discussion essay about covid 19

Persuasive Essay Guide

Persuasive Essay About Covid19

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

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Steps to Write a Persuasive Essay About Covid-19

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

Step 1: Choose a Specific Thesis Statement

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

Step 2: Research and Gather Information

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

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

Step 3: Outline Your Essay

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

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

Step 4: Write the Introduction

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

Step 5: Provide Background Information

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

Step 6: Develop Body Paragraphs

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

Step 7: Address Counterarguments

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

Step 8: Write the Conclusion

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

Step 9: Revise and Proofread

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

Step 10: Cite Your Sources

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

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

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Examples of Persuasive Essay About Covid19

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

Check out some more PDF examples below:

Persuasive Essay About Covid-19 Pandemic

Sample Of Persuasive Essay About Covid-19

Persuasive Essay About Covid-19 In The Philippines - Example

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

Examples of Persuasive Essay About Covid-19 Vaccine

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

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

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

Covid19 Vaccine Persuasive Essay

Persuasive Essay on Covid Vaccines

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Examples of Persuasive Essay About Covid-19 Integration

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

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

Persuasive Essay About Working From Home During Covid19

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

Examples of Argumentative Essay About Covid 19

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

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

Here are some examples of argumentative essays on Covid19.

Argumentative Essay About Covid19 Sample

Argumentative Essay About Covid19 With Introduction Body and Conclusion

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Examples of Persuasive Speeches About Covid-19

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

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

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

Persuasive Speech About Covid-19 Example

Persuasive Speech About Vaccine For Covid-19

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

Tips to Write a Persuasive Essay About Covid-19

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

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

Choose a Specific Angle

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

Provide Credible Sources

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

Use Persuasive Language

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

Organize Your Essay

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

Emphasize Benefits

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

Use Visuals -H3

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

Call to Action

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

Revise and Edit

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

Seek Feedback

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

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Common Topics for a Persuasive Essay on COVID-19

Here are some persuasive essay topics on COVID-19:

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

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

To sum it up,

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

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

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Frequently Asked Questions

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

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

What impact does COVID-19 have on society?

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

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Keep reading

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

Serious disabled woman concentrating on her work she sitting at her workplace and working on computer at office

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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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8 Lessons We Can Learn From the COVID-19 Pandemic

BY KATHY KATELLA May 14, 2021

Rear view of a family standing on a hill in autumn day, symbolizing hope for the end of the COVID-19 pandemic

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

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

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

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

Lesson 1: Masks are useful tools

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

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

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

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

Lesson 2: Telehealth might become the new normal

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

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

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

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

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

Lesson 3: Vaccines are powerful tools

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

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

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

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

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

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

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

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

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

Lesson 5: We need to take mental health seriously

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

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

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

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

Lesson 6: We have the capacity for resilience

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

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

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

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

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

Lesson 7: Community is essential—and technology is too

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

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

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

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

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

Lesson 8: Sometimes you need a dose of humility

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

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

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

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

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Essay On Covid-19: 100, 200 and 300 Words

Updated on
Sep 20, 2023

COVID-19, also known as the Coronavirus, is a global pandemic that has affected people all around the world. It first emerged in a lab in Wuhan, China, in late 2019 and quickly spread to countries around the world. This virus was reportedly caused by SARS-CoV-2. Since then, it has spread rapidly to many countries, causing widespread illness and impacting our lives in numerous ways. This blog talks about the details of this virus and also drafts an essay on COVID-19 in 100, 200 and 300 words for students and professionals.

This Blog Includes:

Essay on covid-19 in english 100 words, essay on covid-19 in 200 words, essay on covid-19 in 300 words.

Simran Popli

An avid writer and a creative person. With an experience of 1.5 years content writing, Simran has worked with different areas. From medical to working in a marketing agency with different clients to Ed-tech company, the journey has been diverse. Creative, vivacious and patient are the words that describe her personality.

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A guide to writing the covid-19 essay for the common app.

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Students can use the Common App's new Covid-19 essay to expand on their experiences during the ... [+] pandemic.

Covid-19 has heavily impacted students applying to colleges in this application cycle. High schools have gone virtual, extracurricular activities have been canceled and family situations might have changed. Having recognized this, the Common App added a new optional 250-word essay that will give universities a chance to understand the atypical high school experience students have had. The prompt will be:

“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.”

Should I Write About The Coronavirus Pandemic?

For many high schoolers, the pandemic will have had a lasting impact on their education and everyday lives. Some students might have had a negative experience: a parent laid off or furloughed, limited access to online classes or a family member (or the student) having fallen ill from the virus.

Other students might have had the opposite experience. Even though they might have undergone a few negative events or stressful times, they might have learned something new, started a new project or gained a new perspective that changed their future major or career choice.

If you fit into either of these categories, writing the optional essay might be a good idea.

Remember, the admission officers have also been dealing with the crisis and understand the situation students are going through. They are well aware that the AP exams were administered remotely, SAT/ACT test dates were canceled and numerous schools transitioned to a virtual learning model. There is likely no need to reiterate this in an essay unless there was a direct impact on an aspect of your application.

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As with every college essay you write, it is important to think about the tone and word choice. You want to remain sensitive to the plight of other students during this global crisis. While every student has likely been affected by the pandemic, the level of impact will vary greatly. For some, classes moved online, but life remained more or less the same. For these types of students, it might not be a strategic move to write about the coronavirus if you don’t have anything meaningful, unique or personal to say. If you only have a limited time to impress the admission officer, you want to ensure that each word is strategically thought out and showcases a new aspect of your personality.

Using this space as a time to complain about how you weren’t able to go to the beach, see friends or eat out could be seen as you flaunting your privilege. Careful consideration of how you portray yourself will be key.

Nearly every student has had an activity or event canceled. It likely won’t be a good use of your word count lamenting on the missed opportunities. Instead, it would be more illuminating to talk about how you remained flexible and pivoted to other learning opportunities.

How To Write The Covid-19 Essay

The Covid-19 essay was introduced so universities could gain a better understanding of how their applicants have had their lives and education disrupted due to the pandemic. You’ll want to give the admission officers context to understand your experiences better.

Here are some examples of how to write this optional essay.

Outline any extenuating circumstances related to Covid-19. Some students might find themselves crammed in a small apartment or home with their entire family. This disruptive environment might have made it difficult for the student to concentrate on their classes. Some students might be required to care for younger siblings during the day. In many areas of the country, lack of access to high-speed internet or smart devices meant that students couldn’t participate in online learning. Now is the time to share those details.
Include the impact. Ultimately, this essay is about you. Things likely happened to family members, friends or your community, but you need to show how it altered your life specifically.
Provide specific details. Give the admission officers a peek into your everyday life. Including specific details can help make your story come alive. For example, don’t just say that it was hard dealing with the emotional trauma of seeing friends and family fall ill. Instead, be specific and talk about how your friend was diagnosed with Covid-19 and had to be hospitalized. Seeing the long-term effects caused you to take the pandemic much more seriously and moved you to take action. Perhaps you were inspired to start a nonprofit that makes masks or to help your neighbors through this difficult time.

Covid-19 Essay for School Counselors

It’s not just students who will get to submit an additional statement regarding the impact of the coronavirus: Counselors will also get a chance to submit a 500-word essay. Their prompt will be:

Your school may have made adjustments due to community disruptions such as COVID–19 or natural disasters. If you have not already addressed those changes in your uploaded school profile or elsewhere, you can elaborate here. Colleges are especially interested in understanding changes to:

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

The counselor’s response will populate to all the applications of students from the high school. They will cover any school or district policies that have impacted students. No specific student details will be included.

Students can ask to see a copy of this statement so they know what information has already been shared with colleges. For example, if the school states that classes went virtual starting in March, you don’t need to repeat that in your Covid-19 essay.

Should I Write About The Covid-19 In My Personal Statement?

The world before Covid-19 might seem like a distant memory, but you did spend more than 15 years engaging in a multitude of meaningful activities and developing your passions. It’s important to define yourself from more than just the coronavirus crisis. You likely will want to spend the personal statement distinguishing yourself from other applicants. With the Covid-19 optional essay and the additional information section, you should have plenty of space to talk about how you’ve changed—for better or for worse—due to the pandemic. Use the personal statement to talk about who you were before quarantining.

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Special Issue: COVID-19

This essay was published as part of a Special Issue on Misinformation and COVID-19, guest-edited by Dr. Meghan McGinty (Director of Emergency Management, NYC Health + Hospitals) and Nat Gyenes (Director, Meedan Digital Health Lab).

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The causes and consequences of COVID-19 misperceptions: Understanding the role of news and social media

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We investigate the relationship between media consumption, misinformation, and important attitudes and behaviours during the coronavirus disease 2019 (COVID-19) pandemic. We find that comparatively more misinformation circulates on Twitter, while news media tends to reinforce public health recommendations like social distancing. We find that exposure to social media is associated with misperceptions regarding basic facts about COVID-19 while the inverse is true for news media. These misperceptions are in turn associated with lower compliance with social distancing measures. We thus draw a clear link from misinformation circulating on social media, notably Twitter, to behaviours and attitudes that potentially magnify the scale and lethality of COVID-19.

Department of Political Science, McGill University, Canada

Munk School of Global Affairs and Public Policy, University of Toronto, Canada

Max Bell School of Public Policy, McGill University, Canada

School of Computer Science, McGill University, Canada

Department of Languages, Literatures, and Cultures, McGill University, Canada

Computer Science Program, McGill University, Canada

Research Questions

How prevalent is misinformation surrounding COVID-19 on Twitter, and how does this compare to Canadian news media?
Does the type of media one is exposed to influence social distancing behaviours and beliefs about COVID-19?
Is there a link between COVID-19 misinformation and perceptions of the pandemic’s severity and compliance with social distancing recommendations?

Essay Summary

We evaluate the presence of misinformation and public health recommendations regarding COVID-19 in a massive corpus of tweets as well as all articles published on nineteen Canadian news sites. Using these data, we show that preventative measures are more encouraged and covered on traditional news media, while misinformation appears more frequently on Twitter.
To evaluate the impact of this greater level of misinformation, we conducted a nationally representative survey that included questions about common misperceptions regarding COVID-19, risk perceptions, social distancing compliance, and exposure to traditional news and social media. We find that being exposed to news media is associated with fewer misperceptions and more social distancing compliance while conversely, social media exposure is associated with more misperceptions and less social distancing compliance.
Misperceptions regarding the virus are in turn associated with less compliance with social distancing measures, even when controlling for a broad range of other attitudes and characteristics.
Association between social media exposure and social distancing non-compliance is eliminated when accounting for effect of misperceptions, providing evidence that social media is associated with non-compliance through increasing misperceptions about the virus.

Implications

The COVID-19 pandemic has been accompanied by a so-called “infodemic”—a global spread of misinformation that poses a serious problem for public health. Infodemics are concerning because the spread of false or misleading information has the capacity to change transmission patterns (Kim et al., 2019) and consequently the scale and lethality of a pandemic. This information can be shared by any media, but there is reason to be particularly concerned about the role that social media, such as Facebook and Twitter, play in incidentally boosting misperceptions. These platforms are increasingly relied upon as primary sources of news (Mitchell et al., 2016) and misinformation has been heavily documented on them (Garrett, 2019; Vicario et al., 2016). Scholars have found medical and health misinformation on the platforms, including that related to vaccines (Radzikowski et al., 2016) and other virus epidemics such as Ebola (Fung et al., 2016) and Zika (Sharma et al., 2017).

However, misinformation content typically makes up a low percentage of overall discussion of a topic (e.g. Fung et al., 2016) and mere exposure to misinformation does not guarantee belief in that misinformation. More research is thus needed to understand the extent and consequences of misinformation surrounding COVID-19 on social media. During the COVID-19 pandemic, Twitter, Facebook and other platforms have engaged in efforts to combat misinformation but they have continued to receive widespread criticism that misinformation is still appearing on prominent pages and groups (Kouzy et al., 2020; NewsGuard, 2020). The extent to which misinformation continues to circulate on these platforms and influence people’s attitudes and behaviours is still very much an open question.

Here, we draw on three data sets and a sequential mixed method approach to better understand the consequences of online misinformation for important behaviours and attitudes. First, we collected nearly 2.5 million tweets explicitly referring to COVID-19 in the Canadian context. Second, we collected just over 9 thousand articles from nineteen Canadian English-language news sites from the same time period. We coded both of these media sets for misinformation and public health recommendations. Third, we conducted a nationally representative survey that included questions related to media consumption habits, COVID-19 perceptions and misperceptions, and social distancing compliance. As our outcome variables are continuous, we use Ordinary Least Squares (OLS) regression to identify relationships between news and social media exposure, misperceptions, compliance with social distancing measures, and risk perceptions. We use these data to illustrate: 1) the relative prevalence of misinformation on Twitter; and 2) a powerful association between social media usage and misperceptions, on the one hand, and social distancing non-compliance on the other.

Misinformation and compliance with social distancing

We first compare the presence of misinformation on Twitter with that on news media and find, consistent with the other country cases (Chadwick & Vaccari, 2019; Vicario et al., 2016), comparatively higher levels of misinformation circulating on the social media platform. We also found that recommendations for safe practices during the pandemic (e.g. washing hands, social distancing) appeared much more frequently in the Canadian news media. These findings are in line with literature examining fake news which finds a large difference in information quality across media (Al-Rawi, 2019; Guess & Nyhan, 2018).

Spending time in a media environment that contains misinformation is likely to change attitudes and behaviours. Even if users are not nested in networks that propagate misinformation, they are likely to be incidentally exposed to information from a variety of perspectives (Feezell, 2018; Fletcher & Nielsen, 2018; Weeks et al., 2017). Even a highly curated social media feed is thus still likely to contain misinformation. As cumulative exposure to misinformation increases, users are likely to experience a reinforcement effect whereby familiarity leads to stronger belief (Dechêne et al., 2010).

To evaluate this empirically, we conducted a national survey that included questions on information consumption habits and a battery of COVID-19 misperceptions that could be the result of exposure to misinformation. We find that those who self-report exposure to the misinformation-rich social media environment do tend to have more misperceptions regarding COVID-19. These findings are consistent with others that link exposure to misinformation and misperceptions (Garrett et al., 2016; Jamieson & Albarracín, 2020). Social media users also self-report less compliance with social distancing.

Misperceptions are most meaningful when they impact behaviors in dangerous ways. During a pandemic, misperceptions can be fatal. In this case, we find that misperceptions are associated with reduced COVID-19 risk perceptions and with lower compliance with social distancing measures. We continue to find strong effects after controlling for socio-economic characteristics as well as scientific literacy. After accounting for the effect of misperceptions on social distancing non-compliance, social media usage no longer has a significant association with non-compliance, providing evidence that social media may lead to less social distancing compliance through its effect on COVID-19 misperceptions.

While some social media companies have made efforts to suppress misinformation on their platforms, there continues to be a high level of misinformation relative to news media. Highly polarized political environments and media ecosystems can lead to the spread of misinformation, such as in the United States during the COVID-19 pandemic (Allcott et al., 2020; Motta et al., 2020). But even in healthy media ecosystems with less partisan news (Owen et al., 2020), social media can continue to facilitate the spread of misinformation. There is a real danger that without concerted efforts to reduce the amount of misinformation shared on social media, the large-scale social efforts required to combat COVID-19 will be undermined.

We contribute to a growing base of evidence that misinformation circulating on social media poses public health risks and join others in calling for social media companies to put greater focus on flattening the curve of misinformation (Donovan, 2020). These findings also provide governments with stronger evidence that the misinformation circulating on social media can be directly linked to misperceptions and public health risks. Such evidence is essential for them to chart an effective policy course. Finally, the methods and approach developed in this paper can be fruitfully applied to study other waves of misinformation and the research community can build upon the link clearly drawn between misinformation exposure, misperceptions, and downstream attitudes and behaviours.

We found use of social media platforms broadly contributes to misperceptions but were unable to precise the overall level of misinformation circulating on non-Twitter social media. Data access for researchers to platforms such as Facebook, YouTube, and Instagram is limited and virtually non-existent for SnapChat, WhatsApp, and WeChat. Cross-platform content comparisons are an important ingredient for a rich understand of the social media environment and these social media companies must better open their platforms to research in the public interest.

Finding 1: Misinformation about COVID-19 is circulated more on Twitter as compared to traditional media.

We find large differences between the quality of information shared about COVID-19 on traditional news and Twitter. Figure 1 shows the percentage of COVID-19 related content that contains information linked to a particular theme. The plot reports the prevalence of information on both social and news media for: 1) three specific pieces of misinformation; 2) a general set of content that describes the pandemic itself as a conspiracy or a hoax; and 3) advice about hygiene and social distancing during the pandemic. We differentiate content that shared misinformation (red in the plot) from content that debunked misinformation (green in the plot).

There are large differences between the levels of misinformation on Twitter and news media. Misinformation was comparatively more common on Twitter across all four categories, while debunking was relatively more common in traditional news. Meanwhile, advice on hygiene and social distancing appeared much more frequently in news media. Note that higher percentages are to be expected for longer format news articles since we rely on keyword searches for identification. This makes the misinformation findings even starker – despite much higher average word counts, far fewer news articles propagate misinformation.

Finding 2: There is a strong association between social media exposure and misperceptions about COVID-19. The inverse is true for exposure to traditional news.

Among our survey respondents we find a corresponding strong association between social media exposure and misperceptions about COVID-19. These results are plotted in Figure 2, with controls included for both socioeconomic characteristics and demographics. Moving from no social media exposure to its maximum is expected to increase one’s misperceptions of COVID-19 by 0.22 on the 0-1 scale and decreased self-reported social distancing compliance by 0.12 on that same scale.

This result stands in stark contrast with the observed relationship between traditional news exposure and our outcome measures. Traditional news exposure is positively associated with correct perceptions regarding COVID-19. Moving from no news exposure to its highest level is expected to reduce misperceptions by 0.12 on the 0-1 scale and to increase social distancing compliance by 0.28 on that same scale. The effects are plotted in Figure 2. Social media usage appears to be correlated with COVID-19 misperceptions, suggesting these misperceptions are partially a result of misinformation on social media. The same cannot be said of traditional news exposure.

Finding 3: Misperceptions about the pandemic are associated with lower levels of risk perceptions and social distancing compliance.

COVID-19 misperceptions are also powerfully associated with lower levels of social distancing compliance. Moving from the lowest level of COVID-19 misperceptions to its maximum is associated with a reduction of one’s social distancing by 0.39 on the 0-1 scale. The previously observed relationship between social media exposure and misperceptions disappears, suggestive of a mediated relationship. That is, social media exposure increases misperceptions, which in turn reduces social distancing compliance. Misperceptions is also weakly associated with lower COVID-19 risk perceptions. Estimates from our models using COVID-19 concern as the outcome can be found in the left panel of Figure 3, while social distancing can be found in the right panel.

Finally, we also see that the relationship between misinformation and both social distancing compliance and COVID-19 concern hold when including controls for science literacy and a number of fundamental predispositions that are likely associated with both misperceptions and following the advice of scientific experts, such as anti-intellectualism, pseudoscientific beliefs, and left-right ideology. These estimates can similarly be found in Figure 3.

Canadian Twitter and news data were collected from March 26 th to April 6 th , 2020. We collected all English-language tweets from a set of 620,000 users that have been determined to be likely Canadians. For inclusion, a given user must self-identify as Canadian-based, follow a large number of Canadian political elite accounts, or frequently use Canadian-specific hashtags. News media was collected from nineteen prominent Canadian news sites with active RSS feeds. These tweets and news articles were searched for “covid” or “coronavirus”, leaving a sample of 2.25 million tweets and 8,857 news articles.

Of the COVID-19 related content, we searched for terms associated with four instances of misinformation that circulated during the COVID-19 pandemic: that COVID-19 was no more serious than the flu, that vitamin C or other supplements will prevent contraction of the virus, that the initial animal-to-human transfer of the virus was the direct result of eating bats, or that COVID-19 was a hoax or conspiracy. Given that we used keyword searches to identify content, we manually reviewed a random sample of 500 tweets from each instance of misinformation. Each tweet was coded as one of four categories: propagating misinformation, combatting misinformation, content with the relevant keywords but unrelated to misinformation, or content that refers to the misinformation but does not offer comment.

We then calculated the overall level of misinformation for that instance on Twitter by multiplying the overall volume of tweets by the proportion of hand-coded content where misinformation was identified. Each news article that included relevant keywords was similarly coded. The volume of the news mentioning these terms was sufficiently low that all news articles were hand coded. To identify health recommendations, we used a similar keyword search for terms associated with particular recommendations: 1) social distancing including staying at home, staying at least 6 feet or 2 meters away and avoiding gatherings; and 2) washing hands and not touching any part of your face. 1 Further details on the media collection strategy and hand-coding schema are available in the supporting materials.

For survey data, we used a sample of nearly 2,500 Canadian citizens 18 years or older drawn from a probability-based online national panel fielded from April 2-6, 2020. Quotas we set on age, gender, region, and language to ensure sample representativeness, and data was further weighted within region by gender and age based on the 2016 Canadian census.

We measure levels of COVID-19 misperceptions by asking respondents to rate the truthfulness of a series of nine false claims, such as the coronavirus being no worse than the seasonal flu or that it can be warded off with Vitamin C. Each was asked on a scale from definitely false (0) to definitely true (5). We use Cronbach’s Alpha as an indicator of scale reliability. Cronbach’s Alpha ranges from 0-1, with scores above 0.8 indicating the reliability is “good.” These items score 0.88, so we can safely construct a 0-1 scale of misperceptions from them.

We evaluate COVID-19 risk perceptions with a pair of questions asking respondents how serious of a threat they believe the pandemic to be for themselves and for Canadians, respectively. Each question was asked on a scale from not at all (0) to very (4). We construct a continuous index with these items.

We quantify social distancing by asking respondents to indicate which of a series of behaviours they had undertaken in response to the pandemic, such as working from home or avoiding in-person contact with friends, family, and acquaintances. We use principal component analysis (PCA) to reduce the number of dimensions in these data while minimizing information loss. The analysis revealed 2 distinct dimensions in our questions. One dimension includes factors strongly determined by occupation, such as working from home and switching to online meetings. The other dimension contains more inclusive behaviours such as avoiding contact, travel, and crowded places. We generate predictions from the PCA for this latter dimension to use in our analyses. The factor loadings can be found in Table A1 of the supporting materials.

We gauge news and social media consumption by asking respondents to identify news outlets and social media platforms they have used over the past week for political news. The list of news outlets included 17 organizations such as mainstream sources like CBC and Global, and partisan outlets like Rebel Media and National Observer. The list of social media platforms included 10 options such as Facebook, Twitter, YouTube, and Instagram. We sum the total number of outlets/platforms respondents report using and take the log to adjust for extreme values. We measure offline political discussion with an index based on questions asking how often respondents have discussed politics with family, friends, and acquaintances over the past week. Descriptions of our primary variables can be found in Table A2 of the supporting materials.

We evaluate our hypotheses using a standard design that evaluates the association between our explanatory and outcome variables controlling for other observable factors we measured. In practice, randomly assigning social media exposure is impractical, while randomly assigning misinformation is unethical. This approach allows us to describe these relationships, though we cannot make definite claims to causality.

We hypothesize that social media exposure is associated with misinformation on COVID-19. Figure 2 presents the coefficients of models predicting the effects of news exposure, social media exposure, and political discussion on COVID-19 misinformation, risk perceptions, and social distancing. Socio-economic and demographic control estimates are not displayed. Full estimation results can be found in the Table A3 of the supporting materials.

We further hypothesize that COVID-19 misinformation is associated with lower COVID-19 risk perceptions and less social distancing compliance. Figure 3 presents the coefficients for models predicting the effects of misinformation, news exposure, and social media exposure on severity perceptions and social distancing. We show models with and without controls for science literacy and other predispositions. Full estimation results can be found in the Table A4 of the supporting materials.

Limitations and robustness

A study such as this comes with clear limitations. First, we have evaluated information coming from only a section of the overall media ecosystem and during a specific time-period. The level of misinformation differs across platforms and online news sites and a more granular investigation into these dynamics would be valuable. Our analysis suggests that similar dynamics exist across social media platforms, however. In the supplementary materials we show that associations between misperceptions and social media usage are even higher for other social media platforms, suggesting that our analysis of Twitter content may underrepresent the prevalence of misinformation on social media writ large. As noted above, existing limitations on data access make such cross-platform research difficult.

Second, our data is drawn from a single country and language case study and other countries may have different media environments and levels of misinformation circulating on social media. We anticipate the underlying dynamics found in this paper to hold across these contexts, however. Those who consume information from platforms where misinformation is more prevalent will have greater misperceptions and that these misperceptions will be linked to lower compliance with social distancing and lower risk perceptions. Third, an ecological problem is present wherein we do not link survey respondents directly to their social media consumption (and evaluation of the misinformation they are exposed to) and lack the ability to randomly assign social media exposure to make a strong causal argument. We cannot and do not make a causal argument here but argue instead that there is strong evidence for a misinformation to misperceptions to lower social distancing compliance link.

/ Fake News
/ Mainstream Media
/ Public Health
/ Social Media

Cite this Essay

Bridgman, A., Merkley, E., Loewen, P. J., Owen, T., Ruths, D., Teichmann, L., & Zhilin, O. (2020). The causes and consequences of COVID-19 misperceptions: Understanding the role of news and social media. Harvard Kennedy School (HKS) Misinformation Review . https://doi.org/10.37016/mr-2020-028

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The project was funded through the Department of Canadian Heritage’s Digital Citizens Initiative.

Competing Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The research protocol was approved by the institutional review board at University of Toronto. Human subjects gave informed consent before participating and were debriefed at the end of the study.

This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided that the original author and source are properly credited.

Data Availability

All materials needed to replicate this study are available via the Harvard Dataverse: https://doi.org/10.7910/DVN/5QS2XP .

POLICY BRIEF article

Lessons learnt from the covid-19 pandemic.

$\nNils Chr. Stenseth &#x;&#x;$

1 Centre for Ecological and Evolutionary Synthesis, Department of Biosciences, University of Oslo, Oslo, Norway
2 Savannah River Ecology Laboratory, University of Georgia, Aiken, SC, United States
3 CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China
4 State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
5 CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
6 Chinese Center for Disease Control and Prevention, Beijing, China

The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has been characterized by unprecedented rates of spatio-temporal spread. Here, we summarize the main events in the pandemic's timeline and evaluate what has been learnt by the public health community. We also discuss the implications for future public health policy and, specifically, the practice of epidemic control. We critically analyze this ongoing pandemic's timeline and contrast it with the 2002–2003 SARS outbreak. We identify specific areas (e.g., pathogen identification and initial reporting) wherein the international community learnt valuable lessons from the SARS outbreak. However, we also identify the key areas where international public health policy failed leading to the exponential spread of the pandemic. We outline a clear agenda for improved pandemic control in the future.

Introduction

In late-December 2019, pneumonia of unknown etiology (PUE) was reported from a cluster of patients who were initially linked epidemiologically to the Huanan Seafood Market in Wuhan, China ( 1 , 2 ). These cases of PUE were reported to the WHO China Country Office on December 31, 2019 ( 3 ), and the Chinese Center for Disease Control and Prevention (CCDC) sent an investigative team to Wuhan on the same day. The first batch of samples was dispatched to three organizations (China CDC, Wuhan Institute of Virology under Chinese Academy of Sciences and Chinese Academy of Medical Sciences) for virus genome sequencing and virus isolation. Parallel experiments from these organizations were carried out with coordination of the National Health Commission to make sure the results were comparable. The novel SARS-related coronavirus was identified when several PUE samples tested positive with a pan-coronavirus RT-PCR covering all SARS-related coronaviruses, and the pan-PCR product was sequenced. As of January 7, 2020, Chinese health officials had confirmed that the PUE was caused by a novel coronavirus ( 4 ). Hence, it took China just about a week to inform the world about the etiology of the PUE, which is indeed efficient for identifying a novel pathogen causing an emerging infectious disease, demonstrating China's improved ability to manage new outbreaks ( 5 ). Concurrent to the virus identification, NGS-sequencing was also carried out and on 10 January, 2020, the CCDC shared the whole genome sequences through the Global Initiative on Sharing All Influenza Data (GISAID; Accession numbers EPI_ISL_402119 and EPI_ISL_402121) ( 6 ), and reported these data to the WHO. Prior to the work in early January 2020, the Wuhan Institute of Virology had sequenced similar bat-derived coronaviruses, but did not have SARS-CoV-2 in the lab suggesting a laboratory-origin as being unlikely ( 7 ), a finding supported by a recent WHO report ( 8 ). Specifically, the Wuhan Institute of Virology got the partial sequences of the RdRp gene by pan-coronavirus RT-PCR from a bat fecal swab collected in 2013 (sample ID 4991) and later named RaTG13 following the bat species, samples location and year. The institute ignored this sequence when they found it is distantly related to SARS-CoV. In 2018, they decided to sequence as much as possible of the full-length genome from their stock samples which are positive for SARS-related coronavirus. They completed the nearly full-length genome sequence of RaTG13 but didn't publish it. In 2020, after they received the SARS-CoV-2 sequence, the institute compared it with all of their unpublished sequences and found its closest relative RaTG13 (96.2% nucleotide identity), and they then completed the whole genome sequence ( 9 ). As of current date, the RaTG13 strain has never been isolated and has not been the focus of further studies, except with regard to ACE2 interaction using pseudovirus and binding affinity assays. The current data indicate that the TG13 spike has low binding affinity to human ACE2 compared to SARS-CoV-1, SARS-CoV-2, Pangolin CoV and bat SARS-related CoV WIV1 ( 10 – 13 ).

