covid 19 health protocols informative essay

COVID-19 Was a Turning Point for Health

Our new book focuses on the lessons of the pandemic..

Posted February 15, 2024 | Reviewed by Michelle Quirk

• To think comprehensively about COVID-19 is to think not just about the past but also about the future.
• The narratives we accept about the pandemic will do much to shape our ability to create a healthier world.
• Understanding the pandemic, and learning from it, means coming to terms with the emotions of that time.

In 2021, the United States was at a turning point. We had just lived through the acute phase of a global pandemic. During that time, the country had experienced an economic crisis, civil unrest, a deeply divisive federal election, and a technological revolution in how we live, work, and congregate. The emergence of COVID-19 vaccines allowed us, finally, to look ahead to a post-pandemic world, but what would that world be like? Would it be a return to the pre-COVID-19 status quo, or would it be something radically new?

It was with these questions in mind that, in 2021, I partnered with my colleague Michael Stein to write a series of essays reflecting on the COVID-19 pandemic. Our aim was to engage with the COVID moment through the lens of cutting -edge public health science. By exploring the pandemic’s intersection with topics like digital surveillance, vaccine distribution, big data, and the link between science and political decision-making , we tried to sketch what the moment meant while it unfolded and what its implications might be for the future. If journalism is “the first rough draft of history,” these essays were, in a way, our effort to produce just such a draft, from the perspective of a forward-looking public health. I am delighted to announce that a book based on this series of essays has just been published by Oxford University Press: The Turning Point: Reflections on a Pandemic .

The book includes a series of short chapters, structured in five sections that address the following themes:

This section looks at the COVID-19 moment through the lens of what we might learn from it, toward better addressing future pandemics. It tackles challenges we faced in our approach to testing, our successes and shortcomings in implementing contact tracing, the intersection of the pandemic and mass incarceration, and more. Many of these lessons emerged organically from the day-to-day experience of the pandemic, reflecting “unknown unknowns”—areas where we encountered unexpected deficits in our knowledge, which were revealed by the circumstances of the pandemic. Chapter 8, for example, explores the necessity of public health officials speaking with care, mindful that our words may be used to justify authoritarian approaches in the name of health, a challenge we saw in the actions of the Chinese government during the pandemic.

Our understanding of large-scale health challenges like pandemics depends on more than collections of data and a timeline of events. It depends on our stories. The narratives we accept about the pandemic will do much to shape our ability to create a healthier world before the next contagion strikes. This section explores the stories we told during COVID-19 about what was happening to us and looks ahead to the narratives that will likely define our recollections of the pandemic moment. It addresses narratives around the virtues and limits of expertise, the role of the media as both a shaper of stories and a character in them, the hotly contested narrative around vaccines, and the role scientists, physicians, and epidemiologists played in shaping the story of the pandemic as it unfolded.

This section explores how our values informed what we did during COVID-19 through the ethical considerations that shaped our engagement with the moment. These include the ethical tradeoffs involved in questions of digital surveillance, scientific bias, vaccine mandates, balancing individual autonomy and collective responsibility, and the role of the profit motive in creating critical treatments. At times, these reflections reach back into history, grappling with past moments when we failed in our ethical obligations to support the health of all, as in a chapter discussing how the legacy of medical racism shaped our engagement with communities of color during the pandemic. Such soul-searching is core to our ability to evaluate our performance during COVID-19 and face the future grounded in the values that support effective, ethical public health action.

As human beings, we do not process events through reason alone. We are deeply swayed by emotion . This is particularly true in times of tragedy like COVID-19. Understanding the pandemic, and learning from it, means coming to terms with the emotions of that time, the feelings that attended all we did. Grief and loss, humility and hope, trust and mistrust , compassion and fear —both individual and collective—were all core to the experience of the pandemic. The simple act of recognizing our collective grief, as several chapters in this section try to do, can help us move forward, acknowledging the emotions that attend tragedy as we work toward a better world.

To think comprehensively about COVID-19 is to think not just about the past but about the future. We seek to understand the pandemic to prevent something like it from ever happening again. This means creating a world that is fundamentally healthier than the one that existed in 2019. This final section looks to the future from the perspective of the COVID-19 moment, with an eye toward using the lessons of that time to create a healthier world, as in Chapter 50, which addresses the challenge of rebuilding trust in public health institutions after it was tested during the pandemic. The section also touches on leadership and decision-making, shaping a better health system, shoring up our investment in health, the future of remote work, and next steps in our efforts to support health in the years to come.

I end with a note of gratitude to Michael Stein, who led on the development of this book. It is, as always, a privilege to work with him and learn from him. I look forward to continued collaborations in the months and years to come, and to hearing from readers of The Turning Point as we engage in our collective task of building a healthier world, informed by what we have lived through and looking to the future.

A version of this essay appeared on Substack.

Sandro Galea, M.D., is the Robert A. Knox professor and dean of the Boston University School of Public Health

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Covid 19 Essay in English

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

100 Words Essay on Covid 19

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

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

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

My Experience of COVID-19

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

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

Effects of CoronaVirus on Education

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

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

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

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

Effects of CoronaVirus on Economy

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

Effects of CoronaVirus on Health

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

Explore Career Options (By Industry)

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Data Administrator

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

Bio Medical Engineer

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

Ethical Hacker

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

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

Data Analyst

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

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

Geothermal Engineer

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

Database Architect

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

Remote Sensing Technician

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

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

Budget Analyst

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

Underwriter

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

Finance Executive

Product manager.

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

Operations Manager

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

Stock Analyst

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

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

Welding Engineer

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

Transportation Planner

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

Environmental Engineer

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

Safety Manager

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

Conservation Architect

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

Structural Engineer

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

Highway Engineer

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

Field Surveyor

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

Orthotist and Prosthetist

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

Pathologist

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

Veterinary Doctor

Speech therapist, gynaecologist.

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

Audiologist

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

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

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

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

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

Video Game Designer

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

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

Radio Jockey

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

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

Choreographer

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

Social Media Manager

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

Photographer

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

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

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

Copy Writer

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

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

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

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

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

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

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

Corporate Executive

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

Multimedia Specialist

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

Quality Controller

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

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

Production Manager

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

Process Development Engineer

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

AWS Solution Architect

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

Azure Administrator

An Azure Administrator is a professional responsible for implementing, monitoring, and maintaining Azure Solutions. He or she manages cloud infrastructure service instances and various cloud servers as well as sets up public and private cloud systems. 

Computer Programmer

Careers in computer programming primarily refer to the systematic act of writing code and moreover include wider computer science areas. The word 'programmer' or 'coder' has entered into practice with the growing number of newly self-taught tech enthusiasts. Computer programming careers involve the use of designs created by software developers and engineers and transforming them into commands that can be implemented by computers. These commands result in regular usage of social media sites, word-processing applications and browsers.

Information Security Manager

Individuals in the information security manager career path involves in overseeing and controlling all aspects of computer security. The IT security manager job description includes planning and carrying out security measures to protect the business data and information from corruption, theft, unauthorised access, and deliberate attack 

ITSM Manager

Automation test engineer.

An Automation Test Engineer job involves executing automated test scripts. He or she identifies the project’s problems and troubleshoots them. The role involves documenting the defect using management tools. He or she works with the application team in order to resolve any issues arising during the testing process. 

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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

Getty Images

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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Students’ Essays on Infectious Disease Prevention, COVID-19 Published Nationwide

As part of the BIO 173: Global Change and Infectious Disease course, Professor Fred Cohan assigns students to write an essay persuading others to prevent future and mitigate present infectious diseases. If students submit their essay to a news outlet—and it’s published—Cohan awards them with extra credit.

As a result of this assignment, more than 25 students have had their work published in newspapers across the United States. Many of these essays cite and applaud the University’s Keep Wes Safe campaign and its COVID-19 testing protocols.

Cohan, professor of biology and Huffington Foundation Professor in the College of the Environment (COE), began teaching the Global Change and Infectious Disease course in 2009, when the COE was established. “I wanted very much to contribute a course to what I saw as a real game-changer in Wesleyan’s interest in the environment. The course is about all the ways that human demands on the environment have brought us infectious diseases, over past millennia and in the present, and why our environmental disturbances will continue to bring us infections into the future.”

Over the years, Cohan learned that he can sustainably teach about 170 students every year without running out of interested students. This fall, he had 207. Although he didn’t change the overall structure of his course to accommodate COVID-19 topics, he did add material on the current pandemic to various sections of the course.

“I wouldn’t say that the population of the class increased tremendously as a result of COVID-19, but I think the enthusiasm of the students for the material has increased substantially,” he said.

To accommodate online learning, Cohan shaved off 15 minutes from his normal 80-minute lectures to allow for discussion sections, led by Cohan and teaching assistants. “While the lectures mostly dealt with biology, the discussions focused on how changes in behavior and policy can solve the infectious disease problems brought by human disturbance of the environment,” he said.

Based on student responses to an introspective exam question, Cohan learned that many students enjoyed a new hope that we could each contribute to fighting infectious disease. “They discovered that the solution to infectious disease is not entirely a waiting game for the right technologies to come along,” he said. “Many enjoyed learning about fighting infectious disease from a moral and social perspective. And especially, the students enjoyed learning about the ‘socialism of the microbe,’ how preventing and curing others’ infections will prevent others’ infections from becoming our own. The students enjoyed seeing how this idea can drive both domestic and international health policies.”

A sampling of the published student essays are below:

Alexander Giummo ’22 and Mike Dunderdale’s ’23  op-ed titled “ A National Testing Proposal: Let’s Fight Back Against COVID-19 ” was published in the Journal Inquirer in Manchester, Conn.

They wrote: “With an expansive and increased testing plan for U.S. citizens, those who are COVID-positive could limit the number of contacts they have, and this would also help to enable more effective contact tracing. Testing could also allow for the return of some ‘normal’ events, such as small social gatherings, sports, and in-person class and work schedules.

“We propose a national testing strategy in line with the one that has kept Wesleyan students safe this year. The plan would require a strong push by the federal government to fund the initiative, but it is vital to successful containment of the virus.

“Twice a week, all people living in the U.S. should report to a local testing site staffed with professionals where the anterior nasal swab Polymerase Chain Reaction (PCR) test, used by Wesleyan and supported by the Broad Institute, would be implemented.”

Kalyani Mohan ’22 and Kalli Jackson ’22 penned an essay titled “ Where Public Health Meets Politics: COVID-19 in the United States ,” which was published in Wesleyan’s Arcadia Political Review .

They wrote: “While the U.S. would certainly benefit from a strengthened pandemic response team and structural changes to public health systems, that alone isn’t enough, as American society is immensely stratified, socially and culturally. The politicization of the COVID-19 pandemic shows that individualism, libertarianism and capitalism are deeply ingrained in American culture, to the extent that Americans often blind to the fact community welfare can be equivalent to personal welfare. Pandemics are multifaceted, and preventing them requires not just a cultural shift but an emotional one amongst the American people, one guided by empathy—towards other people, different communities and the planet. Politics should be a tool, not a weapon against its people.”

Sydnee Goyer ’21 and Marcel Thompson’s ’22  essay “ This Flu Season Will Be Decisive in the Fight Against COVID-19 ” also was published in Arcadia Political Review .

“With winter approaching all around the Northern Hemisphere, people are preparing for what has already been named a “twindemic,” meaning the joint threat of the coronavirus and the seasonal flu,” they wrote. “While it is known that seasonal vaccinations reduce the risk of getting the flu by up to 60% and also reduce the severity of the illness after the contamination, additional research has been conducted in order to know whether or not flu shots could reduce the risk of people getting COVID-19. In addition to the flu shot, it is essential that people remain vigilant in maintaining proper social distancing, washing your hands thoroughly, and continuing to wear masks in public spaces.”

An op-ed titled “ The Pandemic Has Shown Us How Workplace Culture Needs to Change ,” written by Adam Hickey ’22 and George Fuss ’21, was published in Park City, Utah’s The Park Record .

