life after covid pandemic essay

Life after COVID: most people don’t want a return to normal – they want a fairer, more sustainable future

Chair of Cognitive Psychology, University of Bristol

Professor of Cognitive Psychology and Australian Research Council Future Fellow, The University of Western Australia

Disclosure statement

Stephan Lewandowsky receives funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 964728 (JITSUVAX). He also receives funding from the Australian Research Council via a Discovery Grant to Ullrich Ecker, from Jigsaw (a technology incubator created by Google), from UK Research and Innovation (through the Centre of Excellence, REPHRAIN), and from the Volkswagen Foundation in Germany. He also holds a European Research Council Advanced Grant (no. 101020961, PRODEMINFO) and receives funding from the John Templeton Foundation (via Wake Forest University’s Honesty Project).

Ullrich Ecker receives funding from the Australian Research Council.

University of Western Australia provides funding as a founding partner of The Conversation AU.

University of Bristol provides funding as a founding partner of The Conversation UK.

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We are in a crisis now – and omicron has made it harder to imagine the pandemic ending. But it will not last forever. When the COVID outbreak is over, what do we want the world to look like?

In the early stages of the pandemic – from March to July 2020 – a rapid return to normal was on everyone’s lips, reflecting the hope that the virus might be quickly brought under control. Since then, alternative slogans such as “ build back better ” have also become prominent, promising a brighter, more equitable, more sustainable future based on significant or even radical change.

Returning to how things were, or moving on to something new – these are very different desires. But which is it that people want? In our recent research , we aimed to find out.

Along with Keri Facer of the University of Bristol, we conducted two studies, one in the summer of 2020 and another a year later. In these, we presented participants – a representative sample of 400 people from the UK and 600 from the US – with four possible futures, sketched in the table below. We designed these based on possible outcomes of the pandemic published in early 2020 in The Atlantic and The Conversation .

We were concerned with two aspects of the future: whether it would involve a “return to normal” or a progressive move to “build back better”, and whether it would concentrate power in the hands of government or return power to individuals.

Four possible futures

In both studies and in both countries, we found that people strongly preferred a progressive future over a return to normal. They also tended to prefer individual autonomy over strong government. On balance, across both experiments and both countries, the “grassroots leadership” proposal appeared to be most popular.

People’s political leanings affected preferences – those on the political right preferred a return to normal more than those on the left – yet intriguingly, strong opposition to a progressive future was quite limited, even among people on the right. This is encouraging because it suggests that opposition to “building back better” may be limited.

Our findings are consistent with other recent research , which suggests that even conservative voters want the environment to be at the heart of post-COVID economic reconstruction in the UK.

The misperceptions of the majority

This is what people wanted to happen – but how did they think things actually would end up? In both countries, participants felt that a return to normal was more likely than moving towards a progressive future. They also felt it was more likely that government would retain its power than return it to the people.

In other words, people thought they were unlikely to get the future they wanted. People want a progressive future but fear that they’ll get a return to normal with power vested in the government.

We also asked people to tell us what they thought others wanted. It turned out our participants thought that others wanted a return to normal much more than they actually did. This was observed in both the US and UK in both 2020 and 2021, though to varying extents.

This striking divergence between what people actually want, what they expect to get and what they think others want is what’s known as “ pluralistic ignorance ”.

This describes any situation where people who are in the majority think they are in the minority. Pluralistic ignorance can have problematic consequences because in the long run people often shift their attitudes towards what they perceive to be the prevailing norm. If people misperceive the norm, they may change their attitudes towards a minority opinion, rather than the minority adapting to the majority. This can be a problem if that minority opinion is a negative one – such as being opposed to vaccination , for example.

In our case, a consequence of pluralistic ignorance may be that a return to normal will become more acceptable in future, not because most people ever desired this outcome, but because they felt it was inevitable and that most others wanted it.

Ultimately, this would mean that the actual preferences of the majority never find the political expression that, in a democracy, they deserve.

To counter pluralistic ignorance, we should therefore try to ensure that people know the public’s opinion. This is not merely a necessary countermeasure to pluralistic ignorance and its adverse consequences – people’s motivation also generally increases when they feel their preferences and goals are shared by others. Therefore, simply informing people that there’s a social consensus for a progressive future could be what unleashes the motivation needed to achieve it.

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Three Years Later: How the Pandemic Changed Us

From routines to deep losses, the global health crisis altered lives of staff and faculty

Since her father’s death from COVID-19 in 2021, Alexy Hernandez’s days have become emotional minefields. Any small thing can be a gut punch, reminding her of what’s lost.

Perhaps it’s a football highlight, since she and her father, Josue, shared a love of the sport. Coffee has become complicated since her dad always got a kick out of pictures she sent of the creative designs left in her latte foam.

Or maybe it will simply be the small pieces of her daily routine — getting into work in the morning, coming home at night — experiences that warranted a quick text to her dad, who always wrote back with love and encouragement.

“He was my best friend, my biggest supporter, my biggest cheerleader,” said Hernandez, 28, a clinical research coordinator with the Department of Population Health Sciences . “I am who I am because of him.”

The pandemic changed the way most of us lived. We learned how to work remotely or gained new appreciation for human connection. And, for the loved ones of the roughly 1 million Americans who died from the virus, life will forever feel incomplete.

While the worst of the pandemic may be behind us, its effects linger. According to a Gallup poll , 53 percent of U.S. adults don’t expect their life to ever be the same as it was before the pandemic.

“We all felt this,” said Rachel Kranton, the James B. Duke Professor of Economics who, early in the pandemic, contributed to Project ROUSE , an independent Duke faculty research study that looked at how staff and faculty at Duke coped with changes to life, work, and well-being.

Project ROUSE showed that the pandemic had profound effects on everyone, including that, during the pandemic’s first year, roughly 40 percent of nearly 5,000 study respondents were at risk of moderate or severe depression.

As the pandemic’s difficult early days fade, Kranton said that other changes will likely endure, such as a willingness to connect in new ways, reassess careers, or build lives with more flexibility.

“I think there’s probably a new normal, and I think that new normal includes both good things and bad things,” Kranton said.

Hernandez’s life won’t be the same after her father’s death, but she is moving forward.

She’s learned not to stress about trivial things and thinks often about how she can make her father proud. Nothing, she said, can be taken for granted.

“Losing my dad has completely changed how I view and interact with the world and has given me more clarity on what I value,” said Hernandez, who has worked at Duke for four years.

We asked staff and faculty to share how the pandemic changed their lives, and here’s what some colleagues shared.

‘I’ve learned from students’

“It’s a new normal. You’ve got to deal with what you’ve got to deal with. Teaching markets and management, I’ve tried to move on and try to keep things fun. I like to make my courses interactive. So whether that’s changing materials or adding new things to a class, I’ve had to adapt. A lot of new stuff I’ve learned from students, whether it’s using polls, or Kahoot, or other activities. You’ve got to keep things fresh. The world is changing, you’ve got to change with it.”

George Grody, 64, Lecturing Fellow of Markets & Management, Trinity College of Arts and Sciences

Value of Life

“I appreciate more than ever before, not only the value of life, but a strong appreciation for others in the respiratory field and healthcare. I have been a respiratory therapist 33 years, and I’ve worked at Duke 35 years. Many have come and some have gone from this world. It’s devastating when you’ve worked so hard on patients, and they don’t make it out. Nothing can replace the value of life and what it means. Life is so important, and each and every day that you work with your patients is important. This all taught me a lot about what it means to really care for your patients, and it taught me a great deal of humility in caring for those who needed me.”

Pamela Bowman, 63, recently retired Respiratory Care Practitioner, Duke Regional Hospital

Out of the Quiet

“Though it’s crazy to say, my life started to flourish during the pandemic in more ways than one. I went back to school at the beginning of the pandemic at Durham Technical Community College to study business. I got in the best shape of my life by focusing on clean eating, and I lost 35 pounds. I started earning more money by taking a job at Duke. The pandemic was a time for me to quiet down the noise around me. Personally, I was able to shut out the world, decide what I really wanted out of life, and for myself, and start making those things happen. Ever since things started getting back to how they were pre-pandemic, those progressions I’ve made slowly started to derail. I gained back the 35 pounds I lost once the world started to open up again, and it’s just been harder to do everything I was doing to better myself every day. I went into a bit of a depression, but now I’m finally coming out of it. I’m back down 20 pounds. I’m learning how to cope with things and get back to being able to do those things that progressed for me and made me happy, even though I’m not able to get the same quietness I once had.”

Sadie Horton, 27, Staff Assistant, Academic Support, Fuqua School of Business

Cherish Loved Ones

“My mom, Johnnie Mae Snipes, was put on hospice on Jan. 11, 2021, and she passed away on January 20, 2021, at age 83. Me and my sisters were holding her hand, and, needless to say, we lost the strongest woman we ever knew. Our queen was gone. My mother had six daughters, 17 grandchildren, 44 great grandchildren and seven great, great grandchildren. My mother passed away from dementia and COVID. The past few years have taught me to never take anything for granted and to cherish your loved ones. It also has showed me how the world can change in one day. But one thing I know for sure that will never change is God is still in charge.”

Clara Bailey, 58, Staff Assistant, Department of Medicine, Oncology

‘I don’t go anywhere without my mask’

“When Dr. Anthony Fauci came out and said we need to wear masks in public, I did it. I’m claustrophobic, so when I first started wearing the cloth masks, I would have panic and anxiety attacks, particularly at the grocery store. Over time, I got used to it, and I started feeling safer by wearing my mask. Now, I don't think I will ever go into another crowded event without a mask. As a woman, we have our purses. We don’t go anywhere without our purses. Now, I don’t go anywhere without my mask. Since wearing my mask, I haven't caught a cold, let alone anything else. It's a piece of cloth, no big deal.”

Sandy Ouellette, 62, Access Specialist, Consultation & Referral Center

Rethinking What’s Most Important

“During the pandemic, my wife got a new job in Virginia, and because I’ve been working remote since March 2020, it made it easy to move with her because, in the past, somebody would have had to quit their job, find a new job, and do all kinds of stuff. Personally, the pandemic has made me rethink what’s most important in life, such as making sure to set aside time for family and friends. Now, I get to spend more time with my wife. We can do house projects, take our dogs out and explore. Now that our parents are getting older, we try to take advantage of any time we can spend with them. The pandemic made spending time with people who are important to you a little extra important because they’re what helped me get through.”

Christopher Morgenstern, 39, Administrative Manager, Cardiology

‘180-degrees different’

“My wedding, honeymoon, and bachelorette party were all canceled due to COVID, so my husband, Brent Durden, and I got married in our backyard with just our parents. We were going to wait several years to start a family so we could travel but decided to seize the day during quarantine after buying a house. Now, we have a beautiful 18-month-old daughter, Eliana. As tragic as the losses we experienced as a country and community have been through this pandemic, my entire world is 180-degrees different than it was before COVID, and it makes me so grateful to have the family that I do.”

Tricia Smar, 36, Education and Training Coordinator, Duke Trauma Center

‘I’m fulfilling my bucket list’

“I have terminal prostate cancer. I live one day at a time. They gave me 18 months to live about six years ago. During the pandemic, I retired to fulfill my bucket list only to find disappointment. I made all sorts of plans, but everything was shut down so my plans were shot. I returned to work. I have a love for nursing and have no regrets coming back to patient care. I missed interacting with people. I missed my coworkers, I missed the patients. Now I travel, and I'm fulfilling my bucket list, but I always look forward to coming back to Duke for both my own care and to care for our patients.”

Doug Buehrle, 68, Clinical Nurse, Apheresis, Duke University Hospital

Savor Small Moments

“I learned to make the best out of a horrific situation. My kids, Derek and Joshua, were 5 and nearly 3 when COVID hit. In the clinical research field, we had to scramble to see which trials could keep going and which ones would have to go on pause. We had to be very flexible to work around each other’s schedules and everyone’s kid’s schedules. But I got to spend a lot more time with my kids than I ever would have if COVID didn't hit, so I'm grateful I was able to do it. We got to spend time going to the park and flying kites since the playgrounds were closed. We went hiking and exploring since the museums were closed. Those were memories I am thankful to have made, and I'm hoping they don't fade.”

Kristin Byrne, 41, Clinical Research Coordinator, Hematology

‘Packed up my car with as much as I could fit into it’

“I graduated from nursing school at George Fox University in Oregon about a month after lockdown happened. I have a grandmother in High Point, so I started applying to hospitals in North Carolina, and Duke turned out to be the best option. In October of 2020, I packed up my car with as much as I could fit into it, and I drove across the country with my dad. I left my family, friends, my church back in Portland, and I’ve had to build an entirely new life here. My first nursing job was working for the medical-surgical float pool at Duke University Hospital, which basically staffed the COVID-19 floors for a while. I was thrown into the thick of it, and I really had to stay on my toes all the time. It was really hard, and it was really a dark period in my life, until I started to get my feet settled. I just started to put myself out there out of my comfort zone, and I started inviting people to do things with me. I found Bright City Church too. Over time, I started to find those little sparks of hope, when you send a patient home instead of the ICU. I’ve learned a lot from my nursing career, and I’ve learned a lot about myself and how to take care of myself.”

Lauren Berky, 25, Clinical Nurse, Internal Staffing Resource Pool

‘More Openness to Change’

“I think COVID has opened the clinical community to change more than ever before. Sharing data has replaced hoarding data. Technology has come so far, and we had a hard time getting people to change the way they think about data. I think COVID opened their minds that we need other ways of dealing with data, particularly that the patient needs to be the centerpiece of everything that we’re doing. Some people have said to me, that five years ago we’d have been laughed at for some of the things we’re trying to do. But now, everybody is at least willing to have the conversation.”

William Edward Hammond, 88, Professor of Biostatistics and Bioinformatics, Family Medicine and Community Health

‘Never take tomorrow for granted’

“I am much more committed to ‘living in the moment,’ appreciating what I have, and looking inward. At home, I find joy with my husband. I walk much more. I cook at home almost all the time. And, maybe most important, I appreciate the beautiful natural environment around our home on Morgan Creek in Chapel Hill, where husband, David, and I began walking nearly every afternoon in January 2021. I’ve learned to never take tomorrow for granted. To appreciate friendships and family and the place where we are, now. To be OK with less ‘running around.’  To not take progress for granted, and to realize that things can get worse.”

Anne Mitchell Whisnant, 55, Director, Graduate Liberal Studies, and Associate Professor of the Practice, Social Science Research Institute

Bittersweet Milestones

“COVID was honestly a bittersweet time. My father-in-law, Mark, the president of North Georgia Technical College, passed away from COVID on September 13, 2020. Then in January 2021, my husband, Andrew, and I found out we were pregnant with our first child, Lilly, after a very long time. We thought we couldn’t have kids, so that was quite the surprise. When she was born on October 21, 2021, the joy of having her was indescribable. She just turned a year old, and I know she’ll never know her grandfather, and he’ll never know her. We want her to be happy and healthy and treat others the best way possible, and we’ll continue to tell her about her Papa when we can. We can’t wish Mark back because he’s not coming back. We’re living in the reality knowing that we can’t change it; it’s something Ecclesiastes calls our lot in life. COVID-19 brought out the worst for so many families, including ours, but it also brought so much good.”

Marissa Ivester, 34, Fellowship Program Coordinator, Office of Pediatrics

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Life After COVID-19

COVID-19 is significantly impacting the lives of all people on the globe. Strict quarantine measures changed the attitude towards such simple things as walking in the park, talking to strangers, working, and studying in a team. What is more, people started to value the work of medics as keen as never before. Unfortunately, many nurses become victims of this virus. The current paper discusses the impact of COVID-19 on the loss of nurses on personal and professional levels.

The loss of nurses caused by the death from the coronavirus leads to the shortage of labor in health institutions. Someday, the pandemic will come to an end, and people will return to the usual lifestyle; however, the losses of nurses are irretrievable. During the pandemic situation, some countries such as China, Russia, Japan, the US send their medics to foreign countries. This help is relevant during these hard times. Nevertheless, after the pandemic, other states will hardly share their nurses, medical equipment, and medicines. The shortage of nurses will cause a higher workload on the doctors to whom they usually assist. It would be harder to take care of inpatients since nurses do a great job helping doctors to monitor them.