Policy Options and Implications

Global response.

It is clear that both China and the WHO demonstrated dramatically improved responses to COVID-19 with the lessons learned from previous epidemics (see Figure 1 ). For example, in the case of the SARS-CoV epidemic (2002-2003), initial cases were identified in mid-November 2002 but it was only on 10 February 2003 that the developing epidemic was confirmed and the first report to WHO was made ( 14 ). In stark contrast, as highlighted above, Chinese officials informed WHO of a potential epidemic within a week of the first cases being identified in Wuhan. The WHO also acted quickly and formally alerted the world of a public health emergency of international concern (PHEIC) by end of January, well before pandemic spread had started. Indeed, at the time the PHEIC was declared only 25 countries/regions outside mainland China had reported any cases of the disease, and of these only 6 (i.e., Hong Kong, Japan, Singapore, South Korea, Taiwan, Thailand) had reported over 10 cases. Unfortunately, the rest of the world did not seem to pay too much attention to these alerts, and it was not until mid-March—when WHO Director-General announced COVID-19 as a global pandemic ( 25 )—that the rest of the world “woke up” and started to accept that a pandemic was developing.

Figure 1 . Comparative timelines of two coronavirus epidemics. The relative timelines for SARS-CoV epidemic of 2002–2003 (top row) ( 14 – 19 ) and SARS-CoV-2 pandemic of 2019 (bottom row) ( 20 – 22 ), specifically highlighting dramatic differences in duration to notification of the WHO, identification of the pathogen and sequencing of the pathogen genome after the identification of the first case. The maps show the spatial extent of SARS-CoV-2 infection at three critical time points ( 23 , 24 ).

Source Identification

While identifying the origin of COVID-19 is essential to prevent the next pandemic ( 26 ), the actual origin of SARS-CoV-2 remains enigmatic ( 8 ). Viruses that are phylogenetically related to SARS-CoV-2 have been identified in several wildlife species (e.g., horseshoe bats and pangolins), but as of now no wildlife species has tested positive SARS-CoV-2 across China ( 8 ). It is currently proposed that the entry of the virus into the human population could have been facilitated by cross-species transmission through one or multiple intermediate host species ( 9 , 27 , 28 ). However, this hypothesis is primarily based on our understanding of SARS MERS, and/or avian flu, and may need to be revisited and assessed as more data come to light. Initially it was also suspected that the coronavirus had entered the human population through the Huanan Seafood Market, a live animal market in Wuhan, China. However, the early report for COVID-19 did not find direct epidemiological links for many patients with the market ( 29 ). Thus, it is possible that the live animal markets might have served as an amplifier due to large numbers of people in close proximity to each other in the cold environment—just like the after-ski bar in Kitzloch, Austria ( 30 ).

Control Strategies

Different strategies have been implemented to combat the pandemic in different countries. Some countries (e.g., Sweden) initially tried so-called herd immunity by natural infections and some used mitigation or suppression, but in general these approaches had minimal effects on stopping the spread of the disease within and between countries. Generally, most countries across the globe tried to limit the spread of the pathogen through various non-pharmaceutical interventions (NPIs), including the implementation of lockdowns of varying intensity and geographic scope. However, it has been noted that the inadequate (e.g., United States and India) or delayed (e.g., Russia, United Kingdom, and France) implementation of lockdowns could have reduced their efficacy in impeding the spread of infections in many countries ( 31 ). Just as delays in implementing lockdowns have increased pathogen spread, the premature lifting of these restrictions can also cause a resurgence in case numbers as has been observed recently in India ( 32 , 33 ). One of the most effective implementations of NPIs was undertaken by China, which took immediate and stringent measures to prevent pathogen spread, including the lock-down of the city of Wuhan, where the virus was first identified, and suppression measures for the rest of the country ( 34 ). The WHO-China Joint Mission on COVID-19 ( 35 ) revealed that the immediate prevention and control measures that China took to curtail the epidemic were implemented in three main phases. The first stage focused primarily on preventing cases from being exported from Wuhan in conjunction with closing wet markets and enhanced surveillance to try to identify the zoonotic source. The second stage focused on controlling the impacts of the epidemic through medical intervention, improved diagnostics for rapid identification of infected individuals, and critically on reducing the rate of spread by curtailing the movement of people, restriction of mass gatherings, contact tracing, increased quarantine measures, and enhanced border security. Finally, in the third stage the focus shifted to controlling isolated and/or sporadic case clusters. In this stage there was a critical effort to strike a balance between effective disease control and sustainable economic/social development. The effective implementation of these policies made China one of the most successful countries in terms of COVID-19 control. The effectiveness of China's control measures is evidenced in terms of the per-capita cases reported. Thus, as of May 6, 2021, the global infection rate was about 20,022/million persons, with considerable variation amongst various countries (e.g., 98,503 and 15,573 cases/million persons in USA and India, respectively). However, China's cumulative infection rates remained one of the lowest globally (71 cases/million persons) ( 36 ). It is important to note that after Wuhan outbreak which was cleared on April 8, 2020 ( 37 – 39 ), China has experienced many small waves of outbreak with local transmission due to imported cases, but all the viruses are “stable” strains (with single imported case of both 501Y.V1 and 501Y.V2 but no local spread) and there are no new variants arising from China, indicating the successful suppression of virus circulation. For both containment and suppression strategies, lock-down of the city/region (the areas could be very small), lock-down of the household and isolation/quarantine are the three important factors for the success. Looking to the future, with no recurrent outbreaks in China even in the winter season (as of Feb 23, 2021), we might consider such a mitigation strategy to ensure meeting public health goals, while keeping the society socially active and economically strong. It is also important to recognize the need for better international coordination in terms of reducing transmission (e.g., restriction of social gatherings and mask ordinances) and the timely identification of potential spread (e.g., contact tracing). Early in the pandemic these measures, in conjunction with stricter limitations of international travel, would have helped reduce the initial global spread of the virus. However, in these late stages of the pandemic, localized lockdowns (e.g., at city or county scale) are likely to be more effective than large-scale lockdowns at national or regional levels ( 40 ).

Actionable Recommendations

We have learnt many critical lessons from the ongoing coronavirus pandemic with respect to the requirements for rapid response and large-scale surveillance, as well as the needs for effective and coordinated strategies to control novel pathogens. While there remain many unknowns and uncertainties relating to the control of future pandemics, based on what we learnt from SARS-CoV-2 we make the following recommendations:

1. While pandemics are unpredictable by nature, proper preparation and prior planning can help manage them better. For a long time, coronaviruses have been identified as pathogens with high pandemic potential, and have thus been high on the prioritized preparedness list. Yet the globe was still unprepared to effectively deal with COVID-19. There is no doubt that many of the science-based requirements for pandemic control—rapid identification of the causative agent, genome sequence and determination of the key epidemiological parameters related to transmission—were met, but the global management of the pandemic still failed in many respects. Clearly, science alone cannot control a pandemic. In the long run, active science outreach to the public and policy makers are fundamental to achieving a coordinated implementation of intervention across scales, sectors and population groups ( 41 ). There is no doubt that a unifying science-based strategy, public involvement, and informed decision-making are the three key steps to improve the control of such public health emergencies in the future.

2. Both China and international communities outside China have learnt the vital need for improved preparedness to rapidly identify and limit the spread of emerging pathogens. Stockpiling of emergency supplies and the logistics of meeting rapidly ramped-up demand was a major bottleneck in the response to COVID-19. From the very beginning medical and public health workers were faced with the shortage of many essential items, including equipment for oxygenation support (e.g., oxygen masks, respirators, and ECMO/extracorporeal membrane oxygenation) and even personal protection equipment (e.g., face masks and gloves). Despite the lesson learnt, there seems to be no practical way to address this issue because there is no easy way to store such supplies in bulk for logistic and economic reasons. Additionally, the next pandemic may be characterized by other symptomatology (e.g., hemorrhagic fever) rather than respiratory failure. Thus, there is a need to think of creative solutions to address our ability to meet such sudden supply-demand dynamics in the future, and we would like to leave this as an open question to the readers.

3. The WHO has to be given a much stronger role in the coordination of the implementation of the various control-measures. Given the exponential nature of pathogen spread it is imperative that we ensure the rapid mobilization of mitigation and control strategies at international scales before local epidemics can progress to pandemics. The authority of the WHO for global coordination of pandemic responses must be strengthened.

4. There is also an urgent need to address several open questions related to COVID-19, particularly the possible reservoir or intermediate host(s), the role of live-animal markets in introducing or maintaining the virus in the human population. China-WHO Joint Study Group recently spent a month (January-February, 2021) in Wuhan to investigate the origins of the virus, but with no definitive answers yet. For the whole year of 2020, scientists and public health professionals in China and across the globe have been trying to answer this critical question, but with limited success. For example, it still remains unclear if SARS-CoV-2 differs fundamentally from other coronaviruses (e.g., SARS-CoV and MERS-CoV) in terms of its epidemiology and entry into the human population ( 42 ). Given the lack of information there is a necessity to keep an open mind and follow an objective scientific agenda to address the outstanding questions.

5. It is encouraging that shortly after the genome was made publicly available identification of potential vaccine candidates was initiated, with NIH joining up with Moderna Inc. in mid-January ( 43 ). Potential vaccine candidates were rapidly screened, with Moderna publishing their preliminary report on the mRNA-based COVID-19 vaccine on 14 July 2020 ( 44 ), and BioNTech and Pfizer publishing safety and immunogenicity data from Phase 1 clinical trials of two RNA vaccine candidates on October 14, 2020 ( 45 ). Given that several vaccines have now been approved for human use, it is clear that vaccine development for COVID-19 has progressed at an extremely rapid rate, with less than a year elapsing from initial pathogen discovery to vaccine deployment. There is no doubt that the rapid development of the SARS-CoV-2 vaccine was only possible because it was able to leverage a large body of basic research on other coronaviruses, such as MERS-CoV ( 46 ). Such an approach to preparedness using prototype pathogens could also be started for the other 23 virus families known to infect humans (e.g., Flaviviridae and Filoviridae), thus dramatically improving our ability to manage future pandemics ( 43 ).

6. While vaccines are a key component of control, the recent pandemic has also highlighted the fundamental importance of NPIs given their efficacy in reducing viral spread ( 47 ). While the effectiveness of these NPIs is highly variable (e.g., depending on community-level infection rates), several specific NPIs have been shown to consistently reduce the transmission of SARS-CoV-2. These interventions include the closure of schools and workplaces, bans on public events and gatherings of more than 10 people, as well as limiting human movement ( 48 ). The continued use of such NPIs needs to be enforced especially at the very early stages of vaccination.

7. Most importantly, an international scientific conference should be convened, as soon as possible, to discuss not only the biomedical issues related to the pandemic, but also other issues related to pandemic control, such as the effectiveness of the various interventions adopted in different countries ( 47 ) and the need for improved policy coordination ( 49 ). Such large international conferences have been very effective in the past. A historic example includes the international sanitary conference held in February 1897 at Venice to discuss the spread of plague ( 50 ), and the international conference following the Manchurian plague of 1910-1911 in Shenyang (then Fengtian), China ( 50 – 53 ). These examples can serve as portfolios that can be effectively adopted to better evaluate the strengths and weaknesses of country-specific and international responses to the COVID-19 pandemic and to improve pandemic response in the future.

Conclusions

The ongoing COVID-19 pandemic caused by SARS-CoV-2 has brought to the fore the devastating societal and economic consequences associated with emerging infectious diseases. Human history has been punctuated by many such global pandemics including the bubonic plague (14th century), the flu (20th century) and HIV/AIDS (20th and 21st century), and it is unlikely that COVID-19 will be the last one. Indeed, the risk of emergence of novel diseases in human populations is increasing at an alarming rate due to numerous factors including the rapid range expansion of disease vectors, destabilization of natural ecosystems, as well as the rapid increase in agriculture and urbanization. By critically comparing the 2002–2003 SARS outbreak and COVID-19 pandemic, we identified that significant strides have been made in terms of rapid pathogen identification and expedited initial outbreak reporting by China, as well as the PHEIC declaration by WHO. However, one of the major failures was the delayed international response to the PHEIC declaration by the WHO, a delay which allowed for the exponential spread of the pandemic. We recommend that these are the critical areas that the international public health community must focus on to better control future pandemics in a highly connected global population. In the end we feel that the most essential lesson we can learn from COVID-19 is that pandemic control hinges on rapid, effective, coordinated and sustained pandemic response at local, national and international levels.

Author Contributions

NS developed the idea. GD and NS wrote the first draft of the manuscript. GD coordinated input from other authors. All other authors contributed to specific sections, discussed results, and edited the manuscript.

NS acknowledges support from the COVID-19 Seasonality Project (reference number 312740) from the Research Council of Norway. GD acknowledges support through the US Department of Energy Financial Assistance Award no. DE-EM0004391 to the University of Georgia Research Foundation. RL acknowledges support from Researcher Project for Young Talents (reference number 325041) from the Research Council of Norway. RY acknowledges support from Ministry of Science and Technology of China (no. 2020YFC0848900). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. All data are available from the references cited, code for graphs is available from GD on request.

Conflict of Interest

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

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: pandemic, COVID-19, epidemiology, SARS-CoV, public health

Citation: Stenseth NC, Dharmarajan G, Li R, Shi Z-L, Yang R and Gao GF (2021) Lessons Learnt From the COVID-19 Pandemic. Front. Public Health 9:694705. doi: 10.3389/fpubh.2021.694705

Received: 13 April 2021; Accepted: 05 July 2021; Published: 02 August 2021.

Reviewed by:

Copyright © 2021 Stenseth, Dharmarajan, Li, Shi, Yang and Gao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Nils Chr. Stenseth, n.c.stenseth@mn.uio.no ; Guha Dharmarajan, guha@srel.uga.edu

† These authors have contributed equally to this work

‡ ORCID: Nils Chr. Stenseth orcid.org/0000-0002-1591-5399 Guha Dharmarajan orcid.org/0000-0001-8500-0429 Ruiyun Li orcid.org/0000-0001-8927-9965 Ruifu Yang orcid.org/0000-0003-3219-7269 George F. Gao orcid.org/0000-0002-3869-615X

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

COVID-19 Was a Turning Point for Health

Our new book focuses on the lessons of the pandemic..

Posted February 15, 2024 | Reviewed by Michelle Quirk

To think comprehensively about COVID-19 is to think not just about the past but also about the future.
The narratives we accept about the pandemic will do much to shape our ability to create a healthier world.
Understanding the pandemic, and learning from it, means coming to terms with the emotions of that time.

In 2021, the United States was at a turning point. We had just lived through the acute phase of a global pandemic. During that time, the country had experienced an economic crisis, civil unrest, a deeply divisive federal election, and a technological revolution in how we live, work, and congregate. The emergence of COVID-19 vaccines allowed us, finally, to look ahead to a post-pandemic world, but what would that world be like? Would it be a return to the pre-COVID-19 status quo, or would it be something radically new?

It was with these questions in mind that, in 2021, I partnered with my colleague Michael Stein to write a series of essays reflecting on the COVID-19 pandemic. Our aim was to engage with the COVID moment through the lens of cutting -edge public health science. By exploring the pandemic’s intersection with topics like digital surveillance, vaccine distribution, big data, and the link between science and political decision-making , we tried to sketch what the moment meant while it unfolded and what its implications might be for the future. If journalism is “the first rough draft of history,” these essays were, in a way, our effort to produce just such a draft, from the perspective of a forward-looking public health. I am delighted to announce that a book based on this series of essays has just been published by Oxford University Press: The Turning Point: Reflections on a Pandemic .

The book includes a series of short chapters, structured in five sections that address the following themes:

This section looks at the COVID-19 moment through the lens of what we might learn from it, toward better addressing future pandemics. It tackles challenges we faced in our approach to testing, our successes and shortcomings in implementing contact tracing, the intersection of the pandemic and mass incarceration, and more. Many of these lessons emerged organically from the day-to-day experience of the pandemic, reflecting “unknown unknowns”—areas where we encountered unexpected deficits in our knowledge, which were revealed by the circumstances of the pandemic. Chapter 8, for example, explores the necessity of public health officials speaking with care, mindful that our words may be used to justify authoritarian approaches in the name of health, a challenge we saw in the actions of the Chinese government during the pandemic.

Our understanding of large-scale health challenges like pandemics depends on more than collections of data and a timeline of events. It depends on our stories. The narratives we accept about the pandemic will do much to shape our ability to create a healthier world before the next contagion strikes. This section explores the stories we told during COVID-19 about what was happening to us and looks ahead to the narratives that will likely define our recollections of the pandemic moment. It addresses narratives around the virtues and limits of expertise, the role of the media as both a shaper of stories and a character in them, the hotly contested narrative around vaccines, and the role scientists, physicians, and epidemiologists played in shaping the story of the pandemic as it unfolded.

This section explores how our values informed what we did during COVID-19 through the ethical considerations that shaped our engagement with the moment. These include the ethical tradeoffs involved in questions of digital surveillance, scientific bias, vaccine mandates, balancing individual autonomy and collective responsibility, and the role of the profit motive in creating critical treatments. At times, these reflections reach back into history, grappling with past moments when we failed in our ethical obligations to support the health of all, as in a chapter discussing how the legacy of medical racism shaped our engagement with communities of color during the pandemic. Such soul-searching is core to our ability to evaluate our performance during COVID-19 and face the future grounded in the values that support effective, ethical public health action.

As human beings, we do not process events through reason alone. We are deeply swayed by emotion . This is particularly true in times of tragedy like COVID-19. Understanding the pandemic, and learning from it, means coming to terms with the emotions of that time, the feelings that attended all we did. Grief and loss, humility and hope, trust and mistrust , compassion and fear —both individual and collective—were all core to the experience of the pandemic. The simple act of recognizing our collective grief, as several chapters in this section try to do, can help us move forward, acknowledging the emotions that attend tragedy as we work toward a better world.

To think comprehensively about COVID-19 is to think not just about the past but about the future. We seek to understand the pandemic to prevent something like it from ever happening again. This means creating a world that is fundamentally healthier than the one that existed in 2019. This final section looks to the future from the perspective of the COVID-19 moment, with an eye toward using the lessons of that time to create a healthier world, as in Chapter 50, which addresses the challenge of rebuilding trust in public health institutions after it was tested during the pandemic. The section also touches on leadership and decision-making, shaping a better health system, shoring up our investment in health, the future of remote work, and next steps in our efforts to support health in the years to come.

I end with a note of gratitude to Michael Stein, who led on the development of this book. It is, as always, a privilege to work with him and learn from him. I look forward to continued collaborations in the months and years to come, and to hearing from readers of The Turning Point as we engage in our collective task of building a healthier world, informed by what we have lived through and looking to the future.

A version of this essay appeared on Substack.

Sandro Galea, M.D., is the Robert A. Knox professor and dean of the Boston University School of Public Health

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Covid 19 Essay in English

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

100 Words Essay on Covid 19

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

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

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

My Experience of COVID-19

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

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

Effects of CoronaVirus on Education

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

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

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

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

Effects of CoronaVirus on Economy

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

Effects of CoronaVirus on Health

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

Explore Career Options (By Industry)

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Data Administrator

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

Bio Medical Engineer

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

Ethical Hacker

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

GIS officer work on various GIS software to conduct a study and gather spatial and non-spatial information. GIS experts update the GIS data and maintain it. The databases include aerial or satellite imagery, latitudinal and longitudinal coordinates, and manually digitized images of maps. In a career as GIS expert, one is responsible for creating online and mobile maps.

Data Analyst

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

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

Geothermal Engineer

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

Database Architect

If you are intrigued by the programming world and are interested in developing communications networks then a career as database architect may be a good option for you. Data architect roles and responsibilities include building design models for data communication networks. Wide Area Networks (WANs), local area networks (LANs), and intranets are included in the database networks. It is expected that database architects will have in-depth knowledge of a company's business to develop a network to fulfil the requirements of the organisation. Stay tuned as we look at the larger picture and give you more information on what is db architecture, why you should pursue database architecture, what to expect from such a degree and what your job opportunities will be after graduation. Here, we will be discussing how to become a data architect. Students can visit NIT Trichy , IIT Kharagpur , JMI New Delhi .

Remote Sensing Technician

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

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

Budget Analyst

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

Underwriter

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

Finance Executive

Product manager.

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

Operations Manager

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

Stock Analyst

Individuals who opt for a career as a stock analyst examine the company's investments makes decisions and keep track of financial securities. The nature of such investments will differ from one business to the next. Individuals in the stock analyst career use data mining to forecast a company's profits and revenues, advise clients on whether to buy or sell, participate in seminars, and discussing financial matters with executives and evaluate annual reports.

A Researcher is a professional who is responsible for collecting data and information by reviewing the literature and conducting experiments and surveys. He or she uses various methodological processes to provide accurate data and information that is utilised by academicians and other industry professionals. Here, we will discuss what is a researcher, the researcher's salary, types of researchers.

Welding Engineer

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

Transportation Planner

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

Environmental Engineer

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

Safety Manager

A Safety Manager is a professional responsible for employee’s safety at work. He or she plans, implements and oversees the company’s employee safety. A Safety Manager ensures compliance and adherence to Occupational Health and Safety (OHS) guidelines.

Conservation Architect

A Conservation Architect is a professional responsible for conserving and restoring buildings or monuments having a historic value. He or she applies techniques to document and stabilise the object’s state without any further damage. A Conservation Architect restores the monuments and heritage buildings to bring them back to their original state.

Structural Engineer

A Structural Engineer designs buildings, bridges, and other related structures. He or she analyzes the structures and makes sure the structures are strong enough to be used by the people. A career as a Structural Engineer requires working in the construction process. It comes under the civil engineering discipline. A Structure Engineer creates structural models with the help of computer-aided design software.

Highway Engineer

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

Field Surveyor

Are you searching for a Field Surveyor Job Description? A Field Surveyor is a professional responsible for conducting field surveys for various places or geographical conditions. He or she collects the required data and information as per the instructions given by senior officials.

Orthotist and Prosthetist

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

Pathologist

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

Veterinary Doctor

Speech therapist, gynaecologist.

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

Audiologist

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

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

Are you searching for an ‘Anatomist job description’? An Anatomist is a research professional who applies the laws of biological science to determine the ability of bodies of various living organisms including animals and humans to regenerate the damaged or destroyed organs. If you want to know what does an anatomist do, then read the entire article, where we will answer all your questions.

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

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

Video Game Designer

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

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

Radio Jockey

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

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Choreographer

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

Social Media Manager

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

Photographer

Photography is considered both a science and an art, an artistic means of expression in which the camera replaces the pen. In a career as a photographer, an individual is hired to capture the moments of public and private events, such as press conferences or weddings, or may also work inside a studio, where people go to get their picture clicked. Photography is divided into many streams each generating numerous career opportunities in photography. With the boom in advertising, media, and the fashion industry, photography has emerged as a lucrative and thrilling career option for many Indian youths.

An individual who is pursuing a career as a producer is responsible for managing the business aspects of production. They are involved in each aspect of production from its inception to deception. Famous movie producers review the script, recommend changes and visualise the story.

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Copy Writer

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

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

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

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

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

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

Individuals who opt for a career as a reporter may often be at work on national holidays and festivities. He or she pitches various story ideas and covers news stories in risky situations. Students can pursue a BMC (Bachelor of Mass Communication) , B.M.M. (Bachelor of Mass Media) , or MAJMC (MA in Journalism and Mass Communication) to become a reporter. While we sit at home reporters travel to locations to collect information that carries a news value.

Corporate Executive

Are you searching for a Corporate Executive job description? A Corporate Executive role comes with administrative duties. He or she provides support to the leadership of the organisation. A Corporate Executive fulfils the business purpose and ensures its financial stability. In this article, we are going to discuss how to become corporate executive.

Multimedia Specialist

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

Quality Controller

A quality controller plays a crucial role in an organisation. He or she is responsible for performing quality checks on manufactured products. He or she identifies the defects in a product and rejects the product.

A quality controller records detailed information about products with defects and sends it to the supervisor or plant manager to take necessary actions to improve the production process.

Production Manager

A QA Lead is in charge of the QA Team. The role of QA Lead comes with the responsibility of assessing services and products in order to determine that he or she meets the quality standards. He or she develops, implements and manages test plans.

Process Development Engineer

The Process Development Engineers design, implement, manufacture, mine, and other production systems using technical knowledge and expertise in the industry. They use computer modeling software to test technologies and machinery. An individual who is opting career as Process Development Engineer is responsible for developing cost-effective and efficient processes. They also monitor the production process and ensure it functions smoothly and efficiently.

AWS Solution Architect

An AWS Solution Architect is someone who specializes in developing and implementing cloud computing systems. He or she has a good understanding of the various aspects of cloud computing and can confidently deploy and manage their systems. He or she troubleshoots the issues and evaluates the risk from the third party.

Azure Administrator

An Azure Administrator is a professional responsible for implementing, monitoring, and maintaining Azure Solutions. He or she manages cloud infrastructure service instances and various cloud servers as well as sets up public and private cloud systems.

Computer Programmer

Careers in computer programming primarily refer to the systematic act of writing code and moreover include wider computer science areas. The word 'programmer' or 'coder' has entered into practice with the growing number of newly self-taught tech enthusiasts. Computer programming careers involve the use of designs created by software developers and engineers and transforming them into commands that can be implemented by computers. These commands result in regular usage of social media sites, word-processing applications and browsers.

Information Security Manager

Individuals in the information security manager career path involves in overseeing and controlling all aspects of computer security. The IT security manager job description includes planning and carrying out security measures to protect the business data and information from corruption, theft, unauthorised access, and deliberate attack

ITSM Manager

Automation test engineer.

An Automation Test Engineer job involves executing automated test scripts. He or she identifies the project’s problems and troubleshoots them. The role involves documenting the defect using management tools. He or she works with the application team in order to resolve any issues arising during the testing process.

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Coronavirus disease (covid-19): key tips and discussion points for community workers and volunteers.

Social mobilizers, community workers and volunteers have an important role in providing timely and actionable health information so that people know how to protect themselves and reduce the risks associated with the coronavirus disease 2019 (COVID-19). These tips for community engagement – from UNICEF, the World Health Organization (WHO) and the International Federation of Red Cross and Red Crescent Societies (IFRC) – were last updated in March 2020.

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Research article
Open access
Published: 04 June 2021

Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews

Israel Júnior Borges do Nascimento 1 , 2 ,
Dónal P. O’Mathúna 3 , 4 ,
Thilo Caspar von Groote 5 ,
Hebatullah Mohamed Abdulazeem 6 ,
Ishanka Weerasekara 7 , 8 ,
Ana Marusic 9 ,
Livia Puljak ORCID: orcid.org/0000-0002-8467-6061 10 ,
Vinicius Tassoni Civile 11 ,
Irena Zakarija-Grkovic 9 ,
Tina Poklepovic Pericic 9 ,
Alvaro Nagib Atallah 11 ,
Santino Filoso 12 ,
Nicola Luigi Bragazzi 13 &
Milena Soriano Marcolino 1

On behalf of the International Network of Coronavirus Disease 2019 (InterNetCOVID-19)

BMC Infectious Diseases volume 21 , Article number: 525 ( 2021 ) Cite this article

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Navigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging, and ongoing critical appraisal of this output is essential. We aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic.

Nine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO’s Global Research, LILACS, and Epistemonikos) were searched from December 1, 2019, to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory, and radiological findings), and quality assessment (AMSTAR 2). A meta-analysis was performed of the prevalence of clinical outcomes.

