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My Experience During The Covid-19 Pandemic

• Categories: Covid 19

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Words: 440 |

Published: Jan 30, 2024

Words: 440 | Page: 1 | 3 min read

Table of contents

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

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

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Personal Experience With the COVID-19 Pandemic

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

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

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

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

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

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

Works Cited

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

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

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

• Chicago (A-D)
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IvyPanda. (2024, February 26). Personal Experience With the COVID-19 Pandemic. https://ivypanda.com/essays/personal-experience-with-the-covid-19-pandemic/

"Personal Experience With the COVID-19 Pandemic." IvyPanda , 26 Feb. 2024, ivypanda.com/essays/personal-experience-with-the-covid-19-pandemic/.

IvyPanda . (2024) 'Personal Experience With the COVID-19 Pandemic'. 26 February.

IvyPanda . 2024. "Personal Experience With the COVID-19 Pandemic." February 26, 2024. https://ivypanda.com/essays/personal-experience-with-the-covid-19-pandemic/.

1. IvyPanda . "Personal Experience With the COVID-19 Pandemic." February 26, 2024. https://ivypanda.com/essays/personal-experience-with-the-covid-19-pandemic/.

Bibliography

IvyPanda . "Personal Experience With the COVID-19 Pandemic." February 26, 2024. https://ivypanda.com/essays/personal-experience-with-the-covid-19-pandemic/.

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Read these 12 moving essays about life during coronavirus

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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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Tell us about your experiences during the Covid pandemic

Whether you’ve suffered in the past year or been lucky enough to escape the worst of it, we would like to hear your stories about the pandemic

The pandemic has been a difficult, dramatic time for so many of us, for so many different reasons. We have lost loved ones, had our families torn apart, struggled financially and emotionally. Some of us have been stressed by overwork; others by sudden unemployment. We have had to shield from the outside world – or been reluctantly obliged to mix with it.

If you have a story to share we would love to hear from you. You might be a doctor working flat out in A&E, a student who was locked down at university, a key worker forced to serve the public with inadequate PPE, a single mother who had to go months without childcare, a son who couldn’t visit his dying father in the care home … or even one of the lucky ones who has come out of the past year feeling stronger and more optimistic about life.

For a special feature, we’re aiming to put readers in touch with each other, to talk about their experiences and insights.

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Essays reveal experiences during pandemic, unrest.

Field study students share their thoughts 

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

Becoming Socially Distant Through Technology: The Tech Contagion

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

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

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

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

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

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

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

Privilege in a Pandemic 

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

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

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

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

My World is Burning 

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

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

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

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

Opportunity to Serve

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

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

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

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

Let’s Do Better

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

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

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

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

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

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

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

The Virus That Makes You Forget

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

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

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

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

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

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

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

Welcome to My Cage: The Pandemic and PTSD

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

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

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

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

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

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

A Somatic Pandemonium in Quarantine

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

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

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

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

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

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

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

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

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

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

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

How COVID-19 Changed My Senior Year

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

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

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

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

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

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

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

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

Physical Distancing

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

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

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

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

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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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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

Related items

• SDG: SDG 3 - Ensure healthy lives and promote well-being for all at all ages
• SDG: SDG 4 - Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
• SDG: SDG 10 - Reduce inequality within and among countries
• See more add

This article is related to the United Nation’s Sustainable Development Goals .

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Coronavirus: My Experience During the Pandemic

Anastasiya Kandratsenka George Washington High School, Class of 2021

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

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

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

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

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

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

Articles in this Volume

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

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Copyright 2024 The University of Pennsylvania Graduate School of Education's Online Urban Education Journal

Seven short essays about life during the pandemic

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

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

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

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

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

Nakia Hill, Boston

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

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

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

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

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

Nancy S. Taylor, Boston

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

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

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

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

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

“It’s me,” said my husband.

“It’s me,” said my father-in-law.

“I love you,” said my husband.

“I love you,” said my father-in-law.

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

Lucia Thompson, Wayland

Would racism exist if we were blind?

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

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

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

Faizah Shareef, Boston

My Family is “Out” There

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

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

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

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

Barbara Anderson, Raynham

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

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

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

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

Melissa Lee, Waltham

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

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

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

Precious child. I pray, safeguard her.

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

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

Kirstan Barnett, Watertown

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

Writing about COVID-19 in a college admission essay

by: Venkates Swaminathan | Updated: September 14, 2020

Print article

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

The CommonApp COVID-19 question

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

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

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

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

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

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

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

Counselor recommendations and school profiles

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

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

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

Writing about COVID-19 in your main essay

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

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

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

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

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ORIGINAL RESEARCH article

Positive and negative experiences of living in covid-19 pandemic: analysis of italian adolescents’ narratives.

• Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Firenze, Italy

Introduction: Despite a growing interest in the field, scarce narrative studies have delved into adolescents’ psychological experiences related to global emergencies caused by infective diseases. The present study aims to investigate adolescents’ narratives on positive and negative experiences related to COVID-19.

Methods: Italian adolescents, 2,758 (females = 74.8%, mean age = 16.64, SD = 1.43), completed two narrative tasks on their most negative and positive experiences during the COVID-19 emergency. Data were analyzed by modeling an analysis of emergent themes.

Results: “Staying home as a limitation of autonomy,” “School as an educational, not relational environment,” the impact of a “new life routine,” and experiencing “anguish and loss” are the four emergent themes for negative experiences. As for positive experiences, the four themes were “Being part of an extraordinary experience,” “Discovering oneself,” “Re-discovering family,” and “Sharing life at a distance.”

Conclusion: Authors discuss the impact of COVID-19 on adolescents’ developmental tasks, such as identity processes and autonomy acquisition.

Introduction

After the first case of COVID-19 in Italy was discovered on the 21st of February, schools and universities were shut down on March 5. On the March 9, the government declared lockdown status in order to hinder the spread of the virus. In order to reduce contagion, citizens were required to stay home except for emergencies and primary needs. Over 8 million children and adolescents stopped their social and educational activities, which were reorganized online. On April 5, the last day of data collection for the present study, out of a global number of 1,133,758 ( Johns Hopkins Coronavirus Resource Center, 2020 ), 128,948 people had been infected by COVID-19 in Italy, of which 15,887 (about the 12.3%) had died ( Italian Ministry of Health, 2020 ).

The COVID-19 pandemic is a public health emergency that poses questions and dilemmas regarding the psychological well-being of people at varying levels.

Currently, several studies have been conducted on how the general population experiences emergencies related to pandemic infectious diseases. Some authors ( Yeung and Fung, 2007 ; Dodgson et al., 2010 ; Peng et al., 2010 ; Main et al., 2011 ; Van Bortel et al., 2016 ), in analyzing the impact of infectious diseases such as SARS or Ebola, report experiences such as fear and anxiety for themselves and their families, separation anxieties, impotence, depression, as well as anger and frustration. In the case of COVID-19, scholars have highlighted several psychological effects of the pandemic on adult samples in China ( Qiu et al., 2020 ; Wang et al., 2020a , b ) and in Italy ( Rossi et al., 2020 ), and found psychological symptoms related to posttraumatic stress disorder. In a recent review, anxiety, depression, psychological stress, and poor sleep have been reported to be the main psychological outcomes of living with the COVID-19 emergency ( Rajkumar, 2020 ).

Considering children and adolescents, several studies have specifically explored psychological experiences related to the global emergency and lockdown experience of COVID-19 ( Lee, 2020 ), but evidence from autobiographical narratives are lacking. Qiu et al. (2020) compared different Chinese aged populations and found lower levels of psychological distress in people under 18. Similarly, Xie et al. (2020) found symptoms of anxiety (18.9%) and depression (22.6%) in primary school children in China.

As for US adolescents, evidence suggests that social trust and greater attitudes toward the severity of COVID-19 are related with more adolescents’ monitoring risk behaviors, performing social distancing, and disinfecting properly. Motivation to perform social distancing is also associated with symptoms of anxiety and depression ( Oosterhoff et al., 2020 ).

A study on Canadian adolescents’ well-being and psychiatric symptoms highlighted that depression and feelings of loneliness are related with great time spent on social media, while family time, physical activity, and schoolwork play a protective role for depression ( Ellis et al., 2020 ). Similarly, in a recent review of adolescents’ experience of lockdown for COVID-19, Guessoum et al. (2020) discuss the relation between the current pandemic and adolescents’ posttraumatic stress, depressive, and anxiety disorders, as well as grief-related symptoms. Furthermore, they found that data on adolescent mental health are still scarce and need to be empowered.

Adolescence is connected to certain developmental tasks ( Havighurst, 1948 ) related, among others, to defining one’s own personal identity ( Kroger and Marcia, 2011 ) and developing one’s autonomy by redefining family ties and building bonds with peers ( Alonso-Stuyck et al., 2018 ).

Considering identity changes, adolescence is characterized by a developmental crisis between the definition of a personal identity and a status of confusion of roles ( Erikson, 1968 ). Adolescents’ ego growth is linked to the separation from childhood identifications in order to allow an individual identity status to emerge. This gradual process is connected with four different styles of identity definition concerning vocational, ideological, and sexual issues ( Kroger et al., 2010 ): identity achievements, moratorium, foreclosure, and diffusion. Overall, the identity process may develop from a period of diffusion, not connected to significant identifications, or with foreclosure, in which identifications are still related to significant childhood figures. The opportunity to explore new relationships with peers and other developmental environments often stresses a time of identity moratorium where individuals investigate themselves by making identity-defining commitments, which usually end by achieving a balance between personal interests and the vocational and ideological opportunities provided by surrounding context.

A turning point in identity development is the acquisition of personal autonomy. Scholars define autonomy as a multidimensional variable related to a set of phenomena involved in psychosocial development: the separation-individuation task as reported by Erikson (1968) , management of detachment, and independence from family in order to look for new developmental environments, psychosocial maturity, self-regulation, self-control, self-efficacy, self-determination, and decision making ( Noom et al., 2001 ).

The main theories on autonomy acquisition during adolescence stress the relation between the desire for autonomy and the development of beliefs about personal capabilities, the need to explore one’s own life goals and reflect on personal desires and preferences. As teenagers gain self-confidence and focus on personal goals and attitudes related to their individual interests and talents, the demand for autonomy in the household increases ( Van Petegem et al., 2013 ). At the same time, intimate relationships with peers in adolescence acquire a vital importance for the definition of autonomous and personal identity. Adolescent friendships represent the possibility of strengthening the completion of the process of identification through establishing relationships with significant others ( Jones et al., 2014 ).

As a privileged context of peer interaction and acquisition of knowledge and personal maturity, school greatly contributes to the development of adolescent identity and interpersonal relationships ( Lannegrand-Willems and Bosma, 2006 ). Both curricular and extracurricular activities at school promote interpersonal interactions, and adolescents’ participation in school activities may have a protective role for academic achievement, substance use, sexual activity, psychological adjustment, delinquency, and young adult outcomes ( Feldman and Matjasko, 2005 ).

During the COVID-19 emergency and the consequent lockdown in Italy, adolescents experienced a strong change in their personal and social environment, which could have affected the trajectory of their developmental tasks. Nevertheless, currently, there is a lack of knowledge of adolescents’ experience of living with COVID-19 and the main psychological issues related to it. Lockdown and the consequent closing of schools ushered in a new life routine for adolescents, centered on sharing time with family and temporarily interrupting face-to-face peer relationships. In this sense, similar to others, very impacting autobiographical events such as diseases or natural disasters, lockdown, and pandemic might have caused a biographical disruption ( Bury, 1982 ; Tuohy and Stephens, 2012 ) interrupting developmental tasks typical of adolescence or forcing a reorganization. To understand the subjective experience of Italian adolescents and the potential impact of the biographical disruption on developmental tasks, we asked them the most impacting experiences related to COVID-19 and the national lockdown. We therefore collected narratives of positive and negative autobiographical events. Our main hypothesis was that the imposed lockdown may have constituted a turning point of pivotal developmental processes of autonomy acquisition and identity development, forcing adolescents to re-organize their personal resources. Therefore, we aimed to explore how Italian adolescents dealt with this peculiar life experience in terms of managing their developmental tasks.

Considering the lack of knowledge in literature and the need to investigate an unexplored topic, we performed a qualitative study to explore adolescents’ feelings and thoughts by means of their narratives. Qualitative research design helps “to generate useful knowledge about health and illness, from individual perceptions to how global systems work” ( Green and Thorogood, 2018 , p. 6) allowing for deep knowledge. Furthermore, narrative is a recognized tool to explore autobiographical experiences in terms of thoughts, emotions, and feelings as well as an intervention to promote emotional elaboration and meaning making ( Pennebaker, 1997 ; Pennebaker et al., 2003 ). As a natural act to elaborate life episodes and generate meanings ( Bruner, 1990 ), narrative enriches the search for evidence on autobiographical experience especially in both normative and not normative life transitions, when the need for meaning making about the self is strong. For this reason, the research design was exploratory, and it was caused by the need to generate insights on adolescence and COVID-19 starting from the direct adolescents’ narrated experience.

Materials and Methods

Participants.

Participants of the present study were part of a broader study involving 5,295 Italian adolescents (mean age = 16.67, SD = 1.43; females = 75.2%; Min = 14, Max = 20) exploring emotional and cognitive patterns involved in COVID-19 experience. Since 14 is the Italian minimum age to give individual consent to having one’s online data processed, inclusion criteria for the present study were to be high school students and to be aged between 14 and 20. From the whole sample, we did not include data about adolescents with any missing data on either narrative task.

The final sample of 2,758 adolescents (females = 74.8%; mean age = 16.64, SD = 1.43; min = 14, max = 20; 14 years old = 7%, 15 years old = 17%, 16 years old = 22.4%, 17 years old = 22.2%, 18 years old = 23.2%, 19 years old = 6.3%, 20 years old = 1.9%) was composed by students attending lyceums (76.9%), technical high schools (16.9%), and vocational high schools (5.5%). Participants came from all regions of Italy: considering the impact of COVID-19 spread in Italy during data collection, the 16.8% of participants came from Lombardy (the most impacted region), the 20.7% came from medium impacted regions (Emilia Romagna, Liguria, Marche, Piedmont, Trentino Alto-Adige, Valle d’Aosta, Veneto), and the 62.5% came from other Italian region less impacted. Overall, 2,464 of them reported and narrated their most negative experiences and 2,110 reported their most positive experiences.

We also collected data about personal experiences involving COVID-19. Of the sample, 7.8% experienced a COVID-19 infection within the family circle (e.g., parents, brothers/sisters, grandparents, etc.). Of the sample, 38.6% experienced COVID-19 infections within friendship, scholastic, or broader social circles (e.g., neighbors, acquaintances). Ten participants (0.4%) reported to be infected themselves.

Procedures and Data Analyses

After the approval of the ethical committee of the University of Florence, data collection took place from April 1 to April 5, 2020, during the peak of the COVID-19 outbreak in Italy, through a popular student website for sharing notes and receiving help with homework 1 , via a pop-up window asking the users to take part in the study. All respondents provided explicit informed consent at the beginning of the survey. It was possible to leave the survey at any point by simply closing the pop-up window. All data collected were anonymous. The contacts of a national helpline (i.e., telephone number and website chat) were provided at the end of the survey, inviting participants to get in touch if they need psychological support.

We invited participants to fill in two narrative tasks: the first on their most negative experience (“ Please, think about your memories surrounding COVID-19 and the “quarantine”. Would you please tell us your most negative experience during the last two weeks? Take your time and narrate what happened and how you experienced it. There are no limits of time and space for your narrative” ) and a second about their most positive experience of life during COVID-19 pandemic (“ Referring again to your memories surrounding COVID-19 and the “quarantine”, would you please tell us your most positive experience of the last two weeks? Please, narrate what happened and how you experienced that episode. There are no limits of time and space for your narrative” ).

The time frame of 2 weeks was referred to time approximately spent between the beginning of lockdown (March 9) and data collection.

All narratives were joined in two different full texts, one for the positive experience narratives and one for the negative ones. Then, a modeling emergent themes analysis was run by the T-Lab Software ( Lancia, 2004 ). Modeling of Emergent Themes discovers, examines, and extrapolates the main themes (or topics) emerging from the text by means of co-occurrence patterns of key-term analysis by a probabilistic model, which uses the Latent Dirichlet Allocation ( Blei et al., 2003 ). The results of the data analysis are several themes describing the main contents of a textual corpus. Researchers discussed in groups emergent themes and selected from elementary contexts derived from analysis those better explaining each theme.

This kind of textual analysis is therefore suggested in studies aiming to deepen unexplored topics in order to identify variables related to a specific kind of experience to be further investigated upon ( Cortini and Tria, 2014 ).

First, the total word count of both narratives by the participants were analyzed. Adolescents’ negative experience narratives were composed of 76,007 words, with a mean number of 30.84 words per narrative, while 38,452 was the number of words used to narrate the most positive experiences (with a mean of 18.22 words per narrative collected). Table 1 shows the words mostly reported in the two texts.

Table 1. The occurrence of the most reported 20 words both for positive and negative experience narratives.

Looking at word occurrence in the two texts (positive and negative experience), many communalities emerged. Among the 20 most cited words in both texts there are: “Home,” “To See,” “Experience,” “Friend,” “To feel,” “Moment,” “Person,” “School,” “Day,” “Boyfriend,” and “Family.” Overall, 11 words out of 20 are shared between the vocabulary of the two collected narratives.

Looking at the modeling emergent themes analysis, The T-Lab software revealed four themes for each text. Tables 2 , 3 summarize the emergent themes and the main words associated with each of them.

Table 2. Themes of negative experience narratives and main words for each of them.

Table 3. Themes of positive experience narratives and specific words for each of them.

Negative Experiences Narratives

For negative experiences narratives, the first and most representative theme concerned feelings of “Anguish and Loss” and was explained by 34% of lemmas. Adolescents shared their anguish for having lost physical and emotional contact with relatives due to quarantine: “I went to my grandmother’s house because she lives next door. I went to hug her and she pushed me away as if I stank, it was so ugly, I felt like a stranger” (Participant n. 1070, male 17 years old) . In this narrative, social distancing acquired the meaning of loss of intimacy in close relationships; other adolescents narrated their anguish for their parents’ and relatives’ health due to the spread of COVID-19. One participant wrote: “When I heard that both my parents were going to have to go back to work, I got very scared, and I’m still scared for their health. We have a lot of friends who are sick, some are dead and we couldn’t even say goodbye to them” (Participant n. 1234, male 16 years old).

The inability to say goodbye to relatives and friends and to experience contact with their deaths is a frequent issue in collected narratives. As shared by a female participant, grief is a process hindered by the inability to experience loss directly: “The most negative experience I had was the death of my grandfather, who died after contracting COVID-19. You will think that I’m only talking about the loss itself, but actually difficulties came later. Not because there were people crying at the funeral and I had to show myself strong in front of my parents; not because when I went to his house I couldn’t find him; not because I won’t get to be spoiled by him just like every other granddaughter is by her grandfather; but because I had to undergo this process with just my mind. I had to imagine a funeral, I had to imagine him, pale and cold, in the coffin and try to feel the dampness of the tears on my cheeks at the moment of burial. There was nothing to help me metabolize the death, to make it happen in my mind. I’m usually a crybaby, but when they told me that my grandfather died I cried only once. When I think about it I feel guilty for how insensitive I’ve been, but he’s still there for me, when I think of him I see him alive. I tried to kill him with my thoughts because that’s the reality, but how hard is it to understand someone’s death when you don’t face it? When you don’t live it?” (Participant n. 23, female 16 years old) .

The second theme explained 24% of lemmas and it was labeled “Home as a limitation to autonomy.” Participants narrated their experience of feeling a limitation to their personal autonomy in daily life activities.

A female participant narrated: “Staying at home brings me moments of nervousness and I’m easily irritable. I often have panic attacks, precisely because staying at home for so long is not good for me. One feels alone, like in a cage and suffocated feelings give rise to nervousness that causes tension” (Participant n. 645, female 16 years old). Similarly, the following narrative introduces the difficulty of finding a personal space to give voice to individual needs at home: “It’s very hard for me to concentrate and I can’t stand spending 24 hours a day with my parents arguing. I don’t even have my own bedroom, because the door is missing so I have to be with them all the time. Personally, I’m not afraid of the virus, there have always been cases in history and of course we have always come out of it unscathed; the point is that I just want to go back to having the chance to be away from home, for example at school and possibly soon at university” (Participant n. 2185, female 18 years old) . The two negative experiences suggested adolescents’ perception of living with COVID-19 as a time to forcibly lose their personal autonomy.

Another male adolescent shared the sensation of being in prison as the result of having lost an individual identity related to a state of suspension of personal desires and identity: “It’s bad to wake up in the morning knowing you can’t accomplish anything with your life, you can’t do anything. I look out the window and it’s all deserted, no more sounds of cars, buses or people talking. It’s like a changed world, it’s like being in prison for something that’s not your fault. All I can do is wait and stay at home.” (Participant n. 1460, 16 years old).

The third theme, saturating by 24% of lemmas, concerned the impact of “A new life routine.” Adolescents narrated their contact with life in quarantine as well as social distancing. Participant n. 488, a 17-year-old male, narrated his most negative experience of not recognizing his best friend because of the mask: “The worst experience I had was when I went out for the first time to go shopping, wearing a mask and gloves. It was horrible to see used masks and gloves in the street that someone threw on the ground. Across the street someone said goodbye to me. He was my best friend with his dog, but I didn’t recognize him because he was covered by the mask. My best friend!” Narratives reported the adolescents’ difficult impact with a new daily routine in which their closest relationships (best friend) and daily activities (shopping) acquire the meaning of something unusual and perturbing. Similarly, the following extract focused on the feeling of being aware of taking part in a new life routine, which is completely different from one’s wishes about adolescent life: “There is not one episode in particular, but perhaps there is the most negative ‘feeling’ of this period, and it is certainly awareness. It’s being aware that you can’t live your senior year in high school as you would have liked. It’s the awareness of not being able to kiss your mom who just came back from the supermarket with your favorite dessert. It’s the awareness that you can’t go dancing or simply talk with friends about something that isn’t the ‘war bulletin’ or the press conference that resounds in the homes of Italians every night at 6 p.m.” (Participant n. 359, female 16 years old).

The fourth emergent theme was saturated by 18% of lemmas and was labeled “School as educational but not relational environment.” Participants reported the difficulty of being engaged in educational activities, which are perceived as lacking in social opportunities. A male adolescent (n. 60, 17 years old) reported: “since there have been positive cases I’ve stayed at home, but with the online lessons and lots of homework I am getting sad and especially stressed. I wanted to talk about Bergamo with the teachers and my classmates, but there is no time and in the online lessons we only talk about school and homework.”

A participant expressed his feeling of being unwelcome and misunderstood by teachers due to the relational distance: “In my opinion this is the saddest thing that this virus has brought: we young people no longer believe in dreams, but above all in hope for a better future. The professors, instead of understanding this situation, blame us, saying that we are ‘slackers’ and that we think we are on holiday, punishing us with millions of tasks, depriving us of everything. […] So, these are the reasons why we young people are exhausted and full of repressed hatred, because we see our peers die before our eyes and teachers often don’t understand us” (Participant n. 2545, female 17 years old).

Moreover, homework and online classes work as stressors and increase the lack of relations: “I felt agitated because homework and video tutorials have stressed me so much. It’s not the same online. I understand the gravity of the situation, the images we see are terrible, all those coffins. I miss my class, the teacher coming in, everything” (Participant n. 260, male 17 years old).

Positive Experiences Narratives

Concerning positive experiences, four themes emerged from the modeling analysis.

The first theme, the most representative for positive experiences collected, covered 33% of the lemmas and dealt with “Discovering oneself.” Adolescents reported to have discovered the pleasure of spending time with themselves and dedicating time to reading, listening to music, painting, and working out on their own. In this sense, lockdown became an opportunity for self-disclosure and personal growth: “I read, studied, I’ve cooked various stuff, experimented, relaxed taking time for myself, watched TV series, movies, played chess. Everything that made me feel good. I felt accepted by myself, because I had time to think about myself much more and to reflect, making me feel like a better and acceptable person” (Participant n. 2069, male 15 years old).

Similarly, a girl narrated: “Like never before, I have time to look inside and talk to myself in my bedroom, having more doubts, being able to resolve them, or simply leaving them unresolved, discovering what confuses me and understanding who I am” (Participant n. 1369, female 18 years old) .

The second emergent theme was labeled “Sharing life at a distance” (31% of lemmas) and dealt with the opportunity to be in a close relationship even at a distance. A participant narrated his relief in feeling his best friend’s support via video-call: “I Hear my friend tell me on the video-call that everything’s going to be okay and we’re going to come out of this even stronger. She said, ‘We’ll come back and watch the sunset on the beach, we’ll come back and eat ice cream together, we’ll come back and hug everybody, have faith’. I felt safe and full of hope” (Participant n. 2721, male 14 years old).

Friendship as an anchor is a frequent issue in adolescents’ narratives: “I felt a big panic inside and I had a video-call with all my friends at 1 am in a tense moment, it helped me a lot!” (Participant n. 1970, female 17 years old).

The third emerged theme, named “Re-discovering family,” was saturated by 22% of the lemmas and focused on the positive impact of spending time with family members and discovering the joy of doing things together: “I’m realizing how precious time is, every moment must be enjoyed because we could be deprived of it at any moment. I spend more time with my parents, before they were always at work and I used to see them for a few hours” (Participant n. 881, female, 16 years old). Similarly, a boy narrated the positive value of spending time with his grandparents: “I’m spending a lot of time with my grandparents and I’m growing up because they teach me so many things I didn’t know! We’ve rediscovered board games and we often play them all together” (Participant n. 2648, 17 years old).

The last theme, “To be part of an extraordinary experience”, was saturated by 14% of the lemmas and concerned participants’ feeling of being part of an unusual experience, which will have an impact on the culture they are living in. A participant narrated: “When I’m in class and I see my classmates, even if we do a test or an inquiry, it’s still a unique experience that I will tell my kids about!” (Participant n. 2044, male 18 years old). Most of the participants reported their satisfaction in their perception of having an active role in society by following the rules of social distancing and protecting others from contagion: “For once I really felt like a fundamental part of society” (Participant 1841, female 15 years old) .

The present study aimed to explore adolescents’ experience of living during the COVID-19 emergency and national lockdown in terms of narratives on positive and negative experiences. In light of a lack of scientific evidence on adolescents’ experience of living with infectious diseases and under national lockdown, the present study brings knowledge on negative and positive issues of such an impactful experience in this peculiar developmental age of adolescence.

At first, results show that adolescents were more forthcoming about their negative experiences than about positive ones. This datum is not a surprise: scientific literature defines one’s need to “create coherence out of chaos” ( Fivush et al., 2003 , p. 1). Scientific literature highlights that negative narratives are usually longer and more coherent than positive ones, and this is due to the narrator’s need to elaborate autobiographical past by means of language ( Fioretti and Smorti, 2015 , 2017 ).

Looking at word occurrence in both texts, results show similarities between terms used to describe the most negative and positive experiences. Nevertheless, emergent themes put in light different issues related to the same words. Overall, results highlight indeed a complex experience of adolescents characterized by a developmental challenge that may entail risk factors, as in the case of loss and anguish related to illness and contagion, or protective factors, such as the possibility of transforming the COVID-19 experience into an opportunity for personal growth.

In the case of impacting experiences such as diseases or traumatic events, scholars introduced the construct of biographical disruption ( Bury, 1982 ; Fioretti and Smorti, 2014 ), which determines a strong breakdown in one’s life trajectory forcing the individual to restore it finding a continuity between past, present, and future. Concerning COVID-19, our results point out that such a biographical disruption may be associated with the interruption of important developmental tasks such as personal autonomy ( Alonso-Stuyck et al., 2018 ). Of the adolescents’ lemmas, 24% narrated lockdown as a stressor in their process of constructing an individual physical and mental environment separate from the family one.

As shown by narratives on positive experiences of living with COVID-19, home acquires a duplex meaning in adolescents’ lives: loss of autonomy, but also the place where re-discovering family as a protective factor thanks to the opportunity to share activities and to spend time together. As argued by Guessoum et al. (2020) , family time is related with less depression symptoms in adolescents. Moreover, our results suggest that family can play an active role in the co-construction of what it means to live during a pandemic and can provide support during experiences of loss, which, as results show, appear to be the most represented issue in adolescents’ narratives.

As reported by participants, the impossibility of experiencing a direct contact with loss and death may play a traumatic role in adolescents’ lives. In their narratives, grief is forcibly an intimate and individual process in which, as in the case of traumatic events, the disruption is sudden and unexpected. Starting from these results, further investigation on potential posttraumatic disorders and long-term symptoms in adolescents related to COVID-19 is needed.

If family plays a protective role in collected narratives, adolescents denounce the absence of school as a place for relationships and emotional sharing. Participants narrate how they feel like receptors of educational contents without being able to play an active role within the educational process. Passivity and the inability to find a space to share concerns and emotions about the impact of the COVID-19 disease on their lives are the base of a feeling of disconnection from the educational environment. In this sense, the current “absence” of school may constitute a risk factor in adolescents’ development, as described in scientific literature ( Feldman and Matjasko, 2005 ).

School closing is part of a broader spectrum of the breakdown of the daily routine that participants described as a negative experience. In developmental psychology, routines acquire a pivotal role in fostering the security necessary for the process of autonomy and self-definition, in childhood and adolescence ( Crocetti, 2018 ). In this sense, the new life routine of wearing masks and gloves, and performing social distancing strongly impacts the process of creating one’s own identity.

On the other hand, narratives on positive experiences also see COVID-19 as an opportunity to make contact and define certain aspects of one’s identity that have not yet been considered. As shown, the discovery of oneself plays a pivotal role in positive experiences narratives saturating 33% of lemmas in analysis.

Identity, as described by Marcia et al. (2012) , undergoes a strong process of moratorium which, as results suggest, during the quarantine also becomes a path of deeper research into one’s sense of self, without the pressure of external agents. The discovery of the self-emergent theme suggests the hypothesis of a posttraumatic growth (PTG) related to life during the COVID-19 emergency. Participants narrated their individual research of themselves and the discovery of the importance of intimate reflexivity. In literature, over time, several terms have been used to describe the positive changes experienced by a person as a result of stress: “perceived benefits” ( Calhoun and Tedeschi, 1991 ), “raising existential awareness” ( Yalom and Lieberman, 1991 ), “stress-related growth” ( Park et al., 1996 ), and “growth through adversity” ( Joseph and Linley, 2006 ). Posttraumatic growth has been defined as an individual transformation entailing both positive intrapersonal and interpersonal changes caused by the impact of facing life challenges ( Tedeschi and Calhoun, 1995 ). Our results suggest that, together with the importance of sharing experiences with peers as reported in 31% of lemmas about positive experiences, an intimate developmental process of self-moratorium was facilitated by living in lockdown due to the COVID-19 emergency. Adolescents narrate their discovery of alone-time as a personal process of growth. Studies on PTG during adolescence are still poor ( Milam et al., 2004 ) and suggest the importance of investigating potential specificities of growth in this peculiar developmental age and its correlations. Future studies could explore the construct of PTG in adolescents exposed to the COVID-19 pandemic in order to further assess a positive impact of living with the current emergency in their lives.

Limitations and Conclusion

Although it provides evidence on a topic which is unknown, the present study has some limitations. First, we did not control for narrative task administration order. All participants completed first the narrative on negative memories and, second, the one on positive experiences. For this reason, the present study did not aim to compare negative and positive experience, rather it considers them as separate narratives on autobiographical experience of living with COVID-19 pandemic.

Moreover, the sample is composed of a large percentage of females and of high school students and does not consider the portions of adolescents of the Italian population who are not currently involved in education. Further studies should consider adolescents’ varying economic and cultural backgrounds. A second limitation is related to the varying impact of the COVID-19 emergency in the different regions of Italy. Adolescents’ experiences might be related to having or not having personal contacts with the disease in their family or social environment. Future studies should focus on specific developmental challenges due to direct or indirect contact with COVID-19.

A third limitation is related to the lack of consideration of the interindividual differences. The study describes a process related to the COVID-19 in the global population without considering possible differential impacts related to personal characteristics and vulnerabilities.

To conclude, the results suggest the need to take into account the impact of lockdown in the developmental tasks of adolescence. As for the negative experiences, loss of autonomy and anguish related to death and loss are the most representative topics. Further studies could better investigate the autonomy issue related to COVID-19 emergency considering the role family and different parenting models can play. For instance, very few studies have investigated the role of pre-pandemic maltreatment experience ( Guo et al., 2020 ) or other experience related to family environment. Our results suggest the duplex role of family and invite scholars and professionals to design specific intervention programs for adolescents with family vulnerability.

Conversely, school, a pivotal developmental environment according to scientific literature, represented a smaller percentage of words in the narratives we collected for our sample, suggesting the need to debate on the lack of relation adolescents perceive in online didactic activities. Home and family may play a double role, both limiting adolescents’ acquisition of autonomy and providing an enriching setting for their personal growth. The latter, discovering oneself, is the most representative in positive experience narratives. In this sense, the starting hypothesis of the present study was left partially unconfirmed. Lockdown and life during the COVID-19 emergency may activate both a disruption and an empowering process in adolescents’ developmental tasks. Further studies are needed on psychological and social variables promoting or contrasting both processes.

In the light of scarce studies exploring narratives on COVID-19 experience, the present research supports the importance of giving language to the autobiographical past by means of methods exploring qualitatively participants’ experience. Results show that a narrative is a tool to collect information on personal experience and to generate insight starting from it. Additionally, a narrative allows narrators emotional disclosure and to give meaning to their life story ( Bruner, 1990 ; McAdams et al., 2006 ). This meaning-making process is even more important in developmental ages, as adolescence is, characterized by self and identity definition and growth of autobiographical process skills ( Habermas and Bluck, 2000 ). We support the need to further investigate adolescents’ narratives in this pandemic transition both as a tool to collect data and as an intervention to promote well-being through emotional and intrapsychic disclosure.

Data Availability Statement

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

Ethics Statement

The studies involving human participants were reviewed and approved by the Commissione per l’Etica della Ricerca, Università degli Studi di Firenze. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.

Author Contributions

CF, BP, AN, and EM conceived and performed the study design, data collection, and mastered the data. CF ran the data analysis. BP, AN, and EM discussed the results. CF wrote the manuscript with the support of BP and AN. EM and AN supervised the project and manuscript preparation. All authors contributed to the article and approved the submitted version.

