compare and contrast essay about life before and after covid 19

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

Human Life Before and After COVID-19 Pandemics Research Paper

Introduction, human life: before and during covid-19, post covid-19, works cited.

The ongoing coronavirus disease of 2019 (COVID-19) can be studied as one of the most dangerous diseases in the recent times. This condition has led to unprecedented problems that have shaken all aspects of human life. Before the onset of this disease, many economies were performing optimally and capable of meeting the demands of the targeted citizens. Unfortunately, the condition forced governments to implement lockdown measures to reduce its spread. The imposed initiatives have affected human life and the global economy negatively by creating money problems, triggering unprecedented job cuts, and compelling companies to downsize.

COVID-19 is a pulmonary infection that has claimed thousands of life in different parts of the world. Experts have agreed that the disease was reported for the first time towards the end of 2019 in Wuhan, China. The forces of globalization and international transport are believed to have led to the spread of COVID-19 across the globe. By March 2020, this condition had already been recorded in most of the countries in different continents (Sikder et al. 328). The mysterious nature and complexity of COVID-19 forced governments to institute a wide range of measures that would minimize human contact and travel.

Some of the implemented strategies included washing hands with soaps, carrying and using hand sanitizers, and keeping social distance. Communities and regions would rely on the power of lockdown measures to achieve better results within a short period. Nonetheless, many people continued to contract the virus with some of them losing their lives (Lebleu). Within the last twelve months, international health organizations, pharmaceutical companies, and world health organization (WHO) have been working hard to get an effective vaccine and support the anticipated economic recovery.

Economic growth depends on the inputs the government provides and the measures different people put in place. Before COVID-19, many countries were performing optimally and engaging in international trade (“Coronavirus World Map”). Most of the people were able to get better jobs and earn competitive salaries. Most of the companies and industries were able to achieve their goals due to the processes of globalization. International trade was also undisturbed for many decades. Such forces were making it possible for some of the emerging economies to compete with giant ones (Sikder et al. 329). For example, China and Brazil were capable of producing additional goods and meeting the increasing demand in the global market.

These scenarios reveal that many people were leading better lives in most of the successful countries. For instance, unemployment rates had reduced significantly in both the developing and the developed world. The changing social and cultural dynamics were allowing people to travel across the globe and search for new job opportunities. Such trends were capable of transforming the experiences and lives of many citizens (Lebleu). Most of the implemented fiscal policies and economic stimulus packages had the potential to improve performance.

Unfortunately, the emergence of this pulmonary disease led to sweeping social, economic, and cultural changes across the globe. First, the imposed transportation measures and curfews worsened the situation for many people. Those who had travelled to other countries were unable to go back to their regions (Lebleu). Some were compelled to stay at home for over two months. Such developments affected the gains that had been recorded within the past two decades. Second, the lockdown measures meant that most of the people were unable to work or open their businesses. Such individuals could not earn any form of income, thereby being forced to exhaust their savings.

Third, most of governments were keen to introduce additional measures that could reduce the spread of COVID-19. For instance, individuals who were found to have the disease after testing were quarantined or hospitalized. The idea of contact tracing was also considered to identify people who could be having the condition. Consequently, millions of people across the globe were forced to isolate or engage in self-quarantine (see Fig. 1). Those who had travelled to countries with reported cases had to quarantine themselves. Such measures were capable of supporting the fight against the COVID-19 (Petersen et al. 234). However, the consequences were felt across the globe since many people lost their jobs or were unable to earn a living.

Fourth, the instituted measures proved to be more catastrophic and damaging to small businesses enterprises. Over the decades, such investments had been promoted due to their capabilities in addressing poverty and empowering more people to transform their lives. The lockdown measures compelled most of these entities to close for good. This trend meant that their owners would be unable to earn a living or pursue their social and economic goals (Kebede et al. e0233744). Those who lacked adequate savings were affected the most by these measures. Similarly, companies operating in different sectors had to downsize and reduce the number of workers to minimize infections.

While the outlined measures were critical to deal with this disease, many experts acknowledged that they were harmful to the lives and experiences of many individuals. Such initiatives led to numerous challenges associated with job losses and poor economic performance. The decision to close schools and other social functions indefinitely affected many people negatively (Petersen et al. 234). Some of the individuals who contracted the virus were forced to use their savings for medication purposes. These issues explain why life has changed significantly in different parts of the world. Without proper mechanisms and strategies to mitigate the disease, chances are high that more individuals will continue to experience similar challenges and be unable to achieve their maximum potential.

Currently, the impacts of COVID-19 are being experienced in both the developed and developing countries. However, Europe and America were some of the continents that suffered due to this disease. Some experts indicated that certain parameters were capable of describing such trends, including population size, age, and travel history (*). Fortunately, most of the nations in the African and Asian continents were not affected the most by this condition. Nonetheless, the implemented strategies were observed to trigger numerous challenges that would change the world forever.

Post COVID-19 is a hypothetical period or era that is expected after human beings succeeded in treating and getting rid of this disease. In such a scenario, scholars believe that most of the countries will continue to feel the impacts of this condition in different ways (Petersen et al. 236). For instance, those who lost their jobs in the developing world might be hit the hardest since businesses and industries might take long to recover. The predicted reliance on modern technologies means that individuals born from the 1980s would be able to use such innovations to complete their jobs (“Coronavirus World Map”). Older people will encounter additional challenges since they have been relying on traditional methods of production.

Governments in the underdeveloped world will be unable to provide adequate stimulus packages and financial resources to support emerging businesses. Such regions lack proper mechanisms and contingency plans to deal with the shocks of this pandemic. This reality means that most of the affected firms will be unable to hire more people and provide high-quality support to the targeted clients (“Coronavirus World Map”). The race to get a vaccine is an initiative that is expected to consume financial resources. More countries will also be compelled to incur huge expenses to acquire immunizations for their citizens. These priority areas would indicate that the recovery process might take longer that many people would expect.

Those who have lost their loved ones and jobs will find it hard to restore their life experiences. Governments might be unable to implement proper mechanisms and initiatives that can help more people to transform their situations (Petersen et al. 235). This knowledge should encourage policymakers and experts to consider some of the best ways to address the predicted challenges. Companies, institutions, and government agencies should also transform their models in such a way that they help mitigate the predicted predicaments in the anticipated post-COVID-19 world.

The ongoing COVID-19 has led to numerous challenges that have transformed human life in different ways. Most of the affected people have lost their jobs, thereby being unable to provide for their children and relatives. The instituted measures have worsened the condition for small-small businesses and workers. The move to find a vaccine for this disease means that governments will exhaust most of their resources, thereby making the process of recovery unpredictable. The developing world is expected to encounter numerous challenges due to the absence of proper contingency plans to deal with pandemics.

“ Art and Lockdown: Your Drawings in the Time of Coronavirus .” Voices of Youth, 2020, Web.

“ Coronavirus World Map: Tracking the Global Outbreak .” The New York Times, 2020, Web.

Kebede, Yohannes, et al. “Knowledge, Perceptions and Preventive Practices towards COVID-19 Early in the Outbreak among Jimma University Medical Center Visitors, Southwest Ethiopia. PLoS ONE , vol. 15, no. 5, 2020, p. e0233744.

Lebleu, Rita. “ After Surviving 2 Hurricanes, COVID-19, A Family is Blessed .” The Washington Times, 2020, Web.

Petersen, Eskild, et al. “COVID-19-We Urgently Need to Start Developing an Exit Strategy.” International Journal of Infectious Diseases, vol. 96, no. 1, 2020, pp. 233-239.

Sikder, Mukut, et al. “The Consequential Impact of the Covid-19 Pandemic on Global Emerging Economy.” American Journal of Economics, vol. 10, no. 6, 2020, pp. 325-331.

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IvyPanda. (2022, February 28). Human Life Before and After COVID-19 Pandemics. https://ivypanda.com/essays/human-life-before-and-after-covid-19-pandemics/

"Human Life Before and After COVID-19 Pandemics." IvyPanda , 28 Feb. 2022, ivypanda.com/essays/human-life-before-and-after-covid-19-pandemics/.

IvyPanda . (2022) 'Human Life Before and After COVID-19 Pandemics'. 28 February.

IvyPanda . 2022. "Human Life Before and After COVID-19 Pandemics." February 28, 2022. https://ivypanda.com/essays/human-life-before-and-after-covid-19-pandemics/.

1. IvyPanda . "Human Life Before and After COVID-19 Pandemics." February 28, 2022. https://ivypanda.com/essays/human-life-before-and-after-covid-19-pandemics/.

Bibliography

IvyPanda . "Human Life Before and After COVID-19 Pandemics." February 28, 2022. https://ivypanda.com/essays/human-life-before-and-after-covid-19-pandemics/.

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The world before this coronavirus and after cannot be the same

Professor of Globalisation and Development; Director of the Oxford Martin Programme on Technological and Economic Change, University of Oxford

Lecturer, Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio)

Disclosure statement

Ian Goldin is Professor of Globalisation and Development at Oxford University and the author of The Butterfly Defect and Age of Discovery. He has co-authored a forthcoming book Terra Incognita with Robert Muggah. It is due to be published by Penguin. @ian_goldin

Robert Muggah is the co-founder of the Igarape Institute and a principal of the SecDev Group and a regular contributor to TED and several major news outlets. His forthcoming book, Terra Incognita, co-authored with Ian Goldin, is due to be published by Penguin later in 2020.

University of Oxford provides funding as a member of The Conversation UK.

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With COVID-19 infections now evident in 176 countries , the pandemic is the most significant threat to humanity since the second world war. Then, as now, confidence in international cooperation and institutions plumbed new lows.

While the onset of the second world war took many people by surprise, the outbreak of the coronavirus in December 2019 was a crisis foretold. Infectious disease specialists have been raising the alarm about the accelerated pace of outbreaks for decades. Dengue, Ebola, SARS, H1N1, and Zika are just the tip of the iceberg. Since 1980, more than 12,000 documented outbreaks have infected and killed tens of millions of people around the world, many of them the poorest of the poor. In 2018, the World Health Organisation (WHO) detected outbreaks of six of its eight “priority diseases” for the very first time.

No one can say we weren’t warned .

Even as we attend to the countless emergencies generated by COVID-19, we need to think deeply about why the international community was so unprepared for an outbreak that was so inevitable. This is hardly the first time we’ve faced global catastrophes.

The second world war reflected the catastrophic failure of leaders to learn the lessons of the 1914-1918 war. The creation of the United Nations and Bretton Woods institutions in the late 1940s and early 1950s provided some grounds for optimism, but these were overshadowed by the Cold War. Moreover, the Reagan and Thatcher revolutions of the 1980s rolled back the capacity of governments to address inequality through taxation and redistribution and governments’ ability to deliver health and essential services.

The capacity of international institutions to regulate globalisation was undermined precisely at a time when they were most needed. The 1980s, 1990s and 2000s were a period of rapidly rising cross-border movements of trade, finance and people. The accelerated flow of goods, services and skills is one of the principal reasons for the most rapid reduction of global poverty in history. Since the late 1990s, more than 2 billion people have climbed out of extreme poverty. Improved access to employment, nutrition, sanitation and public health, including vaccine availability, added over a decade in average life expectancy to the world’s population.

But international institutions failed to manage the downside risks generated by globalisation.

Far from empowering the United Nations, the world is governed by divided nations , who prefer to go it alone, starving the institutions designed to safeguard our future of the necessary resources and authority. The WHO shareholders, not its personnel, have failed dismally to ensure it can exercise its vital mandate to protect global health.

Butterfly defect

As the world becomes more connected, it also necessarily becomes more interdependent. This is the dark underbelly, the butterfly defect of globalisation, that if left unmanaged inevitably means that we will suffer escalating, increasingly dangerous systemic risks.

One of the most graphic demonstrations was the 2008 financial crisis. The economic meltdown reflected a dangerous negligence by public authorities and experts in managing the growing complexities of the global financial system. Not surprisingly, the carelessness of the world’s political and economic elite cost them dearly at the ballot box. Campaigning on an explicitly anti-globalisation and anti-expert ticket, populists stormed to power.

Emboldened by public outrage, they have followed an ancient tradition, blaming foreigners and turning their backs on the outside world. The US president, in particular , spurned scientific thinking, spawned fake news, and shunned traditional allies and international institutions.

With evidence of infections rising fast, most national politicians now recognise the traumatic human and economic costs of COVID-19. The Centers for Disease Control’s worst-case scenario is that about 160 million to 210 million Americans will be infected by December 2020. As many as 21 million will need hospitalisation and between 200,000 and 1.7 million people could die within a year. Harvard University researchers believe that 20% to 60% of the global population could be infected , and conservatively estimate that 14 million to 42 million people might lose their lives.

The extent to which direct and excess mortality is prevented depends on how quickly societies can reduce new infections, isolate the sick and mobilise health services, and on how long relapses can be prevented and contained. Without a vaccine, COVID-19 will be a hugely disruptive force for years.

Where the damage will be worst

The pandemic will be especially damaging to poorer and more vulnerable communities within many countries, highlighting the risks associated with rising inequality .

In the US, over 60% of the adult population suffers from a chronic disease. Around one in eight Americans live below the poverty line – more than three-quarters of them live from paycheque to paycheque and over 44 million people in the US have no health coverage at all.

The challenges are even more dramatic in Latin America, Africa and South Asia, where health systems are considerably weaker and governments less able to respond. These latent risks are compounded by the failure of leaders such as Jair Bolsonaro in Brazil or Narendra Modi in India to take the issue seriously enough.

The economic fallout from COVID-19 will be dramatic everywhere. The severity of the impacts depends on how long the pandemic lasts, and the national and international response of governments. But even in the best case it will far exceed that of the 2008 economic crisis in its scale and global impact, leading to losses which could exceed $9 trillion , or well over 10% of global GDP.

In poor communities where many individuals share a single room and depend on going to work to put food on the table, the call for social isolation will be very difficult if not impossible to adhere to. Around the world, as individuals lose their incomes, we should expect rapidly rising homelessness and hunger.

