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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.

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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.

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?

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.

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.

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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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 .

More from TIME

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.

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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.

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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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How to Write About Coronavirus in a College Essay

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

Writing About COVID-19 in College Essays

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

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

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

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

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

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

Writing About COVID-19 for a College Application

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

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

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

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

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

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

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

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

Above all, she urges honesty.

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

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

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

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

Writing About Coronavirus in Main and Supplemental Essays

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

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

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

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

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

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

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

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

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

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

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

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

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

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• Rachel Wilson-Lowe 1 ,
• http://orcid.org/0000-0002-4409-6601 Kirstin R Mitchell 2
• 1 MRC/CSO Social and Public Health Sciences Unit , University of Glasgow , Glasgow , UK
• 2 MRC/CSO Social and Public Health Sciences Unit, Institute of Health & Wellbeing , University of Glasgow , Glasgow , UK
• Correspondence to Dr Emily Long, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow G3 7HR, UK; emily.long{at}glasgow.ac.uk

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

• inequalities

Data availability statement

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

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

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

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Introduction

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

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

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

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

Social networks

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

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

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

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

Social support

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

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

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

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

Social and interactional norms

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

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

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

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

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

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

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

Recommendations and conclusions

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

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

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

Recommendation 2: intelligently balance online and offline ways of relating

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

Recommendation 3: build stronger and sustainable localised communities

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

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

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

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

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

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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• Published: 25 June 2021

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

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

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

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

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

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

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

Peer Review reports

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Statistical analyses

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

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

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

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

Lifestyle changes during the COVID-19 pandemic

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Intention to continue lifestyle changes and the required support

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Availability of data and materials

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

Abbreviations

Complementary and Alternative Medicine

Confidence interval

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Acknowledgements

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

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

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

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

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

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Introduction.

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

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

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

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

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

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

Are there age differences in participants’ perceived social isolation?

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

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

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

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

Participants

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

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

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

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

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

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

Demographics

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

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

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

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

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

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

Social isolation and demographics

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

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

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

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

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

Social isolation and life satisfaction

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

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

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

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

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

Social isolation and trust of institutions

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

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

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

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

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

Coping strategies

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

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

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

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

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

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

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

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

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

Conclusions

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

Data availability

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

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Ruta Clair, Maya Gordon, Matthew Kroon & Carolyn Reilly

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

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MY COVID-19 Story: how young people overcome the covid-19 crisis

As part of UNESCO’s initiative “MY COVID-19 Story”,  young people have been invited to tell their stories and experiences: how they feel, how they act, what makes them feel worried and what future they envision, how the crisis has affected their lives, the challenges they face, new opportunities being explored, and their hopes for the future. This campaign was launched in April as part of UNESCO’s response to the COVID-19 pandemic. It aims to give the floor to young people worldwide, share their views and amplify their voices. While the world grapples with the challenges of the COVID-19 pandemic, many young people are taking on new roles, demonstrating leadership in their countries and communities, and sharing creative ideas and solutions. To this day, UNESCO has already received more than 150 written testimonials.

Self-isolation can be a difficult time… However, many young people worldwide decided to tackle this with productivity and positivity. Monty (17), a secondary school student from the United Kingdom, is developing new digital skills and has created his own mini radio station. Lockdown helped Öykü (25), a young filmmaker from Turkey, to concentrate on her creative projects. And for Joseph (30), a teacher from Nigeria, this time is a way to open up to lots of learning opportunities through webinars.

The crisis has changed not only the daily routine, but also perceptions of everyday life. For some young people rethinking the value of time and common moral principles appears to be key. 

“The biggest lesson for me is understanding … [the value of] time. During these last months I made more use of my time than in a past year.” - shares young tech entrepreneur Barbara (21), from Russia. Ravikumar (24), a civil engineer from India, believes  “This crisis makes us socialize more than ever. We are eating together, sharing our thoughts and playing together which happened rarely within my family before.”

Beyond the crisis

After massive upheavals in the lives of many people, the future for young people seems to be both a promising perspective to seize some new emerging opportunities, and a time filled with uncertainty about the crisis consequences and the future world order.

“It is giving us an opportunity to look into how we need to better support our vulnerable populations, in terms of food and educational resources”, says Anusha (19), from the United States of America. For Mahmoud (22), from Egypt, the COVID-19 crisis is a call to action: “After the pandemic, I will put a lot of efforts into helping people who have been affected by COVID-19. I am planning to improve their health by providing sports sessions, highlighting the importance of a healthy lifestyle.”

