experience during covid 19 pandemic essay

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My Experience During The Covid-19 Pandemic

• Categories: Covid 19

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Words: 440 |

Published: Jan 30, 2024

Words: 440 | Page: 1 | 3 min read

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

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

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Home > History Community Special Collections > Remembering COVID-19 Community Archive > Community Reflections > 21

Community Reflections

My life experience during the covid-19 pandemic.

Melissa Blanco Follow

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Affiliation with sacred heart university.

Undergraduate, Class of 2024

My content explains what my life was like during the last seven months of the Covid-19 pandemic and how it affected my life both positively and negatively. It also explains what it was like when I graduated from High School and how I want the future generations to remember the Class of 2020.

Class assignment, Western Civilization (Dr. Marino).

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Blanco, Melissa, "My Life Experience During the Covid-19 Pandemic" (2020). Community Reflections . 21. https://digitalcommons.sacredheart.edu/covid19-reflections/21

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COVID-19 Lockdown: My Experience

When the lockdown started, I was ecstatic. My final year of school had finished early, exams were cancelled, the sun was shining. I was happy, and confident I would be OK. After all, how hard could staying at home possibly be? After a while, the reality of the situation started to sink in.

The novelty of being at home wore off and I started to struggle. I suffered from regular panic attacks, frozen on the floor in my room, unable to move or speak. I had nightmares most nights, and struggled to sleep. It was as if I was stuck, trapped in my house and in my own head. I didn't know how to cope.

However, over time, I found ways to deal with the pressure. I realised that lockdown gave me more time to the things I loved, hobbies that had been previously swamped by schoolwork. I started baking, drawing and writing again, and felt free for the first time in months. I had forgotten how good it felt to be creative. I started spending more time with my family. I hadn't realised how much I had missed them.

Almost a month later, I feel so much better. I understand how difficult this must be, but it's important to remember that none of us is alone. No matter how scared, or trapped, or alone you feel, things can only get better.  Take time to revisit the things you love, and remember that all of this will eventually pass. All we can do right now is stay at home, look after ourselves and our loved ones, and look forward to a better future.

View the discussion thread.

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Read these 12 moving essays about life during coronavirus

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

by Alissa Wilkinson

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

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

• The Vox guide to navigating the coronavirus crisis

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

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

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

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

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

• A syllabus for the end of the world

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

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

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

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

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

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

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

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

• What day is it today?

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

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

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

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

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

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

• Vox is starting a book club. Come read with us!

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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Writing about COVID-19 in a college admission essay

by: Venkates Swaminathan | Updated: September 14, 2020

Print article

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

The CommonApp COVID-19 question

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

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

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

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

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

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

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

Counselor recommendations and school profiles

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

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

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

Writing about COVID-19 in your main essay

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

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

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

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

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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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Read More: The Family Time the Pandemic Stole

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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8 Lessons We Can Learn From the COVID-19 Pandemic

BY KATHY KATELLA May 14, 2021

Note: Information in this article was accurate at the time of original publication. Because information about COVID-19 changes rapidly, we encourage you to visit the websites of the Centers for Disease Control & Prevention (CDC), World Health Organization (WHO), and your state and local government for the latest information.

The COVID-19 pandemic changed life as we know it—and it may have changed us individually as well, from our morning routines to our life goals and priorities. Many say the world has changed forever. But this coming year, if the vaccines drive down infections and variants are kept at bay, life could return to some form of normal. At that point, what will we glean from the past year? Are there silver linings or lessons learned?

“Humanity's memory is short, and what is not ever-present fades quickly,” says Manisha Juthani, MD , a Yale Medicine infectious diseases specialist. The bubonic plague, for example, ravaged Europe in the Middle Ages—resurfacing again and again—but once it was under control, people started to forget about it, she says. “So, I would say one major lesson from a public health or infectious disease perspective is that it’s important to remember and recognize our history. This is a period we must remember.”

We asked our Yale Medicine experts to weigh in on what they think are lessons worth remembering, including those that might help us survive a future virus or nurture a resilience that could help with life in general.

Lesson 1: Masks are useful tools

What happened: The Centers for Disease Control and Prevention (CDC) relaxed its masking guidance for those who have been fully vaccinated. But when the pandemic began, it necessitated a global effort to ensure that everyone practiced behaviors to keep themselves healthy and safe—and keep others healthy as well. This included the widespread wearing of masks indoors and outside.

What we’ve learned: Not everyone practiced preventive measures such as mask wearing, maintaining a 6-foot distance, and washing hands frequently. But, Dr. Juthani says, “I do think many people have learned a whole lot about respiratory pathogens and viruses, and how they spread from one person to another, and that sort of old-school common sense—you know, if you don’t feel well—whether it’s COVID-19 or not—you don’t go to the party. You stay home.”

Masks are a case in point. They are a key COVID-19 prevention strategy because they provide a barrier that can keep respiratory droplets from spreading. Mask-wearing became more common across East Asia after the 2003 SARS outbreak in that part of the world. “There are many East Asian cultures where the practice is still that if you have a cold or a runny nose, you put on a mask,” Dr. Juthani says.

She hopes attitudes in the U.S. will shift in that direction after COVID-19. “I have heard from a number of people who are amazed that we've had no flu this year—and they know masks are one of the reasons,” she says. “They’ve told me, ‘When the winter comes around, if I'm going out to the grocery store, I may just put on a mask.’”

Lesson 2: Telehealth might become the new normal

What happened: Doctors and patients who have used telehealth (technology that allows them to conduct medical care remotely), found it can work well for certain appointments, ranging from cardiology check-ups to therapy for a mental health condition. Many patients who needed a medical test have also discovered it may be possible to substitute a home version.

What we’ve learned: While there are still problems for which you need to see a doctor in person, the pandemic introduced a new urgency to what had been a gradual switchover to platforms like Zoom for remote patient visits. 

More doctors also encouraged patients to track their blood pressure at home , and to use at-home equipment for such purposes as diagnosing sleep apnea and even testing for colon cancer . Doctors also can fine-tune cochlear implants remotely .

“It happened very quickly,” says Sharon Stoll, DO, a neurologist. One group that has benefitted is patients who live far away, sometimes in other parts of the country—or even the world, she says. “I always like to see my patients at least twice a year. Now, we can see each other in person once a year, and if issues come up, we can schedule a telehealth visit in-between,” Dr. Stoll says. “This way I may hear about an issue before it becomes a problem, because my patients have easier access to me, and I have easier access to them.”

Meanwhile, insurers are becoming more likely to cover telehealth, Dr. Stoll adds. “That is a silver lining that will hopefully continue.”

Lesson 3: Vaccines are powerful tools

What happened: Given the recent positive results from vaccine trials, once again vaccines are proving to be powerful for preventing disease.

What we’ve learned: Vaccines really are worth getting, says Dr. Stoll, who had COVID-19 and experienced lingering symptoms, including chronic headaches . “I have lots of conversations—and sometimes arguments—with people about vaccines,” she says. Some don’t like the idea of side effects. “I had vaccine side effects and I’ve had COVID-19 side effects, and I say nothing compares to the actual illness. Unfortunately, I speak from experience.”

Dr. Juthani hopes the COVID-19 vaccine spotlight will motivate people to keep up with all of their vaccines, including childhood and adult vaccines for such diseases as measles , chicken pox, shingles , and other viruses. She says people have told her they got the flu vaccine this year after skipping it in previous years. (The CDC has reported distributing an exceptionally high number of doses this past season.)  

But, she cautions that a vaccine is not a magic bullet—and points out that scientists can’t always produce one that works. “As advanced as science is, there have been multiple failed efforts to develop a vaccine against the HIV virus,” she says. “This time, we were lucky that we were able build on the strengths that we've learned from many other vaccine development strategies to develop multiple vaccines for COVID-19 .” 

Lesson 4: Everyone is not treated equally, especially in a pandemic

What happened: COVID-19 magnified disparities that have long been an issue for a variety of people.

What we’ve learned: Racial and ethnic minority groups especially have had disproportionately higher rates of hospitalization for COVID-19 than non-Hispanic white people in every age group, and many other groups faced higher levels of risk or stress. These groups ranged from working mothers who also have primary responsibility for children, to people who have essential jobs, to those who live in rural areas where there is less access to health care.

“One thing that has been recognized is that when people were told to work from home, you needed to have a job that you could do in your house on a computer,” says Dr. Juthani. “Many people who were well off were able do that, but they still needed to have food, which requires grocery store workers and truck drivers. Nursing home residents still needed certified nursing assistants coming to work every day to care for them and to bathe them.”  

As far as racial inequities, Dr. Juthani cites President Biden’s appointment of Yale Medicine’s Marcella Nunez-Smith, MD, MHS , as inaugural chair of a federal COVID-19 Health Equity Task Force. “Hopefully the new focus is a first step,” Dr. Juthani says.

Lesson 5: We need to take mental health seriously

What happened: There was a rise in reported mental health problems that have been described as “a second pandemic,” highlighting mental health as an issue that needs to be addressed.

What we’ve learned: Arman Fesharaki-Zadeh, MD, PhD , a behavioral neurologist and neuropsychiatrist, believes the number of mental health disorders that were on the rise before the pandemic is surging as people grapple with such matters as juggling work and childcare, job loss, isolation, and losing a loved one to COVID-19.

The CDC reports that the percentage of adults who reported symptoms of anxiety of depression in the past 7 days increased from 36.4 to 41.5 % from August 2020 to February 2021. Other reports show that having COVID-19 may contribute, too, with its lingering or long COVID symptoms, which can include “foggy mind,” anxiety , depression, and post-traumatic stress disorder .

 “We’re seeing these problems in our clinical setting very, very often,” Dr. Fesharaki-Zadeh says. “By virtue of necessity, we can no longer ignore this. We're seeing these folks, and we have to take them seriously.”

Lesson 6: We have the capacity for resilience

What happened: While everyone’s situation is different­­ (and some people have experienced tremendous difficulties), many have seen that it’s possible to be resilient in a crisis.

What we’ve learned: People have practiced self-care in a multitude of ways during the pandemic as they were forced to adjust to new work schedules, change their gym routines, and cut back on socializing. Many started seeking out new strategies to counter the stress.

“I absolutely believe in the concept of resilience, because we have this effective reservoir inherent in all of us—be it the product of evolution, or our ancestors going through catastrophes, including wars, famines, and plagues,” Dr. Fesharaki-Zadeh says. “I think inherently, we have the means to deal with crisis. The fact that you and I are speaking right now is the result of our ancestors surviving hardship. I think resilience is part of our psyche. It's part of our DNA, essentially.”

Dr. Fesharaki-Zadeh believes that even small changes are highly effective tools for creating resilience. The changes he suggests may sound like the same old advice: exercise more, eat healthy food, cut back on alcohol, start a meditation practice, keep up with friends and family. “But this is evidence-based advice—there has been research behind every one of these measures,” he says.

But we have to also be practical, he notes. “If you feel overwhelmed by doing too many things, you can set a modest goal with one new habit—it could be getting organized around your sleep. Once you’ve succeeded, move on to another one. Then you’re building momentum.”

Lesson 7: Community is essential—and technology is too

What happened: People who were part of a community during the pandemic realized the importance of human connection, and those who didn’t have that kind of support realized they need it.

What we’ve learned: Many of us have become aware of how much we need other people—many have managed to maintain their social connections, even if they had to use technology to keep in touch, Dr. Juthani says. “There's no doubt that it's not enough, but even that type of community has helped people.”

Even people who aren’t necessarily friends or family are important. Dr. Juthani recalled how she encouraged her mail carrier to sign up for the vaccine, soon learning that the woman’s mother and husband hadn’t gotten it either. “They are all vaccinated now,” Dr. Juthani says. “So, even by word of mouth, community is a way to make things happen.”

It’s important to note that some people are naturally introverted and may have enjoyed having more solitude when they were forced to stay at home—and they should feel comfortable with that, Dr. Fesharaki-Zadeh says. “I think one has to keep temperamental tendencies like this in mind.”

But loneliness has been found to suppress the immune system and be a precursor to some diseases, he adds. “Even for introverted folks, the smallest circle is preferable to no circle at all,” he says.

Lesson 8: Sometimes you need a dose of humility

What happened: Scientists and nonscientists alike learned that a virus can be more powerful than they are. This was evident in the way knowledge about the virus changed over time in the past year as scientific investigation of it evolved.

What we’ve learned: “As infectious disease doctors, we were resident experts at the beginning of the pandemic because we understand pathogens in general, and based on what we’ve seen in the past, we might say there are certain things that are likely to be true,” Dr. Juthani says. “But we’ve seen that we have to take these pathogens seriously. We know that COVID-19 is not the flu. All these strokes and clots, and the loss of smell and taste that have gone on for months are things that we could have never known or predicted. So, you have to have respect for the unknown and respect science, but also try to give scientists the benefit of the doubt,” she says.

“We have been doing the best we can with the knowledge we have, in the time that we have it,” Dr. Juthani says. “I think most of us have had to have the humility to sometimes say, ‘I don't know. We're learning as we go.’"

Information provided in Yale Medicine articles is for general informational purposes only. No content in the articles should ever be used as a substitute for medical advice from your doctor or other qualified clinician. Always seek the individual advice of your health care provider with any questions you have regarding a medical condition.

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Coronavirus: My Experience During the Pandemic

Anastasiya Kandratsenka George Washington High School, Class of 2021

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

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

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

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

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

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

Articles in this Volume

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

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What Life Was Like for Students in the Pandemic Year

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In this video, Navajo student Miles Johnson shares how he experienced the stress and anxiety of schools shutting down last year. Miles’ teacher shared his experience and those of her other students in a recent piece for Education Week. In these short essays below, teacher Claire Marie Grogan’s 11th grade students at Oceanside High School on Long Island, N.Y., describe their pandemic experiences. Their writings have been slightly edited for clarity. Read Grogan’s essay .

“Hours Staring at Tiny Boxes on the Screen”

By Kimberly Polacco, 16

I stare at my blank computer screen, trying to find the motivation to turn it on, but my finger flinches every time it hovers near the button. I instead open my curtains. It is raining outside, but it does not matter, I will not be going out there for the rest of the day. The sound of pounding raindrops contributes to my headache enough to make me turn on my computer in hopes that it will give me something to drown out the noise. But as soon as I open it up, I feel the weight of the world crash upon my shoulders.

Each 42-minute period drags on by. I spend hours upon hours staring at tiny boxes on a screen, one of which my exhausted face occupies, and attempt to retain concepts that have been presented to me through this device. By the time I have the freedom of pressing the “leave” button on my last Google Meet of the day, my eyes are heavy and my legs feel like mush from having not left my bed since I woke up.

Tomorrow arrives, except this time here I am inside of a school building, interacting with my first period teacher face to face. We talk about our favorite movies and TV shows to stream as other kids pile into the classroom. With each passing period I accumulate more and more of these tiny meaningless conversations everywhere I go with both teachers and students. They may not seem like much, but to me they are everything because I know that the next time I am expected to report to school, I will be trapped in the bubble of my room counting down the hours until I can sit down in my freshly sanitized wooden desk again.

“My Only Parent Essentially on Her Death Bed”

By Nick Ingargiola, 16

My mom had COVID-19 for ten weeks. She got sick during the first month school buildings were shut. The difficulty of navigating an online classroom was already overwhelming, and when mixed with my only parent essentially on her death bed, it made it unbearable. Focusing on schoolwork was impossible, and watching my mother struggle to lift up her arm broke my heart.

My mom has been through her fair share of diseases from pancreatic cancer to seizures and even as far as a stroke that paralyzed her entire left side. It is safe to say she has been through a lot. The craziest part is you would never know it. She is the strongest and most positive person I’ve ever met. COVID hit her hard. Although I have watched her go through life and death multiple times, I have never seen her so physically and mentally drained.

I initially was overjoyed to complete my school year in the comfort of my own home, but once my mom got sick, I couldn’t handle it. No one knows what it’s like to pretend like everything is OK until they are forced to. I would wake up at 8 after staying up until 5 in the morning pondering the possibility of losing my mother. She was all I had. I was forced to turn my camera on and float in the fake reality of being fine although I wasn’t. The teachers tried to keep the class engaged by obligating the students to participate. This was dreadful. I didn’t want to talk. I had to hide the distress in my voice. If only the teachers understood what I was going through. I was hesitant because I didn’t want everyone to know that the virus that was infecting and killing millions was knocking on my front door.

After my online classes, I was required to finish an immense amount of homework while simultaneously hiding my sadness so that my mom wouldn’t worry about me. She was already going through a lot. There was no reason to add me to her list of worries. I wasn’t even able to give her a hug. All I could do was watch.

“The Way of Staying Sane”

By Lynda Feustel, 16

Entering year two of the pandemic is strange. It barely seems a day since last March, but it also seems like a lifetime. As an only child and introvert, shutting down my world was initially simple and relatively easy. My friends and I had been super busy with the school play, and while I was sad about it being canceled, I was struggling a lot during that show and desperately needed some time off.

As March turned to April, virtual school began, and being alone really set in. I missed my friends and us being together. The isolation felt real with just my parents and me, even as we spent time together. My friends and I began meeting on Facetime every night to watch TV and just be together in some way. We laughed at insane jokes we made and had homework and therapy sessions over Facetime and grew closer through digital and literal walls.

The summer passed with in-person events together, and the virus faded into the background for a little while. We went to the track and the beach and hung out in people’s backyards.

Then school came for us in a more nasty way than usual. In hybrid school we were separated. People had jobs, sports, activities, and quarantines. Teachers piled on work, and the virus grew more present again. The group text put out hundreds of messages a day while the Facetimes came to a grinding halt, and meeting in person as a group became more of a rarity. Being together on video and in person was the way of staying sane.

In a way I am in a similar place to last year, working and looking for some change as we enter the second year of this mess.

“In History Class, Reports of Heightening Cases”

By Vivian Rose, 16

I remember the moment my freshman year English teacher told me about the young writers’ conference at Bread Loaf during my sophomore year. At first, I didn’t want to apply, the deadline had passed, but for some strange reason, the directors of the program extended it another week. It felt like it was meant to be. It was in Vermont in the last week of May when the flowers have awakened and the sun is warm.

I submitted my work, and two weeks later I got an email of my acceptance. I screamed at the top of my lungs in the empty house; everyone was out, so I was left alone to celebrate my small victory. It was rare for them to admit sophomores. Usually they accept submissions only from juniors and seniors.

That was the first week of February 2020. All of a sudden, there was some talk about this strange virus coming from China. We thought nothing of it. Every night, I would fall asleep smiling, knowing that I would be able to go to the exact conference that Robert Frost attended for 42 years.

Then, as if overnight, it seemed the virus had swung its hand and had gripped parts of the country. Every newscast was about the disease. Every day in history, we would look at the reports of heightening cases and joke around that this could never become a threat as big as Dr. Fauci was proposing. Then, March 13th came around--it was the last day before the world seemed to shut down. Just like that, Bread Loaf would vanish from my grasp.