In the US a record 3.3 million people have already filed for unemployment benefit, and across Europe unemployment similarly is reaching record levels. But whereas in the richer countries some safety net exists, even though it is too often in tatters, poor countries simply do not have the capacity to ensure that no-one dies of hunger.

With supply chains broken as factories close and workers are quarantined, and consumers prevented from travelling, shopping, other than for food, or engaging in social activities, there is no scope for a fiscal stimulus. Meanwhile monetary policy has been stymied as interest rates are already close to zero. Governments therefore should focus on providing all in need with a basic income , to ensure that no-one starves as a result of the crisis. While the concept of basic income guarantees seemed utopian only a month ago, it now needs to be at the centre of every government’s agenda.

A global Marshall plan

The sheer scale and ferocity of the pandemic demands bold proposals. Some European governments have announced packages of measures to keep their economies from grinding to a halt. In the UK, the government has agreed to cover 80% of wages and self-employed income, up to £2,500 ($2,915) per month , and is providing a lifeline to firms. In the US, a previously unthinkable aid package of $2 trillion has been agreed, though this is likely just the beginning. A gathering of G20 leaders also resulted in a pledge of $5 trillion , though details are slim.

The COVID-19 pandemic provides a turning point in national and global affairs. It demonstrates our interdependence and that when risks arise we turn to governments, not the private sector, to save us.

The unprecedented economic and medical response in the rich countries is simply not available to many developing countries. As a result the tragic implication is the consequences will be far more severe and long lasting in poorer countries. Progress in development and democracy in many African, Latin American and Asian societies will be reversed. Like climate and other risks, this global pandemic will dramatically worsen inequality within and between countries.

A global Marshall plan, with massive injections of funding, is urgently needed to sustain governments and societies.

The COVID-19 pandemic is not the death knell of globalisation, as some commentators have suggested. While travel and trade are frozen during the pandemic, there will be a contraction or deglobalisation. In the longer term the continued growth in incomes in Asia, which is home to two-thirds of the world’s population, is likely to mean that travel, trade and financial flows will resume their upward trajectory.

But in terms of physical flows, 2019 will likely go down in history as the time of peak supply chain fragmentation. The pandemic will accelerate the reshoring of production, reinforcing a trend of bringing production closer to markets that was already under way. The growth of robotics, artificial intelligence and 3D printing, together with customers expecting quick delivery of increasingly customised products, politicians eager to bring production home, and businesses seeking to minimise the price of machines, removes the comparative advantages of low-income countries.

It is not only manufacturing which is being automated, but also services such as call centres and administrative processes that now can be more cheaply done by computers in the basement of a headquarters than by people at distant locations. This poses profound questions about the future of work everywhere. It is a particular challenge for low income countries with a young population of work seekers. Africa alone expects 100 million workers to enter the labour market over the next 10 years. Their prospects were unclear before the pandemic struck. Now they are even more precarious.

Implications for political stability

At a time when faith in democracy is at its lowest point in decades , deteriorating economic conditions will have far-reaching implications for political and social stability. There is already a tremendous trust gap between leaders and citizens. Some political leaders are sending mixed signals and citizens are receiving conflicting messages. This reinforces their lack of trust in public authorities and “the experts”.

This lack of trust can make responding to the crisis much more difficult at the national level, and also has undermined the global response to the pandemic.

While making urgent calls for multilateral cooperation , the United Nations is still missing in action, having been sidelined by the major powers in recent years. Promising to inject billions – even trillions – into the response , the World Bank and International Monetary Fund will need to ramp up their activities to have a meaningful impact.

Owing to a shortage of international leadership from the US, cities, businesses and philanthropies are stepping up. China has gone from villain to hero in responding to the pandemic, partly by extending its soft power – in the form of doctors and equipment – to affected countries. Singaporean, South Korean, Chinese, Taiwanese, Italian, French and Spanish researchers are actively publishing and sharing their experience, including by fast-tracking research on what works.

So far, some of the most inspiring action is nongovernmental. For example, city networks such as the US Conference of Mayors and National League of Cities are rapidly sharing good practice on how to keep infectious diseases from spreading, which should improve local responses. The Bill and Melinda Gates Foundation contributed $100 million to expanding local health capacities in Africa and South Asia. Groups like Wellcome Trust , Skoll , the Open Society Foundations , the UN Foundation , and Google.org are also scaling up assistance.

Needless to say, the complexities of globalisation will not be resolved by appeals to nationalism and closed borders. The spread of COVID-19 must be met with a similarly coordinated international effort to find vaccines, mobilise medical supplies and, when the volcanic dust settles, to ensure that we never again face what could be an even deadlier disease.

Now is not the time for recriminations: it is the time for action. National and city governments , businesses, and ordinary citizens around the world must do everything they can to flatten the epidemic curve immediately, following the examples set by Singapore, South Korea, Hong Kong, Hangzhou and Taiwan.

Coalition of the willing must lead global response

Now more than ever, we need a comprehensive global response. The Group of Seven and G20 leading economies appear rudderless under their current leadership. While promising to ensure attention to the poorest countries and to refugees, their recent virtual meeting offered too little too late. But this cannot be allowed to stop others acting to mitigate the impact of COVID-19. In partnership with G20 nations, a creative coalition of willing countries should take urgent steps to restore confidence not just in the markets but in global institutions.

The European Union, China and other nations will have to step up and lead a global effort, dragging the US into a global response which includes accelerating vaccine trials and ensuring free distribution once a vaccine and antivirals are found. Governments around the world will also need to take dramatic action toward massive investments in health, sanitation and basic income.

Eventually, we will get over this crisis. But too many people will have died, the economy will be severely scarred, and the threat of pandemics will remain. The priority then must be not only recovery, but also establishing a robust multilateral mechanism for ensuring that a similar or even worse pandemic never again arises.

There is no wall high enough that will keep out the next pandemic, or indeed any of the other great threats to our future. But what these high walls will keep out is the technologies, people, finance and most of all the collective ideas and will to cooperate that we need to address pandemics, climate change, antibiotic resistance, terror and other global threats.

The world Before Coronavirus and After Coronavirus cannot be the same. We must avoid the mistakes made throughout the 20th and early 21st centuries by undertaking fundamental reforms to ensure that we never again face the threat of pandemics.

If we can work together within our countries to prioritise the needs of all our citizens, and internationally to overcome the divides that have allowed the threats of pandemics to fester, out of the terrible fire of this pandemic a new world order could be forged. By learning to cooperate we would not only have learnt to stop the next pandemic, but also to address climate change and other critical threats.

Now is the time to start building the necessary bridges at home and abroad.

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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.

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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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• Open access
• Published: 25 January 2022

Living conditions, lifestyle habits and health among adults before and after the COVID-19 pandemic outbreak in Sweden - results from a cross-sectional population-based study

• Anu Molarius 1 , 2 &
• Carina Persson 3  

BMC Public Health volume  22 , Article number:  171 ( 2022 ) Cite this article

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Metrics details

Studies on the public health consequences of COVID-19 pandemic showing data based on robust methods are scarce. The aim of this study was to investigate mental and physical health as well as living conditions and lifestyle habits in the general population before and after the COVID-19 outbreak in Sweden.

The study is based on 2273 persons 16-84 years who responded to the national public health survey in February-May 2020 in Värmland county (overall response rate 45%). The differences between early respondents (before the outbreak, n  = 1711) and late respondents (after the outbreak, n  = 562) were studied using multivariate logistic regression, adjusting for background characteristics: age, gender, educational level, and country of birth. The same analyses were also completed in the corresponding survey carried out in February-June 2018.

Statistically significant differences between the groups were obtained for economic difficulties and worry about losing one’s job, which were more common among late respondents, and for sleeping difficulties, which were more common among early respondents after adjusting for background characteristics. There were no differences in other living conditions nor in lifestyle factors. Prevalence of good self-rated health, high blood pressure, aches in shoulders or neck, anxiety or worry and stress did not differ between the groups. In 2018, the only statistically significant difference between early and late respondents concerned economic difficulties.

Conclusions

Very few differences in living conditions, lifestyle factors and health were observed in the study population before and after the COVID-19 outbreak. The results suggest that, in addition to a possible decrease in sleeping difficulties, the prevalence of being worried about losing one’s job increased among the employed after the outbreak.

Peer Review reports

In March 2020, the worldwide pandemic of coronavirus causing COVID-19 reached Sweden. This led to restrictions in many sectors of society, an increased burden on health care, and an economic downturn with a sharp increase in layoffs and unemployment. The impact of the pandemic on the mental health of the population has not yet been investigated in depth in Sweden, but a few studies have been published. A longitudinal study on 1071 older adults, aged 65-71 years, found that mental well-being remained stable or was even higher in the early days of the pandemic compared to previous years [ 1 ]. A cross-sectional online survey of 1212 adult volunteers showed high levels of depression, anxiety, and insomnia but no comparison could be made with the situation before the COVD-19 outbreak [ 2 ]. An early study in the UK showed that the prevalence of depression and anxiety increased, especially among young adults, immediately after the first lockdown [ 3 ]. In Sweden, it was expressed that, based on past experiences of economic crises, it is likely that the COVD-19 pandemic will lead to a rise in mortality in the future [ 4 ]. This is because mass unemployment leads to increased mortality in the population, including mortality from alcohol-related diseases, suicide, and cardiovascular diseases, especially among men with low socioeconomic status [ 5 ].

The negative effects of the pandemic on mental health may arise from social measures such as quarantine and lockdown, fear of COVID-19 disease and lifestyle changes [ 6 , 7 ]. In addition, some specific population groups such as young people, the elderly and people with learning disabilities and mental disabilities may be more affected than others [ 7 ]. The WHO and the UN have also highlighted the impact of the pandemic on the mental health of the population and the need to invest in health promotion and prevention in addition to health interventions [ 8 , 9 ].

Mental health is strongly linked to the individual’s living conditions and lifestyle habits [ 10 , 11 ]. The recommendations to the public made by the authorities due to the COVID-19 pandemic called on people to reduce their social contacts and those over 70 years of age were recommended to refrain from seeing people outside their own family. However, social relations are in many ways important for mental health [ 12 ]. Social support is a protective factor that can act as a buffer in psychosocial crisis situations or pressures. Furthermore, involuntary loneliness has been shown to have a strong link to depression among the elderly [ 13 ]. In addition to social relations, economic factors have a major impact on mental health. Those with financial difficulties have more mental health problems and depression [ 14 , 15 ]. Recipients of financial assistance and unemployed young adults have a higher incidence of mental health problems than others [ 16 ]. Other factors strongly linked to mental ill-health are physical inactivity, daily smoking, and obesity [ 17 , 18 , 19 ].

Mental health is also associated with physical health. This is especially true for musculoskeletal disorders that are often work-related and symptoms of overexertion. Psychological factors such as stress and anxiety are also assumed to be related to musculoskeletal pain. Anxiety, nervousness, and experiences of mental stress increase muscle tension which contributes to pain, especially in the neck and shoulders [ 20 ].

Population surveys are commonly used to measure living conditions, lifestyle habits and health in the general population. The answers from persons who respond early or late, that is before and after a first reminder to a survey questionnaire tend, however, to differ in several ways [ 21 ]. For example, non-native persons, those with only pre-secondary education and younger age groups are more often late respondents. Furthermore, younger people and people with low levels of education can more often be reached by telephone follow-ups of non-respondents [ 22 , 23 ]. We observed in a large survey in Sweden, that it was somewhat more common with good health as well as being physically active and having trust in others among those who responded early compared to those who responded late [ 21 ]. However, anxiety and nervousness were somewhat more common among those with late responses. These differences persisted even when age was taken into account.

A panel of experts on mental health in the UK published a recommendation for mental health research in Lancet Psychiatry in the context of the COVID-19 pandemic [ 24 ] and called for high-quality data and integration of different perspectives. Another group also emphasized the importance of monitoring mental disorders as well as risk factors such as unemployment, economic difficulties, alcohol consumption, and lack of social support in the population [ 25 ]. Several studies on the adverse effects of the pandemic on mental health and risk factors among adults, for example in Sweden [ 2 ], Canada [ 26 ] and Australia [ 27 ] were published after the first wave of the pandemic. However, these were usually conducted only after the outbreak of the pandemic and based on questionnaires distributed via social media, leading to self-selection, and have therefore probably exaggerated the effects of the pandemic [ 28 ]. Since then, many more studies have been published, including a review on the mental health effects of the pandemic [ 29 ] and a rapid review on the cardiovascular risk factors [ 30 ]. Neither of these reviews included, however, studies from Sweden. In addition, as Freiberg et al. [ 30 ] indicated, there is a high number of epidemiological studies on the impact of COVID-19 lockdown measures on modifiable cardiovascular risk factors, but only a few have used probability sampling methods. Epidemiologically robust methods, such as population studies based on random population sampling and the use of exactly the same questions before and after the outbreak of the pandemic are therefore of great value.

The aim of this study was to highlight mental and physical health as well as living conditions and lifestyle habits in the adult population before and after the COVID-19 outbreak in one county in Sweden by comparing early and late respondents to the public health survey “Health on equal terms?” carried out in February-May 2020.

The study is based on data from the population survey “Health on equal terms?” conducted in collaboration with the Public Health Agency of Sweden [ 31 ]. The national survey started in 2004 and has been carried out every two years since 2016 to monitor the health of the population in Sweden. The age group addressed is 16–84 years. The sample frame is the total population register at Statistics Sweden, the statistical administrative authority in Sweden, covering all inhabitants in the country. The national simple random sample in 2020 included 40,000 persons.

The present study is based on data from one county (Värmland) where an extended simple random sample was drawn. In total, the questionnaire was sent to 5091 persons in the county and 2273 individuals answered the questionnaire giving an overall response rate of 45%. The questionnaire was postal but could also be answered online. Data collection was discontinued after two postal reminders. In Värmland county, the first COVID-19 cases were reported on 6th March 2020 [ 31 ]. To define those who replied before and after the COVID-19 outbreak in Sweden the respondents were divided into early ( n  = 1711) and late ( n  = 562) respondents, i.e. those responding between 3th February and 11th March 2020, and those responding between 12th March and 5th May, respectively. The date 11th March coincided with posting the first reminder of the survey.