Conflict of Interest

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

Acknowledgments

We are thankful to Skuola.net and especially its CEO, Daniele Grassucci and Carla Ardizzone and Marcello Gelardini, for the support with data collection. This research would have not been possible without their help during the hard time of the COVID-19 pandemic.

• ^ www.skuola.net

Alonso-Stuyck, P., Zacarés, J. J., and Ferreres, A. (2018). Emotional separation, autonomy in decision-making, and psychosocial adjustment in adolescence: a proposed typology. J. Child Fam. Stud. 27, 1373–1383. doi: 10.1007/s10826-017-0980-5

CrossRef Full Text | Google Scholar

Blei, D. M., Ng, A. Y., and Jordan, M. I. (2003). Latent dirichlet allocation. J. Mach. Learn. Res. 3, 993–1022.

Google Scholar

Bruner, J. S. (1990). Acts of Meaning. Cambridge, MA: Harvard university press.

Bury, M. (1982). Chronic illness as biographical disruption. Sociol. Health Illness 4, 167–182. doi: 10.1111/1467-9566.ep11339939

PubMed Abstract | CrossRef Full Text | Google Scholar

Calhoun, L. G., and Tedeschi, R. G. (1991). Perceiving benefits in trau matic events: some issues for practicing psychologists. J. Train. Pract. Prof. Psychol. 5, 45–52.

Cortini, M., and Tria, S. (2014). Triangulating qualitative and quantitative approaches for the analysis of textual materials: an introduction to T-lab. Soc. Sci. Comput. Rev. 32, 561–568. doi: 10.1177/0894439313510108

Crocetti, E. (2018). Identity dynamics in adolescence: processes, antecedents, and consequences. Eur. J. Dev. Psychol. 15, 11–23. doi: 10.1080/17405629.2017.1405578

Dodgson, J. E., Tarrant, M., Chee, Y.-O., and Watkins, A. (2010). New mothers’ experiences of social disruption and isolation during the severe acute respiratory syndrome outbreak in Hong Kong. Nurs. Health Sci. 12, 198–204. doi: 10.1111/j.1442-2018.2010.00520.x

Ellis, W. E., Dumas, T. M., and Forbes, L. M. (2020). Physically isolated but socially connected: Psychological adjustment and stress among adolescents during the initial COVID-19 crisis. Can. J. Behav. 52, 177–187. doi: 10.1037/cbs0000215

Erikson, E. H. (1968). Identity Youth and Crisis. New York, NY: W.W. Norton Inc.

Feldman, A. F., and Matjasko, J. L. (2005). The role of school-based extracurricular activities in adolescent development: a comprehensive review and future directions. Rev. Educ. Res. 75, 159–210. doi: 10.3102/00346543075002159

Fioretti, C., and Smorti, A. (2014). Improving doctor-patient communication through an autobiographical narrative theory. Commun. Med. 11, 275–284. doi: 10.1558/cam.v11i3.20369

Fioretti, C., and Smorti, A. (2015). How emotional content of memories changes in narrative. Narrat. Inq. 25, 37–56. doi: 10.1075/ni.25.1.03fio

Fioretti, C., and Smorti, A. (2017). Narrating positive versus negative memories of illness: does narrating influence the availability and the emotional involvement of memories of illness? Eur. J. Cancer Care 23, 1–7. doi: 10.1111/ECC.12524

Fivush, R., Hazzard, A., McDermott Sales, J., Sarfati, D., and Brown, T. (2003). Creating coherence out of chaos? Children’s narratives of emotionally positive and negative events. Appl. Cogn. Psychol. 17, 1–19. doi: 10.1002/acp.854

Green, J., and Thorogood, N. (2018). Qualitative Methods for Health Research. Thousand Oaks, CA: Sage Pubblications.

Guessoum, S. B., Lachal, J., Radjack, R., Carretier, E., Minassian, S., Benoit, L., et al. (2020). Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown. Psychiatry Res. 291:113264. doi: 10.1016/j.psychres.2020.113264

Guo, J., Fu, M., Liu, D., Zhan, B., Wang, X., and van IJzendoorn, M. H. (2020). Is the psychological impact of exposure to COVID-19 stronger in adolescents with pre-pandemic maltreatment experiences? a survey of rural chinese adolescents. Child Abuse Neglect. 2020:104667. doi: 10.1016/j.chiabu.2020.104667

Habermas, T., and Bluck, S. (2000). Getting a life: the emergence of the life story in adolescence. Psychol. Bull. 126:748. doi: 10.1037/0033-2909.126.5.748

Havighurst, R. J. (1948). Developmental Tasks and Education. Chicago: University of Chicago Press.

Italian Ministry of Health (2020). COVID-19 Daily New Cases and Deaths in Italy. Rome: Italian Ministry of Health.

Johns Hopkins Coronavirus Resource Center (2020). Cases and Mortality by Country. Available online at: https://coronavirus.jhu.edu/ (accessed July 13, 2020).

Jones, R. M., Vaterlaus, J. M., Jackson, M. A., and Morrill, T. B. (2014). Friendship characteristics, psychosocial development, and adolescent identity formation. Pers. Relationsh. 21, 51–67. doi: 10.1111/pere.12017

Joseph, S., and Linley, P. A. (2006). Growth following adversity: theoretical perspectives and implications for clinical practice. Clin. Psychol. Rev. 26, 1041–1053. doi: 10.1016/j.cpr.2005.12.006

Kroger, J., and Marcia, J. E. (2011). “The identity statuses: origins, meanings, and interpretations,” in Handbook of Identity Theory and Research , eds S. J. Schwartz, K. Luyckx, and V. L. Vignoles (New York, NY: Springer), 31–53. doi: 10.1007/978-1-4419-7988-9_2

Kroger, J., Martinussen, M., and Marcia, J. E. (2010). Identity status change during adolescence and young adulthood: a meta-analysis. J. Adolesc. 33, 683–698. doi: 10.1016/j.adolescence.2009.11.002

Lancia, F. (2004). Strumenti Per L’analisi dei Testi [Tools for Textual Analysis]. Milan: FrancoAngeli.

Lannegrand-Willems, L., and Bosma, H. A. (2006). Identity development-in-context: the school as an important context for identity development. Identity 6, 85–113. doi: 10.1207/s1532706xid0601_6

Lee, J. (2020). Mental health effects of school closures during COVID-19. Lancet Child Adolesc. Health 4:421. doi: 10.1016/S2352-4642(20)30109-7

Main, A., Zhou, Q., Ma, Y., Luecken, L. J., and Liu, X. (2011). Relations of SARS-related stressors and coping to Chinese college students’ psychological adjustment during the 2003 Beijing SARS epidemic. J. Counsel. Psychol. 58, 410–423. doi: 10.1037/a0023632

Marcia, J. E., Waterman, A. S., Matteson, D. R., Archer, S. L., and Orlofsky, J. L. (2012). Ego Identity: A Handbook for Psychosocial Research. Berlin: Springer Science & Business Media.

McAdams, D. P., Bauer, J. J., Sakaeda, A. R., Anyidoho, N. A., Machado, M. A., Magrino-Failla, K., et al. (2006). Continuity and change in the life story: a longitudinal study of autobiographical memories in emerging adulthood. J. Pers. 74, 1371–1400. doi: 10.1111/j.1467-6494.2006.00412.x

Milam, J. E., Ritt-Olson, A., and Unger, J. B. (2004). Posttraumatic growth among adolescents. J. Adolesc. Res. 19, 192–204.

Noom, M. J., Deković, M., and Meeus, W. (2001). Conceptual analysis and measurement of adolescent autonomy. J. Youth Adolesc. 30, 577–595. doi: 10.1023/a:1010400721676

Oosterhoff, B., Palmer, C. A., Wilson, J., and Shook, N. (2020). Adolescents’ motivations to engage in social distancing during the COVID-19 pandemic: associations with mental and social health. J. Adolesc. Health 67, 179–185. doi: 10.1016/j.jadohealth.2020.05.004

Park, C. L., Cohen, L. H., and Murch, R. L. (1996). Assessment and prediction of stress-related growth. J. Pers. 64, 71–105. doi: 10.1111/j.1467-6494.1996.tb00815.x

Peng, E. Y.-C., Lee, M.-B., Tsai, S.-T., Yang, C.-C., Morisky, D. E., Tsai, L.-T., et al. (2010). Population-based post-crisis psychological distress: an example from the SARS outbreak in Taiwan. J. Form. Med. Assoc. 109, 524–532. doi: 10.1016/S0929-6646(10)60087-3

Pennebaker, J. W. (1997). Opening Up: The Healing Power of Expressing Emotions. New York, NY: Guilford Press.

Pennebaker, J. W., Mehl, M. R., and Niederhoffer, K. G. (2003). Psychological aspects of natural language use: our words, our selves. Annu. Rev. Psychol. 54, 547–577. doi: 10.1146/annurev.psych.54.101601.145041

Qiu, J., Shen, B., Zhao, M., Wang, Z., Xie, B., and Xu, Y. (2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen. Psychiatr. 33, 1–3. doi: 10.1136/gpsych-2020-100213

Rajkumar, R. P. (2020). COVID-19 and mental health: a review of the existing literature. Asian J. Psychiatr. 52:102066. doi: 10.1016/j.ajp.2020.102066

Rossi, R., Socci, V., Talevi, D., Mensi, S., Niolu, C., Pacitti, F., et al. (2020). COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. An N = 18147 web-based survey. medRxiv [Preprint], doi: 10.1101/2020.04.09.20057802

Tedeschi, R. G., and Calhoun, L. G. (1995). Trauma & Transformation: Growing in the Aftermath of Suffering. Thousand Oaks, CA: Sage Publications Inc.

Tuohy, R., and Stephens, C. (2012). Older adults’ narratives about a flood disaster: resilience, coherence, and personal identity. J. Aging Stud. 26, 26–34. doi: 10.1016/j.jaging.2011.06.002

Van Bortel, T., Basnayake, A., Wurie, F., Jambai, M., Koroma, A. S., Muana, A. T., et al. (2016). Psychosocial effects of an Ebola outbreak at individual, community and international levels. Bull. World Health Organ. 94, 210–214. doi: 10.2471/BLT.15.158543

Van Petegem, S., Vansteenkiste, M., and Beyers, W. (2013). The jinglejangle fallacy in adolescent autonomy in the family: in search of an underlying structure. J. Youth Adolesc. 42, 994–1014. doi: 10.1007/s10964-012-9847-7

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., et al. (2020a). Immediate psychological responses and associated factors during the initial stage of the 2019 Coronavirus disease (COVID-19) epidemic among the general population in China. Intern. J. Environ. Res. Public Health 17:1729. doi: 10.3390/ijerph17051729

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., McIntyre, R. S., et al. (2020b). A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain Behav. Immun. 87, 40–48. doi: 10.1016/j.bbi.2020.04.028

Xie, X., Xue, Q., Zhou, Y., Zhu, K., Liu, Q., Zhang, J., et al. (2020). Mental Health Status Among children in home confinement during the Coronavirus disease 2019 outbreak in Hubei province, China. JAMA Pediatr. 174, 898–900. doi: 10.1001/jamapediatrics.2020.1619

Yalom, I. D., and Lieberman, M. A. (1991). Bereavement and heightened existential awareness. Psychiatry 54, 334–345. doi: 10.1080/00332747.1991.11024563

Yeung, D. Y.-L., and Fung, H. H. (2007). Age differences in coping and emotional responses toward SARS: a longitudinal study of Hong Kong Chinese. Aging Ment. Health 11, 579–587. doi: 10.1080/13607860601086355

Keywords : adolescence, COVID-19, narratives, identity, qualitative research

Citation: Fioretti C, Palladino BE, Nocentini A and Menesini E (2020) Positive and Negative Experiences of Living in COVID-19 Pandemic: Analysis of Italian Adolescents’ Narratives. Front. Psychol. 11:599531. doi: 10.3389/fpsyg.2020.599531

Received: 27 August 2020; Accepted: 12 October 2020; Published: 19 November 2020.

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

*Correspondence: Chiara Fioretti, [email protected]

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8 Lessons We Can Learn From the COVID-19 Pandemic

BY KATHY KATELLA May 14, 2021

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

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

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

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

Lesson 1: Masks are useful tools

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

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

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

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

Lesson 2: Telehealth might become the new normal

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

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

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

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

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

Lesson 3: Vaccines are powerful tools

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

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

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

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

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

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

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

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

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

Lesson 5: We need to take mental health seriously

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

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

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

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

Lesson 6: We have the capacity for resilience

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

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

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

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

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

Lesson 7: Community is essential—and technology is too

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

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

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

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

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

Lesson 8: Sometimes you need a dose of humility

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

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

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

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

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Students’ experience of online learning during the COVID‐19 pandemic: A province‐wide survey study

Lixiang yan.

1 Centre for Learning Analytics at Monash, Faculty of Information Technology, Monash University, Clayton VIC, Australia

Alexander Whitelock‐Wainwright

2 Portfolio of the Deputy Vice‐Chancellor (Education), Monash University, Melbourne VIC, Australia

Quanlong Guan

3 Department of Computer Science, Jinan University, Guangzhou China

Gangxin Wen

4 College of Cyber Security, Jinan University, Guangzhou China

Dragan Gašević

Guanliang chen, associated data.

The data is not openly available as it is restricted by the Chinese government.

Online learning is currently adopted by educational institutions worldwide to provide students with ongoing education during the COVID‐19 pandemic. Even though online learning research has been advancing in uncovering student experiences in various settings (i.e., tertiary, adult, and professional education), very little progress has been achieved in understanding the experience of the K‐12 student population, especially when narrowed down to different school‐year segments (i.e., primary and secondary school students). This study explores how students at different stages of their K‐12 education reacted to the mandatory full‐time online learning during the COVID‐19 pandemic. For this purpose, we conducted a province‐wide survey study in which the online learning experience of 1,170,769 Chinese students was collected from the Guangdong Province of China. We performed cross‐tabulation and Chi‐square analysis to compare students’ online learning conditions, experiences, and expectations. Results from this survey study provide evidence that students’ online learning experiences are significantly different across school years. Foremost, policy implications were made to advise government authorises and schools on improving the delivery of online learning, and potential directions were identified for future research into K‐12 online learning.

Practitioner notes

What is already known about this topic

• Online learning has been widely adopted during the COVID‐19 pandemic to ensure the continuation of K‐12 education.
• Student success in K‐12 online education is substantially lower than in conventional schools.
• Students experienced various difficulties related to the delivery of online learning.

What this paper adds

• Provide empirical evidence for the online learning experience of students in different school years.
• Identify the different needs of students in primary, middle, and high school.
• Identify the challenges of delivering online learning to students of different age.

Implications for practice and/or policy

• Authority and schools need to provide sufficient technical support to students in online learning.
• The delivery of online learning needs to be customised for students in different school years.

INTRODUCTION

The ongoing COVID‐19 pandemic poses significant challenges to the global education system. By July 2020, the UN Educational, Scientific and Cultural Organization (2020) reported nationwide school closure in 111 countries, affecting over 1.07 billion students, which is around 61% of the global student population. Traditional brick‐and‐mortar schools are forced to transform into full‐time virtual schools to provide students with ongoing education (Van Lancker & Parolin,  2020 ). Consequently, students must adapt to the transition from face‐to‐face learning to fully remote online learning, where synchronous video conferences, social media, and asynchronous discussion forums become their primary venues for knowledge construction and peer communication.

For K‐12 students, this sudden transition is problematic as they often lack prior online learning experience (Barbour & Reeves,  2009 ). Barbour and LaBonte ( 2017 ) estimated that even in countries where online learning is growing rapidly, such as USA and Canada, less than 10% of the K‐12 student population had prior experience with this format. Maladaptation to online learning could expose inexperienced students to various vulnerabilities, including decrements in academic performance (Molnar et al.,  2019 ), feeling of isolation (Song et al.,  2004 ), and lack of learning motivation (Muilenburg & Berge,  2005 ). Unfortunately, with confirmed cases continuing to rise each day, and new outbreaks occur on a global scale, full‐time online learning for most students could last longer than anticipated (World Health Organization,  2020 ). Even after the pandemic, the current mass adoption of online learning could have lasting impacts on the global education system, and potentially accelerate and expand the rapid growth of virtual schools on a global scale (Molnar et al.,  2019 ). Thus, understanding students' learning conditions and their experiences of online learning during the COVID pandemic becomes imperative.

Emerging evidence on students’ online learning experience during the COVID‐19 pandemic has identified several major concerns, including issues with internet connection (Agung et al.,  2020 ; Basuony et al.,  2020 ), problems with IT equipment (Bączek et al.,  2021 ; Niemi & Kousa,  2020 ), limited collaborative learning opportunities (Bączek et al.,  2021 ; Yates et al.,  2020 ), reduced learning motivation (Basuony et al.,  2020 ; Niemi & Kousa,  2020 ; Yates et al.,  2020 ), and increased learning burdens (Niemi & Kousa,  2020 ). Although these findings provided valuable insights about the issues students experienced during online learning, information about their learning conditions and future expectations were less mentioned. Such information could assist educational authorises and institutions to better comprehend students’ difficulties and potentially improve their online learning experience. Additionally, most of these recent studies were limited to higher education, except for Yates et al. ( 2020 ) and Niemi and Kousa’s ( 2020 ) studies on senior high school students. Empirical research targeting the full spectrum of K‐12students remain scarce. Therefore, to address these gaps, the current paper reports the findings of a large‐scale study that sought to explore K‐12 students’ online learning experience during the COVID‐19 pandemic in a provincial sample of over one million Chinese students. The findings of this study provide policy recommendations to educational institutions and authorities regarding the delivery of K‐12 online education.

LITERATURE REVIEW

Learning conditions and technologies.

Having stable access to the internet is critical to students’ learning experience during online learning. Berge ( 2005 ) expressed the concern of the divide in digital‐readiness, and the pedagogical approach between different countries could influence students’ online learning experience. Digital‐readiness is the availability and adoption of information technologies and infrastructures in a country. Western countries like America (3rd) scored significantly higher in digital‐readiness compared to Asian countries like China (54th; Cisco,  2019 ). Students from low digital‐readiness countries could experience additional technology‐related problems. Supporting evidence is emerging in recent studies conducted during the COVID‐19 pandemic. In Egypt's capital city, Basuony et al. ( 2020 ) found that only around 13.9%of the students experienced issues with their internet connection. Whereas more than two‐thirds of the students in rural Indonesia reported issues of unstable internet, insufficient internet data, and incompatible learning device (Agung et al.,  2020 ).

Another influential factor for K‐12 students to adequately adapt to online learning is the accessibility of appropriate technological devices, especially having access to a desktop or a laptop (Barbour et al., 2018 ). However, it is unlikely for most of the students to satisfy this requirement. Even in higher education, around 76% of students reported having incompatible devices for online learning and only 15% of students used laptop for online learning, whereas around 85% of them used smartphone (Agung et al.,  2020 ). It is very likely that K‐12 students also suffer from this availability issue as they depend on their parents to provide access to relevant learning devices.

Technical issues surrounding technological devices could also influence students’ experience in online learning. (Barbour & Reeves,  2009 ) argues that students need to have a high level of digital literacy to find and use relevant information and communicate with others through technological devices. Students lacking this ability could experience difficulties in online learning. Bączek et al. ( 2021 ) found that around 54% of the medical students experienced technical problems with IT equipment and this issue was more prevalent in students with lower years of tertiary education. Likewise, Niemi and Kousa ( 2020 ) also find that students in a Finish high school experienced increased amounts of technical problems during the examination period, which involved additional technical applications. These findings are concerning as young children and adolescent in primary and lower secondary school could be more vulnerable to these technical problems as they are less experienced with the technologies in online learning (Barbour & LaBonte,  2017 ). Therefore, it is essential to investigate the learning conditions and the related difficulties experienced by students in K‐12 education as the extend of effects on them remain underexplored.

Learning experience and interactions

Apart from the aforementioned issues, the extent of interaction and collaborative learning opportunities available in online learning could also influence students’ experience. The literature on online learning has long emphasised the role of effective interaction for the success of student learning. According to Muirhead and Juwah ( 2004 ), interaction is an event that can take the shape of any type of communication between two or subjects and objects. Specifically, the literature acknowledges the three typical forms of interactions (Moore,  1989 ): (i) student‐content, (ii) student‐student, and (iii) student‐teacher. Anderson ( 2003 ) posits, in the well‐known interaction equivalency theorem, learning experiences will not deteriorate if only one of the three interaction is of high quality, and the other two can be reduced or even eliminated. Quality interaction can be accomplished by across two dimensions: (i) structure—pedagogical means that guide student interaction with contents or other students and (ii) dialogue—communication that happens between students and teachers and among students. To be able to scale online learning and prevent the growth of teaching costs, the emphasise is typically on structure (i.e., pedagogy) that can promote effective student‐content and student‐student interaction. The role of technology and media is typically recognised as a way to amplify the effect of pedagogy (Lou et al.,  2006 ). Novel technological innovations—for example learning analytics‐based personalised feedback at scale (Pardo et al.,  2019 ) —can also empower teachers to promote their interaction with students.

Online education can lead to a sense of isolation, which can be detrimental to student success (McInnerney & Roberts,  2004 ). Therefore, integration of social interaction into pedagogy for online learning is essential, especially at the times when students do not actually know each other or have communication and collaboration skills underdeveloped (Garrison et al.,  2010 ; Gašević et al.,  2015 ). Unfortunately, existing evidence suggested that online learning delivery during the COVID‐19 pandemic often lacks interactivity and collaborative experiences (Bączek et al.,  2021 ; Yates et al.,  2020 ). Bączek et al., ( 2021 ) found that around half of the medical students reported reduced interaction with teachers, and only 4% of students think online learning classes are interactive. Likewise, Yates et al. ( 2020 )’s study in high school students also revealed that over half of the students preferred in‐class collaboration over online collaboration as they value the immediate support and the proximity to teachers and peers from in‐class interaction.

Learning expectations and age differentiation

Although these studies have provided valuable insights and stressed the need for more interactivity in online learning, K‐12 students in different school years could exhibit different expectations for the desired activities in online learning. Piaget's Cognitive Developmental Theory illustrated children's difficulties in understanding abstract and hypothetical concepts (Thomas,  2000 ). Primary school students will encounter many abstract concepts in their STEM education (Uttal & Cohen,  2012 ). In face‐to‐face learning, teachers provide constant guidance on students’ learning progress and can help them to understand difficult concepts. Unfortunately, the level of guidance significantly drops in online learning, and, in most cases, children have to face learning obstacles by themselves (Barbour,  2013 ). Additionally, lower primary school students may lack the metacognitive skills to use various online learning functions, maintain engagement in synchronous online learning, develop and execute self‐regulated learning plans, and engage in meaningful peer interactions during online learning (Barbour,  2013 ; Broadbent & Poon,  2015 ; Huffaker & Calvert, 2003; Wang et al.,  2013 ). Thus, understanding these younger students’ expectations is imperative as delivering online learning to them in the same way as a virtual high school could hinder their learning experiences. For students with more matured metacognition, their expectations of online learning could be substantially different from younger students. Niemi et al.’s study ( 2020 ) with students in a Finish high school have found that students often reported heavy workload and fatigue during online learning. These issues could cause anxiety and reduce students’ learning motivation, which would have negative consequences on their emotional well‐being and academic performance (Niemi & Kousa,  2020 ; Yates et al.,  2020 ), especially for senior students who are under the pressure of examinations. Consequently, their expectations of online learning could be orientated toward having additional learning support functions and materials. Likewise, they could also prefer having more opportunities for peer interactions as these interactions are beneficial to their emotional well‐being and learning performance (Gašević et al., 2013 ; Montague & Rinaldi, 2001 ). Therefore, it is imperative to investigate the differences between online learning expectations in students of different school years to suit their needs better.

Research questions

By building upon the aforementioned relevant works, this study aimed to contribute to the online learning literature with a comprehensive understanding of the online learning experience that K‐12 students had during the COVID‐19 pandemic period in China. Additionally, this study also aimed to provide a thorough discussion of what potential actions can be undertaken to improve online learning delivery. Formally, this study was guided by three research questions (RQs):

RQ1 . What learning conditions were experienced by students across 12 years of education during their online learning process in the pandemic period? RQ2 . What benefits and obstacles were perceived by students across 12 years of education when performing online learning? RQ3 . What expectations do students, across 12 years of education, have for future online learning practices ?

Participants

The total number of K‐12 students in the Guangdong Province of China is around 15 million. In China, students of Year 1–6, Year 7–9, and Year 10–12 are referred to as students of primary school, middle school, and high school, respectively. Typically, students in China start their study in primary school at the age of around six. At the end of their high‐school study, students have to take the National College Entrance Examination (NCEE; also known as Gaokao) to apply for tertiary education. The survey was administrated across the whole Guangdong Province, that is the survey was exposed to all of the 15 million K‐12 students, though it was not mandatory for those students to accomplish the survey. A total of 1,170,769 students completed the survey, which accounts for a response rate of 7.80%. After removing responses with missing values and responses submitted from the same IP address (duplicates), we had 1,048,575 valid responses, which accounts to about 7% of the total K‐12 students in the Guangdong Province. The number of students in different school years is shown in Figure  1 . Overall, students were evenly distributed across different school years, except for a smaller sample in students of Year 10–12.

The number of students in each school year

Survey design

The survey was designed collaboratively by multiple relevant parties. Firstly, three educational researchers working in colleges and universities and three educational practitioners working in the Department of Education in Guangdong Province were recruited to co‐design the survey. Then, the initial draft of the survey was sent to 30 teachers from different primary and secondary schools, whose feedback and suggestions were considered to improve the survey. The final survey consisted of a total of 20 questions, which, broadly, can be classified into four categories: demographic, behaviours, experiences, and expectations. Details are available in Appendix.

All K‐12 students in the Guangdong Province were made to have full‐time online learning from March 1, 2020 after the outbreak of COVID‐19 in January in China. A province‐level online learning platform was provided to all schools by the government. In addition to the learning platform, these schools can also use additional third‐party platforms to facilitate the teaching activities, for example WeChat and Dingding, which provide services similar to WhatsApp and Zoom. The main change for most teachers was that they had to shift the classroom‐based lectures to online lectures with the aid of web‐conferencing tools. Similarly, these teachers also needed to perform homework marking and have consultation sessions in an online manner.

The Department of Education in the Guangdong Province of China distributed the survey to all K‐12 schools in the province on March 21, 2020 and collected responses on March 26, 2020. Students could access and answer the survey anonymously by either scan the Quick Response code along with the survey or click the survey address link on their mobile device. The survey was administrated in a completely voluntary manner and no incentives were given to the participants. Ethical approval was granted by the Department of Education in the Guangdong Province. Parental approval was not required since the survey was entirely anonymous and facilitated by the regulating authority, which satisfies China's ethical process.

The original survey was in Chinese, which was later translated by two bilingual researchers and verified by an external translator who is certified by the Australian National Accreditation Authority of Translators and Interpreters. The original and translated survey questionnaires are available in Supporting Information. Given the limited space we have here and the fact that not every survey item is relevant to the RQs, the following items were chosen to answer the RQs: item Q3 (learning media) and Q11 (learning approaches) for RQ1, item Q13 (perceived obstacle) and Q19 (perceived benefits) for RQ2, and item Q19 (expected learning activities) for RQ3. Cross‐tabulation based approaches were used to analyse the collected data. To scrutinise whether the differences displayed by students of different school years were statistically significant, we performed Chi‐square tests and calculated the Cramer's V to assess the strengths of the association after chi‐square had determined significance.

For the analyses, students were segmented into four categories based on their school years, that is Year 1–3, Year 4–6, Year 7–9, and Year 10–12, to provide a clear understanding of the different experiences and needs that different students had for online learning. This segmentation was based on the educational structure of Chinese schools: elementary school (Year 1–6), middle school (Year 7–9), and high school (Year 10–12). Children in elementary school can further be segmented into junior (Year 1–3) or senior (Year 4–6) students because senior elementary students in China are facing more workloads compared to junior students due to the provincial Middle School Entry Examination at the end of Year 6.

Learning conditions—RQ1

Learning media.

The Chi‐square test showed significant association between school years and students’ reported usage of learning media, χ 2 (55, N  = 1,853,952) = 46,675.38, p  < 0.001. The Cramer's V is 0.07 ( df ∗ = 5), which indicates a small‐to‐medium effect according to Cohen’s ( 1988 ) guidelines. Based on Figure  2 , we observed that an average of up to 87.39% students used smartphones to perform online learning, while only 25.43% students used computer, which suggests that smartphones, with widespread availability in China (2020), have been adopted by students for online learning. As for the prevalence of the two media, we noticed that both smartphones ( χ 2 (3, N  = 1,048,575) = 9,395.05, p < 0.001, Cramer's V  = 0.10 ( df ∗ = 1)) and computers ( χ 2 (3, N  = 1,048,575) = 11,025.58, p <.001, Cramer's V  = 0.10 ( df ∗ = 1)) were more adopted by high‐school‐year (Year 7–12) than early‐school‐year students (Year 1–6), both with a small effect size. Besides, apparent discrepancies can be observed between the usages of TV and paper‐based materials across different school years, that is early‐school‐year students reported more TV usage ( χ 2 (3, N  = 1,048,575) = 19,505.08, p <.001), with a small‐to‐medium effect size, Cramer's V  = 0.14( df ∗ = 1). High‐school‐year students (especially Year 10–12) reported more usage of paper‐based materials ( χ 2 (3, N  = 1,048,575) = 23,401.64, p < 0.001), with a small‐to‐medium effect size, Cramer's V  = 0.15( df ∗ = 1).

Learning media used by students in online learning

Learning approaches

School years is also significantly associated with the different learning approaches students used to tackle difficult concepts during online learning, χ 2 (55, N  = 2,383,751) = 58,030.74, p < 0.001. The strength of this association is weak to moderate as shown by the Cramer's V (0.07, df ∗ = 5; Cohen,  1988 ). When encountering problems related to difficult concepts, students typically chose to “solve independently by searching online” or “rewatch recorded lectures” instead of consulting to their teachers or peers (Figure  3 ). This is probably because, compared to classroom‐based education, it is relatively less convenient and more challenging for students to seek help from others when performing online learning. Besides, compared to high‐school‐year students, early‐school‐year students (Year 1–6), reported much less use of “solve independently by searching online” ( χ 2 (3, N  = 1,048,575) = 48,100.15, p <.001), with a small‐to‐medium effect size, Cramer's V  = 0.21 ( df ∗ = 1). Also, among those approaches of seeking help from others, significantly more high‐school‐year students preferred “communicating with other students” than early‐school‐year students ( χ 2 (3, N  = 1,048,575) = 81,723.37, p < 0.001), with a medium effect size, Cramer's V  = 0.28 ( df ∗ = 1).

Learning approaches used by students in online learning

Perceived benefits and obstacles—RQ2

Perceived benefits.

The association between school years and perceived benefits in online learning is statistically significant, χ 2 (66, N  = 2,716,127) = 29,534.23, p  < 0.001, and the Cramer's V (0.04, df ∗ = 6) indicates a small effect (Cohen,  1988 ). Unsurprisingly, benefits brought by the convenience of online learning are widely recognised by students across all school years (Figure  4 ), that is up to 75% of students reported that it is “more convenient to review course content” and 54% said that they “can learn anytime and anywhere” . Besides, we noticed that about 50% of early‐school‐year students appreciated the “access to courses delivered by famous teachers” and 40%–47% of high‐school‐year students indicated that online learning is “helpful to develop self‐regulation and autonomy” .

Perceived benefits of online learning reported by students

Perceived obstacles

The Chi‐square test shows a significant association between school years and students’ perceived obstacles in online learning, χ 2 (77, N  = 2,699,003) = 31,987.56, p < 0.001. This association is relatively weak as shown by the Cramer's V (0.04, df ∗ = 7; Cohen,  1988 ). As shown in Figure  5 , the biggest obstacles encountered by up to 73% of students were the “eyestrain caused by long staring at screens” . Disengagement caused by nearby disturbance was reported by around 40% of students, especially those of Year 1–3 and 10–12. Technological‐wise, about 50% of students experienced poor Internet connection during their learning process, and around 20% of students reported the “confusion in setting up the platforms” across of school years.

Perceived obstacles of online learning reported by students

Expectations for future practices of online learning – RQ3

Online learning activities.

The association between school years and students’ expected online learning activities is significant, χ 2 (66, N  = 2,416,093) = 38,784.81, p < 0.001. The Cramer's V is 0.05 ( df ∗ = 6) which suggests a small effect (Cohen,  1988 ). As shown in Figure  6 , the most expected activity for future online learning is “real‐time interaction with teachers” (55%), followed by “online group discussion and collaboration” (38%). We also observed that more early‐school‐year students expect reflective activities, such as “regular online practice examinations” ( χ 2 (3, N  = 1,048,575) = 11,644.98, p < 0.001), with a small effect size, Cramer's V  = 0.11 ( df ∗ = 1). In contrast, more high‐school‐year students expect “intelligent recommendation system …” ( χ 2 (3, N  = 1,048,575) = 15,327.00, p < 0.001), with a small effect size, Cramer's V  = 0.12 ( df ∗ = 1).

Students’ expected online learning activities

Regarding students’ learning conditions, substantial differences were observed in learning media, family dependency, and learning approaches adopted in online learning between students in different school years. The finding of more computer and smartphone usage in high‐school‐year than early‐school‐year students can probably be explained by that, with the growing abilities in utilising these media as well as the educational systems and tools which run on these media, high‐school‐year students tend to make better use of these media for online learning practices. Whereas, the differences in paper‐based materials may imply that high‐school‐year students in China have to accomplish a substantial amount of exercise, assignments, and exam papers to prepare for the National College Entrance Examination (NCEE), whose delivery was not entirely digitised due to the sudden transition to online learning. Meanwhile, high‐school‐year students may also have preferred using paper‐based materials for exam practice, as eventually, they would take their NCEE in the paper format. Therefore, these substantial differences in students’ usage of learning media should be addressed by customising the delivery method of online learning for different school years.

Other than these between‐age differences in learning media, the prevalence of smartphone in online learning resonates with Agung et al.’s ( 2020 ) finding on the issues surrounding the availability of compatible learning device. The prevalence of smartphone in K‐12 students is potentially problematic as the majority of the online learning platform and content is designed for computer‐based learning (Berge,  2005 ; Molnar et al.,  2019 ). Whereas learning with smartphones has its own unique challenges. For example, Gikas and Grant ( 2013 ) discovered that students who learn with smartphone experienced frustration with the small screen‐size, especially when trying to type with the tiny keypad. Another challenge relates to the distraction of various social media applications. Although similar distractions exist in computer and web‐based social media, the level of popularity, especially in the young generation, are much higher in mobile‐based social media (Montag et al.,  2018 ). In particular, the message notification function in smartphones could disengage students from learning activities and allure them to social media applications (Gikas & Grant,  2013 ). Given these challenges of learning with smartphones, more research efforts should be devoted to analysing students’ online learning behaviour in the setting of mobile learning to accommodate their needs better.