“One Day Every Day Won’t Be As Terrible”

By Nick Wollweber, 17

COVID created personal problems for everyone, some more serious than others, but everyone had a struggle.

As the COVID lock-down took hold, the main thing weighing on my mind was my oldest brother, Joe, who passed away in January 2019 unexpectedly in his sleep. Losing my brother was a complete gut punch and reality check for me at 14 and 15 years old. 2019 was a year of struggle, darkness, sadness, frustration. I didn’t want to learn after my brother had passed, but I had to in order to move forward and find my new normal.

Routine and always having things to do and places to go is what let me cope in the year after Joe died. Then COVID came and gave me the option to let up and let down my guard. I struggled with not wanting to take care of personal hygiene. That was the beginning of an underlying mental problem where I wouldn’t do things that were necessary for everyday life.

My “coping routine” that got me through every day and week the year before was gone. COVID wasn’t beneficial to me, but it did bring out the true nature of my mental struggles and put a name to it. Since COVID, I have been diagnosed with severe depression and anxiety. I began taking antidepressants and going to therapy a lot more.

COVID made me realize that I’m not happy with who I am and that I needed to change. I’m still not happy with who I am. I struggle every day, but I am working towards a goal that one day every day won’t be as terrible.

Coverage of social and emotional learning is supported in part by a grant from the NoVo Foundation, at www.novofoundation.org . Education Week retains sole editorial control over the content of this coverage. A version of this article appeared in the March 31, 2021 edition of Education Week as What Life Was Like for Students in the Pandemic Year

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Personal Experience With the COVID-19 Pandemic

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

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

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

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

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

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

Works Cited

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

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

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

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Essays reveal experiences during pandemic, unrest.

Field study students share their thoughts 

Members of Advanced Field Study, a select group of Social Ecology students who are chosen from a pool of applicants to participate in a year-long field study experience and course, had their internships and traditional college experience cut short this year. During our final quarter of the year together, during which we met weekly for two hours via Zoom, we discussed their reactions as the world fell apart around them. First came the pandemic and social distancing, then came the death of George Floyd and the response of the Black Lives Matter movement, both of which were imprinted on the lives of these students. This year was anything but dull, instead full of raw emotion and painful realizations of the fragility of the human condition and the extent to which we need one another. This seemed like the perfect opportunity for our students to chronicle their experiences — the good and the bad, the lessons learned, and ways in which they were forever changed by the events of the past four months. I invited all of my students to write an essay describing the ways in which these times had impacted their learning and their lives during or after their time at UCI. These are their voices. — Jessica Borelli , associate professor of psychological science

Becoming Socially Distant Through Technology: The Tech Contagion

The current state of affairs put the world on pause, but this pause gave me time to reflect on troubling matters. Time that so many others like me probably also desperately needed to heal without even knowing it. Sometimes it takes one’s world falling apart for the most beautiful mosaic to be built up from the broken pieces of wreckage. 

As the school year was coming to a close and summer was edging around the corner, I began reflecting on how people will spend their summer breaks if the country remains in its current state throughout the sunny season. Aside from living in the sunny beach state of California where people love their vitamin D and social festivities, I think some of the most damaging effects Covid-19 will have on us all has more to do with social distancing policies than with any inconveniences we now face due to the added precautions, despite how devastating it may feel that Disneyland is closed to all the local annual passholders or that the beaches may not be filled with sun-kissed California girls this summer. During this unprecedented time, I don’t think we should allow the rare opportunity we now have to be able to watch in real time how the effects of social distancing can impact our mental health. Before the pandemic, many of us were already engaging in a form of social distancing. Perhaps not the exact same way we are now practicing, but the technology that we have developed over recent years has led to a dramatic decline in our social contact and skills in general. 

The debate over whether we should remain quarantined during this time is not an argument I am trying to pursue. Instead, I am trying to encourage us to view this event as a unique time to study how social distancing can affect people’s mental health over a long period of time and with dramatic results due to the magnitude of the current issue. Although Covid-19 is new and unfamiliar to everyone, the isolation and separation we now face is not. For many, this type of behavior has already been a lifestyle choice for a long time. However, the current situation we all now face has allowed us to gain a more personal insight on how that experience feels due to the current circumstances. Mental illness continues to remain a prevalent problem throughout the world and for that reason could be considered a pandemic of a sort in and of itself long before the Covid-19 outbreak. 

One parallel that can be made between our current restrictions and mental illness reminds me in particular of hikikomori culture. Hikikomori is a phenomenon that originated in Japan but that has since spread internationally, now prevalent in many parts of the world, including the United States. Hikikomori is not a mental disorder but rather can appear as a symptom of a disorder. People engaging in hikikomori remain confined in their houses and often their rooms for an extended period of time, often over the course of many years. This action of voluntary confinement is an extreme form of withdrawal from society and self-isolation. Hikikomori affects a large percent of people in Japan yearly and the problem continues to become more widespread with increasing occurrences being reported around the world each year. While we know this problem has continued to increase, the exact number of people practicing hikikomori is unknown because there is a large amount of stigma surrounding the phenomenon that inhibits people from seeking help. This phenomenon cannot be written off as culturally defined because it is spreading to many parts of the world. With the technology we now have, and mental health issues on the rise and expected to increase even more so after feeling the effects of the current pandemic, I think we will definitely see a rise in the number of people engaging in this social isolation, especially with the increase in legitimate fears we now face that appear to justify the previously considered irrational fears many have associated with social gatherings. We now have the perfect sample of people to provide answers about how this form of isolation can affect people over time. 

Likewise, with the advancements we have made to technology not only is it now possible to survive without ever leaving the confines of your own home, but it also makes it possible for us to “fulfill” many of our social interaction needs. It’s very unfortunate, but in addition to the success we have gained through our advancements we have also experienced a great loss. With new technology, I am afraid that we no longer engage with others the way we once did. Although some may say the advancements are for the best, I wonder, at what cost? It is now commonplace to see a phone on the table during a business meeting or first date. Even worse is how many will feel inclined to check their phone during important or meaningful interactions they are having with people face to face. While our technology has become smarter, we have become dumber when it comes to social etiquette. As we all now constantly carry a mini computer with us everywhere we go, we have in essence replaced our best friends. We push others away subconsciously as we reach for our phones during conversations. We no longer remember phone numbers because we have them all saved in our phones. We find comfort in looking down at our phones during those moments of free time we have in public places before our meetings begin. These same moments were once the perfect time to make friends, filled with interactive banter. We now prefer to stare at other people on our phones for hours on end, and often live a sedentary lifestyle instead of going out and interacting with others ourselves. 

These are just a few among many issues the advances to technology led to long ago. We have forgotten how to practice proper tech-etiquette and we have been inadvertently practicing social distancing long before it was ever required. Now is a perfect time for us to look at the society we have become and how we incurred a different kind of pandemic long before the one we currently face. With time, as the social distancing regulations begin to lift, people may possibly begin to appreciate life and connecting with others more than they did before as a result of the unique experience we have shared in together while apart.

Maybe the world needed a time-out to remember how to appreciate what it had but forgot to experience. Life is to be lived through experience, not to be used as a pastime to observe and compare oneself with others. I’ll leave you with a simple reminder: never forget to take care and love more because in a world where life is often unpredictable and ever changing, one cannot risk taking time or loved ones for granted. With that, I bid you farewell, fellow comrades, like all else, this too shall pass, now go live your best life!

Privilege in a Pandemic 

Covid-19 has impacted millions of Americans who have been out of work for weeks, thus creating a financial burden. Without a job and the certainty of knowing when one will return to work, paying rent and utilities has been a problem for many. With unemployment on the rise, relying on unemployment benefits has become a necessity for millions of people. According to the Washington Post , unemployment rose to 14.7% in April which is considered to be the worst since the Great Depression. 

Those who are not worried about the financial aspect or the thought never crossed their minds have privilege. Merriam Webster defines privilege as “a right or immunity granted as a peculiar benefit, advantage, or favor.” Privilege can have a negative connotation. What you choose to do with your privilege is what matters. Talking about privilege can bring discomfort, but the discomfort it brings can also carry the benefit of drawing awareness to one’s privilege, which can lead the person to take steps to help others. 

I am a first-generation college student who recently transferred to a four-year university. When schools began to close, and students had to leave their on-campus housing, many lost their jobs.I was able to stay on campus because I live in an apartment. I am fortunate to still have a job, although the hours are minimal. My parents help pay for school expenses, including housing, tuition, and food. I do not have to worry about paying rent or how to pay for food because my parents are financially stable to help me. However, there are millions of college students who are not financially stable or do not have the support system I have. Here, I have the privilege and, thus, I am the one who can offer help to others. I may not have millions in funding, but volunteering for centers who need help is where I am able to help. Those who live in California can volunteer through Californians For All  or at food banks, shelter facilities, making calls to seniors, etc. 

I was not aware of my privilege during these times until I started reading more articles about how millions of people cannot afford to pay their rent, and landlords are starting to send notices of violations. Rather than feel guilty and be passive about it, I chose to put my privilege into a sense of purpose: Donating to nonprofits helping those affected by COVID-19, continuing to support local businesses, and supporting businesses who are donating profits to those affected by COVID-19.

My World is Burning 

As I write this, my friends are double checking our medical supplies and making plans to buy water and snacks to pass out at the next protest we are attending. We write down the number for the local bailout fund on our arms and pray that we’re lucky enough not to have to use it should things get ugly. We are part of a pivotal event, the kind of movement that will forever have a place in history. Yet, during this revolution, I have papers to write and grades to worry about, as I’m in the midst of finals. 

My professors have offered empty platitudes. They condemn the violence and acknowledge the stress and pain that so many of us are feeling, especially the additional weight that this carries for students of color. I appreciate their show of solidarity, but it feels meaningless when it is accompanied by requests to complete research reports and finalize presentations. Our world is on fire. Literally. On my social media feeds, I scroll through image after image of burning buildings and police cars in flames. How can I be asked to focus on school when my community is under siege? When police are continuing to murder black people, adding additional names to the ever growing list of their victims. Breonna Taylor. Ahmaud Arbery. George Floyd. David Mcatee. And, now, Rayshard Brooks. 

It already felt like the world was being asked of us when the pandemic started and classes continued. High academic expectations were maintained even when students now faced the challenges of being locked down, often trapped in small spaces with family or roommates. Now we are faced with another public health crisis in the form of police violence and once again it seems like educational faculty are turning a blind eye to the impact that this has on the students. I cannot study for exams when I am busy brushing up on my basic first-aid training, taking notes on the best techniques to stop heavy bleeding and treat chemical burns because at the end of the day, if these protests turn south, I will be entering a warzone. Even when things remain peaceful, there is an ugliness that bubbles just below the surface. When beginning the trek home, I have had armed members of the National Guard follow me and my friends. While kneeling in silence, I have watched police officers cock their weapons and laugh, pointing out targets in the crowd. I have been emailing my professors asking for extensions, trying to explain that if something is turned in late, it could be the result of me being detained or injured. I don’t want to be penalized for trying to do what I wholeheartedly believe is right. 

I have spent my life studying and will continue to study these institutions that have been so instrumental in the oppression and marginalization of black and indigenous communities. Yet, now that I have the opportunity to be on the frontlines actively fighting for the change our country so desperately needs, I feel that this study is more of a hindrance than a help to the cause. Writing papers and reading books can only take me so far and I implore that professors everywhere recognize that requesting their students split their time and energy between finals and justice is an impossible ask.

Opportunity to Serve

Since the start of the most drastic change of our lives, I have had the privilege of helping feed more than 200 different families in the Santa Ana area and even some neighboring cities. It has been an immense pleasure seeing the sheer joy and happiness of families as they come to pick up their box of food from our site, as well as a $50 gift card to Northgate, a grocery store in Santa Ana. Along with donating food and helping feed families, the team at the office, including myself, have dedicated this time to offering psychosocial and mental health check-ups for the families we serve. 

Every day I go into the office I start my day by gathering files of our families we served between the months of January, February, and March and calling them to check on how they are doing financially, mentally, and how they have been affected by COVID-19. As a side project, I have been putting together Excel spreadsheets of all these families’ struggles and finding a way to turn their situation into a success story to share with our board at PY-OCBF and to the community partners who make all of our efforts possible. One of the things that has really touched me while working with these families is how much of an impact this nonprofit organization truly has on family’s lives. I have spoken with many families who I just call to check up on and it turns into an hour call sharing about how much of a change they have seen in their child who went through our program. Further, they go on to discuss that because of our program, their children have a different perspective on the drugs they were using before and the group of friends they were hanging out with. Of course, the situation is different right now as everyone is being told to stay at home; however, there are those handful of kids who still go out without asking for permission, increasing the likelihood they might contract this disease and pass it to the rest of the family. We are working diligently to provide support for these parents and offering advice to talk to their kids in order to have a serious conversation with their kids so that they feel heard and validated. 

Although the novel Coronavirus has impacted the lives of millions of people not just on a national level, but on a global level, I feel that in my current position, it has opened doors for me that would have otherwise not presented themselves. Fortunately, I have been offered a full-time position at the Project Youth Orange County Bar Foundation post-graduation that I have committed to already. This invitation came to me because the organization received a huge grant for COVID-19 relief to offer to their staff and since I was already part-time, they thought I would be a good fit to join the team once mid-June comes around. I was very excited and pleased to be recognized for the work I have done at the office in front of all staff. I am immensely grateful for this opportunity. I will work even harder to provide for the community and to continue changing the lives of adolescents, who have steered off the path of success. I will use my time as a full-time employee to polish my resume, not forgetting that the main purpose of my moving to Irvine was to become a scholar and continue the education that my parents couldn’t attain. I will still be looking for ways to get internships with other fields within criminology. One specific interest that I have had since being an intern and a part-time employee in this organization is the work of the Orange County Coroner’s Office. I don’t exactly know what enticed me to find it appealing as many would say that it is an awful job in nature since it relates to death and seeing people in their worst state possible. However, I feel that the only way for me to truly know if I want to pursue such a career in forensic science will be to just dive into it and see where it takes me. 

I can, without a doubt, say that the Coronavirus has impacted me in a way unlike many others, and for that I am extremely grateful. As I continue working, I can also state that many people are becoming more and more hopeful as time progresses. With people now beginning to say Stage Two of this stay-at-home order is about to allow retailers and other companies to begin doing curbside delivery, many families can now see some light at the end of the tunnel.

Let’s Do Better

This time of the year is meant to be a time of celebration; however, it has been difficult to feel proud or excited for many of us when it has become a time of collective mourning and sorrow, especially for the Black community. There has been an endless amount of pain, rage, and helplessness that has been felt throughout our nation because of the growing list of Black lives we have lost to violence and brutality.

To honor the lives that we have lost, George Floyd, Tony McDade, Breonna Taylor, Ahmaud Arbery, Eric Garner, Oscar Grant, Michael Brown, Trayon Martin, and all of the other Black lives that have been taken away, may they Rest in Power.

Throughout my college experience, I have become more exposed to the various identities and the upbringings of others, which led to my own self-reflection on my own privileged and marginalized identities. I identify as Colombian, German, and Mexican; however navigating life as a mixed race, I have never been able to identify or have one culture more salient than the other. I am visibly white-passing and do not hold any strong ties with any of my ethnic identities, which used to bring me feelings of guilt and frustration, for I would question whether or not I could be an advocate for certain communities, and whether or not I could claim the identity of a woman of color. In the process of understanding my positionality, I began to wonder what space I belonged in, where I could speak up, and where I should take a step back for others to speak. I found myself in a constant theme of questioning what is my narrative and slowly began to realize that I could not base it off lone identities and that I have had the privilege to move through life without my identities defining who I am. Those initial feelings of guilt and confusion transformed into growth, acceptance, and empowerment.

This journey has driven me to educate myself more about the social inequalities and injustices that people face and to focus on what I can do for those around me. It has motivated me to be more culturally responsive and competent, so that I am able to best advocate for those around me. Through the various roles I have worked in, I have been able to listen to a variety of communities’ narratives and experiences, which has allowed me to extend my empathy to these communities while also pushing me to continue educating myself on how I can best serve and empower them. By immersing myself amongst different communities, I have been given the honor of hearing others’ stories and experiences, which has inspired me to commit myself to support and empower others.

I share my story of navigating through my privileged and marginalized identities in hopes that it encourages others to explore their own identities. This journey is not an easy one, and it is an ongoing learning process that will come with various mistakes. I have learned that with facing our privileges comes feelings of guilt, discomfort, and at times, complacency. It is very easy to become ignorant when we are not affected by different issues, but I challenge those who read this to embrace the discomfort. With these emotions, I have found it important to reflect on the source of discomfort and guilt, for although they are a part of the process, in taking the steps to become more aware of the systemic inequalities around us, understanding the source of discomfort can better inform us on how we perpetuate these systemic inequalities. If we choose to embrace ignorance, we refuse to acknowledge the systems that impact marginalized communities and refuse to honestly and openly hear cries for help. If we choose our own comfort over the lives of those being affected every day, we can never truly honor, serve, or support these communities.

I challenge any non-Black person, including myself, to stop remaining complacent when injustices are committed. We need to consistently recognize and acknowledge how the Black community is disproportionately affected in every injustice experienced and call out anti-Blackness in every role, community, and space we share. We need to keep ourselves and others accountable when we make mistakes or fall back into patterns of complacency or ignorance. We need to continue educating ourselves instead of relying on the emotional labor of the Black community to continuously educate us on the history of their oppressions. We need to collectively uplift and empower one another to heal and rise against injustice. We need to remember that allyship ends when action ends.

To the Black community, you are strong. You deserve to be here. The recent events are emotionally, mentally, and physically exhausting, and the need for rest to take care of your mental, physical, and emotional well-being are at an all time high. If you are able, take the time to regain your energy, feel every emotion, and remind yourself of the power you have inside of you. You are not alone.

The Virus That Makes You Forget

Following Jan. 1 of 2020 many of my classmates and I continued to like, share, and forward the same meme. The meme included any image but held the same phrase: I can see 2020. For many of us, 2020 was a beacon of hope. For the Class of 2020, this meant walking on stage in front of our families. Graduation meant becoming an adult, finding a job, or going to graduate school. No matter what we were doing in our post-grad life, we were the new rising stars ready to take on the world with a positive outlook no matter what the future held. We felt that we had a deal with the universe that we were about to be noticed for our hard work, our hardships, and our perseverance.

Then March 17 of 2020 came to pass with California Gov. Newman ordering us to stay at home, which we all did. However, little did we all know that the world we once had open to us would only be forgotten when we closed our front doors.

Life became immediately uncertain and for many of us, that meant graduation and our post-graduation plans including housing, careers, education, food, and basic standards of living were revoked! We became the forgotten — a place from which many of us had attempted to rise by attending university. The goals that we were told we could set and the plans that we were allowed to make — these were crushed before our eyes.

Eighty days before graduation, in the first several weeks of quarantine, I fell extremely ill; both unfortunately and luckily, I was isolated. All of my roommates had moved out of the student apartments leaving me with limited resources, unable to go to the stores to pick up medicine or food, and with insufficient health coverage to afford a doctor until my throat was too swollen to drink water. For nearly three weeks, I was stuck in bed, I was unable to apply to job deadlines, reach out to family, and have contact with the outside world. I was forgotten.