On a personal level, I admire medical staffers who work with people infected with the virus. They wear special costumes that minimize the probability of getting infected. Notwithstanding this fact, the statistics indicate how significant are the losses among the nurses. Grace Oghiehor-Enoma, a nurse from New York, compared physicians with fighters on the battlefield. She says: “You see the fire, and you are running into the fire, not thinking about yourself. That is the selflessness that you can see in nursing today” (World Health Organization, 2020). People used to underestimate the importance of nurses while now see who the saviors of humanity are.

To sum up, the work of nurses is an excellent feat. They are an example of people whom we must take an example. From the very beginning of the pandemic, it was apparent that the losses among nurses are inevitable. Nevertheless, no one could expect that these losses will be that big. Still, all of us could help them just staying home and minimizing the probability of getting infected.

World Health Organization. (2020). Support Nurses and Midwives through COVID-19 and beyond . Web.

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

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

Where we're going

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

The Next Normal: Emerging stronger from the coronavirus pandemic

Greater Good Science Center • Magazine • In Action • In Education

How Life Could Get Better (or Worse) After COVID

How do pandemics change our societies? It is tempting to believe that there will not be a single sector of society untouched by the COVID-19 pandemic . However, a quick look at previous pandemics in the 20th century reveals that such negative forecasts may be vastly exaggerated.

Prior pandemics have corresponded to changes in architecture and urban planning, and a greater awareness of public health . Yet the psychological and societal effects of the Spanish flu, the worst pandemic of the 20th century, were later perceived as less dramatic than anticipated, perhaps because it originated in the shadow of WWI. Austrian psychoanalyst Sigmund Freud described Spanish flu as a “ Nebenschauplatz ”—a sideshow in his life of that time, even though he eventually lost one of his daughters to the disease. Neither do we recall much more recent pandemics: the Asian flu of 1957 and the Hong Kong flu from 1968.

Imagining and planning for the future can be a powerful coping mechanism to gain some sense of control in an increasingly unpredictable pandemic life. Over the past year, some experts proclaimed that the world after COVID would be a completely different place , with changed values and a new map of international relations. The opinions of oracles who were not downplaying the virus were mostly negative . Societal unrest and the rise of totalitarian regimes, stunted child social development, mental health crises, exacerbated inequality, and the worst economic recession since the Great Depression were just a few worries discussed by pundits and on the news.

Other predictions were brighter—the disruptive force of the pandemic would provide an opportunity to reshape the world for the better, some said. To complement the voices of journalists, pundits, and policymakers, one of us (Igor Grossmann) embarked on a quest to gather opinions from the world’s leading scholars on behavioral and social science, founding the World after COVID project.

The World after COVID project is a multimedia collection of expert visions for the post-pandemic world, including scientists’ hopes, worries, and recommendations. In a series of 57 interviews, we invited scientists, along with futurists, to reflect on the positive and negative societal or psychological change that might occur after the pandemic, and the type of wisdom we need right now. Our team used a range of methodological techniques to quantify general sentiment, along with common and unique themes in scientists’ responses.

The results of this interview series were surprising, both in terms of the variability and ambivalence in expert predictions. Though the pandemic has and will continue to create adverse effects for many aspects of our society, the experts observed, there are also opportunities for positive change, if we are deliberate about learning from this experience.

Three opportunities after COVID-19

Scientists’ opinions about positive consequences were highly diverse. As the graph shows, we identified 20 distinct themes in their predictions. These predictions ranged from better care for elders, to improved critical thinking about misinformation, to greater appreciation of nature. But the three most common categories concerned social and societal issues.

1. Solidarity. Experts predicted that the shared struggles and experiences that we face due to the pandemic could foster solidarity and bring us closer together, both within our communities and globally. As clinical psychologist Katie A. McLaughlin from Harvard University pointed out, the pandemic could be “an opportunity for us to become more committed to supporting and helping one another.”

Similarly, sociologist Monika Ardelt from the University of Florida noted the possibility that “we realize these kinds of global events can only be solved if we work together as a world community.” Social identities—such as group memberships, nationality, or those that form in response to significant events such as pandemics or natural disasters—play an important role in fostering collective action. The shared experience of the pandemic could help foster a more global, inclusive identity that could promote international solidarity.

2. Structural and political changes. Early in the pandemic, experts also believed that we might also see proactive efforts and societal will to bring about structural and political changes toward a more just and diversity-inclusive society. Experts observed that the pandemic had exposed inequalities and injustices in our societies and hoped that their visibility might encourage societies to address them.

Philosopher Valerie Tiberius from the University of Minnesota suggested that the pandemic might bring about an “increased awareness of our vulnerability and mutual dependence.”

Fellow of the Royal Institute for International Affairs in the U.K. Anand Menon proposed that the pandemic might lead to growing awareness of economic inequality, which could lead to “greater sustained public and political attention paid to that issue.” Cultural psychologist Ayse Uskul from Kent University in the U.K. shared this sentiment and predicted that this awareness “will motivate us to pick up a stronger fight against the unfair distribution of resources and rights not just where we live, but much more globally.”

3. Renewed social connections. Finally, the most common positive consequence discussed was that we might see an increased awareness of the importance of our social connections. The pandemic has limited our ability to connect face to face with friends and families, and it has highlighted just how vulnerable some of our family members and neighbors might be. Greater Good Science Center founding director and UC Berkeley professor Dacher Keltner suggested that the pandemic might teach us “how absolutely sacred our best relationships are” and that the value of these relationships would be much higher in the post-pandemic world. Past president of the Society of Evolution and Human Behavior Douglas Kenrick echoed this sentiment by predicting that “tighter family relationships would be the most positive outcome of this [pandemic].”

Similarly, Jennifer Lerner—professor of decision-making from Harvard University—discussed how the pandemic had led people to “learn who their neighbors are, even though they didn’t know their neighbors before, because we’ve discovered that we need them.” These kinds of social relationships have been tied to a range of benefits, such as increased well-being and health , and could provide lasting benefits to individuals.

Post-pandemic risks

How about predictions for negative consequences of the pandemic? Again, opinions were variable, with more than half of the themes were mentioned by less than 10% of our interviewees. Only two predictions were mentioned by at least ten experts: the potential for political unrest and increased prejudice or racism. These predictions highlight a tension in expert predictions: Whereas some scholars viewed the future bright and “diversity-inclusive,” others fear the rise in racism and prejudice. Before we discuss this tension, let us examine what exactly scholars meant by these two worries.

1. Increased prejudice or racism. Many experts discussed how the conditions brought about by the pandemic could lead us to focus on our in-group and become more dismissive of those outside our circles. Incheol Choi, professor of cultural and positive psychology from Seoul National University, discussed that his main area of concern was that “stereotypes, prejudices against other group members might arise.” Lisa Feldman Barrett, fellow of the American Academy of Arts & Sciences and the Royal Society of Canada, echoed this sentiment, noting that previous epidemics saw “people become more entrenched in their in-group and out-group beliefs.”

2. Political unrest. Similarly, many experts discussed how a greater focus on our in-groups might also exacerbate existing political divisions. Past president of the Society for Philosophy and Psychology Paul Bloom discussed how a greater dismissiveness toward out-groups was visible both within countries and internationally, where “countries are blaming other countries and not working together enough.” Dilip Jeste, past president of the American Psychiatric Association, discussed his concerns that the tendency to view both candidates and supporters as winners and losers in elections could mean that the “political polarization that we are observing today in the U.S. and the world will only increase.”

These predictions were not surprising— pundits and other public figures have been discussing these topics, too. However, as we analyzed and compared predictions for positive and negative consequences, we found something unexpected.

The yin and yang of COVID’s effects

Almost half of the interviewees spontaneously mentioned that the same change could be a force for good and for bad . In other words, they were dialectical , recognizing the multidetermined nature of predictions and acknowledging that context matters—context that determines who may be the winners and losers in the years to come. For example, experts predicted that we may see greater acceptance of digital technologies at home and at work. But besides the benefits of this—flexible work schedules, reduced commutes—they also mentioned likely costs, such as missing social information in virtual communication and disadvantages for people who cannot afford high-speed internet or digital devices.

Share Your Perspective

Curious about the world after COVID? So are we, and we'd love your opinion about possible changes ahead. Fill out this short survey to offer your perspective on the hopes and worries of a post-pandemic world.

Amid this complexity, experts weighed in on what type of wisdom we need to help bring about more positive changes ahead. Not only do we need the will to sustain political and structural change, many argued, but also a certain set of psychological strategies promoting sound judgment: perspective taking, critical thinking, recognizing the limits of our knowledge, and sympathy and compassion.

In other words, experts’ recommended wisdom focuses on meta-cognition, which underlies successful emotion regulation, mindfulness, and wiser judgment about complex social issues. The good news is that these psychological strategies are malleable and trainable ; one way we can cultivate wisdom and perspective, for example, is by adopting a third-person, observer perspective on our challenges.

On the surface, the “it depends” attitude of many experts about the world after COVID may be dissatisfying. However, as research on forecasting shows, such a dialectical attitude is exactly what distinguishes more accurate forecasters from the rest of the population. Forecasting is hard and predictions are often uncertain and likely wrong. In fact, despite some hopes for the future, it is equally possible that the change after the pandemic will not even be noticeable. Not because changes will not happen, but because people quickly adjust to their immediate circumstances.

The future will tell whether and how the current pandemic has altered our societies. In the meantime, the World after COVID project provides a time-stamped window into experts’ apartments and their minds. As we embrace another pandemic spring, these insights can serve as a reminder that the pandemic may lead not only to worries but also to hopes for the years ahead.

About the Authors

Igor Grossmann

Igor Grossmann, Ph.D. , studies people and cultures, sometimes together, and often across time. He is an associate professor of psychology at the University of Waterloo, where he directs the Wisdom and Culture Lab.

Oliver Twardus

Oliver Twardus is the lab manager for the Wisdom and Culture lab and an aspiring researcher. He will be starting his master’s in neuroscience and applied cognitive science in September 2021.

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Artists, novelists, critics, and essayists are writing the first draft of history.

by Alissa Wilkinson

The world is grappling with an invisible, deadly enemy, trying to understand how to live with the threat posed by a virus . For some writers, the only way forward is to put pen to paper, trying to conceptualize and document what it feels like to continue living as countries are under lockdown and regular life seems to have ground to a halt.

So as the coronavirus pandemic has stretched around the world, it’s sparked a crop of diary entries and essays that describe how life has changed. Novelists, critics, artists, and journalists have put words to the feelings many are experiencing. The result is a first draft of how we’ll someday remember this time, filled with uncertainty and pain and fear as well as small moments of hope and humanity.

• The Vox guide to navigating the coronavirus crisis

At the New York Review of Books, Ali Bhutto writes that in Karachi, Pakistan, the government-imposed curfew due to the virus is “eerily reminiscent of past military clampdowns”:

Beneath the quiet calm lies a sense that society has been unhinged and that the usual rules no longer apply. Small groups of pedestrians look on from the shadows, like an audience watching a spectacle slowly unfolding. People pause on street corners and in the shade of trees, under the watchful gaze of the paramilitary forces and the police.

His essay concludes with the sobering note that “in the minds of many, Covid-19 is just another life-threatening hazard in a city that stumbles from one crisis to another.”

Writing from Chattanooga, novelist Jamie Quatro documents the mixed ways her neighbors have been responding to the threat, and the frustration of conflicting direction, or no direction at all, from local, state, and federal leaders:

Whiplash, trying to keep up with who’s ordering what. We’re already experiencing enough chaos without this back-and-forth. Why didn’t the federal government issue a nationwide shelter-in-place at the get-go, the way other countries did? What happens when one state’s shelter-in-place ends, while others continue? Do states still under quarantine close their borders? We are still one nation, not fifty individual countries. Right?

• A syllabus for the end of the world

Award-winning photojournalist Alessio Mamo, quarantined with his partner Marta in Sicily after she tested positive for the virus, accompanies his photographs in the Guardian of their confinement with a reflection on being confined :

The doctors asked me to take a second test, but again I tested negative. Perhaps I’m immune? The days dragged on in my apartment, in black and white, like my photos. Sometimes we tried to smile, imagining that I was asymptomatic, because I was the virus. Our smiles seemed to bring good news. My mother left hospital, but I won’t be able to see her for weeks. Marta started breathing well again, and so did I. I would have liked to photograph my country in the midst of this emergency, the battles that the doctors wage on the frontline, the hospitals pushed to their limits, Italy on its knees fighting an invisible enemy. That enemy, a day in March, knocked on my door instead.

In the New York Times Magazine, deputy editor Jessica Lustig writes with devastating clarity about her family’s life in Brooklyn while her husband battled the virus, weeks before most people began taking the threat seriously:

At the door of the clinic, we stand looking out at two older women chatting outside the doorway, oblivious. Do I wave them away? Call out that they should get far away, go home, wash their hands, stay inside? Instead we just stand there, awkwardly, until they move on. Only then do we step outside to begin the long three-block walk home. I point out the early magnolia, the forsythia. T says he is cold. The untrimmed hairs on his neck, under his beard, are white. The few people walking past us on the sidewalk don’t know that we are visitors from the future. A vision, a premonition, a walking visitation. This will be them: Either T, in the mask, or — if they’re lucky — me, tending to him.

Essayist Leslie Jamison writes in the New York Review of Books about being shut away alone in her New York City apartment with her 2-year-old daughter since she became sick:

The virus. Its sinewy, intimate name. What does it feel like in my body today? Shivering under blankets. A hot itch behind the eyes. Three sweatshirts in the middle of the day. My daughter trying to pull another blanket over my body with her tiny arms. An ache in the muscles that somehow makes it hard to lie still. This loss of taste has become a kind of sensory quarantine. It’s as if the quarantine keeps inching closer and closer to my insides. First I lost the touch of other bodies; then I lost the air; now I’ve lost the taste of bananas. Nothing about any of these losses is particularly unique. I’ve made a schedule so I won’t go insane with the toddler. Five days ago, I wrote Walk/Adventure! on it, next to a cut-out illustration of a tiger—as if we’d see tigers on our walks. It was good to keep possibility alive.

At Literary Hub, novelist Heidi Pitlor writes about the elastic nature of time during her family’s quarantine in Massachusetts:

During a shutdown, the things that mark our days—commuting to work, sending our kids to school, having a drink with friends—vanish and time takes on a flat, seamless quality. Without some self-imposed structure, it’s easy to feel a little untethered. A friend recently posted on Facebook: “For those who have lost track, today is Blursday the fortyteenth of Maprilay.” ... Giving shape to time is especially important now, when the future is so shapeless. We do not know whether the virus will continue to rage for weeks or months or, lord help us, on and off for years. We do not know when we will feel safe again. And so many of us, minus those who are gifted at compartmentalization or denial, remain largely captive to fear. We may stay this way if we do not create at least the illusion of movement in our lives, our long days spent with ourselves or partners or families.

• What day is it today?

Novelist Lauren Groff writes at the New York Review of Books about trying to escape the prison of her fears while sequestered at home in Gainesville, Florida:

Some people have imaginations sparked only by what they can see; I blame this blinkered empiricism for the parks overwhelmed with people, the bars, until a few nights ago, thickly thronged. My imagination is the opposite. I fear everything invisible to me. From the enclosure of my house, I am afraid of the suffering that isn’t present before me, the people running out of money and food or drowning in the fluid in their lungs, the deaths of health-care workers now growing ill while performing their duties. I fear the federal government, which the right wing has so—intentionally—weakened that not only is it insufficient to help its people, it is actively standing in help’s way. I fear we won’t sufficiently punish the right. I fear leaving the house and spreading the disease. I fear what this time of fear is doing to my children, their imaginations, and their souls.

At ArtForum , Berlin-based critic and writer Kristian Vistrup Madsen reflects on martinis, melancholia, and Finnish artist Jaakko Pallasvuo’s 2018 graphic novel Retreat , in which three young people exile themselves in the woods:

In melancholia, the shape of what is ending, and its temporality, is sprawling and incomprehensible. The ambivalence makes it hard to bear. The world of Retreat is rendered in lush pink and purple watercolors, which dissolve into wild and messy abstractions. In apocalypse, the divisions established in genesis bleed back out. My own Corona-retreat is similarly soft, color-field like, each day a blurred succession of quarantinis, YouTube–yoga, and televized press conferences. As restrictions mount, so does abstraction. For now, I’m still rooting for love to save the world.

