lifestyle during pandemic essay

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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Impact of COVID-19 on people's livelihoods, their health and our food systems

Joint statement by ilo, fao, ifad and who.

The COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems and the world of work. The economic and social disruption caused by the pandemic is devastating: tens of millions of people are at risk of falling into extreme poverty, while the number of undernourished people, currently estimated at nearly 690 million, could increase by up to 132 million by the end of the year.

Millions of enterprises face an existential threat. Nearly half of the world’s 3.3 billion global workforce are at risk of losing their livelihoods. Informal economy workers are particularly vulnerable because the majority lack social protection and access to quality health care and have lost access to productive assets. Without the means to earn an income during lockdowns, many are unable to feed themselves and their families. For most, no income means no food, or, at best, less food and less nutritious food. 

The pandemic has been affecting the entire food system and has laid bare its fragility. Border closures, trade restrictions and confinement measures have been preventing farmers from accessing markets, including for buying inputs and selling their produce, and agricultural workers from harvesting crops, thus disrupting domestic and international food supply chains and reducing access to healthy, safe and diverse diets. The pandemic has decimated jobs and placed millions of livelihoods at risk. As breadwinners lose jobs, fall ill and die, the food security and nutrition of millions of women and men are under threat, with those in low-income countries, particularly the most marginalized populations, which include small-scale farmers and indigenous peoples, being hardest hit.

Millions of agricultural workers – waged and self-employed – while feeding the world, regularly face high levels of working poverty, malnutrition and poor health, and suffer from a lack of safety and labour protection as well as other types of abuse. With low and irregular incomes and a lack of social support, many of them are spurred to continue working, often in unsafe conditions, thus exposing themselves and their families to additional risks. Further, when experiencing income losses, they may resort to negative coping strategies, such as distress sale of assets, predatory loans or child labour. Migrant agricultural workers are particularly vulnerable, because they face risks in their transport, working and living conditions and struggle to access support measures put in place by governments. Guaranteeing the safety and health of all agri-food workers – from primary producers to those involved in food processing, transport and retail, including street food vendors – as well as better incomes and protection, will be critical to saving lives and protecting public health, people’s livelihoods and food security.

In the COVID-19 crisis food security, public health, and employment and labour issues, in particular workers’ health and safety, converge. Adhering to workplace safety and health practices and ensuring access to decent work and the protection of labour rights in all industries will be crucial in addressing the human dimension of the crisis. Immediate and purposeful action to save lives and livelihoods should include extending social protection towards universal health coverage and income support for those most affected. These include workers in the informal economy and in poorly protected and low-paid jobs, including youth, older workers, and migrants. Particular attention must be paid to the situation of women, who are over-represented in low-paid jobs and care roles. Different forms of support are key, including cash transfers, child allowances and healthy school meals, shelter and food relief initiatives, support for employment retention and recovery, and financial relief for businesses, including micro, small and medium-sized enterprises. In designing and implementing such measures it is essential that governments work closely with employers and workers.

Countries dealing with existing humanitarian crises or emergencies are particularly exposed to the effects of COVID-19. Responding swiftly to the pandemic, while ensuring that humanitarian and recovery assistance reaches those most in need, is critical.

Now is the time for global solidarity and support, especially with the most vulnerable in our societies, particularly in the emerging and developing world. Only together can we overcome the intertwined health and social and economic impacts of the pandemic and prevent its escalation into a protracted humanitarian and food security catastrophe, with the potential loss of already achieved development gains.

We must recognize this opportunity to build back better, as noted in the Policy Brief issued by the United Nations Secretary-General. We are committed to pooling our expertise and experience to support countries in their crisis response measures and efforts to achieve the Sustainable Development Goals. We need to develop long-term sustainable strategies to address the challenges facing the health and agri-food sectors. Priority should be given to addressing underlying food security and malnutrition challenges, tackling rural poverty, in particular through more and better jobs in the rural economy, extending social protection to all, facilitating safe migration pathways and promoting the formalization of the informal economy.

We must rethink the future of our environment and tackle climate change and environmental degradation with ambition and urgency. Only then can we protect the health, livelihoods, food security and nutrition of all people, and ensure that our ‘new normal’ is a better one.

Media Contacts

Kimberly Chriscaden

Communications Officer World Health Organization

Nutrition and Food Safety (NFS) and COVID-19

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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• v.22(8); 2020 Aug

Impact of the COVID-19 Epidemic on Lifestyle Behaviors and Their Association With Subjective Well-Being Among the General Population in Mainland China: Cross-Sectional Study

1 Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China

Atipatsa Chiwanda Kaminga

2 Department of Mathematics and Statistics, Mzuzu University, Luwinga, Mzuzu, Malawi

3 Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China

The world is experiencing an unprecedented challenge due to the coronavirus disease (COVID-19) pandemic. However, it is unclear whether people’s lifestyles will change as a result.

The aim of this study is to explore perceived lifestyle changes after the outbreak of COVID-19 and their association with subjective well-being (SWB) among the general population in Mainland China.

An online survey was conducted in May 2020. Lifestyle behaviors including leisure-time physical exercise, leisure-time screen time, and dietary intake were self-reported. SWB was measured using the General Wellbeing Schedule (GWS). Other covariates including sociodemographic factors, self-rated physical health, perceived social support, and loneliness were also assessed by a structured questionnaire. A multivariate ordinal regression method was used to analyze the association between SWB and lifestyle behaviors as well as perceived lifestyle changes.

A total of 1033 participants aged between 18 and 60 years were included in this study. The mean GWS score was 71.7 points. About 70% of the respondents reported spending more time looking at screens, whereas about 30% reported an increased frequency of vegetable and fruit intake after the outbreak of COVID-19. Inactive physical exercise (odds ratio [OR] 1.16, 95% CI 1.02-1.48), infrequent vegetable intake (OR 1.45, 95% CI 1.10-1.90), infrequent fruit intake (OR 1.31, 95% CI 1.01-1.70), and often skipping breakfast (OR 1.43, 95% CI 1.08-1.91) were associated with lower SWB after adjusting for sociodemographic factors, self-rated physical health, perceived social support, and loneliness. Moreover, participants who perceived a decrease in the frequency of vegetable, fruit, and breakfast intake were more likely to report lower SWB.

Conclusions

The COVID-19 pandemic may have positive and negative impacts on different aspects of lifestyle behaviors. Both unhealthy lifestyle behaviors and negative lifestyle changes were associated with lower SWB. These findings provide scientific evidence that can inform lifestyle guidelines and public mental health interventions during the COVID-19 outbreak.

Introduction

The ongoing coronavirus disease (COVID-19) outbreak has led to an unprecedented public health crisis worldwide [ 1 ]. COVID-19, similar to severe acute respiratory syndrome (SARS), is a beta-coronavirus that can be spread to humans through intermediate hosts such as bats [ 2 ]. The COVID-19 outbreak was first revealed in late December 2019 in Wuhan, Hubei Province, China. On January 30, 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern [ 3 ]. In the following months, COVID-19 spread rapidly in China and worldwide.

At the same time, the global population is experiencing life-altering challenges due to the COVID-19 pandemic [ 4 ]. Given the lack of effective treatment for COVID-19, nonpharmacological interventions (NPIs) are required to decrease its transmission [ 5 ]. In essence, NPIs are intended to modify disease-related lifestyle behaviors such that these should no longer contribute to the spread of the disease. However, lifestyle choices or behavioral change may lead to unforeseen detrimental or protective consequences for mental health outcomes [ 6 - 10 ]. For example, some NPIs, such as personal restrictions, mass confinement, and compulsory home isolation, may be associated with worse psychological conditions [ 8 ], whereas some NPIs, such as good ventilation in the workplace and wearing a face mask, were found to be protective of mental health during the COVID-19 pandemic [ 9 , 10 ]. Furthermore, evidence from recent studies suggests that current pandemic-related coping strategies may have an adverse impact on mental health, such as decreased well-being and increased posttraumatic stress disorders (PTSD), depression and anxiety symptoms, insomnia, and anger [ 11 - 13 ]. In addition, fear of the disease and social isolation may lead to stress reactions that could develop into other psychological disorders [ 14 ].

Unhealthy lifestyle habits such as poor diet, lack of physical activity, smoking, and alcohol use are not only major contributors to the global burden of disease [ 15 ], but are also positively associated with worse mental health outcomes [ 16 ]. Recently, lifestyle guidelines have emphasized maintaining a healthy nutritional status and engaging in physical exercise at home during the COVID-19 outbreak [ 17 , 18 ]. Many other studies have suggested that the focus should be on addressing the mental health aspect when implementing public disease control and prevention interventions [ 19 , 20 ]. However, observational studies on the characteristics of behavior patterns such as dietary intake, physical exercise, and screen time among the general population after the outbreak of COVID-19 are lacking [ 21 ]. Similarly, data about perceived lifestyle changes among the general population after the outbreak of COVID-19 are also lacking. Moreover, the associations between mental health outcomes and lifestyle behaviors as well as lifestyle changes during the COVID-19 pandemic represent a research gap.

Therefore, this study aimed to explore the perceived lifestyle changes after the outbreak of COVID-19, and their association with subjective well-being among the general population in Mainland China. It is hoped that, from the public health and preventative care perspectives, this study can provide valuable information to inform public health policies or interventions aimed at maintaining good mental health and a healthy lifestyle during the COVID-19 pandemic.

This study was conducted from May 10 to May 15, 2020, through an online survey using an internet platform [ 22 ]. This platform has more than 2.6 million members distributed across more than 30 provinces in China, of which 52.00% are female, 29.34% are aged 26 to 30 years, and 39.20% are general staff. All participants signed an online informed consent form before filling out this questionnaire. The target population comprised all Chinese people in Mainland China aged between 18 and 60 years. A computer-assisted simple random sampling method was used to select eligible participants from this internet platform. Adolescents were not interviewed because it would be difficult to obtain parental consent over the internet, and older adults (≥60 years old) were not investigated as recall bias may be strong in this group. Participants were also excluded if they refused to participate in this survey, did not reply, or could not complete the online survey independently.

Data Collection

Sociodemographic information.

A self-administrated structured questionnaire was used to collect the participants’ sociodemographic information including age, gender (male or female), residential location (urban or rural area), marital status (married or unmarried), education (high school and below, college or university degree, master’s degree and above) and personal monthly income. The unmarried group included those who were divorced, single, and widowed.

Lifestyle Behaviors Assessment

Lifestyle behaviors in the 4 months immediately before and the 4 months immediately after the COVID-19 outbreak were assessed. In addition, the perceived lifestyle changes after the COVID-19 outbreak were assessed in relation to lifestyle behaviors in the 4 months before the COVID-19 outbreak. The specific lifestyle behaviors that were assessed included the following: leisure-time physical exercise, leisure-time screen time, and dietary intake. To measure leisure-time physical exercise, four items from the long version of the International Physical Activity Questionnaire (IPAQ), a valid and reliable questionnaire assessing physical activity [ 23 ], were used. Of the four items, two assess the frequency of moderate or vigorous physical exercise (such as running and dancing) per week and the other two items assess the duration of physical exercise every time. Participants were defined as active if they reported a total moderate-vigorous physical exercise time of more than 150 minutes/week [ 24 ]. The Cronbach α of these items in this study was 0.685. Leisure-time screen time was viewed as a major indicator of sedentary behavior, and was calculated by summing up the screen time related to watching TV/videos, internet use (such as news and Douban) through a smartphone or the internet, playing computer or smartphone games, studying online, and social platform use (such as QQ and Wechat). Leisure-time screen time was further classified as short (<2 hours/day) and long (≥2 hours/day). Three items from the simplified food frequency questionnaire (FFQ-25) [ 25 ] were used to assess the weekly frequency of consuming vegetables (including light- and deep-colored vegetables) and fruits (such as apples and pears). Thus, participants were dichotomized as frequently (≥5 times/week) and infrequently (<5 times/week) consuming fruits and vegetables. The Cronbach α of these items in this study was 0.725. The question “How many days do you skip breakfast weekly after the outbreak of COVID-19?” was used to assess the frequency of skipping breakfast and this dichotomized participants as seldom (<3 days/week) and often (≥3 days/week). Perceived lifestyle changes compared to lifestyle behaviors before the outbreak of COVID-19 were classified into three categories as follows: increased or much increased, same as before, and decreased or much decreased.

Other covariates assessed were self-rated physical health, perceived social support (PSS), and loneliness during the COVID-19 epidemic. Self-rated physical health was assessed using a 5-item Likert scale. For example, one of the questions asked, “How do you feel about your physical condition?” Participants rated their physical condition as good, fair, or poor. PSS was measured using the Chinese version of the Perceived Social Support Scale (PSSS). The PSSS was developed by Zimet in 1988 [ 26 ] and was used to measure PSS from three sources: family, friends, and significant others. This scale contain 12 items, scored on a 7-point rating scale from 1 (very strongly disagree) to 7 (very strongly agree). The total score ranges from 12 to 84, and PSS is divided into low (a score from 12 to 36), intermediate (a score from 37 to 60), and high (a score from 61 to 84). The Cronbach α of this scale in this study was 0.881. Loneliness was measured using the short from of the University of California, Los Angeles (UCLA) Loneliness Scale (ULS-8) [ 27 ], which was adapted by Hays and DiMatteo in 1987 on the basis of UCLA-20 [ 28 ]. This scale contains 8 items and the total score ranges from 8 to 32, with higher scores indicating higher levels of loneliness. The loneliness of participants was classified into three levels (low, intermediate, and high) according to the tertile of total score of ULS-8. The Cronbach α of this scale in this study was 0.818.

Subjective Well-Being Assessment

Subjective well-being (SWB), a main indicator of mental health, is a broad category of phenomena that includes people’s emotional response, domain satisfaction, and global judgments of life satisfaction [ 29 ]. SWB was measured using the Chinese adapted version of the General Wellbeing Schedule (GWS) [ 30 ], which was first developed by the US National Center for Health Statistics in 1977. It contains the following 6 dimensions: satisfaction and interest in life; health concerns; energy; depression or pleasant mood; control of emotions and behavior; and relaxation and tension. The total scores for this instrument are yielded by summing up the items’ scores, with higher scores indicating higher levels of SWB. The SWB of participants was classified into three levels (high, intermediate, and low) according to the tertile of total scores on the GWS. The GWS has high reliability and validity in the Chinese population, with a Cronbach of 0.91 and 0.95 for men and women, respectively [ 30 ]. The Cronbach α of this scale in this study was 0.812.