Eighteen systematic reviews were included; one was empty (did not identify any relevant study). Using AMSTAR 2, confidence in the results of all 18 reviews was rated as “critically low”. Identified symptoms of COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%) and gastrointestinal complaints (5–9%). Severe symptoms were more common in men. Elevated C-reactive protein and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. A frequent finding on chest imaging was uni- or bilateral multilobar ground-glass opacity. A single review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3 to 13.9%.

Conclusions

In this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic were of questionable usefulness. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards.

Peer Review reports

The spread of the “Severe Acute Respiratory Coronavirus 2” (SARS-CoV-2), the causal agent of COVID-19, was characterized as a pandemic by the World Health Organization (WHO) in March 2020 and has triggered an international public health emergency [ 1 ]. The numbers of confirmed cases and deaths due to COVID-19 are rapidly escalating, counting in millions [ 2 ], causing massive economic strain, and escalating healthcare and public health expenses [ 3 , 4 ].

The research community has responded by publishing an impressive number of scientific reports related to COVID-19. The world was alerted to the new disease at the beginning of 2020 [ 1 ], and by mid-March 2020, more than 2000 articles had been published on COVID-19 in scholarly journals, with 25% of them containing original data [ 5 ]. The living map of COVID-19 evidence, curated by the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), contained more than 40,000 records by February 2021 [ 6 ]. More than 100,000 records on PubMed were labeled as “SARS-CoV-2 literature, sequence, and clinical content” by February 2021 [ 7 ].

Due to publication speed, the research community has voiced concerns regarding the quality and reproducibility of evidence produced during the COVID-19 pandemic, warning of the potential damaging approach of “publish first, retract later” [ 8 ]. It appears that these concerns are not unfounded, as it has been reported that COVID-19 articles were overrepresented in the pool of retracted articles in 2020 [ 9 ]. These concerns about inadequate evidence are of major importance because they can lead to poor clinical practice and inappropriate policies [ 10 ].

Systematic reviews are a cornerstone of today’s evidence-informed decision-making. By synthesizing all relevant evidence regarding a particular topic, systematic reviews reflect the current scientific knowledge. Systematic reviews are considered to be at the highest level in the hierarchy of evidence and should be used to make informed decisions. However, with high numbers of systematic reviews of different scope and methodological quality being published, overviews of multiple systematic reviews that assess their methodological quality are essential [ 11 , 12 , 13 ]. An overview of systematic reviews helps identify and organize the literature and highlights areas of priority in decision-making.

In this overview of systematic reviews, we aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic.

Methodology

Research question.

This overview’s primary objective was to summarize and critically appraise systematic reviews that assessed any type of primary clinical data from patients infected with SARS-CoV-2. Our research question was purposefully broad because we wanted to analyze as many systematic reviews as possible that were available early following the COVID-19 outbreak.

Study design

We conducted an overview of systematic reviews. The idea for this overview originated in a protocol for a systematic review submitted to PROSPERO (CRD42020170623), which indicated a plan to conduct an overview.

Overviews of systematic reviews use explicit and systematic methods for searching and identifying multiple systematic reviews addressing related research questions in the same field to extract and analyze evidence across important outcomes. Overviews of systematic reviews are in principle similar to systematic reviews of interventions, but the unit of analysis is a systematic review [ 14 , 15 , 16 ].

We used the overview methodology instead of other evidence synthesis methods to allow us to collate and appraise multiple systematic reviews on this topic, and to extract and analyze their results across relevant topics [ 17 ]. The overview and meta-analysis of systematic reviews allowed us to investigate the methodological quality of included studies, summarize results, and identify specific areas of available or limited evidence, thereby strengthening the current understanding of this novel disease and guiding future research [ 13 ].

A reporting guideline for overviews of reviews is currently under development, i.e., Preferred Reporting Items for Overviews of Reviews (PRIOR) [ 18 ]. As the PRIOR checklist is still not published, this study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 statement [ 19 ]. The methodology used in this review was adapted from the Cochrane Handbook for Systematic Reviews of Interventions and also followed established methodological considerations for analyzing existing systematic reviews [ 14 ].

Approval of a research ethics committee was not necessary as the study analyzed only publicly available articles.

Eligibility criteria

Systematic reviews were included if they analyzed primary data from patients infected with SARS-CoV-2 as confirmed by RT-PCR or another pre-specified diagnostic technique. Eligible reviews covered all topics related to COVID-19 including, but not limited to, those that reported clinical symptoms, diagnostic methods, therapeutic interventions, laboratory findings, or radiological results. Both full manuscripts and abbreviated versions, such as letters, were eligible.

No restrictions were imposed on the design of the primary studies included within the systematic reviews, the last search date, whether the review included meta-analyses or language. Reviews related to SARS-CoV-2 and other coronaviruses were eligible, but from those reviews, we analyzed only data related to SARS-CoV-2.

No consensus definition exists for a systematic review [ 20 ], and debates continue about the defining characteristics of a systematic review [ 21 ]. Cochrane’s guidance for overviews of reviews recommends setting pre-established criteria for making decisions around inclusion [ 14 ]. That is supported by a recent scoping review about guidance for overviews of systematic reviews [ 22 ].

Thus, for this study, we defined a systematic review as a research report which searched for primary research studies on a specific topic using an explicit search strategy, had a detailed description of the methods with explicit inclusion criteria provided, and provided a summary of the included studies either in narrative or quantitative format (such as a meta-analysis). Cochrane and non-Cochrane systematic reviews were considered eligible for inclusion, with or without meta-analysis, and regardless of the study design, language restriction and methodology of the included primary studies. To be eligible for inclusion, reviews had to be clearly analyzing data related to SARS-CoV-2 (associated or not with other viruses). We excluded narrative reviews without those characteristics as these are less likely to be replicable and are more prone to bias.

Scoping reviews and rapid reviews were eligible for inclusion in this overview if they met our pre-defined inclusion criteria noted above. We included reviews that addressed SARS-CoV-2 and other coronaviruses if they reported separate data regarding SARS-CoV-2.

Information sources

Nine databases were searched for eligible records published between December 1, 2019, and March 24, 2020: Cochrane Database of Systematic Reviews via Cochrane Library, PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Sciences, LILACS (Latin American and Caribbean Health Sciences Literature), PDQ-Evidence, WHO’s Global Research on Coronavirus Disease (COVID-19), and Epistemonikos.

The comprehensive search strategy for each database is provided in Additional file 1 and was designed and conducted in collaboration with an information specialist. All retrieved records were primarily processed in EndNote, where duplicates were removed, and records were then imported into the Covidence platform [ 23 ]. In addition to database searches, we screened reference lists of reviews included after screening records retrieved via databases.

Study selection

All searches, screening of titles and abstracts, and record selection, were performed independently by two investigators using the Covidence platform [ 23 ]. Articles deemed potentially eligible were retrieved for full-text screening carried out independently by two investigators. Discrepancies at all stages were resolved by consensus. During the screening, records published in languages other than English were translated by a native/fluent speaker.

Data collection process

We custom designed a data extraction table for this study, which was piloted by two authors independently. Data extraction was performed independently by two authors. Conflicts were resolved by consensus or by consulting a third researcher.

We extracted the following data: article identification data (authors’ name and journal of publication), search period, number of databases searched, population or settings considered, main results and outcomes observed, and number of participants. From Web of Science (Clarivate Analytics, Philadelphia, PA, USA), we extracted journal rank (quartile) and Journal Impact Factor (JIF).

We categorized the following as primary outcomes: all-cause mortality, need for and length of mechanical ventilation, length of hospitalization (in days), admission to intensive care unit (yes/no), and length of stay in the intensive care unit.

The following outcomes were categorized as exploratory: diagnostic methods used for detection of the virus, male to female ratio, clinical symptoms, pharmacological and non-pharmacological interventions, laboratory findings (full blood count, liver enzymes, C-reactive protein, d-dimer, albumin, lipid profile, serum electrolytes, blood vitamin levels, glucose levels, and any other important biomarkers), and radiological findings (using radiography, computed tomography, magnetic resonance imaging or ultrasound).

We also collected data on reporting guidelines and requirements for the publication of systematic reviews and meta-analyses from journal websites where included reviews were published.

Quality assessment in individual reviews

Two researchers independently assessed the reviews’ quality using the “A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2)”. We acknowledge that the AMSTAR 2 was created as “a critical appraisal tool for systematic reviews that include randomized or non-randomized studies of healthcare interventions, or both” [ 24 ]. However, since AMSTAR 2 was designed for systematic reviews of intervention trials, and we included additional types of systematic reviews, we adjusted some AMSTAR 2 ratings and reported these in Additional file 2 .

Adherence to each item was rated as follows: yes, partial yes, no, or not applicable (such as when a meta-analysis was not conducted). The overall confidence in the results of the review is rated as “critically low”, “low”, “moderate” or “high”, according to the AMSTAR 2 guidance based on seven critical domains, which are items 2, 4, 7, 9, 11, 13, 15 as defined by AMSTAR 2 authors [ 24 ]. We reported our adherence ratings for transparency of our decision with accompanying explanations, for each item, in each included review.

One of the included systematic reviews was conducted by some members of this author team [ 25 ]. This review was initially assessed independently by two authors who were not co-authors of that review to prevent the risk of bias in assessing this study.

Synthesis of results

For data synthesis, we prepared a table summarizing each systematic review. Graphs illustrating the mortality rate and clinical symptoms were created. We then prepared a narrative summary of the methods, findings, study strengths, and limitations.

For analysis of the prevalence of clinical outcomes, we extracted data on the number of events and the total number of patients to perform proportional meta-analysis using RStudio© software, with the “meta” package (version 4.9–6), using the “metaprop” function for reviews that did not perform a meta-analysis, excluding case studies because of the absence of variance. For reviews that did not perform a meta-analysis, we presented pooled results of proportions with their respective confidence intervals (95%) by the inverse variance method with a random-effects model, using the DerSimonian-Laird estimator for τ 2 . We adjusted data using Freeman-Tukey double arcosen transformation. Confidence intervals were calculated using the Clopper-Pearson method for individual studies. We created forest plots using the RStudio© software, with the “metafor” package (version 2.1–0) and “forest” function.

Managing overlapping systematic reviews

Some of the included systematic reviews that address the same or similar research questions may include the same primary studies in overviews. Including such overlapping reviews may introduce bias when outcome data from the same primary study are included in the analyses of an overview multiple times. Thus, in summaries of evidence, multiple-counting of the same outcome data will give data from some primary studies too much influence [ 14 ]. In this overview, we did not exclude overlapping systematic reviews because, according to Cochrane’s guidance, it may be appropriate to include all relevant reviews’ results if the purpose of the overview is to present and describe the current body of evidence on a topic [ 14 ]. To avoid any bias in summary estimates associated with overlapping reviews, we generated forest plots showing data from individual systematic reviews, but the results were not pooled because some primary studies were included in multiple reviews.

Our search retrieved 1063 publications, of which 175 were duplicates. Most publications were excluded after the title and abstract analysis ( n = 860). Among the 28 studies selected for full-text screening, 10 were excluded for the reasons described in Additional file 3 , and 18 were included in the final analysis (Fig. 1 ) [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Reference list screening did not retrieve any additional systematic reviews.

PRISMA flow diagram

Characteristics of included reviews

Summary features of 18 systematic reviews are presented in Table 1 . They were published in 14 different journals. Only four of these journals had specific requirements for systematic reviews (with or without meta-analysis): European Journal of Internal Medicine, Journal of Clinical Medicine, Ultrasound in Obstetrics and Gynecology, and Clinical Research in Cardiology . Two journals reported that they published only invited reviews ( Journal of Medical Virology and Clinica Chimica Acta ). Three systematic reviews in our study were published as letters; one was labeled as a scoping review and another as a rapid review (Table 2 ).

All reviews were published in English, in first quartile (Q1) journals, with JIF ranging from 1.692 to 6.062. One review was empty, meaning that its search did not identify any relevant studies; i.e., no primary studies were included [ 36 ]. The remaining 17 reviews included 269 unique studies; the majority ( N = 211; 78%) were included in only a single review included in our study (range: 1 to 12). Primary studies included in the reviews were published between December 2019 and March 18, 2020, and comprised case reports, case series, cohorts, and other observational studies. We found only one review that included randomized clinical trials [ 38 ]. In the included reviews, systematic literature searches were performed from 2019 (entire year) up to March 9, 2020. Ten systematic reviews included meta-analyses. The list of primary studies found in the included systematic reviews is shown in Additional file 4 , as well as the number of reviews in which each primary study was included.

Population and study designs

Most of the reviews analyzed data from patients with COVID-19 who developed pneumonia, acute respiratory distress syndrome (ARDS), or any other correlated complication. One review aimed to evaluate the effectiveness of using surgical masks on preventing transmission of the virus [ 36 ], one review was focused on pediatric patients [ 34 ], and one review investigated COVID-19 in pregnant women [ 37 ]. Most reviews assessed clinical symptoms, laboratory findings, or radiological results.

Systematic review findings

The summary of findings from individual reviews is shown in Table 2 . Overall, all-cause mortality ranged from 0.3 to 13.9% (Fig. 2 ).

A meta-analysis of the prevalence of mortality

Clinical symptoms

Seven reviews described the main clinical manifestations of COVID-19 [ 26 , 28 , 29 , 34 , 35 , 39 , 41 ]. Three of them provided only a narrative discussion of symptoms [ 26 , 34 , 35 ]. In the reviews that performed a statistical analysis of the incidence of different clinical symptoms, symptoms in patients with COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%), gastrointestinal disorders, such as diarrhea, nausea or vomiting (5.0–9.0%), and others (including, in one study only: dizziness 12.1%) (Figs. 3 , 4 , 5 , 6 , 7 , 8 and 9 ). Three reviews assessed cough with and without sputum together; only one review assessed sputum production itself (28.5%).

A meta-analysis of the prevalence of fever

A meta-analysis of the prevalence of cough

A meta-analysis of the prevalence of dyspnea

A meta-analysis of the prevalence of fatigue or myalgia

A meta-analysis of the prevalence of headache

A meta-analysis of the prevalence of gastrointestinal disorders

A meta-analysis of the prevalence of sore throat

Diagnostic aspects

Three reviews described methodologies, protocols, and tools used for establishing the diagnosis of COVID-19 [ 26 , 34 , 38 ]. The use of respiratory swabs (nasal or pharyngeal) or blood specimens to assess the presence of SARS-CoV-2 nucleic acid using RT-PCR assays was the most commonly used diagnostic method mentioned in the included studies. These diagnostic tests have been widely used, but their precise sensitivity and specificity remain unknown. One review included a Chinese study with clinical diagnosis with no confirmation of SARS-CoV-2 infection (patients were diagnosed with COVID-19 if they presented with at least two symptoms suggestive of COVID-19, together with laboratory and chest radiography abnormalities) [ 34 ].

Therapeutic possibilities

Pharmacological and non-pharmacological interventions (supportive therapies) used in treating patients with COVID-19 were reported in five reviews [ 25 , 27 , 34 , 35 , 38 ]. Antivirals used empirically for COVID-19 treatment were reported in seven reviews [ 25 , 27 , 34 , 35 , 37 , 38 , 41 ]; most commonly used were protease inhibitors (lopinavir, ritonavir, darunavir), nucleoside reverse transcriptase inhibitor (tenofovir), nucleotide analogs (remdesivir, galidesivir, ganciclovir), and neuraminidase inhibitors (oseltamivir). Umifenovir, a membrane fusion inhibitor, was investigated in two studies [ 25 , 35 ]. Possible supportive interventions analyzed were different types of oxygen supplementation and breathing support (invasive or non-invasive ventilation) [ 25 ]. The use of antibiotics, both empirically and to treat secondary pneumonia, was reported in six studies [ 25 , 26 , 27 , 34 , 35 , 38 ]. One review specifically assessed evidence on the efficacy and safety of the anti-malaria drug chloroquine [ 27 ]. It identified 23 ongoing trials investigating the potential of chloroquine as a therapeutic option for COVID-19, but no verifiable clinical outcomes data. The use of mesenchymal stem cells, antifungals, and glucocorticoids were described in four reviews [ 25 , 34 , 35 , 38 ].

Laboratory and radiological findings

Of the 18 reviews included in this overview, eight analyzed laboratory parameters in patients with COVID-19 [ 25 , 29 , 30 , 32 , 33 , 34 , 35 , 39 ]; elevated C-reactive protein levels, associated with lymphocytopenia, elevated lactate dehydrogenase, as well as slightly elevated aspartate and alanine aminotransferase (AST, ALT) were commonly described in those eight reviews. Lippi et al. assessed cardiac troponin I (cTnI) [ 25 ], procalcitonin [ 32 ], and platelet count [ 33 ] in COVID-19 patients. Elevated levels of procalcitonin [ 32 ] and cTnI [ 30 ] were more likely to be associated with a severe disease course (requiring intensive care unit admission and intubation). Furthermore, thrombocytopenia was frequently observed in patients with complicated COVID-19 infections [ 33 ].

Chest imaging (chest radiography and/or computed tomography) features were assessed in six reviews, all of which described a frequent pattern of local or bilateral multilobar ground-glass opacity [ 25 , 34 , 35 , 39 , 40 , 41 ]. Those six reviews showed that septal thickening, bronchiectasis, pleural and cardiac effusions, halo signs, and pneumothorax were observed in patients suffering from COVID-19.

Quality of evidence in individual systematic reviews

Table 3 shows the detailed results of the quality assessment of 18 systematic reviews, including the assessment of individual items and summary assessment. A detailed explanation for each decision in each review is available in Additional file 5 .

Using AMSTAR 2 criteria, confidence in the results of all 18 reviews was rated as “critically low” (Table 3 ). Common methodological drawbacks were: omission of prospective protocol submission or publication; use of inappropriate search strategy: lack of independent and dual literature screening and data-extraction (or methodology unclear); absence of an explanation for heterogeneity among the studies included; lack of reasons for study exclusion (or rationale unclear).

Risk of bias assessment, based on a reported methodological tool, and quality of evidence appraisal, in line with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method, were reported only in one review [ 25 ]. Five reviews presented a table summarizing bias, using various risk of bias tools [ 25 , 29 , 39 , 40 , 41 ]. One review analyzed “study quality” [ 37 ]. One review mentioned the risk of bias assessment in the methodology but did not provide any related analysis [ 28 ].

This overview of systematic reviews analyzed the first 18 systematic reviews published after the onset of the COVID-19 pandemic, up to March 24, 2020, with primary studies involving more than 60,000 patients. Using AMSTAR-2, we judged that our confidence in all those reviews was “critically low”. Ten reviews included meta-analyses. The reviews presented data on clinical manifestations, laboratory and radiological findings, and interventions. We found no systematic reviews on the utility of diagnostic tests.

Symptoms were reported in seven reviews; most of the patients had a fever, cough, dyspnea, myalgia or muscle fatigue, and gastrointestinal disorders such as diarrhea, nausea, or vomiting. Olfactory dysfunction (anosmia or dysosmia) has been described in patients infected with COVID-19 [ 43 ]; however, this was not reported in any of the reviews included in this overview. During the SARS outbreak in 2002, there were reports of impairment of the sense of smell associated with the disease [ 44 , 45 ].

The reported mortality rates ranged from 0.3 to 14% in the included reviews. Mortality estimates are influenced by the transmissibility rate (basic reproduction number), availability of diagnostic tools, notification policies, asymptomatic presentations of the disease, resources for disease prevention and control, and treatment facilities; variability in the mortality rate fits the pattern of emerging infectious diseases [ 46 ]. Furthermore, the reported cases did not consider asymptomatic cases, mild cases where individuals have not sought medical treatment, and the fact that many countries had limited access to diagnostic tests or have implemented testing policies later than the others. Considering the lack of reviews assessing diagnostic testing (sensitivity, specificity, and predictive values of RT-PCT or immunoglobulin tests), and the preponderance of studies that assessed only symptomatic individuals, considerable imprecision around the calculated mortality rates existed in the early stage of the COVID-19 pandemic.

Few reviews included treatment data. Those reviews described studies considered to be at a very low level of evidence: usually small, retrospective studies with very heterogeneous populations. Seven reviews analyzed laboratory parameters; those reviews could have been useful for clinicians who attend patients suspected of COVID-19 in emergency services worldwide, such as assessing which patients need to be reassessed more frequently.

All systematic reviews scored poorly on the AMSTAR 2 critical appraisal tool for systematic reviews. Most of the original studies included in the reviews were case series and case reports, impacting the quality of evidence. Such evidence has major implications for clinical practice and the use of these reviews in evidence-based practice and policy. Clinicians, patients, and policymakers can only have the highest confidence in systematic review findings if high-quality systematic review methodologies are employed. The urgent need for information during a pandemic does not justify poor quality reporting.

We acknowledge that there are numerous challenges associated with analyzing COVID-19 data during a pandemic [ 47 ]. High-quality evidence syntheses are needed for decision-making, but each type of evidence syntheses is associated with its inherent challenges.

The creation of classic systematic reviews requires considerable time and effort; with massive research output, they quickly become outdated, and preparing updated versions also requires considerable time. A recent study showed that updates of non-Cochrane systematic reviews are published a median of 5 years after the publication of the previous version [ 48 ].

Authors may register a review and then abandon it [ 49 ], but the existence of a public record that is not updated may lead other authors to believe that the review is still ongoing. A quarter of Cochrane review protocols remains unpublished as completed systematic reviews 8 years after protocol publication [ 50 ].

Rapid reviews can be used to summarize the evidence, but they involve methodological sacrifices and simplifications to produce information promptly, with inconsistent methodological approaches [ 51 ]. However, rapid reviews are justified in times of public health emergencies, and even Cochrane has resorted to publishing rapid reviews in response to the COVID-19 crisis [ 52 ]. Rapid reviews were eligible for inclusion in this overview, but only one of the 18 reviews included in this study was labeled as a rapid review.

Ideally, COVID-19 evidence would be continually summarized in a series of high-quality living systematic reviews, types of evidence synthesis defined as “ a systematic review which is continually updated, incorporating relevant new evidence as it becomes available ” [ 53 ]. However, conducting living systematic reviews requires considerable resources, calling into question the sustainability of such evidence synthesis over long periods [ 54 ].

Research reports about COVID-19 will contribute to research waste if they are poorly designed, poorly reported, or simply not necessary. In principle, systematic reviews should help reduce research waste as they usually provide recommendations for further research that is needed or may advise that sufficient evidence exists on a particular topic [ 55 ]. However, systematic reviews can also contribute to growing research waste when they are not needed, or poorly conducted and reported. Our present study clearly shows that most of the systematic reviews that were published early on in the COVID-19 pandemic could be categorized as research waste, as our confidence in their results is critically low.

Our study has some limitations. One is that for AMSTAR 2 assessment we relied on information available in publications; we did not attempt to contact study authors for clarifications or additional data. In three reviews, the methodological quality appraisal was challenging because they were published as letters, or labeled as rapid communications. As a result, various details about their review process were not included, leading to AMSTAR 2 questions being answered as “not reported”, resulting in low confidence scores. Full manuscripts might have provided additional information that could have led to higher confidence in the results. In other words, low scores could reflect incomplete reporting, not necessarily low-quality review methods. To make their review available more rapidly and more concisely, the authors may have omitted methodological details. A general issue during a crisis is that speed and completeness must be balanced. However, maintaining high standards requires proper resourcing and commitment to ensure that the users of systematic reviews can have high confidence in the results.

Furthermore, we used adjusted AMSTAR 2 scoring, as the tool was designed for critical appraisal of reviews of interventions. Some reviews may have received lower scores than actually warranted in spite of these adjustments.

Another limitation of our study may be the inclusion of multiple overlapping reviews, as some included reviews included the same primary studies. According to the Cochrane Handbook, including overlapping reviews may be appropriate when the review’s aim is “ to present and describe the current body of systematic review evidence on a topic ” [ 12 ], which was our aim. To avoid bias with summarizing evidence from overlapping reviews, we presented the forest plots without summary estimates. The forest plots serve to inform readers about the effect sizes for outcomes that were reported in each review.

Several authors from this study have contributed to one of the reviews identified [ 25 ]. To reduce the risk of any bias, two authors who did not co-author the review in question initially assessed its quality and limitations.

Finally, we note that the systematic reviews included in our overview may have had issues that our analysis did not identify because we did not analyze their primary studies to verify the accuracy of the data and information they presented. We give two examples to substantiate this possibility. Lovato et al. wrote a commentary on the review of Sun et al. [ 41 ], in which they criticized the authors’ conclusion that sore throat is rare in COVID-19 patients [ 56 ]. Lovato et al. highlighted that multiple studies included in Sun et al. did not accurately describe participants’ clinical presentations, warning that only three studies clearly reported data on sore throat [ 56 ].

In another example, Leung [ 57 ] warned about the review of Li, L.Q. et al. [ 29 ]: “ it is possible that this statistic was computed using overlapped samples, therefore some patients were double counted ”. Li et al. responded to Leung that it is uncertain whether the data overlapped, as they used data from published articles and did not have access to the original data; they also reported that they requested original data and that they plan to re-do their analyses once they receive them; they also urged readers to treat the data with caution [ 58 ]. This points to the evolving nature of evidence during a crisis.

Our study’s strength is that this overview adds to the current knowledge by providing a comprehensive summary of all the evidence synthesis about COVID-19 available early after the onset of the pandemic. This overview followed strict methodological criteria, including a comprehensive and sensitive search strategy and a standard tool for methodological appraisal of systematic reviews.

In conclusion, in this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all the reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic could be categorized as research waste. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards to provide patients, clinicians, and decision-makers trustworthy evidence.

Availability of data and materials

All data collected and analyzed within this study are available from the corresponding author on reasonable request.

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Acknowledgments

We thank Catherine Henderson DPhil from Swanscoe Communications for pro bono medical writing and editing support. We acknowledge support from the Covidence Team, specifically Anneliese Arno. We thank the whole International Network of Coronavirus Disease 2019 (InterNetCOVID-19) for their commitment and involvement. Members of the InterNetCOVID-19 are listed in Additional file 6 . We thank Pavel Cerny and Roger Crosthwaite for guiding the team supervisor (IJBN) on human resources management.

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Israel Júnior Borges do Nascimento

Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, College of Nursing, The Ohio State University, Columbus, OH, USA

Dónal P. O’Mathúna

School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland

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Thilo Caspar von Groote

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Hebatullah Mohamed Abdulazeem

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Livia Puljak

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IJBN conceived the research idea and worked as a project coordinator. DPOM, TCVG, HMA, IW, AM, LP, VTC, IZG, TPP, ANA, SF, NLB and MSM were involved in data curation, formal analysis, investigation, methodology, and initial draft writing. All authors revised the manuscript critically for the content. The author(s) read and approved the final manuscript.

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Supplementary Information

Additional file 1: appendix 1..

Search strategies used in the study.

Additional file 2: Appendix 2.

Adjusted scoring of AMSTAR 2 used in this study for systematic reviews of studies that did not analyze interventions.

Additional file 3: Appendix 3.

List of excluded studies, with reasons.

Additional file 4: Appendix 4.

Table of overlapping studies, containing the list of primary studies included, their visual overlap in individual systematic reviews, and the number in how many reviews each primary study was included.

Additional file 5: Appendix 5.

A detailed explanation of AMSTAR scoring for each item in each review.

Additional file 6: Appendix 6.

List of members and affiliates of International Network of Coronavirus Disease 2019 (InterNetCOVID-19).

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Borges do Nascimento, I.J., O’Mathúna, D.P., von Groote, T.C. et al. Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews. BMC Infect Dis 21 , 525 (2021). https://doi.org/10.1186/s12879-021-06214-4

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As a result of the COVID-19 (Coronavirus) outbreak, daily life has been negatively affected, impacting the worldwide economy. Thousands of individuals have been sickened or died as a result of the outbreak of this disease. When you have the flu or a viral infection, the most common symptoms include fever, cold, coughing up bone fragments, and difficulty breathing, which may progress to pneumonia. It’s important to take major steps like keeping a strict cleaning routine, keeping social distance, and wearing masks, among other things. This virus’s geographic spread is accelerating (Daniel Pg 93). Governments restricted public meetings during the start of the pandemic to prevent the disease from spreading and breaking the exponential distribution curve. In order to avoid the damage caused by this extremely contagious disease, several countries quarantined their citizens. However, this scenario had drastically altered with the discovery of the vaccinations. The research aims to investigate the effect of the Covid-19 epidemic and its impact on the population’s well-being.

There is growing interest in the relationship between social determinants of health and health outcomes. Still, many health care providers and academics have been hesitant to recognize racism as a contributing factor to racial health disparities. Only a few research have examined the health effects of institutional racism, with the majority focusing on interpersonal racial and ethnic prejudice Ciotti et al., Pg 370. The latter comprises historically and culturally connected institutions that are interconnected. Prejudice is being practiced in a variety of contexts as a result of the COVID-19 outbreak. In some ways, the outbreak has exposed pre-existing bias and inequity.