Forty-five days before graduation, I had clawed my way out of illness and was catching up on an honors thesis about media depictions of sexual exploitation within the American political system, when I was relayed the news that democratic presidential candidate Joe Biden was accused of sexual assault. However, when reporting this news to close friends who had been devastated and upset by similar claims against past politicians, they all were too tired and numb from the quarantine to care. Just as I had written hours before reading the initial story, history was repeating, and it was not only I who COVID-19 had forgotten, but now survivors of violence.

After this revelation, I realize the silencing factor that COVID-19 has. Not only does it have the power to terminate the voices of our older generations, but it has the power to silence and make us forget the voices of every generation. Maybe this is why social media usage has gone up, why we see people creating new social media accounts, posting more, attempting to reach out to long lost friends. We do not want to be silenced, moreover, we cannot be silenced. Silence means that we have been forgotten and being forgotten is where injustice and uncertainty occurs. By using social media, pressing like on a post, or even sending a hate message, means that someone cares and is watching what you are doing. If there is no interaction, I am stuck in the land of indifference.

This is a place that I, and many others, now reside, captured and uncertain. In 2020, my plan was to graduate Cum Laude, dean's honor list, with three honors programs, three majors, and with research and job experience that stretched over six years. I would then go into my first year of graduate school, attempting a dual Juris Doctorate. I would be spending my time experimenting with new concepts, new experiences, and new relationships. My life would then be spent giving a microphone to survivors of domestic violence and sex crimes. However, now the plan is wiped clean, instead I sit still bound to graduate in 30 days with no home to stay, no place to work, and no future education to come back to. I would say I am overly qualified, but pandemic makes me lost in a series of names and masked faces.

Welcome to My Cage: The Pandemic and PTSD

When I read the campuswide email notifying students of the World Health Organization’s declaration of the coronavirus pandemic, I was sitting on my couch practicing a research presentation I was going to give a few hours later. For a few minutes, I sat there motionless, trying to digest the meaning of the words as though they were from a language other than my own, familiar sounds strung together in way that was wholly unintelligible to me. I tried but failed to make sense of how this could affect my life. After the initial shock had worn off, I mobilized quickly, snapping into an autopilot mode of being I knew all too well. I began making mental checklists, sharing the email with my friends and family, half of my brain wondering if I should make a trip to the grocery store to stockpile supplies and the other half wondering how I was supposed take final exams in the midst of so much uncertainty. The most chilling realization was knowing I had to wait powerlessly as the fate of the world unfolded, frozen with anxiety as I figured out my place in it all.

These feelings of powerlessness and isolation are familiar bedfellows for me. Early October of 2015, shortly after beginning my first year at UCI, I was diagnosed with Post-traumatic Stress Disorder. Despite having had years of psychological treatment for my condition, including Cognitive Behavior Therapy and Eye Movement Desensitization and Retraining, the flashbacks, paranoia, and nightmares still emerge unwarranted. People have referred to the pandemic as a collective trauma. For me, the pandemic has not only been a collective trauma, it has also been the reemergence of a personal trauma. The news of the pandemic and the implications it has for daily life triggered a reemergence of symptoms that were ultimately ignited by the overwhelming sense of helplessness that lies in waiting, as I suddenly find myself navigating yet another situation beyond my control. Food security, safety, and my sense of self have all been shaken by COVID-19.

The first few weeks after UCI transitioned into remote learning and the governor issued the stay-at-home order, I hardly got any sleep. My body was cycling through hypervigilance and derealization, and my sleep was interrupted by intrusive nightmares oscillating between flashbacks and frightening snippets from current events. Any coping methods I had developed through hard-won efforts over the past few years — leaving my apartment for a change of scenery, hanging out with friends, going to the gym — were suddenly made inaccessible to me due to the stay-at-home orders, closures of non-essential businesses, and many of my friends breaking their campus leases to move back to their family homes. So for me, learning to cope during COVID-19 quarantine means learning to function with my re-emerging PTSD symptoms and without my go-to tools. I must navigate my illness in a rapidly evolving world, one where some of my internalized fears, such as running out of food and living in an unsafe world, are made progressively more external by the minute and broadcasted on every news platform; fears that I could no longer escape, being confined in the tight constraints of my studio apartment’s walls. I cannot shake the devastating effects of sacrifice that I experience as all sense of control has been stripped away from me.

However, amidst my mental anguish, I have realized something important—experiencing these same PTSD symptoms during a global pandemic feels markedly different than it did years ago. Part of it might be the passage of time and the growth in my mindset, but there is something else that feels very different. Currently, there is widespread solidarity and support for all of us facing the chaos of COVID-19, whether they are on the frontlines of the fight against the illness or they are self-isolating due to new rules, restrictions, and risks. This was in stark contrast to what it was like to have a mental disorder. The unity we all experience as a result of COVID-19 is one I could not have predicted. I am not the only student heartbroken over a cancelled graduation, I am not the only student who is struggling to adapt to remote learning, and I am not the only person in this world who has to make sacrifices.

Between observations I’ve made on social media and conversations with my friends and classmates, this time we are all enduring great pain and stress as we attempt to adapt to life’s challenges. As a Peer Assistant for an Education class, I have heard from many students of their heartache over the remote learning model, how difficult it is to study in a non-academic environment, and how unmotivated they have become this quarter. This is definitely something I can relate to; as of late, it has been exceptionally difficult to find motivation and put forth the effort for even simple activities as a lack of energy compounds the issue and hinders basic needs. However, the willingness of people to open up about their distress during the pandemic is unlike the self-imposed social isolation of many people who experience mental illness regularly. Something this pandemic has taught me is that I want to live in a world where mental illness receives more support and isn’t so taboo and controversial. Why is it that we are able to talk about our pain, stress, and mental illness now, but aren’t able to talk about it outside of a global pandemic? People should be able to talk about these hardships and ask for help, much like during these circumstances.

It has been nearly three months since the coronavirus crisis was declared a pandemic. I still have many bad days that I endure where my symptoms can be overwhelming. But somehow, during my good days — and some days, merely good moments — I can appreciate the resilience I have acquired over the years and the common ground I share with others who live through similar circumstances. For veterans of trauma and mental illness, this isn’t the first time we are experiencing pain in an extreme and disastrous way. This is, however, the first time we are experiencing it with the rest of the world. This strange new feeling of solidarity as I read and hear about the experiences of other people provides some small comfort as I fight my way out of bed each day. As we fight to survive this pandemic, I hope to hold onto this feeling of togetherness and acceptance of pain, so that it will always be okay for people to share their struggles. We don’t know what the world will look like days, months, or years from now, but I hope that we can cultivate such a culture to make life much easier for people coping with mental illness.

A Somatic Pandemonium in Quarantine

I remember hearing that our brains create the color magenta all on their own. 

When I was younger I used to run out of my third-grade class because my teacher was allergic to the mold and sometimes would vomit in the trash can. My dad used to tell me that I used to always have to have something in my hands, later translating itself into the form of a hair tie around my wrist.

Sometimes, I think about the girl who used to walk on her tippy toes. medial and lateral nerves never planted, never grounded. We were the same in this way. My ability to be firmly planted anywhere was also withered. 

Was it from all the times I panicked? Or from the time I ran away and I blistered the soles of my feet 'til they were black from the summer pavement? Emetophobia. 

I felt it in the shower, dressing itself from the crown of my head down to the soles of my feet, noting the feeling onto my white board in an attempt to solidify it’s permanence.

As I breathed in the chemical blue transpiring from the Expo marker, everything was more defined. I laid down and when I looked up at the starlet lamp I had finally felt centered. Still. No longer fleeting. The grooves in the lamps glass forming a spiral of what felt to me like an artificial landscape of transcendental sparks. 

She’s back now, magenta, though I never knew she left or even ever was. Somehow still subconsciously always known. I had been searching for her in the tremors.

I can see her now in the daphnes, the golden rays from the sun reflecting off of the bark on the trees and the red light that glowed brighter, suddenly the town around me was warmer. A melting of hues and sharpened saturation that was apparent and reminded of the smell of oranges.

I threw up all of the carrots I ate just before. The trauma that my body kept as a memory of things that may or may not go wrong and the times that I couldn't keep my legs from running. Revelations bring memories bringing anxieties from fear and panic released from my body as if to say “NO LONGER!” 

I close my eyes now and my mind's eye is, too, more vivid than ever before. My inner eyelids lit up with orange undertones no longer a solid black, neurons firing, fire. Not the kind that burns you but the kind that can light up a dull space. Like the wick of a tea-lit candle. Magenta doesn’t exist. It is perception. A construct made of light waves, blue and red.

Demolition. Reconstruction. I walk down the street into this new world wearing my new mask, somatic senses tingling and I think to myself “Houston, I think we’ve just hit equilibrium.”

How COVID-19 Changed My Senior Year

During the last two weeks of Winter quarter, I watched the emails pour in. Spring quarter would be online, facilities were closing, and everyone was recommended to return home to their families, if possible. I resolved to myself that I would not move back home; I wanted to stay in my apartment, near my boyfriend, near my friends, and in the one place I had my own space. However, as the COVID-19 pandemic worsened, things continued to change quickly. Soon I learned my roommate/best friend would be cancelling her lease and moving back up to Northern California. We had made plans for my final quarter at UCI, as I would be graduating in June while she had another year, but all of the sudden, that dream was gone. In one whirlwind of a day, we tried to cram in as much of our plans as we could before she left the next day for good. There are still so many things – like hiking, going to museums, and showing her around my hometown – we never got to cross off our list.

Then, my boyfriend decided he would also be moving home, three hours away. Most of my sorority sisters were moving home, too. I realized if I stayed at school, I would be completely alone. My mom had been encouraging me to move home anyway, but I was reluctant to return to a house I wasn’t completely comfortable in. As the pandemic became more serious, gentle encouragement quickly turned into demands. I had to cancel my lease and move home.

I moved back in with my parents at the end of Spring Break; I never got to say goodbye to most of my friends, many of whom I’ll likely never see again – as long as the virus doesn’t change things, I’m supposed to move to New York over the summer to begin a PhD program in Criminal Justice. Just like that, my time at UCI had come to a close. No lasts to savor; instead I had piles of things to regret. In place of a final quarter filled with memorable lasts, such as the senior banquet or my sorority’s senior preference night, I’m left with a laundry list of things I missed out on. I didn’t get to look around the campus one last time like I had planned; I never got to take my graduation pictures in front of the UC Irvine sign. Commencement had already been cancelled. The lights had turned off in the theatre before the movie was over. I never got to find out how the movie ended.

Transitioning to a remote learning system wasn’t too bad, but I found that some professors weren’t adjusting their courses to the difficulties many students were facing. It turned out to be difficult to stay motivated, especially for classes that are pre-recorded and don’t have any face-to-face interaction. It’s hard to make myself care; I’m in my last few weeks ever at UCI, but it feels like I’m already in summer. School isn’t real, my classes aren’t real. I still put in the effort, but I feel like I’m not getting much out of my classes.

The things I had been looking forward to this quarter are gone; there will be no Undergraduate Research Symposium, where I was supposed to present two projects. My amazing internship with the US Postal Inspection Service is over prematurely and I never got to properly say goodbye to anyone I met there. I won’t receive recognition for the various awards and honors I worked so hard to achieve.

And I’m one of the lucky ones! I feel guilty for feeling bad about my situation, when I know there are others who have it much, much worse. I am like that quintessential spoiled child, complaining while there are essential workers working tirelessly, people with health concerns constantly fearing for their safety, and people dying every day. Yet knowing that doesn't help me from feeling I was robbed of my senior experience, something I worked very hard to achieve. I know it’s not nearly as important as what many others are going through. But nevertheless, this is my situation. I was supposed to be enjoying this final quarter with my friends and preparing to move on, not be stuck at home, grappling with my mental health and hiding out in my room to get some alone time from a family I don’t always get along with. And while I know it’s more difficult out there for many others, it’s still difficult for me.

The thing that stresses me out most is the uncertainty. Uncertainty for the future – how long will this pandemic last? How many more people have to suffer before things go back to “normal” – whatever that is? How long until I can see my friends and family again? And what does this mean for my academic future? Who knows what will happen between now and then? All that’s left to do is wait and hope that everything will work out for the best.

Looking back over my last few months at UCI, I wish I knew at the time that I was experiencing my lasts; it feels like I took so much for granted. If there is one thing this has all made me realize, it’s that nothing is certain. Everything we expect, everything we take for granted – none of it is a given. Hold on to what you have while you have it, and take the time to appreciate the wonderful things in life, because you never know when it will be gone.

Physical Distancing

Thirty days have never felt so long. April has been the longest month of the year. I have been through more in these past three months than in the past three years. The COVID-19 outbreak has had a huge impact on both physical and social well-being of a lot of Americans, including me. Stress has been governing the lives of so many civilians, in particular students and workers. In addition to causing a lack of motivation in my life, quarantine has also brought a wave of anxiety.

My life changed the moment the Centers of Disease Control and Prevention and the government announced social distancing. My busy daily schedule, running from class to class and meeting to meeting, morphed into identical days, consisting of hour after hour behind a cold computer monitor. Human interaction and touch improve trust, reduce fear and increases physical well-being. Imagine the effects of removing the human touch and interaction from midst of society. Humans are profoundly social creatures. I cannot function without interacting and connecting with other people. Even daily acquaintances have an impact on me that is only noticeable once removed. As a result, the COVID-19 outbreak has had an extreme impact on me beyond direct symptoms and consequences of contracting the virus itself.

It was not until later that month, when out of sheer boredom I was scrolling through my call logs and I realized that I had called my grandmother more than ever. This made me realize that quarantine had created some positive impacts on my social interactions as well. This period of time has created an opportunity to check up on and connect with family and peers more often than we were able to. Even though we might be connecting solely through a screen, we are not missing out on being socially connected. Quarantine has taught me to value and prioritize social connection, and to recognize that we can find this type of connection not only through in-person gatherings, but also through deep heart to heart connections. Right now, my weekly Zoom meetings with my long-time friends are the most important events in my week. In fact, I have taken advantage of the opportunity to reconnect with many of my old friends and have actually had more meaningful conversations with them than before the isolation.

This situation is far from ideal. From my perspective, touch and in-person interaction is essential; however, we must overcome all difficulties that life throws at us with the best we are provided with. Therefore, perhaps we should take this time to re-align our motives by engaging in things that are of importance to us. I learned how to dig deep and find appreciation for all the small talks, gatherings, and face-to-face interactions. I have also realized that friendships are not only built on the foundation of physical presence but rather on meaningful conversations you get to have, even if they are through a cold computer monitor. My realization came from having more time on my hands and noticing the shift in conversations I was having with those around me. After all, maybe this isolation isn’t “social distancing”, but rather “physical distancing” until we meet again.

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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.

How COVID-19 pandemic changed my life

Table of Contents

Introduction

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

Social and Academic Changes

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

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

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

Positive Changes

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

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

• Haleem, A., Javaid, M., & Vaishya, R. (2020). Effects of COVID-19 pandemic in daily life.  Current medicine research and practice ,  10 (2), 78.
• Rume, T., & Islam, S. D. U. (2020). Environmental effects of COVID-19 pandemic and potential strategies of sustainability.  Heliyon ,  6 (9), e04965.
• ☠️ Assisted Suicide
• Affordable Care Act
• Breast Cancer
• Genetic Engineering

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Alvin Powell and his mother, Alynne Martelle, who passed away from COVID-19 in April 2020.

Photos courtesy of Alvin Powell

Portraits of Loss

Alvin powell.

A collection of stories and essays that illustrate the indelible mark left on our community by a pandemic that touched all our lives.

I remember thinking, “I guess I’m having the full COVID-19 experience,” though I knew immediately it wasn’t true. Having the full experience would mean switching places with the frail woman before me. It would mean my eyes were the ones that were closed, my breath silent and shallow.

But I also knew she wouldn’t want it that way. My mother, Alynne Martelle, was protective like that.

It was April 2020, and I was sitting in a Connecticut nursing home across the bed from my sister Kelly San Martin. I wasn’t thinking about how outlandishly I was dressed, but each glance across the bed provided a reminder. We were both wearing thin, disposable yellow gowns and too-big rubber gloves, with surgical masks covering our noses and mouths. We were each hoping the protection would be enough, but at that point in the pandemic’s first spring surge, nothing seemed certain.

Earlier that day — a Friday — I had been working from home and heard from my sister that my mom, 80 and diagnosed with COVID-19, had taken a turn for the worse. I called the nursing home where she’d lived for nearly five years, and the nurse said to come right away. So I told my editors at the Gazette what was going on, got in the car, and headed down the Pike.

I had a couple of hours to think during the drive. As a science writer for the Gazette, I routinely monitor disease outbreaks around the world — SARS, H1N1, seasonal flu — and discuss them with experts at the University. My hope is to lend perspective for readers on news that can seem too distant to be threatening — yet to which they might want to pay attention— or things that seem threateningly close, but in fact are rare enough that the screaming headlines may not be warranted.

“I suspect that a nursing home isn’t part of anyone’s plan for their final years, and it certainly wasn’t for my mother.“ Alvin Powell

There were two times during my coverage of the pandemic that I felt an almost physical sensation — that pit-of-the-stomach feeling of shock or fear. The first was when Marc Lipsitch, an epidemiologist and head of the Harvard Chan School’s Center for Communicable Disease Dynamics, said early on that, unlike its recent predecessors SARS and MERS, which got people very sick, this virus also caused a lot of mild or asymptomatic cases. As that news sank in, I realized how difficult the future might become: How can you stop something before you know it’s there?

The second time I had that feeling was just a few weeks later. Through February 2020, the number of cases in the U.S. and globally had continued to grow, and it became clear that a major public health emergency was underway. Harvard’s experts, among many others, were offering a way forward, and I was writing regularly about the pandemic, about the new-to-me concept of “social distancing” and the importance of using masks to reduce spread — even as faculty members at our hospitals were also warning of shortages of personal protective equipment, or PPE — another term now embedded in our daily language. That was when President Donald Trump used the word “hoax” in discussing the pandemic. When I read that I thought, “This could get a lot worse.”

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By the third week in April, it had. Then, of course, the winter’s much larger surge was still just a vague threat and 100,000 deaths nationally from COVID-19 would soon warrant front-page treatment in The New York Times. Nursing homes — which concentrated society’s frail and elderly — had been hit hard early, as protective measures were being worked out and individual habits — life-saving ones — were still being ingrained.

I suspect that a nursing home isn’t part of anyone’s plan for their final years, and it certainly wasn’t for my mother. She was born in Hartford, poor and proudly Irish. She was artistic, eccentric, and joked later in life that if she hyphenated all her last names, she’d be Alynne Cummings-Powell-Martelle-Martelle-Herzberger-Harripersaud. Though she was tough on her husbands, she was easy on her kids. Despite the roiling of her married life, our home in the Hartford suburbs was mostly stable. That was largely due to the stick-to-it-iveness of my stepfather Sal — the two Martelles in there — and the fact that her four kids never doubted that she loved them.

