients in the major health-care hubs 2 , 3 , 4 , 5 . We first had a sprint, from March through to May 2020 when elective procedures and in-person patient visits were halted to reduce the risk of viral transmission, conserve personal protective equipment (PPE) and make more health-care workers available for the enormous clinical impact of COVID-19. As initial social distancing and other efforts to contain the virus dampened the spread, we began to gradually re-open in health-care systems and society at large. However, this was soon followed by another uptick in cases beginning in June 2020 that required backtracking to more restrictive measures. It is now clear that COVID-19 is with us for the long haul, a marathon that we will run for months or years to come.

COVID-19 is with us for the long haul, a marathon that we will run for months or years to come

SARS-CoV-2 infection spreads via extremely contagious respiratory droplets 6 . COVID-19 is commonly a mild upper respiratory illness, but a substantial minority of patients develop severe bilateral pneumonia leading to hospitalization for supplementary oxygen and supportive care, or respiratory failure requiring mechanical ventilation 7 , 8 , 9 . SARS-CoV-2 infection also spreads from the lungs to other organs 6 . Acute kidney injury is common in patients with COVID-19 and may be due to viral infiltration or other kidney injuries caused by a systemic inflammatory response, hypotension or nephrotoxins 2 , 3 , 4 , 7 , 10 . As a result, clinical nephrology services have been overwhelmed by the acute dialysis needs of patients hospitalized with COVID-19. Many of us, no matter how senior or focused on academic work, have been called to clinical service. I was the only nephrologist still in practice who knew how to implement acute peritoneal dialysis should we run short of resources for continuous kidney replacement therapy. This important skill has all but disappeared in contemporary nephrology practice, despite its practicality and effectiveness in acute care settings.

I began my career as an intern in 1982 when AIDS had started to wreak havoc at Northwestern Memorial Hospital in Chicago. I cared for more pneumocystis pneumonia than pneumococcal pneumonia and more Kaposi’s sarcoma than breast cancer. Nearly half of the medical services were AIDS wards when I finished my residency in 1985. HIV was identified as the cause around that time. However, intense research efforts led to HIV testing and novel treatment options, which have dramatically reduced the number of full-blown AIDS cases and turned HIV infection into a mostly manageable chronic condition. There are many lessons from HIV/AIDS that have informed my current thinking and response to COVID-19.

The Providence St Joseph Health hospitals in Washington state have had >7,000 admissions for COVID-19 as of 20 July 2020, and more come each day. Within this health-care system, I am executive director for research in the Providence Health Care region and, in this role, I rapidly turned old lessons from the HIV/AIDS era into new actions. Our overarching goal was to address the critical needs of COVID-19 research while maintaining research for essential concerns across other therapeutic areas in both adult and paediatric medicine. The main priority was to open the platform clinical trial of anti-viral treatments sponsored by the National Institutes of Allergy and Infectious Diseases/National Institutes of Health (NIAID/NIH), which required redirection of clinical research resources from other therapeutic areas to COVID-19 and a rapid administrative response. Our regulatory group and Institutional Review Board prepared, reviewed and approved the study protocol and informed consent form within 3 days over a weekend. Our budget and contracting groups similarly moved with record speed. As a result, our site was among the first ten sites activated on the initial NIAID/NIH clinical trial of remdesivir versus placebo. Our first participant was enrolled just 5 days after we received the study protocol.

Research groups from other therapeutic areas were quickly deployed, trained and certified by NIAID/NIH to ensure that enough investigators and study coordinators were available to manage this intense clinical trial activity. Our COVID-19 investigators are a multi-specialty team consisting of experts in infectious diseases, pulmonary and critical care, hospital medicine and nephrology. Similarly, research coordinators who normally manage studies in cardiology and nephrology were moved onto the COVID-19 team. We meet in a daily huddle to review all hospital admissions for COVID-19 with the goal of having a study option for every patient. The NIAID/NIH platform trial is continuing and we have since activated other new protocols for serology testing, biobanking and therapeutic interventions in those who have been excluded from the NIAID/NIH protocols, such as patients with an estimated glomerular filtration rate of <30 ml/min/1.73m 2 . Informed consent forms are currently available in five languages, and we have implemented Institutional Review Board-approved consent via remote technologies and using legally authorized representatives.

The COVID-19 pandemic has placed a tremendous strain on the clinical research enterprise. With the redirection of resources and temporary halting of in-person visits, studies in other therapeutic areas have been unavoidably constrained. However, the COVID-19 response has also introduced innovations that have advanced our overall conduct of clinical research (Table  1 ). Although recruitment and enrolment for most other studies stopped during the early stages of the pandemic, both our study sponsors and sites developed new approaches to conduct remote visits by telehealth, use home-based testing or monitoring technologies, and provide curbside or courier pick-up and delivery of participant samples and investigational products. Our research leaders, investigators and staff have made concerted efforts to provide study updates to participants — by telephone, email and through the electronic health record portal — during and after the pause in the studies. We re-opened for in-person visits on 18 May 2020 under strict enforcement of clinical protocols for viral infection prevention and the use of PPE according to the guidelines established by our health-care system. Study participants are given the option of a remote visit whenever possible. Every person who enters the clinical research centre is screened for COVID-19 symptoms, fever and potential exposure. Masks and physical distancing are required for all in-person interactions and no visitors are allowed, except for one parent in the case of paediatric patients, or one carer in the case of patients with disabilities.

