essay about covid 19 impact

The Impact of COVID-19 Pandemic

The year 2019 will forever be engraved in many people’s hearts and minds as the time when a deadly virus known as the coronavirus disease 2019 (COVID-19) invaded almost all the sectors, thereby disrupting daily activities. It is described as a communicable respiratory illness which is triggered by a new strain of coronavirus which leads to various ailments in human beings. There is currently no known cure or vaccine for the virus as scientists worldwide are still trying to learn about the illness to respond appropriately through research (Goodell, 2020). This paper aims at exploring the effects that the pandemic has had on society regarding the economy, social life, education, religion, and family.

The emergence of the pandemic, which began in China-2019, quickly spread to other nations across the world with devastating effects on their economies As a way of containing the disease, many countries instituted strict measures, such as curfews, the mandatory wearing of masks, and social distancing of 1 meter apart (Goodell, 2020). Covid-19 has significantly changed the way these preventive methods relate with each concerning trade matters. The majority of the states affected opted to close their borders as fear among the citizens increased. The implementation of the strict rules interfered with the business operations of many nations. It became difficult for international trade to continue as a result of the closed borders. Most businesses have also had to close due to financial constraints.

When it comes to socialization, people have been forced to use other means to meet their friends and families across the world. Social media platforms have seen an increased usage during this difficult time as people try to find new ways of socializing. It has happened especially in such countries as Australia, where the restrictions were extreme as it enforced a lockdown for close to a hundred days (Goodell, 2020). The use of masks is also quickly becoming the new norm across numerous states. Unlike in developed countries where the governments have offered their citizens some aid mostly in terms of cash transfers, developing countries have struggled to balance between the people’s livelihood and the containment of the Covid-19. As such, most people have turned to social media platforms as a medium of communication and socialization due to lockdowns.

Learning institutions have also not been spared by the Covid-19 pandemic. Most countries affected by the spread of the virus were forced to suspend their educational curriculum calendar to allow children and university students to stay home until the time when the disease is finally neutralized (Goodell, 2020). However, students and parents have been pushing the governments to resume schools with clear protocols which ensure that both the students and the teachers follow the rules, including the mandatory wearing of masks. Religion has also been significantly affected as it has become difficult for people to seek for spiritual nourishment (Goodell, 2020). Many religious leaders have had to devise other ways of reaching out to the congregates. For example, many churches now have to move their services online by using such platforms as YouTube, Facebook, Zoom, among others to convey essential teachings.

Covid-19 has also directly affected many families across the world, as the majority have succumbed to the disease. The United States of America and Italy are some of the pandemic’s worst casualties, where many people were killed by the lethal virus (Goodell, 2020). Some people have in the end lost more than one member of the family because of the disease, and in some worse case scenarios, the illness has claimed a whole family.

In conclusion, this paper has highlighted the impacts of the Covid-19 pandemic on the economy, social life, education, religion, and family units. Many countries and businesses had underestimated the disease’s impact before they later suffered from the consequences. Therefore, international bodies, such as the World Health Organization, need to help developing countries establish critical management healthcare systems, which can help to deal with the future pandemics.

Goodell, J. W. (2020). COVID-19 and finance: Agendas for future research. Finance Research Letters , 35 , 101512. Web.

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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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• 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.

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

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

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

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Introduction

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

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

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

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

Social networks

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

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

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

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

Social support

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

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

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

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

Social and interactional norms

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

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

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

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

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

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

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

Recommendations and conclusions

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

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

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

Recommendation 2: intelligently balance online and offline ways of relating

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

Recommendation 3: build stronger and sustainable localised communities

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

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

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

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

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

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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‘When Normal Life Stopped’: College Essays Reflect a Turbulent Year

This year’s admissions essays became a platform for high school seniors to reflect on the pandemic, race and loss.

By Anemona Hartocollis

This year perhaps more than ever before, the college essay has served as a canvas for high school seniors to reflect on a turbulent and, for many, sorrowful year. It has been a psychiatrist’s couch, a road map to a more hopeful future, a chance to pour out intimate feelings about loneliness and injustice.

In response to a request from The New York Times, more than 900 seniors submitted the personal essays they wrote for their college applications. Reading them is like a trip through two of the biggest news events of recent decades: the devastation wrought by the coronavirus, and the rise of a new civil rights movement.

In the wake of the high-profile deaths of Black people like George Floyd and Breonna Taylor at the hands of police officers, students shared how they had wrestled with racism in their own lives. Many dipped their feet into the politics of protest, finding themselves strengthened by their activism, yet sometimes conflicted.

And in the midst of the most far-reaching pandemic in a century, they described the isolation and loss that have pervaded every aspect of their lives since schools suddenly shut down a year ago. They sought to articulate how they have managed while cut off from friends and activities they had cultivated for years.

To some degree, the students were responding to prompts on the applications, with their essays taking on even more weight in a year when many colleges waived standardized test scores and when extracurricular activities were wiped out.

This year the Common App, the nation’s most-used application, added a question inviting students to write about the impact of Covid-19 on their lives and educations. And universities like Notre Dame and Lehigh invited applicants to write about their reactions to the death of George Floyd, and how that inspired them to make the world a better place.

The coronavirus was the most common theme in the essays submitted to The Times, appearing in 393 essays, more than 40 percent. Next was the value of family, coming up in 351 essays, but often in the context of other issues, like the pandemic and race. Racial justice and protest figured in 342 essays.

“We find with underrepresented populations, we have lots of people coming to us with a legitimate interest in seeing social justice established, and they are looking to see their college as their training ground for that,” said David A. Burge, vice president for enrollment management at George Mason University.

Family was not the only eternal verity to appear. Love came up in 286 essays; science in 128; art in 110; music in 109; and honor in 32. Personal tragedy also loomed large, with 30 essays about cancer alone.

Some students resisted the lure of current events, and wrote quirky essays about captaining a fishing boat on Cape Cod or hosting dinner parties. A few wrote poetry. Perhaps surprisingly, politics and the 2020 election were not of great interest.

Most students expect to hear where they were admitted by the end of March or beginning of April. Here are excerpts from a few of the essays, edited for length.

Nandini Likki

Nandini, a senior at the Seven Hills School in Cincinnati, took care of her father after he was hospitalized with Covid-19. It was a “harrowing” but also rewarding time, she writes.

When he came home, my sister and I had to take care of him during the day while my mom went to work. We cooked his food, washed his dishes, and excessively cleaned the house to make sure we didn’t get the disease as well.

It was an especially harrowing time in my life and my mental health suffered due to the amount of stress I was under.

However, I think I grew emotionally and matured because of the experience. My sister and I became more responsible as we took on more adult roles in the family. I grew even closer to my dad and learned how to bond with him in different ways, like using Netflix Party to watch movies together. Although the experience isolated me from most of my friends who couldn’t relate to me, my dad’s illness taught me to treasure my family even more and cherish the time I spend with them.

Nandini has been accepted at Case Western and other schools.

Grace Sundstrom

Through her church in Des Moines, Grace, a senior at Roosevelt High School, began a correspondence with Alden, a man who was living in a nursing home and isolated by the pandemic.

As our letters flew back and forth, I decided to take a chance and share my disgust about the treatment of people of color at the hands of police officers. To my surprise, Alden responded with the same sentiments and shared his experience marching in the civil rights movement in the 1960s.

Here we were, two people generations apart, finding common ground around one of the most polarizing subjects in American history.

When I arrived at my first Black Lives Matter protest this summer, I was greeted by the voices of singing protesters. The singing made me think of a younger Alden, stepping off the train at Union Station in Washington, D.C., to attend the 1963 March on Washington.

Grace has been admitted to Trinity University in San Antonio and is waiting to hear from others.

Ahmed AlMehri

Ahmed, who attends the American School of Kuwait, wrote of growing stronger through the death of his revered grandfather from Covid-19.

Fareed Al-Othman was a poet, journalist and, most importantly, my grandfather. Sept. 8, 2020, he fell victim to Covid-19. To many, he’s just a statistic — one of the “inevitable” deaths. But to me, he was, and continues to be, an inspiration. I understand the frustration people have with the restrictions, curfews, lockdowns and all of the tertiary effects of these things.

But I, personally, would go through it all a hundred times over just to have my grandfather back.

For a long time, things felt as if they weren’t going to get better. Balancing the grief of his death, school and the upcoming college applications was a struggle; and my stress started to accumulate. Covid-19 has taken a lot from me, but it has forced me to grow stronger and persevere. I know my grandfather would be disappointed if I had let myself use his death as an excuse to slack off.

Ahmed has been accepted by the University of California, Irvine, and the University of Miami and is waiting to hear from others.

Mina Rowland

Mina, who lives in a shelter in San Joaquin County, Calif., wrote of becoming homeless in middle school.

Despite every day that I continue to face homelessness, I know that I have outlets for my pain and anguish.

Most things that I’ve had in life have been destroyed, stolen, lost, or taken, but art and poetry shall be with me forever.

The stars in “Starry Night” are my tenacity and my hope. Every time I am lucky enough to see the stars, I am reminded of how far I’ve come and how much farther I can go.

After taking a gap year, Mina and her twin sister, Mirabell, have been accepted at the University of Maryland Eastern Shore and are waiting on others.

Christine Faith Cabusay

Christine, a senior at Stuyvesant High School in New York, decided to break the isolation of the pandemic by writing letters to her friends.

How often would my friends receive something in the mail that was not college mail, a bill, or something they ordered online? My goal was to make opening a letter an experience. I learned calligraphy and Spencerian script so it was as if an 18th-century maiden was writing to them from her parlor on a rainy day.

Washing lines in my yard held an ever-changing rainbow of hand-recycled paper.

With every letter came a painting of something that I knew they liked: fandoms, animals, music, etc. I sprayed my favorite perfume on my signature on every letter because I read somewhere that women sprayed perfume on letters overseas to their partners in World War II; it made writing letters way more romantic (even if it was just to my close friends).

Christine is still waiting to hear from schools.

Alexis Ihezue

Her father’s death from complications of diabetes last year caused Alexis, a student at the Gwinnett School of Mathematics, Science and Technology in Lawrenceville, Ga., to consider the meaning of love.

And in the midst of my grief swallowing me from the inside out, I asked myself when I loved him most, and when I knew he loved me. It’s nothing but brief flashes, like bits and pieces of a dream. I hear him singing “Fix You” by Coldplay on our way home, his hands across the table from me at our favorite wing spot that we went to weekly after school, him driving me home in the middle of a rainstorm, his last message to me congratulating me on making it to senior year.

It’s me finding a plastic spoon in the sink last week and remembering the obnoxious way he used to eat. I see him in bursts and flashes.