Statistical Analysis

Categorical variables were summarized as counts and percentages, while continuous variables were summarized as mean and standard deviation. The statistical difference in the distribution of the GWS scores across different sociodemographic characteristics and lifestyle behaviors was assessed using the Student t test or the one-way analysis of variance (ANOVA). The statistical difference in the distribution of perceived lifestyle changes across different groups was assessed using the chi-square test. Multivariate ordinal regression models were used to explore the association between SWB (1=low; 2=intermediate; 3=high) and lifestyle behaviors as well as perceived lifestyle changes. The strength of association was reported as odds ratio (OR) and 95% CI. An unadjusted relationship between SWB and each lifestyle behavior as well as its change was examined in Model 1 (crude model), whereas an adjusted relationship between SWB and each lifestyle behavior as well as its change was examined in Model 2, adjusted for the variables age, gender, education, marital status, residential location, and personal monthly income. Finally, a relationship between SWB and each lifestyle behavior as well as its change was examined in Model 3, which adjusted for covariates including self-rated physical health, perceived social support, loneliness, and all the covariates entered in Model 2. The statistical analyses were conducted in SPSS (Version 22.0; IBM Corp). All statistical tests were two-tailed and a P <.05 was considered statistically significant.

A total of 1600 registrants were invited to take part in this online survey and a total of 1081 subjects consented to take part in the study, providing a response rate of 67.6%. The main reasons for nonresponse were declining to participate and no reply. After excluding 48 participants due to an incomplete questionnaire or missing data, a total of 1033 participants were included in this study. Among them, 637 participants were aged between 18 and 30 years (61.7%) and 498 were female (48.2%). Further, a very small proportion of the participants (n=95, 9.2%) had attended high school and lower levels of education. In addition, 730 subjects (70.7%) were living in urban areas, 846 participants (81.9%) considered their physical health status as good, and 675 participants (65.3%) felt that they had been receiving high social support. Regarding lifestyle, 58.8% (n=607) of the participants had leisure-time physical exercise of more than 150 min/week, about 86.8% (n=897) had screen time of 2 hours/day or more, and 67.9% (n=701) ate vegetables 5 times/week or more, whereas 41.8% (n=432) of the subjects ate fruits 5 times/week or more. Characteristics of participants are summarized in Table 1 .

Distribution of sample characteristics and General Wellbeing Schedule scores.

a P values were obtained according to the Student t test or one-way analysis of variance.

b N/A: not applicable.

The mean GWS score in this sample was 71.7 points (SD 12.5). In addition, the distribution of GWS scores was not significantly different across the categories of gender, education, and leisure-time screen time ( P >.05). Table 1 shows the details.

Furthermore, about 17.0% of the respondents stated that they spent more time doing physical exercise, and about 2/3 of the respondents reported that they spent more time looking at screens. Additionally, a small proportion of participants decreased the frequency of their intake of vegetables, fruits, and breakfast. In addition, changes in the frequency of fruit and breakfast intake were associated with participants’ residential locations. There were no statistical differences in perceived lifestyle changes associated with gender. These results are shown in Table 2 .

Perceived lifestyle changes by gender and place of residence.

a P value was obtained by chi-square test.

The association between lifestyle behaviors during the COVID-19 pandemic and subjective well-being among the general population in Mainland China is summarized in Table 3 . The multivariate ordinal regression model showed that participants with inadequate leisure-time physical exercise (OR 1.16, 95% CI 1.02-1.48), infrequent vegetable intake (OR 1.45, 95% CI 1.10-1.90), infrequent fruit intake (OR 1.31, 95% CI 1.01-1.70), as well as those who often skipped breakfast (OR 1.43, 95% CI 1.08-1.91) were associated with a higher risk of lower subjective well-being after adjusting for age, gender, education, marital status, residential location, personal monthly income, self-rated physical health, perceived social support, and loneliness.

The association between lifestyle behaviors and subjective well-being.

a OR: odds ratio.

b Adjusted for age, gender, marital status, residential location, education, and personal monthly income.

c Adjusted for covariates in Model 2 and plus self-rated physical health, perceived social support, and loneliness.

The association between perceived lifestyle changes, before and after the outbreak of COVID-19, and subjective well-being is summarized in Table 4 . An ordinal regression model indicated that participants with decreased frequency of vegetable and fruit intake, and increased frequency of skipping breakfast were more likely to report lower subjective well-being after adjusting for sociodemographic factors and other covariates.

The association between perceived lifestyle changes and subjective well-being.

Previous studies have predominantly focused on the psychological impact of the COVID-19 epidemic, rather than lifestyle issues. For the first time, some perceived lifestyle changes after the outbreak of COVID-19 have been assessed, and the impact of such changes on mental health was also explored among the general population in Mainland China. Noticeably, NPIs have modified some lifestyle behaviors positively and others negatively. Both unhealthy lifestyle behaviors and negative lifestyle changes were associated with lower SWB. Although about half of the participants reported no lifestyle changes, the percentages of reported favorable lifestyle changes were larger than the percentages of reported unfavorable lifestyle changes, especially in relation to the frequency of vegetable and fruit intake. However, the situation was the opposite when considering leisure-time physical exercise and screen time. Thus, it is possible that the sudden occurrence of COVID-19 made people reconsider their healthy lifestyle habits. In addition, the social or home isolation policy made people avoid public places and increase their indoor time, which may have increased their use of electronic media at home. Cognitive behavior therapy enables activity scheduling during home isolation and improves mental health [ 31 ].

Accordingly, unhealthy lifestyle behaviors were recorded among the Chinese population after the outbreak of COVID-19. For example, about 40% of the participants had inactive leisure-time physical exercise and about 90% had longer screen time. In addition, vegetable and fruit intake was less than 5 times/week for about 30% and 60% of the participants, respectively. However, it is not known whether such lifestyle patterns would persist during the COVID-19 pandemic or after the COVID-19 pandemic. Therefore, further studies to assess the lasting effects of the COVID-19 pandemic on lifestyle behaviors are warranted.

The findings of this study have added to the existing evidence that physical exercise is associated with mental well-being [ 32 , 33 ]. For example, a larger cross-sectional study indicated that sports and vigorous recreational activities were positively associated with emotional well-being even after adjusting for sex, social class, and health status [ 34 ]. In addition, active physical exercises were associated with reduced risk of mental health conditions such as depression and anxiety [ 35 ]. Similarly, during the SARS epidemic, increased exercise time was associated with decreased perceived stress and incidence of PTSD in the general population of Hong Kong [ 36 ]. However, increased exercise time did not significantly predict subjective well-being. A possible explanation could be that SWB may be associated with the intensity of physical exercise. Many studies demonstrated that vigorous physical exercises were positively associated with SWB, while moderate physical exercises were either not associated or negatively associated with SWB [ 37 , 38 ]. Another reason is that the environment for physical exercise may have a great impact on mental well-being [ 39 ]. Therefore, further studies about intensity of physical exercises under different environments are needed to fully elucidate the effects on wellbeing.

The finding that a higher frequency of vegetable and fruit intake was positively associated with subjective well-being is consistent with previous studies [ 40 - 42 ]. There is an urgent need to disseminate this health information to the public during the COVID-19 pandemic via the internet and health collaborators [ 43 , 44 ]. For example, Stranges et al [ 45 ] reported that the odds for low mental well-being were increased in those with decreasing fruit and vegetable intake. Furthermore, a systematic review of 61 studies indicated that higher total intake of fruits and vegetables may promote higher levels of optimism and reduce psychological distress, thereby having a positive influence on mental health [ 42 ]. Even though the total quantities of vegetable and fruit intake were not obtained in this study, we assumed that a higher frequency of intake may lead to higher total volume intake; thus, the former and the latter may have the same influence. Nevertheless, further studies are warranted to understand the association between mental health and quantities of vegetables and fruits consumed. The finding about the relationship between eating habits, like skipping breakfast, and well-being added to the existing evidence that skipping breakfast is associated with poorer physical and mental health outcomes [ 41 , 46 , 47 ]. For instance, breakfast skippers had significantly worse health-related quality of life both physically and mentally in a Taiwanese national representative sample [ 48 ]. In addition, a large cohort study indicated that an eating pattern characterized by skipping or delaying breakfast was associated with mood disorders among Australian adults [ 49 ]. However, the relationship between mental health and the manner in which breakfast is eaten needs further investigation.

In summary, this original preliminary study examined some positive and negative lifestyle changes due to the influence of the COVID-19 pandemic. It has revealed the pressing need to provide individuals, communities, and health agencies with information to help maintain healthy lifestyles to some degree while in isolation. Moreover, this study has contributed to the scant literature on the association between lifestyle behaviors and mental health during the COVID-19 pandemic. However, this study has several limitations. First, this study had a cross-sectional design and was conducted during the COVID-19 pandemic. Thus, causality relationships could not be inferred, and it is not clear whether the association between subjective well-being and lifestyle behaviors as well as their changes will last medium- and long-term. Second, precise information about lifestyle behaviors was difficult to collect before the start of the COVID-19 pandemic. Therefore, only perceived lifestyle changes were measured. Moreover, lifestyle behaviors and perceived changes were self-reported, thus these measurements may be susceptible to recall bias. Third, this study population had a high proportion of subjects aged 18 to 40 years (approximately 90%) and a high proportion of participants had a higher education level. Whether the observed changes and associations are present in a more representative study population requires further exploration. Therefore, longitudinal studies with representative samples should be conducted during the COVID-19 pandemic to better understand the lasting effects of this pandemic on lifestyle behaviors and their changes.

Acknowledgments

We thank all the participants for their cooperation throughout the study. There was no funding for this study.

Abbreviations

Authors' Contributions: ZH and XL contributed to analyzing data and writing the first original draft. ACK contributed to the editing of all versions of the manuscript. HX contributed to the editing of the first draft and provided supervision. All authors have read and agreed to the final draft of the manuscript.

Conflicts of Interest: None declared.

• Open access
• Published: 25 June 2021

Lifestyle changes during the first wave of the COVID-19 pandemic: a cross-sectional survey in the Netherlands

• Esther T. van der Werf 1 , 2 ,
• Martine Busch 2 , 3 ,
• Miek C. Jong 4 , 5 &
• H. J. Rogier Hoenders 2 , 6  

BMC Public Health volume  21 , Article number:  1226 ( 2021 ) Cite this article

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During the Covid-19 pandemic the Dutch government implemented its so-called ‘intelligent lockdown’ in which people were urged to leave their homes as little as possible and work from home. This life changing event may have caused changes in lifestyle behaviour, an important factor in the onset and course of diseases. The overarching aim of this study is to determine life-style related changes during the first wave of the COVID-19 pandemic among a representative sample of the adult population in the Netherlands.

Life-style related changes were studied among a random representative sample of the adult population in the Netherlands using an online survey conducted from 22 to 27 May 2020. Differences in COVID-19-related lifestyle changes between Complementary and Alternative Medicine (CAM) users and non-CAM users were determined. The survey included a modified version of the I-CAM-Q and 26 questions on lifestyle related measures, anxiety, and need for support to maintain lifestyle changes.

1004 respondents were included in the study, aged between 18 and 88 years (50.7% females). Changes to a healthier lifestyle were observed in 19.3% of the population, mainly due to a change in diet habits, physical activity and relaxation, of whom 56.2% reported to be motivated to maintain this behaviour change in a post-COVID-19 era. Fewer respondents (12.3%) changed into an unhealthier lifestyle. Multivariable logistic regression analyses revealed that changing into a healthier lifestyle was positively associated with the variables ‘Worried/Anxious getting COVID-19’ (OR: 1.56, 95% C.I. 1.26–1.93), ‘CAM use’ (OR: 2.04, 95% C.I. 1.38–3.02) and ‘stress in relation to financial situation’ (OR: 1.89, 95% C.I. 1.30–2.74). ‘Age’ (OR 18–25: 1.00, OR 25–40: 0.55, 95% C.I. 0.31–0.96, OR 40–55:0.50 95% C.I. 0.28–0.87 OR 55+: 0.1095% C.I. 0.10–0.33), ‘stress in relation to health’ (OR: 2.52, 95% C.I. 1.64–3.86) and ‘stress in relation to the balance work and home’ (OR: 1.69, 95% C.I. 1.11–2.57) were found predicting the change into an unhealthier direction.

These findings suggest that the coronavirus crisis resulted in a healthier lifestyle in one part and, to a lesser extent, in an unhealthier lifestyle in another part of the Dutch population. Further studies are warranted to see whether this behavioural change is maintained over time, and how different lifestyle factors can affect the susceptibility for and the course of COVID-19.

Peer Review reports

The rapid spread of COVID-19 to nearly all parts of the world has posed enormous health, economic, environmental and social challenges worldwide. In the absence of effective drugs or vaccines, social distancing, surgical masks, washing hands and other preventive measures are presented as the only ways to fight the (spread of the) virus. Lockdown is among one of the options suggested by WHO to reduce spread of the virus. Although underreported, preventative strategies such as a healthy lifestyle seem important alternative avenues to fight (the spread of) COVID-19. From a public health perspective, these strategies are very important to consider. Between February 2020 and 1st of June 2021 1.651.780 positive cases and 17,632 deaths has been registered in The Netherlands [ 1 ]. As a response to COVID-19, many countries are using a combination of containment and mitigation activities with the intention of delaying major surges of patients and levelling the demand for hospital beds, while protecting the most vulnerable from infection, including elderly people and those with comorbidities [ 2 ]. In the Netherlands, a so-called “intelligent lockdown” was enforced on 15th of March 2020, with easing of restrictions per 1st of July 2020 [ 3 ]. With the intelligent lockdown, the Dutch Government appealed to the responsibility and self-discipline of citizens to practice 1.5 m social distance, and to maintain home isolation when showing COVID-19-related symptoms. Over the course of several weeks in March and April 2020, additional measures were taken to restrict the further spread of the coronavirus in the Netherlands. These measures included closure of schools, restaurants, certain beaches and parks, and prohibition of spontaneous group gatherings in public spaces.