At the Paris Review , Matt Levin writes about reading Virginia Woolf’s novel The Waves during quarantine:

A retreat, a quarantine, a sickness—they simultaneously distort and clarify, curtail and expand. It is an ideal state in which to read literature with a reputation for difficulty and inaccessibility, those hermetic books shorn of the handholds of conventional plot or characterization or description. A novel like Virginia Woolf’s The Waves is perfect for the state of interiority induced by quarantine—a story of three men and three women, meeting after the death of a mutual friend, told entirely in the overlapping internal monologues of the six, interspersed only with sections of pure, achingly beautiful descriptions of the natural world, a day’s procession and recession of light and waves. The novel is, in my mind’s eye, a perfectly spherical object. It is translucent and shimmering and infinitely fragile, prone to shatter at the slightest disturbance. It is not a book that can be read in snatches on the subway—it demands total absorption. Though it revels in a stark emotional nakedness, the book remains aloof, remote in its own deep self-absorption.

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In an essay for the Financial Times, novelist Arundhati Roy writes with anger about Indian Prime Minister Narendra Modi’s anemic response to the threat, but also offers a glimmer of hope for the future:

Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next. We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it.

From Boston, Nora Caplan-Bricker writes in The Point about the strange contraction of space under quarantine, in which a friend in Beirut is as close as the one around the corner in the same city:

It’s a nice illusion—nice to feel like we’re in it together, even if my real world has shrunk to one person, my husband, who sits with his laptop in the other room. It’s nice in the same way as reading those essays that reframe social distancing as solidarity. “We must begin to see the negative space as clearly as the positive, to know what we don’t do is also brilliant and full of love,” the poet Anne Boyer wrote on March 10th, the day that Massachusetts declared a state of emergency. If you squint, you could almost make sense of this quarantine as an effort to flatten, along with the curve, the distinctions we make between our bonds with others. Right now, I care for my neighbor in the same way I demonstrate love for my mother: in all instances, I stay away. And in moments this month, I have loved strangers with an intensity that is new to me. On March 14th, the Saturday night after the end of life as we knew it, I went out with my dog and found the street silent: no lines for restaurants, no children on bicycles, no couples strolling with little cups of ice cream. It had taken the combined will of thousands of people to deliver such a sudden and complete emptiness. I felt so grateful, and so bereft.

And on his own website, musician and artist David Byrne writes about rediscovering the value of working for collective good , saying that “what is happening now is an opportunity to learn how to change our behavior”:

In emergencies, citizens can suddenly cooperate and collaborate. Change can happen. We’re going to need to work together as the effects of climate change ramp up. In order for capitalism to survive in any form, we will have to be a little more socialist. Here is an opportunity for us to see things differently — to see that we really are all connected — and adjust our behavior accordingly. Are we willing to do this? Is this moment an opportunity to see how truly interdependent we all are? To live in a world that is different and better than the one we live in now? We might be too far down the road to test every asymptomatic person, but a change in our mindsets, in how we view our neighbors, could lay the groundwork for the collective action we’ll need to deal with other global crises. The time to see how connected we all are is now.

The portrait these writers paint of a world under quarantine is multifaceted. Our worlds have contracted to the confines of our homes, and yet in some ways we’re more connected than ever to one another. We feel fear and boredom, anger and gratitude, frustration and strange peace. Uncertainty drives us to find metaphors and images that will let us wrap our minds around what is happening.

Yet there’s no single “what” that is happening. Everyone is contending with the pandemic and its effects from different places and in different ways. Reading others’ experiences — even the most frightening ones — can help alleviate the loneliness and dread, a little, and remind us that what we’re going through is both unique and shared by all.

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

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

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

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

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

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

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

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

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

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How COVID-19 pandemic changed my life

Table of Contents

Introduction

The COVID-19 pandemic is one of the biggest challenges that our world has ever faced. People around the globe were affected in some way by this terrible disease, whether personally or not. Amid the COVID-19 pandemic, many people felt isolated and in a state of panic. They often found themselves lacking a sense of community, confidence, and trust. The health systems in many countries were able to successfully prevent and treat people with COVID-19-related diseases while providing early intervention services to those who may not be fully aware that they are infected (Rume & Islam, 2020). Personally, this pandemic has brought numerous changes and challenges to my life. The COVID-19 pandemic affected my social, academic, and economic lifestyle positively and negatively.

Social and Academic Changes

One of the changes brought by the pandemic was economic changes that occurred very drastically (Haleem, Javaid, & Vaishya, 2020). During the pandemic, food prices started to rise, affecting the amount of money my parents could spend on goods and services. We had to reduce the food we bought as our budgets were stretched. My family also had to eliminate unhealthy food bought in bulk, such as crisps and chocolate bars. Furthermore, the pandemic made us more aware of the importance of keeping our homes clean, especially regarding cooking food. Lastly, it also made us more aware of how we talked to other people when they were ill and stayed home with them rather than being out and getting on with other things.

Furthermore, COVID-19 had a significant effect on my academic life. Immediately, measures to curb the pandemic were announced, such as closing all learning institutions in the country; my school life changed. The change began when our school implemented the online education system to ensure that we continued with our education during the lockdown period. At first, this affected me negatively because when learning was not happening in a formal environment, I struggled academically since I was not getting the face-to-face interaction with the teachers I needed. Furthermore, forcing us to attend online caused my classmates and me to feel disconnected from the knowledge being taught because we were unable to have peer participation in class. However, as the pandemic subsided, we grew accustomed to this learning mode. We realized the effects on our performance and learning satisfaction were positive, as it seemed to promote emotional and behavioral changes necessary to function in a virtual world. Students who participated in e-learning during the pandemic developed more ownership of the course requirement, increased their emotional intelligence and self-awareness, improved their communication skills, and learned to work together as a community.

If there is an area that the pandemic affected was the mental health of my family and myself. The COVID-19 pandemic caused increased anxiety, depression, and other mental health concerns that were difficult for my family and me to manage alone. Our ability to learn social resilience skills, such as self-management, was tested numerous times. One of the most visible challenges we faced was social isolation and loneliness. The multiple lockdowns made it difficult to interact with my friends and family, leading to loneliness. The changes in communication exacerbated the problem as interactions moved from face-to-face to online communication using social media and text messages. Furthermore, having family members and loved ones separated from us due to distance, unavailability of phones, and the internet created a situation of fear among us, as we did not know whether they were all right. Moreover, some people within my circle found it more challenging to communicate with friends, family, and co-workers due to poor communication skills. This was mainly attributed to anxiety or a higher risk of spreading the disease. It was also related to a poor understanding of creating and maintaining relationships during this period.

Positive Changes

In addition, this pandemic has brought some positive changes with it. First, it had been a significant catalyst for strengthening relationships and neighborhood ties. It has encouraged a sense of community because family members, neighbors, friends, and community members within my area were all working together to help each other out. Before the pandemic, everybody focused on their business, the children going to school while the older people went to work. There was not enough time to bond with each other. Well, the pandemic changed that, something that has continued until now that everything is returning to normal. In our home, it strengthened the relationship between myself and my siblings and parents. This is because we started spending more time together as a family, which enhanced our sense of understanding of ourselves.

The pandemic has been a challenging time for many people. I can confidently state that it was a significant and potentially unprecedented change in our daily life. By changing how we do things and relate with our family and friends, the pandemic has shaped our future life experiences and shown that during crises, we can come together and make a difference in each other’s lives. Therefore, I embrace wholesomely the changes brought by the COVID-19 pandemic in my life.

• Haleem, A., Javaid, M., & Vaishya, R. (2020). Effects of COVID-19 pandemic in daily life.  Current medicine research and practice ,  10 (2), 78.
• Rume, T., & Islam, S. D. U. (2020). Environmental effects of COVID-19 pandemic and potential strategies of sustainability.  Heliyon ,  6 (9), e04965.
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• A NEW MAP OF LIFE

THE NEW MAP OF LIFE

AFTER THE PANDEMIC

It is said that culture is like the air we breathe. We don’t notice it until it’s gone.

The COVID-19 pandemic is bringing into focus a once invisible culture that guides us through life. Seemingly overnight, we experienced profound changes in the ways that we work, socialize, learn, and engage with our neighborhoods and larger communities.

For a short time, before new routines and practices replace familiar old ones, we can see with greater clarity the positive and negative aspects of our former lives. The suddenness and starkness of this transformation allows us to examine daily practices, social norms and institutions from perspectives rarely allowed.

The fragility of the global economy becomes glaringly apparent as critical supply chains faulter, unemployment surges, and markets vacillate. Tacit assumptions about health care systems become clear as we see how they function, fail to function, and have long underserved large parts of the population. Just as sure, sheltering in place allows us to appreciate precious details of our lives that we have taken for granted: the appeal of workplaces, the comfort of human touch, dinner parties, travel, and paychecks. Indeed, through ambivalent eyes we also recognize ways that life is better as we shelter in place.

The premise of the New Map of Life:™ After the Pandemic project is that we have a fleeting window of time that affords us an unprecedented opportunity to examine our lives.  Going forward, life will be different and by compiling the insights we have today we can inform and guide the culture that will inevitably emerge from our collective experience. Your insights can contribute to the reshaping of social norms, systems, and practices that shape our collective futures.

Since the founding of the Stanford Center on Longevity, we have advocated for a major redesign of life that better supports century-long lives. More recently, we undertook the New Map of Life ™ initiative, which focuses on envisioning a world where people experience a sense of purpose, belonging, and worth at all stages of life. As tragedies unfold before our eyes, we aim to capture the lessons they teach. With your help, we can compile current insights, fleeting thoughts and deeper reflections about the ways we live now so that going forward we bolster, modify and reinvent cultures that improve quality of life for ourselves, our children, and future generations.

The opinions, beliefs, and viewpoints expressed by the various authors on this website do not necessarily reflect the opinions, beliefs and viewpoints of the Stanford Center on Longevity or official policies of the Stanford Center on Longevity. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Beyond the pandemic: The truth of life after COVID-19

This study focused on how to deal with the psychological trauma from the perspective of a doctor on the front line of the fight against COVID-19. As the pandemic continues to ravage our world, post-pandemic psychological counseling urgently needs to be addressed. Based on the experience of fighting the epidemic, this study discusses the psychological changes since the COVID-19 outbreak in 2020. Taking a 19-year-old with breast cancer as an example, this study considered how to find spiritual comfort, and examined how to find meaning in today's complicated world and lives, as well as turning the crisis into an opportunity for spiritual renewal and adding meaning to our lives. It is hoped that this study will inspire readers to overcome the difficulties of the epidemic, find strength and see it as a life-changing opportunity.

Introduction

The Covid-19 pandemic is in its third year. China has been battling the outbreak since early 2020. 1 To date, we are still fighting SARS-Cov-2 and the Omicron variants on multiple fronts. 2 The dramatic changes brought about by COVID-19 have affected every aspect of people's lives. Some of the measures to control the epidemic, including isolation, access restrictions and economic shutdowns, radically changed psychosocial behavior, and induced psychological trauma, especially China's strict prevention and control policies have affected large numbers of people. Nevertheless, there is a lack of timely research on post-pandemic trauma and psychological counseling. 3 Here, I would like to share some thoughts about the trauma under the epidemic from the viewpoint of an infectious disease specialist. It is hoped this will inspire readers and help them overcome psychological trauma and bring a new perspective on life in the post-pandemic era.

Trauma haunts many people and psychological counseling is urgent

Before COVID-19, like everyone else around me, I had made plans, looked forward to the future, and expected things to go according to my wishes. We live so uneventfully for so long that we become desensitized to major events. Even in the hospital, faced with life, death, and severe diseases, we do things according to procedure and remain unperturbed. However, when COVID-19 hit, things changed.

In the early days of fighting COVID-19, the knowledge of the Novel Coronavirus was limited. We risked our lives in the fight against an unknown enemy. From public officials to medical staff, even ordinary Chinese citizens, people paid a high price for the first victory against COVID-19. In the most difficult times, I held multiple roles: a doctor in a fever clinic, a comforter of anxious patients, a collector of throat swabs for SARS-Cov-2 tests, and a member of staff collating patients’ data. Initially, I was lost, terrified, overwhelmed, and had never felt so close to death. I lived alone, apart from my family. What I could do was immerse myself in various roles, held on through psychological trauma, dedicated to the fight against the epidemic, and looked forward to overcoming it as soon as possible. People around me, including colleagues, friends, were also suffering from trauma; some even struggled with feelings of powerlessness and desperation. We pulled through the hard times and made hard-won progress.

Unfortunately, COVID-19 became a global pandemic. 4 , 5 At this moment, we are still experiencing waves of the Omicron variants. I often wonder, what does COVID-19 bring after we have suffered so much? How do we define ourselves in a medical career under such conditions? It could be said without exaggeration that human destiny and behavior have been forced to undergo momentous changes, including lives, work, study, and entertainment, among others. Many people experienced psychological distress, even to the brink of collapse. Personally, I have experienced a range of emotions and situations. Facing life, death, illness, science, religion, mission, work, family, solitude, incomprehension from others, pressure, and so on, which are intertwined as diversely as cytokine signaling pathways.

How do we respond to these huge changes? What is the most essential change that COVID-19 has brought? What are the key factors in the chaos and how do we make the right choices? We may complain that the epidemic and the competitive society have caused a seismic shift in our day to day lives, increased social inequities and adversities; however, complaining leads nowhere. The real difficulty is how to embrace life according to inner ideas and think independently. I cannot help but think, the most important thing I can do under the pandemic is to find things that touch our soul truly live our lives.

Turning crisis into opportunity

Whenever I think about things in life that touch our souls, I miss a friend named Xiao Yue, who was once one of my patients. At that time, I was a medical intern and studied thoracic surgery. Xiao Yue was a 19-year-old girl with advanced breast cancer. She had no choice but to have one breast removed, leaving thick stitches on her chest. She said to me: “I want to be a doctor in the future, specializing in breast reconstruction, so that many patients like me can get their lost breasts back. I hope to be able to stand out with my proud chest.”

Xiao Yue was gone a few years later, leaving no legacy. However, her words had a lasting impact on my life. As I look back, how should I use my friend's words to guide me in difficult situations like the pandemic? Do I “go with the flow”, or follow my mission, even in hard times? I do not want to be a mindless and insensitive man, but look forward to a colorful life, although there will be a lot of difficulties. How then do we find the truth about life? As a doctor, I will do everything I can to help patients, and guide them to understand the disease, life, and death. As a thinker, I would like to devote myself to the integration of medical science, my mission as a doctor, passion for the unknown, and real-life, give meaning to life, not only to the individual and families but also to devotion to society and medicine.

Reality and dreams, just like the double helix of DNA, are closely intertwined and create beautiful lives. Maybe this is where the truth of life is hidden. Life and death are nothing more than a dreamlike gathering of particles that constantly assemble and disintegrate. We should face reality and try to make the best of our lives and make them as fulfilling as possible.

Acknowledgment

I would like to express my deep gratitude to my wife, Yun Liu, for her continuous support. This work was supported by the research start-up fund of the Second Affiliated Hospital of Nanchang University (B2117).

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The World We Want to Live in After COVID

In 1909, the French ethnographer Arnold van Gennep published a book called “ The Rites of Passage .” In it, he explored the rituals that cultures use to transition people from one stage of life to the next. Birth, puberty, graduation, religious initiation, marriage, pregnancy, promotions, the seasons—we’re always on the threshold of one phase or another. How do communities shepherd individuals from the pre- to the post-?

Van Gennep argued that certain universal principles underlie rites of passage across cultures and eras. First, there’s the “pre-liminal” phase, in which “rites of separation” detach individuals from their earlier thoughts, feelings, and perspectives: the Old You dies. Next comes the “liminal” phase, a volatile interregnum that’s simultaneously disorienting and ambiguous, destructive and constructive, during which “rites of transition” open up the possibility of a new and different future. Finally, in the “post-liminal” phase, the “rites of incorporation” allow one to reënter society somehow changed. A New You is inaugurated. “Life itself means to separate and to be reunited, to change form and condition, to die and to be reborn,” van Gennep wrote. “It is to act and to cease, to wait and to rest, and then to begin acting again, but in a different way.”

Van Gennep’s observations were a landmark in the nascent field of anthropology. “Elements of ceremonial behavior were no longer the relics of former superstitious eras,” the anthropologists Richard Huntington and Peter Metcalf later wrote, but “keys to a universal logic of human social life.” In the century since, scholars have applied van Gennep’s framework not just to individuals but to societies in times of turmoil and transformation. Famines, wars, political revolutions, economic downturns, civil-rights movements—societies, too, move from one way of life to another, often experiencing intense periods of renunciation, restructuring, and rebirth.