Värmland county is situated in the west of Mid-Sweden, bordering to Norway, and comprises about 282,000 inhabitants. It includes one bigger city with over 90,000 inhabitants and 15 smaller municipalities. The incidence of COVID-19 was lower in Värmland than in Sweden in general during March-May 2020 and by the last week in May 533 persons had been diagnosed with COVID-19 in Värmland [ 31 ].

The measures taken to combat the COVID-19 pandemic in Sweden included e.g. recommendations to keep distance to other people, to wash hands often, to stay at home when having symptoms of flu, to avoid travelling abroad and unnecessary travelling in Sweden, to avoid public places with crowds, and to work from home when possible. Those over 70 years of age were recommended to refrain from seeing people outside their own family. In the end of March, public gatherings of more than 50 persons were forbidden. No total lockdown was, however, instituted in Sweden.

To explore whether the results observed in 2020 are due to the COVID-19 pandemic, the same analyses were run in the corresponding “Health on equal terms?” survey which was carried out between 28th February and 18th June 2018. In total, 2142 persons aged 16-84 years responded to the survey in Värmland county with an overall response rate 42%. Out of these, 1660 individuals responded before (early respondents) and 482 after (late respondents) the first reminder sent on 10th April 2018.

Confounding variables

Information on gender, age, level of education and country of birth are based on register data from Statistics Sweden. Educational level was categorised into three levels: compulsory education, secondary education, and postsecondary education. Country of birth was dichotomized into those born in Sweden and those born outside Sweden.

Outcome variables

Living conditions.

Social support was measured with the question “Do you have anyone you can share your innermost feelings with and confide in?” (yes/no).

Economic difficulties were estimated with the question “During the last 12 months, have you ever had difficulty in managing the regular expenses for food, rent, bills etc.?”. The response options were “no”, “yes, once”, “yes, more than once” where the last two categories were combined to yes.

Trust in other people was measured with the question “Do you think that, in general, people can be trusted?” (yes/no). Employed people were defined as being worried about losing their job if they answered “yes” to the question “Are you worried about losing your job in the coming year?”

Lifestyle factors

Two questions for measuring physical activity were used. The first question was: How much time do you spend in a normal week on physical training that leaves you out of breath – for example running, fitness training, or ball sports? The response options were: 0 min/no time; less than 30 min; 30–59 min (0.5–1 h); 60–89 min (1–1.5 h); 90–119 min (1.5–2 h); 2 h or more. The second question was: How much time do you spend in a normal week on daily activities – for example walking, cycling, or gardening? Count all time together (at least 10 min at a time). The response options were: 0 min; less than 30 min; 30–59 min (0.5–1 h); 60–89 min (1–1.5 h); 90–149 min (1.5–2.5 h); 150–299 min (2.5–5 h); 5 h or more. These questions are used to measure whether the respondent reaches 150 activity minutes per week as recommended by the WHO. The number of minutes from the physical training and daily activities were summed together, with the number from the first variable counting double [ 32 ].

Sitting duration was asked with the question “How much do you sit during a normal day, not counting sleep?” The answer categories were dichotomised into those who sit less than 10 h and those who sit at least 10 h a day.

Smoking was measured using the question “Do you smoke” (“no”, “yes, sometimes”, “yes, daily”).

Alcohol consumption was measured using Alcohol Use Disorders Identification Test-C (AUDIT-C). AUDIT-C is a widely used and validated screening instrument of alcohol use. It comprises three questions on the frequency and quantity of alcohol consumption. We used the following cut-offs for risk-drinker: 6 or more points in men and 5 or more points in women [ 32 ].

The following variables were used to measure the respondents’ health [ 32 ]. Self-rated health (SRH) was measured with the question “How would you describe your health in general?”. Response options were very good, good, fair, poor and very poor. In the statistical analysis the options were dichotomised into good (very good or good) and poorer than good (fair, poor or very poor) SRH.

Illnesses were measured with the following question: Do you have any of the following illnesses (with answer options No; Yes, but no discomfort; Yes, minor discomfort; Yes, severe discomfort)? Illnesses included high blood pressure, and the last three categories were combined to Yes.

Symptoms were derived from the question: Do you have any of the following discomforts or symptoms? These included “aches in the shoulders or neck”, “sleeping difficulties” and “anxiety or worry”. The answer categories were No; Yes, minor discomfort and Yes, severe discomfort, where the two latter categories were combined to Yes.

Stress was measured with the question “Do you feel stressed at present? By stressed, we mean a condition where you feel tense, restless, nervous, uneasy or unable to concentrate.” The answer options were Not at all; To some extent; Quite a lot and Very much, where the last three options were defined as having stress.

Ethical considerations

The study followed the Swedish guidelines for studies in social sciences and humanities, in accord with the Declaration of Helsinki and the data are protected by the law of official statistics. The participants were informed that completed questionnaires would be linked to the Swedish official registries through personal identification numbers, to access registry information on gender, age, country of birth and educational level. The respondents thus gave their informed consent to the linking of registry data. The personal identification numbers were deleted before the data was delivered to Region Värmland. Statistics Sweden carried out the sampling, data collection and linkage with registry data and delivered the de-identified data. The study was approved by the Swedish Ethical Review Authority (Dnr 2020–04202).

Statistical analysis

Differences in the distribution of background characteristics and SRH between early and late respondents were tested using chi-square statistics. Difference in mean age was tested using independent samples t-test. P -values < 0.05 were considered as statistically significant. The differences in living conditions, lifestyle habits, and health between early and late respondents were studied using multivariate binary logistic regression, with early/late response as the independent variable (reference category = early response), adjusting for background characteristics gender, age group, educational level, and country of birth. The results are reported as odds ratios (OR) and 95% confidence intervals (95% CI) for each living condition, lifestyle habit and health condition as outcome at a time. All analyses were conducted in IBM SPSS Statistics, version 26.

Table  1 shows the background characteristics of the study population among early and late respondents. Late respondents were younger than early respondents (mean age 53.5 and 58.2 years, respectively, p  < .05) and they had a larger proportion of persons born outside Sweden than early respondents. There were no statistically significant differences in gender or level of education between the respondent groups.

Some differences in living conditions, lifestyle factors and health between the two groups were observed (Table  2 ). Late respondents had more economic difficulties, had lower trust in other people, and were more often worried about losing their job than early respondents. There were no statistically significant differences between the groups regarding lifestyle factors. Sleeping difficulties were more common among early respondents whereas stress was more common among late respondents. Otherwise no statistically significant differences in health problems were found.

Due to the differences in age and country of birth between the groups, multivariate logistic regression analyses were carried out adjusting for gender, age group, educational level, and country of birth (last column in Table 2 ). When adjusting for these background characteristics, statistically significant differences between early and late respondents remained for economic difficulties and worry about losing one’s job, which were more common among late respondents, and for sleeping difficulties, which were more common among early respondents. There were no differences in other living conditions nor in lifestyle factors. Self-rated health, high blood pressure, aches in shoulders or neck, anxiety or worry and stress did not differ between the groups when adjusting for background characteristics.

When the same multivariate logistic regression analyses were carried out in the corresponding survey in 2018, no statistically significant differences were observed between early and late respondents for lifestyle factors or health variables (see Supplementary Table S 1 , Additional file  1 ). For living conditions, the only statistically significant association was found for economic difficulties (OR: 1.64; 95% CI: 1.20-2.24). The prevalence of being worried about losing one’s job did not differ between early and late respondents (OR: 1.03; 95% CI: 0.64-1.65). The same applies to sleeping difficulties (OR: 0.84; 95% CI: 0.67-1.05).

In this study, very few differences were observed between early and late respondents in 2020 regarding living conditions, lifestyle factors and health. However, in the 2020-survey, it was more common among the late respondents to be worried about losing their job, and more common among the early respondents to report sleeping difficulties. These differences could not be seen in the corresponding survey in 2018.

The COVID-19 pandemic hit hard in Sweden in spring 2020 and until the last week in May 4499 people, predominantly persons over 70 years, had lost their lives and 2088 persons had been or were being treated in intensive care [ 31 ]. The short-term public health consequences of the COVID-19 pandemic and the restrictions related to it were however rather small at the population level in the present study. This is in line with the findings of the review of Prati et al. [ 29 ] who showed that the psychological impact of COVID-19 lockdowns was small in magnitude and highly heterogeneous, and no change for instance in social support was observed. Nevertheless, there can be subgroups where the impact has been detrimental. For example, Pierce et al. [ 33 ] found that even though the mental health of most UK adults remained resilient or returned to pre-pandemic levels between April and October 2020, about one in nine had a deteriorating or consistently poor mental health. Those in the deteriorating mental health group were more likely to be women, younger, without a partner, and have a previous mental illness [ 33 ]. The review of Freiberg et al. [ 30 ] reported, in turn, that physical activity decreased whereas sedentary behavior and alcohol consumption increased during the COVD-19 lockdown. But even though only studies using probability sampling were included in the review there were methodological shortcomings in many of these studies [ 30 ]. The only direct consequence of the pandemic in the present study seems to have been a rise in the proportion who worry about losing their job. Since worrying about losing one’s job is associated with mental health problems [ 9 ], it can be assumed that if this increase persists or continues, it will have a detrimental effect for the future mental health of the population. The proportion of persons having economic difficulties was also higher among the late respondents, but since similar findings were observed in the 2018 study, it is improbable that the difference in 2020 was due to the COVID-19 pandemic. Furthermore, this finding underlines the point that researchers should be observant and not to draw hasty conclusions that study results are due to the pandemic just because they occur during the same time period. Moreover, since early and late respondents differ from each other in many health-related aspects, it is important to adjust for known background characteristics and take the period of time into account.

The result that sleeping difficulties were more common among early than late respondents is somewhat puzzling. Similar findings were not observed in the 2018 study. An increase in the proportion who worry about losing their job suggests that an increase in sleeping difficulties may have been more likely. A cross-sectional study in Reggio Emilia in Italy, based on 1826 individuals, found that the first lockdown may have worsened the quality of sleep [ 34 ]. On the other hand, a study based on smartphone data in the US and 16 European countries found that the subjects increased their sleep duration but delayed their sleep onset during the COVID-pandemic in comparison to before the pandemic [ 35 ]. In Sweden, there was no total lockdown and the result that the mental well-being remained stable or was even higher after the outbreak of the pandemic among Swedish elderly [ 1 ] suggests that the changes in health are not necessarily always as expected. In addition, we did not find any increase in anxiety or worry or in stress. One, although somewhat improbable, explanation for the fact that late respondents reported less sleeping difficulties could be that an increasing number of employees were able to better control their working hours since they were working from home. This could perhaps contribute to better sleep. The decrease in sleeping difficulties may, of course, also be a spurious finding.

The response rate in our study was somewhat higher in 2020 (45%) than in 2018 (42%). This may have been due to the pandemic, increased interest in health issues, in recognizing the sender, the National Public Health Agency of Sweden, which had a press conference nearly every day at the beginning of the pandemic, or just because of chance.

Our sample was rather small, and we could not differentiate any groups within the two categories. It is possible that some groups have been affected by the COVID-19 pandemic more than others, for example those who have lost their jobs or persons over 70 years who were recommended to social isolation. It has been suggested that the pandemic will lead to increased inequalities in health [ 36 ]. In this study we were not able to assess health inequalities and changes in them. Also, the time frame was short and the effect of the second wave during the late autumn 2020 and other long-term consequences are not yet known. The survey was also limited to one county, where the number of cases treated in hospital care in relation to population was rather limited compared to for example the county of Stockholm [ 31 ]. The restrictions due to the pandemic were, however, similar.

The strength of our study is that it is based on a random population sample and the same questionnaire was used both by the early and late respondents. Another advantage is that we could compare the results directly with the survey carried out in 2018 so that false conclusions could be avoided. Several studies on the adverse effects of the pandemic on mental health and risk factors among adults have already been published [ 2 , 26 , 27 ]. However, it has been noted that these have usually been conducted only after the outbreak of the COVID-19 pandemic and been based on questionnaires distributed via social media, leading to self-selection and probable exaggerated effects of the pandemic [ 28 , 29 , 30 ]. Many papers on the pandemic have been published in public health journals, and even though more studies using robust methodology have been published since the early days of the pandemic, papers showing data based on robust methods have been scarce [ 29 , 30 , 37 ]. In addition, the results can vary between countries and the time of the study. For example, a study from Austria showed that COVID-19 restriction measures resulted in increased, but only on short-term, levels of loneliness among older adults during the lockdown [ 38 ].

In conclusion, there was a statistically significant difference between early and late respondents in the study population in 2020 for worry about losing one’s job that could not be observed in the 2018-material. It is probable that this is attributable to the outbreak of the COVID-19 pandemic. The observed decrease in sleeping difficulties remains more puzzling. More research on the short- and long-term public health consequences of the pandemic in the general population and in different subgroups as well differences between populations, using robust data and methods, is thus needed.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available due to confidentiality and regulations under the Swedish law (the Public and Privacy Act 2009: 400, Chapter 24, Section 8), but descriptive data in table form are available from the corresponding author on reasonable request.

Abbreviations

Confidence interval

Alcohol Use Disorders Identification Test-C

Self-rated health

World Health Organization

Kivi M, Hansson I, Bjälkebring P. Up and about: older adults' well-being during the COVID-19 pandemic in a Swedish longitudinal study. J Gerontol B Psychol Sci Soc Sci. 2021;76:e4–9.

Article   Google Scholar  

McCracken L, Badinlou F, Buhrman M, Brocki K. Psychological impact of COVID-19 in the Swedish population: depression, anxiety, and insomnia and their associations to risk and vulnerability factors. Eur Psychiatry. 2020;63:E81.

The Guardian Rise in depression and anxiety day after UK lockdown announced – study 31 March 2020. https://www.theguardian.com/world/2020/mar/31/rise-in-depression-and-anxiety-day-after-uk-lockdown-announced-study-coronavirus . Accessed 20 September 2021.