The enrolment rates for our research programme are now similar to those recorded pre-pandemic. To the best of our knowledge, we have sustained retention in the ongoing studies. We will survey participants about their experiences and perspectives to facilitate research despite the risks associated with COVID-19. Notably, we must be cognizant that COVID-19 might affect key study outcomes. For example, SARS-CoV-2 infection could worsen glycaemic control in persons with diabetes, raise or lower blood pressure in those with hypertension, or accelerate progression of chronic kidney disease. Adverse events, particularly acute illnesses, hospitalizations and mortality may be caused by the viral infection or by deferral of care due to fear of contracting it. Participants are also likely to have changed their lifestyles to minimize contact with others, which may also affect outcomes. These are crucial considerations for study analysis and interpretation. Potential confounding may be addressed by examining pre-and post-pandemic outcome rates and COVID-19 surveillance with control for evidence of exposure or infection entered into data analysis plans. Nevertheless, with proactive measures, it is feasible to maintain interest, participation and quality in clinical research.

with proactive measures, it is feasible to maintain interest, participation and quality in clinical research

Investigators, coordinators and clinicians have a renewed sense of urgency and purpose to use science to solve problems that are important to patients and the public. We do get tired at times, and burnout is a real risk. Yet, we move forward with mutual support, encouragement and focus on tangible goals to keep making research better. All of these are positive changes that we will retain long after the COVID-19 pandemic subsides.

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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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Honors Theses

An analysis of the effects of covid-19 on students at the university of mississippi: family, careers, mental health.

Hannah Newbold Follow

Date of Award

Spring 5-1-2021

Document Type

Undergraduate Thesis

Integrated Marketing Communication

First Advisor

Second advisor.

Cynthia Joyce

Third Advisor

Marquita Smith

Relational Format

Dissertation/Thesis

This study analyzes the effects of COVID-19 on students at the University of Mississippi. For students, COVID-19 changed the landscape of education, with classes and jobs going online. Students who graduated in May 2020 entered a poor job market and many ended up going to graduate school instead of finding a job. Access to medical and professional help was limited at the very beginning, with offices not taking patients or moving appointments to virtual only. This would require that each student needing help had to have access to quality internet service, which wasn’t always guaranteed, thus producing additional challenges.

These chapters, including a robust literature review of relevant sources, as well as a personal essay, consist further of interviews with students and mental health counselors conducted over the span of several months. These interviews were conducted and recorded over Zoom. The interviews were conducted with individuals who traveled in similar social circles as me. These previously existing relationships allowed the conversation to go deeper than before and allowed new levels of relationship. Emerging from these conversations were six overlapping themes: the importance of family, the need for health over career, the challenge of isolation, struggles with virtual education, assessing mental health, and facing the reality of a bright future not promised. Their revelations of deep academic challenges and fears about the future amid stories of devastating personal loss, produces a striking and complex picture of emerging strength.

Recommended Citation

Newbold, Hannah, "An Analysis Of The Effects Of COVID-19 On Students At The University of Mississippi: Family, Careers, Mental Health" (2021). Honors Theses . 1912. https://egrove.olemiss.edu/hon_thesis/1912

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An Introduction to COVID-19

Simon james fong.

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

Nilanjan Dey

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

Jyotismita Chaki

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

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

A Brief History of the Coronavirus Outbreak

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

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

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

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

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

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

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

Coronavirus Versus Seasonal Influenza

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

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

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

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

Coronavirus Versus Bird Flu (H5N1 and H7N9)

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

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

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

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

Coronavirus Versus Ebola Epidemic

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

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

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

Coronavirus Versus Camel Flu (MERS)

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

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

Coronavirus Versus Swine Flu (H1N1)

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

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

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

Coronavirus Versus Severe Acute Respiratory Syndrome (SARS)

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

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

Coronavirus Versus Hong Kong Flu (H3N2)

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

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

Coronavirus Versus Spanish Flu (H1N1)

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

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

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

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

Coronavirus Versus Common Cold (Typically Rhinovirus)

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

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

Reviews of Online Portals and Social Media for Epidemic Information Dissemination

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

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

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

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

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

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

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

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

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

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

WHO Advice [ 49 ]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

South Korea

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

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

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

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

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

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

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

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

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

United States

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

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

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

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

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

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

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

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

Emergency Funding to Fight the COVID-19

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

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

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

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

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

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

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

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

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

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

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

Public Health Surveillance

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

Remote Biosignal Measurement

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

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

IoT and Wearables

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

Chatbots and Communication

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

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

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

Social Media and Open Data

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

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

Automated Diagnostics

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

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

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

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

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

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

Drug Development Research

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

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

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

Colour Coding

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

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

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

Autonomous Vehicles

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

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

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