The differences in learning approaches, once again, illustrated that early‐school‐year students have different needs compared to high‐school‐year students. In particular, the low usage of the independent learning methods in early‐school‐year students may reflect their inability to engage in independent learning. Besides, the differences in help seeking behaviours demonstrated the distinctive needs for communication and interaction between different students, that is early‐school‐year students have a strong reliance on teachers and high‐school‐year students, who are equipped with stronger communication ability, are more inclined to interact with their peers. This finding implies that the design of online learning platforms should take students’ different needs into account. Thus, customisation is urgently needed for the delivery of online learning to different school years.

In terms of the perceived benefits and challenges of online learning, our results resonate with several previous findings. In particular, the benefits of convenience are in line with the flexibility advantages of online learning, which were mentioned in prior works (Appana,  2008 ; Bączek et al.,  2021 ; Barbour,  2013 ; Basuony et al.,  2020 ; Harvey et al.,  2014 ). Early‐school‐year students’ higher appreciation in having “access to courses delivered by famous teachers” and lower appreciation in the independent learning skills developed through online learning are also in line with previous literature (Barbour,  2013 ; Harvey et al.,  2014 ; Oliver et al.,  2009 ). Again, these similar findings may indicate the strong reliance that early‐school‐year students place on teachers, while high‐school‐year students are more capable of adapting to online learning by developing independent learning skills.

Technology‐wise, students’ experience of poor internet connection and confusion in setting up online learning platforms are particularly concerning. The problem of poor internet connection corroborated the findings reported in prior studies (Agung et al.,  2020 ; Barbour,  2013 ; Basuony et al.,  2020 ; Berge,  2005 ; Rice,  2006 ), that is the access issue surrounded the digital divide as one of the main challenges of online learning. In the era of 4G and 5G networks, educational authorities and institutions that deliver online education could fall into the misconception of most students have a stable internet connection at home. The internet issue we observed is particularly vital to students’ online learning experience as most students prefer real‐time communications (Figure  6 ), which rely heavily on stable internet connection. Likewise, the finding of students’ confusion in technology is also consistent with prior studies (Bączek et al.,  2021 ; Muilenburg & Berge,  2005 ; Niemi & Kousa,  2020 ; Song et al.,  2004 ). Students who were unsuccessfully in setting up the online learning platforms could potentially experience declines in confidence and enthusiasm for online learning, which would cause a subsequent unpleasant learning experience. Therefore, both the readiness of internet infrastructure and student technical skills remain as the significant challenges for the mass‐adoption of online learning.

On the other hand, students’ experience of eyestrain from extended screen time provided empirical evidence to support Spitzer’s ( 2001 ) speculation about the potential ergonomic impact of online learning. This negative effect is potentially related to the prevalence of smartphone device and the limited screen size of these devices. This finding not only demonstrates the potential ergonomic issues that would be caused by smartphone‐based online learning but also resonates with the aforementioned necessity of different platforms and content designs for different students.

A less‐mentioned problem in previous studies on online learning experiences is the disengagement caused by nearby disturbance, especially in Year 1–3 and 10–12. It is likely that early‐school‐year students suffered from this problem because of their underdeveloped metacognitive skills to concentrate on online learning without teachers’ guidance. As for high‐school‐year students, the reasons behind their disengagement require further investigation in the future. Especially it would be worthwhile to scrutinise whether this type of disengagement is caused by the substantial amount of coursework they have to undertake and the subsequent a higher level of pressure and a lower level of concentration while learning.

Across age‐level differences are also apparent in terms of students’ expectations of online learning. Although, our results demonstrated students’ needs of gaining social interaction with others during online learning, findings (Bączek et al.,  2021 ; Harvey et al.,  2014 ; Kuo et al.,  2014 ; Liu & Cavanaugh,  2012 ; Yates et al.,  2020 ). This need manifested differently across school years, with early‐school‐year students preferring more teacher interactions and learning regulation support. Once again, this finding may imply that early‐school‐year students are inadequate in engaging with online learning without proper guidance from their teachers. Whereas, high‐school‐year students prefer more peer interactions and recommendation to learning resources. This expectation can probably be explained by the large amount of coursework exposed to them. Thus, high‐school‐year students need further guidance to help them better direct their learning efforts. These differences in students’ expectations for future practices could guide the customisation of online learning delivery.

Implications

As shown in our results, improving the delivery of online learning not only requires the efforts of policymakers but also depend on the actions of teachers and parents. The following sub‐sections will provide recommendations for relevant stakeholders and discuss their essential roles in supporting online education.

Technical support

The majority of the students has experienced technical problems during online learning, including the internet lagging and confusion in setting up the learning platforms. These problems with technology could impair students’ learning experience (Kauffman,  2015 ; Muilenburg & Berge,  2005 ). Educational authorities and schools should always provide a thorough guide and assistance for students who are experiencing technical problems with online learning platforms or other related tools. Early screening and detection could also assist schools and teachers to direct their efforts more effectively in helping students with low technology skills (Wilkinson et al.,  2010 ). A potential identification method involves distributing age‐specific surveys that assess students’ Information and Communication Technology (ICT) skills at the beginning of online learning. For example, there are empirical validated ICT surveys available for both primary (Aesaert et al.,  2014 ) and high school (Claro et al.,  2012 ) students.

For students who had problems with internet lagging, the delivery of online learning should provide options that require fewer data and bandwidth. Lecture recording is the existing option but fails to address students’ need for real‐time interaction (Clark et al.,  2015 ; Malik & Fatima,  2017 ). A potential alternative involves providing students with the option to learn with digital or physical textbooks and audio‐conferencing, instead of screen sharing and video‐conferencing. This approach significantly reduces the amount of data usage and lowers the requirement of bandwidth for students to engage in smooth online interactions (Cisco,  2018 ). It also requires little additional efforts from teachers as official textbooks are often available for each school year, and thus, they only need to guide students through the materials during audio‐conferencing. Educational authority can further support this approach by making digital textbooks available for teachers and students, especially those in financial hardship. However, the lack of visual and instructor presence could potentially reduce students’ attention, recall of information, and satisfaction in online learning (Wang & Antonenko,  2017 ). Therefore, further research is required to understand whether the combination of digital or physical textbooks and audio‐conferencing is appropriate for students with internet problems. Alternatively, suppose the local technological infrastructure is well developed. In that case, governments and schools can also collaborate with internet providers to issue data and bandwidth vouchers for students who are experiencing internet problems due to financial hardship.

For future adoption of online learning, policymakers should consider the readiness of the local internet infrastructure. This recommendation is particularly important for developing countries, like Bangladesh, where the majority of the students reported the lack of internet infrastructure (Ramij & Sultana,  2020 ). In such environments, online education may become infeasible, and alternative delivery method could be more appropriate, for example, the Telesecundaria program provides TV education for rural areas of Mexico (Calderoni,  1998 ).

Other than technical problems, choosing a suitable online learning platform is also vital for providing students with a better learning experience. Governments and schools should choose an online learning platform that is customised for smartphone‐based learning, as the majority of students could be using smartphones for online learning. This recommendation is highly relevant for situations where students are forced or involuntarily engaged in online learning, like during the COVID‐19 pandemic, as they might not have access to a personal computer (Molnar et al.,  2019 ).

Customisation of delivery methods

Customising the delivery of online learning for students in different school years is the theme that appeared consistently across our findings. This customisation process is vital for making online learning an opportunity for students to develop independent learning skills, which could help prepare them for tertiary education and lifelong learning. However, the pedagogical design of K‐12 online learning programs should be differentiated from adult‐orientated programs as these programs are designed for independent learners, which is rarely the case for students in K‐12 education (Barbour & Reeves,  2009 ).

For early‐school‐year students, especially Year 1–3 students, providing them with sufficient guidance from both teachers and parents should be the priority as these students often lack the ability to monitor and reflect on learning progress. In particular, these students would prefer more real‐time interaction with teachers, tutoring from parents, and regular online practice examinations. These forms of guidance could help early‐school‐year students to cope with involuntary online learning, and potentially enhance their experience in future online learning. It should be noted that, early‐school‐year students demonstrated interest in intelligent monitoring and feedback systems for learning. Additional research is required to understand whether these young children are capable of understanding and using learning analytics that relay information on their learning progress. Similarly, future research should also investigate whether young children can communicate effectively through digital tools as potential inability could hinder student learning in online group activities. Therefore, the design of online learning for early‐school‐year students should focus less on independent learning but ensuring that students are learning effective under the guidance of teachers and parents.

In contrast, group learning and peer interaction are essential for older children and adolescents. The delivery of online learning for these students should focus on providing them with more opportunities to communicate with each other and engage in collaborative learning. Potential methods to achieve this goal involve assigning or encouraging students to form study groups (Lee et al.,  2011 ), directing students to use social media for peer communication (Dabbagh & Kitsantas,  2012 ), and providing students with online group assignments (Bickle & Rucker,  2018 ).

Special attention should be paid to students enrolled in high schools. For high‐school‐year students, in particular, students in Year 10–12, we also recommend to provide them with sufficient access to paper‐based learning materials, such as revision booklet and practice exam papers, so they remain familiar with paper‐based examinations. This recommendation applies to any students who engage in online learning but has to take their final examination in paper format. It is also imperative to assist high‐school‐year students who are facing examinations to direct their learning efforts better. Teachers can fulfil this need by sharing useful learning resources on the learning management system, if it is available, or through social media groups. Alternatively, students are interested in intelligent recommendation systems for learning resources, which are emerging in the literature (Corbi & Solans,  2014 ; Shishehchi et al.,  2010 ). These systems could provide personalised recommendations based on a series of evaluation on learners’ knowledge. Although it is infeasible for situations where the transformation to online learning happened rapidly (i.e., during the COVID‐19 pandemic), policymakers can consider embedding such systems in future online education.

Limitations

The current findings are limited to primary and secondary Chinese students who were involuntarily engaged in online learning during the COVID‐19 pandemic. Despite the large sample size, the population may not be representative as participants are all from a single province. Also, information about the quality of online learning platforms, teaching contents, and pedagogy approaches were missing because of the large scale of our study. It is likely that the infrastructures of online learning in China, such as learning platforms, instructional designs, and teachers’ knowledge about online pedagogy, were underprepared for the sudden transition. Thus, our findings may not represent the experience of students who voluntarily participated in well‐prepared online learning programs, in particular, the virtual school programs in America and Canada (Barbour & LaBonte,  2017 ; Molnar et al.,  2019 ). Lastly, the survey was only evaluated and validated by teachers but not students. Therefore, students with the lowest reading comprehension levels might have a different understanding of the items’ meaning, especially terminologies that involve abstract contracts like self‐regulation and autonomy in item Q17.

In conclusion, we identified across‐year differences between primary and secondary school students’ online learning experience during the COVID‐19 pandemic. Several recommendations were made for the future practice and research of online learning in the K‐12 student population. First, educational authorities and schools should provide sufficient technical support to help students to overcome potential internet and technical problems, as well as choosing online learning platforms that have been customised for smartphones. Second, customising the online pedagogy design for students in different school years, in particular, focusing on providing sufficient guidance for young children, more online collaborative opportunity for older children and adolescent, and additional learning resource for senior students who are facing final examinations.

CONFLICT OF INTEREST

There is no potential conflict of interest in this study.

ETHICS STATEMENT

The data are collected by the Department of Education of the Guangdong Province who also has the authority to approve research studies in K12 education in the province.

Supporting information

Supplementary Material

ACKNOWLEDGEMENTS

This work is supported by the National Natural Science Foundation of China (62077028, 61877029), the Science and Technology Planning Project of Guangdong (2020B0909030005, 2020B1212030003, 2020ZDZX3013, 2019B1515120010, 2018KTSCX016, 2019A050510024), the Science and Technology Planning Project of Guangzhou (201902010041), and the Fundamental Research Funds for the Central Universities (21617408, 21619404).

SURVEY ITEMS

Yan, L , Whitelock‐Wainwright, A , Guan, Q , Wen, G , Gašević, D , & Chen, G . Students’ experience of online learning during the COVID‐19 pandemic: A province‐wide survey study . Br J Educ Technol . 2021; 52 :2038–2057. 10.1111/bjet.13102 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

DATA AVAILABILITY STATEMENT

• Aesaert, K. , Van Nijlen, D. , Vanderlinde, R. , & van Braak, J. (2014). Direct measures of digital information processing and communication skills in primary education: Using item response theory for the development and validation of an ICT competence scale . Computers & Education , 76 , 168–181. 10.1016/j.compedu.2014.03.013 [ CrossRef ] [ Google Scholar ]
• Agung, A. S. N. , Surtikanti, M. W. , & Quinones, C. A. (2020). Students’ perception of online learning during COVID‐19 pandemic: A case study on the English students of STKIP Pamane Talino . SOSHUM: Jurnal Sosial Dan Humaniora , 10 ( 2 ), 225–235. 10.31940/soshum.v10i2.1316 [ CrossRef ] [ Google Scholar ]
• Anderson, T. (2003). Getting the mix right again: An updated and theoretical rationale for interaction . The International Review of Research in Open and Distributed Learning , 4 ( 2 ). 10.19173/irrodl.v4i2.149 [ CrossRef ] [ Google Scholar ]
• Appana, S. (2008). A review of benefits and limitations of online learning in the context of the student, the instructor and the tenured faculty . International Journal on E‐learning , 7 ( 1 ), 5–22. [ Google Scholar ]
• Bączek, M. , Zagańczyk‐Bączek, M. , Szpringer, M. , Jaroszyński, A. , & Wożakowska‐Kapłon, B. (2021). Students’ perception of online learning during the COVID‐19 pandemic: A survey study of Polish medical students . Medicine , 100 ( 7 ), e24821. 10.1097/MD.0000000000024821 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Barbour, M. K. (2013). The landscape of k‐12 online learning: Examining what is known . Handbook of Distance Education , 3 , 574–593. [ Google Scholar ]
• Barbour, M. , Huerta, L. , & Miron, G. (2018). Virtual schools in the US: Case studies of policy, performance and research evidence. In Society for information technology & teacher education international conference (pp. 672–677). Association for the Advancement of Computing in Education (AACE). [ Google Scholar ]
• Barbour, M. K. , & LaBonte, R. (2017). State of the nation: K‐12 e‐learning in Canada, 2017 edition . http://k12sotn.ca/wp‐content/uploads/2018/02/StateNation17.pdf [ Google Scholar ]
• Barbour, M. K. , & Reeves, T. C. (2009). The reality of virtual schools: A review of the literature . Computers & Education , 52 ( 2 ), 402–416. [ Google Scholar ]
• Basuony, M. A. K. , EmadEldeen, R. , Farghaly, M. , El‐Bassiouny, N. , & Mohamed, E. K. A. (2020). The factors affecting student satisfaction with online education during the COVID‐19 pandemic: An empirical study of an emerging Muslim country . Journal of Islamic Marketing . 10.1108/JIMA-09-2020-0301 [ CrossRef ] [ Google Scholar ]
• Berge, Z. L. (2005). Virtual schools: Planning for success . Teachers College Press, Columbia University. [ Google Scholar ]
• Bickle, M. C. , & Rucker, R. (2018). Student‐to‐student interaction: Humanizing the online classroom using technology and group assignments . Quarterly Review of Distance Education , 19 ( 1 ), 1–56. [ Google Scholar ]
• Broadbent, J. , & Poon, W. L. (2015). Self‐regulated learning strategies & academic achievement in online higher education learning environments: A systematic review . The Internet and Higher Education , 27 , 1–13. [ Google Scholar ]
• Calderoni, J. (1998). Telesecundaria: Using TV to bring education to rural Mexico (Tech. Rep.). The World Bank. [ Google Scholar ]
• Cisco . (2018). Bandwidth requirements for meetings with cisco Webex and collaboration meeting rooms white paper . http://dwz.date/dpbc [ Google Scholar ]
• Cisco . (2019). Cisco digital readiness 2019 . https://www.cisco.com/c/m/en_us/about/corporate‐social‐responsibility/research‐resources/digital‐readiness‐index.html#/ (Library Catalog: www.cisco.com). [ Google Scholar ]
• Clark, C. , Strudler, N. , & Grove, K. (2015). Comparing asynchronous and synchronous video vs. text based discussions in an online teacher education course . Online Learning , 19 ( 3 ), 48–69. [ Google Scholar ]
• Claro, M. , Preiss, D. D. , San Martín, E. , Jara, I. , Hinostroza, J. E. , Valenzuela, S. , Cortes, F. , & Nussbaum, M. (2012). Assessment of 21st century ICT skills in Chile: Test design and results from high school level students . Computers & Education , 59 ( 3 ), 1042–1053. 10.1016/j.compedu.2012.04.004 [ CrossRef ] [ Google Scholar ]
• Cohen, J. (1988). Statistical power analysis for the behavioral sciences . Routledge Academic. [ Google Scholar ]
• Corbi, A. , & Solans, D. B. (2014). Review of current student‐monitoring techniques used in elearning‐focused recommender systems and learning analytics: The experience API & LIME model case study . IJIMAI , 2 ( 7 ), 44–52. [ Google Scholar ]
• Dabbagh, N. , & Kitsantas, A. (2012). Personal learning environments, social media, and self‐regulated learning: A natural formula for connecting formal and informal learning . The Internet and Higher Education , 15 ( 1 ), 3–8. 10.1016/j.iheduc.2011.06.002 [ CrossRef ] [ Google Scholar ]
• Garrison, D. R. , Cleveland‐Innes, M. , & Fung, T. S. (2010). Exploring causal relationships among teaching, cognitive and social presence: Student perceptions of the community of inquiry framework . The Internet and Higher Education , 13 ( 1–2 ), 31–36. 10.1016/j.iheduc.2009.10.002 [ CrossRef ] [ Google Scholar ]
• Gašević, D. , Adesope, O. , Joksimović, S. , & Kovanović, V. (2015). Externally‐facilitated regulation scaffolding and role assignment to develop cognitive presence in asynchronous online discussions . The Internet and Higher Education , 24 , 53–65. 10.1016/j.iheduc.2014.09.006 [ CrossRef ] [ Google Scholar ]
• Gašević, D. , Zouaq, A. , & Janzen, R. (2013). “Choose your classmates, your GPA is at stake!” The association of cross‐class social ties and academic performance . American Behavioral Scientist , 57 ( 10 ), 1460–1479. [ Google Scholar ]
• Gikas, J. , & Grant, M. M. (2013). Mobile computing devices in higher education: Student perspectives on learning with cellphones, smartphones & social media . The Internet and Higher Education , 19 , 18–26. [ Google Scholar ]
• Harvey, D. , Greer, D. , Basham, J. , & Hu, B. (2014). From the student perspective: Experiences of middle and high school students in online learning . American Journal of Distance Education , 28 ( 1 ), 14–26. 10.1080/08923647.2014.868739 [ CrossRef ] [ Google Scholar ]
• Kauffman, H. (2015). A review of predictive factors of student success in and satisfaction with online learning . Research in Learning Technology , 23 . 10.3402/rlt.v23.26507 [ CrossRef ] [ Google Scholar ]
• Kuo, Y.‐C. , Walker, A. E. , Belland, B. R. , Schroder, K. E. , & Kuo, Y.‐T. (2014). A case study of integrating interwise: Interaction, internet self‐efficacy, and satisfaction in synchronous online learning environments . International Review of Research in Open and Distributed Learning , 15 ( 1 ), 161–181. 10.19173/irrodl.v15i1.1664 [ CrossRef ] [ Google Scholar ]
• Lee, S. J. , Srinivasan, S. , Trail, T. , Lewis, D. , & Lopez, S. (2011). Examining the relationship among student perception of support, course satisfaction, and learning outcomes in online learning . The Internet and Higher Education , 14 ( 3 ), 158–163. 10.1016/j.iheduc.2011.04.001 [ CrossRef ] [ Google Scholar ]
• Liu, F. , & Cavanaugh, C. (2012). Factors influencing student academic performance in online high school algebra . Open Learning: The Journal of Open, Distance and e‐Learning , 27 ( 2 ), 149–167. 10.1080/02680513.2012.678613 [ CrossRef ] [ Google Scholar ]
• Lou, Y. , Bernard, R. M. , & Abrami, P. C. (2006). Media and pedagogy in undergraduate distance education: A theory‐based meta‐analysis of empirical literature . Educational Technology Research and Development , 54 ( 2 ), 141–176. 10.1007/s11423-006-8252-x [ CrossRef ] [ Google Scholar ]
• Malik, M. , & Fatima, G. (2017). E‐learning: Students’ perspectives about asynchronous and synchronous resources at higher education level . Bulletin of Education and Research , 39 ( 2 ), 183–195. [ Google Scholar ]
• McInnerney, J. M. , & Roberts, T. S. (2004). Online learning: Social interaction and the creation of a sense of community . Journal of Educational Technology & Society , 7 ( 3 ), 73–81. [ Google Scholar ]
• Molnar, A. , Miron, G. , Elgeberi, N. , Barbour, M. K. , Huerta, L. , Shafer, S. R. , & Rice, J. K. (2019). Virtual schools in the US 2019 . National Education Policy Center. [ Google Scholar ]
• Montague, M. , & Rinaldi, C. (2001). Classroom dynamics and children at risk: A followup . Learning Disability Quarterly , 24 ( 2 ), 75–83. [ Google Scholar ]
• Montag, C. , Becker, B. , & Gan, C. (2018). The multipurpose application Wechat: A review on recent research . Frontiers in Psychology , 9 , 2247. 10.3389/fpsyg.2018.02247 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Moore, M. G. (1989). Editorial: Three types of interaction . American Journal of Distance Education , 3 ( 2 ), 1–7. 10.1080/08923648909526659 [ CrossRef ] [ Google Scholar ]
• Muilenburg, L. Y. , & Berge, Z. L. (2005). Student barriers to online learning: A factor analytic study . Distance Education , 26 ( 1 ), 29–48. 10.1080/01587910500081269 [ CrossRef ] [ Google Scholar ]
• Muirhead, B. , & Juwah, C. (2004). Interactivity in computer‐mediated college and university education: A recent review of the literature . Journal of Educational Technology & Society , 7 ( 1 ), 12–20. [ Google Scholar ]
• Niemi, H. M. , & Kousa, P. (2020). A case study of students’ and teachers’ perceptions in a finnish high school during the COVID pandemic . International Journal of Technology in Education and Science , 4 ( 4 ), 352–369. 10.46328/ijtes.v4i4.167 [ CrossRef ] [ Google Scholar ]
• Oliver, K. , Osborne, J. , & Brady, K. (2009). What are secondary students’ expectations for teachers in virtual school environments? Distance Education , 30 ( 1 ), 23–45. 10.1080/01587910902845923 [ CrossRef ] [ Google Scholar ]
• Pardo, A. , Jovanovic, J. , Dawson, S. , Gašević, D. , & Mirriahi, N. (2019). Using learning analytics to scale the provision of personalised feedback . British Journal of Educational Technology , 50 ( 1 ), 128–138. 10.1111/bjet.12592 [ CrossRef ] [ Google Scholar ]
• Ramij, M. , & Sultana, A. (2020). Preparedness of online classes in developing countries amid covid‐19 outbreak: A perspective from Bangladesh. Afrin, Preparedness of Online Classes in Developing Countries amid COVID‐19 Outbreak: A Perspective from Bangladesh (June 29, 2020) .
• Rice, K. L. (2006). A comprehensive look at distance education in the k–12 context . Journal of Research on Technology in Education , 38 ( 4 ), 425–448. 10.1080/15391523.2006.10782468 [ CrossRef ] [ Google Scholar ]
• Shishehchi, S. , Banihashem, S. Y. , & Zin, N. A. M. (2010). A proposed semantic recommendation system for elearning: A rule and ontology based e‐learning recommendation system. In 2010 international symposium on information technology (Vol. 1, pp. 1–5).
• Song, L. , Singleton, E. S. , Hill, J. R. , & Koh, M. H. (2004). Improving online learning: Student perceptions of useful and challenging characteristics . The Internet and Higher Education , 7 ( 1 ), 59–70. 10.1016/j.iheduc.2003.11.003 [ CrossRef ] [ Google Scholar ]
• Spitzer, D. R. (2001). Don’t forget the high‐touch with the high‐tech in distance learning . Educational Technology , 41 ( 2 ), 51–55. [ Google Scholar ]
• Thomas, R. M. (2000). Comparing theories of child development. Wadsworth/Thomson Learning. United Nations Educational, Scientific and Cultural Organization. (2020, March). Education: From disruption to recovery . https://en.unesco.org/covid19/educationresponse (Library Catalog: en.unesco.org)
• Uttal, D. H. , & Cohen, C. A. (2012). Spatial thinking and stem education: When, why, and how? In Psychology of learning and motivation (Vol. 57 , pp. 147–181). Elsevier. [ Google Scholar ]
• Van Lancker, W. , & Parolin, Z. (2020). Covid‐19, school closures, and child poverty: A social crisis in the making . The Lancet Public Health , 5 ( 5 ), e243–e244. 10.1016/S2468-2667(20)30084-0 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wang, C.‐H. , Shannon, D. M. , & Ross, M. E. (2013). Students’ characteristics, self‐regulated learning, technology self‐efficacy, and course outcomes in online learning . Distance Education , 34 ( 3 ), 302–323. 10.1080/01587919.2013.835779 [ CrossRef ] [ Google Scholar ]
• Wang, J. , & Antonenko, P. D. (2017). Instructor presence in instructional video: Effects on visual attention, recall, and perceived learning . Computers in Human Behavior , 71 , 79–89. 10.1016/j.chb.2017.01.049 [ CrossRef ] [ Google Scholar ]
• Wilkinson, A. , Roberts, J. , & While, A. E. (2010). Construction of an instrument to measure student information and communication technology skills, experience and attitudes to e‐learning . Computers in Human Behavior , 26 ( 6 ), 1369–1376. 10.1016/j.chb.2010.04.010 [ CrossRef ] [ Google Scholar ]
• World Health Organization . (2020, July). Coronavirus disease 2019 (COVID‐19): Situation Report‐164 (Situation Report No. 164). https://www.who.int/docs/default‐source/coronaviruse/situation‐reports/20200702‐covid‐19‐sitrep‐164.pdf?sfvrsn$=$ac074f58$_$2
• Yates, A. , Starkey, L. , Egerton, B. , & Flueggen, F. (2020). High school students’ experience of online learning during Covid‐19: The influence of technology and pedagogy . Technology, Pedagogy and Education , 9 , 1–15. 10.1080/1475939X.2020.1854337 [ CrossRef ] [ Google Scholar ]

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

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

• inequalities

Data availability statement

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

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

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

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Introduction

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

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

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

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

Social networks

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

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

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

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

Social support

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

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

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

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

Social and interactional norms

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

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

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

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

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

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

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

Recommendations and conclusions

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

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

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

Recommendation 2: intelligently balance online and offline ways of relating

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

Recommendation 3: build stronger and sustainable localised communities

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

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

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Not required.

• Office for National Statistics (ONS)
• Ford T , et al
• Riordan R ,
• Ford J , et al
• Glonti K , et al
• McPherson JM ,
• Smith-Lovin L
• Granovetter MS
• Fancourt D et al
• Stadtfeld C
• Office for Civil Society
• Cook J et al
• Rodriguez-Llanes JM ,
• Guha-Sapir D
• Patulny R et al
• Granovetter M
• Winkeler M ,
• Filipp S-H ,
• Kaniasty K ,
• de Terte I ,
• Guilaran J , et al
• Wright KB ,
• Martin J et al
• Gabbiadini A ,
• Baldissarri C ,
• Durante F , et al
• Sommerlad A ,
• Marston L ,
• Huntley J , et al
• Turner RJ ,
• Bicchieri C
• Brennan G et al
• Watson-Jones RE ,
• Amichai-Hamburger Y ,
• McKenna KYA
• Page-Gould E ,
• Aron A , et al
• Pietromonaco PR ,
• Timmerman GM
• Bradbury-Jones C ,
• Mikocka-Walus A ,
• Klas A , et al
• Marshall L ,
• Steptoe A ,
• Stanley SM ,
• Campbell AM
• ↵ (ONS), O.f.N.S., Domestic abuse during the coronavirus (COVID-19) pandemic, England and Wales . Available: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/domesticabuseduringthecoronaviruscovid19pandemicenglandandwales/november2020
• Rosenberg M ,
• Hensel D , et al
• Banerjee D ,
• Bruner DW , et al
• Bavel JJV ,
• Baicker K ,
• Boggio PS , et al
• van Barneveld K ,
• Quinlan M ,
• Kriesler P , et al
• Mitchell R ,
• de Vries S , et al

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

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

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

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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• Published: 24 March 2022

Health care workers’ experiences during the COVID-19 pandemic: a scoping review

• Souaad Chemali 1 ,
• Almudena Mari-Sáez 1 ,
• Charbel El Bcheraoui 2 &
• Heide Weishaar   ORCID: orcid.org/0000-0003-1150-0265 2  

Human Resources for Health volume  20 , Article number:  27 ( 2022 ) Cite this article

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COVID-19 has challenged health systems worldwide, especially the health workforce, a pillar crucial for health systems resilience. Therefore, strengthening health system resilience can be informed by analyzing health care workers’ (HCWs) experiences and needs during pandemics. This review synthesizes qualitative studies published during the first year of the COVID-19 pandemic to identify factors affecting HCWs’ experiences and their support needs during the pandemic. This review was conducted using the Joanna Briggs Institute methodology for scoping reviews. A systematic search on PubMed was applied using controlled vocabularies. Only original studies presenting primary qualitative data were included.

161 papers that were published from the beginning of COVID-19 pandemic up until 28th March 2021 were included in the review. Findings were presented using the socio-ecological model as an analytical framework. At the individual level, the impact of the pandemic manifested on HCWs’ well-being, daily routine, professional and personal identity. At the interpersonal level, HCWs’ personal and professional relationships were identified as crucial. At the institutional level, decision-making processes, organizational aspects and availability of support emerged as important factors affecting HCWs’ experiences. At community level, community morale, norms, and public knowledge were of importance. Finally, at policy level, governmental support and response measures shaped HCWs’ experiences. The review identified a lack of studies which investigate other HCWs than doctors and nurses, HCWs in non-hospital settings, and HCWs in low- and lower middle income countries.

This review shows that the COVID-19 pandemic has challenged HCWs, with multiple contextual factors impacting their experiences and needs. To better understand HCWs’ experiences, comparative investigations are needed which analyze differences across as well as within countries, including differences at institutional, community, interpersonal and individual levels. Similarly, interventions aimed at supporting HCWs prior to, during and after pandemics need to consider HCWs’ circumstances.

Conclusions

Following a context-sensitive approach to empowering HCWs that accounts for the multitude of aspects which influence their experiences could contribute to building a sustainable health workforce and strengthening health systems for future pandemics.

Peer Review reports

Introduction

The COVID-19 pandemic has put health systems worldwide under pressure and tested their resilience. The World Health Organization (WHO) acknowledges health workforce as one of the six building blocks of health systems [ 1 ]. Health care workers (HCWs) are key to a health system’s ability to respond to external shocks such as outbreaks and as first responders are often the hardest hit by these shocks [ 2 ]. Therefore, interventions supporting HCWs are key to strengthening health systems resilience (ibid). To develop effective interventions to support this group, a detailed understanding of how pandemics affect HCWs is needed.

Several recent reviews [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] focus on HCWs’ experiences during COVID-19 and the impact of the pandemic on HCWs’ well-being, including their mental health [ 3 , 7 , 8 , 11 , 12 , 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Most of these reviews refer to psychological scales measurements to provide quantifiable information on HCWs’ well-being and mental health [ 8 , 13 , 14 , 19 , 21 , 22 , 23 , 24 , 25 , 28 ]. While useful in assessing the scale of the problem, such quantitative measures are insufficient in capturing the breadth of HCWs’ experiences and the factors that impact such experiences. The added value of qualitative studies is in understanding the complex experiences of HCWs during COVID-19 and the contextual factors that influence them [ 29 ].

This paper reviews qualitative studies published during the first year of the pandemic to investigate what is known about HCWs’ experiences during COVID-19 and the factors and support needs associated with those experiences. By presenting HCWs’ perspectives on the pandemic, the scoping review provides the much-needed evidence base for interventions that can help strengthen HCWs and alleviate the pressures they experience during pandemics.

The review follows the Joanna Briggs Institute (JBI) process and guideline on conducting scoping reviews [ 30 ]. JBI updated guidelines identify scoping reviews as the most suitable choice to explore the breadth of literature on a topic, by mapping and summarizing available evidence [ 30 ]. Scoping reviews are also suitable to address knowledge gaps and provide insightful input for decision-making [ 30 ]. The review also applies the PRISMA checklist guidance on reporting literature reviews [ 31 ].

Information sources

A systematic search was conducted on PubMed database between the 9th and 28th of March 2021.

Search strategy

Drawing on Shaw et al. [ 32 ] and WHO [ 33 ], the search strategy used a controlled vocabulary of index terms including Medical Subject Headings (Mesh) of the keywords and synonyms “COVID-19”, “HCWs”, and “qualitative”. Keywords were combined using the Boolean operator “AND” (see Additional file 1 ).

Eligibility criteria

The population of interest included all types of HCWs, independent of geography and settings. Only original studies were included in the review. Papers further had to (1) report primary qualitative data, (2) report on HCWs’ experiences and perceptions during COVID-19, and (3) be available as full texts in English, German, French, Spanish or Arabic, i.e., in a language that could be reviewed by one or several of the authors. Studies focusing solely on HCWs’ assessment of newly introduced modes of telemedicine during COVID-19 were excluded from the review as their clear emphasis on coping with technical challenges deviated from the review’s focus on HCWs’ personal and professional experiences during the pandemic.

Selection process

The initial search yielded 3976 papers. All papers were screened and assessed against the eligibility criteria by one researcher (SC) to identify relevant studies. A random 25% sample of all papers was additionally screened by a second researcher (HW). Any uncertainty or inconsistency regarding inclusion were resolved by discussing the respective articles ( n  = 76) among the authors.