SVT. Arbetslösa riskerar att dö i förtid. [The unemployed are at risk to die prematurely.] 26 March 2020. https://www.svt.se/nyheter/inrikes/arbetslosa-riskerar-att-do-i-fortid . Accessed 20 September 2021.

Vågerö D, Garcy AM. Does unemployment cause long-term mortality? Selection and causation after the 1992-96 deep Swedish recession. Eur J Pub Health. 2016;26:778–83.

Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395:912–20.

Article   CAS   Google Scholar  

Karolinska Institutet. Covid-19: Resurser för psykiskt välbefinnande. [Covid-19: Resources for psychological well-being.] Nationellt Centrum för Suicidforskning och Prevention, 2020. https://ki.se/nasp/covid-19-resurser-for-psykiskt-valbefinnande . Accessed 20 September 2021.

World Health Organization. Mental health & COVID-19. WHO, 2020. https://www.who.int/teams/mental-health-and-substance-use/covid-19 . Accessed 20 September 2021.

United Nations. Policy brief: COVID-19 and the Need for Action on Mental Health. United Nations, 13 May 2020. https://www.un.org/sites/un2.un.org/files/un_policy_brief-covid_and_mental_health_final.pdf . Accessed 20 September 2021.

Lund C, Brooke-Sumner C, Baingana F, Baron EC, Breuer E, Chandra P, et al. Social determinants of mental disorders and the sustainable development goals: a systematic review of reviews. Lancet Psychiatry. 2018;5:357–69.

Molarius A, Berglund K, Eriksson C, Eriksson HG, Lindén-Boström M, Nordström E, et al. Mental health symptoms in relation to socio-economic conditions and lifestyle factors-a population-based study in Sweden. BMC Public Health. 2009;9:302.

Cooper H, Arber S, Fee L, Ginn J. The influence of social support and social capital on health. A review and analysis of British data. London: Health Education Authority; 1999.

Google Scholar  

Erzen E, Çikrikci Ö. The effect of loneliness on depression: a meta-analysis. Int J Soc Psychiatry. 2018;64:427–35.

Molarius A, Granström F. Educational differences in psychological distress? Results from a population-based sample of men and women in Sweden in 2012. BMJ Open. 2018;8:e021007.

Ahnquist J, Wamala S. Economic hardship in adulthood and mental health in Sweden. The Swedish National Public Health Survey 2009. BMC Public Health. 2011;11:788.

The Public Health Agency of Sweden. Ojämlikheter i psykisk hälsa. Kunskapssammanställning. [Inequalities in mental health. Knowledge overview.] Stockholm; Folkhälsomyndigheten, 2019.

Dinas PC, Koutedakis Y, Flouris AD. Effects of exercise and physical activity on depression. Ir J Med Sci. 2011;180:319–25.

Banzer R, Haring C, Buchheim A, Oehler S, Carli V, Wasserman C, et al. Factors associated with different smoking status in European adolescents: results of the SEYLE study. Eur Child Adolesc Psychiatry. 2017;26:1319–29.

Scott KM, Bruffaerts R, Simon GE, Alonso J, Angermeyer M, de Girolamo G, et al. Obesity and mental disorders in the general population: results from the world mental health surveys. Int J Obesity. 2008;32:192–200.

Melin B, Lundberg U. A biopsychosocial approach to work-stress and musculoskeletal disorder. J Psychophysiol. 1997;11:238–47.

Bortfallsanalys. Liv & hälsa i Mellansverige 2017. [Non-response analysis. Life & health in Mid-Sweden 2017.] Rapportserie utgiven i samverkan mellan regionerna i Uppsala, Sörmlands, Västmanlands, Värmlands och Örebro län, 2019. https://www.regionvarmland.se/globalassets/vardgivarwebb/samverkan-avtal-och-vardval/folkhalsa-och-samhallsmedicin/folkhalsa-i-siffror/bortfallsanalys_liv_och_halsa_i_mellansverige_2017.pdf . Accessed 20 September 2021.

Lindén-Boström M, Persson C. A selective follow-up study on a public health survey. Eur J Pub Health. 2013;23:152–7.

Helakorpi S, Mäkelä P, Holstila A, Uutela A, Vartiainen E. Can the accuracy of health behaviour surveys be improved by non-response follow-ups? Eur J Pub Health. 2015;25:487–90.

Holmes EA, O’Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. 2020;7:547–60.

Gunnell D, Appleby L, Arensman E, Hawton K, John A, Kapur N, et al. COVID-19 suicide prevention research collaboration. Suicide risk and prevention during the COVID-19 pandemic. Lancet. Psychiatry. 2020;7:468–71.

PubMed   Google Scholar  

Lesser IA, Nienhuis CP. The impact of COVID-19 on physical activity behaviour and well-being of Canadians. Int J Environ Res Public Health. 2020;17:3899.

Stanton R, To QG, Khalesi S, Williams SL, Alley SJ, Twaite TL, et al. Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults. Int J Environ Res Public Health. 2020;17:4065.

Hotopf M, Bullmore E, O'Connor RC, Holmes EA. The scope of mental health research during the COVID-19 pandemic and its aftermath. Br J Psychiatry. 2020;217:540–2.

Prati G, Mancini AD. The psychological impact of COVID-19 pandemic lockdowns: a review and meta-analysis of longitudinal studies and natural experiments. Psychol Med. 2021;51:201–11.

Freiberg A, Schubert M, Starke KR, Hegewald J, Seidler A. A rapid review on the influence of COVID-19 lockdown and quarantine measures on modifiable cardiovascular risk factors in the general population. Int J Environ Res Public Health. 2021;18:8567.

The Public Health Agency of Sweden. Covid-19. Bekräftade fall i Sverige. [Covid-19. Confirmed cases in Sweden]. https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/statistik-och-analyser/bekraftade-fall-i-sverige/ . Accessed 20 September 2021.

The Public Health Agency of Sweden. Hälsa på lika villkor? Nationella folkhälsoenkäten [Health on equal terms? The national public health survey]. http://www.folkhalsomyndigheten.se . Accessed 20 September 2021.

Pierce M, McManus S, Hope H, Hotopf M, Ford T, Hatch SL, et al. Mental health responses to the COVID-19 pandemic: a latent class trajectory analysis using longitudinal UK data. Lancet Psychiatry. 2021;8:610–9.

Costi S, Paltrinieri S, Bressi B, Fugazzaro S, Giorgi Rossi P, Mazzini E. Poor sleep during the first peak of the SARS-CoV-2 pandemic: a cross-sectional study. Int J Environ Res Public Health. 2021;18:306.

Lee PH, Marek J, Nálevka P. Sleep pattern in the US and 16 European countries during the COVID-19 outbreak using crowdsourced smartphone data. Eur J Pub Health. 2021;31:23–30.

Burström B, Tao W. Social determinants of health and inequalities in COVID-19. Eur J Pub Health. 2020;30:617–8.

Odone A, Galea C, Stuckler D, Signorelli C. The first 10 000 COVID-19 papers in perspective: are we publishing what we should be publishing? Eur J Pub Health. 2020;30:849–50.

Stolz E, Mayerl E, Freidl W. The impact of COVID-19 restriction measures on loneliness among older adults in Austria. Eur J Pub Health. 2021;31:44–9.

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Acknowledgements

We thank Bernard Swift and Anna Swift-Johannison for helpful comments on the English language.

Open access funding provided by Karlstad University. The survey was funded by Region Värmland.

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Centre for Clinical Research, Region Värmland, 651 85, Karlstad, Sweden

Anu Molarius

Department of Public Health Sciences, Karlstad University, Karlstad, Sweden

Department for Sustainable Development, Region Örebro County, Örebro, Sweden

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Both authors (AM and CP) participated in designing the study and in interpreting the results. AM drafted the manuscript and conducted the statistical analyses. Both authors contributed to writing and revising the manuscript and have read and approved the final version of the manuscript.

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The study was approved by the Swedish Ethical Review Authority (Dnr 2020–04202). The respondents gave their informed consent to the linking of registry data by answering the questionnaire. The dataset includes subjects who are 16-17 years old, but according to the Swedish regulations they do not need an informed consent from a parent or guardian to answer the questionnaire. The study followed the Swedish guidelines for studies in social sciences and humanities, in accord with the Declaration of Helsinki and the data are protected by the law of official statistics.

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Additional file 1: table s1.

. Living conditions, lifestyle factors and health among early and late respondents 16-84 years in 2018 and adjusted odds ratios (with 95% confidence intervals in parenthesis) for living conditions, lifestyle factors and health among late respondents compared to early respondents.

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Molarius, A., Persson, C. Living conditions, lifestyle habits and health among adults before and after the COVID-19 pandemic outbreak in Sweden - results from a cross-sectional population-based study. BMC Public Health 22 , 171 (2022). https://doi.org/10.1186/s12889-021-12315-1

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DOI : https://doi.org/10.1186/s12889-021-12315-1

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Life before COVID-19: how was the World actually performing?

Affiliations.

• 1 School of Information, Systems and Modelling (ISM), University of Technology Sydney, Sydney, Australia.
• 2 Centre on Persuasive Systems for Wise Adaptive Living (PERSWADE), University of Technology Sydney, Sydney, Australia.
• PMID: 33456074
• PMCID: PMC7799424
• DOI: 10.1007/s11135-020-01091-6

The COVID-19 pandemic has suddenly and deeply changed our lives in a way comparable with the most traumatic events in history, such as a World war. With millions of people infected around the World and already thousands of deaths, there is still a great uncertainty on the actual evolution of the crisis, as well as on the possible post-crisis scenarios, which depend on a number of key variables and factors (e.g. a treatment, a vaccine or some kind of immunity). Despite the optimism enforced by the positive results recently achieved to produce a vaccine, uncertainty is probably still somehow the predominant feeling. From a more philosophical perspective, the COVID-19 drama is also a kind of stress-test for our global system and, probably, an opportunity to reconsider some aspects underpinning it, as well as its sustainability. In this article we focus on the pre-crisis situation by combining a number of selected global indicators that are likely to represent measures of different aspects of life. How was the World actually performing? We have defined 6 macro-categories and inferred their relevance from different sources. Results show that economic-oriented priorities correspond to positive performances, while all other distributions point to a negative performance. Additionally, balanced and economy-focused distributions of weights propose an optimistic interpretation of performance regardless of the absolute score.

Keywords: Global indicators; Multi-criteria decision analysis; Sustainability.

© The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature 2021.

Life before, during, and after COVID-19

Most everyone has been asked this question and I am sure many of us would come up with similar answers.

Being limited in mobility for people used to multi-tasking in various settings could have some psychological consequences. While some who are retired like myself, may enjoy having more quiet time to reflect, read, catch up with Netflix shows, or watch sunrises and sunsets, one can’t go through the same routine over a lengthy period of time.

Thus, the norm for most people would be that of having to postpone vacations and travels within the country and abroad, cancel receptions for weddings, anniversaries and office and family parties, or attendance at live concerts and shows. Meetings have migrated to digital platforms through Zoom. Lack of face-to-face communication had forced many to use Facebook and the social media. Even funeral masses are now held virtually.

Those who work go through considerable restrictions as they are constrained by travel protocols or limited transportation. Most middle class families have to resort to online or other forms of home delivery of food and essentials while the rest of the population – labor, farm, and informal settlers have had to fend for themselves by taking on part-time work as many businesses had been shuttered. Since I let go of my driver several months ago, he now engages in vegetable farming or doing part-time construction work.

We still await studies on impact of online on our students, our most important human resources in the post-COVID era.

The COVID-19 period had given rise to a new “employee group” – the “delivery riders” from small enterprises like Lala Food, Grabfood, Food Panda, and several other delivery apps, and are now considered part of our “frontliners” Some vendors in Metro Manila markets have become enterprising, hiring riders to deliver to their “suki” fresh fish, veggies, fruits, meats and other fresh produce.

A newspaper’s report examines the future of this “scattered work sector” on whether it could become a formal employee group of digital platforms like the situation in the UK and possibly, Spain where they can demand security benefits like insurance and separation pay.

What is the status of the COVID-19 vaccine rollout? Latest reports indicate dissatisfaction about the slow pace of jab rollout. We are nearly midway into the year but only about 2.02 million had been inoculated which is way below the target of 58 million to 70 million to achieve herd immunity.

The delay was caused by the hesitancy of government to start the rollout because of the then lack of available vaccines. This is reportedly due to the quality checks that had to be done. Now that they have arrived and are in storage, we are still confronted with lack of vaccination centers and refusal of some of the priority groups to be inoculated.

“We need vaccine awareness, promotion and good supply management to get the vaccines administered to as many at the fastest time possible, and with least amount of wastage,” notes former government pandemic adviser, Dr. Tony Leachon. But how do we go about this?

I was recently asked “to play “prognosticator” and “envision the COVID situation by the end of the year. What then should I say?

I would like to be positive and hope we can attain herd immunity by then. But some doubt that and believe it would take more than a year to reach the goal given the present situation where only 40,000 to 60,000 are inoculated daily. The magic number should be about 100,000 but this would depend on suggestions by experts on the control of the various variables, i.e., increase in number of vaccination centers, smart handling of storage of vaccines that have brief shelf life, or giving away extra vaccines to the private sector to administer.

It may be necessary to schedule an extra day like Saturday and to start at 7 a.m. and continue till 7 p.m. But this would of course require an additional shift. The more challenging task is motivating every Filipino to trust the safety of the vaccine and the system.

Those who have undergone the inoculation would attest to the efficiency of the vaccination system. It is in the decision processes at the higher levels, and we don’t mean only in the deployment of the vaccine, but other aspects of decision-making made by the Inter-Agency Task Force, the local government, the Department of Health, and the economists.

Calibrating is how economists describe the ability to manage health and safety concerns together with that of economic survival Since our economy is now in its longest recession since the foreign debt crisis in the 1980’s, government should now come up with innovative strategies that would ensure economic survival as it focuses on the more serious challenge of addressing surges in number of COVID-19 cases and fatalities.