They wrote: “One review of academic surveys (most of which were conducted in the United States) conducted in 2019 found that between 35% and 97% of respondents in those surveys reported having attended work while they were ill, often because of workplace culture or policy which generated pressure to do so. Choosing to ignore sickness and return to the workplace while one is ill puts colleagues at risk, regardless of the perceived severity of your own illness; COVID-19 is an overbearing reminder that a disease that may cause mild, even cold-like symptoms for some can still carry fatal consequences for others.

“A mandatory paid sick leave policy for every worker, ideally across the globe, would allow essential workers to return to work when necessary while still providing enough wiggle room for economically impoverished employees to take time off without going broke if they believe they’ve contracted an illness so as not to infect the rest of their workplace and the public at large.”

Women’s cross country team members and classmates Jane Hollander ’23 and Sara Greene ’23 wrote a sports-themed essay titled “ This Season, High School Winter Sports Aren’t Worth the Risk ,” which was published in Tap into Scotch Plains/Fanwood , based in Scotch Plains, N.J. Their essay focused on the risks high school sports pose on student-athletes, their families, and the greater community.

“We don’t propose cutting off sports entirely— rather, we need to be realistic about the levels at which athletes should be participating. There are ways to make practices safer,” they wrote. “At [Wesleyan], we began the season in ‘cohorts,’ so the amount of people exposed to one another would be smaller. For non-contact sports, social distancing can be easily implemented, and for others, teams can focus on drills, strength and conditioning workouts, and skill-building exercises. Racing sports such as swim and track can compete virtually, comparing times with other schools, and team sports can focus their competition on intra-team scrimmages. These changes can allow for the continuation of a sense of normalcy and team camaraderie without the exposure to students from different geographic areas in confined, indoor spaces.”

Brook Guiffre ’23 and Maddie Clarke’s ’22  op-ed titled “ On the Pandemic ” was published in Hometown Weekly,  based in Medfield, Mass.

“The first case of COVID-19 in the United States was recorded on January 20th, 2020. For the next month and a half, the U.S. continued operating normally, while many other countries began their lockdown,” they wrote. “One month later, on February 29th, 2020, the federal government approved a national testing program, but it was too little too late. The U.S. was already in pandemic mode, and completely unprepared. Frontline workers lacked access to N-95 masks, infected patients struggled to get tested, and national leaders informed the public that COVID-19 was nothing more than the common flu. Ultimately, this unpreparedness led to thousands of avoidable deaths and long-term changes to daily life. With the risk of novel infectious diseases emerging in the future being high, it is imperative that the U.S. learn from its failure and better prepare for future pandemics now. By strengthening our public health response and re-establishing government organizations specialized in disease control, we have the ability to prevent more years spent masked and six feet apart.”

In addition, their other essay, “ On Mass Extinction ,” was also published by Hometown Weekly .

“The sixth mass extinction—which scientists have coined as the Holocene Extinction—is upon us. According to the United Nations, around one million plant and animal species are currently in danger of extinction, and many more within the next decade. While other extinctions have occurred in Earth’s history, none have occurred at such a rapid rate,” they wrote. “For the sake of both biodiversity and infectious diseases, it is in our best interest to stop pushing this Holocene Extinction further.”

An essay titled “ Learning from Our Mistakes: How to Protect Ourselves and Our Communities from Diseases ,” written by Nicole Veru ’21 and Zoe Darmon ’21, was published in My Hometown Bronxville, based in Bronxville, N.Y.

“We can protect ourselves and others from future infectious diseases by ensuring that we are vaccinated,” they wrote. “Vaccines have high levels of success if enough people get them. Due to vaccines, society is no longer ravaged by childhood diseases such as mumps, rubella, measles, and smallpox. We have been able to eradicate diseases through vaccines; smallpox, one of the world’s most consequential diseases, was eradicated from the world in the 1970s.

“In 2000, the U.S. was nearly free of measles, yet, due to hesitations by anti-vaxxers, there continues to be cases. From 2000–2015 there were over 18 measles outbreaks in the U.S. This is because unless a disease is completely eradicated, there will be a new generation susceptible.

“Although vaccines are not 100% effective at preventing infection, if we continue to get vaccinated, we protect ourselves and those around us. If enough people are vaccinated, societies can develop herd immunity. The amount of people vaccinated to obtain herd immunity depends on the disease, but if this fraction is obtained, the spread of disease is contained. Through herd immunity, we protect those who may not be able to get vaccinated, such as people who are immunocompromised and the tiny portion of people for whom the vaccine is not effective.”

Dhruvi Rana ’22 and Bryce Gillis ’22 co-authored an op-ed titled “ We Must Educate Those Who Remain Skeptical of the Dangers of COVID-19 ,” which was published in Rhode Island Central .

“As Rhode Island enters the winter season, temperatures are beginning to drop and many studies have demonstrated that colder weather and lower humidity are correlated with higher transmissibility of SARS-CoV-2, the virus that causes COVID-19,” they wrote. “By simply talking or breathing, we release respiratory droplets and aerosols (tiny fluid particles which could carry the coronavirus pathogen), which can remain in the air for minutes to hours.

“In order to establish herd immunity in the US, we must educate those who remain skeptical of the dangers of COVID-19.  Whether community-driven or state-funded, educational campaigns are needed to ensure that everyone fully comprehends how severe COVID-19 is and the significance of airborne transmission. While we await a vaccine, it is necessary now more than ever that we social distance, avoid crowds, and wear masks, given that colder temperatures will likely yield increased transmission of the virus.”

Danielle Rinaldi ’21 and Verónica Matos Socorro ’21 published their op-ed titled “ Community Forum: How Mask-Wearing Demands a Cultural Reset ” in the Ewing Observer , based in Lawrence, N.J.

“In their own attempt to change personal behavior during the pandemic, Wesleyan University has mandated mask-wearing in almost every facet of campus life,” they wrote. “As members of our community, we must recognize that mask-wearing is something we are all responsible and accountable for, not only because it is a form of protection for us, but just as important for others as well. However, it seems as though both Covid fatigue and complacency are dominating the mindsets of Americans, leading to even more unwillingness to mask up. Ultimately, it is inevitable that this pandemic will not be the last in our lifespan due to global warming creating irreversible losses in biodiversity. As a result, it is imperative that we adopt the norm of mask-wearing now and undergo a culture shift of the abandonment of an individualistic mindset, and instead, create a society that prioritizes taking care of others for the benefit of all.”

Shayna Dollinger ’22 and Hayley Lipson ’21  wrote an essay titled “ My Pandemic Year in College Has Brought Pride and Purpose. ” Dollinger submitted the piece, rewritten in first person, to Jewish News of Northern California . Read more about Dollinger’s publication in this News @ Wesleyan article .

“I lay in the dead grass, a 6-by-6-foot square all to myself. I cheer for my best friend, who is on the stage constructed at the bottom of Foss hill, dancing with her Bollywood dance group. Masks cover their ordinarily smiling faces as their bodies move in sync. Looking around at friends and classmates, each in their own 6-by-6 world, I feel an overwhelming sense of normalcy.

“One of the ways in which Wesleyan has prevented outbreaks on campus is by holding safe, socially distanced events that students want to attend. By giving us places to be and things to do on the weekends, we are discouraged from breaking rules and causing outbreaks at ‘super-spreader’ events.”

An op-ed written by Luna Mac-Williams ’22 and Daëlle Coriolan ’24 titled “ Collectivist Practices to Combat COVID-19 ” was published in the Wesleyan Argus .

“We are embroiled in a global pandemic that disproportionately affects poor communities of color, and in the midst of a higher cultural consciousness of systemic inequities,” they wrote. “A cultural shift to center collectivist thought and action not only would prove helpful in disease prevention, but also belongs in conversation with the Black Lives Matter movement. Collectivist models of thinking effectively target the needs of vulnerable populations including the sick, the disenfranchised, the systematically marginalized. Collectivist systems provide care, decentering the capitalist, individualist system, and focusing on how communities can work to be self-sufficient and uplift our own neighbors.”

An essay written by Maria Noto ’21 , titled “ U.S. Individualism Has Deadly Consequences ,” is published in the Oneonta Daily Star , based in Oneonta, N.Y.

She wrote, “When analyzing the cultures of certain East Asian countries, several differences stand out. For instance, when people are sick and during the cold and flu season, many East Asian cultures, including South Korea, use mask-wearing. What is considered a threat to freedom by some Americans is a preventive action and community obligation in this example. This, along with many other cultural differences, is insightful in understanding their ability to contain the virus.

“These differences are deeply seeded in the values of a culture. However, there is hope for the U.S. and other individualistic cultures in recognizing and adopting these community-centered approaches. Our mindset needs to be revolutionized with the help of federal and local assistance: mandating masks, passing another stimulus package, contact tracing, etc… However, these measures will be unsuccessful unless everyone participates for the good of a community.”

A published op-ed by Madison Szabo ’23 , Caitlyn Ferrante ’23 ran in the Two Rivers Times . The piece is titled “ Anxiety and Aspiration: Analyzing the Politicization of the Pandemic .”

John Lee ’21 and Taylor Goodman-Leong ’21 have published their op-ed titled “ Reassessing the media’s approach to COVID-19 ” in Weekly Monday Cafe 24 (Page 2).

An essay by Eleanor Raab ’21 and Elizabeth Nefferdorf ’22 titled “ Preventing the Next Epidemic ” was published in The Almanac .

• Keep Wes Safe
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Understanding COVID-19

How To Protect Yourself During the Pandemic

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

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

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

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

Protecting Yourself

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

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

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

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

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

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

What to Look For

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

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

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

Getting Treatment

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

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

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

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

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

A Shot of Hope: Vaccines

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

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

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

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

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

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

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

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

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

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

• inequalities

Data availability statement

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

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

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

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Introduction

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

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

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

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

Social networks

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

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

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

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

Social support

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

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

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

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

Social and interactional norms

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

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

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

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

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

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

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

Recommendations and conclusions

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

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

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

Recommendation 2: intelligently balance online and offline ways of relating

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

Recommendation 3: build stronger and sustainable localised communities

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

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

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

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

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

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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What did the pandemic teach us about effective health communication? Unpacking the COVID-19 infodemic

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The spread of unvetted scientific information about COVID-19 presents a significant challenge to public health, adding to the urgency for increased understanding of COVID-19 information-seeking preferences that will allow for the delivery of evidence-based health communication. This study examined factors associated with COVID-19 information-seeking behavior.

An online survey was conducted with US adults ( N  = 1800) to identify key interpersonal (e.g., friends, health care providers) and mediated (e.g., TV, social media) sources of COVID-19 information. Logistic regression models were fitted to explore correlates of information-seeking.

Study findings show that the first sought and most trusted sources of COVID-19 information had different relationships with sociodemographic characteristics, perceived discrimination, and self-efficacy. Older adults had greater odds of seeking information from print materials (e.g., newspapers and magazines) and TV first. Participants with less educational attainment and greater self-efficacy preferred interpersonal sources first, with notably less preference for mass media compared to health care providers. Those with more experiences with discrimination were more likely to seek information from friends, relatives, and co-workers. Additionally, greater self-efficacy was related to increased trust in interpersonal sources.

Study results have implications for tailoring health communication strategies to reach specific subgroups, including those more vulnerable to severe illness from COVID-19. A set of recommendations are provided to assist in campaign development.

Peer Review reports

Since first identified in December 2019, the novel SARS-CoV-2 (COVID-19) virus has left a trail of death and economic disruption in its wake. In the United States (US) alone, the COVID-19 pandemic has caused more than 1 million deaths, with many more likely due to reporting errors [ 1 , 2 ]. The spread of COVID-19 can be mitigated through strategies such as mask-wearing and social distancing in public settings, and while the development of vaccines and therapeutics offer effective options for prevention and care, hesitancy and non-compliance with these treatments and strategies remains a considerable problem [ 3 ]. While new and more contagious variants continue to emerge, we have also witnessed the spread of conspiracy theories on virus origin, racist threats, and suspicion towards public health institutions that present significant challenges to public health measures [ 4 , 5 , 6 ].