2020, when the pandemic began, was a pre-liminal year—a headlong, vaccine-less descent away from normality and into calamity. We were torn from our established ways, undergoing separation, loss, and upheaval. 2021 was a liminal year—neither here nor there, not quite normal but not wholly abnormal, either. The inauguration of Joe Biden , the widespread availability of vaccines, and the return of weddings, dining, travel, and sports all coexisted alongside vaccine holdouts, breakthrough infections, new variants, booster shots, and regional surges.

Today, Omicron might make it feel as though we’re still squarely in the liminal phase. But, in fact, we may soon be tipping into a post-liminal paradigm. Omicron’s extraordinary contagiousness—combined with rising vaccination and booster rates—could mean that, in the coming months, nearly all Americans will have some level of immunity to COVID . Repeat infections and breakthrough cases will still occur, but, as our individual and collective immunity broadens, these will become milder and less disruptive. The influenza pandemics of the twentieth century each lasted around two years; now, twenty-one months into our battle with the coronavirus, Omicron is accelerating what could be this pandemic’s final chapter. It’s becoming possible to ask, and perhaps answer, some broad questions: Where will we end up in our attitudes toward ourselves and the social web in which we live? Who will we be on the other side of our transition?

The coronavirus crisis is first and foremost a health crisis, and many of the most obvious changes in our attitudes have to do with health. Some of us have come to reflect more regularly on our age and medical conditions. We’ve gained familiarity with obscure scientific jargon, from PCR tests to mRNA. We meditate on the trade-offs involved in social events, examine the threats we pose to others (and vice versa), and judge people for their choices. Americans differ hugely on what to think and do about all this—the behavior of people in one community can seem unfathomable to those in another—but, at least for now, health has shifted from a narrow individual consideration to a more expansive, social one. Going to work, attending a concert, hosting a dinner party, boarding a flight—if you have a cough, a fever, or just the sniffles, these activities now carry an ethical dimension. Will this remain true after the acute threat of COVID -19 has subsided? We may return to inflicting colds, flus, and various G.I. bugs on one another—or, possibly, we’ll adopt some version of the physician’s oath to do no harm.

The sense that making others sick is an action we’ve taken—and that, conversely, it’s within our power to avoid becoming agents of contagion—reflects a more general paradox of the pandemic. Since COVID arrived, we’ve been both powerless and empowered. Many aspects of our lives have been changed by events beyond our control; at the same time, we have sometimes been pushed to make consequential decisions and chart our own course. Over the past two years, for instance, Americans have quit their jobs in record numbers; in some cases, they’ve been forced to do so—perhaps by medical vulnerability, or unprecedented disruptions in schooling—while, in others, the pandemic’s chaos presented an opportunity to reëvaluate priorities. Regardless, faced with historical circumstances, they made big changes. In this crisis, as in many rites of passage, we don’t just passively recite our lines; we write them, taking vows that may reverberate for decades.

One of the questions we face now is whether we can make such changes on a social level, in addition to an individual one. The pandemic’s school disruptions are the result not just of a novel virus but of years of underinvestment that have yielded underpaid teachers, crowded classrooms, and poorly ventilated buildings. We’ve seen the same pattern in many aspects of our pandemic experience. Decades of investment in basic science allowed American scientists to race from genomic sequencing to an effective COVID vaccine in less than a year—but, during the same period, a public-health system that had been neglected for decades hampered our ability to contain the virus at every turn. We’ve made real changes in our lives. Can we make them in our society, too, building capacity so that our institutions can be more resilient and flexible?

The pandemic has posed similar questions for the world as a whole. COVID -19 struck during the seventy-fifth anniversary of the creation of the United Nations, and arrived at a moment characterized by a sharp rise in nationalism and a broadening skepticism about the international arrangements that have governed since the Second World War. Even before the virus, the multilateral system of international coöperation was fraying. After the 2008 financial crisis, Americans had grown increasingly suspicious of globalization and frustrated by their leaders’ failure to address its consequences: inequality, job displacement, social atomization. Now the coronavirus has shown that globalization moves not just goods and people across borders but pathogens, too.

In March, the National Intelligence Council released a report arguing that, in the coming years, the world will face global crises—pandemics, extreme-weather events, technological disruptions—with growing frequency. At the same time, greater international fragmentation and tension will impede our ability to respond to them. The report outlined several possible futures. In the optimistic scenario, called the “renaissance of democracies,” the world settles into a new equilibrium characterized by technological progress, rising incomes, and responsive democratic governance, led by the U.S. and its allies. In another future, “a world adrift,” the international system is “directionless, chaotic, and volatile”; global problems are largely ignored, and multilateral institutions lose their influence.

At a global level, as at the national one, the health crisis of the pandemic has put another preëxisting crisis into sharper relief. Effective pandemic response requires coördination across nations; this is the work of the World Health Organization, of which America has long been the largest funder. In 2019, the U.S. contributed more than four hundred million dollars to the W.H.O., but in April, 2020, Donald Trump announced that the U.S. would stop its funding. For much of the year, the U.S. also declined to join COVAX , the world’s primary global vaccine-distribution mechanism. Today less than nine per cent of people in low-income countries have received a single dose of a COVID vaccine; the rise of ever more concerning variants, such as Delta and Omicron, is due, in part, to a failure of the U.S. and other wealthy countries to vaccinate the world.

Recently, the G-20—a forum comprising nineteen nations and the European Union, which together account for ninety per cent of the world’s economic output—proposed key steps for strengthening the global response to future infectious threats: higher and more consistent funding for the W.H.O.; greater collaboration between governments and the W.H.O. on data collection, humanitarian support, and vaccine development; and the establishment of global norms for the reporting of emerging pathogens. Will countries unite in making such changes? That depends, in large part, on their willingness to act multilaterally—to see that their own security is interwoven with the security of others. It’s an issue that’s larger than the virus. COVID -19, like the Second World War, has created a hinge in the history of the world, which could swing either toward greater cohesion or toward disarray.

In 1954, a researcher named Muzafer Sherif conducted what would become one of the most famous experiments in social psychology. Sherif was interested in the dynamics of group conflict: how easily loyalties form; how little it takes for rival factions to quarrel; what, if anything, can be done to repair relations. As my colleague Elizabeth Kolbert wrote recently, in a piece on political polarization , Sherif invited twenty-two fifth-grade boys to a summer camp at Robbers Cave State Park, in southeastern Oklahoma. The boys were all white, from middle-class, Protestant, two-parent households. Sherif and his team divided them into two groups, each unaware that the other was housed in a cabin at another end of the camp. In the first phase of the study, lasting about a week, the groups, which named themselves the Eagles and the Rattlers, bonded over shared interests and activities—hiking, swimming, a treasure hunt with a ten-dollar reward. In the second phase, the groups were brought together in a series of zero-sum competitions: baseball, tug-of-war, touch football. The researchers, who doubled as camp counsellors, orchestrated hijinks. One group was delayed in arriving at a picnic; when they got there, they were led to believe that the other group had eaten their food. Tensions rose. The Eagles burned the Rattlers’ flag; the Rattlers raided the Eagles’ cabin. Researchers had to step in to break up fights. Division had set in.

The goal of the third phase was to defuse the animosity. As a first step, the researchers organized a series of noncompetitive activities. The boys shared meals, watched a movie together, and celebrated the Fourth of July. Little changed. Only when the campers were given tasks requiring collaboration on a common endeavor—restarting a stalled food truck, pitching a tent with missing supplies, raising money for a movie night—did conflict decline. In the end, one group bought the other malted milk.

The findings of the Robbers Cave experiment have become a staple of undergraduate seminars and psychology textbooks. But they appear not to apply to our current moment. Never before has it been so clear that our work, behavior, and fates are inextricably linked to those around us. Working together to control the virus should have been the ultimate shared goal. And yet, facing viral invasion, Americans couldn’t agree not to sneeze on one another. While fighting the pandemic, America has remained one of the world’s most polarized nations.

It turns out that the Robbers Cave experiment doesn’t tell the whole story. As Gina Perry explains in her book “ The Lost Boys ,” Sherif had conducted a near-identical experiment the year before, in 1953. He’d invited a similar cohort of boys to a camp in upstate New York and divided them into groups: the Panthers and the Pythons. The researchers had carried out a similar series of conflict-generating shenanigans: they’d stolen clothes, ransacked tents, and broken a boy’s ukulele. This time, however, the boys caught on—they realized that they were being manipulated. Instead of fighting one another, they turned on the adults. “Maybe you just wanted to see what our reactions would be,” one boy suggested to a researcher. ​​One of the groups decided that their clothes must have gone missing because of a laundry mishap; both sides worked together to restore an overturned tent. As the experiment unravelled, Sherif began drinking heavily. He grew so despondent that he nearly punched a research assistant in the face. The experiment was stopped early; Sherif never published the findings.

In an era of social-media virality, cable-news punditry, and political celebrity, we, too, are being manipulated. The ire we direct at one another is, at least in part, a result of forces that aim to extract political or financial gain by stoking division and appealing to our basest instincts. Despite knowing better, people in power traffic in half-truths, adding to the cacophony of conflict. They reflect our discord but also create it. We don’t yet know what post-liminal life looks like—but recognizing that truth may be the first step to healing the divide.

More on the Coronavirus

How China’s response set the stage for a worldwide wave of censorship .

Why are preschoolers subject to the strictest COVID rules in New York City ?

Ecuador’s largest city endured one of the world’s most lethal outbreaks .

What it was like to treat some of the oldest and sickest people in New York’s jails .

Young New Yorkers grapple with the pandemic’s mental toll .

In the COVID era, the success of the chickenpox vaccine is staggering to contemplate.

Sign up for our daily newsletter to receive the best stories from The New Yorker .

When Computer Bugs Were Actual Insects

Extreme natural phenomena, openmind books, scientific anniversaries, a loop towards the extinction of species,the other ‘butterfly effect’, featured author, latest book, a changing world: life after covid-19, understanding as a way to reinvent ourselves following a lethally smart virus.

It happened in the blink of an eye, to put it metaphorically.  Suddenly, the virus had made its home in the body of more than hundreds, if not thousands, of people in different countries around the world. The coronavirus that started in the city of Wuhan, China, according to official sources , on December 31, 2019, which is where it got the name COVID-19, followed its natural course, ignoring borders, customs and tariffs.  

The part about following its natural course refers to a Chinese proverb that has become something like the slogan of the so-called chaos theory , developed by the mathematician and meteorologist Edward Lorenz in the 1960s, together with other scientists, which tries to answer the following question: Is it possible for a butterfly flapping its wings in Sri Lanka to cause a hurricane in the United States? If we interpret and adapt the chaos theory and butterfly effect to the current situation we are globally experiencing, this new outbreak of coronavirus, it could lead us to give the answer that an event, regardless of how unlikely it may seem, does not mean it is impossible for it to occur.

Proof of this is that the disaster is already upon us, shaking our political, social and economic gears as never before. So how can an invisible virus be defeated when it does not seem to produce symptoms in the people who carry, or carried, it the most? Furthermore, even though some insist with all their might on denying the obvious, the truth is that the virus does not care about social class, race, gender or other labels that divide us. COVID-19 has once again put Darwin’s hypothesis of “survival of the fittest” in style, which does not necessarily have to correspond to the strongest. In fact, it is Trump’s America that is the country that has been hit the hardest by COVID-19, and Italy and Spain have the highest number of deaths in Europe.

Going back in time to take stock of the situation

Media coverage of disasters or health crises is no simple task when right in the middle of them. However, it is important to analyze and clear up certain unknowns to the extent possible . That’s why, one of the key questions in this global pandemic is whether it could have been avoided. If it could not have been avoided, it could fall under the category of what the Lebanese-American philosopher and researcher Nassim Nicholas Taleb calls a black swan. 

This concept is a metaphor that  Taleb developed in his 2007 book entitled The Black Swan: The Impact of the Highly Improbable. A black swan is a surprising event (for the observer) that has a great socioeconomic impact and after it happens it is rationalized retrospectively (making it seem predictable or explainable and giving the impression that it was expected to occur). In addition, these types of incidents considered extremely atypical, collectively play much bigger roles that regular events. 

For Taleb, examples of “black swans” throughout the history of humankind have included: the start of World War I, the Spanish flu , or the September 11, 2001 terrorist attacks. That said, what do you think Taleb said about whether COVID-19 is another black swan? The answer, which is in this video published on March 31st, is no, as the author feels that the pandemic could have been prevented.

However, although COVID-19 does not meet all the requirements for Taleb’s theory to be considered a real black swan, we cannot deny the evidence that we are facing an event that is disruptive on a planetary scale, whose future consequences we are not currently able to make out.  If there are documented facts, who in the past could have warned about the possibility of a pandemic outbreak of this magnitude?

Coronavirus pandemic: an overlooked reality

In October 2007, the academic journal Clinical Microbiology Reviews published that it is specializing in analysis of the most innovative developments in the areas of clinical microbiology and immunology in an article called: Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection . In its introduction, it says: “The rapid economic growth in southern China has led to an increasing demand for animal proteins including those from exotic game food animals such as civets. Large numbers and varieties of these wild game mammals in overcrowded cages and the lack of biosecurity measures in wet markets allowed the jumping of this novel virus from animals to human. Its capacity for human-to-human transmission, the lack of awareness in hospital infection control, and international air travel facilitated the rapid global dissemination of this agent.” The conclusion of the same article says: “The possibility of the reemergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored.”

In the year 2013, German authorities published the 2012 Report on risk analysis in civil protection ( Bericht zur Risikoanalyse im Bevölkerungsschutz 2012 ). One of the sections of this official document described a simulation of a hypothetical outbreak of coronavirus around the world. The researchers who carried out this “simulation game” were a group or researchers led by the Robert Koch Institute . This is Germany’s public health agency, as well as the research center in charge of controlling and preventing diseases. On April 7th, the German magazine Der Spiegel published an article in which the author asked the following question, which is exactly what many people are thinking, and which can be extrapolated beyond Germany: “Why wasn’t Germany better prepared if it knew that this kind of scenario could occur? And therefore, what was the purpose of the report?” 

Meanwhile, Luis Enrique Martín Otero , colonel veterinarian and coordinator of VISVET at the Network of Biological Alert Laboratories (RE-LAB), who at the same time was Technical Director on a national level of the 2001 anthrax crisis, wrote the following article near the end of March: Covid19: silent biological threat . The first paragraph of this article has the following: 

In this fragment, Martín Otero also makes it clear that this pandemic was not a black swan. He argues the following: “ As long as nothing happens, politicians do not value the importance of constantly researching these biological threats. Those of us working on them know that they will occur, but we don’t know when.” 

However, humans are not the only ones who have been making forecasts about a possible global pandemic from coronavirus. So have some  AI based computer programs , as described by Ramón López de Mántaras Badia , Director of the CSIC Institute for Artificial Intelligence , which anticipated the outbreak, but the use of these data was not completely smart and effective. It was missing a human mind, as Ramón clarifies, or more precisely, a group of them spaced out over the world in order to interpret and manage the data or conclusions obtained from the machines. 

On a sinking ship, focus on what is important 

Apparently, for some unknown reason, deciphering the future continues to be humans’ great dream. So far, we have been chasing this goal, and continue to do do, still drunk on a sort of blind hope. 

Some of the hypothetical causes that could have led to this scenario could stem from: the very limits of human understanding of reality and human nature, which have led us to not have appropriate mechanisms to manage these kinds of incidents; perhaps out of some kind of ignorance or arrogance; together with an implemented technology that is even baptized with the name artificial intelligence, which is not yet as intelligent as previously believed, as it has not been adapted to the basic needs of a globalized, constantly evolving world. This could be due once again to the knowledge, understanding or more precisely, the design of artificial intelligence itself, as more than betting on implementing technology that lowers the weaknesses we face as a species, we have attempted, and continue to attempt, to only simulate some aspects of our human intelligence, playing some sort of Homo Deus. 

If the famous cult of reason and the systematization of science, which is so important to the method and for scientific progress is combined with the impetus to continue deciphering the role that human emotions play to a greater extent, as well as the nature of our fear of uncertain events, the origin of power struggles, our systems of beliefs and values, of our decision-making and therefore of our identity, we will have managed to make a qualitative evolutionary leap. 

However, these more profound causes will be better analyzed and studied after the fact, when we are able to take stock of this historic period with more perspective, understood as from a distance, with the calmness and tranquility that no one currently possesses as we are completely immersed in the fight for survival. However, if we don’t do it, our eternal great enemy will have won the battle: oblivion. 