Due to this intelligent lockdown, a sudden and radical change occurred in the lives and habits of the Dutch population. Life experiences that may greatly influence an individual’s daily routine are referred to as life changing events [ 4 ], defined as “those occurrences, including social, psychological and environmental, which require an adjustment or effect a change in an individual’s pattern of living.” Life changing events may influence lifestyle behaviours for better or worse [ 5 , 6 ]. For instance, Engberg et al. showed that transition to university, having a child, remarriage and mass urban disasters were associated with decreased physical activity levels, while retirement was associated with increased physical activity [ 7 ]. Stressful life events have been correlated with excessive alcohol consumption and alcohol dependence and emotional eating [ 8 ].

Maintaining a healthy nutrition status and level of certain exercise is crucial, especially in a period when the immune system might need to fight back. In fact, subjects with (severe) obesity (BMI ≥ 30 kg/m2) are one of the groups with a higher risk for COVID-19 complications [ 9 , 10 ]. Therefore, losing weight may be one of the strategies to lower the risk of severe illness from COVID-19. Worldwide, authorities and healthcare professional’s recommendations on how to stay healthy during the COVID-19 pandemic, besides taking appropriate hygiene measures, are related to healthy life-style measures such as assuring sufficient sleep, eat plenty of fresh fruits and vegetables, reduce stress and social isolation and stay active [ 11 , 12 ].

The COVID-19 pandemic might motivate people to make healthier choices and adopt a healthier lifestyle. Conversely, COVID-19 control measures such as social distancing and compulsory home isolation can be expected to increase sedentary behaviour and might cause an unhealthy eating and sleeping pattern. For example, the interruption of the daily (work) routine caused by the staying at home (which includes digital-education, working from home, and limitation of outdoors and in-gym physical activity) could result in boredom, which in turn is associated with a greater energy intake [ 13 ]. In addition, hearing or reading continuously about the COVID-19 pandemic and its possible impact from media can be stressful. Stress leads individuals toward overeating, especially ‘comfort foods’ or inactivity [ 14 ]. For future actions it is important to determine the lifestyle changes taken during this COVID-19 pandemic, and what support will be needed to (dis) continue this health behaviour in a post-COVID-19 era.

Previous studies show that Complementary and Alternative Medicine (CAM) users have on average a healthier lifestyle behaviour than non-CAM users, and overall a stronger focus on wellness [ 15 , 16 , 17 , 18 ]. In general, CAM is defined as a group of diverse medical and health care symptoms, practices and products that are not generally considered part of conventional medicine [ 19 ]. Nahin et al. found based on a survey among the US population that engaging in leisure-time physical activity, having consumed alcohol in one’s life but not being a current heavy drinker, and being a former smoker are independently associated with the use of CAM [ 16 ]. Interestingly, reported significantly better health status and healthier behaviours overall (higher rates of physical activity and lower rates of obesity) seems more prominent in adults using CAM for health promotion than those who use CAM as treatment [ 15 ]. The relation between CAM use and lifestyle needs further investigation in various populations.

The overarching aim of this reported study is to investigate life-style related changes during the first wave of the COVID-19 pandemic among a representative sample of the adult population in the Netherlands. Within this aim the following objectives has been framed: i) To determine life-style related changes (healtier/unhealthier) during the first wave of the COVID-19 pandemic; (ii) To identify the (sociodemographic) factors independently associated with changes into lifestyle (healthy/unhealthy); (iii) To explore possible differences in COVID-19-related lifestyle changes between CAM users and non-CAM users, and (iv) To determine the intention to continue lifestyle changes and the required support.

An international cross-sectional survey on CAM use and self-care strategies for prevention and treatment of COVID-19 related symptoms was carried out in Norway, Sweden and the Netherlands in spring 2020. The results of this international survey will be published elsewhere. This online survey consisted of a modified version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q) [ 20 ], and a country specific part on lifestyle for The Netherlands (it is the latter on which this paper reports). The modified I-CAM-Q consisted of four parts, and all parts related to CAM use during the past three COVID-19 pandemic months as did the Dutch part on lifestyle.

The modified I-CAM-Q included questions about visits to conventional and unconventional health care providers, self-management strategies such as use of natural remedies and self-help techniques such as mindfulness used within the last three months. The questions regarding specific therapies were adapted to The Netherlands ( supplementary material ).

The country specific part for the Netherlands included 26 questions divided into three sections on 1) current lifestyle related measures (alcohol use, smoking, daily consumption of certain foods, exercise, sleep, stress and meaning and purpose/spirituality), 2) lifestyle related changes since the COVID-19 outbreak and anxiety (section 1 and 2: 20 questions) and 3) intention to continue lifestyle changes and need for support (6 questions). For this study, we included six aspects of lifestyle with established effects on physical and mental health: nutrition, exercise, sleep, addiction, relaxation and meaning and purpose/spirituality.

In the Netherlands, an online survey was performed between May 22 and May 27, 2020 in collaboration with Ipsos Netherlands. An internal Ipsos tool (ISS) has been used to gather the respondents. The respondents registered into the IIS panel have shared their baseline information such as age,gender, region, and more specific information on education, income and work. From the panel of 45,000 Dutch residents, a representative sample (based on the baseline parameters) was invited to complete the questionnaire until 1000 responses were received (limit set due to costs). Individuals who were reached and refused participation ( n  = 3607) were considered non-respondents, leading to a response rate of 22%. The final sample contained 1004 individuals.

Taking into account multiple response biases, the questionnaire was designed as followed: 1) answer options were randomized. Meaning every participant will see the same answer options, but in different order, preventing primacy bias (to decrease the amount of times one answer can be chosen which might lead to survey results being too unfairly weighted towards one option), and 2) questions were formulated in a neutral way when asked about education level, salary, age and gender to prevent prestige/stereotype bias as much as possible. Respondents received a personal link (password/username) to prevent filling in the questionnaire more than one time or any self-selection bias would happen.

Demographic characteristics collected were gender, age, municipality of residence and county, income, and level of education. Income was classified as high (Euro 75,000 >), middle (Euro 25,000 – 74,999) and low income (< Euro 24,999). Education was classified as higher education ((applied) university/ post-doctoral level), secondary education (middle and higher secondary education) and lower education (no school/primary school only/lower secondary education).

All data was anonymously collected and reported. The anonymous nature of the web-survey did not allow to trace in any way sensitive personal data. The study protocol was reviewed by the Medical Ethical Reviewing Committee of Wageningen University. They decided that this study did not fall within the remit of the Dutch Medical Research Involving Human Subjects Act (WMO), and therefore was exempt from further medical ethical review. Informed consent was obtained from all participants and all patients agreed their data to be used for scientific publication. GDPR guidelines were taken into account [ 21 ]. Once completed, each questionnaire was transmitted to the survey platform, and the final database was downloaded.

The current paper reports on the country specific part of the survey using data of the I-CAM-Q, only to categorize users and non-users of CAM. Here, CAM use is defined as all treatments and (self) care strategies that are used in addition or as an alternative to the usual (regular) care of e.g. general practitioner, specialist, dietician, physiotherapist or nurse in the past 3 months.

Statistical analyses

Descriptive statistics like measures of central tendencies, frequencies and proportions were used to evaluate the responses. Data are represented as number and/or percentage for categorical variables or mean and standard deviation for continuous variables. Pearson’s Chi-square test and ANOVA tests were performed to identify differences in socio-demographics (age, education level, household income), as well as to identify differences in lifestyle/lifestyle changes between users and non-users of CAM.

Univariable and multivariable logistic regression was used to identify the (sociodemographic) factors independently associated with changes in lifestyle (healthy/unhealthy). Outcomes on changes in lifestyle questions were dichotomized. Change in lifestyle due to corona crisis: answer categories: Yes, I live healthier, Yes, I live unhealthier and No. Multivariable models were derived through several iterations using backward stepwise logistic regression, including all variables that were statistically significant in the univariable analyses. The authors controlled for age, gender and education in these models.

Statistics were carried out using Statistical Package for Social Sciences (SPSS) v. 26.0. Results were statistically significant for p value < 0.05.

A total of 1013 individuals completed the online questionnaire, and, after validation of the data, 1004 respondents (age 18–88 years) were included in the study. As shown in Table  1 , most respondents were between 50 to 69 years of age (37.5%), and female respondents represented 50.7% of the population sample. Respondents were distributed across the 12 provinces, with 27.3% from the northern regions of the Netherlands, 27.6% from the central regions of the Netherlands and 45.1% from the southern regions of the Netherlands. Of all respondents, 46.5% resided in urban zones, 23.8% in sub-urban zones and 24.9% in rural/sub-rural zones. Married respondents living with or without children accounted for the majority of sample distribution, making up to 63.3% of responses followed by individuals living alone without children (24.8%). Half of the respondents (49.9%) had a higher education status and 49.7% of respondents was categorized to have a middle income.

Lifestyle changes during the COVID-19 pandemic

Although the majority of the surveyed population reported no significant change in their daily habits or intake of food/snacks since the COVID-19 outbreak in the Netherlands, we found substantial lifestyle changes in a considerable part of the population, both for the better and the worse (see Table  2 ). 14.0% of all respondents reported a decrease in sleeping hours, while 13.0% reported an increase. One fifth (20.0%) of the respondents reported to snack more than before the COVID-19 pandemic, and 7.7% snacked less. Intake of vegetables increased in 11.7% whereas it decreased in 1.7%.

Table 2 shows that the majority did not know whether their stress levels had changed in relation to ‘the balance between work and childcare’ and ‘care for their family’, respectively 57.8 and 62.1%. 52.3% of the respondents indicated no change in stress related to their own health, but nearly a quarter (22.2%) did perceive more health-related stress or future perspective related stress (27.7%).

As shown in Tables  3 , 80% of the respondents reported that in general they were happy with their current lifestyle. 12.2% of the total population reported an unhealthier lifestyle since the outbreak of the COVID-19 pandemic, whereas 19.3%, ( n  = 194) indicated that the COVID-19 pandemic positively influenced their lifestyle (Table  3 ). The 194 respondents reported a healthier lifestyle due to a higher intake of fruit and vegetables (54.6%), exercise (63.4%), and relaxation (46.4%). Only a small proportion of the participants reported to live healthier due to a change in meaning of life aspects/spirituality (6.2%) (Table 3 ).

Remarkably, the number of respondents that thought that lifestyle changes can influence the natural history (symptoms) of COVID-19 once infected, was higher than the number of respondents that thought lifestyle changes can influence the risk of getting infected (Table 3 ). Nearly halve of respondents (48.2%) did not think that a change in their lifestyle could decrease their risk of getting infected by the corona virus (Table 3 ).

Factors independently associated with changes into lifestyle (healthy/unhealthy)

Table  4 shows the univariable statistically significant associated variables with a change to healthy- or unhealthy lifestyle that are entered into the multivariable analyses to come to the final models ( P  < 0.05). Based on univariable analyses, no statistically significant associations with a change to a healthy lifestyle were found with regards to age, gender, residential region, smoking, alcohol use, stress in relation to work and stress in relation to future perspectives. With regard to a change to an unhealthy lifestyle no statistically significant associations were found for gender, income level, living region, smoking, alcohol use, use of CAM and anxiety for getting infected their selves with Covid-19.

The final multivariate models (Table 4 ) included 1004/1004 (100%) of the respondents of the survey. Three predictors were strongly associated with changing into a healthy lifestyle: Worried/Anxious getting infected with SARS-coV-2 (OR: 1.56, 95% C.I. 1.26–1.93), CAM use (OR: 2.04, 95% C.I. 1.38–3.02) and stress in relation to financial situation (OR: 1.89, 95% C.I. 1.30–2.74). Together these gave an AUROC of 0.66 (95% CI = 0.63 to 0.71). Similarly, three predictors were strongly associated with changing into an unhealthy lifestyle: Age (OR 18–25: 1.00, OR 25–40: 0.55, 95% C.I. 0.31–0.96, OR 40–55:0.50 95% C.I. 0.28–0.87 OR 55+: 0.1095% C.I. 0.10–0.33), stress in relation to health (OR: 2.52, 95% C.I. 1.64–3.86) and stress in relation to the balance work and home (OR: 1.69, 95% C.I. 1.11–2.57). Together these gave an AUROC of 0.56 (95% C.I. 0.50–0.62)).

Differences in COVID-19-related lifestyle changes between CAM users and non-CAM users

Our multivariable model shows that CAM use is an important predictor of changing to a healthier lifestyle during the first wave of the COVID-19 pandemic and is not statistically significant associated with a change to an unhealthy lifestyle. More than two third (68%) of the respondents indicated use of CAM in the past 3 months. 13.3% of all respondents consulted a CAM practitioner (medical doctor or other (non) healthcare professional specialized in CAM, 59.4% used (CAM) supplements (e.g. vitamins/minerals, herbs, and/or dietary supplements) and 30% indicated to make use of (CAM) self-help techniques ((e.g. breathing exercises, yoga) (Table  5 ).

No statistically significant differences were found between non-CAM and CAM users with regards to mean age, residential region, marital status, education and yearly income. Lifestyle related behaviour measures as smoking, alcohol use and daily exercise were similarly distributed between the two groups. The younger aged (age < 30) and the elderly (age 65+) did make less use of CAM then those aged between 31 and 64 years old, as did men (male non-CAM users: 61.7%).

As shown in Tables  5 , 87.7 and 84.0% of the CAM users and non-CAM users respectively reported that in general they were happy with their current lifestyle. The proportion CAM users that changed into a healthier lifestyle influenced by the COVID-19 pandemic is bigger than the proportion of non-CAM users.

More than one third of the CAM users indicated to think changes in lifestyle could change their risk of getting infected with SARS-coV2 (38.1%), and 46.3% did also think that changing their lifestyle could influence the course of the illness once infected, compared to 40.3% of the non-CAM users and 44.8% of all participants. CAM users were statistically significant less anxious/worried to get infected with COVID-19 than non-CAM users.

In general, CAM users perceived more often an increase in stress than non-CAM users. Rather large differences were found between more stress in the previous three months in relation to work (CAM users: 23.1%, Non-CAM users: 12.3%, P  < 0.001), health (CAM users: 25.9%, Non-CAM users: 10.7%, P  < 0.001), balance work/childcare (CAM users: 12.0%, Non-CAM users: 7.0%, P  = 0.012)), financial situation (CAM users: 21.2%, Non-CAM users:10.7%, P  < 0.001)) and future perspective (CAM users: 33.8, Non-CAM users:16.9%, P  < 0.001)).