This rise in COVID-related incivility, skepticism, and conspiracy beliefs can partly be attributed to high levels of dis/misinformation and distrust in media that has been described as a “hidden epidemic” [ 7 , 8 ]. As efforts to control virus spread in the US reduced opportunities for face-to-face communication, individuals turned instead to social media, TV news, and other mass media platforms often littered with inaccuracies in search of COVID-19 information. As this information went viral and became widely spread many of these “fake news” stories became ubiquitous in American culture. The spread of unvetted scientific information presents a significant challenge to public health efforts, adding to the urgency for increased understanding of information-seeking preferences during the COVID-19 pandemic that will ultimately allow for the tailored delivery of evidence-based health communication through these preferred sources and channels.

Information-seeking

According to the Protective Action Decision Model (PADM) [ 9 ], behavioral response to health risks depends partly on information exposure. By receiving timely and accurate information about COVID-19, individuals are better equipped to formulate accurate risk perceptions and engage in preventive steps [ 10 , 11 , 12 , 13 ]. Following this logic, it is essential that evidence-based COVID-19 information be translated in a manner that meets the needs of diverse stakeholder groups by understanding the factors associated with health information-seeking behavior (HISB). One strategy for understanding HISBs during the pandemic is to explore preferences for the first sought information source as an indicator of persuasiveness [ 14 ], and for sources deemed most trustworthy as a proxy for credibility [ 15 ].

The concept of uncertainty is important to HISB. The novelty of COVID-19 and lack of societal preparedness increased uncertainty in how to respond [ 16 ], increasing the likelihood that individuals will seek to manage this uncertainty by searching for relevant information [ 17 , 18 , 19 ]. Related to this idea of HISB as a tool to manage uncertainty is self-efficacy, which refers to the extent to which one believes in their ability to successfully perform a behavior [ 20 ]. Prior to engaging in a HISB, individuals have a tendency to first develop outcome expectations and evaluate whether they possess the ability to enact this search [ 21 ].

HISB during the pandemic operates within the context of advances in mass media technology, with increased use of digital media platforms (e.g., Internet search engines, social media) and the associated concerns regarding false information [ 22 , 23 ]. In addition to information received from interpersonal sources (e.g., friends, family, health care providers), information consumers now have diverse opportunities to seek and obtain health-related information with platforms such as Facebook, YouTube, and Google providing 24/7 access to information of varying quality [ 12 ]. The affordances of these platforms (e.g., sharing, liking, commenting) allow for an enhanced ability to create, receive, and disseminate health information. This increased media choice also allows for selective exposure to like-minded voices, which can lead to increased perceptions of bias within the general media [ 24 ]. Further, media slant towards a specific political ideology or issue position can be extreme within these mediated settings, with exposure having an influence on COVID-19 incidence [ 25 ]. All told, preferences for health information in the current media landscape warrant exploration to assess how audience factors are related to HISB.

While technological advancements have placed a wealth of information at our fingertips, there are disparities in who utilizes and benefits from these technologies based in part on longstanding social and digital inequalities [ 26 , 27 ]. While it has been argued that groups often marginalized by society (e.g., inequality based on age, gender, educational attainment, etc.) are simply lagging behind the curve in uptake of these technologies and will eventually bridge the gap, many of these groups often require government intervention to stimulate use and are more likely to discontinue use once begun [ 28 ]. Also, for these marginalized groups, self-efficacy in the use of technology is likely to be lower compared to those with more capital [ 29 ]. Therefore, while mass media technology provides wide reach and convenience to many, the associated inequities in use suggest that health communication campaigns seeking to tailor dissemination strategies should attend to audience features that may point to source preferences.

The COVID-19 pandemic illuminated how racial and ethnic discrimination can be amplified via the media, making HISB difficult for some groups. Anti-Asian sentiment, fueled in part by social media, has seen a dramatic increase during the pandemic, and politicians have used this crisis to propagate stereotyping and discriminatory policies against racial and ethnic minorities [ 30 , 31 , 32 ]. Black Americans who have historically been confronted with significant racism and discrimination in the US also report that their experiences with discrimination have increased during COVID-19 [ 33 ]. This lived discrimination can act as a biological stressor for which individuals must develop coping strategies, such as information-seeking [ 34 , 35 ].

Given that uncertainty about COVID-19 has increased HISB [ 36 , 37 ], focused effort is needed to deliver evidence-based health information through preferred sources in order to combat mis/disinformation and improve population health. Prior work has demonstrated that self-efficacy is positively associated with the frequency of HISB during the pandemic [ 38 , 39 ]. However additional work is needed to explore the sources people seek out first and which ones they trust the most, particularly in relation to confidence in information-seeking ability. In some cases, first sought and most trusted sources may be the same. In other cases, the sources that are most readily available to an individual may not be the most trusted. For example, some individuals may find health care providers to be highly trustworthy, but they are unavailable 24/7 to meet information needs.

Digital inequalities have also likely been exacerbated during the pandemic as marginalized groups are unable to offset the loss of in-person communication [ 40 ]; these factors may contribute to differences in HISB [ 41 ]. Further, increases in perceived discrimination may be associated with information-seeking strategies during the pandemic [ 42 ]. Building on previous work related to HISB during COVID-19 [ 41 , 43 ], the aim of this study was to investigate individual preferences for the first sought out and most trusted sources of COVID-19 information to guide tailored campaign development.

Research questions

RQ1: Are sociodemographic characteristics associated with preferences for (a) first sought and (b) most trusted source of COVID-19 information?

RQ2: Are discrimination and self-efficacy associated with preferences for (a) first sought and (b) most trusted source of COVID-19 information?

Study design and participant recruitment

Using a cross-sectional study design, between September and November 2020, a period that saw approximately 94,000 deaths from COVID-19 in the US (Johns Hopkins COVID-19 Tracker https://coronavirus.jhu.edu/us-map ), US adults aged ≥ 18 years ( N  = 1800) recruited through a panel owned by a cloud-based survey platform completed the online Florida Health Ancestry Study survey (FHAS). The sampling framework was specified so that quotas would represent the general US adult population (see Table  1 ).

Participants meeting these inclusion criteria received an electronic link to the survey. Partial responses were not recorded, but all participants were given one week to complete the survey. The “Forced Response” validation was used for all items, although participants could select “prefer not to answer.“ A $15.00 incentive was mailed to participants who completed the survey. The University of Florida Institutional Review Board (IRB201901264) approved this study with a waiver of documentation of informed consent.

Participants completed the 48-item FHAS survey developed using the behavioral core measures from NCI-designated cancer center catchment area supplements [ 44 ]. The FHAS includes investigator-derived measures related to COVID-19, perceived discrimination, and self-efficacy in obtaining health information (see supplement “additional_file_ 1 ” for more information on items used in this analysis). For all items, responses of “Don’t know” and “Prefer not to answer” were treated as missing.

COVID-19 information-seeking

To measure the first sought and most trusted sources of information about COVID-19, participants responded to two items (the COVID-19 questions in this study were adapted from a Palliative Care & Supportive Oncology Workgroup Survey and the eHealth Literacy Scale [ 45 ]), (“When you had a strong need to get information about COVID-19, where did you FIRST go to get information?“; “When you had a strong need to get information about COVID-19, which of the following did you find to be the MOST trusted as a source of information about coronavirus or COVID-19?“). For the univariable and multivariable analyses, response options for both items were dichotomized into the following sources: “Mass media” (Internet: Google or another search engine/WebMD or another medical website; Printed materials: newspapers, magazines; Social media: Facebook, Instagram, Twitter; Television) and “Interpersonal” (Conversations with people you trust: friends, relatives, or co-workers; Health care provider: doctor, nurse, social worker). Responses of “Other (Please specify:)” were treated as missing.

Self-efficacy

On a 5-point scale where 1 = “Not confident at all” and 5 = “Completely confident,“ self-efficacy was measured as confidence in obtaining general health information using a single item [ 46 ], “Overall, how confident are you that you could get advice or information about health or medical topics if you needed it?“ (M = 4.1, SD = 1.0).

Perceived discrimination

Experiences with everyday discrimination were assessed with a five-item measure on a four-point scale [ 47 ] where 0 = “Never,“ 1 = “Rarely,“ and 2 = “Sometimes”; responses of Often,“ “At least once a week,“ and “Almost every day” were categorized as 3. Participants were asked how often they are treated with less courtesy or respect than others, how often they receive poorer services at restaurants or stores, how often people act as if they are afraid of them, how often people act as if they are not smart, and how often they are threatened or harassed. Perceived discrimination was calculated as the mean score of these items (α = 0.91, M = 1.3, SD = 1.0).

Sociodemographic characteristics

Participant information about age, gender, race, education, marital status, living situation (live alone/live with someone), income, and overall health status was also obtained.

COVID-19 mitigation beliefs

On a 5-point scale where 1 = “Strongly disagree” and 5 = “Strongly agree,“ participants responded to two items asking how important they thought it was to wear a mask and maintain social distance when going out in public. These two items were combined for a mean score (α = 0.81, M = 4.5, SD = 1.0).

Analysis plan

Multivariable logistic regression models were fitted for the first source of COVID-19 information (mass media vs. interpersonal) and the most trusted source (mass media vs. interpersonal), respectively. Specifically, an odds ratio (OR) larger than 1 indicated higher odds of choosing a mass media source, and an OR smaller than 1 showed higher odds of selecting an interpersonal information source. Univariable logistic regressions were fitted first with factors identified as potentially relevant to COVID-19 information-seeking based on previous research (e.g., [ 12 , 29 , 42 , 48 , 49 ]), and factors with p -values less than 0.15 were then considered for multivariable logistic regressions. Backward selection was used to build final multivariable models. Age, race, gender, education, marital status, and overall health status were kept in the multivariable model of the first source of COVID-19 information, while living situation, income, and marital status were kept in the multivariable model of most trusted source of COVID-19 information regardless of their p -values.

Multivariable multinomial logistic regression models were also fitted for the first sought and most trusted source of COVID-19 information to look at specific associations between source types, but in a non-aggregated fashion: comparing trusted individuals vs. Internet vs. printed materials vs. social media vs. Television vs. health care providers.

Participant characteristics are presented in Table  2 . Average age was about 47 years (M = 46.6, SD = 17.5) with slightly more females (51.1%) than males (48.3%). Participants were primarily White (75.5%), followed by Black (14.8%) and Asian (5.8%). Most participants were college-educated (72.4%). In addition, a majority of participants were non-Hispanic (82.4%). Over half of the participants reported an income of $50,000 or greater (56%). Most participants were married (56.7%), living with someone else (77.6%), and did not live in a rural area (69.2%). Among the overall sample, 61.4% of participants preferred mass media as the first source of COVID-19 information, while the most trusted source was evenly split.

RQ1: How are sociodemographic characteristics associated with information seeking about COVID-19?

Table  3 presents univariable and multivariable logistic regression estimates for the association between individual characteristics and COVID-19 information-seeking behavior (See Additional file 2 : Appendix for boxplots and bar graphs of significant predictors). Tables  4 and 5 present multivariable multinomial logistic regression estimates that provide a more granulated analysis of information-seeking across source category.

Tables  3 , 4 and 5 also present univariable and multivariable logistic regression estimates along with findings from the multinomial analysis to evaluate the association between individual characteristics and COVID-19 information-seeking behavior.

Univariable/multivariable logistic model

On univariable analysis, characteristics associated with a preference for mass media as the first source of information rather than interpersonal connections were older age (OR: 1.02, p  < .01), poor health status (OR: 1.99, p  = .05), and stronger beliefs in the importance of masking and social distancing (OR: 1.27, p  < .01). Conversely, factors related to a preference for interpersonal communication as an initial source were self-identifying as Black or African American (OR: 0.63, p  = < 0.01), self-identifying as male (OR: 0.73, p  = < 0.01), and high school education or less (OR: 0.79, p  = .04). Further, related to trustworthiness, living with someone else (OR: 0.74, p  = .02). Having a higher income level (see Table  3 ) was associated with greater trust in interpersonal sources of COVID-19 information in the univariable model.