The COVID-19 pandemic brings uncertainty and instability to young people across the world, making them feel worried about this new reality they’re living in and presenting several new challenges every day, as they find themselves at the front line of the crisis. That is why, more than ever, we need to put the spotlight on young women and men and let their voice be heard! 

Be part of the campaign!

Join the  “MY COVID-19 Story” campaign! Tell us your story!

We will share it on  UNESCO’s social media channels  (Twitter, Facebook, and Instagram), our  website,  and through our  networks  across the world. 

You can also share your testimonials by recording your own creative video! How? Sign up and create your video here:  https://zg8t9.app.goo.gl/Zw2i . 

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• SDG: SDG 4 - Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
• SDG: SDG 10 - Reduce inequality within and among countries
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12 Ideas for Writing Through the Pandemic With The New York Times

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

By Natalie Proulx

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

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

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

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

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

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

In the meantime, happy writing!

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

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

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

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

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

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

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

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

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

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

2. Personal Narrative

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

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

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

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

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

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

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

Is the Coronavirus Pandemic Bringing Your Extended Family Closer Together?

How Is the Coronavirus Outbreak Affecting Your Life?

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

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

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

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

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

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

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

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

4. Letter to the Editor

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

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

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

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

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

Write briefly and to the point.

Be prepared to back up your facts with evidence.

Write about something off the beaten path.

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

5. Editorial

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

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

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

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

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

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

Should Schools Change How They Grade Students During the Pandemic?

What Role Should Celebrities Have During the Coronavirus Crisis?

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

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

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

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

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

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

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

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

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

She continues:

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

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

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

7. How-to Guide

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

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

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

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

Related Resource: Writing Curriculum | Unit 4: Informational Writing

8. 36 Hours Column

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

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

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

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

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

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

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

9. Photo Essay

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

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

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

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

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

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

10. Comic Strip

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

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

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

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

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

11. Podcast

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

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

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

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

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

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

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

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

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

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

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

12. Revise and Edit

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

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

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

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

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

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

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

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

Where we're going

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

The Next Normal: Emerging stronger from the coronavirus pandemic

Numbers, Facts and Trends Shaping Your World

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

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

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

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

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

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

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

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

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

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One Student's Perspective on Life During a Pandemic

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

person sitting at table with open laptop, notebook and pen

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

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

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

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

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

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

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

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

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

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

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Community Reflections

My life experience during the covid-19 pandemic.

Melissa Blanco Follow

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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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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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Ivan Specht decided to employ his love of math during pandemic, which led to contact-tracing app, papers, future path

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Ivan Specht started at Harvard on track to study pure mathematics. But when COVID-19 sent everyone home, he began wishing the math he was doing had more relevance to what was happening in the world.

Specht, a New York City native, expanded his coursework, arming himself with statistical modeling classes, and began to “fiddle around” with simulating ways diseases spread through populations. He got hooked. During the pandemic, he became one of only two undergraduates to serve on Harvard’s testing and tracing committee, eventually developing a prototype contact-tracing app called CrimsonShield.

Specht took his curiosity for understanding disease propagation to the lab of computational geneticist Pardis Sabeti , professor in Organismic and Evolutionary Biology at Harvard and member of the Broad Institute, known for her work sequencing the Ebola virus in 2014 . Specht, now a senior, has since co-authored several studies around new statistical methods for analyzing the spread of infectious diseases, with plans to continue that work in graduate school.

“Ivan is absolutely brilliant and a joy to work with, and his research accomplishments already as an undergraduate are simply astounding,” Sabeti said. “He is operating at the level of a seasoned postdoc.”

His senior thesis, “Reconstructing Viral Epidemics: A Random Tree Approach,” described a statistical model aimed at tackling one of the most intractable problems that plague infectious disease researchers: determining who transmitted a given pathogen to whom during a viral outbreak. Specht was co-advised by computer science Professor Michael Mitzenmacher, who guided the statistical and computational sections of his thesis, particularly in deriving genomic frequencies within a host using probabilistic methods.

Specht said the pandemic made clear that testing technology could provide valuable information about who got sick, and even what genetic variant of a pathogen made them sick. But mapping paths of transmission was much more challenging because that process was completely invisible. Such information, however, could provide crucial new details into how and where transmission occurred and be used to test things such as vaccine efficacy or the effects of closing schools. 

Specht’s work exploited the fact that viruses leave clues about their transmission path in their phylogenetic trees, or lines of evolutionary descent from a common ancestor. “It turns out that genome sequences of viruses provide key insight into that underlying network,” said the joint mathematics and statistics concentrator.

Uncovering this transmission network goes to the heart of how single-stranded RNA pathogens survive: Once they infect their host, they mutate, producing variants that are marked by slightly different genetic barcodes. Specht’s statistical model determines how the virus spreads by tracking the frequencies of different viral variants observed within a host.  