I believe most would agree that the effective management of COVID-19 could become the litmus test as it would determine attributes needed for future governance.

My email, [email protected]

Life after Covid: will our world ever be the same?

From cities, to science, to politics, six Observer writers assess how a post-pandemic world will emerge into a new normal

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Here are some things that the pandemic changed. It accustomed some people – those whose jobs allowed it – to remote working . It highlighted the importance of adequate living space and access to the outdoors. It renewed, through their absence, an appreciation of social contact and large gatherings. It showed up mass daily commuting for the dehumanising drain on energy and resources that it is.

These changes do not add up to the abandonment of big cities and offices predicted by more excitable commentaries, not a future of rural bubbles and of tumbleweed blowing through the City of London, but a welcome shift in priorities. There will always be millions who want to live in cities and millions who want to live in towns and villages, but there are also those for whom these are borderline decisions, with pros and cons on each side.

These decisions might be based on life changes, such as having children. If you no longer have to go to an office daily, you can live further from the city in which it is placed. If the magic spell of the big city, which kept people in the tiny and expensive flats that now look so inadequate, is broken, then you might consider living in cheaper, more relaxed locations that hadn’t occurred to you before. Those ex-urbanites, still valuing social contact and public life, might seek towns and small cities rather than a lonely cottage in a field.

Such changes could help to address, without the pouring of any concrete or the laying of a brick, the imbalance in the nation’s housing that was at breaking point before Covid. On the one hand there are overheated residential markets in London, Bristol, Manchester, Edinburgh and elsewhere. On the other there are towns and small cities with good housing stock, an inherited infrastructure of parks and civic buildings and easy access to beautiful countryside, which through their location suffer from underinvestment and depopulation.

This is not to say that no new homes should be built, nor that there won’t be problems with such a shift. It could simply be gentrification, if done wrong, at a national scale. And this vision assumes that Covid passes, and that it is not one of a future series of equally vicious viruses. But there is at least a chance that the travails of 2020 could lead to a saner approach to the places where we live and work. Rowan Moore, Observer architecture critic

Interaction

The first kiss my baby niece blew me was bittersweet, because like so many pandemic interactions it happened not in person but on camera. Covid means that big chunks of her life have only been seen on a phone screen as she grows into a toddler. And I’m one of the lucky ones: I haven’t had to say goodbye to someone on FaceTime or break the worst news to someone over the phone.

If you live by yourself, you’ve made do without human touch for months on end; if you’re crammed into a small space with your partner, kids and your parents, you may have spent weeks craving time and space not encroached upon by other human beings. Totally different experiences of the same social earthquake: surely they cannot but profoundly change us for the long term?

I’m not so sure. Lockdown, then not-lockdown, then lockdown again have served as a reminder of just how adaptable we are as human beings. I was amazed at how quickly the idea of socialising with friends indoors became a fuzzy memory, then the norm, then distant again. The emotions I felt so acutely back in March – the sharp fear Covid could steal my parents, the communal endeavour of clapping for our carers every Thursday night – soon faded into a new normal, impossible to sustain even though many of the realities have barely changed.

The pandemic has underlined the extent to which digital interaction is no substitute for the real thing. In some ways, I’m more in touch with people than ever thanks to the numerous WhatsApp groups that revived themselves into a constant source of company. But tapping away in a couple of group chats while absent-mindedly watching the latest Netflix offering doesn’t come close to the wonderful feeling of hugging a friend, or spending three hours giving someone you haven’t seen for ages your undivided attention over a meal, or of having a conversation based not just on words but physical cues. I doubt the pandemic will seed a long-term distaste for crowds; if anything, I suspect that, if all goes well with the vaccine rollout, summer 2021 will see a crop of riotous street parties and carnivals.

But a return to life as usual will not mask the emotional toll Covid will have had on so many people. People who suffer from anxiety and depression; women in abusive relationships ; children experiencing abuse or neglect at the hands of their parents: they have had it the worst, and their experiences of isolation and loneliness during lockdown could have consequences for their personal relationships that will not magically disappear with a vaccine.

And that is before you factor in the added strain of the intense financial hardship so many are being forced to endure. As a society, recovering from Covid is about much more than antibodies: it cannot happen without support for those who have experienced its worst financial and mental health impacts. Sonia Sodha, the Observer’s chief leader writer

Britain has had an uncomfortable year in its battle to contain Covid. Failures to test, trace and isolate infected individuals allowed grim numbers of deaths to accumulate while deficiencies in the acquisition of stocks of Personal Protection Equipment (PPE) left countless health workers exposed to danger and illness. However, these deficiencies have been balanced by the manner and striking speed with which our scientists have turned away from existing projects in order to focus their attentions on ridding us of Covid. Their work has earned global praise for its swiftness and precision.

“The Brits are on course to save the world,” wrote leading US economist Tyler Cowen in Bloomberg Opinion about our scientists efforts last summer while the journal Science quoted leading international researchers who have heaped praise on British anti-Covid work. Science in the UK is perceived, correctly, to have done well in facing up to the pandemic.

A perfect example is provided by the UK’s Recovery trial, a drug-testing programme involving more than 3,000 doctors and nurses who worked with more than 12,000 Covid patients in hundreds of hospitals across the nation – from the Western Isles to Truro and from Derry to King’s Lynn. Set up within a few days of the pandemic reaching the UK, and carried out in intensive care units crammed with seriously ill people, Recovery revealed that one cheap inflammation treatment could save the lives of seriously ill Covid patients while two much-touted therapies were shown to be useless at tackling the disease.

No other country has come close to matching these achievements. “We had the people with the right skills and a willingness to drop everything else and contribute to the effort,” says one of Recovery’s founders, Martin Landray of Oxford University. “That made all the difference.” In a nation which had only recently reviled, openly, the concept of expertise, scientists like Landray have restored the reputation of the wise and the informed.

Fiona Fox, director of the Science Media Centre, also points to the willingness of our scientists to communicate. “Time after time, we have asked for comments from leading researchers, epidemiologists and vaccine experts on breaking Covid stories, and despite being inundated with work, they have taken the time to provide clear analyses that have helped to make sense of rapidly changing developments,” she says. “It has been extraordinary.”

And of course, the arrival of three effective vaccines against a disease that was unknown less than a year ago has only further enhanced the image of the scientist. Yes, they may be a bit geeky sometimes, but they have done a lot to help us win the battle against Covid. Robin McKie, Observer Science Editor

The more things change, the more they stay the same.

It may not feel like it at the moment, admittedly. But if this pandemic echoes other defining events in our recent history, from the 9/11 terror attacks to the 2008-09 banking crash, it will leave the political landscape utterly transformed in some respects yet wearily familiar in others.

Last week’s spending review , spelling out how the cost of battling Covid will shape national life for years to come, was a classic example. A public sector pay freeze, plus benefit cuts next April? Well, we’ve been there before; to many families it will feel like austerity all over again.

What’s different this time, however, is that Boris Johnson insists there’ll be no return to austerity-style spending cuts. Instead, taxes will rise. If he actually goes through with threats to target second-home owners or higher earners’ pensions, expect some mutiny in Tory ranks. (The bitter joke among Tory MPs is that they’re implementing more of Jeremy Corbyn’s manifesto than Corbyn ever will.) But the door to a long overdue debate about taxing wealth, as well as income, is at least now open.

The pandemic also seems to be changing what people look for in a leader. The last recession pushed angry, despairing voters towards populists with easy answers; make America great again, take back control. But Covid has been a brutal reminder that in life-and-death situations, competence is everything. Joe Biden isn’t wildly exciting but at least he doesn’t speculate aloud about the merits of drinking bleach. From New Zealand’s Jacinda Ardern to Germany’s Angela Merkel and Scotland’s Nicola Sturgeon, the leaders whose reputations have been enhanced by this crisis tend to be pragmatists and consensus-seekers, not excitable culture warriors. Keir Starmer’s rising poll ratings suggest a hunger for steady-as-she-goes leadership in Britain too.

Optimists will hope that this collective near-death experience brings a renewed political focus on what actually makes life worth living, from supportive communities to the beauty of a natural world that sustained many through lockdown. Pessimists, however, will worry that calls to “build back better”, or reset society along fairer and greener lines, could be an early casualty of a hard recession that leaves people focussed purely on economic survival.

For it would be naive not to expect a backlash against all of this. Nigel Farage is already trying to whip one up via his new anti-lockdown party , targeting voters angry at having freedoms curtailed. But if the last crash unleashed an era of radicalism and revolt, it’s not impossible this one will leave people craving a quiet life. After such turmoil, don’t underestimate the longing to get back to normal, even if the normal we once knew is gone. Gaby Hinsliff, Guardian columnist

We know that the spaces from which “culture” emerges won’t look the same after 2020 as they did before. Many theatres, bookshops, music venues and galleries won’t survive the catastrophe of shutdown, and if they do emerge it will be with diminished resources. But what about the attitude and the focus of creativity. Will it be shadowed by the pandemic post-vaccine or will it celebrate liberation?

History suggests both. The terrible mortality, social distancing and economic hardship resulting from the 1918-19 Spanish flu epidemic that followed the war were shaping forces in both the doom-laden experiments of modernism and the high hedonism of the jazz age. The Waste Land and the Charleston emerged within months of each other. TS Eliot wrote much of the former while suffering from the after-effects of the influenza, haunted, as his wife Vivienne noted, by the fear that as a result of the virus, “his mind is not acting as it used to do”. Certainly, that poem’s most memorable lines, with their stress on the mass gathering, read more pointedly from our current vantage point: “Under the brown fog of a winter dawn,/ A crowd flowed over London Bridge, so many,/ I had not thought death had undone so many./ Sighs, short and infrequent, were exhaled,/ And each man fixed his eyes before his feet.”

But, contrarily, the spirit of the post-pandemic age was equally alive in the bathtub-gin excitement of the Cotton Club, and the rarefied decadence of the Bright Young Things: raucous celebrations of seize-the-day freedoms after the misery of war and virus.

Not much literature or music that directly responds to the current pandemic has yet emerged. Zadie Smith’s brief book of essays , Intimations , hazarded something of what that response might look and sound like. In a memorable phrase, she described the events of this year as “the global humbling”. That moment when we collectively realised that the confident certainties of what we used to call “normal life” were only ever a heartbeat away from unknown threats – and that the US, Smith’s adopted home, having led the world in many things, was now leading the world in death.

Will such experience engender a new and deepening age of anxiety in the books we read and the films we watch? No doubt that apprehension of apocalypse, of environmental emergency, that draws us to The Road or to Chernobyl will become more insistent. But as Eliot also noted, humankind “cannot bear very much reality”. After this year in which the young have been denied so many of their rites of passage – chances to sing, dance, drink or love – we can surely hope for a post-viral creative outpouring of all those things that make us most happy to be alive. Tim Adams, Observer writer

”Imagine there’s no commuting, it’s easy if you try”, is a popular refrain in discussions of the post-Covid world of work predicting the imminent demise of the office. Sometimes it’s combined with the claim that low-earning hospitality and leisure jobs that have dried up mid-pandemic won’t be coming back and so shouldn’t get support now.

These different predictions are likely to be wrong for the same reason: they pay too much attention to crystal balls, and not enough to rear-view mirrors. Yes, the pandemic itself has meant big changes to the world of work. It has changed where some people (generally higher earners) work while hitting the ability of many lower earners to work at all. But imagining a world without lockdowns is best done by focusing on those pandemic-driven trends that reinforce, rather than run against, patterns visible pre-crisis .

So, expect the pandemic’s turbo-charging of retail’s online shift (with Arcadia’s likely administration the latest example) to continue – there will be fewer cashiers and more delivery drivers. But don’t believe the hype on the decline of hospitality and leisure. Workers in those sectors are twice as likely to have lost their jobs or been furloughed as the pandemic has left us spending more on buying things than going out, but the long-term trend is the opposite: hotels and restaurants accounted for a fifth of the pre-pandemic employment surge.

Working from home (or living in the office, as it can feel like) has been the big change for professional Britain. But history warns against the idea that the office is finished. Only one in 20 of us worked entirely remotely pre-crisis. But three times that number worked at home at least one day a week, a trend that was rapidly growing. Hybrid home/office working is the future. But be careful about assuming this transforms Britain’s disgracefully big economic gaps: some will benefit from more choice about where to live but offices in poorer areas, rather than those in central London, may be the ones that end up empty. And remember, we’re only talking about a fraction of the workforce here. Post-Covid, waiters and cleaners won’t be doing their jobs from their spare room or kitchen table.

As well as predicting the future, we should be trying to shape it. Higher pay and more security for the low paid workers who faced the biggest health and economic risks from this crisis would be a good place to start. Torsten Bell, chief executive of the Resolution Foundation

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What Do You Miss Most About Your Life Before the Pandemic?

Are there moments of “normalcy” that you feel nostalgic for? Is there anything from life a few months ago that you took for granted?

By Shannon Doyne

Find all our Student Opinion questions here.

In “ When Life Felt Normal: Your Pre-Pandemic Moments ,” Hannah Wise writes:

Our lives have been forever changed by the coronavirus pandemic. Hundreds of thousands of people around the world have died. Millions in the United States alone have lost their jobs. Though the coronavirus outbreak was declared a pandemic just over a month ago, many of us are already feeling nostalgic for our lives before the virus went global.

What do you miss most about your life before the pandemic?

For a little inspiration, watch the short compilation above created from videos taken before the coronavirus crisis.

Then read the rest of the article’s introduction:

We asked you to send us photos and videos that captured those moments of normalcy. We received nearly 700 submissions from all over the world — from Wuhan, China, to Paris, Milan to Mumbai, and across the United States. You shared photos from weddings, funerals, meals with friends, and powerful scenes from crowded places that feel almost unthinkable now. Nearly every submission expressed a sense of gratitude and appreciation for the time before the pandemic. Many also conveyed worry and a longing to feel a sense of safety and normalcy again.

Gigi Silla submitted the photo below of her friends on the “very last day of high school together.”