Rosae Martín Peña

Related publications.

• What’s Next: the (In)Equality to come
• 3 Historic Discoveries That Allow Us to Fight Against COVID-19
• How Science can Defeat the Coronavirus: Challenges and Tools

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

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

• inequalities

Data availability statement

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

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

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

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Introduction

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

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

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

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

Social networks

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

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

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

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

Social support

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

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

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

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

Social and interactional norms

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

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

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

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

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

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

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

Recommendations and conclusions

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

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

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

Recommendation 2: intelligently balance online and offline ways of relating

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

Recommendation 3: build stronger and sustainable localised communities

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

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

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

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

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

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

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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Unique associations between strategies of coping with COVID-19-related stress and internalizing symptoms in a clinical sample of adolescents

• Open access
• Published: 20 August 2024

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• Bente Storm Mowatt Haugland   ORCID: orcid.org/0000-0002-9114-4856 1 ,
• Mari Hysing 2 ,
• Yngvild Sørebø Danielsen 1 , 3 ,
• Bruce E. Compas 4 ,
• Linda H. Knudsen Flygel 5 ,
• Åshild Tellefsen Håland 6 , 7 &
• Gro Janne H. Wergeland 5 , 8  

Youth internalizing symptoms increased significantly during COVID-19, suggesting a need for more knowledge on how to prevent youth mental health problems during future widespread societal health crises. This cross-sectional study examined coping strategies and how these were associated with internalizing problems in a clinical sample of youth during COVID-19. Youth (13–19 years) referred to mental health treatment for internalizing problems were assessed 6–18 months into the pandemic. Participants ( N  = 160, mean age = 15.8 years, SD = 1.2; 80% female, 5% non-binary) completed the Response to Stress Questionnaire, assessing COVID-19 stress, coping strategies, and involuntary stress responses. Internalizing symptoms were evaluated by the Spence Children’s Anxiety Scale and the Short Mood and Feelings Questionnaire. Results showed that coping strategies were associated with internalizing symptoms, after controlling for sex, age, and COVID-19-related stress. Youth using primary control coping had lower levels of anxiety whereas those using secondary control coping strategies had fewer depressive symptoms and fewer involuntary disengagement responses. Secondary control coping (i.e., adapting to the situations) was the most frequent strategy. The highest COVID-19 stressors reported were insecurity about the future, and having to change, postpone or cancel important plans/events. Thus, in a clinical sample of youth, unique associations were found between the type of coping strategy and levels of anxiety and depressive symptoms. During future pandemics and societal health crises, measures to reduce unpredictability in everyday life and insecurity about the future should be implemented, followed by interventions to support adaptive coping strategies.

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Introduction

The COVID-19 outbreak represented a major public health crisis, even though positive effects on family relationships and the well-being of youth were also observed (Panchal et al., 2023 ). In addition to considerable negative health consequences and an increased number of deaths due to COVID-19 infections, the pandemic involved complex stressors of uncertainty, anxiety-inducing information, loss of daily routines, decreased perceived control, and changed social interactions. The current study had several aims. We wanted to examine the type and level of stress related to COVID-19 as experienced by youth referred to mental health treatment, six to eighteen months into the pandemic. We also wanted to investigate the strategies reported by vulnerable youth to cope with the pandemic stress. Finally, we aimed to investigate associations between the type of coping strategies and the youth’s internalizing symptoms, controlling for sex, age, and level of COVID-19-related stress. The findings from the study may have implications for the development of measures to prevent increased internalizing problems in youth during future pandemics or societal health crises.

COVID-19-related stress and internalizing problems in youth

During the pandemic, an increase in youth mental health problems was demonstrated worldwide (Bera et al., 2022 ; Hussong et al., 2021 ; Kostev et al., 2023 ; Panchal et al., 2023 ; Racine et al., 2021 ; Revet et al., 2021 ), followed by a rise in referrals to mental health services (Revet et al., 2021 ). A Norwegian registry study demonstrated increased primary care consultations concerning youth internalizing problems (i.e. symptoms of anxiety and depression) from summer 2020 throughout 2021, with a corresponding rise in specialist mental health consultations from mid-2021 (Evensen et al., 2022 ).

In general, internalizing disorders (i.e., anxiety and depression) are among the most common mental health problems in youth (Merikangas et al., 2010 ), with a worldwide prevalence of 6.5% for anxiety disorders and 2.6% for depression in youth aged 6–18 years (Polanczyk et al., 2015 ). A rise in internalizing problems was observed during the COVID-19 pandemic (Bera et al., 2022 ; Hafstad et al., 2022 ). A meta-analysis including 29 studies on general population samples of youth, found that during COVID-19, about 25% experienced clinically elevated depression symptoms whereas about 20% experienced clinically elevated anxiety symptoms (Racine et al., 2021 ). This indicates that youth were susceptible to the negative effects following the COVID-19 pandemic. Furthermore, the findings highlight the need for knowledge, both to develop interventions to prevent future increases in youth mental health problems and to make authorities better prepared to handle pandemics and similar society-wide health crises.

Some subgroups of youth seem to have experienced the lockdowns as more problematic than others, e.g., youth with lower socioeconomic status, and youth born in developing countries (Lehman et al., 2021 ). Differences in risk, as well as resources available for the individual and his/her family (e.g., lifetime abuse exposure, social support), have also been found to influence the mental health outcomes of adolescents during COVID-19 (Hafstad et al., 2022 ; Qi et al., 2020 ). Further, studies indicate that girls were more affected by anxiety and depression during COVID-19, whereas older adolescents were more at risk for depressive symptoms (Bera et al., 2022 ; Hafstad et al., 2022 ; Racine et al.,  2021 ; Thorisdottir et al., 2021 ).

How young people were impacted by the pandemic also depended on their exposure to and perception of COVID-19 stress (Bera et al., 2022 ). Four types of stressors related to COVID-19 have been identified among youth: (a) fear of the COVID-19 illness, (b) social isolation from friends and family, (c) missing important events, and (d) stress related to schoolwork (Mohler-Kuo et al., 2021 ). These are stressors identified in population samples of youth. Unfortunately, very few studies have been found on the experiences of youth with mental health problems during COVID-19 (see Kudinova et al., 2022 ; Nissen et al., 2020 for exceptions). Consequently, we know very little about the experiences of pandemic-related stress in clinical samples of youth.

Voluntary coping strategies and involuntary stress responses

How adolescents cope with stress, in general, affects their current and future adjustment (Compas et al., 2001 , 2017 ). Importantly, not all coping efforts necessarily result in positive health outcomes. Coping has been described as broad dimensions (e.g., problem-focused coping) and as specific strategies (e.g., emotional expression). A key dimension seems to be whether coping efforts are directed towards a stressor (engagement strategies, e.g., problem-solving) or oriented away from a stressor (disengagement strategies, e.g., denial) (Compas et al., 2001 ). Coping strategies are neither considered universally helpful nor detrimental across stressors. Whether a coping strategy is adaptive is assumed to be closely related to the characteristics of the stressor (Compas et al., 2001 ). Thus, we cannot generalize from previous studies on other stressors whether strategies for coping with COVID-19 have been adaptive or not.

Due to an imbalance between rapidly increasing emotional reactivity and slower development of voluntary regulatory strategies, coping strategies are both important and challenging during adolescence (Rapee et al., 2019 ; Zimmer-Gembeck & Skinner, 2010 ). This underlines the need to examine strategies for coping with COVID-19 stress specifically within samples of adolescents.

Coping responses are defined as voluntary and intentional. However, individuals may also have involuntary reactions to stress. Involuntary stress responses can be conscious (e.g., ruminative thoughts) or subconscious (e.g., physiological hyperarousal). According to a model on strategies for reacting to stress in adolescents (Connor-Smith et al., 2000 ) both voluntary coping strategies and involuntary stress responses may either be directed toward the stressor (engagement strategies, e.g., intrusive thoughts) or away from it (disengagement strategies, e.g., emotional numbing).

The level of involuntary reactions is furthermore assumed to be influenced by the nature and intensity of the stressor (Compas et al., 2001 ). Due to elements of uncontrollability, threats, and possible losses associated with COVID-19, involuntary stress responses were expected to increase during the pandemic (Gruber et al., 2021 ). Thus, to be able to tailor interventions to the needs of youth with mental health problems, we need knowledge about both adaptive coping strategies and involuntary stress responses.

Strategies to cope with COVID-19 stress

Acceptance is a coping strategy that was often used by young people in community samples during the COVID-19 pandemic (Babicka-Wirkus et al., 2021 ; Bourduge et al., 2022 ; Dewa et al., 2021 ; Orgilés et al., 2021 ). However, a range of other coping strategies, such as self-distraction (Bourduge et al., 2022 ; Demaray et al., 2022 ), avoidance (Dewa et al., 2021 ; Kudinova et al., 2022 ), seeking emotional support (Babicka-Wirkus et al., 2021 ; Bourduge et al., 2022 ), positive reframing (Demaray et al., 2022 ; Waselewski et al., 2020 ), and cognitive restructuring (Foster et al., 2023 ) were also used. As most studies on strategies for coping with COVID-19 stress have examined community samples of adolescents, we have limited knowledge of the type of coping strategies applied by youth in clinical samples.

Coping strategies and youth internalizing symptoms

A very limited number of studies have examined associations between coping strategies and youth mental health during COVID-19. Among the studies identified, the coping strategies acceptance (Dewa et al., 2021 ), positive reframing, and cognitive restructuring (Demaray et al., 2022 ; Dewa et al., 2021 ; Foster et al., 2023 ) have been associated with better mental health outcomes. On the other hand, coping strategies such as self-distraction, avoidant, and negative coping have been associated with increased anxiety- and depressive symptoms (Demaray et al., 2022 ; Turk, 2021 ). Mixed results have been found regarding self-distraction (Dewa et al., 2021 ). When parent-report of coping strategies in youth has been used, fewer youth mental health symptoms have been associated with the use of problem-focused coping, whereas emotion-focused coping strategies and disengaged coping have been associated with more mental health problems (Hussong et al., 2021 ). Parent-reported task-oriented (e.g., acceptance) or avoidant coping have been associated with fewer mental health symptoms (Orgilés et al., 2021 ).

Summing up, only a handful of studies have examined associations between strategies for coping with COVID-19 stress and youth mental health. Results indicate that coping strategies have been associated with youth mental health problems, but findings are somewhat inconsistent regarding which strategies have been adaptive, probably due to conceptual and methodological differences between studies, as well as discrepancies between informants (self-report versus parent-report). Very few studies have examined coping with COVID-19 stress in clinical samples of youth (see Kudinova et al., 2022 for an exception). This is unfortunate, as COVID-19 and the infection control restrictions seem to have significantly impacted young people with mental disorders (Bera et al., 2022 ; Foster et al., 2023 ; Panchal et al., 2023 ). Also, during COVID-19, poor coping strategies probably intensified the mental health problems among youth with psychiatric problems (Kudinova et al., 2022 ).

The current study

The present study examined Norwegian adolescents referred to Child and Adolescent Mental Health Services (CAMHS) for treatment for anxiety and/or depressive symptoms six to eight months after lockdown in Norway. Norway had a relatively low rate of infection deaths and hospitalization during COVID-19 (Christensen & Lægreid, 2020 ). However, the infection control measures applied were comparable to other Western countries, with national and regional restrictions, including physical distancing, quarantine, isolation of infected, and lockdowns of schools with periods of homeschooling (for an overview, see Government.no, February 2020 -February2022).

Most studies published on coping strategies in youth were conducted during the first months of the pandemic, while mental health problems seemed to have increased more in later phases of the pandemic (Hafstad et al., 2022 ). Thus, to get a thorough understanding of stress and adaptive coping among youth, we need to examine data also from later phases of the pandemic.

The main aim of the present study was to examine associations between coping strategies, and internalizing symptoms in a clinical sample of adolescents, six to eighteen months after lockdown. The coping measure used is based on an acknowledged theoretical model for coping with stress in children and adolescents (Connor-Smith et al., 2000 ). A COVID-19 version was made available by the developers of the scale and translated into Norwegian by the authors of this study. As the COVID-19 version of the coping scale had not been used previously in a clinical youth sample, the study should be considered exploratory.

As sex, age, and the level of COVID-19 stress may influence the association between coping strategies and internalizing symptoms, these variables were controlled for in the analyses. Thus, the following research questions were examined in a sample of adolescents with internalizing problems referred for treatment in CAMHS during COVID-19:

What type and level of COVID-19 stress was reported by the youth?

Which strategies were used to cope with COVID-19-related stress?

Were coping strategies and involuntary stress responses associated with internalizing symptoms, after controlling for sex, age, and COVID-19-related stress?

Were associations between coping strategies or involuntary stress responses and internalizing symptoms moderated by the level of COVID-19 stress?

Participants and clinical settings

All youth 13–19 years, referred to mental health services for anxiety or depressive symptoms between October 1st, 2020, and September 30th, 2021, were invited to participate. Information about the study and informed consent forms were sent to youth (above 16 years) and/or parents or youth (below 16 years) as soon as possible after referral was received by the clinics and before a decision about treatment status had been made. The participants were recruited from the eight child and adolescence mental health outpatient clinics (CAMHS) in the City of Bergen Hospital Trust (seven clinics) and Kristiansand City (one clinic); as well as from the student training clinic for psychological treatment in Bergen (University of Bergen, Norway). These cities and clinics were chosen because of the authors’ affiliation with the trust and/or clinics.

Youth were excluded from the study if referral information indicated: (a) limited understanding of the Norwegian language, (b) other mental health problems with higher priority (e.g., eating disorders), (c) a diagnosis making the questionnaires challenging to complete (e.g., severe learning disability), or c) the youth being in alternative care due to child protection concerns. Also, youth were excluded if parents were not informed about the referral to CAMHS.

Administrative and clinical personnel identified eligible participants based on referral information. Clinical staff sent text messages with information about the study, consent forms, and an online questionnaire to youth  ≥  16 years and parents of youth < 16 years. No information was made available for the researchers until consent was obtained. After receiving consent from parents of youth < 16 years and from youth  ≥  16 years, the research staff sent invitations, consent forms, and an online survey to youth < 16 years and parents of youth  ≥  16 years. This procedure follows Norwegian health legislation. Participating youth received a movie theatre ticket (15 $) to compensate for their time to complete the questionnaire. Two randomly chosen participants each received a gift card of 100$.

A total of 834 youth were eligible for inclusion (see Fig. 1 ), with 55 youth removed due to exclusion criteria and 36 due to inadequate contact information, failure in SMS procedures, or duplicated responses. Response was received from 234 cases (31.5% response rate). The present study includes only youth reports, comprising 179 cases (some of the 234 cases included both youth and parent reports, whereas others included only youth or only parent reports). Youth not completing the questionnaire on coping strategies ( n  = 19) were removed, resulting in a final sample of 160 youth.

Flow chart. Recruitment of a sample of clinically referred youth

Coding of demographic variables

Gender was reported as boy, girl, or other (non-binary). Perceived economic well-being was reported with response options: poorer than others , equal to others , and better than others . Nationality was dichotomized as Norwegian versus immigrant, based on whether at least one versus none of the parents of the youth were born in Norway. The living situation was categorized as: (a) living with both parents, (b) living with one parent, or (c) other arrangements.

COVID-19 related variables

Pandemic-related variables comprised whether the youth had been infected by COVID-19 ( yes , no , or don’t know ), and date of assessment. The assessment dates were re-coded in three-month intervals and included to control for differences in infection control measures and infection rates during the inclusion period.

The Responses to Stress Questionnaire – COVID-19 version, RSQ (Connor-Smith et al., 2000 ), was used to assess COVID-19-related stress. Youth were provided with a list of 14 stressors (e.g., unable to participate in social activities and normal routines because of COVID-19 ) and one open question. They were asked to rate how stressful each stressor had been in the last six months. Each stressor was rated on a four-point scale (from 1 =  not at all to 4 =  very ). A sum score, with a maximum score of 60, indicated higher levels of stress. Cronbach alpha for the stress scale was good ( α  = 0.85). The RSQ was translated into Norwegian for the current study.

