corona a global challenge essay 250 words

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Covid-19 as a global challenge: towards an inclusive and sustainable future, covid-19 as a challenge of complex interdependency.

COVID-19 is a global challenge that demands researchers, policymakers, and governments to address multiple dimensions that go far beyond the implications of this pandemic for health and wellbeing. Just as the UN Sustainable Development Goals call for a focus on the connections between development policy sectors, the pandemic has exposed the complex global interdependencies that underpin economies. It has also highlighted fault lines in societal structures that perpetuate ethnic, economic, social, and gender inequalities.

How to collectively address these challenges within the framing of the UKRI’s Global Challenges Research Fund

Here, we highlight the pandemic’s emerging potential consequences for achieving sustainable development with respect to the six global challenge areas we collectively address at the UK Research and Innovation’s Global Challenges Research Fund:

Food systems;
Cities and sustainable infrastructure;
Security, protracted conflict, refugee crises, and forced displacement;
Environmental resilience; and
Global health.

As the immediate health consequences of the pandemic unfold and begin to be superseded by the impact of public health containment measures, we call for a refocusing of research and action not only to mitigate these impacts but to build sustainability and strengthened resilience into future recovery.

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Jaideep Gupte

Research Fellow and Cities Cluster Co-Leader

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Covid 19 Essay in English

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

100 Words Essay on Covid 19

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

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

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

My Experience of COVID-19

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

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

Effects of CoronaVirus on Education

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

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

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

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

Effects of CoronaVirus on Economy

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

Effects of CoronaVirus on Health

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

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Bio Medical Engineer

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

Data Administrator

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

Ethical Hacker

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

Data Analyst

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

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

Geothermal Engineer

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

Remote Sensing Technician

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

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

Geotechnical engineer

The role of geotechnical engineer starts with reviewing the projects needed to define the required material properties. The work responsibilities are followed by a site investigation of rock, soil, fault distribution and bedrock properties on and below an area of interest. The investigation is aimed to improve the ground engineering design and determine their engineering properties that include how they will interact with, on or in a proposed construction.

The role of geotechnical engineer in mining includes designing and determining the type of foundations, earthworks, and or pavement subgrades required for the intended man-made structures to be made. Geotechnical engineering jobs are involved in earthen and concrete dam construction projects, working under a range of normal and extreme loading conditions.

Cartographer

How fascinating it is to represent the whole world on just a piece of paper or a sphere. With the help of maps, we are able to represent the real world on a much smaller scale. Individuals who opt for a career as a cartographer are those who make maps. But, cartography is not just limited to maps, it is about a mixture of art , science , and technology. As a cartographer, not only you will create maps but use various geodetic surveys and remote sensing systems to measure, analyse, and create different maps for political, cultural or educational purposes.

Budget Analyst

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

Product Manager

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

Underwriter

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

Finance Executive

Operations manager.

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

Bank Probationary Officer (PO)

Investment director.

An investment director is a person who helps corporations and individuals manage their finances. They can help them develop a strategy to achieve their goals, including paying off debts and investing in the future. In addition, he or she can help individuals make informed decisions.

Welding Engineer

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

Transportation Planner

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

An expert in plumbing is aware of building regulations and safety standards and works to make sure these standards are upheld. Testing pipes for leakage using air pressure and other gauges, and also the ability to construct new pipe systems by cutting, fitting, measuring and threading pipes are some of the other more involved aspects of plumbing. Individuals in the plumber career path are self-employed or work for a small business employing less than ten people, though some might find working for larger entities or the government more desirable.

Construction Manager

Individuals who opt for a career as construction managers have a senior-level management role offered in construction firms. Responsibilities in the construction management career path are assigning tasks to workers, inspecting their work, and coordinating with other professionals including architects, subcontractors, and building services engineers.

Urban Planner

Urban Planning careers revolve around the idea of developing a plan to use the land optimally, without affecting the environment. Urban planning jobs are offered to those candidates who are skilled in making the right use of land to distribute the growing population, to create various communities.

Urban planning careers come with the opportunity to make changes to the existing cities and towns. They identify various community needs and make short and long-term plans accordingly.

Highway Engineer

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

Environmental Engineer

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

Naval Architect

A Naval Architect is a professional who designs, produces and repairs safe and sea-worthy surfaces or underwater structures. A Naval Architect stays involved in creating and designing ships, ferries, submarines and yachts with implementation of various principles such as gravity, ideal hull form, buoyancy and stability.

Orthotist and Prosthetist

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

Veterinary Doctor

Pathologist.

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

Speech Therapist

Gynaecologist.

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

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

Audiologist

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

Hospital Administrator

The hospital Administrator is in charge of organising and supervising the daily operations of medical services and facilities. This organising includes managing of organisation’s staff and its members in service, budgets, service reports, departmental reporting and taking reminders of patient care and services.

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

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

Video Game Designer

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

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

Radio Jockey

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

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

Choreographer

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

Videographer

Multimedia specialist.

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

Social Media Manager

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

Copy Writer

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

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

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

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

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

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

Linguistic meaning is related to language or Linguistics which is the study of languages. A career as a linguistic meaning, a profession that is based on the scientific study of language, and it's a very broad field with many specialities. Famous linguists work in academia, researching and teaching different areas of language, such as phonetics (sounds), syntax (word order) and semantics (meaning).

Other researchers focus on specialities like computational linguistics, which seeks to better match human and computer language capacities, or applied linguistics, which is concerned with improving language education. Still, others work as language experts for the government, advertising companies, dictionary publishers and various other private enterprises. Some might work from home as freelance linguists. Philologist, phonologist, and dialectician are some of Linguist synonym. Linguists can study French , German , Italian .

Public Relation Executive

Travel journalist.

The career of a travel journalist is full of passion, excitement and responsibility. Journalism as a career could be challenging at times, but if you're someone who has been genuinely enthusiastic about all this, then it is the best decision for you. Travel journalism jobs are all about insightful, artfully written, informative narratives designed to cover the travel industry. Travel Journalist is someone who explores, gathers and presents information as a news article.

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corona a global challenge essay 250 words

Coronavirus Pandemic

COVID-19: breaking down a global health crisis

Saad i. mallah.

1 School of Medicine, Royal College of Surgeons in Ireland, Bahrain, Kingdom of Bahrain

2 The National Taskforce for Combating the Coronavirus (COVID-19), Bahrain, Kingdom of Bahrain

Omar K. Ghorab

Sabrina al-salmi, omar s. abdellatif.

3 Department of Political Science, Faculty of Arts and Science, University of Toronto, Toronto, Canada

4 G7 and G20 Research Groups, Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Canada

Tharmegan Tharmaratnam

5 School of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland

Mina Amin Iskandar

Jessica atef nassef sefen, pardeep sidhu, bassam atallah.

6 Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates

7 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA

Rania El-Lababidi

Manaf al-qahtani.

8 Department of Medicine, Royal College of Surgeons in Ireland, Bahrain, Kingdom of Bahrain

9 Department of Infectious Diseases, Royal Medical Services, Bahrain Defence Force Hospital, Riffa, Kingdom of Bahrain

Associated Data

Not applicable.

Coronavirus disease 2019 (COVID-19) is the second pandemic of the twenty-first century, with over one-hundred million infections and over two million deaths to date. It is a novel strain from the Coronaviridae family, named Severe Acute Respiratory Distress Syndrome Coronavirus-2 (SARS-CoV-2); the 7th known member of the coronavirus family to cause disease in humans, notably following the Middle East Respiratory syndrome (MERS), and Severe Acute Respiratory Distress Syndrome (SARS). The most characteristic feature of this single-stranded RNA molecule includes the spike glycoprotein on its surface. Most patients with COVID-19, of which the elderly and immunocompromised are most at risk, complain of flu-like symptoms, including dry cough and headache. The most common complications include pneumonia, acute respiratory distress syndrome, septic shock, and cardiovascular manifestations. Transmission of SARS-CoV-2 is mainly via respiratory droplets, either directly from the air when an infected patient coughs or sneezes, or in the form of fomites on surfaces. Maintaining hand-hygiene, social distancing, and personal protective equipment (i.e., masks) remain the most effective precautions. Patient management includes supportive care and anticoagulative measures, with a focus on maintaining respiratory function. Therapy with dexamethasone, remdesivir, and tocilizumab appear to be most promising to date, with hydroxychloroquine, lopinavir, ritonavir, and interferons falling out of favour. Additionally, accelerated vaccination efforts have taken place internationally, with several promising vaccinations being mass deployed. In response to the COVID-19 pandemic, countries and stakeholders have taken varying precautions to combat and contain the spread of the virus and dampen its collateral economic damage. This review paper aims to synthesize the impact of the virus on a global, micro to macro scale.

Introduction

Novel Coronavirus disease 2019 (COVID-19) was crowned as the second pandemic of the twenty-first century by the World Health Organisation (WHO) on March 11th, 2020 [ 1 ]. COVID-19 is caused by the Severe Acute Respiratory Distress Syndrome Coronavirus-2 (SARS-CoV-2), a novel strain from the Coronaviridae family, first isolated in Wuhan (China) after a cluster of outbreaks. SARS-CoV-2 is a positive-sense, single-stranded enveloped RNA virus that transmits via respiratory droplets and fomites. The virus causes a disease spectrum ranging from asymptomatic to severe acute respiratory distress syndrome (ARDS), and death. Management of this novel disease remains largely supportive, with no approved medications available for treatment [ 2 ].

Only after around two months since the initial case report in Wuhan, the first one thousand infections were recorded. Within a short period of time, the infection rate had grown exponentially, and as of February 25, 2021, over one-hundred and thirteen million infections have been registered globally, with over two million deaths (~ 2.2% overall mortality to date, which has been reduced from the ~ 5% mortality at the start of the outbreak) [ 3 , 4 ]. As global leaders and civil servants worldwide enforce life-altering regulations to contain the disease, scientists scramble to develop timely vaccines, and with healthcare providers treating patients on the frontlines and testing new treatments, it is now more important than ever for the research community to disseminate timely, evidence-based, and up-to-date information about COVID-19 for the public and medical communities alike, both for current and future reference. Therefore, the aim of this review is to provide a holistic, comprehensive overview, both in a retrospective and interim manner, of the relevant epidemiology, pathogenesis, management, potential therapies and vaccines, global efforts, disease burden, and preventive measures that have and can be implemented in the global pursuit of containing COVID-19.

Search strategy and selection criteria

A range of databases and search strategies were adopted in order to curate a comprehensive overview that addresses the topic from various angles. The WHO Global COVID-19 Database, PubMed, Google Scholar, and medRxiv were mainly searched. Additionally, the WHO and US CDC webpages were often searched for guidelines and data. External webpages such as ClinicalTrials.gov, Our World in Data (OWID), the Oxford COVID-19 Government Response Tracker (OxCGRT), governmental and ministerial webpages, and other UN and Economic related forums and reports were frequently referenced. Alternatives of the ‘COVID-19’ term, such as ‘2019-nCov’, ‘Novel Coronavirus’, ‘Coronavirus 2019’, ‘SARS-CoV-2’, ‘SARS-2’…etc. were used alongside the terms relevant to each sub-header. Non-peer reviewed work was at times referenced due to the exceptional nature of the topic at hand. Papers were only referenced if they were primarily written in English or Arabic, or secondarily referenced in English from a different language. A diverse list of works were reviewed and discussed, ranging from case reports to systematic reviews.

Epidemiology

In late December 2019, numerous local healthcare institutions in Wuhan, Hubei Province, China had reported several clusters of atypical pneumonia cases (27 cases total) with signs and symptoms greatly resembling those of viral pneumonia, seemingly linked to the South China Seafood City (Huanan Seafood Wholesale Market) [ 1 , 5 – 7 ]. Shortly thereafter, on December 31, 2019, the Wuhan Municipal Health Commission issued a notification to the Chinese Center for Disease Control (China CDC). This resulted in a Chinese rapid response team dispatched to undertake immediate investigations, and a subsequent alert issued to the WHO (Fig. 1 ) [ 8 , 9 ]. Since then, the Wuhan Seafood Market, which was epidemiologically implicated in the outbreak, was shut down, disinfected, and investigated [ 5 , 7 , 9 , 10 ].

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Epidemiologic timeline of events concerning the COVID-19 pandemic [ 1 , 5 , 11 – 13 ]

In early January 2020, all mimicking etiologies such as the influenza virus, severe acute respiratory syndrome coronavirus (SARS-CoV), and Middle East respiratory syndrome coronavirus (MERS-CoV) were excluded, and the causative agent recognised as a novel coronavirus, now labelled as “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)” by the International Committee on Taxonomy of Viruses [ 7 , 9 , 14 , 15 ]. It has been genomically sequenced for the first time by scientists of the National Institute of Viral Disease Control and Prevention [ 16 ].

The initial transmission event(s), also known as ground zero, are believed to have occurred at the Huanan Seafood Market in Wuhan, via single or multiple animal-to-human transmission events, possibly from bats and pangolins captured and sold at the market. The magnitude of the initial bat-to-human transmission event is not yet known however [ 7 , 16 – 18 ]. From those initial cases infected by zoonotic transmission, Chan et al. [ 19 ] reported subsequent and successive human-to-human transmission to have occurred. Chan et al. [ 19 ], reported a case of a family of six who had travelled to Wuhan from elsewhere in China, with no history of visiting the market, but with a history of visit for only two of the six members to a hospital in Wuhan; the first 2 members contracted the virus from the hospital (possibly from an infected person), and then went on to transmit it to the remaining family members [ 19 ]. As such, results of Chan et al. [ 19 ] are consistent with person-to-person transmission and with travel-related transmission.

While there has been some speculation regarding alternative origins of the virus, such as it being engineered in a laboratory and subsequently being released or accidentally escaping, Anderson et al., (2020) describes that SARS-CoV-2′s genomic features are highly inconsistent with any laboratory-related scenario of spread/escape, re-emphasising its natural origins with relation to bats [ 20 ].

The emergence of SARS-CoV-2 coincided with the Chinese Lunar New Year, which is China’s most celebrated occasion, with millions of people traveling from their residence back to their families and hometowns in other provinces and cities [ 21 ]. With an estimated cumulative number of trips amounting to upwards of 3 billion over the 40-day holiday period, an estimated 5 million people had already left Wuhan before the Chinese government implemented a travel ban in late January 2020, making containment of the outbreak difficult [ 21 ]. In fact, Zhao et al. [ 22 ] found a strong correlation between domestic train-travel from Wuhan to other provinces and the spread of SARS-CoV-2 across China.

Shortly thereafter, positive cases for SARS-CoV-2 began emerging worldwide, facilitated by air travel; both Wuhan and Beijing airports had hundreds of flights to 22 and 54 countries daily, respectively, before the implemented travel bans [ 23 – 25 ]. As of February 25, 2021, the WHO reports a total of 112,224,022 confirmed cases and 2,491,171 confirmed deaths in 236 countries or territories worldwide, equating to a resultant overarching death rate of 2.22% per case of COVID-19 [ 4 ]; it is worth mentioning however, that the aforementioned percentage is a simplified calculation based on numbers provided by WHO, and that earlier estimates of the actual global case fatality rate (CFR) vary between 0.3 and 3% [ 11 , 26 , 27 ], with concrete evidence showing CFR to sharply increase with age and comorbidities [ 28 ], and by territory [ 11 ]. Globally, the list of worst-affected countries includes the United States (28+ million cases; 500,000+ deaths), India (11+ million cases; 156,000+ deaths), Brazil (10+ million cases; 245,000+ deaths), Russia (4+ million cases; 85,000+ deaths), and the United Kingdom [UK] (4+ million cases; 121,000+ deaths). [ 4 ]. The spread of COVID-19 has not been proportional to the sizes of the regional populations, which may indicate a range of contributing factors, from containment and screening measures to population demographics (Fig. 2 ).

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Comparison between prevalence of COVID-19 cases in each continent as a percentage of global cases, and their respective population size as a percentage of global population [ 11 ]

During the progression of the outbreak, the situation in Italy had been particularly concerning, with a CFR of 14.44% (95% CI 14.29–14.58) on May 26, 2020 [ 29 ]. Additionally, it was reported that Italian infection rates mimic an exponential curve, with unease and doubt regarding whether the Italian healthcare system would be able to cope [ 30 ]. Likewise, the outbreak that took place in Iran had been of particular concern, specifically due to the fact that at least six neighbouring countries (Bahrain, Iraq, Kuwait, Oman, Afghanistan, and Pakistan) have reported cases of COVID-19 related to travel from Iran [ 31 ].