She writes:

I took this picture of my friends on March 13, on what ended up being our very last day of high school together. We were sitting outside on the soccer field during our lunch period having what would be our last in-person conversation together. Life certainly didn’t feel normal then (what does “normal” even mean these days?), but I definitely hadn’t fully processed the scale and emotional toll we were about to go through. This photo was taken less than 24 hours after we were told that our school would be closed in April. We had no idea it would last this long. I’m incredibly grateful we had this day to grieve the ending of our senior year together. One of the most difficult parts of quarantine recently has been coming to terms with the fact that our transition out of high school will not be marked by the usual traditions of prom and graduation. The school is working on finding alternatives, but they will likely feel less satisfying. Nevertheless, I am thankful we had this day together to process and say goodbye and clean out our lockers. We did in one afternoon what we thought we’d have three months for, and although it was less than ideal, I’m grateful we even had that afternoon.

Jeremy Wallace submitted the video below, recorded in a Brooklyn subway station after a Celine Dion concert.

Mr. Wallace writes:

After the Celine Dion concert in Brooklyn the trains were delayed. Instead of a mob of angry, frustrated people, we experienced a classic New York subway moment. Stuck in a confined space with a large group of people, the joyous concertgoers locked arms and started singing their favorite Celine Dion songs at the top of their lungs. There is only one way you can live in New York, and it is together. That togetherness is captured in this moment and reminds me that the concept of “stranger” has a different meaning here. I wonder if in a post-Covid19 world, if we would be so bold to embrace the arms of a stranger and sway together, sharing our breath by singing in unison — the close moments when New York’s tapestry of different cultures, languages and skin tones are molded into a special kinship. I sure hope so.

Students, read the entire article and look carefully at the images. Then tell us:

Reflect on your life before the pandemic struck. What do you miss most?

Do any moments stand out to you? Do you have any videos or photos that you could have submitted for Ms. Wise’s article?

What image or sentiment from the article resonates most with you? Which submission do you appreciate most? Why?

Jeremy Wallace writes, “There is only one way you can live in New York, and it is together.” Do you feel the same way about the place you live? If not, how would you rewrite that sentence in a way that tells the truth about where you are from or about your current living situation?

Some readers in the article express regret, or that they had taken things for granted before the global crisis. Is there anything from your pre-pandemic life that you feel you took for granted? Are there things that you might appreciate more after the pandemic ends?

Students 13 and older are invited to comment. All comments are moderated by the Learning Network staff, but please keep in mind that once your comment is accepted, it will be made public.

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Open Access

Peer-reviewed

Research Article

Impact of COVID-19 on health-related quality of life in the general population: A systematic review and meta-analysis

Roles Conceptualization, Data curation, Formal analysis, Methodology, Supervision, Writing – original draft

* E-mail: [email protected]

Affiliations Departement of Research & Innovation, Mont Kenya University, Thika, Kenya, Department of Health Systems Management, School of Health Sciences, Nairobi Campus, Kenya Methodist University (KeMU), Meru, Kenya, College of Doctoral Studies, Grand Canyon University, Phoenix, Arizona, United States of America

Roles Conceptualization, Data curation, Methodology, Writing – review & editing

Affiliation Department of Community Health & Behavioral Sciences, School of Medicine, Masinde Muliro University of Science & Technology, Kakamega, Kenya

Roles Data curation, Methodology, Writing – review & editing

Affiliation Departement of Research & Innovation, Mont Kenya University, Thika, Kenya

Roles Formal analysis, Methodology, Writing – review & editing

Roles Methodology, Writing – review & editing

Affiliation Department of Environmental Health, Colleges of Health Sciences, Jumeira University, Dubai, The United Arab Emirates

Affiliation Department of Dermatology, International Hospital Kampala, Kampala, Uganda

• Desire Aime Nshimirimana, 
• Donald Kokonya, 
• Jesse Gitaka, 
• Bernard Wesonga, 
• Japheth Nzioki Mativo, 
• Jean Marie Vianey Rukanikigitero

• Published: October 26, 2023
• https://doi.org/10.1371/journal.pgph.0002137
• Peer Review
• Reader Comments

The World Health Organization declared coronavirus disease of 2019 as an epidemic and public health emergency of international concern on January 30 th , 2020. Different factors during a pandemic can contribute to low quality of life in the general population. Quality of life is considered multidimensional and subjective and is assessed by using patient reported outcome measures. The aim and objective of this review is to assess the impact of coronavirus disease of 2019 and associated factors on the Quality of Life in the general population. This review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A protocol was registered in the international Prospective Register of Systematic Reviews database(CRD42021269897). A comprehensive electronic search in PubMed, EBSCO Host Research Databases, MEDLINE and Google scholar search engine was conducted. A total number of 1,7000,074 articles were identified from electronic search. 25 full text articles were retained for qualitative synthesis and seventeen articles for quantitative analysis. Seven main quality of life scales were used to assess the quality of life of the general population; World Health Organization Quality of Life-bref, EuroQuality of Life-Five dimensions, Short Form, European Quality of Life Survey, coronavirus disease of 2019 Quality of Life, General Health Questionnaire12 and My Life Today Questionnaire. The mean World Health Organization Quality of Life-brief was found to be 53.38% 95% confidence interval [38.50–68.27] and EuroQuality of Life-Five dimensions was 0.89 95% confidence interval [0.69–1.07]. Several factors have been linked to the Coronavirus disease of 2019 such as sociodemographic factors, peoples living with chronic diseases, confinement and financial constraints. This review confirms that the Coronavirus disease of 2019 pandemic affected the quality of life of the general population worldwide. Several factors such as sociodemographic, peoples living with chronic diseases, confinement and financial constraints affected the quality of life.

Citation: Nshimirimana DA, Kokonya D, Gitaka J, Wesonga B, Mativo JN, Rukanikigitero JMV (2023) Impact of COVID-19 on health-related quality of life in the general population: A systematic review and meta-analysis. PLOS Glob Public Health 3(10): e0002137. https://doi.org/10.1371/journal.pgph.0002137

Editor: Anil Gumber, Sheffield Hallam University, UNITED KINGDOM

Received: April 21, 2023; Accepted: October 3, 2023; Published: October 26, 2023

Copyright: © 2023 Nshimirimana et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: A protocol was registered in the international Prospective Register of Systematic Reviews database (PROSPERO) registration number (CRD42021269897).

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

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

The World Health Organization (WHO) declared coronavirus disease of 2019 (COVID-19) an epidemic and public health emergency of international concern on January 30 th , 2020. The virus is known to have originated from Wuhan City, Hubei Province, China in December 2019. COVID-19 drew global attention due to rapid increase in the numbers reported both in China and internationally within shortest period [ 1 ]. By February 20 th , 2020, the number of contaminated COVID-19 cases in China reached a cumulative total of 75,465 cases and it had already spread to more than 25 countries among them Germany, Italy, France, Japan, Malaysia, Singapore, South Korea, Spain, Thailand, Vietnam, the United Arab Emirates, the United Kingdom (UK), the United States of America (USA) and Africa [ 2 ]. According to WHO (2021), a total of 190,597,409 confirmed cases of COVID-19, among them 4,093,145 deaths and only 3,430,051,539 vaccine doses have already been administered worldwide by 18 th July 2021. Psychological conditions such as depression, anxiety and stress can contribute to the deterioration of quality of life (QoL) of populations. A Spanish study assessed the impact of COVID-19 on mental health and find that the most prevalent mental disorders were anxiety, sleep and affective disorders as well as depression with a considerable increase in suicidal behavior among women and men over 70 years old [ 3 ]. A national study in France reported a burnout of 55% during COVID-19 pandemic and he also find out that there was a strong link between the severity of the burnout syndrome, QoL and the impact of COVID-19 pandemic [ 2 , 4 ]. Health related quality of life (HRQoL) is considered multidimensional and subjective and is assessed by patients using patient reported outcome measures (PROMs). According to WHO, HRQoL is defined as the general perception of individuals of their position in life (i) considering, the culture and value systems and (ii) in relation to expectations, goals, standards, and concerns [ 4 ]. HRQoL considers a wide-ranging concept influenced in a complex and interconnected manner by the psychological state, physical health, personal beliefs, social relationships and relationship to prominent features of the environment [ 5 ]. A systematic review discussed the impact of COVID-19 on the HRQoL on children and adolescents. Their results showed that lockdown significantly affected QoL, happiness and optimism (p < 0.001), as well as perceived stress. In their findings, the authors reported that only 15.3% (n = 146) of children and adolescents had low QoL before COVID-19 outbreak and during the pandemic, 40.2% of them reported low QoL [ 6 ]. A study conducted in the Kingdom of Saudi Arabia [ 7 ] assessed the QoL during COVID-19 in the general population and reported that being male (OR = 1.96; 95% CI = [1.31–2.94]), aged between 26 to 35 years (OR = 5.1; 95% CI = [1.33–19.37]), non-Saudi participants (OR = 1.69; 95% CI = [1.06–2.57]), individuals with chronic diseases (OR = 2.15; 95% CI = [1.33–3.48]), loss of job (OR = 2.18; 95% CI = [1.04–4.57]) and participants with depression (OR = 5.70; 95% CI = [3.59–9.05]), anxiety (OR = 5.47; 95% CI = [3.38–8.84]) and stress (OR = 6.55; 95% CI = [4.01–10.70]) were at a high risk of having lower levels of QoL during COVID-19 pandemic and lockdown period [ 7 ]. Swedish authors assessed the changes of QoL of the Swedish population using data of February and April 2020 and reported that on visual analogue scale (VAS), the mean QoL reduced from 77.1(SD:17.7) in February to 68.7(SD:68.7) in April 2020, a reduction of 8.4% pre and post pandemic measurements (P<0.000) [ 8 ]. In 2021, authors compared the QoL of Brazilian dietitians before (3.83 ± 0.59) and during COVID-19 pandemic (3.36 ± 0.66) and find that the results were statistically different [ 9 ]. To the best of our knowledge, this is one of the first systematic reviews to assess the impact of COVID-19 on HRQoL in the general population. The aim and objective of this systematic review is to assess the impact of COVID-19 and associated factors to Health Related Quality of Life in the general population.

Design and protocol

This systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)( Fig 1 ) [ 10 ]. A protocol was registered in the international Prospective Register of Systematic Reviews database (PROSPERO) with the registration number CRD42021269897.

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https://doi.org/10.1371/journal.pgph.0002137.g001

Eligibility

Articles were included if they were (i) primary and empirical, quantitative, cross-sectional, cohort, case-control, peer reviewed, assessing effects of COVID-19 on the quality of life during COVID-19 in the general population, utilized validated scales for measurement, published in English language from inception to June 30 th , 2022. Articles were excluded if (ii) focusing on subgroups of populations such as health care workers, population with previous mental health, population with cancer, HIV or any other chronic disease, utilized secondary data and non-empirical, non-peer review, review articles such as scoping, narrative or Systematic reviews, papers on Medrxiv and SSRN server, comments, letters, conference abstracts, books and book chapters, articles not assessing the quality of life, papers on the population with previous mental health or papers not assessing quality of life in the general population during COVID-19 pandemic. There was no limit on the number of papers to synthetize. All articles satisfied the eligibility criteria were included. Grey literature was used only to support the background section of the research ( Table 1 ).

https://doi.org/10.1371/journal.pgph.0002137.t001

Search strategy and selection

A comprehensive electronic search in the PubMed, EBSCO Host Research Databases (Academic Research Complete), MEDLINE (OVID) and Google scholar search engine was conducted from January 5 th , 2022 to February 28 th , 2022 and updated on June 30 th , 2022. The search strategy and data extraction were designed by DAN, DK and JG using Medical Subject Headings (MeSH), field tags and relevant keywords related to quality of life, COVID-19 and general population. Boolean operators, thesaurus, truncation, nesting and quotation marks were used to strengthen the search. The full search strategy was provided in supplementary documents. Additional search of the references from retrieved systematic reviews through snow balling was performed. All retrieved papers were downloaded and saved to Mendeley for intext citations and referencing. The following was used as search string for PubMed; “("Quality of Life"[Mesh] OR “quality of life” [tw] OR “Health-related Quality of Life” [tw] OR HRQoL[tw]) AND ("COVID-19"[Mesh] OR COVID-19[tw] OR “SARS-CoV-2” [tw] OR Sars-cov-2[tw] OR Coronavirus[tw] OR SARS OR “Coronavirus disease 2019” [tw] OR “severe acute respiratory syndrome coronavirus 2” [tw] OR “2019-nCoV Infection” [tw] OR 2019-nCoV[tw] OR “COVID-19 Virus Disease” [tw]) AND (Population[Mesh] OR “general population”[tw] OR “general public”[tw] OR public[tw] OR communit*[tw]).

Data extraction technique

A standardized data collection tool to extract relevant information from papers was designed. The following data was collected; authors, country of publication, study design, sample size, demographic characteristics, HRQoL before COVID-19, HRQoL during COVID-19, QoL measurement tool, statistical tests and risk factors as well as their odds ratios (OR). Data was extracted by two authors (DAN & BW) and verified by the second author (JNM). Discrepancies were resolved by the 3 rd author (JG).

Quality appraisal

Two authors (DAN and JG) independently assessed the quality of the included papers using a modified Newcastle-Ottawa Scale (NOS) modified for cross-sectional studies. The quality criteria used in cross-sectional studies were: sample representation, sample size, response rate and validated measurement tools with appropriate cut-off points and the control of confounding variables or use of multiple regression. The quality score ranged between 0 and 5 and any study scoring > or = 3 was considered as high and any study scoring < 3 was considered to be at low quality.

Main outcome

Health related quality of life (HRQoL).

Measures of effect

Health related quality of life measurements such as means of EQ5D and WHOQoL-BREF and their standard deviations were calculated.