In the 3 months ahead of the survey, CAM users were more aware of their own diet habits than non-CAM users (CAM users: 18.8%, Non-CAM users: 9.1%, P  < 0.05).

Intention to continue lifestyle changes and the required support

This study provides information that may be relevant to policy makers, health insurances and research funding organizations to guide future decisions on lifestyle and COVID-19.

Table  6 shows that in general, more than halve of the 194 respondents who reported a positive change in their lifestyle since the start of the COVID-19 pandemic indicated the wish to continue their changes through healthy food (56.2%) and exercise (54.6%). Of the pre-defined options: 1) healthy choices at work/school (food, drinks, exercise during breaks e.g., yoga, tai chi, mindfulness) 2) free choice and reimbursement of any treatment in relation to CAM and Lifestyle; 3) support from GP/Health centre/Community care; 4) online advice and support, and 5) affordable and easilyaccessible healthy food, 55.8% of respondents declared needing none of these.

However, affordable and easily accessible healthy food was perceived as helpful by one third of the respondents (34.7%), followed by healthy choices at work/school and free choice and reimbursement of CAM and lifestyle treatments with respectively 17.2 and 16.0%.

Statistically significant more CAM users reported a desire to continue more activities regarding meaning of life/ spirituality/ (CAM users: 27.4%, Non-CAM users: 10.8%, P  = 0.03) in a post Covid-19 era.

This population-based study is a snapshot of the health related lifestyle changes of Dutch residents during the first wave of the COVID-19 pandemic which included nine weeks of Intelligent lockdown as declared by the Dutch Government. Our study seems to indicate that one fifth of the Dutch residents changed their lifestyle into a healthier one and that this was mainly due to healthier food habits, more exercise and more relaxation. More than half of these respondents reported to be motivated to maintain this behaviour change in a post-COVID-19 era. Around 10% of the total study population, on the other hand, admitted to have started living unhealthier due to the corona crisis. 35% of respondents thought that a lifestyle change could change their risk of getting infected by the corona virus and nearly half of the total group thought this change could influence the course of the illness once infected.” Our study also shows that CAM use is an important predictor of changing to a healthier lifestyle during the first wave of the COVID-19 pandemic. The use of CAM and healthy lifestyle has been associated previously [ 15 , 16 , 17 , 18 ], and our results confirm this positive association.

Regardless of the time and context within one decides to eat better, exercise more, or be less stressed, it can be hard to make a lifestyle change, and even harder to make it a habit [ 22 ]. Life changing events might provide a unique opportunity to live healthier and to continue these changes [ 23 ]. Since the outbreak of the novel coronavirus disease (COVID-19) in China, the world is in the grip of a coronavirus pandemic, a unique crisis with disastrous health, societal and economic effects worldwide [ 24 ]. The Corona crisis is said to be the biggest crises since World War III in the Netherlands and is expected to change the way we think and live at individual and societal levels.

A large part of non-communicable diseases is caused by unhealthy behaviour [ 20 , 25 , 26 ]. Addressing modifiable risks such as tobacco use, physical inactivity, unhealthy diet and harmful use of alcohol are among most effective interventions to keep people healthy and productive, reducing the individual, societal and economic impact and suffering caused by non-communicable diseases [ 20 , 25 , 26 ]. Nearly 20% of our respondents indicated that the COVID-19 pandemic positively influenced their lifestyle. This is a positive finding from a public health perspective, in which the importance of a healthier lifestyle to prevent chronic and non-communicable diseases is emphasized. A comparable percentage among a representative sample of the general population of Italy surveyed in the first months of 2020 was found to change to a healthier lifestyle. The survey in Italy further revealed that most of the Italian respondents declared not to have changed its habits (46.1%) (compared to 68% of our respondents), while 37.2% (compared to 12% of our respondents) felt to have made them worse [ 27 ]. This latter difference might be due to the difference in lockdown, with a stricter one in Italy.

Although healthy lifestyles offer a number of health benefits, non- adherence to recommended lifestyle changes remains a frequent and difficult obstacle to realizing these benefits [ 28 , 29 ]. It is therefore promising that of this representative sample of the Dutch population, more than half who changed into a healthier lifestyle indicates to be willing to maintain to these new habits. A US poll has found that as many as 80% of American adults will try to practice self-care more regularly once the COVID-19 pandemic is over [ 30 ]. The prospect of improving health and reducing illness through changes in living habits rather than through curative healthcare, is attractive from the perspective of public health and on economic grounds.

Our final multivariable model for changing into a healthy lifestyle showed positive associations with: (i) anxiety to get infected with SARs-coV-2; (ii) the use of CAM; and (iii) stress with regards to financial situation. Taylor et al. (2020) recently developed the COVID stress Scales (CSS) and identified five factors of stress and anxiety symptoms relating to the coronavirus in two large samples in Canada and the United States including ‘danger and contamination’ and ‘fears about economic consequences’. Two predictive factors (anxiety to get infected with SARs-coV-2 and stress with regards to financial situation) we found to be positively associated with a change into a healthy lifestyle. Previously, Anderson et al. showed that occurrence of life events and subsequent effects, can contribute to health promoted behaviour despite the potential worries, poor health and diseases which may also be associated with them [ 23 ].

Analyses of data from the National Health Interview Study (NHIS) found that CAM users were more likely to use exercise and less likely to be obese than those who did not use CAM [ 15 , 16 ]. Associations of CAM with exercise [ 15 , 16 , 31 , 32 ], higher vegetable intake [ 31 , 32 , 33 ], lower fat or lipid intake [ 31 , 32 , 33 ], and smoking cessation or decreased smoking [ 16 , 31 , 34 ] have been reported previously. These studies, like ours, show a commitment to overall wellbeing that spans both lifestyle and CAM use and hypothesise that CAM therapies may even be used as a gateway to healthy lifestyle. Concurrent use of the two modalities should be investigated further in various populations. Moreover, CAM users in our study indicated to favour support of policy driven decisions related to a healthy lifestyle, consequently, a focus on the Dutch CAM users could work as a gateway to a healthier lifestyle for the general population.

On the other hand, younger age and stress regarding health and the balance between work and family life were found to be positively associated (final multivariable model) with a change into an unhealthy lifestyle. Our data shows that especially younger age was a risk factor for a change into an unhealthier direction. The fact that the young generation seems to be more prone might be due to fact that the restrictions as home confinement during the pandemic has especially impacted their lives by home schooling, working from home and balancing work and childcare (parents) causing a long period of stress resulting into an unhealthier lifestyle. Heightened life stress has been linked to unhealthy eating [ 35 , 36 ] and stressed people are more likely to crave food high in energy, fats, and sugars [ 37 ]. Moreover, parenting is found to be stressful under normative circumstances but pandemic-related data indicate that COVID-19 has led to significant increases in the population’s general stress, a change felt even more acutely for parents than their non-parent counterparts [ 38 ]. The results obtained by our study are relevant if we consider that people with stress in relation to balancing work and family care have a 1.7 higher chance of changing into an unhealthy lifestyle than people not perceiving this specific stress.

Some strengths and limitations of this study need to be noted.

Our study has been strengthened by the fact that the survey was conducted during the first critical period of the epidemic in the Netherlands. Responses from over 1000 individuals were rapidly collected within a period of five days from a representative sample of the population. Another strength is that our sample size was sufficiently large for detecting correlations. A limitation of this study is the rather low response rate of 22% to the survey, increasing the risk of non-response bias. Furthermore, because of the urgency to rapidly assess lifestyle changes in a very critical period of the pandemic, the questionnaire was not first piloted among a smaller sample. Although the research team carefully developed and selected life-style related questions and thoroughly discussed comprehensiveness, flow and clarity of the survey, it is not known whether the questionnaire was fully understandable and acceptable for the target population. Another limitation includes the fact that the results are limited by a self-reported questionnaire. The assessment of lifestyle changes was based on individual recall methods, and not by direct measurement of dietary and sleeping pattern, smoking and alcohol consumption. Respondents may thus have either overestimated or underestimated their changes in behaviour. An obvious other limitation of a cross-sectional study design is that it does not allow causal inferences about relationships and thus limits any claim about the directionality of the results. Last, no data on comorbidities (e.g. diabetes, hypertension and obesity) were gathered for the purpose of this study, which might limit the results. Linking with GP data on comorbidities would strengthen future research [ 15 , 16 , 31 , 32 ].

The COVID-19 pandemic and following Intelligent lockdown provides an unique window of opportunity to improve lifestyle habits on a population level. This is not only important to combat COVID-19 but also the other pandemic; of obesity and other non-communicable lifestyle-related disease. For a part of the Dutch population, the Corona crisis has already brought a shift in thinking, working and lifestyle behaviour, another large part is now motivated to make such changes. From a public health perspective, it is important to use this unique situation optimally and immediately as this increased motivation is crucial to obtain sustainable lifestyle changes, but may disappear quickly once COVID-19 wanes off. Strategies may include investing in prevention and education (e.g. smoking, drugs, alcohol), health campaigns, lowering taxes on healthy foods and sponsorship of sport facilities. Further studies are warranted to see whether this behavioural change is maintained over time, and how (changing) lifestyle behaviour can affect the susceptibility for and the course of COVID-19. Finally, the results of this study are in line with others showing the potential synergistic relationship between CAM use and healthy lifestyle behaviours [ 15 , 16 , 31 , 32 ]. This relation could be targeted in future interventions to increase general wellbeing, symptom control, and clinical outcomes in at-risk populations and might be used as a potential translatable strategy to increase healthy lifestyle behaviours in general populations.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Complementary and Alternative Medicine

Confidence interval

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Acknowledgements

We would like to thank Barbara Wider Vellinga for her assistance with survey development.

This study was funded by co-funding of Triodos Foundation, Fred Foundation, Association of Homeopathy, Iona Foundation and the Artsen Vereniging Integrale Geneeskunde (AVIG)).

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EvdW and MB designed the study. EvdW analysed the data and drafted the manuscript. RH,MB and MJ provided critical feedback for revisions. The authors read and approved the final manuscript.

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van der Werf, E.T., Busch, M., Jong, M.C. et al. Lifestyle changes during the first wave of the COVID-19 pandemic: a cross-sectional survey in the Netherlands. BMC Public Health 21 , 1226 (2021). https://doi.org/10.1186/s12889-021-11264-z

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The effects of social isolation on well-being and life satisfaction during pandemic

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• Maya Gordon 1 ,
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• Carolyn Reilly 1  

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The SARS-CoV-2 pandemic placed many locations under ‘stay at home” orders and adults simultaneously underwent a form of social isolation that is unprecedented in the modern world. Perceived social isolation can have a significant effect on health and well-being. Further, one can live with others and still experience perceived social isolation. However, there is limited research on psychological well-being during a pandemic. In addition, much of the research is limited to older adult samples. This study examined the effects of perceived social isolation in adults across the age span. Specifically, this study documented the prevalence of social isolation during the COVID-19 pandemic as well as the various factors that contribute to individuals of all ages feeling more or less isolated while they are required to maintain physical distancing for an extended period of time. Survey data was collected from 309 adults who ranged in age from 18 to 84. The measure consisted of a 42 item survey from the Revised UCLA Loneliness Scale, Measures of Social Isolation (Zavaleta et al., 2017 ), and items specifically about the pandemic and demographics. Items included both Likert scale items and open-ended questions. A “snowball” data collection process was used to build the sample. While the entire sample reported at least some perceived social isolation, young adults reported the highest levels of isolation, χ 2 (2) = 27.36, p  < 0.001. Perceived social isolation was associated with poor life satisfaction across all domains, as well as work-related stress, and lower trust of institutions. Higher levels of substance use as a coping strategy was also related to higher perceived social isolation. Respondents reporting higher levels of subjective personal risk for COVID-19 also reported higher perceived social isolation. The experience of perceived social isolation has significant negative consequences related to psychological well-being.

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Social activity promotes resilience against loneliness in depressed individuals: a study over 14-days of physical isolation during the COVID-19 pandemic in Australia

Introduction.

In March 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic, prompting most governors in the United States to issue stay-at-home orders in an effort to minimize the spread of COVID-19. This was after several months of similar quarantine orders in countries throughout Asia and Europe. As a result, a unique situation arose, in which most of the world’s population was confined to their homes, with only medical staff and other essential workers being allowed to leave their homes on a regular basis. Several studies of previous quarantine episodes have shown that psychological stress reactions may emerge from the experience of physical and social isolation (Brooks et al., 2020 ). In addition to the stress that might arise with social isolation or being restricted to your home, there is also the stress of worrying about contracting COVID-19 and losing loved ones to the disease (Brooks et al., 2020 ; Smith and Lim, 2020 ). For many families, this stress is compounded by the challenge of working from home while also caring for children whose schools had been closed in an effort to slow the spread of the disease. While the effects of social isolation has been reported in the literature, little is known about the effects of social isolation during a global pandemic (Galea et al., 2020 ; Smith and Lim, 2020 ; Usher et al., 2020 ).

Social isolation is a multi-dimensional construct that can be defined as the inadequate quantity and/or quality of interactions with other people, including those interactions that occur at the individual, group, and/or community level (Nicholson, 2012 ; Smith and Lim, 2020 ; Umberson and Karas Montez, 2010 ; Zavaleta et al., 2017 ). Some measures of social isolation focus on external isolation which refers to the frequency of contact or interactions with other people. Other measures focus on internal or perceived social isolation which refers to the person’s perceptions of loneliness, trust, and satisfaction with their relationships. This distinction is important because a person can have the subjective experience of being isolated even when they have frequent contact with other people and conversely they may not feel isolated even when their contact with others is limited (Hughes et al., 2004 ).

When considering the effects of social isolation, it is important to note that the majority of the existing research has focused on the elderly population (Nyqvist et al., 2016 ). This is likely because older adulthood is a time when external isolation is more likely due to various circumstances such as retirement, and limited physical mobility (Umberson and Karas Montez, 2010 ). During the COVID-19 pandemic the need for physical distancing due to virus mitigation efforts has exacerbated the isolation of many older adults (Berg-Weger and Morley, 2020 ; Smith et al., 2020 ) and has exposed younger adults to a similar experience (Brooks et al., 2020 ; Smith and Lim, 2020 ). Notably, a few studies have found that young adults report higher levels of loneliness (perceived social isolation) even though their social networks are larger (Child and Lawton, 2019 ; Nyqvist et al., 2016 ; Smith and Lim, 2020 ); thus indicating that age may be an important factor to consider in determining how long-term distancing due to COVID-19 will influence people’s perceptions of being socially isolated.