Thousands of businesses are in danger of failure. Around 2.3 billion of the world’s 3.3 billion employees are out of work. These workers are especially susceptible since they lack access to social security and adequate health care, and they’ve also given up ownership of productive assets, which makes them highly vulnerable. Many individuals lose their employment as a result of lockdowns, leaving them unable to support their families. People strapped for cash are often forced to reduce their caloric intake while also eating less nutritiously (Fraser et al, Pg 3). The epidemic has had an impact on the whole food chain, revealing vulnerabilities that were previously hidden. Border closures, trade restrictions, and confinement measures have limited farmer access to markets, while agricultural workers have not gathered crops. As a result, the local and global food supply chain has been disrupted, and people now have less access to healthy foods. As a consequence of the epidemic, many individuals have lost their employment, and millions more are now in danger. When breadwinners lose their jobs, become sick, or die, the food and nutrition of millions of people are endangered. Particularly severely hit are the world’s poorest small farmers and indigenous peoples.

Infectious illness outbreaks and epidemics have become worldwide threats due to globalization, urbanization, and environmental change. In developed countries like Europe and North America, surveillance and health systems monitor and manage the spread of infectious illnesses in real-time. Both low- and high-income countries need to improve their public health capacities (Omer et al., Pg 1767). These improvements should be financed using a mix of national and foreign donor money. In order to speed up research and reaction for new illnesses with pandemic potential, a global collaborative effort including governments and commercial companies has been proposed. When working on a vaccine-like COVID-19, cooperation is critical.

The epidemic has had an impact on the whole food chain, revealing vulnerabilities that were previously hidden. Border closures, trade restrictions, and confinement measures have limited farmer access to markets, while agricultural workers have been unable to gather crops. As a result, the local and global food supply chain has been disrupted, and people now have less access to healthy foods (Daniel et al.,Pg 95) . As a consequence of the epidemic, many individuals have lost their employment, and millions more are now in danger. When breadwinners lose their jobs, the food and nutrition of millions of people are endangered. Particularly severely hit are the world’s poorest small farmers and indigenous peoples.

While helping to feed the world’s population, millions of paid and unpaid agricultural laborers suffer from high levels of poverty, hunger, and bad health, as well as a lack of safety and labor safeguards, as well as other kinds of abuse at work. Poor people, who have no recourse to social assistance, must work longer and harder, sometimes in hazardous occupations, endangering their families in the process (Daniel Pg 96). When faced with a lack of income, people may turn to hazardous financial activities, including asset liquidation, predatory lending, or child labor, to make ends meet. Because of the dangers they encounter while traveling, working, and living abroad; migrant agricultural laborers are especially vulnerable. They also have a difficult time taking advantage of government assistance programs.

The pandemic also has a significant impact on education. Although many educational institutions across the globe have already made the switch to online learning, the extent to which technology is utilized to improve the quality of distance or online learning varies. This level is dependent on several variables, including the different parties engaged in the execution of this learning format and the incorporation of technology into educational institutions before the time of school closure caused by the COVID-19 pandemic. For many years, researchers from all around the globe have worked to determine what variables contribute to effective technology integration in the classroom Ciotti et al., Pg 371. The amount of technology usage and the quality of learning when moving from a classroom to a distant or online format are presumed to be influenced by the same set of variables. Findings from previous research, which sought to determine what affects educational systems ability to integrate technology into teaching, suggest understanding how teachers, students, and technology interact positively in order to achieve positive results in the integration of teaching technology (Honey et al., 2000). Teachers’ views on teaching may affect the chances of successfully incorporating technology into the classroom and making it a part of the learning process.

In conclusion, indeed, Covid 19 pandemic have affected the well being of the people in a significant manner. The economy operation across the globe have been destabilized as most of the people have been rendered jobless while the job operation has been stopped. As most of the people have been rendered jobless the living conditions of the people have also been significantly affected. Besides, the education sector has also been affected as most of the learning institutions prefer the use of online learning which is not effective as compared to the traditional method. With the invention of the vaccines, most of the developed countries have been noted to stabilize slowly, while the developing countries have not been able to vaccinate most of its citizens. However, despite the challenge caused by the pandemic, organizations have been able to adapt the new mode of online trading to be promoted.

Ciotti, Marco, et al. “The COVID-19 pandemic.” Critical reviews in clinical laboratory sciences 57.6 (2020): 365-388.

Daniel, John. “Education and the COVID-19 pandemic.” Prospects 49.1 (2020): 91-96.

Fraser, Nicholas, et al. “Preprinting the COVID-19 pandemic.” BioRxiv (2021): 2020-05.

Omer, Saad B., Preeti Malani, and Carlos Del Rio. “The COVID-19 pandemic in the US: a clinical update.” Jama 323.18 (2020): 1767-1768.

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About COVID-19

What is covid-19.

COVID-19 (coronavirus disease 2019) is a disease caused by a virus named SARS-CoV-2. It can be very contagious and spreads quickly. Over one million people have died from COVID-19 in the United States.

COVID-19 most often causes respiratory symptoms that can feel much like a cold, the flu, or pneumonia. COVID-19 may attack more than your lungs and respiratory system. Other parts of your body may also be affected by the disease. Most people with COVID-19 have mild symptoms, but some people become severely ill.

Some people including those with minor or no symptoms will develop Post-COVID Conditions – also called “Long COVID.”

How does COVID-19 spread?

COVID-19 spreads when an infected person breathes out droplets and very small particles that contain the virus. Other people can breathe in these droplets and particles, or these droplets and particles can land on their eyes, nose, or mouth. In some circumstances, these droplets may contaminate surfaces they touch.

Anyone infected with COVID-19 can spread it, even if they do NOT have symptoms.

The risk of animals spreading the virus that causes COVID-19 to people is low. The virus can spread from people to animals during close contact. People with suspected or confirmed COVID-19 should avoid contact with animals.

What are antibodies and how do they help protect me?

Antibodies are proteins your immune system makes to help fight infection and protect you from getting sick in the future. A positive antibody test result can help identify someone who has had COVID-19 in the past or has been vaccinated against COVID-19. Studies show that people who have antibodies from an infection with the virus that causes COVID-19 can improve their level of protection by getting vaccinated.

Who is at risk of severe illness from COVID-19?

Some people are more likely than others to get very sick if they get COVID-19. This includes people who are older , are immunocompromised (have a weakened immune system), have certain disabilities , or have underlying health conditions . Understanding your COVID-19 risk and the risks that might affect others can help you make decisions to protect yourself and others .

What are ways to prevent COVID-19?

There are many actions you can take to help protect you, your household, and your community from COVID-19. CDC’s Respiratory Virus Guidance provides actions you can take to help protect yourself and others from health risks caused by respiratory viruses, including COVID-19. These actions include steps you can take to lower the risk of COVID-19 transmission (catching and spreading COVID-19) and lower the risk of severe illness if you get sick.

CDC recommends that you

Stay up to date with COVID-19 vaccines
Practice good hygiene (practices that improve cleanliness)
Take steps for cleaner air
Stay home when sick
Seek health care promptly for testing and treatment when you are sick if you have risk factors for severe illness . Treatment may help lower your risk of severe illness.

Masks , physical distancing , and tests can provide additional layers of protection.

What are variants of COVID-19?

Viruses are constantly changing, including the virus that causes COVID-19. These changes occur over time and can lead to new strains of the virus or variants of COVID-19 . Slowing the spread of the virus, by protecting yourself and others , can help slow new variants from developing. CDC is working with state and local public health officials to monitor the spread of all variants, including Omicron.

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Open Access

Peer-reviewed

Research Article

Effect of face-covering use on adherence to other COVID-19 protective behaviours: A systematic review

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

Affiliation Behavioural Science and Insights Unit, UK Health Security Agency, London, United Kingdom

Roles Formal analysis, Visualization, Writing – original draft, Writing – review & editing

Roles Formal analysis, Project administration, Supervision, Visualization, Writing – review & editing

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Supervision, Writing – review & editing

* E-mail: [email protected]

Adam Millest,
Sidra Saeed,
Charles Symons,
Holly Carter

Published: April 11, 2024
https://doi.org/10.1371/journal.pone.0284629
Peer Review
Reader Comments

During the COVID-19 pandemic, concerns were raised that face covering use may elicit risk compensation; a false sense of security resulting in reduced adherence to other protective behaviours such as physical distancing. This systematic review aimed to investigate the effect of face covering use on adherence to other COVID-19 related protective behaviours. Medline, Embase, PsychInfo, EmCare, medRxiv preprints, Research Square and WHO COVID-19 Research Database were searched for all primary research studies published from 1 st January 2020 to 17 th May 2022 that investigated the effect of face covering use on adherence to other protective behaviours in public settings during the COVID-19 pandemic. Papers were selected and screened in accordance with the PRISMA framework. Backwards and forwards citation searches of included papers were also conducted on 16 th September 2022, with eligible papers published between 1 st January 2020 and that date being included. A quality appraisal including risk of bias was assessed using the Academy of Nutrition and Dietetics’ Quality Criteria Checklist. This review is registered on PROSPERO, number CRD42022331961. 47 papers were included, with quality ranging from low to high. These papers investigated the effects of face covering use and face covering policies on adherence to six categories of behaviour: physical distancing; mobility; face-touching; hand hygiene; close contacts; and generalised protective behaviour. Results reveal no consistent evidence for or against risk compensation, with findings varying according to behaviour and across study types, and therefore confident conclusions cannot be made. Any policy decisions related to face coverings must consider the inconsistencies and caveats in this evidence base.

Citation: Millest A, Saeed S, Symons C, Carter H (2024) Effect of face-covering use on adherence to other COVID-19 protective behaviours: A systematic review. PLoS ONE 19(4): e0284629. https://doi.org/10.1371/journal.pone.0284629

Editor: Wondwossen Amogne Degu, Addis Ababa University, College of Health Sciences, ETHIOPIA

Received: March 22, 2023; Accepted: March 23, 2024; Published: April 11, 2024

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

Data Availability: All data that were used for synthesis are available in the data extraction table. This table can be found in the file titled ' S3_Appendix ' in the Supporting information zip file. Please note that we did not have access to the original raw data for each individual study included in our review. The data that were synthesised in our analysis were extracted from the results sections of each paper.

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

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

1. Introduction

The COVID-19 pandemic highlighted the important role that public behaviour can play in the control of infectious disease. Prior to the introduction of vaccination, measures to control the spread of COVID-19 consisted primarily of non-pharmaceutical interventions (NPIs) (e.g., hand cleaning; reducing contact with others; staying at home), which included the use of face-coverings [ 1 ]. Over 160 governments mandated or recommended face-coverings during the pandemic [ 2 ], and their use was seen as crucial to controlling the spread of COVID-19.

At the onset of the pandemic however, concerns were raised that the use of face coverings may provide a false sense of security, leading to lower adherence to other protective measures such as hand hygiene and physical distancing; a phenomenon known as ‘risk compensation’ [ 3 , 4 ] that has its theoretical origins in both economonics and psychology. Peltzman [ 4 ], for example, proposes that each individual has a targeted level of risk. If a person feels that they have taken an action to reduce their risk in a particular context, they may feel able to take greater risks in other areas in order to maintain their targeted risk level. People therefore compensate for the perceived decline in risk by taking other risky behaviours; this is known as the Peltzman effect. For example, in the case of driving cars, the Peltzman effect predicts that safer cars will prompt riskier driving as drivers increase their driving intensity to offset their reduced risk [ 5 ]. According to this effect, face-coverings may provide a level of safety that exceeds a targeted level, and people may compensate through a reduction in other COVID-19-related safety measures. Wilde [ 6 ] predicts such behaviour through a phenomenon he refers to as ‘risk homeostasis.’ Wilde posits that, just as our bodies have a certain biological balance that we unconsciously look to maintain, psychologically we have an optimum level of risk that we also seek to maintain, and that, depending on the circumstances we find ourselves in, we will look to make risk-related adjustments. As such if we find ourselves in circumstances in which our level of risk is below this optimum level, we will look to increase it through our behaviour. In the case of face-covering use, these theories would predict that by wearing face-coverings our perceived risk of catching or transmitting a virus may decrease to below our optimum level, and so we compensate by reducing other COVID-19-related safety behaviours, such as physical distancing. In summary, though these two theories take a slightly different angle, both predict that when our behaviour or circumstances reduce the level of risk we are subjected to, we look to compensate for that risk by undertaking behaviour that has an equal and opposite effect.

The literature on risk compensation during COVID-19 has found mixed results [ 7 , 8 ]. One review was carried out early in the pandemic to examine the extent to which risk compensation may affect public behaviour [ 9 ], however, given the paucity of research into COVID-19 specifically at the time, this review necessarily relied on research into risk compensation in other contexts (such as the wearing of bike or ski helmets, the use of pre-exposure prophylaxis for HIV, and the use of the HPV vaccination). In a study in Germany, Henk et al. [ 10 ] found that self-reported adherence to protective behaviours was significantly lower after the implementation of two policies: mandatory quarantine for visitors to the country and mandatory face-covering use in shops and on public transport. Similarly, Jones Ritten et al. [ 11 ] investigated the risk compensating effect of COVID-19 testing by surveying students at two large universities in the US and found a positive association between testing behaviour and the number of risky events attended (e.g., large indoor gatherings). Moreover, it was found that those who participated in the testing programme perceived that doing so reduced their risk of contracting COVID-19, and further, that there was a positive association in the perceived risk-reducing effect of the testing programme and frequency of attending risky events; that is, the more respondents believed that testing reduced their risk of contracting COVID-19, the more likely they were to attend risky events. In contrast, Ludema et al. [ 12 ], used a randomised controlled trial to investigate risk compensation and anti-body testing and found that, irrespective of whether the result was positive or negative, receiving antibody test results did not lead to significant changes in adherence to COVID-19 protective behaviours. The extent to which risk compensation has occurred during the COVID-19 pandemic is therefore unclear.

There is now a substantial body of research investigating risk compensation in relation to face-covering use in the context of COVID-19. The aim of this systematic review was therefore to identify, summarise and assess the findings from studies examining the effect of face covering use on adherence to other protective behaviours in the context of COVID-19.

Details of the protocol for this systematic review were registered on PROSPERO before screening took place. The protocol’s number is CRD42022331961 and can be accessed at https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=331961 [ 13 ]. It can also be seen in S1 Appendix .

2.1 Eligibility criteria

Studies were eligible if they reported primary quantitative or qualitative research relating to the impact of face covering use on adherence to other protective behaviours during the COVID-19 pandemic. Protective behaviours of interest included but were not limited to: COVID-19 physical/social distancing, hygiene (e.g., avoidance of face-touching, regular handwashing), staying at home, and reducing travel. Studies that examined the effectiveness and/or efficacy of wearing face coverings or factors related to adherence to face covering use were excluded. Published research and pre-publication articles were included. Reviews, position/discussion papers, conference abstracts, protocol papers, modelling studies, case reports and studies published in languages other than English were excluded (see Table 1 ).

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https://doi.org/10.1371/journal.pone.0284629.t001

2.2 Search strategy

A systematic search was conducted by UKHSA researchers on 17 th May 2022 for papers from January 2020 until the date of searches. Sources searched included Ovid Medline, Ovid Embase, Ovid PsychInfo, Ovid EmCare, medRxiv preprints, Research Square and WHO COVID-19 Research Database. Search terms included terms related to COVID-19 (e.g., COVID-19, coronavirus, Sars-COV2), face coverings (e.g., mask, face cover, mouth covers) and protective behaviours (e.g., social distancing, handwashing, face-touching). A complete list of search terms is available in S2 Appendix .

Forward and backward citation searches of included papers were also conducted on 16 th September 2022, and eligible papers from 1 st January 2020 to that date were also included.

2.3 Study identification

Selection and screening of papers followed a systematic search method following a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework [ 14 ]. The study identification process is detailed in Fig 1 and contains full details of papers included and excluded at each stage. Papers were initially title- and abstract-screened (decisions were made as to the eligibility of each paper following a review of their title and abstract alone). In the first stage of title and abstract screening, 10% of records were assessed in duplicate by two reviewers, and disagreements were resolved by discussion and consensus. In the second stage of title and abstract screening one reviewer assessed the remaining 90% of records. The screening tool Rayyan [ 15 ] was used for both these first and second stages. All relevant records were then screened by full text by one reviewer (decisions were made as to the eligibility of each paper following a review of the paper in full). These decisions were then checked by a second reviewer. There were five reasons for exclusion: (i) The direction of analysis was incorrect e.g., the study investigated behavioural predictors of face-covering use rather than vice versa (n = 5), (ii) the independent variables or outcome variables were not relevant to the research question (n = 14), (iii) the study did not comprise primary empirical research (n = 6), (iv) the paper was a previously undetected duplicate (n = 5), and (v) the paper was not written in English (n = 1). By the end of this process, 47 papers were deemed eligible and included in the review.

https://doi.org/10.1371/journal.pone.0284629.g001

2.4 Data extraction and synthesis

Findings related to any relevant COVID-19 protective behaviours were extracted; at the completion of extraction, these comprised the following behavioural outcomes: physical distancing, mobility, face-touching, hand hygiene, close contacts, and generalised measures of protective behaviour. All results from selected papers were included. The following information was then collated for each study: country, publication status, population and sample size, methods, key outcome variables and main results. Data were initially collated into one table which included an outcome variable column. This table was then divided by outcome variable into six smaller data extraction tables, and a narrative summary of results was produced, structured by these six outcome variable categories.

Data extraction was completed for each included study by one reviewer and independently checked by a second reviewer, with discrepancies resolved by discussion. Any evidence that was not directly relevant to the review question was not extracted.

2.5 Quality assessment

Quality of the selected articles, including risk of bias, was evaluated by one reviewer using the Quality Criteria Checklist (QCC) tool which can be used to assess the methodological quality of a study [ 16 ]. Using the QCC, studies were characterized as high, medium, or low quality.

This checklist tool is composed of ten questions, 4 of which are considered critical (questions on selection bias, group comparability, description of exposure/assessment of transmission routes, and validity of outcome measurements); full details can be seen in S3 Appendix .

A study was rated as high methodological quality if the answers were yes to the four critical questions plus at least one of the remaining questions. A study was rated as low methodological quality if answers were no to more than half of the 10 questions. Otherwise, a study was rated as medium methodological quality. In line with a systematic review that found that self-report methods of capturing adherence to protective behaviours can over-estimate objectively observed adherence by up to a factor of five [ 17 ], any studies which employed a self-report methodology were deemed not to satisfy the validity of outcome criterion, and so were necessarily limited to a quality score of medium or below. An additional reviewer independently assessed five of the studies, and conflicting findings were discussed. Following discussions, a potential source of bias was identified in the first reviewer’s application of one of the tool’s questions, and all studies were subsequently re-evaluated to correct for this bias.

3.1 Overview of search results

The initial searches generated 12,662 articles. After de-duplication, 7,980 records remained, and title and abstract screening resulted in 70 papers being accepted for full text screening. Following full text screening, 39 papers were accepted for inclusion in the review. Backwards and forwards citation searches were conducted that yielded a further 8 papers for inclusion, meaning the total number of papers included in the review was 47. Quality appraisal of the articles revealed that nine were of a high quality, 33 of a medium quality, and five of a low quality. Of the papers included nine were pre-prints, 35 were peer-reviewed publications, and three were published conference papers. Finally, it was found that some papers included more than one methodology, intervention, or protective behaviour and thus, the number of studies described for each of these categories may exceed the total number of papers.

All studies included used quantitative methods, and none used qualitative methods. Methods included field experiments (n = 7), natural experiments (n = 14), lab experiments (n = 14), observational studies (n = 10) and cross-sectional studies (n = 9). Of these, 30 studies measured behaviour through observation, and 22 measured behaviour through self-report. Of the self-report studies, 10 were concerned with current or previous behaviour, and 12 with expected or intended behaviour. Though all included papers necessarily investigated the effect of face covering use on protective behaviours, the exact intervention of focus in each case was varied and fit into one of five categories: face covering use (self) i.e., the act of wearing a face covering oneself (n = 21); face covering use (other) i.e., in some way interacting with someone else wearing a face covering (n = 18); face covering use (self and other) i.e., in some way interacting with someone else who is wearing a face covering whilst also wearing a face covering oneself (n = 1); face covering policy i.e., the implementation of a face covering mandate (n = 19); and face covering intervention package i.e., a community programme designed to increase uptake of face covering usage (n = 1). The protective behaviour(s) in each case also varied, and in each case fit into one of 6 categories: physical distancing i.e., interpersonal distance (n = 30); mobility i.e., the extent to which people leave their home and visit public or residential spaces (n = 13); face-touching (n = 7); hand hygiene e.g., hand washing, avoidance of handshakes (n = 5); close contacts i.e., the extent to which people have close and extended interactions with people outside of their household (n = 4); and generalised protective behaviour i.e., a single measure to encapsulate two or more COVID-19 protective behaviours other than face-covering use, e.g., hand-washing, physical distancing and staying at home (n = 2). Full details on each paper can be seen in the data extraction tables in S4 Appendix .

Some studies initially appeared to meet the inclusion criteria but were ultimately excluded. For example, one study investigated how face covering use affected perceptions of physical distance between oneself and another person, however, since it did not investigate how face covering use affected distancing behaviour, it was not deemed to be eligible for inclusion [ 18 ]. Similarly, another study investigated participants’ judgements on how face covering use moderates the relationship between a given physical distance and transmission risk and was not included since, although its focus was related to the review’s objectives, it did not directly address it, in that it did not investigate how face covering use directly impacted adherence to protective behaviours [ 19 ].

The section below presents findings in relation to each of these six behaviours and describes the extracted data in terms of the effect that face covering use has on each type of behaviour, also exploring any patterns with regards to how the effect of face covering use varies by the type of intervention, and the type of study design.

3.2 Physical distancing (see table 2a in S4 Appendix for full details)

Outcomes in relation to the impact of face covering use on physical distancing were mixed and varied depending on the type of study. Findings from the majority of lab experiments (10 of 13) indicated that physical distancing was lower in conditions where a face covering was used by another person compared with conditions where it was not [ 20 – 27 ], [ 28 : two different studies], and two of these studies also found that physical distancing was lower when a face covering was used by the self [ 28 : two different studies]. Additionally, one of these studies investigated how physical distancing in conditions with and without face covering use compared with a baseline measure (that is, physical distancing outside the context of face covering use) [ 20 ]. It was found that physical distancing was significantly greater than the baseline in conditions without face covering use, but not significantly different in conditions with face covering use, potentially suggesting that differences between conditions is driven by participants moving away from people without face coverings (relative to where they would normally position themselves), rather than towards people with face coverings. Of the remaining three studies, one found that physical distancing was lower in conditions of face covering use (other), but that this effect was conditional on situational factors such as effort required to maintain physical distance, and age of the other person [ 29 ], and two found that distancing was greater in the case of face covering use (other) [ 30 ], [ 31 : Study 2].

In contrast, the majority of field experiments (5 of 6) found that physical distancing was either greater or not significantly different in conditions where face coverings were used, compared to conditions where they were not. Two studies found that physical distancing was greater in conditions where face coverings (self or other) were used compared to when they were not [ 31 : Study 1], [ 32 ], with a third study finding that physical distancing was greater in areas where a face covering intervention package had been implemented compared to those where it had not [ 33 ]. One study found mixed effects: face covering use (self) had no effect on distancing, but distancing was greater in conditions of face covering use (other) [ 34 ]. Another study found no differences in distancing between conditions of face covering use (self and other) and conditions without face covering use [ 35 ]. A minority of field experiments (1 of 6) found that physical distancing was lower in conditions of face covering use (other), but that this effect was conditional on gender of participant, race, and social status of confederate (a member of the research team acting as a participant), and face covering policy implemented at the time [ 36 ]. Additionally, three of the above studies also investigated through a natural design whether the effect of face covering use on physical distancing differed between different time periods that varied by the face covering policy (mandatory or voluntary) implemented at the time. One study found that face-covering use by others significantly reduced physical distancing adherence amongst men only, both in mandatory and in voluntary face covering policy contexts; the effect was slightly more pronounced in the mandatory context [ 36 ]. The two other studies found no difference between policy contexts; both found that face covering use (other) increased physical distancing both when it was mandated and when it was voluntary [ 32 , 34 ].

The four natural experiments explored the impact of face covering policy on physical distancing. Three of these found that physical distancing did not significantly differ according to whether face covering wearing was voluntary or mandatory [ 28 : Study 2], [ 34 ], [ 37 : Study 2], while a third found that the impact of face covering policy on physical distancing was dependent on context; attention given to physical distancing decreased when a face covering mandate was introduced on public transport, but increased when the mandate was expanded to bars and restaurants, and again when expanded to all public spaces [ 38 ].

The four observational studies found either a positive or a neutral relationship between face covering use or face covering policy and physical distancing. Three observational studies found no significant relationship between face covering use (self) or face covering policy and physical distancing [ 37 : two studies], [ 39 ], while the fourth observational study found that physical distancing was greater in those who wore face coverings, and also that it was greater when a face covering mandate was implemented [ 40 ].

Four of the six correlational studies found that as self-reported face covering use (self or other) increased, so did self-reported physical distancing [ 41 – 44 ]. One study showed mixed results for the relationship between face covering use and physical distancing, finding that those who reported wearing face coverings all the time were more likely to report adherence to physical distancing compared with those who reported never doing so, but those who reported wearing face coverings sometimes were more likely to report having reduced distancing with people than those who reported never doing so [ 45 ]. The final correlational study found no relationship between face covering use (self) and physical distancing [ 46 ].

3.3 Mobility (see table 2b in S4 Appendix for full details)

Of the 10 natural experiments, five found that when face covering policies were in place mobility increased (i.e., people were less likely to stay at home) [ 47 – 51 ], four found that mobility was unchanged [ 52 – 55 ], and one found that mobility decreased (i.e., people were more likely to stay at home) [ 56 ]. The only lab experiment found that mobility is likely to increase when policies are in place, as participants reported being more willing to use the London Underground when a face covering mandate was in operation [ 57 ].

Of the two cross-sectional studies, one found that self-reported adherence to personal protective behaviours, which included face covering use (self), predicted self-reported frequency of going out in public, and that this relationship was mediated by belief in ‘substitution myths’; the belief that one protective behaviour can be substituted for another, with risk staying constant [ 46 ]. The second cross-sectional study found that those who reported always wearing a face covering outside their home were less likely to report visiting a friend, neighbour, bar or club, compared with those who did not report always wearing a face covering outside their home [ 44 ].

3.4 Face-touching (see table 2c in S4 Appendix for full details)

The only field experiment found that face covering use (self) resulted in less face-touching; there was a significant increase in the number of individuals who touched their eyes or hair when they were not wearing a face covering, and, when investigating areas not covered by a face covering (hair, forehead, eyes, and ears) the absolute number of total touches was significantly higher in those not wearing one [ 58 ]. Two of the six observational studies found similar results; those who wore face coverings were less likely to touch their face [ 59 , 60 ]. Two more observational studies found that results were dependent on the operationalisation of face-touching; when face-touching was defined as making contact with any part of the face (including touches to the mask), there was no significant relationship between face covering use (self) and face-touching, but when it was defined as making contact with specific parts of the face (not including touches to the mask), those who wore face coverings touched their faces less frequently [ 61 : two studies]. A minority of observational studies (1 of 6) found a greater frequency of face-touching in those who wore coverings compared with those who did not [ 62 ]. The final observational study found that face covering policy had no impact on face-touching; there was no statistically significant association between the face covering policy in operation and frequency of face-touching [ 63 ].

3.5 Hand hygiene (see table 2d in S4 Appendix for full details)

The only natural experiment found that face covering policy had no impact on hand hygiene; attention paid to hygiene practices was not significantly different according to the implementation of different face covering policies (38). The three cross-sectional studies found that those who reported wearing face coverings more often were more likely to report also adhering to hand hygiene practices [ 41 , 44 , 45 ].

3.6 Close contacts (see table 2e in S4 Appendix for full details)

One of the two natural experiments found that the number of close contacts a person had was significantly lower when a face covering mandate was expanded from public transport to include restaurants and bars, and lower again when expanded to all public spaces [ 38 ]. The other natural experiment found that a face covering mandate did not affect whether participants cancelled or postponed personal or social activities [ 55 ].