She traveled even more than she married, preferring out-of-the-way places and bringing home images of the people who lived there. Among her destinations, she spent a summer in Calcutta volunteering at one of Mother Teresa’s orphanages and, on her return, she struck up a correspondence with the future saint.

Alynne Martell (center) surrounded by her children, Laura Lynne Powell (clockwise from left), Kelly San Martin, Alvin Powell, and Joseph Martelle. They are pictured at Hawks Nest Beach in Old Lyme, Conn., where they’ve gone for a week each summer for more than 45 years. Powell and his mother on a family kayak trip on the Black Hall River in Old Lyme.

Mom’s later years were difficult. Her mental decline had her moving from independent to assisted living and then to round-the-clock care. In the last year, her physical health and mobility had declined as well. When my mother spiked a fever in April, my siblings and I assumed it was COVID. It took the doctors some time to work through the possibilities, but they eventually got there, too. They and the nurses reminded us that it was not universally fatal, but nonetheless asked whether she had a living will. She did, and wanted no extraordinary measures taken.

Though many hospitals and nursing homes weren’t allowing visitors, the home where my mother stayed would let us in. Several family members had converged on the parking lot there, and we had a robust discussion of how safe it would be to go inside. My mother’s room was on the first floor, and some family members peered through its sliding glass door. My sister and I decided it was worth the risk to sit with Mom during her final hours, as she would have if indeed our places had been reversed.

On that Friday when Kelly and I entered the lobby, the facility appeared to be taking necessary precautions. In addition to providing PPE, they questioned us about our health and took our temperatures before letting us farther into the building. The main thing I was uneasy about was the use of surgical masks rather than N95 respirators. The N95s, I thought, would provide a level of protection commensurate with sitting in a place where we knew the virus was circulating.

On the second day, two friends teamed up to get us the N95s one had stockpiled during the 2009 H1N1 epidemic. We met in the parking lot for the handover — accomplished with profuse thanks and at a safe distance. The masks eased my mind. The key to weathering the pandemic came not from hiding away, but from a clear-eyed assessment of risks and having a plan to manage them. I had also learned during months of covering the pandemic that even measures inadequate on their own could be powerful when layered over one another. So, though it now seems like overkill, after doffing all the protective gear on the way out, we also changed into clean clothes in the chilly April parking lot, our modesty shielded by open car doors. We stowed the dirty clothes in plastic bags in the trunk and made liberal use of the giant bottle of hand sanitizer Kelly had brought.

“My mom had a metal sculpture of herself made by artist Karen Rossi. Her four kids are hanging off her feet in mobile-style,” writes Alvin Powell.

The result was that my sister and I were able to sit with my mom for several hours over the weekend. She was mostly asleep or unconscious but roused herself, seeming to rise from a place deep inside, to rasp out that she loved us. Then she retreated inward again.

Mom died the following Monday, and I went into home quarantine for two weeks, breaking it once to head back down the Pike to make arrangements with a completely overwhelmed funeral home. She had wanted to be cremated, but the crematorium was also backed up, so they refrigerated her body for several days until they could get to her. Afterward, my brother, Joe Martelle, picked up her remains and brought her home to await her burial.

But we delayed too. We put off her funeral until the family could gather for the bash she wanted as a farewell — she’d picked out the music and assigned tasks to different family members — Joe and I were to build the wooden box for interment. “August,” I initially thought. Then “October.” I was sure about October. My sister in Sacramento, Laura Lynne Powell, had suggested early on we might have to wait for the April anniversary of her death, which at the time seemed ridiculously distant since the pandemic surely would be controlled by then. Now, of course, April’s here and it is still too early for a big gathering.

In the year since my mother died, I’ve been back at work and have continued to learn as much as I can in order to convey our shifting — yet advancing — knowledge to readers. I’ve been repeatedly reminded how far I still am from “the full COVID experience” because the virus seems insatiable and just keeps on taking.

I don’t for a minute think my family is unique in its impacts, but many of those around me have experienced some ugly aspect of it. My son was laid off; my daughter’s 18th birthday, high school graduation, and freshman year in college have been canceled, delayed, or distorted beyond recognition. Two daughters and four grandchildren have been diagnosed with COVID and recovered. In February, four family friends in my Massachusetts town saw the contagion flare through their households, while my own family in Connecticut watched with concern as a loved one became severely ill, later rejoicing at her recovery after treatment with remdesivir.

The pandemic picture seems to have become even muddier lately, devolving into a foot race between vaccines and variants. Through much of March, vaccines seemed sure to win, but warnings from public health officials have become dire of late, warning of too-soon reopenings and the potential for a fourth surge. My stepfather Sal has gotten his second vaccine dose though, so hopefully he, at least, is out of harm’s way. I’m also hearing of friends and family whose first dose appointments are looming. That gives me hope and serves as a reminder that there is one part of “the full COVID experience” I’m looking forward to: its end.

Alvin Powell is the Harvard Gazette’s senior science writer.

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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.

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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.

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• Library of Congress
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Stories from the COVID-19 Pandemic: A Resource Guide

Introduction.

• National and Regional Collections
• Library of Congress Collections
• Share Your COVID-19 Story with StoryCorps
• Using the Library of Congress

American Folklife Center : Ask a Librarian

Have a question? Need assistance? Use our online form to ask a librarian for help.

Authors: Allina Migoni, Reference Librarian, American Folklife Center

Douglas D. Peach , Folklife Specialist, American Folklife Center

Created: May 12, 2023

Last Updated:  July 22, 2024

The COVID-19 pandemic created many changes in American society: previously unimaginable devastation and loss of life; advances in technology and media to meet humanity's need for connection; physical and geospatial changes as people quarantined; and social and psychological changes as humanity grappled with the "new normal." 

These changes also inspired many Americans to document their experiences with COVID-19. Since March 2020, thousands of people have contacted the Library of Congress to learn how to document their lives and for resources to understand this once-in-a-lifetime phenomenon. In early 2023, Congress recognized the importance of this documentation by passing the COVID-19 American History Project. The bill tasks the Library of Congress to “record, collect, and keep the stories of Americans impacted by the pandemic."

This research guide is a response to this Congressional mandate and the public’s interest. The guide provides links to COVID-19 collections within the Library of Congress and to online collections outside of the Library. These resources provide an expansive view into Americans’ experiences to life in a pandemic. This research guide also links to StoryCorps—a resource to document your own story, or to record the experiences of another, with COVID-19. In summary, this guide provides historical perspectives on American life, and an opportunity to document contemporary experiences, as COVID-19 transitions from a pandemic to an endemic in the United States.

Selections from the Library's Online Collections

Vergara, Camilo J., photographer. Dariana, Elmhurst Hospital, Corona Virus testing site, 79-01 Broadway, Queens . April 25, 2020. Library of Congress Prints and Photographs Division.

Jimenez, Eileen, artist. Together We Lift the Sky . [Seattle], Amplifier, 2020. Library of Congress Prints and Photographs Division.

Krauthamer, Diane, photographer. Stay Home. Stay Safe. January 8, 2021. Library of Congress COVID-19: American Experiences Collection. Flickr.

Pandemic folk architecture: outdoor dining sheds and urban creativity on the sidewalks of new york folklife today blog november 8, 2021. library of congress american folklife center..

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Peer-reviewed

Research Article

Emergency medical service interventions and experiences during pandemics: A scoping review

Contributed equally to this work with: Despina Laparidou, Ffion Curtis, Nimali Wijegoonewardene

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

Affiliation Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, United Kingdom

Roles Conceptualization, Formal analysis, Investigation, Methodology, Supervision, Validation, Writing – review & editing

Affiliation Department of Health Data Science, Liverpool Reviews & Implementation Group (LRiG), Institute of Population Health, University of Liverpool, Liverpool, United Kingdom

Roles Formal analysis, Investigation, Writing – review & editing

Affiliations Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, United Kingdom, Ministry of Health, Colombo, Sri Lanka

¶ ‡ JA, DDW, PDK and ANS also contributed equally to this work.

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

* E-mail: [email protected]

• Despina Laparidou, 
• Ffion Curtis, 
• Nimali Wijegoonewardene, 
• Joseph Akanuwe, 
• Dedunu Dias Weligamage, 
• Prasanna Dinesh Koggalage, 
• Aloysius Niroshan Siriwardena

• Published: August 1, 2024
• https://doi.org/10.1371/journal.pone.0304672
• Peer Review
• Reader Comments

The global impact of COVID-19 has been profound, with efforts to manage and contain the virus placing increased pressure on healthcare systems and Emergency Medical Services (EMS) in particular. There has been no previous review of studies investigating EMS interventions or experiences during pandemics. The aim of this scoping review was to identify and present published quantitative and qualitative evidence of EMS pandemic interventions, and how this translates into practice.

Six electronic databases were searched from inception to July 2022, supplemented with internet searches and forward and backward citation tracking from included studies and review articles. A narrative synthesis of all eligible quantitative studies was performed and structured around the aims, key findings, as well as intervention type and content, where appropriate. Data from the qualitative studies were also synthesised narratively and presented thematically, according to their main aims and key findings.

The search strategy identified a total of 22,599 citations and after removing duplicates and excluding citations based on title and abstract, and full text screening, 90 studies were included. The quantitative narrative synthesis included seven overarching themes, describing EMS pandemic preparedness plans and interventions implemented in response to pandemics. The qualitative data synthesis included five themes, detailing the EMS workers’ experiences of providing care during pandemics, their needs and their suggestions for best practices moving forward.

Conclusions

Despite concerns for their own and their families’ safety and the many challenges they are faced with, especially their knowledge, training, lack of appropriate Personal Protective Equipment (PPE) and constant protocol changes, EMS personnel were willing and prepared to report for duty during pandemics. Participants also made recommendations for future outbreak response, which should be taken into consideration in order for EMS to cope with the current pandemic and to better prepare to respond to any future ones.

Trial registration

The review protocol was registered with the Open Science Framework ( osf.io/2pcy7 ).

Citation: Laparidou D, Curtis F, Wijegoonewardene N, Akanuwe J, Weligamage DD, Koggalage PD, et al. (2024) Emergency medical service interventions and experiences during pandemics: A scoping review. PLoS ONE 19(8): e0304672. https://doi.org/10.1371/journal.pone.0304672

Editor: Zeus Aranda, Partners In Health, MEXICO

Received: July 22, 2023; Accepted: May 15, 2024; Published: August 1, 2024

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

Data Availability: Data are provided within the paper and its Supporting Information files together with additional data extraction files available from https://repository.lincoln.ac.uk/articles/dataset/EMS_pandemics_Repository_Data_19_02_2024_xlsx/25245448 .

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

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

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was first discovered in humans in Autumn 2019. By February 2020 it had spread around the world and was declared to be a global pandemic on March the 11 th by the World Health Organization (WHO). The global impact of COVID-19 has been profound and attempts to manage and contain the virus have placed increased pressure on healthcare systems and Emergency Medical Services (EMS) in particular. Lessons learnt from previous pandemics, such as Severe Acute Respiratory Syndrome (SARS-CoV) in 2002, as well as the current COVID-19 pandemic, are essential for informing global pandemic preparedness plans [ 1 ], which are key tools for fighting the current and any future pandemics as well.

Emergency Medical Services, in particular, have a vital role within emergency preparedness systems as they are on the front line of responses to the urgent medical needs of patients. There have been few studies investigating EMS’ role in pandemic preparedness prior to the COVID-19 pandemic, but there has been a flurry of evidence since the current pandemic started. For example, one study [ 2 ] investigated EMS personnel’s willingness to respond to an influenza outbreak and found that those workers who were concerned, but confident in their abilities and knowledge in flu as well as in workplace safety, were more likely to report for duty. A more recent study [ 3 ], aiming to assess EMS’ available resources, including personal protective equipment (PPE) availability, and institutional policies and practices during the COVID-19 pandemic found there was a need for better education and training around clinical symptom recognition and origins of the disease, as well as about decontamination of personal items, such as stethoscopes, and EMS equipment.

In addition, Labrague and colleagues [ 4 ] published a systematic review of preparedness levels for future disaster response, but their population of interest was nurses and not EMS personnel. To date, based on our preliminary searches and to our knowledge, there has been no attempt to bring together all the studies that discuss EMS preparedness levels and understand how the evidence translates into practice. Two scoping reviews have been published recently, but one review [ 5 ] focused solely on the value of call-centre dispatch and ambulance-based syndromic surveillance for infectious disease detection, whereas the second study [ 6 ] only explored applications of quality improvement at public health agencies (not EMS) during the COVID-19 pandemic. Finally, a narrative review [ 7 ] investigated the global increase of EMS calls due to COVID-19 and the reasons behind the bottleneck of EMS calls during the early phase of the pandemic. A scoping review of all available evidence on current and past EMS pandemic preparedness interventions, as well as exploring EMS personnel’s experiences and perceptions, would be crucial to identify gaps in the design and implementation of current pandemic preparedness interventions. Furthermore, lessons learnt so far can help provide recommendations for future EMS pandemic preparedness planning.

Aim and research questions

The aim of this scoping review was to identify and present the available quantitative and qualitative evidence of EMS pandemic preparedness, and how this translates into practice. This included studies of EMS pandemic preparedness plans, intervention implementation and evaluations, and importantly perceptions of EMS staff and patients. The findings of this scoping review will be used to inform future research to strengthen EMS pandemic preparedness planning.

Our research questions were:

• What interventions (e.g., infection control, PPE) have been implemented within the Emergency Medical Services (EMS) in response to/during pandemics and what outcomes are reported relating to such interventions?
• What evidence is there describing the experiences of EMS staff and patients during pandemics?

We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist [ 8 ] and the Arksey & O’Malley framework [ 9 ] for conducting this scoping review. The review protocol was registered with the Open Science Framework (osf.io/2pcy7). See Supporting Information for the completed PRISMA-ScR checklist (S1 PRISMA-ScR Checklist) and a copy of the review protocol (S2 Open Science Framework Protocol Registration).

Inclusion criteria

Studies were eligible for inclusion if they reported on original (primary or secondary data analysis), quantitative, qualitative or mixed-methods studies within which ambulance service/EMS personnel and patients were engaged (including papers with mixed samples, provided that the majority of the participants were EMS staff members and/or patients) during epidemic or pandemic disease outbreaks. For studies to be considered eligible they had to meet the following inclusion criteria: Participants: Ambulance service or EMS staff, pre-hospital patients, attended by ambulance service or EMS staff during epidemics or pandemics and their relatives; Concept/phenomena of interest: any type of intervention implemented in response to epidemics or pandemics within prehospital EMS/ambulance services, as well as the experiences of EMS staff and/or pre-hospital patients during epidemics or pandemics; Context: All global prehospital EMS/ambulance services; Types of study: Quantitative approaches including, but not limited to, interventional studies, feasibility studies, observational studies (cohort and case control), quasi-experimental studies, cross sectional studies and surveys, As well as qualitative designs including, but not limited to, phenomenology, grounded theory, ethnography, and a generic qualitative approach. Finally, multi-methods studies that met the qualitative and/or quantitative inclusion criteria specified above. Data from multi-methods studies were extracted into the respective quantitative and/or qualitative arm of this review and synthesised accordingly.

Studies were excluded if: they were conducted in the emergency department or hospital; the participants were non-EMS personnel (e.g., hospital nurses, General Practitioners, etc.); the interventions were not implemented during an epidemic or pandemic; and/or the papers were published in a language other than English, due to lack of resources for translation of such papers.

Information sources and search strategy

Electronic database searches were performed in MEDLINE, PubMed, CINAHL, Cochrane Library, PsycINFO (including content from PsycARTICLES), and Web of Science Core Collection. All database searches were supplemented with internet searches (i.e., Google Scholar), and forward and backward citation tracking from the included studies and review articles. PROSPERO was also searched for protocols of existing (completed or ongoing) systematic reviews. Databases were searched from inception to July 2022. The search strategy used in all the above databases was a combination of the following keywords and related terms: ambulance; emergency medical services; and pandemic. The search terms were entered using Boolean operators and truncation. Medical Subject Headings (MeSH) were also employed in forming the search strategy. For the full search strategy used for each of the databases, see Table 1 .

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https://doi.org/10.1371/journal.pone.0304672.t001

Study selection and data charting

All references were reviewed and screened independently by seven reviewers (working in pairs, with one reviewer [DL] forming part of more than one pair of reviewers). Titles and abstracts were initially screened for relevance and final eligibility was assessed through full-text screening against the inclusion criteria, using a pre-designed study selection form. Any disagreement between the reviewers over the eligibility of references was resolved through discussion between the entire team of reviewers.

A standardised, pre-piloted form was used to extract data from the included studies for data synthesis. Extracted information included: study details (title, authors, date, country), methods (aims, objectives, research questions, study design, setting, data collection methods, intervention characteristics,), participant characteristics (demographics, inclusion/exclusion criteria, method of recruitment, sample selection, sample size), and study findings (main and secondary outcomes, data analysis, conclusions). One reviewer extracted data and a second reviewer checked the data extractions for accuracy. Any discrepancies were resolved through discussion.

Data synthesis

A narrative synthesis of all quantitative eligible studies was performed and structured around the study design/methodology adopted and aims, key findings, as well as intervention type and content, where appropriate.

Qualitative data from the qualitative studies were also synthesised narratively and presented thematically, according to meaning and content.

The search strategy identified a total of 22,599 citations and of these 90 were included in this scoping review. Fig 1 presents a flowchart illustrating the results of the selection process.

https://doi.org/10.1371/journal.pone.0304672.g001

Out of the 90 included studies (summarised in Tables 2 – 9 ), 71 were purely quantitative and 12 were purely qualitative studies. In addition, four studies were mixed-methods [ 10 – 13 ] that involved both a quantitative and qualitative design. One of these studies [ 11 ] used interviews only to describe the model for the deployment process of EMS procedures and, as such, only the quantitative arm of this study will be included in this review. In addition, only the qualitative arm of the study by Petrie and colleagues [ 12 ] will be included in this review, as their quantitative arm did not meet our inclusion criteria. Similarly, only the qualitative arm of the study by Vilendrer and colleagues [ 13 ] will be included in this review, as this study did not report on any relevant demographic and user data, due to restrictions in their data use agreements. Findings of the study by Alwidyan [ 10 ], the fourth mixed methods study, will be presented and discussed under the quantitative and qualitative sections of the results below, depending on which type of design is being presented.

https://doi.org/10.1371/journal.pone.0304672.t002

https://doi.org/10.1371/journal.pone.0304672.t003

https://doi.org/10.1371/journal.pone.0304672.t004

https://doi.org/10.1371/journal.pone.0304672.t005

https://doi.org/10.1371/journal.pone.0304672.t006

https://doi.org/10.1371/journal.pone.0304672.t007

https://doi.org/10.1371/journal.pone.0304672.t008

https://doi.org/10.1371/journal.pone.0304672.t009

Two studies [ 14 , 15 ] conducted surveys with open-ended questions and described their design as a cross-sectional [ 15 ] or mixed-methods [ 14 ] study, but analysed their findings qualitatively. One study [ 16 ] was a reflection/text and opinion paper. The study characteristics and results of these three studies [ 14 – 16 ] will be presented and discussed as qualitative studies.