• Coping strategies

The second part of RSQ comprises 57 items assessing coping responses and involuntary stress responses related to COVID-19 stress. The responses involve cognitive, behavioral, emotional, and physiological responses, rated on a scale from 1 ( not at all ) to 4 ( a lot ) (Connor-Smith et al., 2000 ). Voluntary coping reflects conscious coping strategies aimed at changing the stressor (primary control) or actively regulating the person’s responses to the stressor (secondary control). Involuntary responses include responses that may or may not be within conscious awareness (e.g., intrusive thoughts, emotional numbing). The engagement-disengagement dimension relates to whether responses are directed towards (approach) or away from (avoidance) a stressor (Connor-Smith et al., 2000 ). Five factors are derived from these dimensions; (1) Primary Control Engagement Coping (three subscales, e.g., problem-solving); (2) Secondary Control Engagement Coping (four subscales, e.g., positive thinking); (3) Disengagement Coping (three subscales, e.g., avoidance); (4) Involuntary Engagement (five subscales, e.g., physiological arousal), and (5) Involuntary Disengagement (four subscales, e.g., emotional numbing). The standard method for scoring RSQ was applied with the total score for each factor divided by the total score for all factors.

RSQ has demonstrated excellent internal consistency, test-retest reliability, and validity (Compas et al., 2017 ). In the present study, Cronbach’s alpha for the coping and stress response factors ranged from α  = 0.73 (primary control engagement coping) to α  = 0.93 involuntary engagement), indicating adequate to excellent internal consistency.

Internalizing symptoms

Anxiety symptoms were assessed by the Spence Children’s Anxiety Scale (SCAS) (Spence et al., 2003 ) comprising 44 items, on a four-point scale, including six positive filler items. Higher scores indicate more anxiety symptoms. SCAS has demonstrated sound psychometric properties (Arendt et al., 2014 ; Spence et al., 2003 ). Excellent internal consistency was found ( α  = 0.94). The level of anxiety was considered elevated based on recommended cut-off scores (for girls a total SCAS score  ≥  40 and for boys  ≥  33; www.scaswebsite.com ). A Norwegian-translated version of SCAS was applied.

Depressive symptoms were measured by the Short Moods and Feelings Questionnaire (SMFQ) (Angold et al., 1995 ), a 13-item scale rated on a scale from 0 to 2, with good psychometric properties (Lundervold et al., 2013 ). Higher scores indicate more depressive symptoms. Youth were asked to report depressive symptoms during the last two weeks. Scores were considered elevated based on cut-off scores  ≥  12 for girls and ≥  6 for boys (Jarbin et al., 2020 ). Cronbach’s alpha indicated excellent internal consistency ( α  = 0.90). A Norwegian-translated version of SMFQ was applied.

Following Norwegian health research legislation, youth  ≥  16 years consented to participate in the study, whereas parents consented for their youth < 16 years, with assent from the youth himself/herself. The Regional Committee for Medical and Health Research Ethics, Western Norway approved the study (no 138 886). Permission to access the youth’s medical charts to extract mental health diagnoses was given by the youth > 16 years old or by the parents of the youth < 16 years old.

Data analyses were conducted using IBM SPSS Statistics (version 28.0). Descriptive statistics are presented as means, standard deviations, and proportions. Pearson product-moment correlations were used to examine continuous variables and Independent Samples t-tests to examine differences in the types of coping strategies reported by girls versus boys and younger versus older youth. Differences between subtypes of coping strategies and types of stress responses were examined with Paired sample t-tests.

A series of separate hierarchical multiple regression analyses were conducted with separate analyses for anxiety and depressive symptoms as outcomes. In Model 1, the level of COVID-19 stress was included as a predictor. As age and sex are commonly found to be associated with internalizing symptoms (Leikanger et al., 2012 ; Salk et al., 2017 ), these variables were included as predictors in the regression models. Due to high correlations between coping strategies and involuntary stress responses ( r ’s varying from − 0.60 to − 0.77), separate analyses were conducted with coping strategies and involuntary responses as predictors. In model 2a voluntary coping strategies and in model 2b involuntary stress responses were added as predictors. The third model included interactions between COVID-19 stress and coping strategies (model 3a) or COVID-19 stress and involuntary stress responses (model 3b). Variables included in the interaction terms were centered. Time of assessment and infection status were not controlled for as no differences were observed in coping strategies or involuntary stress responses for these variables. To reduce the risk of Type 1 errors due to multiple testing, p -values were adjusted to assume statistical significance at p   ≤  .01.

Sample characteristics

The sample comprised 160 youth, 80% female and 5% non-binary. The majority of the youth (65%) were 16–19 years. Table 1 presents the demographic characteristics of the sample. A large majority were non-immigrant Norwegians (93.7%). Half of the youth (50.3%) reported living with both parents and the remaining with one parent (27.4%) or other living arrangements. A minority (15.6%) considered the economy of their family as poorer than others.

Diagnostic information (ICD-10), from the youth’s medical chart, was gathered approximately six months after study inclusion. The following mental health diagnoses were registered: anxiety disorders (19.4%), depressive disorders (17.5%), and other disorders e.g., OCD, stress-related or somatoform disorders (4.4%). However, the majority (61,9%) was registered with symptoms and signs involving emotional states, i.e., not finally diagnosed.

The mean levels of anxiety ( M  = 50.07, SD  = 20.63) and depressive symptoms ( M  = 18.13, SD  = 6.18) were elevated. A total of 33,5% of youth reported having had COVID-19 (2,5% didn’t know). The time point when the survey was completed showed a balanced distribution of responses throughout the inclusion period (Table 2 ).

Level and types of COVID-19 stress

Regarding the level of COVID-19 stress, participants reported a total score of 33.22 ( SD  = 7.98, range 14–55) and a mean item score of 2.24 ( SD  = 0.53, range 1.00–3,67). This corresponds to a score between a little and somewhat stressful . As presented in Fig. 2 , most items were rated as a little or not at all stressful. However, 71.0% reported insecurity about the future, and 67.9% that having to change, postpone, or cancel important plans or events was somewhat or very stressful. About half of the youth (55.4%) reported difficulties participating in social activities and normal routines and having problems completing school assignments online (55.1%) as being somewha t or very stressful (Fig. 1 ).

Types of COVID-19 stress in clinically referred youth ( N =160; age 13-19 years)

Higher level of COVID-19 stress was associated with more anxiety ( r  = − .36, p  < .001) and depressive symptoms ( r  = − .40, p  < .001).

Coping strategies and stress responses

Secondary control coping strategies were the most frequent strategies applied ( M  = 0.22,  SD  = 0.05), followed by disengagement ( M  = 0.17, SD  = 0.03) and primary control coping ( M  = 0.16, SD  = 0.03) (Fig. 3 ). Significant differences in frequency were found between secondary control coping and disengagement strategies t (145) = 17.19, p  < .001), and secondary control and primary control coping t (145) = 10.11, p  < .001). Involuntary engagement ( M  = 0.25, SD  = 0.04) was reported more frequently than involuntary disengagement ( M  = 0.20, SD  = 0.03), t (149) = 12.05, p  < .001).

Mean scores on three factors of voluntary coping strategies and two factors of involuntary stress responses to COVID-19 stress in a clinical sample of youth ( N = 160; age 13-19 years)

Age and sex differences

Age was related to the level of COVID-19 stress, with older adolescents reporting higher levels of stress ( r  = − .25, p  < .01). However, no difference was found between boys and girls. Furthermore, no age or sex differences were found regarding the type of coping strategies applied. However, girls ( M  = 0.25, SD  = 0.04) reported more involuntary engagement stress responses t( 141) = 2.67, p  < .008) compared to boys ( M  = 0.22, SD  = 0.04).

COVID-19 stress, coping strategies, and involuntary stress responses

Level of COVID-19 stress was negatively associated with primary ( r = − .26, p  < .01) and secondary control coping ( r  = − .42, p  < .001), with youth using both types of strategies reporting lower COVID-19 stress (Table 3 ). Involuntary engagement and disengagement stress responses were positively associated with the level of COVID-19 stress ( r  = .42, and r  = .28, both p  < .001). Furthermore, primary and secondary control coping was negatively associated with all involuntary stress responses ( r ’s ranging from − 0.41 to − 0.77, all p  < .001) i.e., youth who reported more use of primary or secondary control coping, had lower levels of involuntary stress responses (Table 3 ).

Coping strategies and involuntary stress responses as predictors of internalizing symptoms

Results from the regression analyses with anxiety symptoms as outcomes are presented in Table 4 . Model 1 with the predictors of sex, age, and COVID-19-related stress explained 18% of the variance in anxiety symptoms (F[1,133] = 25.25, p  < .001). When adding coping factors to the regression (model 2a), the explained variance in anxiety symptoms increased by 8% (F [3,130] = 4.78, p  = .003). More specifically, primary control strategies were associated with lower levels of anxiety symptoms ( β = − 0.22, p  < .01). No moderating effect of the level of COVID-19 stress on the association between coping strategies and anxiety was observed (model 3a).

Involuntary stress responses (model 2b), explained 5% of the variance in anxiety (F[2,131] = 4.45, p  = .014) after controlling for sex and age. And COVID-19-related stress. However, involuntary engagement responses ( β  = 0.22, p  < .015) were not significant contributors to the level of anxiety given our predetermined level of significance ( p  < .01). No moderating effect of the level of COVID-19-related stress was observed on the association between involuntary engagement and anxiety (model 3b).

Corresponding analyses for depressive symptoms as outcomes are presented in Table 5 . Sex, age, and COVID-19-related stress (model 1) explained 15% of the variance in depressive symptoms (F [1,134] = 27.01, p  < .001). Coping factors (model 2a) accounted for a further 16% of the variance (F [3,131] = 10.02, p  < .001). Secondary control coping was a negative predictor of depressive symptoms ( β = − 0.29, p  < .001), with those reporting more use of secondary control coping strategies having fewer depressive symptoms. The level of COVID-19 stress did not moderate the association between secondary control coping and depressive symptoms (Table 5 ).

Involuntary stress responses accounted for 9% of the variation in depressive symptoms after controlling for sex, age, and COVID-19 stress (F[2,132] = 8,36, p  < .001). Involuntary disengagement stress responses ( β  = 0.30, p  < .001) contributed to depressive symptoms, with more disengagement associated with more depressive symptoms. The level of COVID-19 stress did not moderate the association between involuntary disengagement and depressive symptoms (Table 5 ).

The current study addresses a gap in the literature by examining associations between types of coping strategies, involuntary stress responses, and internalizing symptoms in a clinical sample of youth, six to 18 months into the COVID-19 pandemic. The most frequent COVID-19 stressors reported were related to insecurity and unpredictability in everyday life, followed by difficulties with schoolwork. Furthermore, youth who reported higher levels of COVID-19-related stress had more internalizing symptoms. Secondary control coping strategies, i.e., adapting to the situation, were the most frequently applied strategies. No age or sex differences were found regarding the type of coping strategies reported. However, coping strategies and involuntary stress responses contributed to both anxiety and depressive symptoms after controlling for the level of COVID-19-related stress. Unique associations were found between the type of coping strategies reported and levels of anxiety and depressive symptoms, indicating that during widespread societal health crises, some types of coping strategies may reduce anxiety symptoms whereas other coping strategies may reduce depressive symptoms.

Level and type of COVID-19 stress

The moderate level of COVID-19 stress reported by the youth in this study should be interpreted in the context of COVID-19 representing a limited health risk for most Norwegians (Christensen & Lægreid, 2020 ). Despite this, the youth reported changes in plans, social activities, and everyday routines, as well as insecurity about the future as highly stressful. This is comparable to stressors reported in previous studies (Demaray et al., 2022 ; Foster et al., 2023 ; Watson et al., 2023 ), indicating comparable COVID-19 stress experienced by youth across clinical and community samples and between countries. Furthermore, these stressors were probably related to the infection control measures, more than the danger represented by the virus itself. The relationship between the level of COVID-19 stress and age suggests that older adolescents (16–19 years) may have experienced the unpredictability and uncertainty related to the pandemic, including the lockdowns as more stressful. This may perhaps be due to adolescents in this age group being more dependent on peer support and outside-of-home activities to maintain well-being.

The associations between level of COVID-19 stress and internalizing symptoms in the present study are in line with findings in previous population samples (Demaray et al., 2022 ; Foster et al., 2023 ), suggesting that infection control measures (e.g., the physical distancing and lockdowns of schools and leisure activities) increased anxiety and depressive problems in both clinical and non-clinical samples of youth. The negative effects of the infection control measures have been explained by increased social isolation and loneliness (Loades et al., 2020 ), but could also be a result of youth having diminished access to protective factors, such as social support from friends, teachers, couches, etc. Together this may have left vulnerable youth with limited resources to cope with COVID-19-related stress.

Type of coping strategies and internalizing symptoms

Secondary control coping (i.e., acceptance, distraction, cognitive restructuring, positive thinking) were the most frequent strategies reported (e.g., I realize that I just have to live with things the way they are ). This is in line with findings from population samples (e.g., Bourduge et al., 2022 ; Demaray et al., 2022 ; Dewa et al., 2021 ; Orgilés et al., 2021 ). The COVID-19 pandemic involved stressors characterized by low control and predictability (e.g. infection, deaths, isolation from friends and relatives, lockdown of schools and leisure activities). Secondary control strategies involving adjusting to the situation have been suggested as adaptive, specifically when facing unpredictable and uncontrollable stressors (Zimmer-Gembeck & Skinner, 2016 ).

Primary control strategies were reported less frequently compared to secondary control strategies. Primary control strategies are aimed at altering the situation/stressor or one’s emotional reactions to the stressor. These strategies are generally associated with positive mental health outcomes (Compas et al., 2001 ). In future societal health crises and pandemics, the use of primary control strategies could be reinforced through increasing youths’ experience of personal control, for example by focusing on increasing their control over everyday life and routines and limiting lockdown of schools and leisure activities, if possible.

Whereas developmental differences have previously been found regarding coping strategies (Zimmer-Gembeck & Skinner, 2016 ), the lack of age differences in coping strategies in the current study may be due to the limited age range in the sample, with 65% of the youth being between 16 and 19 years old. The lack of difference between boys and girls in the type of coping strategies applied could partly be due to the standard scoring procedure of the RSQ, where subscales are divided by the total RSQ score to adjust for girls generally scoring higher on coping strategies and stress responses compared to boys (Connor-Smith et al., 2000 ). Furthermore, the uneven sex distribution in the sample, with 80% being girls, may have contributed to potential sex differences in coping strategies not appearing.

Girls did, however, report more involuntary engagement stress responses compared to boys (e.g., emotional and physiological arousal, intrusive thoughts, rumination). This is in line with previous findings indicating that adolescent girls ruminate more (Jose & Brown, 2008 ) and are more reactive to uncontrollable stress compared to boys (Ge et al., 1994 ).

Unique associations were found for anxiety and depressive symptoms, with youth with high levels of anxiety reporting less primary control coping, whereas youth with more depressive symptoms reported less secondary control coping and more involuntary disengagement stress responses (e.g., emotional numbing). Strategies to create personal control during a pandemic may be difficult for youth with high levels of anxiety, possibly due to feelings dominated by fear, focus on unavoidable danger, and the emotional and physical arousal experienced as part of anxiety. Youth with more depressive symptoms, on the other hand, are often characterized by sadness and hopelessness. They may be less able to engage in positive activities to distract themselves and probably struggle more to accept and tolerate the situation or to look at positive aspects. Instead, they can more likely respond with emotional numbing, inaction, or escape. This is consistent with the results indicating fewer depressive symptoms among youth who used more secondary coping strategies and reporting fewer involuntary disengagement responses.

The present results suggest that by increasing the use of primary control coping, the level of anxiety could be reduced. On the other hand, secondary control coping strategies, adapting to sources of stress, may be beneficial in reducing the level of depression in vulnerable youth during pandemics. Contrary to our findings, a meta-analytic review reports problem-solving, acceptance, and cognitive reappraisal to be strategies predicting both depressive and anxiety symptoms in adolescents (Schäfer et al., 2017 ), whereas a more recent study indicates that the relationship between coping and anxiety and depressive symptoms may indeed be specific (Richardson et al., 2021 ). However, these studies do not examine coping with COVID-19 stress. Hence, further research examining differential associations between coping strategies, involuntary stress responses, and internalizing symptoms among youth during pandemics or other widespread health crises is warranted. If our findings are replicated, mechanisms explaining the unique patterns of associations should be examined.

Strengths and limitations of the study

A strength of the present study is the elaborate assessment of coping strategies and involuntary stress responses, based on an empirically validated model of coping in youth (Connor-Smith et al., 2000 ).