The general pattern in this research is that increased social isolation is associated with decreased life satisfaction, higher levels of depression, and lower levels of psychological well-being (Cacioppo and Cacioppo, 2014 ; Coutin and Knapp, 2017 ; Dahlberg and McKee, 2018 ; Harasemiw et al., 2018 ; Lee and Cagle, 2018 ; Usher et al., 2020 ). Individuals who experience high levels of social isolation may engage in self-protective thinking that can lead to a negative outlook impacting the way individuals interact with others (Cacioppo and Cacioppo, 2014 ). Further, restricting social networks and experiencing elevated levels of social isolation act as mediators that result in elevated negative mood and lower satisfaction with life factors (Harasemiw et al., 2018 ; Zheng et al., 2020 ). The relationship between well-being and feelings of control and satisfaction with one’s environment are related to psychological health (Zheng et al., 2020 ). Dissatisfaction with one’s home, resource scarcity such as food and self-care products, and job instability contribute to social isolation and poor well-being (Zavaleta et al., 2017 ).

Although there are fewer studies with young and middle aged adults, there is some evidence of a similar pattern of greater isolation being associated with negative psychological outcomes for this population (Bergin and Pakenham, 2015 ; Elphinstone, 2018 ; Liu et al., 2019 ; Nicholson, 2012 ; Smith and Lim, 2020 ; Usher et al., 2020 ). There is also considerable evidence that social isolation can have a detrimental impact on physical health (Holt-Lunstad et al., 2010 ; Steptoe et al., 2013 ). In a meta-analysis of 148 studies examining connections between social relationships and risk of mortality, Holt-Lunstad et al. ( 2010 ) concluded that the influence of social relationships on the risk for death is comparable to the risk caused by other factors like smoking and alcohol use, and greater than the risk associated with obesity and lack of exercise. Likewise, other researchers have highlighted the detrimental impact of social isolation and loneliness on various illnesses, including cardiovascular, inflammatory, neuroendocrine, and cognitive disorders (Bhatti and Haq, 2017 ; Xia and Li, 2018 ). Understanding behavioral factors related to positive and negative copings is essential in providing health guidance to adult populations.

Feelings of belonging and social connection are related to life satisfaction in older adults (Hawton et al., 2011 ; Mellor et al., 2008 ; Nicholson, 2012 ; Victor et al., 2000 ; Xia and Li, 2018 ). While physical distancing initiatives were implemented to save lives by reducing the spread of COVID-19, these results suggest that social isolation can have a negative impact on both mental and physical health that may linger beyond the mitigation orders (Berg-Weger and Morley, 2020 ; Brooks et al., 2020 ; Cava et al., 2005 ; Smith et al., 2020 ; Usher et al., 2020 ). It is therefore important that we document the prevalence of social isolation during the COVID-19 pandemic as well as the various factors that contribute to individuals of all ages feeling more or less isolated, while they are required to maintain physical distancing for an extended period of time. It was hypothesized that perceived social isolation would not be limited to an older adult population. Further, it was hypothesized that perceived social isolation would be related to individual’s coping with the pandemic. Finally, it was hypothesized that the experience of social isolation would act as a mediator to life satisfaction and basic trust in institutions for individuals across the adult lifespan. The current study was designed to examine the following research questions:

Are there age differences in participants’ perceived social isolation?

Do factors like time spent under required distancing and worry about personal risk for illness have an association with perceived social isolation?

Is perceived social isolation due to quarantine and pandemic mitigation efforts related to life satisfaction?

Is there an association between perceived social isolation and trust of institutions?

Is there a difference in basic stressors and coping during the pandemic for individuals experiencing varying levels of perceived social isolation?

Participants

Participants were adults age 18 years and above. Individuals younger than 18 years were not eligible to participate in the study. There were no limitations on occupation, education, or time under mandatory “stay at home” orders. The researchers sought a sample of adults that was diverse by age, occupation, and ethnicity. The researchers sought a broad sample that would allow researchers to conduct a descriptive quantitative survey study examining factors related to perceived social isolation during the first months of the COVID-19 mitigation efforts.

Participants were asked to complete a 42-item electronic survey that consisted of both Likert-type items and open-ended questions. There were 20 Likert scale items, 3 items on a 3-point scale (1 = Hardly ever to 3 = Often) and 17 items on a 5-point scale (1 = Not at all satisfied to 4 = very satisfied, 0 = I don’t know), 11 multiple choice items, one of which had an available short response answer, and 11 short answer items.

Items were selected from Measures of Social Isolation (Zavaleta et al., 2017 ) that included 27 items to measure feelings of social isolation through the proxy variables of stress, trust, and life satisfaction. Trust was measured for government, business, and media. Life satisfaction examined overall feelings of satisfaction as well as satisfaction with resources such as food, housing, work, and relationships. Three items related to social isolation were chosen from the Revised UCLA Loneliness Scale. Hughes et al. ( 2004 ) reported that these three items showed good psychometric validity and reliability for the construct of Loneliness.

There were a further 12 items from the authors specifically about circumstances regarding COVID-19 at the time of the survey. Participants answered questions about the length of time spent distancing from others, level of compliance with local regulations, primary news sources, whether physical distancing was voluntary or mandatory, how many people are in their household, work availability, methods of communication, feelings of personal risk of contracting COVID-19, possible changes in behavior, coping methods, stressors, and whether there are children over the age of 18 staying in the home.

This study was submitted to the Cabrini University Institutional Review Board and approval was obtained in March 2020. Researchers recruited a sample of people that varied by age, gender, and ethnicity by identifying potential participants across academic and non-academic settings using professional contact lists. A “snowball” approach to data gathering was used. The researchers sent the survey to a broad group of adults and requested that the participants send the survey to others they felt would be interested in taking part in research. Recipients received an email that contained a description of the purpose of the study and how the data would be used. Included at the end of the email was a link to the online survey that first presented the study’s consent form. Participants acknowledged informed consent and agreed to participate by opening and completing the survey.

At the end of the survey, participants were given the opportunity to supply an email to participate in a longitudinal study which consists of completing surveys at later dates. In addition, the sample was asked to forward the survey to their contacts who might be interested. Overall, the study took ~10 min to complete.

Demographics

Participants were 309 adults who ranged in age from 18 to 84 ( M  = 38.54, s  = 18.27). Data was collected beginning in 2020 from late March until early April. At the time of data collection distancing mandates were in place for 64.7% and voluntary for 34.6% of the sample, while 0.6% lived in places which had not yet outlined any pandemic mitigation policies. The average length of time distancing was slightly more than 2 weeks ( M  = 14.91 days, s  = 4.5) with 30 days as the longest reported time.

The sample identified mostly as female (80.3%), with males (17.8%) and those who preferred not to answer (1.9%) representing smaller numbers. The majority of the sample identified as Caucasian (71.5%). Other ethnic identities reported by participants included Hispanic/Latinx, African-American/Black, Asian/East Asian, Jewish/Jewish White-Passing, Multiracial/Multiethnic, and Country of Origin (Table 1 ). Individuals resided in the United States and Europe.

The majority of the sample lived in households with others (Fig. 1 ). More than one-third (36.7%) lived with one other person, 19.7% lived with two others, and 21% lived with three other people. People living alone comprised 12.1% of the sample. When asked about the presence of children under 18 years of age in the home, 20.5% answered yes.

Figure shows how many additional individuals live in the participant’s household in March 2020.

The highest level of education attained ranged from completion of lower secondary school (0.3%) to doctoral level (6.8%). Two thirds of the sample consisted of individuals with a Bachelor’s degree or above (Table 2 ).

Participants were asked to provide their occupation. The largest group identified themselves as professionals (26.5%), while 38.6% reported their field of work (Table 3 ). Students comprised 23.1% of the sample, while 11.1% reported that they were retired. Some of the occupations reported by the sample included nurses and physicians, lawyers, psychologists, teachers, mental health professionals, retail sales, government work, homemakers, artists across types of media, financial analysts, hairdresser, and veterinary support personnel. One person indicated that they were unemployed prior to the pandemic.

Social isolation and demographics

Spearman’s rank-order correlations were used to examine relationships between the three Likert scale items from the Revised UCLA Loneliness Scale that measure social isolation. Feeling isolated from others was significantly correlated with lacking companionship ( r s = 0.45, p  < 0.001) and feeling left out ( r s = 0.43, p  < 0.001). The items related to lacking companionship and feeling left out were also significantly correlated ( r s = 0.39, p  < 0.001).

Kruskal–Wallis tests were conducted to determine if the variables of time in required distancing and age were each related to the three levels of social isolation (hardly, sometimes, often). There were no significant findings between perceived social isolation and length of time in required distancing, χ 2 (2) = 0.024, p  = 0.98.

A significant relationship was found between perceived social isolation and age, χ 2 (2) = 27.36, p  < 0.001). Subsequently, pairwise comparisons were performed using Dunn’s procedure with a Bonferroni correction for multiple comparisons. Adjusted p values are presented. Post hoc analysis revealed statistically significant differences in age between those with high levels of social isolation (Mdn = 25) and some social isolation (Mdn = 31) ( p  = <0.001) and low isolation (Mdn = 46) ( p  = 0.002). Higher levels of social isolation were associated with younger age.

Age was then grouped (18–29, 30–49, 50–69, 70+) and a significant relationship was found between social isolation and age, χ 2 (3) = 13.78, p  = 0.003). Post hoc analysis revealed statistically significant differences in perceived social isolation across age groups. The youngest adults (age 18–29) reported significantly higher social isolation (Mdn = 2.4) than the two oldest groups (50–69 year olds: Mdn = 1.6, p  = 004); age 70 and above: Mdn = 1.57), p  = 0.01). The difference between the youngest adults and the next youngest (30–49) was not significant ( p  = 0.09).

When asked if participants feel personally at risk for contracting SARS-CoV-2 61.2% reported that they feel at risk. A Mann–Whitney U test was conducted to compare social isolation experienced by those who reported feeling at risk and those who did not feel at risk. Individuals who feel at risk for infection reported more social isolation (Mdn = 2.0) than those that do not feel at risk (Mdn = 1.75), U  = 9377, z  = −2.43, p  = 0.015.

Social isolation and life satisfaction

The relationship between level of social isolation and overall life satisfaction were examined using Kruskal–Wallis tests as the measure consisted of Likert-type items (Table 4 ).

Overall life satisfaction was significantly lower for those who reported greater social isolation ( χ 2 (2) = 50.56, p  < 0.001). Post hoc analysis revealed statistically significant differences in life satisfaction scores between those with high levels of social isolation (Mdn = 2.82) and some social isolation (Mdn = 3.04) ( p  ≤ 0.001) and between high and low isolation (Mdn = 3.47) ( p  ≤ 0.001), but not between high levels of social isolation and some social isolation ( p  = 0.09).

The pandemic added concern about access to resources such as food and 68% of the sample reported stress related to availability of resources. A significant relationship was found between social isolation and satisfaction with access to food, χ 2 (2) = 21.92, p  < 0.001). Individuals reporting high levels of social isolation were the least satisfied with their food situation. Statistical difference were evident between high social isolation (Mdn = 3.28) and some social isolation (Mdn = 3.46) ( p  = 0.003) and between high and low isolation (Mdn = 3.69) ( p  < 0.001). Reporting higher levels of social isolation is associated with lower satisfaction with food.

As a result of stay at home orders, many participants were spending more time in their residences than prior to the pandemic. A significant relationship was found between social isolation and housing satisfaction, χ 2 (2) = 10.33, p  = 0.006). Post hoc analysis revealed statistically a significant difference in housing satisfaction between those with high levels of social isolation (Mdn = 3.49) and low social isolation (Mdn = 3.75) ( p  = 0.006). Higher levels of social isolation is associated with lower levels of satisfaction with housing.

Work life changed for many participants and 22% of participants reported job loss as a result of the pandemic. A significant relationship was found between social isolation and work satisfaction, χ 2 (2) = 21.40, p  < 0.001). Post hoc analysis revealed individuals reporting high social isolation reported much lower satisfaction with work (Mdn = 2.53) than did those reporting low social isolation (Mdn = 3.27) ( p  < 0.001) and moderate social isolation (Mdn = 3.03) ( p  = 0.003).

Social isolation and trust of institutions

The relationship between social isolation and connection to community was measured using a Kruskal–Wallis test. A significant relationship was found between feelings of social isolation and connection to community ( χ 2 (2) = 13.97, p  = 0.001. Post hoc analysis revealed a statistically significant difference in connection to community such that the group reporting higher social isolation (Mdn = 2.27, p  = 0.001) reports less connection to their community than the group reporting low social isolation (Mdn = 2.93).

A significant relationship was found between social isolation and trust of central government institutions, χ 2 (2) = 10.46, p  = 0.005). Post hoc analysis revealed a statistically significant difference in trust of central government between individuals reporting low social isolation (Mdn = 2.91) and those reporting high social isolation (Mdn = 2.32) ( p  = 0.008) and moderate social isolation (Mdn = 2.48) ( p  = 0.03). There was less trust of central government for the group reporting high social isolation. However, distrust of central government did not extend to local government institutions. There was no significant difference in trust of local government for low, moderate, and high social isolation groups, χ 2 (2) = 5.92, p  = 0.052.

Trust levels of business was significantly different between groups that differed in feelings of social isolation, χ 2 (2) = 9.58, p  = 0.008). Post hoc analysis revealed more trust of business institutions for the low social isolation group (Mdn = 3.10) compared to the group reporting high social isolation (Mdn = 2.62) ( p  = 0.007).

Sixty-seven participants reported loss of a job as a result of COVID-19. A Mann–Whitney U test was conducted to compare social isolation experienced by those who had lost their job to those who had not. Individuals who experienced job loss reported more social isolation (Mdn = 2.26) than those that did not lose their job (Mdn = 1.80), U  = 5819.5, z  = −3.66 , p  < 0.001.

Stress related to caring for an elderly family member was identified by 12% of the sample. A Mann–Whitney U test was conducted to compare social isolation experienced by those who reported that caring for an elderly family member is a stressor to those who had not. There was no significant finding, U  = 4483, z  = −1.28, p  = 0.20. Similarly, there was no significant effect for caring for a child, U  = 3568.5, z  = −0.48, p  = 0.63.