Seventy four out of the 90 included studies (82.2%) were conducted and published since the COVID-19 pandemic had started.

Quantitative synthesis

Study characteristics..

The 73 quantitative studies (including the quantitative arms of two mixed-methods studies) (Tables 2 – 8 ) were published between 2004 and 2022 and were from the USA (n = 24; 32.9%) or Canada (n = 2; 2.7%), Europe (n = 21; 28.8%), Asia (n = 22; 30.1%), and Australia (n = 3; 4.1%), while one Delphi study [ 17 ] included an international panel of experts (1.4%).

A large proportion of studies (n = 15; 20.5%) were cross-sectional, questionnaire studies. Sample sizes (excluding those analysing EMS call volumes, dispatches and/or response times) ranged from 10 to 15,339 participants ([ 18 ] did not specify their final sample size). One study [ 19 ] only included male participants and many studies had either data missing or did not report gender data. Ages ranged from 19 to over 80 years, with many studies not reporting any relevant data. Only 8 studies (11%) included details on their participants’ ethnicity, with the majority identifying as White.

Most studies included combinations of paramedics and Emergency Medical Technicians (EMTs) or other types of EMS personnel (such as nurses or physicians), while some studies defined their participants as emergency prehospital medical care workforce [ 20 , 21 ], EMS personnel [ 22 , 23 ] or first responders [ 24 , 25 ]. One study [ 17 ], using a systematic Delphi procedure, included a multidisciplinary group of experts on outbreak preparedness. Various studies included only patients, while two studies included patients and paramedics [ 26 , 27 ]. Two studies recruited healthy volunteers [ 28 , 29 ].

Quantitative narrative synthesis.

After considering each included study’s aims, outcomes, and major findings, we developed seven overarching themes, describing EMS pandemic preparedness plans and interventions implemented in response to pandemics.

Willingness to work , treat patients and get vaccinated . Seven studies (9.6%) [ 2 , 10 , 20 , 30 – 33 ] asked EMS staff members about their views on working during disease outbreaks/pandemics and factors influencing their decisions. Most respondents would be willing to report for duty in case of a disease outbreak or pandemic, with corresponding percentages ranging from 56.3% [ 20 ] to 93% [ 2 ]. One further study [ 24 ], conducted since the COVID-19 pandemic begun, found that willingness to respond to alarms was lower during the pandemic (with or without PPE). Despite that, most participants were willing to perform chest compressions, defibrillate using an automated external defibrillator, ventilate a patient using a bag and mask and an appropriate airway filter, and ventilate a patient using a face mask.

Most papers identified predictors of reporting for duty, such as operating in a state that had emergency preparedness laws [ 34 ]; first responders knowing and being prepared to perform their responsibilities in a pandemic [ 2 , 32 ]; knowing that one of their colleagues had been exposed to suspected or a known case of pandemic human influenza [ 20 ]; confidence about safety at work [ 2 , 10 , 20 , 32 ] or that the employer would provide appropriate training, an effective treatment and vaccine when available [ 10 ] or adequate PPE [ 30 , 31 ]; receiving prophylaxis for themselves and their family members [ 31 , 32 ]; having adequate knowledge and training for disease outbreaks [ 2 , 20 , 30 ]; being concerned about self or family safety [ 10 , 20 , 30 , 33 ]; having family prepared to function in their absence [ 10 ]; lack of confidence in emergency health preparedness and lack of PPE availability [ 33 ]; and, believing their co-workers were likely to work [ 32 ]. Other predictors of a greater likelihood of reporting for duty were younger age, male gender, single status, and having no young children [ 31 ].

Finally, one study [ 35 ], exploring the COVID-19 vaccination acceptance of EMS personnel, found that 57% of participants were willing to be vaccinated and 27.6% were undecided. Participants who showed higher willingness to be vaccinated tended to be male, of higher education level, older age, and felt more strongly that they were personally burdened by the pandemic.

Preparedness to face pandemics/recommendations . Three cross-sectional, questionnaire studies (4.1%) [ 3 , 18 , 33 ] found that EMS workers exhibited low levels of knowledge and training about infectious diseases, as well as compliance with practices (such as selecting and removing PPE) [ 3 , 33 ]. Often, they had limited access to PPE equipment and regular decontamination of EMS equipment after each patient contact was not a regular practice [ 3 ]. On the contrary, a study by Jadidi and colleagues [ 18 ] revealed that Iranian EMS’ efficacy and preparedness levels to face Ebola were higher than standards, as represented by factors such as triage, diagnosis, isolation processes, using PPE, as well as transporting and providing care during transfers.

One study [ 36 ] used discrete event simulation models to evaluate the resource requirements during the peak of the pandemic, by estimating number of beds needed in the ED, number of ambulances required to maintain pre-pandemic response times for emergency patients, as well as to study the effects of ED boarding time for COVID-19 patients. They found that a strict testing policy increased the bed requirements in the ED, while it led to decreased ambulance response times. They also showed that when boarding is considered, the effects were most prominent during night and weekends.

One further study [ 37 ] developed and evaluated a dedicated paramedic surveillance and quarantine program, during a Severe acute respiratory syndrome (SARS) outbreak. They determined the number of paramedics on quarantine each day, the type of quarantine, and the development of SARS-like symptoms, and concluded that their program could provide a useful means to managing the paramedic resource during that and any future SARS outbreaks.

Finally, Belfroid and colleagues [ 17 ] employed a systematic Delphi procedure and presented 18 recommendations for future pandemic preparedness.

Knowledge & education . Thirteen studies (17.8%) [ 20 – 22 , 32 , 33 , 38 – 45 ] explored issues around EMS staff members’ pandemic knowledge and training.

Most studies [ 21 , 32 , 33 , 40 , 45 ] found low levels of pandemic-related training and knowledge including that of infection transmission. Most studies [ 33 , 40 , 45 , 46 ] found that PPE use was inconsistent and knowledge about PPE requirements low, e.g., how N95 masks worked or the correct PPE removal sequence. Practices employed to alter the environment within the ambulance, such as ensuring the desired airflow when transporting a patient with an airborne illness or disinfection of the ambulance at any time were inconsistent, despite respondents reporting that ambulances were routinely cleaned [ 40 ].

Only two studies (2.7%) [ 38 , 42 ] reported adequate levels of training on patient and practitioner safety related to infectious and communicable diseases (including routes of exposure) [ 42 ]; how to screen and provide emergency medical treatment for such patients [ 42 ]; and respirator use during the COVID-19 pandemic [ 38 ]. The main barriers to adequate awareness/training included part-time employment, providing 9-1-1 response service, working at a non-fire-based EMS agency, and working in a rural setting [ 38 ]. Some participants did express an interest in having more quality training and not feeling confident enough to respond to diseases with the magnitude or severity of Ebola virus disease [ 42 ].

In addition, four studies (5.5%) [ 22 , 41 , 43 , 44 ] investigated the effectiveness of various educational interventions. These interventions were effective in increasing knowledge and behavioural intentions to use respirators, get vaccinated and willingness to report for duty during a potential pandemic [ 41 ]; increasing adequate choice of PPE [ 43 , 44 ], especially for those student paramedics who were also actively working in an ambulance company [ 44 ]; and increasing comfort levels in managing respiratory failure in suspected/known COVID-19 patients, as well as non-COVID-19 patients [ 22 ].

Finally, one study [ 39 ] showed that a simulation software environment (SPECTRa) provided a feasible alternative approach to live prehospital simulation and showed potential for remote healthcare research and training during the COVID-19 pandemic.

Infection risks & control . Three studies (4.1%) focused on the safety of ambulances and their role in EMS crew COVID-19 infections [ 47 – 49 ]. Their results showed that negative pressure ambulances can help decrease the number of new, confirmed COVID-19 cases [ 47 ]; that the most frequently contaminated areas in ambulances were the left front door’s outer handle, driver’s handle, gear lever, and mat, the rear door, rear door lining, and handle over the roof [ 48 ]; as far as personnel is concerned, the most frequently contaminated areas before the removal of PPE are the lower chest to the belly area, bilateral hands, lower rim of the gown, and shoes, and after PPE removal, traces of fluorescence were observed over the neck, hands, and legs [ 49 ]; and that when both crew and patient wore respirators or a cloth mask during a simulated ambulance transfer, these practices reduced predicted mean infection risks by 85% (which was a higher reduction than when only one of them wore a respirator or a cloth mask) [ 49 ].

Two further studies (2.7%) [ 19 , 27 ] examined various factors associated with COVID-19 infection risks in EMS staff members. Results showed that EMS providers’ positive tests for COVID-19 (after having been exposed to patients with COVID-19) were not attributed to occupational exposure from inadequate PPE and that programmatic strategies were associated with a temporal increase in adequate PPE use and a decrease in EMS provider exposures [ 27 ]. Results also showed that the factors mostly correlated with the increasing risk of COVID-19 in EMTs were having two EMTs taking care of patients, working with a confirmed case teammate, using personal items (e.g., mobile phone or jewellery) despite protective clothing, contact with the outer surface of clothing while removing PPE, not taking precautions such as seal check after wearing the mask, and not covering the hair with a medical hat [ 19 ].

Making improvements regarding resources & PPE . Six studies (8.2%) evaluated the use of improved resources or PPE during COVID-19 [ 28 , 29 , 50 – 53 ]. Three of these studies [ 28 , 29 , 53 ] found that negative pressure devices (a powered air purifying respirator helmet called AerosolVE; a procedural tent called AerosolVE BioDome; and a portable, reusable, transparent vinyl chloride shield together with suction to generate negative pressure, respectively) can filtrate or reduce aerosol dispersion and exposure to airborne particles, thus, making ambulances potentially safer for EMS personnel. Another study [ 51 ] showed that a compact atmospheric plasma device could be used successfully to disinfect ambulances.

In addition, Małysz and colleagues [ 52 ] showed that chest compressions with LUCAS 3 can increase the chest compression quality (when compared with manual chest compressions and the TrueCPR), as evidenced by the depth and rate of the compressions, as well as chest recoil. Finally, one study [ 50 ] evaluating the influence of PPE with different types of filtering face piece (FFP) masks on attention and dexterity of EMS personnel during basic life support procedures found that neither of these two neuropsychological components were affected by FFP mask use.

Call volumes , ambulance response times and triage (logistics of service delivery) . Twenty five studies (34.2%) [ 11 , 24 , 54 – 76 ] looked at the impact of the COVID-19 pandemic on EMS utilisation and how implementing a variety of COVID-19-related interventions (such as changing coding calls and protocols for assessment or care; developing coronavirus EMS support tracks or web-based self-triage systems, etc.) affected EMS utilisation.

Data analysis of most studies revealed that despite an initial increased demand on EMS resources (especially in relation to call volume), EMS response remained, on the average, relatively controlled, as demonstrated by overall call volume [ 67 , 75 ], response times [ 24 , 66 ], daily ambulance diversion rates [ 68 ], and the number of out-of-hospital cardiac arrests [ 67 ].

Other studies, however, found less positive results related to a sustained increase of EMS calls [ 58 , 69 , 70 , 73 ], queue times (though the significant increase in the total EMS call volume was mitigated by the implementation of a coronavirus EMS support track) [ 60 ], EMS dispatches [ 69 , 73 ], EMS processing times [ 62 ], prehospital times (except for the scene time of cardiac arrest patients) [ 68 ], and response times/interval [ 70 , 72 ]. Mulyono and colleagues [ 11 ], employing an agent-based simulation model, found that the main factors contributing to increased response times were the process of preparing crew and ambulance during the pandemic (relating to the safety procedure in handling patients), service coverage area, traffic density and crew responsiveness. The recommended coverage area for maintaining a low response time was 5 km.

Twelve studies (16.4%) [ 54 – 57 , 59 , 61 , 63 – 65 , 71 , 74 , 76 ] explored ways of managing the response to emergency calls (during the COVID-19 pandemic) by implementing a range of technology and protocol/systems interventions. These were: applying Business Intelligence to the management of EMS [ 74 ]; using the Internet of Things to design a relief supply chain network to address multiple suspected cases during the pandemic [ 76 ]; applying a novel Deep Self-Learning Approach to Artificial Orca Algorithm and based on mutation operators to address ambulance dispatching and emergency calls covering problems [ 55 ]; applying two Swarm Intelligence Algorithms (Artificial Orca Algorithm and Elephant Herding Optimization) to organize and manage the dispatching of emergency vehicles while respecting the cover of calls during a crisis [ 56 ]; running a first-stage optimization model to designate ambulances to serve only infected patients and suspected cases [ 71 ]; and, using information and communication technology for emergency medical services (ICT-EMS) systems to improve the transportation of emergency patients [ 64 ]. A few interventions [6.8%] also focused on phone or video triage [ 54 , 59 , 61 , 63 , 65 ], with positive results. A study [ 57 ] evaluating the safety of a new EMS protocol directing non-transport of low-acuity patients during the COVID-19 pandemic reported large deviations from the novel non-transport protocol and that several patients had to be admitted to hospital, both when the protocol was used correctly and when it was used incorrectly.

Identifying patients , testing & vaccinations . Ten studies (13.7%) investigated the diagnostic accuracy of EMS in identifying COVID-19 patients [ 23 , 46 , 65 , 77 – 82 ] or predicting death from pre-hospital vital signs [ 83 ].

According to their findings, initial vital signs (with the exception of body temperature) [ 82 ], prehospital triage tools [ 81 ], and telephone screening processes/surveillance tools used by emergency medical dispatchers [ 46 , 65 , 77 , 80 ] had little to moderate predictive value for the identification of COVID-19 patients and/or death.

Other studies (n = 4; 5.5%) have found more encouraging results, such as the lowest recorded pre-hospital oxygen saturation being an independent predictor of mortality in COVID-19 patients [ 83 ]; rapid antibody testing helping to diagnose COVID-19 in both asymptomatic and symptomatic EMS personnel [ 23 ]; newly developed clinical criteria for identifying COVID-19 patients showing a strong degree of correlation between such emergency transports and new hospitalizations [ 79 ]; and, a prehospital sit-stand test identifying stable, suspected COVID-19 patients in risk for later deterioration [ 78 ].

Two studies (2.7%) [ 26 , 84 ] explored how EMS can help facilitate testing for COVID-19 by evaluating the implementation of drive-through COVID-19 testing facilities operated by EMS. Results from both studies showed that COVID-19 testing performed by EMS staff can be efficient and safe to operate for both the staff and the patients [ 26 , 84 ], as well as cost-effective [ 84 ].

Finally, two studies (2.7%) looked at the role of EMS in mass vaccinations and concluded that EMS providers were “uniquely equipped to participate in mass immunization efforts” [ 85 ] and played an important role in planning and logistics, patient screening and observation, vaccine preparation and administration, and home vaccination efforts [ 86 ].

Qualitative synthesis

The 18 qualitative studies (including the qualitative arms of 3 mixed-methods studies, the surveys that analysed their findings qualitatively, and the text and opinion paper) ( Table 9 ) were published between 2018 and 2022 and were predominantly from the USA (33.3%). Sample sizes ranged from 3 to 424 participants and included both male and female participants (27.8% did not report any data on gender). Participants were EMS staff members or community members. One study included EMS providers [ 16 ] but did not report any more information about their participants. Two studies [ 13 , 87 ] also reported the perceptions and experiences of hospital healthcare workers and essential workers (e.g., gas station and grocery store employees), respectively, whose views, however, will not be included in this review, as they did not meet the study’s criteria for inclusion.

Only 12 studies (66.7%) presented information about the participants’ age, with ages ranging from 22 to 78 years old for emergency services personnel; community members’ ages ranged between 35 and 64 years old [ 88 ]. Only two studies (11.1%) [ 13 , 89 ] specified the ethnicity of their participants, with the majority identifying as White.

Most studies were based on individual semi-structured interviews (61.1%) and two studies were PhD theses (11.1%) [ 10 , 90 ]. One study [ 16 ] was a reflection/text and opinion paper that included excerpts of participants but gave no additional information about their data collection methods and did not include any formal analysis. Various methods of analysis were employed, with seven studies using thematic analysis (38.9%).

Qualitative data synthesis.

We used narrative synthesis to summarise and explain the findings of this scoping review.

Motivation , confidence , and feelings about working during pandemics . Working during a pandemic was a traumatic experience for many staff members [ 16 , 91 ], who felt that they were often faced with significant challenges [ 13 , 16 , 91 , 92 ], such as not knowing how to properly treat patients, not feeling safe due to poor PPE or the constant changes in protocols and procedures [ 16 ]; being unable to socialise and take comfort in colleagues and friends [ 12 , 16 ]; as well as having less contact with their families [ 12 , 13 , 16 , 90 ].

When asked about their feelings about working during pandemics, EMS personnel reported feeling a myriad of different emotions, such as stress [ 12 , 13 , 16 , 25 , 87 , 89 – 91 , 93 , 94 ], anxiety and fear [ 10 , 12 , 13 , 15 , 16 , 25 , 87 – 96 ], as well as feelings of frustration [ 13 , 91 , 94 ] or failure, when they couldn’t save a patient [ 16 ]. They also felt they were faced with difficult clinical and ethical decisions in their practice, such as having to decide between prioritising their own safety and the safety/care of the patient [ 92 ].

Despite these negative emotions, many participants also felt positive about the experience of caring for patients and reported feeling proud [ 87 ], excited [ 87 , 89 ], or even safe and protected [ 87 ]. They also mentioned what they felt were the positive outcomes of pandemics, such as giving them a chance to test their protocols and increasing their team spirit [ 87 ], as well as encouraging the use of technology across the healthcare system [ 91 ] and using what they’ve learned to help expand prehospital care [ 16 ].

As a result, the majority of EMS personnel were willing to report for duty during a pandemic [ 10 , 13 , 16 , 89 ] and often felt they had a high professional and ethical obligation to work under any and all situations [ 10 , 13 , 16 , 88 , 89 , 91 ].

There were others who were unwilling to report for work or provide care for patients [ 10 , 88 , 89 ]. Some of the main reasons behind their unwillingness to report for duty were not understanding the cause and modes of transfer of a disease [ 10 ], not having been provided with appropriate PPE [ 10 ], not feeling confident in their skill set [ 10 ], role ambiguity [ 90 ], lack of trust in their employer [ 90 ], and being concerned about their own or their family’s safety [ 10 , 89 , 90 ]. On the contrary, some of the factors that would positively affect someone’s willingness to report for duty were receiving adequate education and training, having appropriate PPE and equipment, and transparent protocols [ 10 , 89 ].

Balancing safety and risks . Overall, participants felt that being an EMS staff member was inherently risky work [ 10 , 89 , 90 , 92 , 94 ] but understood and accepted the risks and felt a duty to perform their jobs despite this [ 10 , 16 , 88 , 89 , 91 , 94 ].