Data collection process

Based on the research question, an initial data extraction form was developed, independently piloted on ten papers by SC and HW and finalised to include information on: (1) author(s), (2) year of publication, (3) type of HCW, (5) study design, (6) sample size, (7) topic of investigation, (8) data collection tool(s), (9) analytical approach, (10) period of data collection, (11) country, (12) income level according to World Bank [ 34 ], (13) context, and (14) main findings related to experiences, factors and support needs. Using the final extraction form, all articles were extracted by SC, with the exception of four German articles (which were extracted by HW), one Spanish and one French article (which were extracted by AMS). As far as applicable, the quality of the included articles was appraised using the JBI critical appraisal tool for qualitative research [ 35 ].

Synthesis methods

The socio-ecological model originally developed by Brofenbrenner was adapted as a framework to analyze and present the findings [ 36 , 37 , 38 ]. The model aims to understand the interconnectedness and dynamics between personal and contextual factors in shaping human development and experiences [ 36 , 38 ]. The model was chosen, because it accounts for the multifaceted interactions between individuals and their environment and is thus suited to capture the different dimensions of HCWs’ experiences, the factors associated with those experiences as well as the sources of support identified. The five socio-ecological levels (individual, interpersonal, institutional, community and policy) of the model served as a framework for analysis and were used to categorise the main themes that were identified in the scoping review as relevant to HCWs’ experiences. The process of identifying the sub-themes was conducted by SC using an excel extraction sheet, in which the main findings were captured and mapped against the socio-ecological framework.

Study selection

The selection process and the number of papers found, screened and included are illustrated in a PRISMA flow diagram (Fig.  1 ). A total of 161 papers were included in the review (see Additional file 2 ). Table 1 lists the included studies based on study characteristics, including type of HCW, healthcare setting, income level of countries studied and data collection tools.

PRISMA flow diagram

Study characteristics

Included papers investigated various types of HCWs. The most investigated type were nurses, followed by doctors/physicians. Medical and nursing students were also studied frequently, while only a small number of studies focused on other professions, e.g., community health workers, therapists and managerial staff. A third of all studies studied multiple HCWs, rather than targeting single professions. The majority of papers investigated so-called “frontline staff”, i.e., HCWs who engaged directly with patients who were suspected or confirmed to be infected with COVID-19. Fewer studies focused on non-frontline staff, and some explored both frontline and non-frontline staff.

Around two-thirds of all papers studied HCWs’ experiences in high-income countries, notably the USA, followed by the UK. Many papers also focused on HCWs in upper-middle income countries, with almost half of them conducted in China. Few papers investigated HCWs in lower-middle income countries, including India, Zimbabwe, Pakistan, Nigeria, and Senegal. Finally, one paper focused on HCWs in Ethiopia, a low-income country. A couple of studies presented data from multiple countries of different income levels, and one study investigating HCWs in Palestine could not be categorised. Overall, the USA was the most studied and China the second most studied geographical location (see Additional file 3 ). Hospitals were by far the most investigated healthcare settings, whereas outpatient settings, including primary care, pharmacies, homes care, nursing homes, healthcare facilities in prisons and schools as well as clinics, were investigated to a considerably lesser extent. Several studies covered more than one setting.

All studies applied a cross-sectional study design, with 54% published in 2020, and the remainder in 2021. A range of qualitative data collection methods were applied, with interviews being by far the most prominent one, followed by open-ended questionnaires. Focus groups and a few other methods including social media, online platforms or recording systems submissions, observations and open reflections were used with rare frequencies. The sample size in studies using interviews ranged between 6 and 450 interviewees. The sample size in studies using Focus Group Discussions (FGDs) ranged between 7 and 40 participants. Further information on the composition and context of the FGDs can be found in additional file 4 . Several studies used multiple data collection tools. The majority of studies applied common analysis methods, including thematic and content analysis, with few using other specific approaches.

Results of syntheses

An overview of the findings based on the socio-ecological framework is summarised in Table 2 , which lists the main sub-themes identified under each socio-ecological level.

Individual level

At the individual level, HCWs’ experiences related to their well-being, professional and personal identity as well as daily work–life routine. In terms of well-being, HCWs reported negative impacts on their physical health (e.g., tiredness, discomfort, skin damage, sleep disorders) [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ] and compromised mental health. The reported negative impact on mental health included increased levels of self-reported stress, depression, anxiety, fear, grief, guilt, anger, isolation, uncertainty and helplessness [ 39 , 41 , 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 ]. The reported reasons for HCWs’ reduced well-being included work-related factors, such as having to adhere to new requirements in the workplace, the lack and/or burden of using Personal Protective Equipment (PPE) [ 41 , 44 , 52 , 63 , 64 , 78 , 93 , 124 , 125 ], increased workload, lack of specialised knowledge and experience, concerns over delivering low quality of care [ 42 , 44 , 49 , 52 , 53 , 63 , 69 , 70 , 73 , 74 , 76 , 78 , 79 , 83 , 84 , 85 , 86 , 89 , 90 , 93 , 94 , 101 , 103 , 109 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 ] and being confronted with ethical dilemmas [ 43 , 72 , 76 , 78 , 136 , 141 , 142 , 143 , 144 , 145 ]. HCWs’ compromised psychological well-being was also triggered by extensive exposure to concerning information via the media and by the pressure that was experienced due to society and the media assigning HCWs hero status [ 53 , 72 , 81 , 92 , 97 , 107 , 139 , 146 ]. Factors that were reported by HCWs as helping them cope with pressure comprised diverse self-care practices and personal activities, including but not limited to psychological techniques and lifestyle adjustments [ 47 , 56 , 64 , 71 , 72 , 78 , 90 , 139 , 147 , 148 ] as well as religious practices [ 81 , 112 , 149 ].

Self-reported well-being differed across occupations, roles in the pandemic response and work settings. One study reported that HCWs working in respiratory, infection and emergency departments expressed more worries compared to HCWs who worked in other hospital wards [ 64 ]. Similarly, frontline HCWs seemed more likely to experience feelings of helplessness and guilt as they witnessed the worsening situation of COVID-19 patients, whereas non-frontline HCWs seemed to experience feelings of guilt due to not supporting their frontline colleagues [ 98 ]. HCWs with managerial responsibility reported heightened concern for their staff’s health [ 75 , 110 , 150 ]. HCWs working in nursing homes and home care reported feelings of being abandoned and not sufficiently recognised [ 75 , 123 , 144 ], while one study investigating HCWs responding to the pandemic in a slums-setting reported fear of violence [ 56 ].

HCWs reported that the pandemic impacted both positively and negatively on their professional and personal identity. While negative emotions were more dominant at the beginning of the pandemic, positive effects were reported to gradually develop after the initial pandemic phase and included an increased sense of motivation, purpose, meaningfulness, pride, resilience, problem-solving attitude, as well as professional and personal growth [ 43 , 44 , 47 , 49 , 50 , 51 , 63 , 67 , 68 , 69 , 71 , 73 , 74 , 75 , 76 , 78 , 79 , 87 , 90 , 91 , 92 , 93 , 98 , 102 , 104 , 112 , 114 , 117 , 118 , 119 , 122 , 124 , 131 , 132 , 143 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 ]. Frontline staff reported particularly strong positive effects related to feelings of making a difference [ 69 , 92 ]. On the other hand, some HCWs reported doubts with regard to their career choices and job dissatisfaction [ 40 , 46 , 59 , 130 ]. Junior staff, assistant doctors and students often reported feelings of exclusion and concerns about the negative effects of the pandemic on their training [ 40 , 162 , 163 ]. Challenges with regard to their professional identity and a sense of failing their colleagues on the frontline were particularly reported by HCWs who had acquired COVID-19 themselves and experienced long COVID-19 [ 121 , 160 , 164 ]. HCWs who reached out to well-being support services expressed concern at being stigmatised [ 97 ].

HCWs reported a work–life imbalance [ 57 , 97 ] as they had to adapt to the disruption of their usual work routine [ 59 , 62 , 131 ]. This disruption manifested in taking on different roles and responsibilities [ 39 , 49 , 67 , 73 , 83 , 89 , 94 , 97 , 110 , 137 , 139 , 144 , 151 ], increased or decreased workload pressure [ 85 , 128 , 130 , 133 ] and sometimes redeployment [ 57 , 155 , 165 ]. HCWs also reported negative financial effects [ 59 , 86 , 166 ].

Interpersonal level

The findings presented in this section relate to HCWs’ perceptions of their relationships in the private and professional environment during the pandemic and to the impact these relationships had on them. With regard to the home environment, HCWs’ concerns over being infected with COVID-19 and transmitting the virus to family members were identified in almost all studies [ 41 , 44 , 48 , 51 , 54 , 56 , 61 , 68 , 75 , 77 , 80 , 85 , 90 , 128 , 139 , 160 , 167 , 168 , 169 , 170 , 171 ]. HCWs living with children or elderly family members were particularly concerned [ 47 , 65 , 95 , 97 , 163 , 172 ]. In some cases, HCWs reported that they had introduced changes to their living situation to protect their loved ones, with some deciding to move out to ensure physical distance and minimise the risk of transmission [ 39 , 43 , 44 , 89 , 105 , 161 ]. Some HCWs reported sharing limited details about their COVID-19-related duties to decrease the anxiety and fear of their significant others [ 81 ]. While in several studies, interpersonal relationships were reported to cause concerns and worries, some study also identified interpersonal relationships and the subsequent emotional connectedness as a helpful resource [ 47 , 173 , 174 ] that could, for example, alleviate anxiety [ 64 ] or provide encouragement for working on the frontline [ 49 , 106 ]. However, interpersonal relationships did not always have a supportive function, with some HCWs reporting being shunned by family and friends [ 66 , 111 , 175 ].

With regard to the work environment, relationships with colleagues were mainly described as supportive and empowering, with various studies reporting the value of teamwork during the pandemic [ 47 , 51 , 52 , 67 , 71 , 77 , 83 , 91 , 97 , 98 , 108 , 134 , 148 , 151 , 161 ]. Challenges with regard to collegial relationships included social distancing (which hindered HCWs’ interaction in the work place) [ 176 ] and working with colleagues one had never worked with before (causing a lack of familiarity with the work environment and difficulties to adapt) [ 79 ]. HCWs who worked in prisons reported interpersonal conflicts due to perceived increased authoritarian behaviour by security personnel that was perceived to manifest in arrogance and non-compliance with hygiene practices [ 88 ].

In terms of HCWs’ relationships with patients, many studies reported challenges in communicating with patients [ 50 , 55 , 126 , 132 , 133 , 172 ]. This was attributed to the use of PPE during medical examinations and care and the reduction of face-to-face visits or a complete switch to telehealth [ 128 , 139 ]. The changes in the relationships with patients varied according to the nature of work. Frontline HCWs, for example, reported challenges in caring for isolated patients [ 41 , 43 , 52 , 148 ], whereas HCWs working in specific settings and occupational roles that required specific interpersonal skills faced other challenges. This was, for example, the case for HCWs working with people with intellectual disabilities, who found it challenging to explain COVID-19 measures to this group and also had to mitigate physical contact that was considered a significant part of their work [ 71 ]. For palliative care staff, the use of PPE and measures of social distancing were challenging to apply with regard to patients and family members [ 177 ]. Building relationships and providing appropriate emotional support was reported to be particularly challenging for mental health and palliative care professionals supporting vulnerable adults or children [ 117 ]. Challenges for health and social care professionals were associated with virtual consultations and more difficult conversations [ 117 ]. Physicians reported particular frustration with remote monitoring of chronic diseases when caring for low-income, rural, and/or elderly patients [ 169 ]. Having to adjust, and compromise on, the relationships with patients caused concerns about the quality of care, which in turn, was reported to impact negatively on HCWs’ professional identity and emotional well-being.

Institutional level

This section presents HCWs’ perceptions of decision-making processes in the work setting, organizational factors and availability of institutional support.

With regard to decision-making, a small number of studies reported HCWs’ trust in the institutions they worked in [ 143 , 172 ], while the majority of studies revealed discontent about institutional leadership and feelings of exclusion from decision-making processes [ 65 , 178 ]. More specifically, HCWs reported a lack of clear communication and coordination [ 41 , 70 , 144 , 148 , 179 ] and a wish to be provided with the rationales behind management decisions and to be included in recovery phase planning [ 48 ]. They perceived centralised decision-making processes as unfamiliar and restrictive [ 150 ]. Instead, HCWs endorsed de-centralised and participatory approaches to communication and decision-making [ 56 ]. Emergency and critical care physicians suggested to include bioethicists as part of the decision-making on triaging scarce critical resources [ 126 ]. Studies of both hospital and primary care settings reported perceived disconnectedness and poor collaboration between managerial, administrative and clinical staff, which was a contributing factor to burnout among HCWs [ 60 , 83 , 149 , 169 , 180 , 181 , 182 ]. Dissatisfaction with communication also related to constantly changing protocols, which were perceived as highly burdening and frustrating, creating ambiguity and negatively affecting HCWs’ work performance [ 44 , 55 , 59 , 78 , 112 , 183 ].

In terms of organizational factors, many HCWs reported a perceived lack of organizational preparedness and poor organization of care [ 60 , 65 , 120 , 179 ]. Changes in the organization of care were perceived as chaotic, especially at the beginning of the pandemic, and changes in roles and responsibilities and role allocation were perceived as unfair and unsatisfying [ 72 , 97 ]. Only in one study, changes in work organisation were perceived positively, with nurses reporting satisfaction with an improved nurse–patient ratio resulting from organisational changes [ 52 ]. Overall, frontline HCWs advocated for more stability in team structure to ensure familiarity and consistency at work [ 47 , 66 , 72 , 114 , 116 ]. HCWs appreciated multidisciplinary teams, despite challenges with regard to achieving rapid and efficient collaboration between members from different departments [ 41 , 143 , 152 ].

Regarding institutional support, in some instances, psychological, managerial, material and technical support was positively acknowledged, while the majority of studies reported HCWs’ dissatisfaction with the support provided by the institution they worked in [ 46 , 48 , 73 , 84 , 92 , 97 , 114 , 139 , 144 , 174 , 184 ]. Across studies, a lack of equipment, including the unavailability of suitable PPEs, was one of the most prominent critiques, especially in the initial phase the pandemic [ 41 , 46 , 54 , 55 , 61 , 69 , 70 , 72 , 73 , 81 , 84 , 85 , 96 , 97 , 111 , 118 , 144 , 147 , 168 ]. In one study of a rural nursing home, HCWs reported being illegally required to treat COVID-19 patients without adequate PPE [ 39 ]. Specialised physicians, such as radiologists, for example, reported that PPE were prioritised for COVID-19 ward workers [ 65 ]. In another instance, HCWs reported that they had taken care of their own mask supply [ 113 ]. Insufficient equipment and the subsequent lack of protection induced fear and anxiety regarding one’s personal safety [ 64 , 87 ]. HCWs also reported inadequate human resources, which had consequences on increased workload [ 44 , 46 , 54 , 69 , 75 , 85 ]. Dissatisfaction with limited infrastructure was reported overall and across settings, but specific limitations were particularly relevant in certain contexts [ 116 ]. HCWs in low resource settings, including Pakistan, Zimbabwe and India, reported worsening conditions regarding infrastructure, characterised by a lack of water supply and ventilation, poor conditions of isolation wards and lack of quality rest areas for staff [ 41 , 58 , 84 ]. Despite adaptive interventions aimed at shifting service delivery to outdoors, procedures such as patient registration and laboratory work took place in poorly ventilated rooms [ 56 ]. Technical support such as the accessibility to specialised knowledge and availability of training were identified by HCWs as an important resource that required strengthening. They advocated for better “tailor-made” trainings in emergency preparedness and response, crisis management, PPE use and infection control [ 41 , 52 , 61 , 68 , 73 , 127 , 144 ]. HCWs argued that the availability of such training would improve their sense of control in health emergencies, while a lack of training compromised their confidence in their ability to provide quality healthcare [ 47 , 134 ].

Structural factors such as power hierarchies and inequalities played a role in HCWs’ perceived sense of institutional support amidst the quick changes in their institutions. Such factors were particularly mentioned in studies investigating nurses who reported dissatisfaction over doctors’ dominance and discrimination in obtaining PPE [ 54 ] as well as unfairness in work allocation [ 72 , 184 ]. They also perceived ambiguity in roles and responsibilities between nurses and doctors [ 101 ]. A low sense of institutional support was also reported by other HCWs. Junior medical staff and administrative staff reported feeling exposed to unacceptable risks of infection and a lack of recognition by their institution [ 139 ]. Staff in non‐clinical roles, non-frontline staff, staff working from home, acute physicians and those on short time contracts felt less supported and less recognised compared to colleagues on the frontline [ 48 , 139 ].

Community level

This level entails how morale and norms, as well as public knowledge relate to HCWs’ experiences in the pandemic. On the positive side, societal morale and norms were perceived as enhancing supportive attitudes among the public toward HCWs and triggering community initiatives that supported HCWs in both emotional and material ways [ 47 , 78 , 92 , 108 , 140 , 147 ]. This supportive element was especially experienced by frontline HCWs, who felt valued, appreciated and empowered by their communities. HCWs’ reaction to the hero status that was assigned to them was ambivalent [ 146 , 185 ]. In response to this status attribution, HCWs reported a sense of pressure to be on the frontline and to work beyond their regular work schedule [ 51 ]. With community support being perceived as clearly focusing on hospital frontline staff, HCWs working from home, in nursing homes, home care and non-frontline facilities and wards perceived less public support [ 139 ] and appreciation [ 85 , 144 ]. One study highlighted that HCWs did not benefit from this form of public praise but preferred an appreciation in the form of tangible and financial resources instead [ 160 ].

A clear negative aspect of social norms manifested in the stigmatisation and negative judgment by community members [ 72 , 100 , 106 , 186 , 187 ], who avoided contact with HCWs based on the perceptions that they were virus carriers and spreaders [ 43 , 68 , 92 , 111 ]. Such discrimination had negative consequences with regard to HCWs’ personal lives, including lack of access to public transportation, supermarkets, childcare and other public services [ 65 , 80 , 107 ]. Chinese HCWs working abroad reported bullying due to others perceiving and labeling COVID-19 as the ‘Chinese virus’ [ 77 ]. Negative judgment was mainly reported in studies on nurses . In a study of a COVID-19-designated hospital, frontline nurses reported unusually strict social standards directed solely at them [ 122 ]. In a comparative study of nursing homes in four countries, geriatric nurses reported social stigma toward their profession, which the society perceive not worth of respect [ 75 ].

Beyond social norms, studies identified the level of public awareness, knowledge and compliance as important determinants of HCWs’ experiences and emotional well-being [ 147 ]. For example, a lack of compliance with social distancing and other preventive measures was reported to induce feelings of betrayal, anger and anxiety among HCWs [ 41 , 80 , 81 , 111 , 188 ]. The dissemination of false information and rumors and their negative influence on knowledge and compliance was also reported with anger by HCWs in general [ 58 ], an in particular by those who worked closely with local communities [ 129 ]. Online resources and voluntary groups facilitated information exchange and knowledge transfer, factors which were valued by HCWs as an important source of information and support [ 131 , 189 ].

Policy level

Findings presented here include HCWs’ perceptions of governmental responses, governmental support and the impact of governmental measures on their professional and private situation. In a small number of studies, HCWs expressed confidence in their government’s ability to respond to the pandemic and satisfaction with governmental compensation [ 45 , 47 ]. In most cases, however, HCWs expressed dissatisfactions with the governmental response, particularly with the lack of health system organisation, the lack of a coordinated, unified response and the failure to follow an evidence-based approach to policy making. HCWs also perceived governmental guidelines as chaotic, confusing and even contradicting [ 61 , 85 , 86 , 115 , 117 , 118 , 120 , 123 , 147 , 160 , 182 , 190 ]. In one study, inadequate staffing was directly attributed to inadequate governmental funding decisions [ 191 ]. Many studies reported that HCWs had a sense of being failed by their governments [ 60 , 100 , 191 ], with non-frontline staff, notably HCWs working with the disabled [ 71 , 181 ], the elderly [ 39 , 75 , 123 , 151 ] or in home-based care [ 58 ], being particularly likely to voice feelings of being forgotten, deprioritised, invisible, less recognised and less valued by their governments. Care home staff perceived governmental support to be unequally distributed across health facilities and as being focused solely on public institutions, which prevented them from receiving state benefits [ 149 ].

Measures and regulations imposed at the governmental level had a considerable impact on HCWs’ professional as well as personal experiences. In nursing homes, HCWs perceived governmental regulations such as visiting restrictions as particularly challenging and complained that rules had not been designed or implemented with consideration to individual cases [ 62 ]. The imposed rules burdened them with additional administrative tasks and forced them to compromise on the quality of care, resulting in moral distress [ 62 ]. In abortion clinics, HCWs expressed concerns about their services being classed as non-essential services during the early stages of the pandemic [ 190 ]. Governmental policies also had impacts on HCWs personally. For example, the closure of childcare negatively impacted HCWs’ ability to balance personal and private roles and commitments. National lockdowns which restricted travel made it harder for HCWs to get to work or to see their families, especially in places with low political stability [ 95 ]. The de-escalation of measures, notably the opening of airports, was perceived as betrayal by HCWs who felt they bore the burden of increased COVID-19 incidences resulting from de-escalation strategies [ 111 ].

HCWs identified clear and consistent governmental crisis communication [ 97 , 126 ], better employees’ rights and salaries, and tailored pandemic preparedness and crisis management policies that considered different healthcare settings and HCWs’ needs [ 43 , 64 , 81 , 101 , 124 , 160 , 167 , 169 , 188 , 192 , 193 ] as important areas for improvement. HCWs in primary care advocated for strengthened primary health care, improved public health education [ 45 , 130 ] and a multi-sectoral approach in pandemic management [ 129 ].

Our scoping review of HCWs’ experiences, support needs and factors that influence these experiences during COVID-19 shows that HCWs were affected at individual, interpersonal, institutional, community and policy levels. It also highlights that certain experiences can have disruptive effects on HCWs’ personal and professional lives, and thus identifies problems which need to be addressed and areas that could be strengthened to support HCWs during pandemics.

To the best of our knowledge, our review is the first to provide a comprehensive account of HCWs’ experiences during COVID-19 across contexts. By applying an exploratory angle and focusing on existing qualitative studies, the review does not only provide a rich description of the situation of HCWs but also develops an in-depth analysis of the contextual multilevel factors which impact on HCWs’ experiences.

Our scoping review shows that, while studies on HCWs’ experiences in low resource settings are scarce, the few studies that exist and the comparison with other studies point towards setting-specific experiences and challenges. We thus argue that understanding HCWs’ experiences requires comparative investigations, which not only take countries’ income levels into account but also other contextual differences. For example, in our analysis, we identify particular challenges experienced by HCWs working in urban slums and places with limited infrastructure and low political stability. Similarly, in a recent short communication in Social Science & Medicine, Smith [ 194 ] presents a case study on the particular challenges of midwives in resource-poor rural Indonesia at the start of the pandemic, highlighting increased risks and intra-country health system inequalities. Contextual intra-country differences in HCWs’ experiences also manifest at institutional level. For example, the review suggests that HCWs who work in non-hospital settings, such as primary care services, nursing homes, home based care or disability services, experienced particular challenges and felt less recognized in relation to hospital-based HCWs. In a similar vein, HCWs working in care homes felt that as state support was not equally distributed, those working in public institutions had better chances to benefit from state support.

The review highlights that occupational hierarchies play a crucial role in HCWs’ work-related experiences. Our analysis suggests that existing occupational hierarchies seem to increase or be exposed during pandemics and that occupation is a structural factor in shaping HCWs’ experiences. The review thus highlights the important role that institutions and employers play in pandemics and is in line with the growing body of evidence that associates HCWs’ well-being during COVID-19 with their occupational role [ 195 ] and the availability of institutional support [ 195 , 196 ]. The findings suggest that to address institutional differences and ensure the provision of needs-based support to all groups of HCWs, non-hierarchical and participative processes of decision-making are crucial.

Another contextual factor affecting HCWs’ experiences are their communities. While the majority of HCWs experience emotional and material support from their community, some also feel pressure by the expectations they are confronted with. The most prominent example of such perceived pressure is the ambivalence that was reported with regard to the assignment of a hero status to HCWs. On the one hand, this attribution meant that HCWs felt recognized and appreciated by their communities. On the other hand, it led to HCWs feeling pressured to work without respecting their own limits and taking care of themselves.

This scoping review points towards a number of research gaps, which, if addressed, could help to hone interventions to support HCWs and improve health system performance and resilience.

First, the majority of existing qualitative studies investigate nurses’ and doctors’ experiences during COVID-19. Given that other types of HCWs play an equally important role in pandemic responses, future research on HCWs’ experiences in pandemics should aim for more diversity and help to tease out the specific challenges and needs of different types of HCWs. Investigating different types of HCWs could inform and facilitate the development of tailored solutions and provide need-based support.

Second, the majority of studies on HCWs’ experiences focus on hospital settings. This is not surprising considering that the bulk of societal and political attention during COVID-19 has been on the provision of acute, hospital-based care. The review thus highlights a gap with regard to research on HCWs in settings which might be considered less affected and neglected but which might, in fact, be severely collaterally affected during pandemics, such as primary health centers, care homes and home-based care. It also indicates that research which compares HCWs’ experiences across levels of care can help to tease out differences and identify specific challenges and needs.

Third, the review highlights the predominance of cross-sectional studies. In fact, we were unable to identify any longitudinal studies of HCWs’ experiences during COVID-19. A possible reason for the lack of longitudinal research is the relatively short time that has passed since the start of the pandemic which might have made it difficult to complete longitudinal qualitative studies. Yet, given the dynamics and extended duration of the pandemic, and knowledge about the impact of persistent stress on an individual’s health and well-being [ 197 , 198 , 199 , 200 ], longitudinal studies on HCWs’ experiences during COVID-19 would provide added value and allow an analysis across different stages of the pandemic as well as post-pandemic times. In our review, three differences in HCWs’ experiences across the phases of the pandemic were observed. The first one is on the individual level, reflecting the dominance of the negative emotions at the initial phase of the pandemic, which was gradually followed by increased reporting of the positive impact on HCWs’ personal and professional identity. The two other differences were on the institutional level, referring to the dissatisfaction over the lack of equipment and organization of care, mainly observed at the initial pandemic phase. Further comparative analysis of changes in HCWs’ experiences over the course of a pandemic is an interesting and important topic for future research, which could also map HCWs’ experiences against hospital capacities, availability of vaccines and tests as well as changes in pandemic restrictions. Such comparative analysis can inform the development of suitable policy level interventions accounting for HCWs’ experiences at different pandemic stages, from preparedness to initial response and recovery.

Finally, the majority of studies included in the review were conducted in the Northern hemisphere, revealing a gap in understanding the reality of HCWs in low- and lower middle income countries. Ensuring diversity in geographies and including resource-poor settings in research on HCWs would help gain a better contextual understanding, contribute to strengthening pandemic preparedness in settings, where the need is greatest, and facilitate knowledge transfer between the global North and South. While further research can help to increase our understanding of HCWs’ experiences during pandemics, this scoping review establishes a first basis for the evaluation and improvement of interventions aimed at supporting HCWs prior to, during and after COVID-19. A key finding of our analysis to strengthen HCWs’ resilience are the interdependencies of factors across the five levels of the socio-ecological model. For example, institutional, community or policy level factors (such as dissatisfaction with decision-making processes, public non-compliance or failures in pandemic management) can have a negative impact on HCWs at interpersonal and individual levels by impacting on their professional relationships, mental health or work performance. Similarly, policy, community or institutional level factors (such as adequate policy measures, appreciation within the community and the provision of PPE and other equipment) can act as protective factors for HCWs’ well-being. In line with the social support literature [ 201 ], interpersonal relationships were identified as a key factor in shaping HCWs’ experiences. The identification of the inter-dependencies between factors affecting HCWs during pandemics further highlights that health systems are severely impacted by factors outside the health systems’ control. Previous scholars have recognized the embeddedness of health systems within, and their constant interaction with, their socio-economic and political environment [ 202 ]. Previous literature, however, also shows that interventions tackling distress of HCWs have largely focused on individual level factors, e.g., on interventions aimed at relieving psychological symptoms, rather than on contextual factors [ 16 ]. To strengthen HCWs and empower them to deal with pandemics, the contextual factors that affect their situation during pandemics need to be acknowledged and interventions need to follow a multi-component approach, taking the multitude of aspects and circumstances into account which impact on HCWs’ experiences.

Limitations and strengths

Our scoping review comes with a number of limitations. First, due to resource constraints, the search was conducted using only one database. The authors acknowledge that running the search strategy on other search engines could have resulted in additional interesting studies to be reviewed. To mitigate any weaknesses, extensive efforts were made to build a strong search string by reviewing previous peer-reviewed publications as well as available resources from recognized public health institutions. Considering the high numbers of studies identified, it can be, however, assumed that the search strategy and review led to valid conclusions. Second, the review excluded non-original publications. While other types of publications could have provided additional data and perspectives on HCWs’ experiences, we decided to limit our review to original, peer-reviewed research articles to ensure quality. Third, the review excluded studies on other pandemics, which could have provided further insights into HCWs’ experiences during health crises. Given the limited resources available to the research project, it was decided to focus only on COVID-19 to accommodate a larger target group of all types of HCWs and a variety of geographical locations and healthcare settings. Furthermore, it can be argued that previous pandemics did not reach the magnitude of COVID-19 and did not lead to similar responses. With the review looking at the burden of COVID-19 as a stressor, it can be assumed that the more important the stressor, the more interesting the results. Therefore, the burdens and the way in which HCWs dealt with these burdens would be particularly augmented with regard to COVID-19, making it a suitable focus example to investigate HCWs’ experiences in health crises. The authors acknowledge that during other pandemics HCWs’ experiences might differ and be less pronounced, yet this review has addressed stressors and ways of supporting HCWs that could also inform future health crises. In our view, a major strength of the review is that is does not apply any limitation in terms of the types of HCWs, the geographical locations or the healthcare settings included. This approach did not only allow us to review a wide range of literature on an expanding area of knowledge [ 30 ], but to appropriately investigate HCWs’ experiences during a public health emergency of international concern that affects countries across the globe. Providing detailed information about the contexts in which HCWs were studied, allowed us to shed light on the contextual factors affecting HCWs’ experiences.

Implications for policy and practice

Areas of future interventions that improve HCWs’ resilience at individual level could aim towards alleviating stress and responding to their specific needs during pandemics, in line with encouraging self-care activities that can foster personal psychological resilience. Beyond that, accounting for the context when designing and implementing interventions is crucial. This can be done by addressing the circumstances HCWs live and work in, referred to in German-speaking countries as “Verhältnisprävention”, i.e., prevention through tackling living and working conditions. Respective interventions should tackle all levels outlined in the socio-ecological model, applying a systems approach. At the interpersonal level, creating a positive work environment in times of crises that is supportive of uninterrupted and efficient communication among HCWs and between HCWs and patients is important. In addition, interpersonal support, e.g., by family and friends could be facilitated. At institutional level, organizational change should consider transparent and participatory decision making and responsible planning of resources availability and allocation. At community level, tracing rumors and misinformation during health emergencies is crucial, as well as advocating for accountable journalism and community initiatives that support HCWs in times of crisis. At policy level, pandemic regulations need to account for their consequences on HCWs’ work situations and personal lives. Governmental policies and guidelines should build on scientific evidence and take into account the situations and lived experiences of HCWs across all levels of care.

This scoping review of existing qualitative research on HCWs’ experiences during COVID-19 sheds light on the impact of a major pandemic on the health workforce, a key pillar of health systems. By identifying key drawbacks, strengths that can be built upon, and crucial entry-points for interventions, the review can inform strategies towards strengthening HCWs and improving their experiences. Following a systems approach which takes the five socio-ecological levels into account is crucial for the development of context-sensitive strategies to support HCWs prior to, during and after pandemics. This in turn can contribute to building a sustainable health workforce and to strengthening and better preparing health systems for future pandemics.

Availability of data and materials

All data generated during this study are included in this published article and its supplementary information files, except for a detailed extraction sheet for all studies included, which is available from the corresponding author upon request.

Abbreviations

• Health care workers

Joanna Briggs Institute

Focus Groups Discussions

Personal Protective Equipment

World Health Organization

World Health Organization. Strengthening health systems to improve health outcomes—WHO framework for action 2007. https://www.who.int/healthsystems/strategy/everybodys_business.pdf?ua=1 . Accessed 29 July 2020.

Hanefeld J, Mayhew S, Legido-Quigley H, Martineau F, Karanikolos M, Blanchet K. Towards an understanding of resilience: responding to health systems shocks. Health Policy Plan. 2018;33(3):355–67.

PubMed   PubMed Central   Google Scholar  

Schwartz R, Sinskey JL, Anand U, Margolis RD. Addressing postpandemic clinician mental health: a narrative review and conceptual framework. Ann Intern Med. 2020;173(12):981–8.

PubMed   Google Scholar  

Houghton C, Meskell P, Delaney H, Smalle M, Glenton C, Booth A, et al. Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane Database Syst Rev. 2020;4(4):CD013582.

Bhaumik S, Moola S, Tyagi J, Nambiar D, Kakoti M. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020;5(6): e002769.

Chersich MF, Gray G, Fairlie L, Eichbaum Q, Mayhew S, Allwood B, et al. COVID-19 in Africa: care and protection for frontline healthcare workers. Glob Health. 2020;16(1):46.

Google Scholar  

Giorgi G, Lecca LI, Alessio F, Finstad GL, Bondanini G, Lulli LG, et al. COVID-19-related mental health effects in the workplace: a narrative review. Int J Environ Res Public Health. 2020;17(21):7857.

CAS   PubMed Central   Google Scholar  

De Brier N, Stroobants S, Vandekerckhove P, De Buck E. Factors affecting mental health of health care workers during coronavirus disease outbreaks (SARS, MERS & COVID-19): a rapid systematic review. PLoS ONE. 2020;15(12): e0244052.

Rieckert A, Schuit E, Bleijenberg N, Ten Cate D, de Lange W, de Man-van Ginkel JM, et al. How can we build and maintain the resilience of our health care professionals during COVID-19? Recommendations based on a scoping review. BMJ Open. 2021;11(1): e043718.

Kuek JTY, Ngiam LXL, Kamal NHA, Chia JL, Chan NPX, Abdurrahman A, et al. The impact of caring for dying patients in intensive care units on a physician’s personhood: a systematic scoping review. Philos Ethics Humanit Med. 2020;15(1):12.