In the multivariable model, older age and stronger beliefs in the importance of masking and social distancing were independently associated with a preference for mass media as the first source of COVID-19 information. Self-identifying as male and less educational attainment were independently related to increased odds of seeking COVID-19 information first from interpersonal sources. Living with someone else was independently associated with trust in interpersonal rather than mass media sources.

Multivariable multinomial logistic model

Findings from the multivariable multinomial analysis suggest the preference of older adults for mass media as a first source of information was only significant for printed materials (e.g., newspapers, magazines) (OR: 1.02, p  = .04) and television (OR: 1.04, p  < .01) when compared to health care providers. There was no specific preference for mass media type based on mitigation beliefs. Also, while there was not a reported preference for interpersonal source based on educational attainment, the Internet (e.g., Google, WebMD) was less preferred as an initial source of COVID-19 information by participants with less formal educational attainment when compared to health care providers (OR: 0.50, p  < .01). Similarly, while males were inclined towards interpersonal sources first, there was not a meaningful difference in the preferred interpersonal source type based on gender. However, male participants did report less preference for Internet (OR: 0.70, p  = .02) and television (OR: 0.69, p  = .04) sources when compared to their health care providers.

Regarding the sources most trusted for COVID-19 information, living with someone else was not found to have a significant relationship with a preferred interpersonal source, but printed materials were considered a less trustworthy source of information compared to health care providers for individuals living with another person (OR: 0.47, p  = .02).

RQ2: How are discrimination and self-efficacy associated with information-seeking about COVID-19?

Tables  3 , 4 and 5 also present univariable and multivariable logistic regression estimates for the relationship between self-efficacy, perceived discrimination, and COVID-19 information-seeking behavior.

On univariable analysis, experiences with discrimination (OR: 0.73, p  < .01) were related to a preference for interpersonal sources of COVID-19 information. Further, greater confidence in personal health information-seeking ability (self-efficacy) was associated with seeking out interpersonal sources first (OR: 0.87, p  = .01) and regarding these sources as more trustworthy (OR: 0.79, p  < .001) compared to mass media sources.

In the multivariable model, having more experiences with discrimination was independently related to an increased odds of seeking COVID-19 information first from interpersonal sources. Increased self-efficacy was also an independent correlate of both increased preference and trust in interpersonal sources for COVID-19 information compared to mass media.

Results of the multivariable multinomial analysis suggest that individuals with stronger experiences with discrimination preferred to seek out COVID-19 information first from trusted family, relatives, or coworkers (OR: 1.30, p  = .05) and printed materials (OR: 1.5, p  < .01), but were less likely to seek information first from the Internet (OR: 0.70, p  < .01) and television (OR: 0.63, p  < .01) compared to their health care provider. There was not a meaningful difference in which interpersonal source participants preferred based on self-efficacy; however, greater efficacy was associated with less preference for the Internet (OR: 0.71, p  < .01), social media (OR: 0.66, p  = .02), and television (OR: 0.73, p  < .01) compared to health care providers.

Regarding the most trusted source of COVID-19 information, individuals with greater efficacy had smaller odds of viewing their family, relatives, or coworkers (OR: 0.76, p  = .01), Internet (OR: 0.72, p  < .01), and social media (OR:0.67, p  < .01) as a trustworthy source of information compared to health care providers. Table  6 provides a summary of the study findings.

The purpose of this study was to explore factors associated with audience preferences (first sought, most trusted) for COVID-19 information to inform the development of tailored health communication strategies. The current work adds to literature on HISB during the COVID-19 pandemic by providing evidence for the relationship between sociodemographics and source trust first proposed by Ali et al. [ 41 ], and extends by demonstrating how information sources, notably those first sought, are related to discrimination and information efficacy.

Sociodemographics driving COVID-19 information-seeking

One key finding is that mass media outlets, specifically print materials (e.g., newspapers, magazines) and TV, were preferred as initial sources for COVID-19 information for older participants. The elderly are particularly vulnerable to becoming severely ill from COVID-19, increasing the urgency for tailored communication strategies [ 50 ]. This preference for mass media as initial sources of information conflicts with previous findings suggesting that older adults rely on interpersonal sources such as health care providers and family members, not only for information but also to satisfy emotional needs stemming from social isolation during the pandemic [ 51 , 52 ].

One rationale for this inconsistency might be that the COVID-19 pandemic morphed into a political wedge issue in which risk perceptions, conspiracy beliefs, and responses to government recommendations were demarcated along partisan lines [ 6 , 53 , 54 ]. As a result, older adults might have sought information from their political echo chambers (e.g., cable news networks) rather than other sources such as government websites or health care providers [ 41 , 55 , 56 ].

Another explanation is that the novelty of the SARS-CoV-2 virus and the associated uncertainty, fear, and confusion limited the value of interpersonal discussions, prompting information to be sought elsewhere. It is worth noting that a large portion of this sample was college-educated, and other factors including health status may have contributed to this finding; individuals with chronic conditions may access COVID-19 information more often through the mass media but have less trust in these sources [ 57 ]. The interaction of age and health status on COVID-19 information-seeking is an area of future study.

Another key finding was that communication with interpersonal sources was preferred as a primary resource for information by those with lower levels of educational attainment. Further analysis revealed that there was not a significant difference in preference of first information source for participants with less formal education between preferring friends/relatives/co-workers or health care providers. However, the Internet was a less preferred source compared to health care providers for these participants, suggesting that providers can be targeted for campaigns aimed at this group. Studies of education level and COVID-19 misinformation have reported relationships with a multitude of factors, including lower confidence in government and scientific institutions as well as lower perceived infection risk [ 58 , 59 ]. However, previous research suggests that those with less formal education may perceive a greater risk of dying from COVID-19 and experience greater economic consequences because of the pandemic [ 58 ]; it is possible that this increased risk prompts information-seeking from professional sources. Further, individuals with lower levels of educational attainment are more likely to have reduced health literacy, and these individuals may instead turn to their doctors for information [ 60 ]. Educational attainment has been found to positively correlate with a diversity of sources [ 43 ], furthering the argument that education level is a barrier to information-seeking through mass media.

Mitigation beliefs

Participants with weaker beliefs in the importance of masking and social distancing when in public were more likely to seek out COVID-19 information through their interpersonal contacts first, regardless of the source. Individuals with strong doubts about the effectiveness of masking and social distancing are less prone to seek knowledge through external mass media channels, particularly when there is evolving information [ 61 ]. This finding offers confirming evidence for previous research demonstrating a significant relationship between COVID-19 information-seeking and adherence to mitigation strategies [ 62 ].

Given the politicization and polarization of the pandemic, those more skeptical of mitigation strategies would be more likely to look for information within their interpersonal networks rather than a media system that is viewed as biased [ 26 , 63 , 64 ]. These individuals may be challenging to target with health communication campaigns. However, given the demonstrated direct relationship between COVID-19 information seeking and preventive behavior [ 65 , 66 ], there is a pressing need for evidence-based efforts.

Discrimination and self-efficacy driving COVID-19 information-seeking

Discrimination.

Individuals reporting more common experiences with discrimination also described a greater preference for interpersonal contacts as an initial source for COVID-19 information, specifically friends, relatives, and co-workers. Discrimination can cause a delay in seeking medical care, including cancer screenings [ 67 ], and significantly increases stress response [ 68 ]. One speculation for this finding is that while mass media may be used as a means of coping with the stress that comes along with mistreatment, information exposure during a health crisis such as COVID-19 can intensify feelings of stress, leading to avoidance [ 69 , 70 ]. Given the high levels of discrimination reported during the pandemic [ 71 , 72 ], these groups may find it less distressing to receive information from trusted interpersonal sources, particularly those that share similar demographic backgrounds [ 69 ]. Additional research is needed to disentangle the effect of different sources of discrimination (e.g., gender, race, ethnicity) on information-seeking about COVID-19 [ 73 ].

Finally, this work also found that individuals with greater confidence in their ability to obtain health information preferred to seek out interpersonal sources first, with a particularly lower preference for the Internet, social media, and TV compared to their health care provider. Participants with greater efficacy also found interpersonal sources to be more trustworthy, yet maintained a lower perception of trustworthiness for friends, relatives, and family compared to health care providers. Individuals tend to make determinations on whether to engage in information-seeking by evaluating three types of efficacies: communication efficacy (whether the individual has the skill to seek information), target efficacy (whether their interpersonal source has the knowledge and is willing to share it), and coping efficacy (whether the individual can emotionally deal with the information) [ 21 ]. Thus, individuals with greater efficacy may feel more confidence in their ability to seek information from interpersonal sources based on their communication skills, beliefs that their interpersonal sources have reliable information, and beliefs that they can cope with the information potentially shared.

Interpersonal sources may also help calm the often overwhelming “noise” of competing and emerging information shared by media channels. Individuals who are confident in obtaining health information are also more likely to experience feelings such as fatalism when they experience challenges and frustrations in seeking this information [ 74 ]. Therefore, individuals with increased self-efficacy in their HISB may prefer to engage with interpersonal sources rather than mass media to attenuate the uncertainty associated with this massive influx of information.

Practical implications

Audience segmentation refers to the process of dividing an audience into definable, measurable groups to create messaging that is responsive to specific population needs [ 75 ]. This approach to message design can significantly impact engagement, as well as attitude and behavior change [ 76 ] and is thus considered an essential piece of tailored communication strategies already applied to COVID-19 messaging [ 69 ].

Findings from this study have meaningful implications for future practice through the identified audience variations regarding information-seeking preferences. These results can be leveraged to enhance the capability of specific target audiences to engage with evidence-based COVID-19 information. The politicization of COVID-19 and its influence on health inequalities, along with the rapid and uneven pace of information dissemination on COVID-19 guidelines, has been a challenge for effective health communication [ 77 ]. Thus, health communication campaigns that can efficiently identify strategies to reach various audiences in a targeted manner will have increased effectiveness. The following guidelines should be priority considerations when developing audience-focused COVID-19 information campaigns:

Understand the unique contexts of the intended audience, including the influence of societal inequalities on information-seeking behavior. Taking a user-centered approach to campaign design that actively seeks out and incorporates feedback will ensure that the preferences, needs, and values of the target audience are fully understood. This approach will also enhance campaign acceptability while reducing the effort required to engage with its components, all of which will increase efficacy. We offer the following specific recommendations for campaign tailoring based on the findings of this study:

Campaigns targeting older adults should develop materials for dissemination through television and print.

When developing campaigns targeting individuals with less formal educational attainment, include medical professionals.

Incorporating close social ties (i.e., friends, relatives, and co-workers) may increase the effectiveness of campaigns targeting groups experiencing discrimination.

Audiences with greater efficacy can be effectively targeted through their health care provider, whereas those with weaker beliefs in their ability to obtain health information can be better reached through the Internet (e.g., WebMD) and social media.

In addition to examining the “what” and “how” of message dissemination, the “where” and “who” should also be carefully considered. Theoretical frameworks such as diffusion of innovations [ 78 ] and social influence [ 79 ] can serve as starting points to further understand the influence of social networks and source credibility in information-seeking. Building capacity to bring these campaigns to scale will also be required and can be facilitated through the development of diverse collaborations that include community members and other stakeholders.

Lastly, consider the context of the topic and understand that source preferences for information may vary when the topics change, particularly given the political climate (e.g., COVID-19 information seeking may be very different than cancer screening). Campaign development should be iterative and agile in order to adapt to the fluidity inherent to these politically charged health topics, with systems in place for ongoing evaluation.

Strengths and limitations

This study adds to the literature on information-seeking about COVID-19 through the examination of sources of COVID-19 information most likely to be sought first and the exploration of the role of discrimination and self-efficacy on source preference (i.e., first sought and most trusted). The findings also offer support for previous research on the influence of sociodemographic factors in HISB.