One of the three cross-sectional studies found that the relationship between face covering use (self) and number of close contacts was mixed; those who reported wearing face coverings all the time were more likely to report spending less than 15 minutes in close contact with someone compared with those who reported never wearing face coverings, while those who reported sometimes wearing face coverings were more likely to report spending over 60 minutes in close contact with someone compared with those who reported never doing so [ 45 ]. The second cross-sectional study found that those who did not always wear face coverings were more likely than those who always wore face coverings to have close contact with people they do not live with [ 44 ], whilst the final cross-sectional study found that workers who self-reported wearing a face covering outside of work reported more daily contacts than those who did not wear a mask outside work [ 64 ].

3.7 Generalised protective behaviour (see table 2f in S4 Appendix for full details)

The term ‘generalised protective behaviour’ was used to categorise any studies whose outcome variable was a single measure which encapsulated two or more other COVID-19 protective behaviours besides face covering use e.g., hand washing, physical distancing and staying at home. Two studies examined generalised protective behaviour, and both found that self-reported face covering use (self) was associated with self-reported behaviours that are likely to reduce the spread of COVID-19. In one study the majority of participants reported that their adherence to other protective behaviours was either unchanged or greater when they wore a face covering compared with when they did not [ 65 ], while the other study found that self-reported face covering use (self) was associated with self-reported reduced engagement with COVID-19 related risky behaviour [ 66 ].

3.8 Quality assessment

Few clear patterns were found when analysing the results of studies cross-sectionally by quality. With the exception of face-touching, for all behaviours (physical distancing, mobility, hand hygiene, close contacts and generalised protective behaviour), there was no apparent association between quality of the study and the results. For face-touching, studies were either of a low or medium quality, with all four studies of medium quality finding the same result: a negative effect of (or association with) face covering use. The three studies of low quality were mixed: one found a positive association, one found a negative association, and one found a nonsignificant association.

4. Discussion

Concerns have been raised about the potential impact of face covering use on adherence to other COVID-19 protective behaviours. While several studies that explore this issue have been conducted, they had not previously been brought together in a review. This systematic review has identified and summarised the findings of 47 papers that collectively investigate the effect of face covering use on other COVID-19-related protective behaviours, namely, physical distancing, mobility, face-touching, hand hygiene, close contacts and generalised protective behaviour. Findings showed that results varied considerably, and that the nature of the variation often depended upon the specific behaviour investigated and the type of study employed to investigate it. The sections below, organised by behaviour, summarise and discuss the findings.

4.1 Physical distancing

One of the clearest patterns emerging from the studies relating to physical distancing was the distinction between the respective findings of lab experiments and field experiments. The majority of lab experiments found that physical distancing was lower in conditions of face covering use (compared with conditions without face covering use), whereas the majority of field experiments found that physical distancing was either greater or unchanged in conditions of face covering use.

A number of considerations should be made when interpreting these results, starting with the respective merits of field and lab experiments. There are three main advantages of lab experiments. First, the majority of the lab experiments employed a within-subjects design, meaning that individual differences that may impact physical distancing (e.g., age, gender, risk perception, conscientiousness) are essentially controlled for in a way that cannot be done with between-subjects field experiments [ 67 ] (although estimates of such variables, e.g., age, were in some cases recorded and controlled for in the field experiments). Second, the lab experiments typically allowed for more precision in data collection. The majority of lab experiments used an on-screen slider for participants to indicate their preferred distances, or a virtual reality environment in which computers captured the distances participants maintained from virtual agents. In contrast, some of the field experiments employed human judgement to determine whether a physical distancing guideline had been violated, increasing the risk of bias. However, four of the six field experiments used some form of electronic sensor to collect data (all of which found that physical distancing was greater or unchanged in conditions of face covering use). Third, lab experiments are able to examine the impact of face covering use on physical distancing in a context which is agnostic of face covering policy (mandatory vs voluntary), in contrast to field experiments which are necessarily conducted under periods of either mandatory or voluntary face covering wear (the potential for an interaction between face covering use and face covering policy is discussed in more detail in subsection 4.7).

However, whilst field experiments are less controlled than lab experiments, they are more ecologically valid [ 68 ]. A key advantage of field experiments compared to lab experiments is that the disease transmission risk is real, not hypothetical; therefore, a person’s approach to physical distancing has a real impact on their own risk and on others’ risk of contracting and spreading COVID-19. In all but one of the six field experiments not only were participants blinded to the experimental condition they were assigned to, but they were also unaware that they were taking part in an experiment at all, and so responses were unlikely to be biased by, for example, demand characteristics. Behaviour captured in field experiments may therefore be more representative of, and generalisable to, wider populations than that collected during lab experiments, in which participants could second-guess research objectives, potentially causing demand effects [ 67 ]. Additionally, in the majority of lab experiments, rather than being measured for actual behaviour, participants were asked to indicate distances they would prefer from the avatars or characters, allowing them to make a conscious decision which may or may not be indicative of how they might behave in real-life scenarios.

In addition to the lab and field experiments, the effect of face covering use on physical distancing was also investigated through a number of different methodologies; the majority of natural and observational studies tended not to find any significant associations between face covering use (or face covering policy) and physical distancing, and cross-sectional studies tended to find positive associations between self-reported face covering-wearing and physical distancing. These different study types also have their respective strengths and weaknesses that should be considered when interpreting the results. The observational studies are necessarily high in ecological validity, however, are less controlled [ 69 ]. As such, the means of measurement (human judgement) may be lacking in precision and subject to bias, and furthermore, only claims of association (and not causality) can be made [ 70 ]. For example, it is likely that relationships between face covering wearing and physical distancing are driven by confounding variables (e.g., risk perception, age, conscientiousness) impacting both behaviours. The natural experiments, though again high in validity, are types of observational studies and so are subject to the same qualifications. Cross-sectional studies are also unable to draw claims of causality due to the likely impact of confounding variables [ 70 ] and may also be limited in their precision since measures are self-reported and not necessarily indicative of real-life behaviour [ 17 ].

A final consideration that should be made when interpreting the results is to consider the nature of the intervention in each case. Specifically, consideration should be given to: whether the independent variable (IV) is face covering condition of the self, face covering condition of another person, face covering policy, or some combination of any of the three; and the way in which physical distancing is operationalised in each case. Whilst there is no clear pattern with regards to how these different interventions and operationalisations of distancing impact outcomes, it is important to consider such differences when interpreting findings. Overall, it is clear that there is no consensus in relation to the impact of face covering use on physical distancing. Further research is therefore required to bring the merits of different study types together and capture more reliable, and perhaps more consistent, findings with regards to the effect of face covering use on physical distancing.

4.2 Mobility

The findings on mobility are also inconclusive, although there is more evidence to suggest that face covering policies increase mobility than there is to suggest that they decrease mobility. Natural experiments tended to compare changes in mobility from a baseline between areas and periods of time that varied according to the face covering policy implemented. The findings arising from such studies are therefore likely to be confounded by any number of other variables which are likely to impact upon mobility (e.g., other COVID-19 public health measures, rate of infection at time/area of data collection) and claims of causality must be made with caution. Generally speaking, however, these studies employ rich data sources and complex statistical models to account for these variables as far as is possible, and so conclusions made from these studies can be arrived at with a certain level of confidence. If it is the case that implementing face covering policies increases mobility, a plausible explanation may be that a mandate instils confidence in people that if they are to leave home others are more likely to wear a face covering, leading to a greater sense of security; this is therefore a potential example of the Peltzman Effect [ 4 ]. Further qualitative work could be conducted to investigate how face covering policies impact upon people’s decision to leave home and move around their communities.

Two cross-sectional self-report studies which investigated how face covering use by the self impacted mobility were inconclusive, with relationships found in both directions [ 44 , 46 ]. Interestingly however, in one case it was found that a positive relationship between self-reported adherence to personal protective behaviour (including wearing a face covering) and going out in public with people outside ones’ household was mediated by a belief that one protective behaviour can be safely substituted for another [ 46 ], providing evidence in favour of the risk compensation hypothesis.

4.3 Face-touching

The impact of face covering use on face-touching was the most consistent of all the behavioural outcomes, with a general trend for face-touching to be lower in conditions of face covering use than in conditions without. This result was found in a field experiment [ 58 ] and four of six observational studies investigating the relationship between face covering use by the self and face-touching [ 59 , 60 ], [ 61 : two studies]. Whilst observational studies are subject to the same caveats described in the physical distancing subsection the general pattern of a negative relationship between face touching and face covering use suggests that even if risk compensation is at play, it is not strong enough to result in a positive relationship. Furthermore, that this pattern is corroborated by the experimental study boosts the claim that face covering use might reduce face touching behaviour. Additionally, all of the relatively higher-quality studies investigating face-touching (which were all of a medium, as opposed to a low quality) found face covering use to have a negative effect on (or a negative association with) face-touching. It should however be noted that different operationalisations of face-touching were employed across face-touching studies, and that in cases where significant effects or associations were found, they did not always apply to all parts of the face. Further research using experimental designs is required in this area, but on the basis of the studies reviewed to date, it seems reasonable to conclude that face covering use reduces instances of face-touching.

4.4 Hand hygiene

Across four studies (one natural experiment and three cross-sectional studies), three studies found a positive relationship between either face-covering use or face-covering policy and hand hygiene practices and a fourth found no significant relationship. The three studies which found positive relationships were cross-sectional [ 41 , 44 , 46 ] and based on self-report surveys; findings therefore show that those who report wearing face coverings are more likely to also report practicing good hand hygiene, but the cross-sectional nature of the studies means a causal relationship cannot be established. Furthermore, these studies can only inform us on how the isolated practices of wearing a face covering and practising hand hygiene relate to one another and cannot tell us whether hand hygiene is affected whilst wearing a face covering. The natural experiment [ 38 ], which employed face covering policies as an IV and found no significant effect on self-reported attention paid to hygiene practices may be more informative, suggesting that implementing a face covering mandate has no ‘collateral’ effect on hand hygiene practices. It should be noted however that the natural experiment is also subject to the caveats around accuracy associated with self-report data. In summary, the literature on the effect of face covering use on hand hygiene is limited and relies on self-report data, possibly because hand hygiene is a relatively private practice that is difficult to investigate using an experimental or observational design. On the basis of the literature reviewed however, it can be said that there is no evidence thus far to suggest that face covering use causes a reduction in hand hygiene practices.

4.5 Close contacts

There was little consensus in the literature on close contacts. Across two natural experiments, it was found that face covering mandates either had no effect on close contacts, or that they reduced them [ 38 , 55 ]. Across three cross-sectional studies the results were mixed with both positive and negative relationships found [ 44 , 45 , 64 ]. It is therefore difficult to draw robust conclusions about the impact of face covering use on close contacts.

4.6 Generalised protective behaviour

Two cross-sectional studies [ 65 , 66 ] investigated the relationship between face covering use by the self and generalised adherence to other protective behaviours and found a relationship between face covering use and increased adherence to other protective behaviours (or reduced undertaking of risky behaviours). As previously discussed, cross-sectional studies do not allow for claims of causality to be made, and confounding variables are likely to influence any relationships.

4.7 Risk compensation outcomes under different policies

An area for consideration is whether risk compensation behaviour varies according to whether face covering use is voluntary or mandatory. For example, it might be expected that when face covering use is voluntary, there is a stronger relationship between face covering use (i.e., self-selected face covering use) and adherence to other protective behaviours given that the decision to wear a face covering is more likely to be driven by one’s own risk perception rather than the extrinsic factor of the mandatory face covering policy. Equally, when face covering use is voluntary, their use may serve as a stronger social signal as to the preferences or condition of the person using them since others know that they are doing so despite the lack of a mandate. For example, voluntary use may signal that the user is particularly risk-averse and therefore others may be more likely to keep their distance out of consideration and respect. Alternatively, voluntary use may signal that the user is more likely to be infectious, and so others may be more likely to keep their distance for self-protective reasons.

In the present review, only three included studies [ 32 , 34 , 36 ] compared the effect of face covering use across different face covering policies (mandatory or voluntary) and only through a natural design and for one protective behaviour (physical distancing). In all three studies, the effect of face covering use by others on physical distancing adherence was not influenced by policy context, although in one study the effect was reportedly slightly more pronounced in the mandatory than in the voluntary context. There were also 17 studies in which, although the authors did not assess impact of face covering policy, they did provide information on the real-world policy implemented during the time of study; that is whether face covering use was mandatory, voluntary or whether the policy was varied (i.e., that for some of the duration of the study it was mandatory, and for some of the time it was voluntary). Of the 17, thirteen studies focused on physical distancing (five carried out in a mandatory face covering context, six in a voluntary face covering context, and two in contexts where the policy varied between the two) and results across studies were mixed in all three contexts [ 28 : two studies, 29 , 31 : two studies, 33 , 35 , 37 , 40 , 41 , 44 – 46 ]. Two focused on mobility, and in both cases face covering use was voluntary but a positive association was found in one [ 46 ] and a negative association in the other [ 44 ]. There were three studies focused on face-touching [ 58 , 59 , 61 : study two] and three on hand hygiene [ 41 , 44 , 45 ]. For both protective behaviours face covering policy varied across studies but the face-touching studies all reported negative effects or associations and the hand hygiene studies all reported positive effects or associations. Two studies were focused on close contacts, one of which was conducted under mandated face covering use and found the association to be equivocal [ 45 ], and one of which was conducted when face covering use was voluntary and found the association to be negative [ 44 ]. A final study that focused on generalised protective behaviour was conducted under varied policies and found a positive association [ 65 ].

It is difficult to draw robust conclusions about any interaction between face covering use and face covering policy from studies included in this review. A particular limitation of the literature is that no study to date has applied type of face covering policy (mandatory or voluntary) as an independent variable to assess its interaction with face covering use on risk compensation for other protective behaviours. This is an evidence gap that should be addressed in future research.

4.8 Limitations

This review is novel in drawing together current literature on the impact of face covering use on other protective behaviours during the COVID-19 pandemic and contributing to an understanding of risk compensation in this context. However, some limitations should be acknowledged when considering this review’s findings. First, despite every attempt to apply the inclusion and exclusion criteria systematically and objectively, it is likely that some level of subjectivity may have impacted on paper screening and selection. To mitigate against this, 10% of the title and abstract screening was undertaken by two researchers, and any disagreements resolved by discussion and consensus. The full-text screening was also checked by a second researcher. Second, due to resource constraints (namely, the linguistic limitations of the researchers), only papers published in English were included in the review, inevitably creating a geographical bias. For example, 32 of the 47 papers described studies carried out in the UK, Western Europe, Canada, North America, or Australia. An additional consideration relates to the potential to conduct a meta-analysis of the included studies. Given the heterogeneity of the included studies (both in terms of clinical heterogeneity and methodological heterogeneity), a decision was taken not to carry out a meta-analysis. This is in line with Cochrane guidance on heterogeneity within meta-analysis, which states that meta-analysis should only be undertaken if studies are considered to be sufficiently similar to ensure a meaningful outcome and avoid drawing potentially misleading conclusions. However, as further research is conducted in this area, potentially resulting in more clinically and methodologically similar studies, future studies could build on this review by carrying out a meta-analysis.

4.9 Conclusion

Overall, findings relating to the impact of face covering use or policy on other protective behaviours are inconsistent, varying both according to the particular behaviour in question, and by study type. For some behavioural outcomes, it is possible to draw tentative conclusions regarding the impact of face coverings on behaviour. For example, evidence suggests that wearing a face covering reduces the amount that an individual touches their face; face coverings may therefore have a positive impact on face touching behaviours. Conversely, evidence suggests that the introduction of face mask mandates may increase mobility; face coverings may therefore have a negative impact on mobility-related behaviours. Some studies suggest that there may be a relationship between wearing a face covering and other protective behaviours (such as increased hand hygiene). However, these studies are predominately cross-sectional and rely on self-report measures; they therefore do not allow conclusions to be drawn about the impact of face covering use on adherence to these behaviours. Evidence relating to the impact of face covering use on physical distancing and close contacts is mixed. Findings are particularly inconsistent in relation to physical distancing, with considerable discrepancy found between study types. Whilst assessments of behaviour in real-life settings tend to find that face covering use either increases or has no impact upon physical distancing, lab experiments tend to suggest that physical distancing decreases in conditions of face covering use. There is some suggestion that the impact of face covering use on physical distancing could be affected by whether or not mandatory face covering policies are in effect (which would indicate that conclusions drawn from a voluntary context should not be directly applied to a mandatory context and vice versa) but further assessment of this potential moderating effect is warranted. Evidence relating to the potential impact of risk compensation is also inconsistent; while some studies suggest risk compensation may play a role in shaping behaviour, others suggest it has no impact.

Overall, this review highlights that the impact of face covering use on other protective behaviours is likely to vary based on the behaviour under investigation. While for some behaviours the evidence suggests a positive impact (e.g., face coverings may result in reduced face touching), for other behaviours the evidence suggests a negative impact (e.g., increased mobility), or provides no clear consensus (e.g., physical distancing, close contacts, and adherence to other protective behaviours). There are two key recommendations that can be made from this review: 1) further research, using more robust research designs, is needed to establish whether face covering use affects different types of protective behaviours; and 2) any policy decisions made in relation to recommended or mandatory face covering use must take into account the inconsistencies and caveats in the evidence base, recognising that current evidence does not allow firm conclusions to be drawn about the potential impact of face covering use on adherence to other protective behaviours. Recommendations for future research are summarised below.

4.9.1 Recommendations for future research.

Differing effects of face covering use by the self and face covering use by another person
How different face covering policies might moderate the relationship between face covering use and physical distancing. For example, a field experiment could be conducted whereby two manipulations occur; one whereby the setting varies according to the face covering policy implemented (mandatory or voluntary), and one whereby a confederate appears either wearing or not wearing a face covering. Physical distancing from the confederate would then be measured. This would allow for the direct comparison between the moderating effects of voluntary and mandatory settings with more control over extraneous factors.
How effects might vary according to the operationalisation of distancing; for example, whether the absolute distance is measured, or whether a binary variable capturing whether or not a particular distance or guideline is adhered to is captured
Lab experiments replicating those cited in this review, but that vary by the framing of physical distancing (i.e., self-protective or prosocial)
Qualitative research investigating how differing face covering policies affect attitudes towards leaving the home and moving around the community
Experimental studies, including lab, natural, or field experiments, investigating the effect of face covering use and face covering policies on face-touching, hand hygiene and close contacts

Supporting information

S1 appendix. protocol..

https://doi.org/10.1371/journal.pone.0284629.s001

S2 Appendix. Search strategies.

https://doi.org/10.1371/journal.pone.0284629.s002

S3 Appendix. Quality criteria checklist.

https://doi.org/10.1371/journal.pone.0284629.s003

S4 Appendix. Data extraction tables.

https://doi.org/10.1371/journal.pone.0284629.s004

S5 Appendix. PRISMA 2020 checklist.

https://doi.org/10.1371/journal.pone.0284629.s005

S6 Appendix. PRISMA 2020 abstract checklist.

https://doi.org/10.1371/journal.pone.0284629.s006

Acknowledgments

The authors thank Dr Joanna Milward for contributing to the development of the protocol and search terms, Nicola Pearce-Smith for creating the search strategies and running the searches themselves, as well as providing guidance on screening, and Megan Phillips for contributing to the quality appraisal as a second reviewer.

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Elsevier - PMC COVID-19 Collection

A critical analysis of the impacts of COVID-19 on the global economy and ecosystems and opportunities for circular economy strategies

T. ibn-mohammed.

a Warwick Manufacturing Group (WMG), The University of Warwick, Coventry CV4 7AL, United Kingdom

K.B. Mustapha

b Faculty of Engineering and Science, University of Nottingham (Malaysia Campus), Semenyih, Selangor43500, Malaysia

c School of The Built Environment and Architecture, London South Bank University, London SE1 0AA, United Kingdom

K.A. Babatunde

d Faculty of Economics and Management, Universiti Kebangsaan Malaysia, Bangi, Selangor43600, Malaysia

e Department of Economics, Faculty of Management Sciences, Al-Hikmah University, Ilorin, Nigeria

D.D. Akintade

f School of Life Sciences, University of Nottingham, Nottingham NG7 2UH United Kingdom

g Kent Business School, University of Kent, Canterbury CT2 7PE, United Kingdom

h Faculty of Economics, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan

M.M. Ndiaye

i Department of Industrial Engineering, College of Engineering, American University of Sharjah, Sharjah, UAE

F.A. Yamoah

j Department of Management, Birkbeck University of London, London WC1E 7JL United Kingdom

k Sheffield University Management School (SUMS), The University of Sheffield, Sheffield S10 1FL, United Kingdom

• COVID-19 presents unprecedented challenge to all facets of human endeavour.
• A critical review of the negative and positive impacts of the pandemic is presented.
• The danger of relying on pandemic-driven benefits to achieving SDGs is highlighted.
• The pandemic and its interplay with circular economy (CE) approaches is examined.
• Sector-specific CE recommendations in a resilient post-COVID-19 world are outlined.

The World Health Organization declared COVID-19 a global pandemic on the 11th of March 2020, but the world is still reeling from its aftermath. Originating from China, cases quickly spread across the globe, prompting the implementation of stringent measures by world governments in efforts to isolate cases and limit the transmission rate of the virus. These measures have however shattered the core sustaining pillars of the modern world economies as global trade and cooperation succumbed to nationalist focus and competition for scarce supplies. Against this backdrop, this paper presents a critical review of the catalogue of negative and positive impacts of the pandemic and proffers perspectives on how it can be leveraged to steer towards a better, more resilient low-carbon economy. The paper diagnosed the danger of relying on pandemic-driven benefits to achieving sustainable development goals and emphasizes a need for a decisive, fundamental structural change to the dynamics of how we live. It argues for a rethink of the present global economic growth model, shaped by a linear economy system and sustained by profiteering and energy-gulping manufacturing processes, in favour of a more sustainable model recalibrated on circular economy (CE) framework. Building on evidence in support of CE as a vehicle for balancing the complex equation of accomplishing profit with minimal environmental harms, the paper outlines concrete sector-specific recommendations on CE-related solutions as a catalyst for the global economic growth and development in a resilient post-COVID-19 world.

1. Introduction

The world woke up to a perilous reality on the 11th of March, 2020 when the World Health Organization (WHO) declared novel coronavirus (COVID-19) a pandemic ( Sohrabi et al., 2020 ; WHO, 2020a ). Originating from Wuhan, China, cases rapidly spread to Japan, South Korea, Europe and the United States as it reached global proportions. Towards the formal pandemic declaration, substantive economic signals from different channels, weeks earlier, indicated the world was leaning towards an unprecedented watershed in our lifetime, if not in human history ( Gopinath, 2020 ). In series of revelatory reports ( Daszak, 2012 ; Ford et al., 2009 ; Webster, 1997 ), experts across professional cadres had long predicted a worldwide pandemic would strain the elements of the global supply chains and demands, thereby igniting a cross-border economic disaster because of the highly interconnected world we now live in. By all accounts, the emerging havoc wrought by the pandemic exceeded the predictions in those commentaries. At the time of writing, the virus has killed over 800,000 people worldwide ( JHU, 2020 ), disrupted means of livelihoods, cost trillions of dollars while global recession looms ( Naidoo and Fisher, 2020 ). In efforts to isolate cases and limit the transmission rate of the virus, while mitigating the pandemic, countries across the globe implemented stringent measures such as mandatory national lockdown and border closures.

These measures have shattered the core sustaining pillars of modern world economies. Currently, the economic shock arising from this pandemic is still being weighed. Data remains in flux, government policies oscillate, and the killer virus seeps through nations, affecting production, disrupting supply chains and unsettling the financial markets ( Bachman, 2020 ; Sarkis et al., 2020 ). Viewed holistically, the emerging pieces of evidence indicate we are at a most consequential moment in history where a rethink of sustainable pathways for the planet has become pertinent. Despite this, the measures imposed by governments have also led to some “accidental” positive effects on the environment and natural ecosystems. As a result, going forward, a fundamental change to human bio-physical activities on earth now appears on the spectrum of possibility ( Anderson et al., 2020 ). However, as highlighted by Naidoo and Fisher (2020) , our reliance on globalization and economic growth as drivers of green investment and sustainable development is no longer realistic. The adoption of circular economy (CE) – an industrial economic model that satisfies the multiple roles of decoupling of economic growth from resource consumption, waste management and wealth creation – has been touted to be a viable solution.

No doubt, addressing the public health consequences of COVID-19 is the top priority, but the nature of the equally crucial economic recovery efforts necessitates some key questions as governments around the world introduce stimulus packages to aid such recovery endeavours: Should these packages focus on avenues to economic recovery and growth by thrusting business as usual into overdrive or could they be targeted towards constructing a more resilient low-carbon CE? To answer this question, this paper builds on the extant literature on public health, socio-economic and environmental dimensions of COVID-19 impacts ( Gates, 2020b ; Guerrieri et al., 2020 ; Piguillem and Shi, 2020 ; Sohrabi et al., 2020 ), and examines its interplay with CE approaches. It argues for the recalibration and a rethink of the present global economic growth model, shaped by a linear economy system and sustained by profit-before-planet and energy-intensive manufacturing processes, in favour of CE. Building on evidence in support of CE as a vehicle for optimizing the complex equation of accomplishing profit while minimizing environmental damage, the paper outlines tangible sector-specific recommendations on CE-related solutions as a catalyst for the global economic boom in a resilient post-COVID-19 world. It is conceived that the “accidental” or the pandemic-induced CE strategies and behavioural changes that ensued during coronavirus crisis can be leveraged or locked in, to provide opportunities for both future resilience and competitiveness.

In light of the above, the paper is structured as follows. In Section 2 , the methodological framework, which informed the critical literature review is presented. A brief overview of the historical context of previous epidemics and pandemics is presented in Section 3 as a requisite background on how pandemics have shaped human history and economies and why COVID-19 is different. In Section 4 , an overview of the impacts (both negative and positive) of COVID-19 in terms of policy frameworks, global economy, ecosystems and sustainability are presented. The role of the CE as a constructive change driver is detailed in Section 5 . In Section 6 , opportunities for CE after COVID-19 as well as sector-based recommendations on strategies and measures for advancing CE are presented, leading to the summary and concluding remarks in Section 7.

A literature review exemplifies a conundrum because an effective one cannot be conducted unless a problem statement is established ( Ibn-Mohammed, 2017 ). Yet, a literature search plays an integral role in establishing many research problems. In this paper, the approach taken to overcome this conundrum involves searching and reviewing the existing literature in the specific area of study (i.e. impacts of COVID-19 on global economy and ecosystems in the context of CE). This was used to develop the theoretical framework from which the current study emerges and adopting this to establish a conceptual framework which then becomes the basis of the current review. The paper adopts the critical literature review (CLR) approach given that it entails the assessment, critique and synthetisation of relevant literature regarding the topic under investigation in a manner that facilitates the emergence of new theoretical frameworks and perspectives from a wide array of different fields ( Snyder, 2019 ). CLR suffers from an inherent weakness in terms of subjectivity towards literature selection ( Snyder, 2019 ), prompting Grant and Booth (2009) to submit that systematic literature review (SLR) could mitigate this bias given its strict criteria in literature selection that facilitates a detailed analysis of a specific line of investigation. However, a number of authors ( Morrison et al., 2012 ; Paez, 2017 ) have reported that SLR does not allow for effective synthesis of academic and grey literature which are not indexed in popular academic search engines like Google Scholar, Web-of-Science and Scopus. The current review explores the impacts of COVID-19 on the global economy and ecosystems and opportunities for circular economy strategies, rather than investigating a specific aspect of the pandemic. As such, adopting a CLR approach is favoured in realising the goal of the paper as it allows for the inclusion of a wide range of perspectives and theoretical underpinnings from different sources ( Greenhalgh et al., 2018 ; Snyder, 2019 ).

Considering the above, this paper employed archival data consisting of journal articles, documented news in the media, expert reports, government and relevant stakeholders’ policy documents, published expert interviews and policy feedback literature that are relevant to COVID-19 and the concept of CE. To identify the relevant archival data, we focused on several practical ways of literature searching using appropriate keywords that are relevant to this work including impact (positive and negative) of COVID-19, circular economy, economic resilience, sustainability, supply chain resilience, climate change, etc. After identifying articles and relevant documents, their contents were examined to determine inclusions and exclusions based on their relevance to the topic under investigation. Ideas generated from reading the resulting papers from the search were then used to develop a theoretical framework and a research problem statement, which forms the basis for the CLR. The impact analysis for the study was informed by the I = P × A × T model whereby the “impact” (I) of any group or country on the environment is a function of the interaction of its population size (P), per capita affluence (A), expressed in terms of real per capita GDP, as a valid approximation of the availability of goods and services and technology (T) involved in supporting each unit of consumption.