Salazar de Pablo G, Vaquerizo-Serrano J, Catalan A, Arango C, Moreno C, Ferre F, et al. Impact of coronavirus syndromes on physical and mental health of health care workers: systematic review and meta-analysis. J Affect Disord. 2020;275:48–57.

CAS   PubMed   PubMed Central   Google Scholar  

Shreffler J, Petrey J, Huecker M. The impact of COVID-19 on healthcare worker wellness: a scoping review. West J Emerg Med. 2020;21(5):1059–66.

Sanghera J, Pattani N, Hashmi Y, Varley KF, Cheruvu MS, Bradley A, et al. The impact of SARS-CoV-2 on the mental health of healthcare workers in a hospital setting—a systematic review. J Occup Health. 2020;62(1): e12175.

Serrano-Ripoll MJ, Meneses-Echavez JF, Ricci-Cabello I, Fraile-Navarro D, Fiol-deRoque MA, Pastor-Moreno G, et al. Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis. J Affect Disord. 2020;277:347–57.

Fernandez R, Lord H, Halcomb E, Moxham L, Middleton R, Alananzeh I, et al. Implications for COVID-19: a systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic. Int J Nurs Stud. 2020;111: 103637.

Muller AE, Hafstad EV, Himmels JPW, Smedslund G, Flottorp S, Stensland S, et al. The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: a rapid systematic review. Psychiatry Res. 2020;293: 113441.

Paiano M, Jaques AE, Nacamura PAB, Salci MA, Radovanovic CAT, Carreira L. Mental health of healthcare professionals in China during the new coronavirus pandemic: an integrative review. Rev Bras Enferm. 2020;73(suppl 2): e20200338.

Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic—a review. Asian J Psychiatry. 2020;51: 102119.

Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. 2020;88:901–7.

Salari N, Khazaie H, Hosseinian-Far A, Khaledi-Paveh B, Kazeminia M, Mohammadi M, et al. The prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients: a systematic review and meta-regression. Hum Resour Health. 2020;18(1):100.

Cénat JM, Blais-Rochette C, Kokou-Kpolou CK, Noorishad PG, Mukunzi JN, McIntee SE, et al. Prevalence of symptoms of depression, anxiety, insomnia, posttraumatic stress disorder, and psychological distress among populations affected by the COVID-19 pandemic: a systematic review and meta-analysis. Psychiatry Res. 2021;295: 113599.

da Silva FCT, Neto MLR. Psychiatric symptomatology associated with depression, anxiety, distress, and insomnia in health professionals working in patients affected by COVID-19: a systematic review with meta-analysis. Prog Neuro-Psychopharmacol Biol Psychiatry. 2021;104: 110057.

Luo M, Guo L, Yu M, Jiang W, Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public—a systematic review and meta-analysis. Psychiatry Res. 2020;291: 113190.

da Silva FCT, Neto MLR. Psychological effects caused by the COVID-19 pandemic in health professionals: a systematic review with meta-analysis. Progr Neuro-psychopharmacol Biol Psychiatry. 2021;104: 110062.

Preti E, Di Mattei V, Perego G, Ferrari F, Mazzetti M, Taranto P, et al. The psychological impact of epidemic and pandemic outbreaks on healthcare workers: rapid review of the evidence. Curr Psychiatry Rep. 2020;22(8):43.

Carmassi C, Foghi C, Dell’Oste V, Cordone A, Bertelloni CA, Bui E, et al. PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: what can we expect after the COVID-19 pandemic. Psychiatry Res. 2020;292: 113312.

Chow KM, Law BMH, Ng MSN, Chan DNS, So WKW, Wong CL, et al. A Review of psychological issues among patients and healthcare staff during two major coronavirus disease outbreaks in China: contributory factors and management strategies. Int J Environ Res Public Health. 2020;17(18):6673.

Krishnamoorthy Y, Nagarajan R, Saya GK, Menon V. Prevalence of psychological morbidities among general population, healthcare workers and COVID-19 patients amidst the COVID-19 pandemic: a systematic review and meta-analysis. Psychiatry Res. 2020;293: 113382.

Xiong Y, Peng L. Focusing on health-care providers’ experiences in the COVID-19 crisis. Lancet Glob Health. 2020;8(6):e740–1.

Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119–26.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71.

Shaw RL, Booth A, Sutton AJ, Miller T, Smith JA, Young B, et al. Finding qualitative research: an evaluation of search strategies. BMC Med Res Methodol. 2004;4:5.

World Health Organization. Finding public health information: WHO library PubMed cochrane library 2016. https://www.gfmer.ch/SRH-Course-2019/research-methodology/pdf/WHOLibPubMedCochrane-Allen-2019.pdf . Accessed 21 Jan 2021.

World Bank. World development indicators (WDI) 2021. https://databank.worldbank.org/source/world-development-indicators . Accessed 21 July 2021.

Joanna Briggs Institute. Checklist for qualitative research critical appraisal tools for use in JBI systematic reviews 2020. https://jbi.global/sites/default/files/2020-08/Checklist_for_Qualitative_Research.pdf . Accessed 19 May 2021.

Bronfenbrenner U. Toward an experimental ecology of human development. Am Psychol. 1977;32(7):513–31.

Bronfenbrenner U. The Ecology of human development. Cambridge: Harvard University Press; 1979.

McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351–77.

CAS   PubMed   Google Scholar  

Leskovic L, Erjavec K, Leskovar R, Vukovič G. Burnout and job satisfaction of healthcare workers in Slovenian nursing homes in rural areas during the COVID-19 pandemic. Ann Agric Environ Med. 2020;27(4):664–71.

Whelehan DF, Connelly TM, Ridgway PF. COVID-19 and surgery: a thematic analysis of unintended consequences on performance, practice and surgical training. Surgeon. 2021;19(1):e20–7.

Haq W, Said F, Batool S, Awais HM. Experience of physicians during COVID-19 in a developing country: a qualitative study of Pakistan. J Infect Dev Ctries. 2021;15(2):191–7.

Okediran JO, Ilesanmi OS, Fetuga AA, Onoh I, Afolabi AA, Ogunbode O, et al. The experiences of healthcare workers during the COVID-19 crisis in Lagos, Nigeria: a qualitative study. Germs. 2020;10(4):356–66.

Muz G, Erdoğan YG. Experiences of nurses caring for patients with COVID-19 in Turkey: a phenomenological enquiry. J Nurs Manag. 2021;29(5):1026–35.

Ardebili ME, Naserbakht M, Bernstein C, Alazmani-Noodeh F, Hakimi H, Ranjbar H. Healthcare providers experience of working during the COVID-19 pandemic: a qualitative study. Am J Infect Control. 2021;49(5):547–54.

Xu Z, Ye Y, Wang Y, Qian Y, Pan J, Lu Y, et al. Primary care practitioners’ barriers to and experience of COVID-19 epidemic control in China: a qualitative study. J Gen Intern Med. 2020;35(11):3278–84.

Yıldırım N, Aydoğan A, Bulut M. A qualitative study on the experiences of the first nurses assigned to COVID-19 units in Turkey. J Nurs Manag. 2021;29(6):1366–74.

Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control. 2020;48(6):592–8.

Cubitt LJ, Im YR, Scott CJ, Jeynes LC, Molyneux PD. Beyond PPE: a mixed qualitative–quantitative study capturing the wider issues affecting doctors’ well-being during the COVID-19 pandemic. BMJ Open. 2021;11(3): e050223.

Cui S, Zhang L, Yan H, Shi Q, Jiang Y, Wang Q, et al. Experiences and psychological adjustments of nurses who voluntarily supported COVID-19 patients in Hubei Province, China. Psychol Res Behav Manag. 2020;13:1135–45.

Aksoy H, Ayhan Başer D, Fidancı İ, Arsava EY, Cankurtaran M. Family medicine research assistants’ experiences during COVID-19 pandemic: a qualitative study. Int J Clin Pract. 2020;75: e13975.

Gómez-Ibáñez R, Watson C, Leyva-Moral JM, Aguayo-González M, Granel N. Final-year nursing students called to work: experiences of a rushed labour insertion during the COVID-19 pandemic. Nurse Educ Pract. 2020;49: 102920.

Fernández-Castillo RJ, González-Caro MD, Fernández-García E, Porcel-Gálvez AM, Garnacho-Montero J. Intensive care nurses’ experiences during the COVID-19 pandemic: a qualitative study. Nurs Crit Care. 2021;26(5):397–406.

Alizadeh A, Khankeh HR, Barati M, Ahmadi Y, Hadian A, Azizi M. Psychological distress among Iranian health-care providers exposed to coronavirus disease 2019 (COVID-19): a qualitative study. BMC Psychiatry. 2020;20(1):494.

Moradi Y, Baghaei R, Hosseingholipour K, Mollazadeh F. Challenges experienced by ICU nurses throughout the provision of care for COVID-19 patients: a qualitative study. J Nurs Manag. 2021;29(5):1159–68.

Hoernke K, Djellouli N, Andrews L, Lewis-Jackson S, Manby L, Martin S, et al. Frontline healthcare workers’ experiences with personal protective equipment during the COVID-19 pandemic in the UK: a rapid qualitative appraisal. BMJ Open. 2021;11(1): e046199.

George CE, Inbaraj LR, Rajukutty S, de Witte LP. Challenges, experience and coping of health professionals in delivering healthcare in an urban slum in India during the first 40 days of COVID-19 crisis: a mixed method study. BMJ Open. 2020;10(11): e042171.

Yu JC, McIntyre M, Dow H, Robinson L, Winston P. Changes to rehabilitation service delivery and the associated physician perspectives during the COVID-19 pandemic: a mixed-methods needs assessment study. Am J Phys Med Rehabil. 2020;99(9):775–82.

Mackworth-Young CR, Chingono R, Mavodza C, McHugh G, Tembo M, Chikwari CD, et al. Community perspectives on the COVID-19 response, Zimbabwe. Bull World Health Organ. 2021;99(2):85–91.

Szabo RA, Wilson AN, Homer C, Vasilevski V, Sweet L, Wynter K, et al. Covid-19 changes to maternity care: experiences of Australian doctors. Aust N Z J Obstet Gynaecol. 2021;61(3):408–15.

Bennett P, Noble S, Johnston S, Jones D, Hunter R. COVID-19 confessions: a qualitative exploration of healthcare workers experiences of working with COVID-19. BMJ Open. 2020;10(12): e043949.

Collado-Boira EJ, Ruiz-Palomino E, Salas-Media P, Folch-Ayora A, Muriach M, Baliño P. “The COVID-19 outbreak”—an empirical phenomenological study on perceptions and psychosocial considerations surrounding the immediate incorporation of final-year Spanish nursing and medical students into the health system. Nurse Educ Today. 2020;92: 104504.

Sizoo EM, Monnier AA, Bloemen M, Hertogh C, Smalbrugge M. Dilemmas with restrictive visiting policies in dutch nursing homes during the COVID-19 pandemic: a qualitative analysis of an open-ended questionnaire with elderly care physicians. J Am Med Dir Assoc. 2020;21(12):1774-81.e2.

Chen F, Zang Y, Liu Y, Wang X, Lin X. Dispatched nurses’ experience of wearing full gear personal protective equipment to care for COVID-19 patients in China—a descriptive qualitative study. J Clin Nurs. 2021;30(13–14):2001–14.

Fang M, Xia B, Tian T, Hao Y, Wu Z. Drivers and mediators of healthcare workers’ anxiety in one of the most affected hospitals by COVID-19: a qualitative analysis. BMJ Open. 2021;11(3): e045048.

Foley SJ, O’Loughlin A, Creedon J. Early experiences of radiographers in Ireland during the COVID-19 crisis. Insights Imaging. 2020;11(1):104.

Crowe S, Howard AF, Vanderspank-Wright B, Gillis P, McLeod F, Penner C, et al. The effect of COVID-19 pandemic on the mental health of Canadian critical care nurses providing patient care during the early phase pandemic: a mixed method study. Intensive Crit Care Nurs. 2020;63: 102999.

Palacios-Ceña D, Fernández-de-Las-Peñas C, Florencio LL, de-la-Llave-Rincón AI, Palacios-Ceña M. Emotional experience and feelings during first COVID-19 outbreak perceived by physical therapists: a qualitative study in Madrid, Spain. Int J Environ Res Public Health. 2020;18(1):127.

PubMed Central   Google Scholar  

Urooj U, Ansari A, Siraj A, Khan S, Tariq H. Expectations, fears and perceptions of doctors during Covid-19 pandemic. Pak J Med Sci. 2020;36(Covid19-s4):S37–42.

Kaur R, Kaur A, Kumar P. An experience of otorhinolaryngologists as frontline worker with novel coronavirus: a qualitative analysis. Indian J Otolaryngol Head Neck Surg. 2021. https://doi.org/10.1007/s12070-021-02369-3 .

Article   PubMed   Google Scholar  

González-Timoneda A, Hernández Hernández V, Pardo Moya S, Alfaro Blazquez R. Experiences and attitudes of midwives during the birth of a pregnant woman with COVID-19 infection: a qualitative study. Women Birth. 2020;34(5):465–72.

Embregts P, Tournier T, Frielink N. Experiences and needs of direct support staff working with people with intellectual disabilities during the COVID-19 pandemic: a thematic analysis. J Appl Res Intell Disabil. 2021;34(2):480–90.

Kackin O, Ciydem E, Aci OS, Kutlu FY. Experiences and psychosocial problems of nurses caring for patients diagnosed with COVID-19 in Turkey: a qualitative study. Int J Soc Psychiatry. 2020;67(2):158–67.

Tan R, Yu T, Luo K, Teng F, Liu Y, Luo J, et al. Experiences of clinical first-line nurses treating patients with COVID-19: a qualitative study. J Nurs Manag. 2020;28(6):1381–90.

Liu YE, Zhai ZC, Han YH, Liu YL, Liu FP, Hu DY. Experiences of front-line nurses combating coronavirus disease-2019 in China: a qualitative analysis. Public Health Nurs. 2020;37(5):757–63.

Sarabia-Cobo C, Pérez V, de Lorena P, Hermosilla-Grijalbo C, Sáenz-Jalón M, Fernández-Rodríguez A, et al. Experiences of geriatric nurses in nursing home settings across four countries in the face of the COVID-19 pandemic. J Adv Nurs. 2021;77(2):869–78.

Billings J, Biggs C, Ching BCF, Gkofa V, Singleton D, Bloomfield M, et al. Experiences of mental health professionals supporting front-line health and social care workers during COVID-19: qualitative study. BJPsych Open. 2021;7(2): e70.

Song J, McDonald C. Experiences of New Zealand registered nurses of Chinese ethnicity during the COVID-19 pandemic. J Clin Nurs. 2020;30(5–6):757–64.

LoGiudice JA, Bartos S. Experiences of nurses during the COVID-19 pandemic: a mixed-methods study. AACN Adv Crit Care. 2021;32(1):e1–13.

CoşkunŞimşek D, Günay U. Experiences of nurses who have children when caring for COVID-19 patients. Int Nurs Rev. 2021;68(2):219–27.

Galehdar N, Kamran A, Toulabi T, Heydari H. Exploring nurses’ experiences of psychological distress during care of patients with COVID-19: a qualitative study. BMC Psychiatry. 2020;20(1):489.

Munawar K, Choudhry FR. Exploring stress coping strategies of frontline emergency health workers dealing Covid-19 in Pakistan: a qualitative inquiry. Am J Infect Control. 2021;49(3):286–92.

Nyashanu M, Pfende F, Ekpenyong M. Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: experiences of frontline workers in the English Midlands region. UK J Interprof Care. 2020;34(5):655–61.

Gemine R, Davies GR, Tarrant S, Davies RM, James M, Lewis K. Factors associated with work-related burnout in NHS staff during COVID-19: a cross-sectional mixed methods study. BMJ Open. 2021;11(1): e042591.

Raza A, Matloob S, Abdul Rahim NF, Abdul Halim H, Khattak A, Ahmed NH, et al. Factors impeding health-care professionals to effectively treat coronavirus disease 2019 patients in Pakistan: a qualitative investigation. Front Psychol. 2020;11: 572450.

White EM, Wetle TF, Reddy A, Baier RR. Front-line nursing home staff experiences during the COVID-19 pandemic. J Am Med Dir Assoc. 2021;22(1):199–203.

Shalhub S, Mouawad NJ, Malgor RD, Johnson AP, Wohlauer MV, Coogan SM, et al. Global vascular surgeons’ experience, stressors, and coping during the coronavirus disease 2019 pandemic. J Vasc Surg. 2021;73(3):762-771.e4.

Lapum J, Nguyen M, Fredericks S, Lai S, McShane J. “Goodbye … through a glass door”: emotional experiences of working in COVID-19 acute care hospital environments. Can J Nurs Res = Revue canadienne de recherche en sciences infirmieres. 2020;53(1):5–15.

Testoni I, Francioli G, Biancalani G, Libianchi S, Orkibi H. Hardships in Italian prisons during the COVID-19 emergency: the experience of healthcare personnel. Front Psychol. 2021;12: 619687.

Ness MM, Saylor J, Di Fusco LA, Evans K. Healthcare providers’ challenges during the coronavirus disease (COVID-19) pandemic: a qualitative approach. Nurs Health Sci. 2021;23(2):389–97.

Mayfield-Johnson S, Smith DO, Crosby SA, Haywood CG, Castillo J, Bryant-Williams D, et al. Insights on COVID-19 from community health worker state leaders. J Ambul Care Manag. 2020;43(4):268–77.

He Q, Li T, Su Y, Luan Y. Instructive messages and lessons from Chinese countermarching nurses of caring for COVID-19 patients: a qualitative study. J Transcult Nurs. 2021;32(2):96–102.

DeliktasDemirci A, Oruc M, Kabukcuoglu K. ‘It was difficult, but our struggle to touch lives gave us strength’: the experience of nurses working on COVID-19 wards. J Clin Nurs. 2020;30(5–6):732–41.

Fontanini R, Visintini E, Rossettini G, Caruzzo D, Longhini J, Palese A. Italian nurses’ experiences during the COVID-19 pandemic: a qualitative analysis of internet posts. Int Nurs Rev. 2021;68(2):238–47.

Comfort AB, Krezanoski PJ, Rao L, El Ayadi A, Tsai AC, Goodman S, et al. Mental health among outpatient reproductive health care providers during the US COVID-19 epidemic. Reprod Health. 2021;18(1):49.

Maraqa B, Nazzal Z, Zink T. Mixed method study to explore ethical dilemmas and health care workers’ willingness to work amid COVID-19 pandemic in Palestine. Front Med. 2020;7: 576820.

Gesser-Edelsburg A, Cohen R, Shahbari NAE, Hijazi R. A mixed-methods sequential explanatory design comparison between COVID-19 infection control guidelines’ applicability and their protective value as perceived by Israeli healthcare workers, and healthcare executives’ response. Antimicrob Resist Infect Control. 2020;9(1):148.

Feeley T, Ffrench-O’Carroll R, Tan MH, Magner C, L’Estrange K, O’Rathallaigh E, et al. A model for occupational stress amongst paediatric and adult critical care staff during COVID-19 pandemic. Int Arch Occup Environ Health. 2021;94(7):1–17.

Shaw C, Gallagher K, Petty J, Mancini A, Boyle B. Neonatal nursing during the COVID-19 global pandemic: a thematic analysis of personal reflections. J Neonatal Nurs. 2021;27(3):165–71.

García-Martín M, Roman P, Rodriguez-Arrastia M, Diaz-Cortes MDM, Soriano-Martin PJ, Ropero-Padilla C. Novice nurse”s transitioning to emergency nurse during COVID-19 pandemic: a qualitative study. J Nurs Manag. 2021;29(2):258–67.

Arnetz JE, Goetz CM, Arnetz BB, Arble E. Nurse reports of stressful situations during the COVID-19 pandemic: qualitative analysis of survey responses. Int J Environ Res Public Health. 2020;17(21):8126.

Jia Y, Chen O, Xiao Z, Xiao J, Bian J, Jia H. Nurses’ ethical challenges caring for people with COVID-19: a qualitative study. Nurs Ethics. 2021;28(1):33–45.

Danielis M, Peressoni L, Piani T, Colaetta T, Mesaglio M, Mattiussi E, et al. Nurses’ experiences of being recruited and transferred to a new sub-intensive care unit devoted to COVID-19 patients. J Nurs Manag. 2021;29(5):1149–58.

Gao X, Jiang L, Hu Y, Li L, Hou L. Nurses’ experiences regarding shift patterns in isolation wards during the COVID-19 pandemic in China: a qualitative study. J Clin Nurs. 2020;29(21–22):4270–80.

Zhang MM, Niu N, Zhi XX, Zhu P, Wu B, Wu BN, et al. Nurses’ psychological changes and coping strategies during home isolation for the 2019 novel coronavirus in China: a qualitative study. J Adv Nurs. 2021;77(1):308–17.

Arcadi P, Simonetti V, Ambrosca R, Cicolini G, Simeone S, Pucciarelli G, et al. Nursing during the COVID-19 outbreak: a phenomenological study. J Nurs Manag. 2021;29(5):1111–9.

KalatehSadati A, Zarei L, Shahabi S, Heydari ST, Taheri V, Jiriaei R, et al. Nursing experiences of COVID-19 outbreak in Iran: a qualitative study. Nurs Open. 2020;8(1):72–9.

Ohta R, Matsuzaki Y, Itamochi S. Overcoming the challenge of COVID-19: a grounded theory approach to rural nurses’ experiences. J Gen Fam Med. 2020;22(3):134–40.

Vindrola-Padros C, Andrews L, Dowrick A, Djellouli N, Fillmore H, Bautista Gonzalez E, et al. Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the UK. BMJ Open. 2020;10(11): e040503.

Banerjee D, Vajawat B, Varshney P, Rao TS. Perceptions, experiences, and challenges of physicians involved in dementia care during the COVID-19 lockdown in India: a qualitative study. Front Psychiatry. 2020;11: 615758.

White JH. A phenomenological study of nurse managers’ and assistant nurse managers’ experiences during the COVID-19 pandemic in the United States. J Nurs Manag. 2021;29(6):1525–34.

Gunawan J, Aungsuroch Y, Marzilli C, Fisher ML, Nazliansyah, Sukarna A. A phenomenological study of the lived experience of nurses in the battle of COVID-19. Nurs Outlook. 2021;69(4):652–9.

Norful AA, Rosenfeld A, Schroeder K, Travers JL, Aliyu S. Primary drivers and psychological manifestations of stress in frontline healthcare workforce during the initial COVID-19 outbreak in the United States. Gen Hosp Psychiatry. 2021;69:20–6.

Moradi Y, Baghaei R, Hosseingholipour K, Mollazadeh F. Protective reactions of ICU nurses providing care for patients with COVID-19: a qualitative study. BMC Nurs. 2021;20(1):45.

Zhang Y, Wei L, Li H, Pan Y, Wang J, Li Q, et al. The psychological change process of frontline nurses caring for patients with COVID-19 during its outbreak. Issues Ment Health Nurs. 2020;41(6):525–30.

Fawaz M, Itani M. The psychological experiences of Lebanese ground zero front-line nurses during the most recent COVID-19 outbreak post Beirut blast: a qualitative study. Int J Soc Psychiatry. 2021. https://doi.org/10.1177/00207640211004989 .

Zerbini G, Ebigbo A, Reicherts P, Kunz M, Messman H. Psychosocial burden of healthcare professionals in times of COVID-19—a survey conducted at the University Hospital Augsburg. German Med Sci. 2020;18:Doc05.

Aughterson H, McKinlay AR, Fancourt D, Burton A. Psychosocial impact on frontline health and social care professionals in the UK during the COVID-19 pandemic: a qualitative interview study. BMJ Open. 2021;11(2): e047353.

Lee RLT, West S, Tang ACY, Cheng HY, Chong CYY, Chien WT, et al. A qualitative exploration of the experiences of school nurses during COVID-19 pandemic as the frontline primary health care professionals. Nurs Outlook. 2020;69(3):399–408.

Paula ACR, Carletto AGD, Lopes D, Ferreira JC, Tonini NS, Trecossi SPC. Reactions and feelings of health professionals in the care of hospitalized patients with suspected covid-19. Revista gaucha de enfermagem. 2021;42(spe): e20200160.

Iheduru-Anderson K. Reflections on the lived experience of working with limited personal protective equipment during the COVID-19 crisis. Nurs Inquiry. 2021;28(1): e12382.

Taylor AK, Kingstone T, Briggs TA, O’Donnell CA, Atherton H, Blane DN, et al. ‘Reluctant pioneer’: a qualitative study of doctors’ experiences as patients with long COVID. Health Expect. 2021;24(3):833–42.

Lee N, Lee HJ. South Korean nurses’ experiences with patient care at a COVID-19-designated hospital: growth after the frontline battle against an infectious disease pandemic. Int J Environ Res Public Health. 2020;17(23):9015.

Nyashanu M, Pfende F, Ekpenyong MS. Triggers of mental health problems among frontline healthcare workers during the COVID-19 pandemic in private care homes and domiciliary care agencies: lived experiences of care workers in the Midlands region, UK. Health Soc Care Community. 2020;30(2):e370–6.

Galehdar N, Toulabi T, Kamran A, Heydari H. Exploring nurses’ perception of taking care of patients with coronavirus disease (COVID-19): a qualitative study. Nurs Open. 2021;8(1):171–9.

Arasli H, Furunes T, Jafari K, Saydam MB, Degirmencioglu Z. Hearing the voices of wingless angels: a critical content analysis of nurses’ COVID-19 experiences. Int J Environ Res Public Health. 2020;17(22):8484.

Mulla A, Bigham BL, Frolic A, Christian MD. Canadian emergency medicine and critical care physician perspectives on pandemic triage in COVID-19. J Emerg Manag. 2020;18(7):31–5.

Ortiz Z, Antonietti L, Capriati A, Ramos S, Romero M, Mariani J, et al. Concerns and demands regarding COVID-19. Survey of health personnel. Medicina. 2020;80(Suppl 3):16–24.

Monzani A, Ragazzoni L, Della Corte F, Rabbone I, Franc JM. COVID-19 pandemic: perspective from italian pediatric emergency physicians. Disaster Med Public Health Prep. 2020;14(5):648–51.

Al Ghafri T, Al Ajmi F, Anwar H, Al Balushi L, Al Balushi Z, Al Fahdi F, et al. The experiences and perceptions of health-care workers during the COVID-19 pandemic in Muscat, Oman: a qualitative study. J Prim Care Community Health. 2020;11:2150132720967514.

Yin Y, Chu X, Han X, Cao Y, Di H, Zhang Y, et al. General practitioner trainees’ career perspectives after COVID-19: a qualitative study in China. BMC Fam Pract. 2021;22(1):18.

Foye U, Dalton-Locke C, Harju-Seppänen J, Lane R, Beames L, Vera San Juan N, et al. How has Covid-19 affected mental health nurses and the delivery of mental health nursing care in the UK? Results of a mixed methods study. J Psychiatr Ment Health Nurs. 2021;28(2):126–37.

Goh YS, Ow Yong QYJ, Chen TH, Ho SHC, Chee YIC, Chee TT. The impact of COVID-19 on nurses working in a University Health System in Singapore: a qualitative descriptive study. Int J Ment Health Nurs. 2020;30(3):643–52.

Verhoeven V, Tsakitzidis G, Philips H, Van Royen P. Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs. BMJ Open. 2020;10(6): e039674.

Travers JL, Schroeder K, Norful AA, Aliyu S. The influence of empowered work environments on the psychological experiences of nursing assistants during COVID-19: a qualitative study. BMC Nurs. 2020;19:98.

Semaan A, Audet C, Huysmans E, Afolabi B, Assarag B, Banke-Thomas A, et al. Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic. BMJ Glob Health. 2020;5(6): e002967.

Begerow A, Michaelis U, Gaidys U. Wahrnehmungen von Pflegenden im Bereich der Intensivpflege während der COVID-19-Pandemie. Pflege. 2020;33(4):229–36.

Santos J, Balsanelli AP, Freitas EO, Menegon FHA, Carneiro IA, Lazzari DD, et al. Work environment of hospital nurses during the COVID-19 pandemic in Brazil. Int Nurs Rev. 2021;68(2):228–37.

Fan J, Jiang Y, Hu K, Chen X, Xu Q, Qi Y, et al. Barriers to using personal protective equipment by healthcare staff during the COVID-19 outbreak in China. Medicine. 2020;99(48): e23310.

Digby R, Winton-Brown T, Finlayson F, Dobson H, Bucknall T. Hospital staff well-being during the first wave of COVID-19: staff perspectives. Int J Ment Health Nurs. 2020;30(2):440–50.

Nelson H, Hubbard Murdoch N, Norman K. The role of uncertainty in the experiences of nurses during the Covid-19 pandemic: a phenomenological study. Can J Nurs Res = Revue canadienne de recherche en sciences infirmieres. 2021;53(2):124–33.

Patterson JE, Edwards TM, Griffith JL, Wright S. Moral distress of medical family therapists and their physician colleagues during the transition to COVID-19. J Marital Fam Ther. 2021;47(2):289–303.

Palinkas LA, Whiteside L, Nehra D, Engstrom A, Taylor M, Moloney K, et al. Rapid ethnographic assessment of the COVID-19 pandemic April 2020 ‘surge’ and its impact on service delivery in an Acute Care Medical Emergency Department and Trauma Center. BMJ Open. 2020;10(10): e041772.

Hou Y, Zhou Q, Li D, Guo Y, Fan J, Wang J. Preparedness of our emergency department during the coronavirus disease outbreak from the nurses’ perspectives: a qualitative research study. J Emerg Nurs. 2020;46(6):848-861.e1.

Sterling MR, Tseng E, Poon A, Cho J, Avgar AC, Kern LM, et al. Experiences of home health care workers in New York City during the coronavirus disease 2019 pandemic: a qualitative analysis. JAMA Intern Med. 2020;180(11):1453–9.

Butler CR, Wong SPY, Wightman AG, O’Hare AM. US clinicians’ experiences and perspectives on resource limitation and patient care during the COVID-19 pandemic. JAMA Netw Open. 2020;3(11): e2027315.

Halberg N, Jensen PS, Larsen TS. We are not heroes—the flipside of the hero narrative amidst the COVID19-pandemic: a Danish hospital ethnography. J Adv Nurs. 2021;77(5):2429–36.

Hennein R, Lowe S. A hybrid inductive-abductive analysis of health workers’ experiences and wellbeing during the COVID-19 pandemic in the United States. PLoS ONE. 2020;15(10): e0240646.

Casafont C, Fabrellas N, Rivera P, Olivé-Ferrer MC, Querol E, Venturas M, et al. Experiences of nursing students as healthcare aid during the COVID-19 pandemic in Spain: a phemonenological research study. Nurse Educ Today. 2021;97: 104711.

Bilal A, Saeed MA, Yousafzai T. Elderly care in the time of coronavirus: perceptions and experiences of care home staff in Pakistan. Int J Geriatr Psychiatry. 2020;35(12):1442–8.

Butler CR, Wong SPY, Vig EK, Neely CS, O’Hare AM. Professional roles and relationships during the COVID-19 pandemic: a qualitative study among US clinicians. BMJ Open. 2021;11(3): e047782.

Williams CM, Couch A, Haines T, Menz HB. Experiences of Australian podiatrists working through the 2020 coronavirus (COVID-19) pandemic: an online survey. J Foot Ankle Res. 2021;14(1):11.

Liu Q, Luo D, Haase JE, Guo Q, Wang XQ, Liu S, et al. The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. Lancet Glob Health. 2020;8(6):e790–8.

Härter M, Bremer D, Scherer M, von dem Knesebeck O, Koch-Gromus U. Impact of COVID-19-pandemic on clinical care, work flows and staff at a University Hospital: results of an interview-study at the UKE. Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)). 2020;82(8–09):676–81.

Sheng Q, Zhang X, Wang X, Cai C. The influence of experiences of involvement in the COVID-19 rescue task on the professional identity among Chinese nurses: a qualitative study. J Nurs Manag. 2020;28(7):1662–9.

Donnelly C, Ashcroft R, Bobbette N, Mills C, Mofina A, Tran T, et al. Interprofessional primary care during COVID-19: a survey of the provider perspective. BMC Fam Pract. 2021;22(1):31.

Losty LS, Bailey KD. Leading through chaos: perspectives from nurse executives. Nurs Adm Q. 2021;45(2):118–25.

Catania G, Zanini M, Hayter M, Timmins F, Dasso N, Ottonello G, et al. Lessons from Italian front-line nurses’ experiences during the COVID-19 pandemic: a qualitative descriptive study. J Nurs Manag. 2020;29(3):404–11.

Daphna-Tekoah S, MegadasiBrikman T, Scheier E, Balla U. Listening to hospital personnel’s narratives during the COVID-19 outbreak. Int J Environ Res Public Health. 2020;17(17):6413.

Fan J, Hu K, Li X, Jiang Y, Zhou X, Gou X, et al. A qualitative study of the vocational and psychological perceptions and issues of transdisciplinary nurses during the COVID-19 outbreak. Aging. 2020;12(13):12479–92.

Missel M, Bernild C, Dagyaran I, Christensen SW, Berg SK. A stoic and altruistic orientation towards their work: a qualitative study of healthcare professionals’ experiences of awaiting a COVID-19 test result. BMC Health Serv Res. 2020;20(1):1031.

Pravder HD, Langdon-Embry L, Hernandez RJ, Berbari N, Shelov SP, Kinzler WL. Experiences of early graduate medical students working in New York hospitals during the COVID-19 pandemic: a mixed methods study. BMC Med Educ. 2021;21(1):118.

de Wit K, Mercuri M, Wallner C, Clayton N, Archambault P, Ritchie K, et al. Canadian emergency physician psychological distress and burnout during the first 10 weeks of COVID-19: a mixed-methods study. J Am College Emerg Physicians Open. 2020;1(5):1030–8.

Kuliukas L, Hauck Y, Sweet L, Vasilevski V, Homer C, Wynter K, et al. A cross sectional study of midwifery students’ experiences of COVID-19: uncertainty and expendability. Nurse Educ Pract. 2021;51: 102988.

Ladds E, Rushforth A, Wieringa S, Taylor S, Rayner C, Husain L, et al. Developing services for long COVID: lessons from a study of wounded healers. Clin Med. 2021;21(1):59–65.

Searby A, Burr D. The impact of COVID-19 on alcohol and other drug nurses’ provision of care: a qualitative descriptive study. J Clin Nurs. 2021;30(11–12):1730–41.