This study is not without limitations. The measures of information sources may contain within-group differences (e.g., different social media platforms such as Facebook and Twitter are often used in different ways). Yet, this study provides compelling evidence for HISB during the pandemic and how individuals can be targeted with persuasive messaging. Also, while this online survey asked only for the FIRST preferred source or the MOST trusted, communication does not occur in a vacuum. Mass and interpersonal methods of communication are becoming increasingly intermingled [ 77 ], and factors such as authority (e.g., government websites and health care providers) might play a role [ 41 ]. Additional research is needed to build information-seeking models of increasing complexity surrounding the interplay of these factors.

The COVID-19 pandemic has weakened the US economy and led to tremendous life loss, and the uptake of protective measures is lacking due in part to false information being circulated within the media and personal networks. The findings of this study contribute to our understanding of how people are seeking out information about COVID-19 during the pandemic, which will allow for the development of evidence-based dissemination strategies. As information-seeking increases during the pandemic, exposure to risk information can have a direct tie to behavior, and the results of this study suggest that even with such a wide diversity of digital information sources and the capacity for scalable health communication campaigns that maximizing efforts to involve interpersonal connections may be preferable for some individuals. This idea is even more relevant during the current infodemic, where mass media channels have, in many ways, been corrupted by misinformation. By considering the audience factors illuminated in this study, researchers and practitioners become better equipped to deliver messaging through the sources and channels that are highly sought and trusted.

Availability of data and materials

Data are available upon request from the corresponding author.

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Research reported in this publication was supported by the State of Florida, the Florida Academic Cancer Center Alliance (FACCA), and the University of Florida Health Cancer Center (UFHCC), Cancer Population Sciences research program, and Biostatistics & Quantitative Sciences Shared Resource (BQS-SR). This research was also supported by the Team-based Interdisciplinary Cancer Research Training Program (T32 CA257923) at the University of Florida Health Cancer Center. And Grant Number U54CA233444 from the National Institutes of Health (NIH), National Cancer Institute (NCI). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the State of Florida, FACCA, NIH, or NCI.

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Contributions. EJC: Conceptualization, Writing – Original Draft, Writing – Review & Editing; MJV: Conceptualization, Writing—Original Draft, Writing-Review & Editing; BWD: Conceptualization, Methodology, Investigation, Writing – Original Draft, Writing-Review & Editing; SW: Formal analysis, Methodology, Writing-Original Draft, Writing-Review & Editing; GM: Writing-Original Draft, Writing-Review & Editing; AR: Conceptualization; Writing-Original Draft; BK: Conceptualization, Writing – Original Draft; Writing-Review & Editing; GCS: Conceptualization, Writing—Original Draft, Writing-Review & Editing; DJW: Funding Acquisition, Methodology, Investigation, Writing-Review & Editing; FO: Funding Acquisition, Methodology, Investigation, Writing-Review & Editing; VJM: Investigation, Writing-Review & Editing; YY: Methodology, Investigation, Writing-Review & Editing; JLK: Funding Acquisition, Conceptualization, Methodology, Investigation, Writing—Original Draft, Writing-Review & Editing. *All authors have read and approved the final manuscript. *

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Additional file 1..

 Study questionnaire. 

Additional file 2: Appendix 1.

Boxplots and bar graphs for predictors of COVID-19 information-seeking. 

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Cooks, E.J., Vilaro, M.J., Dyal, B.W. et al. What did the pandemic teach us about effective health communication? Unpacking the COVID-19 infodemic. BMC Public Health 22 , 2339 (2022). https://doi.org/10.1186/s12889-022-14707-3

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

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

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

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

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

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

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

Conclusions

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

Peer Review reports

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

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

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

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

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

Methodology

Research question.

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

Study design

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

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

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

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

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

Eligibility criteria

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

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

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

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

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

Information sources

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

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

Study selection

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

Data collection process

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

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

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

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

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

Quality assessment in individual reviews

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

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

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

Synthesis of results

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

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

Managing overlapping systematic reviews

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

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

PRISMA flow diagram

Characteristics of included reviews

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

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

Population and study designs

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

Systematic review findings

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

A meta-analysis of the prevalence of mortality

Clinical symptoms

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

A meta-analysis of the prevalence of fever

A meta-analysis of the prevalence of cough

A meta-analysis of the prevalence of dyspnea

A meta-analysis of the prevalence of fatigue or myalgia

A meta-analysis of the prevalence of headache

A meta-analysis of the prevalence of gastrointestinal disorders

A meta-analysis of the prevalence of sore throat

Diagnostic aspects

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

Therapeutic possibilities

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

Laboratory and radiological findings

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

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

Quality of evidence in individual systematic reviews

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Availability of data and materials

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

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Acknowledgments

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

This research received no external funding.

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University Hospital and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

Israel Júnior Borges do Nascimento & Milena Soriano Marcolino

Medical College of Wisconsin, Milwaukee, WI, USA

Israel Júnior Borges do Nascimento

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

Dónal P. O’Mathúna

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

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

Thilo Caspar von Groote

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

Hebatullah Mohamed Abdulazeem

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

Ishanka Weerasekara

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

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

Ana Marusic, Irena Zakarija-Grkovic & Tina Poklepovic Pericic

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

Livia Puljak

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

Vinicius Tassoni Civile & Alvaro Nagib Atallah

Yorkville University, Fredericton, New Brunswick, Canada

Santino Filoso

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

Nicola Luigi Bragazzi

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

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Supplementary Information

Additional file 1: appendix 1..

Search strategies used in the study.

Additional file 2: Appendix 2.

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

Additional file 3: Appendix 3.

List of excluded studies, with reasons.

Additional file 4: Appendix 4.

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

Additional file 5: Appendix 5.

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

Additional file 6: Appendix 6.

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

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The Role of Public Health in COVID-19 Emergency Response Efforts From a Rural Health Perspective

COMMENTARY — Volume 17 — July 23, 2020

Sandra C. Melvin, DrPH, MPH 1 ; Corey Wiggins, PhD, MSPH 2 ; Nakeitra Burse, DrPH, MS 3 ; Erica Thompson, MD, MPH 4 ; Mauda Monger, PhD, MPH 5 ( View author affiliations )

Suggested citation for this article: Melvin SC, Wiggins C, Burse N, Thompson E, Monger M. The Role of Public Health in COVID-19 Emergency Response Efforts From a Rural Health Perspective. Prev Chronic Dis 2020;17:200256. DOI: http://dx.doi.org/10.5888/pcd17.200256 external icon .

PEER REVIEWED

Introduction

Challenges for rural communities, covid-19 community vulnerability index, special concerns for rural communities, implications for public health, author information, acknowledgments.

What is already known on this topic?

Coronavirus disease 2019 (COVID-19) is a serious global pandemic. Rural minority communities are particularly at risk because of a weakened health care infrastructure, health care provider shortages, and lower socioeconomic status.

What is added by this report?

This report describes challenges faced by rural communities affected by the COVID-19 pandemic and provides recommendations to address those challenges.

What are the implications for public health practice?

The COVID-19 Community Vulnerability Index is a tool that can help identify communities most at risk for COVID-19 based on indicators such as socioeconomic status and health care system factors.

As the country responds to coronavirus disease 2019 (COVID-19), the role of public health in ensuring the delivery of equitable health care in rural communities has not been fully appreciated. The impact of such crises is exacerbated in rural racial/ethnic minority communities. Various elements contribute to the problems identified in rural areas, including a declining population; economic stagnation; shortages of physicians and other health care providers; a disproportionate number of older, poor, and underinsured residents; and high rates of chronic illness. This commentary describes the challenges faced by rural communities in addressing COVID-19, with a focus on the issues faced by southeastern US states. The commentary will also address how the COVID-19 Community Vulnerability Index may be used as a tool to identify communities at heightened risk for COVID-19 on the basis of 6 clearly defined indicators.

Rural communities are heterogeneous. In 2010, 19.3% of the US population resided in rural areas, compared with 54.4% in 1910, with the highest concentration being in the southeastern United States. The southeastern region includes Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Texas, and racial and ethnic minorities make up 19% of the entire rural population (1). Socioeconomic characteristics influence the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For example, in Mississippi, approximately 20% of the population lives in poverty (2). In 2019, Mississippi, Louisiana, Arkansas, and Alabama were ranked as the country’s least healthy states (2). This statistic is important, because the less healthy the population, the more likely the epidemic is to have fatal consequences. In addition, the weaker the health system, the harder it is to contain the virus.

Most of the states that make up the southeastern United States are rural ( Table 1 ). Rural communities face a unique set of challenges in the face of the coronavirus disease 2019 (COVID-19) pandemic. They are often areas already affected by high levels of poverty, lower levels of access to quality health care, lower levels of health literacy, and social stigma. Many elements contribute to these problems, including a declining population; economic stagnation; shortages of physicians and other health care professionals; a disproportionate number of older, poor, and underinsured residents; and high rates of chronic illness. This commentary will describe the challenges and issues faced by rural communities in addressing the COVID-19 pandemic. It will also show how the COVID-19 Community Vulnerability Index (CCVI) (4) may be used as a tool to identify communities at highest risk for COVID-19 on the basis of 6 clearly defined indicators ( Table 2 ).

As the COVID-19 outbreak continues to place a burden on hospitals throughout the United States, concern is growing that many hospitals, in particular rural hospitals, may not have the financial reserves to remain fiscally viable. Most rural hospitals operate on tight budgets, and they rely on high-profit services, such as elective surgery, to keep them in business. For many rural hospitals, canceling these profitable services to cope with the COVID-19 pandemic may result in financial catastrophe (5).

The closure of rural health care facilities or the discontinuation of services can negatively affect access to health care in a rural community. People in rural areas who get sick with COVID-19 have fewer hospitals to treat them. Compared with urban hospitals, rural hospitals are smaller, have a higher proportion of primary care physicians and a lower proportion of board-certified physicians on their medical staffs, have fewer intensive care beds, and are less likely to have contracts with health maintenance organizations and preferred provider organizations.

People living in rural areas are at increased risk of COVID-19, because they are less likely to be employed and more likely have low incomes than people living in other areas. They also face significant barriers to accessing care, including provider shortages, recent closures of rural hospitals, and long travel distances to providers. Local rural health care systems are fragile; when one facility closes or a provider leaves, it can affect care and access to care throughout the community. Furthermore, when a hospital closes, access to nonhospital care can also decline, because many specialists cluster around hospitals. Rural hospitals face severe financial challenges, and they are also more likely than urban hospitals to close. For example, 15 of 21 hospitals that closed in the United States in 2016 were in rural communities, and since 2010, nearly 90 rural hospitals in the United States have closed (6). Another financial challenge to rural hospitals is shrinking populations, which means fewer patients to fill beds. Although populations in urban counties have increased since 2000, populations in half of rural counties in the United States have decreased, which has caused a reduction in revenue for rural hospitals. Most recent hospital closings have been in states that opted not to expand Medicaid under the Affordable Care Act, which means that a significant portion of their health care costs remain uncompensated, thus creating a financial burden for these states (7).

Given the unique challenges for rural communities — exacerbated by a weakening rural health care infrastructure, health care provider shortages, and closure of rural hospitals — monitoring and control plans need to be developed to ensure that the magnitude of illness and death in those communities are assessed. Specifically, solutions need to be developed that account for the rural nature of these communities as well as the social determinants of health that influence health care outcomes.

Community-level social disadvantage and vulnerability to disasters can influence the incidence of COVID-19 and its adverse outcomes in several ways. For example, lower socioeconomic status (SES) is associated with poor health care access, which may increase risk for adverse health outcomes. Labor inequalities, lack of workplace protections, and household overcrowding may decrease the ability to adhere to social-distancing guidelines. Additionally, racial/ethnic minorities and immigrants are less likely to have access to appropriate and timely health care. Evidence suggests that these inequalities contributed to disease spread and severity during the H1N1 influenza pandemic (8–11).

