personal narrative essay about covid 19 pandemic

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My Experience During The Covid-19 Pandemic

• Categories: Covid 19

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Words: 440 |

Published: Jan 30, 2024

Words: 440 | Page: 1 | 3 min read

Table of contents

Introduction, physical impact, mental and emotional impact, social impact.

• World Health Organization. (2021). Coronavirus (COVID-19) Dashboard. https://covid19.who.int/
• American Psychiatric Association. (2020). Mental health and COVID-19. https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2020/03/mental-health-and-covid-19
• The New York Times. (2020). Coping with Coronavirus Anxiety. https://www.nytimes.com/2020/03/11/well/family/coronavirus-anxiety-mental-health.html

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How to Write About Coronavirus in a College Essay

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

Writing About COVID-19 in College Essays

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

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

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

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

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

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

Writing About COVID-19 for a College Application

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

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

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

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

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

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

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

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

Above all, she urges honesty.

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

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

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

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

Writing About Coronavirus in Main and Supplemental Essays

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

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

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

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

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

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

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

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

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

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

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

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

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

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I Thought We’d Learned Nothing From the Pandemic. I Wasn’t Seeing the Full Picture

M y first home had a back door that opened to a concrete patio with a giant crack down the middle. When my sister and I played, I made sure to stay on the same side of the divide as her, just in case. The 1988 film The Land Before Time was one of the first movies I ever saw, and the image of the earth splintering into pieces planted its roots in my brain. I believed that, even in my own backyard, I could easily become the tiny Triceratops separated from her family, on the other side of the chasm, as everything crumbled into chaos.

Some 30 years later, I marvel at the eerie, unexpected ways that cartoonish nightmare came to life – not just for me and my family, but for all of us. The landscape was already covered in fissures well before COVID-19 made its way across the planet, but the pandemic applied pressure, and the cracks broke wide open, separating us from each other physically and ideologically. Under the weight of the crisis, we scattered and landed on such different patches of earth we could barely see each other’s faces, even when we squinted. We disagreed viciously with each other, about how to respond, but also about what was true.

Recently, someone asked me if we’ve learned anything from the pandemic, and my first thought was a flat no. Nothing. There was a time when I thought it would be the very thing to draw us together and catapult us – as a capital “S” Society – into a kinder future. It’s surreal to remember those early days when people rallied together, sewing masks for health care workers during critical shortages and gathering on balconies in cities from Dallas to New York City to clap and sing songs like “Yellow Submarine.” It felt like a giant lightning bolt shot across the sky, and for one breath, we all saw something that had been hidden in the dark – the inherent vulnerability in being human or maybe our inescapable connectedness .

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But it turns out, it was just a flash. The goodwill vanished as quickly as it appeared. A couple of years later, people feel lied to, abandoned, and all on their own. I’ve felt my own curiosity shrinking, my willingness to reach out waning , my ability to keep my hands open dwindling. I look out across the landscape and see selfishness and rage, burnt earth and so many dead bodies. Game over. We lost. And if we’ve already lost, why try?

Still, the question kept nagging me. I wondered, am I seeing the full picture? What happens when we focus not on the collective society but at one face, one story at a time? I’m not asking for a bow to minimize the suffering – a pretty flourish to put on top and make the whole thing “worth it.” Yuck. That’s not what we need. But I wondered about deep, quiet growth. The kind we feel in our bodies, relationships, homes, places of work, neighborhoods.

Like a walkie-talkie message sent to my allies on the ground, I posted a call on my Instagram. What do you see? What do you hear? What feels possible? Is there life out here? Sprouting up among the rubble? I heard human voices calling back – reports of life, personal and specific. I heard one story at a time – stories of grief and distrust, fury and disappointment. Also gratitude. Discovery. Determination.

Among the most prevalent were the stories of self-revelation. Almost as if machines were given the chance to live as humans, people described blossoming into fuller selves. They listened to their bodies’ cues, recognized their desires and comforts, tuned into their gut instincts, and honored the intuition they hadn’t realized belonged to them. Alex, a writer and fellow disabled parent, found the freedom to explore a fuller version of herself in the privacy the pandemic provided. “The way I dress, the way I love, and the way I carry myself have both shrunk and expanded,” she shared. “I don’t love myself very well with an audience.” Without the daily ritual of trying to pass as “normal” in public, Tamar, a queer mom in the Netherlands, realized she’s autistic. “I think the pandemic helped me to recognize the mask,” she wrote. “Not that unmasking is easy now. But at least I know it’s there.” In a time of widespread suffering that none of us could solve on our own, many tended to our internal wounds and misalignments, large and small, and found clarity.

Read More: A Tool for Staying Grounded in This Era of Constant Uncertainty

I wonder if this flourishing of self-awareness is at least partially responsible for the life alterations people pursued. The pandemic broke open our personal notions of work and pushed us to reevaluate things like time and money. Lucy, a disabled writer in the U.K., made the hard decision to leave her job as a journalist covering Westminster to write freelance about her beloved disability community. “This work feels important in a way nothing else has ever felt,” she wrote. “I don’t think I’d have realized this was what I should be doing without the pandemic.” And she wasn’t alone – many people changed jobs , moved, learned new skills and hobbies, became politically engaged.

Perhaps more than any other shifts, people described a significant reassessment of their relationships. They set boundaries, said no, had challenging conversations. They also reconnected, fell in love, and learned to trust. Jeanne, a quilter in Indiana, got to know relatives she wouldn’t have connected with if lockdowns hadn’t prompted weekly family Zooms. “We are all over the map as regards to our belief systems,” she emphasized, “but it is possible to love people you don’t see eye to eye with on every issue.” Anna, an anti-violence advocate in Maine, learned she could trust her new marriage: “Life was not a honeymoon. But we still chose to turn to each other with kindness and curiosity.” So many bonds forged and broken, strengthened and strained.

Instead of relying on default relationships or institutional structures, widespread recalibrations allowed for going off script and fortifying smaller communities. Mara from Idyllwild, Calif., described the tangible plan for care enacted in her town. “We started a mutual-aid group at the beginning of the pandemic,” she wrote, “and it grew so quickly before we knew it we were feeding 400 of the 4000 residents.” She didn’t pretend the conditions were ideal. In fact, she expressed immense frustration with our collective response to the pandemic. Even so, the local group rallied and continues to offer assistance to their community with help from donations and volunteers (many of whom were originally on the receiving end of support). “I’ve learned that people thrive when they feel their connection to others,” she wrote. Clare, a teacher from the U.K., voiced similar conviction as she described a giant scarf she’s woven out of ribbons, each representing a single person. The scarf is “a collection of stories, moments and wisdom we are sharing with each other,” she wrote. It now stretches well over 1,000 feet.

A few hours into reading the comments, I lay back on my bed, phone held against my chest. The room was quiet, but my internal world was lighting up with firefly flickers. What felt different? Surely part of it was receiving personal accounts of deep-rooted growth. And also, there was something to the mere act of asking and listening. Maybe it connected me to humans before battle cries. Maybe it was the chance to be in conversation with others who were also trying to understand – what is happening to us? Underneath it all, an undeniable thread remained; I saw people peering into the mess and narrating their findings onto the shared frequency. Every comment was like a flare into the sky. I’m here! And if the sky is full of flares, we aren’t alone.

I recognized my own pandemic discoveries – some minor, others massive. Like washing off thick eyeliner and mascara every night is more effort than it’s worth; I can transform the mundane into the magical with a bedsheet, a movie projector, and twinkle lights; my paralyzed body can mother an infant in ways I’d never seen modeled for me. I remembered disappointing, bewildering conversations within my own family of origin and our imperfect attempts to remain close while also seeing things so differently. I realized that every time I get the weekly invite to my virtual “Find the Mumsies” call, with a tiny group of moms living hundreds of miles apart, I’m being welcomed into a pocket of unexpected community. Even though we’ve never been in one room all together, I’ve felt an uncommon kind of solace in their now-familiar faces.

Hope is a slippery thing. I desperately want to hold onto it, but everywhere I look there are real, weighty reasons to despair. The pandemic marks a stretch on the timeline that tangles with a teetering democracy, a deteriorating planet , the loss of human rights that once felt unshakable . When the world is falling apart Land Before Time style, it can feel trite, sniffing out the beauty – useless, firing off flares to anyone looking for signs of life. But, while I’m under no delusions that if we just keep trudging forward we’ll find our own oasis of waterfalls and grassy meadows glistening in the sunshine beneath a heavenly chorus, I wonder if trivializing small acts of beauty, connection, and hope actually cuts us off from resources essential to our survival. The group of abandoned dinosaurs were keeping each other alive and making each other laugh well before they made it to their fantasy ending.

Read More: How Ice Cream Became My Own Personal Act of Resistance

After the monarch butterfly went on the endangered-species list, my friend and fellow writer Hannah Soyer sent me wildflower seeds to plant in my yard. A simple act of big hope – that I will actually plant them, that they will grow, that a monarch butterfly will receive nourishment from whatever blossoms are able to push their way through the dirt. There are so many ways that could fail. But maybe the outcome wasn’t exactly the point. Maybe hope is the dogged insistence – the stubborn defiance – to continue cultivating moments of beauty regardless. There is value in the planting apart from the harvest.

I can’t point out a single collective lesson from the pandemic. It’s hard to see any great “we.” Still, I see the faces in my moms’ group, making pancakes for their kids and popping on between strings of meetings while we try to figure out how to raise these small people in this chaotic world. I think of my friends on Instagram tending to the selves they discovered when no one was watching and the scarf of ribbons stretching the length of more than three football fields. I remember my family of three, holding hands on the way up the ramp to the library. These bits of growth and rings of support might not be loud or right on the surface, but that’s not the same thing as nothing. If we only cared about the bottom-line defeats or sweeping successes of the big picture, we’d never plant flowers at all.

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Coronavirus: My Experience During the Pandemic

Anastasiya Kandratsenka George Washington High School, Class of 2021

At this point in time there shouldn't be a single person who doesn't know about the coronavirus, or as they call it, COVID-19. The coronavirus is a virus that originated in China, reached the U.S. and eventually spread all over the world by January of 2020. The common symptoms of the virus include shortness of breath, chills, sore throat, headache, loss of taste and smell, runny nose, vomiting and nausea. As it has been established, it might take up to 14 days for the symptoms to show. On top of that, the virus is also highly contagious putting all age groups at risk. The elderly and individuals with chronic diseases such as pneumonia or heart disease are in the top risk as the virus attacks the immune system. 

The virus first appeared on the news and media platforms in the month of January of this year. The United States and many other countries all over the globe saw no reason to panic as it seemed that the virus presented no possible threat. Throughout the next upcoming months, the virus began to spread very quickly, alerting health officials not only in the U.S., but all over the world. As people started digging into the origin of the virus, it became clear that it originated in China. Based on everything scientists have looked at, the virus came from a bat that later infected other animals, making it way to humans. As it goes for the United States, the numbers started rising quickly, resulting in the cancellation of sports events, concerts, large gatherings and then later on schools. 

As it goes personally for me, my school was shut down on March 13th. The original plan was to put us on a two weeks leave, returning on March 30th but, as the virus spread rapidly and things began escalating out of control very quickly, President Trump announced a state of emergency and the whole country was put on quarantine until April 30th. At that point, schools were officially shut down for the rest of the school year. Distanced learning was introduced, online classes were established, a new norm was put in place. As for the School District of Philadelphia distanced learning and online classes began on May 4th. From that point on I would have classes four times a week, from 8AM till 3PM. Virtual learning was something that I never had to experience and encounter before. It was all new and different for me, just as it was for millions of students all over the United States. We were forced to transfer from physically attending school, interacting with our peers and teachers, participating in fun school events and just being in a classroom setting, to just looking at each other through a computer screen in a number of days. That is something that we all could have never seen coming, it was all so sudden and new. 

My experience with distanced learning was not very great. I get distracted very easily and   find it hard to concentrate, especially when it comes to school. In a classroom I was able to give my full attention to what was being taught, I was all there. However, when we had the online classes, I could not focus and listen to what my teachers were trying to get across. I got distracted very easily, missing out on important information that was being presented. My entire family which consists of five members, were all home during the quarantine. I have two little siblings who are very loud and demanding, so I’m sure it can be imagined how hard it was for me to concentrate on school and do what was asked of me when I had these two running around the house. On top of school, I also had to find a job and work 35 hours a week to support my family during the pandemic. My mother lost her job for the time being and my father was only able to work from home. As we have a big family, the income of my father was not enough. I made it my duty to help out and support our family as much as I could: I got a job at a local supermarket and worked there as a cashier for over two months. 

While I worked at the supermarket, I was exposed to dozens of people every day and with all the protection that was implemented to protect the customers and the workers, I was lucky enough to not get the virus. As I say that, my grandparents who do not even live in the U.S. were not so lucky. They got the virus and spent over a month isolated, in a hospital bed, with no one by their side. Our only way of communicating was through the phone and if lucky, we got to talk once a week. Speaking for my family, that was the worst and scariest part of the whole situation. Luckily for us, they were both able to recover completely. 

As the pandemic is somewhat under control, the spread of the virus has slowed down. We’re now living in the new norm. We no longer view things the same, the way we did before. Large gatherings and activities that require large groups to come together are now unimaginable! Distanced learning is what we know, not to mention the importance of social distancing and having to wear masks anywhere and everywhere we go. This is the new norm now and who knows when and if ever we’ll be able go back to what we knew before. This whole experience has made me realize that we, as humans, tend to take things for granted and don’t value what we have until it is taken away from us. 

Articles in this Volume

[tid]: dedication, [tid]: new tools for a new house: transformations for justice and peace in and beyond covid-19, [tid]: black lives matter, intersectionality, and lgbtq rights now, [tid]: the voice of asian american youth: what goes untold, [tid]: beyond words: reimagining education through art and activism, [tid]: voice(s) of a black man, [tid]: embodied learning and community resilience, [tid]: re-imagining professional learning in a time of social isolation: storytelling as a tool for healing and professional growth, [tid]: reckoning: what does it mean to look forward and back together as critical educators, [tid]: leader to leaders: an indigenous school leader’s advice through storytelling about grief and covid-19, [tid]: finding hope, healing and liberation beyond covid-19 within a context of captivity and carcerality, [tid]: flux leadership: leading for justice and peace in & beyond covid-19, [tid]: flux leadership: insights from the (virtual) field, [tid]: hard pivot: compulsory crisis leadership emerges from a space of doubt, [tid]: and how are the children, [tid]: real talk: teaching and leading while bipoc, [tid]: systems of emotional support for educators in crisis, [tid]: listening leadership: the student voices project, [tid]: global engagement, perspective-sharing, & future-seeing in & beyond a global crisis, [tid]: teaching and leadership during covid-19: lessons from lived experiences, [tid]: crisis leadership in independent schools - styles & literacies, [tid]: rituals, routines and relationships: high school athletes and coaches in flux, [tid]: superintendent back-to-school welcome 2020, [tid]: mitigating summer learning loss in philadelphia during covid-19: humble attempts from the field, [tid]: untitled, [tid]: the revolution will not be on linkedin: student activism and neoliberalism, [tid]: why radical self-care cannot wait: strategies for black women leaders now, [tid]: from emergency response to critical transformation: online learning in a time of flux, [tid]: illness methodology for and beyond the covid era, [tid]: surviving black girl magic, the work, and the dissertation, [tid]: cancelled: the old student experience, [tid]: lessons from liberia: integrating theatre for development and youth development in uncertain times, [tid]: designing a more accessible future: learning from covid-19, [tid]: the construct of standards-based education, [tid]: teachers leading teachers to prepare for back to school during covid, [tid]: using empathy to cross the sea of humanity, [tid]: (un)doing college, community, and relationships in the time of coronavirus, [tid]: have we learned nothing, [tid]: choosing growth amidst chaos, [tid]: living freire in pandemic….participatory action research and democratizing knowledge at knowledgedemocracy.org, [tid]: philly students speak: voices of learning in pandemics, [tid]: the power of will: a letter to my descendant, [tid]: photo essays with students, [tid]: unity during a global pandemic: how the fight for racial justice made us unite against two diseases, [tid]: educational changes caused by the pandemic and other related social issues, [tid]: online learning during difficult times, [tid]: fighting crisis: a student perspective, [tid]: the destruction of soil rooted with culture, [tid]: a demand for change, [tid]: education through experience in and beyond the pandemics, [tid]: the pandemic diaries, [tid]: all for one and 4 for $4, [tid]: tiktok activism, [tid]: why digital learning may be the best option for next year, [tid]: my 2020 teen experience, [tid]: living between two pandemics, [tid]: journaling during isolation: the gold standard of coronavirus, [tid]: sailing through uncertainty, [tid]: what i wish my teachers knew, [tid]: youthing in pandemic while black, [tid]: the pain inflicted by indifference, [tid]: education during the pandemic, [tid]: the good, the bad, and the year 2020, [tid]: racism fueled pandemic, [tid]: coronavirus: my experience during the pandemic, [tid]: the desensitization of a doomed generation, [tid]: a philadelphia war-zone, [tid]: the attack of the covid monster, [tid]: back-to-school: covid-19 edition, [tid]: the unexpected war, [tid]: learning outside of the classroom, [tid]: why we should learn about college financial aid in school: a student perspective, [tid]: flying the plane as we go: building the future through a haze, [tid]: my covid experience in the age of technology, [tid]: we, i, and they, [tid]: learning your a, b, cs during a pandemic, [tid]: quarantine: a musical, [tid]: what it’s like being a high school student in 2020, [tid]: everything happens for a reason, [tid]: blacks live matter – a sobering and empowering reality among my peers, [tid]: the mental health of a junior during covid-19 outbreaks, [tid]: a year of change, [tid]: covid-19 and school, [tid]: the virtues and vices of virtual learning, [tid]: college decisions and the year 2020: a virtual rollercoaster, [tid]: quarantine thoughts, [tid]: quarantine through generation z, [tid]: attending online school during a pandemic.

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A personal narrative of my COVID experience

One of the Experts by Experience supporting the Prevention and Early Detection Theme of ARC EoE, the University of Hertfordshire shares her reflections and experiences of life during COVID 19. Her personal narrative shines a light on the value of community and the importance of hearing individual voices from these communities to guide what, how and why we do research.

I am an Expert by Experience supporting the Prevention and Early Detection Theme of ARC EoE and the University of Hertfordshire. I live with my parents who are in their mid – late 70s in a rural Village of around 1000 people.

Before COVID my life really revolved around my Expert by Experience work and involvement in Church and community activities so mostly all outdoors and with people.  I used public transport to get around.  When COVID struck, like most people, my diary cleared within a few days and my life moved indoors and on to my laptop and phone.

There was initially extreme anxiety amongst my community groups about how to identify the vulnerable, a great desire to help, and a lot of pressure to do something.  This was very difficult as we were in a pandemic and we were very concerned about spreading infection.  It felt very powerless.

Before COVID I ran a popular weekly craft group which also provided a lot of social support.  Fortunately, one of the Group members set up a local craft group on Facebook immediately on lockdown and a lot of members joined.  Those not online I have continued to contact via phone, text and email regularly so we keep connected until we can meet again. 

Then the authorities banded together and the Church went online and continued the Food Banks which was all great.  I contacted some of the local groups to see how we could work together and  started mapping my community in terms of what resources were available to support people as I felt a coordinated community response was the best approach to pool our resources and identify potential gaps.  For me generally though it felt like a disconnect between the authorities and residents.  I felt that we were all worried about the same thing, the vulnerable and people falling through the gaps but somehow, we were not able to join up in much of a practical way. 

I also found there was also a big confusion over who the vulnerable were.  Some people did not see themselves as vulnerable while others not seen as vulnerable clearly were. Even though my parents are in their 70s, it was very difficult to know whether they were eligible for supermarket priority slots (not that we could get any anyway and we soon gave up trying).  This caused a lot of tension and arguments when the food started to run down as to how to get supplies as no one wanted anyone to go out.  A friend whose only method of communication was the phone ran out of phone credit early on and I spent the rest of lockdown concerned about them until I could go and knock on the door again once restrictions had lifted.

Fortunately, quite early on, our local supermarket began home delivery by email order and card and a local business set up a fruit and veg stall on one of the local farms. This helped greatly in the early days of lockdown as getting fresh supplies was very difficult.  Some people I know felt this gave them more independence rather than relying on others to get food for them.  Our local shop was also very supportive of our community and local pharmacies did home deliveries of prescriptions.

After much stress and feeling powerless being told to stay at home and also wanting to stay safe and not spread infection, I finally found the best way to support my community was from my laptop and phone, sharing official info from the Government website and our Councils, local Library resources, Neighbourhood Watch, local Surgery Patient Participation Group, Local Resilience Forum and Third Sector contacts and other trusted sources via our community Facebook page, email and phone.  I was able to quickly pass on public health info as well as info on local supplies as resources and information emerged.  I also printed official COVID posters for the local notice boards as nothing was appearing on the council boards due to the situation.

From the beginning of lockdown I started to use social media more for public information but found the COVID information very useful but the volume of it was becoming overwhelming and decided to also post things to help motivate, inspire and lift spirits particularly in the depths of lockdown such as daily photos of flowers from the garden, a Virtual History tour using our village photo archive and an armchair quiz. These have been very popular and I found it a good way of checking in with people I knew as they responded to posts. It was also useful to help get lost items of post redelivered and get lost cats back home.

Before lockdown I was getting increasingly anxious about the situation and was very happy once we were in lockdown as I felt safe.  After some time, I was worried that it felt too safe and I was then anxious about going out as most days I stayed in.  The outside environment felt very unsafe as germs could be anywhere, on surfaces, in the air and it felt that nowhere was safe.  When I did go out into the Village I have known all my life, it felt very strange, quite disorientating and even crossing the road seemed daunting. When it was mentioned that lockdown was going to end then I became very anxious and this has only increased over the weeks.  I still hardly go out.  I always wear a mask when I am near or with people even though I know nothing about whether masks are effective or necessary and it is probably starting to look a little odd, I feel safer with one on.

Throughout lockdown I was terrified I had COVID as I was quite unwell for some time early on with digestive symptoms not listed by the Government but which were reported in the media.  It was difficult to tell if they were COVID or stress related and I was not sure what to do. I had telephone consultations with GPs and found these excellent. I would like this option to continue.

I have found a lot of official advice to be confusing particularly now that restrictions are lifting and am not sure who I can meet as the situation is changing rapidly.  There is a lot of pressure from friends who are bored, fed up and want to meet up.  Some friends have been asking to meet up for weeks but I don’t want to go out as I am not sure if it is safe. It feels now that they might think I am avoiding them when really, I am afraid. Some friends have been shielding and are highly anxious, afraid and are not sure how to begin to take those first steps outside.

I look at the terrible things which are happening as reported in the media and feel even more afraid of going out.  Not knowing what to expect when going out, how I am supposed to behave, how other people are going to behave, what shops, banks, etc are open, opening times and especially whether toilets are open makes it difficult to even think about going out to Town centres and whether it is actually worth it.  I used to get public transport but cannot imagine doing this now which also makes it very difficult. 