A myriad of colors and experiences. And I think to myself, ‘That’s what it is.’ It’s a second. It’s a minute. That’s what love is. It isn’t measured in years, but moments.

Alexis has been accepted by the University of North Carolina at Chapel Hill and is waiting on others.

Ivy Wanjiku

She and her mother came to America “with nothing but each other and $100,” writes Ivy, who was born in Kenya and attends North Cobb High School in Kennesaw, Ga.

I am a triple threat. Foreign, black, female. From the dirt roads and dust that covered the attire of my ancestors who worshiped the soil, I have sprouted new beginnings for generations.

But the question arises; will that generation live to see its day?

Melanin mistaken as a felon, my existence is now a hashtag that trends as often as my rights, a facade at best, a lie in truth. I now know more names of dead blacks than I do the amendments of the Constitution.

Ivy is going to Emory University in Atlanta on full scholarship and credits her essay with helping her get in.

Mary Clare Marshall

The isolation of the pandemic became worse when Mary Clare, a student at Sacred Heart Greenwich in Connecticut, realized that her mother had cancer.

My parents acted like everything was normal, but there were constant reminders of her diagnosis. After her first chemo appointment, I didn’t acknowledge the change. It became real when she came downstairs one day without hair.

No one said anything about the change. It just happened. And it hit me all over again. My mom has cancer.

Even after going to Catholic school for my whole life, I couldn’t help but be angry at God. I felt myself experiencing immense doubt in everything I believe in. Unable to escape my house for any small respite, I felt as though I faced the reality of my mom’s cancer totally alone.

Mary Clare has been admitted to the University of Virginia and is waiting on other schools.

Nora Frances Kohnhorst

Nora, a student at the High School of American Studies at Lehman College in New York, was always “a serial dabbler,” but found commitment in a common pandemic hobby.

In March, when normal life stopped, I took up breadmaking. This served a practical purpose. The pandemic hit my neighborhood in Queens especially hard, and my parents were afraid to go to the store. This forced my family to come up with ways to avoid shopping. I decided I would learn to make sourdough using recipes I found online. Initially, some loaves fell flat, others were too soft inside, and still more spread into strange blobs.

I reminded myself that the bread didn’t need to be perfect, just edible.

It didn’t matter what it looked like; there was no one to see or eat it besides my brother and parents. They depended on my new activity, and that dependency prevented me from repeating the cycle of trying a hobby, losing steam, and moving on to something new.

Nora has been admitted to SUNY Binghamton and the University of Vermont and is waiting to hear from others.

Gracie Yong Ying Silides

Gracie, a student at Greensboro Day School in North Carolina, recalls the “red thread” of a Chinese proverb and wonders where it will take her next.

Destiny has led me into a mysterious place these last nine months: isolation. At a time in my life when I am supposed to be branching out, the Covid pandemic seems to have trimmed those branches back to nubs. I have had to research colleges without setting foot on them. I’ve introduced myself to strangers through essays, videos, and test scores.

I would have fallen apart over this if it weren’t for my faith.

In Hebrews 11:1, Paul says that “faith is the substance of things hoped for, the evidence of things not seen.” My life has shown me that the red thread of destiny guides me where I need to go. Though it might sound crazy, I trust that the red thread is guiding me to the next phase of my journey.

Gracie has been accepted to St. Olaf College, Ithaca College and others.

Levi, a student at Westerville Central High School in Ohio, wrestles with the conflict between her admiration for her father, a police officer, and the negative image of the police.

Since I was a small child I have watched my father put on his dark blue uniform to go to work protecting and serving others. He has always been my hero. As the African-American daughter of a police officer, I believe in what my father stands for, and I am so proud of him because he is not only my protector, but the protector of those I will likely never know. When I was young, I imagined him always being a hero to others, just as he was to me. How could anyone dislike him??? However, as I have gotten older and watched television and social media depict the brutalization of African-Americans, at the hands of police, I have come to a space that is uncomfortable.

I am certain there are others like me — African-Americans who love their police officer family members, yet who despise what the police are doing to African-Americans.

I know that I will not be able to rectify this problem alone, but I want to be a part of the solution where my paradox no longer exists.

Levi has been accepted to the University of North Carolina at Chapel Hill and North Carolina Agricultural and Technical State University, and is waiting to hear from others.

Henry Thomas Egan

When Henry, a student at Creighton Preparatory School in Omaha, attended a protest after the death of George Floyd, it was the words of a Nina Simone song that stayed with him.

I had never been to a protest before; neither my school, nor my family, nor my city are known for being outspoken. Thousands lined the intersection in all four directions, chanting, “He couldn’t breathe! George Floyd couldn’t breathe!”

In my head, thoughts of hunger, injustice, and silence swirled around.

In my ears, I heard lyrics playing on a speaker nearby, a song by Nina Simone: “To be young, gifted, and Black!” The experience was exceptionally sad and affirming and disorienting at the same time, and when the police arrived and started firing tear gas, I left. A lot has happened in my life over these last four years. I am left not knowing how to sort all of this out and what paths I should follow.

Henry has not yet heard back from colleges.

Anna Valades

Anna, a student at Coronado High School in California, pondered how children learned racism from their parents.

“She said I wasn’t invited to her birthday party because I was black,” my sister had told my mom, devastated, after coming home from third grade as the only classmate who had not been invited to the party. Although my sister is not black, she is a dark-skinned Mexican, and brown-skinned people in Mexico are thought of as being a lower class and commonly referred to as “negros.” When my mom found out who had been discriminating against my sister, she later informed me that the girl’s mother had also bullied my mom about her skin tone when she was in elementary school in Mexico City.

Through this situation, I learned the impact people’s upbringing and the values they are taught at home have on their beliefs and, therefore, their actions.

Anna has been accepted at Northeastern University and is waiting to hear from others.

Research was contributed by Asmaa Elkeurti, Aidan Gardiner, Pierre-Antoine Louis and Jake Frankenfield.

Anemona Hartocollis is a national correspondent, covering higher education. She is also the author of the book, “Seven Days of Possibilities: One Teacher, 24 Kids, and the Music That Changed Their Lives Forever.” More about Anemona Hartocollis

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

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

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

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

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

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

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

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

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

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About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

Governments today are facing serious, seemingly intractable public management issues in the aftermath of COVID-19 that go to the core of effective governance and leadership, testing the very form, structure, and capacity required to meet these problems head-on. Leaders have found it necessary to go beyond established parameters and institutional structures, working across organizational boundaries in pursuit of multilayered, networked approaches that better respond to system and societal shocks brought by the pandemic.

In fall 2020, the IBM Center for The Business of Government initiated a Challenge Grant competition soliciting essays from academics and practitioners describing how government can best transform the way it works, operates, and delivers services to the public in light of the impact of the COVID-19 pandemic. Edited by Center Leadership Fellow Michael J. Keegan, COVID-19 and its Impact: Seven Essays on Reframing Government Management, features selected commentary on sustaining transformation and increasing resilience. ICMA's Tad McGalliard, director of research and development, and Laura Goddeeris, director of survey research, are among the contributing authors. Their essay draws upon ICMA survey research in exploring which pandemic-driven innovations and operational changes might prevail in a post-pandemic environment.

Expert Insight

"The key to transformation is not to lose momentum and fall back on the old ways, when potentially innovative practices and programs are still evolving from the crisis." -- Tad McGalliard, ICMA director of research and development

Key takeaways from this report include:

• The pandemic accelerated changes in the way government works and delivers services that were already underway. This change has unlocked opportunities to build a new civic future.
• Local leaders will need to address numerous policy issues raised by these changes in work environments and service delivery. Fostering a more flexible and outcome-driven culture will contribute to a new model of success for government.
• Expectations of individuals and communities will focus on access to continued online services even after conditions merit reopening of government facilities. Building a hybrid operating model to engage with citizens that adopts consistent standards for customer experience will be necessary for successful government performance.
• Cities and counties across the country are leading the way in understanding how to deliver COVID and other services to communities in need, who suffer disproportionately during the pandemic.
• Governments must anticipate risks and develop data-driven programs to mitigate risks, respond to events, and be resilient in the aftermath of inevitable threats—physical and cyber—that face agencies at all levels.
• Unprecedented demand on public procurement in response to the COVID-19 pandemic reveal significant vulnerabilities in government supply chains and procurement processes. The pandemic offers the opportunity to consider how governments can make contracting more resilient going forward.

Essays featured in this compendium:

• Five Ways COVID-19 Changes How Local Governments Do Business, by Richard Feiock
• The Future of Work in Local Governments Beyond COVID-19, by Sherri Greenberg
• Transforming Local Government Service Delivery in the Wake of COVID-19, by Tad McGalliard and Laura Goddeeris
• Community Driven Government—Reimagining Systems in a Pandemic, by Maya McKenzie and Gurdeep Gill
• COVID-19 and the Resilience Imperative in Public Procurement: Building Back Better, by Zach Huitink
• Achieving Supply Chain Immunity: Planning, Preparation, and Coordination in National Emergency Response, by Rob Handfield
• Trust and Resilience: How Public Service Principles Encouraged Compliance with COVID-19 Public Health Guidelines in New Zealand, by Rodney Scott and Eleanor Merton

You may be interested in related resources from ICMA survey research:

• COVID-19 Impacts on Local Governments (complete survey summary), July 2020
• New ICMA Survey Shows Depth of Economic Downturn for Cities and Counties, July 2020
• New Data Estimates Local Governments Will Spend Up to $20 Billion On COVID-19 Actions, March 2020
• Government Technology Solutions Survey (complete survey summary), 2017

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Writing about COVID-19 in a college admission essay

by: Venkates Swaminathan | Updated: September 14, 2020

Print article

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

The CommonApp COVID-19 question

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

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

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

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

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

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

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

Counselor recommendations and school profiles

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

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

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

Writing about COVID-19 in your main essay

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

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

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

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

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Australians warned to get tested or brace for extra 1,000 cancer cases over 10 years

A new study by Australian researchers has found the nation's healthcare system could be inundated with more than a thousand new cancer cases in the next six years if testing rates do not pick up.

The report looked into the impact of COVID-19 disruptions like lockdowns on bowel cancer screening, diagnosis and treatment in Australia, and found testing rates had fallen off around the country.

The study was published by PLOS One and was carried out by researchers at the University of New South Wales, the Daffodil Centre and the Cancer Council of New South Wales.

What happened?

Bowel cancer is one of just three cancers that has a national screening program in Australia.

It's one of the most common forms of cancer and can be deadly if not detected and treated early.