The CCVI, developed by the Surgo Foundation (4), can be used to identify which communities may need the most support during a pandemic or similar public health emergency. CCVI scores range in value from 0 to 1, with higher scores indicating greater vulnerability. A given geographic unit — for example, a census tract or county — is ranked relative to all similar units across the country on the basis of 6 themes: 1) SES, 2) household composition and disability, 3) minority status and language, 4) housing type and transportation, 5) epidemiologic factors, and 6) health care system factors. The score generated can then be used to designate a level of vulnerability. Each designation corresponds to a quintile of that geographic unit type in the United States. For example, a county score of 0 to 0.20 would correspond to very low vulnerability compared with all other US counties, a score of 0.21 to 0.40 would correspond to low vulnerability, and so on through the last category of very high vulnerability and a score of 0.81 to 1.

The CCVI is not designed to predict which individuals will become infected with SARS-CoV-2. However, it can provide information about the anticipated negative impact at the community level. This information can help decision makers target resources where they are most needed. The index could be useful in developing a community risk profile for SARS-CoV-2 infection that can be used to target and tailor control efforts. Data from the CCVI demonstrate that each of the 9 southeastern states has a CCVI score that indicates very high vulnerability. Scores for each state also indicated very high vulnerability on each of the 6 indicators used to generate the CCVI (4,12–14). For example, Mississippi has a score of 1 for SES and household composition and disability and a score of 0.92 for epidemiologic factors. The overall CCVI score for Mississippi is 0.92. This score indicates that Mississippi is particularly vulnerable and prone to poorer COVID-19–related outcomes, especially in communities with lower SES and poor health status overall.

Since the outbreak of COVID-19, health care delivery has changed considerably. The United States has adapted its technology and policies to accommodate health care delivery at a distance. However, although telehealth use has increased during the pandemic, the regulatory changes that made this increase possible are not permanent. Moreover, the kinds of technologic advancements required for remote health care delivery can be challenging to implement in rural communities. The terrain can make it difficult, sometimes impossible, to install fiber or other infrastructure, and the biggest barrier to obtaining broadband internet service in certain areas of the country is low population density.

Furthermore, the cost of telemedicine for rural health clinics is an issue, because many rural patients receive either Medicare or Medicaid, and reimbursements from these government health care programs, as well as from private insurance companies, do not fully cover the costs of virtual medicine.

For rural communities in the Southeast, success at implementing these virtual systems has been fragmented. Unreliable access to at-home technology, broadband internet service, and cellular telephone reception have prevailed in some communities, while ever-present financial hurdles abound. The COVID-19 pandemic has exposed the limitations of these remote areas (15).

Affordability of health care is a significant challenge for rural areas in the southeastern United States. However, several of the most rural states in the country opted not to expand Medicaid under the Affordable Care Act; 59% of uninsured rural people live in these states (16). Lack of insurance has implications for access to care, because people without health insurance may delay seeking care even if they have symptoms, for fear of incurring expenses that they cannot pay (16).

In addition to lacking good health insurance, many people living in southeastern and rural states face the barrier of distance (17). Geographic isolation and related challenges, including lack of transportation and extreme weather conditions, make it harder for people in rural communities than people in urban communities to travel for care, and services are typically farther away (18). For example, to get to Sunflower Medical Center in Ruleville, Mississippi, some patients travel as far as 45 miles to receive care (15).

The lack of infrastructure is not limited to roads and highways; in rural areas, health care infrastructure may also be extremely limited, health care resources scarce, and clinical providers few. Only 9% of the nation’s physicians and 16% of the nation’s registered nurses practice in rural areas. Dentists and pharmacists are also scarce in these areas (18).

Community health centers play an important role in rural and remote areas and form one of the largest systems of care available to rural populations. Today, community health centers serve 1 in 6 rural residents (19), so they have a critical role in the response strategy to COVID-19 in rural communities. Because health centers are in virtually every community in our country, they are in a unique position to respond to COVID-19. They can help increase access and availability of COVID-19 testing for the community.

However, despite ramping up testing and virtual visits, health centers are reporting steep declines in patient visits, and many staff members are unable to work because of COVID-19–related issues. These issues include having to juggle work obligations and parenting obligations as a result of school closings and not being able to find appropriate child care as a result of day care closings. Another challenge is the temporary closures of health centers as a result of the pandemic. Although health care centers received $1.98 billion in rapid response grants from the federal government, more financial support may be needed to sustain services (20). Health centers also have issues related to the availability of personal protective equipment and testing supplies. Staffing to assist with contact tracing for COVID-19–positive people is also necessary.

The CCVI is a valuable tool that can be used as part of a coordinated response to identify communities at greatest risk for COVID-19, so that resources can be deployed strategically to those areas. This tool, in coordination with targeted testing and contact tracing, can be effective in flattening the COVID-19 curve and ensuring that the most vulnerable communities have access to health care resources. Creating a complete profile of people at risk for SARS-CoV-2 infection is also important. A complete risk profile, including geographic hotspots, needs to be developed for the southeastern region to target and tailor control efforts.

Stakeholders that work with underserved populations should be included in the emergency response planning process and enlisted to help reach disadvantaged and marginalized communities. Information generated from the CCVI can be used to develop a coordinated, comprehensive approach to addressing the pandemic that is specific to rural communities in the South. These stakeholders should include hospitals, health care centers, insurance providers, policy makers, community-based organizations, and faith-based organizations. This coordination would be valuable in planning emergency response, identifying areas of greatest needs, developing culturally appropriate messaging, and disseminating information throughout the community.

Corresponding Author: Sandra C. Melvin, DrPH, MPH, Institute for the Advancement of Minority Health, 215 Katherine Dr, Flowood, MS 39232. Telephone: 601-665-3812. Email: [email protected] .

Author Affiliations: 1 Institute for the Advancement of Minority Health, Ridgeland, Mississippi. 2 Mississippi State Conference of the NAACP, Jackson, Mississippi. 3 Six Dimensions, LLC, Ridgeland, Mississippi. 4 Magnolia Medical Foundation, Jackson, Mississippi. 5 MLM Center for Health Education and Equity Consulting Services, LLC, Jackson, Mississippi.

We thank the Surgo Foundation for providing the data we used to create Table 2, COVID-19 Community Vulnerability Index Applied to 9 Southeastern US States.

• Paschal O. The rural South defies demographic and political stereotypes; 2017. https://www.facingsouth.org/2017/06/rural-south-defies-demographic-and-political-stereotypes. Accessed June 18, 2020.
• US Census Bureau. Quickfacts; 2010. https://www.census.gov/quickfacts. Accessed June 23, 2020.
• US Census Bureau. American Community Survey: 2010 data. https://www.census.gov/programs-surveys/acs/guidance/comparing-acs-data/2010.html. Accessed June 25, 2020.
• Surgo Foundation. Tracking the spread of COVID-19 through the lens of community vulnerability; 2020. https://precisionforcovid.org/cases. Accessed June 19, 2020.
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• iVantage Health Analytics. Rural relevance — vulnerability to value, 2016. https://www.chartis.com/resources/files/INDEX_2016_Rural_Relevance_Study_FINAL_Formatted_02_08_16.pdf. Accessed June 23, 2020.
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• Link BG. Epidemiological sociology and the social shaping of population health. J Health Soc Behav 2008;49(4):367–84. CrossRef external icon PubMed external icon
• Drago R, Miller K. Sick at work: infected employees in the workplace during the H1N1 pandemic. Washington (DC): Institute for Women’s Policy Research; 2010.
• Quinn SC, Kumar S, Freimuth VS, Musa D, Casteneda-Angarita N, Kidwell K. Racial disparities in exposure, susceptibility, and access to health care in the US H1N1 influenza pandemic. Am J Public Health 2011;101(2):285–93. CrossRef external icon PubMed external icon
• Flanagan BE, Hallisey EJ, Adams E, Lavery A. Measuring community vulnerability to natural and anthropogenic hazards: the Centers for Disease Control and Prevention’s Social Vulnerability Index. J Environ Health 2018;80(10):34–6. PubMed external icon
• Horney J, Nguyen M, Salvesen D, Dwyer C, Cooper J, Berke P. Assessing the quality of rural hazard mitigation plans in the southeastern United States. J Plann Educ Res 2017;37(1):56–65. CrossRef external icon
• Horney J, Simon M, Grabich S, Berke P. Measuring participation by socially vulnerable groups in hazard mitigation planning, Bertie County, North Carolina. J Environ Plann Manage 2015;58(5):802–18. CrossRef external icon
• Sklar J. Why rural hospitals may not survive COVID-19. National Geographic. 2020. https://www.nationalgeographic.com/science/2020/06/why-rural-hospitals-may-not-survive-coronavirus-telemedicine/#close. Accessed June 19, 2020.
• Foultz AJ, Artiga S, Garfield R. The role of Medicaid in rural America. 2017. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/the-role-of-medicaid-in-rural-america. Accessed July 1, 2020.
• Rural Health Information Hub. Healthcare access in rural communities. 2019. https://www.ruralhealthinfo.org/topics/healthcare-access#barriers. Accessed July 1, 2020.
• Hartzband D, Jacobs F. Population health approaches to improving rural health. 2019. RCHN Community Health Foundation. https://www.rchnfoundation.org/wp-content/uploads/2018/04/Pop-Health-Approaches-to-Improving-Rural-Health.pdf. Accessed July 1, 2020.
• Bolin JN, Bellamy GR, Ferdinand AO, Vuong AM, Kash BA, Schulze A, et al. Rural Healthy People 2020: new decade, same challenges. J Rural Health 2015;31(3):326–33. CrossRef external icon PubMed external icon
• Corallo B, Tolbert J. Impact of coronavirus on community health centers. Kaiser Family Foundation; 2020. https://www.kff.org/coronavirus-covid-19/issue-brief/impact-of-coronavirus-on-community-health-centers. Accessed June 24, 2020.

a Source: American Community Survey (3).

Abbreviations: CCVI, COVID-19 Community Vulnerability Index; SES, socioeconomic status. a CCVI scores range from 0 to 1; higher scores indicate greater vulnerability. Source: Surgo Foundation (4).

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

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Persuasive Essay Guide

Persuasive Essay About Covid19

How to Write a Persuasive Essay About Covid19 | Examples & Tips

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Are you looking to write a persuasive essay about the Covid-19 pandemic?

Writing a compelling and informative essay about this global crisis can be challenging. It requires researching the latest information, understanding the facts, and presenting your argument persuasively.

But don’t worry! with some guidance from experts, you’ll be able to write an effective and persuasive essay about Covid-19.

In this blog post, we’ll outline the basics of writing a persuasive essay . We’ll provide clear examples, helpful tips, and essential information for crafting your own persuasive piece on Covid-19.

Read on to get started on your essay.

• 1. Steps to Write a Persuasive Essay About Covid-19
• 2. Examples of Persuasive Essay About Covid19
• 3. Examples of Persuasive Essay About Covid-19 Vaccine
• 4. Examples of Persuasive Essay About Covid-19 Integration
• 5. Examples of Argumentative Essay About Covid 19
• 6. Examples of Persuasive Speeches About Covid-19
• 7. Tips to Write a Persuasive Essay About Covid-19
• 8. Common Topics for a Persuasive Essay on COVID-19 

Steps to Write a Persuasive Essay About Covid-19

Here are the steps to help you write a persuasive essay on this topic, along with an example essay:

Step 1: Choose a Specific Thesis Statement

Your thesis statement should clearly state your position on a specific aspect of COVID-19. It should be debatable and clear. For example:

Step 2: Research and Gather Information

Collect reliable and up-to-date information from reputable sources to support your thesis statement. This may include statistics, expert opinions, and scientific studies. For instance:

• COVID-19 vaccination effectiveness data
• Information on vaccine mandates in different countries
• Expert statements from health organizations like the WHO or CDC

Step 3: Outline Your Essay

Create a clear and organized outline to structure your essay. A persuasive essay typically follows this structure:

• Introduction
• Background Information
• Body Paragraphs (with supporting evidence)
• Counterarguments (addressing opposing views)

Step 4: Write the Introduction

In the introduction, grab your reader's attention and present your thesis statement. For example:

Step 5: Provide Background Information

Offer context and background information to help your readers understand the issue better. For instance:

Step 6: Develop Body Paragraphs

Each body paragraph should present a single point or piece of evidence that supports your thesis statement. Use clear topic sentences, evidence, and analysis. Here's an example:

Step 7: Address Counterarguments

Acknowledge opposing viewpoints and refute them with strong counterarguments. This demonstrates that you've considered different perspectives. For example:

Step 8: Write the Conclusion

Summarize your main points and restate your thesis statement in the conclusion. End with a strong call to action or thought-provoking statement. For instance:

Step 9: Revise and Proofread

Edit your essay for clarity, coherence, grammar, and spelling errors. Ensure that your argument flows logically.