Heterogeneity and risk of bias assessment of included studies

Qualitative synthesis and quantitative analysis

Data was summarized following the “Institute of Medicine committee on the standards for systematic reviews of comparative effectiveness research: Finding out what works in health care; standards for systematic reviews: recommended standards for qualitative synthesis” [ 19 ] and the key characteristics of included studies if similar were grouped, synthetized qualitatively and discussed in order to draw conclusions. The mean effect size was performed and pooled for both EQ5D and WHOQoL_BREF using Random effect model. In meta-analysis, they are two classes of models; fixed and random effect models. For fixed-effect model, all studies are assumed that population effect sizes are the same and are appropriate for drawing inferences on the studies included in the meta-analysis whereas random-effect model attempt to generalize the findings beyond included studies and assume that the selected studies are random samples from a larger population. According to Dettori et al. (2022), the observed effect size is a combination of the study-specific effect and the sampling error [ 20 ]. The model is: Yi = B random+Ui+ei, where B random is the average of the true effect sizes, Ui addition of random effect, ei = error. Homogeneity of effect sizes, that is τ2 = 0 can be tested by chi-square statistic which is Q statistic. The τ2 can be used to estimate the degree of heterogeneity. τ2 also depends on the type of effect size used and the common one is I2. I2 is interpreted as the proportion of between-study heterogeneity to the total variation (between–study heterogeneity plus sampling error). When I2 is negative, it is truncated to zero. I2 of 25, 50 and 75% is considered low, moderate and high heterogeneity respectively as a rule of thumb [ 21 ]. When conducting a random effect model, it is required to estimate the amount of heterogeneity. The most widely used heterogeneity estimator in medical science is DerSimonian and Laid. Other estimators such as maximum likelihood and restricted maximum likelihood may also be used.

A total number of 1,700,074 articles were identified from electronic databases on PubMed (1,334,241), Medline (OVID) (365,401), EBSCO (Host Research Databases (Academic Research Complete)) (425) and manual search with Google scholar search engine (5). 121,211 duplicates and 1,578,317 papers not related to quality of life were removed and 546 papers were retained. 461 full text papers and abstracts were removed to retain 85 full articles for screening. Finally, 25 full text articles were included for quality synthesis. 8 full articles were excluded because there were no papers with similar instruments to compare and 17 studies were included for quantitative analysis (PRISMA) ( Fig 1 ).

Characteristics of included studies

The total sample size of included studies was N = 22,967 participants and ranges from 225 to 3,002 participants per study. The majority (64.85%) were female (n = 14,894). 3 studies were done in China [ 22 – 24 ], 2 Morocco [ 25 , 26 ], 2 Vietnam [ 27 , 28 ], 2 Italy [ 29 , 30 ], 1 Saudi Arabia [ 7 ], 1 Malaysia [ 31 , 32 ], 1 Jordan [ 33 ], 1 Philippines [ 34 ], 1 Hong Kong [ 35 ], 1 Portugal [ 36 ], 1 Israel [ 37 ], 1 Spain [ 38 ], 1 Brazil [ 39 ], 1 Scotland [ 40 ], 1 USA [ 41 ], 1 Egypt [ 42 ], 1 study done in two countries Belgium and Netherlands [ 43 ] and one in Africa, North America, Asia, Australia, Europe, South America [ 44 ]. Nine articles used the WHOQoL-BREF tool to measure the quality of life in their respective countries [ 7 , 30 – 33 , 35 , 37 , 39 , 41 ], six papers utilized the EQ-5D [ 22 , 25 , 27 , 28 , 36 , 43 ], three used SF12/SF-8/ SF36 [ 24 , 26 , 38 ], one utilized EQLS [ 40 ], one used GH12 [ 29 ], one utilized the COVID-19 QoL questionnaire [ 44 ], on used the COVID-19 (COV19- Impact on the quality of life (COV19-QoL) scale) [ 42 ] and one utilized MLT [ 34 ]. The majority of the studies (n = 23) were of cross-sectional design and only one [ 40 ] was of a mixed method. Nine studies utilized the WHOQoL-BREF [ 7 , 30 – 33 , 35 , 37 , 39 , 41 ], nine utilized the EQ-5D [ 22 , 25 , 27 , 28 , 36 , 40 , 43 ] among them two studies compared and reported QoL scores before and during COVID-19 [ 25 , 36 ], three articles utilized the SF12/SF-8/SF36 [ 24 , 26 , 38 ] one article utilized EQLS [ 40 ], one paper used GH12 [ 29 ]. Another one assessed the HRQoL using COVID-19 QoL questionnaire [ 44 ] and one article used MLT [ 34 ] to assess HRQoL in general population ( Table 2 ).

https://doi.org/10.1371/journal.pgph.0002137.t002

Measurement tools

The most used instruments in this study (WHOoQoL and EQ5D) are explained below and a brief description of their normal values for unaffected populations are given at the beginning of each reported instrument. Eight (n = 8) scales have been used to assess health related quality of life on the general population worldwide during COVID-19. EQ-5D: Euro_QoL-Five dimensions; is a preference and generic quality of life instrument to valuate and describe health related quality of life; the higher the index, the better the health. It describes health in terms of five dimensions; mobility, self-care, usual activities, pain/discomfort and anxiety/depression [ 45 ]. A utility score can be generated from the five dimensions based on a published algorithm with a value of 0 for death and 1 for perfect health. WHO_OoL-BREF: the WHO_BREF is a 26-item instrument with four domains: physical health (7 items), psychological health (6 items), social relationships (3 items), and environmental health (8 items) [ 46 ]. It is scored from 1 to 5 on a response scale but transformed linearly to a 0 to 100 scale. 0 point represent the worse possible health state while 100 points represent the best possible health state. SF12: Short form are generic health survey short-forms (don’t use preference based approach) to assess quality of life which are used in research and clinical practice, health policy and general surveys [ 47 ]. EQLS: European Quality of Life Survey is a 2012 scale which considers the following dimensions; employment and work-life balance, family and social life, health and public services, home and local environment, quality of society, social exclusion and community involvement, standard of living and deprivation, subjective well-being which is designed for the general population[ 48 ]. GHQ: General Health Questionnaire is a measure of current mental health and since its development by Goldberg in the 1970s it has been extensively used in different settings and different cultures [ 49 ]. COV19-QoL is a 6-item scale covering main areas of quality of life in relation to mental health. The first item covers patients’ feelings about the impact of the current pandemic on their quality of life in general population. The second and third include the participants’ perceptions of possible mental and physical health deterioration. COV19-QoL scale is a recently developed specific reliable and valid tool assessing perceptions of deterioration in QoL as a result of the COVID-19 pandemic [ 42 ]. MLT: My Life Today the 9-tem (4) scale was used to measure the participants’ perceptions of various life domains, including the assessment of life in general population [ 34 ].

Quality of life before and during COVID-19

Among 25 articles reporting changes in QoL, 23 reported the mean QoL only during COVID-19 and did not report the QoL before COVID-19. Nine papers [ 22 , 25 , 27 , 28 , 36 , 40 , 43 ] utilized EQ5D among them only two reported both QoL before COVID-19 as compared to that of during COVID-19 [ 25 , 36 ] using EQ5D instrument. Azizi et al. (2020) in Morocco reported an EQ5D mean score before COVID-19 of 0.91(SD: NR) and 0.86 (SD: NR) during the pandemic. This makes a drop of 0.05 on QoL. Ferreira et al. (2021) in Portugal also reported an EQ5D mean score before COVID-19 of 0.887 (SD: NR) and 0.861 (SD: NR) during COVID-19 making a drop of 0.026 of QoL. Using EQ5D, the minimum score reported during COVID-19 was 0.79 (SD: 0.17–1.41) and a maximum of 0.95 (SD:.14–1.76) with a mean score 0.89 (SD: 0.66–1.13). Among papers reporting QoL using WHOQoL, no study reported both scores (before and after) and the WHOQoL minimum score reported during COVID-19 was 13.20 (SD: 9.85, 16.55) with a maximum of 73.50 (SD:66.14, 80.86). The mean reported was 53.38 (SD:38.50, 68.27). The lower the score, the lower the QoL. The rest of quality of life instruments were used at least once making it not practical to report their means for a comparison.

Forest plot WHO_BREF

Study1 [ 7 ], study2 [ 31 ], Study3 [ 33 ], Study4 [ 35 ], Study5 [ 7 ], Study6 [ 37 ], Study 7 [ 32 ], Study8 [ 41 ], study 9 [ 50 ]. The mean health related quality of life using WHOQoL_BREF is estimated at 53.38.

https://doi.org/10.1371/journal.pgph.0002137.g002

Forest plot EQ5D

Study 1 [ 25 ], Study2 [ 43 ], Study3 [ 43 ], Study4 [ 22 ], Study5 [ 36 ], Study6 [ 23 ], Study7 [ 27 ], Study8 [ 28 ].

https://doi.org/10.1371/journal.pgph.0002137.g003

Heterogeneity and risk of bias of WHO-BREF studies

A funnel plot of the estimates is shown in ( Fig 4 ). The regression test indicated funnel plot asymmetry ( p = 0.0019) but not the rank correlation test ( p = 0.1194) ( Fig 4 ).

Study1 [ 7 ], study2 [ 31 ], Study3 [ 33 ], Study4 [ 35 ], Study5 [ 7 ], Study6 [ 37 ], Study 7 [ 32 ], Study8 [ 41 ], study 9 [ 50 ].

https://doi.org/10.1371/journal.pgph.0002137.g004

Heterogeneity and risk of bias of EQ5D studies

https://doi.org/10.1371/journal.pgph.0002137.g005

Quality assessment

We used the Modified Newcastle-Ottawa quality assessment scale tool to assess the quality of included papers and only 3 papers scored five out five (5/5) [ 29 , 36 , 39 ]. Ten papers scored four out of five (4/5) [ 7 , 22 , 23 , 30 , 31 , 33 , 35 , 38 , 42 , 44 ]. Eight studies scored three out five (3/5) [ 24 , 27 , 28 , 32 , 34 , 38 , 43 ]. Only three papers [ 25 , 26 , 40 ] scored 2 out five making it the lowest score and therefore low quality. We included the three low quality articles in the qualitative synthesis however only one low quality paper [ 25 ] was included in the quantitative analysis (meta-analysis) because it was lying within two standard deviations of the mean therefore it was not affecting the results ( Table 3 ).

https://doi.org/10.1371/journal.pgph.0002137.t003

Quality of life and factors associated to the low HRQoL

Eight studies [ 22 , 25 , 27 , 28 , 36 , 40 , 43 ] have used the EQ-5D to assess the quality of life for the general population during COVID-19 pandemic. The mean score using EQ-5D estimated at 0.89 [95% CI 0.66–1.13]. By using EQ-5D, authors [ 25 ] reported the results (before and during confinement) that the quality of life was affected in the five health dimensions; mobility 87%(87%), self-care 97%(93%), usual activities 82%(89%), pain/discomfort 70%(78%) and anxiety/depression 44%(66%). His comparison on the two samples showed that during confinement, peoples had lower scores of HRQoL at 0.86 (p<0.001) as compared to before confinement whose score was 0.91 [ 25 ]. Female gender was affected with lower scores of HRQoL than their counterpart male on both utility (0.85; P = <0.0001 and VAS (78.49; P = 0.004) and (utility = 0.89 and VAS = 83.78) respectively. Marital status was significantly associated to EQ-5D utility (P = 0.002) and VAS (P = 0.005) scores, widowed had the worst HRQoL (utility = 0.43 and VAS = 48.75) compared to single (utility = 0.87 and VAS = 80.09), married (utility = 0.86 and VAS = 81.43), and separated (utility = 0.89 and VAS = 80.15) participants. Participants with university education had the higher EQ-5D utility score (0.88; p<0.001) and age did not have a significant impact. A study done in Belgium and Netherlands also evaluated the quality of life using EQ5D as well, a minority in both countries felt stressed with 27% and 14% respectively [ 43 ]. The majority reported concerns about their personal current and future financial situation (59 and 48% respectively) and the national economies (88 and 86%). Specifically, in Belgium, the EQ-5D before COVID-19 measured 0.82 (95% CI; 0.80–0.84) and during COVID-19 measures 0.79 (95% CI; 0.77–0.81). In Netherlands, before COVID-19, 0.85 (95% CI; 0.83–87) and during COVID-19 outbreak, it was 0.84 (95% CI; 0.82–0.86). Chen et al. (2021), using EQ5D concluded that the mean EQ-5D score and VAS were 0.99 and 93.5. Their multiple linear regression showed that the quality of life measure was related to physical activities (β = 0.006) and keeping home ventilation (β = 0.063) in Daqing, and were related to wearing a mask when going out (β = 0.014), keeping home ventilation (β = 0.061), other marital status (β = − 0.011), worry about the epidemic (β = − 0.005) and having a centralized or home quarantine (β = − 0.005) in Taizhou [ 22 ]. Using EQ5D, authors concluded that those quarantined at home experienced higher levels of anxiety and a lower HRQoL compared with the pre-COVID-19 pandemic population. Females and elderly individuals experienced the highest levels of anxiety and poorest HRQoL (OR not reported) [ 36 ]. Other authors [ 23 ] using the same instrument EQ5D reported that the risk of pain/discomfort and anxiety/depression in general population in China raised significantly with aging, with chronic disease, lower income, epidemic effects, worried about get COVID-19 during the COVID-19 pandemic (OR not reported) [ 23 ]. Tran et al. (2020) With the same instrument EQ5D (n = 341) reported that 66.9% of household income loss was due to the impact of COVID-19. The mean score of EQ-5D and EQ-VAS was 0.95 (SD ± 0.07) and 88.2 (SD ± 11.0) respectively. The domain of Anxiety/Depression had the highest proportion of reporting any problems among 5 dimensions of EQ-5D (38.7%). Being female, having chronic conditions and living in the family with 3–5 members were associated with lower HRQOL score (OR not reported) [ 27 ]. Vu et al. (2020) using EQ5D reported the highest mean EQ-VAS at 90.5 (SD: 7.98) among people in government quarantine facilities, followed by 88.54 (SD: 12.24) among general population and 86.54 (SD 13.69) among people in self-isolation group [ 28 ]. The EQ-5D value was reported as the highest among general population at 0.95 (SD: 0.07), followed by 0.94 (SD: 0.12) among people in government quarantine facilities, and 0.93 (SD: 0.13) among people who put themselves in self-isolation. Overall, most people, at any level, reported having problems with anxiety and/or depression in all groups.