Likewise, the status of the United States had been just as concerning, being the leading nation in cases and in deaths, housing over a fifth of the total number of infected people worldwide. Even conservative estimates reported in early 2020 showed that the outbreak in the United States may push the American healthcare system beyond its capacity [ 32 ]. Indeed The United States had faced a dire shortage in Personal Protective Equipment (PPEs) and ventilators in March 2020 [ 33 ], with a small national reserve not equipped for such an unprecedented demand [ 34 ]. An increase in ventilator production however soon followed, replenishing the CDC Strategic National Stockpile of Ventilators by September, 2020 [ 35 ].

The epicentre of the COVID-19 pandemic has been, and continues to be, dynamic in nature. It had begun in Asia, before transitioning to Europe, then the Americas, and back to Europe (UK) with a variant strain [ 4 , 36 ]. The WHO had warned that Africa’s increasing infection rates may possibly place it as the next epicentre for the pandemic [ 37 ], but that did not seem to manifest.

A number of studies have attempted to model the epidemiological trajectory of the COVID-19 pandemic. Neher et al. (2020), demonstrated that simulation models show a small peak in early 2020, followed by a larger peak in winter 2020/2021 in temperate regions of the Northern Hemisphere [ 38 ]. In contrast to this, Wilson et al. (2020) reported that predictions of infection rates and CFRs are highly variable and difficult to establish, given COVID-19’s widespread reach and country-specific infection rates, control efforts, and wildly varying testing and reporting rates [ 39 ]. Indeed, an early predictive model set forth by the CoronaTracker Community Research Group anticipated the outbreak to peak before February 20, 2020, which did not occur [ 40 ]. The US Centre for Disease Control (CDC) however has been utilising a diverse list of models from various universities and institutes that adopt a range of statistical and machine learning methodologies, to a fair degree of accuracy [ 41 ]. Furthermore, attempts at forecasting epidemiologic dynamics via novel markers, such as mean viral loads as indicated by Cycle threshold values, have surfaced [ 42 ]. It is worth mentioning, however, that the disease trajectory to date has been exponential: It took around 3 months for the first 500,000 cases to be registered, and a week for the second 500,000. Likewise, it took two weeks to get from the first million to the second, but three days from the 31st to the 32nd million [ 3 ]. As of July 2020, countries such as China, Japan, Singapore, and most Middle East countries reported a doubling number of cases between every 5 to 10 days, while the majority of countries, such as the United States, Canada, Italy, Iran, Turkey, and the United Kingdom had cases doubling every 2 to 5 days [ 43 ]. This of course was largely fluctuating as the outbreak progressed.

Over time, variant strains of COVID-19 began to appear, often with slightly varying characteristics. The new highly transmissible SARS-CoV-2 strain/variant identified in the UK (London and southeast England) in December, 2020 (named “VUI-202012/01” or “B.1.1.7”) has since spread to many countries, including Ireland, Denmark [ 44 ], India [ 45 ], and Italy [ 46 ]. Since then, other seemingly related and newly identified variants have been implicated in surges of cases in France, South Africa, Israel, Brazil, Japan, and South Korea [ 44 ] (REFERENCE 1002), creating public unrest and stress on the already-strained global public health and vaccination efforts to contain COVID-19 [ 47 ]. Another novel strain (named “501Y.V2”, which shares one mutation with B.1.1.7 [ 48 ], first identified in South Africa [ 49 ], has also spread to neighbouring Botswana, as well as distant countries such as the UK and France [ 44 , 48 , 49 ].

The causative agent of COVID-19 is the SARS-CoV-2, which has become the 7th known member of the coronavirus family that causes disease in humans. It is a beta-coronavirus that consists of a long single-stranded positive-sense RNA molecule, surrounded by a lipid envelope that anchors many structural viral glycoproteins, most important of which is the spike glycoprotein [ 50 ]. The virus has been found to be about 80% similar in genetic sequence to SARS-CoV, with less similarity to MERS-CoV [ 18 ]. An earlier phylogenetic analysis of 103 strains of SARS-CoV-2 in China showed that there are two different types of the virus, an L type and an S type, with the L type forming the majority (70%) of the isolated strains [ 51 ].

The SARS-CoV-2 protein likely to be involved in the pathogenesis of COVID-19 is its spike glycoprotein, which has been shown to interact with host cell targets such as the ACE2 receptor and CD26, and is the same viral protein involved in the pathogenesis of SARS [ 2 , 52 ]. The spike glycoprotein consists of two subunits: S1 (for ACE2 receptor binding), and S2 (for plasma membrane fusion). Upon plasma membrane fusion, the spike protein is cleaved by host proteases, releasing a spike fusion peptide which facilitates viral entry into the host cell [ 53 , 54 ]. It has been shown that the SARS-CoV-2 spike glycoprotein has a stronger binding affinity to host cell ACE2 receptors than SARS-CoV, and therefore a higher infectious potency [ 55 ]. Moreover, the SARS-CoV-2 spike glycoprotein has been shown to contain a unique cleavage site not found in other SARS-like coronaviruses [ 56 ]. The identification of the unique features of SARS-CoV-2 such as its spike glycoprotein, the host cell receptors it binds, and the host proteases that act on the virus could be essential in understanding disease pathogenesis, and therefore identifying potential treatment modalities.

The source of SARS-CoV-2 is difficult to confirm, however it most likely originated from bats due to its genetic similarity to bat coronaviruses. Zhou et al. (2020) were the first to display that the SARS-CoV-2 is 96% identical to the bat coronavirus at the whole-genome level [ 18 ], and this figure was similarly reported by Yu et al. (2020), who reported that the virus was 96.11% identical to a bat SARS-like coronavirus strain (RaTG13) [ 57 ]. It is also yet to be identified whether virus transmission is directly from one organism, or through an intermediate host. Pangolin coronaviruses were found to be 91.02% identical to SARS-CoV-2 at the whole genome level (second most identical after RaTG13 bat coronavirus), and therefore there is great belief that pangolins may be the intermediate hosts for virus transmission to humans [ 58 , 59 ]. Another study by Zhu et al. (2020) suggested that bats and minks are the two reservoirs of the virus, with minks being the intermediate hosts [ 60 ].

Pathogenesis

The complete pathogenesis of SARS-CoV-2 is yet to be fully comprehended. It is believed that the virus is inhaled through respiratory droplets and acquires entry into the respiratory tract through the nasopharyngeal mucosal membranes. In about 80% of cases, the virus resides in the upper respiratory tract leading to an innate immune response that is mild and requires conservative symptomatic therapy. The remaining 20% of cases experience a much severe form of the disease; the virus diffusely invades and destroys lung alveolar cells, leading to a systemic inflammatory response with ‘cytokine storm’, followed by healing and fibrosis [ 10 , 61 ]. One study has suggested that intussusceptive angiogenesis may be a part of the pathophysiology of COVID-19; this is a unique disease characteristic when compared to other viral illnesses like influenza. However, this association remains to be further studied and confirmed [ 62 ]. Regarding extra-pulmonary manifestations, the virus may disseminate into the blood and affect organs that express ACE2 receptors, such as the lungs, heart, kidneys, and gastrointestinal tract [ 63 , 64 ].

Disease severity ranges from asymptomatic to severe, with the latter shown to be associated with older age and presence of comorbidities [ 65 ]. The most common symptoms being reported are fever and cough [ 66 ]. Severe disease involves acute respiratory distress syndrome (ARDS), which can also be associated with severe pneumonia. In fact, the most commonly reported cause of death is respiratory failure [ 67 ]. The pneumonia most commonly presents with bilateral multiple lobular and subsegmental areas of ground-glass opacities on CT scan [ 68 ]. Non-respiratory complications of COVID-19 may include septic shock (reported in 81.2% of non-survivors in one case series) [ 69 ], acute liver injury [ 70 ], acute kidney injury [ 71 ], ocular problems [ 72 ], neurological manifestations [ 73 ], and resemblances of disseminated intravascular coagulation (reported in 71% of non-survivors in a case series) [ 74 ]. Another complication of increasing concern is the formation of diffuse microvascular thrombi—this has led some health institutions worldwide to recommend thromboprophylaxis for all COVID-19 patients [ 75 ].

Several months after the start of the outbreak, a Kawasaki-like disease had been associated with COVID-19 presentation; one province in Italy had detected a 30-fold increase in the incidence of Kawasaki-like disease [ 76 ]. Now referred to as multisystem inflammatory syndrome in children (MIS-C), the most common associated signs and symptoms include abdominal pain, vomiting, skin rash, diarrhoea, and hypotension, with a majority having gastrointestinal, cardiovascular, and/or dermatologic or mucocutaneous involvement. The complications are often severe, requiring ICU care in the majority of cases [ 77 ].

COVID-19 has also been linked with chemosensory dysfunction; loss of sense of taste and smell has been widely reported in cases of COVID-19, sometimes as the only symptom [ 78 , 79 ]. This has led the WHO to add loss of smell and/or taste to the official list of COVID-19 symptoms [ 80 ].

When compared to SARS and MERS-CoV from a clinical perspective, COVID-19 shares many of the clinical features seen in those diseases; however, it has been associated with fewer occurrences of gastrointestinal and upper respiratory tract symptoms [ 81 ]. Several other complications and underlying pathologic mechanisms continue to be reported as potentially associated with COVID-19 (Fig. 3 ) [ 77 , 82 – 86 ].

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Complications reported to be potentially associated with COVID-19 [ 77 , 82 – 86 ]

Risk factors

The presence of comorbidities has been associated with a worse COVID-19 prognosis; these specifically include cardiovascular disease, diabetes, respiratory disease, and smoking [ 87 , 88 ]. Elevated levels of blood markers such as lactate dehydrogenase, D-dimers, procalcitonin, serum ferritin, and interleukin-6, as well as leucopoenia, were also found to be associated with worse COVID-19 outcomes, and therefore could potentially be used to monitor disease prognosis [ 89 – 91 ]. The cytokine storm induced by SARS-CoV-2 brings with it a multitude of cytokines; Yang et al. [ 68 ] found that interferon gamma induced protein (IP10), interleukin-1 receptor antagonist (IL-1ra), and monocyte chemotactic protein-3 (MCP-3) were significantly associated with increased COVID-19 severity and progression [ 92 ]. One case series suggested that thrombocytopenia was significantly associated with death in COVID-19 [ 93 ]. The use of non-steroidal anti-inflammatory drugs (NSAIDs) during suspected COVID-19 had also been widely discouraged, due to belief that those drugs may worsen disease outcomes [ 94 ]. Recent evidence however seems to suggest there may be no increased risk posed [ 95 ]. Other reports hypothesized that ACE inhibitors and nicotine exposure may be associated with cardiorespiratory manifestations in COVID-19 due to upregulation of ACE-2 receptors (which is essential for SARS-COV-2 cell entry), however this remains to be properly studied [ 96 – 98 ]. A protective role however has also been suggested due to the drug limiting angiotensin II related pro-inflammatory signalling, as well as limiting breakdown of bradykinin, which would attenuate hypertension and prevent ventricular apoptosis [ 99 ]. In fact, paradoxically, ACE inhibitors suppress TMPRSS2 expression which is an essential co-receptor for SARS-COV-2 cell entry [ 99 ]. Evidence on the effect of NSAIDs and ACE inhibitors on COVID-19 outcomes remains inconclusive [ 100 ].

Transmission and precautions

COVID-19 is transmitted from person-to-person through droplet spread, similar to other subtypes of the coronavirus family. The virus may infect a host by coming in contact with any mucosal linings, including mouth, nostrils, and eyes, either directly as respiratory air droplets (suspended in the air when an infected person coughs, sneezes, or talks) or by touching a contaminated surface and then touching a mucosal surface (when droplets rest on a surface; fomites) [ 101 ]. COVID-19′s reproduction number ( R 0 ) continues to fluctuate, with estimates from a meta-analysis ranging from 1.4 to 6.49, with a mean of 3.28, a median of 2.79; which is higher than that of SARS [ 102 ].

Most worryingly, viral spread can occur through infected asymptomatic individuals, referred to as asymptomatic transmission. This is largely due to the virus’s rather long incubation period, the median of which is estimated around 5.1 (95% CI 4.5 to 5.8) days, but can extend to over 14 days in some cases. By 11.7 days (95% CI 9.7 to 14.2), 95% of people have been shown to demonstrate symptoms of the disease [ 103 ].

In a study exploring aerosol and surface stability, SARS-CoV-2 was found to have a very similar profile to SARS-CoV in terms of stability kinetics [ 104 ]. The estimated median half-life of SARS-CoV-2 in aerosols is believed to be 1.1 to 1.2 h (95% CI 0.64 to 2.64). Both viruses were more stable on plastic and stainless steel, with viable viruses still detected after 72 h of contamination. The half-life of SARS-CoV-2 on stainless steel and plastic were 5.6 days and 6.8 days respectively. On copper, no viable SARS-CoV-2 was measured after 4 h, in contrast to SARS-CoV-1 which was only undetectable after 8 hours [ 104 ]. Contrary to this, on cardboard SARS-CoV-2 lasted longer (24 h) than SARS-CoV-1 (8 h) [ 104 ]. The estimated median half-life of SARS-CoV-2 in aerosols is believed to be 1.1 to 1.2 h (95% CI 0.64 to 2.64) [ 104 ].

Closed-environments are believed to be grounds for a superspreading event in the transmission of COVID-19. In one study in Japan, 110 positive cases among eleven clusters were contact traced. The study found that the odds of a primary case transmitting COVID-19 in a closed-environment was 18.7 times greater compared to an open-air environment, (95% CI 6.0–57.9). The odds of a superspreading event (defined in this case as transmission to three or more persons), in a closed environment was as high as 29.8 that of an open-air environment (95% CI 5.8–153.4) [ 105 ].

The association of weather or meteorological factors with the spread of COVID-19 has been highly contested in public and scientific discourse. One study from China found that meteorological factors play an independent role in COVID-19 transmission. Specifically, that low temperatures, low humidity, and a mild diurnal (daytime) temperature range favours the transmission [ 106 ]. On the other hand, another study from China as well, found that after adjustment for relative humidity and ultraviolet (UV) radiation, temperature had no significant association with cumulative incidence rate, indicating that transmission of the virus would not change with increasing temperature. Furthermore, exposure to UV radiation was not significantly associated with cumulative incidence rate after adjusting for temperature and relative humidity either. Relative humidity, maximum temperature, and minimum temperature, were likewise not significantly associated with cumulative incidence rate or the reproduction number of COVID-19 [ 107 ].

Although the main mode of SARS-CoV-2 transmission is person-to-person, a number of isolated cases of animals have been reported to test positive for SARS-CoV-2 following close contact with infected humans. Preliminary findings suggest that, of the animal species investigated so far, cats are the most susceptible species to SARS-CoV-2 and can be affected with clinical disease. In the laboratory setting, cats were able to transmit infection to other cats. Ferrets also appear to be susceptible to infection but less so to disease and were also able to transmit infection to other ferrets. Dogs appear to be susceptible to infection but appear to be less affected than ferrets or cats. Egyptian fruit bats were also infected in the laboratory setting but did not show signs of disease or the ability to transmit infection efficiently to other bats. To date, these preliminary findings suggest that poultry and pigs are not susceptible to SARS-CoV-2 infection [ 108 ]. Despite this, there is no evidence to suggest that infected animals are playing a role in the spread of COVID-19. Nevertheless, the WHO advises caution at live animal markets and avoiding any direct interaction. Good food safety practices are also recommended especially when dealing with raw animal products [ 101 ].

One of the newest COVID variants; B.1.1.7 VOC (Variant of Concern) 202012/01, first detected in the UK and predominantly identified in people younger than 60 years, has been linked to an increasing incidence of COVID-19, but higher mortality or particularly affected groups have not been reported according to the European Centre for Disease Prevention and Control [ 109 ]. Upon further investigation, trends have shown that VOC 202012/01 has clear transmission advantage over the non-VOC strain. Epidemiological studies have shown that despite the increased transmissibility, the VOC cases are expected to decline faster than non-VOC cases [ 110 ].