As the centerpiece of his thesis, he reconstructed a dataset of about 45,000 SARS-CoV-2 genomes across Massachusetts, providing insights into how outbreaks unfolded across the state.

Specht will take his passion for epidemiological modeling to graduate school at Stanford University, with an eye toward helping both researchers and communities understand and respond to public health crises.

A graphic designer with experience in scientific data visualization, Specht is focused not only on understanding outbreaks, but also creating clear illustrations of them. For example, his thesis contains a creative visual representation of those 45,000 Massachusetts genomes, with colored dots representing cases, positioned nearby other “dots” they are likely to have infected.

Specht’s interest in graphics began in middle school when, as an enthusiast of trains and mass transit, he started designing imagined subway maps for cities that lack actual subways, like Austin, Texas . At Harvard, he designed an interactive “subway map” depicting a viral outbreak.

As a member of the Sabeti lab, Specht taught an infectious disease modeling course to master’s and Ph.D. students at University of Sierra Leone last summer. His outbreak analysis tool is also now being used in an ongoing study of Lassa fever in that region. And he co-authored two chapters of a textbook on outbreak science in collaboration with the Moore Foundation.

Over the past three years, Specht has been lead author of a paper in Scientific Reports and another in Cell Patterns , and co-author on two others, including a cover story in Cell . His first lead-author paper, “The case for altruism in institutional diagnostic testing,” showed that organizations like Harvard should allocate COVID-19 testing capacity to their surrounding communities, rather than monopolize it for themselves. That work was featured in The New York Times .

During his time at Harvard, Specht lived in Quincy House and was design editor of the Harvard Advocate, the University’s undergraduate literary magazine. In his free time he also composes music, and he still considers himself a mass transit enthusiast.

In the acknowledgements section of his thesis, he credited Sabeti with opening his eyes to the “many fascinating problems at the intersection of math, statistics, and computational biology.”

“I could fill this entire thesis with reasons I am grateful for Professor Sabeti, but I think they can be summarized by the sense of wonder and inspiration I feel every time I set foot in her lab.”

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COVID-19 pandemic and its impact on social relationships and health

1 MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK

Susan Patterson

Karen maxwell, carolyn blake, raquel bosó pérez, mark mccann, julie riddell, kathryn skivington, rachel wilson-lowe, kirstin r mitchell.

2 MRC/CSO Social and Public Health Sciences Unit, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK

Associated Data

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

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

Introduction

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

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

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

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

Social networks

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

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

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

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

Social support

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

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

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

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

Social and interactional norms

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

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

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

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

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

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

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

Recommendations and conclusions

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

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

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

Recommendation 2: intelligently balance online and offline ways of relating

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

Recommendation 3: build stronger and sustainable localised communities

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

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

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

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

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

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement

Ethics statements, patient consent for publication.

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Coming out of the ashes we rise: Experiences of culturally and linguistically diverse international nursing students at two Australian universities during the Covid-19 pandemic

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Background and aim: Research on international students conducted during the COVID-19 pandemic has persistently highlighted the vulnerabilities and challenges that they experienced when staying in the host country to continue with their studies. The findings from such research can inevitably create a negative image of international students and their ability to respond to challenges during unprecedented times. Therefore, this paper took a different stance and reported on a qualitative study that explored culturally and linguistically diverse (CaLD) international nursing students who overcame the challenges brought about by the pandemic to continue with their studies in Australia. Method: A descriptive qualitative research design guided by the processes of constructivist grounded theory was selected to ascertain insights from participants' experiences of studying abroad in Australia during the COVID-19 pandemic. Results: Three themes emerged from the collected data that described the participants' lived experiences, and they were: 1) Viewing international education as the pursuit of a better life, 2) Focusing on personal growth, and 3) Coming out of the ashes we rise. Discussion: The findings highlight the importance of recognising the investments and sacrifices that CaLD international students and their families make in pursuit of international tertiary education. The findings also underscore the importance of acknowledging the qualities that CaLD international students have to achieve self-growth and ultimately self-efficacy as they stay in the host country during a pandemic. Conclusion: Future research should focus on identifying strategies that are useful for CaLD international nursing students to experience personal growth and ultimately self-efficacy and continue with their studies in the host country during times of uncertainty such as a pandemic.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical approval was obtained from Curtin University Human Research Ethics Office (HRE2022-0238) and The University of Southern Queensland Ethical Review Committee (H22REA114).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Data Availability

All data produced in the present study are available upon reasonable request to the authors

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