Step 10: Cite Your Sources

Include proper citations and a bibliography page to give credit to your sources.

Remember to adjust your approach and arguments based on your target audience and the specific angle you want to take in your persuasive essay about COVID-19.

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Examples of Persuasive Essay About Covid19

When writing a persuasive essay about the Covid-19 pandemic, it’s important to consider how you want to present your argument. To help you get started, here are some example essays for you to read:

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Persuasive Essay About Covid-19 Pandemic

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Examples of Persuasive Essay About Covid-19 Vaccine

Covid19 vaccines are one of the ways to prevent the spread of Covid-19, but they have been a source of controversy. Different sides argue about the benefits or dangers of the new vaccines. Whatever your point of view is, writing a persuasive essay about it is a good way of organizing your thoughts and persuading others.

A persuasive essay about the Covid-19 vaccine could consider the benefits of getting vaccinated as well as the potential side effects.

Below are some examples of persuasive essays on getting vaccinated for Covid-19.

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Examples of Persuasive Essay About Covid-19 Integration

Covid19 has drastically changed the way people interact in schools, markets, and workplaces. In short, it has affected all aspects of life. However, people have started to learn to live with Covid19.

Writing a persuasive essay about it shouldn't be stressful. Read the sample essay below to get idea for your own essay about Covid19 integration.

Persuasive Essay About Working From Home During Covid19

Searching for the topic of Online Education? Our persuasive essay about online education is a must-read.

Examples of Argumentative Essay About Covid 19

Covid-19 has been an ever-evolving issue, with new developments and discoveries being made on a daily basis.

Writing an argumentative essay about such an issue is both interesting and challenging. It allows you to evaluate different aspects of the pandemic, as well as consider potential solutions.

Here are some examples of argumentative essays on Covid19.

Argumentative Essay About Covid19 Sample

Argumentative Essay About Covid19 With Introduction Body and Conclusion

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Examples of Persuasive Speeches About Covid-19

Do you need to prepare a speech about Covid19 and need examples? We have them for you!

Persuasive speeches about Covid-19 can provide the audience with valuable insights on how to best handle the pandemic. They can be used to advocate for specific changes in policies or simply raise awareness about the virus.

Check out some examples of persuasive speeches on Covid-19:

Persuasive Speech About Covid-19 Example

Persuasive Speech About Vaccine For Covid-19

You can also read persuasive essay examples on other topics to master your persuasive techniques!

Tips to Write a Persuasive Essay About Covid-19

Writing a persuasive essay about COVID-19 requires a thoughtful approach to present your arguments effectively. 

Here are some tips to help you craft a compelling persuasive essay on this topic:

Choose a Specific Angle

Start by narrowing down your focus. COVID-19 is a broad topic, so selecting a specific aspect or issue related to it will make your essay more persuasive and manageable. For example, you could focus on vaccination, public health measures, the economic impact, or misinformation.

Provide Credible Sources 

Support your arguments with credible sources such as scientific studies, government reports, and reputable news outlets. Reliable sources enhance the credibility of your essay.

Use Persuasive Language

Employ persuasive techniques, such as ethos (establishing credibility), pathos (appealing to emotions), and logos (using logic and evidence). Use vivid examples and anecdotes to make your points relatable.

Organize Your Essay

Structure your essay involves creating a persuasive essay outline and establishing a logical flow from one point to the next. Each paragraph should focus on a single point, and transitions between paragraphs should be smooth and logical.

Emphasize Benefits

Highlight the benefits of your proposed actions or viewpoints. Explain how your suggestions can improve public health, safety, or well-being. Make it clear why your audience should support your position.

Use Visuals -H3

Incorporate graphs, charts, and statistics when applicable. Visual aids can reinforce your arguments and make complex data more accessible to your readers.

Call to Action

End your essay with a strong call to action. Encourage your readers to take a specific step or consider your viewpoint. Make it clear what you want them to do or think after reading your essay.

Revise and Edit

Proofread your essay for grammar, spelling, and clarity. Make sure your arguments are well-structured and that your writing flows smoothly.

Seek Feedback 

Have someone else read your essay to get feedback. They may offer valuable insights and help you identify areas where your persuasive techniques can be improved.

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Common Topics for a Persuasive Essay on COVID-19 

Here are some persuasive essay topics on COVID-19:

• The Importance of Vaccination Mandates for COVID-19 Control
• Balancing Public Health and Personal Freedom During a Pandemic
• The Economic Impact of Lockdowns vs. Public Health Benefits
• The Role of Misinformation in Fueling Vaccine Hesitancy
• Remote Learning vs. In-Person Education: What's Best for Students?
• The Ethics of Vaccine Distribution: Prioritizing Vulnerable Populations
• The Mental Health Crisis Amidst the COVID-19 Pandemic
• The Long-Term Effects of COVID-19 on Healthcare Systems
• Global Cooperation vs. Vaccine Nationalism in Fighting the Pandemic
• The Future of Telemedicine: Expanding Healthcare Access Post-COVID-19

In search of more inspiring topics for your next persuasive essay? Our persuasive essay topics blog has plenty of ideas!

To sum it up,

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Frequently Asked Questions

Are there any ethical considerations when writing a persuasive essay about covid-19.

Yes, there are ethical considerations when writing a persuasive essay about COVID-19. It's essential to ensure the information is accurate, not contribute to misinformation, and be sensitive to the pandemic's impact on individuals and communities. Additionally, respecting diverse viewpoints and emphasizing public health benefits can promote ethical communication.

What impact does COVID-19 have on society?

The impact of COVID-19 on society is far-reaching. It has led to job and economic losses, an increase in stress and mental health disorders, and changes in education systems. It has also had a negative effect on social interactions, as people have been asked to limit their contact with others.

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COVID-19 photo essay: We’re all in this together

About the author, department of global communications.

The United Nations Department of Global Communications (DGC) promotes global awareness and understanding of the work of the United Nations.

23 June 2020 – The COVID-19 pandemic has  demonstrated the interconnected nature of our world – and that no one is safe until everyone is safe.  Only by acting in solidarity can communities save lives and overcome the devastating socio-economic impacts of the virus.  In partnership with the United Nations, people around the world are showing acts of humanity, inspiring hope for a better future. 

Everyone can do something    

Rauf Salem, a volunteer, instructs children on the right way to wash their hands, in Sana'a, Yemen.  Simple measures, such as maintaining physical distance, washing hands frequently and wearing a mask are imperative if the fight against COVID-19 is to be won.  Photo: UNICEF/UNI341697

Creating hope

Venezuelan refugee Juan Batista Ramos, 69, plays guitar in front of a mural he painted at the Tancredo Neves temporary shelter in Boa Vista, Brazil to help lift COVID-19 quarantine blues.  “Now, everywhere you look you will see a landscape to remind us that there is beauty in the world,” he says.  Ramos is among the many artists around the world using the power of culture to inspire hope and solidarity during the pandemic.  Photo: UNHCR/Allana Ferreira

Inclusive solutions

Wendy Schellemans, an education assistant at the Royal Woluwe Institute in Brussels, models a transparent face mask designed to help the hard of hearing.  The United Nations and partners are working to ensure that responses to COVID-19 leave no one behind.  Photo courtesy of Royal Woluwe Institute

Humanity at its best

Maryna, a community worker at the Arts Centre for Children and Youth in Chasiv Yar village, Ukraine, makes face masks on a sewing machine donated by the Office of the United Nations High Commissioner for Refugees (UNHCR) and civil society partner, Proliska.  She is among the many people around the world who are voluntarily addressing the shortage of masks on the market. Photo: UNHCR/Artem Hetman

Keep future leaders learning

A mother helps her daughter Ange, 8, take classes on television at home in Man, Côte d'Ivoire.  Since the COVID-19 pandemic began, caregivers and educators have responded in stride and have been instrumental in finding ways to keep children learning.  In Côte d'Ivoire, the United Nations Children’s Fund (UNICEF) partnered with the Ministry of Education on a ‘school at home’ initiative, which includes taping lessons to be aired on national TV and radio.  Ange says: “I like to study at home.  My mum is a teacher and helps me a lot.  Of course, I miss my friends, but I can sleep a bit longer in the morning.  Later I want to become a lawyer or judge."  Photo: UNICEF/UNI320749

Global solidarity

People in Nigeria’s Lagos State simulate sneezing into their elbows during a coronavirus prevention campaign.  Many African countries do not have strong health care systems.  “Global solidarity with Africa is an imperative – now and for recovering better,” said United Nations Secretary-General António Guterres.  “Ending the pandemic in Africa is essential for ending it across the world.” Photo: UNICEF Nigeria/2020/Ojo

A new way of working

Henri Abued Manzano, a tour guide at the United Nations Information Service (UNIS) in Vienna, speaks from his apartment.  COVID-19 upended the way people work, but they can be creative while in quarantine.  “We quickly decided that if visitors can’t come to us, we will have to come to them,” says Johanna Kleinert, Chief of the UNIS Visitors Service in Vienna.  Photo courtesy of Kevin Kühn

Life goes on

Hundreds of millions of babies are expected to be born during the COVID-19 pandemic.  Fionn, son of Chloe O'Doherty and her husband Patrick, is among them.  The couple says: “It's all over.  We did it.  Brought life into the world at a time when everything is so uncertain.  The relief and love are palpable.  Nothing else matters.”  Photo: UNICEF/UNI321984/Bopape

Putting meals on the table

Sudanese refugee Halima, in Tripoli, Libya, says food assistance is making her life better.  COVID-19 is exacerbating the existing hunger crisis.  Globally, 6 million more people could be pushed into extreme poverty unless the international community acts now.  United Nations aid agencies are appealing for more funding to reach vulnerable populations.  Photo: UNHCR

Supporting the frontlines

The United Nations Air Service, run by the World Food Programme (WFP), distributes protective gear donated by the Jack Ma Foundation and Alibaba Group, in Somalia. The United Nations is using its supply chain capacity to rapidly move badly needed personal protective equipment, such as medical masks, gloves, gowns and face-shields to the frontline of the battle against COVID-19. Photo: WFP/Jama Hassan  

S7-Episode 2: Bringing Health to the World

“You see, we're not doing this work to make ourselves feel better. That sort of conventional notion of what a do-gooder is. We're doing this work because we are totally convinced that it's not necessary in today's wealthy world for so many people to be experiencing discomfort, for so many people to be experiencing hardship, for so many people to have their lives and their livelihoods imperiled.”

Dr. David Nabarro has dedicated his life to global health. After a long career that’s taken him from the horrors of war torn Iraq, to the devastating aftermath of the Indian Ocean tsunami, he is still spurred to action by the tremendous inequalities in global access to medical care.

“The thing that keeps me awake most at night is the rampant inequities in our world…We see an awful lot of needless suffering.”

:: David Nabarro interviewed by Melissa Fleming

Brazilian ballet pirouettes during pandemic

Ballet Manguinhos, named for its favela in Rio de Janeiro, returns to the stage after a long absence during the COVID-19 pandemic. It counts 250 children and teenagers from the favela as its performers. The ballet group provides social support in a community where poverty, hunger and teen pregnancy are constant issues.