An epidemiological study from the Imperial College of London has quantified the transmission advantage of the VOC in comparison to the non-VOC lineages both additively as an increase in R that ranged between 0.4 and 0.7, and also multiplicatively, wherein the increase in R ranged between a 50% and 75% advantage [ 110 ]. Additionally, there has been a small shift towards people under their 20 s being more affected by the VOC, but the mechanism that underlies these differences is not yet understood [ 110 ].

From a sexual transmission standpoint, SARS-CoV-2 has been detected in the semen of patients with COVID-19 and may also be present in the semen of recovering patients. Owing to the fallibility of the blood-testis/deferens/epididymis barriers, SARS-CoV-2 may be seeded to the male reproductive tract, especially in the presence of systemic local inflammation. It has not been proven, however, that COVID-19 can be spread through sexual transmission [ 111 ]. Similarly, the virus has also been detected in other non-respiratory samples such as stool, blood and ocular secretions [ 112 , 113 ].

With regards to pregnant women, physiological changes in pregnancy and an immunocompromised status could increase susceptibility [ 114 ]. However, evidence suggests no risk of increased maternal–fetal transmission. In a cohort of 38 pregnant women, Schwartz et al. (2020) [ 115 ] reported no evidence of transplacental or intrauterine transfer. The WHO reports that pregnancy and childbirth do not necessarily aggravate the disease course in the mother [ 116 ]. Additionally, the literature is limited with regards to whether COVID-19 can be transmitted in breast milk. In a sample of 6 women, Mullin et al. (2020) [ 117 ] were unable to report any findings of the virus in maternal breast milk. However, a symptomatic mother may transmit the illness if in close contact with the neonate. Therefore, social distancing is important, and following appropriate precautions, pumped breast milk may be fed to the neonate by another caregiver. During this process, the mother should ensure she follows strict contact precautions, such as wearing gloves and a face mask, to reduce the risk of transmission, as well as the routine disinfection of surfaces. Note that breastfeeding should not be discouraged unless the mother is acutely ill [ 118 ].

The most important public precaution to contain the outbreak remains to be social distancing [ 119 ]. It is advised to remain at home except for necessity, which has prompted the implementation of various travel bans, curfews, strict screening procedures, and self-isolation or governmental/hospital quarantine [ 120 ]. Moreover, mass gatherings are not advised [ 121 ]. The American Academy of Ophthalmology also recommends wearing glasses instead of contact lenses, to decrease eye-touching tendencies [ 122 ]. Finally, it is advised to keep a minimum of 2 m distance between individuals to minimise transmission [ 80 ].

As of April 3 2020, the CDC also recommends wearing cloth face coverings in public settings, especially in areas of significant community-based transmission [ 123 ]. There has been much debate regarding the effectiveness of various forms of face coverings. A meta-analysis of RCTs found that surgical/medical masks offered similar protection against viral respiratory infection (including coronavirus) in health-care workers during non-aerosol generating care as N95 respirator masks [ 124 ]. Another systematic review found that that cloth face coverings offered limited efficacy compared to medical grade masks, but can be improved by using a multi-layer cloth mask made of cotton in combination with synthetic cloth material, as well as by improving the fit, and disinfecting it regularly [ 125 ]. Finally, a population modelling study found masks of various efficacy to be useful in preventing both illness in health individuals as well as preventing asymptomatic transmission. Hypothetical scenarios of near-universal (80%) adoption of moderately (50%) effective masks in US states were found to potentially prevent 17–45% of projected deaths over two months. Even masks of very low (20%) efficacy were found to be useful if underlying transmission rates were low or decreasing, reducing mortality by up to 24–65% in such scenarios [ 126 ]. As such, in view of the evidence, universal face covering/masking has been adopted as a potentially effective public health tool in curtailing community transmission [ 127 ].

These extreme measures are necessary to curb the transmission rates and for individuals to protect themselves and others by decreasing the likelihood of exposure to those sick or infected, while also decreasing transmission by infected individuals. The overwhelming of healthcare systems would otherwise be an imminent risk. Other important measures include maintaining hand hygiene and avoiding touching the face after touching other surfaces [ 128 ]. Studies on symptomatic patients showed that significant environmental contamination by patients with SARS-CoV-2 through respiratory droplets and fecal shedding suggests that the environment is a potential medium of transmission and supports the need for strict adherence to environmental and hand hygiene and precaution [ 129 ].

In addition to the above-mentioned public precautions, the Recommended Interim Infection Prevention and Control (IPC) Recommendations for Patients with Suspected or Confirmed COVID-19 in Healthcare Settings by the CDC provides an extensive list of preventive measures for both healthcare professionals and patients under Section 2 of their guidelines: [ https://www.cdc.gov/coronavirus/ 2019-ncov/hcp/infection-control-recommendations.html] [ 130 ].

Whether COVID-19 is airborne or not has been a source of uncertainty during the start of the outbreak. In fact, 239 scientists submitted signatories appealing to the medical community and relevant national and international bodies to recognise the potential for airborne spread of COVID-19, via microscopic respiratory droplets at a distance of up to several meters [ 100 ]. Experimental data supports the possibility that SARS-COV-2 may be transmitted via aerosols produced emitted during speaking and coughing, which can travel for up to 27 feet. This so-called airborne transmission has become a worry as SARS-COV-2 RNA was shown to be recovered from air-samples in hospitals; underlining the risk of poor ventilation prolonging the amount of time in which aerosols will remain airborne and thus an infection risk [ 129 ]. Despite the presence of such data indicating the possibility of aerosol-based transmission, data on infection rates and transmissions in populations during normal daily life has proven difficult to reconcile with long-range airborne/aerosol-based transmission [ 131 ].

Nonetheless, for the time being, the use of airborne precautions, specifically the use of the N95 Respirator Masks or equivalent, is warranted in aerosol-producing procedures as declared by the CDC, under Section 1 of their guidelines: [ https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html ] These procedures include tracheal intubation, non-invasive ventilation, manual ventilation before intubation, bronchoscopy, administration of high-flow oxygen or nebulized medications, tracheotomy, cardiopulmonary resuscitation, and upper endoscopy, but not nasopharyngeal or oropharyngeal specimen collection [ 132 ].

Another precautionary method of interest had been the use of hydroxychloroquine in post-exposure prophylaxis. This, however, has not proven to be particularly effective. In a randomized trial of hydroxychloroquine as post-exposure prophylaxis for COVID-19, the incidence of new illness compatible with COVID-19 did not differ significantly between those receiving hydroxychloroquine and participants receiving placebo [ 133 ]. Hydroxychloroquine has also completely failed as an effective prophylaxis in a double-blind, placebo-controlled trial among health-care workers [ 134 ]. Alternatively, the most promising prophylaxis thus far, is the use of the COVID-19 vaccines [ 135 ].

Screening and diagnosis

Successful containment of COVID-19 is heavily reliant on its accurate diagnosis and efficient population screening. Currently, nucleic acid testing to detect SARS-CoV-2 (RNA genetic identification) is the primary method of diagnosis. Reverse transcription polymerase chain reaction (RT-PCR) kits, using upper or lower respiratory samples, is considered gold standard [ 136 ]. Due to shortage of kits, and fairly high false negative rates, CT scans (reported variably with higher sensitivities [ 137 ]) have been considered for use in patients with clinical and epidemiologic indications for COVID-19 but a negative RT-PCR [ 138 , 139 ]. CT scans may also be beneficial as a prognostic test to ascertain disease progression [ 138 , 139 ]. COVID-19 patients with pneumonia may in fact have lung abnormalities on chest CT (ground-glass opacities), but an initially negative RT-PCR [ 140 ]. Of note however, up to approximately 50% of patients with COVID-19 infection may have normal CT scans 0–2 days after onset of flu-like symptoms [ 138 ]. Additionally, CT findings, which have much lower specificities thant viral tests, may overlap with many other viral respiratory illnesses and may be completely absent in many positive patients [ 141 ]. The former points must thus be considered when diagnosing patients and interpreting the results. The American College of Radiology’s recommendations echo those of the CDC, which emphasise that viral testing (more conventionally, RT-PCR) remains the most specific and confirmatory standard test for COVID-19 [ 141 ].

Current progress is being made to develop rapid and accurate point-of-care tests that would reduce the burden on clinical laboratories and speed up the screening process. For instance, the FDA authorized use of a point-of-care test delivering positive results in as little as five minutes and negative results in 13 min. The molecular test identifies a small section of the virus’ genome then amplifies it for detection [ 142 ]. Antigen testing, specifically rapid forms, have also been a centre of attention, with some countries making them available commercially [ 143 ]. However, antigen tests are generally considered less sensitive than RT-PCR, but just as specific [ 144 , 145 ]. As such, a negative test should often be followed up by an RT-PCR test, which remains the gold standard for diagnosing COVID-19 [ 145 ]. Other tests that are less frequently used or undergoing testing, utilise loop-mediated isothermal amplification, lateral flow, and enzyme-linked immunosorbent assays [ 100 , 107 ].

As for screening, it is an essential tool for risk communication, and thus outbreak containment. Several studies have attempted to estimate the effectiveness of current common screening procedures. Gostic et al. [ 146 ] found that in a growing epidemic, and under best-case assumptions, the median fraction of infected travellers detected is only 0.30 (95% confidence interval: 0.10–0.53). The total fraction detected was found to be lower for programs with only one layer of screening, with arrival screening preferable to departure screening considering possibility of developing symptoms during travel [ 146 ]. In a simulation of 100 SARS-CoV-2 infected travellers planning to board a flight, it was estimated for the baseline scenario that 44% (95% CI 33–56) of them would be detected by exit screening, no case (95% CI 0–3) would develop severe symptoms during travel, another 9% (95% CI 2–16) additional cases would be detected by entry screening, and the remaining 46% (95% CI 36–58) would not be detected [ 147 ]. Overall, viral testing is only one aspect of what should be a comprehensive approach to outbreak containment via surveillance, including symptom-screening and intensive contact tracing [ 148 ].

More innovatively, a study by Qin et al. [ 149 ] attempted to create an effective and affordable model to predict new cases in a population. Influenced by the current context of the digital age, social media search indexes (SMSI) for “dry cough”, “fever”, “chest distress”, “coronavirus”, and “pneumonia” were tracked and collected from December 31st, 2019 to February 9th, 2020. SMSI was found to be a predictor of new suspected COVID-19 confirmed cases, and could be detected 6–9 days earlier than the official diagnostic confirmation [ 149 ]. This social media-driven approach could therefore be used by national task forces to estimate the new incidence of disease symptoms in the population and prepare accordingly.

Patient management

Management of COVID-19 is contingent on disease severity. In patients with mild disease, the CDC and WHO recommend home isolation in an effort to alleviate the burden on healthcare systems worldwide. Additionally, in patients with mild disease, hospitalization is not advised unless signs of rapid deterioration are evident, such as respiratory distress [ 132 , 150 , 151 ]. Patients should be educated about important self-isolation measures, such as wearing a face mask at home, disinfecting commonly touched services in co-habited areas, not sharing washrooms or utensils, and practising social distancing. According to the CDC, the decision to discontinue home isolation is contingent on both test and non-test based strategies (see: https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html ). The decision as to which strategy to employ is based on patient and system-level factors such as co-morbidities, immunogenicity, and the availability of testing resources. A non-test-based strategy involves discontinuing home isolation if at least 24 h have passed since resolution of fever without the use of anti-pyretic medications, and other symptoms (e.g. cough, shortness of breath) have improved. In addition, at least ten days must have passed since the appearance of symptom onset. Alternatively, the test-based strategy additionally involves two negative results on nasopharyngeal swabs at least ≥ 24 h apart but is generally not recommended (due to prolonged viral shedding in some cases despite lack of contagiousness) except in cases of severe immunosuppression or if otherwise indicated [ 152 ].

In the case of outpatients with mild to moderate disease who are at high risk of disease progression, SARS-CoV-2 neutralizing antibodies (e.g., bamlanivimab plus etesevimab or casirivimab plus imdevimab) may be considered [ 153 , 154 ].

While patients with mild disease may be able to self-isolate and recover, those with severe disease require hospitalization. This may include complications of SARS-CoV-2 such as pneumonia, ARDS, and sepsis. In response to the COVID outbreak, the CDC has developed a preparedness checklist for hospitals to optimize management of patients from triage to discharge (See: https://www.cdc.gov/coronavirus/2019-ncov/downloads/hcp-preparedness-checklist.pdf ], as well as interim-clinical guidance for management of confirmed cases [See: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html ).

Upon admission after triage, regular vital signs should be monitored to prevent clinical deterioration such as septicaemia and ARDS. Antimicrobial agents should also be given if a clinical diagnosis of pneumonia is made. In addition, the use of supplemental oxygen may be warranted with high-flow oxygenation and non-invasive positive pressure ventilation if hypoxemic respiratory failure is suspected. More severe cases may warrant the need for invasive mechanical ventilation or ECMO. Antivirals (e.g. remdesivir) and, more importantly, corticosteroids (e.g. dexamethasone) may be warranted in cases of severe disease. More recently, anti-inflammatories such as tocilizumab have gained interest. The WHO and US National Institute of Health, as well as a wide range of institutions worldwide, continue to update and publish their recommendations as new evidence appears. (A living WHO guideline on drugs for COVID-19: https://www.bmj.com/content/370/bmj.m3379 ) (The US NIH COVID-19 treatment guidelines: https://www.covid19treatmentguidelines.nih.gov/whats-new/ ).

Considering the prevalence of coagulopathies as a cause of mortality in COVID-19 patients, standard dose antithrombotic prophylaxis has been recommended in order to circumvent incidences of venous and arterial thrombotic events in hospitalised patients with mild disease. Full-dose therapeutic low-molecular-weight heparin should also be considered in moderately ill hospitalised patients, and should be considered in the case of patients with mild disease who present with indicators of hypercoagulability (e.g. elevated D-Dimer levels) or confirmed VTE (positive point of care ultrasound or CT angiography) [ 155 – 159 ]. Recent data however suggests that in the case of patients with critical illness or those admitted to the ICU, therapeutic dose anticoagulation may worsen mortality-related outcomes due to the increased risk of bleeding—Instead, a prophylactic-intensity anticoagulation dosage is recommended if no thrombosis is suspected or confirmed [ 160 , 161 ]. A high-intensity pharmacologic thromboprophylaxis (intermediate dose low-molecular-weight heparin) in selected intensive care patients may be ideal to balance between the increased risk of bleeding in this critically ill patient population and the overall COVID-19 related pro-thrombotic state. However, randomized controlled trials are needed to evaluate this strategy. Generally, it is crucial to evaluate overall bleeding and thrombosis tendencies to ensure a personalized management plan informed by the presence of co-morbidities, contraindications (e.g., bleeding tendencies), and other patient-level factors.

Management in children

The literature suggests that children generally display milder disease and have a better prognosis than adults [ 162 – 164 ]. In a systematic review of 45 studies, Ludvigsson (2020) concluded that children generally have a milder spectrum of disease, and overall, have accounted for only 1–5% of all COVID cases, with death being exceedingly rare [ 164 ]. In another study of 2000 children from China, Dong et al. [ 216 ] reported that only 13% of children with COVID-19 were symptomatic [ 165 ]. However, a limitation of this study was that ‘infected’ status was based on clinical diagnosis and not laboratory confirmation [ 166 ]. In another more recent systematic review of clinical manifestations in children with COVID-19, 1124 RT-PCR-confirmed cases from 38 studies were included. Out of the cases with severity classified (n = 1117), 14.2% were asymptomatic, 36.3% mild, 46.0% moderate, 2.1% severe, and 1.2% were critical. It should be noted however that since the results are from patients who presented for medical attention, it is likely that they overestimate the severity of illness in children. Overall, clinicians should have a high level of clinical suspicion, since most cases of COVID-19 in children are asymptomatic or mild, and since reported symptoms of fever and respiratory illness were noted to be not as prevalent as with adult cases [ 167 ].

An asymptomatic state could provide the perfect opportunity for children to be implicated in community-based transmission as asymptomatic carriers, and be implicated in family cluster outbreaks, thus emphasising the importance of educating them about maintaining appropriate hygiene, social distancing, and reassurance aimed at mitigating fears regarding the illness. While children may have a better prognosis than adults, this does not necessarily mean they are less susceptible to infection with SARS-CoV-2. In fact, Zheng et al. [ 162 ] reported that while children have more favourable prognoses, those < 3 years often had critical illness in the form of pneumonia, which may be due to close contact with a caregiver or family member [ 162 ]. Additionally, one retrospective study from.