Coping strategies

Participants were asked to check off whether they were using virtual communication, exercise, going outdoors, and/or substances in order to cope with the challenges of distancing during pandemic. A Mann–Whitney U test was conducted to compare social isolation experienced by those who used substances as a coping strategy and those that did not. Individuals who reported substance use reported more social isolation (Mdn = 2.12) than those that did not (Mdn = 1.80), U  = 6724, z  = −2.01, p  = 0.04.

There was no significant difference on Mann–Whitney U test for social isolation between those individuals who went outdoors to cope with pandemic versus those that did not, U  = 5416, z  = −0.72, p  = 0.47. Similarly, there was no difference in social isolation between those individuals who used exercise as a coping tool and those that did not. Finally, there was no difference in social isolation between those that used virtual communication tools and those that did not, U  = 7839.5, z  = −0.56, p  = 0.58. The only coping strategy which was significantly associated with social isolation was substance use.

While research has explored the subjective experience of social isolation, the novel experience of mass physical distancing as a result of the SARS-CoV-2 pandemic suggests that social isolation is a significant factor in the public health crisis. The experience of social isolation has been examined in older populations but less often in middle-age and younger adults (Brooks et al., 2020 ; Smith and Lim, 2020 ). Perceived social isolation is related to numerous negative outcomes related to both physical and mental health (Bhatti and Haq, 2017 ; Holt-Lunstad et al., 2010 , Victor et al., 2000 ; Xia and Li, 2018 ). Our findings indicate that younger adults in their 20s reported more social isolation than did those individuals aged 50 and older during physical distancing. This supports the findings of Nyqvist et al. ( 2016 ) that found teenagers and young adults in Finland reported greater loneliness than did older adults.

The experience of social isolation is related to a reduction in life satisfaction. Previous research has shown that feelings of social connection are related to general life satisfaction in older adults (Hawton et al., 2011 , Hughes et al., 2004 , Mellor et al., 2008 ; Victor et al., 2000 , Xia and Li, 2018 ). These findings indicate that perceived social isolation can be a significant mediator in life satisfaction and well-being across the adult lifespan during a global health crisis. Individuals reporting higher levels of social isolation experience less satisfaction with the conditions in their home.

During mandated “stay-at-home” conditions, the experience of work changed for many people. For many adults work is an essential aspect of identity and life satisfaction. The experience of individuals reporting elevated social isolation was also related to lower satisfaction with work. This study included a wide span of occupations involving both individuals required to work from home and essential workers continuing to work outside the home. Further, ~22% of the sample ( n  = 67) reported job loss as a stressor related to the SARS-CoV-2 pandemic and reported elevated social isolation. As institutions and businesses consider whether remote work is an economically viable alternative to face-to-face offices once physical distancing mandates are ended, the needs of workers for social interaction should be considered.

Further, individuals reporting higher social isolation also indicated less connection to their community and lower satisfaction with environmental factors such as housing and food. Findings indicate that higher perceived social isolation is associated with broad dissatisfaction across social and life domains and perceptions of personal risk from COVID-19. This supports research that identified a relationship between social isolation and health-related quality of life outcomes (Hawton et al., 2011 , Victor et al., 2000 ). Perceptions of elevated social isolation are related to lower life satisfaction in functional and social domains.

Perceived social isolation is likewise related to trust of some institutions. While there was no effect for local government, individuals with higher perceived social isolation reported less trust of central government and of business. There is an association between higher levels of perceived social isolation and less connection to the community, lower life satisfaction, and less trust of large-scale institutions such as central government and businesses. As a result, the individuals who need the most support may be the most suspicious of the effectiveness of those institutions.

Coping strategies related to exercise, time spent outdoors, and virtual communication were not related to social isolation. However, individuals who reported using substances as a coping strategy reported significantly higher social isolation than did the group who did not indicate substance use as a coping strategy. Perceived social isolation was associated with negative coping rather than positive coping. This study shows that clinicians and health care providers should ask about coping strategies in order to provide effective supports for individuals.

There are several limitations that may limit the generalizability of the findings. The study is heavily female and this may have an effect on findings. In addition, the majority of the sample has a post-secondary degree and, as such, this study may not accurately reflect the broad experience of individuals during pandemic. Further, it cannot be ruled out that individuals reporting high levels of perceived social isolation may have experienced some social isolation prior to the pandemic.

Conclusions

In conclusion, this study suggests that perceived social isolation is a significant element of health-related quality of life during pandemic. Perceived social isolation is not just an issue for older adults. Indeed, young adults appear to be suffering greatly from the distancing required to reduce the spread of SARS-CoV-2. The experience of social isolation is associated with poor life satisfaction across domains, work-related stress, lower trust of institutions such as central government and business, perceived personal risk for COVID-19, and higher levels of use of substances as a coping strategy. Measuring the degree of perceived social isolation is an important addition to wellness assessments. Stress and social isolation can impact health and immune function and so reducing perceived social isolation is essential during a time when individuals require strong immune function to fight off a novel virus. Further, it is anticipated that these widespread effects may linger as the uncertainty of the virus continues. As a result, we plan to follow participants for at least a year to examine the impact of SARS-CoV-2 on the well-being of adults.

Data availability

The dataset generated during and analyzed during the current study is not publicly available due to ethical restrictions and privacy agreements between the authors and participants.

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Clair, R., Gordon, M., Kroon, M. et al. The effects of social isolation on well-being and life satisfaction during pandemic. Humanit Soc Sci Commun 8 , 28 (2021). https://doi.org/10.1057/s41599-021-00710-3

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Received : 29 August 2020

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DOI : https://doi.org/10.1057/s41599-021-00710-3

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Fitter, better rested, more appreciative: research reveals the positive changes experienced by some during lockdown

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Lynn Williams has received funding from the Scottish Government's Chief Scientist Office.

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National lockdowns have been the most profound and significant public health interventions within living memory. They have been difficult socially and economically, and have negatively affected people’s health in many different ways .

But for some people lockdowns have provided an unexpected opportunity to make positive changes to their lives, running counter to prevailing narratives of disrupted daily lives, health inequalities and damaged mental health .

In May 2020, my colleagues and I surveyed over 3,000 people in Scotland to find out what positive changes people had made in their lives during the lockdown period. We also wanted to find out who had made these positive changes, to see if there were particular groups that were more able to do this than others.

In the survey, we assessed the positive changes that people had experienced across a number of different aspects of their lives since the start of lockdown. There were questions about whether people had experienced positive changes in relationships with family and friends and in the wider community. We also asked about beneficial changes in people’s behaviour relating to their health, including physical activity and sleep.

More than half the people we surveyed reported these changes for the better: being more appreciative of things usually taken for granted (reported by 83% of participants), having more time to do enjoyable things (by 67%), spending more time in nature or outdoors (by 65%), paying more attention to personal health (by 62%), doing more physical activity (by 54%) and spending more time with a partner or spouse (by 53%).

An Australian study (still in preprint, meaning its findings are yet to be reviewed by other scientists) also sought to find out similar information. In a survey of over 1,000 people, it found that 70% of participants reported having experienced at least one positive effect of the pandemic. Three main positive effects noted in this survey were: having the opportunity to spend more time with family, having greater flexibility in working arrangements and appreciating having a less busy life.

The important role of time was highlighted across both studies. Lockdown has removed many of life’s routines and demands – and for some people this has afforded them more time to spend on activities they enjoyed and valued. Noticing that how we spend time has changed – and thinking about what we can do with any additional time that we have – may be an important first step in making positive changes to our lives during lockdown.

People also noted being more appreciative of things previously taken for granted and the slower pace of life that lockdown has brought. For many people, this may have enabled them to step back and reflect on their lives, their futures and what is important to them in a way that they would not otherwise have the opportunity to do, without the demands of daily commutes or social commitments.

Positive changes not universal

Turning to who experienced the positive changes, our study revealed that the groups with higher levels of positive change were women, younger people, people who were married or living with their partner, those who were employed and those reporting better health. These findings suggest that while some groups were able to take advantage of lockdown as an unexpected opportunity to make positive changes in their lives, others – such as older adults and those living on their own – were not.

We were also interested in finding out what would happen to the positive changes that people had made once restrictions started lifting. Would they be able to keep them up? In a separate paper , based on the same group of participants, we examined the changes that people had made to their physical activity, sitting and sleep during the first national lockdown period and whether they had maintained these two months later, once restrictions had been eased.

The good news was that half of the participants who reported positive changes in their behaviours during lockdown were able to keep these going once restrictions were eased. Some were even able to improve them further. So, while we are currently experiencing another period of national lockdown in the UK, it’s reassuring to know that some positives could emerge.

However, we should keep in mind that winter, the new strains of the virus circulating and being over a year into the pandemic will all give this lockdown a different feel to last spring’s, and that this might have an influence on what positive changes people are able to make and sustain. But as we think ahead to the post-pandemic recovery phase, the lesson from our research is that there are definitely some changes people will want to keep.

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In Their Own Words, Americans Describe the Struggles and Silver Linings of the COVID-19 Pandemic

The outbreak has dramatically changed americans’ lives and relationships over the past year. we asked people to tell us about their experiences – good and bad – in living through this moment in history..

Pew Research Center has been asking survey questions over the past year about Americans’ views and reactions to the COVID-19 pandemic. In August, we gave the public a chance to tell us in their own words how the pandemic has affected them in their personal lives. We wanted to let them tell us how their lives have become more difficult or challenging, and we also asked about any unexpectedly positive events that might have happened during that time.

The vast majority of Americans (89%) mentioned at least one negative change in their own lives, while a smaller share (though still a 73% majority) mentioned at least one unexpected upside. Most have experienced these negative impacts and silver linings simultaneously: Two-thirds (67%) of Americans mentioned at least one negative and at least one positive change since the pandemic began.

For this analysis, we surveyed 9,220 U.S. adults between Aug. 31-Sept. 7, 2020. Everyone who completed the survey is a member of Pew Research Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories.  Read more about the ATP’s methodology . 

Respondents to the survey were asked to describe in their own words how their lives have been difficult or challenging since the beginning of the coronavirus outbreak, and to describe any positive aspects of the situation they have personally experienced as well. Overall, 84% of respondents provided an answer to one or both of the questions. The Center then categorized a random sample of 4,071 of their answers using a combination of in-house human coders, Amazon’s Mechanical Turk service and keyword-based pattern matching. The full methodology  and questions used in this analysis can be found here.

In many ways, the negatives clearly outweigh the positives – an unsurprising reaction to a pandemic that had killed  more than 180,000 Americans  at the time the survey was conducted. Across every major aspect of life mentioned in these responses, a larger share mentioned a negative impact than mentioned an unexpected upside. Americans also described the negative aspects of the pandemic in greater detail: On average, negative responses were longer than positive ones (27 vs. 19 words). But for all the difficulties and challenges of the pandemic, a majority of Americans were able to think of at least one silver lining. 

Both the negative and positive impacts described in these responses cover many aspects of life, none of which were mentioned by a majority of Americans. Instead, the responses reveal a pandemic that has affected Americans’ lives in a variety of ways, of which there is no “typical” experience. Indeed, not all groups seem to have experienced the pandemic equally. For instance, younger and more educated Americans were more likely to mention silver linings, while women were more likely than men to mention challenges or difficulties.

Here are some direct quotes that reveal how Americans are processing the new reality that has upended life across the country.

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

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

• inequalities

Data availability statement

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

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

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

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Introduction

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

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

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

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

Social networks

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

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

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

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

Social support

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

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

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

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

Social and interactional norms

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

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

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

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

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

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

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

Recommendations and conclusions

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

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

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

Recommendation 2: intelligently balance online and offline ways of relating

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

Recommendation 3: build stronger and sustainable localised communities

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

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

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

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

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

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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COVID-19: Where we’ve been, where we are, and where we’re going

One of the hardest things to deal with in this type of crisis is being able to go the distance. Moderna CEO Stéphane Bancel

Where we're going

Living with covid-19, people & organizations, sustainable, inclusive growth, related collection.

The Next Normal: Emerging stronger from the coronavirus pandemic

• PERSPECTIVES
• SUBMIT A PERSPECTIVE
• A NEW MAP OF LIFE

THE NEW MAP OF LIFE

AFTER THE PANDEMIC

It is said that culture is like the air we breathe. We don’t notice it until it’s gone.

The COVID-19 pandemic is bringing into focus a once invisible culture that guides us through life. Seemingly overnight, we experienced profound changes in the ways that we work, socialize, learn, and engage with our neighborhoods and larger communities.

For a short time, before new routines and practices replace familiar old ones, we can see with greater clarity the positive and negative aspects of our former lives. The suddenness and starkness of this transformation allows us to examine daily practices, social norms and institutions from perspectives rarely allowed.

The fragility of the global economy becomes glaringly apparent as critical supply chains faulter, unemployment surges, and markets vacillate. Tacit assumptions about health care systems become clear as we see how they function, fail to function, and have long underserved large parts of the population. Just as sure, sheltering in place allows us to appreciate precious details of our lives that we have taken for granted: the appeal of workplaces, the comfort of human touch, dinner parties, travel, and paychecks. Indeed, through ambivalent eyes we also recognize ways that life is better as we shelter in place.

The premise of the New Map of Life:™ After the Pandemic project is that we have a fleeting window of time that affords us an unprecedented opportunity to examine our lives.  Going forward, life will be different and by compiling the insights we have today we can inform and guide the culture that will inevitably emerge from our collective experience. Your insights can contribute to the reshaping of social norms, systems, and practices that shape our collective futures.

Since the founding of the Stanford Center on Longevity, we have advocated for a major redesign of life that better supports century-long lives. More recently, we undertook the New Map of Life ™ initiative, which focuses on envisioning a world where people experience a sense of purpose, belonging, and worth at all stages of life. As tragedies unfold before our eyes, we aim to capture the lessons they teach. With your help, we can compile current insights, fleeting thoughts and deeper reflections about the ways we live now so that going forward we bolster, modify and reinvent cultures that improve quality of life for ourselves, our children, and future generations.

The opinions, beliefs, and viewpoints expressed by the various authors on this website do not necessarily reflect the opinions, beliefs and viewpoints of the Stanford Center on Longevity or official policies of the Stanford Center on Longevity. 

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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.

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Seven short essays about life during the pandemic

The boston book festival's at home community writing project invites area residents to describe their experiences during this unprecedented time..