Radio journalist gives the facts on COVID-19 in Uzbekistan

The pandemic has put many people to the test, and journalists are no exception. Coronavirus has waged war not only against people's lives and well-being but has also spawned countless hoaxes and scientific falsehoods.

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Examining persuasive message type to encourage staying at home during the COVID-19 pandemic and social lockdown: A randomized controlled study in Japan

• • We examined persuasive message types in terms of a narrator encouraging self-restraint.
• • Messages from a governor, an expert, a physician, a patient, and a resident were compared.
• • The message from a physician increased intention to stay at home the most.
• • The physician’s message conveyed the crisis of collapse of the medical system.

Behavioral change is the only prevention against the COVID-19 pandemic until vaccines become available. This is the first study to examine the most persuasive message type in terms of narrator difference in encouraging people to stay at home during the COVID-19 pandemic and social lockdown.

Participants (n = 1,980) were randomly assigned to five intervention messages (from a governor, a public health expert, a physician, a patient, and a resident of an outbreak area) and a control message. Intention to stay at home before and after reading messages was assessed. A one-way ANOVA with Tukey’s or Games–Howell test was conducted.

Compared with other messages, the message from a physician significantly increased participants’ intention to stay at home in areas with high numbers of people infected (versus a governor, p  = .002; an expert, p  = .023; a resident, p  = .004).

The message from a physician―which conveyed the crisis of overwhelmed hospitals and consequent risk of people being unable to receive treatment―increased the intent to stay at home the most.

Practice implications

Health professionals and media operatives may be able to encourage people to stay at home by disseminating the physicians’ messages through media and the internet.

1. Introduction

The outbreak of the coronavirus disease 2019 (COVID-19) has emerged as the largest global pandemic ever experienced [ 1 ]. Experts have proposed that social lockdown will lead to improvements such as controlling the increase in the number of infected individuals and preventing a huge burden on the healthcare system [ [2] , [3] , [4] ]. Governments of many countries across the world have declared local and national social lockdown [ 4 , 5 ]. In April 2020, the Japanese government declared a state of emergency, which allows prefectural governors to request residents to refrain from unnecessary and nonurgent outings from home [ 6 ]. However, despite such governor declarations, people in various countries have resisted and disregarded calls to stay at home [ [7] , [8] , [9] ]. Because social lockdown is the only existing weapon for prevention of the pandemic until vaccines becomes available to treat COVID-19, behavioral change in individuals regarding staying at home is crucial [ 3 , 4 ]. Many news articles about COVID-19 are published daily by the mass media and over the internet. Such articles convey messages from governors, public health experts, physicians, COVID-19 patients, and residents of outbreak areas, encouraging people to stay at home. This is the first study to examine which narrator’s message is most persuasive in encouraging people to do so during the COVID-19 pandemic and social lockdown.

2.1. Participants and design

Participants were recruited from people registered in a survey company database in Japan. The eligibility criterion was men and women aged 18–69 years. Exclusion criteria were individuals who answered screening questions by stating: that they cannot go out because of illness or disability; that they have been diagnosed with a mental illness; or/and that they or their family members have been infected with COVID-19. A total of 1,980 participants completed the survey from May 9–11, 2020, when the state of emergency covered all prefectures in Japan. Participants were included according to the population composition ratio in Japan nationwide by gender, age, and residential area. Participants were randomly assigned either to a group that received an intervention message (i.e., from a governor, a public health expert, a physician, a patient, and a resident of the outbreak area) or to one that received a control message. The study was registered as a University Hospital Medical Information Network Clinical Trials Registry (number: UMIN000040286) on May 1, 2020. The methods of the present study adhered to CONSORT guidelines. The protocol was approved by the ethical review committee at the Graduate School of Medicine, University of Tokyo (number: 2020032NI). All participants gave written informed consent in accordance with the Declaration of Helsinki.

2.2. Intervention and control messages

We searched news articles about COVID-19 using Yahoo! JAPAN News ( https://news.yahoo.co.jp ), the largest Japanese news portal site. We also searched videos posted by residents of outbreak areas such as New York using YouTube ( https://www.youtube.com/user/YouTubeJapan ). By referring to these articles and videos, we created five intervention messages from a governor, a public health expert, a physician, a patient, and a resident of an outbreak area. The content of each message encouraged readers to stay at home. We included threat and coping messages in each intervention message based on protection motivation theory (PMT) [ 10 , 11 ]. Appendix A shows the five intervention messages used in this study, translated into English for this report. For a control message we obtained textual information about bruxism from the website of the Ministry of Health, Labour and Welfare ( https://www.e-healthnet.mhlw.go.jp/ ).

2.3. Measures

The primary outcome was intention to stay at home. The secondary outcomes were PMT constructs (i.e., perceived severity, vulnerability, response efficacy, and self-efficacy). Participants responded to two or three questions for each measure (see Appendix B ). These measures were adapted and modified from previous studies [ [12] , [13] , [14] , [15] ]. All primary and secondary outcomes were measured before and after the participants read intervention or control messages, and mean scores were calculated. Higher scores indicated greater intention and perception. All participants were asked for their sociodemographic information before they read intervention or control messages.

2.4. Sample size

Based on the effect size in a previous randomized controlled study [ 16 ], we estimated a small effect size (Cohen’s d  = .20) in the current study. We conducted a power analysis at an alpha error rate of .05 (two-tailed) and a beta error rate of .20. The power analysis indicated that 330 participants were required in each of the intervention and control groups.

2.5. Statistical analysis

A one-way analysis of variance (ANOVA) was conducted with the absolute change in mean values for each measure before and after intervention as the dependent variable and the group assignment as the independent variable. For multiple comparisons, Tukey’s test was conducted on significant main effects where appropriate. The Games–Howell test was performed when the assumption of homogeneity of variances was not satisfied. Additionally, we conducted subgroup analyses including only participants who lived in 13 “specified warning prefectures,” where the number of infected individuals showed a marked increase [ 17 ]. A p value of <.05 was considered significant in all statistical tests. All statistical analyses were performed using IBM SPSS Statistics for Windows, Version 21.0 (IBM, Armonk, NY, USA).

Table 1 shows the participants’ characteristics. Table 2 , Table 3 present a comparison among the five intervention groups using one-way ANOVA and multiple comparisons when including all prefectures and only participants who lived in the specified warning prefectures, respectively. More significant differences between intervention messages were found in the specified warning prefectures compared with all prefectures. In Table 3 , the Games–Howell test indicates that the message from a physician increased participants’ intention to stay at home significantly more than other narrators’ messages (versus a governor, p  = .002; an expert, p  = .023; a resident, p  = .004). Multiple comparisons demonstrated that the message from a physician increased participants’ perceived severity (versus a governor, p  = .015), response efficacy (versus a resident, p  = .014), and self-efficacy (versus a governor, p  = .022; a patient, p  = .009) significantly more than other narrators’ messages.

Participants’ sociodemographic information.

Comparison of amount of change before and after intervention among groups when including all prefectures (N = 1,980).

Comparison of amount of change before and after intervention among groups when including only the “specified warning prefectures” (N = 1,274).

4. Discussion and conclusion

4.1. discussion.

As Appendix A shows, the message from a physician specifically communicated the critical situation of hospitals being overwhelmed and the consequent risk of people being unable to receive treatment. Depiction of the crisis of overwhelmed hospitals may have evoked heightened sensation that elicited sensory, affective, and arousal responses in recipients. Social lockdown presumably evoked psychological reactance in many individuals [ 18 ]. Psychological reactance is considered one of the factors that impedes individuals’ staying at home during a pandemic [ 18 ]. Studies of psychological reactance have indicated that heightened sensation is the feature of a message that reduces psychological reactance [ 19 , 20 ]. Additionally, in Japan recommendations by physicians have a strong influence on individuals’ decision making owing to the remnants of paternalism in the patient–physician relationship [ 21 ]. These may constitute the reasons for the message from a physician generating the greatest impact on recipients’ protection motivation.

Public health professionals, governors, media professionals, and other influencers should use messages from physicians and disseminate relevant articles through the media and social networking services to encourage people to stay at home. It is important that health professionals and media have a network and collaborate with one another [ 22 ]. To build relationships and provide reliable resources, health professionals are expected to hold press conferences and study meetings with journalists. Through such networking, journalists can acquire accurate information in dealing with the pandemic, such as using messages from physicians to encourage people to stay at home. Consequently, journalists should disseminate such messages. It is also important that governments, municipalities, medical associations, and other public institutions convey messages from physicians and that the media effectively spread those messages. Owing to the advances of Web 2.0 [ 23 ], health professionals’ grassroots communication with journalists and citizens via social media may provide opportunities for many people to access persuasive messages from physicians.

4.1.1. Limitations

First, the content of the intervention messages in this study may not represent voices of all governors, public health experts, physicians, patients, and residents of outbreak areas. Second, it is not clear from this study which sentences in the intervention message made the most impact on recipients and why. Third, this study assessed intention rather than actual behavior. Finally, it is unclear as to what extent the present findings are generalizable to populations other than the Japanese participants in this study.

4.2. Conclusion

In areas with high numbers of infected people, the message from a physician, which conveyed the crisis of hospitals being overwhelmed and the consequent risk of people being unable to receive treatment, increased the intention to stay at home to a greater extent than other messages from a governor, a public health expert, a patient with COVID-19, and a resident of an outbreak area.

4.3. Practice implications

Governors, health professionals, and media professionals may be able to encourage people to stay at home by disseminating the physicians’ messages through media such as television and newspapers as well as social networking services on the internet.

This work was supported by the Japan Society for the Promotion of Science KAKENHI (grant number 19K10615).

CRediT authorship contribution statement

Tsuyoshi Okuhara: Conceptualization, Methodology, Formal analysis, Investigation, Writing - original draft, Funding acquisition. Hiroko Okada: Methodology, Investigation, Writing - review & editing. Takahiro Kiuchi: Supervision, Writing - review & editing.

Declaration of Competing Interest

The authors declare that there is no conflict of interest.

Acknowledgement

We thank Hugh McGonigle, from Edanz Group ( https://en-author-services.edanzgroup.com/ac ), for editing a draft of the manuscript.

Appendix A. 

Intervention: the message from a governor.

The following is a message from the governor of your local area.

Please avoid leaving your house as much as possible.

Staying at home can save lives and prevent the spread of infection.

Intervention: The message from an expert

The following is a message from an infectious disease control expert.

Intervention: The message from a physician

The following is a message from an emergency medical care doctor.

Intervention: The message from a patient

The following is a message from a patient who is infected with the novel coronavirus.

Intervention: The message from a resident

The following is a message from an individual who lives in an area where an outbreak of novel coronavirus has occurred.

A control message

According to the traditional definition, grinding one’s teeth is when somebody makes a sound by strongly grinding the teeth together, usually unconsciously or while asleep. Nowadays, it is often referred to as ‘teeth grinding,’ a term which also covers various actions that we do while awake.

Whether you are sleeping or awake, the non-functional biting habit of grinding one’s teeth dynamically or statically, or clenching one’s teeth, can also be referred to as bruxism (sleep bruxism if it occurs at night). Bruxism can be categorized into the movements of: sliding the upper and lower teeth together like mortar and pestle (grinding); firmly and statically engaging the upper and lower teeth (clenching); and dynamically bringing the upper and lower teeth together with a tap (tapping).

Bruxism is difficult to diagnose, as it often has no noticeable symptoms. Stress and dentition are thought to be causes of bruxism, but it is currently unclear and future research is anticipated.

Splint therapy, which involves the use of a mouthpiece as an artificial plastic covering on one’s teeth, and cognitive behavioral therapy are being researched as treatments for bruxism.

Appendix B. 

All questions above were on a scale of 1–6, ranging from “extremely unlikely” to “unlikely,” “a little unlikely,” “a little likely,” “likely,” and “extremely likely.”