Pediatric cases in Wuhan suggests that children younger than 2 years were most susceptible to SARS-CoV-2 from the pediatric population [ 168 ]. Thus, in hospitalized children management should include intravenous fluids, oxygen support, nutritional aid, and maintaining electrolyte balance [ 164 ]. In children with airway compromise, respiratory distress, or suspected sepsis, airway management and oxygen therapy to target SpO2 > 94% are essential to improve clinical outcomes [ 169 ]. If mechanical ventilation is unavailable, bubble continuous positive airway pressure (CPAP) is recommended as an alternative [ 170 ]. MIS-C has additionally been a major concern in the pediatric population. Management is often supportive, but may include anti-inflammatory measures (e.g., administration of intravenous Immunoglobulins and steroids). Aspirin for concerns regarding coronary artery involvement as well as thrombotic prophylaxis due to associated hypercoagulable state, may also be considered [ 171 ]. See: ( https://www.who.int/publications-detail/ clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected) for complete management of the hospitalized pediatric patients.

Management in pregnancy

Currently, a paucity of data exists on COVID-19 and management during pregnancy. The American College of Obstetricians and Gynecologists (ACOG) recommends that management in pregnant individuals should be the same as non-pregnant females (see: https://www.acog.org/-/media/project/acog/acogorg/files/pdfs/clinical-guidance/practice-advisory/covid-19-algorithm.pdf ). However, a review of guidelines recommends designating an area for COVID-19 positive pregnant patients, or those under investigation. Additionally, early discharge from hospital (one day for vaginal delivery and two days for cesarean delivery) is encouraged to reduce risk of transmission [ 118 ]. However, despite the evidence, there remains limited literature on the effects of SARS-CoV-2 on pregnant females, such as its effects on the fetus and on labour, if any; more robust studies are thus warranted.

Cardiovascular controversies

Cardiovascular disease and injury has been reported as both a co-morbidity associated with severe disease, and a complication associated with mortality [ 87 , 172 ]. SARS-CoV-2’s cellular entry via ACE2 receptors has implicated the heart, where these receptors have been reported to be present [ 173 ]. This fact triggers multiple controversies regarding the interplay of the virus with the cardiovascular system. The first question of whether patients with chronically up-regulated ACE2 receptors, such as those on ACE inhibitors, are more prone to viral uptake has been a topic of debate. The second being the need to stop, start, or continue such medications and their effect on the progression of the virus. The ACE-like enzyme appears to partially reverse the effects of its homolog by reverse converting angiotensin II to angiotensin 1–7. This will theoretically result in lessening the known vasoconstriction and remodelling effects associated with the renin–angiotensin–aldosterone system (RAAS), which is a hypothesis that has been utilized to explain the benefits of this strategy in animal models [ 174 , 175 ]. The lack of data and randomized trials on humans have led many prominent cardiovascular societies to advise against changing clinical practice with regard to the use of RAAS inhibition for the sole purpose of mitigating the pandemic, and instead to continue the standard indication-based utilization. In fact, a case-population study has demonstrated no increase in risk, and even a decreased COVID-19 risk associated with use of RAAS inhibitors in certain populations [ 176 ]. However, the use of RAAS inhibition in general is avoided in the setting of vasoplegic shock, which continues to apply for those COVID-19 patients who progress to what has been recently described as stage III (severe) or systemic hyperinflammation [ 89 ].

The other main controversy that stemmed from the ACE2 receptor binding mechanism is that of cardiac injury observed in COVID-19, particularly in those that progress to severe disease. Epidemiologic data from Shi et al. (2020) has not only highlighted the common occurrence of such injury but also proved its association with higher mortality through regression models [ 172 , 177 ]. What continues to be debated is the etiology of said cardiac injury; the first theory being inflammatory cytokine storm-mediated injury rather than an isolated myocardial injury that may be associated with an imbalance in oxygen supply and demand. The other perspective is a direct viral injury caused by the viral binding to the ACE2 cardiac receptors (leading to myocarditis). In either case, it seems reasonable to monitor cardiac troponins, particularly high sensitivity troponin at baseline and then at set intervals when elevated in all hospitalized COVID-19 patients [ 178 ]. This is relevant due to the aforementioned association of cardiac injury with mortality, as well as given the results of a recent meta-analysis of all COVID-19 studies that included troponin measurements, highlighting the specific elevation in those with severe infection [ 179 ].

Several of the potential medications in the treatment of COVID-19 have QT prolonging potential including lopinavir/ritonavir, azithromycin, and both chloroquine and hydroxychloroquine [ 180 ], and thus risk of torsades de pointes (TdP) and sudden cardiac death. Lack of clinical data with favipiravir also suggests the need for monitoring. QT prolongation after single oral doses of favipiravir 1200 mg and 2400 mg has not been reported with this agent except in one case report, where it was found to prolong the QT at higher doses [ 181 , 182 ].

Below is a suggested protocol for monitoring patients on agents with QT prolonging potential:

Discontinue and avoid all other non-critical QT prolong agents
Assess baseline ECG, renal and hepatic function, serum potassium and magnesium
When possible, have an experienced cardiologist/electrophysiologist measure QTc, and seek pharmacist input in the setting of acute renal or hepatic failure
Assess baseline risk of QT prolongation using the Tisdale risk score [ 183 ]
Relative contraindications: history of long QT syndrome or baseline QTc > 500ms
Ongoing monitoring includes telemetry, laboratory studies, and ECG 2–3 h after the second dose and daily thereafter
Duration of use of these medications for COVID-19 infection is short (5 to 10 days for acute illness)

Vaccination efforts

The ultimate and time-sensitive goal in combating the COVID-19 pandemic is the development of a successful preventative vaccine. As of 25 February 2021, there are 12 SARS-CoV-2 vaccines that have been approved/authorized for full or emergency use in different areas around the world, with over 200 million doses administered worldwide [ 11 , 184 ]. This experience with the development of COVID-19 vaccines has been a testimony to the outcomes that can be achieved with sufficient resources and international collaboration. Considering the trend of major coronavirus pandemics every decade so far in the twenty-first century, such international effort for an optimised and efficient emergent vaccine production plan is needed for long-term safeguarding of global health.

The current target of SARS-CoV-2 vaccines is the viral S glycoprotein. In fact, it was also the target for the development of vaccines against other coronaviruses, with attempts made in the past to develop S glycoprotein-based SARS and MERS vaccines [ 185 , 186 ]. The S glycoprotein is responsible for both viral binding to the host cell receptor (ACE2 receptor), and host-viral membrane fusion for viral replication. Therefore, it is believed that S glycoprotein-based vaccines should induce the production of antibodies that block receptor binding and viral genome uncoating [ 187 ]. It has also been shown that the presence or absence of other viral glycoproteins does not affect the immunogenicity of the S glycoprotein nor its ability to bind to the ACE2 receptor, further warranting the use of this glycoprotein for vaccine development [ 188 ]. The possibility of developing a ‘pan-CoV’ vaccine is also being studied, owing to the genetic homogeneity between coronaviruses. However, it has been shown that different residues exist between SARS-CoV-1 and SARS-CoV-2, specifically in the S glycoprotein; therefore, antibodies produced against SARS-CoV-1 may not be effective against SARS-CoV-2 [ 189 ].

There are currently 6 vaccines approved for full use, and 6 others authorized for limited use against COVID-19 by various countries worldwide [ 190 ]. Additionally, there are 21 other vaccines currently in Phase III, 27 in Phase II, and 42 in Phase I [ 190 ]. Table Table1 1 elaborates on the available details for each of the approved/authorized vaccines. They include inactivated vaccines, recombinant adenovirus (human and non-human) vaccines, and novel mRNA-based vaccines. Current studies have shown that many of these vaccines provide significant protection against severe COVID-19 (often up to 100%), and to a lesser extent, symptomatic COVID-19. Side effect profiles tend to be mild to moderate, and acute [ 191 – 202 ]. Both the long-term efficacy and side effects of these vaccines remain to be determined, as well as their ability to prevent transmission (sterilizing immunity).

Vaccine candidates for COVID-19 as of February 25, 2021 [ 191 – 202 ]

Novel potential therapies

As discussed, current management of COVID-19 is supportive, with respiratory failure from ARDS being the leading cause of mortality [ 203 ]. Although the clinical safety of older medications has been established, including safety profile, side effects, physiology, and drug interactions, some medications may cause serious adverse reactions, both known and unclear, in patients with COVID-19 [ 203 ].

During the viral infection process—including intracellular transport, proliferation, and assembling of virions in the infected cell—structural and functional proteins, as well as some proteases, play a key part in the virus’s pathogenesis, suggesting that targeted-therapies against SARS-CoV-2 infection could be a promising strategy. Some drugs have displayed potent inhibitory effects on the virus in vitro and in vivo; however, not all mechanisms are clear [ 203 ]. Considering the seriousness and suddenness of the pandemic, over 200 clinical trials on COVID-19 had commenced in China alone a couple months into the reporting of the outbreak, and have successfully reported that certain targets and their agents have displayed strong antiviral potential, of which some have been permitted to be used in clinical trials [ 204 ].

Scientists have suggested multiple existing compounds to undergo clinical trials to determine their efficacy against COVID-19. The international “SOLIDARITY” trial, developed by the WHO, had set to test the efficacy of five different treatment modalities: (1) standard of care, (2) standard of care plus Remdesivir, (3) standard of care plus Lopinavir and Ritonavir, (4) standard of care plus Lopinavir, Ritonavir and Interferon beta, and (5) standard of care plus Hydroxychloroquine [ 205 ]. On the other hand, the UK’s national Randomized Evaluation of COVID-19 Therapy (RECOVERY) Trial encompassed several primary and branching treatment arms in addition to standard of care; these include the use of Lopinavir and Ritonavir, Azithromycin, low-dose corticosteroids, convalescent plasma, and Tocilizumab [ 206 ]. Furthermore, the US National Institute of Health (NIH) launched the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) trial, which is set to test in outpatient and inpatients settings, various immune modulators, monoclonal antibodies, antithrombotics, anti-retrovirals, and convalescent plasma [ 207 ]. Data has also emerged from independent studies and trials worldwide, which have contributed to the developing interim clinical consensus.

Dexamethasone

Low-dose Dexamethasone, a potent steroid, is currently the most promising potential therapeutic for severe COVID-19. In the RECOVERY trial, 2104 patients were randomized to receive dexamethasone for ten days and compared with 4321 patients randomised to usual care alone. Dexamethasone was found to reduce deaths by one-third in ventilated patients and by one fifth in patients receiving oxygen only. However, there were no statistically significant benefits among patients who did not require respiratory support [ 208 ]—A point that needs to be stressed in order to avert cases of self-treatment, over-treatment, and drug-shortage. These findings have encouraged the WHO, NIH, and CDC to recommend the use of dexamethasone or alternative glucocorticoids/corticosteroids such as hydrocortisone where appropriate [ 209 , 210 ].

Furthermore, a meta-analysis was conducted on 7 randomized clinical trials in 12 different countries, evaluating the efficacy of corticosteroids in 1703 critically ill patients with COVID-19. The meta-analysis showed that dexamethasone reduced 28-day mortality compared to standard of care or placebo by 36%. On the other hand, hydrocortisone and methylprednisolone did not significantly reduce mortality [ 211 ]. Similarly, a large systematic review and network meta-analysis on 85 trials enrolling 41,669 COVID-19 patients found that corticosteroids were the only therapeutic to reduce mortality and morbidity (mechanical ventilation) to a moderate extent compared to standard of care—A finding that did not similarly transfer to remdesivir, azithromycin, hydroxychloroquine, lopinavir/ritonavir, interferon-beta, or tocilizumab [ 212 ].

The WHO’s living guidance on COVID-19 therapeutics, developed in partnership with Magic Evidence Ecosystem Foundation (MAGIC), is based on a current systematic review and network analysis of all relevant trials. The results report lower mortality rates in critical or severe COVID-19 patients who are on corticosteroids (specifically, dexamethasone), as well as increased hyperglycaemia. The analysis includes tens of trials with an evidence quality of “low” to “moderate”. Thus, the use of dexamethasone in severe/critical COVID-19 patients is “strongly” recommended. On the other hand, due to “low quality” data showing increased mortality in non-severe cases of COVID-19 taking corticosteroids, it is “weakly” recommended against [ 213 ].

As such, dexamethasone seems to be a reasonable therapeutic for severe and critical COVID-19 patients who require supplemental oxygenation, both invasive and non-invasive [ 213 , 214 ].

Remdesivir (GS-5734), an experimental intravenous drug originally developed for the treatment of Ebola virus, inhibits viral replication by inhibiting RNA-dependent RNA polymerase [ 215 ]. Notably, Remdesivir has demonstrated antiviral activity in treating MERS and SARS [ 216 ]. The first COVID-19 patient diagnosed in the United States—A young man in Washington—was given Remdesivir when his condition worsened; he improved the next day, according to a case report in the New England Journal of Medicine [ 217 ]. The drug has since then been tested in a number of RCTs globally. Remdesivir is currently the only antiviral drug that the CDC does not recommend against using [ 218 ]. It is recommended by the NIH either as monotherapy or with dexamethasone, in cases of hospitalized patients who may or may not require supplementary oxygenation [ 214 ]. WHO guidelines however do not find there to be enough evidence as of now to recommend its use [ 213 ].

The first double-blind randomized trial conducted with Remdesivir (n = 158) versus placebo (n = 79) in severe COVID-19 patients found no significant difference in primary outcome of time to clinical improvement within 28-days either in the intention-to-treat analysis or the per-protocol analysis. Clinically speaking however, the results slightly favoured Remdesivir over placebo in both analyses [ 219 ].

In another RCT, the National Institute of Allergy and Infectious Diseases announced the interim results of their Adaptive COVID-19 Treatment Trial (ACTT; {"type":"clinical-trial","attrs":{"text":"NCT04280705","term_id":"NCT04280705"}} NCT04280705 )—A phase 3, randomized, double-blind, placebo-controlled trial. The trial involved 1062 patients, and was conducted at 68 sites in the USA, Europe, and Asia. Preliminary results suggested that patients treated with Remdesivir had a 31% faster time to recovery (11 days vs 15 days) than those who received placebo (p < 0.001). However, the survival benefit of Remdesivir (8.0% mortality rate) was not statistically significant compared to the placebo group (11.6%; p = 0.059) [ 220 ]. Recent update from the first stage ACTT-1 further suggests benefits for the use of remdesivir in the setting of COVID-19. The trial, which assigned 541 patients to treatment and 521 to placebo, reported a shorter median recovery time (10 vs 15 days) in patients who received remdesivir (rate ratio for recovery, 1.29; 95% CI 1.12 to 1.49; P < 0.001). The Kaplan–Meier estimates of mortality were also lower for the treatment group, with a hazard ratio of 0.73 (95% CI 0.52 to 1.03) [ 221 ].

Furthermore, the SIMPLE trial; an open-label, randomized, phase III trial in 15 countries primarily compared clinical improvement of 5-day versus 10-day treatment duration of Remdesivir in addition to standard of care, in hospitalised patients with severe COVID-19 (n = 397). The study reported similar outcomes between the 5-day and the 10-day treatment course, which, interestingly, was slightly in favor of the 5-day course. An exploratory analysis of the data, using pooled data from both arms, found that more patients were discharged earlier when Remdesivir was started early within 10 days of symptoms onset [ 222 ].

In contrast to the mentioned evidence, recent reports from the WHO SOLIDARITY Trial suggests a lack of benefit for Remdesivir. A total of 405 hospitals in 30 countries participated, with a total of 11,266 randomized adults, 2750 of which were allocated to Remdesivir. A total of 301/2743 (10.97%) patients expired on Remdesivir, compared to 303/2708 (11.1%) from the control. The death rate ratio or relative risk for Remdesivir was therefore 0.95 (0.81–1.11, p = 0.50), suggesting a lack of benefit or hazard. The preprint also reports a meta-analysis that combines data from 4 trials: SOLIDARITY, ACTT-1, and two smaller trials; the Remdesivir versus control death rate ratio or relative risk was insignificant, at 0.91 (95% CI 0.79–1.05) [ 223 ].

As for the WHO’s living guidelines on COVID-19 therapeutics, based on MAGIC’s meta-analysis, the results reported no “important difference” in any clinical outcome, including mortality, requirement and duration of mechanical ventilation, and serious adverse events. All evidence quality was classified as “low” or “very low”, concluding with a “weak” recommendation against use of Remdesivir at any COVID-19 severity.