Lead researcher Joachim Worthington said the COVID-19 pandemic had a crushing impact on how the Australian health system coped with the disease, and his team set out to find out why.

"At the end of March 2020, we really had no idea what was going to happen at hospitals or national screening programs," he said.

"We were looking into what would happen if, hypothetically, those cancer screening programs had to shut down.

"The main concern was people having these cancers and having them lie undetected because they aren't accessing health services."

Dr Worthington teamed up with researchers from Canada to begin modelling the impact of COVID-19 disruptions on the prevention, testing, diagnosis and treatment of colorectal cancer.

"We've got the official statistics saying that fewer people completed their bowel screening tests," he said.

"We've also got the official statistics saying that there were delays to people getting their cancer diagnosed, as well as getting their treatment after that."

What do the numbers say?

According to the report, disruptions caused by the pandemic could lead to an extra 234 cancer cases and 1,186 deaths in Australia over 10 years, between 2020 and 2030.

"In Australia, COVID disruptions were predicted to lead to a 2.4 per cent increase in mortality compared with a scenario with no screening disruption or diagnostic treatment delays," the report reads.

The research found Australia experienced a 7 per cent decrease in screening, an 11.7 per cent decrease in diagnoses and up to a 7 per cent decrease in treatment, spanning COVID-19-era cancer control data.

While the results were confronting, Dr Worthington said the teams also worked together to model what "mitigation" would look like in patients.

That is, what would start happening if Australians got back into regular bowel cancer screenings and testing.

If mitigated, the report found, Australia would record 842 deaths rather than the predicted 1,186.

What can Australians do?

"It's a simple test, but only 40 per cent of Australians do it," Dr Worthington said.

"There's definitely scope for a lot more people to get into screening or return to screening if … they've lost that habit over the pandemic.

"It wasn't too long ago that we didn't have this screening program, and for a lot of cancers, we don't have the opportunity to detect these early.

"On a broader government level, we're just hoping to highlight the importance of the bowel cancer screening program, and make sure that's as resilient as possible in future when there's more disruptions if that ever comes around again."

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The ability of the public to remain psychologically resilient in the face of public health emergencies and disasters (such as the COVID-19 pandemic) is a key factor in the effectiveness of a national response to such events. Community resilience and social capital are often perceived as beneficial and ensuring that a community is socially and psychologically resilient may aid emergency response and recovery. This review presents a synthesis of literature which answers the following research questions: How are community resilience and social capital quantified in research?; What is the impact of community resilience on mental wellbeing?; What is the impact of infectious disease outbreaks, disasters and emergencies on community resilience and social capital?; and, What types of interventions enhance community resilience and social capital?

A scoping review procedure was followed. Searches were run across Medline, PsycInfo, and EMBASE, with search terms covering both community resilience and social capital, public health emergencies, and mental health. 26 papers met the inclusion criteria.

The majority of retained papers originated in the USA, used a survey methodology to collect data, and involved a natural disaster. There was no common method for measuring community resilience or social capital. The association between community resilience and social capital with mental health was regarded as positive in most cases. However, we found that community resilience, and social capital, were initially negatively impacted by public health emergencies and enhanced by social group activities.

Several key recommendations are proposed based on the outcomes from the review, which include: the need for a standardised and validated approach to measuring both community resilience and social capital; that there should be enhanced effort to improve preparedness to public health emergencies in communities by gauging current levels of community resilience and social capital; that community resilience and social capital should be bolstered if areas are at risk of disasters or public health emergencies; the need to ensure that suitable short-term support is provided to communities with high resilience in the immediate aftermath of a public health emergency or disaster; the importance of conducting robust evaluation of community resilience initiatives deployed during the COVID-19 pandemic.

Peer Review reports

For the general population, public health emergencies and disasters (e.g., natural disasters; infectious disease outbreaks; Chemical, Biological, Radiological or Nuclear incidents) can give rise to a plethora of negative outcomes relating to both health (e.g. increased mental health problems [ 1 , 2 , 3 , 4 ]) and the economy (e.g., increased unemployment and decreased levels of tourism [ 4 , 5 , 6 ]). COVID-19 is a current, and ongoing, example of a public health emergency which has affected over 421 million individuals worldwide [ 7 ]. The long term implications of COVID-19 are not yet known, but there are likely to be repercussions for physical health, mental health, and other non-health related outcomes for a substantial time to come [ 8 , 9 ]. As a result, it is critical to establish methods which may inform approaches to alleviate the longer-term negative consequences that are likely to emerge in the aftermath of both COVID-19 and any future public health emergency.

The definition of resilience often differs within the literature, but ultimately resilience is considered a dynamic process of adaptation. It is related to processes and capabilities at the individual, community and system level that result in good health and social outcomes, in spite of negative events, serious threats and hazards [ 10 ]. Furthermore, Ziglio [ 10 ] refers to four key types of resilience capacity: adaptive, the ability to withstand and adjust to unfavourable conditions and shocks; absorptive, the ability to withstand but also to recover and manage using available assets and skills; anticipatory, the ability to predict and minimize vulnerability; and transformative, transformative change so that systems better cope with new conditions.

There is no one settled definition of community resilience (CR). However, it generally relates to the ability of a community to withstand, adapt and permit growth in adverse circumstances due to social structures, networks and interdependencies within the community [ 11 ]. Social capital (SC) is considered a major determinant of CR [ 12 , 13 ], and reflects strength of a social network, community reciprocity, and trust in people and institutions [ 14 ]. These aspects of community are usually conceptualised primarily as protective factors that enable communities to cope and adapt collectively to threats. SC is often broken down into further categories [ 15 ], for example: cognitive SC (i.e. perceptions of community relations, such as trust, mutual help and attachment) and structural SC (i.e. what actually happens within the community, such as participation, socialising) [ 16 ]; or, bonding SC (i.e. connections among individuals who are emotionally close, and result in bonds to a particular group [ 17 ]) and bridging SC (i.e. acquaintances or individuals loosely connected that span different social groups [ 18 ]). Generally, CR is perceived to be primarily beneficial for multiple reasons (e.g. increased social support [ 18 , 19 ], protection of mental health [ 20 , 21 ]), and strengthening community resilience is a stated health goal of the World Health Organisation [ 22 ] when aiming to alleviate health inequalities and protect wellbeing. This is also reflected by organisations such as Public Health England (now split into the UK Health Security Agency and the Office for Health Improvement and Disparities) [ 23 ] and more recently, CR has been targeted through the endorsement of Community Champions (who are volunteers trained to support and to help improve health and wellbeing. Community Champions also reflect their local communities in terms of population demographics for example age, ethnicity and gender) as part of the COVID-19 response in the UK (e.g. [ 24 , 25 ]).

Despite the vested interest in bolstering communities, the research base establishing: how to understand and measure CR and SC; the effect of CR and SC, both during and following a public health emergency (such as the COVID-19 pandemic); and which types of CR or SC are the most effective to engage, is relatively small. Given the importance of ensuring resilience against, and swift recovery from, public health emergencies, it is critically important to establish and understand the evidence base for these approaches. As a result, the current review sought to answer the following research questions: (1) How are CR and SC quantified in research?; (2) What is the impact of community resilience on mental wellbeing?; (3) What is the impact of infectious disease outbreaks, disasters and emergencies on community resilience and social capital?; and, (4) What types of interventions enhance community resilience and social capital?

By collating research in order to answer these research questions, the authors have been able to propose several key recommendations that could be used to both enhance and evaluate CR and SC effectively to facilitate the long-term recovery from COVID-19, and also to inform the use of CR and SC in any future public health disasters and emergencies.

A scoping review methodology was followed due to the ease of summarising literature on a given topic for policy makers and practitioners [ 26 ], and is detailed in the following sections.

Identification of relevant studies

An initial search strategy was developed by authors CH and DW and included terms which related to: CR and SC, given the absence of a consistent definition of CR, and the link between CR and SC, the review focuses on both CR and SC to identify as much relevant literature as possible (adapted for purpose from Annex 1: [ 27 ], as well as through consultation with review commissioners); public health emergencies and disasters [ 28 , 29 , 30 , 31 ], and psychological wellbeing and recovery (derived a priori from literature). To ensure a focus on both public health and psychological research, the final search was carried across Medline, PsycInfo, and EMBASE using OVID. The final search took place on the 18th of May 2020, the search strategy used for all three databases can be found in Supplementary file 1 .

Selection criteria

The inclusion and exclusion criteria were developed alongside the search strategy. Initially the criteria were relatively inclusive and were subject to iterative development to reflect the authors’ familiarisation with the literature. For example, the decision was taken to exclude research which focused exclusively on social support and did not mention communities as an initial title/abstract search suggested that the majority of this literature did not meet the requirements of our research question.

The full and final inclusion and exclusion criteria used can be found in Supplementary file 2 . In summary, authors decided to focus on the general population (i.e., non-specialist, e.g. non-healthcare worker or government official) to allow the review to remain community focused. The research must also have assessed the impact of CR and/or SC on mental health and wellbeing, resilience, and recovery during and following public health emergencies and infectious disease outbreaks which affect communities (to ensure the research is relevant to the review aims), have conducted primary research, and have a full text available or provided by the first author when contacted.

Charting the data

All papers were first title and abstract screened by CH or DW. Papers then were full text reviewed by CH to ensure each paper met the required eligibility criteria, if unsure about a paper it was also full text reviewed by DW. All papers that were retained post full-text review were subjected to a standardised data extraction procedure. A table was made for the purpose of extracting the following data: title, authors, origin, year of publication, study design, aim, disaster type, sample size and characteristics, variables examined, results, restrictions/limitations, and recommendations. Supplementary file 3 details the charting the data process.

Analytical method

Data was synthesised using a Framework approach [ 32 ], a common method for analysing qualitative research. This method was chosen as it was originally used for large-scale social policy research [ 33 ] as it seeks to identify: what works, for whom, in what conditions, and why [ 34 ]. This approach is also useful for identifying commonalities and differences in qualitative data and potential relationships between different parts of the data [ 33 ]. An a priori framework was established by CH and DW. Extracted data was synthesised in relation to each research question, and the process was iterative to ensure maximum saturation using the available data.

Study selection

The final search strategy yielded 3584 records. Following the removal of duplicates, 2191 records remained and were included in title and abstract screening. A PRISMA flow diagram is presented in Fig.  1 .

PRISMA flow diagram

At the title and abstract screening stage, the process became more iterative as the inclusion criteria were developed and refined. For the first iteration of screening, CH or DW sorted all records into ‘include,’ ‘exclude,’ and ‘unsure’. All ‘unsure’ papers were re-assessed by CH, and a random selection of ~ 20% of these were also assessed by DW. Where there was disagreement between authors the records were retained, and full text screened. The remaining papers were reviewed by CH, and all records were categorised into ‘include’ and ‘exclude’. Following full-text screening, 26 papers were retained for use in the review.