Despite being highly anxious about technology which made it difficult to try or use Zoom at the beginning of lockdown, I am so glad that I persevered with all the problems of anxiety and unstable internet connection etc as it has meant that I have been able to continue with a small amount of work, some community activities, access webinars, creative sessions and undertake online Spot the Signs Suicide training.  Zoom has opened up so many opportunities and now I am afraid of having to go back into buildings for any reason and want the online world to continue. It also cuts out all the problems, the stress and tiredness of travelling on public transport as it enables me to manage my health much better.  I think it makes things more accessible for those who are disabled, managing health conditions or who have caring responsibilities.

I think people are going to need a lot of support: getting acclimatized to going out again and knowing what to expect and how to behave when outside. Help and support adjusting to unemployment, new work environments, working from home etc. Support with bereavement, loss and change. 

Being indoors every day during lockdown caused a lot of tension in the house as everyone was anxious about the situation and doing anything was so difficult.  Constant hand washing, checking for symptoms, checking for information on the news, talking and thinking about COVID.  We had lots of arguments over food and going out for supplies.

COVID has been quite traumatising, watching the horror of the situation unfold on a global and local scale.  Doing anything at all in the early days was so challenging and it felt like it was all I thought about.  There has been such a lot of loss that I think it will take a long time for the full impact to be felt and dealt with.  Fearing for the lives of friends who have been ill with COVID and not being able to see them felt very powerless and am not sure how to grieve the loss of a family member when we were not able to attend their direct funeral early on in lockdown. 

It has been difficult to plan the future when everything is so uncertain and there seems no end to it. The foundations of our lives have been and continue to be affected; our surroundings. employment, housing, the food we eat, money and resources, transport, education and skills, families, friends and communities have all been affected. All of these practical everyday concerns are connected to mental health problems and will be greater and need addressing.  Our community food bank definitely saw a big increase in demand.

At the beginning it seemed that we were all in it together and that there were probably few people who were not thinking about COVID. Then it became apparent that there were great divides, between generations, income groups etc that were all differently affected and that some had not been affected at all whilst others had lost so much. For me it shone a spotlight on all the problems in our society such as poverty which were greatly exacerbated by the situation. 

Technology poverty was also greatly apparent.  One day everything was outdoors and people, the next day everything went online and the whole world just vanished.  Councils, Churches, shops, services all shut their doors and put their services online.  My great concern throughout was for those not online and I feel that more needs to be done now to support people to get more connected in as many preferred ways as possible.  Teaching people how to text, setting up email accounts, teaching skills around accessing online resources and services, video conference technology, as well as connection through neighbours, local groups, services, etc

Community became more important than ever .  We need to strengthen the links and foster greater connections between neighbours, community groups, third sector, businesses, faith groups, services etc.

Keeping what has been useful; the use of video conference technology for meetings enables people who generally use public transport/or are unable or find it difficult to leave home to participate in involvement or research work e.g. disabilities, health conditions, carer commitments etc.  Explore the use of technology for online training resources for the public on all forms of healthcare, caring, support groups might be useful to continue.

Prevention and early detection in health and social care

Research in patient and public involvement

We have a research theme dedicated to finding out the best ways to involve patients, service users, carers and members of the public in research.

Writing about COVID-19 in a college admission essay

by: Venkates Swaminathan | Updated: September 14, 2020

Print article

For students applying to college using the CommonApp, there are several different places where students and counselors can address the pandemic’s impact. The different sections have differing goals. You must understand how to use each section for its appropriate use.

The CommonApp COVID-19 question

First, the CommonApp this year has an additional question specifically about COVID-19 :

Community disruptions such as COVID-19 and natural disasters can have deep and long-lasting impacts. If you need it, this space is yours to describe those impacts. Colleges care about the effects on your health and well-being, safety, family circumstances, future plans, and education, including access to reliable technology and quiet study spaces. Please use this space to describe how these events have impacted you.

This question seeks to understand the adversity that students may have had to face due to the pandemic, the move to online education, or the shelter-in-place rules. You don’t have to answer this question if the impact on you wasn’t particularly severe. Some examples of things students should discuss include:

• The student or a family member had COVID-19 or suffered other illnesses due to confinement during the pandemic.
• The candidate had to deal with personal or family issues, such as abusive living situations or other safety concerns
• The student suffered from a lack of internet access and other online learning challenges.
• Students who dealt with problems registering for or taking standardized tests and AP exams.

Jeff Schiffman of the Tulane University admissions office has a blog about this section. He recommends students ask themselves several questions as they go about answering this section:

• Are my experiences different from others’?
• Are there noticeable changes on my transcript?
• Am I aware of my privilege?
• Am I specific? Am I explaining rather than complaining?
• Is this information being included elsewhere on my application?

If you do answer this section, be brief and to-the-point.

Counselor recommendations and school profiles

Second, counselors will, in their counselor forms and school profiles on the CommonApp, address how the school handled the pandemic and how it might have affected students, specifically as it relates to:

• Grading scales and policies
• Graduation requirements
• Instructional methods
• Schedules and course offerings
• Testing requirements
• Your academic calendar
• Other extenuating circumstances

Students don’t have to mention these matters in their application unless something unusual happened.

Writing about COVID-19 in your main essay

Write about your experiences during the pandemic in your main college essay if your experience is personal, relevant, and the most important thing to discuss in your college admission essay. That you had to stay home and study online isn’t sufficient, as millions of other students faced the same situation. But sometimes, it can be appropriate and helpful to write about something related to the pandemic in your essay. For example:

• One student developed a website for a local comic book store. The store might not have survived without the ability for people to order comic books online. The student had a long-standing relationship with the store, and it was an institution that created a community for students who otherwise felt left out.
• One student started a YouTube channel to help other students with academic subjects he was very familiar with and began tutoring others.
• Some students used their extra time that was the result of the stay-at-home orders to take online courses pursuing topics they are genuinely interested in or developing new interests, like a foreign language or music.

Experiences like this can be good topics for the CommonApp essay as long as they reflect something genuinely important about the student. For many students whose lives have been shaped by this pandemic, it can be a critical part of their college application.

Want more? Read 6 ways to improve a college essay , What the &%$! should I write about in my college essay , and Just how important is a college admissions essay? .

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• v.45(4); 2020 Jul

A Narrative Review of COVID-19: The New Pandemic Disease

Kiana shirani, md.

1 Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Erfan Sheikhbahaei, MD

2 Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Zahra Torkpour, MD

Mazyar ghadiri nejad, phd.

3 Industrial Engineering Department, Girne American University, Kyrenia, TRNC, Turkey

Bahareh Kamyab Moghadas, PhD

4 Department of Chemical Engineering, Shiraz Branch, Islamic Azad University, Shiraz, Iran

Matina Ghasemi, PhD

5 Faculty of Business and Economics, Business Department, Girne American University, Kyrenia, TRNC, Turkey

Hossein Akbari Aghdam, MD

6 Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Athena Ehsani, PhD

7 Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran

Saeed Saber-Samandari, PhD

8 New Technologies Research Center, Amirkabir University of Technology, Tehran, Iran

Amirsalar Khandan, PhD

9 Department of Electrical Engineering, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

10 0Technology Incubator Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

Nearly every 100 years, humans collectively face a pandemic crisis. After the Spanish flu, now the world is in the grip of coronavirus disease 2019 (COVID-19). First detected in 2019 in the Chinese city of Wuhan, COVID-19 causes severe acute respiratory distress syndrome. Despite the initial evidence indicating a zoonotic origin, the contagion is now known to primarily spread from person to person through respiratory droplets. The precautionary measures recommended by the scientific community to halt the fast transmission of the disease failed to prevent this contagious disease from becoming a pandemic for a whole host of reasons. After an incubation period of about two days to two weeks, a spectrum of clinical manifestations can be seen in individuals afflicted by COVID-19: from an asymptomatic condition that can spread the virus in the environment, to a mild/moderate disease with cold/flu-like symptoms, to deteriorated conditions that need hospitalization and intensive care unit management, and then a fatal respiratory distress syndrome that becomes refractory to oxygenation. Several diagnostic modalities have been advocated and evaluated; however, in some cases, diagnosis is made on the clinical picture in order not to lose time. A consensus on what constitutes special treatment for COVID-19 has yet to emerge. Alongside conservative and supportive care, some potential drugs have been recommended and a considerable number of investigations are ongoing in this regard

What’s Known

• Substantial numbers of articles on COVID-19 have been published, yet there is controversy among clinicians and confusion among the general population in this regard. Furthermore, it is unreasonable to expect physicians to read all the available literature on this subject.

What’s New

• This article reviews high-quality articles on COVID-19 and effectively summarizes them for healthcare providers and the general population.

Introduction

A pathogen from a human-animal virus family, the coronavirus (CoV), which was identified as the main cause of respiratory tract infections, evolved to a novel and wild kind in Wuhan, a city in Hubei Province of China, and spread throughout the world, such that it created a pandemic crisis according to the World Health Organization (WHO). CoV is a large family of viruses that were first discovered in 1960. These viruses cause such diseases as common colds in humans and animals. Sometimes they attack the respiratory system, and sometimes their signs appear in the gastrointestinal tract. There have been different types of human CoV including CoV-229E, CoV-OC43, CoV-NL63, and CoV-HKU1, with the latter two having been discovered in 2004 and 2005, respectively. These types of CoV regularly cause respiratory infections in children and adults. 1 There are also other types of these viruses that are associated with more severe symptoms. The new CoV, scientifically known as “SARS-CoV-2”, causes severe acute respiratory syndrome (SARS). 2 A newer type of the virus was discovered in September 2012 in a 60-year-old man in Saudi Arabia who died of the disease; the man had traveled to Dubai a few days earlier. The second case was a 49-year-old man in Qatar who also passed away. The discovery was first confirmed at the Health Protection Agency’s Laboratory in Colindale, London. The outbreak of this CoV is known as the Middle East Respiratory Syndrome (MERS), commonly referred to as “MERS-CoV”. The virus has infected 2260 people and has killed 912, most of them in the Middle East. 3 - 5 Finally, in December 2019, for the first time in Wuhan, in Hubei Province of China, a new type of CoV was identified that caused pneumonia in humans. 6 SARS-CoV-2 has affected 5404512 people and killed more than 343514 around the world according to the WHO situation report-127 (May 26, 2020). 3 , 7 - 10 The WHO has officially termed the disease “COVID-19”, which refers to corona, the virus, the disease, the year 2019, and its etiology (SARS-CoV-2). This type of CoV had never been seen in humans before. The initial estimates showed a mortality rate ranging from between 1% and 3% in most countries to 5% in the worst-hit areas ( Figure 1 ). 9 Some Chinese researchers succeeded in determining how SARS-CoV-2 affects human cells, which could help to develop techniques of viral detection and had antiviral therapy potential. Via a process termed “cryogenic electron microscopy (cryo-EM)”, these scientists discovered that CoV enters human cells utilizing a kind of cell membrane glycoprotein: angiotensin-converting enzyme 2 (ACE2). Then, the S protein is split into two sub-units: S1 and S2. S1 keeps a receptor-binding domain (RBD); accordingly, SARS-CoV-2 can bind to the peptidase domain of ACE2 directly. It appears that S2 subsequently plays a role in cellular fusion. Chinese researchers used the cryo-EM technique to provide ACE2 when it is linked to an amino acid transporter called “B0AT1”. They also discovered how to connect SARS-CoV-2 to ACE2-B0AT1, which is another complex structure. Given that none of these molecular structures was previously known, the researchers hoped that these studies would lead to the development of an antiviral or vaccine that would help to prevent CoV. Along the way, scientists found that ACE2 has to undergo a molecular process in which it binds to another molecule to be activated. The resulting molecule can bind two SARS-CoV-2 protein molecules simultaneously. The scientists also studied different SARS-CoV-2 RBD binding methods compared with other SARS-CoV-RBDs, which showed how subtle changes in the molecular binding sequence make the coronal structure of the virus stronger.

Most cases with SARS-CoV-2 are asymptomatic or have mild clinical pictures such as influenza and colds. This group of patients should be detected and isolated in their homes to break the transmission chain of the disease and adhere to the precautionary recommendations in order not to infect other people. The screening process will help this group and suppress the outbreak in the community. Patients with the confirmed disease who are admitted to hospitals can contaminate this environment, which should be borne in mind by healthcare providers and policymakers.

Transmission

While the first mode of the transmission of COVID-19 to humans is still unknown, a seafood market where live animals were sold was identified as a potential source at the beginning of the outbreak in the epidemiologic investigations that found some infected patients who had visited or worked in that place. The other viruses in this family, namely MERS and SARS, were both confirmed to be zoonotic viruses. Afterward, the person-to-person spread was established as the main mode of transmission and the reason for the progression of the outbreak. 11 Similar to the influenza virus, SARS-CoV-2 spreads through the population via respiratory droplets. When an infected person coughs, sneezes, or talks, the respiratory secretions, which contain the virus, enter the environment as droplets. These droplets can reach the mucous membranes of individuals directly or indirectly when they touch an infected surface or any other source; the virus, thereafter, finds its ways to the eyes, nose, or mouth as the first incubation places. 11 - 15 It has been reported that droplets cannot travel more than two meters in the air, nor can they remain in the air owing to their high density. Nonetheless, given the other hitherto unknown modes of transmission, routine airborne transmission precautions should be considered in high-risk countries and during high-risk procedures such as manual ventilation with bags and masks, endotracheal intubation, open endotracheal suctioning, bronchoscopy, cardiopulmonary resuscitation, sputum induction, lung surgery, nebulizer therapy, noninvasive positive pressure ventilation (eg, bilevel positive airway pressure and continuous positive airway pressure ), and lung autopsy. In the early stages of the disease, the chances of the spread of the virus to other persons are high because the viral load in the body may be high despite the absence of any symptoms ( Figure 2 ). 11 - 13 The person-to-person transmission rates can be different depending on the location and the infection control intervention; still, according to the latest reports, the secondary COVID-19 infection rate ranges from 1% to 5%. 13 - 23 Although the RNA of the virus has been detected in blood and stool, fecal-oral and blood-borne transmissions are not regarded as significant modes of transmission yet. 19 - 26 There have been no reports of mother-to-fetus transmission in pregnant women. 27

SARS-CoV-2 mode of transmission and clinical manifestations are illustrated in this figure. The potential source of this outbreak was identified to be from animals, similar to MERS and SARS, in epidemiologic studies; nonetheless, person-to-person transmission through droplets is currently the important mode. After reaching mucous membranes by direct or indirect close contact, the virus replicates in the cells and the immune system attacks the body due to its nature. Afterward, the clinical pictures appear, which are much more similar to influenza. However, different patients will have a spectrum of signs and symptoms.

Source Investigation

Recently, the appearance of SARS-CoV-2 in society shocked the healthcare system. 28 - 32 Veterinary corona virologists reported that COVID-19 was isolated from wildlife. Several studies have shown that bats are receptors of the CoV new version in 2019 with variants and changes in the environment featuring various biological characteristics. 33 - 36 The aforementioned mammals are a major source of CoV, which causes mild-to-severe respiratory illness and can even be deadly. In recent years, the virus has killed several thousands of people of all ages. 37 - 39 The mutated alternative of the virus can be transmitted to humans and cause acute respiratory distress. 40 , 41 One of the main causes of the spread of the virus is the exotic and unusual Chinese food in Wuhan: CoV is a direct result of the Chinese food cycle. The virus is found in the body of animals such as bats, 42 and snake or bat soup is a favorite Chinese food. Therefore, this sequence is replicated continuously. Almost everyone who was infected for the first time was directly in the local Wuhan market or had indirectly tried snake or bat soup in a Chinese restaurant. An investigation stated that the Malayan pangolin (Manis javanica) was a possible host for SARS-CoV-2 and recommended that it be removed from the wet market to prevent zoonotic transmissions in the future. 43 , 44

Pathogenesis

The important mechanisms of the severe pathogenesis of SARS-CoV-2 are not fully understood. Extensive lung injury in SARS-CoV-2 has been related to increased virus titers; monocyte, macrophage, and neutrophil infiltrations into the lungs; and elevated levels of pro-inflammatory cytokines and chemokines. Thus, the clinical exacerbation of SARS-CoV-2 infection may be in consequence of a combination of direct virus-induced cytopathic and immunopathological effects due to excessive cytokinesis. Changes in the cytokine/chemokine profile during SARS infection showed increased levels of circulating cytokines such as tumor necrosis factor-α (TNF-α), C–X–C motif chemokine 10 (CXCL10), interleukin (IL)-6, and IL-8 levels, in conjunction with elevated levels of serum pro-inflammatory cytokines such as IL-1, IL-6, IL-12, interferon-gamma (IFN-γ), and transforming growth factor-β (TGF-β). Nevertheless, constant stimulation by the virus creates a cytokine storm that has been related to acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndromes (MODS) in patients with COVID-19, which may ultimately lead to diminished immunity by lowering the number of CD4+ and CD8+ T cells and natural killer cells (crucial in antiviral immunity) and decreasing cytokine production and functional ability (exhaustion). It has been shown that IL-10, an inhibitory cytokine, is a major player and a potential target for therapeutic aims. 45 - 51 Severe cases of COVID-19 have respiratory distress and failure, which has been linked to the altered metabolism of heme by SARS-CoV-2. Some virus proteins can dissociate iron from porphyrins by attacking the 1-β chain of hemoglobin, which decreases the oxygen-transferring ability of hemoglobin. Research has also indicated that chloroquine and favipiravir might inhibit this process. 52

Clinical Manifestations

SARS-CoV-2, which attacks the respiratory system, has a spectrum of manifestations; nonetheless, it has three main primary symptoms after an incubation period of about two days to two weeks: fever and its associated symptoms such as malaise/fatigue/weakness; cough, which is nonproductive in most of the cases but can be productive indeed; and shortness of breath (dyspnea) due to low blood oxygenation. Although these symptoms appear in the body of the affected person over two to 14 days, patients may refer to the clinic with gastrointestinal symptoms (nausea/vomiting-diarrhea) or decreased sense of smell and/or taste. More devastatingly, however, patients may refer to the emergency room with such coagulopathies as pulmonary thromboembolism, cerebral venous thrombosis, and other related manifestations. The WHO has stated that dry throat and dry cough are other symptoms detected in the early stages of the infection. 53 , 54 The estimations of the severity of the disease are as follows: mild (no or mild pneumonia) in 81%, severe (eg, with dyspnea, hypoxia, or >50% lung involvement on imaging within 24 to 48 hours) in 14%, and critical (eg, with respiratory failure, shock, or multiorgan dysfunction) in 5%. In the early stages, the overall mortality rate was 2.3% and no deaths were observed in non-severe patients. Patients with advanced age or underlying medical comorbidities have more mortality and morbidity. 55 Although adults of middle age and older are most commonly affected by SARS-CoV-2, individuals at any age can be infected. A few studies have reported symptomatic infection in children; still, when it occurs, it has mild symptoms. The vast majority of cases have the infection with no signs and symptoms or mild clinical pictures; they are called “the asymptomatic group”. These patients do not seek medical care and if they come into close contact with others, they can spread the virus. Therefore, quarantine in their home is the best option for the population to break the transmission of the virus. It should be considered that some of these asymptomatic patients have clinical signs such as chest computed tomography scan (CT-Scan) infiltrations. Similar to bacterial pneumonia, lower respiratory signs and symptoms are the most frequent manifestations in serious cases of COVID-19, characterized by fever, cough, dyspnea, and bilateral infiltrates on chest imaging. In a study describing pneumonia in Wuhan, the most common clinical signs and symptoms at the onset of the illness were fever in 99% (although fever might not be a universal finding), fatigue in 70%, dry cough in 59%, anorexia in 40%, myalgia in 35%, dyspnea in 31%, and sputum production in 27%. Headache, sore throat, and rhinorrhea are less common, and gastrointestinal symptoms (eg, nausea and diarrhea) are relatively rare. 7 , 42 , 43 , 45 - 48 , 56 , 57 According to our clinical experience in Iran, anosmia, atypical chest pain, diarrhea, nausea/vomiting, and hemoptysis are other presenting symptoms in the clinic. It should be noted that COVID-19 has some unexplained potential complications such as secondary bacterial infections, myocarditis, central nervous system injury, cerebral edema, MODS, acute demyelinating encephalomyelitis (ADEM), kidney injury, liver injury, new-onset seizure, coagulopathy, and arrhythmias.

Laboratory data : Complete blood counts, which constitute a routine laboratory test, have shown different results in terms of the white blood cell count: from leukopenia and lymphopenia to leukocytosis, although lymphopenia appears to be the most common. Fatal cases have exhibited severe lymphopenia accompanied by an increased level of D-dimer. Liver function enzymes can be increased; however, it is not sufficient to diagnose a disease. The serum procalcitonin level is a marker of infection, especially in bacterial diseases. Patients with COVID-19 who require intensive care unit (ICU) management may have elevated procalcitonin. Increased urea and creatinine, creatinine-phosphokinase, lactate dehydrogenase, and C-reactive protein are other findings in some cases. 7 , 56 , 57

Imaging studies : Routine chest X-ray (CXR) is widely deemed the first-step management to evaluate any respiratory involvement. Although negative findings in CXR do not rule out the viral disease, patients without common findings do not have severe disease and can, consequently, be managed in the outpatient setting. 58 , 59 Another modality is chest CT-Scan. It can be ordered in suspected cases with typical symptoms at the first step, or it can be performed after the detection of any abnormalities in CXR. The most common demonstrations in CT-Scan images are ground-glass opacification, round opacities, and crazy paving with or without bilateral consolidative abnormalities (multilobar involvement) in contrast to most cases of bacterial pneumonia, which have locally limited involvement. Pleural thickening, pleural effusion, and lymphadenopathy are less common. 58 - 61 Tree-in-bud, peribronchial distribution, nodules, and cavity are not in favor of common COVID-19 findings. Although reverse transcriptase-polymerase chain reaction (RT-PCR) is used to confirm the diagnosis, it is a time-consuming procedure and has high false-negative/false-positive findings; hence, in the emergency clinical setting, CT-Scan findings can be a good approach to make the diagnosis. It is deserving of note, however, that false-positive/false-negative cases were reported by one study to be high and other differential diagnoses should be in mind in order not to miss any other cases such as acute pulmonary edema in patients with heart disease.