My alarm sounds at 8:15 a.m. I open my eyes and take a deep breath. I wiggle my toes and move my legs. I do this religiously every morning. Today, marks day 74 of staying at home.

My mornings are filled with reading biblical scripture, meditation, breathing in the scents of a hanging eucalyptus branch in the shower, and making tea before I log into my computer to work. After an hour-and-a-half Zoom meeting, I decided to take a long walk to the post office and grab a fresh bouquet of burnt orange ranunculus flowers. I embrace the warm sun beaming on my face. I feel joy. I feel at peace.

I enter my apartment and excessively wash my hands and face. I pour a glass of iced kombucha. I sit at my table and look at the text message on my phone. My coworker writes that she is thinking of me during this difficult time. She must be referring to the Amy Cooper incident. I learn shortly that she is not.

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I Google Minneapolis and see his name: George Floyd. And just like that a simple and beautiful day transitions into a day of sorrow.

Nakia Hill, Boston

It was a wobbly, yet solemn little procession: three masked mourners and a canine. Beginning in Kenmore Square, at David and Sue Horner’s condo, it proceeded up Commonwealth Avenue Mall.

S. Sue Horner died on Good Friday, April 10, in the Year of the Virus. Sue did not die of the virus but her parting was hemmed by it: no gatherings to mark the passing of this splendid human being.

David devised a send-off nevertheless. On April 23rd, accompanied by his daughter and son-in-law, he set out for Old South Church. David led, bearing the urn. His daughter came next, holding her phone aloft, speaker on, through which her brother in Illinois played the bagpipes for the length of the procession, its soaring thrum infusing the Mall. Her husband came last with Melon, their golden retriever.

I unlocked the empty church and led the procession into the columbarium. David drew the urn from its velvet cover, revealing a golden vessel inset with incandescent tiles. We lifted the urn into the niche, prayed, recited Psalm 23, and shared some words.

It was far too small for the luminous “Dr. Sue”, but what we could manage in the Year of the Virus.

Nancy S. Taylor, Boston

On April 26, 2020, our household was a bustling home for four people. Our two sons, ages 18 and 22, have a lot of energy. We are among the lucky ones. I can work remotely. Our food and shelter are not at risk.

As I write this a week later, it is much quieter here.

On April 27, our older son, an EMT, transported a COVID-19 patient to the ER. He left home to protect my delicate health and became ill with the virus a week later.

On April 29, my husband’s 95-year-old father had a stroke. My husband left immediately to be with his 90-year-old mother near New York City and is now preparing for his father’s discharge from the hospital. Rehab people will come to the house; going to a facility would be too dangerous.

My husband just called me to describe today’s hospital visit. The doctors had warned that although his father had regained the ability to speak, he could only repeat what was said to him.

“It’s me,” said my husband.

“It’s me,” said my father-in-law.

“I love you,” said my husband.

“I love you,” said my father-in-law.

“Sooooooooo much,” said my father-in-law.

Lucia Thompson, Wayland

Would racism exist if we were blind?

I felt his eyes bore into me as I walked through the grocery store. At first, I thought nothing of it. With the angst in the air attributable to COVID, I understood the anxiety-provoking nature of feeling as though your 6-foot bubble had burst. So, I ignored him and maintained my distance. But he persisted, glaring at my face, squinting to see who I was underneath the mask. This time I looked back, when he yelled, in my mother tongue, for me to go back to my country.

In shock, I just laughed. How could he tell what I was under my mask? Or see anything through the sunglasses he was wearing inside? It baffled me. I laughed at the irony that he would use my own language against me, that he knew enough to guess where I was from in some version of culturally competent racism. I laughed because dealing with the truth behind that comment generated a sadness in me that was too much to handle. If not now, then when will we be together?

So I ask again, would racism exist if we were blind?

Faizah Shareef, Boston

My Family is “Out” There

But I am “in” here. Life is different now “in” Assisted Living since the deadly COVID-19 arrived. Now the staff, employees, and all 100 residents have our temperatures taken daily. Everyone else, including my family, is “out” there. People like the hairdresser are really missed — with long straight hair and masks, we don’t even recognize ourselves.

Since mid-March we are in quarantine “in” our rooms with meals served. Activities are practically non-existent. We can sit on the back patio 6 feet apart, wearing masks, do exercises there, chat, and walk nearby. Nothing inside. Hopefully June will improve.

My family is “out” there — somewhere! Most are working from home (or Montana). Hopefully an August wedding will happen, but unfortunately, I may still be “in” here.

From my window I wave to my son “out” there. Recently, when my daughter visited, I opened the window “in” my second-floor room and could see and hear her perfectly “out” there. Next time she will bring a chair so we can have an “in” and “out” conversation all day, or until we run out of words.

Barbara Anderson, Raynham

My boyfriend Marcial lives in Boston, and I live in New York City. We had been doing the long-distance thing pretty successfully until coronavirus hit. In mid-March, I was furloughed from my temp job, Marcial began working remotely, and New York started shutting down. I went to Boston to stay with Marcial.

We are opposites in many ways, but we share a love of food. The kitchen has been the center of quarantine life —and also quarantine problems.

Marcial and I have gone from eating out and cooking/grocery shopping for each other during our periodic visits to cooking/grocery shopping with each other all the time. We’ve argued over things like the proper way to make rice and what greens to buy for salad. Our habits are deeply rooted in our upbringing and individual cultures (Filipino immigrant and American-born Chinese, hence the strong rice opinions).

On top of the mundane issues, we’ve also dealt with a flooded kitchen (resulting in cockroaches) and a mandoline accident leading to an ER visit. Marcial and I have spent quarantine navigating how to handle the unexpected and how to integrate our lifestyles. We’ve been eating well along the way.

Melissa Lee, Waltham

It’s 3 a.m. and my dog Rikki just gave me a worried look. Up again?

“I can’t sleep,” I say. I flick the light, pick up “Non-Zero Probabilities.” But the words lay pinned to the page like swatted flies. I watch new “Killing Eve” episodes, play old Nathaniel Rateliff and The Night Sweats songs. Still night.

We are — what? — 12 agitated weeks into lockdown, and now this. The thing that got me was Chauvin’s sunglasses. Perched nonchalantly on his head, undisturbed, as if he were at a backyard BBQ. Or anywhere other than kneeling on George Floyd’s neck, on his life. And Floyd was a father, as we all now know, having seen his daughter Gianna on Stephen Jackson’s shoulders saying “Daddy changed the world.”

Precious child. I pray, safeguard her.

Rikki has her own bed. But she won’t leave me. A Goddess of Protection. She does that thing dogs do, hovers increasingly closely the more agitated I get. “I’m losing it,” I say. I know. And like those weighted gravity blankets meant to encourage sleep, she drapes her 70 pounds over me, covering my restless heart with safety.

As if daybreak, or a prayer, could bring peace today.

Kirstan Barnett, Watertown

Until June 30, send your essay (200 words or less) about life during COVID-19 via bostonbookfest.org . Some essays will be published on the festival’s blog and some will appear in The Boston Globe.

3 lessons about what really matters in life, learned in the pandemic

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The last year has been like no other.

Since March 2020, every person on the planet has had their life shaken by the COVID-19 pandemic in some way. In the midst of the hardship and challenges, there’s been the sense among many people that this period has helped us evaluate our lives and focus on what’s truly important.

And maybe, just maybe, we’ve learned something from this moment.

In response to the pandemic, StoryCorps — a nonprofit dedicated to recording the largest collection of human stories and winner of the 2015 TED Prize — created StoryCorps Connect , a new tool to bring together loved ones via video conferencing and record the audio of their conversations.

Below are excerpts from a handful of the thousands of interviews recorded in recent months through StoryCorps Connect.

Lesson #1: The pandemic has helped us find deeper meaning in our work

Two mail carriers see the value in every delivery they make

Before getting a job as a mail carrier in Palm Beach, Florida, Evette Jourdain was going through a hard time — she’d lost her father, her brother and then her home. Finding reliable work helped tremendously, but then came COVID-19.

As Jourdain talked to her coworker , fellow postal worker Craig Boddie, she shared how she was feeling. “My anxiety levels are always on 10,” she says. “I pray on my way to work, I pray on my lunch break, I pray when I’m at the box. What keeps me going is just the fact that I need to keep going.”

Boddie agreed. His wife has autoimmune disease, and as he puts it, “Every day I wake up and wonder, ‘Is this the day that COVID-19 is gonna come home with me?’”

But he also knows that his work is more important than ever, and he thinks about how each package he carries contains something to keep people afloat in some way. “We’re like a lifeline — getting these people their medicines, their supplies.”

A health care provider gains inspiration from a classic novel 

Josh Belser and Sam Dow are good friends who grew up in Tampa, Florida, and who now both work in healthcare 400 miles apart — Belser as a nurse in Syracuse, New York, and Dow as a health technician in Ann Arbor, Michigan.

And with COVID-19, they’ve both found themselves on the frontlines. “My floor was one of the first that was converted to strictly dealing with COVID patients. Our jobs changed like overnight,” says Dow in their StoryCorps conversation. “There was no dress rehearsal — the numbers started to go up and it was show time.”

So how did they get through? Dow tells his friend he found some inspiration in Albert Camus’s classic novel The Plague . “It’s about an epidemic, and the main character was a doctor,” he explains. “And he says the way to get through something like this is to be a decent person. Somebody asks him, ‘What makes a decent person?’ He says, ‘I don’t know but, for me, it’s just doing my job the best way I can.’”

Dow says he’s tried to do exactly that. “Hopefully I made a difference in people’s lives.”

Lesson #2: Family rhythms have shifted, but our ties are as important as ever

A grandmother takes strength from her ancestors

Like so many other people, COVID-19 took Jackie Stockton by surprise. One day, she was at her church in Long Beach Island, New Jersey, celebrating her 90th birthday — and the next thing she knew, she was in the hospital. What’s more, she was part of a community cluster, and five members of the church eventually died from the virus, including Stockton’s best friend as well as her son-in-law.

Stockton spoke to her daughter , Alice Stockton-Rossini, about these losses. She says, “I remember 9/11 as though it just happened, but then it was over. This will never, ever be over.”

As a way to cope, she finds herself thinking of her great-grandmother. “She lost half of her children. She lived through the worst kind of hell,” she recalls. “She was an amazing woman, and so was her husband. They just did the things they needed to do. And they survived.”

The pandemic brings together a mother and daughter

In 2005, attorney Chalana McFarland of Atlanta, Georgia, was convicted of mortgage fraud and sentenced to 30 years in prison. The judge hoped this harsh sentence would deter others from similar crimes, but it had severe consequences for McFarland’s 4-year-old daughter, Nia Cosby.

In 2020, with the onset of COVID-19, McFarland was transferred to home confinement. Upon being released, the first person she saw was her now college-age daughter. In a candid conversation during their first weekend together in 15 years, Nia describes their reunion as “one of the best moments of my life.”

McFarland agrees. “When I left, you were driving a Barbie car, and now you’re flexin’ in the Honda Accord,” she says. “We’ve had a relationship over the years, but it’s like pieces of a puzzle that we’re just now putting together. I can’t wait for you to discover how much alike we really are, because you haven’t really gotten to know who I am. But I see so much of me in you. Out of all the things that I’ve done in my life, you are the absolute one thing that I got right.”

A canceled reunion highlights the power of family stories

The Quander family has a long history in the US. Its matriarch, Nancy Carter, was one of 123 enslaved people owned by George Washington, and she was freed in his will. She later married Charles Quander, and in 1926, their descendents held the first Quander family reunion.

It took place every year since 1926 — until now.

“This one would have been the 95th reunion,” Rohulamin Quander, 76, tells his 18-year-old cousin , Alicia Argrett.

In lieu of gathering in person, Argrett asks him: “What would you like to pass on to me?” His reply: “That you are the keeper of the stories.”

Argrett appreciates his call to take this responsibility seriously. “As we’ve seen this year, you never know when your last [family reunion] could be,” she says. “I think it’s important to capture those opportunities while you still have them in your grasp. And I’m going to do what I can on my end to keep the spirit of the family alive.”

Lesson #3: Small gestures have a huge impact on our well-being

This pandemic led to the best date of her life — a staircase apart

As the director of microbiology at a hospital in Rochester, New York, Roberto Vargas’s job is to diagnose infectious disease. With his lab running constant COVID-19 tests, he needed to isolate himself from his wife, Susan Vargas, and their four children.

Initially, he stayed in a hotel but found it too lonely. So he moved into the family’s basement, stipulating that no one else was to go beyond the top of the stairs. One night, as the Vargases recall in their conversation, a coworker brought them all a home-cooked meal. “You sat at the bottom of the stairs in a rocking chair, and I was at the top. It was the first time we had been able to connect in so long,” says Susan.

This simple moment, she says, helped get her through the months of the pandemic, and it will forever be what she remembers most from this time: “As crazy as it sounds, it’s the best date I’ve ever had with you in my life.”

Mother and son reflect on a special, shared memory

In 2015, nine-year-old William Chambers went to work with his mother. Not to an office, but to a senior center near Boston, Massachusetts, where Ceceley Chambers works as an interfaith chaplain providing spiritual counsel to those with memory loss. Ceceley knew the seniors would enjoy spending time with a young person.

What she didn’t expect was for William to sit down at a table with a woman cradling a baby doll she thought was real, and talk to her as easily as if she were his friend. “You just jumped into her world,” she recalls.

As Ceceley continues her work during the pandemic, both she and William have been thinking about that moment a lot. Although the structure of her days hasn’t changed, she’s seeing much more fear in those she’s counseling. William says he has been working hard to cultivate empathy for whatever mood she comes home with. Thinking of that woman with the doll and the other patients helps him.

He adds, “They made me think you should enjoy life as much as you can, ‘cause it doesn’t happen forever.”

Want to record an interview with a loved one — nearby or far away — about their experiences during the pandemic? Here’s how to get started . You can also explore more StoryCorps stories here .

Watch StoryCorps founder Dave Isay’s TED Prize Talk here:

About the author

Kate Torgovnick May is a journalist and writer based in Los Angeles. A former storyteller at TED, she has worked with the ambitious thinkers of the TED Prize and Audacious Project, helping them share their stories in video and text. She's also the author of the narrative nonfiction book, CHEER!: Inside the Secret World of College Cheerleaders, and has written for the television series NCIS and Hellcats. Read more about her work at KateTorgovnickMay.com.