Most studies examining strategies used by youth to cope with COVID-19 stress are population studies, including substantially larger sample sizes than the current study. However, compared to other studies focusing on clinical youth during COVID-19 (Kudinova et al., 2022 ; Nissen et al., 2020 ), the current study included a relatively large clinical sample of difficult-to-access youth. Furthermore, all available youth who consented to participate were included in the study.

Another aspect of the sample in the current study is the predominance of girls. This is in line with the increased risk of internalizing problems found among adolescent girls (e.g. Leikanger et al., 2012 ; Salk et al., 2017 ). Also, during adolescence, more girls than boys are referred to CAMHS for internalizing problems, a pattern found to increase during the COVID-19 pandemic (Evensen et al., 2022 ).

A strength of the current study is the timing, with data collected from the fall of 2020 and throughout the winter and summer of 2021. This is important as youth internalizing problems seemed to have increased as the pandemic and the infection restrictions were prolonged (Hafstad et al., 2022 ). Finally, previous studies on youth mental health during COVID-19 have to a lesser degree studied strategies used by youth to cope with COVID-19-related stress.

Several limitations should be noted. Considerable attrition limits the generalizability of the findings. Due to the ethical permission, we could only use data from patients who consented to participate in the study. This prevented any comparison between the study sample and the youth who were referred for internalizing problems but did not respond to the invitation to take part in the study. Thus, we do not know if our sample is representative of the population. Also, the lack of a comparison group prevents conclusions as to whether the youth differed from their non-clinical peers regarding the type and level of COVID-19-related stress, coping strategies, and involuntary stress responses. Further, the cross-sectional design precludes determining the directionality of associations between variables. Longitudinal studies are needed to establish whether anxiety and depressive symptoms influence coping strategies and involuntary stress responses or the other way around. Furthermore, even though there were pandemic-related restrictions during the year of data collection, they varied somewhat. Also, we cannot rule out bias due to self-selection. As data for the independent and the dependent variables were obtained from the same person and in the same data collection context, the possibility of a common method bias in the results cannot be excluded.

To ensure that the participants who were included in the study understood the survey questions, youth were excluded if they had diagnoses suggesting that it would be difficult for them to complete the questionnaire (e.g., severe learning disability, not sufficient Norwegian language proficiency). Further control on whether the youth understood the survey questions was limited as no test of the comprehension of the survey questions was included.

A significant but modest level of explained variance of internalizing symptoms was found. However, the moderate level of explained variance should not be regarded as trivial, as internalizing problems are multidetermined, involving a range of factors in addition to coping strategies, e.g., genetic factors, temperament, negative life events, altered neurotransmission, dysfunctional parenting, cognitive bias (Bernaras et al., 2019 ; Rapee et al., 2023 ).

All variables were obtained by self-report, considered a reasonable choice as coping strategies and internalizing symptoms are internal states difficult to assess by others. However, this may have inflated associations due to shared method variance.

Finally, generalizing our results should be done with caution due to differences in pandemic and economic situation between countries.

Implications

Policymakers, educators, and health professionals need to consider the side effects of physical distancing and lockdowns for adolescents. In pandemics and similar societal health-related crises, the everyday life and social arenas important for youth must be upheld as much as possible. Fear of the future among youth could be addressed by offering opportunities to talk to reassuring adults (e.g., school and health personnel) who may provide realistic information and hope in times of uncertainty and unpredictability. Informing caregivers, teachers, school counselors, and others to assess youth for adaptive coping could help identify those at risk for mental health problems. Furthermore, large-scale interventions focusing on adaptive coping could prevent some of the internalizing problems observed during COVID-19.

Teaching adaptive coping skills should be prioritized during, but also after pandemics, especially for youth who continue to have internalizing problems. More specifically, our results indicate that youth with anxiety could profit from learning primary coping strategies (e.g., problem-solving, and emotional expression). For youth with depressive problems secondary control coping strategies should be reinforced (e.g., cognitive strategies) as well as taking part in interventions to reduce involuntary disengagement responses (e.g., stepwise procedures to reduce avoidance).

Coping strategies and involuntary stress responses contributed to the level of internalizing symptoms in clinically referred youth after controlling for sex, age, and the level of COVID-19 stress. During future pandemics or comparable society-wide health crises increase in mental health problems may be prevented or reduced, among vulnerable youth, by implementing interventions aiming to increase adaptive coping strategies. The unique associations between coping strategies and anxiety and depressive symptoms may inform the content of interventions offered during times of uncertainty and uncontrollable stress. Youth with anxiety problems could be taught how to use primary control coping strategies, whereas youth with depressive problems could be offered training in secondary control coping strategies.

Data availability

The data generated and analysed during the current study are not publicly available due to privacy regulations from the Norwegian Regional Committees for Medical and Health Research Ethics (REC). Data are available from the corresponding author on reasonable request, given approval from REC.

Angold, A., Costello, E. J., Messer, S. C., & Pickles, A. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5 (4), 237–249.

Google Scholar  

Arendt, K., Hougaard, E., & Thastum, M. (2014). Psychometric properties of the child and parent versions of Spence children’s anxiety scale in a Danish community and clinical sample. Journal of Anxiety Disorders, 28 (8), 947–956. https://doi.org/10.1016/j.janxdis.2014.09.021

Article   PubMed   Google Scholar  

Babicka-Wirkus, A., Wirkus, L., Stasiak, K., & Kozłowski, P. (2021). University students’ strategies of coping with stress during the coronavirus pandemic: Data from Poland. PLoS One, 16 (7), e0255041. https://doi.org/10.1371/journal.pone.0255041

Article   PubMed   PubMed Central   Google Scholar  

Bera, L., Souchon, M., Ladsous, A., Colin, V., & Lopez-Castroman, J. (2022). Emotional and Behavioral Impact of the COVID-19 Epidemic in Adolescents. Current Psychiatry Reports, 24 (1), 37–46. https://doi.org/10.1007/s11920-022-01313-8

Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments. Frontiers in Psychology, 10 (543). https://doi.org/10.3389/fpsyg.2019.00543

Bourduge, C., Teissedre, F., Morel, F., Flaudias, V., Izaute, M., & Brousse, G. (2022). Lockdown Impact on Stress, Coping Strategies, and Substance Use in Teenagers. Frontiers in Psychiatry, 12 . https://doi.org/10.3389/fpsyt.2021.790704

Christensen, T., & Lægreid, P. (2020). Balancing Governance Capacity and Legitimacy: How the Norwegian government handled the COVID-19 Crisis as a high performer. Public Administration Review, 80 (5), 774–779. https://doi.org/10.1111/puar.13241

Compas, B. E., Connor-Smith, J. K., Saltzman, H., Thomsen, A. H., & Wadsworth, M. E. (2001). Coping with stress during childhood and adolescence: Problems, progress, and potential in theory and research. Psychological Bulletin, 127 (1), 87–127. https://doi.org/10.1037/0033-2909.127.1.87

Compas, B. E., Jaser, S. S., Bettis, A. H., Watson, K. H., Gruhn, M. A., Dunbar, J. P., Williams, E., & Thigpen, J. C. (2017). Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review. Psychological Bulletin, 143 (9), 939–991. https://doi.org/10.1037/bul0000110

Connor-Smith, J. K., Compas, B. E., Wadsworth, M. E., Thomsen, A. H., & Saltzman, H. (2000). Responses to stress in adolescence: Measurement of coping and involuntary stress responses. Journal of Consulting and Clinical Psychology, 68 (6), 976–992.

Demaray, M. K., Ogg, J. A., Malecki, C. K., & Styck, K. M. (2022). COVID-19 stress and coping and associations with internalizing problems in 4th through 12th grade students. School Psychology Review, 51 , 150–169. https://doi.org/10.1080/2372966X.2020.1869498

Article   Google Scholar  

Dewa, L. H., Crandell, C., Choong, E., Jaques, J., Bottle, A., Kilkenny, C., Lawrence-Jones, A., Di Simplicio, M., Nicholls, D., & Aylin, P. (2021). CCopeY: A mixed-methods Coproduced Study on the Mental Health Status and coping strategies of Young people during COVID-19 UK Lockdown. Journal of Adolescent Health, 68 (4), 666–675. https://doi.org/10.1016/j.jadohealth.2021.01.009

Evensen, M., Hart, R., Godøy, A. A., Hauge, L. J., Lund, I. O., Knudsen, A. K. S., Grøtting, M. W., Surén, P., & Reneflot, A. (2022). Impact of the COVID-19 pandemic on mental healthcare consultations among children and adolescents in Norway: A nationwide registry study. European Child & Adolescent Psychiatry . https://doi.org/10.1007/s00787-022-02046-y

Foster, S., Estévez-Lamorte, N., Walitza, S., Dzemaili, S., & Mohler-Kuo, M. (2023). Perceived stress, coping strategies, and mental health status among adolescents during the COVID-19 pandemic in Switzerland: A longitudinal study. European Child & Adolescent Psychiatry, 32 (6), 937–949. https://doi.org/10.1007/s00787-022-02119-y

Ge, X., Lorenz, F. O., Conger, R. D., Elder, G. H., & Simons, R. L. (1994). Trajectories of stressful life events and depressive symptoms during adolescence. Developmental Psychology, 30 (4), 467–483. https://doi.org/10.1037/0012-1649.30.4.467

Government.no. February2020-February2022. Timeline: News from Norwegian Ministries about the Coronavirus disease Covid-19 . Retrieved 07.01.2023 from https://www.regjeringen.no/en/topics/koronavirus-covid-19/timeline-for-news-from-norwegian-ministries-about-the-coronavirus-disease-covid-19/id2692402/

Gruber, J., Prinstein, M. J., Clark, L. A., Rottenberg, J., Abramowitz, J. S., Albano, A. M., Aldao, A., Borelli, J. L., Chung, T., Davila, J., Forbes, E. E., Gee, D. G., Hall, G. C. N., Hallion, L. S., Hinshaw, S. P., Hofmann, S. G., Hollon, S. D., Joormann, J., Kazdin, A. E., Klein, D. N., et al. (2021). Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action. American Psychologist, 76 (3), 409–426. https://doi.org/10.1037/amp0000707

Hafstad, G. S., Sætren, S. S., Wentzel-Larsen, T., & Augusti, E. M. (2022). Changes in adolescent Mental and somatic Health complaints throughout the COVID-19 pandemic: A Three-Wave prospective longitudinal study. Journal of Adolescent Health . https://doi.org/10.1016/j.jadohealth.2022.05.009

Hussong, A. M., Midgette, A. J., Thomas, T. E., Coffman, J. L., & Cho, S. (2021). Coping and Mental Health in Early Adolescence during COVID-19. Research on Child and Adolescent Psychopathology, 49 (9), 1113–1123. https://doi.org/10.1007/s10802-021-00821-0

Jarbin, H., Ivarsson, T., Andersson, M., Bergman, H., & Skarphedinsson, G. (2020). Screening efficiency of the Mood and feelings Questionnaire (MFQ) and Short Mood and feelings Questionnaire (SMFQ) in Swedish help seeking outpatients. PLoS One, 15 (3), e0230623. https://doi.org/10.1371/journal.pone.0230623

Jose, P. E., & Brown, I. (2008). When does the gender difference in rumination begin? Gender and age differences in the use of rumination by adolescents. Journal of Youth and Adolescence, 37 (2), 180–192. https://doi.org/10.1007/s10964-006-9166-y

Kostev, K., Weber, K., Riedel-Heller, S., von Vultée, C., & Bohlken, J. (2023). Increase in depression and anxiety disorder diagnoses during the COVID-19 pandemic in children and adolescents followed in pediatric practices in Germany. European Child & Adolescent Psychiatry, 32 (5), 873–879. https://doi.org/10.1007/s00787-021-01924-1

Kudinova, A. Y., Bettis, A. H., Thompson, E. C., Thomas, S. A., Nesi, J., Erguder, L., MacPherson, H. A., Burke, T. A., & Wolff, J. C. (2022). COVID-19 related daily stressors, coping, and suicidal ideation in Psychiatrically Hospitalized Youth. Child & Youth Care Forum, 51 (3), 579–592. https://doi.org/10.1007/s10566-021-09641-1

Lehmann, S., Skogen, J. C., Haug, E., Mæland, S., Fadnes, L. T., Sandal, G. M., et al. (2021). Perceived consequences and worries among youth in Norway during the COVID-19 pandemic lockdown. Scandinavian Journal of Public Health, 49 (7), 755–65. https://doi.org/10.1177/1403494821993714

Leikanger, E., Ingul, J. M., & Larsson, B. O. (2012). Sex and age-related anxiety in a community sample of Norwegian adolescents. Scandinavian Journal of Psychology, 53 (2), 150–157. https://doi.org/10.1111/j.1467-9450.2011.00915.x

Loades, M. E., Chatburn, E., Higson-Sweeney, N., Reynolds, S., Shafran, R., Brigden, A., Linney, C., McManus, M. N., Borwick, C., & Crawley, E. (2020). Rapid systematic review: The impact of social isolation and loneliness on the Mental Health of Children and adolescents in the Context of COVID-19. Journal of the American Academy of Child & Adolescent Psychiatry, 59 (11), 1218–1239e1213. https://doi.org/10.1016/j.jaac.2020.05.009

Lundervold, A., Breivik, K., Posserud, M. B., Stormark, K. M., & Hysing, M. (2013). Symptoms of depression as reported by Norwegian adolescents on the Short Mood and Feelings Questionnaire [Original Research]. Frontiers in Psychology, 4 (613). https://doi.org/10.3389/fpsyg.2013.00613

Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of Mental disorders in US adolescents: Results from the National Comorbidity Study-Adolescent supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49 (10), 980–989. https://doi.org/10.1016/j.jaac.2010.05.017

Mohler-Kuo, M., Dzemaili, S., Foster, S., Werlen, L., & Walitza, S. (2021). Stress and Mental Health among Children/Adolescents, Their Parents, and Young Adults during the First COVID-19 Lockdown in Switzerland. International journal of environmental research and public health, 18 (9). https://doi.org/10.3390/ijerph18094668

Nissen, J. B., Højgaard, D., & Thomsen, P. H. (2020). The Immediate Effect of COVID-19 pandemic on children and adolescents with obsessive compulsive disorder. Bmc Psychiatry . https://doi.org/10.21203/rs.3.rs-54132/v1

Orgilés, M., Morales, A., Delvecchio, E., Francisco, R., Mazzeschi, C., Pedro, M., & Espada, J. P. (2021). Coping Behaviors and Psychological Disturbances in Youth Affected by the COVID-19 Health Crisis [Original Research]. Frontiers in Psychology, 12 (845). https://doi.org/10.3389/fpsyg.2021.565657

Panchal, U., Salazar de Pablo, G., Franco, M., Moreno, C., Parellada, M., Arango, C., & Fusar-Poli, P. (2023). The impact of COVID-19 lockdown on child and adolescent mental health: systematic review. European Child & Adolescent Psychiatry, 32 (7), 1151–1177. https://doi.org/10.1007/s00787-021-01856-w

Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual Research Review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56 (3), 345–365. https://doi.org/10.1111/jcpp.12381

Qi, M., Zhou, S. J., Guo, Z. C., Zhang, L. G., Min, H. J., Li, X. M., et al. (2020). The Effect of Social Support on Mental Health in Chinese Adolescents During the Outbreak of COVID-19. Journal of Adolescent Health, 67 (4), 514–8.