Suspected cases should be diagnosed as soon as possible to isolate and control the infection immediately. COVID-19 should be considered in any patient with fever and/or lower respiratory tract symptoms with any of the following risk factors in the previous 2 weeks: close contact with confirmed or suspected cases in any environment, especially at work in healthcare places without sufficient protective equipment or long-time standing in those places, and living in or traveling from well-known places where the disease is an epidemic. 61 - 66 Patients with severe lower respiratory tract disease without alternative etiologies and a clear history of exposure should be considered having COVID-19 unless confirmed otherwise. According to the Centers for Disease Control and Prevention (CDC), sending tests to check SARS-CoV-2 in suspected cases is based on physicians’ clinical judgment. Although there are some positive cases without clinical manifestations (ie, fever and/or symptoms of acute respiratory illness such as cough and dyspnea), infectious disease and control centers should take action in society to limit the exposure of such patients to other healthy individuals. The CDC prioritizes the use of the specific test for hospitalized patients, symptomatic patients who are at risk of fatal conditions (eg, age ≥65 y, chronic medical conditions, and immunocompromising conditions) and those who have exposure risks (recent travel, contact with patients with COVID-19, and healthcare workers). 61 - 66 Although treatment should be started after the confirmation of the disease, RT-PCR for highly suspected cases is a time-consuming test; accordingly, a considerable number of clinicians favor the use of a combination of clinical manifestations with imaging modalities (eg, CT-Scan findings) and their clinical judgment regarding the probability of the disease in order not to lose more time. 61 - 66

Treatment of COVID-19

There is no confirmed recommended treatment or vaccine for SARS-CoV-2; prevention is, therefore, better than treatment. Nevertheless, the high contagiousness of COVID-19, combined with the fact that some individuals fail to adhere to precautionary measures or they have significant risk factors, means that this infectious disease is inevitable in some people. Beside supportive treatments, many types of medications have been introduced. These medications come from previous experimental studies on SARS, MERS, influenza, or human immunodeficiency virus (HIV); hence, their efficacy needs further experimental and clinical approval. Patients with mild symptoms who do not have significant risk factors should be managed in their home like a self-made quarantine (in an isolated room); still, prompt hospital admission is required if patients exhibit signs of disease deterioration. 25 , 67 , 68 Isolation from other family members is an important prevention tip. Patients should wear face masks, eat healthy and warm foods similar to when struggling with influenza or colds, do the handwashing process, dispose of the contaminated materials cautiously, and disinfect suspicious surfaces with standard disinfectants. 69 Patients with severe symptoms or admission criteria should be hospitalized with other patients who have the same disease in an isolated department. When the disease is progressed, ICU care is mandatory. 25 , 67 , 68 SARS-CoV-2 attacks the respiratory system, diminishing the oxygenation process and forcing patients with low blood oxygen saturation to take extra oxygen from different modalities. Nasal cannulae, face masks with or without a reservoir, intubation in severe cases, and then extracorporeal membrane oxygenation in refractory hypoxia have been used; however, the safety and efficacy of these measures should be evaluated. As was mentioned above, impaired coagulation is one of the major complications of the disease; consequently, alongside all recommended supportive care and drugs, anticoagulants such as heparin should be administered prophylactically ( Table 1 ). Although it is said that all the clinical signs and symptoms of COVID-19 are induced by the immune system, as other research on influenza and MERS has revealed, glucocorticoids are not recommended in COVID-19 pneumonia unless other indications are present (eg, exacerbation of chronic obstructive pulmonary disease and refractory septic shock) due to the high risk of mortality and delayed viral clearance. Earlier in the national and international guidelines, nonsteroidal anti-inflammatory drugs such as naproxen were recommended on the strength of their antipyretic and anti-inflammatory components; however, the guideline has been revised recently and acetaminophen with or without codeine is currently the favored drug in patients with COVID-19. 25 , 67 , 68 According to the pathogenesis of the disease, whereby cytokine storm and immune-cell exhaustion can be seen in severe cases, selective antibodies against harmful interleukins such as IL-6 and IL-10 or other possible agents can be therapeutic for fatal complications. Tocilizumab, an IL-6 inhibitor, albeit with limited clinical efficacy, has been introduced in China’s National Health Commission treatment guideline for severe infection with profound pulmonary involvement (ie, white lung). 70 , 87

Summary of possible anti-COVID-19 drugs

mg, Milligrams; BD, Every 12 hours; RdRP, RNA-dependent RNA polymerase; TDS, Every 8 hours; IV, Intravenous; IL, Interleukin; μg, Micrograms

RNA synthesis inhibitors (eg, tenofovir disoproxil fumarate and 2’-deoxy-3’-thiacytidine [3TC]), neuraminidase inhibitors (NAIs), nucleoside analogs, lopinavir/ritonavir, atazanavir, remdesivir, favipiravir, INF-β, and Chinese traditional medicine (eg, Shufeng Jiedu and Lianhuaqingwen capsules) are the major candidates for COVID-19. 26 , 70 , 85 , 88 - 96 Antiviral drugs have been investigated for various diseases, but their efficacy in the treatment of COVID-19 is under investigation and several randomized clinical trials are ongoing to release a consensus result on the treatment of this infectious disease. Moderate-to-severe SARS-CoV-2 disease needs drug therapy. Favipiravir, a previously validated drug for influenza, is a drug that has shown promising results for COVID-19 in experimental and clinical studies, but it is under further evaluation. 70 , 79 , 80 Remdesivir, which was developed for Ebola, is an antiviral drug that is under evaluation for moderate-to-severe COVID-19 owing to its promising results in in vitro investigations. 70 , 73 - 75 , 81 Remdesivir was shown to have reduced the virus titer in infected mice with MERS-CoV and improved lung tissue damage with more efficiency compared with a group treated with lopinavir/ritonavir/INF-β. 67 , 70 Another investigation studied the potential efficacy of INF-β-1 in the early stages of COVID-19 as a potential antiviral drug. 86 Although there is some hope, an evidence-based consensus requires further clinical trials. 70 , 77 A combined protease inhibitor, lopinavir/ritonavir, is used for HIV infection and has shown interesting results for SARS and MERS in in vitro studies. 73 - 75 The clinical effectiveness of lopinavir/ritonavir for SARS-CoV-2 was also reported in a case report. 70 , 71 , 74 , 76 Atazanavir, another protease inhibitor, with or without ritonavir is another possible anti-COVID-19 treatment. 77 , 78 NAIs, including oseltamivir, zanamivir, and peramivir, are recommended as antiviral treatment in influenza. 68 Oral oseltamivir was tried for COVID-19 in China and was first recommended in the Iranian guideline for COVID-19 treatment; nevertheless, because of the absence of strong evidence indicating its efficacy for SARS-CoV-2, it was eliminated from the subsequent updates of the guideline. 85 RNA-dependent RNA polymerase inhibitors with anti-hepatitis C effects such as ribavirin have shown satisfactory results against SARS-CoV-2 RNA polymerase; however, they have limited clinical approval. 82 - 84 The well-known drugs for rheumatoid arthritis, systemic lupus erythematosus, and an antimalarial drug, chloroquine 71 and hydroxychloroquine 21 are other potential drugs for moderate-to-severe COVID-19 but with limited or no clinical appraisal. Hydroxychloroquine has exhibited better safety and fewer side effects than chloroquine, which makes it the preferred choice. 70 Furthermore, the immunomodulatory effects of hydroxychloroquine can be used to control the cytokine precipitation in the late phases of SARS-CoV-2 infections. There are numerous mechanisms for the antiviral activity of hydroxychloroquine. A weak base drug, hydroxychloroquine concentrates on such intracellular sections as endosomes and lysosomes, thereby halting viral replication in the phase of fusion and uncoating. Additionally, this immunosuppressive and antiparasitic drug is capable of altering the glycosylation of ACE2 and inhibiting both S-protein binding and phagocytosis. 72 A recent multicenter study showed that regarding the risks of cardiovascular adverse effects and mortality rates, hydroxychloroquine or chloroquine with or without a macrolide (eg, azithromycin) was not beneficial for hospitalized patients, although further research is needed to end such controversies. 97

Disease Duration

It is not easy to quarantine the patients who have fully recovered because there is evidence that they are highly infectious. 81 The recovery time for confirmed cases based on the National Health Commission reports of China’s government was estimated to range between 18 and 22 days. 73 As indicated by the WHO, the healing time seems to be around two weeks for moderate infections and 3 to 6 weeks for the severe/ serious disease. 75 Pan Feng and others studied 21 confirmed cases with COVID-19 pneumonia with about 82 CT-Scan images with a mean interval of four days. Lung abnormalities on chest CT showed the highest severity approximately 10 days after the initial onset of symptoms. All patients became clear after 11 to 26 days of hospitalization. From day zero to day 26, four stages of lung CT were defined as follows: Stage 1 (first 4 days): ground-glass opacities; Stage 2 (second 4 days): crazy-paving patterns; Stage 3 (days 9–13): maximum total CT scores in the consolidations; and Stage 4 (≥14 d): steady improvements in the consolidations with a reduction in the total CT score without any crazy-paving pattern. 74 Nevertheless, there are also rare cases reported from some studies that show the recurrence of COVID-19 after negative preliminary RT-PCR results. For example, Lan and othersstudied one hospitalized and three home-quarantined patients with COVID-19 and evaluated them with RT-PCR tests of the nucleic acid. All the patients with positive RT-PCR test results had CT imaging with ground-glass opacification or mixed ground-glass opacification and consolidation with mild-to-moderate disease. After antiviral treatments, all four patients had two consecutive negative RT-PCR test results within 12 to 32 days. Five to 13 days after hospital discharge or the discontinuation of the quarantine, RT-PCR tests were repeated, and all were positive. An additional RT-PCR test was performed using a kit from a different manufacturer, and the results were also positive. Their findings propose that a minimum percentage of recovered patients may still be infection carriers. 76

Supplements for COVID-19

Since the appearance of SARS-CoV-2 in Wuhan, China, there have been reports of the unreliable and unpredictable use of mysterious therapies. Some recommendations such as the use of certain herbs and extracts including oregano oil, mulberry leaf, garlic, and black sesame may be safe as long as people do not utilize their hands for instance. 98 According to data released by the CDC, vitamin C (VitC) supplements can decrease the risk of colds in people besides preventing CoV from spreading. The aforementioned organization states that frequent consumption of VitC supplements can also decrease the duration of the cold; however, if used only after the cold has risen, its consumption does not influence the disease course. VitC also plays an important role in the body. One of the main reasons for taking VitC is to strengthen the immune system because this vitamin plays a significant part in the immune system. Firstly, VitC can increase the production of white blood cells (lymphocytes and phagocytes) in the bone marrow, which can support and protect the body against infections. Secondly, VitC helps immune cells to function better while preserving white blood cells from damaging molecules such as free oxidative radicals and ions. Thirdly, VitC is an essential part of the skin’s immune system. This vitamin is actively transported to the skin surface, where it serves as an antioxidant and helps to strengthen the skin barrier by optimizing the collagen synthesis process. Patients with pneumonia have lower levels of VitC and have been revealed to have a longer recovery time. 69 , 99 In a randomized investigation, 200 mg/d of VitC was applied to older patients and resulted in improvements in the respiratory symptoms. Another investigation reported 80% fewer mortalities in a controlled group of VitC takers. 73 However, for effective immune system improvement, VitC should be consumed alongside adequate doses of several other supplements. Although VitC plays an important role in the body, often a balanced diet and the consumption of fresh fruits and vegetables can quickly fill the blanks. While taking high amounts of VitC is less risky because it is water-soluble and its waste is eliminated in the urine, it can induce diarrhea, nausea, and abdominal spasms at higher concentrations. Too much VitC may cause calcium-oxalate kidney stones. People with genetic hemochromatosis, an iron deficiency disorder, should consult a physician before taking any VitC supplements as high levels of VitC can lead to tissue damage. Some studies have evaluated the different doses of oral or intravenous VitC for patients admitted to the hospital for COVID-19. Although they used different regimens, all of them demonstrated satisfactory results regarding the resolution of the compilations of the disease, decreased mortality, and shortened lengths of stay in the ICU and/or the hospital. 100 , 101 Immunologists have also recommended 6 000 units of vitamin A (VitA) per day for two weeks, more than twice the recommended limit for VitA, which can create a poisoning environment over time. According to the guidance of the National Institutes of Health (NIH), middle-aged men and women should take 1 and 2 mg of VitA every day, respectively. The safe upper limit of this vitamin is 6000 mg or 5000 units, and overdose can have serious outcomes such as dizziness, nausea, headache, coma, and even death. Extreme consumption of VitA throughout pregnancy can lead to birth anomalies.

Similar to VitC, vitamin D (VitD) has antioxidant, anti-inflammatory, and immune-modulatory effects in our body such as reducing pro-inflammatory cytokines and inhibiting viral replication according to experimental studies. 83 The VitD state of our body is checked through 25 (OH) VitD in the serum. VitD deficiency is pandemic around the world due to multifactorial reasons. It has been shown that VitD deficient patients are prone to SARS-CoV-2 and, accordingly, treating VitD deficiency is not without benefits. Grant and others recommended 10 000 units per day for two weeks and then 5 000 units per day as the maintenance dose to keep the level between 40 and 100 ng/mL. 102 VitD toxicity causes gastrointestinal discomfort (dyspepsia), congestion, hypercalcemia, confusion, positional disorders, dysrhythmia, and kidney dysfunction.

James Robb, 103 a researcher who detected CoV for the first time as a consultant pathologist with the National Cancer Institute of America, suggested the influence of zinc consumption. Oral zinc supplements can be dissolved in the nback of the throat. Short-term therapy with oral zinc can decrease the duration of viral colds in adults. Zinc intake is also associated with the faster resolution of nasal congestion, nasal drainage, sore throats, and coughs. Researchers 104 , 105 have warned that the consumption of more than 1 mg of zinc a day can lead to zinc poisoning and have side effects such as lowered immune function. Children and old people with zinc insufficiency in developing nations are extremely vulnerable to pneumonia and other viral infections. It has also been determined that zinc has a major role in the production and activation of T-cell lymphocytes. 106 , 107

And finally, for high-risk people or those who work in high-risk places such as healthcare providers, hydroxychloroquine has been mentioned to be effective as a prophylactic regimen ( Table 2 ). Although different doses have been investigated so far, Pourdowlat and others recommended 200 mg daily before exposure, and for the post-exposure scenario, a loading dose of 600-800 mg followed by a maintenance dose of 200 mg daily. 74

Possible prophylactic regimens against SARS-CoV-2 infection

IU, International unit; mg, Milligrams; kg, Kilograms; ICU, Intensive care unit; g, Grams; IV, Intravenous; Vit, Vitamin; ng, Nanograms; mL, Milliliter

COVID-19 Kits and Deep Learning

COVID-19 has threatened public health, and its fast global spread has caught the scientific community by surprise. 108 Hence, developing a technique capable of swiftly and reliably detecting the virus in patients is vital to prevent the spreading of the virus. 109 , 110 One of the ways to diagnose this new virus is through RT-PCR, a test that has previously demonstrated its efficacy in detecting such CoV infections as MERS-CoV and SARS-CoV. Consequently, increasing the availability of RT-PCR kits is a worldwide concern. The timing of the RT-PCR test and the type of strain collected are of vital importance in the diagnosis of COVID-19. One of the characteristics of this new virus is that the serum is negative in the early stage, while respiratory specimens are positive. The level of the virus at the early stage of the illness is also high, even though the infected individual experiences mild symptoms. 111 For the management of the emerging situation of COVID-19 in Wuhan, various effective diagnostic kits were urgently made available to markets. While a few different diagnostics kits are used merely for research endeavors, only a single kit developed by the Beijing Genome Institute (BGI) called “Real-Time Fluorescent PCR” has been authenticated for clinical diagnostics. Fluorescent RT-PCR is reliable and able to offer fast results probably within a few hours (usually within two hours). Besides RT-PCR, China has successfully developed a metagenomic-sequencing kit based on combinatorial probe-anchor synthesis that can identify virus-related bacteria, allowing observation and evaluation during the transmission of the virus. Furthermore, the metagenomic-sequencing kit based on combinatorial probe-anchor synthesis is far faster than the abovementioned fluorescent RT-PCR kit. Apart from China, a Singapore-based laboratory, Veredus, developed a virus detection kit (Vere-CoV) in late January. It is a portable Lab-On-Chip used to detect MERS-CoV, SARS-CoV, and SARS-CoV-2, in a single examination. This kit works based on the VereChip™ technology, the lines of code (LOC) program incorporating two different influential molecular biological functions (microarray and PCR) precisely. Several studies have focused on SARS-CoV diagnostic testing. These papers have presented investigative approaches to the identification of the virus using molecular testing (ie, RT-PCR). Researchers probed into the use of a nested PCR technique that contains a pre-amplification step or integrating the N gene as an extra subtle molecular marker to improve on the sensitivity. 112 - 115 CT-Scan is very useful for diagnosing, evaluating, and screening infections caused by COVID-19. One recommendation for scanning the disease is to take a scan every three to five days. According to researchers, most CT-Scan images from patients with COVID-19 are bilateral or peripheral ground-glass opacification, with or without stabilization. Nowadays, because of a paucity of computerized quantification tools, only qualitative reports and sometimes inaccurate analyses of contaminated areas are drawn upon in radiology reports. A categorization system based on the deep learning approach was proposed by a study to automatically measure infected parts and their volumetric ratios in the lung. The functionality of this system was evaluated by making some comparisons between the infected portions and the manually-delineated ones on the CT-Scan images of 300 patients with COVID-19. To increase the manual drawing of training samples and the non-interference in the automated results, researchers adopted a human-based approach in collaboration with radiologists so as to segment the infected region. This approach shortens the time to about four minutes after 3-time updating. The mean Dice similarity coefficient illustrated that the automatically detected infected parts were 91.6% similar to the manually detected ones, and the average of the percentage estimated error was 0.3% for the whole lung. 116 , 117

Prevention Considerations

In the healthcare setting, any individual with the manifestations of COVID-19 (eg, fever, cough, and dyspnea) should wear a face mask, have a separate waiting area, and keep the distance of at least two meters. Symptomatic patients should be asked about recent travel or close contact with a patient in the preceding two weeks to find other possible infected patients. The CDC and WHO have announced special precautions for healthcare providers in the hospital and during different procedures. Wearing tight-fitting face masks with special filters and impermeable face shields is necessary for all of them. 11 , 18 , 65 , 66 , 76 , 118 - 124 Other people should pay attention to the CDC and WHO preventive strategies, which recommend that individuals not touch their eyes, mouth, and nose before washing or disinfecting their hands; wash their hands regularly according to the standard protocol; use effective disinfection solutions (ie, containing at least 60% ethylic alcohol) for contaminated surfaces; cover their mouth when coughing and sneezing; avoid waiting or walking in crowded areas, and observe isolation protocols in their home. Postponing elective work and decreasing non-urgent visits and traveling to areas in the grip of COVID-19 may be useful to lessen the risk of exposure. If suspected individuals with mild symptoms are managed in outpatient settings, an isolated room with minimal exposure to others should be designed. Patients and their caregivers should wear tight-fitting face masks. 11 , 18 , 65 , 66 , 76 , 118 - 124 Substantial numbers of individuals with COVID-19 are asymptomatic with potential exposure; accordingly, a screening tool should be employed to evaluate these cases. In addition to passport checks, corona checks have been incorporated into the protocols in airports and other crowded places. The use of a remote thermometer to measure body temperature leads to an increase in the number of false-negative cases. It is, thus, essential that everyone pay sufficient heed to the WHO and CDC recommendations in their daily life. Traveling is not prohibited, but it should be restricted and passengers from any country should be monitored. 11 , 18 , 65 , 66 , 76 , 118 - 124

SARS-CoV-2 is the new highly contagious CoV, which was first reported in China. While it had a zoonotic origin in the beginning, it subsequently spread throughout the world by human contact. COVID-19 has a spectrum of manifestations, which is not lethal most of the time. To diagnose this condition, physicians can avail themselves of laboratory and imaging findings besides signs and symptoms. RT-PCR is the gold standard, but it lacks sufficient sensitivity and specificity. Although there are some potential drugs for COVID-19 and some vitamins or minerals for prophylaxis, the best preventive strategies are quarantine (staying at home) and the use of personal protective equipment and disinfectants.

Acknowledgement

The authors express their gratitude toward the Supporting Organizations for Foreign Iranian Students, Islamic Azad University Isfahan (Khorasgan) Branch, and Isfahan University of Medical Sciences.

Conflict of Interest: None declared.

Personal Experience With the COVID-19 Pandemic

The COVID-19 pandemic has affected many areas of individuals’ daily living. The vulnerability to any epidemic depends on a person’s social and economic status. Some people with underlying medical conditions have succumbed to the disease, while others with stronger immunity have survived (Cohut para.6). Governments have restricted movements and introduced stern measures against violating such health precautions as physical distancing and wearing masks. The COVID-19 pandemic has forced people to adopt various responses to its effects, such as homeschooling, working from home, and ordering foods and other commodities from online stores.

I have restricted my movements and opted to order foodstuffs and other essential goods online with doorstep delivery services. I like adventure, and before the pandemic, I would go to parks and other recreational centers to have fun. But this time, I am mostly confined to my room studying, doing school assignments, or reading storybooks, when I do not have an in-person session at college. I have also had to use social media more than before to connect with my family and friends. I miss participating in outdoor activities and meeting with my friends. However, it is worth it because the virus is deadly, and I have had to adapt to this new normal in my life.

With the pandemic requiring stern measures and precautions due to its transmission mode, the federal government has done well in handling the matter. One of the positives is that it has sent financial and material aid to individual state and local governments to help people cope up with the economic challenges the pandemic has posed (Solomon para. 8). Another plus for the federal government is funding the COVID-19 testing, contact tracing, and distributing the vaccine. Lastly, the government has extended unemployment benefits as a rescue plan to help households with an income of less than $150,000 (Solomon para. 9). Therefore, the federal government is trying its best to handle this pandemic.

The New Jersey government has done all it can to handle this pandemic well, but there are still some areas of improvement. As of March 7, 2021, New Jersey was having the highest number of deaths related to COVID-19, but Governor Phil Murphy’s initial handling of the pandemic attracted praises from many quarters (Stanmyre para. 10). In his early days in office, Gov. Murphy portrayed a sense of competency and calm, but it seems other states adopted much of his policies better than he did, explaining the reduction in the approval ratings. In November 2020, Governor Murphy signed an Executive Order cushioning and protecting workers from contracting COVID-19 at the workplace (Stanmyre para. 12). Therefore, although there are mixed feelings, the NJ government is handling this pandemic well.

Some states have reopened immediately after the vaccination, but this poses a massive risk of spreading the virus. Soon, citizens will begin to neglect the laid down health protocols, which would increase the possibility of the increase of the COVID-19 cases. There is a need for health departments to ensure that the health precautions are followed and campaign on the need to adhere to the guidelines. Some individuals are protesting their states’ economy to be reopened, but that is a rash, ill-informed decision. The threat of the pandemic is still high, and it is not the right time to demand the reopening of the economy yet.

In conclusion, the pandemic has affected individuals, businesses, and governments in many ways. Due to how the virus spreads, physical distancing has become a new normal, with people forced to homeschool or work from home to prevent themselves from contracting the disease. The federal government has done its best to cushion its people from the pandemic’s economic effects through various financial rescue schemes and plans. New Jersey’s government has also done well, although its cases continue to soar as it is the leading state in COVID-19 prevalence. Some states have reopened, while in others, people continue to demand their state governments to open the economy, which would be a risky move.

Works Cited

Cohut, Maria. “COVID-19 at the 1-year Mark: How the Pandemic Has Affected the World.” Medical and Health Information . Web.

Solomon, Rachel. “What is the Federal Government Doing to Help People Impacted by Coronavirus?” Cancer Support Community . Web.

Stanmyre, Matthew. “N.J.’s Pandemic Response Started Strong. Why Has So Much Gone Wrong Since?” 2021. Web.

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1. IvyPanda . "Personal Experience With the COVID-19 Pandemic." September 29, 2022. https://ivypanda.com/essays/personal-experience-with-the-covid-19-pandemic/.

Bibliography

IvyPanda . "Personal Experience With the COVID-19 Pandemic." September 29, 2022. https://ivypanda.com/essays/personal-experience-with-the-covid-19-pandemic/.