Various participants expressed concerns about their own safety [ 10 , 12 , 15 , 16 , 25 , 90 – 92 , 94 – 96 ], not having adequate training or PPE [ 10 , 93 – 95 ], and the risk of transmitting the disease to their family [ 10 , 12 , 13 , 15 , 16 , 25 , 87 , 89 – 92 , 94 – 96 ]. As a result, they often took extra care and precautions to limit their risk of exposure [ 10 , 15 , 90 ]. Similarly, families of EMS personnel were also anxious about their safety and that of their working relative [ 87 ]. Finally, one study [ 97 ] found that fear of exposure and infection delayed EMS utilisation among patients with chronic health conditions and was also a concern for patients with acute health conditions (although they did continue to access services as required).

Despite participants’ need for and greater feeling of safety with PPE, they also discussed the negative side of wearing PPE while providing care for patients (especially during hot weather), such as experiencing stress and anxiety, profuse sweating, shortness of breath, local pain, restricted movement, or discomfort due to fogging goggles and/or prolonged use of masks [ 90 , 95 , 96 ]. Similarly, patients and their carers also discussed how communicating with EMS staff wearing PPE was challenging, especially for those who were deaf or hard-of-hearing [ 97 ].

The limits to personal moral duty . Even though most participants felt that EMS personnel had a duty to report for work, many also felt that there were potential limitations on duty to treat [ 88 , 91 ]. Some of these acceptable limitations were their own physical health (such as pregnancy or pre-existing chronic conditions) or that of a family member [ 88 , 91 ]; having mental health problems [ 88 ]; being a single caregiver with dependents or when both parents were healthcare workers [ 88 ]; as well as work-related factors, such as lack of appropriate PPE, anti-viral medication or appropriate vaccines during infectious disease outbreaks/pandemics, lack of appropriate quarantine facilities away from the home, and lack of relevant training [ 88 ].

One paper [ 88 ] also discussed community views on risk-taking by EMS personnel. Community members had differing views; some felt that EMS personnel shouldn’t be expected to put themselves at risk to treat patients during a disaster, pandemic, or even on a normal day, whereas others felt that there was a certain level of duty or obligation that comes with being an EMS worker [ 88 ].

Need for information , communication , and support . First responders expressed a desire for infectious disease information (such as routes of transmission, incubation period, infection rates, policies and protocols) [ 10 , 90 , 93 , 95 ], as well as follow-up information regarding a transported patient’s health status and detailed, localised data that could help them understand the geographic spread of cases throughout their area [ 13 ]. However, many also felt that receiving too much and constantly changing information was overwhelming and challenging [ 13 , 14 , 91 ] and that there was a lot of misinformation and lack of reliable data (in regard to COVID-19), which often made them sceptical about the information they were receiving [ 13 , 16 , 25 , 90 – 92 ].

Participants also highlighted the importance of proper communication during disease outbreaks [ 10 , 12 – 14 , 16 , 87 , 89 – 91 , 94 ] and how they felt that it was their employer’s responsibility to keep them (and their families) informed with the most up-to-date information about the disease and what they were expected to do [ 10 , 12 , 87 ]. Despite many participants reporting feeling adequately informed by their employers [ 10 , 91 ], but some felt that there was lack of communication by leadership, management, and politicians [ 12 , 16 , 94 ]. Participants said they would have liked to receive more consistent and transparent information about the disease [ 12 – 14 , 87 , 89 – 90 , 92 ], the provision of support in case of illness [ 94 ], and any protocols for triaging and transporting patients [ 12 , 13 , 87 , 89 , 90 , 93 , 94 ]. Others felt that there was lack of communication and collaboration between departments and organisations, such as the emergency department and EMS or the hospital and coordinating centres such as the Centre for Disease Control in the United States [ 13 , 14 , 16 , 89 , 92 , 94 ].

Another topic discussed in various papers was the importance of support from employers, colleagues and managers. Participants felt that building a relationship of trust between colleagues was an important element in the EMS [ 10 , 90 ] and reported often turning to their colleagues and team managers for emotional support and for stress relief [ 10 , 13 , 16 , 87 ]. In contrast, participants found it particularly tough when they could not socialise or take comfort from their teammates, for example during COVID-19 [ 16 ].

EMS personnel also recognised that their organisations put effort into their comfort and safety, and knowing that their organisation was continuously reviewing and improving procedures made them feel safe and protected [ 87 ]. They also expected organisations to provide them with resources, necessary materials and PPE, training and communication during disease outbreaks [ 10 , 87 , 92 ], as well as prioritising testing to keep them safe and to enable them to return to their duties [ 13 ]. In addition, some felt that it was the employer’s responsibility to provide a “safe haven” to their families as well, including offering them vaccines and/or treatment, if available [ 10 ]. Some EMS workers, however, felt unsupported and “left alone to fend” for themselves [ 12 – 14 , 16 , 94 ].

Regarding mental health support, opinions were also divided. Some would have liked to have received such support [ 12 , 87 , 93 ], while others felt either that they did not need it or that they could get it from other sources (e.g., family, friends, colleagues, private counsellors, the service Chaplain, etc.) [ 91 ]. Finally, EMS personnel found lack of financial support in the case of illness a major challenge, especially for those who were new in their role or couldn’t take any sick days, and often led to people hesitating to get tested, as they wouldn’t be able to take any time off work [ 13 ].

Requirement for resources , training , guidance , evaluation & solutions . Participants felt that adequate and up-to-date training and education were important [ 10 , 12 , 87 , 89 , 95 ] and could influence their willingness to report for work [ 10 , 89 ]. Most participants were satisfied with the training they received, as they felt it prepared them well for their tasks [ 87 , 89 ], while others were not satisfied [ 10 , 12 , 89 , 90 , 91 ], especially when it was lecture-based and not hands-on training [ 10 ].

Participants also felt that having clear, transparent, and simple protocols was equally important [ 87 , 89 , 90 , 93 ] and that it helped them remain calm by following the instructions [ 87 ]. In addition, lack of transparency about how the protocols were designed [ 89 ] and the constant protocol changes (e.g., about PPE) as the pandemic evolved, only added to their anxiety, frustration, and confusion [ 12 – 14 , 16 , 90 , 91 , 93 – 95 ] and made them concerned about whether the new protocols were sufficient [ 87 ]. Some also thought that these changes in clinical practice and guidance were rushed [ 91 ], that the quality of care was being compromised [ 91 ] and they felt ethically challenged, as the new protocols were asking them to deviate from what they were taught [ 16 ]. Participants also felt that their organisations and the governments were overall ill prepared to face a pandemic, such as COVID-19 [ 12 , 95 ].

Regarding the provision of resources and equipment to keep them safe and to ensure that they are able to carry out their job properly, various participants reported not having access to appropriate or up-to-date PPE during the COVID-19 pandemic and that this was a major concern for them [ 12 , 13 , 90 – 92 , 94 – 96 ]. Participants also mentioned that in some cases EMS workers did not comply to wearing PPE, mainly due to force of habit, not being used to having PPE on, not recognizing when it is the appropriate time to use the PPE, and/or thinking they won’t need them since they may not directly contact the patient [ 10 ]; this study, however, was conducted prior to the COVID-19 pandemic. Concern about and frustration with lack of compliance with hand hygiene routines (during the COVID-19 pandemic) was also discussed [ 15 ]. The main factors affecting hygiene compliance were the unpredictable work environment, situations where time is critical, worries about the risk of using new protective equipment (e.g., gas masks, which were introduced in the ambulance service during the pandemic), and having initiatives supported by their managers/organisations [ 15 ]. Having access to testing was also considered important for workers to be able to return to their duties, but many reported challenges in scheduling testing [ 13 ].

Finally, participants made a series of recommendations for future outbreak response. Participants felt that it would be best to have specialised teams dealing with outbreaks, such as a permanent infectious disease response team that would be responsible for maintaining and updating protocols, the training of personnel, and the “institutional readiness of disease outbreaks and epidemics” [ 89 ]. Participants also highlighted the importance of continuous training and education for pandemic preparedness [ 12 , 89 ] and suggested using a tiered training model (or even a peer training approach), where a few selected staff members would be trained comprehensively, who would, in turn, train others based on what their roles would be [ 89 ]. They also thought it would be a good idea to have regular “drills for the triage and transport of infectious patients, similar to that of mass casualty and disaster drills”, as well as to have training on how to use different types of PPE, to ensure that everyone is always prepared for a future pandemic [ 89 ]. Other suggestions were to have a dedicated app, through which accurate, up-to-date information (including localized infection rates and spread) could be delivered directly to EMS personnel, holding local question and answer sessions, or using social media to keep them informed [ 13 ].

This scoping review explored the available quantitative and qualitative evidence of EMS pandemic preparedness (i.e., to be able to respond and take action effectively on a personal and organisational level), and how this translates into practice. The findings of the review have shown that the majority of the EMS personnel are prepared and willing to report for duty during pandemics, despite their concerns for their own and their families’ safety and the many challenges they are faced with.

More specifically, participants reported being willing to report for work during pandemics and the main factors impacting their willingness were: their levels of training for and knowledge of disease outbreaks, and confidence in their skills; feeling that it’s their responsibility to work; confidence about safety at work (including adequate PPE, availability of treatment and vaccines); being concerned about their own or their family’s safety; and mistrust with the employer. Results also showed that the participants’ knowledge was often marginal (especially about infection transmission mechanisms and use of PPE), they had limited training on pandemic response, and either had issues accessing appropriate PPE or using PPE consistently. Lack of proper disinfection of the ambulances was also reported. Past studies have also shown moderate levels of perceived preparedness for the next pandemic, especially in reference to training and confidence in skills, of both social workers in hospital settings [ 98 ] and nurses [ 4 ]. In our review, various educational interventions were found to be effective in improving participants’ knowledge levels and intentions to use PPE, as well as improving management of respiratory failure in COVID-19 patients and could be considered appropriate means of educating EMS personnel on future pandemic preparedness issues.

Numerous studies also looked at infection risks and control and found that negative pressure ambulances can help reduce numbers of new COVID-19 cases; which areas in an ambulance are the most frequently contaminated areas during transfer of a patient with an infectious respiratory disease (including which areas of the EMS workers’ body are most frequently contaminated before and after the removal of PPE); the ability of face masks worn by both crew and patients to reduce predicted mean infection risks; that proper use of appropriate PPE can decrease occupational exposure; a portable, reusable, transparent vinyl chloride shield for use in an ambulance, together with suction to generate negative pressure, can reduce aerosol dispersion and exposure to airborne particle (without interfering with ventilation in the ambulance or endotracheal intubation in the emergency department); and, that chest compressions with LUCAS 3 can increase the chest compression quality. Also, the factors mostly correlated with the increasing risk of COVID-19 in crew members were having two crew members taking care of patients, working with a confirmed case teammate, using personal items (e.g., mobile phone or jewellery) despite protective clothing, contact with the outer surface of clothing while removing PPE, not taking precautions such as seal check after wearing the mask, and not covering the hair with a medical hat.

In addition, many studies looked at the impact of the COVID-19 pandemic on EMS utilisation and found that, although there was an initial increase in call volumes (and sometimes response times), on average, most ambulance dispatches remained relatively controlled (or even decreased in some cases, especially during later waves of the pandemic). Often this was the result of the different interventions that were implemented after the pandemic had started, such as having a coronavirus support track or using Business Intelligence models to identify infection clusters and relocate vehicles and personnel accordingly to these areas where it was more needed, to name a few. A past scoping review [ 5 ] on the utility of emergency call centre, dispatch, and ambulance data for syndromic surveillance of infectious diseases also concluded that data timeliness, high level of data standardization, and the clinical value of call-centre dispatch and ambulance data can help detect infectious disease outbreaks.

Other studies explored the diagnostic accuracy of EMS personnel in identifying patients or predicting death from pre-hospital vital signs, as well as how EMS can help facilitate testing for COVID-19 and mass vaccinations. Accordingly, results showed that initial vital signs (with the exception of body temperature) and prehospital triage tools (qSOFA, NEWS, NEWS2 and PRESEP) have little predictive value for the identification of COVID-19 patients or death, intensive care unit admission, and disease severity of COVID-19 patients, respectively. In addition, it was shown that rapid antibody test can help diagnose COVID-19 in both asymptomatic and symptomatic EMS personnel, but sensitivity could be enhanced when used together with other diagnostic methods, such as RT-PCR test or chest CT-scan. Finally, it was shown that EMS staff are uniquely equipped to perform COVID-19 testing and participate in mass immunization efforts efficiently and safely, for both the staff and the patients.

The qualitative synthesis resulted in similar narratives among EMS workers, who felt they had gone through a traumatic experience, especially those working during the COVID-19 pandemic, and had to face various challenges (e.g., insufficient knowledge and training, poor PPE, constant protocol changes, concern regarding their own and their families’ safety, etc.) but were willing to report for duty, as they understood and accepted the risks and felt a duty to perform their jobs. They did, however, feel there were acceptable limitations to this, such as having physical and mental health issues, lack of appropriate PPE, anti-viral medication, or appropriate vaccines, etc. In addition, participants expressed a strong need for reliable, trustworthy information, training, access to adequate and up-to-date PPE, proper communication from their organisations, and transparent protocols. The need for policies that are up-to-date, clear, and transparent was also highlighted by another recent publication [ 99 ] that investigated the public health regulations and policies dealing with preparedness and emergency management during the COVID-19 pandemic in Italy. They also concluded that more funds should be allocated in prevention, training, and information activities to make sure that we are better prepared for the next pandemic.

Participants stressed the importance of supportive relationships with significant others and their colleagues, as well as recognising that their organisations put effort into their comfort and safety, which they valued and which made them feel safe. Others, though, felt tired and “left alone to fend” for themselves as they had to perform procedures outside of their job description and scope of practice or felt like they didn’t receive enough support or information about getting tested (for COVID-19) nor any mental health or financial support from their employers. The importance of support (especially organisational support) in safeguarding frontline workers’ mental health and well-being during the COVID-19 pandemic was also highlighted in a recent study [ 98 ] that explored the perceived support and pandemic preparedness among social workers in hospital settings in Israel. According to their results, only half of the social workers perceived receiving high levels of support during the COVID-19 pandemic; a finding echoing some of this review’s results as well.

This review has also identified various gaps in current literature and the need for future research across various areas. None of the included studies reported on the experiences and views of patients that had been attended to by EMS during a disease outbreak/pandemic; this could be an area for future research to help us understand better the needs of this population. In addition, the majority of the reviewed studies were conducted in high-income countries, with predominantly White participants. More studies are, therefore, needed in low- and middle-income countries, with participants from diverse ethnic backgrounds, to evaluate whether the same interventions can be successfully implemented across different countries and populations. Further research with more diverse populations is also needed to explore potential factors affecting EMS providers’ experiences, views, and attitudes towards working during pandemics. Equally, it would be crucial to investigate the long-term impact of working in a pandemic on the well-being and working conditions of emergency medical services and how these may be affected by the trajectory of the disease outbreak. Finally, the majority of the included studies did not report any or had missing data on the age, gender and/or ethnicity of their participants. Better reporting is, therefore, needed of demographic characteristics of the participants in published papers in the future.

Strengths and limitations

This is the first scoping review of published studies that discuss EMS preparedness levels and aims to understand how the evidence translates into practice. This review has brought together papers discussing EMS preparedness during various disease outbreaks (including the current COVID-19 pandemic) and evaluating different types of interventions, as well as exploring EMS personnel’s experiences of working during pandemics, and has synthesised them for the first time. The study followed a rigorous pre-specified protocol (registered with Open Science Framework), which ensured that the review process was transparent and replicable. We identified 90 studies for inclusion. The final development of themes (both quantitative and qualitative) was undertaken through discussion with the wider review team, consisting of reviewers from different backgrounds (e.g., medicine, nursing, and psychology).

This scoping review has some limitations. We are still learning to live with COVID-19 and more studies will be conducted and published as a result; therefore, the findings of this review are subject to change as more studies are being added to the existing literature base. Despite our efforts to be as inclusive as possible, studies and journal articles that have not been published yet, or are only available in languages other than English, have not been included in this review. Another limitation of this review was the absence of a subject librarian review of the search strategy, as this would have made for a stronger methodology. That said, many search terms were searched for in full text fields and there were further supplementary searches conducted to identify any additional references, which produced a high number of references to be screened. Finally, our synthesis of the 18 qualitative papers led to five main themes and various sub-themes, but we did not conduct a detailed analysis, such as a content or thematic analysis. Future reviews could focus on, analyse and synthesise EMS personnel’s experiences only and publish these as a systematic review and meta-synthesis study.

Implications for policy and practice

Synthesising this literature has allowed us to explore EMS pandemic preparedness in various countries around the world, as well as to identify what interventions have been successfully implemented and to better understand the experiences of EMS staff during pandemics.

An important aspect of pandemic preparedness is making sure that EMS workers are able and willing to work during pandemics. Our findings have shown that the main factors affecting EMS personnel’s willingness to report for duty are having adequate PPE and having access to vaccines for themselves and, ideally, their families as well. Other important factors were knowing and feeling prepared to perform their responsibilities (including having adequate knowledge and training for disease outbreaks), confidence about safety at work and trust in their employer. EMS organisations, therefore, should make sure they are appropriately equipped with up-to-date PPE and that they offer training on how to correctly use this equipment on a regular basis. Having the funds to procure enough vaccines and treatments, if available, for those who need it would also be essential for making EMS workers feel safer in case of a future pandemic. Participants also highlighted the importance of continuous training and education for pandemic preparedness. Therefore, detailed and frequent training on various aspects of infection control practices would also be advantageous, especially about basic knowledge of infectious diseases (including routes of transmission and signs/symptoms), patient and practitioner safety related to infectious and communicable diseases, and how to properly decontaminate and disinfect ambulances after each patient contact. Conducting regular pandemic exercises or having skill-based drills (similar to that of mass casualty and disaster drills) might also be helpful in increasing EMS personnel’s knowledge levels and maintaining their skills, as this was suggested by the participants as well [ 89 ].

Participants also felt that having clear, transparent, and simple protocols was very important and that it helped them remain calm by following the instructions and guidelines, while at the same time knowing that their organisation is continuously reviewing and improving procedures made them feel safe and protected. Hence, EMS organisations should aim to develop agency/department-specific infection control policies and procedures (e.g., PPE requirements and the proper use of masks and respirators) that EMS workers can implement during routine calls, but also during a pandemic. Such initiatives would also increase trust in their employers, which as they stated was an important factor impacting their willingness to report for duty. Misinformation, lack of reliable data/information and communication about the pandemic from their employers was another one of the main concerns of the EMS workers; therefore, providing clear, up-to-date and accurate information (including detailed, localised data that could help them understand the geographic spread of cases throughout their area) on a regular basis would be imperative as well. This process could be facilitated by having a dedicated app or using social media, through which information could be delivered directly to EMS personnel, or even holding local question and answer sessions, as was suggested by the participants themselves [ 13 ]. Better communication and collaboration between departments and organisations, such as the emergency department and EMS, would also be helpful in ensuring that there is seamless continuation of care and less frustration for everyone involved.