As shown in the methodological framework in Fig. 1 , the paper starts with a brief review of the impacts of historical plagues to shed more light on the link between the past and the unprecedented time, which then led to an overview of the positive and negative impacts of COVID-19. The role of CE as a vehicle for constructive change in the light of COVID-19 was then explored followed by the synthesis, analysis and reflections on the information gathered during the review, leading to sector-specific CE strategy recommendations in a post-COVID-19 world.

Methodological framework for the critical literature review.

3. A brief account of the socio-economic impacts of historical outbreaks

At a minimum, pandemics result in the twin crisis of stressing the healthcare infrastructure and straining the economic system. However, beyond pandemics, several prior studies have long noted that depending on latency, transmission rate, and geographic spread, any form of communicable disease outbreak is a potent vector of localized economic hazards ( Bloom and Cadarette, 2019 ; Bloom and Canning, 2004 ; Hotez et al., 2014 ). History is littered with a catalogue of such outbreaks in the form of endemics, epidemics, plagues and pandemics. In many instances, some of these outbreaks have hastened the collapse of empires, overwhelmed the healthcare infrastructure, brought social unrest, triggered economic dislocations and exposed the fragility of the world economy, with a knock-on effect on many sectors. Indeed, in the initial few months of COVID-19 pandemic, it has become more evident that natural, accidental or intentional biological threats or outbreak in any country now poses an unquantifiable risk to global health and the world economy ( Bretscher et al., 2020 ).

Saunders-Hastings and Krewski (2016) reported that there have been several pandemics over the past 100 years. A short but inexhaustible list of outbreaks of communicable diseases include ‘the great plague’ ( Duncan-Jones, 1996 ; Littman and Littman, 1973 ), the Justinian plague ( Wagner et al., 2014 ), the Black Death ( Horrox, 2013 ), the Third Plague pandemic ( Bramanti et al., 2019 ; Tan et al., 2002 ), the Spanish flu ( Gibbs et al., 2001 ; Trilla et al., 2008 ), HIV/AIDS ( De Cock et al., 2012 ), SARS ( Lee and McKibbin, 2004 ), dengue ( Murray et al., 2013 ), and Ebola ( Baseler et al., 2017 ), among others. The potency of each of these outbreaks varies. Consequently, their economic implications differ according to numerous retrospective analyses ( Bloom and Cadarette, 2019 ; Bloom and Canning, 2004 ; Hotez et al., 2014 ). For instance, the Ebola epidemic of 2013-2016 created socio-economic impact to the tune of $53 billion across West Africa, plummeted Sierra Leone's GDP in 2015 by 20% and that of Liberia by 8% between 2013 and 2014, despite the decline in death rates across the same timeframe ( Fernandes, 2020 ).

As the world slipped into the current inflection point, some of the historical lessons from earlier pandemics remain salutary, even if the world we live in now significantly differs from those of earlier period ( McKee and Stuckler, 2020 ). Several factors differentiate the current socio-economic crisis of COVID-19 from the previous ones ( Baker et al., 2020 ), which means direct simple comparisons with past global pandemics are impossible ( Fernandes, 2020 ). Some of the differentiating factors include the fact that COVID-19 is a global pandemic and it is creating knock-on effects across supply chains given that the world has become much more integrated due to globalisation and advancements in technology ( McKenzie, 2020 ). Moreover, the world has witnessed advances in science, medicine and engineering. The modest number of air travellers during past pandemics delayed the global spread of the virus unlike now where global travel has increased tremendously. From an economic impact perspective, interest rates are at record lows and there is a great imbalance between demand and supply of commodities ( Fernandes, 2020 ). More importantly, many of the countries that are hard hit by the current pandemic are not exclusively the usual low-middle income countries, but those at the pinnacle of the pyramid of manufacturing and global supply chains. Against this backdrop, a review of the impact of COVID-19 is presented in the next section.

4. COVID-19: Policy frameworks, global economy, ecosystems and sustainability

4.1. evaluation of policy frameworks to combat covid-19.

The strategies and policies adopted by different countries to cope with COVID-19 have varied over the evolving severity and lifetime of the pandemic during which resources have been limited ( Siow et al., 2020 ). It is instructive that countries accounting for 65% of global manufacturing and exports (i.e. China, USA, Korea, Japan, France, Italy, and UK) were some of the hardest to be hit by COVID-19 ( Baldwin and Evenett, 2020 ). Given the level of unpreparedness and lack of resilience of hospitals, numerous policy emphases have gone into sourcing for healthcare equipment such as personal protective equipment (PPE) and ventilators ( Ranney et al., 2020 ) due to global shortages. For ventilators, in particular, frameworks for rationing them along with bed spaces have had to be developed to optimise their usage ( White and Lo, 2020 ). Other industries have also been affected, with shocks to their existence, productivity and profitability ( Danieli and Olmstead-Rumsey, 2020 ) including the CE-sensitive materials extraction and mining industries that have been hit by disruption to their operations and global prices of commodities ( Laing, 2020 ).

As highlighted in subsequent sub-sections, one of the psychological impacts of COVID-19 is panic buying ( Arafat et al., 2020 ), which happens due to uncertainties at national levels (e.g. for scarce equipment) and at individual levels (e.g. for everyday consumer products). In both instances, the fragility, profiteering and unsustainability of the existing supply chain model have been exposed ( Spash, 2020 ). In fact, Sarkis et al. (2020) questioned whether the global economy could afford to return to the just-in-time (JIT) supply chain framework favoured by the healthcare sector, given its apparent shortcomings in dealing with much needed supplies. The sub-section that follow examines some of the macro and micro economic ramifications of COVID-19.

4.1.1. Macroeconomic impacts: Global productions, exports, and imports

One challenge faced by the healthcare industry is that existing best practices, in countries like the USA (e.g. JIT macroeconomic framework), do not incentivise the stockpiling of essential medical equipment ( Solomon et al., 2020 ). Although vast sums were budgeted, some governments (e.g. UK, India and USA) needed to take extraordinary measures to protect their supply chain to the extent that manufacturers like Ford and Dyson ventured into the ventilator design/production market ( Iyengar et al., 2020 ). The US, in particular activated the Defense Production Act to compel car manufacturers to shift focus on ventilator production ( American Geriatrics Society, 2020 ; Solomon et al., 2020 ) due to the high cost and shortage of this vital equipment. Hospitals and suppliers in the US were also forced to enter the global market due to the chronic shortfall of N95 masks as well as to search for lower priced equipment ( Solomon et al., 2020 ). Interestingly, the global production of these specialist masks is thought to be led by China ( Baldwin and Evenett, 2020 ; Paxton et al., 2020 ) where COVID-19 broke out, with EU's supply primarily from Malaysia and Japan ( Stellinger et al., 2020 ). Such was the level of shortage that the US was accused of ‘pirating’ medical equipment supplies from Asian countries intended for EU countries ( Aubrecht et al., 2020 ).

France and Germany followed suit with similar in-ward looking policy and the EU itself imposed restrictions on the exportation of PPEs, putting many hitherto dependent countries at risk ( Bown, 2020 ). Unsurprisingly, China and the EU saw it fit to reduce or waive import tariffs on raw materials and PPE, respectively ( Stellinger et al., 2020 ). Going forward, the life-threatening consequences of logistics failures and misallocation of vital equipment and products could breathe new life and impetus to technologies like Blockchain, RFID and IoT for increased transparency and traceability ( Sarkis et al., 2020 ). Global cooperation and scenario planning will always be needed to complement these technologies. In this regard, the EU developed a joint procurement framework to reduce competition amongst member states, while in the US, where states had complained that federal might was used to interfere with orders, a ventilator exchange program was developed ( Aubrecht et al., 2020 ). However, even with trade agreements and cooperative frameworks, the global supply chain cannot depend on imports – or donations ( Evenett, 2020 ) for critical healthcare equipment and this realisation opens doors for localisation of production with consequences for improvements in environmental and social sustainability ( Baldwin and Evenett, 2020 ). This can be seen in the case of N95 masks which overnight became in such high demand that airfreights by private and commercial planes were used to deliver them as opposed to traditional container shipping ( Brown, 2020 ).

As detailed in forthcoming sections, a significant reduction in emissions linked to traditional shipping was observed, yet there was an increase in use of airfreighting due to desperation and urgency of demand. Nevertheless, several countries are having to rethink their global value chains ( Fig. 2 ) as a result of realities highlighted by COVID-19 pandemic ( Javorcik, 2020 ). This is primarily because national interests and protectionism have been a by-product of COVID-19 pandemic and also because many eastern European/Mediterranean countries have a relative advantage with respect to Chinese exports. As shown in Fig. 2 , the global export share which each of these countries has, relative to China's share of the same exports (x-axis) is measured against the economies of countries subscribing to the European Bank for Reconstruction and Development (EBRD) (y-axis). For each product, the ideal is to have a large circle towards the top right-hand corner of the chart.

A summary of how some Eastern European / Mediterranean countries have advantages over China on certain exports – based on the Harmonized Commodity Description and Coding System from 2018, where export volume is represented by dot sizes in millions of USD; Source: Javorcik (2020) .

4.1.2. Microeconomic impacts: Consumer behaviour

For long, there has been a mismatch between consumerist tendencies and biophysical realities ( Spash, 2020 ). However, COVID-19 has further exacerbated the need to reflect on the social impacts of individual lifestyles. The behaviour of consumers, in many countries, was at some point alarmist with a lot of panic buying of food and sanitary products ( Sim et al., 2020 ). At private level, consumer sentiment is also changing. Difficult access to goods and services has forced citizens to re-evaluate purchasing patterns and needs, with focus pinned on the most essential items ( Company, 2020 ; Lyche, 2020 ). Spash (2020) argued that technological obsolescence of modern products brought about by rapid innovation and individual consumerism is also likely to affect the linear economy model which sees, for instance, mobile phones having an average life time of four years (two years in the US), assuming their manufacture/repair services are constrained by economic shutdown and lockdowns ( Schluep, 2009 ). On the other hand, a sector like healthcare, which could benefit from mass production and consumerism of vital equipment, is plagued by patenting. Most medical equipment are patented and the issue of a 3D printer's patent infringement in Italy led to calls for ‘Open Source Ventilators’ and ‘Good Samaritan Laws’ to help deal with global health emergencies like COVID-19 ( Pearce, 2020 ). It is plausible that such initiatives/policies could help address the expensive, scarce, high-skill and material-intensive production of critical equipment, via cottage industry production.

For perspective, it should be noted that production capacity of PPE (even for the ubiquitous facemasks) have been shown by COVID-19 to be limited across many countries ( Dargaville et al., 2020 ) with some countries having to ration facemask production and distribution in factories ( San Juan, 2020 ). Unsurprisingly, the homemade facemask industry has not only emerged for the protection of mass populations as reported by Livingston et al. (2020) , it has become critical for addressing shortages ( Rubio-Romero et al., 2020 ) as well as being part of a post-lockdown exit strategy ( Allison et al., 2020 ). A revival of cottage industry production of equipment and basic but essential items like facemasks could change the landscape of global production for decades, probably leading to an attenuation of consumerist tendencies.This pandemic will also impact on R&D going forward, given the high likelihood that recession will cause companies to take short-term views, and cancel long and medium-term R&D in favour of short-term product development and immediate cash flow/profit as was certainly the case for automotive and aerospace sectors in previous recessions.

4.2. Overview of the negative impacts of COVID-19

The negative effects have ranged from a severe contraction of GDP in many countries to multi-dimensional environmental and social issues across the strata of society. In many respects, socio-economic activities came to a halt as: millions were quarantined; borders were shut; schools were closed; car/airline, manufacturing and travel industries crippled; trade fairs/sporting/entertainment events cancelled, and unemployment claims reached millions while the international tourist locations were deserted; and, nationalism and protectionism re-surfaced ( Baker et al., 2020 ; Basilaia and Kvavadze, 2020 ; Devakumar et al., 2020 ; Kraemer et al., 2020 ; Thunstrom et al., 2020 ; Toquero, 2020 ). In the subsections that follow, an overview of some of these negative impacts on the global economy, environment, and society is presented.

4.2.1. Negative macroeconomic impact of COVID-19

Undoubtedly, COVID-19 first and foremost, constitutes a ferocious pandemic and a human tragedy that swept across the globe, resulting in a massive health crisis ( WHO, 2020b ), disproportionate social order ( UN DESA, 2020 ), and colossal economic loss ( IMF, 2020 ). It has created a substantial negative impact on the global economy, for which governments, firms and individuals scramble for adjustments ( Fernandes, 2020 ; Pinner et al., 2020 ; Sarkis et al., 2020 ; Sohrabi et al., 2020 ; Van Bavel et al., 2020 ). Indeed, the COVID-19 pandemic has distorted the world's operating assumptions, revealing the absolute lack of resilience of the dominant economic model to respond to unplanned shocks and crises ( Pinner et al., 2020 ). It has exposed the weakness of over-centralization of the complex global supply and production chains networks and the fragility of global economies, whilst highlighting weak links across industries( Fernandes, 2020 ; Guan et al., 2020 ; Sarkis et al., 2020 ). This has had a direct impact on employment and heightened the risk of food insecurity for millions due to lockdown and border restrictions ( Guerrieri et al., 2020 ). To some extent, some of the interventional measures introduced by governments across the world have resulted in the flattening of the COVID-19 curve (as shown in Fig. 3 ). This has helped in preventing healthcare systems from getting completely overwhelmed ( JHU, 2020 ), although as at the time of writing this paper, new cases are still being reported in different parts of the globe. Fernandes (2020) and McKibbin and Fernando (2020) reported thatthe socio-economic impact of COVID-19 will be felt for many months to come.

Daily confirmed new COVID-19 cases of the current 10 most affected countries based on a 5-day moving average. Valid as of August 31st, 2020 at 11:46 PM EDT ( JHU, 2020 ).

Guan et al. (2020) submitted that how badly and prolonged the recession rattles the world depends on how well and quickly the depth of the socio-economic implications of the pandemic is understood. IMF (2020) reported that in an unprecedented circumstance (except during the Great Depression), all economies including developed, emerging, and even developing will likely experience recession. In its April World Economic Outlook, IMF (2020) reversed its early global economic growth forecast from 3.3% to -3 %, an unusual downgrade of 6.3% within three months. This makes the pandemic a global economic shock like no other since the Great Depression and it has already surpassed the global financial crisis of 2009 as depicted in Fig. 4 . Economies in the advanced countries are expected to contract by -6.1% while recession in emerging and developing economies is projected (with caution) to be less adverse compared to the developed nations with China and India expected to record positive growth by the end of 2020. The cumulative GDP loss over the next year from COVID-19 could be around $9 trillion ( IMF, 2020 ).

Socioeconomic impact of COVID-19 lockdown: (a) Comparison of global economic recession due to COVID-19 and the 2009 global financial crisis; (b) Advanced economies, emerging and developing economies in recession; (c) the major economies in recession; (d) the cumulative economic output loss over 2020 and 2021. Note: Real GDP growth is used for economic growth, as year-on-year for per cent change ( IMF, 2020 ).

With massive job loss and excessive income inequality, global poverty is likely to increase for the first time since 1998 ( Mahler et al., 2020 ). It is estimated that around 49 million people could be pushed into extreme poverty due to COVID-19 with Sub-Sahara Africa projected to be hit hardest. The United Nations’ Department of Economic and Social Affairs concluded that COVID-19 pandemic may also increase exclusion, inequality, discrimination and global unemployment in the medium and long term, if not properly addressed using the most effective policy instruments ( UN DESA, 2020 ). The adoption of detailed universal social protection systems as a form of automatic stabilizers, can play a long-lasting role in mitigating the prevalence of poverty and protecting workers ( UN DESA, 2020 ).

4.2.2. Impact of COVID-19 on global supply chain and international trade

COVID-19 negatively affects the global economy by reshaping supply chains and sectoral activities. Supply chains naturally suffer from fragmentation and geographical dispersion. However, globalisation has rendered them more complex and interdependent, making them vulnerable to disruptions. Based on an analysis by the U.S. Institute for Supply Management, 75% of companies have reported disruptions in their supply chain ( Fernandes, 2020 ), unleashing crisis that emanated from lack of understanding and flexibility of the several layers of their global supply chains and lack of diversification in their sourcing strategies ( McKenzie, 2020 ). These disruptions will impact both exporting countries (i.e. lack of output for their local firms) and importing countries (i.e. unavailability of raw materials) ( Fernandes, 2020 ). Consequently, this will lead to the creation of momentary “manufacturing deserts” in which the output of a country, region or city drops significantly, turning into a restricted zone to source anything other than essentials like food items and drugs ( McKenzie, 2020 ). This is due to the knock-on effect of China's rising dominance and importance in the global supply chain and economy ( McKenzie, 2020 ). As a consequence of COVID-19, the World Trade Organization (WTO) projected a 32% decline in global trade ( Fernandes, 2020 ). For instance, global trade has witnessed a huge downturn due to reduced Chinese imports and the subsequent fall in global economic activities. This is evident because as of 25 th March 2020, global trade fell to over 4% contracting for only the second time since the mid-1980s ( McKenzie, 2020 ). Fig. 5 shows a pictorial representation of impact of pandemics on global supply chains based on different waves and threat levels.

Impact of pandemics on global supply chains. Adapted from Eaton and Connor (2020) .

4.2.3. Impact of COVID-19 on the aviation sector

The transportation sector is the hardest hit sector by COVID-19 due to the large-scale restrictions in mobility and aviation activities ( IEA, 2020 ; Le Quéré et al., 2020 ; Muhammad et al., 2020 ). In the aviation sector, for example, where revenue generation is a function of traffic levels, the sector has experienced flight cancellations and bans, leading to fewer flights and a corresponding immense loss in aeronautical revenues. This is even compounded by the fact that in comparison to other stakeholders in the aviation industry, when traffic demand declines, airports have limited avenues to reducing costs because the cost of maintaining and operating an airport remains the same and airports cannot relocate terminals and runaways or shutdown ( Hockley, 2020 ). Specifically, in terms of passenger footfalls in airports and planes, the Air Transport Bureau (2020) modelled the impact of COVID-19 on scheduled international passenger traffic for the full year 2020 under two scenarios namely Scenario 1 (the first sign of recovery in late May) and Scenario 2 (restart in the third quarter or later). Under Scenario 1, it estimated an overall reduction of: between 39%-56% of airplane seats; 872-1,303 million passengers, corresponding to a loss of gross operating revenues between ~$153 - $ 231 billion. Under Scenario 2, it predicted an overall drop of: between 49%-72% of airplane seats; 1,124 to 1,540 million passengers, with an equivalent loss of gross operating revenues between ~$198 - $ 273 billion. They concluded that the predicted impacts are a function of the duration and size of the pandemic and containment measures, the confidence level of customers for air travel, economic situations, and the pace of economic recovery ( Air Transport Bureau, 2020 ).

The losses incurred by the aviation industry require context and several other comparison-based predictions within the airline industry have also been reported. For instance, the International Civil Aviation Organization ICAO (2020) predicted an overall decline ininternational passengers ranging from 44% to 80% in 2020 compared to 2019. Airports Council International, ACI (2020) also forecasted a loss of two-fifths of passenger traffic and >$76 billion in airport revenues in 2020 in comparison to business as usual. Similarly, the International Air Transport Association IATA (2020) forecasted $113 billion in lost revenue and 48% drop in revenue passenger kilometres (RPKs) for both domestic and international routes ( Hockley, 2020 ). For pandemic scenario comparisons, Fig. 6 shows the impact of past disease outbreaks on aviation. As shown, the impact of COVID‐19 has already outstripped the 2003 SARS outbreak which had resulted in the reduction of annual RPKs by 8% and $6 billion revenues for Asia/Pacific airlines, for example. The 6‐month recovery path of SARS is, therefore, unlikely to be sufficient for the ongoing COVID-19 crisis ( Air Transport Bureau, 2020 ) but gives a backdrop and context for how airlines and their domestic/international markets may be impacted.

Impact of past disease outbreaks on aviation ( Air Transport Bureau, 2020 ).

Notably, these predictions are bad news for the commercial aspects of air travel (and jobs) but from the carbon/greenhouse gas emission and CE perspective, these reductions are enlightening and should force the airline industry to reflect on more environmentally sustainable models. However, the onus is also on the aviation industry to emphasise R&D on solutions that are CE-friendly (e.g. fuel efficiency; better use of catering wastes; end of service recycling of aircraft in sectors such as mass housing, or re-integrating airplane parts into new supply chains) and not merely investigating ways to recoup lost revenue due to COVID-19.

4.2.4. Impact of COVID-19 on the tourism industry

Expectedly, the impact of COVID-19 on aviation has led to a knock-on effect on the tourismindustry, which is nowadays hugely dependent on air travel. For instance, the United Nation World Tourism Organization UNWTO (2020) reported a 22% fall in international tourism receipts of $80 billion in 2020, corresponding to a loss of 67 million international arrivals. Depending on how long the travel restictions and border closures last, current scenario modelling indicated falls between 58% to 78% in the arrival of international tourists, but the outlook remains hugely uncertain. The continuous existence of the travel restrictions could put between 100 to 120 million direct tourism-related jobs at risk. At the moment, COVID-19 has rendered the sector worst in the historical patterns of international tourism since 1950 with a tendency to halt a 10-year period of sustained growth since the last global economic recession ( UNWTO, 2020 ). It has also been projected that a drop of ~60% in international tourists will be experienced this year, reducing tourism's contribution to global GDP, while affecting countries whose economy relies on this sector ( Naidoo and Fisher, 2020 ). Fig. 7 depicts the impact of COVID-19 on tourism in Q1 of 2020 based on % change in international tourists’ arrivals between January and March.

The impact of COVID-19 on tourism in quarter 1of 2020. Provisional data but current as of 31st August 2020 ( UNWTO, 2020 ).

4.2.5. Impact of COVID-19 on sustainable development goals

In 2015, the United Nations adopted 17 Sustainable Development Goals (SDGs) with the view to improve livelihood and the natural world by 2030, making all countries of the world to sign up to it. To succeed, the foundations of the SDGs were premised on two massive assumptions namely globalisation and sustained economic growth. However, COVID-19 has significantly hampered this assumption due to several factors already discussed. Indeed, COVID-19 has brought to the fore the fact that the SDGs as currently designed are not resilient to shocks imposed by pandemics. Prior to COVID-19, progress across the SDGs was slow. Naidoo and Fisher (2020) reported that two-thirds of the 169 targets will not be accomplished by 2030 and some may become counterproductive because they are either under threat due to this pandemic or not in a position to mitigate associated impacts.

4.3. Positive impact of COVID-19

In this section, we discussed some of the positive ramifications of COVID-19. Despite the many detrimental effects, COVID-19 has provoked some natural changes in behaviour and attitudes with positive influences on the planet. Nonetheless, to the extent that the trends discussed below were imposed by the pandemic, they also underscore a growing momentum for transforming business operations and production towards the ideal of the CE.

4.3.1. Improvements in air quality

Due to the COVID-19-induced lockdown, industrial activities have dropped, causing significant reductions in air pollution from exhaust fumes from cars, power plants and other sources of fuel combustion emissions in most cities across the globe, allowing for improved air quality ( Le Quéré et al., 2020 ; Muhammad et al., 2020 ). This is evident from the National Aeronautics and Space Administration ( NASA, 2020a ) and European Space Agency ( ESA, 2020 ) Earth Observatory pollution satellites showing huge reductions in air pollution over China and key cities in Europe as depicted in Fig. 8 . In China, for example, air pollution reduction of between 20-30% was achieved and a 20-year low concentration of airborne particles in India is observed; Rome, Milan, and Madrid experienced a fall of ~45%, with Paris recording a massive reduction of 54% ( NASA, 2020b ). In the same vein, the National Centre for Atmospheric Science, York University, reported that air pollutants induced by NO 2 fell significantly across large cities in the UK. Although Wang et al. (2020) reported that in certain parts of China, severe air pollution events are not avoided through the reduction in anthropogenic activities partially due to the unfavourable meteorological conditions. Nevertheless, these data are consistent with established accounts linking industrialization and urbanization with the negative alteration of the environment ( Rees, 2002 ).

The upper part shows the average nitrogen dioxide (NO 2 ) concentrations from January 1-20, 2020 to February 10-25, 2020, in China. While the lower half shows NO 2 concentrations over Europe from March 13 to April 13, 2020, compared to the March-April averaged concentrations from 2019 ( ESA, 2020 ; NASA, 2020a ).

The scenarios highlighted above reiterates the fact that our current lifestyles and heavy reliance on fossil fuel-based transportation systems have significant consequences on the environment and by extension our wellbeing. It is this pollution that was, over time, responsible for a scourge of respiratory diseases, coronary heart diseases, lung cancer, asthma etc.( Mabahwi et al., 2014 ), rendering plenty people to be more susceptible to the devastating effects of the coronavirus ( Auffhammer et al., 2020 ). Air pollution constitutes a huge environmental threat to health and wellbeing. In the UK for example, between ~28,000 to ~36,000 deaths/year was linked to long-term exposure to air pollutants ( PHE, 2020 ). However, the reduction in air pollution with the corresponding improvements in air quality over the lockdown period has been reported to have saved more lives than already caused by COVID-19 in China ( Auffhammer et al., 2020 ).

4.3.2. Reduction in environmental noise

Alongside this reduction in air pollutants is a massive reduction in environmental noise. Environmental noise, and in particular road traffic noise, has been identified by the European Environment Agency, EEA (2020) to constitute a huge environmental problem affecting the health and well-being of several millions of people across Europe including distortion in sleep pattern, annoyance, and negative impacts on the metabolic and cardiovascular system as well as cognitive impairment in children. About 20% of Europe's population experiences exposure to long-term noise levels that are detrimental to their health. The EEA (2020) submitted that 48000new cases of ischaemic heart disease/year and ~12000 premature deaths are attributed to environmental noise pollution. Additionally, they reported that ~22 million people suffer chronic high annoyance alongside ~6.5 million people who experienceextreme high sleep disturbance. In terms of noise from aircraft, ~12500 schoolchildren were estimated to suffer from reading impairment in school. The impact of noise has long been underestimated, and although more premature deaths are associated with air pollution in comparison to noise, however noise constitutes a bigger impact on indicators of the quality of life and mental health ( EEA, 2020 ).

A recent study on the aftereffect of COVID-19 pandemic on exercise rates across the globe concluded that reduced traffic congestions and by extension reduced noise and pollution has increased the rate at which people exercise as they leveraged the ensued pleasant atmosphere. Average, moderate, and passive (i.e. people who exercised once a week before COVID-19) athletes have seen the frequency of their exercise regime increased by 88%, 38%, and 156% respectively ( Snider-Mcgrath, 2020 ).

4.3.3. Increased cleanliness of beaches

Beaches constitute the interface between land and ocean, offering coastal protection from marine storms and cyclones ( Temmerman et al., 2013 ), and are an integral part of natural capital assets found in coastal areas ( Zambrano-Monserrate et al., 2018 ). They provide services (e.g. tourism, recreation) that are crucial for the survival of coastal communities and possess essential values that must be prevented against overexploitation ( Lucrezi et al., 2016 ; Vousdoukas et al., 2020 ). Questionable use to which most beaches have been subjected have rendered them pollution ridden ( Partelow et al., 2015 ). However, due to COVID-19-induced measures, notable changes in terms of the physical appearance of numerous beaches across the globe have been observed ( Zambrano-Monserrate et al., 2020 ).

4.3.4. Decline in primary energy use

Global energy demand during the first quarter of 2020 fell by ~3.8% compared to the first quarter of 2019, with a significant effect noticeable in March as control efforts heightened in North America and Europe ( IEA, 2020 ). The International Energy Agency (IEA) submitted that if curtailment measures in the form of restricted movement continue for long and economic recoveries are slow across different parts of the globe, as is progressively likely, annual energy demand will plummet by up to 6%, erasing the last five years energy demand growth. As illustrated in Fig. 9 , if IEA's projections become the reality, the world could experience a plunge in global energy use to a level not recorded in the last 70 years. The impact will surpass the effect of the 2008 financial crisis by a factor of more than seven times. On the other hand, if COVID-19 is contained earlier than anticipated and there is an early re-start of the economy at a successful rate, the fall in energy could be constrained to <4% ( IEA, 2020 ). However, a rough re-start of the economy characterised by supply chain disruptions and a second wave of infections in the second half of the year could further impede growth ( IEA, 2020 ).

Annual rate of change in primary energy demand, since 1900, with key events impacting energy demand highlighted ( IEA, 2020 ).