Study characteristics

This section of the review addresses study characteristics of those which met the inclusion criteria, which comprises: date of publication, country of origin, study design, study location, disaster, and variables examined.

Date of publication

Publication dates across the 26 papers spanned from 2008 to 2020 (see Fig.  2 ). The number of papers published was relatively low and consistent across this timescale (i.e. 1–2 per year, except 2010 and 2013 when none were published) up until 2017 where the number of papers peaked at 5. From 2017 to 2020 there were 15 papers published in total. The amount of papers published in recent years suggests a shift in research and interest towards CR and SC in a disaster/ public health emergency context.

Graph to show retained papers date of publication

Country of origin

The locations of the first authors’ institutes at the time of publication were extracted to provide a geographical spread of the retained papers. The majority originated from the USA [ 35 , 36 , 37 , 38 , 39 , 40 , 41 ], followed by China [ 42 , 43 , 44 , 45 , 46 ], Japan [ 47 , 48 , 49 , 50 ], Australia [ 51 , 52 , 53 ], The Netherlands [ 54 , 55 ], New Zealand [ 56 ], Peru [ 57 ], Iran [ 58 ], Austria [ 59 ], and Croatia [ 60 ].

There were multiple methodological approaches carried out across retained papers. The most common formats included surveys or questionnaires [ 36 , 37 , 38 , 42 , 46 , 47 , 48 , 49 , 50 , 53 , 54 , 55 , 57 , 59 ], followed by interviews [ 39 , 40 , 43 , 51 , 52 , 60 ]. Four papers used both surveys and interviews [ 35 , 41 , 45 , 58 ], and two papers conducted data analysis (one using open access data from a Social Survey [ 44 ] and one using a Primary Health Organisations Register [ 56 ]).

Study location

The majority of the studies were carried out in Japan [ 36 , 42 , 44 , 47 , 48 , 49 , 50 ], followed by the USA [ 35 , 37 , 38 , 39 , 40 , 41 ], China [ 43 , 45 , 46 , 53 ], Australia [ 51 , 52 ], and the UK [ 54 , 55 ]. The remaining studies were carried out in Croatia [ 60 ], Peru [ 57 ], Austria [ 59 ], New Zealand [ 56 ] and Iran [ 58 ].

Multiple different types of disaster were researched across the retained papers. Earthquakes were the most common type of disaster examined [ 45 , 47 , 49 , 50 , 53 , 56 , 57 , 58 ], followed by research which assessed the impact of two disastrous events which had happened in the same area (e.g. Hurricane Katrina and the Deepwater Horizon oil spill in Mississippi, and the Great East Japan earthquake and Tsunami; [ 36 , 37 , 38 , 42 , 44 , 48 ]). Other disaster types included: flooding [ 51 , 54 , 55 , 59 , 60 ], hurricanes [ 35 , 39 , 41 ], infectious disease outbreaks [ 43 , 46 ], oil spillage [ 40 ], and drought [ 52 ].

Variables of interest examined

Across the 26 retained papers: eight referred to examining the impact of SC [ 35 , 37 , 39 , 41 , 46 , 49 , 55 , 60 ]; eight examined the impact of cognitive and structural SC as separate entities [ 40 , 42 , 45 , 48 , 50 , 54 , 57 , 59 ]; one examined bridging and bonding SC as separate entities [ 58 ]; two examined the impact of CR [ 38 , 56 ]; and two employed a qualitative methodology but drew findings in relation to bonding and bridging SC, and SC generally [ 51 , 52 ]. Additionally, five papers examined the impact of the following variables: ‘community social cohesion’ [ 36 ], ‘neighbourhood connectedness’ [ 44 ], ‘social support at the community level’ [ 47 ], ‘community connectedness’ [ 43 ] and ‘sense of community’ [ 53 ]. Table  1 provides additional details on this.

How is CR and SC measured or quantified in research?

The measures used to examine CR and SC are presented Table  1 . It is apparent that there is no uniformity in how SC or CR is measured across the research. Multiple measures are used throughout the retained studies, and nearly all are unique. Additionally, SC was examined at multiple different levels (e.g. cognitive and structural, bonding and bridging), and in multiple different forms (e.g. community connectedness, community cohesion).

What is the association between CR and SC on mental wellbeing?

To best compare research, the following section reports on CR, and facets of SC separately. Please see Supplementary file 4  for additional information on retained papers methods of measuring mental wellbeing.

• Community resilience

CR relates to the ability of a community to withstand, adapt and permit growth in adverse circumstances due to social structures, networks and interdependencies within the community [ 11 ].

The impact of CR on mental wellbeing was consistently positive. For example, research indicated that there was a positive association between CR and number of common mental health (i.e. anxiety and mood) treatments post-disaster [ 56 ]. Similarly, other research suggests that CR is positively related to psychological resilience, which is inversely related to depressive symptoms) [ 37 ]. The same research also concluded that CR is protective of psychological resilience and is therefore protective of depressive symptoms [ 37 ].

• Social capital

SC reflects the strength of a social network, community reciprocity, and trust in people and institutions [ 14 ]. These aspects of community are usually conceptualised primarily as protective factors that enable communities to cope and adapt collectively to threats.

There were inconsistencies across research which examined the impact of abstract SC (i.e. not refined into bonding/bridging or structural/cognitive) on mental wellbeing. However, for the majority of cases, research deems SC to be beneficial. For example, research has concluded that, SC is protective against post-traumatic stress disorder [ 55 ], anxiety [ 46 ], psychological distress [ 50 ], and stress [ 46 ]. Additionally, SC has been found to facilitate post-traumatic growth [ 38 ], and also to be useful to be drawn upon in times of stress [ 52 ], both of which could be protective of mental health. Similarly, research has also found that emotional recovery following a disaster is more difficult for those who report to have low levels of SC [ 51 ].

Conversely, however, research has also concluded that when other situational factors (e.g. personal resources) were controlled for, a positive relationship between community resources and life satisfaction was no longer significant [ 60 ]. Furthermore, some research has concluded that a high level of SC can result in a community facing greater stress immediately post disaster. Indeed, one retained paper found that high levels of SC correlate with higher levels of post-traumatic stress immediately following a disaster [ 39 ]. However, in the later stages following a disaster, this relationship can reverse, with SC subsequently providing an aid to recovery [ 41 ]. By way of explanation, some researchers have suggested that communities with stronger SC carry the greatest load in terms of helping others (i.e. family, friends and neighbours) as well as themselves immediately following the disaster, but then as time passes the communities recover at a faster rate as they are able to rely on their social networks for support [ 41 ].

Cognitive and structural social capital

Cognitive SC refers to perceptions of community relations, such as trust, mutual help and attachment, and structural SC refers to what actually happens within the community, such as participation, socialising [ 16 ].

Cognitive SC has been found to be protective [ 49 ] against PTSD [ 54 , 57 ], depression [ 40 , 54 ]) mild mood disorder; [ 48 ]), anxiety [ 48 , 54 ] and increase self-efficacy [ 59 ].

For structural SC, research is again inconsistent. On the one hand, structural SC has been found to: increase perceived self-efficacy, be protective of depression [ 40 ], buffer the impact of housing damage on cognitive decline [ 42 ] and provide support during disasters and over the recovery period [ 59 ]. However, on the other hand, it has been found to have no association with PTSD [ 54 , 57 ] or depression, and is also associated with a higher prevalence of anxiety [ 54 ]. Similarly, it is also suggested by additional research that structural SC can harm women’s mental health, either due to the pressure of expectations to help and support others or feelings of isolation [ 49 ].

Bonding and bridging social capital

Bonding SC refers to connections among individuals who are emotionally close, and result in bonds to a particular group [ 17 ], and bridging SC refers to acquaintances or individuals loosely connected that span different social groups [ 18 ].

One research study concluded that both bonding and bridging SC were protective against post-traumatic stress disorder symptoms [ 58 ]. Bridging capital was deemed to be around twice as effective in buffering against post-traumatic stress disorder than bonding SC [ 58 ].

Other community variables

Community social cohesion was significantly associated with a lower risk of post-traumatic stress disorder symptom development [ 35 ], and this was apparent even whilst controlling for depressive symptoms at baseline and disaster impact variables (e.g. loss of family member or housing damage) [ 36 ]. Similarly, sense of community, community connectedness, social support at the community level and neighbourhood connectedness all provided protective benefits for a range of mental health, wellbeing and recovery variables, including: depression [ 53 ], subjective wellbeing (in older adults only) [ 43 ], psychological distress [ 47 ], happiness [ 44 ] and life satisfaction [ 53 ].

Research has also concluded that community level social support is protective against mild mood and anxiety disorder, but only for individuals who have had no previous disaster experience [ 48 ]. Additionally, a study which separated SC into social cohesion and social participation concluded that at a community level, social cohesion is protective against depression [ 49 ] whereas social participation at community level is associated with an increased risk of depression amongst women [ 49 ].

What is the impact of Infectious disease outbreaks / disasters and emergencies on community resilience?

From a cross-sectional perspective, research has indicated that disasters and emergencies can have a negative effect on certain types of SC. Specifically, cognitive SC has been found to be impacted by disaster impact, whereas structural SC has gone unaffected [ 45 ]. Disaster impact has also been shown to have a negative effect on community relationships more generally [ 52 ].

Additionally, of the eight studies which collected data at multiple time points [ 35 , 36 , 41 , 42 , 47 , 49 , 56 , 60 ], three reported the effect of a disaster on the level of SC within a community [ 40 , 42 , 49 ]. All three of these studies concluded that disasters may have a negative impact on the levels of SC within a community. The first study found that the Deepwater Horizon oil spill had a negative effect on SC and social support, and this in turn explained an overall increase in the levels of depression within the community [ 40 ]. A possible explanation for the negative effect lays in ‘corrosive communities’, known for increased social conflict and reduced social support, that are sometimes created following oil spills [ 40 ]. It is proposed that corrosive communities often emerge due to a loss of natural resources that bring social groups together (e.g., for recreational activities), as well as social disparity (e.g., due to unequal distribution of economic impact) becoming apparent in the community following disaster [ 40 ]. The second study found that SC (in the form of social cohesion, informal socialising and social participation) decreased after the 2011 earthquake and tsunami in Japan; it was suggested that this change correlated with incidence of cognitive decline [ 42 ]. However, the third study reported more mixed effects based on physical circumstances of the communities’ natural environment: Following an earthquake, those who lived in mountainous areas with an initial high level of pre-community SC saw a decrease in SC post disaster [ 49 ]. However, communities in flat areas (which were home to younger residents and had a higher population density) saw an increase in SC [ 49 ]. It was proposed that this difference could be due to the need for those who lived in mountainous areas to seek prolonged refuge due to subsequent landslides [ 49 ].