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One Student's Perspective on Life During a Pandemic

• Markkula Center for Applied Ethics
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• COVID-19: Ethics, Health and Moving Forward

The pandemic and resulting shelter-in-place restrictions are affecting everyone in different ways. Tiana Nguyen, shares both the pros and cons of her experience as a student at Santa Clara University.

person sitting at table with open laptop, notebook and pen

Tiana Nguyen ‘21 is a Hackworth Fellow at the Markkula Center for Applied Ethics. She is majoring in Computer Science, and is the vice president of Santa Clara University’s Association for Computing Machinery (ACM) chapter .

The world has slowed down, but stress has begun to ramp up.

In the beginning of quarantine, as the world slowed down, I could finally take some time to relax, watch some shows, learn to be a better cook and baker, and be more active in my extracurriculars. I have a lot of things to be thankful for. I especially appreciate that I’m able to live in a comfortable house and have gotten the opportunity to spend more time with my family. This has actually been the first time in years in which we’re all able to even eat meals together every single day. Even when my brother and I were young, my parents would be at work and sometimes come home late, so we didn’t always eat meals together. In the beginning of the quarantine I remember my family talking about how nice it was to finally have meals together, and my brother joking, “it only took a pandemic to bring us all together,” which I laughed about at the time (but it’s the truth).

Soon enough, we’ll all be back to going to different places and we’ll be separated once again. So I’m thankful for my living situation right now. As for my friends, even though we’re apart, I do still feel like I can be in touch with them through video chat—maybe sometimes even more in touch than before. I think a lot of people just have a little more time for others right now.

Although there are still a lot of things to be thankful for, stress has slowly taken over, and work has been overwhelming. I’ve always been a person who usually enjoys going to classes, taking on more work than I have to, and being active in general. But lately I’ve felt swamped with the amount of work given, to the point that my days have blurred into online assignments, Zoom classes, and countless meetings, with a touch of baking sweets and aimless searching on Youtube.

The pass/no pass option for classes continues to stare at me, but I look past it every time to use this quarter as an opportunity to boost my grades. I've tried to make sense of this type of overwhelming feeling that I’ve never really felt before. Is it because I’m working harder and putting in more effort into my schoolwork with all the spare time I now have? Is it because I’m not having as much interaction with other people as I do at school? Or is it because my classes this quarter are just supposed to be this much harder? I honestly don’t know; it might not even be any of those. What I do know though, is that I have to continue work and push through this feeling.

This quarter I have two synchronous and two asynchronous classes, which each have pros and cons. Originally, I thought I wanted all my classes to be synchronous, since that everyday interaction with my professor and classmates is valuable to me. However, as I experienced these asynchronous classes, I’ve realized that it can be nice to watch a lecture on my own time because it even allows me to pause the video to give me extra time for taking notes. This has made me pay more attention during lectures and take note of small details that I might have missed otherwise. Furthermore, I do realize that synchronous classes can also be a burden for those abroad who have to wake up in the middle of the night just to attend a class. I feel that it’s especially unfortunate when professors want students to attend but don’t make attendance mandatory for this reason; I find that most abroad students attend anyway, driven by the worry they’ll be missing out on something.

I do still find synchronous classes amazing though, especially for discussion-based courses. I feel in touch with other students from my classes whom I wouldn’t otherwise talk to or regularly reach out to. Since Santa Clara University is a small school, it is especially easy to interact with one another during classes on Zoom, and I even sometimes find it less intimidating to participate during class through Zoom than in person. I’m honestly not the type to participate in class, but this quarter I found myself participating in some classes more than usual. The breakout rooms also create more interaction, since we’re assigned to random classmates, instead of whomever we’re sitting closest to in an in-person class—though I admit breakout rooms can sometimes be awkward.

Something that I find beneficial in both synchronous and asynchronous classes is that professors post a lecture recording that I can always refer to whenever I want. I found this especially helpful when I studied for my midterms this quarter; it’s nice to have a recording to look back upon in case I missed something during a lecture.

Overall, life during these times is substantially different from anything most of us have ever experienced, and at times it can be extremely overwhelming and stressful—especially in terms of school for me. Online classes don’t provide the same environment and interactions as in-person classes and are by far not as enjoyable. But at the end of the day, I know that in every circumstance there is always something to be thankful for, and I’m appreciative for my situation right now. While the world has slowed down and my stress has ramped up, I’m slowly beginning to adjust to it.

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Life during the pandemic has been hard for most, but some of us have experienced a new and better world

A year has now passed since the coronavirus swept through the world. people have reacted very differently to a closed society, researchers have found..

What has it really been like for us during this strange, unimaginable year?

Many researchers in a number of different disciplines are now working to answer this exact question.

Despite the tragedy the coronavirus has wreaked, the unusual circumstances also offer a unique window of time for research.

Never before has it been possible to study so many people living in a closed society.

Some of the researchers who have been taking the temperature on how this year has affected us recently presented their main findings at an event under the auspices of Oslo Life Science 2021.

A new and better world for some

Several researchers reported that the differences between people have been amplified during the pandemic.

Coronavirus life has been hard for many of us. But for others, a new and better world has opened up.

"It's so nice to finally have a society adapted for us introverts, rather than the extrovert hell you have to deal with otherwise.”

The quote comes from a person from one research project who told researchers about her life during the pandemic.

She is not alone in finding positive aspects of her new life.

“I have worked with quite a few datasets, but have never come across one with such a large spread as this”, says Marte Blikstad-Balas.

Less stress

Marte Blikstad-Balas is a professor at the Faculty of Education at the University of Oslo who has studied what happens when the classroom moves into the living room during the pandemic.

She has talked to parents who believe that home schooling and closed kindergartens are the best things that have happened to their family. These parents have experienced less stress and enjoyed more family time.

But there is a huge variation in parents’ experiences. Most think the shift has been difficult.

“I have worked with quite a few datasets, but have never come across one with such a large spread as this,” says Blikstad-Balas.

More personal time

Arve Hansen at the Centre for Development and the Environment at the University of Oslo has studied how routines and habits have changed this past year.

He has found that many people have woken up to the fact that their lives were very stressful before the coronavirus.

Some say that they have more energy because they don’t have to spend so much time travelling back and forth to work. Some people have used this extra time for exercise, to cook more food and enjoy nature more.

Some have become more cultured.

A mother of small children who hadn’t previously had time to go to cultural events, felt like a whole new world had opened up. Everything she had previously missed suddenly came into her living room.

When researchers ask people what habits they want to take with them after the pandemic, many mention more use of home offices.

They want to free up more time to do other things in life than travel back and forth to work, Hansen says.

In worse shape

Almost everyone who has felt like they have more free time has bought a bicycle, hammock or skis and spent much more time out in nature this year.

There are also many stories in the researchers’ data to suggest that the threshold to get out of the house to exercise has become even higher than it was before. And that this year has led to people being in worse shape, both physically and mentally.

They have heard stories of people who distinguished between work time and leisure time by popping a cork on a wine bottle, and of people who have eaten more junk food than ever before.

One person told Hansen about an abrupt transition from having an extreme social life to being left at home watching Netflix. This person ended up sleeping ten hours straight and staying up all night.

Netflix eventually became less fun.

The interviews also showed that many people found it difficult to be effective at work. Suddenly they found themselves sitting in their home office watching cat videos on YouTube instead of working.

“Life during the pandemic has reinforced the differences between people. Coronavirus life has gone surprisingly well for some, but for many it has been brutal,” Hansen said.

Why do we react so differently?

Why do people react so differently to the shutdown of society?

We asked two psychologists who both have research projects examining the consequences of the shutdown.

Mona Bekkhus is a researcher at the Department of Psychology at the University of Oslo. She asked young people aged 16-19 how they felt after the restrictions on social interactions came into force.

She believes that how we deal with a situation like this depends on underlying individual differences, which are due to heredity, personality and conditions at home.

“It may be that you experience the shutdown differently depending on how you feel at home with your family. It also makes a difference as to where in the country you live and how you live,” she said.

There have been big differences in how many limitations have been placed on the social lives of young people this year. Some live in places where it has been easy to go out to meet friends, even this year. Elsewhere, young people find themselves sitting inside far too much.

Most do not thrive

Bekkhus also finds examples of young people who have enjoyed this new life, who experience it as positive to have more time for the family and more time to do things other than organized activities.

Young people are also different; not everyone is so social, she points out.

“For some, pressure at school and many social relationships can be tiring, so perhaps they thrive more alone. They may feel better during the shutdown, because they can work without interruption and have more time alone,” she said.

But most of the stories she hears from young people are not about increased well-being, she says.

Many feel lonely

Bekkhus and her colleagues did their study at the very beginning of the pandemic.

At that time, every third youth answered that they had not met any friends physically in the last week. About 40 per cent had met one or more friends once or twice.

“Not being able to physically get together with your friends during the pandemic is linked to feeling lonely and having symptoms of anxiety and depression,” Bekkhus said.

An overwhelming number of people in her study mentioned that they missed physical contact with friends.

One group more vulnerable than others

Bekkhus believes that when society gradually begins to return to normal, we must be aware that there may be more people who will struggle with mental illness.

A new study from the United States suggests that this has particularly affected young adults. Researchers estimate that over 60 per cent of Americans between the ages of 18 and 24 are at risk for developing anxiety or depression. A quarter reported they had considered suicide in the past month.

This is a vulnerable age group, she believes.

“Adolescence is a period where we go through major changes, and many mental disorders start at precisely this period. As a result, we don’t fully know the consequences for this group of the social measures that have been enacted. We have never been in this situation before,” she said.

Not surprised

Psychologist and researcher Omid V. Ebrahimi and his colleagues Asle Hoffart and Sverre Urnes Johnson at the University of Oslo and Modum Bad have studied mental health related to isolation and quarantine under the coronavirus. They have focused on adults.

Ebrahimi is not surprised that people react so differently to a closed society.

“There have gradually been enough studies on mental health during the coronavirus pandemic, both nationally and internationally, that we have had a look at the overall impact in so-called meta-studies,” he said.

These are studies that summarize the findings from many studies.

“Both our study of the Norwegian population and other international meta-studies show that there is a difference in how people have experienced the shutdown,” he says.

All researchers have found a few people who have had a better life during this period.

“People who have been overworked before and now have much more time with their family and a little more peace from work, experienced less stress than before. It seems they have finally had time to take a deep breath and relax a little,” he said.

Significantly more anxiety and depression

An important future research question is to find out more about the people who have actually had a better life during the pandemic, he says.

What distinguishes them from people who are struggling during the pandemic?

But Ebrahimi's research team is now mainly looking at the majority during the pandemic, meaning people who have gotten worse and suffered more ailments.

The fact is that most people have had a tough time during the pandemic.

“We find significant increases in symptoms of depression, loneliness and anxiety in the population during the pandemic,” he said.

Tripling in symptoms of depression

During the periods with strict shutdowns, anxiety symptoms among the population has doubled, and incidences of symptoms of depression have tripled.

This is true across many countries — in addition to the Norwegian study led by Ebrahimi.

Most people will most likely return to their original level of mental health from before the pandemic, once the pandemic and its associated measures cease, the researchers believe. They base their opinion on studies of previous pandemics such as SARS and MERS.

But for some people, the onset of symptoms will trigger a more prolonged state of mental illness that they may struggle with, even after the pandemic.

“Our first priority as of today is to find out who exactly is in this group, so that we can best prevent serious problems and do something for them now,” says Ebrahimi.

The researchers will then study people who have done well during the pandemic and try to understand their equally important experiences.

This is also important knowledge for future pandemics.

“But now it’s most urgent to look at people who are in pain, which turns out to be the majority of the population,” he said.

Loneliness triggers

Social distancing means loneliness for many. And loneliness is strongly linked to symptoms of depression, among other things, Ebrahimi said.

He explains this based on evolutionary psychological theories.

“A central theory deals with how loneliness as a feeling has arisen during our evolutionary history. The feeling will bring us back to the group and thus increase our chances of survival,” he said.

Seen in an evolutionary context, people who are alone had reduced chances of survival. As a result, we have evolved to experience the feeling of loneliness as a form of pain that is similar to physical pain. This pain is meant to motivate us to return to our group, says the psychologist.

Leads to concern

When we have now been involuntarily isolated from our group and at the same time can’t actually return to it, the experience activates this pain, Ebrahimi says.

If you want to do something about loneliness, but can’t because of coronavirus restrictions, you’ll find yourself in an essentially insoluble situation that can lead to a number of painful emotional and mental processes.

“Among other things, it leads to worrying. We know this is the driving force behind both anxiety and depressive symptoms,” he said.

This is the researchers' leading working hypothesis for the reason behind the sharp increase in mental ailments that has been observed in the majority of the population.

A pandemic after the pandemic?

Ebrahimi and several other pandemic researchers now fear that there may be a mental illness pandemic after the coronavirus pandemic.

“At the beginning of the pandemic, we were more positive about people's ability to get back on their feet quickly afterwards. We are now beginning to see numbers of concern with respect to the long-term consequences of the pandemic. It will be very important to increase our focus on mental health in the period to come to prevent this as best we can,” he said.

Unique research situation

Friends are an important social support for people. This is especially true for young people.

Researchers have never before been able to study what happens when friends cannot get together.

The pandemic gives researchers a unique window to study this, says Mona Bekkhus.

“We know from before that spending a lot of time alone means that young people are less adaptable. Social relationships are important for our mental well-being and quality of life,” she said.

Researchers are now studying in more detail whether it is possible to compensate for the loss of physical encounters by playing games or via contact on digital platforms.

So far, the data indicate that there is something special about meeting face-to-face, says Bekkhus.

“We don’t know exactly why this is the case. Perhaps physical togetherness provides a greater degree of closeness and intimacy. It can be more difficult for us to perceive each other's feelings and receive immediate feedback from those we are with during digital meetings,” she said.

Translated by: Nancy Bazilchuk.

Read the Norwegian version of this article on forskning.no.

Source: Ebrahimi, O. V., Hoffart, A., & Johnson, S. U: Physical distancing and mental health during the COVID-19 pandemic: Factors associated with psychological symptoms and adherence to pandemic mitigation strategies. Clinical Psychological Science, (2021, in press).Preprint available at: https://doi.org/10.31234/osf.io/kjzsp

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