Most participants also reported feeling stress, fear, anxiety, as well as feelings of frustration or failure, when they couldn’t save a patient. Although opinions were divided and not everyone expressed a need for mental health support, offering such opportunities for employees who need it would be important for their overall well-being. This is true especially given the fact that participants also reported not being able to socialise and take comfort in colleagues, while at the same time having less contact with their families, which they also found to be challenging. Peer support groups that can take place face-to-face or on-line, if needed to maintain social distancing rules, may be an ideal solution not only for the individuals (who have expressed the need for support from their team members and colleagues), but also for EMS organisations, as the financial cost would be minimal. Employers could also support EMS workers further by prioritising testing to keep them safe and to enable them to return to their duties, as well as by offering financial support in the case of illness, as participants also reported being unable to take any time off work in case of exposure and/or infection during the pandemic.

Many of the included papers in this review also implemented interventions that showed evidence of benefits in helping EMS services manage the COVID-19 pandemic and should be considered for further evaluation and adoption. These interventions included negative pressure ambulances and devices [ 28 , 29 , 47 , 53 ]; a compact atmospheric plasma device [ 51 ]; and, performing chest compressions with the LUCAS 3 mechanical chest compression device [ 52 ]. In addition, having a dedicated COVID-19 EMS support track and/or video triage systems were found to be effective in handling the increased need for contact with EMS on call volume during the COVID-19 pandemic [ 54 , 59 , 61 , 65 ] and similar triage measures could be applied to better manage future pandemics as well. Using discrete event simulation models [ 36 ] or first-stage optimization models [ 71 ], swarm intelligence algorithms [ 55 , 56 ], Business Intelligence models [ 74 ] and/or the Internet of Things [ 76 ], could also help EMS to successfully manage the response to emergency calls.

Finally, our results showed that EMS staff are uniquely equipped to perform COVID-19 testing and participate in mass immunization efforts efficiently and safely. Therefore, EMS personnel can be a valuable resource in providing further services as well and help increase the number of persons that can be tested (even in more remote, underserved areas), while diminishing exposure to health care workers and other patients as well.

Despite concerns for their own and their families’ safety and the many challenges they were faced with, especially knowledge and training gaps, lack of appropriate PPE and constant protocol changes, EMS personnel were willing and prepared to report for duty during pandemics. Participants also made recommendations for future outbreak response, which should be taken into consideration in order for EMS to be better prepared to respond to any future pandemics.

Supporting information

S1 file. preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (prisma-scr) checklist..

https://doi.org/10.1371/journal.pone.0304672.s001

S2 File. Ambulance (emergency medical service) interventions in response to pandemics: A scoping review protocol.

https://doi.org/10.1371/journal.pone.0304672.s002

Acknowledgments

We would like to thank Dr Withanage Iresha Udayangani Jayawickrama and Dr Sarathchandra Kumarawansa for their help conducting the initial searches for this scoping review. We would also like to thank the members of the Community and Health Research Unit (CaHRU) study review group (University of Lincoln) for their valuable comments on a draft of this paper.

• 1. WHO global influenza preparedness plan: The role of WHO and recommendations for national measures before and during pandemics. 2005; Retrieved April 05, 2020, from https://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_5.pdf .
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• 56. Bendimerad LS, Houacine NA, Drias H. Swarm Intelligent Approaches for Ambulance Dispatching and Emergency Calls Covering: Application to COVID-19 Spread in Saudi Arabia. Proceedings of the 13th International Conference on Soft Computing and Pattern Recognition (SoCPaR 2021). 2021;417. https://doi.org/10.1007/978-3-030-96302-6_58
• 90. Tawalbeh R. Sources of role conflict: a critical evaluation of Emergency Medical Service work-family conflict during the COVID-19 pandemic. Doctoral Thesis, Oklahoma State University. 2021.

The Role of Online University Teaching and Learning during COVID-19 Pandemic

Proceedings of the International Conference on Best Innovative Teaching Strategies (ICON-BITS 2021)

4 Pages Posted: 6 Aug 2024

Monali Chatterjee

Nirma University, Ahmedabad

Date Written: August 06, 2024

Amidst the worldwide prevalence of the COVID-19 pandemic since March 2020, there has been an abrupt transition to online teaching and learning. Among students of various age groups, students pursuing university education have been one of the most drastically affected by this sudden change. Responding to this critical predicament adapting completely and rapidly to online education that ensures effective learning, has been the need of the hour. It is imperative to also investigate the ways in which Information and Communication Technologies affect the learners, teachers and supporting staff members during the lockdown of COVID-19. This paper proposes to evaluate the challenges faced by instructors across universities in India. Through this exploratory research, an attempt will be made to understand through an exhaustive literature review, the measures that have been deployed to overcome the challenges that hamper effective learning among university students and online pedagogies. The paper concludes with insights to focus on students' experiences of learning online. As a part of this prescriptive research, it also aims to propose effective best practices of teaching and learning as well as pedagogical innovations that can improve distance education.

Keywords: online university teaching, COVID-19, pedagogy, learning, ICT, higher education

Suggested Citation: Suggested Citation

Monali Chatterjee (Contact Author)

Nirma university, ahmedabad ( email ).

Ahmedabad India

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COVID-19: Long-term effects

Some people continue to experience health problems long after having COVID-19. Understand the possible symptoms and risk factors for post-COVID-19 syndrome.

Most people who get coronavirus disease 2019 (COVID-19) recover within a few weeks. But some people — even those who had mild versions of the disease — might have symptoms that last a long time afterward. These ongoing health problems are sometimes called post- COVID-19 syndrome, post- COVID conditions, long COVID-19 , long-haul COVID-19 , and post acute sequelae of SARS COV-2 infection (PASC).

What is post-COVID-19 syndrome and how common is it?

Post- COVID-19 syndrome involves a variety of new, returning or ongoing symptoms that people experience more than four weeks after getting COVID-19 . In some people, post- COVID-19 syndrome lasts months or years or causes disability.

Research suggests that between one month and one year after having COVID-19 , 1 in 5 people ages 18 to 64 has at least one medical condition that might be due to COVID-19 . Among people age 65 and older, 1 in 4 has at least one medical condition that might be due to COVID-19 .

What are the symptoms of post-COVID-19 syndrome?

The most commonly reported symptoms of post- COVID-19 syndrome include:

• Symptoms that get worse after physical or mental effort
• Lung (respiratory) symptoms, including difficulty breathing or shortness of breath and cough

Other possible symptoms include:

• Neurological symptoms or mental health conditions, including difficulty thinking or concentrating, headache, sleep problems, dizziness when you stand, pins-and-needles feeling, loss of smell or taste, and depression or anxiety
• Joint or muscle pain
• Heart symptoms or conditions, including chest pain and fast or pounding heartbeat
• Digestive symptoms, including diarrhea and stomach pain
• Blood clots and blood vessel (vascular) issues, including a blood clot that travels to the lungs from deep veins in the legs and blocks blood flow to the lungs (pulmonary embolism)
• Other symptoms, such as a rash and changes in the menstrual cycle

Keep in mind that it can be hard to tell if you are having symptoms due to COVID-19 or another cause, such as a preexisting medical condition.

It's also not clear if post- COVID-19 syndrome is new and unique to COVID-19 . Some symptoms are similar to those caused by chronic fatigue syndrome and other chronic illnesses that develop after infections. Chronic fatigue syndrome involves extreme fatigue that worsens with physical or mental activity, but doesn't improve with rest.

Why does COVID-19 cause ongoing health problems?

Organ damage could play a role. People who had severe illness with COVID-19 might experience organ damage affecting the heart, kidneys, skin and brain. Inflammation and problems with the immune system can also happen. It isn't clear how long these effects might last. The effects also could lead to the development of new conditions, such as diabetes or a heart or nervous system condition.

The experience of having severe COVID-19 might be another factor. People with severe symptoms of COVID-19 often need to be treated in a hospital intensive care unit. This can result in extreme weakness and post-traumatic stress disorder, a mental health condition triggered by a terrifying event.

What are the risk factors for post-COVID-19 syndrome?

You might be more likely to have post- COVID-19 syndrome if:

• You had severe illness with COVID-19 , especially if you were hospitalized or needed intensive care.
• You had certain medical conditions before getting the COVID-19 virus.
• You had a condition affecting your organs and tissues (multisystem inflammatory syndrome) while sick with COVID-19 or afterward.

Post- COVID-19 syndrome also appears to be more common in adults than in children and teens. However, anyone who gets COVID-19 can have long-term effects, including people with no symptoms or mild illness with COVID-19 .

What should you do if you have post-COVID-19 syndrome symptoms?

If you're having symptoms of post- COVID-19 syndrome, talk to your health care provider. To prepare for your appointment, write down:

• When your symptoms started
• What makes your symptoms worse
• How often you experience symptoms
• How your symptoms affect your activities

Your health care provider might do lab tests, such as a complete blood count or liver function test. You might have other tests or procedures, such as chest X-rays, based on your symptoms. The information you provide and any test results will help your health care provider come up with a treatment plan.

In addition, you might benefit from connecting with others in a support group and sharing resources.

• Long COVID or post-COVID conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html. Accessed May 6, 2022.
• Post-COVID conditions: Overview for healthcare providers. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-conditions.html. Accessed May 6, 2022.
• Mikkelsen ME, et al. COVID-19: Evaluation and management of adults following acute viral illness. https://www.uptodate.com/contents/search. Accessed May 6, 2022.
• Saeed S, et al. Coronavirus disease 2019 and cardiovascular complications: Focused clinical review. Journal of Hypertension. 2021; doi:10.1097/HJH.0000000000002819.
• AskMayoExpert. Post-COVID-19 syndrome. Mayo Clinic; 2022.
• Multisystem inflammatory syndrome (MIS). Centers for Disease Control and Prevention. https://www.cdc.gov/mis/index.html. Accessed May 24, 2022.
• Patient tips: Healthcare provider appointments for post-COVID conditions. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/post-covid-appointment/index.html. Accessed May 24, 2022.
• Bull-Otterson L, et al. Post-COVID conditions among adult COVID-19 survivors aged 18-64 and ≥ 65 years — United States, March 2020 — November 2021. MMWR Morbidity and Mortality Weekly Report. 2022; doi:10.15585/mmwr.mm7121e1.

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• Open access
• Published: 07 August 2024

Effects of stress on burnout among infection control nurses during the COVID-19 pandemic: the mediating effects of social support and self-efficacy

• Su-jin Lee 1 ,
• Ju-Young Park 1 &
• Seo-Hyeon Kim 1  

BMC Nursing volume  23 , Article number:  537 ( 2024 ) Cite this article

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Metrics details

This study investigated the mediating effects of self-efficacy and social support on the relationship between stress and burnout among infection control nurses (ICNs) during an emerging infectious disease pandemic.

The study participants encompassed 210 ICNs with at least six months’ experience in an infection control unit at a general hospital in South Korea during the COVID-19 pandemic. Data were analyzed using independent t-tests or one-way analysis of variance (ANOVA), while descriptive statistics were performed using SPSS/WIN 26.0 software. Hayes’s PROCESS macro 4.2 software was used to verify the significance of the indirect effects of the mediators.

Stress had a significant positive effect on burnout (β = 0.80, p  < .001), accounting for 73% of the variance. Self-efficacy (β = − 0.26, p  < .001) and social support (β = − 0.11, p  = .034) had a significant negative effect on burnout, accounting for 78% of the variance. Stress was lower when self-efficacy and social support were entered into the model (β = 0.80 → 0.59), indicating that self-efficacy and social support mediated the relationship between stress and burnout.

This study is significant in that it confirms the effects of self-efficacy and social support on the relationship between stress and burnout among ICNs. The results highlight the importance of establishing organizational support systems and developing and implementing programs for enhancing self-efficacy in order to reduce burnout among ICNs.

Peer Review reports

Introduction

The global spread of coronavirus disease 2019 (COVID-19), initiated by the SARS-CoV-2 virus in December 2019, led the World Health Organization (WHO) to declare a pandemic in March 2020, the highest warning level for infectious diseases [ 1 ]. The emergence of new variants, such as Beta, Delta, and Omicron, intensified COVID-19’s global threat and the populace’s anxiety [ 2 ]. Despite international efforts to combat the virus, the WHO declared it endemic in May 2023 after three years of fighting the pandemic [ 1 ]. The history of infectious diseases, including severe acute respiratory syndrome (SARS) in 2003, H1N1 in 2009, and Middle East respiratory syndrome (MERS) in 2015, suggests that the threat of both new and reemerging infectious diseases is ongoing [ 3 ]. The unprecedented crisis presented by the COVID-19 pandemic significantly impacted healthcare services, society, and the economy, highlighting the need for developing and implementing proactive management and prevention strategies against such infectious diseases [ 4 ].

To ensure systematic infection control, relevant laws were amended in 2016, in South Korea while the standards for infection control staffing were strengthened for each type of hospital, thereby intensifying the roles and responsibilities of infection control nurses (ICNs) [ 5 ]. ICN nurses play a pivotal role in preventing disease outbreaks and curbing the spread of infections among patients, caregivers, and staff [ 6 ]. During the COVID-19 pandemic, their duties expanded from standard infection control practices to tasks such as information gathering, reporting, policy-related decision-making and implementation, staff education (e.g., regarding infection, isolation procedures, and use of personal protective equipment), advising and consulting, coordination of epidemiological investigations, and management of exposed individuals. The additional responsibilities also increased their administrative workload [ 6 ].

During the prolonged COVID-19 pandemic, ICNs experienced significant physical and mental exhaustion due to overwhelming workloads and the pressure to manage all aspects of infection control at the frontline [ 7 ]. The broad scope of their responsibilities increased their stress [ 8 , 9 ]. Continuous work-related stress in nurses can cause them to become disinterested in their patients, decrease their work efficiency and productivity, increase their turnover and absenteeism rates, increase depression, and, ultimately, cause burnout—a state of physical, emotional, and mental exhaustion [ 9 , 10 ]. Thus, it is important to assess the extent of the increased stress and burnout among ICNs in a challenging context such as the COVID-19 pandemic.

Burnout is a negative experience caused by repetitive exposure to stressors; it refers to a state of energy depletion that induces emotional exhaustion, feelings of anger, powerlessness, and depression [ 11 ]. Nurses who fail to cope with increases in work-related stress and consequently experience burnout have reduced job satisfaction, exhibit a poor quality of care, and have high turnover rates, thereby creating a cycle of negative outcomes [ 12 ]. Persistent burnout not only affects individuals but also impacts organizational efficiency and effective personnel management [ 13 ]. Thus, nurses’ burnout is a major issue for clinical practice.

Self-efficacy and social support have been identified as factors that mitigate stress and reduce burnout [ 13 , 14 , 15 , 16 , 17 , 18 ]. Self-efficacy is a belief in one’s ability to achieve desired goals in a particular situation [ 19 ], and a lack of self-efficacy in nurses can lead to low confidence in their work to manage and prevent infectious diseases [ 20 ]. Social support is the support and encouragement nurses receive from their peers, supervisors, family members, and others [ 18 , 21 ]. Infection control work involves a high degree of emergency and risk, which can place a high emotional burden on nurses [ 8 ]. Inadequate social support can lead to nurses feeling isolated, which increases the risk of burnout [ 13 ]. On the other hand, nurses with enhanced self-efficacy and social support are better able to cope with and manage the stress of their work, thereby reducing burnout [ 18 ].

Previous studies on ICNs have examined the relationship between work satisfaction, ego resilience, and job stress [ 8 ], path models for burnout and retention intention [ 22 ], the core competencies of ICNs [ 5 ], and the important roles of ICNs [ 23 ]. Studies have also explored ICNs’ work experiences during the COVID-19 outbreak [ 7 ]; however, few studies have examined ICN burnout.

In this study, we established a conceptual framework of the study’s variables based on Lazarus & Folkman’s [ 24 ] stress, appraisal-coping model to investigate the relationship between stress and burnout among ICNs. Previous studies on stress-coping and adaptation have used this model as a theoretical framework because it provides a systematic and logical framework for understanding the processes of appraisal, coping, and adaptation in response to stressful events [ 25 , 26 ]. As stress is conceptualized as an interaction between the individual and their environment, as opposed to a simple stimulus [ 24 ], we included personal-level factors (gender, age, education, spouse, position, salary, type of hospital, clinical career, infection control career, and certification) as contextual factors that could affect burnout. We used stress as the environmental variable, social support and self-efficacy as coping resources (mediators), and burnout as the negative outcome.

To effectively prepare for future emerging infectious disease crises, it is crucial to identify factors influencing burnout among ICNs. Utilizing this data can help mitigate ICN burnout, foster expertise in infection prevention within healthcare facilities, and enhance patient safety and nursing care quality.

Therefore, this study aims to provide basic data for developing nursing intervention programs by identifying the relationship between stress and burnout in infection control nurses during the COVID-19 pandemic based on Lazarus & Folkman’s [ 24 ] stress, appraisal-coping model; in this way, this study sought to confirm the mediating effect of self-efficacy and social support in burnout alleviation.

Study design

This descriptive correlation study attempted to confirm the mediating effect of self-efficacy and social support on the relationship between stress and burnout in infection control nurses who worked in general hospitals during the pandemic based on Lazarus & Folkman’s [ 24 ] stress, appraisal-coping model.

Participants

Inclusion criteria were ICNs who had worked in the infection control department of a general hospital in South Korea for at least six months between January 2020, when the first case of COVID-19 was confirmed in South Korea, and May 2023 (Endemic declaration). Exclusion criteria were temporary seconded nurses, even if they had worked in an infection control unit for more than six months during the pandemic. The study included 210 ICNs who understood the purpose of the study and gave consent. The sample size was determined using G-power 3.1 software. For a regression analysis with a significance level of 0.05, a medium effect size of 0.15 [ 27 ], a power of 95%, and 14 predictor variables, the minimum sample size was determined as 194. Thus, our study sample size was adequate for the intended statistical analyses.

Instruments

The relevant instruments were used after obtaining permission from the authors via e-mail. The structured questionnaire was validated by two nursing professors and two ICNs.

We purchased the Korean version of the Maslach burnout inventory-human services survey (medical personnel) (MBI-HSS [MP]), which was originally developed by Maslach and Jackson [ 11 ]. The MBI-HSS (MP) is a 22-item scale with three subscales: emotional exhaustion (9 items), depersonalization (5 items), and reduced personal accomplishment (8 items). Each item is rated on a seven-point scale, ranging from 0 (“none”) to 6 (“every day”). A higher score indicates a higher degree of burnout. In this study, we used the mean total score. The Cronbach’s α values in Maslach and Jackson [ 11 ] was 0.76; this value was 0.86 and 0.93 in our study.