Hower KI, Pfaff H, Pförtner TK. Pflege in Zeiten von COVID-19: onlinebefragung von Leitungskräften zu Herausforderungen. Belastungen und Bewältigungsstrategien Pflege. 2020;33(4):207–18.

He K, Stolarski A, Whang E, Kristo G. Addressing general surgery residents’ concerns in the early phase of the COVID-19 pandemic. J Surg Educ. 2020;77(4):735–8.

Góes FGB, Silva A, Santos A, Pereira-Ávila FMV, Silva LJD, Silva LFD, et al. Challenges faced by pediatric nursing workers in the face of the COVID-19 pandemic. Rev Lat Am Enfermagem. 2020;28: e3367.

Halley MC, Mathews KS, Diamond LC, Linos E, Sarkar U, Mangurian C, et al. The intersection of work and home challenges faced by physician mothers during the coronavirus disease 2019 pandemic: a mixed-methods analysis. J Women’s Health. 2021;30(4):514–24.

Algunmeeyn A, El-Dahiyat F, Altakhineh MM, Azab M, Babar ZU. Understanding the factors influencing healthcare providers’ burnout during the outbreak of COVID-19 in Jordanian hospitals. J Pharm Policy Pract. 2020;13:53.

Sougou NM, Diouf JB, Diallo AA, Seck I. Risk perception of COVID-19 pandemic among health care providers: qualitative study conducted at the King Baudoin Hospital in Guédiawaye, the first hospital faced with managing a community-acquired COVID-19 case in Senegal. Pan Afr Med J. 2020;37(Suppl 1):23.

Conlon C, McDonnell T, Barrett M, Cummins F, Deasy C, Hensey C, et al. The impact of the COVID-19 pandemic on child health and the provision of care in paediatric emergency departments: a qualitative study of frontline emergency care staff. BMC Health Serv Res. 2021;21(1):279.

Bender AE, Berg KA, Miller EK, Evans KE, Holmes MR. “Making sure we are all okay”: healthcare workers’ strategies for emotional connectedness during the COVID-19 pandemic. Clin Soc Work J. 2021;49(4):1–11.

Yin X, Zeng L. A study on the psychological needs of nurses caring for patients with coronavirus disease 2019 from the perspective of the existence, relatedness, and growth theory. Int J Nurs Sci. 2020;7(2):157–60.

Creese J, Byrne JP, Conway E, Barrett E, Prihodova L, Humphries N. “We all really need to just take a breath”: composite narratives of hospital doctors’ well-being during the COVID-19 pandemic. Int J Environ Res Public Health. 2021;18(4):2051.

Silies K, Schley A, Sill J, Fleischer S, Müller M, Balzer K. Die COVID-19-Pandemie im akutstationären Setting aus Sicht von Führungspersonen und Hygienefachkräften in der Pflege - Eine qualitative Studie. Pflege. 2020;33(5):289–98.

Tremblay-Huet S, McMorrow T, Wiebe E, Kelly M, Hennawy M, Sum B. The impact of the COVID-19 pandemic on medical assistance in dying in Canada and the relationship of public health laws to private understandings of the legal order. J Law Biosci. 2020;7(1): lsaa087.

Geremia DS, Vendruscolo C, Celuppi IC, Adamy EK, Toso B, Souza JB. 200 years of Florence and the challenges of nursing practices management in the COVID-19 pandemic. Rev Lat Am Enfermagem. 2020;28: e3358.

Kurotschka PK, Serafini A, Demontis M, Serafini A, Mereu A, Moro MF, et al. General practitioners’ experiences during the first phase of the COVID-19 pandemic in Italy: a critical incident technique study. Front Public Health. 2021;9: 623904.

Renaa T, Brekke M. Restructuring in a GP practice during the COVID-19 pandemic—a focus-group study. Tidsskrift for den Norske laegeforening: tidsskrift for praktisk medicin, ny raekke. 2021. https://doi.org/10.4045/tidsskr.20.0713 .

Article   Google Scholar  

Desroches ML, Ailey S, Fisher K, Stych J. Impact of COVID-19: nursing challenges to meeting the care needs of people with developmental disabilities. Disabil Health J. 2021;14(1): 101015.

Damian AJ, Gonzalez M, Oo M, Anderson D. A national study of community health centers’ readiness to address COVID-19. J Am Board Fam Med. 2021;34(Suppl):S85–94.

Schroeder K, Norful AA, Travers J, Aliyu S. Nursing perspectives on care delivery during the early stages of the covid-19 pandemic: a qualitative study. Int J Nurs Stud Adv. 2020;2: 100006.

Cho H, Sagherian K, Steege LM. Hospital nursing staff perceptions of resources provided by their organizations during the COVID-19 pandemic. Workplace Health Saf. 2021;69(4):174–81.

Hennekam S, Ladge J, Shymko Y. From zero to hero: an exploratory study examining sudden hero status among nonphysician health care workers during the COVID-19 pandemic. J Appl Psychol. 2020;105(10):1088–100.

He J, Liu L, Chen X, Qi B, Liu Y, Zhang Y, et al. The experiences of nurses infected with COVID-19 in Wuhan, China: a qualitative study. J Nurs Manag. 2021;29(5):1180–8.

Fawaz M, Samaha A. The psychosocial effects of being quarantined following exposure to COVID-19: a qualitative study of Lebanese health care workers. Int J Soc Psychiatry. 2020;66(6):560–5.

Mersha A, Shibiru S, Girma M, Ayele G, Bante A, Kassa M, et al. Perceived barriers to the practice of preventive measures for COVID-19 pandemic among health professionals in public health facilities of the Gamo zone, southern Ethiopia: a phenomenological study. BMC Public Health. 2021;21(1):199.

Austin Z, Gregory P. Resilience in the time of pandemic: the experience of community pharmacists during COVID-19. Res Soc Adm Pharm. 2021;17(1):1867–75.

Roberts SCM, Schroeder R, Joffe C. COVID-19 and independent abortion providers: findings from a rapid-response survey. Perspect Sex Reprod Health. 2020;52(4):217–25.

Brophy JT, Keith MM, Hurley M, McArthur JE. Sacrificed: Ontario healthcare workers in the time of COVID-19. New Solut. 2021;30(4):267–81.

Ilesanmi OS, Afolabi AA, Akande A, Raji T, Mohammed A. Infection prevention and control during COVID-19 pandemic: realities from health care workers in a north central state in Nigeria. Epidemiol Infect. 2021;149: e15.

Halcomb E, Williams A, Ashley C, McInnes S, Stephen C, Calma K, et al. The support needs of Australian primary health care nurses during the COVID-19 pandemic. J Nurs Manag. 2020;28(7):1553–60.

Smith C. The structural vulnerability of healthcare workers during COVID-19: observations on the social context of risk and the equitable distribution of resources. Soc Sci Med. 2020;258: 113119.

Khanal P, Devkota N, Dahal M, Paudel K, Joshi D. Mental health impacts among health workers during COVID-19 in a low resource setting: a cross-sectional survey from Nepal. Glob Health. 2020;16(1):89.

Labrague LJ, De Los Santos JAA. COVID-19 anxiety among front-line nurses: predictive role of organisational support, personal resilience and social support. J Nurs Manag. 2020;28(7):1653–61.

Abdallah CG, Geha P. Chronic pain and chronic stress: two sides of the same coin? Chronic Stress. 2017. https://doi.org/10.1177/2470547017704763 .

Article   PubMed   PubMed Central   Google Scholar  

Vachon-Presseau E. Effects of stress on the corticolimbic system: implications for chronic pain. Prog Neuropsychopharmacol Biol Psychiatry. 2018;87(Pt B):216–23.

Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, Andrade SM. Physical, psychological and occupational consequences of job burnout: a systematic review of prospective studies. PLoS ONE. 2017;12(10): e0185781.

Hapke U, Maske UE, Scheidt-Nave C, Bode L, Schlack R, Busch MA. Chronic stress among adults in Germany: results of the German health interview and examination survey for adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56(5–6):749–54.

Killgore WDS, Taylor EC, Cloonan SA, Dailey NS. Psychological resilience during the COVID-19 lockdown. Psychiatry Res. 2020;291: 113216.

Karl B, Sara LN, Ben R, Francisco P-M. Governance and capacity to manage resilience of health systems: towards a new conceptual framework. Int J Health Policy Manag. 2017;6(8):431–5.

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Souaad Chemali & Almudena Mari-Sáez

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HW and AMS conceived and designed the scoping review. SC extracted, analyzed and conceptualized the data as well as drafted the initial version of this manuscript. HW and AMS provided quality checks for the methodology and analysis. HW, AMS and CEB substantively revised each version of the manuscript and provided substantial inputs. All authors read and approved the final manuscript.

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Additional file 1.

: Table S1. Search strategy. The document includes the search strings for the review.

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: Table S2. List of included papers. The file lists the 161 included papers, detailing the title, authors, publication year and DOI link.

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: Table S3. List of countries studied. The file includes a table listing the countries in which the included studies were conducted according to frequency.

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: Table S4. Detailed information on FGDs. This document provides information extracted from studies that used FGDs as a qualitative data collection tool. The table lists the overall number of focus group discussion’s participants in each of those studies, the number of FGDs per study, whether FGDs were conducted online or offline, the type of study participants, and any other information on the methods that could be extracted.

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Chemali, S., Mari-Sáez, A., El Bcheraoui, C. et al. Health care workers’ experiences during the COVID-19 pandemic: a scoping review. Hum Resour Health 20 , 27 (2022). https://doi.org/10.1186/s12960-022-00724-1

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Received : 23 September 2021

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Published : 24 March 2022

DOI : https://doi.org/10.1186/s12960-022-00724-1

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'An epidemic of loneliness': How the COVID-19 pandemic changed life for older adults

Y ears after the U.S. began to slowly emerge from mandatory COVID-19 lockdowns, more than half of older adults still spend more time at home and less time socializing in public spaces than they did pre-pandemic, according to new University of Colorado Boulder research.

Participants cited fear of infection and "more uncomfortable and hostile" social dynamics as key reasons for their retreat from civic life.

"The pandemic is not over for a lot of folks. Some people feel left behind," said Jessica Finlay, an assistant professor of geography whose findings are revealed in a series of new papers.

The study comes amid what the U.S. Surgeon General recently called an "epidemic of loneliness" in which older adults—especially those who are immune compromised or have disabilities—are particularly vulnerable.

"We found that the pandemic fundamentally altered neighborhoods, communities and everyday routines among aging Americans and these changes have long-term consequences for their physical, mental, social and cognitive health," said Finlay.

'I just can't go back'

As a health geographer and environmental gerontologist, Finlay studies how social and built environments impact health as we age.

In March 2020 as restaurants, gyms, grocery stores and other gathering places shuttered amid shelter-in-place orders, she immediately wondered what the lasting impacts would be. Shortly thereafter, she launched the COVID-19 Coping Study with University of Michigan epidemiologist Lindsay Kobayashi. They began their research with a baseline and monthly survey. Since then, nearly 7,000 people over age 55 from all 50 states have participated.

The researchers check in annually, asking open-ended questions about how neighborhoods and relationships have changed, how people spend their time, opinions and experiences of the COVID-19 pandemic, and their physical and mental health.

"We've been in the field for some incredibly pivotal moments," said Finlay, noting that surveys went out shortly after George Floyd was murdered in May 2020 and again after the attack on the U.S. Capitol on Jan. 6, 2021.

Collectively, the results paint a troubling picture in which a substantial portion of the older population remains isolated even after others have moved on.

In one paper published in February in the journal Wellbeing, Space and Society , 60% of respondents said they spend more time in their home while 75% said they dine out less. Some 62% said they visit cultural and arts venues less, and more than half said they attend church or the gym less than before the pandemic.

The most recent survey, taken in spring 2023, showed similar trends, with more than half of respondents still reporting that their socialization and entertainment routines were different than they were pre-pandemic.

In another paper titled "I just can't go back," published in SSM—Qualitative Research in Health , 80% of respondents reported that there are some places they are reluctant to visit in person anymore.

"The thought of going inside a gym with lots of people breathing heavily and sweating is not something I can see myself ever doing again," said one 72-year-old male.

Those who said they still go to public places like grocery stores reported that they ducked in and out quickly and skipped casual chitchat.

"It's been tough," said one 68-year-old female. "You don't stop and talk to people anymore."

Many respondents reported that they were afraid of getting infected with a virus or infecting young or immune-compromised loved ones, and said they felt "irresponsible" for being around a lot of people.

Some reported getting dirty looks or rude comments when wearing masks or asking others to keep their distance—interpersonal exchanges that reinforced their inclination to stay home.

Revitalizing human connection

The news is not all bad, stresses Finlay.

At least 10% of older adults report exercising outdoors more frequently since the pandemic. And a small but vocal minority said that their worlds had actually opened up, as more meetings, concerts and classes became available online.

Still, Finlay worries that the loss of spontaneous interactions in what sociologists call "third places" could have serious health consequences.

Previous research shows that a lack of social connection can increase risk of premature death as much as smoking 15 cigarettes a day and exacerbate mental illness and dementia.

"For some older adults who live alone, that brief, unplanned exchange with the butcher or the cashier may be the only friendly smile they see in the day, and they have lost that," Finlay said.

Societal health is also at risk.

"It is increasingly rare for Americans with differing sociopolitical perspectives to collectively hang out and respectfully converse," she writes.

Finlay hopes that her work can encourage policymakers to create spaces more amenable to people of all ages who are now more cautious about getting sick—things like outdoor dining spaces, ventilated concert halls or masked or hybrid events.

She also hopes that people will give those still wearing masks or keeping distance some grace.

"It is a privilege to be able to 'just get over' the pandemic and many people, for a multitude of reasons, just don't have that privilege. The world looks different to them now," she said.

"How can we make it easier for them to re-engage?"

More information: Jessica Finlay et al, Altered place engagement since COVID-19: A multi-method study of community participation and health among older americans, Wellbeing, Space and Society (2024). DOI: 10.1016/j.wss.2024.100184

Jessica Finlay et al, "I just can't go back": Challenging Places for Older Americans since the COVID-19 Pandemic Onset, SSM—Qualitative Research in Health (2023). DOI: 10.1016/j.ssmqr.2023.100381

Provided by University of Colorado at Boulder

Exploring perspectives on living through the COVID-19 pandemic for people experiencing homelessness and dealing with mental ill-health and/or substance use: qualitative study

Advances in Dual Diagnosis

ISSN : 1757-0972

Article publication date: 16 April 2024

This study aims to explore the experiences of living through the COVID-19 pandemic for people who faced homelessness and dealt with mental health and/or substance use challenges.

Design/methodology/approach

This qualitative study was comprised of 26 1:1 interviews (16 men and 10 women), conducted between February and May 2021 with people who experienced homelessness in North East England during the COVID-19 pandemic. An inductive reflexive thematic analysis was undertaken, with input from individuals with lived experience who were involved throughout the study.

Four themes were developed. The first theme, lack of support and exacerbation of mental health and substance use difficulties, highlighted how the lack of in-person support and increased isolation and loneliness led to relapses or new challenges for many people’s mental health and substance use. The second theme, uncertainty and fear during the pandemic, explored how the “surreal” experience of the pandemic led to many people feeling uncertain about the future and when things would return to normal. The third theme, isolation and impacts on social networks, discussed how isolation and changes to relationships also played a role in mental health and substance use. Finally, opportunity for reflection and self-improvement for mental health and substance use, explored how some people used the isolated time to re-evaluate their recovery journey and focus on self-improvement.

Practical implications

The experiences shared within this study have important implications for planning the future delivery and commissioning of health and social care services for people facing homelessness, such as sharing information accessibly through clear, consistent and simple language.

Originality/value

As one of the few papers to involve people with lived experience as part of the research, the findings reflect the unique narratives of this population with a focus on improving services.

• Qualitative research
• Health inequalities
• Mental health
• Homelessness
• Substance use

Adams, E.A. , Hunter, D. , Kennedy, J. , Jablonski, T. , Parker, J. , Tasker, F. , Widnall, E. , O'Donnell, A.J. , Kaner, E. and Ramsay, S.E. (2024), "Exploring perspectives on living through the COVID-19 pandemic for people experiencing homelessness and dealing with mental ill-health and/or substance use: qualitative study", Advances in Dual Diagnosis , Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/ADD-06-2023-0014

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Copyright © 2024, Emma Audrey Adams, Desmond Hunter, Joanne Kennedy, Tony Jablonski, Jeff Parker, Fiona Tasker, Emily Widnall, Amy Jane O'Donnell, Eileen Kaner and Sheena E. Ramsay.

Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial & non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

The rapid emergence of the COVID-19 virus led to reactive changes internationally in an attempt to mitigate negative consequences and limit virus transmission. In many high- and middle-income countries, this meant identifying populations at increased risk of infection and implementing targeted protection measures in response ( Government of Canada, 2022 ; Public Health England, 2021 ; European Centre for Disease Prevention and Control, 2020 ; Centers for Disease Control and Prevention, 2022 ). With the introduction of “stay at home” measures during the pandemic, there became a growing concern for people experiencing homelessness who may have been unable to safely abide by these restrictions ( Rodriguez et al. , 2021 ; Allaria et al. , 2021 ; Cabinet Office, 2020 ). Global policy responses for homeless populations varied, but similarities existed around efforts to increase access to temporary accommodation solutions, either through creating new shelters, or repurposing existing hotels ( Martin et al. , 2020 ; O’Shea et al. , 2020 ; Kelly et al. , 2021 ; National Social Inclusion Office, 2020 ; Scallan et al. , 2022 ; Brown and Edwards, 2021 ). In England, such efforts were termed the “Everyone In” initiative ( Cromarty, 2021 ), marking the first national attempt at a coordinated offer of access to accommodation for people experiencing homelessness.

People who experience homelessness have high levels of physical and mental health needs compared to the general population, including co-occurring substance use ( Bramley et al. , 2015 ; Fazel et al. , 2008 ; Grant et al. , 2004 ). Yet although in most cases, offers of accommodation in England were paired with access to food, health and social care including drug and alcohol support, broader COVID-19 safety measures introduced during this period resulted in the closure of many face-to-face health and social care services and/or use of socially distanced or remote support often leveraging digital technology. Evidence suggests that people experiencing homelessness were disproportionately affected by these reductions in service provision and resultant social isolation ( Tsai and Wilson, 2020 ; Leifheit et al. , 2021 ; Rodriguez et al. , 2021 ). For example, qualitative studies based on a Scottish homeless service found that a reduction in services coupled with experiences of isolation and emotional impacts from the pandemic led to increased drug use, anxiety, depression and confusion/fear among some homeless people ( Parkes et al. , 2021b , Parkes et al. , 2021a ).

Although these trends are echoed elsewhere in the international literature, with increased rates of drug use and drug overdoses observed in Spain and America ( Appa et al. , 2021 ; Aguilar et al. , 2021 ; Tucker et al. , 2020 ) alongside a range of mental health challenges, including hopelessness, anxiety, loneliness, depression and sleep problems ( Tucker et al. , 2020 ), other studies report more positive outcomes. One Canadian case study reported periods of decreased drug use which was strongly related to periods of supported housing during the pandemic ( Scallan et al. , 2022 ). Another longitudinal study of young people experiencing homelessness found increased physical activity and improved mental well-being during the pandemic ( Thomas et al. , 2021 ). These contrasting negative and positive impacts on substance use and mental health in current evidence suggest further investigation is needed to understand the complexity of individuals’ experiences.

Qualitative research involving people with lived experience of homelessness has the potential to elucidate their unique experiences and perspective. We worked with people with lived experience of homelessness, mental ill-health and/or substance use to understand the perspectives of living through the COVID-19 pandemic for people experiencing homelessness and the challenges and benefits it presented them in dealing with mental ill-health and/or substance use.

Recognising that reality is subjective and socially constructed, this research was informed by an interpretivist paradigm and social constructivism ( Creswell and Poth, 2016 ). Thus, a qualitative methodology involving semi-structured interviews with people who experienced homelessness was used for this study conducted in North East England during the COVID-19 pandemic between February and May 2021.

People who have experienced homelessness, mental ill-health and/or substance use were involved in the design and conduct of our study, including collaboratively analysing the data, developing themes and co-writing the final paper. This led to the recruitment of three men (J.P., D.H., T.J.) and two women (J.K., F.T.) with lived experience of homelessness, substance use and/or mental ill-health from local lived experience groups. They became part of the core research project team as “Experts by Experience”. Approaches for involvement were determined collectively and based on best practices for community-based research with vulnerable populations ( Souleymanov et al. , 2016 ). Ethics approval for the study was granted by the Faculty of Medical Sciences Research Ethics Committee, part of Newcastle University’s Research Ethics Committee (ref: 2034/6698/2020).

Potential participants were initially purposively recruited through gatekeepers in housing and voluntary sectors alongside “Experts by Experience” networks in two areas in North East England (Newcastle upon Tyne and Gateshead). Recruited participants were then invited to share study information within their networks, a snowball strategy approach ( Johnson, 2014 ). Participants were aged 18 and over and self-identified as experiencing homelessness during the COVID-19 pandemic as well as mental health and/or substance use challenges. To recognise the breadth of homelessness in the region ( Shelter, 2021 ), a broad definition was used including rough sleeping, staying with friends or sofa surfing, in temporary accommodations and having approached the local government for housing ( Crisis, n.d. ). People who were interested in participating could contact the lead researcher (E.A.A.) by telephone, email or consent to a service provider sharing their contact details with the researcher. Information sheets were shared with potential participants at least 24 h in advance of the interview and had the opportunity to ask any questions before the interview.

Given the social distancing restrictions in place across England at the time of this study, all interviews were conducted by telephone. Adjustments were made to enable people to participate, which included rescheduling interviews, working with local hostels or housing providers to provide access to a designated phone for conversations and offering to conduct interviews outside of normal working hours. Once no new themes were identified within interviews (data sufficiency/saturation), active recruitment ended, and only those who had previously expressed interest were given a two-week window to participate.

access to mental health and substance use services; and

the impact of the COVID-19 pandemic on their lives, mental health and substance use.

All interviews were digitally recorded, transcribed, anonymised and checked for accuracy. At the end of interviews, participants were provided with a debrief sheet, which contained signposting to local services for housing, homelessness, mental health and substance use.

E.A.A. worked with the five “Experts by Experience” through a series of workshops to conduct the analysis, which was informed by Braun and Clarke’s (2006) inductive reflexive thematic analysis. All transcripts were reviewed by E.A.A. for familiarisation and a select number were reviewed by “Experts by Experience” independently. Initial codes were then developed for transcripts. Using initial coding, preliminary themes were developed collectively and reviewed to determine patterns of shared meaning across transcripts. Theme and subthemes were refined collaboratively and discussed with all co-authors before finalisation. The non-linear stages of analysis enabled early theme development based on central concepts within transcripts ( Braun and Clarke, 2021 ). Themes and subthemes related to access to mental health and substance use support are reported elsewhere ( Adams et al. , 2022 ).

lack of support and exacerbation of mental health and substance use difficulties;

uncertainty and fear during the pandemic;

isolation and impacts on social networks; and

opportunity for reflection and self-improvement for mental health and substance use.

Lack of support and exacerbation of mental health and substance use difficulties

Individuals spoke about how they felt that access to mental health and substance use support had been deprioritised while health and care system efforts focused on combatting the virus. Individuals felt frustrated that they could not access mental health and substance use support during this period, and, in some cases, this left them feeling helpless. Many people spoke about using drugs as a coping mechanism and others spoke about how they considered suicide in response to not being able to cope with their emotions and adversity.

I think it’s failing us the pandemic. Because people are starting to use excuses to say they can’t help you as much as they normally do. And mostly it’s failure. It seems like the system is failing us. (Male, 40s)

I’ve tried to take my life. Just not having the support and just feeling like I've been left. (Female, 30s)

People were further frustrated by the inconsistencies between easing of restrictions and which venues/places could reopen. There was particular frustration in relation to the challenges they faced accessing in-person support.

I can’t go to an AA meeting because of lockdown because of social distancing, yet I can go in a pub and get pissed out my skull. It’s really- it’s a bit of mind-bender for me, it really is. (Male, 40s)

Others spoke about how their present situations (such as inadequate housing or being unable to leave home) exacerbated pre-existing mental health challenges.

Yes, so it’s been a rollercoaster. It’s just been up and down, up and down. The full time I’m trying to live in a hostel system. […] It’s just been a rollercoaster of emotions. (Female, 40s)

I found it really, really scary, really difficult where the walls were closing in. I couldn’t watch the news. It started to a point where I just physically wouldn’t go out even if I just needed a loaf of bread, where I wouldn’t go to the local shop. (Female, 40s)

The isolation, loneliness and reduction in services brought about by the pandemic resulted in some relapses in participants’ mental health and substance use. People shared how they suddenly found themselves facing new mental health and substance use challenges. This meant, for some people who were using drugs, that they were suddenly requiring mental health support or those who had faced mental health challenges began to use drugs/alcohol.

I’ve basically went back to using drugs to deal with the loneliness and deal with the isolation and to deal with the solitude. People can think that’s an excuse, yes it is, it’s a bloody good one as well. It’s a bloody good excuse because I’m on my own, I'm isolated, I've got no outside communication. Hardly [any] contact with other people face to face much so I’m using drugs again to deal with it. Basically, everything I’ve achieved before the lockdown, which took years and years and years to achieve, like being stable on my script, not using, dealing with people, it has all been wiped away really because of lockdown. (Male, 30s)

I kind of really just bottle things up a lot and end up exploding and taking it out on myself and trying to commit suicide. (Female, 20s)

Uncertainty and fear during the pandemic

During interviews, people spoke about the large volume of information that was available from varying sources regarding the COVID-19 virus. Individuals felt overwhelmed with the amount of information about the virus and explained that it was often hard to determine the accuracy of the information provided. In addition, some participants spoke about “conspiracy theories” and concerns around misinformation. This was a particular concern given many had experienced mental health or substance use related paranoia or delusions and expressed distrust in the government. This led to some participants struggling to grasp the severity of the situation at the beginning of the pandemic.

It’s just, something that I’m not used to. I cannot understand it in a way. There’s too much information out there. It’s just all these conspiracy theories about it and I don’t know. […] You are listening to the news and the media and then you are listening to other stuff then you don’t know what’s right and what’s wrong. (Male, 30s)

Over time, and with continued information about the pandemic and its severity, many people transitioned into feeling afraid of catching the virus and the uncertainty of what catching the virus would entail. People also spoke about the realisation that they had existing vulnerabilities (such as pre-existing health conditions or post-surgery aftercare), which shaped their experience of the pandemic. Furthermore, the uncertainty on how long the pandemic would last, led to added concern and heightened anxiety.

Actually, I came out of the hospital in [date removed], but it was the start of the covid lockdown […] so, I was shielding at the time, but I still had to get out and get my shopping even though I wasn’t meant to. (Female, 40s)

Well, the scariest part is if we don’t find a cure for it basically. I know we’ve got these vaccinations now, but you never know, they say in some countries they’re having a third wave. […] I’m scared this vaccination might not work; it might mutate and I’m worried. (Male, 40s)

When mass vaccination began, people experiencing homelessness were a priority group. Although vaccination was not consistently discussed across interviews, one person explained they felt forced into getting a vaccine and expressed concerns about the contents of the vaccines and unknown long-term side effects, reiterating the lack of clarity around information during the pandemic.

I got the jab the other day. I didn’t want to have the vaccine, but I got it the other day after I was pressured by three doctors and the staff here to have it. I’d already said no in the first instance, but then they came back and they said, “ Well, you have to have it. Twenty-seven thousand people have had it. This one has had it, that one has had it”. I went, “ Fair enough, but I don’t have to have it. I don’t want to have it. Tell me what’s in it and I might have it”. You don’t know the effect that these vaccines are going to have on the body in ten/fifteen years’ time. (Male, 30s)

Isolation and impacts on social networks

During the early months of the pandemic, safety measures (such as social distancing and the “stay at home” order) and reductions in in-person service provision were introduced nationally to reduce the spread of the virus. With restrictions in place and fines introduced to encourage compliance with the “stay at home” order, many people were left feeling trapped; a particular concern for people who were housed in multiple unit occupancies (such as hostels) or even small single unit accommodations with minimum space.

I think before the lockdown, you know, you just took it for granted that you could get out […] I can’t get out all the time, I can’t go and visit people. You’re just stuck on your own, it’s horrible. (Female, 50s)

I Just felt like I was like a caged animal stuck in the flat. (Female, 40 s)

When speaking about changes over the last year, people recognised that the reasons they interacted with people have changed. It became clear that several individuals sought emotional and informal psychological support from family and friends, suggesting that the pandemic served to highlight the existence/lack of social networks.

So I’ve got a girlfriend now who comes and stays over, because I live by myself, I’ve created a bubble with her, and her family […] if I hadn’t met her, I think things would be a lot harder this time round, because with it being so cold, winter, dark, this third lockdown would have been really, really hard. (Male, 20s)

Like I met this lass in the last hostel I was in and like she’s like me best mate now. And she’s been through similar stuff uh, and we both help each other, so she’s a good support network. (Female, 20s)

In contrast, others spoke about losing people during the pandemic or being unable to seek support from family and friends as a result of pandemic restrictions/measures. This loss of social contact led to many people feeling alone and isolated which likely exacerbated existing mental health difficulties. In some cases, people spoke about how their housing officer or support worker would be the only person they would speak to.

I would’ve been able to call on family for housing support and somewhere to stay but my step dad [caught] Covid and had to go to hospital and mother tested positive so I've not been able to seek refuge or shelter due to the laws surrounding isolation and shielding which has worsened my situation considerably. (Male, 30s)

[…] No, I haven’t really been in touch with any- I haven’t really got any friends. (Female, 30s)

One participant described the negative impact of not having support and social interaction, explaining that no one would have noticed had he died.

[…] I could have taken my own life in here and I could have been lying on that bed for weeks and weeks, literally through the whole lockdown, and nobody would know. I know it sounds completely awful, depressing, but the only thing that would probably alert anybody was the smell of a decomposing body. (Male, 50s)

Opportunity for reflection and self-improvement for mental health and substance use

When discussing the impact of the COVID-19 pandemic on mental health and substance use, people reflected on how the pandemic has influenced their recovery journeys and acknowledged recovery as an ongoing process.

[…] if you’re not working on your recovery you’re working on your relapse. (Male, 30s)

I call it recovery because there is no cure. You are always recovering. Every day, if you get up every day, you are recovering. (Female, 40s)

Some individuals reflected on how the pandemic led to them seeing others face the same hardships they have been struggling with previously. This created some degree of validation and normalisation of the depression and mental health challenges individuals had experienced.

For the last few years before the pandemic, I was going through really, really, really hard times. I felt like I was the only one […] I felt very isolated and very sick due to depression, mental health and losing loved ones and things over the last few years. This last year, seeing people going through it. It’s strange, it’s almost like people have sort of joined me in what I was already going through. (Male, 20s)

Although many people experienced relapses or faced new challenges, others found the pandemic allowed them to reflect on and improve their mental health and substance use. Although there was recognition that the pandemic has been challenging, many people reported feeling that the forced isolation and distancing led them to be separated from others and reflect on their own well-being.

I’ve been clean for the last year. I’ll be a year in September. (Male, 40s)

I haven’t been able to see anybody really. I think that’s probably been a godsend to me because half my friends are all drug users or alcoholics and I’m ex for both of them so it’s probably a good thing I don’t get pulled back into it. (Male, 30s)

But before lockdown, it was just- I think we were all a bit fuzzy-headed, if that’s a word, before that. […] At one time, I didn’t have a TV or a phone or a radio in my room, I was sitting in my little room, and it was like a time for self-reflection. And obviously, it’s been so peaceful and quiet outside, I just loved it. (Female, 30s)

Some people reported finally receiving housing through new initiatives (such as the “Everyone In” programme) rolled out in response to the pandemic. This stability in accommodation was perceived to positively influence mental health and substance use.

Personally, for me, this year has actually been quite good. (Laughter) It sounds a bit daft because it’s been quite good because, obviously, I was homeless for, let’s say, six years and then the pandemic happened and I got put into shared accommodation and then I’ve obviously got my own flat through it so it’s been quite a good one for me. (Male, 20s)

This study explored the perspectives of people experiencing homelessness in North East England on living through the COVID-19 pandemic and the impact it had on their daily lives alongside mental health and/or substance use challenges. The findings highlight the unique circumstances of this population and their starkly contrasting experiences of the pandemic. The negative experiences shared regarding new and continued challenges for mental health and substance use among homeless people present potential target areas for future interventions, for example, the need for interventions around isolation and loneliness. The positive findings relating to improvements in mental health and substance use recovery and self-reflection could be important areas for future research and potential mechanisms for individual recovery journeys for people experiencing homelessness. The findings also highlight the importance of social and environmental circumstances, and access to both formal and informal support, in shaping individual experiences of the COVID-19 pandemic.

Previous studies have highlighted both the increases and decreases in mental health and substance use during the COVID-19 pandemic ( National Social Inclusion Office, 2020 ; Tucker et al. , 2020 ; Appa et al. , 2021 ; Aguilar et al. , 2021 ; Thomas et al. , 2021 ; Corey et al. , 2022 ). However, qualitative narratives capturing the lived experience and perspectives of people who experienced homelessness alongside mental health and substance use difficulties are missing from the current evidence base ( Rodriguez et al. , 2021 ; Parkes et al. , 2021a , Pixley et al. , 2022 ). Findings from our study provide a nuanced understanding for why changes occurred within this population or not.

One of the findings in our study related to negative mental health impacts of the pandemic among people experiencing homelessness of both new and existing difficulties. The loneliness, isolation and general sense of feeling left behind or forgotten by services led to many people facing relapses and experiencing new problems, including severe anxiety, depression, suicidal thoughts, drug use and drinking. Increases in mental ill-health and drug use during the pandemic has been noted in quantitative evidence ( Tucker et al. , 2020 ; Aguilar et al. , 2021 ; Scallan et al. , 2022 ). However, during the pandemic, these issues of depression, isolation, anxiety were experienced, not just by homeless populations, but much more widely by the general population ( Groarke et al. , 2020 ; Kwong et al. , 2021 ). Interestingly for some people, social restrictions were seen as a benefit, helping them separate themselves from people who were negative influences on their substance use or mental health, whereas for others it offered an opportunity to focus on their mental health and well-being. By stark contrast, there were others with limited social networks who spoke about severe isolation, coping with drug use and in some cases feeling suicidal. Similarly another cross-UK study found challenges during the pandemic were most acutely felt among people experiencing homelessness with limited social networks ( Dawes et al. , 2022 ). The relationship between social networks, homelessness trajectories and substance use patterns has been previously explored ( DiGuiseppi et al. , 2020 ; Neale and Stevenson, 2015 ; Neale and Brown, 2016 ; Hawkins and Abrams, 2007 ; Ravenhill, 2008 ).