Coal was reported to have been hit the hardest by ~8% in comparison to the first quarter of 2019 due to the impact of COVID-19 in China whose economy is driven by coal, reduced gas costs, continued growth in renewables, and mild weather conditions. Oil demand was also strongly affected, plummeting by ~5% in the first quarter driven mainly by restrictions in mobility and aviation activities which constitute ~60% of global oil demand ( IEA, 2020 ). For instance, global road transport and aviation activities were respectively ~50% and 60% below the 2019 average. Global electricity demand declined by >20% during full lockdown restrictions, with a corresponding spill over effect on the energy mix. Accordingly, the share of renewable energy sources across the energy supply increased due to priority dispatch boosted by larger installed capacity and the fact that their outputs are largely unconstrained by demand ( IEA, 2020 ). However, there was a decline for all other sources of electricity including gas, coal and nuclear power ( IEA, 2020 ).

4.3.5. Record low CO 2 emissions

Unprecedented reduction in global CO 2 emissions is another positive effect that can be attributed to the COVID-19 pandemic.The massive fall in energy demand induced by COVID-19 accounted for the dramatic decline in global GHG emissions. The annual CO 2 emissions have not only been projected to fall at a rate never seen before, but the fall is also envisioned to be the biggest in a single year outstripping the fall experienced from the largest recessions of the past five decades combined ( IEA, 2020 ).The global CO 2 emissions are projected to decline by ~8% (2.6 GCO 2 ) to the levels of the last decade. If achieved, this 8% emissions reduction will result in the most substantial reduction ever recorded as it is expected to be six times larger than the milestone recorded during the 2009 financial crisis, ( Fig. 10 ). Characteristically, after an economic meltdown, the surge in emissions may eclipse the decline, unless intervention options to set the economy into recovery mode is based on cleaner and more resilient energy infrastructure ( IEA, 2020 ).

Global energy-related emissions (top) and annual change (bottom) in GtCO 2 , with projected 2020 levels highlighted in red. Other major events are indicated to provide a sense of scale ( IEA, 2020 ).

4.3.6. Boost in digitalisation

The COVID-19 pandemic has been described as an opportunity to further entrench digital transformation without the ‘digitalism’ which is an extreme and adverse form of connectedness ( Bayram et al., 2020 ). Protecting patients from unnecessary exposure was a driver for telemedicine ( Moazzami et al., 2020 ) and virtual care would become the new reality ( Wosik et al., 2020 ). The necessity for social distancing under lockdown circumstances has also highlighted the importance (and need) for remote working ( Dingel and Neiman, 2020 ; Omary et al., 2020 ), which has had implications for broadband connectivity ( Allan et al., 2020 ) as well as reductions in transportation-related pollution levels ( Spash, 2020 ). The impact of COVID-19 on remote working and digitalisation of work is expected to constitute long-term implications for reduced fossil fuel consumption due to mobility and commuting ( Kanda and Kivimaa, 2020 ). Besides, the survival and thriving of many small business restaurants during the lockdown period depended on whether they had a digital resilience, via online platforms, through which they could exploit the home delivery market via Uber Eats ( Raj et al., 2020 ). For consumers, the pandemic has seen a noticeable increase in online orders for food in many countries such as: Taiwan ( Chang and Meyerhoefer, 2020 ); Malaysia ( Hasanat et al., 2020 ); Germany ( Dannenberg et al., 2020 ) as well as Canada ( Hobbs, 2020 ).

4.4. Unsustainability of current economic and business models amidst COVID-19

It is interesting to observe that while COVID-19 has led to a very steep reduction in air pollution in advanced economies due to reduced economic activity imposed by the lockdown, this pandemic-driven positive impact is only temporary as they do not reflect changes in economic structures of the global economy ( Le Quéré et al., 2020 ). The changes are not due to the right decisions from governments in terms of climate breakdown policies and therefore should not be misconstrued as a climate triumph. More importantly, life in lockdown will not linger on forever as economies will need to rebuild and we can expect a surge in emissions again. To drive home the point, we conducted a decomposition analysis of key drivers (accelerators or retardants) of four global air pollutants using Logarithmic Mean Divisia Index (LMDI) framework ( Ang, 2005 ; Fujii et al., 2013 ), with the results shown in Fig. 11 . The drivers of the pollutants considered based on the production side of an economy include: (i) economic activity effect, given thatemissions can increase or decrease as a result of changes in the activity level of the entire economy; (ii) industrialeconomy structure effect, based on the fact thatthe growth in emissions is a function of the changes in the industrial activity composition; (iii) emissions intensity effect, which can be improvements or deteriorations at the sectoral level, depending on theenergy efficiency (e.g. cleaner production processes) of the sector; (iv) fuel mix or fuel dependency effect, given that its composition influences the amount of emissions; and (v) emission factors effect, because these factors, for different fuel types, changes over time due toswitching from fossil fuels to renewables, for example.

Drivers of representative four (4) global pollutants: a) CO 2 emissions; b) NO x emissions; c) SO x emissions; d) CO emissions. All data for the decomposition analysis of the four pollutants were obtained from the WIOD database ( Timmer et al., 2012 ).

As shown in Fig. 11 a, for example, between 1995 and 2009, global change in CO 2 emission was 32%, where economic activity (+48%) and emission factor (+2%) acted as accelerators, while economic structure (-8%), emission intensity (-9%) and fuel mix (-1%) acted as retardants, of the global CO 2 emission dynamics and trajectory.This implies that although economic activities, as expected, alongside emission factor drove up emissions, however, the upward effect of both drivers was offset by the combined improvements of other driving factors namely economic structure, emission intensity, and fuel mix. Indeed, cutting back on flying or driving less as we have experienced due to COVID-19 contributed to ~8% in emission reduction, however, zero-emissions cannot be attained based on these acts alone. Simply put, emissions reduction cannot be sustained until an optimal balance across the aforementioned drivers informed by structural changes in the economy is attained. As Gates (2020a) rightly stated – the world should be using more energy, not less, provided it is clean.

Characteristically, after an economic meltdown, like the global recession in 2008, there is a surge in emissions ( Feng et al., 2015 ; Koh et al., 2016 ). The current social trauma of lockdown and associated behavioural changes tends to modify the future trajectory unpredictably. However, social responses would not drive the profound and sustained reduction required to attain a low-carbon economy ( Le Quéré et al., 2020 ). This is evident given that we live on a planet interlinked by networked product supply chains, multidimensional production technologies, and non-linear consumption patterns ( Acquaye et al., 2017 ; Ibn-Mohammed et al., 2018 ; Koh et al., 2016 ). Additionally, post COVID-19, the society may suffer from green bounce back– there appears to be an increasing awareness of climate change and air pollution because of this pandemic (though the linkages are non-causal). On the one hand this might promote greener choices on behalf of consumers, but on the other it may result in increased car ownership (at the expense of mass transit), driving up emissions. As such, establishing approaches that ensure an optimal balance between quality of life and the environmental burden the planet can bear is pertinent, if the boundaries of environmental sustainability informed by the principles of low-carbon CE are to be extended. In the next section, the role of the CE as a potential strategy for combating pandemics such as COVID-19 is discussed.

5. The role of circular economy

For long, the central idea of the industrial economy rests on the traditional linear economic system of taking resources, making products from them, and disposing of the product at the end of life. Experts referred to this as “extract-produce-use-dump”, “take-make-waste”, or “take-make-dispose” energy flow model of industrial practice ( Geissdoerfer et al., 2017 ; Kirchherr et al., 2017 ; MacArthur, 2013 ). However, the unlimited use of natural resources with no concern for sustainability jeopardizes the elastic limit of the planet's resource supply. For instance, Girling (2011) submitted that ~90% of the raw materials used in manufacturing become waste before the final product leaves the production plant while ~80% of products manufactured are disposed of within the first 6 months of their life. Similarly, Hoornweg and Bhada-Tata (2012) reported that ~1.3 billion tonnes of solid waste with a corresponding cost implication of $205.4 billion/year is generated by cities across the globe and that such waste might grow to ~2.2 billion tonnes by 2025, with a corresponding rate of $375.5 billion. This is further compounded by the fact that at the global level, the demand for resources is forecasted to double by 2050 ( Ekins et al., 2016 ).

Against this backdrop, the search for an industrial economic model that satisfies the multiple roles of decoupling of economic growth from resource consumption, waste management and wealth creation, has heightened interests in concepts about circular economy ( Ekins et al., 2016 ; MacArthur, 2013 ).In theory, CE framework hinges on three principles: designing out waste, keeping products and materials in use and regenerating the natural systems ( MacArthur, 2013 ). Practically, CE is aimed at: (i) emphasizing environmentally-conscious manufacturing and product recovery ( Gungor and Gupta, 1999 ); (ii) promoting the avoidance of unintended ecological degradation in symbiotic cooperation between corporations, consumers and government ( Bauwens et al., 2020 ); and (iii) shifting the focus to a holistic product value chain and cradle-to-cradle life cycle via promotion of product repair/re-use and waste management ( Duflou et al., 2012 ; Lieder and Rashid, 2016 ; Rashid et al., 2013 ).

Given the current COVID-19 pandemic, there has never been a more adequate time to consider how the principles of CE could be translated into reality when the global economy begins to recover. This is pertinent because the pandemic has further exposed the limitations of the current dominant linear economy regarding how it is failing the planet and its inhabitants, and has revealed the global ecosystem's exposure to many risks including climate breakdown, supply chain vulnerabilities and fragility, social inequality and inherent brittleness ( Bachman, 2020 ; Sarkis et al., 2020 ). The pandemic continues to amplify the global interlinkages of humankind and the interdependencies that link our natural environment, economic, and social systems ( Haigh and Bäunker, 2020 ). In the subsections that follow, the potentials of CE as a tool for: (i) climate change mitigation; (ii) crafting a more resilient economy, and ; (iii) facilitating a socially just and inclusive society, is briefly discussed.

5.1. Circular economy as a tool for climate breakdown mitigation

As highlighted in Section 4.3.5 , a CO 2 emission reduction of 8%, which in real terms implies an equivalent of ~172 billion tCO 2 will be released instead of ~187 billion tCO 2 , is indeed unprecedented. Nevertheless, the peculiar conclusion from the lockdown is that it still entails emissions of 92% of the initial value while there was restrictions to mobility and other related leisure activities. Measures for mitigating climate change have often been presented dramatically as a "prohibition of the nice things of life", but as shown, a cut-off of such an amount of nice things only delivers an 8% reduction. More importantly, it comes at a heavy cost of between $3,200/tCO 2 and $5,400/tCO 2 in the US, for example, based on data from the Rhodium Group ( Gates, 2020a ). In other words, the shutdown is reducing emissions at a cost between 32 and 54 times the $100/tCO 2 deemed a reasonable carbon price by economists ( Gates, 2020a ). This suggests that a completely different approach to tackling climate issue is required.

Accordingly, there is the need for a system that calls for greater adoption of a more resilient low-carbon CE model, given the predictions by experts that climate breakdown and not COVID-19 will constitute the biggest threat to global health ( Hussey and Arku, 2020 ; Watts et al., 2018a ; Watts et al., 2018b ). International bodies and country-level environmental policies have highlighted the fact that a significant reduction in GHG emissions cannot be achieved by transitioning to renewables alone but with augmentation with CE strategies. The demands side CE strategies such as (i)material recirculation (more high-value recycling, less primary material production, lower emissions per tonne of material); (ii)product material efficiency (improved production process, reuse of components and designing products with fewer materials); (iii)circular business models (higher utilisation and longer lifetime of products through design for durability and disassembly, utilisation of long-lasting materials, improved maintenance and remanufacturing), could reduce emissions whilst contributing to climate change mitigation ( Enkvist et al., 2018 ). CE principles, when adopted in a holistic manner provide credible solutions to the majority of the structural weaknesses exposed by COVID-19, offering considerable opportunities in competitiveness and long-term reduced GHG emissions across value chains. Investments in climate-resilient infrastructure and the move towards circular and low-carbon economy future can play the dual role of job creation while enhancing environmental and economic benefits.

5.2. Circular economy as a vehicle for crafting more resilient economies

Haigh and Bäunker (2020) reported that if we muddle through every new crisis based on the current economic model, using short-term solutions to mitigate the impact, future shocks will continue to surpass capacities. It is, therefore, necessary to devise long-term risk-mitigation and sustainable fiscal thinking with the view to shift away from the current focus on profits and disproportionate economic growth. Resilience in the context of the CE largely pertains to having optimized cycles (i.e. products are designed for longevity and optimized for a cycle of disassembly and reuse that renders them easier to handle and transform). Some cycles can be better by being closed locally (e.g. many food items), and for other cycles, a global value chain could be a better option (e.g. rare earth elements). Due to globalization, all cycles have become organized at the global level, diminishing resilience. COVID-19 has further shown how some particular cycles had the wrong scale level, as such, the adoption of CE can be seen as an invitation to reconsider the optimal capacity of cycles.

Sustainability through resilience thinking would have a positive and lasting impact as reported by the Stockholm Resilience Centre (2016) , which concluded that prosperity and sustainability cannot be accomplished without building “ resilient systems that promote radical innovation in economic policy, corporate strategy, and in social systems and public governance”. It calls for sustainability through resilience thinking to become an overarching policy driver and encourages the application of the principles of such thinking to enhance social innovation. Haigh and Bäunker (2020) concluded that when resilience thinking is employed as a guide, all innovations emanating from circular thinking would extend beyond focusing mainly on boosting the market and competitiveness and recognise the general well-being of the populace as an equal goal. As the global economy recovers from COVID-19, it has become more apparent that there is a strong sense of interconnectedness between environmental, economic and social sustainability ( Bauwens et al., 2020 ).

5.3. Circular economy as a facilitator of a socially just and inclusive society

Advanced economies have mainly focused on maintaining the purchasing power of households through the establishment of the furlough scheme (in the UK, for example). Most developing countries have also adopted a similar approach through the integration of containment measures with a huge increase in social protection spending. However, these intervention strategies in response to the pandemic have further revealed the social injustice and inequality between countries and communities given that the deployment of such strategy in advanced economies could devastate developing countries and communities ( Ahmed et al., 2020 ; Haigh and Bäunker, 2020 ). Guan and Hallegatte (2020) revealed that developing and underdeveloped economies face tougher and more challenging situation in comparison to their developed counterparts, because even under the assumption that social protection systems could fully replace income and shield businesses from bankruptcy, maintaining access to essential commodities is impossible if the country is lacking in production capabilities in the first place. Furthermore, in the underdeveloped world, the idea of working from home is very difficult due to the lack of infrastructure and access to health facilities is severely cumbersome. As such, short-term fixes adopted by governments cannot adequately address deep-rooted inequality and social injustice.

Accordingly, Preston et al. (2019) submitted that CE has the potential to minimise prevailing pressures and struggles regarding conflicts due to imbalanced distribution of resources, through participatory forms of governance that entails the inclusion of local stakeholders in resource management initiatives. This can be achieved through the adoption of CE strategy such as closed-loop value chains, where wastes are transformed into resources with the view to not only reduce pollution but to simultaneously aid the pursuance of social inclusion objectives. A number of companies are already embracing this idea. For instance, under the Food Forward SA initiative, “ the world of excess is connected with the world of need ” through the recovery of edible surplus food from the consumer goods supply chain and gets redistributed to the local community. This ensures loops are closed and the needy receive nourishment ( Haigh and Bäunker, 2020 ). With sufficient investment in the CE, developing countries can leapfrog their developed counterparts in digital and materials innovation to integrate sustainable production and consumption and low-carbon developments at the core of their economies. Additionally, Stahel (2016) reported that another benefit of the CE as a facilitator of a socially just and inclusive society is that it is likely to be more labour-intensive due to the variety of end-of-life products and the high cost of automating their processing compared to manual work. As such, CE can enable the creation of local jobs and “reindustrialisation of regions” ( Stahel, 2019 ) through the substitution of: manpower for energy, materials for (local) labour, and local workshops for centralised factories ( Stahel, 2019 ), while boosting the repair economy and local micro industries. Of course, not everybody will see this as a benefit, and many would like to see more automation, not less. However, this is a political/economic argument, not an engineering or scientific one. In the next section, barriers to CE in general and in the context of COVID-19 is discussed.

5.4. Barriers to CE in the context of COVID-19

On the surface, the benefits of CE should be obvious as it strives for three wins in the three dimensions of social, economic and environment impacts through a symbiotic vision of reduced material usage, reduced waste generation, extending value retention in products and designing products for durability. However, limiting barriers obviating the success of CE have existed around technical implementation, behavioural change, financial and intellectual investments, policy and regulations, market dynamics, socio-cultural considerations as well as operational cost of transforming from the linear economy to one based on circularity ( Friant et al., 2020 ). In more concrete terms, the barriers dwell within the ecosystem of actors (and the interactions within the actors) involved in the move towards CE ( Lieder and Rashid, 2016 ).

Pre-COVID-19, Korhonen et al. (2018) enumerated six fundamental factors hindering the promise of CE: (i) thermodynamic factors (i.e. limit imposed by material and energy combustion in recycling/re-manufacturing); (ii) complexity of spatial and temporal boundaries (i.e. material and energy footprints for a product cannot be easily reduced to a point in space and time for an in-depth analysis of environmental impacts); (iii) interlink of governance and nation's economy; (iv) consumer and organizational inertia (i.e. reluctance to embrace new way of doing things due to uncertainty about the success of business models as well as fuzziness around organizational culture and management models that rely on CE); (v) fragile industrial ecosystems (featuring the difficulty of establishing and managing intra-/inter-organizational collaboration along with local/regional authorities); and (vi) lack of consensus on what the many Rs (re-use, recycle, recover, repurpose, repair, refurbish, remanufacture) embedded in CE framework really means ( Kirchherr et al., 2017 ). Challenges in data sharing between product end points and stakeholders, complexity in the supply chain with unclear details of product biography over time, and prohibitive start-up investment costs have also been identified as CE barrier in other climes ( Jaeger and Upadhyay, 2020 ; Manninen et al., 2018 ). Other issues along similar lines were captured in the work by several other authors including Galvão et al. (2020) , Kirchherr et al. (2018) , Govindan and Hasanagic (2018) , De Jesus and Mendonça (2018) and many more.

The paradox of COVID-19 is grounded on creating a once in a lifetime opportunity to re-examine the difficulty of some of these barriers, but it also unveiled a new set of challenges. For instance, the sharing economy models that have been hitherto hailed as exemplars of CE strategy is now perceived differently by many urban dwellers because of the behavioural change embedded in “social distancing”, which is necessary to limit the spread of the virus. Although if concepts such as “access over ownership” or “pay for performance” service have become fully operational, they could have constituted a significant solution to offer flexibility. Additionally, it has been argued that COVID-19 will ‘disrupt some disruptors’ peer-to-peer (P2P) providers such as Airbnb, which has reported a 4.16% drop in local bookings for every doubling new COVID-19 cases ( Hu and Lee, 2020 ). In transportation, demand from ride-sharing modes could increase due to commuters wanting to minimise exposure to COVID-19 in mass transport systems like buses and trains ( Chandra, 2020 ). However, the risks of human-to-human transmission of COVID-19 for passengers not wearing facemask have been noted ( Liu and Zhang, 2020 ), including when either passengers or drivers in ride-hailing and car-sharing disruptors like Uber do not wear facemasks ( Wong et al., 2020 ).

Reducing emissions, in the long run, requires large investments, from both the public and private sectors, in low-carbon technologies and infrastructure in terms of both innovation and diffusion ( OECD, 2018 ). Given the downturn of the global economy due to COVID-19, the prospects of significant low-carbon investments from the private sector have significantly reduced compared to pre-COVID-19. This view is not just limited to the private sector, but also to the public sector, as echoed by Naidoo and Fisher (2020) . Hence, post COVID-19, accelerating progress towards CE still requires: (i) a decisive legal and financial championships from local, regional and national authorities; (ii) innovation across multiple domains (product design, production technologies, business models, financing and consumer behaviours); (iii) governments to promote green logistics and waste management regulations with reasonable incentives to aid producers and manufacturers in minimizing loss while maximizing value. It is therefore recommended that governments provide the much-needed policy framework that will eliminate some of aforementioned barriers to facilitate the urgent transition to CE. Doing this will build resilience for community response to future pandemic and it also aligns with some of the existing roadmaps for resource efficiency ( European Commission, 2011 ).

6. Opportunities for circular economy post COVID-19

COVID-19 has instigated a focus on vibrant local manufacturing as an enabler of resilient economy and job creation; fostered behavioural change in consumers; triggered the need for diversification and circularity of supply chains, and evinced the power of public policy for tackling urgent socio-economic crises. As we rise to the challenges imposed by COVID-19, the question is no longer should we build back better, but how. Consequently, going forward, crafting a roadmap for a sustainable future is as much about the governmental will to forge a new path to socio-economic growth as it is about local businesses joining forces with the consumers to enable the transition to CE. As already documented in the earlier sections of this paper, governments around the world have deployed many financial policy instruments to combat the short-term consequences of COVID-19 pandemic. Still, in the long-term, the adoption of circular economy principles across various technological frontiers holds the promise to bring about a desired technical and behavioural change that will benefit many nations around the world.

Specifically, adopting the CE principle will alleviate some of the detrimental effects of COVID-19 pandemic in the future. To mention just a few: (i) a national level adoption of CE will reduce the over-reliance on one country as the manufacturing hub of the world; (ii) a systematic shift away from the traditional polluting, energy-intensive, manufacturing-driven economy to a CE, based on renewable energy, smart materials, smart re-manufacturing, and digital technology will strengthen the fight against pollution; and (iii) the transition to CE will also spur local job creation along several of the axes of societal needs (e.g. built environment, mobility, health, consumables, etc.). Accordingly, in the subsections that follow, an overview of recommendations as well as policy measures, incentives, and regulatory support for advancing sector-specific CE strategies in a post-COVID-19 world is presented.

6.1. Local manufacturing and re-manufacturing of essential medical accessories

Disruptions due to COVID-19 has been attributed to unprecedented demand, panic buying, and intentional hoarding of essential medical goods for profit ( Bradsher and Alderman, 2020 ; Fischer et al., 2020 ). The shortage of many items was so dire in many countries that the principle of CE, such as re-use, is already been unwittingly recommended ( Gondi et al., 2020 ), by respectable bodies such as the US Centres for Disease Control and Prevention (CDC) ( Ranney et al., 2020 ). However, designed and produced from non-CE compliant processes, medical accessories such as PPE cannot be easily refurbished for re-use without leading to severe degradation in their efficiencies, as noticed for example, in the case of particulate respirators ( Liao et al., 2020 ). Accordingly, it is recommended that companies strive to establish competencies in eco-design and environmentally beneficial innovation to facilitate product re-use in the long run. Some of the desired competencies centre on design strategies for closing resource loops (e.g. designing for technological and biological cycles) as pioneered by McDonough and Braungart (2010) .

A detailed discussion of these competencies is also enunciated by Braungart et al. (2007) , where the authors differentiated between eco-efficiency (less desirable) and eco-effectiveness (the desired dream of CE), for companies to be compliant with the CE framework. Meanwhile, a starting point for companies to shift to eco-effectiveness at the product design level, which will facilitate product re-use, is to follow the five-step framework enumerated by Braungart et al. (2007) or to adopt the analytical framework to explore some of the key dimensions in eco-design innovations developed by Carrillo-Hermosilla et al. (2010) . During implementation, the preceding steps comport with the idea of eco-factories that take pride in design for effortless end-of-life product re-use and design for “upcycling” and remanufacturing ( Bocken et al., 2016 ; Herrmann et al., 2014 ; Ijomah, 2010 ), all of which falls under the umbrella of CE.

Another emerging evidence in favour of CE, also adopted inadvertently during this pandemic, is the ease with which several manufacturers have pivoted their factory floors to make different products in response to the shortage of medical accessories. Few examples of these companies in the UK include, but not limited to: AE Aerospace, which retooled its factory floor to produce milled parts for ventilators; Alloy Wire International re-purposed its machinery to make springs for ventilators; AMTICO (flooring manufacture) re-configured its production lines to make visors for front line workers; BAE Systems deployed its factory resources to produce and distribute over 40000 face shields; and BARBOUR (a clothing company) re-purposed to produce PPE for nurses ( Williamson, 2020 ).

6.2. CE strategies for managing hospital medical and general waste

Wastes generated by the healthcare industry (HCI) normally arouse concerns about operational, public, and environmental safety as a result of the awareness of the corrosive, hazardous, infectious, reactive, possibly radioactive, and toxic nature of the wastes’ composition ( Lee et al., 1991 ; Prüss-Üstün et al., 1999 ). Consequently, the management of the different categories of healthcare waste far removed from the traditional municipal wastes, falls under stringent national or local regulatory frameworks. Pre-COVID-19, the staggering scale of HCI waste is reported to reach into millions of tonnes per year and there have been many studies of national-level attempts at managing these wastes ( Da Silva et al., 2005 ; Insa et al., 2010 ; Lee et al., 1991 ; Oweis et al., 2005 ; Tudor et al., 2005 ). However, this problem is expected to worsen with the tremendous surge, in the last few months, in the volume of disposable medical hardware (PPE, masks, gloves, disposable gears worn by healthcare workers and sanitation workers as well as those contaminated by contacts with COVID-19 patients). Another allied problem is the troubling shift among consumers who now prioritize concerns for hygiene by leaning towards plastic packaging (e.g. in food delivery and grocery shopping) during this pandemic at the expense of environmental impacts ( Prata et al., 2020 ). Most of these products are derived from non-biodegradable plastics, and their disposal has not been given much thought. As a result, the management of these wastes has raised understandable angst in several quarters ( Klemeš et al., 2020 ; Xiao and Torok, 2020 ). Frustratingly, there is much less that can be done at the moment apart from devising judicious waste management policy for these potentially hazardous wastes.

The traditional steps concerning the treatment of HCI wastes (such as collection and separation, storage, transportation to landfill, and decontamination/disposal) suffer from many complications that make the management a challenging undertaking ( Windfeld and Brooks, 2015 ). To alleviate the complexity, the characterization of the physicochemical composition of HCI waste has become an important tool in devising crucial steps for setting up waste minimization and recycling programs ( Kaiser et al., 2001 ). This aligns with the objective of circular economy (CE), which prioritizes the prevention of waste, failing which it proposes the re-use/recyclability of materials from waste to close the loop.

Wong et al. (1994) reported that hospital wastes involve different types of materials: plastics (tubes, gloves, syringes, blood bags), metals (basins, aluminium cans), papers (towel papers, toilet papers, newspapers), cotton/textiles (drapes, table covers, diapers, pads, bandages), glass (bottles) etc. With this categorization in mind, a CE product design consideration that looks promising in the near future, as a way to avert some of the dangers that can be triggered by events such as COVID-19, is to increase the volume of recyclable materials and biodegradable bioplastics in the production of medical accessories. However, the reality is that not all medical gears and products can be derived from bio-plastics or recyclable materials, and some will inevitably continue to be fabricated with materials that need further downstream processing. Yet, the application of CE to the healthcare industry (HCI) remains a touchy subject. Understandably, health and safety concerns, as well as requirements to meet stringent regulations, tend to override the environmental gain from the 4R practice promoted by CE ( Kane et al., 2018 ). Nonetheless, the benefits of CE are starting to catch on in the HCI as a means of optimizing hospital supply chains and reduce overhead cost, all the while creating environmental benefits in the course of saving human lives.

Principally, the applications of CE in HCI, like in other fields, are tied to materials flow and an examination of the nature of wastes. Pioneering studies on hospital wastes characterizations ( Diaz et al., 2008 ; Eleyan et al., 2013 ; Özkan, 2013 ; Wong et al., 1994 ), revealed that close to 80% of the wastes can be classified as general wastes, while the remaining 20% falls under the infectious waste category ( WHO, 1998 ). A prevalent method of dealing with the two HCI waste categories has been incineration ( Wong et al., 1994 ). Although suitable for large volumes, incineration produces toxic pollutants such as heavy metals, dioxins, acid gases, and hydrogen chloride ( Yang et al., 2009 ). Consequently, pre-COVID-19, besides incineration, reducing or preventing the volume of wastes in both categories is also shaped by the adoption of green purchasing practices ( Wormer et al., 2013 ). While this may help in the short term, a holistic approach to confronting this problem is the adoption of CE, which can facilitate the shift towards eco-efficient HCI, starting with lifecycle evaluations of medical products to the proposal for re-usable medical instruments ( Cimprich et al., 2019 ; De Soete et al., 2017 ; Penn et al., 2012 ). Numerous CE strategies for healthcare waste management are detailed by Kane et al. (2018) and Voudrias (2018) . Undoubtedly, with COVID-19, there is an uptick in the percentage of waste under the infectious category due to hospitals taking various precautions to facilitate control of the pandemic ( Peng et al., 2020 ). Nevertheless, by subjecting the general waste category to proper sterilization procedure via any of thermal, microwave, bio-chemical sterilization, the huge potential from upcycling of the retrieved materials will edge towards fulfilling the promise of CE within the sector ( Yang et al., 2009 ).