In the absence of further evidence, Remdesivir remains a promising experimental drug in comparison to other investigated therapeutics, with at most a moderate clinical benefit. However, considering concerns of limited availability, it has been recommended in light of the recent evidence that treatment should be prioritized for hospitalized patients requiring low-flow supplemental oxygen, as they seem to derive the most benefit [ 224 ].

Tocilizumab (IL-6 antagonists)

Tocilizumab is a recombinant humanized monoclonal antibody that targets interleukin 6 (IL-6); a pro-inflammatory cytokine that induces acute phase reactants (e.g. CRP) [ 225 ], and is highly implicated in the resultant cytokine storm. Since cytokine storms have been established as an important pathogenic mechanism of mortality in severe COVID-19 [ 226 ], the blocking of IL-6 activity may offer a promising therapeutic target in severe COVID-19.

One retrospective observational cohort study on 544 adults with severe COVID-19 pneumonia compared a non-randomly selected subset of patients who received tocilizumab in addition to standard of care (n = 179), with the rest of the controls (n = 365). The study found that after adjustment for potential confounding factors, tocilizumab treatment was associated with reduced risk of invasive mechanical ventilation or death (adjusted hazard ratio: 0.61, 95% CI 0.40–0.92; p = 0.02) [ 227 ].

The UK RECOVERY trial tested Tocilizumab in admitted patients with COVID-19, adopting a randomized, controlled, open-label, platform design. The study found that patients allocated to tocilizumab were more likely to be discharged alive within 28 days compared to standard of care (54% vs. 47%; rate ratio 1·22; 95% CI 1·12–1·34; p < 0·0001). Additionally, among patients not on invasive mechanical ventilation at baseline, those allocated to tocilizumab were less likely to reach composite endpoints of invasive mechanical ventilation or death (33% vs 38%, risk ratio: 0.85; 95% CI 0.78–0.93) [ 228 ].

Finally, In the international, multifactorial, adaptive platform trial REMAP-CAP ( {"type":"clinical-trial","attrs":{"text":"NCT02735707","term_id":"NCT02735707"}} NCT02735707 ), both tocilizumab and sarilumab (another IL-6 inhibitor), met predefined criteria for efficacy against COVID-19 in critically ill patients receiving organ support in ICU. An analysis of 90-day survival showed improved survival in the pooled IL-6 receptor antagonist groups (n = 414). When compared to control group (412), patients receiving Il-6 antagonists had lower median organ support-free days. The in-hospital mortality in the pooled Il-6 antagonist groups was lower than the control group (27% vs 36%)—Median adjusted odds ratio for in-hospital survival in the tocilizumab group was 1.64 (95% CI 1.14 to 2.35), and 2.01 (95% CI 1.18 to 4.71) for sarilumab as compared to control [ 229 ].

In earlier reported trials, a clear benefit was not similarly observed in the primary outcome [ 230 – 232 ]. In fact, in one open-label RCT, it was suggested that tocilizumab might even increase mortality and the study was stopped early based on the interim analysis [ 233 ].

As such, the US CDC’s treatment guidelines now recommend the use of tocilizumab in combination with dexamethasone in certain hospitalized patients who exhibit rapid respiratory decompensation due to COVID-19. Based on the results of the RECOVERY and REMAP-CAP trials, these patients should be either (1) recently hospitalized patients who were admitted to the ICU within the prior 24 h, requiring invasive or non-invasive ventilation, or HFNC, or (2) recently hospitalized patients not in the ICU with rapidly increasing oxygen demands (requiring HFNC or non-invasive ventilation) and have significantly increased inflammatory markers [ 234 ].

Anti-SARS-CoV-2 monoclonal antibodies

Monoclonal antibodies, currently undergoing initial stages of testing, have been developed against SARS-CoV-2’s virulence factors. The most prominent of these tests is the Blocking Viral Attachment and Cell Entry with SARS-CoV-2 Neutralizing Antibodies (BLAZE-1) trial, targeting various components of the virus’s spike glycoprotein and cell entry mechanisms. 533 patients were included in the final analysis of Phase II of the study, randomized to three main groups: Bamlanivimab monotherapy (700, 2800, and 7000 mg), combination treatment group (bamlanivimab and etesevimab), or placebo. Compared to placebo, the difference in the change in log viral load at day 11 from baseline was only significant for the combination group. As for secondary outcome measures (symptom relief and clinical progression), each treatment group had statistically significant differences in outcome for 10 out of 82 of these endpoints. These findings however were restricted to non-hospitalised patients with mild to moderate COVID-19 illness [ 154 ].

Yet-to-be-published results from Phase III of the BLAZE-1 trial randomized 1,035 participants with mild to moderate COVID-19 (but a high risk for disease progression) to either the bamlanivimab plus etesevimab arm (n = 518) or to the placebo arm (n = 517). The study found that participants who received bamlanivimab plus etesevimab as opposed to placebo had a 5% absolute reduction and 70% relative reduction in risk for COVID-19 related hospitalisation or death from any cause (p < 0.001). Additionally, there were no deaths in the intervention arm, compared to 10 deaths in the placebo arm (p < 0.001). Virus level decline was also greater and more rapid in the group that received the combination antibody therapy as opposed to placebo [ 234 ].

A Phase I/II randomized trial comparing a combination of casirivimab plus imdevimab to placebo has also been conducted. Interim analysis suggests potential clinical benefit from the combination therapy for outpatients with mild to moderate COVID-19, who receive the drug infusion a median of 3 days after symptom onset. In terms of outcomes, 2% (8/434) of participants in the pooled casirivimab plus imdevimab arm, as opposed to 4% (10/231) in the placebo arm, were hospitalised or required emergency department visits within 28 days of treatment. In those specifically at higher risk for hospitalisation, 3% (4/151) in the combination therapy arm as opposed to 9% (7/78) in the placebo arm were hospitalised or required emergency department visits [ 235 ].

As of recent, the US FDA issued emergency use authorization for the use of investigational monoclonal antibody therapy bamlanivimab for the treatment of mild-to-moderate COVID-19 in adult and pediatric out-patients [ 236 ]. Likewise, the US NIH echoed these recommendations, stressing on its use for those at increased risk for disease progression [ 234 ].

Hydroxychloroquine

Hydroxychloroquine for a while had been the drug of choice for large-scale use before the emergence of controversial findings, due to its availability, safety record in Malaria patients, and relatively low cost [ 237 ]. Chloroquine and its derivatives, including hydroxychloroquine and chloroquine phosphate, have elicited antiviral effects on several viruses such as SARS-CoV and Human Coronavirus 229E by interfering with endosomal acidification [ 238 ]. Based on the advantage of known broad-spectrum activity and supposed safe adverse effects profile, a series of RCTs on chloroquine and its derivatives for COVID-19 treatment advanced rapidly. Therapeutic effects were observed in aspects of fever reduction, improvements on CT imaging, and disease progression [ 238 ]. In light of the preliminary clinical data, chloroquine had been added to the list of trial drugs in the Guidelines for the Diagnosis and Treatment of COVID-19 published by National Health Commission of the People’s Republic of China [ 237 ].

Initially, Hydroxychloroquine seemed to be a promising drug in early small trials. An open label non-randomized clinical trial conducted in France set out to test the effects of Hydroxychloroquine and azithromycin. In the study, a total of twenty COVID-19 positive patients received 600 mg of hydroxychloroquine daily, and their viral load measured on a daily basis in a hospital setting. Depending on the patients’ clinical presentation, azithromycin was added to their treatment; a significant reduction in the viral load at day 6 post Azihromycin inclusion compared to control group was observed. Additionally, in patients who had Azithromycin added to Hydroxychloroquine, a synergistic effect was reported [ 239 ]. As a single arm study nonetheless, this may have been the normal course of the disease in this small sample size, allowing much room for bias. Another study, a randomized parallel-group trial (n = 62), suggested the use of hydroxychloroquine could shorten time to clinical recovery (body temperature and cough), and improve pneumonia (ChiCTR2000029559) [ 240 ]. On the other hand, a multicenter, open-label, randomized controlled trial (n = 150) found that the administration of hydroxychloroquine with standard of care did not result in a significantly higher probability of negative conversion by day 28 (two negative PCR tests 24 h apart) than standard of care alone in patients hospitalized with persistent mild to moderate COVID-19. Additionally, adverse events were higher in hydroxychloroquine recipients (ChiCTR2000029868) [ 241 ].

Overall, there has been much controversy with regards to the use of Hydroxychloroquine in both scientific and public discourse. The WHO halted the SOLIDARITY trial’s Hydroxychloroquine arm following a retrospective observational analysis published in The Lancet that suggested an association with increased mortality [ 242 , 243 ]. The paper was later retracted due to data integrity issues, following announcement of resumption of WHO’s hydroxychloroquine arm of the SOLIDARITY trial on the basis of the available interim mortality data [ 244 ].

Hydroxychloroquine’s adverse event profile in healthy has also been looked at in the HyPE study. In a retrospective, cross-sectional, web-based survey, data was collected on COVID-19 negative and asymptomatic healthcare workers (n = 166) who were taking hydroxychloroquine prophylactically. Overall, a higher incidence of adverse events was reported (37.9%) compared to data from studies of patients on long-term hydroxychloroquine therapy, with gastrointestinal bleeding being the most common. This finding was more prominent in those under 40 years of age. The self-reported nature of this study remains a limitation [ 245 ].

In line with the growing negative attitudes towards Hydroxychloroquine, the RECOVERY ( {"type":"clinical-trial","attrs":{"text":"NCT04381936","term_id":"NCT04381936"}} NCT04381936 ) trial found no significant difference in the primary endpoint of 28-day mortality, or any evidence of beneficial effects on hospital stay duration or other outcomes, in patients randomised to Hydroxychloroquine (n = 1542) vs usual care alone (n = 3132) [ 246 ]. In another randomized, double-blind, placebo-controlled trial (n = 423), the use of Hydroxychloroquine in non-hospitalised adults 4-days within symptom onset, did not substantially reduce symptom severity, but did significantly increase prevalence of adverse events [ 247 ].

Finally, the WHO SOLIDARITY trial reported that 104 (10.98%) of 947 patients on hydroxychloroquine had expired, compared to 84 (9.27%) of 906 controlled. The relative risk or death rate ratio was therefore 1.19 (0.89–1.59, p = 0.23)—The highest out of all the other investigated drugs in the trial [ 223 ]. As for the WHO’s living guidelines on COVID-19 therapeutics, based on MAGIC’s meta-analysis, the results reported no “important difference” in any clinical outcome, including mortality, requirement for mechanical ventilation, admission to hospital, and viral clearance at seven days. However, there were fewer cases of diarrhoea and nausea/vomiting reported in supportive care as opposed to hydroxychrloquine arm. All evidence quality was classified ranged from “very low” to “moderate”, concluding with a “strong” recommendation against use of Hydroxychloroquine for COVID-19 patients at any severity [ 213 ].

In view of the emerging evidence, the FDA revoked Hydroxychloroquine and Chloroquine’s emergency use authorization to treat COVID-19 in certain hospitalized patients, unless a justifiable clinical trial is available and participation is feasible [ 248 ]. Several large trials have also been halted globally, including that of the US National Institute of Health [ 249 ].

Lopinavir and ritonavir

This drug combination, sold under the brand name Kaletra, was approved in the US in 2000 to treat HIV infections. Lopinavir specifically inhibits HIV protease, an important enzyme that cleaves a long protein chain into peptides during the assembly of new viruses. Since Lopinavir is readily broken down in the human body by our own proteases, it is given with low levels of Ritonavir, another protease inhibitor, that prolongs the effects caused by the action of Lopinavir. This combination has been shown to inhibit the protease of other viruses as well in-vitro, specifically coronaviruses [ 250 ].

Lopinavir and Ritonavir were investigated for their potential to treat patients with SARS in China in 2003. Furthermore, shortly after the emergence of MERS, researchers also identified Lopinavir and Ritonavir as inhibitors of MERS-CoV [ 237 ]. However, the first trial of Lopinavir and Ritonavir to treat COVD-19 was not encouraging [ 251 ]. This trial was an open-label, individually randomized, controlled trial, conducted in early 2020 in Wuhan, China. Of the 199 patients who underwent randomization, 99 patients were assigned to the treatment group with Lopinavir and Ritonavir twice a day for 14 days, in addition to standard care, and 100 patients to the control group with standard care alone. Patients assigned to the Lopinavir and Ritonavir treatment group did not have a time to clinical improvement that differed from that of the patients assigned to standard care alone in the intention-to-treat population [ 251 ]. Additionally, it was determined that the viral RNA loads over time did not differ between the Lopinavir and Ritonavir recipients and those receiving standard care. Although treatment with Lopinavir and Ritonavir did not significantly accelerate clinical improvement, reduce mortality, or diminish throat viral RNA detectability in patients with serious COVID-19 in this study, it is important to note that both groups were heterogeneous and received various additional treatments, including other pharmacologic interventions such as interferon (11%) and glucocorticoids (34%) [ 252 ]. However, the median time from symptom initiation was 13 days, which may not be ideal to identify a difference between groups, specifically that the study was underpowered (recruitment was suspended early due to Remdesivir being available for clinical trials). Additionally, the recruited patients had more severe illness [ 251 ]—It is known to be questionable whether antivirals would have a significant role in later disease stages.

On the other hand, in a systematic review and meta-analysis of the efficacy and safety of antiviral treatments for COVID-19, Lopinavir-Ritonavir combination was the only positive outcome with “low-quality evidence” suggesting a small decrease in mortality and reduction in length of hospital and ICU stay for severe COVID-19, in addition to “moderate-quality evidence” suggesting likely increases in diarrhea, nausea and vomiting. The other drugs, including Hydroxychloroquine, Ribavarin, Interferon, Umifenovir, and Favipiravir, were only met with “very low-quality evidence” with little or no suggestion of benefit for most treatments and outcomes in both non-severe and severe COVID-19 [ 253 ].

The WHO SOLIDARITY trial recently reported that the relative risk of Lopinavir (co-administered with Ritonavir) was 1.00 (0.79–1.25, p = 0.97) with a mortality of 148/1399 (10.58%), compared to 146/1372 (10.64%) in the control group. Furthermore, the joint mortality combining SOLIDARITY, RECOVERY, and other smaller trials was 1.02 (95% CI 0.91–1.14) [ 223 ]. As such, the use of these agents in COVID-19 patients is not supported by the current evidence.

As for the WHO’s living guidelines on COVID-19 therapeutics, based on MAGIC’s meta-analysis, the results reported no “important difference” in any clinical outcome, including mortality, requirement for mechanical ventilation, admission to hospital, and viral clearance at seven days. However, similarly to hydroxychloroquine, there were fewer cases of diarrhoea and nausea/vomiting reported in supportive care as opposed to the lopinavir-ritonavir arm. All evidence quality was classified ranged from “very low” to “moderate”, concluding with a “strong” recommendation against use of lopinavir-ritonavir for COVID-19 patients at any severity [ 213 ].

Interferons

Interferons (IFNs) are cytokine proteins that bind to cell surface receptors and initiate signalling cascades, which have shown to be effective against many viruses like Hepatitis B and Hepatitis C [ 254 ]. Studies evaluating the antiviral activity of types I and II interferons have reported that interferon beta is the most potent interferon in reducing in vitro MERS-CoV replication [ 254 ]. A combination of these drugs are now being tested on MERS patients in Riyadh, Saudi Arabia, in the placebo-controlled MIRACLE trial [ 255 ]. The study assesses the feasibility, efficacy and safety of a combination of Lopinavir/Ritonavir and Interferon Beta-1b in hospitalized patients with MERS [ 256 ].

The efficacy of this combination with interferon alpha was analysed in a retrospective cross-sectional study from two hospitals in Anhui, China, on 181 patients with confirmed COVID-19. The analyses suggested that early initiation of lopinavir/ritonavir plus IFN‐α combination therapy was associated with a shortened duration of SARS‐CoV‐2 RNA shedding (HR 1.649 [95% CI 1.162–2.339] [ 257 ].

In another RCT (IRCT20100228003449N28) on the efficacy and safety of Interferon Beta-1a in treating severe COVID-19, a total of 42 patients were randomized into the IFN group and 39 patients into the control group. Time to clinical response was not significantly difference between both groups. However, more patients in the IFN group were discharged on day 14 compared to the control group (odds ratio = 2.5; 95% CI 1.05 to 6.37). Additionally, the 28-day overall mortality was significantly lower in the IFN group (19%) vs control (43.6%, p = 0.015). Early administration was also found to significantly reduce mortality [ 258 ].