Despite study participants all having mental health and substance use challenges, conversations highlighted the wider impacts of the COVID-19 pandemic on their lives and the role environmental circumstances (such as housing and having access to space). Many spoke about the struggles of balancing the uncertainty and restrictions the pandemic introduced, particularly around volume of (mis)information. Existing evidence has highlighted the poor communication and messaging of information surrounding COVID-19 and related regulations for people experiencing homelessness ( Rodriguez et al. , 2022 ). Our research builds on these findings by highlighting that the lack of clear communication and ambiguity often led to mistrust, confusion and paranoia among people experiencing homelessness. This is particularly concerning given the high rates of psychosis and more specifically paranoia often present among people experiencing homelessness ( Fazel et al. , 2008 ; Bebbington et al. , 2005 ; Powell and Maguire, 2018 ). These experiences were compounded by environmental circumstances such as access to adequate housing, space and not feeling confined. Some people spoke about the positives of finally being housed due to new COVID-19 housing initiatives (such as “Everyone In”); others spoke about how they lost their job or lost a family member, which led them to access hostel provision for the first time. Alongside other studies highlighting the complexity of individual situations for experiencing homelessness during the COVID-19 pandemic ( Dawes et al. , 2022 ; Parkin et al. , 2021 ), we recommend a need to recognise that the needs and priorities of those experiencing homelessness changed throughout the pandemic and will likely continue to change over their cycle of homelessness.

Strengths and limitations of the study

This study reported the experiences and views of people experiencing homelessness over one year after initial restrictions and pandemic measures were introduced in England. This allowed participants to reflect on changes across the year and in some cases reflect on longer-term impacts and consequences. The use of a broad definition and self-identification of homelessness allowed for narratives to be shared from voices who might have otherwise not been explored (e.g. those who experience more hidden forms of homelessness such as those sleeping on couches or staying with friends and family). The reflective process during analysis with those with lived experience led to a more nuanced understanding of the experiences and the development of themes ( Braun and Clarke, 2019 ), and was a unique aspect of this study compared to previously published research ( Tucker et al. , 2020 ; Appa et al. , 2021 ; Aguilar et al. , 2021 ; Thomas et al. , 2021 ; Parkes et al. , 2021b , Parkes et al. , 2021a ).

The findings should be considered with recognition of some limitations resulting from the design of the study. As participants were recruited from two urban regions in North East England, they may not reflect the experiences of those residing in rural or coastal areas or other parts of the globe. In addition, all participants in our study identified as White British and refugee populations were not included within the study’s definition of homelessness. Further research is needed to explore the experiences of refugee populations and those of other ethnicities.

Implications for practice and policy

Study findings will help providers and policymakers for health, social care and housing to better understand that the COVID-19 pandemic did not uniformly impact people experiencing homelessness. Findings also highlight that support will need to be adapted to support people who are new or returning to services and at different stages of their mental health and substance use recovery. With increased levels of isolation and loneliness among people who are homeless, services need to recognise there could be heightened stress and anxiety about accessing services in-person or in group-based settings. Efforts should be made to provide people with options for how they engage and access services moving forward to resolve any related anxiety. Many people shared confusion and frustration related to the amount of COVID-19 information and misinformation and having to navigate it. Future health-care campaigns should consider communicating issues in a way that uses clear, consistent and simple language to make it easily understandable. Working with people with lived experience of homelessness could reduce the risk of poor or inaccessible communication. As well, working with people with lived experience of homelessness or those who support them to identify ways to combat potential misinformation is key to ensuring people can make informed decisions and understand current health issues.

The pandemic placed existing and new adversity at the forefront for public health. Moving forward, policymakers and practitioners need to consider the immediate and longer-term impacts the pandemic has had on the lives of people experiencing homelessness. Future research should continue to explore the broader health impacts, aside from the virus itself, faced as a result of the pandemic for people experiencing homelessness.

Acknowledgements

The authors thank the members of our Advisory Group who provided input on initial theme development, Kate Dotsikas, Cassey Muir and Claire Smiles, and our colleagues in practice from Crisis Skylight Newcastle, Fulfilling Lives Newcastle Gateshead and Tyne Housing to name a few.

Declarations .

Ethics approval: Ethics approval for the study was granted by the Faculty of Medical Sciences Research Ethics Committee, part of Newcastle University’s Research Ethics Committee (ref: 2034/6698/2020). Verbal or written consent was obtained from participants before the interviews commenced.

Availability of data and materials: The data generated and/or analysed during the current study are not publicly available as due to the highly sensitive nature of the data and to protect participant’s confidentiality as they could contain potentially identifiable information, but summaries are available from the corresponding author on reasonable request.

Competing interests: All authors declare they have no competing interests.

Funding : This research was funded by the National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR) development fund for early career researchers (ECRs) (PD-SPH-2015), and by the NIHR Public Health Policy Research Unit (PH-PRU) (Grant Reference PHSEZQ47-21-A). EAA was supported by the NIHR School for Public Health Research (SPHR) Pre-doctoral Fellowship, Grant Reference Number PD- SPH-2015. EAA is now funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC) (NIHR200173). AO is an NIHR Advanced Fellow. EK is supported by an NIHR Senior Investigator award and is Director of the NIHR Applied Research Collaboration North East and North Cumbria. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. NIHR funding acknowledgement and disclaimer: This report is independent research commissioned and funded by the National Institute for Health and Care Research Policy Research Programme. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health and Care Research, the Department of Health and Social Care or its arm’s length bodies, and other Government Departments.

Adams , E.A. , Parker , J. , Jablonski , T. , Kennedy , J. , Tasker , F. , Hunter , D. , Denham , K. , Smiles , C. , Muir , C. , O’Donnell , A. , Widnall , E. , Dotsikas , K. , Kaner , E. and Ramsay , S.E. ( 2022 ), “ A qualitative study exploring access to mental health and substance use support among individuals experiencing homelessness during COVID-19 ”, International Journal of Environmental Research and Public Health , Vol. 19 No. 6 , p. 3459 .

Aguilar , L. , Vicente-Hernández , B. , Remón-Gallo , D. , García-Ullán , L. , Valriberas-Herrero , I. , Maciá-Casas , A. , Pérez-Madruga , A. , Garzón , M.Á. , Álvarez-Navares , A. and Roncero , C. ( 2021 ), “ A real-world ten-week follow-up of the Covid outbreak in an outpatient drug clinic in Salamanca (Spain) ”, Journal of Substance Abuse Treatment , Vol. 125 , p. 108303 .

Allaria , C. , Loubière , S. , Mosnier , E. , Monfardini , E. , Auquier , P. and Tinland , A. ( 2021 ), “ ‘Locked down outside': perception of hazard and health resources in COVID-19 epidemic context among homeless people ”, SSM - Population Health , Vol. 15 , p. 100829 .

Appa , A. , Rodda , L.N. , Cawley , C. , Zevin , B. , Coffin , P.O. , Gandhi , M. and Imbert , E. ( 2021 ), “ Drug overdose deaths before and after shelter-in-place orders during the Covid-19 pandemic in San Francisco ”, JAMA Network Open , Vol. 4 No. 5 , pp. E2110452-E2110452 .

Bebbington , P.E. , Angermeyer , M. , Azorin , J.-M. , Brugha , T. , Kilian , R. , Johnson , S. , Toumi , M. and Kornfeld , Å. and EuroSC Research Group ( 2005 ), “ The European schizophrenia cohort ”, Social Psychiatry and Psychiatric Epidemiology , Vol. 40 No. 9 , pp. 707 - 717 .

Bramley , G. , Fitzpatrick , S. , Edwards , J. , Ford , D. , Johnsen , F. and Watkins , D. ( 2015 ), “ Hard edges: mapping severe and multiple disadvantage (England) ”, London : Lankelly Chase Foundation , available at: www.lankellychase.org.uk/our_work/policy_research/hard_edges

Braun , V. and Clarke , V. ( 2006 ), “ Using thematic analysis in psychology ”, Qualitative Research in Psychology , Vol. 3 No. 2 , pp. 77 - 101 .

Braun , V. and Clarke , V. ( 2019 ), “ Reflecting on reflexive thematic analysis ”, Qualitative Research in Sport, Exercise and Health , Vol. 11 No. 4 , pp. 589 - 597 .

Braun , V. and Clarke , V. ( 2021 ), “ One size fits all? What counts as quality practice in (reflexive) thematic analysis? ”, Qualitative Research in Psychology , Vol. 18 No. 3 , pp. 328 - 352 .

Brown , D. and Edwards , F.L. ( 2021 ), “ Sheltering the homeless during Covid-19 in San Jose, California ”, International Journal of Public Administration , Vol. 44 Nos 11/12 , pp. 952 - 962 .

Cabinet Office ( 2020 ), “ Stay at home and away from others (social distancing) ”, available at: www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others/full-guidance-on-staying-at-home-and-away-from-others#:∼:text=You%20should%20only%20leave%20or,with%20members%20of%20your%20household (accessed 1 June 2023 ).

Centers For Disease Control And Prevention ( 2022 ), “ CDC strategy for global response to Covid-19 (2020-2023) ”, available at: www.cdc.gov/coronavirus/2019-ncov/global-covid-19/pdfs/CDCGlobalCOVIDStrategy_2020-2023.pdf?v=3 (accessed 1 June 2023 ).

Corey , J. , Lyons , J. , O’Carroll , A. , Stafford , R. and Ivers , J.-H. ( 2022 ), “ A scoping review of the health impact of the Covid-19 pandemic on persons experiencing homelessness in North America and Europe ”, International Journal of Environmental Research and Public Health , Vol. 19 No. 6 .

Creswell , J.W. and Poth , C.N. ( 2016 ), Qualitative Inquiry and Research Design: Choosing among Five Approaches , 4th ed ., Sage publications , London .

Crisis ( n.d. ), “ Types of homelessness ”, available at: www.crisis.org.uk/ending-homelessness/homelessness-knowledge-hub/types-of-homelessness/ (accessed 29 October 2021 ).

Cromarty , H. ( 2021 ), “ Coronavirus: support for rough sleepers (England) ”, House Of Commons Library, available at: https://commonslibrary.parliament.uk/research-briefings/cbp-9057/#:∼:text=Throughout%20the%20pandemic%20the%20Government,tackle%20homelessness%20and%20rough%20sleeping (accessed 1 April 2023 ).

Dawes , J. , May , T. , Fancourt , D. and Burton , A. ( 2022 ), “ The impact of the Covid-19 pandemic and associated societal restrictions on people experiencing homelessness (PEH): a qualitative interview study with PEH and service providers in the UK ”, International Journal of Environmental Research and Public Health , Vol. 19 No. 23 .

Diguiseppi , G.T. , Davis , J.P. , Christie , N.C. and Rice , E. ( 2020 ), “ Polysubstance use among youth experiencing homelessness: the role of trauma, mental health, and social network composition ”, Drug and Alcohol Dependence , Vol. 216 , p. 108228 .

European Centre For Disease Prevention And Control ( 2020 ), “ Guidance on the provision of support for medically and socially vulnerable populations in EU/EEA countries and the United Kingdom during the COVID-19 pandemic ”, Stockholm : European Centre For Disease Prevention And Control .

Fazel , S. , Khosla , V. , Doll , H. and Geddes , J. ( 2008 ), “ The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis ”, Plos Medicine , Vol. 5 No. 12 , p. E225 .

Government of Canada ( 2022 ), “ Covid-19: Canada’s response ”, available at: www.Canada.Ca/En/Public-Health/Services/Diseases/2019-Novel-Coronavirus-Infection/Canadas-Reponse.Html (accessed 1 July 2023 ).

Grant , B.F. , Dawson , D.A. , Stinson , F.S. , Chou , S.P. , Dufour , M.C. and Pickering , R.P. ( 2004 ), “ The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002 ”, Drug and Alcohol Dependence , Vol. 74 No. 3 , pp. 223 - 234 .

Groarke , J.M. , Berry , E. , Graham-Wisener , L. , Mckenna-Plumley , P.E. , Mcglinchey , E. and Armour , C. ( 2020 ), “ Loneliness in the UK during the Covid-19 pandemic: cross-sectional results from the Covid-19 psychological wellbeing study ”, Plos One , Vol. 15 No. 9 , p. E0239698 .

Hawkins , R.L. and Abrams , C. ( 2007 ), “ Disappearing acts: the social networks of formerly homeless individuals with co-occurring disorders ”, Social Science & Medicine , Vol. 65 No. 10 , pp. 2031 - 2042 .

Johnson , T.P. ( 2014 ), “ Snowball sampling: introduction ”, in Balakrishnan , N. , Colton , T. , Everitt , B. , Piegorsch , W. , Ruggeri , F. and Teugels , J.L. (Eds), Wiley StatsRef: Statistics Reference Online , Wiley , NJ , doi: 10.1002/9781118445112.stat05720 .

Kelly , D. , Murphy , H. , Vadlamudi , R. , Kraut , R. , Dalessio , K. , Malani , A.N. , Glabach , M. and Marquez , J.L. ( 2021 ), “ Successful public health measures preventing coronavirus disease 2019 (Covid-19) at a Michigan homeless shelter ”, Infection Control & Hospital Epidemiology , Vol. 42 No. 9 , pp. 1155 - 1156 .

Kwong , A.S.F. , Pearson , R.M. , Adams , M.J. , Northstone , K. , Tilling , K. , Smith , D. , Fawns-Ritchie , C. , Bould , H. , Warne , N. , Zammit , S. , Gunnell , D.J. , Moran , P.A. , Micali , N. , Reichenberg , A. , Hickman , M. , Rai , D. , Haworth , S. , Campbell , A. , Altschul , D. , Flaig , R. , Mcintosh , A.M. , Lawlor , D.A. , Porteous , D. and Timpson , N.J. ( 2021 ), “ Mental health before and during the Covid-19 pandemic in two longitudinal UK population cohorts ”, The British Journal of Psychiatry , Vol. 218 No. 6 , pp. 334 - 343 .

Leifheit , K.M. , Chaisson , L.H. , Medina , J.A. , Wahbi , R.N. and Shover , C.L. ( 2021 ), “ Elevated mortality among people experiencing homelessness with Covid-19 ”, Open Forum Infectious Diseases , Vol. 8 No. 7 .

Martin , C. , Andrés , P. , Bullón , A. , Villegas , J.L. , De La Iglesia-Larrad , J.I. , Bote , B. , Prieto , N. and Roncero , C. ( 2020 ), “ Covid pandemic as an opportunity for improving mental health treatments of the homeless people ”, International Journal of Social Psychiatry , Vol. 67 No. 4 , pp. 335 - 343 .

National Social Inclusion Office ( 2020 ), “ National Covid-19 homeless service user experience survey-report of findings ”, available at: www.drugsandalcohol.ie/33362/1/HSE_homeless-service-user-experience-survey.pdf (accessed 1 May 2023 ).

Neale , J. and Brown , C. ( 2016 ), “ ‘We are always in some form of contact’: friendships among homeless drug and alcohol users living in hostels ”, Health & Social Care in the Community , Vol. 24 No. 5 , pp. 557 - 566 .

Neale , J. and Stevenson , C. ( 2015 ), “ Social and recovery capital amongst homeless hostel residents who use drugs and alcohol ”, International Journal of Drug Policy , Vol. 26 No. 5 , pp. 475 - 483 .

O’Shea , T. , Bodkin , C. , Mokashi , V. , Beal , K. , Wiwcharuk , J. , Lennox , R. , Guenter , D. , Smieja , M. , Bulir , D. and Chong , S. ( 2020 ), “ Pandemic planning in homeless shelters: a pilot study of a coronavirus disease 2019 (Covid-19) testing and support program to mitigate the risk of Covid-19 outbreaks in congregate settings ”, Clinical Infectious Diseases , Vol. 72 No. 9 , pp. 1639 - 1641 .

Parkes , T. , Carver , H. , Masterton , W. , Falzon , D. , Dumbrell , J. , Grant , S. and Wilson , I. ( 2021a ), “ They already operated like it was a crisis, because it always has been a crisis’: a qualitative exploration of the response of one homeless service in Scotland to the Covid-19 pandemic ”, Harm Reduction Journal , Vol. 18 No. 1 , pp. 1 - 16 .

Parkes , T. , Carver , H. , Masterton , W. , Falzon , D. , Dumbrell , J. , Grant , S. and Wilson , I. ( 2021b ), “ You know, we can change the services to suit the circumstances of what is happening in the world: a rapid case study of the Covid-19 response across city centre homelessness and health services in Edinburgh, Scotland ”, Harm Reduction Journal , Vol. 18 No. 1 , p. 64 .

Parkin , S. , Neale , J. , Bowen , A. , Brobbin , E. , Craft , S. , Drummond , C. , Dwyer , G. , Finch , E. , Henderson , J. , Hermann , L. , et al. ( 2021 ), “ Experiences of being housed in a London hotel as part of the ‘everyone in’ initiative. Part 3: life, nine months, after leaving the hotel ”, available at: https://kclpure.kcl.ac.uk/portal/en/publications/experiences-of-being-housed-in-a-london-hotel-as-part-of-the-everyone-in-initiative-part-3-life-nine-months-after-leaving-the-hotel(4b8263ae-c0a8-41e2-b6c1-870b6264f434).html (accessed on 1 February 2023 ).

Pixley , C.L. , Henry , F.A. , Deyoung , S.E. and Settembrino , M.R. ( 2022 ), “ The role of homelessness community based organizations during Covid-19 ”, Journal of Community Psychology , Vol. 50 No. 4 , pp. 1816 - 1830 .

Powell , K. and Maguire , N. ( 2018 ), “ Paranoia and maladaptive behaviours in homelessness: the mediating role of emotion regulation ”, Psychology and Psychotherapy: Theory, Research and Practice , Vol. 91 No. 3 , pp. 363 - 379 .

Public Health England ( 2021 ), “ JCVI advises prioritising homeless people and rough sleepers for Covid-19 vaccine ”, available at: www.gov.uk/government/news/jcvi-advises-prioritising-homeless-people-and-rough-sleepers-for-covid-19-vaccine (accessed on 1 May 2023 ).

Ravenhill , M. ( 2008 ), The Culture of Homelessness , Routledge , London, UK .

Rodriguez , N.M. , Lahey , A.M. , Macneill , J.J. , Martinez , R.G. , Teo , N.E. and Ruiz , Y. ( 2021 ), “ Homelessness during Covid-19: challenges, responses, and lessons learned from homeless service providers in Tippecanoe county, Indiana ”, BMC Public Health , Vol. 21 No. 1 , p. 1657 .

Rodriguez , N.M. , Martinez , R.G. , Ziolkowski , R. , Tolliver , C. , Young , H. and Ruiz , Y. ( 2022 ), “ ‘Covid knocked me straight into the dirt’: perspectives from people experiencing homelessness on the impacts of the covid-19 pandemic ”, BMC Public Health , Vol. 22 No. 1 , p. 1327 .

Scallan , E. , Bodkin , C. , Wiwcharuk , J. , O'Shea , T. and Lennox , R. ( 2022 ), “ Finding stability amidst the Covid-19 pandemic: the impact of emergency temporary housing for people who use drugs ”, Drug Alcohol Rev , Vol. 41 .

Shelter ( 2021 ), “ Homelessness in England 2021: the numbers behind the story ”, available at: https://assets.ctfassets.net/6sxvmndnpn0s/2PuyTofvY2k2Fi6uJxcd98/68fb35a1267c54ab3fc05896b8ab7a85/FINAL_Homelessness_in_England_2021_report.pdf (accessed 1 May 2023 ).

Souleymanov , R. , Kuzmanović , D. , Marshall , Z. , Scheim , A.I. , Mikiki , M. , Worthington , C. and Millson , M. ( 2016 ), “ The ethics of community-based research with people who use drugs: results of a scoping review ”, BMC Medical Ethics , Vol. 17 No. 1 , p. 25 .

Thomas , J. , Bowes , N. , Meyers , R. and Thirlaway , K. ( 2021 ), “ Mental well-being and physical activity of young people experiencing homelessness before and during covid-19 lockdown: a longitudinal study ”, Mental Health and Physical Activity , Vol. 21 , p. 100407 .

Tsai , J. and Wilson , M. ( 2020 ), “ Covid-19: a potential public health problem for homeless populations ”, Lancet Public Health , Vol. 5 No. 4 , pp. E186 - E187 .

Tucker , J.S. , D'amico , E.J. , Pedersen , E.R. , Garvey , R. , Rodriguez , A. and Klein , D.J. ( 2020 ), “ Behavioral health and service usage during the Covid-19 pandemic among emerging adults currently or recently experiencing homelessness ”, Journal of Adolescent Health , Vol. 67 No. 4 , pp. 603 - 605 .

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“If I Do not Go to Work, They Will Die!” Dual Roles of Older-Adult Personal Support Workers’ Contributions During the COVID-19 Pandemic

• Open access
• Published: 16 April 2024

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• Haorui Wu 1 &
• Mandy Yung 1  

When COVID-19 devastated older-adult organizations (long-term care homes and retirement homes), most public attention was directed toward the older-adult residents rather than their service providers. This was especially true in the case of personal support workers, some of whom are over the age of 55, putting them in two separate categories in the COVID-19 settings: (1) a vulnerable and marginalized group who are disproportionately impacted by COVID-19; and (2) essential healthcare workers. Since the current disaster-driven research, practice, and policy have primarily focused on generalized assumptions that older-adults are a vulnerable, passive, and dependent group rather than recognizing their diversity, expertise, assets, and experiences, this study aimed to identify their contributions from the perspective of older-adult personal support worker (OAPSW). This qualitative study conducted in-depth interviews, inviting 15 OAPSWs from the Greater Toronto Area, Canada. This study uncovered the OAPSWs’ contribution at three levels: individual (enhancing physical health, mental health, and overall well-being), work (improving working environment and service and supporting co-workers), and family (protecting their nuclear and extended families). The outcomes inform the older-adult research, practice, policy, public discourse, and education by enhancing the appreciation of older-adults’ diverse strengths and promoting their engagement and contributions in disaster settings.

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1 Introduction

“If I do not go to work, they will die!” This was the major motivation of one older-adult personal support worker (OAPSW) from the Greater Toronto Area (GTA), Canada, who chose to ignore her own risk to continually provide essential healthcare service for residents in long-term care facilities, during the height of the first two waves of the COVID-19 pandemic. When COVID-19 devastated older-adult organizations (long-term care facilities, nursing home and group homes), most public attention was driven toward the adult residents rather than these residents’ service providers, especially the personal support workers, who provide hands-on assistance to support older-adults and/or people with (dis)Abilities in their own homes or in institutions (Kelly and Bourgeault 2015 ). Unlike the healthcare professionals in traditional healthcare settings (for example, hospitals, emergency rooms, clinics) whose contributions have been widely recognized worldwide, personal support workers bear the same level of health risk (Hapsari et al. 2022 ) but their contributions have not been widely recognized. Other factors, such as precarious and dangerous settings, violence, low hourly rate, limited employment benefits, and unregular working hours, however, increased their vulnerabilities and their coping capacities during the global public health emergency (Allison et al. 2020 ).

Research shows that older adults (55 years and above) are disproportionately affected by extreme events (for example, wildfires, heatwaves, and pandemics) (Aldrich and Benson 2008 ). COVID-19 data have confirmed that older adults are one of the most vulnerable groups (World Health Organization 2023 ). Regardless of these risks, numerous older-adult physicians, nurses, and other healthcare workers were fighting on the frontline during the pandemic, helping to maintain the regular operation of our society (Lieberman 2021 ). Older-adult personal support workers are among these frontline professionals, featuring two positions: bearing a higher individual health risk from COVID-19 due to their age and working in a high-risk occupational environment. Furthermore, these OAPSWs have their own families (nuclear families) and extended families (the families of their parents and their children), with both their individual and occupational health effecting their public (at the work level) and private (at the family level) responsibilities. This individual-family-work triangulation forms a critical approach to comprehensively examine how these OAPSWs manage their health risks, while performing their public and private responsibilities. This became the aim of this study.

2 Older-Adult Personal Support Workers and COVID-19

Drawing on previous literature, this section elaborates on the two critical components associated with OAPSWs in disaster settings in general, and also in the global context of COVID-19, in particular. The identified research deficits will lead to the research question of this study.

2.1 Older Adults: Vulnerable But Resilient

Generally, older adults have been labeled as a vulnerable group in disaster settings, bearing higher risks of disaster-driven suffering and/or mortality due to their reduced cognitive capacity, physical functioning, mental health, and overall well-being (Aldrich and Benson 2008 ). This constraint of public discourse marginalizes them and causes some of them to internalize a sense of worthlessness (Brooke and Jackson 2020 ). However, previous studies have identified evidence-based outcomes to confirm that older adults are vulnerable but resilient (Barusch 2011 ). For instance, Hou and Wu’s ( 2020 ) study regarding the 2008 Wenchuan Earthquake in China illustrated that although older adults were unable to participate in labor-intensive tasks during the emergency response stage (for example, search and rescue), their community-based social networks enabled them to swiftly coordinate residents to conduct self-rescue before the external emergency teams arrived. The older adults’ long-term place-making experience put them in positions to lead their community-based reconstruction by identifying the best (safest) locations, construction methods, and materials to build new residential and other structures (Wu 2020 ).

Although older-adults’ contributions at the grassroots level have been widely recognized, their life-long experience, knowledge, skills, and expertise have not been fully engaged at the decision-making level. Sinha et al. ( 2020 ) point out that older people tend to be overlooked at the legislative and policy levels. This type of disregard reduces their engagement and contributions, increasing the sense of worthlessness, but more importantly, the lack of older-adults’ direct input produced some non-elder-friendly plans, policies, and regulations, resulting in their special needs not being met. Sometimes this negligence can result in tragedies, such as injuries and unnecessary deaths of older-adults during and after disasters.

Focusing on COVID-19, some studies continued the same trajectory (Vervaecke and Meisner 2021 ), by portraying them in an over-simplified fashion, “as a monolithic group of frails, helpless and vulnerable individuals” (Ng and Indran 2022 , p. 64). Their reduced health status required extra protection from social isolation, which triggers their sense of loneliness (Brooke and Jackson 2020 ). However, Moye ( 2022 ) found that older adults’ mental health was less likely to be negatively impacted than the younger generation. Their lifelong experiences have equipped them with a certain level of coping capacity (for example, adapting their daily routine and creating more socializing activities) to support their mental health (Solly and Wells 2020 ).

On the other hand, older-adult healthcare professionals’ contributions have been widely recognized during COVID-19. For instance, there were retired physicians and nurses who returned to the frontline to help healthcare organizations (hospitals, emergency rooms, and clinics) deal with the public health emergency (Lieberman 2021 ). Out of healthcare, older-adult professionals also supported the regular operation of essential societal functions, such as transportation, supply chain, critical infrastructure, and emergency shelters (d’Entremont 2021 ; Wu et al. 2022 ). Although personal support workers belong to this essential worker group, there has been limited research focused on OAPSWs.

Although long-term care facilities (LTC) worldwide were dramatically devastated by COVID-19, most attention was focused on the mortality of LTC residents, with little attention given to these facilities’ healthcare professional teams (Slick and Wu 2022 ). This directly resulted in the fact that the confirmed COVID-19 cases documented among healthcare professional teams in LTC are the second highest among all the healthcare occupation categories (Canadian Institute for Health Information 2021 ). Within the LTC healthcare professional team, personal support workers have not received comparable attention as their peers from the general public. Furthermore, a certain number of them are only being offered part-time positions with a comparatively lower hourly rate and might not have employment benefits (for example, sick leaves, health insurance, and other health service benefits) (Kelly and Bourgeault 2015 ), COVID-19 related challenges (for example, short of personal protective equipment and short of staff) increased their workload and exposed them to higher potential risk of infection (Pinto et al. 2022 ), and the age variable worsens their already vulnerable status (Langmann 2023 ). However, there is a paucity of literature that focuses on the OAPSWs during the pandemic.

2.2 Older-Adult Personal Support Workers in the Individual-Family-Work Triangulation

COVID-19 presented fundamental challenges among healthcare professionals themselves, their families, and their occupational performance (Adams and Wu 2020 ). The interconnected characteristics among these three domains form an individual-work-family triangulation, enabling the further examination of diverse COVID-19 impacts and identification of the OAPSWs’ unique contributions to their public responsibilities during this health emergency. At the individual level, COVID-19 threatened everyone’s health and well-being through occupational exposure. Many of them were infected at the initial stage due to a lack of personal protective equipment (PPE) supply, related knowledge, training, and prevention skills (Nguyen et al. 2020 ). Their physical health in all scenarios was directly associated with their occupational and family obligations, affecting their mental health (United Nations 2020 ). Older-adult healthcare staff had more physical risks than their younger peers. The OAPSWs experienced all of these challenges.

During the initial stage of COVID-19, the global challenge regarding the shortage of PPE prevented health care professionals from effectively protecting themselves in workplace settings. Although most personal support workers preferred to follow the PPE guidelines (King et al. 2023 ), they received inconsistent guidance and unclear PPE usage instruction, experienced physical discomfort when delivering care, and had difficulty communicating with service users and co-workers. All this caused unfavorable impacts on their occupational performance and mental health (Hoernke et al. 2021 ). High-risk workplace environments and lower benefits propelled some of them to temporarily leave their employment and even quit the healthcare industry (White et al. 2021 ). The staff shortage in the healthcare sector resulted in many staff being overworked (White et al. 2021 ), and experiencing physical and mental burnout (Basa 2022 ).

The society-wide economic impact of COVID-19 threatened income security (Hapsari et al. 2022 ). Some service users canceled their in-person services in order to avoid infections, and some clients could no longer afford the service due to their individual financial hardship (Pinto et al. 2022 ). That caused many personal support workers losing their income, which added an extra financial burden on their already stressed mental health (Pappa et al. 2020 ). Many of them were reluctant to seek emotional support from their peers because they did not want to burden others (Nizzer et al. 2022 ), which further jeopardized their health and well-being. At the outset of the COVID-19 pandemic, OAPSWs who had worked for over 10 years were equipped with some experiences and skills from previous pandemics, especially Severe Acute Respiratory Syndrome (SARS). Information about how these OAPSWs utilized their previous experience and skills to protect themselves and support their peers in the work settings remains sparse.

During pandemics or other public health emergencies, “it is morally permissible for healthcare workers to abstain from work when their duty to treat is outweighed by the combined risks and burdens of that work” (McConnell 2020 , p. 363). Healthcare workers’ family obligations feature at both nuclear and extended family levels. In order to better fulfill their public responsibilities, many healthcare professionals decided to sacrifice time with their families (Helou et al. 2022 ). For example, they followed the recommendations on infection control and stopped being in constant touch with their families. They showed care by running family errands, sending cards, letters, and care packages, and visiting in person by maintaining social distance (Bender et al. 2021 ). In some cases, some older staff had to stop seeing their grandchildren (Brophy et al. 2021 ). For those who lived with their elderly parents, a social distance at home had to be maintained (Doolittle et al. 2020 ). These types of contributions, in turn, enabled healthcare professionals to balance their public and private responsibilities and support their mental health. However, these contributions have not been examined among OAPSWs.

In summary, in disaster settings in general, previous studies confirm that many older-adults experience age-related vulnerabilities, but their life-related expertise enabled them to contribute to diverse disaster management efforts. In the COVID-19 context, in particular, OAPSWs have experienced challenges in balancing their personal health and well-being, as well as work and family obligations. Integrating the general and particular scenarios generates the research question: How did OAPSWs contribute to their individual-work-family triangulations during the COVID-19 pandemic?

3 Research Methods

This qualitative study applied a phenomenological approach to explore how the OAPSWs overcame their challenges when they provided direct care during the first two COVID-19 waves in GTA, Ontario, Canada (Wave 1: 1 March to 31 August 2020; and Wave 2: 1 September 2020 to 15 February 2021) (Canadian Institute for Health Information 2021 ). The GTA was considered one of the epicenters of the COVID-19 pandemic in Canada (Xia et al. 2022 ), where the LTC facilities featured the second highest resident and staff-specific COVID-19 cases after Quebec (Canadian Institute for Health Information 2021 ). These characteristics of both general geographic surroundings and their employment environment jointly increased the potential risk for OAPSWs, building a valuable research background to deeply explain how the COVID-19 pandemic affected the individual-work-family triangulation of these essential workers. This study was approved by the Social Sciences and Humanities Research Ethics Board at Dalhousie University (certificate number #: 2022-5955), Canada.

3.1 Research Participants

Older-adult personal support workers are usually employed in two types of employment settings: (1) LTC homes, where the majority of the older-adult residents have chronic, complex health issues, and where the healthcare services are available 24 hours a day, 7 days per week. The service users in LTC homes are referred to as residents; and (2) retirement homes, also known as assisted living in community settings, where OAPSWs provide service (Canadian Institute for Health Information 2021 ). The service users in retirement homes are also referred to as residents. This study recruited 15 OAPSWs from both occupational arrangements: 7 OAPSWs were recruited from LTC homes (referred to as L-OAPSW) and 8 OAPSWs came from retirement homes (referred to as R-OAPSW) through a snowball sampling strategy. The seed samples were identified from both authors’ professional connections and networks with LTC homes and retirement homes. Then, these seed people helped distribute the research invitation through their professional connections. Interested participants contacted the two authors directly. The first 15 eligible participants were invited for interview. Table 1 shows the participants’ demographic composition.

3.2 Data Collection

The 15 OAPSWs were invited for individual, in-depth, and semistructured interviews supported by Microsoft Teams. Each virtual interview, ranging from half an hour to one hour, was conducted during March 2022. The two authors interviewed L-OAPSWs and R-OAPSWs respectively. As shown in the table, all the participants are immigrants. Hence, the two authors used the participants’ preferred languages (Cantonese, English, and Mandarin) to conduct the interview. The open-ended interview questions were developed based on four main categories: (1) the OAPSWs’ basic demographic information; (2) their individual experience; (3) their work performance and experience during the first two waves of COVID-19; and (4) family-specific impacts. The semistructured interview allowed the interviewers to swiftly adjust the sequence of questions according to the interviewee’s responses, and this encouraged the interviewees to elaborate more on different topics (Young et al. 2018 ). The interviews were audio-recorded, transcribed, translated into English, and analyzed by qualitative data analysis software NVivo 12. The second author proofread all the interview transcripts priori to data analysis.