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Read these 12 moving essays about life during coronavirus

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

by Alissa Wilkinson

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

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

• The Vox guide to navigating the coronavirus crisis

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

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

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

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

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

• A syllabus for the end of the world

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

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

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

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

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

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

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

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

• What day is it today?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Coronavirus Disease 2019

Defining the covid-19 narrative, the story we tell about this pandemic will shape our preparedness for the next..

Posted July 6, 2021 | Reviewed by Vanessa Lancaster

• The core narrative of the pandemic, and arguably the central one, is the presence of inequities.
• COVID-19 exposed inequities in morbidity and mortality, who bears the burden of steps we have taken to mitigate the virus, and vaccine uptake.
• The effects of these inequities will likely be with us for some time, shaping the story of the pandemic and the lives of those who lived it. 

What story will we tell about COVID-19 ? The events of the past year and a half were more than just a story of the emergence and behavior of a virus. It was also a story of the social, economic, scientific, and political context into which the virus emerged and the intersection of these forces within complex, dynamic systems. Given this complexity, it can be challenging to predict which stories will rise to the surface of the overarching story of the pandemic. Yet, we need to try. The stories we tell about health shape how we engage with the present moment to support a better future—or how we fail to do so.

With this in mind, I suggest four critical narratives that emerged from the broader story of the pandemic and which can help define the overall COVID-19 narrative in the years to come. Next week, I will address the perhaps deeper issue of why we remember what we remember.

The first narrative which has come to define the COVID-19 moment is that of scientific excellence. The speed with which a COVID-19 vaccine was developed, supported by mRNA technology, reflects a new era in cutting -edge science. This narrative of scientific excellence is powerful for two key reasons.

First, because this latest vaccine technology is unique and impressive and has begun the long-awaited process of helping return us to our families, friends, colleagues, lives. Second, it is powerful because of how closely it aligns with how we already think about health. We often think about health in terms of treatment—doctors and medicines—which can cure us when we are sick, rather than in terms of the structural forces in society which shape whether or not we get sick, to begin with. We tend to confuse health (the state of not being sick) with healthcare (what we turn to once sickness strikes), which has led us to invest vast sums in healthcare at the expense of the core forces that shape health. The success of vaccines reflects that this investment is indeed core to supporting scientific excellence. Still, our story of health and COVID-19 is incomplete if it is confined to science and treatment alone.

This leads to the following core narrative of the pandemic and arguably the central one—the presence of inequities. These include, centrally, inequities in morbidity and mortality, who bears the burden of the steps we have taken to mitigate the virus and vaccine uptake. When COVID-19 struck, it quickly became apparent that certain groups—such as Black Americans, people over 65, and people with underlying health conditions—were more vulnerable to the virus than others. This vulnerability was shaped by longstanding health inequities informed by marginalization, social and economic injustice, and other foundational forces in our society. The story of COVID-19 is, in large part, the level of these forces.

These inequities have also come to define who has most felt the consequences of our efforts to mitigate the pandemic. COVID-19 caused us to embrace extraordinary measures, shut down society, and incur severe economic costs in the process. The pandemic led to significant job losses , which most affected low-income, minority workers. When the economy began to recover, with higher-wage workers bouncing back relatively quickly, lower-wage minority workers recovered at a far slower rate. The effects of this inequity will likely be with us for some time, shaping the story of the pandemic and the lives of those who lived it.

Third, the story of COVID-19 would be incomplete without an honest reckoning with widespread loss of trust in institutions and the consequences of this for public health. The most prominent example of this was how the inconsistent, often dishonest, words of former President Trump informed a lack of trust in guidance from the White House throughout the crisis. It is also true that seeming inconsistencies occasionally characterized public health efforts, perhaps most clearly in our field’s widespread embrace of civic protests last summer, in apparent contrast with our guidance on social distancing and masks. Given that COVID-19 emerged at a time when trust in institutions was already declining , the story of the pandemic may well be, in large part, a story of how this trend accelerated, making it harder for anyone to speak with a widely-heeded, authoritative voice on matters core to health.

Finally, a core narrative of the pandemic, one which could well characterize our future memory of this time, is that, as bad as COVID-19 was, it could have been far worse. I realize that this may seem strange, even unfeeling, in the context of mass death and suffering. But it is nevertheless true. COVID-19 has been a disaster. Yet, the virus itself, compared to past pandemics, is nowhere near as lethal as it might have been. A future pandemic could combine the high transmissibility of COVID-19 with the lethality of, say, SARS or even of the Black Death. While the latter may seem historically remote, there is no reason why we could not see something as deadly strike in our own time. The better we understand this, the more the story we tell about COVID-19 can help inform our efforts to build a world that is no longer vulnerable to contagion.

Each of these stories represents a vital part of the broader narrative of COVID-19. It is also the case that one or two of these narratives may rise even further to the top of our minds to conclusively define this era. Only time will tell for sure what will happen. However, I would argue several factors contribute to making stories stick when we think back on critical events, which increases the chance that the stories I have presented here will long outlast this moment. I will explore these factors and how we come to believe what we believe in our narratives next week.

This piece was also posted 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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How COVID-19 pandemic changed my life

Table of Contents

Introduction

The COVID-19 pandemic is one of the biggest challenges that our world has ever faced. People around the globe were affected in some way by this terrible disease, whether personally or not. Amid the COVID-19 pandemic, many people felt isolated and in a state of panic. They often found themselves lacking a sense of community, confidence, and trust. The health systems in many countries were able to successfully prevent and treat people with COVID-19-related diseases while providing early intervention services to those who may not be fully aware that they are infected (Rume & Islam, 2020). Personally, this pandemic has brought numerous changes and challenges to my life. The COVID-19 pandemic affected my social, academic, and economic lifestyle positively and negatively.

Social and Academic Changes

One of the changes brought by the pandemic was economic changes that occurred very drastically (Haleem, Javaid, & Vaishya, 2020). During the pandemic, food prices started to rise, affecting the amount of money my parents could spend on goods and services. We had to reduce the food we bought as our budgets were stretched. My family also had to eliminate unhealthy food bought in bulk, such as crisps and chocolate bars. Furthermore, the pandemic made us more aware of the importance of keeping our homes clean, especially regarding cooking food. Lastly, it also made us more aware of how we talked to other people when they were ill and stayed home with them rather than being out and getting on with other things.

Furthermore, COVID-19 had a significant effect on my academic life. Immediately, measures to curb the pandemic were announced, such as closing all learning institutions in the country; my school life changed. The change began when our school implemented the online education system to ensure that we continued with our education during the lockdown period. At first, this affected me negatively because when learning was not happening in a formal environment, I struggled academically since I was not getting the face-to-face interaction with the teachers I needed. Furthermore, forcing us to attend online caused my classmates and me to feel disconnected from the knowledge being taught because we were unable to have peer participation in class. However, as the pandemic subsided, we grew accustomed to this learning mode. We realized the effects on our performance and learning satisfaction were positive, as it seemed to promote emotional and behavioral changes necessary to function in a virtual world. Students who participated in e-learning during the pandemic developed more ownership of the course requirement, increased their emotional intelligence and self-awareness, improved their communication skills, and learned to work together as a community.

If there is an area that the pandemic affected was the mental health of my family and myself. The COVID-19 pandemic caused increased anxiety, depression, and other mental health concerns that were difficult for my family and me to manage alone. Our ability to learn social resilience skills, such as self-management, was tested numerous times. One of the most visible challenges we faced was social isolation and loneliness. The multiple lockdowns made it difficult to interact with my friends and family, leading to loneliness. The changes in communication exacerbated the problem as interactions moved from face-to-face to online communication using social media and text messages. Furthermore, having family members and loved ones separated from us due to distance, unavailability of phones, and the internet created a situation of fear among us, as we did not know whether they were all right. Moreover, some people within my circle found it more challenging to communicate with friends, family, and co-workers due to poor communication skills. This was mainly attributed to anxiety or a higher risk of spreading the disease. It was also related to a poor understanding of creating and maintaining relationships during this period.

Positive Changes

In addition, this pandemic has brought some positive changes with it. First, it had been a significant catalyst for strengthening relationships and neighborhood ties. It has encouraged a sense of community because family members, neighbors, friends, and community members within my area were all working together to help each other out. Before the pandemic, everybody focused on their business, the children going to school while the older people went to work. There was not enough time to bond with each other. Well, the pandemic changed that, something that has continued until now that everything is returning to normal. In our home, it strengthened the relationship between myself and my siblings and parents. This is because we started spending more time together as a family, which enhanced our sense of understanding of ourselves.

The pandemic has been a challenging time for many people. I can confidently state that it was a significant and potentially unprecedented change in our daily life. By changing how we do things and relate with our family and friends, the pandemic has shaped our future life experiences and shown that during crises, we can come together and make a difference in each other’s lives. Therefore, I embrace wholesomely the changes brought by the COVID-19 pandemic in my life.

• Haleem, A., Javaid, M., & Vaishya, R. (2020). Effects of COVID-19 pandemic in daily life.  Current medicine research and practice ,  10 (2), 78.
• Rume, T., & Islam, S. D. U. (2020). Environmental effects of COVID-19 pandemic and potential strategies of sustainability.  Heliyon ,  6 (9), e04965.
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Home > LIBRARIES > Archives and Special Collections > Personal Narratives of COVID-19

Together Again: Personal Narratives of COVID-19 Uniting the Seton Hall Community

The COVID-19 pandemic has disrupted life at Seton Hall as it has for millions of others around the country and the world. In the name of saving lives, the social distancing needed to slow the spread of the virus has scattered us into our homes around the region and the country. Although we are now physically distant from one another, we remain united as Setonians through our connection to Seton Hall.

To reconnect as a community, we seek your stories of what this time has been like for you. How has it changed your experience at Seton Hall, as a student, faculty, staff member, or alum? We hope that sharing these stories with one another will bring us back together in a new way, through sharing our personal experiences of this moment. When we move forward, because there will be a time when we move forward, we plan to listen to these stories together as a community, reflect on what we have learned, and let them guide us into the future.

Questions to guide your response:

● What is your day to day life like? What would you want people the future to know about what life is like for us now?

● What has been most challenging about this time? What do you miss about your life before COVID-19? Are there specific places or things on campus that you miss?

● Essential is a word we are hearing a lot right now. What does essential mean to you? Who is essential? What are we learning about what is essential?

● What is COVID-19 making possible that never existed before? What good do you see coming out of this moment? How can we re-frame this moment as an opportunity?

● What is it you want to remember about this time? What have you learned?

● After this pandemic ends, will things go back to the way they were? What kinds of changes would you like to see? How will you contribute to rebuilding the world? What will you do differently?

Please submit your 1-3 minute audio or video recording to our portal. Please view submission instructions.

Need an Accessible transcript of this submission? Please email [email protected] to request.

With thanks to the scholars and librarians who came together to create this project: Professors Angela Kariotis Kotsonis, Sharon Ince, Marta Deyrup, Lisa DeLuca, and Alan Delozier, Technical Services Archivist Sheridan Sayles and Assistant Deans Elizabeth Leonard and Sarah Ponichtera.

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12 Ideas for Writing Through the Pandemic With The New York Times

A dozen writing projects — including journals, poems, comics and more — for students to try at home.

By Natalie Proulx

The coronavirus has transformed life as we know it. Schools are closed, we’re confined to our homes and the future feels very uncertain. Why write at a time like this?

For one, we are living through history. Future historians may look back on the journals, essays and art that ordinary people are creating now to tell the story of life during the coronavirus.

But writing can also be deeply therapeutic. It can be a way to express our fears, hopes and joys. It can help us make sense of the world and our place in it.

Plus, even though school buildings are shuttered, that doesn’t mean learning has stopped. Writing can help us reflect on what’s happening in our lives and form new ideas.

We want to help inspire your writing about the coronavirus while you learn from home. Below, we offer 12 projects for students, all based on pieces from The New York Times, including personal narrative essays, editorials, comic strips and podcasts. Each project features a Times text and prompts to inspire your writing, as well as related resources from The Learning Network to help you develop your craft. Some also offer opportunities to get your work published in The Times, on The Learning Network or elsewhere.

We know this list isn’t nearly complete. If you have ideas for other pandemic-related writing projects, please suggest them in the comments.

In the meantime, happy writing!

Journaling is well-known as a therapeutic practice , a tool for helping you organize your thoughts and vent your emotions, especially in anxiety-ridden times. But keeping a diary has an added benefit during a pandemic: It may help educate future generations.

In “ The Quarantine Diaries ,” Amelia Nierenberg spoke to Ady, an 8-year-old in the Bay Area who is keeping a diary. Ms. Nierenberg writes:

As the coronavirus continues to spread and confine people largely to their homes, many are filling pages with their experiences of living through a pandemic. Their diaries are told in words and pictures: pantry inventories, window views, questions about the future, concerns about the present. Taken together, the pages tell the story of an anxious, claustrophobic world on pause. “You can say anything you want, no matter what, and nobody can judge you,” Ady said in a phone interview earlier this month, speaking about her diary. “No one says, ‘scaredy-cat.’” When future historians look to write the story of life during coronavirus, these first-person accounts may prove useful. “Diaries and correspondences are a gold standard,” said Jane Kamensky, a professor of American History at Harvard University and the faculty director of the Schlesinger Library at the Radcliffe Institute. “They’re among the best evidence we have of people’s inner worlds.”

You can keep your own journal, recording your thoughts, questions, concerns and experiences of living through the coronavirus pandemic.

Not sure what to write about? Read the rest of Ms. Nierenberg’s article to find out what others around the world are recording. If you need more inspiration, here are a few writing prompts to get you started:

How has the virus disrupted your daily life? What are you missing? School, sports, competitions, extracurricular activities, social plans, vacations or anything else?

What effect has this crisis had on your own mental and emotional health?

What changes, big or small, are you noticing in the world around you?

For more ideas, see our writing prompts . We post a new one every school day, many of them now related to life during the coronavirus.

You can write in your journal every day or as often as you like. And if writing isn’t working for you right now, try a visual, audio or video diary instead.

2. Personal Narrative

As you write in your journal, you’ll probably find that your life during the pandemic is full of stories, whether serious or funny, angry or sad. If you’re so inspired, try writing about one of your experiences in a personal narrative essay.

Here’s how Mary Laura Philpott begins her essay, “ This Togetherness Is Temporary, ” about being quarantined with her teenage children:

Get this: A couple of months ago, I quit my job in order to be home more. Go ahead and laugh at the timing. I know. At the time, it was hitting me that my daughter starts high school in the fall, and my son will be a senior. Increasingly they were spending their time away from me at school, with friends, and in the many time-intensive activities that make up teenage lives. I could feel the clock ticking, and I wanted to spend the minutes I could — the minutes they were willing to give me, anyway — with them, instead of sitting in front of a computer at night and on weekends in order to juggle a job as a bookseller, a part-time gig as a television host, and a book deadline. I wanted more of them while they were still living in my house. Now here we are, all together, every day. You’re supposed to be careful what you wish for, but come on. None of us saw this coming.

Personal narratives are short, powerful stories about meaningful life experiences, big or small. Read the rest of Ms. Philpott’s essay to see how she balances telling the story of a specific moment in time and reflecting on what it all means in the larger context of her life.

To help you identify the moments that have been particularly meaningful, difficult, comical or strange during this pandemic, try responding to one of our writing prompts related to the coronavirus:

Holidays and Birthdays Are Moments to Come Together. How Are You Adapting During the Pandemic?

Has Your School Switched to Remote Learning? How Is It Going So Far?

Is the Coronavirus Pandemic Bringing Your Extended Family Closer Together?

How Is the Coronavirus Outbreak Affecting Your Life?

Another option? Use any of the images in our Picture Prompt series to inspire you to write about a memory from your life.

Related Resource: Writing Curriculum | Unit 1: Teach Narrative Writing With The New York Times

People have long turned to creative expression in times of crisis. During the coronavirus pandemic, artists are continuing to illustrate , play music , dance , perform — and write poetry .

That’s what Dr. Elizabeth Mitchell, an emergency room doctor in Boston, did after a long shift treating coronavirus patients. Called “ The Apocalypse ,” her poem begins like this:

This is the apocalypse A daffodil has poked its head up from the dirt and opened sunny arms to bluer skies yet I am filled with dark and anxious dread as theaters close as travel ends and grocery stores display their empty rows where toilet paper liquid bleach and bags of flour stood in upright ranks.

Read the rest of Dr. Mitchell’s poem and note the lines, images and metaphors that speak to you. Then, tap into your creative side by writing a poem inspired by your own experience of the pandemic.

Need inspiration? Try writing a poem in response to one of our Picture Prompts . Or, you can create a found poem using an article from The Times’s coronavirus outbreak coverage . If you have access to the print paper, try making a blackout poem instead.

Related Resources: 24 Ways to Teach and Learn About Poetry With The New York Times Reader Idea | How the Found Poem Can Inspire Teachers and Students Alike

4. Letter to the Editor

Have you been keeping up with the news about the coronavirus? What is your reaction to it?

Make your voice heard by writing a letter to the editor about a recent Times article, editorial, column or Opinion essay related to the pandemic. You can find articles in The Times’s free coronavirus coverage or The Learning Network’s coronavirus resources for students . And, if you’re a high school student, your school can get you free digital access to The New York Times from now until July 6.

To see examples, read the letters written by young people in response to recent headlines in “ How the Young Deal With the Coronavirus .” Here’s what Addie Muller from San Jose, Calif., had to say about the Opinion essay “ I’m 26. Coronavirus Sent Me to the Hospital ”:

As a high school student and a part of Generation Z, I’ve been less concerned about getting Covid-19 and more concerned about spreading it to more vulnerable populations. While I’ve been staying at home and sheltering in place (as was ordered for the state of California), many of my friends haven’t been doing the same. I know people who continue going to restaurants and have been treating the change in education as an extended spring break and excuse to spend more time with friends. I fear for my grandparents and parents, but this article showed me that we should also fear for ourselves. I appreciated seeing this article because many younger people seem to feel invincible. The fact that a healthy 26-year-old can be hospitalized means that we are all capable of getting the virus ourselves and spreading it to others. I hope that Ms. Lowenstein continues spreading her story and that she makes a full recovery soon.

As you read, note some of the defining features of a letter to the editor and what made these good enough to publish. For more advice, see these tips from Thomas Feyer, the letters editor at The Times, about how to write a compelling letter. They include:

Write briefly and to the point.

Be prepared to back up your facts with evidence.

Write about something off the beaten path.

Publishing Opportunity: When you’re ready, submit your letter to The New York Times.

5. Editorial

Maybe you have more to say than you can fit in a 150-word letter to the editor. If that’s the case, try writing an editorial about something you have a strong opinion about related to the coronavirus. What have you seen that has made you upset? Proud? Appreciative? Scared?

In “ Surviving Coronavirus as a Broke College Student ,” Sydney Goins, a senior English major at the University of Georgia, writes about the limited options for students whose colleges are now closed. Her essay begins:

College was supposed to be my ticket to financial security. My parents were the first ones to go to college in their family. My grandpa said to my mom, “You need to go to college, so you don’t have to depend on a man for money.” This same mentality was passed on to me as well. I had enough money to last until May— $1,625 to be exact — until the coronavirus ruined my finances. My mom works in human resources. My dad is a project manager for a mattress company. I worked part time at the university’s most popular dining hall and lived in a cramped house with three other students. I don’t have a car. I either walked or biked a mile to attend class. I have student debt and started paying the accrued interest last month. I was making it work until the coronavirus shut down my college town. At first, spring break was extended by two weeks with the assumption that campus would open again in late March, but a few hours after that email, all 26 colleges in the University System of Georgia canceled in-person classes and closed integral parts of campus.

Read the rest of Ms. Goins’s essay. What is her argument? How does she support it? How is it relevant to her life and the world?

Then, choose a topic related to the pandemic that you care about and write an editorial that asserts an opinion and backs it up with solid reasoning and evidence.

Not sure where to start? Try responding to some of our recent argumentative writing prompts and see what comes up for you. Here are a few we’ve asked students so far:

Should Schools Change How They Grade Students During the Pandemic?

What Role Should Celebrities Have During the Coronavirus Crisis?

Is It Immoral to Increase the Price of Goods During a Crisis?

Or, consider essential questions about the pandemic and what they tell us about our world today: What weaknesses is the coronavirus exposing in our society? How can we best help our communities right now? What lessons can we learn from this crisis? See more here.

As an alternative to a written essay, you might try creating a video Op-Ed instead, like Katherine Oung’s “ Coronavirus Racism Infected My High School. ”

Publishing Opportunity: Submit your final essay to our Student Editorial Contest , open to middle school and high school students ages 10-19, until April 21. Please be sure to read all the rules and guidelines before submitting.

Related Resource: An Argumentative-Writing Unit for Students Doing Remote Learning

Are games, television, music, books, art or movies providing you with a much-needed distraction during the pandemic? What has been working for you that you would recommend to others? Or, what would you caution others to stay away from right now?

Share your opinions by writing a review of a piece of art or culture for other teenagers who are stuck at home. You might suggest TV shows, novels, podcasts, video games, recipes or anything else. Or, try something made especially for the coronavirus era, like a virtual architecture tour , concert or safari .

As a mentor text, read Laura Cappelle’s review of French theater companies that have rushed to put content online during the coronavirus outbreak, noting how she tailors her commentary to our current reality:

The 17th-century philosopher Blaise Pascal once wrote: “The sole cause of people’s unhappiness is that they do not know how to stay quietly in their rooms.” Yet at a time when much of the world has been forced to hunker down, French theater-makers are fighting to fill the void by making noise online.

She continues:

Under the circumstances, it would be churlish to complain about artists’ desire to connect with audiences in some fashion. Theater, which depends on crowds gathering to watch performers at close quarters, is experiencing significant loss and upheaval, with many stagings either delayed indefinitely or canceled outright. But a sampling of stopgap offerings often left me underwhelmed.

To get inspired you might start by responding to our related Student Opinion prompt with your recommendations. Then turn one of them into a formal review.

Related Resource: Writing Curriculum | Unit 2: Analyzing Arts, Criticizing Culture: Writing Reviews With The New York Times

7. How-to Guide

Being stuck at home with nowhere to go is the perfect time to learn a new skill. What are you an expert at that you can you teach someone?

The Times has created several guides that walk readers through how to do something step-by-step, for example, this eight-step tutorial on how to make a face mask . Read through the guide, noting how the author breaks down each step into an easily digestible action, as well as how the illustrations support comprehension.

Then, create your own how-to guide for something you could teach someone to do during the pandemic. Maybe it’s a recipe you’ve perfected, a solo sport you’ve been practicing, or a FaceTime tutorial for someone who’s never video chatted before.

Whatever you choose, make sure to write clearly so anyone anywhere could try out this new skill. As an added challenge, include an illustration, photo, or audio or video clip with each step to support the reader’s understanding.

Related Resource: Writing Curriculum | Unit 4: Informational Writing

8. 36 Hours Column

For nearly two decades, The Times has published a weekly 36 Hours column , giving readers suggestions for how to spend a weekend in cities all over the globe.