What types of intervention enhance CR and SC and protect survivors?

There were mixed effects across the 26 retained papers when examining the effect of CR and SC on mental wellbeing. However, there is evidence that an increase in SC [ 56 , 57 ], with a focus on cognitive SC [ 57 ], namely by: building social networks [ 45 , 51 , 53 ], enhancing feelings of social cohesion [ 35 , 36 ] and promoting a sense of community [ 53 ], can result in an increase in CR and potentially protect survivors’ wellbeing and mental health following a disaster. An increase in SC may also aid in decreasing the need for individual psychological interventions in the aftermath of a disaster [ 55 ]. As a result, recommendations and suggested methods to bolster CR and SC from the retained papers have been extracted and separated into general methods, preparedness and policy level implementation.

General methods

Suggested methods to build SC included organising recreational activity-based groups [ 44 ] to broaden [ 51 , 53 ] and preserve current social networks [ 42 ], introducing initiatives to increase social cohesion and trust [ 51 ], and volunteering to increase the number of social ties between residents [ 59 ]. Research also notes that it is important to take a ‘no one left behind approach’ when organising recreational and social community events, as failure to do so could induce feelings of isolation for some members of the community [ 49 ]. Furthermore, gender differences should also be considered as research indicates that males and females may react differently to community level SC (as evidence suggests males are instead more impacted by individual level SC; in comparison to women who have larger and more diverse social networks [ 49 ]). Therefore, interventions which aim to raise community level social participation, with the aim of expanding social connections and gaining support, may be beneficial [ 42 , 47 ].

Preparedness

In order to prepare for disasters, it may be beneficial to introduce community-targeted methods or interventions to increase levels of SC and CR as these may aid in ameliorating the consequences of a public health emergency or disaster [ 57 ]. To indicate which communities have low levels of SC, one study suggests implementing a 3-item scale of social cohesion to map areas and target interventions [ 42 ].

It is important to consider that communities with a high level of SC may have a lower level of risk perception, due to the established connections and supportive network they have with those around them [ 61 ]. However, for the purpose of preparedness, this is not ideal as perception of risk is a key factor when seeking to encourage behavioural adherence. This could be overcome by introducing communication strategies which emphasise the necessity of social support, but also highlights the need for additional measures to reduce residual risk [ 59 ]. Furthermore, support in the form of financial assistance to foster current community initiatives may prove beneficial to rural areas, for example through the use of an asset-based community development framework [ 52 ].

Policy level

At a policy level, the included papers suggest a range of ways that CR and SC could be bolstered and used. These include: providing financial support for community initiatives and collective coping strategies, (e.g. using asset-based community development [ 52 ]); ensuring policies for long-term recovery focus on community sustainable development (e.g. community festival and community centre activities) [ 44 ]; and development of a network amongst cooperative corporations formed for reconstruction and to organise self-help recovery sessions among residents of adjacent areas [ 58 ].

This scoping review sought to synthesise literature concerning the role of SC and CR during public health emergencies and disasters. Specifically, in this review we have examined: the methods used to measure CR and SC; the impact of CR and SC on mental wellbeing during disasters and emergencies; the impact of disasters and emergencies on CR and SC; and the types of interventions which can be used to enhance CR. To do this, data was extracted from 26 peer-reviewed journal articles. From this synthesis, several key themes have been identified, which can be used to develop guidelines and recommendations for deploying CR and SC in a public health emergency or disaster context. These key themes and resulting recommendations are summarised below.

Firstly, this review established that there is no consistent or standardised approach to measuring CR or SC within the general population. This finding is consistent with a review conducted by the World Health Organization which concludes that despite there being a number of frameworks that contain indicators across different determinants of health, there is a lack of consensus on priority areas for measurement and no widely accepted indicator [ 27 ]. As a result, there are many measures of CR and SC apparent within the literature (e.g., [ 62 , 63 ]), an example of a developed and validated measure is provided by Sherrieb, Norris and Galea [ 64 ]. Similarly, the definitions of CR and SC differ widely between researchers, which created a barrier to comparing and summarising information. Therefore, future research could seek to compare various interpretations of CR and to identify any overlapping concepts. However, a previous systemic review conducted by Patel et al. (2017) concludes that there are nine core elements of CR (local knowledge, community networks and relationships, communication, health, governance and leadership, resources, economic investment, preparedness, and mental outlook), with 19 further sub-elements therein [ 30 ]. Therefore, as CR is a multi-dimensional construct, the implications from the findings are that multiple aspects of social infrastructure may need to be considered.

Secondly, our synthesis of research concerning the role of CR and SC for ensuring mental health and wellbeing during, or following, a public health emergency or disaster revealed mixed effects. Much of the research indicates either a generally protective effect on mental health and wellbeing, or no effect; however, the literature demonstrates some potential for a high level of CR/SC to backfire and result in a negative effect for populations during, or following, a public health emergency or disaster. Considered together, our synthesis indicates that cognitive SC is the only facet of SC which was perceived as universally protective across all retained papers. This is consistent with a systematic review which also concludes that: (a) community level cognitive SC is associated with a lower risk of common mental disorders, while; (b) community level structural SC had inconsistent effects [ 65 ].

Further examination of additional data extracted from studies which found that CR/SC had a negative effect on mental health and wellbeing revealed no commonalities that might explain these effects (Please see Supplementary file 5 for additional information)

One potential explanation may come from a retained paper which found that high levels of SC result in an increase in stress level immediately post disaster [ 41 ]. This was suggested to be due to individuals having greater burdens due to wishing to help and support their wide networks as well as themselves. However, as time passes the levels of SC allow the community to come together and recover at a faster rate [ 41 ]. As this was the only retained paper which produced this finding, it would be beneficial for future research to examine boundary conditions for the positive effects of CR/SC; that is, to explore circumstances under which CR/SC may be more likely to put communities at greater risk. This further research should also include additional longitudinal research to validate the conclusions drawn by [ 41 ] as resilience is a dynamic process of adaption.

Thirdly, disasters and emergencies were generally found to have a negative effect on levels of SC. One retained paper found a mixed effect of SC in relation to an earthquake, however this paper separated participants by area in which they lived (i.e., mountainous vs. flat), which explains this inconsistent effect [ 49 ]. Dangerous areas (i.e. mountainous) saw a decrease in community SC in comparison to safer areas following the earthquake (an effect the authors attributed to the need to seek prolonged refuge), whereas participants from the safer areas (which are home to younger residents with a higher population density) saw an increase in SC [ 49 ]. This is consistent with the idea that being able to participate socially is a key element of SC [ 12 ]. Overall, however, this was the only retained paper which produced a variable finding in relation to the effect of disaster on levels of CR/SC.

Finally, research identified through our synthesis promotes the idea of bolstering SC (particularly cognitive SC) and cohesion in communities likely to be affected by disaster to improve levels of CR. This finding provides further understanding of the relationship between CR and SC; an association that has been reported in various articles seeking to provide conceptual frameworks (e.g., [ 66 , 67 ]) as well as indicator/measurement frameworks [ 27 ]. Therefore, this could be done by creating and promoting initiatives which foster SC and create bonds within the community. Papers included in the current review suggest that recreational-based activity groups and volunteering are potential methods for fostering SC and creating community bonds [ 44 , 51 , 59 ]. Similarly, further research demonstrates that feelings of social cohesion are enhanced by general social activities (e.g. fairs and parades [ 18 ]). Also, actively encouraging activities, programs and interventions which enhance connectedness and SC have been reported to be desirable to increase CR [ 68 ]. This suggestion is supported by a recent scoping review of literature [ 67 ] examined community champion approaches for the COVID-19 pandemic response and recovery and established that creating and promoting SC focused initiatives within the community during pandemic response is highly beneficial [ 67 ]. In terms of preparedness, research states that it may be beneficial for levels of SC and CR in communities at risk to be assessed, to allow targeted interventions where the population may be at most risk following an incident [ 42 , 44 ]. Additionally, from a more critical perspective, we acknowledge that ‘resilience’ can often be perceived as a focus on individual capacity to adapt to adversity rather than changing or mitigating the causes of adverse conditions [ 69 , 70 ]. Therefore, CR requires an integrated system approach across individual, community and structural levels [ 17 ]. Also, it is important that community members are engaged in defining and agreeing how community resilience is measured [ 27 ] rather than it being imposed by system leads or decision-makers.

In the aftermath of the pandemic, is it expected that there will be long-term repercussions both from an economic [ 8 ] and a mental health perspective [ 71 ]. Furthermore, the findings from this review suggest that although those in areas with high levels of SC may be negatively affected in the acute stage, as time passes, they have potential to rebound at a faster rate than those with lower levels of SC. Ongoing evaluation of the effectiveness of current initiatives as the COVID-19 pandemic progresses into a recovery phase will be invaluable for supplementing the evidence base identified through this review.

• Recommendations

As a result of this review, a number of recommendations are suggested for policy and practice during public health emergencies and recovery.

Future research should seek to establish a standardised and validated approach to measuring and defining CR and SC within communities. There are ongoing efforts in this area, for example [ 72 ]. Additionally, community members should be involved in the process of defining how CR is measured.

There should be an enhanced effort to improve preparedness for public health emergencies and disasters in local communities by gauging current levels of SC and CR within communities using a standardised measure. This approach could support specific targeting of populations with low levels of CR/SC in case of a disaster or public health emergency, whilst also allowing for consideration of support for those with high levels of CR (as these populations can be heavily impacted initially following a disaster). By distinguishing levels of SC and CR, tailored community-centred approaches could be implemented, such as those listed in a guide released by PHE in 2015 [ 73 ].

CR and SC (specifically cognitive SC) should be bolstered if communities are at risk of experiencing a disaster or public health emergency. This can be achieved by using interventions which aim to increase a sense of community and create new social ties (e.g., recreational group activities, volunteering). Additionally, when aiming to achieve this, it is important to be mindful of the risk of increased levels of CR/SC to backfire, as well as seeking to advocate an integrated system approach across individual, community and structural levels.

It is necessary to be aware that although communities with high existing levels of resilience / SC may experience short-term negative consequences following a disaster, over time these communities might be able to recover at a faster rate. It is therefore important to ensure that suitable short-term support is provided to these communities in the immediate aftermath of a public health emergency or disaster.