3.3 Data Analysis

The two authors applied a content analysis approach to analyze the interview transcripts independently and collaboratively (Palinkas et al. 2015 ). Utilizing deductive and inductive strategies, the two authors, with expertise in public health emergency management and social work, respectively, developed codes independently on all the interview transcripts. They discussed their codes and collaboratively grouped different codes into subthemes. This strategy ensured inter-rater reliability when the two researchers coded the same data (Hemmler et al. 2020 ).

Specifically, following the interview flow, the first round of analysis, deductive (top-down) analysis, examined the logical and substantiated ties with predetermined codes associated with various COVID-19-related factors that had direct and indirect impacts on OAPSWs’ individual-family-work triangulation experience (for example, individual health, occupational health, and family well-being) (Hemmler et al. 2020 ). Under these predetermined codes, the two authors further developed sub-codes to contribute to a nuanced understanding of COVID-19-specific impacts. These codes were grouped into different subthemes and then merged into the following three primary categories: personal struggles, challenges at work, and family situations. Then, the two authors discussed the themes and subthemes and identified the connections between the age variable and the participants’ individual-work-family-specific challenges and their solutions, which clearly showed these OAPSWs’ unique contributions.

In the second round of analysis, the researchers used the inductive (bottom-up) approach, which discovered emerging themes based on the data without preconceived categories (Hemmler et al. 2020 ), to review the OAPSWs’ experience. This round of data analysis particularly focused on OAPSWs’ contributions around their private and public responsibilities. New subthemes were developed to support the comprehension of OAPSWs’ unique efforts at the individual, family, and workplace levels.

The two authors discussed the themes, subthemes, and codes from these two rounds of data analysis. Combining the deductive and inductive outcomes guided the authors to have an in-depth understanding of the participants’ experiences (Saldaña 2009 ) and design the final data analysis structure as shown in Fig. 1 . The data analysis structure was built on three thematic areas—individual, work, and family—which is aligned with the core platform of this research: individual-family-work triangulation. Under each thematic area, two or three subthemes were identified, supporting by different codes.

Code and theme structure in older-adult personal support work. PPE personal protective equipment

As shown in Fig. 1 , this section provides detailed information to elaborate on the OAPSWs’ unique contributions within each of their individual-workplace-family triangulations. In each category, interview quotations from both L-OAPSW and R-OAPSW participants are presented in order to comprehensively portray the OAPSWs’ contributions.

4.1 At the Individual Level

Current studies statistically shown that older adults’ physical health, mental health, and overall well-being were disproportionately affected by COVID-19 (Brooke and Jackson 2020 ). Although the OAPSWs fall into two categories (age and occupational health) of high risks of contracting COVID-19, they continued to support the people around them. This section focuses on OAPSWs’ contributions in the areas of these three components.

4.1.1 Physical Health: Protect Themselves and Protect Others

The physical health risk was the first consideration for everyone in the COVID-19 setting. The participants explained their physical health considerations, as shown in what the following two participants said. One participant, a L-OAPSW, shared her reactions to the news regarding the COVID-19 outbreak in Wuhan, China.

You might know about the SARS outbreak in Toronto in 2003, almost 18 years ago. SARS put me on high alert. When I heard about the COVID-19 outbreak in Wuhan, I knew how serious it would be. I am the breadwinner of my family, and I cannot get sick. I must take good care of myself so that I can take care of my family and my clients. I was trying to buy masks and sanitizer, but at that point, they were out of stock in almost every store. I made cloth masks and shared them [with my family, friends, and co-workers].

One R-OAPSW participant highlighted her actions of using PPE.

I know I have a high risk of getting infected due to my age. I doubled my masks every day when I heard the confirmed cases were reported in my community. I do not care about other people’s thoughts about wearing a mask. I am cautious, and do not want to get sick because all my clients are high-risk people. If I got sick, no one would help them.

These two participants expressed their consideration toward individual physical health, not only for themselves but also for their family and their clients. This consideration was reflected in their willingness to reduce the burden on others and better fulfill their private (family) and public (work) responsibilities.

4.1.2 Mental Health: Keeping Positive and Showing Positivity to Others

All the participants indicated that their mental health had been negatively affected by the pandemic. They also understood the long-term impacts of mental health and developed different adaptive strategies. One R-OAPSW shared that she managed her stress by modifying her activity.

[Before the pandemic], I went to gym almost every day. I felt so good because [workout] took the stress away. But now I can’t do that because I am afraid if I get infected, my colleagues, my clients, and my family would be at risk. When I felt stressed, I would play with my doggie and take him for a walk.

The risk of the community spread of the virus made some clients reduce or even cancel their regular service. This had economic impacts on the participants and triggered their anxiety and stress. The following two R-OAPSWs illustrated that focusing on their public responsibilities helped them deal with adverse mental health outcomes and enabled them to continually serve their clients. One R-OAPSW illustrated his strategies of applying positive thinking to deal with negative attitudes toward the mental and economic impacts.

I am workaholic. I feel uncomfortable about not working. Everyone is afraid, but there is someone who has to work. Otherwise, who can take care of the clients [older adults]? Although my hours have decreased, the market will resume because of the large aging population.

Another R-OAPSW shared that when her mood was low, she always put her clients first, which helped her deal with some negative thoughts.

I heard a lot of my co-workers quit their jobs during COVID-19. Although I am only one of them, if I quit my job or am unable to work, they might need to look for a replacement.

Unlike R-OAPSWs, the mental health-related issues of L-OAPSWs were primarily triggered by their work-related consideration. One L-OAPSW participant hid her sadness and worries and always showed joyous smiles to others.

I am afraid of checking my cell phone because of widespread bad news, such as there was a breakout in LTCs, how many older adults got infected, and how many died. I am so worried that it will happen in my organization. I lived in the hotel alone for two weeks. I felt hopeless, but I told myself that I needed to be strong because the residents needed me, my co-workers needed me, my practicum students needed me, and my family needed me. Although we wore masks, I always smiled at them and said, “Everything will be fine.”

These participants identified different coping strategies to reduce the negative impacts on their mental health. These coping strategies were upheld by their feelings of commitment and responsibility toward their clients, colleagues, and family. Their effort in maintaining mental well-being confirms their contributions to the entire society.

4.1.3 Overall Well-Being: Adjusted Social Activities

COVID-19 public health mitigations reshaped people’s social life. All participants illustrated that the changes in their regular social activities impacted their overall well-being. One R-OAPSW used to be an active person, but COVID-19 caused all her regular social activities to be canceled. She developed new ways to help herself and her friends.

I used to join line-dance classes and singing classes weekly and frequently have parties with my friends. During the pandemic, all these activities were canceled, and we had to stay home. I felt depressed and bored, but I think I must change. So I asked my friends to move [our activities] online. We have virtual meetings, parties, and singing together. More and more of my friends joined these [activities], and they felt better as well.

One L-OAPSW used virtual yoga to encourage her friends and family to keep active so that their well-being was supported.

I love yoga, especially hot yoga. I usually went to the morning yoga class after my night shift. [During the closure of the yoga studio], I followed the tutorial on YouTube to do that at home. I also introduced the online yoga class to my friends. I know they felt depressed, and yoga could help. We did the online yoga together, recorded it, and shared the recordings with other friends and family. Of course, more people joined us.

These two participants became proactive to stay grounded by adjusting their usual activities. The individual experiences enabled them to understand that people around them experienced the same challenges. Hence, they shared their strategies to support others.

4.2 At the Work Level

Health-specific considerations propelled many personal support workers to quit, increasing a labor shortage in this field. All the participants stayed at their positions throughout the first 2 years of COVID-19. COVID-19 caused different challenges in their working environments that forced these OAPSWs to re-adjust themselves to better cope with the new normal. This section focuses on three components of the workplace: the workplace environment, the residents or clients, and the staff.

4.2.1 Workplace Environment: Reducing the Spread of Coronavirus

With the unfolding of COVID-19, all the participants confirmed that their agencies implemented new guidelines to protect clients/residents and staff. These OAPSWs took extra care to avoid the spread of the virus at work. In the community settings, R-OAPSWs were not required to wear full PPE when providing service in clients’ homes. One R-OAPSW explained that he always took extra steps to protect his clients and their families.

When I entered my client’s home, I immediately did a screening by observing if [my client] had any symptoms. Then I checked their temperature. If [my client] had a fever or any flu symptoms, I would not provide service and reported the situation to my agency immediately. It is essential to avoid getting infected by the clients and to ensure the safety of all my other clients. I encourage my other co-workers to do the same, protecting themselves and others. I know the young people do not care, but I do; it is my duty.

An R-OAPSW working in a group home for people with developmental (dis)Abilities shared that because the residents did not understand the situation, she had to protect the residents and herself.

When you help them [residents] put on masks, they immediately take them away. Other PSWs might not care about that. So lucky they [residents] had me. I made a distance for each resident, and I wore the [facial] shield when I was in contact with them.

Another R-OAPSW appreciated the COVID-19 training her agency provided. She advocated this type of training for her co-workers to protect themselves, their clients, and others.

My company offered paid training in English, Cantonese, and Mandarin for all the staff. The latest training was on how to observe a client when we provide service. We learned how to determine the wellness of a client by observing their behaviors and speech. All my co-workers should receive this training.

In the long-term care facilities, extra mitigation strategies were applied, such as COVID-19 testing of residents and staff and restricting to essential visitors only (Slick and Wu 2022 ). One L-OAPSW mentioned that although the process was exhausting, it was worth it.

COVID-19 put everyone in my agency on high alert. Although there were no confirmed cases [in my workplace], I always encouraged everyone to follow the requirements. I understand that it is not easy to serve residents while wearing PPE. The guidelines have increased extra hours [for us to prepare before and after serving the residents], but we have to follow the guidelines to complete all the screening and cleaning steps because any oversight would cause huge mistakes.

Four OAPSWs demonstrated their significant role in contributing to the prevention of the spread of the virus while providing essential care to clients. They highlighted that it was their responsibility to protect themselves so that they were able to protect and serve their clients. As the first OAPSW mentioned, he also educated other OAPSWs to feel obligated to follow the COVID-19 precaution practice.

4.2.2 Serving Residents/Clients: Managing Clients’ Challenging Behaviors and Supporting Their Mental Health

Compared with the L-OAPSWs, most of the R-OAPSW participants indicated that they were frequently mistreated by their clients and their families before the pandemic. COVID-19 increased these unfavorable behaviors. One R-OAPSW took on extra responsibilities to provide activities to assist residents in managing their mental health.

The residents used to go out to participate in some day programs every day. But they couldn’t go anymore [during COVID-19]. Their behaviors have changed a lot. I explained the situation, but they still did not understand and became more agitated, more anxious, and sometimes, cannot control their emotions. Even though they have virtual [mental health] programs, it’s not enough for them to take off their stress. It is not my job, but I explained to them again and again, talked with them, and tried to have a little fun with them to make them feel at ease.

One L-OAPSW explained her willingness to take on extra responsibilities.

When LTCs did not allow family visits, most of the residents felt very lonely and became very upset. I had to be careful when I did the screening. Some residents got upset when I asked them questions about their symptoms. I also kept quiet. After completing my work, I always stayed a little bit longer and talked with them. I always told them that the pandemic would be over very soon, and they could see their families soon. There was a resident who passed away during the lockdown. My co-worker and I acted as her family to help her clean and dress up [for funeral].

These OAPSWs illustrated their willingness to take on extra work to deal with clients’ unfavorable behaviors and support their mental health. Other participants also showed their understanding of their clients/residents’ situation and used their knowledge and skills to provide more support.

4.2.3 Co-workers: Providing Mutual Support

Working in the same agency, the L-OAPSWs usually have fixed team members. During COVID-19, PSWs in the same team could work in the same zone or on the same floor. They supported one another, and COVID-19 strengthened their connections. One L-OAPSW shared her experience of leading her team and working with a new team member during COVID-19.

We have been collaborating in a team very well for a long time. Sometimes, just an eye expression from my co-worker, we know what we should do. [This was very important] because we all wore PPE and could only see the eye’s expression. Although we had extra work during COVID-19, everyone just completed the work with no complaints at all. I supervised a new colleague during COVID-19, and I requested other team members to be more patient with [the new colleague]. We went through the most challenging period together, and no one on my floor got COVID-19.

Another L-OAPSW considered that all her team members were overwhelmed, so she did not take her non-COVID-19-related sick leave.

I was planning to take a sick leave due to my back pain, but COVID-19 disrupted the plan. You might know that a lot of PSWs quit their job and my husband asked me to stay at home too. But I decided not to do that because it was tough to find someone to take my position. Otherwise, all my work would be shared by my co-workers, who were overwhelmed as well. Even if a new person could be hired, the new person needs a while to become familiar with all the logistics, so that my co-workers can collaborate well. We were a team, and I could not be so selfish. My co-workers did the same as well.

Another L-OAPSW shared her hand-made PPE with her co-workers and their families.

I had a sewing machine. I made masks, hats, and gowns and shared them with my co-workers. All my co-workers were very proud of me. You knew those things were sold out almost everywhere. They [co-workers] also shared the extra masks, hats, and gowns I made with other PSWs in other long-term care facilities because we were colleagues. When we heard that [some LTCs’] situations were horrible, we all donated our PPE to them.

Compared to the L-OAPSWs, the R-OAPSWs might not have powerful collegial connections. However, they collaborated to advocate for better PPE and showed empathy among them. One R-OAPSW shared that they requested enough and better PPE, in order for all the staff to have access to enough and better equipment.

[At the beginning of the pandemic], there was a shortage of PPE [almost everywhere]. We only received one level-one mask per day, no extra to replace, and the level-one mask does not provide enough protection [when we were in direct contact with clients]. My co-workers teamed in different groups. Each group made complaints to the agency and asked for better PPE. After several complaints, we started to receive more and better PPE.

The OAPSWs faced extra challenges at work during the pandemic but their contributions improved the working environment, provided extra support to their clients/residents, and helped their co-workers in their agencies and beyond.

4.3 At the Family Level

Some OAPSWs’ children live in their own homes with their own families. Some OAPSWs still have children living with them. Their occupational responsibilities directly affected these OAPSWs’ nuclear families and indirectly influenced their extended families.

4.3.1 Committed to Protecting Their Nuclear Families

During the pandemic, most healthcare professionals made extra efforts to protect their nuclear families from contracting the virus after finishing their duties. The following three examples show these OAPSWs’ commitment to support their nuclear families. One R-OAPSW shared that he washed himself before seeing his family after he returned home from work.

When I got home [every afternoon], I took off all the dirty clothes in the laundry room immediately, which was located beside the garage, took a shower, and put on new clothes. After that, I had dinner with my family.

Another L-OAPSW explained that she stayed in a hotel in order to protect her family.

I stayed in the hotel for two weeks since a confirmed case was identified in my agency. I Facetimed with them [my family] every evening after work. It was tough for me because you lived so close, but you could not have dinner with them. But I know it was the best choice I made.

The OAPSWs’ individual and professional experience prompted them to pay extra attention to their family’s mental health and overall well-being. One L-OAPSW explained that:

My daughter’s graduation trip was canceled, she could only socialize with her friends online, and her new job was pending. I realized that these took a hefty toll on her mental health. Hence, on my days off, I always walked with her in our community park. When the travel ban was lifted, we planned a trip immediately.

4.3.2 Supporting Extended Families

Some OAPSWs supported their adult children pre-COVID-19 by taking care of their grandchildren; spending time with their family always would be the most enjoyable time during this daily routine. COVID-19 forced the cancellation of these family times and OAPSWs also took on extra responsibilities to support their extended families. One R-OAPSW indicated that although her antigen test showed negative and she did not have symptoms, she still canceled her family gatherings.

I took care of my grandsons once a week [before COVID-19]. That became my big concern because they are too young to be vaccinated. I did the antigen test, and I did not have any symptoms, but there was still a possibility that I might bring COVID-19 to them. At that time, I was so upset, but I had no choice, and I needed to cancel their visiting to protect them.

One L-OAPSW described her interventions to help her extended family:

All my children have their own families, and we live very close. They all worked from home [during COVID-19]. Since I had to go outside to work every night, I asked them what they needed so that I could prepare the next day. Every morning after work, I purchased groceries and dropped them off at their houses. COVID-19 increased our workload, and I always had colleagues get sick, and I had to cover their responsibilities. I was exhausted after work since COVID-19. But I still did all these things so that my family did not have to go out.

The support given to their extended families always moves beyond their own family circle. The following R-OAPSW explained his reasons for maintaining his employment during the COVID-19 pandemic so that he would help other people in need to benefit from the government’s social benefits.

My wife suggested that I should quit my job and take the EI [employment insurance] or CERB [Canada Emergency Response Benefit]. We have some savings, so we would be OK. So many people, like my children, lost their jobs. They might not have enough experience, and they could not find a new one soon. Although many of my clients canceled their service, I was lucky, and I still had a job to survive. So I decided to work and give the opportunities [EI or CERB] to my children and others.

5 Discussion

Based on the findings of the OAPSWs’ contributions, this section further examines the OAPSWs’ agency associated with the individual-work-family triangulation, contributing to existing literature.

5.1 Empowering Older-Adult Personal Support Workers’ Agency

The interview data confirmed that OAPSWs experienced “complex, challenging, and evolving conditions” during COVID-19 (White et al. 2021 , p. 202) but also highlighted the various COVID-19-specific impacts on OAPSWs through their individual-work-family triangulations. Specifically, this study demonstrated their vulnerable status associated with their age and professional (essential healthcare workers in high-risk workplace settings) variables increased during the COVID-19 pandemic. However, their life-based experiences enable them to manage the diverse vulnerabilities (Solly and Wells 2020 ) and workplace challenges and contribute to the prevention and mitigation of public health emergencies. At the individual level, they made extra efforts to prevent from being infected themselves, by adjusting their regular de-infection practice and their personal activities. For example, one interviewee mentioned that her SARS experience enabled her to swiftly mobilize more protection strategies. The experience not only maintained their physical, mental, and overall well-being but also propelled them to educate their younger colleagues, the residents, and clients at the work level. Their extra efforts created a safer and more supportive working environment. At the family level, their extra efforts developed multiple approaches that enabled them to fulfill their private responsibilities (for example, virtual visiting and grocery shopping) towards their nuclear and extended families (Bender et al. 2021 ).

These OAPSWs’ life-long experiences played an essential role in developing their extra, practice-oriented efforts. Their experiences enabled them to comprehensively consider the vulnerabilities of their residents/clients, their families, and the general public affected by COVID-19. For instance, their consideration regarding the COVID-19-specific mental health consequences for their colleagues, residents/clients, and families, and their decision to maintain their essential duties during the peak period to reduce the workload of their colleagues and to provide the opportunities for other people to receive unemployment benefits illustrated their extended contributions beyond their individual-work-family triangulation, bringing about positive changes in society.

5.2 Supporting Older-Adult Personal Support Workers

This study confirmed the current literature’s argument that older adults are vulnerable but resilient (Hou and Wu 2020 ). They are community-based assets. Leveraging their strengths, experiences, networks, and other expertise fundamentally promotes the community-based disaster management efforts. These types of contributions discussed during the interviews only partially demonstrated the OAPSWs’ heroic contributions made during the pandemic. The stereotype regarding the aging population produced by the public discourse have been challenged by the OAPSWs’ active engagement and tremendous contributions during the pandemic. Their involvement and contributions reflect the urgent need to reframe the passive depiction of aging, and reconsider these people as valuable assets. The limited studies focusing on older adults’ selfless and valuable engagement in disaster settings call for further research to uncover more about the agency of older adults.

Understanding the OAPSWs’ agency indicates that further support for this group is needed in order to promote their contributions. For the healthcare professionals in general, their friends, neighbors, and other community members took care of these frontliners (for example, preparing meals and making care packages for them) and their families (for example, taking care of their children and elderly parents) during COVID-19 so that these frontliners could completely devote themselves to fulfilling their essential roles. All of this support could be offered to OAPSWs as well. The OAPSWs should be recognized as essential workers so that related healthcare resources (for example, PPE and training) could be properly prioritized, fundamentally reducing the barriers so that they will be able to more safely work on the frontline. In the work environment, having older-adult OAPSWs to lead briefing would enable them to share their experience and to provide leadership in handling the challenging time. The OAPSWs should also be assigned leadership roles at the organizational level, so that they could provide frequent peer support (for example, wellness check-in and consulting) to their co-workers, providing these professionals with high-quality services. Receiving family understanding and support is vital in order for OAPSWs to improve their professional performance. Everyone on the Earth is connected to varying degrees. All these multi-aspects of support will augment the contributions of the older adults.

6 Limitations and Future Research

The discussion of this study’s limitations will support knowledge mobilization within Canada and internationally. Although the findings are promising, it is vital to note the following limitations. First, all participants are self-identified immigrants from East Asia or Southeast Asia (China, Hong Kong SAR of China, the Philippines, and Korea). Research has confirmed that although these immigrants have been living in Canada for a long time, their social engagement still primarily focuses on the Asian communities and Asian cultures they come from (Jia and Krettenauer 2022 ). For example, when providing the language choices for the interviewees, all the interviewees whose first language is non-English chose their mother tongue. The snowball sampling approach also confirmed this implication because the interviewees shared the project information within their Asian communities. Furthermore, collectivism predominates among countries in East Asia and Southeast Asia. This cultural background makes them likely to sacrifice themselves to support others. However, the cultural background has not fully engaged in the data analysis process of this project, indicating a future research area to examine the interconnections between the OAPSWs’ contributions and their cultural backgrounds. Future studies should investigate OAPSWs from other ethnic groups to further explore the differences within various cultures and develop appropriate strategies to promote OAPSWs’ strengths.

Although gender information was collected, this study mainly focused on the experience of OAPSWs in general, rather than deeply engaging gender factor into data analysis. Gender, reflecting the OAPSWs’ social roles, significantly shapes OAPSWs’ private and public responsibilities and impacts their contributions in the disaster and emergency management field (Drolet et al. 2015 ; Hou and Wu 2020 ; Wu et al. 2021 ). This indicates a potential research area for applying gender lens to comprehensively examine the OAPSWs’ contributions.

Moreover, although GTA provides a typical research setting, the provincial public health policies and other governmental interventions, and the structure of LTC differ from other provinces or territories in Canada. Hence, the research outcomes might not be directly mobilized beyond GTA and other Canadian jurisdictions, let alone the international scope. However, in this study, promising practices have been assuredly illustrated by the OAPSWs’ agency, which enables them to continually contribute to our society and this should also be reflected in other geographical areas. Prospective research may engage the OAPSWs from other Canadian jurisdictions and international communities to better understand the similarities and differences among them, and strengthen the knowledge mobilization promise.

7 Conclusion

Utilizing an individual-work-family triangulation approach, this study highlighted the three-level contributions that older-adult personal support workers (OAPSWs) delivered during the emergency response phase of the COVID-19 pandemic. At the individual level, they bore the potentially high risk of getting infected by the virus, but, nonetheless, supported the people around them. At the workplace level, they took on extra responsibilities to support their co-workers to keep their organizations’ operations providing a high-quality performance. At the family level, they took on extra responsibilities to take care of their family members physically, socially, and emotionally. While enduring age-related physical health risks, OAPSWs’ life-long experience enabled them to swiftly adapt to the COVID-19 setting, protecting themselves, their colleagues, their residents/clients, and their families.

In the global context of COVID-19, the OAPSWs’ contributions associated with their individual-work-family triangulation illustrate their agency in dealing with public health emergencies, and other disasters in general. Furthermore, these findings shed light on older-adult strengths, expertise, and leadership, which promote different disaster management efforts to enhance the individual and collective health and well-being, as well as advance resilience at the individual, work, and family levels. Future research could engage diverse older-adult professionals and explore their demographic information (for example, gender and ethnicity) in order to comprehensively understand their strengths in different settings. These prospective studies would promote the older adults’ continuous engagement and contributions to our society, promoting individual and collective resilience.

Adams, R., and H. Wu. 2020. Enhancing our healthcare heroes’ overall well-being: Balancing patient health, personal risk, and family responsibilities during the COVID-19 pandemic. Natural Hazards Center Grant Report Series, 316. Boulder, CO: Natural Hazards Center, University of Colorado Boulder. https://hazards.colorado.edu/quick-response-report/balancing-patient-health-personal-risk-and-family-responsibilities-during-the-covid-19-pandemic . Accessed 1 Apr 2024.

Aldrich, N., and W.F. Benson. 2008. Disaster preparedness and the chronic disease needs of vulnerable older adults. Preventing Chronic Disease 5(1): Article A27.

Google Scholar  

Allison, T.A., A. Oh, and K.L. Harrison. 2020. Extreme vulnerability of home care workers during the COVID-19 pandemic—A call to action. JAMA Internal Medicine 180(11): 1459–1460.

Article   CAS   Google Scholar  

Barusch, A.S. 2011. Disaster, vulnerability, and older adults: Toward a social work response. Journal of Gerontological Social Work 54(4): 347–350.

Article   Google Scholar  

Basa, J. 2022. Health care workers in need of mental health support amid pandemic burnout . CTV News , 24 January 2022.

Bender, A.E., K.A. Berg, E.K. Miller, K.E. Evans, and M.R. Holmes. 2021. “Making sure we are all okay”: Healthcare workers’ strategies for emotional connectedness during the COVID-19 pandemic. Clinical Social Work Journal 49: 445–455.

Brooke, J., and D. Jackson. 2020. Older people and COVID-19: Isolation, risk and ageism. Journal of Clinical Nursing 29(13–14): 2044–2046.

Brophy, J.T., M.M. Keith, M. Hurley, and J.E. McArthur. 2021. Sacrificed: Ontario healthcare workers in the time of COVID-19. New Solutions: A Journal of Environmental and Occupational Health Policy 30(4): 267–281.

Canadian Institute for Health Information. 2021. The impact of COVID-19 on long-term care in Canada: Focus on the first 6 months. Ottawa, ON: CIHI. https://www.cihi.ca/sites/default/files/document/impact-covid-19-long-term-care-canada-first-6-months-report-en.pdf . Accessed 1 Apr 2024.

d’Entremont, Y. 2021. Researchers launching online survey to learn how pandemic is affecting grocery store workers. Halifax Examiner , 23 December 2021. https://www.halifaxexaminer.ca/featured/researchers-launching-online-survey-to-learn-how-pandemic-is-affecting-grocery-store-workers/ . Accessed 1 Apr 2024.

Doolittle, R., E. Anderssen, and L. Perreaux. 2020. In Canada’s coronavirus fight, front-line workers miss their families, fear the worst and hope they’re ready. The Globe and Mail , 4 April 2020.

Drolet, J., M. Alston, L. Dominelli, R. Ersing, G. Mathbor, and H. Wu. 2015. Women rebuilding lives post-disaster: Innovative community practices for building resilience and promoting sustainable development. Gender & Development 23(3): 433–448.

Hapsari, A.P., J.W. Ho, C. Meaney, L. Avery, N. Hassen, A. Jetha, A.M. Lay, and M. Rotondi et al. 2022. The working conditions for personal support workers in the Greater Toronto Area during the COVID-19 pandemic: A mixed-methods study. Canadian Journal of Public Health 113(6): 817–833.

Helou, M., N.E.I. Osta, and R. Husni. 2022. Impact of the COVID-19 pandemic on healthcare workers’ families. World Journal of Clinical Cases 10(27): 9964–9966.

Hemmler, V.L., A.W. Kenne, S.D. Langley, C.M. Callahan, E.J. Gubbins, and S. Holder. 2020. Beyond a coefficient: An interactive process for achieving inter-rater consistency in qualitative coding. Qualitative Research 22(2): 194–219.

Hoernke, K., N. Djellouli, L. Andrews, S. Lewis-Jackson, L. Manby, S. Martin, S. Vanderslott, and C. Vindrola-Padros. 2021. Frontline healthcare workers’ experiences with personal protective equipment during the COVID-19 pandemic in the UK: A rapid qualitative appraisal. BMJ Open 11(1): Article e046199.

Hou, C., and H. Wu. 2020. Rescuer, decision-maker, and breadwinner: Women’s predominant leadership across the post-Wenchuan Earthquake efforts in rural areas, Sichuan, China. Safety Science 125: 1–6.

Jia, F., and T. Krettenauer. 2022. Moral identity and acculturation process among Chinese Canadians: Three cultural comparisons. International Journal of Intercultural Relations 88: 125–132.

Kelly, C., and I.L. Bourgeault. 2015. The personal support worker program standard in Ontario: An alternative to self-regulation?. HealthCare Policy 11(2): 20–26.

King, E.C., K.A.P. Zagrodne, S.M. McKay, D.L. Holness, and K.A. Nichol. 2023. Determinants of nurse’s and personal support worker’s adherence to facial protective equipment in a community setting during the COVID-19 pandemic in Ontario, Canada: A pilot study. American Journal of Infection Control 51(5): 490–497.

Langmann, E. 2023. Vulnerability, ageism, and health: Is it helpful to label older adults as a vulnerable group in health care?. Medicine, Health Care, and Philosophy 26(1): 133–142.

Lieberman, C. 2021. COVID-19: Retired health-care workers answer call to help on front lines. Global News , 19 March 2021.

McConnell, D. 2020. Balancing the duty to treat with the duty to family in the context of the COVID-19 pandemic. Journal of Medical Ethics 46(6): 360–363.

Moye, J. 2022. Mental health in older adults during COVID: Creative approaches and adaptive coping. Clinical Gerontologist 45(1): 1–3.

Ng, R., and N. Indran. 2022. Reframing aging during COVID-19: Familial role-based framing of older adults linked to decreased ageism. Journal of the American Geriatrics Society 70(1): 60–66.

Nguyen, L.H., D.A. Drew, M.S. Graham, A.D. Joshi, C.G. Guo, W. Ma, R.S. Mehta, and E. Warner et al. 2020. Risk of COVID-19 among front-line health-care workers and the general community: A prospective cohort study. The Lancet: Public Health 5(9): e475–e483.

Nizzer, S., N. Moreira, S. McKay, and E. King. 2022. Who meets home care workers’ emotional support needs? Toronto, ON: VHA. https://www.vha.ca/wp-content/uploads/2022/10/Moreira_WhoMeetsHomeCareWorkersEmotionalSupportNeeds_Abstract_Sept2022.pdf . Accessed 1 Apr 2024.

Palinkas, L.A., S.M. Horwitz, C.A. Green, J.P. Wisdom, N. Duan, and K. Hoagwood. 2015. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services 42: 533–544.

Pappa, S., V. Ntella, T. Giannakas, V.G. Giannakoulis, E. Papoutsi, and P. Katsaounou. 2020. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, Behavior, and Immunity 88: 901–907.

Pinto, A., A.P. Hapsari, J. Ho, C. Meaney, L. Avery, N. Hassen, A. Jetha, and A. Morgan Lay et al. 2022. Precarious work among personal support workers in the Greater Toronto Area: A respondent-driven sampling study. CMAJ Open 10(2): E527–E538.

Saldaña, J. 2009. The coding manual for qualitative researchers . Thousand Oaks, CA: SAGE.

Sinha, S.K., W.R. Spurlock, G.A. Allison, B. Earley, C. Taylor, E. Prendergast, J. Snelling, and J. Carmody et al. 2020. Closing the gaps: Advancing disaster preparedness, response and recovery for older adults . Ottawa, ON: Canadian Red Cross.

Slick, J., and H. Wu. 2022. The need to protect the most vulnerable: The COVID-19 crisis in long-term and residential care in Canada. In Countries in crisis: Collective cognition action and COVID-19 , ed. M.L. Rhodes, and L. Comfort, 182–207. New York: Routledge.

Solly, K.N., and Y. Wells. 2020. How well have senior Australians been coping with the COVID-19 pandemic?. Australasian Journal on Ageing 39: 386–388.

United Nation. 2020. Policy brief: COVID-19 and the need for action on mental health. https://unsdg.un.org/resources/policy-brief-covid-19-and-need-action-mental-health . Accessed 1 Apr 2024.

Vervaecke, D., and B.A. Meisner. 2021. Caremongering and assumptions of need: The spread of compassionate ageism during COVID-19. Gerontologist 61(2): 159–165.

White, E.M., T.F. Wetle, A. Reddy, and R.R. Baier. 2021. Front-line nursing home staff experiences during the COVID-19 pandemic. Journal of the American Medical Directors Association 22(1): 199–203.

World Health Organization. 2023. COVID-19: Vulnerable and high-risk groups. https://www.who.int/westernpacific/emergencies/covid-19/information/high-risk-groups#:~:text=If%20you're%20at%20risk,to%20contact%20your%20health%20provider . Accessed 8 Oct 2023.

Wu, H. 2020. Airdropped urban condominiums and stay-behind elders’ overall well-being: 10-year lessons learned from the post-Wenchuan Earthquake rural recovery. Journal of Rural Studies 79: 24–33.

Wu, H., J. Karabanow, and T. Hoddinott. 2022. Building emergency response capacity: Social workers’ engagement in supporting homeless communities during COVID-19 in Halifax, Nova Scotia, Canada. International Journal of Environmental Research and Public Health 19: Article 12713.

Wu, H., M. Perez-Lugo, C.O. García, F. Gonzalez, and A. Castillo. 2021. Empowered stakeholders: University female students’ leadership during the COVID-19-triggered on-campus evictions in Canada and the United States. International Journal of Disaster Risk Science 12(4): 581–592.

Xia, Y., H. Ma, G. Moloney, H.A. Velásquez García, M. Sirski, N.Z. Janjua, D. Vickers, and T. Williamson et al. 2022. Geographic concentration of SARS-CoV-2 cases by social determinants of health in metropolitan areas in Canada: A cross-sectional study. CMAJ 194(6): E195–E204.

Young, J.C., D.C. Rose, H.S. Mumby, F. Benitez-Capistros, C.J. Derrick, T. Finch, C. Garcia, and C. Home et al. 2018. A methodological guide to using and reporting on interviews in conservation science research. Methods in Ecology and Evolution 9: 10–19.

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Acknowledgments

This research was supported by the Social Sciences and Humanities Research Council of Canada (SSHRC), Insight Development Grants (Award # 430-2021-00352). This research was also undertaken, in part, thanks to funding from the Canada Research Chairs Program (Award # CRC-2020-00128).

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Wu, H., Yung, M. “If I Do not Go to Work, They Will Die!” Dual Roles of Older-Adult Personal Support Workers’ Contributions During the COVID-19 Pandemic. Int J Disaster Risk Sci (2024). https://doi.org/10.1007/s13753-024-00553-x

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