While traveling for fun is not an option now, the Travel section decided to create a special reader-generated column of how to spend a weekend in the midst of a global pandemic. The result? “ 36 Hours in … Wherever You Are .” Here’s how readers suggest spending a Sunday morning:

8 a.m. Changing routines Make small discoveries. To stretch my legs during the lockdown, I’ve been walking around the block every day, and I’ve started to notice details that I’d never seen before. Like the fake, painted window on the building across the road, or the old candle holders that were once used as part of the street lighting. When the quarantine ends, I hope we don’t forget to appreciate what’s been on a doorstep all along. — Camilla Capasso, Modena, Italy 10:30 a.m. Use your hands Undertake the easiest and most fulfilling origami project of your life by folding 12 pieces of paper and building this lovely star . Modular origami has been my absolute favorite occupational therapy since I was a restless child: the process is enthralling and soothing. — Laila Dib, Berlin, Germany 12 p.m. Be isolated, together Check on neighbors on your block or floor with an email, text or phone call, or leave a card with your name and contact information. Are they OK? Do they need something from the store? Help with an errand? Food? Can you bring them a hot dish or home-baked bread? This simple act — done carefully and from a safe distance — palpably reduces our sense of fear and isolation. I’ve seen the faces of some neighbors for the first time. Now they wave. — Jim Carrier, Burlington, Vt.

Read the entire article. As you read, consider: How would this be different if it were written by teenagers for teenagers?

Then, create your own 36 Hours itinerary for teenagers stuck at home during the pandemic with ideas for how to spend the weekend wherever they are.

The 36 Hours editors suggest thinking “within the spirit of travel, even if many of us are housebound.” For example: an album or a song playlist; a book or movie that transports you; a particular recipe you love; or a clever way to virtually connect with family and friends. See more suggestions here .

Related Resources: Reader Idea | 36 Hours in Your Hometown 36 Hours in Learning: Creating Travel Itineraries Across the Curriculum

9. Photo Essay

Daily life looks very different now. Unusual scenes are playing out in homes, parks, grocery stores and streets across the country.

In “ New York Was Not Designed for Emptiness ,” New York Times photographers document what life in New York City looks like amid the pandemic. It begins:

The lights are still on in Times Square. Billboards blink and storefronts shine in neon. If only there were an audience for this spectacle. But the thoroughfares have been abandoned. The energy that once crackled along the concrete has eased. The throngs of tourists, the briskly striding commuters, the honking drivers have mostly skittered away. In their place is a wistful awareness that plays across all five boroughs: Look how eerie our brilliant landscape has become. Look how it no longer bustles. This is not the New York City anyone signed up for.

Read the rest of the essay and view the photos. As you read, note the photos or lines in the text that grab your attention most. Why do they stand out to you?

What does the pandemic look like where you live? Create your own photo essay, accompanied by a written piece, that illustrates your life now. In your essay, consider how you can communicate a particular theme or message about life during the pandemic through both your photos and words, like in the article you read.

Publishing Opportunity: The International Center of Photography is collecting a virtual archive of images related to the coronavirus pandemic. Learn how to submit yours here.

10. Comic Strip

Sometimes, words alone just won’t do. Visual mediums, like comics, have the advantage of being able to express emotion, reveal inner monologues, and explain complex subjects in ways that words on their own seldom can.

If anything proves this point, it is the Opinion section’s ongoing visual diary, “ Art in Isolation .” Scroll through this collection to see clever and poignant illustrations about life in these uncertain times. Read the comic “ Finding Connection When Home Alone ” by Gracey Zhang from this collection. As you read, note what stands out to you about the writing and illustrations. What lessons could they have for your own piece?

Then, create your own comic strip, modeled after the one you read, that explores some aspect of life during the pandemic. You can sketch and color your comic with paper and pen, or use an online tool like MakeBeliefsComix.com .

Need inspiration? If you’re keeping a quarantine journal, as we suggested above, you might create a graphic story based on a week of your life, or just a small part of it — like the meals you ate, the video games you played, or the conversations you had with friends over text. For more ideas, check out our writing prompts related to the coronavirus.

Related Resource: From Superheroes to Syrian Refugees: Teaching Comics and Graphic Novels With Resources From The New York Times

11. Podcast

Modern Love Podcast: In the Midst of the Coronavirus Pandemic, People Share Their Love Stories

Are you listening to any podcasts to help you get through the pandemic? Are they keeping you up-to-date on the news? Offering advice? Or just helping you escape from it all?

Create your own five-minute podcast segment that responds to the coronavirus in some way.

To get an idea of the different genres and formats your podcast could take, listen to one or more of these five-minute clips from three New York Times podcast episodes related to the coronavirus:

“ The Daily | Voices of the Pandemic ” (1:15-6:50)

“ Still Processing | A Pod From Both Our Houses ” (0:00-4:50)

“ Modern Love | In the Midst of the Coronavirus Pandemic, People Share Their Love Stories ” (1:30-6:30)

Use these as models for your own podcast. Consider the different narrative techniques they use to relate an experience of the pandemic — interviews, nonfiction storytelling and conversation — as well as how they create an engaging listening experience.

Need ideas for what to talk about? You might try translating any of the writing projects above into podcast form. Or turn to our coronavirus-related writing prompts for inspiration.

Publishing Opportunity: Submit your finished five-minute podcast to our Student Podcast Contest , which is open through May 19. Please read all the rules and guidelines before submitting.

Related Resource: Project Audio: Teaching Students How to Produce Their Own Podcasts

12. Revise and Edit

“It doesn’t matter how good you think you are as a writer — the first words you put on the page are a first draft,” Harry Guinness writes in “ How to Edit Your Own Writing .”

Editing your work may seem like something you do quickly — checking for spelling mistakes just before you turn in your essay — but Mr. Guinness argues it’s a project in its own right:

The time you put into editing, reworking and refining turns your first draft into a second — and then into a third and, if you keep at it, eventually something great. The biggest mistake you can make as a writer is to assume that what you wrote the first time through was good enough.

Read the rest of the article for a step-by-step guide to editing your own work. Then, revise one of the pieces you have written, following Mr. Guinness’s advice.

Publishing Opportunity: When you feel like your piece is “something great,” consider submitting it to one of the publishing opportunities we’ve suggested above. Or, see our list of 70-plus places that publish teenage writing and art to find more.

Natalie Proulx joined The Learning Network as a staff editor in 2017 after working as an English language arts teacher and curriculum writer. More about Natalie Proulx

ORIGINAL RESEARCH article

The meaning of living in the time of covid-19. a large sample narrative inquiry.

• 1 Department of History, Society and Human Studies, University of Salento, Lecce, Italy
• 2 Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
• 3 Department of Philosophy, Sociology, Education and Applied Psychology (FI.S.P.P.A.), University of Padua, Padua, Italy

The spread of the COVID-19 pandemic has been a sudden, disruptive event that has strained international and local response capacity and distressed local populations. Different studies have focused on potential psychological distress resulting from the rupture of consolidated habits and routines related to the lockdown measures. Nevertheless, the subjective experience of individuals and the variations in the way of interpreting the lockdown measures remain substantially unexplored. Within the frame of Semiotic Cultural Psychosocial Theory, the study pursued two main goals: first, to explore the symbolic universes (SUs) through which Italian people represented the pandemic crisis and its meaning in their life; and second, to examine how the interpretation of the crisis varies over societal segments with different sociodemographic characteristics and specific life challenges. An online survey was available during the Italian lockdown. Respondents were asked to write a passage about the meaning of living in the time of COVID-19. A total of 1,393 questionnaires (mean = 35.47; standard deviation = 14.92; women: 64.8%; North Italy: 33%; Center Italy: 27%; South Italy: 40%) were collected. The Automated Method for Content Analysis procedure was applied to the collected texts to detect the factorial dimensions underpinning (dis)similarities in the respondents’ discourses. Such factors were interpreted as the markers of latent dimensions of meanings defining the SUs active in the sample. A set of χ 2 analysis allowed exploring the association between SUs and respondents’ characteristics. Four SUs were identified, labeled “Reconsider social priorities,” “Reconsider personal priorities,” “Live with emergency,” and “Surviving a war,” characterized by the pertinentization of two extremely basic issues: what the pandemic consists of (health emergency versus turning point) and its extent and impact (daily life vs. world scenario). Significant associations were found between SUs and all the respondents’ characteristics considered (sex, age, job status, job situation during lockdown, and place of living). The findings will be discussed in light of the role of the media and institutional scenario and psychosocial conditions in mediating the representation of the pandemic and in favoring or constraining the availability of symbolic resources underpinning people’s capability to address the crisis.

Introduction

The spread of the COronaVIrus Disease 2019 (COVID-19) has been a sudden, disruptive event that has strained the health system and had huge repercussions both on the social and economic plane and at the individual level. The containment of the massive outbreak of the virus strained international and local response capacity and distressing local populations. With no established treatment or vaccine to contain the infection rate among the population and not overload the often-limited health systems, most of the affected countries implemented emergency lockdown procedures through mass quarantine.

In Italy—the second country worldwide after China to be massively hit by the crisis (to date, as many as 238,159 reported cases and 34,514 deaths have resulted from COVID-19 in this country— Bulletin of the integrated supervision of the Istituto Superiore di Sanità, and Istituto Nazionale di Statistica, 2020 , updated 19 June 2020)—lockdown measures were established by the Government to contain the infection rate and applied first to the so-called “red zone” (Lombardia and 14 provinces of Veneto, Emilia Romagna, Piemonte and Marche) and then to the whole country (Decree of the President of the Council of Ministers, 9 March 2020). As a result, social contacts, entrenched habits, and daily routines were interrupted as never before: people stopped visiting relatives and friends; praying in churches; doing sports in the gym and in parks; visiting museums; attending cinemas, theaters, bars, and restaurants; participating in social and cultural events; taking a walk; or shopping.

Different scholars emphasized the potential psychological distress produced in citizens by this sharp breakdown of their habits and routine ( Liu et al., 2020 ; Sood, 2020 ; Suresh, 2020 ; Vijayaraghavan and Singhal, 2020 ). For instance, the study by Liu et al. (2020) among the Chinese population found that 44.6% of the people were anxious about the unknown situation and their health, 33.2% suffered from stress due to the biodisaster, and more than half exhibited mild depression, acute stress, and anxiety. A recent review on studies that analyzed the psychological impact of quarantine at the time of previous pandemics—severe acute respiratory syndrome (SARS), Ebola virus disease, Middle East respiratory syndrome, swine flu (H1N1), and equine flu ( Brooks et al., 2020 )—reports symptoms such as confusion, anger, sleeping problems, and even symptoms of posttraumatic disorder (anxiety, bad memories, irritability and depression) related to the isolation and the break in routine. High degrees of social insecurity, in addition to the health hazards ( Pellecchia et al., 2015 ), tensions within households ( Di Giovanni et al., 2004 ), stigma, and psychosomatic distress ( Lee et al., 2005 ), were also reported with regard to previous epidemics.

On the other hand, the overriding focus on the negative effects of the health emergency, although crucial, presents two main limitations. First, it may not allow the researchers to understand what kind of symbolic resources (i.e., worldviews, beliefs, modes of feeling, thinking, and acting) citizens mobilized in response to the acute stage of the pandemic and whether these resources were suited to support the management of the crisis in its whole breadth and depth. Second, it provides limited insight into variations in the experience of quarantine due to individual factors and social situations; negative psychological outcomes could be strongly influenced by contextual aspects related to the microsphere, such as with whom one lives and the quality of the relationship, as well as the macro social sphere (e.g., degree of trust in politics and/or science or kind of media information). For instance, the findings of a study based on qualitative semistructured interviews with community informants and households during Ebola ( Caleo et al., 2018 ) emphasizes the importance of the community having a role in tailoring outbreak responses to make norms more acceptable and effective, as well as in the clear communication of complex health messages. In short, researchers have taken for granted that the pandemic was a psychological tsunami for individuals and that the tsunami was intrinsically determined by the pandemic as disruptive events that can only produce a disruptive impact on daily life, people’s psychosocial conditions, and circumstances. On the other hand, negative or difficult life events may provide special opportunities for meaning making (e.g., King et al., 2000 ; McLean and Pratt, 2006 ; Bakker, 2018 ) and for turning crisis into opportunity.

Surprisingly, little research has been conducted to understand the everyday experience (feelings, experiences, practices, actions) and perspectives of those affected by the lockdown measures for the COVID-19 crisis, as well previous epidemic ( Cava et al., 2005 ; Braunack-Mayer et al., 2013 ). To our knowledge, currently no studies have been performed in Italy, or worldwide.

According to the outline considerations, the present work, within the frame of Semiotic Cultural Psychosocial Theory (SCPT), aims to explore the way Italian people represented the pandemic crisis and its meaning in their life, within the general view that pandemics do not have an invariant psychological meaning, but the opposite: they are the meaning by which people interpret their being-in-the-world to explain their reaction to the crisis. A brief outline of the SCPT will be provided, in order to frame the following analysis of psychosocial processes underpinning people’s current response to the pandemic crisis.

Theoretical Framework

The SCPT ( Valsiner, 2007 ; Salvatore et al., 2009 , 2019c ,d; Salvatore and Venuleo, 2013 , 2017 ; Salvatore, 2018 ; Russo et al., 2020 ; Venuleo et al., 2020a ) postulates the mediational role of sense-making in the way people represent and face their material and social world and in so doing shape their experience. Accordingly, people do not represent and respond to the reality of the pandemic as if it were the same states of affairs for everyone. Rather, each person interprets the pandemic in terms of specific meanings that are consistent with the symbolic universe (SU) grounding their own self and their being-in-the-world ( Salvatore et al., 2018 ; Venuleo et al., 2020b ). SUs are conceptualized as systems of implicit, only partially conscious, embodied generalized assumptions or patterns of meanings (significance, texts, practices, behavioral scripts) that foster and constrain the way the sense-maker interprets any specific event, object, and condition of their life ( Salvatore et al., 2018 ). An example is provided by the generalization of the friend–foe schema, which implies that the whole variability of the circumstances is reduced drastically to just the one degree-of-freedom distinction between being or not being other-than-us.

People vary in their tendency to make use of generalized meanings ( Feldman, 1995 ; Barrett et al., 2001 ; Barrett, 2006 ). According to SCPT, the capacity of the SU to promote adaptive responses is a function of the variable degree of salience of the generalized meanings composing them ( Venuleo et al., 2020b ). Whereas a high salience of the generalized meanings corresponds to a rigid, polarized, way of thinking, producing homogenizing affect-laden interpretations of the reality (typically organized by the bad/good, pleasure/displeasure opposition), a low salience corresponds to more flexible thinking, able to capture the distinct events of the experience and to produce differentiated meanings that favor the process of learning from experience. A similar concept was expressed by Barrett et al. (2001) when they suggest that people vary in their capacity of emotional differentiation and argue that individuals with highly differentiated emotional experience are better able to reflectively regulate emotional experience to inform adaptive responses. With reference to the current pandemic crisis, different scholars have observed how fear and, more broadly, a general state of anxiety (e.g., of getting infected and/or of infecting someone else, of losing friends or relatives, of being alone, of not “making it” economically—the fear that nothing will ever be like before) was the dominant emotional reaction of the society to the pandemic crisis ( Casale and Flett, 2020 ; Presti et al., 2020 ; Schimmenti et al., 2020 ). It is the common response to conditions and events that are a major violation of the expected state (e.g., Proulx and Inzlicht, 2012 ; for a review, see Townsend et al., 2013 ; for an analysis of the emotional response to a pandemic, see Kim and Niederdeppe, 2013 ) and can be interpreted as the marker of high affective activation: it produces global, homogenizing, and generalizing embodied affect-laden interpretations of reality, at the cost of more fine-grained and differentiated analytical thought ( Venuleo et al., 2020a ). Among other manifestations, these high affect-laden interpretations are expressed though the spreading of conspiracy theories (and the related devaluation of experts’ knowledge) and the initial blaming of specific outgroups (“the Chinese,” or the “immigrants,” in some populist propaganda), based on the friend–foe schema, which influenced alarmist comments and discourses on the social media ( Venuleo et al., 2020a ). Less polarized and more flexible interpretations may be indicated by discourses focused on the need to learn from the pandemic what can usefully be changed in past choices and habits to better manage personal and/or societal resources and construct a better future (for one’s own life and/or, more broadly, for the life of society), as well as in the initiatives activated to mobilize relational resources and create a dense solidarity network.

According to SCPT, the SUs through which people’s sense-making is expressed are not transcendental intrapsychic structures, but in their working depend on sociohistorical conditions and are placed within the sphere of social discourses, which suggest what a particular event consists of, why it became a disaster, who was responsible, what should be learned from it ( Fairclough, 1992 ; Ratner, 2008 ; Venuleo and Marinaci, 2017 ; see also Cannon and Müller-Mahn, 2010 ). Broader contextual dimensions (e.g., ideologies; shifting frameworks of knowledge; power structures; health and economic policies; the discourse of the media, scientists, and politicians) such as psychosocial conditions impose constraints on the multiple ways people could make sense of the events, problems, and circumstances of their life ( Salvatore and Zittoun, 2011 ; Venuleo and Marinaci, 2017 ; Marinaci et al., 2019 ).

Framing with SCPT, thus, the “pandemic” can be considered not only a sign referring to an actual event, but a hyperdense polysemic sign ( Venuleo et al., 2020a ). By hyperdense , we mean a sign that stands for the whole of social life, due to the first tenet deriving from SCPT cited above: each person interprets the actual event of the pandemic in terms of specific meanings that are consistent with the SU grounding his/her own self and his/her being-in-the-world. By polysemic, we mean a sign that can be interpreted in very different manners and used within a great many discourses and social practices, with different cultural and psychosocial contexts (cf. Venuleo et al., 2020a ): this aspect reflects the second tenet of SCPT: SUs depend on sociohistorical conditions. One therefore finds “pandemic” associated with signs such as war, enemy, and conspiracy, consistent with a paranoid affective interpretation of the social landscape, which characterizes a vast segment of the population in the contemporary scenario ( Salvatore et al., 2018 ), or also one finds “pandemic” associated with signs such as solidarity, hope, reborn, and consistent with an interpretation of the crisis as a chance to learn from the experience and to make new choices for a better future; and so forth.

Previous studies have shown the essential role of SUs in grounding, motivating, and channeling social and individual behavior ( Venuleo, 2013 ; Venuleo et al., 2015 , 2017 ; Marinaci et al., 2019 ; Salvatore et al., 2019d ; Venezia et al., 2019 ). Different interpretations are not merely abstract judgments—they are a way of being channeled to act and react in a certain way.

Accordingly, research into the interpretative categories that underpinned people’s responses during the pandemic is crucial for public health officials and policy makers in comprehending what favored or hindered an adaptive response to the crisis, in order to outline exit strategies and to design more effective future health emergency plan.

Aims of the Study and Hypotheses

On the basis of the theoretical premises discussed above, the study aims to explore the SUs through which people represented the pandemic crisis and its meaning in their life. The following hypotheses guided the study.

First, based on the theoretical frame of SCPT, stating the dependence of the SUs on the cultural and psychosocial contexts people belong to, we expect that a plurality of representations of the crisis scenario is active in the cultural milieu. Particularly, we expect that highly rigid/polarized and homogenizing affect-laden interpretations of the pandemic crisis framing it in terms of a battle against an uncertain and unknown enemy and the loss of a prior idealized state (e.g., loss of life, freedom, habits) emerge along with more flexible representations (e.g., pandemic as opportunity to change), reflecting people’s variability in the categorization of the experience ( Barrett et al., 2001 ; Salvatore et al., 2018 ) and the variability of the media and social media discourses characterizing the cultural milieu.

Second, we expect SUs to vary over social segments, because of the variability of psychosocial conditions, discourses, and social practices, which people are exposed to during the pandemic. Specifically, we explore the role of respondents’ sociodemographic characteristics—such as sex, age, and job status—which we expect to be related to specific life challenges and health, social, and economic concerns—and social characteristics related to the health emergency, such as work situation during the pandemic and place of living (having different characteristics regarding the spread of the virus and health and media alarm).

Materials and Methods

Narrative inquiry was chosen to gain access to the Italian people’s subjective experience of the health emergency. According to the definition of McAdams (2011) , the story is a selective reconstruction of the autobiographical past and a narrative anticipation of the imagined future that serves to explain, for the self and others, how the person came to be and where his/her life may be going. Social researchers argue that personal narratives can capture particular attitudes, beliefs, and values about themselves as individuals ( Baxen, 2008 ) and their ways of making sense of social experience and of their own role in it, as well as mirroring the changing social conditions ( Bertaux, 1981 ) and elucidating processes of social change and the place of individuals within them ( Andrews, 2007 ). In the terms of Gergen (1985) , narratives are important because they are the means by which people understand and live their lives and because they are ways to participate actively in the practice of a particular culture.

The narratives used in this article were collected as part of the first phase of a mixed-methods research project aimed to analyzing the impact of the COVID-19 health emergency on everyday life. In the first phase, the subjective experience of people living in the time of COVID-19 was investigated, along with their social conditions and sociodemographic characteristics. In the second phase of the research (currently in progress), people were asked to keep a diary periodically to talk about the meaning of the pandemic scenario in their life.

Instruments

An anonymous online survey was designed to assess feelings, emotions, and evaluation of the lockdown measures. The survey was available online from April 1 to May 19, 2020, coinciding with the government decree “Chiudi Italia” and disseminated through social networks.

People were asked to respond to the following question: Imagine telling someone in the future who has not lived through this period what it meant for you to live in the time of COVID-19. What would you tell them? They were encouraged to writing down everything that comes to mind with respect to the situation and responding in the manner that is deemed most appropriate, taking into account that the objective of the investigation was to collect people’s subjective experience.

Then, sociodemographic and social characteristics of respondents (i.e., sex, age, job status, job situation in the current pandemic scenario, and place of living) were collected.

All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. According to the ethical code of the Italian Psychology Association 1 and the Italian Code concerning the protection of personal data (legislative decree no. 101/2018), participants were informed about the general aim of research, the anonymity of responses, and the voluntary nature of participation and signed an informed consent. No incentive was given. The project was approved by the Ethics Commission for Research in Psychology of the Department of History, Society and Human Studies of the University of Salento (protocol no. 53162 of April 30, 2020).

Participants

A total number of 1,393 questionnaires and related texts (mean = 35.47, standard deviation = 14.92, women: 64.8%; North Italy: 33%, Central Italy: 27%, South Italy: 40%) were collected ( Table 1 ).

Table 1. Sociodemographic characteristics of the respondents.

Data Analysis

The analysis aimed to map the main dimensions of meanings underpinning the set of contents of the narratives collected and defining the SUs through which respondents make sense of their COVID-19 experiences. Each dimension of meaning can be conceived of as a generalized meaning component that was highlighted by the interviewees to talk about the time of COVID-19 and that provides space for a plurality of statements and positions. For instance, if the interviewees highlighted the challenges the pandemic brought to their life, then this dimension provides space to express different views/connotations on this aspect (e.g., some interviewees might talk about the change occurring in the relationship with their children; others might describe the changes occurring in their conjugal relationship). Thus, the meanings map goes beyond the descriptive level of content analysis and identifies the latent meanings generating the variability of the contents (for a similar approach, see Visetti and Cadiot, 2002 ; Venuleo et al., 2018a , b , 2019 ). To this end, an automatic procedure for content analysis [Automated Method for Content Analysis (ACASM); Salvatore et al., 2012 ; Salvatore et al., 2017 ], performed by T-LAB software (version T-Lab Plus 2020; Lancia, 2020 ), was applied to the whole corpus of texts obtained through the narratives. The method is grounded on the general assumption that the meanings are shaped in terms of lexical variability. Accordingly, a word such as “father” might, for instance, contribute to the construction of the symbolic meaning of “authority” if it is associated with other words such as “order,” “punishment,” “power.” Otherwise, the same word “father” might help to depict a different meaning, such as “protection” or “warmth,” if it is used together with other words such as “home” and “care.” A similar criterion of co-occurrence is entailed in the semantic differential technique ( Osgood et al., 1957 ) and can be also equated to the free-association principle ( Salvatore, 2014 ). Accordingly, the method of analysis applied to the textual corpus aims at detecting the ways the words combine with each other (that is, co-occur) within utterances, somewhat independently of the referentiality of the sentence ( Lebart et al., 1998 ). ACASM procedure followed three steps.