Robust evaluation of the community resilience initiatives deployed during the COVID-19 pandemic response is essential to inform the evidence base concerning the effectiveness of CR/ SC. These evaluations should continue through the response phase and into the recovery phase to help develop our understanding of the long-term consequences of such interventions.

Limitations

Despite this review being the first in this specific topic area, there are limitations that must be considered. Firstly, it is necessary to note that communities are generally highly diverse and the term ‘community’ in academic literature is a subject of much debate (see: [ 74 ]), therefore this must be considered when comparing and collating research involving communities. Additionally, the measures of CR and SC differ substantially across research, including across the 26 retained papers used in the current review. This makes the act of comparing and collating research findings very difficult. This issue is highlighted as a key outcome from this review, and suggestions for how to overcome this in future research are provided. Additionally, we acknowledge that there will be a relationship between CR & SC even where studies measure only at individual or community level. A review [ 75 ] on articulating a hypothesis of the link to health inequalities suggests that wider structural determinants of health need to be accounted for. Secondly, despite the final search strategy encompassing terms for both CR and SC, only one retained paper directly measured CR; thus, making the research findings more relevant to SC. Future research could seek to focus on CR to allow for a comparison of findings. Thirdly, the review was conducted early in the COVID-19 pandemic and so does not include more recent publications focusing on resilience specifically in the context of COVID-19. Regardless of this fact, the synthesis of, and recommendations drawn from, the reviewed studies are agnostic to time and specific incident and contain critical elements necessary to address as the pandemic moves from response to recovery. Further research should review the effectiveness of specific interventions during the COVID-19 pandemic for collation in a subsequent update to this current paper. Fourthly, the current review synthesises findings from countries with individualistic and collectivistic cultures, which may account for some variation in the findings. Lastly, despite choosing a scoping review method for ease of synthesising a wide literature base for use by public health emergency researchers in a relatively tight timeframe, there are disadvantages of a scoping review approach to consider: (1) quality appraisal of retained studies was not carried out; (2) due to the broad nature of a scoping review, more refined and targeted reviews of literature (e.g., systematic reviews) may be able to provide more detailed research outcomes. Therefore, future research should seek to use alternative methods (e.g., empirical research, systematic reviews of literature) to add to the evidence base on CR and SC impact and use in public health practice.

This review sought to establish: (1) How CR and SC are quantified in research?; (2) The impact of community resilience on mental wellbeing?; (3) The impact of infectious disease outbreaks, disasters and emergencies on community resilience and social capital?; and, (4) What types of interventions enhance community resilience and social capital?. The chosen search strategy yielded 26 relevant papers from which we were able extract information relating to the aims of this review.

Results from the review revealed that CR and SC are not measured consistently across research. The impact of CR / SC on mental health and wellbeing during emergencies and disasters is mixed (with some potential for backlash), however the literature does identify cognitive SC as particularly protective. Although only a small number of papers compared CR or SC before and after a disaster, the findings were relatively consistent: SC or CR is negatively impacted by a disaster. Methods suggested to bolster SC in communities were centred around social activities, such as recreational group activities and volunteering. Recommendations for both research and practice (with a particular focus on the ongoing COVID-19 pandemic) are also presented.

Availability of data and materials

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

Abbreviations

Social Capital

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This study was supported by the National Institute for Health Research Research Unit (NIHR HPRU) in Emergency Preparedness and Response, a partnership between Public Health England, King’s College London and the University of East Anglia. The views expressed are those of the author(s) and not necessarily those of the NIHR, Public Health England, the UK Health Security Agency or the Department of Health and Social Care [Grant number: NIHR20008900]. Part of this work has been funded by the Office for Health Improvement and Disparities, Department of Health and Social Care, as part of a Collaborative Agreement with Leeds Beckett University.

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DW, JSo and JSt had the main idea for the review. The search strategy and eligibility criteria were devised by CH, DW, JSo and JSt. CH conducted the database searches. CH and DW conducted duplicate, title and abstract and full text screening in accordance with inclusion criteria. CH conducted data extraction, CH and DW carried out the analysis and drafted the initial manuscript. All authors provided critical revision of intellectual content. All authors approved the final manuscript.

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Hall, C.E., Wehling, H., Stansfield, J. et al. Examining the role of community resilience and social capital on mental health in public health emergency and disaster response: a scoping review. BMC Public Health 23 , 2482 (2023). https://doi.org/10.1186/s12889-023-17242-x

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The COVID-19 pandemic and OBGYN residency training: We have a problem and it’s not just masks

• Alexandria C. Kraus 1 ,
• Anthony Bui 2 ,
• Kimberly Malloy 1 ,
• Jessica Morse 3 &
• Omar M. Young 1  

BMC Medical Education volume  24 , Article number:  377 ( 2024 ) Cite this article

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The COVID-19 pandemic has left no one untouched. Resident trainees have been driven to reconsider virtually every component of their daily lives. The purpose of this pilot study is to evaluate the impact of the COVID-19 pandemic on Obstetrics and Gynecology (OBGYN) residency training and education.

A cross-sectional pilot study was conducted between 2/2022 and 5/2022. A survey was created and distributed to OBGYN residents. The survey queried the effects of the pandemic on OBGYN residents’ procedure skills training and mental health.

A total of 95 OBGYN residents across programs affiliated with each American College of Obstetricians and Gynecologists (ACOG) district participated in the survey. Among them, just over half ( n  = 52, 55%) self-identified as under-represented minorities. A significant majority, 80% ( n  = 81), felt their gynecological training was inadequate, with 70% of fourth-year residents expressing a lack of confidence in their ability to independently practice gynecology after graduation. This lack of confidence among fourth-year residents suggests a notable disparity in readiness for independent gynecological practice, linked to meeting ACGME requirements before completing their residency ( p  = 0.013). Among the residents who reported a negative impact of the pandemic on their mental health ( n  = 76, 80%), about 40% ( n  = 31) had contemplated self-harm or knew a colleague who considered or attempted suicide ( p  < 0.001). This issue was especially pronounced in residents experiencing burnout ( n  = 44, 46%), as nearly half ( n  = 19, 43%) reported suicidal thoughts or knew someone in their program who had such thoughts or engaged in self-harm ( p  = 0.048).

Conclusions

Residents expressed concerns about reduced hands-on gynecological training and doubts about their readiness for independent practice post-residency, highlighting the need for enhanced support through mentorship and revised training curriculums. Additionally, despite the availability of mental health resources to address pandemic-induced burnout, their underuse suggests a need for more accessible time for residents to use at their discretion and flexible training schedules that encourage mental health support resource utilization.

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Introduction

The disease known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first described in China in December of 2019 [ 1 ], and in March of 2020, the World Health Organization (WHO) declared the SARS-CoV-2 (i.e., COVID-19) outbreak a pandemic [ 2 ]. The disease has left no one untouched. The healthcare industry specifically has been overwhelmed by the effect of COVID-19 on resources with providers driven to reconsider virtually every component of their daily lives and practice. To sustain adequate hospital resources, elective surgical procedures were cancelled, and clinical volumes were dramatically reduced. Telemedicine was utilized to provide a significant portion of outpatient healthcare and inpatient care teams were condensed.

Resident schedules, in particular, were modified to provide a workforce where necessary and educational curricula transitioned toward virtual platforms in attempts to avoid exposures and to enforce social distancing [ 3 ]. While virtual solutions were implemented to counteract missed in-person pedagogic didactics and conferences, there were no immediate substitutes for the significant reduction of hands-on clinical and surgical experiences during this period. Additionally, visitor restrictions impacted the development of resident communication skills and emotional intelligence. Infected residents often required long absences, which resulted in re-assignments of remaining residents and trickle-down effects on overall residency training and education. Nonetheless, limited studies have been published on the impact of COVID-19 on residency training [ 4 , 5 , 6 ], and specifically, in the field obstetrics and gynecology (OBGYN) training [ 7 , 8 , 9 , 10 ]. Therefore, the purpose of this pilot study is to examine the impact of the COVID-19 pandemic on OBGYN residency training and education.

A nationwide, cross-sectional pilot study was conducted between February 2022 and May 2022. An anonymous survey was created using Qualtrics XM, (an online, secure survey platform), and OBGYN residents across the United States were invited to participate. The survey was preceded by a statement (1) explaining the purpose of the survey, (2) clarifying that the data would be de-identified before analysis and (3) delineating that program leadership would not have access to the responses. There were no incentives to participate. The study was reviewed and determined to be exempt by the Institutional Review Board (IRB #22–0136). A link to the survey was e-mailed to OBGYN program directors and program managers with a request that it be forwarded to all the residents in their program. The emails of the program directors and program managers were obtained from the Association of Professors of Gynecology and Obstetrics (APGO) website [ 11 ]. Reminder emails to encourage participation were distributed every four weeks for a period of three months. Recruitment posts were placed on social media as well. Responses were captured anonymously to maintain confidentiality.

All OBGYN residents in the United States were eligible to participate [ 12 ]; however, it is unclear how many residents received access to the survey, as there was limited verification from residency program leadership confirming distribution. In addition, multiple emails to both program directors and program managers were returned as invalid, further suggesting that many residency programs did not receive access to the survey at all. As such, it is difficult to report an accurate response rate.

The 28-question survey was developed after a comprehensive examination of the contemporary literature and following a review by local content experts to improve overall quality as well as to ensure content validity among assessed domains. Attention was paid to the Accreditation Council for Graduate Medical Education (ACGME) core competencies [ 13 ], and in particular, patient care, procedure skills, and medical knowledge, when devising and organizing the survey questions. We were also acutely aware of the potential impact of the pandemic on personal attitudes and a portion of the survey was dedicated to inquiring about resident well-being and burnout.

Demographic and program information was collected and included the following: clinical postgraduate year (PGY), age, race/ethnicity, gender, and residency program location (based on The American College of Obstetricians and Gynecologist (ACOG) District). With respect to patient care and procedural skills, the survey specifically queried residents about modifications to their schedules, duty hours, operative volume (major and minor surgical procedures), clinical duties, and availability and use of personal protective equipment (PPE). Residents were also asked if these changes affected their graduation requirements and overall preparedness for their postgraduate careers. When considering the impact of COVID-19 on residents’ medical knowledge, we asked about changes to educational curricula and their impact on rotation evaluations and CREOG scores. Finally, we attempted to determine the psychological effect of the pandemic on resident well-being and asked about resources provided by residency programs to combat potential burnout. The full survey is available for review in Appendix 1.

Descriptive analysis was used to summarize the data. Statistical analysis was performed using χ 2 test or Fisher’s exact test as appropriate for categorical data and Wilcoxon rank sum test for continuous data. P values of < 0.05 were considered significant. All analyses were performed using multiprocessor Stata 17.0 (StataCorp LP, College Station, Texas).