Treatment with nebulized IFN-α2b has been shown to be promising in a retrospective study of 77 hospitalised patients with COVID-19. The study showcased a significantly reduced duration of detectable virus in the upper respiratory tract and a parallel reduction in duration of elevated blood levels for inflammatory markers IL-6 and CRP. This remained true when IFN-α2b was administered with or without arbidol [ 259 ].

However, several of the studies mentioned suffer from methodological limitations and relatively small sample sizes. On the other hand, the WHO’s SOLIDARITY trial reported based on about 4000 patients, that the mortality relative risk for IFN Beta-1a with Lopinavir co-administration was 1.16 (95% CI 0.96–1.39, p = 0.11), and 1.12 (95% CI 0.83–1.51) without Lopinavir co-administration; all of which point to lack of significant benefit. As such, the current evidence for the use of these Interferons in the treatment of COVID-19 is not sufficient and is recommended against by the US CDC unless in the context of a clinical trial [ 260 ].

Convalescent plasma

Treatment via convalescent plasma has also attracted some attention, with several clinical trials currently recruiting [ 261 ]. A retrospective, propensity score-matched, case–control study that assessed convalescent plasma therapy in 39 patients with severe or life-threatening COVID-19 reported improved oxygen requirements, and survival [ 262 ]. One meta-analysis of three clinical studies for COVID‐19 in China, showed a statistically significant improvement in clinical outcomes of patients treated with convalescent plasma (n = 19) compared with historical controls (n = 10; P < 0.001) [ 263 ].

An RCT of COVID-19 severe pneumonia assigned 228 patients to receive convalescent plasma and 105 to receive placebo. Overall mortality was 10.96% in the intervention arm and 11.43% in the control group, which was not statistically significant. No difference was noted in the distribution of clinical outcomes according to a 6-point ordinal scale on day 30 either. SARS-CoV-2 antibodies titres however tended to be higher in the convalescent plasma group at day 2 after intervention, with similar adverse events in both groups [ 264 ].

A living Cochrane systematic review (n = 38,160 participants of whom 36,081 received plasma) reports uncertainty regarding convalescent plasma’s ability to decrease all-cause mortality, and little to no difference in improvement of clinical symptoms [ 265 ]. Potentially associated unwanted effects however, also with low evidence, include death, allergic reactions, thrombotic or cardiac events, and respiratory complications [ 265 ]. Blood clotting (due to residually active pro-coagulant factors in transfused convalescent plasma) has especially been brought up as a concern, since COVID-19 patients are considered at increased risk [ 266 ]. The evidence supporting this however remains low, as iterated by the Cochrane review.

Note that another meta-analysis and systematic review (n = 35,055) reported that aggregation of mortality data from all controlled studies, including RCTs and matched-controls, indicated that patients transfused with convalescent plasma exhibited 42% reduction in mortality rate compared to patients receiving standard treatment (20% vs 28%; OR: 0.58, 95% CI 0.47–0.71, P < 0.001). Furthermore, an additional dose–response analysis found that the aggregate mortality rate of COVID-19 patients transfused early-on with higher-titre convalescent plasma was lesser than that of patients transfused with lower titre.

Overall, more information will be needed from clinical trials before recommending this approach, thus remaining as a last resort in compassionate use.

Global health response

The global response to the COVID-19 pandemic has widely varied, including complete lockdowns, social distancing measures, and population screening policies—or none of the above (Fig. 4 ). The outbreak continues to exert pressure beyond capacity on countries globally, revealing in some instances a lack of preparation and infrastructure to protect the public and healthcare practitioners, as was seen by the shortage in emergency medical supplies [ 267 ]. COVID-19 has proven to be difficult to control as compared to previous outbreaks due to a large number of cluster transmissions or superspreader events, relatively limited health resources, and the unavailability of rapid testing kits [ 268 , 269 ]. As seen in Fig. 4 , countries that enforced public health measures early on during the progression of their national outbreak, were better able to control the spread of the virus compared to other countries who had not done so. Additionally, vaccine roll-out responses have been widely variable. Several countries, such as China, Russia, India, the US, and the UK, have been directly involved with the production of vaccines [ 190 ]. Multiple other countries have instead led randomized controlled trials testing their safety and efficacy. In terms of vaccination rates, as of February 25, 2021, Israel, the United Arab Emirates, US, UK, and Chile have had the highest total number of vaccination doses per 100 people [ 270 ]. However, this list continues to vary throughout the pandemic. Global equitable access to vaccines has also been a major concern, which propelled the WHO’s COVAX initiative for accelerated equitable access to vaccines worldwide [ 271 ].

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Comparison between the number of COVID-19 cases per million when public health containment initiatives were taken by the five countries (Mauritania, Uganda, Laos, Vietnam, and Gambia) with the lowest number of cases per million and the five countries (Italy, Spain, Switzerland, Belgium, Portugal) with the largest number of cases per million, in the first 30 days since their first confirmed case [ 11 , 272 ]. Countries with a population of less than one million or with exceptional circumstances (civil war) were excluded [ 11 , 272 ]

China and the border Asian region

On December 1, 2019, the first symptomatic patient was identified with SARS-CoV-2 in the Huanan Seafood Market in Wuhan of the Hubei province in China; the epicentre of the pandemic [ 6 ]. On January 23, 2020, weeks after SARS-CoV-2 was identified, the Hubei province underwent a lockdown. Other provinces followed suit on February 11, 2020 due to an increase in the number of cases nationally [ 273 , 274 ], which began to decline on March 15, 2020 [ 275 ]. The lockdown on Wuhan is theorised to have delayed the spread to other areas in China by 2.91 days and decreased the number of cases by 33.3%. Additionally, it is thought to have reduced worldwide spread by 77% with a two to three weeks delay in the spread [ 273 , 276 ].

Other areas in the Asian region responded quickly, using strategies that were refined after the 2003 SARS and 2009 H1N1 Influenza outbreaks. South Korea responded by distribution of test kits early on, by February 7, and implementing restrictive measures by February 23, a month after their first case. Additionally, they established 600 screening sites nationally [ 11 , 277 ]. South Korea’s CFR as of February 25, 2020 is 1.8% [ 11 ]. Taiwan also increased its laboratory capacity by building a national program to include 27 laboratories in the country, and currently boasts a CFR of 1.04% [ 11 , 278 ]. Meanwhile, Singapore announced an orange alert 15 days after their first case. In January 2021, they announced the use of the Moderna vaccines, in addition to implementing tighter restrictions on travels from South Africa after reports of a new variant [ 279 ]. As of February 25, 2021, their CFR is less than 0.01% [ 11 ]. Hong Kong, on the other hand, responded before the appearance of their first case [ 280 , 281 ]. It is noteworthy that these countries have an elderly population that forms only 10 to 14% of the country, which may have contributed to their greater success in containing COVID-19 when compared to other countries [ 269 ].

Nonetheless, Japan, which has the largest elderly population (26%), boasted a relatively low number of cases in comparison to Italy, which has the second largest elderly population (23%). The reason behind the difference between Japan and Italy’s total number of cases is yet to be determined but has been theorised to be due to a lower frequency of testing [ 282 ]. Due to Japan’s initially limited testing capacities, the authorities had opted to depend on mitigation measures [ 283 , 284 ]. However, on January 19, 2021, Japan launched a COVID-19 Robot testing system, and began mass random PCR testing in cities [ 285 ]. As such, on February 25, 2021, Japan had done 60.31 tests per 1000 people [ 11 ]. Japan has currently implemented a state of emergency starting from February 2, 2021 up until March 7, 2021 in order to mitigate the “3rd wave” of COVID-19 that began in November 2020 [ 285 , 286 ].

As of February 2021, the countries with the highest cases in the region are India, Indonesia and Sri Lanka [ 285 , 287 ]. The region as a whole, excluding China, houses 16.99% of global COVID-19 cases, and 18.06% of the global deaths [ 11 , 287 , 288 ].

Middle East and North Africa region

The majority of the region implemented mitigation strategies, as described below [ 289 ]. Iran, the epicentre of the region, began its efforts against COVID-19 on February 19, 2020 with the formation of the COVID-19 National Committee. Partial restrictions were enforced, such as cancellation of congregational prayers. Neighbouring countries also suspended flights to and from Iran on February 25, 2020 [ 31 , 290 ]. As of February 2021, Iran has closed all schools, placed a stricter travel ban and a night traffic ban. They have also introduced a national vaccine campaign [ 291 ]. Additionally, Saudi Arabia began taking actions before their first case with the suspension of pilgrimage visits [ 11 , 292 ]. Following a short-lived return to normal by July of 2020, a lockdown was brought back in February 2021 to suppress a rise in cases [ 293 ]. Similarly, Jordan enforced one of the strictest complete lockdowns globally [ 294 ]. On October 1, 2020, schools and universities were shut down due to a cluster of cases linked to the student population. By February 7, 2021, schools had gradually begun re-opening. Additionally, Jordan was the first country in the world to begin vaccinating refugees and asylum seekers in its territories [ 295 ].

The Eastern Mediterranean Region makes up 6% of cumulative cases worldwide, and 6% of the deaths overall [ 287 ]. Under-testing and lack of funding has been one of the major points of struggle. Many countries, such as Iraq, attempted to increase their testing by opening new laboratories [ 296 ]. The WHO’s regional office has also received support through an increase in PPE and laboratory supplies in Dubai and other countries. Financially, $71 million in funds has been secured (Kuwait—$41 M; Saudi Arabia—$10 M) [ 289 , 292 , 297 ]. The WHO has also donated over 55 tons of health supplies to Syria [ 298 ]. Another issue that has surfaced in the region is the spread of COVID-19 among migrant workers’ camps, as seen in Bahrain, and the wider GCC. The public health policies have been widely dynamic, changing throughout the pandemic as new evidence appeared. Countries like Bahrain for instance cancelled their mandatory 10-day quarantine and tracing bracelets for all travellers, as only 0.2% of arrivals were positive after the 10 days, which was considered not significant enough to continue the measure [299]. Bahrain then began a nationwide vaccination program, which placed it as one of the top three internationally throughout the period of December 2020 and January 2021in terms of population vaccination rates [ 300 ].

Europe and the UK

During March of 2020, Europe became the global epicentre of COVID-19 cases, and only began to see a reduction in its cases around June 2020. As of September 22, 2020, Europe made up 14.38% of cases worldwide, ranking fourth out of the continents [ 11 , 298 ]. The situation began in Italy, which rapidly deteriorated starting from January 23, 2020, leading to a relatively high CFR. On January 30, all travels to China were banned, followed by severe mitigation policies (National Red Zone) which were put in place from March to May 2020. By February 21, 2020, Travellers departing from Italy had spread COVID-19 to 21 other countries [ 301 ]. Italy began its reopening phase around May, 2020, easing out the several month-long restrictions. [ 302 ] Different areas in Italy seemed to report varying CFRs; studying the different containment strategies in each area and their correlation, if any, with the reported CFR, would be worthwhile [ 301 ]. As of February 25, 2021, Italy had a cumulative testing rate of 648.8 tests per thousand people, bringing down its CFR from 14.4% during September of 2020, to 3.4% as of February, 2021 [ 11 , 303 ].

As of February 21, 2021, Europe ranks second (34%) after North America (45%) in percentage of cumulative cases [ 287 ]. The CFR of different countries in this region greatly vary, with Iceland having the lowest CFR (0.5%) and Bulgaria the highest (4.1%). Other countries fall in between this range, such as Germany with 2.9%, and Italy with 3.4% [ 11 ].The difference between the CFRs can be attributed to many factors. In terms of age, an established co-morbidity, a comparison between the average age of the populations in Germany (46 years) and Italy (63 years) may point towards a correlation. Another potential factor is the capacity of the respective healthcare systems, with Germany’s ICUs providing 29 beds per 100,000 people, compared to Italy with 12 beds per 100,000 people, and Spain with 10 beds. Additionally, the timing of the response may be a main differentiating factor, as some public health measures were enforced relatively late into the spread of COVID-19 [ 304 ]. Iceland for instance, with a relatively low CFR, had started implementing random testing (population screening) before their first confirmed case. Patients with a negative result in quarantine were re-tested, which contributed to 54% of the confirmed cases [ 305 ].

Initially, the United Kingdom (UK) opted for a herd-immunity approach; however, mitigation strategies were implemented on March 18, 2020, when the daily new COVID-19 cases reached 407 per day [ 11 , 306 , 307 ]. The UK, at 382.1 deaths per million cases, has exceeded Italy’s death toll at 298.1 deaths per million cases (As of February 25, 2021) [ 11 ]. However, the UK still remains lower on the scale in comparison to the USA, which is at 2,090.9 deaths per million cases. Around August of 2020, the UK began easing up lockdown measures, before resuming stricter measures on November 5, 2020, announcing an ending date of March 2021. This reactive response may have been as a result of the spike that was brought by the reopening of education institutions gradually in June. By doing so, the UK authorities risked raising the reproductive number above 1 [ 308 ]. On November 8, 2020, Scotland elevated their restriction to a level 5, meaning individuals are only allowed to go out for an emergency. Following this, a few travel restrictions were placed again, such as a 14-days quarantine for travellers coming from certain countries (e.g. Spain) starting from December 12, 2020. This continued into 2021, with travellers required to quarantine and take two NP swabs before ending the quarantine if they are arriving from COVID-19 hotspots. On January 8, 2021, the UK hits its highest number of cases per day, at 68,053, with the death toll peaking on January 20, 2021, at 1,820 death [ 309 ]. Additionally, once the UK had identified the presence of a variant of concern in the country, known as B.1.351, which originated from South Africa, the government decided that it would perform additional testing and sequencing in eight different areas in England. While this is less than one in every 10 samples from people who test positive for COVID-19, the UK is the second highest country in Europe to test and sequence the variant of COVID-19. As a result, they have carried out almost half of the COVID-19 genome sequence globally. [Wise J. Covid-19: The E484K mutation and the risks it poses.] On February 22, 2021, the government of the UK announced that they will lift all lockdown restrictions by June 21, 2021, with educational institutes reopening on March 8, 2021. In terms of testing, the UK began testing door-to-door on all households starting from February 1, 2021 [ 309 ].

North and South America

On June 1, 2020, North America ranked first for number of COVID-19 cases and second for total death rate. The USA, encountering its first case of COVID-19 on February 26, 2020, started to reinforce testing and public health measures a month later, influenced by the severity of the predicted death count of up to 2.2 million if restrictive measures were to not be implemented. Consequently, the outbreak in late February of 2020 in Washington was not detected and mitigated in a timely manner. One of the largest set-backs that the healthcare system in the USA had faced included shortage of emergency supplies, such as masks, protective equipment and detection kits [ 11 , 305 ]. However, the public health responses in the US have varied widely between different states. For instance, during the Month of March 2021, states such as California, New York, and Los Angeles, had broad public face mask requirements enforced both indoors and outdoors. States like Minnesota however enforced masks inside public buildings/businesses only. On the other hand, many other states, including Texas, Missouri, and Montana, did not have any face-mask mandates [ 310 ]. This variation extended similarly to travel restrictions and stay-at-home orders [ 310 ]. The Biden-Harris administration’s “plan to beat COVID-19” includes giving all citizens access to free testing, investing in vaccines to be distributed for free to all American citizens, and implementing a public-setting mask requirement nationwide [ 311 ]. Additionally, on January 21, 2021, the United States decided to reverse its decision to withdraw from the WHO, in order to strengthen its plan for combating COVID-19 [ 312 ]. As of February 25, 2021, the USA has a CFR of 1.8% and has performed 2.73 test per 1,000 people [ 11 ].