First, the textual corpus of narratives was split into units of analysis, called elementary context units (ECUs). Second, the lexical forms present in the ECUs were identified and categorized according to the “lemma” they belong to. A lemma is the citation form (namely, the headword) used in a language dictionary, e.g., word forms such as “child” and “children” have “child” as their lemma. A digital matrix of the corpus was defined, having as rows the ECU, as columns the lemmas and in the cell x ij the value “1” if the j th lemma was contained in the i th ECU; otherwise, the x ij cell received the value “0,” Table 2 describes the characteristics of the dataset.

Table 2. Dataset.

Second, a lexical correspondence analysis (LCA)—a factor analysis procedure for nominal data ( Benzécri, 1973 )—has been carried out on the obtained matrix, to retrieve the factors describing lemmas having higher degrees of association, that is, occurring together many times. Each factorial dimension describes the juxtaposition of two patterns of strongly associated (co-occurring) lemmas and, according to the model grounding the analysis ( Salvatore et al., 2017 ; Gennaro et al., 2019 , 2020 ), can be interpreted as a marker of a latent dimension of meanings underpinning dis(similarities) in the respondents’ discourses and defining their SUs. The interpretation of the factorial dimensions is carried out in terms of inferential reconstruction of the global meaning envisaged by the set of co-occurring lemmas associated with each polarity, based on the abductive logic of interpretation of the relationships among single contents/lemmas ( Salvatore, 2014 ). The first two factors extracted from LCA were selected, as the ones explaining the broader part of the data matrix’s inertia, and labeled by three experienced researchers, in double-blind procedure, on the basis of the specific vocabulary and sentences composing the factors. Disagreement among researchers was overcome using a consensus procedure ( Stiles, 1986 ).

The LCA provides a measure of the degree of association of any respondent with every factorial dimension, expressed in terms of respondent’s position (coordinate) on the factorial dimension. Accordingly, the SU the respondent belongs to is detected in terms of their factorial coordinates. In the final analysis, these coordinates reflect the respondent’s positioning with respect to the oppositional generalized meanings sustaining the SUs identified by the study. Once the coordinates of each subject were identified—as the third step—a set of χ 2 analysis allowed us to explore the association between SUs and the respondents’ characteristics. For a more accurate reading, adjusted standard residuals were considered a post hoc procedure for statistically significant omnibus χ 2 test ( Agresti, 2007 ). Residuals represent the difference between the observed and expected values for a cell. The larger the residual, the greater the contribution of the cell to the magnitude of the resulting χ 2 value obtained. Adjusted standard residuals are normally distributed; thus cells having absolute value greater than the critical value N (0,1), 1 - α/2 = 1.96 will have raw p -value less than 0.05 (for two-sided test). In so doing, post hoc hypotheses tests on standardized residuals were tested.

Dimensions of Meanings and Descriptions of SUs

In Tables 3 , 4 , the two factorial dimensions obtained from the ACASM procedure, and for each of their polarities, the lemmas with the highest level of association ( V test), are reported, as well as their interpretation in terms of dimensions of meaning. Henceforth, we adopt capitals letters for labeling the dimensions of meaning and italics for the interpretation of polarities.

Table 3. LCA output.

Table 4. LCA output.

FIRST DIMENSION. REPRESENTATION OF THE PANDEMIC CRISIS : Health emergency versus turning point. This dimension opposes two patterns of words that we interpret as the markers of two ways of representing the COVID-19 crisis ( Table 3 ).

(−) Health emergency . On this polarity, lemmas focusing on a contagiousness ( virus ) that cross the nations ( China , Italy , to arrive ) and having a dramatic impact on health ( to die , death , dead ) co-occur with lemmas related to the changes imposed to contain the health emergency: changes in daily habits ( to wear , mask , glove , supermarket , queues ) and throughout contexts and domains of life ( to close , closed , home , school , shopping , shop , subway ).

(+) Turning point . On this polarity, the reference to uncertainty—which suggests a crisis of meaning, the feeling of not having categories to interpret what happens or what to do to cope with the moment —co-occurs with lemmas that suggest the idea of a process of discovering new meanings to life ( to live , meaning , to mean , to discover , to rediscover , discovery , to appreciate , to reflect ), which invest the individual domain ( lived , for me ) and social life ( social ), and allows one to review one’s priorities and values ( importance , important , time , life , future , freedom , values ).

SECOND DIMENSION. PANDEMIC IMPACT : Daily life versus world scenario. The second factor extracted opposes two patterns of lemma that we interpret as the marker of two different interpretative “lens” to evaluate the impact of the pandemic crisis ( Table 4 ).

(−) Daily life . In this polarity, the lemmas seem to refer to the change occurring in daily life habits (e.g., the adoption of protection: mask , glove ) and domains of experience such as education, working, and interpersonal relationships ( school , university , lesson , exam , to study , to work , friend , shop , online , video call ) due the lockdown measures ( to close , closed ). Temporal trackers ( morning , day , week , time ) evoke the idea of a change unfolding in a limited temporal horizon.

(+) World scenario . In this polarity, a world war scenario is evoked ( enemy , front , war , to fight , to hit , to die , death , dead , victim ), without spatial and temporal borders ( virus , pandemic , worldwide , future ), disrupting social life at different levels ( crisis , policy , healthcare , economy ). A feeling of fear and a sense of helplessness ( impotence ) is associated with this scenario which appears to escape from the very possibility of being represented ( unknown ).

Symbolic Area

The intersection between the two factorial dimensions identifies four quadrants, which we interpret in terms of SUs (henceforth SUs) (cf. Figure 1 ) and that were labeled: Reconsider social priorities , Reconsider personal priorities, Living with emergency , and Surviving a war . A description of each SU is reported below.

Figure 1. The symbolic space defined by the factorial dimensions.

SU 1: Reconsider social priorities . This symbolic area is organized by a symbolization of the pandemic crisis as a “turning point” (right polarity of the first dimension) having an impact on the world scenario (upper polarity of the second factorial dimension). The pandemic here is recounted as something that transcends the health emergency and stands for something else—the by-product of a predatory and short-sighted way of conceiving human and social development, soliciting a reorganization of social values and priorities to build a better tomorrow. As such, the pandemic is shaped as a potential generative social turning point that can undermine the idea of invincibility of human beings, cast shadows on an idea of growth and progress measured in terms of technological and economic development, show the short-sightedness of our own policies, bring to light the connectivity among individuals and the being part of a collective, and help rediscover the importance of cooperation and solidarity. Examples of discourses are as follows:

Just a couple of months ago, we lived in an era where, as privileged spectators, we believed we were strong and invincible. Sitting in comfortable armchairs; many looked at the continuous natural disasters that occurred on the planet, with the strong and solid conviction that they would never touch our lives (…). One cold winter day, we woke up and without proper preparation, they told us that a virus was going to erase our hopes for tomorrow. Scientists, experts told us that we were wrong, that we were no longer the strongest (…). The virus had isolated us from the world, from our loved ones, had pushed us all together on a dangerous barge in a stormy sea, the same that for years had carried many migrants, alone, desperate, helpless, and needy (…). Everything has become fragile, in a few hours, the priorities have changed (…). If our boat is spared this stormy sea and we can survive this difficult test, we hope never to forget all this.

It led us to understand and reflect on the fact that we are not masters of the world! We always thought we were invincible, with our world made mostly of money, cutting-edge technology and comfort. But it is not true. Have we always had everything under control? No, never! When COVID-19 appeared, we may have begun to understand some of the non-material values that are the most important in addressing a pandemic of this kind properly and especially to consider our race, worthy of being called human! (…). In my opinion, the watchwords are solidarity, respect, understanding, listening, altruism, knowledge, and above all love.

I would talk about how the planet slowly began to breathe again (thanks to the closure of a lot of factories or various companies, or with the decrease in traffic). I would like to talk about how many people have rediscovered the Earth, the sacrifices, the fatigue, the fruits, and the satisfactions linked to it, thanks to working in the fields.

SU 2: Reconsider personal priorities . This symbolic area shares with the previous area a symbolization of the pandemic crisis as “turning point” (right polarity of the first dimension) but differs in the focus on the “daily life” impact (bottom polarity of the second factorial dimension). The pandemic is here recounted as sudden interruption of the ordinary, which leads to not taking for granted different aspects of life and being able to change significantly one’s perspective toward oneself and others, one’s way of being-in-the-world. The lockdown measures are experienced here and represented in their aspect of being a space–time suspension of routine, able to generate new meaning for experience and to reconsider values and priorities in life. Examples of discourses are as follows:

The being able to reclaim your time and your spaces.

Everything that used to be part of the normal routine becomes something out of the ordinary and no longer possible, and you are confronted, in an extremely profound way, with yourself.

My life was almost a boring routine, almost following a written script. COVID-19 forced me to reorganize my mental and physical spaces.

I would tell you about an experience of elasticity and resilience where the difference emerged starkly between those who had begun to work on themselves and those who, panicked, railed against the restrictions shifting the focus of their own problems (…). I would recount the rediscovery of some family tensions and wounds and the strengthening of the bond and love with my husband. (…) I would tell him that life always (sooner or later) presents us with challenges and that we must learn from them in order to grow and be better.

SU 3: Live with emergency . It is a symbolic area organized by a symbolization of the pandemic crisis as “health emergency” (left polarity of the first dimension) having an impact on “daily life” (bottom polarity of the second factorial dimension). Here the pandemic crisis, identified with a health emergency, is narrated by referring to the impact of the lockdown measures on personal everyday life, at different levels: change in daily habits to contain the risk of infection (e.g., wearing mask and gloves), management of overlapping roles at home due to the reorganization of school and work from home restriction on freedom of movement, and related feeling of fear and anxiety. The narration of what the pandemic has interrupted or has no longer made possible (e.g., “you can’t see”; “you can’t do”) is in the foreground. The pandemic is mainly seen in terms of loss of the previous condition/sphere of experience, which means that the interpretation of the new reality emerging from the pandemic rupture tends to be made within the affective grounds provided by the prerupture semiotic scenario. Examples of discourses are as follows:

A time where our certainty and habits changed, and the freedom of moving, traveling, and interacting with other persons was greatly limited. A time where the fear of getting sick made you suspect your neighbor and this inevitably changed everyday life, isolating and separating families and friends.

A bad time when you never feel safe when you leave the house and you always need to wear a mask and gloves: You can’t see your friends, you can’t do those normal things like having coffee in a bar, having dinner in a restaurant or having an aperitif. It’s spring, but we’re not enjoying it; we wanted to travel, see new cities or just be around the streets of our town, but you can’t do any of this.

At the beginning, the quarantine has me a bit destabilized; it meant giving up my everyday habits and my freedom of movement, but then I got strong, knowing that it was the only way to stop infection.

Period of anxiety, fear, and confinement. Privation of our freedom to safeguard people.

I have had to be the teacher and mother for my children aged 4 and 6 who have continued to follow the activities with online teaching (…) I don’t understand when I’m a mother or a teacher. My children have suffered so much being away from school and also the motivation to complete a task has fallen day after day. The work of encouragement and support was hard.

SU 4: Survive a war . It is a symbolic area organized by a symbolization of the pandemic crisis as “health emergency” (left polarity of the first dimension) having an impact on the world scenario (upper polarity of the second factorial dimension): a militaristic language is used to talk about COVID-19 and its impact on individual feeling and responses. Tragic , terrifying , and frightening are among the most connotations associated with a pandemic, lived as if it were an unexpected and unannounced war. The unpredictable character attributed to the crisis and its identification with an invisible virus whose space–time location, as well as physical drivers, is very hard to identify are associated with the feeling of being unprepared and helpless. Not being infected and surviving appear to be the only possible goals. Examples of discourses are as follows:

COVID-19 was a terrifying and unimaginable experience, maybe worse than a war because we fought with an invisible enemy, a virus, which has separated us from our loved ones for so long (…) a tragic and traumatic event for every country in the world, with many victims and as many healed.

Living in a pandemic is like living in a war, always with the uncertainty of being able to be saved, always with the fear for oneself and for others.

This is a tragic time that I had not budgeted for other than as one of the worst nightmares. The danger has come from far away, from China, in a subtle way, on the sly, and found us unprepared. First problem: how not to be infected? But many did not have time to ask themselves. I still have in my eyes the images of those in the ICU who died in complete solitude, the columns of army vehicles carrying the coffins, the churches full of coffins.

A nightmare.

Relationships Between SUs and Respondents’ Characteristics

Table 5 reports the results of the χ 2 tests applied to investigate the associations between SUs and respondents’ characteristics. Significant differences were found in all the characteristics.

Table 5. Association between symbolic universes and respondents’ characteristics.

Concerning gender (χ 2 = 12.168, df = 2, p < 0.05), the adjusted standardized residuals show that men were more associated with “Reconsider social priorities” SUs, whereas women were more represented in “Surviving a war.” Concerning age (χ 2 = 41.466, df = 15, p < 0.000), respondents aged 18–25 years mostly represented the COVID-19 experience as surviving a war, respondents aged 26–35 years experienced COVID-19 as an opportunity to reconsider social priorities, and respondents 46–55 and 56–65 years assumed the lockdown in terms of reconsidering personal priorities.

With respect to job status (χ 2 = 28.628, df = 15, p < 0.05), retired persons tend to represent the crisis scenario as a turning point, leading to reconsider personal priorities, employees in terms of living with the emergency, and students in terms of surviving a war. With respect to working during the health emergency (χ 2 = 27.928, df = 15, p < 0.05), individuals maintaining their ordinary work situation during the pandemic tend to experience the crisis scenario as an opportunity to reconsider personal priorities.

The three macro areas of Italy in which respondents live—northern Italy, central Italy, and southern Italy—showed significant difference (χ 2 = 19.104, df = 6, p < 0.05) in the opposition among northern part versus southern part: the former is more associated with surviving a war experience and the latter to reconsidering personal priorities.

In short, the highlighted differences allow us to obtain a clear picture of the respondents belonging to the different SUs retrieved: the representation of the COVID-19 crisis in terms of reconsideration of social priorities (SU 1) is represented by male respondents, aged 26–35 years, and the retired; “Reconsider personal priorities” (SU 2) characterizes people aged 46–55 and 56–65 years, retired, and maintaining ordinary work conditions and people of Southern Italy. The representation of the COVID-19 crisis in terms of Living with emergency (SU 3) characterizes employees, whereas Surviving a war (SU 4) characterizes women, people aged 18–25 years, students, and people living in the north of Italy.

The first goal of the study was to explore the SUs through which Italian people represented the pandemic crisis and its meaning in their life. The analysis of the narratives based on the ACASM procedure led to the identification of four distinct SUs organized by two main dimensions of meaning, which foreground two very basic issues: what the pandemic crisis consists of (health emergency vs. turning point) and its extent and impact (daily life vs. world scenario).

Consistently with the hypothesis, more rigid/polarized and highly homogenizing affect-laden interpretations, triggering feelings of fear and anxiety and framing the pandemic crisis as a battle against an uncertain and unknown enemy and/or the loss of a prior idealized scenario (SUs labeled “Surviving a war” and “Living with an emergency”), emerged along more flexible representations (SUs labeled “Reconsider social priorities” and “Reconsider personal priorities”), reflecting the variability of the media and social media discourses, which seem to characterize the cultural milieu.

Specifically, the SUs labeled “Surviving a war” and “Living with an emergency” differ with regard to the identification of the pandemic crisis as a social or individual rupture but share a short-term representation of the changes imposed by the pandemic related to a focus on the health emergency (more than a crisis encompassing health, economic, political, and social levels of analysis), which brings to the foreground the dichotomy between life and death and between the “normal things” that the pandemic emergency has interrupted to safeguard people (“You can’t see your friends, you can’t have coffee in a bar, you cannot travel …”) and the extraordinary habits imposed by the crisis. The pandemic is thus identified as a sectorial and confined event, although frightening, which can almost trigger at the individual level a reorganization of one’s habits and routines to defend oneself and one’s loved ones, and at the societal level strong measures of restriction of people’s freedom to move to avoid overloading the health system. However, the pandemic does not seem to work as something new that calls for an accommodation of one’s way of interpreting one’s own life and the world scenario; rather, it is approached through categories that foreground the loss or the lack of what existed before the rupture. This kind of position lends itself to be interpreted as the marker of an intense affective activation that triggers a homogenizing form of thinking which represents the new according to the past ( Bria, 1999 ; Salvatore and Freda, 2011 ; Salvatore and Venuleo, 2017 ). Indeed, to express concerns about what was missed or interrupted by the pandemic entails the instantiation/reiteration of the presence of what was before (the past scenario) as the canonical order according to which the present is interpreted. In the final analysis, the concern is an (unintentional) way of keeping a certain version of the self/world psychologically alive regardless of the changes occurring in the real world.

On the other hand, the view of the pandemic as a turning point—which characterizes the SUs labeled “Reconsider social priorities” and “Reconsider personal priorities”—identifies a different area of meaning, where the rupture opens to a new way of being-in-the-world, and is felt as an opportunity to reflect on previous choices and their critical impact and to make the future better. To use an image, people’s meaning-making seems to move from the focus on loss (e.g., the dead people that will never come back, or the daily habits interrupted)—which characterizes the previously discussed SUs—toward a gaze to the future, the new adjustment challenge that one has to address. What one can learn from the crisis and what has to be changed are represented differently. Whereas the turning point concerns the individual life (“Reconsidering personal priorities”), the pandemic as a rupture highlighted the fragility of life and led to the search for a new way of managing one’s time and a clearer consideration of what matters. Whereas the turning point concerns the social and public sphere (“Reconsidering social priorities”), the pandemic rupture highlighted the critical impact of short-term and local politics and the need for more awareness of the interdependence among people and countries, which could facilitate reorganization of previously considered out-groups and in-groups into a single community with a common destiny.

As to Hypothesis 2—the interpretation of the crisis varies over societal segments with different psychosocial characteristics—the findings showed that significant associations exist between SUs and all the respondents’ characteristics considered (sex, age range, job status, job situation during lockdown, and place of living).

It is worth noticing the differentiated position of women, young adults (aged 18–25 years) and students compared respectively to men, adults aged 26–35 and 46–55 years, people maintaining their ordinary work situation during lockdown, or to the retired. The former tend to interpret the pandemic crisis as a health emergency, confronting people with the shared goal to survive, whereas the latter in terms of a personal or social turning point. Findings suggest that having a more stable life situation and less economic and job concerns could favor a more reflexive stance on the pandemic crisis. By contrast, unique challenges imposed by the lockdown measures, such as those related to the disrupted social roles and returning to living with parents, which may impact mainly students and emerging adults ( Gruber et al., 2020 ), could have favored a interpretation of the crisis in terms of loss and urgency to return to the prerupture scenario.

As concerns the association between the SUs “Live with the emergency,” focusing on employees and the disruptive changes occurring in their personal daily life due to the lockdown measures, it can be interpreted considering how they were asked to close their offices and work from home (about 81% of the worldwide workforce has been affected by full or partial workplace closures, see Saviæ, 2020 ). Findings from recent studies show that working from home relates to the feeling of work intruding into personal life and work-life conflict ( Molino et al., 2020 ), which could have triggered the daily stress and the feeling of living with and within an emergency.

The contrasting position of women and men deserves a comment, too. The negative impact of the coronavirus pandemic outbreak on equality ( Bernardi, 2020 ), and particularly on gender equality, is recognized, although few detailed data are currently available ( Kristal and Yaish, 2020 ). Data from the World Economic Forum ( Hutt, 2020 ) show that women are responsible for the so-called unpaid care work three times more than men; it is likely that the care of children, the elderly, and other vulnerable groups was mostly provided by women also during the lockdown. With respect to Italy, the context of the current study, women tend to be the ones mainly responsible for the care of children in the family context. During the lockdown and the related closure of schools, and given also the insufficiency of the resources allocated to family support for children’s care, they have had to do a lot of multitasking and—often in the same space (the home)—to perform work assignments and activities related to the family management and teach their children ( Rinaldi, 2020 ). This complex of circumstances may have triggered greater stress and more in general an affective activation of anxiety, foregrounding the risk of “losing the battle” (health, economics, social resources) more than the hope for a different future. Different exposure to health and media alarms may explain the differences related to the area of residence: people from North Italy tend to interpret the COVID-19 crisis as a war to which one has to survive, whereas people from South Italy as a personal turning point. It is not surprising. The expansion of the COVID-19 outbreak began in northern Italy, where the higher incidence of the coronavirus contagion is currently active and where the percentage of people infected and dead was far higher than in the rest of Italy ( Santacroce et al., 2020 ). The daily bulletin of the data provided by the civil protection about the infected people and deaths and the media discourses depicting the overload of hospitals and of frontline health workers have contributed to depict a war scenario and to fuel feelings of fear and impotence. Fresh in everyone’s minds are the dreadful images—shown worldwide by the media—of the long rows of military trucks transporting the dead from the hospital outside the Lombard city of Bergamo (North Italy), because of lack of space to bury them in the town cemeteries.

Beyond the specificities of the associations detected between respondents’ characteristics and SUs, this kind of results shows how the meaning of the pandemic, the possibility that the crisis seems to be the loss of a previous desirable state of “normality” or a chance to rethink what went before and to generate new opportunities, is not ubiquitous and invariant but mediated by people’s sense-making.

On the other hand, as previously observed, according to SCPT, people’s affective interpretation of the pandemic scenario is not formed in a social vacuum. With regard to the interpretation of the pandemic scenario in terms of a mere health emergency and war against an unknown enemy, which forces government and individuals to fight for people’s survival (see SUs labeled “Surviving a war” and “Living with an emergency”), one can see its full continuity with the media and institutional discourses. Here the pandemic crisis was identified substantially with a health emergency and framed by affect-laden metaphors, with a clear prevalence of militaristic language: COVID-19 was widely depicted as an “enemy to defeat,” hospitals as “the trenches,” doctors and nurses as “heroes on the frontline,” and the counter-action against the virus as a “war” ( Cassandro, 2020 ), as often found in the political and media discourses about previous epidemics (e.g., AIDS: Connelly and Macleod, 2003 ; SARS: Meng and Berger, 2008 ; Ebola: Trèková, 2015 ). Seminal studies argued that the use of militaristic language and metaphors makes it easier to sacrifice people and their rights ( Fornari, 1970 ; Ross, 1986 ) and exculpate governments from responsibility ( Larson et al., 2005 ), such as the kind of economic investment made in the health system and research. The Semiotic Cultural Psychology Theory suggests that affect−laden, simplified interpretations of the reality—such as those that underlie processes of enemization—restore the capacity of making sense of an uncertain social landscape ( Venuleo et al., 2020a ). From this standpoint, the fact that a high affect-laden interpretation of the pandemic scenario emerges in our analysis of how people make sense of this time of crisis is not surprising. The more the uncertainty of the scenario, the more sense-makers are likely to restore the stability of their sense-making through their adherence to generalized worldviews ( Russo et al., 2020 ). Findings of studies based on the Terror Management Theory ( Greenberg et al., 1997 ; Greenberg and Arndt, 2012 ) provide empirical support to this thesis. Recent studies among European societies reveal that about 40% of the respondents view the external world as if it were full of threats that may disrupt their living space ( Salvatore et al., 2018 ). From this standpoint, the identification of the pandemic crisis as war appears to be only a further form reflecting the semiotic mechanism through which a lot of problems, critical changes, and ruptures (e.g., unemployment, worsening of living conditions, …) are currently mentalized by a large segment of the population in the current cultural milieu.