One hundred thirty-five OBGYN residents initiated the survey; however, only 95 residents completed the survey in its entirety. All respondents were vaccinated and trained at programs representing each ACOG District. The respondent demographics are detailed in Table  1 . The majority of participants ( n  = 61, 64.2%) were senior OBGYN residents (i.e., PGY3 or PGY4). Eighteen (18.9%) residents self-identified as PGY1s and 16 (16.8%) as PGY2s. Most were between 25 and 34 years of age ( n  = 88, 92.6%) and more than half of the residents ( n  = 52, 54.7%) self-identified as under-represented minorities (i.e., Black or LatinX). Thirty-two (33.7%) residents had been personally infected by COVID-19, and 38 (40%) had immediate household contacts who contracted COVID-19.

Eighty-two (86.3%) residents felt that their residency training had been adversely affected by COVID-19, and 70 (73.7%) had an interruption in their regularly scheduled residency training; however, over 75% ( n  = 76) of resident participants believed that their CREOG scores and rotational evaluations were unchanged during the pandemic. With respect to their procedural training, most residents ( n  = 75, 78.9%) did not think their obstetrical training had been deleteriously affected, while over 80% ( n  = 81) of residents felt that their gynecological training had suffered. Moreover, over half ( n  = 55, 57.9%) of respondents trained at institutions where restrictions were placed on gynecological procedures for greater than eight weeks. The approximate numbers of gynecological procedures performed by residents by clinical postgraduate year are illustrated in Table  2 . OBGYN minimum numbers (which represent what the ACGME Review Committee [ 14 ] believes to be an acceptable minimal experience for OBGYN residents) are listed as well for reference. Of note, self-reported obstetrical numbers by clinical postgraduate year are described in Supplemental Table 1 for additional review.

As expected, there were significant differences in approximate gynecological numbers by clinical postgraduate year, with increasing numbers from PGY1 to PGY4 ( p  < 0.001). Notably, the median procedure numbers among 4th-year residents were all above the minimum ACGME requirements; however, the lower quartile of self-reported gynecological numbers for vaginal hysterectomies (15 (10.75–16.75)) and incontinence and pelvic floor procedures (25.5 (20.5–30)) were below the minimum ACGME requirements, indicating that the lower quartile of PGY4 respondents were likely not meeting these gynecological procedure minimums.

When asked about reaching their ACGME minimums, over a third ( n  = 40, 42.1%) of respondents were unsure if they would be able to achieve these minimum requirements by graduation. Moreover, almost 65% ( n  = 60) of residents stated that they were not confident they could practice gynecology independently upon graduation. In contrast, approximately 87% ( n  = 83) of OBGYN respondents believed they were poised to practice obstetrics autonomously following residency.

Responses from 4th-year residents to these survey questions are specifically examined in Table  3 . When analyzing the responses of those PGY4 respondents who were worried they would not reach their ACGME minimums by graduation, a significant proportion of residents were not confident in their ability to practice gynecology independently following graduation. Namely, of the 27 4th-year OBGYN respondents, seven (26%) were not certain they would attain their ACGME minimums, and of those seven, over 70% ( n  = 5) did not feel prepared for autonomous practice of gynecology following graduation. Of those PGY4 residents who thought they would attain their ACGME minimums ( n  = 20, 74%), approximately 80% ( n  = 4) felt assured about their self-directed performance of gynecologic procedures after residency. These findings illustrate that there is a significant difference in the proportion of 4th-year residents ready for independent practice in gynecology depending on their ability to meet their ACGME requirements by graduation from residency ( p  = 0.013). This difference did not persist when investigating respondents’ confidence in independent post-graduation obstetrics practice and meeting ACGME minimum requirements ( p  = 0.756).

A significant portion of the survey attempted to determine the psychological effect of the pandemic on resident well-being. When asked about the use of personal protective equipment (PPE) when caring for patients infected with COVID-19, 20% ( n  = 15) of residents reported they did not have access to adequate PPE. Forty-five (47.3%) respondents reported violating the 80-hour per week duty requirement, and 15 residents (15.8%) reported having less than four days off per month on average during the pandemic. Over 45% ( n  = 44) of OBGYN residents conveyed that the pandemic interfered with their ability to perform at work, and 80% ( n  = 76) stated that COVID-19 had adversely influenced their mental health. Notably, 31 (32.6%) participants maintained that they had, or knew another OBGYN resident that had suicidal thoughts or had attempted self-harm or suicide.

Additional questions inquired about the support provided by residency programs and institutions to combat burnout. Over 70% of residents ( n  = 67) considered their residency leadership supportive of their wellness and education during the pandemic. Moreover, 80 (84.2%) OBGYN respondents stated that their institution had mentalhealth resources available; however, only 28 (29.4%) of residents utilized such resources.

The data on residents’ perceptions of the pandemic’s impact on mental health and their ability to perform at work (a measure used to indicate burnout) is correlated with their views on residency support, suicidal thoughts, access to wellness resources, and utilization of mental health services, as presented in Table  4 . Of those residents ( n  = 76) who communicated the negative influence of the epidemic on their mental health, approximately 40% ( n  = 31) had thoughts of or knew a fellow OBGYN resident who had had thoughts of self-harm, or even potentially attempted suicide ( p  < 0.001). This significant finding persisted among those residents who suffered from burnout ( n  = 44) as almost half ( n  = 19, 43.2%) of those residents reported suicidal thoughts or actions either themselves or among those within their residency program ( p  = 0.048). In contrast, of those residents who affirmed that their mental health was unaffected by the pandemic ( n  = 18), none communicated suicidal thoughts or attempted self-harm.

Our data demonstrates that COVID-19 has had a grave academic and psychologic impact on OBGYN residents across the country. Procedural training in gynecology was particularly impacted. Over 80% residents reported that their gynecological training had suffered and over half of respondents trained at institutions where restrictions were placed on gynecological procedures for greater than eight weeks. When asked about attaining their ACGME minimums, over a third of residents were unsure if they would be able to achieve these requirements in gynecology by graduation, and approximately two-thirds of respondents stated that they were not confident that they would be able practice gynecology independently following graduation from residency. When concentrating on graduating (i.e., 4th-year) resident responses, there was a significant difference in the proportion of residents reporting readiness for intendent practice in gynecology depending on their ability to meet their ACGME requirements by graduation from residency.

Resident mentalhealth was also negatively altered by the pandemic. Nearly half of OBGYN residents reported that the pandemic interfered with their ability to perform at work. While over two-thirds of residents stated that their institution had mentalhealth resources available, less than a third of residents utilized such resources. Most notably, almost a third of residents maintained that they had, or knew another OBGYN resident that had, suicidal thoughts or had attempted self-harm or suicide– emphasizing the profound psychological effect of the pandemic.

Our pilot study contributes to the emerging body of research on the effects of the COVID-19 pandemic on OBGYN residents [ 8 , 9 , 10 ]. It corroborates findings from Europe, where OBGYN residents experienced reduced surgical training and teaching, leading to concerns about the quality of patient care [ 15 ]. Work by Harzif et al., also complements this by examining the psychological impact (i.e., anxiety, depression, and psychological trauma) of the pandemic on Indonesian OBGYN residents [ 16 ]. Additionally, a cross-sectional survey by Winkle et al., delved into if residents’ self-reported experiences of burnout and other issues, such as depression, binge drinking, and drug use, vary according to their personal activities, including hobbies [ 17 ]. Further research suggested that resident-led wellness initiatives, like providing discretionary time and promoting social events, were the highest rated in supporting resident wellness [ 18 ]. Akin to our study findings, Wadell et al., found residents worried about the pandemic’s detrimental effects on their training, particularly among senior residents [ 19 ]. This anxiety is intensified by a national decrease in gynecologic surgeries and fellowship directors’ reports of new fellows’ unpreparedness for independent surgical practice [ 20 , 21 ].

Our pilot study has several strengths and is the first of its kind to examine the impact of COVID-19 on OBGYN trainees in the United States. Our survey was conducted nationally with representation from respondents training at centers in each of the ACOG districts at a time when the direct effects of the pandemic on training were either ongoing or still very fresh in respondents’ memories, minimizing the impact of recall bias. Furthermore, while small, more than half of the residents self-identified as underfrepresented minorities, indicative of a diverse respondent population. The findings in our pilot study are suggestive of associations that should be replicated in larger samples.

Nonetheless, our pilot study has limitations, namely our low overall response rate and potential for selection bias. It is unclear how many residents received access to the survey, as there was limited verification from residency program leadership confirming distribution. Significant differences between responders and non-responders could have been overlooked. Our use of a volunteer population may not be representative of the general OBGYN resident population, and it is possible that those residents who felt more strongly about their experiences were more likely to respond. Our pilot study was also not longitudinal and cannot be translated to assess long-term effects.

The COVID-19 pandemic has left virtually no one unharmed. Resident trainees, in particular, have been forced to reexamine their daily lives and practice. OBGYN residents in the United States reported concerns about their abilities for autonomous gynecological practice upon completion of residency, lending us the opportunity to provide increased support to new graduates through both formal and informal mentorship. Other potential solutions include both institutional and national working groups on gynecological procedural minimums and considerations of more flexible curriculums such as tracking. Efforts could also be made to develop surgical simulation training programs so trainees can maximize their surgical learning in the operating room. Respondents also conveyed that the pandemic deleteriously affected their mentalhealth, and while support was provided by their residency programs with resources available at their institutions to combat burnout, few residents utilized such resources. A promising solution includes the broader adoption of institution-based wellness programs and increased flexibility and time-off within clinical training to make use of institutional resources. Further large-scale investigations verifying these findings are critical.

Data availability

Data and materials can be obtained from the corresponding author upon reasonable request.