6.3. Embracing resource efficiency in the construction and built environment

As with other economic sectors, COVID-19 has exposed the shortcomings of the built and natural environment's business-as-usual practices, highlighting the prevalence of poor-quality buildings, issues regarding affordability of decent housing and rigidity of the current building stocks ( EMF, 2020b ). Living in poor-quality houses and in small constricted energy inefficient homes, led to the in-house transmission of the virus in some cases ( Clair, 2020 ). This is particularly the case in poorer countries where inadequate access to sanitation amenities has prevented people from adopting best practices necessary for halting the transmission ( Andrew et al., 2020 ). These issues alongside the growing concern and awareness regarding the resource-wasting nature of the sector, present a strong case for rethinking it. The CE is well positioned to offer potential solutions to these problems.

CE can help balance behavioural challenges and opportunities from occupancy requirements. Humans spend up to 90% of their time indoors ( Marques et al., 2018 ; Pitarma et al., 2017 ). The pandemic has led to people spending more time at ‘home’ than at work, leading to massively underutilised office and business spaces, which is likely to increase due to on-going social distancing constraints ( Feber et al., 2020 ) or perhaps due to more organisation discovering the cost benefits of remote working. It is also plausible that upgrading of existing (or design of new) office and commercial spaces would require making them flexible and adaptable to cope with changing needs (e.g. occupant density, social distancing, ventilation, etc.) by using movable walls ( Carra and Magdani, 2017 ). Insufficient ventilation can increase the risk of infection to healthcare workers and susceptible patients in healthcare buildings, especially makeshift hospitals ( Chen and Zhao, 2020 ). The impact of these engineering measures on energy consumption of typical buildings and healthcare facilities needs to be considered because of social distancing measures, which may require a decrease in occupant density but an increase in ventilation rates. So, although energy recovery is high on the agenda for CE in the built environment ( Eberhardt et al., 2019 ), the additional requirement of more mechanical ventilation for less people will stretch the energy consumed by buildings. Some researchers have argued for buildings to avoid recirculation (essential for energy savings) and use 100% fresh outdoor air for mechanical ventilation systems ( Pinheiro and Luís, 2020 ). Such scenarios are likely to increase the adoption of renewable energy sources to support acceptable indoor air quality (IAQ).

The adoption of CE strategies such as material reuse and development of recycling infrastructure can facilitate value circulation and efficient use of resources within the built and natural environment, ensuring a more competitive and cost-effective post-COVID-19 recovery, while contributing to GHG emissions reduction and creating job opportunities ( EMF, 2020b ). For instance, a study by ARUP estimated that designing for steel reuse has the potential of generating savings of 6-27% and 9-43% for a warehouse and an office respectively, whilst constituting up to 25% savings on material costs ( SYSTEMIQ, 2017 ). The EU is leading in policy direction that would make it a legal requirement to introduce recycled content (i.e. material looping) in specific construction products, after the functionality and safety have been vetted ( European Commission, 2020 ). Such initiatives will encourage designers and researchers to incorporate material looping into their overall design strategy across the value chain to ensure they are fit for circulation ( Deloitte, 2020 ). This material looping has been shown to reduce disposal fees and generate new income streams from the secondary materials market ( Rios et al., 2015 ). It is an approach that would help reduce construction waste, which accounts for a third of all solid wastes in countries like India ( EMF, 2016 ). The adoption of digital material passports that supports end-to-end tracking of building materials has been reported by SYSTEMIQ (2017) to aid the identification of materials for reuse as they approach their end of first life, thereby allowing the longevity and encouraging tighter material looping.

COVID-19 in the context of CE will encourage prefabrication, design thinking and renovation. As the building industry moves towards the industrialisation of construction via prefabrication/offsite production, seven strategies have been suggested by Minunno et al. (2018) out of which the principle of designing for eventual disassembly and reuse is critical. With a combined smart and industrialised prefabrication (SAIP) process ( Abbas Elmualim et al., 2018 ), the intelligent performance and circularity of buildings can be boosted by advanced smart technologies ( Windapo and Moghayedi, 2020 ). The building of 1,000 bed Huoshenshan Hospital in Wuhan covering 34,000m 2 in ten days using modular pre-fabricated components, which can be disassembled and reused ( Zhou et al., 2020 ) has demonstrated the capability of the construction industry to deliver adaptable buildings in record time. But it is perhaps in the sphere of refurbishment and renovation that CE in the built environment would mostly be felt. A CE strategy that promotes repair and refurbishment is preferable to one which encourages recycling, since the economic and environmental value of a product is retained better by the former ( Sauerwein et al., 2019 ).

Renovation helps achieve carbon reduction targets while contributing to economic stimulation ( Ibn-Mohammed et al., 2013 ) . Retrofitting, refurbishing or repairing existing buildings leads to lower emission facilities, is less resource-intensive and more cost-effective than demolition or new construction ( Ardente et al., 2011 ; Ibn-Mohammed et al., 2014 ). Nevertheless, circular renovation of buildings must align with circular design thinking – as alluded to above, in terms of re-integrating materials back into the value chain – as well as the need to enhance material/product durability and energy efficiency ( Pomponi and Moncaster, 2017 ). In Europe, renovation of buildings decreases the residential sector's GHG emissions by 63%, with a reduction of up to 73% in the non-residential sector ( Artola et al., 2016 ). In meeting the emerging needs of the renovation sub-sector, digital infrastructure technologies (such as thermographic and infrared surveys, photogrammetry and 3D laser scanning, as well as BIM and Digital Twinning) will play a crucial role in ensuring the low carbon and energy-efficient future of the built environment ( ARUP, 2020 ).

6.4. Bio-cycle economy and the food sector

COVID-19 or not, the food sector is generally wasteful ( Dilkes-Hoffman et al., 2018 ), contributes to environmental degradation ( Beretta and Hellweg, 2019 ), disrupts nutrient flows due to the current linear nature of its value chain, thereby diminishing the nutritional quality of food ( Castañé and Antón, 2017 ). To address these issues, as part of a future resilience in the food sector, a number of CE levers applicable to the sector is highlighted: (i) closing nutrient loops through the adoption of regenerative agriculture ( Rhodes, 2017 ). The organic content of soil reflects its healthiness and propensity to produce nutritious crops. The adoption of regenerative agriculture can facilitate the preservation of soil health through returning organic matter to the soil in the form of food waste or composted by-products or digestates from treatment plants ( Sherwood and Uphoff, 2000 ); (ii) value recovery from organic nutrients through the adoption of anaerobic digestion facilities ( De Gioannis et al., 2017 ; Huang et al., 2017 ), which is related to controlled biogas production for onward injection into natural gas network or conversion to electrical energy ( Atelge et al., 2020 ; Monlau et al., 2015 ). This has the potential to transform ensuing methane from food waste into carbon-neutral energy; and (iii) the embrace of urban and peri-urban agriculture ( Ayambire et al., 2019 ; Lwasa et al., 2014 ; Opitz et al., 2016 ; Thebo et al., 2014 ), which entails the “ cultivation of crops and rearing of animals for food and other uses within and surrounding the boundaries of cities, including fisheries and forestry ”( EPRS, 2014 ). Indeed, by cultivating food in proximity to where it will be consumed, carbon footprint can be mitigated in numerous ways. For instance, through the adoption of urban agriculture, Lee et al. (2015) demonstrated GHG reduction of 11,668 t yr −1 in the transportation sector. The popularity of local farms has severely increased as a direct consequence of COVID-19, whereby people could experience the power of local food cycles and avoid perceived contamination risks in supermarkets. This will further bolster urban and peri-urban agriculture.

All the above-mentioned CE strategies will contribute towards the establishment of a better and more resilient future food system. However, in the context of COVID-19, transitioning to regenerative agricultural production processes and expanding food collection, redistribution and volarisation facilities constitute an integral part of a more resilient and healthy food system that allows greater food security and less wastage, post COVID-19 ( EMF, 2020a ). Investments towards accelerating regenerative agriculture offer economic benefits facilitated by reforms in food, land, and ocean use ( World Economic Forum, 2020 ). It also offer environmental benefits by supporting biologically active ecosystems ( EMF, 2020a ) and through numerous farming mechanisms including no-till farming, adoption of cover crops, crop rotations and diversification ( Ranganatha et al., 2020 ) as well as managed grazing for regenerative livestock rearing ( Fast Company, 2019 ). Similarly, expanding food collection, redistribution and volarisation facilities offers both economic and environmental benefits for the food system ( EMF, 2020a ). However, realising these benefits will require investment in: (i) physical infrastructure like cold chains that support the storage, processing, and supply of edible food, especially in low-income countries, and (ii) processing infrastructure for the collection and volarisation of waste food ( EMF, 2020a ). This will facilitate door-to-door waste food collection, offering avenues for municipal organic waste volarisation.

6.5. Opportunities for CE in the transport and mobility sector

Facilitating the movement of people, products and materials, transportation infrastructures are imperative to the success of circularity in the shift towards sustainable cities given its impact on the quality of life, the local environment and resource consumption ( Van Buren et al., 2016 ). As noted in an earlier section, the transport sector was one of the sectors most heavily impacted by COVID-19. Going forward, many CE strategies could be adopted as part of building a resilient transport sector. Development of compact city for effective mobility given their attributes in terms of being dense with mixed-use neighbourhoods and transit-oriented ( EMF, 2019 ), can create an enabling environment for both shared mobility options (e.g. trams, buses, ride-shares) and active mobility options (e.g. bicycling, walking) ( Chi et al., 2020 ; Shaheen and Cohen, 2020 ). This will help to re-organize urban fabric and promote intelligent use of transportation infrastructures ( Marcucci et al., 2017 ). However, the behavioural change embedded in “social distancing”, which is necessary to limit the contagion, may affect the perception of many urban dwellers about this. On the other hand, less compact cities require increased mobility infrastructure with a corresponding increase in operational vehicle use, leading to more traffic congestion, energy and resource depletion as well as pollution ( UN Habitat, 2013 ).

The use of urban freight strategies for effective reverse logistics and resource flows is also a viable CE strategy for the transport sector ( EMF, 2019 ) as it enables the provision of services in a manner that also supports similar priorities for economic growth, air quality, environmental noise and waste management ( Akgün et al., 2019 ; Kiba-Janiak, 2019 ). Beyond vehicles and infrastructure, the adoption of these strategies can enable the development of new technologies and practices such as virtualisation of products, digital manufacturing, waste collection, and sorting systems. Interestingly, innovative environmentally-friendly logistics solutions resting on the backbone of the CE framework are already materializing and being trialled in various capacities, including: urban consolidation centre (UCC) ( Johansson and Björklund, 2017 ), crowshipping ( Buldeo Rai et al., 2017a ; Rai et al., 2018 ) and off-hour delivery ( Gatta et al., 2019 ). UCC stresses the use of logistics facilities in city suburbs to ease good deliveries to customers ( Browne et al., 2005 ), while crowshipping is a collaborative measure that employs the use of free mobility resources to perform deliveries ( Buldeo Rai et al., 2017b ).

The availability of rich transport data (e.g. impacts of events on transport, commuter habits) and AI-enabled complex data processing technologies can be leveraged to inform the planning, management, and operations of transport networks over time. Real-time data can also be adopted for monitoring and for instant regulations of traffic flow based on route planning, dynamic pricing and parking space allocation. Noticeably, many of these innovative CE-related initiatives still need an efficient governance mechanism ( Janné and Fredriksson, 2019 ). However, coupling them with the deployment of environmentally efficient vehicles and superior technical solutions hinging on the internet-of-things will bring many nations closer to reaping the benefits of CE. Given that urban planning is most often within the remit of governmental agencies, they must therefore develop integrated pathways and strategies for urban mobility to ensure effective logistics and resource flows. Stakeholder engagements within the transport sector can also facilitate innovative solutions that enable better use of assets and big data solutions.

6.6. Sustaining improvements in air quality

Improvements in air quality is one of the positives recorded due to the COVID-19-imposed lockdown as transportation and industrial activities halted. To sustain such improvements, there is the need to facilitate a step change by ramping up the uptake of low emission vehicles through setting more ambitious targets for the embrace of electric vehicles, constructing more electric car charging points as well as encouraging low emissions fuels. This entails heightening investments in cleaner means of public transportation as well as foot and cycle paths for health improvements; redesigning of cities to ensure no proximity to highly polluting roads and the populace as well as preventing highly polluting vehicles from accessing populated areas using classifications such as clear air or low emission zones ( PHE, 2020 ).

Batteries constitute an integral part towards the decarbonisation of road transportation and support the move to a renewable energy system ( World Economic Forum, 2019 ). As such, it is important to establish a battery value chain that is circular, responsible and just, to realise the aforementioned transitions. This entails the identification of the ( World Economic Forum, 2019 ): (i) challenges inhibiting the scaling up of the battery value chain (e.g. battery production processes, risks of raw materials supplies); (ii) levers to mitigate the challenges such as a circular value chain (e.g. design for life extension, implementation of V1G and V2G and scaling up of electric shared and pooled mobility, coupling the transport and power sectors); sustainable business and technology (e.g. increasing the share of renewables and energy efficiency measures across the value chain, effective regulations and financial incentives to support value creation); and a responsible and just value chain based on a balanced view and interplay between environmental, social and economic factors. Indeed, cost-effective and sustainable batteries, as well as an enabling ecosystem for the deployment of battery-enabled renewable energy technologies backed with a dense infrastructure network for charging, will facilitate the transition towards broader acceptance of electric vehicles and by extension guarantees a sustained improvement in air quality ( Masiero et al., 2017 ; PHE, 2020 ; World Economic Forum, 2019 ).We recognize that if all cars are simply replaced by electricones, there will still be the same volume of traffic and an increased need for raw materials, posing significant social, environmental and integrity risks across its value chain. However, CE through the aforementioned levers can address these challenges and support the achievement of a sustainable battery value chain. This will entail lowering emission during manufacturing, eradicating human rights violations, ensuring safe working conditions across the value chain and improving reuse, recycling and remanufacturing ( World Economic Forum, 2019 ).

6.7. Digitalisation for supply chain resilience post COVID-19

Digitalisation of supply chains through leveraging disruptive digital technologies (DDTs) - technologies or tools underpinning smart manufacturing such as the Internet of Things (IoT), artificial intelligence, big data analytics, cloud computing and 3D printing - constitute an important step for companies to prepare for and mitigate against the disruptions and attain business resilience amidst global pandemics such as COVID-19. Circular supply chain value drivers’ entails elongation of useful lifespan and maximisation of asset utilisation. Intelligent assets value drivers entail gathering knowledge regarding the location, condition and availability of assets ( Morlet et al., 2016 ). Paring these drivers could provide a broad range of opportunities, which could change the nature of both products and business models, enabling innovation and value creation ( Antikainen et al., 2018 ; Morlet et al., 2016 ). For instance, big data analytics, when adopted properly can aid companies in streamlining their supplier selection processes; cloud-computing is currently being used to facilitate and manage supplier relationships; through automation and the IoT, logistics and shipping processes can be greatly enhanced ( McKenzie, 2020 ). Digitalisation enables predictive maintenance, preventing failures while extending the lifespan of a product across the supply chains. It therefore, constitutes an ideal vehicle for circular supply chains transitioning, providing opportunities to close material loops and improve processes ( Morlet et al., 2016 ; Pagoropoulos et al., 2017 ).

Indeed, COVID-19 has prompted renewed urgency in the adoption of automation and robotics towards mitigating against the disruptive impact on supply chains through restrictions imposed on people's movement. Numerous companies are taking advantage of this to automate their production lines. Prior to COVID-19, momentum towards adopting 5G mobile technology was mounting but delays caused by factors including anticipated use evaluations, security, competition and radio communications regulatory issues limited progress ( McKenzie, 2020 ). It is likely that the experience of COVID-19 may accelerate the provision of regulatory certainty for 5G, which will in turn fast-track the deployment of IoT-enabled devices for remote monitoring, to support supply chain resilience post COVID-19.

Despite the benefits of DDTs, tension exists between their potential benefits (i.e. ability to deliver measurable environmental benefits at an affordable cost), and the problems (i.e. heavy burden imposed during manufacturing and disposal phases of their lifecycle) they constitute, creating rebound effects. As such, the tension between the push for increasing digitalisation and the associated energy costs and environmental impacts should be investigated such that they do not exacerbate the existing problems of resource use and pollution caused by rapid obsolescence and disposal of products containing such technologies. This entails identifying, mapping and mitigating unintended consequences across their supply chains, whilst taking into account technological design embedded within green ethical design processes, to identify environmental sustainability hotspots, both in conception, application and end of life phases.

6.8. Policy measures, incentives and regulatory support for CE transitioning

Becque et al. (2016) in their analysis of the political economy of the CE identified six main types of policy intervention to facilitate, advance and guide the move to a CE by addressing either barriers that aim to fix the market and regulatory failures or encourage market activity. Some of the policy intervention options identified include: (i) education, information and awareness that entails the integration of CE and lifecycle systems thinking into educational curricula supported by public communication and information campaigns; (ii) setting up platforms for collaboration including public-private partnerships with ventures at the local, regional and national levels, encouraging information sharing as well as value chain and inter-sectoral initiatives, establishing research and development to facilitate breakthroughs in materials science and engineering, biomaterials systems etc.; (iii) introduction of sustainability initiatives in public procurement and infrastructure ; (iv) provision of business/financial/technical support schemes such as initial capital outlay, incentive programs, direct subsidies and financial guarantees as well as technical support, training, advice and demonstration of best practices; (v) regulatory frameworks such as regulation of products (including design), extension of warranties and product passports; strategies for waste management including standards and targets for collection and treatments, take-back systems and extended producer responsibility; strategies at the sectoral levels and associated targets for resource productivity and CE; consumer, competition, industry and trade regulations; introduction of standard carbon accounting standards and methodologies; and (vi) fiscal frameworks such as reductions of VAT or excise tax for products and services designed with CE principles.

7. Conclusion

COVID-19 has highlighted the environmental folly of ‘extract-produce-use-dump’ economic model of material and energy flows. Short-term policies to cope with the urgency of the pandemic are unlikely to be sustainable models in the long run. Nonetheless, they shed light on critical issues that deserve emphases, such as the clear link between environmental pollution and transportation/industrialization. The role of unrestricted air travel in spreading pandemics particularly the viral influenza types (of which COVID-19 is one) is not in doubt, with sectors like tourism and aviation being walloped (some airlines may never recover or return to profitability in a long time) due to reduced passenger volumes. The fallout will re-shape the aviation sector, which like tourism has been among the hardest to be hit economically, albeit with desirable outcomes for the reduction in adverse environmental impacts. Peer-to-peer (P2P) or sharing economy models (e.g. Uber, Airbnb) which have birthed a new generation of service providers and employees are found to be non-resilient to global systemic shocks.

The urgency of supply and demand led to a reduction in cargo shipping in favour of airfreights whose transatlantic cost/kg tripled overnight. This is matched by job losses, income inequalities, mass increase in global poverty levels and economic shocks across industries and supply chains. The practicability of remote working (once the domain of technology/service industries) has been tried and tested for specific industries/professions with its associated impacts on reduced commuting for workers. Remote healthcare/telemedicine/ and remote working, in general, is no longer viewed as unfeasible because it has been practiced with success over the best part of a four-month global lockdown period. There was a corresponding reduction in primary energy consumption due to the slowing and shutting down of production and economic activities, and the delivery of education remotely is also no longer questioned. The potential of automation, IoT, and robotics in improving manufacturing processes, as well as the use of cloud computing and big data analytics in streamlining supplier selection processes and management of supplier relationships and logistics are now better appreciated.

The inadequacies of modern healthcare delivery systems to cope with mass casualties and emergencies are universally acknowledged, primarily due to the incapacity of hospital JIT procurement process to provide essential medical and emergency supplies in vast quantities at short notice. This had deadly consequences with thousands of patients and healthcare workers paying the ultimate price for lack of planning and shortfalls in PPE inventory and critical care equipment. Protectionism and in-ward looking policies on exports and tariff reductions/waivers on the importation of raw materials and critical PPE have emphasized the importance of cooperation to cope with shortages, which evolved in tandem with profiteering, thereby emphasizing the role/need for cottage industries to help meet global production of essentials (facemasks, 3D printed parts/equipment, etc.). The increase in infectious hospital wastes due to the pandemic was necessitated by precautionary measures to control the transmission, but proper/advanced sterilization procedures via thermal, microwave, biochemical processes can help in upcycling discarded or retrieved materials and PPE.

Changes in consumer behaviour with social distancing have necessitated a huge increase in online purchasing, which has benefitted the big players but seriously harmed SMEs, who were not exploiting web-based product and service delivery. A CE-based resilience of the consumer food sector was found to require: (i) closing nutrient loops with the use of regenerative agriculture; (ii) value recovery from organic nutrients via anaerobic digestion facilities; (iii) adoption of urban and peri-urban agriculture; and (iv) expanding food collection, redistribution and volarisation facilities. It is believed that CE will facilitate a socially just and inclusive society,driven by the need for resilience and sustainability goals, which could see a rise in bio-economy and sharing economy (SE). The consequences of these would be felt in terms of global cooperation and mutual interests; long-term planning as well as the need to strike an optimum balance between dependence on outsourcing/importation and local manufacturing/productivity. A realignment of value chains is likely to occur because of countries with raw materials exploiting this pandemic for their sustainable growth, and a new world order not shaped by the technological superiority of super-powers is likely to emerge.

During the lockdown, offices and commercial spaces were massively underutilized and the need to increase ventilation rates, e.g. in hospitals is leading to more energy consumption. However, there are opportunities to (re)design buildings to have movable walls for adaptable use. The use of modular techniques for fast construction of buildings that can be disassembled and re-configured for new needs, as demonstrated in China, is likely to increase. Renovation and refurbishment will witness a renewed vigour as existing buildings get a new lease of life with reduced carbon emissions and new jobs being created. Nonetheless, integrating circularity (product durability, energy efficiency, recyclability, etc.) via design thinking is essential from the onset if all these potential benefits are to be achieved. Digital technologies will play a crucial role in ensuring the low carbon and energy-efficient future of the built environment.

Governments are recognizing the need for national-level CE policies in many aspects, such as: (a) reducing over-reliance on other manufacturing countries for essential goods as massive shortages forced the unwitting adoption of CE principles such as re-use; (b) intensive research into bio-based materials for the development of biodegradable products and the promotion of bio-economy; (c) legal framework for local, regional and national authorities to promote green logistics and waste management regulations which incentivize local production and manufacturing; and (d) development of compact smart cities for effective mobility (with social distancing considerations) as well as enabling environment for shared mobility options (e.g. ride-shares) and active mobility options (e.g. bicycling, walking).

Going forward, resilience thinking should guide lessons learnt and innovations emanating from circular thinking should target the general well-being of the populace and not merely focus on boosting the competitiveness, profitability or growth of businesses and national economies. The post-COVID-19 investments needed to accelerate towards more resilient, low carbon and circular economies should also be integrated into the stimulus packages for economic recovery being promised by governments, since the shortcomings in the dominant linear economic model are now recognized and the gaps to be closed are known.

Credit author statement

IMT, MKB and GJ conceived the idea. IMT developed the methodological notes. IMT, MKB, AZ & FH conducted the analysis. IMT, MKB, AZ, BKA, ADD, AA and FH designed the structure and outline of the paper. All authors contributed to the writing the paper, with comments and feedback from GJ and KSCL.

Declaration of Competing Interest

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COMMENTS

Persuasive Essay About Covid19
Writing a persuasive essay about COVID-19 requires a thoughtful approach to present your arguments effectively. Here are some tips to help you craft a compelling persuasive essay on this topic: Choose a Specific Angle. Start by narrowing down your focus. COVID-19 is a broad topic, so selecting a specific aspect or issue related to it will make ...
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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 ...
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Essay On Covid-19: 100, 200 and 300 Words
In conclusion, COVID-19 tested the patience and resilience of the mankind. This pandemic has taught people the importance of patience, effort and humbleness. Also Read - Essay on My Best Friend. Essay On COVID-19 in 300 Words. COVID-19, also known as the coronavirus, is a serious and contagious disease that has affected people worldwide.
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1. Introduction. The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented changes in people's daily lives, with implications for mental health and well-being [1-4], both at the level of a given country's population, and when considering specific vulnerable groups [5-7].In order to mitigate the untoward impact of the pandemic (including lockdown) and support mental health ...
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Having recognized this, the Common App added a new optional 250-word essay that will give universities a chance to understand the atypical high school experience students have had. The prompt will ...
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6 Chinese Center for Disease Control and Prevention, Beijing, China. The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has been characterized by unprecedented rates of spatio-temporal spread. Here, we summarize the main events in the pandemic's timeline and evaluate what has been learnt by the public health community.
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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 ...
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Reading time: 3 min (864 words) The COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems and the world of work. The economic and social disruption caused by the pandemic is devastating: tens of millions of people are at risk of falling into extreme poverty ...
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The book includes a series of short chapters, structured in five sections that address the following themes: Lessons. This section looks at the COVID-19 moment through the lens of what we might ...
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A novel coronavirus (CoV) named '2019-nCoV' or '2019 novel coronavirus' or 'COVID-19' by the World Health Organization (WHO) is in charge of the current outbreak of pneumonia that began at the beginning of December 2019 near in Wuhan City, Hubei Province, China [1-4]. COVID-19 is a pathogenic virus. From the phylogenetic analysis ...
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From lifestyle changes to better eating habits, people are using this time to get healthier in many areas. Since the pandemic started, nearly two-thirds of the survey's participants (62%) say ...
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100 Words Essay on Covid 19. COVID-19 or Corona Virus is a novel coronavirus that was first identified in 2019. It is similar to other coronaviruses, such as SARS-CoV and MERS-CoV, but it is more contagious and has caused more severe respiratory illness in people who have been infected. The novel coronavirus became a global pandemic in a very ...
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Social mobilizers, community workers and volunteers have an important role in providing timely and actionable health information so that people know how to protect themselves and reduce the risks associated with the coronavirus disease 2019 (COVID-19). These tips for community engagement - from UNICEF, the World Health Organization (WHO) and the International Federation of Red Cross and Red ...
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Essay on COVID-19 Pandemic. Published: 2021/11/08. Number of words: 1220. As a result of the COVID-19 (Coronavirus) outbreak, daily life has been negatively affected, impacting the worldwide economy. Thousands of individuals have been sickened or died as a result of the outbreak of this disease. When you have the flu or a viral infection, the ...
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The COVID-19 pandemic has mobilized the world scientific community in 2020, especially in the life sciences [ 1, 2 ]. In the first three months after the pandemic, the number of scientific papers about COVID-19 was fivefold the number of articles on H1N1 swine influenza [ 3 ]. Similarly, the number of clinical trials related to COVID-19 ...
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COVID-19 (coronavirus disease 2019) is a disease caused by a virus named SARS-CoV-2. It can be very contagious and spreads quickly. Over one million people have died from COVID-19 in the United States. COVID-19 most often causes respiratory symptoms that can feel much like a cold, the flu, or pneumonia. COVID-19 may attack more than your lungs ...
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During the COVID-19 pandemic, concerns were raised that face covering use may elicit risk compensation; a false sense of security resulting in reduced adherence to other protective behaviours such as physical distancing. This systematic review aimed to investigate the effect of face covering use on adherence to other COVID-19 related protective behaviours. Medline, Embase, PsychInfo, EmCare ...
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1. Introduction. The newly identified infectious coronavirus (SARS-CoV-2) was discovered in Wuhan and has spread rapidly since December 2019 within China and to other countries around the globe (Zhou et al., 2020; Kabir et al., 2020).The source of SARS-CoV-2 is still unclear (Gorbalenya et al., 2020).Fig. 1 demonstrates the initial timeline of the development of SARS-CoV-2 (Yan et al., 2020).
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Screen time for children under 5 is associated with various health risks. Amidst the COVID-19 pandemic, screen use among young children increased significantly. Mothers were more likely than fathers to be the primary caregivers and disproportionally assumed the responsibility of monitoring their children's screen time. Several studies have examined children's screen use throughout the pandemic ...
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Ideas generated from reading the resulting papers from the search were then used to develop a theoretical framework and a research problem statement, which forms the basis for the CLR. ... A detailed discussion of these competencies is also enunciated by Braungart et al. ... COVID-19 and Trade Policy: Why Turning Inward Won't Work. 2020; 111 ...