Unfortunately, we have not collected measures (e.g., people’s attitudes and compliance with the health measures) that allow us to empirically evaluate the impact of the different symbolic positions detected on the pandemic crisis; however, few speculative hypotheses can be made on the bases of previous studies. Scholars have suggested that when people are gripped by strong fear and feel that their survival is at stake, they are more likely to break their entrenched habits ( Barrett et al., 2001 ; Coombs et al., 2007 ), a vital factor in coping with the emergency, as already found among other populations during previous pandemic such as the SARS ( Hsu et al., 2006 ) and H1N1 pandemics ( McVernon et al., 2011 ). With respect to the COVID-19 emergency, it is reasonable to think that the widespread fear of being “hit” (getting infected and/or of infecting someone else), of losing friends or relatives in the battle, favors higher levels of compliance among the Italian population than one might have expected if one considers the quite low level of trust in the institutions and commitment to the common good characterizing Italian communities (e.g., Salvatore et al., 2019a ; Venuleo et al., 2020a ). However, in the medium and long term, the fear response could increasingly prove to be inadequate in managing the pandemic: this is because the fear response persists insofar as the alarm trigger is active while prone to fade away as a result of desensitization. Thus, a global reduction of compliance with measures to contain infection can be expected to be associated with the flattening of the infection curve and of the decrease in the alarms launched by TV, newspapers, social media, and political speeches. Further studies are needed to examine this hypothesis in greater depth.

A further critical aspect of a symbolization of pandemic as a war against a virus is that it looks at the pandemic crisis as a sectorial and confined event, which can trigger short-term changes at the individual level (e.g., avoidance of social aggregations) and societal level (e.g., a greater investment in the health field), but not favor the holistic view required to empower individuals and institutional effort to learn from the crisis how to build a better tomorrow.

On the other hand, the view of the pandemic as a turning point—which characterizes the SUs labeled “Reconsider social priorities” and “Reconsider personal priorities”—identifies a different area of meaning, turning crisis into opportunity, involving a promise of some kind of progress toward better living conditions, opening one’s gaze to the future and leading people to search for a new way of managing their personal and societal resources. Specifically, conceived as a social turning point, the pandemic reveals the presence in the cultural milieu of a set of symbolic resources (e.g., meanings, cognitive schemas, values, social representations, attitudes, behavioral scripts, etc.) that foster the individual’s capacity to interiorize the collective dimension of life, what has been called semiotic capital ( Salvatore et al., 2018 ; Venuleo et al., 2020a ). Recent studies on the SUs active among European societies ( Salvatore et al., 2018 , 2019b ) reveal that, along with a view of the external world as full of threats that can disrupt their living space, there are also SUs, although a minority in the cultural milieus, which recognize the systemic level of social life and the collective interest as something that matters, therefore the common good as a super-ordered framework of sense orienting individual decisions and actions. It is argued that semiotic capital is particularly important in the management of the pandemic scenario, because people will not only have to accomplish the task of complying with negative regulations (e.g., avoid social gatherings, keep a distance from other people), but—more profoundly, to integrate a reference to an abstract common good —the management of the risk of resurgence of the pandemic—in their mindsets, as a salient regulator of their way of feeling, thinking, and acting ( Venuleo et al., 2020a ). And this task requires people to be enabled to recognize and give relevance to the relation between the individual sphere of experience and the sphere of collective life and, as such, to go beyond the mere focus on the individual experience and interest (see also: Schimmenti et al., 2020 ).

Implications for Policy

Typically, the focus on the psychological impact of the pandemic and related lockdown measures was accompanied by the emphasis on individuals’ need for psychologist and psychological support; suggested actions include support lines for anxious people, telecounseling, virtual connecting, and help groups ( Sood, 2020 ). However, this approach, although crucial, does not appear to be enough to sustain the development within the population of the symbolic resources underpinning people’s capability to address the crisis. The pandemic demands that both the individual and society as a whole consider the consequences of particular choices and actions, a strategic issue that has implications far beyond the sphere of individual well-being and beyond the challenge of surviving the health emergency (which is in the foreground in SUs1).

We have above suggested that the impact of the pandemic crisis on individuals and their ability to respond adaptively to it are shaped by the social and cultural resources that they have to hand. This also means recognizing that disruptive events, like a pandemic, constitute not only natural hazards, but also socially constructed events: the product of the impact of a disruptive event on people whose vulnerability is also constructed by social, economic, and political conditions (see Cannon and Müller-Mahn, 2010 ). Counterfactual thinking in support to this thesis is that problems exponentially more disruptive than SARS-CoV-2, such as climate change at the societal level, or smoking at the individual level, have been unable to produce a reaction of fear even remotely like that of the pandemic. By extension, this means that the feeling of fear and impotence that have characterized a large part of the population are not a direct reaction to the pandemic as such, but to the way the crisis scenario has been perceived, discussed, and negotiated in the society. Obviously, this does not mean to question the seriousness of the pandemic emergency; rather, this perspective emphasizes how political decision making and discourses in the public sphere affect the way people make sense of what is happening and their feeling of being passive spectators or victims of an event beyond their control or also active agents and drivers of change.

Cultural manifestations can be addressed and, eventually, counteracted only if the cultural dynamics underpinning them are explained in their specific and contingent way of functioning ( Russo et al., 2020 ). The characteristics of sense-making outlined by SCPT offer a contribution in that direction. More specifically, the fact that sense-making is embedded in affect−laden, generalized, holistic meanings (SUs) and in the cultural milieu and the performative quality of the processes can be translated into methodological criteria for designing strategies to support the cultural possibility of turning the pandemic crisis into a cultural opportunity. Although a deeper, systematic discussion of the methodological criteria that can be drawn from the theoretical framework is beyond the scope of this work, three speculative hypotheses can be considered, showing the heuristic and pragmatic potentiality of SCPT.

First, the acknowledgment of the holistic nature of the generalized meaning underpinning SUs implies that any intervention that restricts its action to the specific domain of health (in terms of fighting the virus) is likely to have limited efficacy, given that people shape their way of addressing the pandemic crisis and relate to sanitary measures not only according to health domain−specific beliefs, but also according to their global worldview that concerns the world of experience as a whole ( Salvatore et al., 2019d ).

Second, if the SUs develop within specific sociohistorical conditions and come alive in the context of discourse and interaction ( Linell, 2009 ), we must also recognize the role of the way the crisis is managed at an institutional level and signified by communicative practices and discourses, which therefore have to be critically examined.

Third, the acknowledgment of the performative nature of sense-making leads us to recognize that SUs are not produced by statements but enacted by social practices and rooted in the social group’s mindscape. This entails that, to act on the cultural dynamics, policy does not have to espouse contents (beliefs, values, principles), but to design social practices that encapsulate those contents ( Venuleo et al., 2020a ). For instance, to promote the value of cooperation and solidarity, rather than advocating it, social practices grounded on the representation of otherness as a resource have to be implemented within the social group. First comes action; then meaning follows. More specifically, the promotion of semiotic capital is carried out through the design and activation of settings of social practices that encapsulate the worldviews, the beliefs, and the views of otherness making up the semiotic capital.

Limitations and Future Direction of Research

The results of the present study should be considered in light of several methodological limitations. First, our case study is based on an Italian convenience sample; thus, the results cannot be generalized and have to be related to the specific cultural context under analysis. Because SUs depend on their working on sociohistorical conditions and are placed within the sphere of social discourses, we might suppose that, in other countries, other SUs emerge to represent the pandemic crisis and its impact.

Second, the analysis of how SUs vary over social segments due to the variability of psychosocial conditions could be improved by considering other potential variables than sociodemographic characteristics, work situation during the pandemic, and place of living. Although these characteristics are supposed to reflect specific life challenges and health, social, and economic concerns, other factors should be considered such as psychological well-being, longer or shorter life expectancy, perceived social support, trust in institutions, sense of belonging to the community, current intergenerational differences with respect to the sensitivity and interests expressed toward other social problems causing a catastrophic impact for the whole of humanity (e.g., climate change), and different exposure to social network communication to better understand how micro and macro social spheres influence the ways of interpreting the pandemic crisis.

Third, on the basis of SCPT and previous studies that have shown the essential role of SUs in grounding, motivating, and channeling social and individual behavior, we have suggested that SUs might favor or hinder an adaptive response to the crisis. However, the current study does not allow this relationship to be examined further. Further studies should longitudinally examine the variability of the SUs over time and their impact on psychological well-being and people responses to the crisis in the medium and long term (e.g., degree of compliance toward the health emergency measures established by the government and levels of engagement in solidarity actions).

This article has explored the meaning of living in the time of COVID-19 through the collection of narratives from Italian adults and within the frame of the semiotic psychological theory of culture to enrich our understanding of the SUs active in the cultural milieu to interpret the current crisis.

The core of our proposal lies in the call to move beyond the idea that the pandemic can be taken for granted as being disruptive with a negative psychological impact on individuals and assume that those are the meanings through which people interpret their being-in-the-world to explain their reaction to the crisis, and that this reaction has to be understood in the light of their social–cultural milieu. What we need to do is to look more closely at the way individuals, their system of activity, and the sociocultural and political scenario interact with each other in constructing the impact of the pandemic on individuals and social life.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

The studies involving human participants were reviewed and approved by the project was approved by the Ethics Commission for Research in Psychology of the Department of History, Society and Human Studies of the University of Salento (protocol n. 53162 of 30 April 2020). The patients/participants provided their written informed consent to participate in this study.

Author Contributions

CV and TM conceived the study and overall edited the manuscript. All the authors collected the data, organized the relevant literature, and interpreted the results. CV wrote the manuscript, with the contribution of TM. TM and AG conducted the data analysis. TM, AG, and AP reviewed the manuscript sections.

Conflict of Interest

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

Acknowledgments

We would like to thank the doctors: Maria Luisa Lezzi, Ludovica Latini, Roberta Licci, Valentina Purini, and Francesca Romagnano for their precious collaboration on data dissemination.

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Keywords : COVID-19 pandemic, Semiotic Cultural Psychosocial Theory (SCPT), sense-making, narratives, symbolic universes, cultural milieu, Italy

Citation: Venuleo C, Marinaci T, Gennaro A and Palmieri A (2020) The Meaning of Living in the Time of COVID-19. A Large Sample Narrative Inquiry. Front. Psychol. 11:577077. doi: 10.3389/fpsyg.2020.577077

Received: 28 June 2020; Accepted: 13 August 2020; Published: 17 September 2020.

Reviewed by:

Copyright © 2020 Venuleo, Marinaci, Gennaro and Palmieri. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Claudia Venuleo, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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• How covid-19 spreads:...

How covid-19 spreads: narratives, counter narratives, and social dramas

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• How covid-19 spreads: narratives, counter narratives, and social dramas - September 06, 2022
• Trisha Greenhalgh , professor of primary care health sciences 1 ,
• Mustafa Ozbilgin , professor of organisational behaviour 2 ,
• David Tomlinson , consultant cardiologist and electrophysiologist 3
• 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
• 2 Brunel University London, Uxbridge, UK
• 3 University Hospitals Plymouth NHS Trust, Plymouth, UK
• Correspondence to: T Greenhalgh trish.greenhalgh{at}phc.ox.ac.uk

Trisha Greenhalgh and colleagues explore why inaccurate narratives about the mode of transmission of SARS-CoV-2 emerged early in the pandemic and shaped a flawed policy response, with tragic consequences

Key messages

A flawed narrative that SARS-CoV-2 was transmitted by droplets rather than being airborne became entrenched early in the pandemic

Measures aimed at an assumed droplet pathogen (handwashing, surface cleansing, physical distancing) were over-emphasised

Measures to reduce airborne transmission (improving indoor air quality, reducing indoor crowding and time spent indoors, and high-grade respiratory protection) were under-emphasised

UK policy makers seemed to favour narratives from a narrow group of scientific advisers

Consequences included care home deaths, mission critical delays in public masking, and avoidable infections of healthcare workers

The draft terms of reference for the UK covid-19 inquiry encompass not just what decisions were made but also how and why. 1 As Dyani Lewis has argued in Nature , the World Health Organization overlooked—and at times explicitly denied—airborne transmission of SARS-CoV-2 for over two years, despite early evidence indicating that this was an important, and perhaps the dominant, route of transmission. 2 UK policy makers likewise adhered to an assumed droplet mode of transmission and prioritised interventions accordingly, neglecting the key topic of indoor air quality. 3

We consider how flawed narratives about SARS-CoV-2 transmission arose and became entrenched, leading to misplaced policies and avoidable deaths, focusing mainly on the UK. We invite the inquiry to consider not just those specific flawed decisions but also the culture of premature scientific conclusions and reluctance to engage with uncertainty.

Policy making as a struggle between narratives

Policy making involves competing narratives (about problems, how they arose, and how they will be resolved), institutions (especially government and its bureaucratic machinery), and interests (financial, political, ideological). 4 Policy might ideally “follow science,” but whose science and why? Science shapes policy narratives through an “inside track” (such as official advisory committees) and, to a lesser extent, through an “outside track” (such as less mainstream scientists and citizen movements). 4 Pandemic policy making has been characterised not by clearly identified knowledge gaps that science obligingly fills but by toxic clashes between competing scientific and moral narratives.

Getting the mode of SARS-CoV-2 transmission right matters, because preventive strategies follow ( box 1 ). 5 6 Being honest about scientific uncertainty also matters, because—among other reasons—it is hard to backtrack after declaring a policy to be “evidence based.” 7

Droplet versus airborne transmission: implications for public health and healthcare worker protection

Droplet transmission.

If an infectious pathogen spreads predominantly through large respiratory droplets that fall quickly, the most important public health measures are:

respiratory hygiene (eg, sneezing into tissues)

disinfecting surfaces and objects (fomites) onto which droplets might have fallen

reducing direct contact (eg, do not shake hands with others or touch one’s own face)

staying physically apart from others at a distance that reflects the effect of gravity on droplets (1-2 m)

wearing face masks within that droplet distance

physical barriers (such as visors or plastic screens)

providing respirator grade facial protection to healthcare staff who undertake “aerosol generating” procedures

These contact, droplet, and fomite precautions do not distinguish between indoor and outdoor settings, because a gravity driven mechanism for transmission would operate similarly in both.

Airborne transmission

If an infectious pathogen is mainly airborne, a person could be infected by inhaling aerosols emitted in the breath of an infected person. These aerosols might remain suspended in the air for many hours. Reducing airborne transmission requires measures to avoid inhalation of infectious aerosols, including:

engineering controls in indoor spaces (ventilation, air filtration)

reducing crowding (eg, by encouraging people to work from home if possible)

reducing time spent indoors (eg, frequent breaks for school classes)

maximising physical distance between people indoors (even beyond 2 m)

wearing masks whenever indoors

careful attention to mask quality (to maximise filtration) and fit (to avoid air getting in through gaps)

taking particular care during indoor activities that generate aerosols (eg, speaking, singing, exercising)

providing respirator grade facial protection to healthcare staff and others that work directly with patients

Competing narratives around transmission

“covid is droplet, not airborne, spread”.

At a press conference on 11 February 2020, WHO’s director general announced that covid-19 was airborne. 8 After a prompt, he corrected himself and declared that the virus was transmitted by droplets (coughs, sneezes, and contaminated objects). The reasons for this hasty correction are not fully known but might have included a desire to prevent public panic and to avoid exacerbating a major supply chain issue with personal protective equipment 9 in the face of known international shortages. 10

WHO’s early public information campaign promoted droplet measures—handwashing, respiratory hygiene, and disinfection of surfaces and objects ( box 1 )—and firmly reassured the public that the virus was not airborne ( fig 1 ). This stance reflected the dominance of infection prevention and control clinicians—whose day jobs included enforcing controls against droplet-borne infections in hospitals—on key committees. 11 Airborne precautions for airborne diseases are, of course, a legitimate component of infection prevention and control science, but in practice this professional group has focused historically on droplet precautions. 12

Tweet from WHO on 28 March 2020 denying airborne transmission of SARS-CoV-2

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The UK government’s narrative ( box 2 ) was similar to WHO’s. It did not reflect nuanced discussions in the Scientific Advisory Group on Emergencies (SAGE), some members of which had raised the possibility of other transmission routes on 18 February 2020. 15 Rather, it reflected advice from a small group of infection prevention and control experts from Public Health England, Public Health Wales, NHS Scotland, and Public Health Agency Northern Ireland (see supplementary file on bmj.com) who favoured a droplet-but-not-airborne narrative.

Contrasting early announcements about preventing transmission of SARS-CoV-2 from England and Japan

From public health england.

“There are general principles you can follow to help prevent the spread of respiratory viruses, including:

washing your hands more often—with soap and water for at least 20 seconds or use a hand sanitiser when you get home or into work, when you blow your nose, sneeze or cough, eat or handle food

avoid touching your eyes, nose, and mouth with unwashed hands

avoid close contact with people who have symptoms

cover your cough or sneeze with a tissue, then throw the tissue in a bin and wash your hands

clean and disinfect frequently touched objects and surfaces in the home”

Posted 3 March 2020, updated 30 March 2020, withdrawn 1 May 2020. 13

This narrative assumes a droplet mode of transmission and implies a high level of certainty.

From the Japanese Prime Minister’s office

“The locations where mass infections were confirmed so far are places where the following three conditions were met simultaneously: closed space with poor ventilation, crowded with many people, and conversations and vocalisation in close proximity (within arm’s reach of one another). It is believed that more people were infected in such places. Therefore, we ask that you predict locations and settings where these three conditions could occur simultaneously and avoid them. We do not have enough scientific evidence yet on how significantly such actions can reduce the risk of spreading infection. However, since places with poor ventilation and crowded places are increasing infections, we ask that you take precautions even before scientific evidence for clear standards is found.”

Posted 9 March 2020. 14

This narrative assumes the possibility of airborne transmission and asks citizens to share the uncertainty and act in a precautionary way.

The droplet-but-not-airborne narrative emphasised randomised controlled trials (see supplementary file on bmj.com), 16 drawing implicitly on the hierarchy of evidence—a formalisation of the assumed superiority of randomised trials, which “typically serve[s] the needs and realities of clinical medicine, but not necessarily public policy.” 17 It did not acknowledge the hierarchy of controls—a public health framework incorporating system level interventions to eliminate pathogens, environmental controls aimed at making air and water safe, and behavioural interventions. 18 This mindset seems to have led policy makers to reject a wealth of evidence on the science of how to optimise indoor air quality. 6

“Covid is unequivocally airborne”

Aerosol scientists study how fluids and particles travel in the air. Some specialise in how respiratory pathogens—including tuberculosis, influenza, and other coronaviruses such as SARS and MERS—travel. They have shown, using laboratory studies, real world case studies, and computer modelling, that these pathogens are transmitted by aerosols and require airborne mitigation measures ( box 1 ) and that coughs and sneezes generate turbulent gas clouds of different sized particles that can travel long distances. 19

Since early 2020, evidence has accumulated from a range of study designs to support the hypothesis that, like most other respiratory pathogens and perhaps more so than other coronaviruses, SARS-CoV-2 is transmitted through the air ( box 3 ). 5 34 35 36

10 Streams of evidence that support airborne transmission of SARS-CoV-2

Superspreading events: the virus is often transmitted at mass events from one or a few people to many people 20 21

Long range transmission: the virus spreads in shared air among people who have never physically met or touched any common surface 22

Asymptomatic and pre-symptomatic transmission: a high proportion of people who pass on the virus have no symptoms at the time 23

Indoor dominance: transmission is many times greater indoors than outdoors, and ventilation reduces transmission 24

Nosocomial infections occur despite strict contact and droplet precautions and reduce when airborne precautions are added 25

Although SARS-CoV-2 is difficult to isolate from air, viable SARS-CoV-2 was detected early in the pandemic in real world settings where infected people had been 26 27 28

SARS-CoV-2 has been detected in air filters in building ducts 29

Transmission between animals has occurred when their cages are connected with air ducts 30

The virus exhibits overdispersion (one person with covid-19 might infect no-one; another might infect dozens) 31

Empirical evidence supporting droplet or fomite transmission is sparse 32 33

Adapted from Greenhalgh et al. 34

Countries such as Japan, 14 where “inside track” aerosol scientists had the ear of government, 11 introduced airborne precautions early in the pandemic ( box 2 ). But in most western countries the aerosol narrative initially fell on deaf policy ears. By July 2020, aerosol scientists were alarmed that official advice was based on oversimplistic and incorrect models of transmission (which had perpetuated for decades in the infection control literature 37 ) and wrote an open letter to WHO offering to help. 5

“Covid is ‘situationally’ airborne”

From the outset, WHO’s guidance on protecting healthcare workers from covid-19 recommended a standard level of protection for most activities but a higher level for “aerosol generating” ones, 38 reflecting a long established (but flawed) medical research tradition. WHO’s Infection Prevention and Control Research and Development Expert Group for Covid-19 did not initially include any aerosol scientists and seemed to ignore the offer of help. A new scientific brief was quickly published, reiterating the dominance of droplet transmission in most circumstances but acknowledging airborne transmission in certain situations—aerosol generating medical procedures and crowded, poorly ventilated indoor settings. 39

Some parts of WHO subsequently welcomed the input of aerosol scientists and changed the guidance in December 2021 to recommend higher grade personal protective equipment (including N95 respirators) for all covid-19 patient care. 40 But the expert group dissented from this overall view, as noted in a footnote (page 1): “WHO provides this interim recommendation independent of the covid-19 infection prevention and control guidelines development group.” That group continued to promote the “situationally airborne” narrative, which has persisted despite evidence against it and has far reaching implications. If aerosols transmit only when certain procedures are being performed, only a small fraction of healthcare staff need higher grade protection and only when performing particular procedures. If that assumption is incorrect, staff (especially non-medical and less senior ones) and patients in most healthcare facilities are under protected.

“Everyone generates aerosols; everyone is vulnerable”

A systematic review found wide disagreement among guideline panels about which procedures and activities should count as aerosol generating (and hence earn respirator grade protection for the person doing them). 41 Many procedures, such as taking a nasopharyngeal swab, were inconsistently classified; some acts, such as coughing, were not procedures; and several procedures were classified as aerosol generating only because they induced coughing. 41 A review of the physiology and aerodynamics of respiratory acts concluded that coughing, sneezing, breathing (especially if laboured), speaking, and singing generated substantial amounts of aerosol and that well documented superspreading events for covid-19 involved a critical triad of poor ventilation, crowding, and loud vocalisation. 42

These findings raise some paradigm challenging questions. Should respirator grade protection be worn by everyone—including other patients—whenever patients are coughing? Should more attention be paid to measures higher up the hierarchy of controls, such as ventilation or filtration of air or ensuring that fewer people share air and for shorter periods?