• Self-efficacy

We used six items for self-efficacy from the Korean version of the Copenhagen psychosocial questionnaire II (COPSOQ-K) [ 28 ]; the original scale had been developed by Pejtersen et al. [ 29 ]. Each item is rated on a five-point scale ranging from 0 (“never/hardly ever”), 25(‘’seldom’’), 50(‘’sometimes’’), 75(‘’often’’), to 100 (“always”). A higher score indicates higher self-efficacy. In this study, we used the mean total score. “The Cronbach’s α values in Jeon and Choi’s study [ 28 ] was .80; this value was .92 in our study.”

We used four items for stress and four items for perceived stress from the COPSOQ-K [ 28 ]. Each item was rated on a five-point scale ranging from 0 (“never/hardly ever”), 25(‘’seldom’’), 50(‘’sometimes’’), 75(‘’often’’), to 100 (“always”). A higher score indicated a greater degree of stress. The Cronbach’s α values in Jeon and Choi’s study [ 28 ] was 0.81; this value was 0.82 in our study.

• Social support

We used three items for support from Social Support from Colleagues and three items for Social Support from Supervisor from the COPSOQ-K [ 28 ]. Each item was rated on a five-point scale ranging from 0 (“never/hardly ever”), 25(‘’seldom’’), 50(‘’sometimes’’), 75(‘’often’’), to 100 (“always”). A higher score indicated a greater degree of social support. The Cronbach’s α values in Jeon and Choi’s study [ 28 ] were 0.76 and 0.86; these values were 0.86 and 0.91 in our study.

Data collection

Data were collected from 4 October to 30 November 2023 from ICNs who had experience in infection control work in the infection control departments of Korean general hospitals during the COVID-19 pandemic. The research assistants contacted infection control units a general hospital to explain the purpose and method of the study and obtained permission to conduct the study. Next, ICNs received a link to the online survey. Purposive sampling was used to recruit eligible ICNs. The questionnaire took approximately 20 min to complete, and a small gift was provided as a token of appreciation after the survey completion.

Ethical considerations

This study was approved by the Institutional Review Board at the authors’ institution (IRB NO: KCN-2023-0901-02-2). Participants who checked the box “I agree” on the online survey’s consent page were allowed to proceed with the questionnaire. The information page provided information about the purpose of the study, the anonymity of the participants, the freedom to withdraw from the study at any time without any repercussions, and the anticipated benefits and risks of study participation. Participants’ data were assigned individual IDs to maintain their anonymity. All study-related data were stored on a password-protected computer for strict management and control. These data will be discarded after the legally specified period of three years.

Data analysis

The collected data were analyzed using SPSS Statistics 26 software and the Process macro ver. 4.2, while statistical significance was determined as 0.05.

Participants’ general characteristics were analyzed using a frequency analysis, while the differences in burnout experiences based on general characteristics were tested using independent t-tests and one-way analysis of variance (ANOVA). For factors that differed significantly, a Scheffé test was performed as a post-hoc comparison. Levels of stress, self-efficacy, social support, and burnout were examined using descriptive statistics. Correlations between stress, self-efficacy, social support, and burnout were analyzed using Pearson correlation analysis.

The effects of the relationships between stress, self-efficacy, social support, and burnout; the estimation of the indirect effect size of stress with regard to burnout through the mediation of self-efficacy and social support; and the statistical significance of the mediating effects were analyzed using the bootstrapping method as proposed by Hayes. Bootstrapping was performed using Process macro model 4.

Burnout according to participants’ general characteristics

A frequency analysis was performed to analyze participants’ general characteristics. There were five male (2.4%) and 205 female (97.6%) participants. The mean age was 33.35 years, with 57 individuals aged 20–29 years (27.1%), 121 aged 30–39 years (57.6%), and 32 aged 40–49 years (15.2%). Regarding education, 24 participants had an associate degree (11.4%), 134 had a bachelor’s degree (63.8%), and 52 had a master’s degree or higher (24.8%). Eighty-six participants were married (41.0%), and 124 were single (59.0%). In terms of job position, 148 were staff nurses (70.5%), 48 were charge nurses (22.9%), and 14 were nurse managers or higher (6.7%). The mean annual salary was 47.41 million KRW. Sixty-four participants earned < 40 million KRW (30.5%), 73 earned 40–49 million KRW (34.8%), and 73 earned ≥ 50 million KRW (34.8%). Hospital type was secondary ( n  = 134, 63.8%) or tertiary ( n  = 76, 36.2%). Mean clinical experience was 8.63 years. Thirty-three participants had < 5 years (15.7%) of experience, 107 had 5–9 years (51.0%) of experience, and 70 had ≥ 10 years (33.3%) of experience. The mean infection control experience was 3.28 years. Fifty-one participants had < 2 years (24.3%) of experience, 107 had 2-3.9 years (51.0%) of experience, and 52 had ≥ 4 years (24.8%) of experience. In terms of certification, 49 participants were certified as ICNs (23.3%), 26 were certified as infection control practitioners (12.4%), and 135 were not certified (64.3%).

We analyzed differences in burnout according to the general characteristics of ICNs using independent t-tests and one-way ANOVAs. Burnout significantly differed according to job position (F = 7.96, p  < .001), clinical career (F = 3.93, p  = .021), and certification (F = 6.87, p  = .001).

A post-hoc comparison was performed using a Scheffé test for the three factors that significantly differed in terms of their impact on burnout. In terms of job position, burnout was significantly higher among charge nurses than among nurse managers or those with higher designations. Burnout was also significantly higher among those with a clinical career of 5–9 or ≥ 10 years of experience, compared to among those with < 5 years of experience. Burnout was also significantly higher among certified infection control practitioners, compared to that among certified ICNs and non-certified ICNs (Table  1 ).

Participants’ stress, self-efficacy, social support, and burnout

Descriptive statistics were used to describe participants’ stress, self-efficacy, social support, and burnout. The mean stress score was 56.55 out of 100; the mean self-efficacy score was 54.62 out of 100; the mean social support score was 58.71 out of 100; and the mean burnout score was 4.08 in a range of 0–6. Skewness and kurtosis were calculated to test the normality of the data. The absolute value of skewness was < 2, while that of kurtosis was < 7, confirming the normality of the data [ 30 ]. In short, the data were suitable for statistical analysis (Table  2 ).

Correlations between participants’ stress, self-efficacy, social support, and burnout

The correlations between participants’ stress, self-efficacy, social support, and burnout were analyzed using Pearson correlation analysis. Stress was significantly negatively correlated with self-efficacy ( r  = − .64, p  < .001) and social support ( r  = − .47, p  < .001) and significantly positively correlated with burnout ( r  = .81, p  < .001). Self-efficacy was significantly positively correlated with social support ( r  = .63, p  < .001) and significantly negatively correlated with burnout ( r  = − .71, p  < .001). Social support was significantly negatively correlated with burnout ( r  = − .56, p  < .001) (Table  3 ).

The relationships among participants’ stress, self-efficacy, social support, and burnout

We analyzed the effect relationships between participants’ stress, self-efficacy, social support, and burnout, and the mediating effects of self-efficacy and social support in the relationship between stress and burnout by using Hayes’ bootstrapping with Process macro model 4. Bootstrapping was performed with 5,000 samples and a 95% confidence interval (CI). Job position, clinical career, and certification differed significantly vis-à-vis burnout and were selected as control variables. As job position and certification were categorical variables, dummy variables were created for charge nurses and ICNs who showed relatively higher levels of burnout.

First, the model for the effects of stress on self-efficacy accounted for 51% of the variance, while stress had a significant negative effect on self-efficacy (β = − 0.63, p  < .001). The model for the effects of stress on social support accounted for 27% of the variance, while stress had a significant negative effect on social support (β = − 0.42, p  < .001). In short, self-efficacy and social support declined with increasing stress. The model for the effects of stress on burnout accounted for 73% of the variance, while stress had a significant positive effect on burnout (β = 0.80, p  < .001), suggesting that burnout increases with increasing stress.

Next, self-efficacy and social support were added to the model to examine their effects on burnout. The regression model accounted for 78% of the variance, and self-efficacy (β=-0.26, p  < .001) and social support (β = − 0.11, p  = .034) had a significant negative effect on burnout. In short, burnout decreased with increasing self-efficacy and social support. Conversely, stress was reduced after adding self-efficacy and social support to the model (β = 0.80 → 0.59), suggesting that self-efficacy and social support mediate the relationship between stress and burnout (Table  4 ).

Next, we examined the direct effect of stress on burnout, the indirect effect of stress on burnout through the mediation of self-efficacy and social support, and their 95% CIs. The direct effect size of stress on burnout was 0.68, while the 95% CI was 0.01-0.12. In both cases, CI do not include 0, thereby confirming statistical significance.

The indirect effect size of stress on burnout through the mediation of self-efficacy was 0.19, while the 95% CI was 0.10-0.29. The indirect effect size of stress on burnout through the mediation of social support was 0.05, while the 95% CI was 0.01-0.12. In both cases, CI included 0, thereby confirming statistical significance. In essence, the results show that stress had an indirect effect on burnout through the mediation of self-efficacy and social support. That is, ICNs who had high levels of stress during the COVID-19 pandemic also had lower self-efficacy and less social support, which, in turn, led to higher levels of burnout (Table  5 ) (Fig.  1 ).

The mediating effect of self-efficacy and social support on stress and burnout

Based on Lazarus & Folkman’s [ 24 ] stress, appraisal-coping model l, this study attempted to confirm the mediating effect of self-efficacy and social support in the relationship between stress and burnout in infection control nurses who worked in general hospitals during an emerging infectious disease pandemic.

In this study, the mean burnout score during the COVID-19 pandemic was 4.08. The mean burnout score of staff nurses was 2.61 [ 31 ]. The mean burnout score of nurses who provided direct patient care on a medical-surgical floor and isolation floor or in an ICU and emergency department was 2.80 [ 12 ]. This showed that the burnout scores of other nurses were markedly lower than the burnout scores of ICNs, despite being substantially higher compared to the pre-COVID-19 period. A previous study [ 22 ] showed that the mean burnout score among ICNs was 2.30 before the COVID-19 pandemic and that this figure nearly doubled to 4.08 during the pandemic. Particularly, before the COVID-19 pandemic, ICNs had lower burnout rates compared with other nurses [ 22 ]; this highlights the need to pay attention to the dramatic increase in the level of burnout among ICNs. Thus, there is a pressing need to discern burnout predictors among ICNs following the COVID-19 pandemic and to promptly implement interventions that reduce burnout in these nurses.

In our study, stress had a direct effect on burnout among ICNs. Although a direct comparison is difficult to establish due to the lack of research on these variables among ICNs, burnout increase accompanied stress increase in nurses during the COVID-19 pandemic [ 12 ] and job stress was the most potent predictor of burnout among nurses during the COVID-19 pandemic [ 10 ], thereby supporting our findings. Grzelak and Szwarc [ 32 ] reported that 89.2% of nurses experienced increased stress symptoms due to the pandemic, and Tomaszewska et al. [ 9 ] reported that 50% of nurses experienced burnout.

ICNs faced significant levels of stress owing to the extremely high transmissibility of COVID-19, which contributed to the rapid spread of the virus; it had higher morbidity and mortality rates compared with SARS and MERS [ 17 ]. Although not involved in direct patient care, ICNs were frequently placed in situations calling for independent decision-making based on expert knowledge and were expected to demonstrate a wide array of competencies to engage in interdisciplinary collaborations within and outside the hospital [ 6 ]; these added responsibilities and psychological burdens caused high levels of stress [ 8 ]. Individuals who experience burnout define it as physical, emotional, and mental exhaustion—a point at which they can no longer cope with stress. Unresolved burnout engenders psychological impairments, such as a sense of failure and guilt, as well as reduced job productivity and nursing performance [ 10 ].

Prolonged burnout causes job dissatisfaction and negative work attitudes, which, in turn, lead to high turnover intentions and actual turnover, thereby causing a shortage of nursing staff and decreased quality of care [ 9 ]. Turnover intention was reported to be higher among nurses who provided care for patients with COVID-19, compared with nurses working on a regular medical-surgical floor [ 12 ]. Therefore, another infectious disease crisis in the future may result in a shortage of staff, which would be detrimental to the effective management of and response to infectious diseases [ 10 , 13 ]. Considering the prolonged stress caused by an emerging infectious disease pandemic, it is of paramount importance to provide adequate and appropriate health management—including environmental and personnel management—to reduce stress among ICNs. Measures, such as the establishment of flexible staff management that considers work intensity and work hours (depending on the severity of the emerging infectious disease crisis), inter-departmental work coordination, and environmental improvement, must be implemented concurrently. As the burnout caused by high levels of persistent stress among ICNs can impact both individuals and organizations, nursing organizations should develop policies and stress reduction programs that promote psychological replenishments to prevent and manage nurses’ burnout.

In our study, self-efficacy and social support were identified as the significant mediators of the relationship between stress and burnout among ICNs, where burnout increased with decreasing self-efficacy and social support. In a study on burnout among emergency department nurses, self-efficacy and social support were significantly correlated with burnout alleviation, while self-efficacy was a key predictor of burnout [ 13 ]; this is consistent with our findings. A study on clinical nurses’ burnout found that self-efficacy and social support were moderators that reduced the negative impact of burnout [ 18 ]. Furthermore, burnout increased with decreasing social support among ICU nurses providing care for patients with COVID-19 [ 16 ] and among floor nurses [ 14 ], while social support was identified as a predictor of burnout in other studies [ 14 , 16 ], supporting our findings.

Self-efficacy refers to an individual’s expectation or belief that they can successfully carry out appropriate actions in a given situation [ 19 ]. Having self-efficacy allows nurses to believe that they can overcome the stressors and adversities prevalent in a clinical setting [ 33 ]. Nurses with high self-efficacy demonstrate better professional nursing performance, provide high-quality care, and enhance organizational performance [ 18 ]. Furthermore, self-efficacy allows nurses to believe that they have the necessary nursing competence [ 33 ]. Thus, self-efficacy is the most important competency for ICNs because they have many responsibilities and high work autonomy [ 8 ]. As shown in the present study, ICNs frequently experience high levels of stress and burnout during infection control activities [ 10 ], while self-efficacy moderates stress symptoms and burnout [ 18 ]. Thus, organizations should develop and implement programs to strengthen self-efficacy to alleviate stress and burnout among ICNs.

Social support refers to the positive support and resources individuals derive from interpersonal relationships, including various forms of mental and material assistance as well as positive resources provided by family members, friends, colleagues, and their superiors [ 18 , 21 ]. Nurses with high levels of social support have reduced stress [ 34 ]; as such, support has a positive impact on their mental health and provides them with the strength to overcome the extreme challenges presented by an infectious disease outbreak, thus alleviating burnout [ 15 ]. As nurses are highly dependent on one another in their work processes and frequently bond with one another, support from co-workers enhances work performance, while increased support from their superiors facilitates psychological adjustment and reduces stress and tension, thereby decreasing burnout [ 13 ]. As COVID-19 personnel, ICNs received tremendous social attention and encouragement during the pandemic while serving in the frontline against the pandemic, which bolstered their camaraderie and bonds [ 17 ].

In the present study, we confirmed that social support, which helps individuals overcome crises, is a critical factor in reducing burnout among ICNs. Thus, to reduce burnout among ICNs, it is important to implement intervention strategies that enhance social support and establish social and organizational support systems, such as fostering a supportive work environment in which nurses feel they can receive adequate support from their colleagues and superiors.

This study revealed the mediating effects of self-efficacy and social support on the relationship between stress and burnout among ICNs in healthcare facilities during an emerging infectious disease pandemic—specifically, the COVID-19 pandemic—based on Lazarus & Folkman’s [ 24 ] stress, appraisal-coping model. Our results indicate that stress has a direct effect on burnout and that self-efficacy and social support mediate this effect. To mitigate burnout among ICNs, it is important to alleviate their stress and increase their self-efficacy and social support. This requires the development and implementation of stress reduction and self-efficacy programs at the organizational level, and the development of support systems for a supportive work environment. There is also a need for universalized policy support for social connections and psychological functioning for infection control nurses.

Limitations

As ICNs in healthcare facilities were purposively sampled during an emerging infectious disease pandemic in South Korea, this study’s findings have limited generalizability. Thus, future studies should examine burnout in different regions and hospital types. Based on these results, we recommend that qualitative studies be conducted for an in-depth exploration of the predictors of burnout among ICNs during an emerging infectious disease crisis. Furthermore, we recommend conducting interventional studies to develop and evaluate the effects of nursing intervention programs that reduce stress and improve self-efficacy and social support in order to reduce burnout among ICNs.

Data availability

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

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Acknowledgements

I would like to thank all participants who participated in this study.

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (No. RS-2022-00165644).

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Lee, Sj., Park, JY. & Kim, SH. Effects of stress on burnout among infection control nurses during the COVID-19 pandemic: the mediating effects of social support and self-efficacy. BMC Nurs 23 , 537 (2024). https://doi.org/10.1186/s12912-024-02209-z

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Negative economic experiences and subjective well-being in South Korea during the COVID-19 pandemic: examining mediating effects of perceived life control and psychological distress

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• Hanso Ryu 1 ,
• Eunju Ji 1 &
• Min-Ah Lee   ORCID: orcid.org/0000-0002-5551-9745 1  

This study analyzed associations between a negative change in employment and household income reduction due to the COVID-19 pandemic and subjective well-being (i.e., happiness and life satisfaction). It also examined the mediating role of perceived life control and psychological distress on these associations. The data were gathered from the 2021 Koreans’ Happiness Study, a nationally representative cross-sectional survey targeting Koreans aged 15 or older. The total number of respondents was 17,357. Multiple regression analyses showed that a negative change in employment and household income reduction were negatively associated with happiness and life satisfaction. The coefficients of the two independent variables were reduced when perceived life control and psychological distress were hierarchically controlled, suggesting that perceived life control and psychological distress had mediating effects. Bootstrapping confirmed the mediating roles of perceived life control and psychological distress. Those who experienced a negative change in employment and reduced household income tended to show lower perceived life control and higher psychological distress, which, in turn, lowered happiness and life satisfaction. The findings suggest that economic stressors due to the COVID-19 pandemic might lower subjective well-being by decreasing perceived life control and increasing psychological distress. Policy-makers should consider developing an intervention program that promotes perceived life control and decreases psychological distress for individuals with negative economic experiences during the pandemic. Furthermore, governmental support, such as job search, training interventions, and subsidies, should also be considered.

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The data are available at Korean Social Science Data Archive ( https://kossda.snu.ac.kr ).

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This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2023S1A5A2A01074474).

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Hanso Ryu, Eunju Ji & Min-Ah Lee

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All authors contributed to the study in a meaningful way. Conceptualization and formal analysis were performed by Min-Ah Lee. Literature review and editing were performed by Hanso Ryu and Eunju Ji. The first draft of the manuscript was written by Hanso Ryu and Min-Ah Lee. All authors read and approved the final manuscript and consent to its publication.

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Ryu, H., Ji, E. & Lee, MA. Negative economic experiences and subjective well-being in South Korea during the COVID-19 pandemic: examining mediating effects of perceived life control and psychological distress. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-06387-6

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Accepted : 05 July 2024

Published : 09 August 2024

DOI : https://doi.org/10.1007/s12144-024-06387-6

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