Canada entered a state of emergency on March 17, 2020, a week after its first case, and expanded its ICU capacities in preparation [ 313 ]. However, the authorities in Canada did not broaden the traveling restrictions accordingly nor enforced testing of all passengers on arrival; hence, out of the initial 118 cases, 30% came from Iran, 18.2% from the US and 13.1% from Europe [ 314 ]. Canada likewise faced a shortage of PPE and medical resources [ 315 ]. Canada has also remained on a strict lockdown up until June 25, 2020, before starting to ease up and reopen certain businesses. However, a few regions continued to extend their lockdowns up until October 7, 2020. On January 5, 2021, Canada enforced COVID-19 testing for all air travellers. With the easing of the restrictions, Canada’s 7-day average for new daily cases reached 9,626.86 by January 9, 2021. As a result, on January 12, 2021, Ontario imposed a stay-at-home order, permitting people to go out shopping for necessities only and for exercising. In addition, travel restrictions were placed against the US and UK. This is planned to continue until the end of March 2021 [ 316 ]. As of February 25, 2021, Canada managed to reduce the 7-day average of new daily COVID-19 cases down to an average of 2,986.43 per day, and now has a CFR of 2.5% [ 11 ].

On the other hand, South America has had varying responses throughout the continent, with Paraguay promoting strict mitigation strategies, and Chile and Colombia establishing a consistent testing policy along with other strict measures [ 317 ]. The South American region stands out due to the wide inequalities in income and the lack of equal access to healthcare services [ 318 ]. In the region, the only country that has not implemented any suppression strategies or strict policies is Brazil. This has overwhelmed their healthcare system, with a CFR that had reached 7.0% in May, dropping to 2.4% by February 25, 2021 [ 11 ]. As a continent, South America constitutes 18.4% of the cumulative confirmed deaths from COVID-19 (February 25, 2021) [ 11 ]. The biggest challenges faced in the region included limited healthcare resources, and lack of consistent compliance by the population to the public health measures in place [ 318 ]. Currently, both Brazil and Mexico place second and third within the region of America for number of cases, respectively.

Australia and New Zealand

Australia saw its first case of COVID-19 on January 25, 2020, and implemented travel bans to China, Iran and Italy on February 1, February 29, and March 10, respectively. It is estimated that the travel ban on China reduced the potential number of cases and deaths by 87% [ 319 ]. The country has performed 54.81 tests per 1,000 people, with one confirmed case per 202.4 tests, exceeding the test ratio performed by South Korea and Iceland, both of which were considered high in their respective regions [ 11 ]. As of February 25, 2021, Australia’s CFR is at 3.1%. Since December 23, 2020, the country has been on lockdown due to the surge of cases [ 320 ].

New Zealand saw its first case on February 28, 2020 and closed its borders on March 19, 2020 with a recorded 5.81 cases per million people. The country eventually entered a strict lockdown on March 25, 2020 [ 321 ]. They have performed 191.75 tests per 1,000 people, with one confirmed case per 3,079.0 tests, placing themselves at the top for the least number of positive cases per tests by the end of September, 2020 [ 11 ]. Overall, New Zealand adopted a proactive approach and implemented strict policies early on, which may have contributed to the relatively low CFR of 1.70% [ 11 , 321 ]. As of February 2021, New Zealand has managed to avoid being severally impacted by COVID-19 and has maintained an almost COVID-19-free status via adoption of an elimination strategy as opposed to mitigation and suppression [ 322 ].

In Africa, the regional CDC began its emergency response on January 27, 2020, quickly implementing mitigation and containment measures to control any potential spread of the disease. By March 20, 2020, they were already seeing a reduction in their average daily case growth. With the extra time that the continent had, they prepared for a continent-wide response, in which they increased their labs from 2 to 43 by mid-March. Additionally, they received funding and medical supplies from various NGOs. Finally, the African Union (AU) announced that they would start a COVID-19 Respond Fund which would support Africa CDC in accelerating COVID-19 testing [ 318 ]. This has been well-reflected in the outcomes, as Africa makes up only 3% of the COVID-19 cases worldwide, and 3% of the deaths as of February 23, 2020, despite forming around 17% of the world population (Fig. (Fig.5) 5 ) [ 11 , 287 ].

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A comparison of the Case Fatality Rate (CFR) and the Recovery Rate in the five countries (Mauritania, Uganda, Laos, Vietnam, and Gambia) with the lowest number of cases per million in the first 30 days since their first confirmed case, to the five countries (Italy, Spain, Switzerland, Belgium, Portugal) with the largest number of cases per million in the first 30 days since their first confirmed case [ 11 ]

Innovative COVID-19 coping responses

Several forms of adaptations in various sectors have been adopted worldwide to cope with the changes brought forth by the COVID-19 pandemic. Telemedicine for instance was introduced in multiple countries to avert the risks of in-person medical visits; these include Singapore (March 8), Australia (March 11), Saudi Arabia (March 12), UK (March 17) and the USA (March 17) [ 323 – 325 ]. In addition, virtual education has been adopted in most countries worldwide, in order to avoid disruption of student learning after closure of campuses [ 326 , 327 ]. In addition, various innovative forms of “contact-less” processes, such as payment and delivery, have been introduced by institutions to decrease risk of virus transmission [ 328 , 329 ]. However, as of the end of May 2020, many countries began studying the option of re-opening and easing restrictions to varying extents, which sparked both public and scientific controversy, and continues to be a point of contention. For instance, according to Kim et al. (2020), school closures have mitigated COVID-19 spread in Korea and re-opening them could result in doubling the cases [ 330 ]. On the other hand, the efficacy of school closures as a means to reduce the number of new COVID-19 cases is considered insignificant in countries like Taiwan, due to already low transmission rate and the minimal number of new cases in the younger population [ 331 ]. Sweden has also been argued as a case against the closure of schools, considering that despite schools remaining open nationwide a low incidence of severe Covid-19 among schoolchildren was observed [ 332 ]. Nonetheless, it is important to point out that severe disease in children has regardless been reported as low in prevalence globally—As such, closure of schools is argued for in order to prevent transmission from children to the adults and elderly they are in contact with who may be more at risk for severe disease [ 333 ]. The responses to the COVID-19 pandemic have been both reactionary and proactive, with policies remaining dynamic throughout. Overall, as theoretical concepts are applied and tested in a novel setting, global health responses to COVID-19 continue to pose a challenge for all stakeholders involved, both within public and scientific circles.

Global economic burden

The outbreak of SARS-CoV-2 has resulted in a global economic slowdown, as demonstrated by the 2020 crash of global financial markets due to the disruption of international business activities [ 334 ]. The pandemic has disrupted international trade, as the global supply chain systems used by organizations and oil-producing countries to conduct business at the global level have been terminated as a result of precautionary measures taken by states to reduce the spread of the virus. In effect, the value of international trade is deteriorating. The World Trade Organization (WTO) estimates the volume of global trade to have declined by an overall of 9.2% in 2020, due to the pandemic’s economic shock [ 335 ]. According to the UNCTAD, global trade began a strong recovery in Q4 of 2020 due to an 8% growth in goods trade [ 336 ]. The recovery of international trade is projected to stall in the first quarter of 2021 (1.5% fall in the trade of goods relative to Q4 of 2020) due to continuous disruptions in the travel sector and the trade of services caused by virus surges [ 336 ]. The UN DESA expects global trade activity to remain below pre−pandemic levels until 2022 [ 336 ]. An overall 6.9% rebound in the cross-border trade of goods and services is projected in 2021, subject to the wide rollout of vaccines, the lift of movement restrictions and uncertainties over the pandemic clearing up [ 337 ].

According to the World Bank, the global economy faced in 2020 the deepest recession since 1945, with a 4.3% contraction in global GDP and a 6.2% decline in global GDP per capita [ 338 , 339 ]. The global GDP is projected to expand by 4% in 2021 and 3.8% in 2022 (global GDP remains 5.3% and 4.4% below pre-pandemic levels respectively) [ 338 ]. The cumulative estimated cost of SARS-CoV-2 on the global economic output in 2020 and 2021 is USD8.5 trillion and USD22 trillion between 2020 and 2025 [ 340 , 341 ]. The economic implications of the COVID-19 outbreak and the global economic growth commence into recovery depends on the path of the virus, duration of the pandemic and the success of vaccines. In addition to agreements made by governments and pharmaceutical companies on vaccines’ distribution mechanism.283 The International Monetary Fund (IMF) anticipates that a wide rollout of effective vaccination could stimulate a 5.5% economic growth in 2021, with economic recovery rates varying across countries depending on policy response effectiveness, vaccination speed, medical interventions, monetary policy initiatives and structural economic characteristics [ 340 ]. Although, new SARS-CoV-2 variants pose risks causing uncertainty on the global economic recovery in 2021. As such the United Kingdom, previously expected to economically rebound in the first quarter of 2021, faces a GDP contraction of 4%, following lockdown 3.0 caused by the spread of the B.1.1.7 variant [ 342 ]. The IMF projects in a downside scenario, that the economic global growth would only recover to 1.6% in 2021 and 2.5% in 2022, if new COVID-19 cases remain high around the world and the vaccine rollout process is disrupted by logistical hurdles, new virus strains or public reluctance to vaccination [ 340 ]. Negative global growth in 2021 remains a possibility under a pessimistic scenario, in which financial stress is widespread [ 340 ].

As a result of the deep global economic recession, the World Bank estimates that in 2020, between 119 and 124 million people worldwide were pushed into extreme poverty, due to the COVID-19 pandemic [ 338 ]. The number of COVID-19 induced poor is estimated to increase between 143 and 163 million in 2021 [ 338 ]. The International Labour Organization (ILO) revealed that the COVID-19 pandemic led to an 8.8% loss in working hours in 2020, equivalent to 250 million full-time jobs [ 343 ]. According to the ILO estimates the working hours lost in 2020 were four times greater than during the 2009 financial crisis, translating into a global employment loss of 114 million jobs, increasing global unemployment by 33 million and reducing the global labour income by a total of USD3.7 trillion [ 343 ]. The ILO and IMF forecast under a baseline, pessimistic and optimistic scenarios that global working hours in 2021 would fall by 3.0%, 4.6% and 1.3% respectively, depending on the epidemiological situation [ 343 ]. Companies in impacted industries express their willingness to retain their employees if a time estimate is provided by the WHO, pertaining to when the outbreak will end. Currently, no confirmed time estimate exists [ 344 ].

Although the incomes of world states declined, governments are required to increase the budgetary allocations for their health sectors to combat the COVID-19 outbreak. The increase in government spending on healthcare is to facilitate hospitals, ICU units, isolation centers, equip medical facilities, procure the relevant drugs and testing kits, and accommodate citizens’ evacuated from abroad [ 345 ]. This shortage between government revenue and spending is an economic challenge that hinders the healthcare response to the pandemic’s outbreak. The virus outbreak in Italy reduced the state’s revenues from the tourism sector (accounts for 14% of GDP), creating a financial deficit. The financial deficit situation hindered the capacity of the Italian government to support its healthcare sector with sufficient resources and funds, resulting in the spread of the outbreak [ 346 ]. In addition, the action of global governments reprioritizing their budgets to support their health sectors with the necessary funds to combat the pandemic would result in a shortage in budgets allocated to other fundamental sectors, primarily education. The World Bank estimates the per capita education spending in all world countries shrunk by 5.7 percent in the second half of 2020 [ 347 ]. While there is no verified global estimate of the financial funds required to control the outbreak, WHO has requested USD 675 million to combat COVID-19 [ 348 ]. On June 26, 2020, the WHO announced that developing COVID-19 tests, treatments, and vaccines will require USD31.3 billion over the next one year. The requested financing will enable the delivery of 500 million tests and 245 million courses of treatment to low and middle-income countries over the next 12–18 months [ 349 ]. The WHO indicated in August 2020, that ensuring global access to SARS-CoV-2 vaccine will require over US$100 billion [ 350 ].

The decline in state revenue caused by the virus outbreak, limited resources, and medical infrastructure prevents developing states from independently financing the combat of the virus. Private financial inflows into the economies of developing countries has dropped in 2020 by a number of US$700 billion in comparison to the levels of 2019. This exceeds the impact of the Global Financial Crisis in 2008 by 60 percent, resulting in setbacks and reductions in global development of infrastructure creating a situation in which states would become more vulnerable to future crises particularly regarding health such as in the case of a future pandemic [ 351 ]. The pandemic has also caused a decline in African states export revenues, followed by depreciation in local currencies. A depreciation in exchange rates increases local inflation rates of foreign currency debt, which intensifies the situation of debt distress. Although governments are required to increase healthcare spending to combat the pandemic, African governments may be required to implement financial tightening measures to manage economic inflation [ 352 ]. Developing countries depend on donations from donor states, international organizations, and NGOs to attain the necessary funds to support their health care sectors in combating the COVID-19 outbreak. In this respect, the WHO introduced a crowdfund requesting the support of public and private donors for its COVID-19 response [ 353 ]. The World Bank also allocated USD14 billion to aid developing countries' COVID-19 response [ 354 ] and USD12 billion to finance their purchase and distribution of vaccines [ 354 , 355 ]. However, the United States, which funded 15% of the WHO's 2018–2019 budget, announced on April 14, 2020, the suspension of its funding to the organisation. The US was due to pay USD58 million to the WHO in 2020 [ 356 ]. The US reversed its withdrawal decision, restoring its funding to the WHO in January 2021 [ 357 ].

To avoid the spread of the pandemic the WHO has urged developing states to implement containment procedures [ 358 ]. However, governments may resist implementing containment precautions, since countries that have imposed lock-downs and curfews have experienced economic repercussions, caused by the decline in volume of trade [ 359 ]. The United States for instance, whose economy contracted by 32.9% in the second quarter of 2020, did not implement containment measures in a timely fashion, due to its forecasted impacts on the national economy [ 360 – 362 ]. If implemented for the long term, the economic consequences of containment measures will be more intense on developing African states, considering their greater dependence on trade. The United Nations Economic Commission for Africa estimates that Africa’s GDP growth rate declines from 3.2% to 1.8% in 2020, pushing tens of millions in Sub-Saharan Africa into extreme poverty through 2021. The continent is expected to require at least USD100 billion as a fiscal stimulus to address the healthcare and economic needs associated with the pandemic [ 352 ]. Moving forward and in order to minimize the global recessionary gaps countries are advised to adopt collective international stimulus measures rather than independent actions. In this respect, the G20 and as part of an international coordinated action, announced the investment of USD11 trillion in the global economy to address financial losses caused by the virus outbreak [ 363 , 364 ].

Worldwide governments encounter social and economic pressures to re-open economic activities, in order to account for increasing poverty rates and financial losses. The World Tourism Organization (UNWTO) revealed that the global tourism sector has lost a total of USD1.1 trillion in 2020 due to the COVID-19 outbreak [ 365 ]. Accordingly, several countries began in May 2020 to announce exit strategies for the COVID-19 pandemic, involving the relaxation of containment measures. Countries which re-open their economies however may be required to reimplement lockdown restrictions due to the resurgence of subsequent waves of COVID-19. The Authorities in France, UK, Ireland, Spain, Italy, Germany, Canada and China re-imposed restrictive lockdown measures during the end of 2020, due to cases surge and the spread of new virus strains [ 366 ]. Governments continue to examine the implementation of policies which would allow for the economy to reopen while avoiding a surge in COVID-19 new cases. Only returning employees aged 20–49, who encounter low fatality rates and the lowest risk of requiring hospitalization, back to the workplace is a proposed policy in countries where the healthcare system no longer has critical congestion. The risk of new waves of infections remains high nonetheless as a large fraction of the population is not immune to the virus. According to a report by the Imperial College COVID-19 Response Team (Ferguson et al. 2020), SARS-CoV-2 infection fatality rate in the age groups 20–29, 30–39, 40–49 is 0.03%, 0.08% and 0.15%, respectively. The corresponding probabilities of requiring hospitalization are 1.2%, 3.2% and 4.9% [ 367 ].

Other governments including Germany, Chile, and the USA proposed restarting the economy through issuing immunity passports, which certifies that an individual has been infected by SARS-CoV-2 and has developed antibodies to the virus. Following the rollout of COVID-19 vaccines, the International Air Transport Association (IATA) and several governments began issuing a digital vaccine passport for individuals who vaccinated against the virus, receiving all required doses [ 368 ]. Holders of vaccination passports could be allowed to resume economic and financial activities, while being exempt from physical restrictions. However, considerable scientific, practical, ethical and legal issues are posed by vaccination passports [ 367 ].