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Kraus, A.C., Bui, A., Malloy, K. et al. The COVID-19 pandemic and OBGYN residency training: We have a problem and it’s not just masks. BMC Med Educ 24 , 377 (2024). https://doi.org/10.1186/s12909-024-05364-8

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Impact of aerosol concentration changes on carbon sequestration potential of rice in a temperate monsoon climate zone during the COVID-19: a case study on the Sanjiang Plain, China

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• Xiaokang Zuo 1 &
• Hanxi Wang   ORCID: orcid.org/0000-0003-4130-6981 1 , 2  

The emission reduction of atmospheric pollutants during the COVID-19 caused the change in aerosol concentration. However, there is a lack of research on the impact of changes in aerosol concentration on carbon sequestration potential. To reveal the impact mechanism of aerosols on rice carbon sequestration, the spatial differentiation characteristics of aerosol optical depth (AOD), gross primary productivity (GPP), net primary productivity (NPP), leaf area index (LAI), fraction of absorbed photosynthetically active radiation (FPAR), and meteorological factors were compared in the Sanjiang Plain. Pearson correlation analysis and geographic detector were used to analyze the main driving factors affecting the spatial heterogeneity of GPP and NPP. The study showed that the spatial distribution pattern of AOD in the rice-growing area during the epidemic was gradually decreasing from northeast to southwest with an overall decrease of 29.76%. Under the synergistic effect of multiple driving factors, both GPP and NPP increased by more than 5.0%, and the carbon sequestration capacity was improved. LAI and FPAR were the main driving factors for the spatial differentiation of rice GPP and NPP during the epidemic, followed by potential evapotranspiration and AOD. All interaction detection results showed a double-factor enhancement, which indicated that the effects of atmospheric environmental changes on rice primary productivity were the synergistic effect result of multiple factors, and AOD was the key factor that indirectly affected rice primary productivity. The synergistic effects between aerosol-radiation-meteorological factor-rice primary productivity in a typical temperate monsoon climate zone suitable for rice growth were studied, and the effects of changes in aerosol concentration on carbon sequestration potential were analyzed. The study can provide important references for the assessment of carbon sequestration potential in this climate zone.

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This research was funded by the High-level Talent Foundation Project of Harbin Normal University (No. 1305123005).

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Zuo, X., Wang, H. Impact of aerosol concentration changes on carbon sequestration potential of rice in a temperate monsoon climate zone during the COVID-19: a case study on the Sanjiang Plain, China. Environ Sci Pollut Res (2024). https://doi.org/10.1007/s11356-024-33149-5

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Editor in Chief's Introduction to Essays on the Impact of COVID-19 on Work and Workers

On March 11, 2020, the World Health Organization declared that COVID-19 was a global pandemic, indicating significant global spread of an infectious disease ( World Health Organization, 2020 ). At that point, there were 118,000 confirmed cases of the coronavirus in 110 countries. China had been the first country with a widespread outbreak in January, and South Korea, Iran and Italy following in February with their own outbreaks. Soon, the virus was in all continents and over 177 countries, and as of this writing, the United States has the highest number of confirmed cases and, sadly, the most deaths. The virus was extremely contagious and led to death in the most vulnerable, particularly those older than 60 and those with underlying conditions. The most critical cases led to an overwhelming number being admitted into the intensive care units of hospitals, leading to a concern that the virus would overwhelm local health care systems. Today, in early May 2020, there have been nearly 250,000 deaths worldwide, with over 3,500,000 confirmed cases ( Hopkins, 2020 ). The human toll is staggering, and experts are predicting a second wave in summer or fall.

As the deaths rose from the virus that had no known treatment or vaccine countries shut their borders, banned travel to other countries and began to issue orders for their citizens to stay at home, with no gatherings of more than 10 individuals. Schools and universities closed their physical locations and moved education online. Sporting events were canceled, airlines cut flights, tourism evaporated, restaurants, movie theaters and bars closed, theater productions canceled, manufacturing facilities, services, and retail stores closed. In some businesses and industries, employees have been able to work remotely from home, but in others, workers have been laid off, furloughed, or had their hours cut. The International Labor Organization (ILO) estimates that there was a 4.5% reduction in hours in the first quarter of 2020, and 10.5% reduction is expected in the second quarter ( ILO, 2020a ). The latter is equivalent to 305 million jobs ( ILO, 2020a ).

Globally, over 430 million enterprises are at risk of disruption, with about half of those in the wholesale and retail trades ( ILO, 2020a ). Much focus in the press has been on the impact in Europe and North America, but the effect on developing countries is even more critical. An example of the latter is the Bangladeshi ready-made-garment sector ( Leitheiser et al., 2020 ), a global industry that depends on a supply chain of raw material from a few countries and produces those garments for retail stores throughout North America and Europe. But, in January 2020, raw material from China was delayed by the shutdown in China, creating delays and work stoppages in Bangladesh. By the time Bangladeshi factories had the material to make garments, in March, retailers in Europe and North American began to cancel orders or put them on hold, canceling or delaying payment. Factories shut down and workers were laid off without pay. Nearly a million people lost their jobs. Overall, since February 2020, the factories in Bangladesh have lost nearly 3 billion dollars in revenue. And, the retail stores that would have sold the garments have also closed. This demonstrates the ripple effect of the disruption of one industry that affects multiple countries and sets of workers, because consider that, in turn, there will be less raw material needed from China, and fewer workers needed there. One need only multiply this example by hundreds to consider the global impact of COVID-19 across the world of work.

The ILO (2020b) notes that it is difficult to collect employment statistics from different countries, so a total global unemployment rate is unavailable at this time. However, they predict significant increase in unemployment, and the number of individuals filing for unemployment benefits in the United States may be an indicator of the magnitude of those unemployed. In the United States, over 30 million filed for unemployment between March 11 and April 30 ( Bureau of Labor Statistics, 2020 ), effectively this is an unemployment rate of 18%. By contrast, in February 2020, the US unemployment rate was 3.5% ( Bureau of Labor Statistics, 2020 ).

Clearly, COVID-19 has had an enormous disruption on work and workers, most critically for those who have lost their employment. But, even for those continuing to work, there have been disruptions in where people work, with whom they work, what they do, and how much they earn. And, as of this writing, it is also a time of great uncertainty, as countries are slowly trying to ease restrictions to allow people to go back to work--- in a “new normal”, without the ability to predict if they can prevent further infectious “spikes”. The anxieties about not knowing what is coming, when it will end, or what work will entail led us to develop this set of essays about future research on COVID-19 and its impact on work and workers.

These essays began with an idea by Associate Editor Jos Akkermans, who noted to me that the global pandemic was creating a set of career shocks for workers. He suggested writing an essay for the Journal . The Journal of Vocational Behavior has not traditionally published essays, but these are such unusual times, and COVID-19 is so relevant to our collective research on work that I thought it was a good idea. I issued an invitation to the Associate Editors to submit a brief (3000 word) essay on the implications of COVID-19 on work and/or workers with an emphasis on research in the area. At the same time, a group of international scholars was coming together to consider the effects of COVID-19 on unemployment in several countries, and I invited that group to contribute an essay, as well ( Blustein et al., 2020 ).

The following are a set of nine thoughtful set of papers on how the COVID-19 could (and perhaps will) affect vocational behavior; they all provide suggestions for future research. Akkermans, Richardson, and Kraimer (2020) explore how the pandemic may be a career shock for many, but also how that may not necessarily be a negative experience. Blustein et al. (2020) focus on global unemployment, also acknowledging the privileged status they have as professors studying these phenomena. Cho examines the effect of the pandemic on micro-boundaries (across domains) as well as across national (macro) boundaries ( Cho, 2020 ). Guan, Deng, and Zhou (2020) drawing from cultural psychology, discuss how cultural orientations shape an individual's response to COVID-19, but also how a national cultural perspective influences collective actions. Kantamneni (2020) emphasized the effects on marginalized populations in the United States, as well as the very real effects of racism for Asians and Asian-Americans in the US. Kramer and Kramer (2020) discuss the impact of the pandemic in the perceptions of various occupations, whether perceptions of “good” and “bad” jobs will change and whether working remotely will permanently change where people will want to work. Restubog, Ocampo, and Wang (2020) also focused on individual's responses to the global crisis, concentrating on emotional regulation as a challenge, with suggestions for better managing the stress surrounding the anxiety of uncertainty. Rudolph and Zacher (2020) cautioned against using a generational lens in research, advocating for a lifespan developmental approach. Spurk and Straub (2020) also review issues related to unemployment, but focus on the impact of COVID-19 specifically on “gig” or flexible work arrangements.

I am grateful for the contributions of these groups of scholars, and proud of their ability to write these. They were able to write constructive essays in a short time frame when they were, themselves, dealing with disruptions at work. Some were home-schooling children, some were worried about an absent partner or a vulnerable loved one, some were struggling with the challenges that Restubog et al. (2020) outlined. I hope the thoughts, suggestions, and recommendations in these essays will help to stimulate productive thought on the effect of COVID-19 on work and workers. And, while, I hope this research spurs to better understand the effects of such shocks on work, I really hope we do not have to cope with such a shock again.

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• Blustein D.L., Duffy R., Ferreira J.A., Cohen-Scali V., Cinamon R.G., Allan B.A. Unemployment in the time of COVID-19: A research agenda. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bureau of Labor Statistics (2020). Labor Force Statistics from the Current Population Survey. Retrieved May 6, 2020 from https://data.bls.gov/cgi-bin/surveymost .
• Cho E. Examining boundaries to understand the impact of COVID-19 on vocational behaviors. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Guan Y., Deng H., Zhou X. Understanding the impact of the COVID-19 pandemic on career development: Insights from cultural psychology. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Johns Hopkins (2020) Coronavirus Outbreak Mapped: Retrieved May 5, 2020 from https://coronavirus.jhu.edu/map.html .
• International Labor Organization ILO monitor: COVID-19 and the world of work. Third edition updated estimates and analysis. 2020. https://www.ilo.org/wcmsp5/groups/public/@dgreports/@dcomm/documents/briefingnote/wcms_743146.pdf Retrieved May 5, 2020 from:
• International Labor Organization (2020b) COVID-19 impact on the collection of labour market statistics. Retrieved May 6, 2020 from: https://ilostat.ilo.org .
• Kantamneni, N. (2020). The impact of the COVID-19 pandemic on marginalized populations in the United States: A research agenda. Journal of Vocational Behavior, 119 . [ PMC free article ] [ PubMed ]
• Kramer A., Kramer K.Z. The potential impact of the Covid-19 pandemic on occupational status, work from home, and occupational mobility. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Leitheiser, E., Hossain, S.N., Shuvro, S., Tasnim, G., Moon, J., Knudsen, J.S., & Rahman, S. (2020). Early impacts of coronavirus on Bangladesh apparel supply chains. https://www.cbs.dk/files/cbs.dk/risc_report_-_impacts_of_coronavirus_on_bangladesh_rmg_1.pdf .
• Restubog S.L.D., Ocampo A.C., Wang L. Taking control amidst the Chaos: Emotion regulation during the COVID-19 pandemic. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Rudolph C.W., Zacher H. COVID-19 and careers: On the futility of generational explanations. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Spurk D., Straub C. Flexible employment relationships and careers in times of the COVID-19 pandemic. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• World Health Organization (2020). World Health Organization Coronavirus Update. Retrieved May 5, 2020 from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 .