Racine, N., McArthur, B. A., Cooke, J. E., Eirich, R., Zhu, J., & Madigan, S. (2021). Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: A Meta-analysis. JAMA Pediatrics, 175 (11), 1142–1150. https://doi.org/10.1001/jamapediatrics.2021.2482

Rapee, R. M., Oar, E. L., Johnco, C. J., Forbes, M. K., Fardouly, J., Magson, N. R., & Richardson, C. E. (2019). Adolescent development and risk for the onset of social-emotional disorders: A review and conceptual model. Behavior Research and Therapy , 123. https://doi.org/10.1016/j.brat.2019.103501

Rapee, R. M., Creswell, C., Kendall, P. C., Pine, D. S., & Waters, A. M. (2023). Anxiety disorders in children and adolescents: A summary and overview of the literature. Behavior Research and Therapy, 168 , 104376. https://doi.org/10.1016/j.brat.2023.104376

Revet, A., Hebebrand, J., Anagnostopoulos, D., Kehoe, L. A., Gradl-Dietsch, G., & Klauser, P. (2021). Perceived impact of the COVID-19 pandemic on child and adolescent psychiatric services after 1 year (February/March 2021): ESCAP CovCAP survey. European Child & Adolescent Psychiatry, 1–8. https://doi.org/10.1007/s00787-021-01851-1

Richardson, C. E., Magson, N. R., Fardouly, J., Oar, E. L., Forbes, M. K., Johnco, C. J., & Rapee, R. M. (2021). Longitudinal associations between coping strategies and psychopathology in pre-adolescence. Journal of Youth and Adolescence, 50 (6), 1189–1204. https://doi.org/10.1007/s10964-020-01330-x

Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143 (8), 783–822. https://doi.org/10.1037/bul0000102

Schäfer, J., Naumann, E., Holmes, E. A., Tuschen-Caffier, B., & Samson, A. C. (2017). Emotion regulation strategies in depressive and anxiety symptoms in Youth: A Meta-Analytic Review. Journal of Youth and Adolescence, 46 (2), 261–276. https://doi.org/10.1007/s10964-016-0585-0

Spence, S. H., Barrett, P. M., & Turner, C. M. (2003). Psychometric properties of the Spence Children’s anxiety scale with young adolescents. Journal of Anxiety Disorders, 17 , 605–625.

Thorisdottir, I. E., Asgeirsdottir, B. B., Kristjansson, A. L., Valdimarsdottir, H. B., Jonsdottir Tolgyes, E. M., Sigfusson, J., Allegrante, J. P., Sigfusdottir, I. D., & Halldorsdottir, T. (2021). Depressive symptoms, mental wellbeing, and substance use among adolescents before and during the COVID-19 pandemic in Iceland: A longitudinal, population-based study. Lancet Psychiatry, 8 (8), 663–672. https://doi.org/10.1016/s2215-0366(21)00156-5

Turk, F., Kul, A., & Kılınç, E. (2021). Depression-anxiety and coping strategies of adolescents during the Covid-19 pandemic. Turkish Journal of Education, 10 (2), 58–75. https://doi.org/10.19128/turje.814621

Waselewski, E. A., Waselewski, M. E., & Chang, T. (2020). Needs and coping behaviors of Youth in the U.S. During COVID-19. Journal of Adolescent Health, 67 (5), 649–652. https://doi.org/10.1016/j.jadohealth.2020.07.043

Watson, K. H., Coiro, M. J., Ciriegio, A. E., Dakkak, A., Jones, M. T., Reisman, J., Kujawa, A., & Compas, B. E. (2023). COVID-19 stressors and symptoms of anxiety and depression in a community sample of children and adolescents. Child and Adolescent Mental Health, 28 (1), 172–179. https://doi.org/10.1111/camh.12598

Zimmer-Gembeck, M. J., & Skinner, E. A. (2010). Review: The development of coping across childhood and adolescence: An integrative review and critique of research. International Journal of Behavioral Development, 35 (1), 1–17. https://doi.org/10.1177/0165025410384923

Zimmer-Gembeck, M. J., & Skinner, E. A. (2016). The development of coping: Implications for psychopathology and resilience. In Developmental psychopathology: Risk, resilience, and intervention, Vol. 4, 3rd ed. (pp. 485–545). John Wiley & Sons, Inc. https://doi.org/10.1002/9781119125556.devpsy410

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Acknowledgements

We are grateful for the adolescents and their parents who participated in this study. We thank the administrative and clinical staff who identified eligible patients. We specifically want to thank Else Irene Napsøy, Reidun Erene Kerlefsen, and Sunniva Mowatt Storm for contributing to the data collection.

Open access funding provided by University of Bergen (incl Haukeland University Hospital). The study received support from L. Meltzer Høyskolefond (2021/2715), Faculty of Psychology, University of Bergen (2020/6726) and Det Allminnelige medisinske Forskningsfond, University of Bergen (2021).

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Bente Storm Mowatt Haugland & Yngvild Sørebø Danielsen

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Mari Hysing

Department of Eating Disorders, Haukeland University Hospital, Haukelandsveien 22, Bergen, 5009, Norway

Yngvild Sørebø Danielsen

Department of Psychology and Human Development, Vanderbilt University, 230 Appleton Place, Nashville, TN, 37203-5721, USA

Bruce E. Compas

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All authors contributed to the conception and design of the study. Data collection and analysis were performed by Bente SM Haugland and Gro Janne Wergeland. Bente SM Haugland wrote the first draft of the manuscript. All authors read and approved the final manuscript.

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Haugland, B.S.M., Hysing, M., Danielsen, Y.S. et al. Unique associations between strategies of coping with COVID-19-related stress and internalizing symptoms in a clinical sample of adolescents. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-06490-8

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John Lansing, the steady CEO who led NPR through the pandemic's crises, dies at 67

David Folkenflik

JOHN LANSING

Former NPR CEO John Lansing NPR hide caption

Former NPR chief executive John Lansing died Wednesday at his lakeside home in Wisconsin, just six months after relinquishing his role at the network and just two weeks after turning 67 years old. His cause of death was not immediately disclosed.

Lansing, previously admired for a long career in broadcasting and cable television, stepped down this past spring from NPR after a turbulent four-and-a-half year stint.

At NPR, Lansing tangled with titans, kept the network’s shows on the air during a global pandemic, navigated intense social headwinds, oversaw an ambitious expansion of digital ambitions and steered NPR through what he defined as an “existential” financial crisis.

His successor, NPR CEO Katherine Maher, said Lansing rose to the moment.

"He had a tremendous impact on NPR’s workplace culture, understood the importance of NPR’s mission to support democracy by informing the American public, and led the organization to rise to the challenge of an unprecedented global pandemic,” Maher told staffers in a note.

Despite layoffs and buyouts of 10% of the staff in early 2023, Lansing earned praise from an unexpected source: the newsroom union’s chief.

"I thought he did a good job," Pat O'Donnell, executive director of SAG-AFTRA Washington-Mid Atlantic local, said after Lansing announced he would retire . "He did the best he could. Crisis after crisis — oh my God."

The union chief cited Lansing's constant communication with staff during the pandemic, his conciliatory approach to negotiations, his emphasis on diversity, and his willingness to ensure the network offered laid-off employees more generous severance terms than required under the existing contract.

Lansing got his start in journalism at the age of 17 as a studio technician and camera operator for a local television station in Paducah, Ky. He soon became a videographer and rose through the ranks of local TV newsrooms, as a news director and ultimately a top official for E.W. Scripps Co. over the local stations. He later became president of the Scripps Networks, which owned such stations as the Food Network, HGTV and the Travel Channel.

In 2015, he became the chief of the U.S. Agency for Global Media, the government outfit that oversees such federally funded international broadcasters as the Voice of America, Radio Free Europe/Radio Liberty and Radio Free Asia.

When Lansing arrived at NPR in 2019, he came with a moral imperative that concurrently served as a business strategy: the need to diversify the staff, its programming, its story selection and its audiences to better reflect American life. He called it his North Star.

Lansing elevated female hosts’ salaries to help them keep pace with their male counterparts — and then became personally involved in contract negotiations after several prominent women hosts of color left the network .

That resulted in significant part from the increased emphasis peer news outlets, including the New York Times  and CNN, are placing on audio — creating a far more competitive marketplace for talent than Lansing’s predecessors faced.

Lansing’s North Star led to a significant shift in workforce hiring and notable changes in demographics for NPR’s workforce and leadership team. It has not yet been accompanied by anticipated increase or concomitant diversification of the network’s audiences.

He made the pitch and the push from the outset, months before the social justice protests that swept through U.S. streets, workplaces and even newsrooms starting in 2020 after the murder of George Floyd.

Yet the initiative ultimately became wrapped up in a national debate over NPR, when then senior business editor Uri Berliner accused the network under Lansing of failing to consider viewpoint diversity even as it pursued greater racial and ethnic representation.

Lansing replied : "The philosophy is: Do you want to serve all of America and make sure it sounds like all of America, or not? I'd welcome the argument against that."

Lansing did not shy from arguments. In January 2020, when then U.S. Secretary of State Mike Pompeo falsely accused All Things Considered host Mary Louise Kelly of lying to listeners, Lansing publicly defended her and the network, on the record.

“Mary Louise Kelly is one of the most respected, truthful, factual, professional and ethical journalists in the United States,” Lansing told  Morning Edition ’s Michel Martin . “And that's known by the entire press corps. And I stand behind her. And I stand behind the NPR newsroom. And the statement from the secretary of state is blatantly false.”

Similarly, Lansing withdrew all of NPR’s formal feeds on X, formerly Twitter, after new owner Elon Musk moved to designate the network “state-affiliated media,” the same term it uses for propaganda outlets in Russia and other autocratic states.

Musk later revised the label to “government-funded media.” (NPR typically receives less than 1% of its $300 million annual budget from the federally funded Corporation for Public Broadcasting.) But Lansing had seen enough. He said he was protecting its credibility and its ability to produce journalism without “a shadow of negativity.”

Later reviews found no appreciable effect on the network’s online audiences from the institution’s withdrawal from the site.

NPR’s chief communications officer, Isabel Lara, wrote Lansing had led the network during some of its hardest years as an organization.

“I learned so much about leadership from him; he just made you want to do your best,” Lara said. “He loved journalism and was proud to defend our editorial independence when it was attacked.”

Despite covering the growing threat of Covid-19, NPR was not prepared for the pandemic, which reached the U.S. just months into Lansing’s tenure.

Lansing later said he was advised by top aides it might take NPR another six months to build back full broadcast capability remotely, with hosts operating live from home studios. They got it done in a week.

The decision to hold weekly all-staff meetings “was the glue that held the culture together during a time when the mission had never really been more important," Lansing said.

NPR received private and public funds to cover the war in Ukraine and has maintained a strong presence there.

In late 2022, the wheels looked as though they would come off, however; Lansing initially warned that all hiring would be frozen and all but essential travel curtailed; early in 2023 he revised his projections far downward, saying that the networks’ underwriting revenues had imploded for podcasts.

Lansing was initially condemned for failing to see the budget crisis coming.

But NPR proved to be on the cutting edge of a media collapse, as corporate advertisers slashed budgets ahead of a recession that has not, to date, transpired. Other major news outlets have been hit even harder.  The Washington Post laid off or bought out about 13% of its staff last year. The Los Angeles Times has cut about a third of its staff over the past two years. New York Public Radio just announced job cuts of 8% of staffers — on top of previous reductions last year.

Ultimately, many staffers concluded Lansing had handled that relatively humanely, with constant updates about budget realities, alterations to meet staffers’ concerns and voluntary buyouts.

In quest for new revenues, NPR expanded its entrepreneurial efforts, for example striking a deal with Amazon Music to run the Guy Raz podcast How I Built This  exclusively for a week before it is released to the public. Similarly, NPR has now licensed its Tiny Desk Concert format in South Korea and Japan.

Lansing also pushed a greater integration with NPR’s hundreds of member stations throughout the country, creating what he called the NPR Network.

In March 2021, Lansing took weeks off to recover from a heart surgery to repair and replace a heart valve and part of an aortic artery. At the time, he told staffers he had been informed there was no sign of heart disease.

Colleagues recalled Lansing in a personal way in the wake of the announcement of his death.

“John was a true friend who led a life of integrity and love,” said Keith Woods, NPR’s chief diversity officer. “He made me want to match his conviction and his special ability to keep the things that truly mattered — his family, his friends, the people he served as a journalist and a leader — at the center of his universe.”

In her note to staffers, Maher wrote that she had only met Lansing just once.

“We broke bread together and I pestered him with my rudimentary questions,” she said. “He was generous with his insight and optimistic about our future. Later when things were difficult at the start of my tenure, he made a point of reaching out to cheer me on. It meant a lot to hear from someone who had sat in the chair before, and I wish we’d had more time together.”

Lansing is survived by his wife Jean, and their children Alex, Jackson, Nicholas, and Jennifer.

Disclosure: This story was reported and written by NPR Media Correspondent David Folkenflik and edited by Managing Editor Gerry Holmes. Under NPR's protocol for reporting on itself, no corporate official or news executive reviewed this story before it was posted publicly.

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Got cold symptoms? Here's when kids should take a sick day from school

Phoenix — As schools reopen for another year, they are focused on improving student attendance. But back-to-school is hitting just as COVID-19 cases are increasing, raising the question: When is a child too sick for school?

School absences surged during the pandemic and have yet to recover. Nearly 1 in 4 students remains chronically absent, defined as missing 10% or more of the academic year, according to the latest data analyzed by The Associated Press.

One reason for continued high absences: After years of COVID-19 quarantines, parents are more cautious about sending children to school when they might be contagious with an illness.

When a child misses school, even for an excused absence like a sick day, it's harder for them to stay on track academically. So schools and health experts are trying to change the culture around sick days.

Here's what they want parents to know.

COVID guidelines have changed

During the pandemic, the Centers for Disease Control and Prevention urged people who tested positive for COVID-19 to isolate at home for a set number of days and to quarantine after exposure to the coronavirus. In some settings, people with any mild illness were urged to remain home until symptoms were clear.

Those standards, and the caution behind them, remained for years after schools reopened to in-person instruction. That meant children often missed large portions of school after contracting or being exposed to COVID-19 or other illnesses.

This spring, COVID-19 guidance officially changed. Now, the CDC suggests people treat COVID-19 like other respiratory illnesses, such as the flu and RSV.

Fever-free for 24 hours

If a child has a fever, they should stay home, no matter the illness.

A child can return to school when their fever has been gone for 24 hours without fever-reducing medication. Other symptoms should be improving.

What about other symptoms?

If a child doesn't have a fever, it's OK to send them to class with some signs of illness, including a runny nose, headache or cough, according to schools and the American Academy of Pediatrics. If those symptoms aren't improving or are severe, such as a hacking cough, call your child's doctor.

The guidance around vomiting and diarrhea varies across school districts. Generally, students should remain home until symptoms stop, according to American Academy of Pediatrics guidelines. Older children may be able to manage mild diarrhea at school.

“Unless your student has a fever or threw up in the last 24 hours, you are coming to school. That’s what we want,” said Abigail Arii, director of student support services in Oakland, California.

Guidance from the Los Angeles Unified School District says students can attend school with mild symptoms such as a runny nose or cold, but should stay home if they have vomiting, diarrhea, severe pain or a fever of 100 degrees Fahrenheit (37 degrees Celsius) or higher.

School districts across the U.S. have similar guidance, including in Texas, Illinois and New York.

When to wear a mask

The CDC says people should take additional precautions for five days after returning to school or other normal activities.

Masks and social distancing are no longer mandated but are encouraged to prevent disease spread. Experts also recommend plenty of handwashing and taking steps for cleaner air, such as opening a window or running an air purifier.

School districts say parents should keep up-to-date on all health examinations and immunizations for students so they don't miss additional days of school.

AP Education Writer Jocelyn Gecker in San Francisco contributed.

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Mpox Case in Sweden Sets Off Concerns of Wider Spread in Europe

Experts expect more cases to surface in European countries because of frequent travel to and from Africa, with the threat of contracting the disease raised from “very low” to “low.”

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By Lynsey Chutel Jenny Gross and Christina Anderson

Lynsey Chutel reported from London, Jenny Gross from Brussels and Christina Anderson from Geilo, Norway.

The announcement that a new version of mpox had been discovered in Sweden this week was the first indication that the disease had slipped out of Africa, where it has caused an escalating crisis in the Democratic Republic of Congo.

The announcement on Thursday about the disease formerly known as monkeypox came just a day after the World Health Organization declared a global health emergency, and it confirmed fears that a further spread was inevitable.

The person with the disease in Sweden had traveled to an area affected by the disease.

The European Center for Disease Prevention and Control said it was “highly likely” that more imported cases would be confirmed, in large part because of frequent travel between Europe and Africa. The center advised member countries to increase preparedness and to issue travel advisories recommending that people traveling to affected areas see if they are eligible for vaccination.

Pamela Rendi-Wagner, the E.C.D.C. director, warned that as long as the outbreak in Africa was not under control, cases would continue to appear in Europe and North America too.

“We have to be concerned, even outside Africa, because with the increasing number and the fast spread, the likelihood of the introduction of cases in Europe and the U.S. will increase,” Dr. Rendi-Wagner said in an interview on Friday.

The E.C.D.C. on Friday raised the risk of people in the European Union contracting the new version from “very low” to “low,” but emphasized that people traveling to and from the affected areas in Africa need to take precautions and are at a high risk.

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