Social dramas

Droplet precautions became ritualised.

The official droplet-but-not-airborne narrative materialised as artefacts (such as posters, disinfectant dispensers, and 2 metre distancing markers) and social practices (actions accepted and expected in particular contexts). Droplet directed practices became ubiquitous, as people washed hands and forearms assiduously for 20 seconds, quarantined and disinfected their post, and stayed a measured distance apart, and institutions installed and policed the various artefacts and practices.

These rituals of purification 43 powerfully reinforced the official narrative. “Clean” and “contaminated” came to be demarcated in terms of how recently and thoroughly hands had been sanitised and how far a droplet was assumed to travel ( box 1 ). The same rituals served to downplay or obscure the narrative of aerosol transmission—which demarcated clean and contaminated in terms of air purity, with practices oriented to controlling indoor crowding and time spent indoors, ventilating or filtering air, and optimising quality and fit of masks ( box 1 ). These material and enacted features of policy discourse served to silence further the narrative that SARS-CoV-2 is airborne.

Care home residents died in their thousands

On 23 March 2020, with up to 500 000 deaths and an overwhelmed NHS predicted, the UK’s prime minister announced a national lockdown. Hospitals had switched into urgent discharge mode on 19 March, sending patients back to care homes without routine pre-discharge testing. Between March and June 2020, 18 104 deaths involving covid-19 and 11 169 additional deaths above the five year UK average occurred among care home residents. 44

Amnesty International depicted the UK’s care home crisis as a gross breach of human rights in which thousands of vulnerable people had been treated as expendable. 45 The crisis was largely avoidable. Public Health England’s guidance for care homes emphasised a situationally airborne narrative. 46 Because aerosol generating procedures are rarely undertaken in care homes, these settings were low priority for personal protective equipment. Under-emphasis of the importance of ventilation and no routine use of masks are likely to have greatly amplified transmission between infectious residents and care home staff. In Hong Kong, by contrast, surgical masks were mandated for all care home staff by late January 2020, and no excess care home deaths occurred in the first wave of covid-19 (March to June 2020). 47

Public masking became a libertarian lightning rod

Libertarianism is a political ideology that favours individual choice, freedom, and a retreat from state and institutional control. Libertarians resist imposed rules and like to do their own research rather than trust scientists or government. Uncertainty and conflict about the value and place of public masking allowed libertarian messages and practices to flourish.

At its 4 February 2020 meeting, SAGE advised masks for patients with symptomatic covid-19 to reduce transmission “if tolerated.” 15 This group had acknowledged the potential for asymptomatic transmission of SARS-CoV-2 on 28 January 2020 15 but did not make the logical leap to recommend that asymptomatic people should wear masks as source control. In official meetings between January and April 2020, either public masking was not mentioned or arguments against it—lack of efficacy, harm, wastage—were tabled (see supplementary file on bmj.com). 15 Public announcements and professional videos 48 issued by Public Health England between February and June 2020 presented masking as ineffective and potentially harmful on the grounds that people might take compensatory risks or self-contaminate while putting on or removing their mask (the “donning” and “doffing” of infection control jargon). They provided no evidence to support these claims.

The confusion about masking in key decision making committees was due partly to confusion about mode of transmission. Asymptomatic transmission reflects a predominantly airborne route (because asymptomatic people are not coughing or sneezing), but the preoccupation with self-contamination and donning and doffing rituals reflected a predominantly droplet model ( box 1 ). Wearing a cloth or surgical mask protects others (imperfectly) from transmission by droplets and (to some extent) aerosols; wearing a well fitting respirator grade mask also provides strong protection for the wearer against aerosol transmission. 49 A presumption of droplet transmission explains the limited attention paid to the type of mask and the excessive concern about self-contamination.

An influential inside track narrative seemed to conflate the absence of relevant randomised controlled trial evidence with evidence that masking was ineffective. 16 Outside track scientists argued for the precautionary principle, on the grounds that there was—as early as March 2020—indirect and mechanistic evidence (notably, around asymptomatic transmission) and strong theoretical arguments for public masking and huge potential risks associated with delay. 50 Mask mandates were finally introduced in England on 15 June (public transport) and 24 July 2020 (all public places). By then, public opinion was polarised, and many thought it was ineffective. 51 Most Asian countries had high public compliance with early masking policies and very low death rates; many western countries introduced masking late and had many more deaths, although causal links are complex and confounders many. 52

Masking policies in the United States, and to a lesser extent the UK, were met with a strong libertarian backlash aligned with populist political leaders, right wing Christianity, anti-authoritarian social media groups, and, latterly, anti-vaccination groups. 53 In this context, masks came to symbolise pointless restriction of individual freedom, mindless compliance with authoritarian governments, and even blasphemy. 54

Healthcare settings became occupational health battlegrounds

As documented in the 9 January minutes of the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG)—an expert committee of the Department of Health and Social Care that advises the UK government, SARS-CoV-2 was initially classified as an airborne high consequence infectious disease by the four nations’ public health agencies. 55 Consequently, staff caring for patients with suspected or confirmed covid-19 required filtering facepiece respirators (FFP3) or equivalent. This reflected guidance from the UK Health Security Agency (previously Public Health England) and Health and Safety Executive on other coronaviruses and avian influenza and legal requirements for employers to protect their workers against airborne biohazards. The Health and Safety Executive had concluded in 2008 that surgical masks “should not be used in situations where close exposure to infectious aerosols is likely.” 56

NERVTAG minutes from 13 March 2020, however, show growing concern about shortages of respirator masks and the Department of Health and Social Care’s request for “adapted” guidance that recommended surgical masks in most circumstances. 55 The deputy chief medical officer agreed to meet with the chair of the government’s Advisory Committee on Dangerous Pathogens, whose members “were unanimous in supporting the declassification of covid-19 [as a high consequence infectious disease].” 55

The declassification of covid-19 in early March 2020 had profound implications for the protection of healthcare workers. The following sentence, for example, was present in version 8.1 of Health Protection Scotland’s guidance for clinicians on infectious pathogens (dated 5 March 2020): “The precautionary principle should be applied for all novel or emerging respiratory pathogens of high consequence when the mode of transmission is incompletely determined. Airborne precautions (including the use of correctly fitted FFP3 respirators) should be applied for all patients admitted with suspected or confirmed covid-19.” 57

But this entire paragraph was removed from version 9.0 of the guidance (dated 10 March 2020). 58 Notes in a marked-up version 8.1 obtained by us under the Freedom of Information Act reveal a comment against the paragraph as follows: “subject to change based on NERVTAG PPE decisions.”

Although NERVTAG minutes from 6 March 2020 allude to severe shortages of respirator grade protective equipment, this was not made explicit in communications to either healthcare organisations or the public. A letter to UK healthcare organisations dated 28 March 2020 from NHS England and NHS Improvement, Public Health England, and the Academy of Medical Royal Colleges stated that, because of rising covid-19 cases and because “more was understood about the behaviour of the virus and its clinical outcomes,” 59 respirator grade protection would now be restricted to aerosol generating procedures. 59

The number of UK health and care workers infected with SARS-CoV-2 at work is not officially documented. The secretary of state for health and social care reported that by mid-2021, around 1500 had died of covid-19 and 120 000 had developed long covid (some of whom remained on long term sick leave). 60 In April 2020, excess deaths were noted among healthcare staff (especially men and ethnic minority groups) working outside intensive care units, and this impression was confirmed in subsequent academic publications. 61 In early 2021, the British Medical Association and Royal College of Nursing demanded respirator grade protection for all staff working with patients with covid-19.

The latest guidance from the UK Health Security Agency, introduced in April 2022 but withdrawn in May 2022 when all jurisdictions were asked to revert to their respective national guidance, continued to promote a situationally airborne narrative and restrict respirator use to aerosol generating procedures. 62 It did not recommend respirator masks for all covid-19 patient care. But the document glossary states, “Airborne particles can be released when a person coughs or sneezes, and during [aerosol generating procedures].” There remains wide variation in infection control policies in different NHS trusts (perhaps because some interpret the guidance as mandatory); those that provide respirator grade protection seem to have much lower nosocomial infection rates for covid-19. 63

At the root of the UK’s limited success in controlling transmission of SARS-CoV-2 lie flawed droplet-but-not-airborne and situationally airborne narratives. These narratives, and the false certainty with which they were conveyed, produced ineffective public health measures, contributed to shocking levels of care home deaths, exacerbated toxic discourse on masking, and justified withholding adequate protection from most health and care staff.

Why did the flawed narratives prevail? We consider four complementary hypotheses. The first is psychological. Social representation theory holds that people faced with new information show two tendencies: anchoring (grounding the new in an existing framework of concepts, ideas, and values) and concretisation (in which something abstract is made meaningful by making it physical and tangible). 64 People are unlikely to change their beliefs in light of complex and contravening evidence because this requires effort and causes aversion. 65 Policy makers are known to exhibit “satisficing” — meaning they narrow the parameters within which their decisions must make sense and be accountable, especially when threats are complex and urgent. 66 These well documented psychological tendencies might underpin the tendency for business and policy decisions to show what has been termed “escalation of commitment to a failing course of action.” 7

Our second hypothesis is scientific elitism. Scientists in infection control have amassed considerable scientific capital (influence, status, accolades); their favoured methods (randomised controlled trials) are greatly valued; and they have much to lose if they discard their long held droplet narrative and concede the importance of other kinds of evidence. 11 The inside track for pandemic policy making in the UK and WHO was narrow and partisan, 11 67 enabling an unusual degree of power to be wielded against outside track scientific voices, imposing a narrow and rigid set of acceptable scientific methods (what Danziger called “methodolatry” 68 ), and precluding the kind of interdisciplinary deliberation that might have allowed a full and fair consideration of important competing narratives. The low status of aerosol science in policy circles was perhaps compounded by the relative youth of this scientific field and the inherent technical difficulties of isolating viable virus from the air (resulting in inconsistent findings in air sampling studies, especially when undertaken by non-experts). 35 The science of indoor air quality (for example, how and when to open windows, what kinds of filters to use) might be (wrongly) viewed as unsophisticated compared with much of modern biomedicine. 3

Our third hypothesis is practical and logistical. As confirmed in official minutes, the national shortage of high grade respiratory protective equipment was a live discussion topic in UK policy advisory groups at the beginning of the pandemic. Although adherence to a droplet-but-not-airborne narrative was not consciously undertaken purely because of this shortage, it certainly helped to make existing stocks go further.

Our fourth hypothesis is political. Droplet precautions are, at least to some extent, under the control of individuals and hence resonate with neoliberal discourses about individual freedom, personal responsibility, and restraint of the state (although the “choice” to distance physically, for example, presupposes sufficient space in which to do so). Airborne precautions require a paradigm shift in policy making, with strategic actions from those responsible for public safety; this approach aligns with a more socialist leaning political discourse and requires considerable up-front investment in the built environment whose benefits may take years to accrue. 6 WHO’s tweet ( fig 1 ) emphasises how to protect yourself rather than what to expect of your employer, your child’s school, or your government. Relatedly, we hypothesise a role for populism, the modus operandi of which is cherry picking evidence that supports the policy drive and validating anti-science sentiment under the guise of bringing power to people. 69 Populism drew on public desires to return to normalcy and further marginalised aerosol science by depicting its recommended measures 6 as obscure, unaffordable, and an enemy of the public interest.

The narratives and dramas presented in this paper are not exhaustive. The framing of protection as a matter of individual responsibility, for example, also accommodates the current political narrative of “learning to live with covid-19,” in which good citizens stoically accept the endemicity of a—hopefully attenuating—virus in exchange for greater individual freedoms.

The covid-19 pandemic can be framed as what Marcel Mauss (cited in Chaunlat 70 ) calls a “total social fact,” a phenomenon that affects all domains and layers of society (economic, legal, political, religious) and requires us to draw evidence from across multiple scientific and other fields. In such circumstances, the combination of the cognitive biases and satisficing behaviour of policy makers, scientists’ desire to protect their interests, and politicians’ alignment with individualist values and populist sentiment proved perilous.

As the pandemic continues to cause death and long term illness more than 30 months after the first case, airborne transmission of SARS-CoV-2 and the mitigations needed to tackle it ( box 1 ) remain misunderstood and under-recognised. Extraordinarily, a recent UK inquiry into errors made in the pandemic did not mention masks or ventilation at all. 71 Although we acknowledge that solutions are always much more evident in retrospect, we think that the inquiry should ask hard questions about policy makers’ accountability in relation to past and ongoing omissions in this regard. We have 10 specific questions for the inquiry ( box 4 ).

Questions for the inquiry

1. Why were early indications that this virus could be airborne overlooked by policy makers, resulting in public health measures that over-emphasised handwashing, surface cleansing, and 2 m distancing? What checks and balances might have helped policy makers keep a more open mind about mode of transmission rather than seeing it as a settled issue from an early stage?

2. Why did policy makers convey an unjustified level of scientific certainty about the mode of transmission and measures to prevent transmission, rather than sharing with the public that the mode was not yet known, as other countries did? How might the culture of UK policy bodies change to foster greater intellectual engagement with scientific uncertainty and how to handle it?

3. What were (and are) the membership and terms of reference of the UK’s “infection prevention and control cell”? Who appoints them? Who checks their work? Does this group include any experts on airborne transmission and the delivery of safe indoor air? Why did (and does) this group have such a high degree of influence on policy? Why are its activities (at least partly) hidden from the public? Where are the minutes of its meetings?

4. Why did policy makers continue to de-emphasise the evidence base on the airborne mode of transmission for so long, even as strong and consistent empirical evidence was accumulating? To what extent were cognitive biases operating at either individual or group level? How might such biases have been minimised or overcome?

5. Why did policy makers continue to place so much emphasis on droplet precautions even after they had accepted that the virus was likely airborne? Why was indoor air quality given so little attention not just at the beginning of the pandemic but two years (and counting) into it?

6. To what extent were policy decisions adversely influenced (either consciously or unconsciously) by the shortage of high grade personal protective equipment? Who made these decisions and what is the chain of accountability?

7. To what extent was the limited public confidence in the efficacy of masks influenced by negative policy announcements on this subject early in the pandemic? Why were early statements that masks were likely ineffective and could be harmful not corrected as evidence to refute them accumulated? What lessons might specific public health leaders be encouraged to learn from this error?

8. Why are UK health and care workers still not fully protected against airborne infections in the workplace? Why is a premature and false narrative that the pandemic is over being used to justify not supplying workers with personal protective equipment designed to protect against airborne pathogens?

9. Are experts in aerosol science now adequately represented on all key science advisory bodies and are measures in place to ensure that their advice is sought and heeded?

10. Why have policy makers put prime responsibility for preventive measures on individuals given that many effective preventive measures for airborne transmission are located at institutional and national policy levels?

Bold action is now needed to ensure that the science of SARS-CoV-2 transmission is freed from the shackles of historical errors, scientific vested interests, ideological manipulation, and policy satisficing. Policy makers should actively seek to broaden the scientific inside track to support interdisciplinarity and pluralism as a route to better policies, greater accountability, and a reduction in the huge inequities that the pandemic has generated.

Acknowledgments

Thanks to Alex Hunt of News EU for permission to reproduce the timeline of mask policy decisions in the supplementary file, to Birgitte Nerlich for additional background material, and to Stephen Reicher for helpful comments on an earlier draft and suggestions of additional references on psychological theories. The research on which it was based is funded from the following sources for TG: UK Research and Innovation via ESRC and NIHR (ES/V010069/1) and Wellcome Trust (WT104830MA).

Contributors and sources: The interdisciplinary author team was from secondary care medicine (DT), primary care and public health (TG), and critical social science (MO). All authors drafted sections of the manuscript. TG produced an initial synthesis which was then improved by iteration and discussion. All authors approved the final manuscript. TG is guarantor.

Patient involvement: The article relates to a public health issue that affects everyone. As such, we are all potential patients. TG lost her mother to hospital acquired covid-19 so brings a user perspective on nosocomial transmission.

Competing interests: We have read and understood BMJ policy on declaration of interests and have the following interests to declare: in November 2020, DT contacted Public Health England, the chair of NERVTAG, the Department of Health and Social Care, and NHS England to request improved personal protective equipment for healthcare staff. In February 2021, TG added her signature to a letter from the Royal College of Nursing to the UK prime minister making a similar request. She is a member of Independent Sage. MO declares no conflicts of interest.

Provenance and peer review: Commissioned; externally peer reviewed.

This article is part of a series commissioned, peer reviewed, and edited by The BMJ . The advisory group for the series was chaired by Kara Hanson and included Martin McKee, although he was not involved in the decision making on the papers that he co-authored. Kamran Abbasi was the lead editor for The BMJ .

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The Pivotal Role of HIPAA in Modern Healthcare: Protecting Privacy while Fueling Innovation

This essay about the Health Insurance Portability and Accountability Act (HIPAA) of 1996 discusses its crucial role in the American healthcare system. It outlines how HIPAA serves as a foundational framework that protects patient privacy and fosters trust between patients and providers by ensuring sensitive health information is shared and used responsibly. The essay also examines HIPAA’s influence on technological innovation, particularly in how it drives the development of secure health technologies like electronic health records and telemedicine platforms. Additionally, it explores HIPAA’s impact across various sectors beyond traditional healthcare, including technology companies that handle health data. Challenges related to compliance and the need for continuous adaptation of the regulations to accommodate new technologies are also discussed. Overall, the essay underscores HIPAA’s dual role in protecting patient information while supporting healthcare improvements through technology.

How it works

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 stands as a watershed in the annals of American healthcare, setting the precedent for patient privacy and data protection. Its profound influence is felt not only in the realm of healthcare but also in the seamless integration of technology within this sector, creating a landscape where patient trust and innovative medical technology thrive together.

HIPAA: A Beacon of Trust in Healthcare

Originally conceived to enhance healthcare coverage for working Americans and their families, HIPAA quickly evolved beyond this initial purpose.

Its most enduring legacy is perhaps the Privacy Rule, which safeguards personal health information, ensuring that it’s handled with the utmost discretion and only shared under circumstances that directly benefit patient care.

This rule forms the backbone of patient confidence in the healthcare system. In a world increasingly driven by data, the assurance that personal health information is protected is not just comforting—it’s essential. Patients are more likely to be forthcoming about their health issues when they trust that their sensitive information won’t be misused. This openness is crucial for accurate diagnosis and effective treatment, directly impacting patient health outcomes.

Fostering Innovation in Healthcare Technology

Alongside its privacy mandates, HIPAA has also spurred a culture of innovation, particularly in relation to the handling of electronic health records (EHRs). The HIPAA Security Rule was introduced to manage the protection of electronic personal health information (ePHI), which includes directives for physical, administrative, and technical safeguards.

These requirements have pushed technology vendors to pioneer new solutions that comply with HIPAA’s stringent standards. From advanced encryption methods to secure patient portals and telemedicine services, technology under HIPAA has had to evolve. This evolution has not only made patient data more secure but has also made healthcare more accessible and efficient. For instance, secure telemedicine platforms, which became particularly vital during the COVID-19 pandemic, are a direct outcome of the need to comply with HIPAA while providing essential services.

HIPAA’s Extended Influence Across Sectors

HIPAA’s reach extends beyond traditional healthcare settings, affecting a wide array of industries that interact with health data. It influences how health apps, wearable devices, and even genetic testing services manage and protect user data. Companies operating in these spaces must design their products and services with HIPAA compliance in mind, integrating data protection from the initial stages of development.

This has led to an environment where patient data protection is paramount, regardless of whether the data is handled in a hospital, through an insurance claim, or via a health management app. The ramifications for data security protocols across these diverse platforms are profound, creating a unified standard that protects individuals’ privacy across the board.

Challenges and Continuous Adaptation

Despite its widespread acceptance and the robust framework it provides, HIPAA also presents challenges. The regulations can be complex and onerous, requiring continuous education and vigilance to ensure compliance. Healthcare providers and their business associates must stay informed about the latest changes to HIPAA regulations and adapt their practices accordingly.

Moreover, as technology continues to advance, HIPAA itself must adapt. The rise of technologies such as artificial intelligence and machine learning in healthcare presents new challenges for maintaining privacy while harnessing these tools for better patient care. Legislators and healthcare leaders must work together to ensure that HIPAA evolves in a way that both protects patient privacy and facilitates the ethical use of new technologies.

Enhancing the Healthcare Experience

Ultimately, the strength of HIPAA lies in its dual role: protecting patient information while enabling the safe use of that data to improve healthcare outcomes. The act not only reassures patients about the security of their information but also underpins the modern healthcare experience, which increasingly relies on digital and remote technologies.

For patients, the impact of HIPAA is most felt in their interactions with healthcare providers. Knowing their data are protected, patients can engage more fully and openly in their healthcare journeys. This can lead to better healthcare experiences and outcomes, thanks to a system that respects their privacy and utilizes their data responsibly to tailor treatments and services.

In the grand narrative of healthcare, HIPAA occupies a central role, championing the cause of privacy while fostering an ecosystem ripe for technological advancement. Its balanced approach to patient data protection and utilization has made it a model of regulatory success. As the digital landscape evolves, the principles upheld by HIPAA will continue to serve as a guiding light, ensuring that healthcare innovation moves forward without compromising the privacy and trust that patients place in the system.

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The Pivotal Role of HIPAA in Modern Healthcare: Protecting Privacy While Fueling Innovation. (2024, May 21). Retrieved from https://papersowl.com/examples/the-pivotal-role-of-hipaa-in-modern-healthcare-protecting-privacy-while-fueling-innovation/

"The Pivotal Role of HIPAA in Modern Healthcare: Protecting Privacy While Fueling Innovation." PapersOwl.com , 21 May 2024, https://papersowl.com/examples/the-pivotal-role-of-hipaa-in-modern-healthcare-protecting-privacy-while-fueling-innovation/

PapersOwl.com. (2024). The Pivotal Role of HIPAA in Modern Healthcare: Protecting Privacy While Fueling Innovation . [Online]. Available at: https://papersowl.com/examples/the-pivotal-role-of-hipaa-in-modern-healthcare-protecting-privacy-while-fueling-innovation/ [Accessed: 21 May. 2024]

"The Pivotal Role of HIPAA in Modern Healthcare: Protecting Privacy While Fueling Innovation." PapersOwl.com, May 21, 2024. Accessed May 21, 2024. https://papersowl.com/examples/the-pivotal-role-of-hipaa-in-modern-healthcare-protecting-privacy-while-fueling-innovation/

"The Pivotal Role of HIPAA in Modern Healthcare: Protecting Privacy While Fueling Innovation," PapersOwl.com , 21-May-2024. [Online]. Available: https://papersowl.com/examples/the-pivotal-role-of-hipaa-in-modern-healthcare-protecting-privacy-while-fueling-innovation/. [Accessed: 21-May-2024]

PapersOwl.com. (2024). The Pivotal Role of HIPAA in Modern Healthcare: Protecting Privacy While Fueling Innovation . [Online]. Available at: https://papersowl.com/examples/the-pivotal-role-of-hipaa-in-modern-healthcare-protecting-privacy-while-fueling-innovation/ [Accessed: 21-May-2024]

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