The global supply side of advanced pharmaceutical ingredients and pharmaceuticals was also disrupted by the virus outbreak. The closure of Chinese factories during the start of the pandemic resulted in a shortage of raw components used by international drug companies to develop essential vitamins and antibiotics. This shortage in the global supply of vital drugs may reflect negatively on the health of patients with diseases other than SARS-CoV-2. Additionally, measures taken by states to preserve their national stocks of vital medications during the outbreak resulted in an increased shortage of its global supply. For instance, the Indian government banned the pharmaceutical industry’s export of 26 drugs, antibiotics, and pharmaceutical ingredients, starting March 3, 2020; according to the India Brand Equity Foundation, one-fifth of the global exports of generic drugs in 2019 was supplied by India (worth USD19 billion of drug exports) [ 369 ]. On June 29, 2020, the United States’ government purchased 500,000 doses of the antiviral drug Remdesivir, accounting for 100% of Gilead Sciences’ global production of the drug in July, and 90% of the projected global stock in August and September 2020. Governments’ focus on marginalized advantages results in a global competition to secure access to SARS-CoV-2 drugs, which increases their global prices. As a result, a shortage in the global supply of Remdesivir is expected between July and September 2020 [ 370 ].

Additionally, the rollout of COVID-19 vaccines was complicated by global economic inequalities. Several high-income countries and due to their purchasing power secured enough doses to vaccinate its entire population multiple times in 2021, with 95% of world vaccines in January 2021 being administered in ten countries only [ 371 ]. The excess demand of vaccines by wealthy states, exceeding the market supply of vaccines by pharmaceutical companies, results in a shortage for developing and low-income countries. Estimates predict 90% of the population in 67 countries will be deprived from receiving the COVID-19 vaccine in 2021 [ 371 ]. The shortage of vaccine supply to world states was intensified by the EU decision to control the foreign exports of vaccines produced within the bloc [ 372 ]. According to the UN, vaccination policies lead to a rapid increase in the price of vaccines, resulting in countries such as South Africa paying 2.5 times higher price than the EU for the AstraZeneca/Oxford vaccine [ 372 , 373 ].

The COVID-19 outbreak results in a negative financial outlook for global non-profit public healthcare sectors. The revenues of global health sectors are likely to decline in comparison to 2019, as a result of hospitals halting certain profitable medical services and elective surgical procedures in order to divert focus on cases linked to COVID-19. Hospitals in the US have an estimated loss of USD323.1 billion in 2020, and one million job loss in the American healthcare sector{Blumenthal, 2020 #202. Expenses will rise as a result of the demand to provide equipment to protect medical staff dealing with infected patients, as well as increased costs of employee upkeep. Under specific conditions, the financial losses of the health sector will be cushioned by government funding aimed at combating the COVID-19 pandemic [ 374 ]. However, government funding will not fully cover the financial losses that will be incurred by healthcare firms or the full cost of treating those infected [ 375 ]. The Spanish government, for instance, has taken measures to monopolize all private health industries and place it under the disposition of the national healthcare sector. The government did not set a time frame for providing financial reimbursement to private healthcare firms [ 283 ].

Nonetheless, the value of the financial budget that governments are required to allocate to support their health sectors in combating the pandemic outbreak differs from one country to another, depending on the current status of its health sector and the extent of its development and preparedness to cope with a pandemic. The fragile health systems of some developing countries are a result of their limited economic capacity, poor governance, and internal conflicts. This creates a situation in which the state’s health and economic resources are insufficient in combating the COVID-19 outbreak, while also continuing to combat the outbreak of other pre-existing epidemics in the country. Yemen for instance, while facing the novel SARS-CoV-2, must also deal with the Cholera epidemic and other communicable diseases (diphtheria, dengue fever and measles). Yemen has recorded 2 million suspected cases of Cholera as of January 2020 [ 376 ]. Yemen’s inflated economy, decreased government revenues, and its limited public healthcare system where only 50% of health facilities are functioning at full capacity, makes it incapable of combating multiple diseases at the same time [ 377 ]. The WHO requested a fund worth US$179 million from donor states to aid Yemen with the essential medical equipment to combat the COVID-19 outbreak [ 378 ]. Furthermore, countries' allocation of most of its health budgets towards combating COVID-19 has also led to a shortfall in budgets allocated for combating Malaria in sub-Saharan Africa where mass insecticide-treated net campaigns have been suspended [ 379 ].

Political contexts also factor into the economic capacity of countries to provide sufficient financial support to their healthcare sector. For example, Iran’s fragile healthcare system coupled with the economic lockdown it experiences due to politically-driven sanctions imposed by the UN and US, may have likely hindered the capacity of the Iranian government to support its health sector with the necessary funds for clinical, laboratory, and pharmaceutical equipment to efficiently combat the outbreak [ 326 ].

The spread of COVID-19 has taken the world by surprise, and unlike most health crises of the recent decades, impacted the routine lives of all humans in all walks of life. Governments and national task forces continue to work with public health experts to contain the spread of the virus on a national level, through implementation of screening, quarantine, and community-based laws and protocols—despite the grave forecasted consequences on the economy. Multidisciplinary groups of scientists meanwhile are working on developing improved diagnostic tests, efficient health equipment, and effective vaccines. Healthcare workers, despite the personal risks associated with the global shortage in PPE, continue work on the frontlines to manage patients as per the published literature and official guidelines, focusing on sustaining respiratory function and preventing septic infections, coagulopathy, and cardiac morbidities—topics that clinical researchers continue to investigate in relation to COVID-19. The WHO continues to coordinate on an international level and disseminate evidence-based information and awareness. National efforts, essential workers, and communities at large, are cooperating with the aforementioned bodies, and each other, to see an end to this global health crisis. Although no end date can be predicted as of yet, once this pandemic is overcome through the collective global efforts, it will leave a significant residual impact behind, and many lessons to be learnt by all stakeholders involved—communities, governments, and health systems—As we move forward to deal with the next pandemic or global health crisis to threaten human existence, in what will hopefully be a more proactive, systematic, and efficient global response.

Acknowledgements

Not applicable

Authors' contributions

SIM was lead author of the project, and MA the senior supervisor. SIM, OGK, SA, TT, OA, PS, MAI, JANS, and BA were all involved in drafting one or multiple sections of the review paper. SIM, OGK, SA, and OA were involved in the creation and design of tables and figures. SIM, TT, RE, and MA were involved in the editing of the manuscript and provided intellectual contributions. MA and RE were involved in the review and provided expert feedback on the content. All authors read and approved the final manuscript.

Funding for Open-Access publication was provided by the Royal College of Surgeons in Ireland, Bahrain.

Availability of data and materials

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Publisher's Note

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Contributor Information

Saad I. Mallah, Email: moc.liamg@hllamidaas .

Manaf Al-Qahtani, Email: moc.liamg@fanamrd .

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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Persuasive Essay Guide

Persuasive Essay About Covid19

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

11 min read

Steps to Write a Persuasive Essay About Covid-19

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

Step 1: Choose a Specific Thesis Statement

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

Step 2: Research and Gather Information

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

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

Step 3: Outline Your Essay

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

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

Step 4: Write the Introduction

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

Step 5: Provide Background Information

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

Step 6: Develop Body Paragraphs

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

Step 7: Address Counterarguments

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

Step 8: Write the Conclusion

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

Step 9: Revise and Proofread

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

Step 10: Cite Your Sources

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

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

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Examples of Persuasive Essay About Covid19

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

Check out some more PDF examples below:

Persuasive Essay About Covid-19 Pandemic

Sample Of Persuasive Essay About Covid-19

Persuasive Essay About Covid-19 In The Philippines - Example

If you're in search of a compelling persuasive essay on business, don't miss out on our “ persuasive essay about business ” blog!

Examples of Persuasive Essay About Covid-19 Vaccine

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

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

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

Covid19 Vaccine Persuasive Essay

Persuasive Essay on Covid Vaccines

Interested in thought-provoking discussions on abortion? Read our persuasive essay about abortion blog to eplore arguments!

Examples of Persuasive Essay About Covid-19 Integration

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

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

Persuasive Essay About Working From Home During Covid19

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

Examples of Argumentative Essay About Covid 19

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

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

Here are some examples of argumentative essays on Covid19.

Argumentative Essay About Covid19 Sample

Argumentative Essay About Covid19 With Introduction Body and Conclusion

Looking for a persuasive take on the topic of smoking? You'll find it all related arguments in out Persuasive Essay About Smoking blog!

Examples of Persuasive Speeches About Covid-19

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

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

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

Persuasive Speech About Covid-19 Example

Persuasive Speech About Vaccine For Covid-19

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

Tips to Write a Persuasive Essay About Covid-19

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

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

Choose a Specific Angle

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

Provide Credible Sources

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

Use Persuasive Language

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

Organize Your Essay

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

Emphasize Benefits

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

Use Visuals -H3

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

Call to Action

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

Revise and Edit

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

Seek Feedback

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

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Common Topics for a Persuasive Essay on COVID-19

Here are some persuasive essay topics on COVID-19:

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

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

To sum it up,

You have read good sample essays and got some helpful tips. You now have the tools you needed to write a persuasive essay about Covid-19. So don't let the doubts stop you, start writing!

If you need professional writing help, don't worry! We've got that for you as well.

MyPerfectWords.com is a professional essay writing service that can help you craft an excellent persuasive essay on Covid-19. Our experienced essay writer will create a well-structured, insightful paper in no time!

So don't hesitate and get in touch with our persuasive essay writing service today!

Frequently Asked Questions

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

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

What impact does COVID-19 have on society?

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

Caleb S. has been providing writing services for over five years and has a Masters degree from Oxford University. He is an expert in his craft and takes great pride in helping students achieve their academic goals. Caleb is a dedicated professional who always puts his clients first.

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Keep reading

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 .

More information on the campaign

More on this subject

Call for participants and presentations: 10th UNESCO-APEID Meeting on Entrepreneurship Education

Challenges and Opportunities in the Post-COVID-19 World

The COVID-19 crisis has affected societies and economies around the globe and will permanently reshape our world as it continues to unfold. While the fallout from the crisis is both amplifying familiar risks and creating new ones, change at this scale also creates new openings for managing systemic challenges, and ways to build back better. This collection of essays draws on the diverse insights of the World Economic Forum’s Global Risks Report Advisory Board to look ahead and across a broad range of issues – trade, governance, health, labour, technology to name a few – and consider where the balance of risk and opportunity may come out. It offers decision-makers a comprehensive picture of expected long-term changes, and inspiration to leverage the opportunities this crisis offers to improve the state of the world.

World Economic Forum reports may be republished in accordance with the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Public License , and in accordance with our Terms of Use .

Will COVID-19 change how we think about migration and migrant workers?

Migrant workers are key to the pandemic response, but the focus on health security could have long-term implications for migrants and migration policy.

The COVID-19 pandemic is not a break for nature – let’s make sure there is one after the crisis

Nature is facing increased pressure due COVID-19 crisis – and to our health and our economy, governments must also prioritize healing our planet, too.

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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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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

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Call for essays: the world after corona crisis.

On behalf of the UBIAS (University-based Institutes for Advanced Study Network

Dear colleagues,

Heavily shaken by the corona pandemics many of us are currently thinking about how we could contribute to overcome this unprecedented situation. We thought that UBIAS could open a unique platform to discuss these questions in an interdisciplinary and international perspective. Therefore we would like to launch a call for papers about:

How will/should the world change? The corona crisis as an interdisciplinary challenge

The corona crisis not only challenges disease control and crisis management, but may also have long-term and far-reaching impacts on states, societies and international cooperation. There are increasing indications that the world will look different after the crisis and that globalization will be questioned in many areas. According to these observations, the corona crisis would mark a turning point. In times of deep uncertainty, science is asked to look to the future and to flank a rational discourse about how to react to the current global crisis, and therefore now better cope with other tantamount global challenges such as the climate change.

Since this challenge is genuinely interdisciplinary, UBIAS could make a contribution with its contacts to interdisciplinary and international scientific communities. The idea is to present scientific essays (max. 10,000 characters incl. spaces) from different disciplines in the blog Interdisciplinarity , which is run by ZiF, over the next few weeks. These essays will sharpen our view of the current situation and contribute to the debate about necessary structural changes. For this purpose, scholars (UBIAS Fellows and others) from different disciplines and countries will be addressed. Contributions can be submitted in English. If the quality of the contributions suggests it, a subsequent UBIAS publication could also be considered.

Please submit your paper until the end of May latest to [email protected] or [email protected] .

We would be happy if you could consider a contribution yourself and/or looking out for scholars and scientists who might find this project appealing. Since some distinguished scholars enthusiastically agreed to submit a paper already (among them Lorraine Daston (History of Science), Christoph Horn (Philosophy), Frank Riedel (Economy) and Oliver Razum (Public Health)) we are very optimistic that this blog will not only deliver valuable contributions for public debates but will also demonstrate the huge intellectual capacity of the global UBIAS network. We are looking forward to receiving papers from all around the world and thank you for your support!

Best wishes,

Véronique Zanetti and Britta Padberg G. Ary Plonski, Clarissa Ball and Raouf Boucekkine

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How to Write About the Impact of the Coronavirus in a College Essay

U.S. News & World Report

October 21, 2020, 12:00 AM

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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.

[ Read: How to Write a College Essay. ]

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

“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.

[ Read: What Colleges Look for: 6 Ways to Stand Out. ]

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.”

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.

[ Read: The Common App: Everything You Need to Know. ]

“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.

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

About the author, department of global communications.

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

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

Everyone can do something

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

Creating hope

man with guitar in front of colorful poster

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

Inclusive solutions

woman models a transparent face mask designed to help the hard of hearing

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

Humanity at its best

woman in protective gear sews face masks

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

Keep future leaders learning

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

Global solidarity

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

A new way of working

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

Life goes on

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

Putting meals on the table

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

Supporting the frontlines

woman handing down box from airplane to WFP employee

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

S7-Episode 2: Bringing Health to the World

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

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

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

:: David Nabarro interviewed by Melissa Fleming

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Essay on Global Warming

Updated on
Nov 23, 2023

Being able to write an essay is an integral part of mastering any language. Essays form an integral part of many academic and scholastic exams like the SAT , and UPSC amongst many others. It is a crucial evaluative part of English proficiency tests as well like IELTS , TOEFL , etc. Major essays are meant to emphasize public issues of concern that can have significant consequences on the world. To understand the concept of Global Warming and its causes and effects, we must first examine the many factors that influence the planet’s temperature and what this implies for the world’s future. Here’s an unbiased look at the essay on Global Warming and other essential related topics.

This Blog Includes:

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Since the industrial and scientific revolutions, Earth’s resources have been gradually depleted. Furthermore, the start of the world’s population’s exponential expansion is particularly hard on the environment. Simply put, as the population’s need for consumption grows, so does the use of natural resources , as well as the waste generated by that consumption.

Climate change has been one of the most significant long-term consequences of this. Climate change is more than just the rise or fall of global temperatures; it also affects rain cycles, wind patterns, cyclone frequencies, sea levels, and other factors. It has an impact on all major life groupings on the planet.

What is Global Warming?

Global warming is the unusually rapid increase in Earth’s average surface temperature over the past century, primarily due to the greenhouse gases released by people burning fossil fuels . The greenhouse gases consist of methane, nitrous oxide, ozone, carbon dioxide, water vapour, and chlorofluorocarbons. The weather prediction has been becoming more complex with every passing year, with seasons more indistinguishable, and the general temperatures hotter. The number of hurricanes, cyclones, droughts, floods, etc., has risen steadily since the onset of the 21st century. The supervillain behind all these changes is Global Warming. The name is quite self-explanatory; it means the rise in the temperature of the Earth.

Sample Essays on Global Warming

Here are some sample essays on Global Warming:

Global Warming is caused by the increase of carbon dioxide levels in the earth’s atmosphere and is a result of human activities that have been causing harm to our environment for the past few centuries now. Global Warming is something that can’t be ignored and steps have to be taken to tackle the situation globally. The average temperature is constantly rising by 1.5 degrees Celsius over the last few years. The best method to prevent future damage to the earth, cutting down more forests should be banned and Afforestation should be encouraged. Start by planting trees near your homes and offices, participate in events, and teach the importance of planting trees. It is impossible to undo the damage but it is possible to stop further harm.

Digvijay Singh

Having 2+ years of experience in educational content writing, withholding a Bachelor's in Physical Education and Sports Science and a strong interest in writing educational content for students enrolled in domestic and foreign study abroad programmes. I believe in offering a distinct viewpoint to the table, to help students deal with the complexities of both domestic and foreign educational systems. Through engaging storytelling and insightful analysis, I aim to inspire my readers to embark on their educational journeys, whether abroad or at home, and to make the most of every learning opportunity that comes their way.

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