WHOQoL-BREF.

The WHOQoL average scores was estimated at 50.55% 95% CI [32.19–68.90]. Authors by using WHOQoL-BREF reported a quality of life affected with a score of 39% (CI not reported) and according to authors, males were more affected with OR = 1.96 (95% CI = 1.31–2.94); participants aged 26 to 35 years OR = 5.1; (95% CI = 1.33–19.37); non-Saudi participants OR = 1.69 (95% CI = 1.06–2.57); individuals with chronic diseases OR = 2.15 (95% CI = 1.33–3.48); those who lost their job OR = 2.18 (95% CI = 1.04–4.57) and those with depression OR = 5.70 (95% CI = 3.59–9.05), anxiety OR = 5.47; (95% CI = 3.38–8.84), and stress OR = 6.55 (95% CI = 4.01–10.70) [ 7 ].

In 2021, a study [ 31 ] concluded that higher psychological QoL reduced the odds of depressive symptoms OR = 0.83 (95% CI = 0.69–0.99, p = 0.032) and depressive with comorbid anxiety symptoms OR = 0.82, (95% CI = 0.68–0.98, p = 0.041), whereas higher physical health QoL OR = 0.85, (95% CI = 0.75–0.97, p = 0.021) and social relationship QoL OR = 0.70 (95% CI = 0.55–0.90, p = 0.009) reduced the odds of anxiety symptoms [ 31 ]. In 2020, a study [ 33 ] had reported a mean for total QoL score of 73.21 (SD ¼ 16.17). The mean general QoL and health scores were 3.15 (SD ¼ 0.94) and 3.40 (SD ¼ 0.95). As for the four QoL subscales, the mean scores in each domain were as follows: 18.04 (SD ¼ 4.39) for physical health, 17.65 (SD ¼ 3.77) for psychological health, 8.69 (SD ¼ 2.67) for social relationships, and 22.29 (SD ¼ 5.84) for environment(29). Choi et al (2021), using the same QoL scale reported that 69.6% of participants were worried about contracting COVID-19, and 41.4% frequently suspected themselves of being infected whereas 29.0% were concerned by the lack of disinfectants. All of these findings were associated with poorer HRQoL in the physical and psychological health, social relationships, and environment domains (OR not reported). 47.4% of participants were concerned that they may lose their job because of the pandemic and 39.4% were bothered by the insufficient supply of surgical masks [ 35 ]. The results of a study [ 30 ] showed statistically significant difference in QoL depending on a number of variables, including sex, area of residence in Italy, and being diagnosed with a medical/psychiatric condition (OR: NR). The overall average score at the WHOQoL-BREF was 54.48 (SD = 7.77). The item with the lowest scores was 14 (about the use of spare time), given that 932 (41.4%) participants reported to have little or no time for leisure at the time of data collection. Regarding the other three domains of the WHOQoL, items with lowest scores were: item 15 for the physical domain, as 1019 (45.3%) participants reported little or no possibility to do physical activity; item 5 for the psychological domain, with 712 (31.6%) respondents reporting that they were not enjoying their lives at the time of data collection, and item 21 for social relationships, as 843 (37.4%) respondents reported that they were little or not at all satisfied with their sexual life [ 30 ]. A research in 2021 [ 37 ] reported that COVID-19 has had a wide impact on the general population, with the potential for negative secondary impacts. Women, young adults, and the unemployed are at high risk for secondary effects (ORs:NR). Another study [ 39 ] scores on the social relationships QoL domain were lower among participants who had a family member or friend with COVID-19 and among those who engaged in negative forms of spiritual religious coping (SRC). The quarantine during the COVID-19 pandemic has limited personal contact with family and friends, adversely affected sexual activity, and has restricted other activities that are assessed in the social relationships QoL domain. Positive forms of spiritual religious coping (SRC) were associated with better scores on this domain, as reported in other studies [ 37 ]. In 2020, a study [ 32 ] highlighted that approximately one in three individual experienced mild-to-severe depressions during the nationwide movement control order (MCO). The results of a study [ 41 ] reported that most would expect quality of life to be challenged during a global pandemic; however, when behavioral health assessed as a component of overall quality of life, longer term outcomes became concerning [ 41 ].

SF12/SF-8/ SF36.

Samlani et al. (2020) by using SF 12/8 (Chinese) scale, all participants obtained a total average score of 70.60 (±13.1) with a mental health score (MCS) of 34.49 (±6.44) and a physical health score (PCS) of 36.10 (± 5.82). The physical (PCS) and mental (MCS) scores of participants with chronic diseases were 32.51 (±7.14) and 29.28 (±1.23), respectively. Overall, the participants’ PCS and MCS scores suffered from chronic diseases and the elderly participants were lower than those of young participants without comorbidities(23). López et al (2021) reported the following results using SF-36; the presence of pain in subjects undergoing confinement was persistent, with varying intensity and frequency based on age, gender, physical activity, and work status (OR:NR). In any of these conditions, the quality of life of the subjects in confinement has been severely affected [ 38 ]. Qi et al. 2020 using–SF8 (Chinese), participants’ average physical component summary score (PCS) and mental component summary score (MCS) for HRQoL were 75.3 (SD = 16.6) and 66.6 (SD = 19.3), respectively. More than half of participants (53.0%) reported moderate levels of stress. Significant correlations between physical activity participation, QoL, and levels of perceived stress were observed (p < 0.05). Prolonged sitting time was also found to have a negative effect on QoL (p < 0.05) [ 24 ].

Campbell & Davison (2022) by using EQLS found that there are strong relationships between QoL and income, disability and living arrangement as well as social isolation and Disability and living arrangement [ 40 ]. Correlation and multiple regression analyses showed a strong relationship between social isolation, gratitude, uncertainty and QoL with social isolation being a significant predictor (OR not reported).

Bonichini & Tremolada (2021) reported that the mean GH12 score in participants amounted to 17.86 (SD = 5.85), reflecting a contingent moderate stressful impact on QoL. GH12 identified 39% of respondents as having subclinical QoL scores (score ≥ 15). 24.5% of such respondents as having very problematic scores (score ≥ 19), and 36.5% of such respondents as having normal scores (score < 15). Analysis of variance (ANOVA) showed there was a significant difference (F(2, 1.836) = 5.50, p = 0.004, η 2 = 0.01) in mean GH12 scores [ 29 ].

COVID-19 QoL questionnaire.

The results of Khodami et al. (2022) showed that Quality of life is significantly decreased over time, perceived stress level raised significantly and an increased level of difficulty in emotion regulation has happened. Younger peoples and individuals who had a worsening quality of life response tended to show more stress and emotion regulation problems [ 44 ]. Mohsen et al. (2022) using COVID-19 on Quality of life scale reported that the total COV19-QoL scale score was 2.3±0.6. Two items show the highest mean with 2.6±0.7 (quality of life in general and perception of danger on their personal safety) indicating the poorest quality of life regarding these 2 items. However, the lowest mean score was related to the perception of mental health deterioration (1.9±0.8). Significant variables in the bivariate analysis revealed that sex (regression coefficient = 0.1 (95% CI(0.02 to 0.2), p value = 0.02), monthly income (regression coefficient (95% CI) = 0.1 (0.004 to 0.2), p value = 0.04), knowing someone infected with COVID19 (regression coefficient (95% CI) = 0.15 (0.08 to 0.3), p value = 0.001), and data collection time (regression coefficient (95% CI) = 0.1 (0.006 to 0.2), p value = 0.04) were the independent predictors for overall QoL scale score [ 42 ].

Aruta et al. (2022) by using MLT questionnaire, the results of the path analysis indicated a good data‐model fit: (χ 2 = 4.97, df = 2, p = 0.08; CFI = 0.99, TLI = 0.96, SRMR = 0.02, RMSEA [90% CI] = 0.06 [0.000 − 0.13]). The direct effects of safety at home (B = −0.27, β = −0.21, SE = 0.05, p ≤ 0.001), TPIs (B = −0.19, β = −0.27, SE = 0.05, p ≤ 0.001), and financial difficulties (B = 0.15, β = 0.18, SE = 0.05, p ≤ 0.001) on psychological distress were found to be significant. Direct effects of safety at home (B = 0.19, β = 0.22, SE = 0.05, p ≤ 0.001), TPIs (B = 0.18, β = 0.27, SE = 0.04, p ≤ 0.001), financial difficulties (B = −0.15, β = −0.21, SE = 0.05, p ≤ 0.001), and psychological distress (B = −0.29, β = −0.34, SE = 0.04, p ≤ 0.001) on quality of life were found to be significant. Results indicated that psychological distress partially mediated the positive influence of safety at home (B = 0.06, β = 0.07, SE = 0.02, p ≤ 0.001) and TPIs (B = 0.06, β = 0.09, SE = 0.02, p ≤ 0.001) on quality of life [ 34 ]. These findings indicate that psychological distress is a mechanism that can partly explain why socio‐ ecological factors (i.e., safety at home, financial difficulties, and trust in institutions) impact the quality of life of Filipino adults during COVID‐19.

Findings of included studies demonstrated how COVID-19 pandemic reduced the QoL of the general population. Different factors influenced directly or indirectly the change of QoL. Researchers utilized different quality of life measurement scales among them EQ-5D leading the pool of measurement scales followed by WHOQoL-BREF then SF12/SF-8/ SF36 as 3 rd scale and the rest. For studies that used EQ-5D to assess the impact of quality of life, all five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) were affected significantly with a mean EQ-5D score of 0.89 with 95% CI [-1.865–2.048] with the lowest score of 0.79 at 95% CI (NR) and upper score of 0.99 at 95% CI (NR) [ 25 ]. The mean WHOQoL-BREF score was estimated at 50.55 with a 95% CI [32.19, 68.90]. Other instruments such as SF12 scored 70.60 with 95% CI [57.5, 83.7], SF8 scored QoL at 75.3 with 95% CI [58.7, 91.9] and SF36 (score NR). In low and middle income countries (LMICs) such as Morocco [ 25 ] using EQ-5D reported low QoL during confinement as compared to before in the 5 health dimensions respectively; mobility 87%(87%), self-care 97%(93%), usual activities 82%(89%), pain/discomfort 70%(78%) and anxiety/depression 44%(66%) with average QoL at 0.91 (p<0.001) before and 0.86 (0.001) after confinement. Whereas in high income countries (HICs), Belgium for example using EQ-5D before COVID-19 QoL measured 0.82 (95% CI; 0.80–0.84) and during COVID-19 measures 0.79 (95% CI; 0.77–0.81), the same with Netherlands, before COVID-19 EQ-5D measured 0.85 (95% CI; 0.83–0.87) before and during COVID-19 0.84 (95% CI; 0.82–0.86). A research in China, using EQ5D concluded that the mean EQ-5D score and VAS were 0.99 before COVID-19 and 93.5 during COVID-19. When compared HICs and LMICs, both countries were affected significantly by COVID-19 and this was exacerbated by confinement [ 51 ]. These results are in line with those of a Chinese study with an average score EQ-5D of 0.949 and VAS score 85.52 [ 22 ]. Nine published papers assessed QoL using WHOQoL [ 7 , 30 – 33 , 35 , 37 , 39 , 41 ] and their mean score was 50.55% with 95% CI [32.19–68.90]. The lower the score, the lower the quality of life. On the other hand, using EQ-5D, the mean score was estimated at 0.89 with 95% CI [0.66–1.13] with the same trend, the lower the score, the lower the quality of life. Our study findings are different from those published in Vietnam that reported EQ5D score 0.95 (SD = NR.) during the national social distancing, against our results (mean EQ5D = 0.89) [ 27 ]. This might be because it is an empirical study while our study summarizes results from a variety of studies making our mean score low. Our main findings rely most on EQ5D and WHOQoL instrument reports. Although, we assessed QoL of the general population during COVID-19 (Mean EQ5D = 0.89), some authors assessed the impact of some chronic diseases on QoL of the general population such as type 2 diabetes [ 52 ] (EQ5D = 0.8 SD = 0.20), human immunodeficiency virus (HIV) [ 53 ] (EQ5D = 0.8 SD = 0.2), skin disease [ 54 ] (EQ5D = 0.73 SD = 0.19), respiratory diseases (EQ5D = 0.66 SD = 0.31), dengue fever (EQ5D = 0.66 SD = 0.24), frail elderly in Vietnam [ 55 ] (EQ5D = 0.58 SD = 0.20), elderly after fall injury and facture injuries (EQ5D = 0.46 SD = NR). QoL in general population during COVID-19 was comparable to that of type2 diabetes and HIV. This may be because Type2 diabetes and HIV are chronic conditions, patients are stable on medication if the management and compliance to medications is respected. QoL of skin disease patients, respiratory diseases, dengue fever, frail elderly, elderly after fall and fracture injuries were low as compared to COVID-19 general population. This may be due to the high score of pain involved in these conditions. Different factors that contributed to low quality of life have been identified; age, gender, education level, marital status, financial constraints, confinement, fear of being contaminated and individual with other chronic conditions. The two measurement scales were the most utilized instruments as compared to the other scales and their results show a considerable reduced quality of life. Using WHOQoL-BREF [ 7 ] reported a quality of life affected with a score of 39% (CI = NR) and according to authors, males were more affected probably because in developing countries, males are responsible of financial support to the family and because of that, they may fear either confinement that affects job market or else being contaminated and not able to work for their families. Concerning age, participants aged 26-35years were more affected and the reason may be because most peoples of this age bracket are the young couples or single mothers therefore the young fathers were worried about their families and finances if they are quarantined. Females were more affected than their counterparts according to [ 25 ] this may be due to the fact that females naturally are the nuclear parts of a family and their emotions towards the family therefore become much worried than males. Widowers had the worst quality of life and this may be due to their worries about their life and that of their children with less psychological support [ 56 , 57 ] from their spouses. Individuals with chronic diseases (hypertension, Type2 diabetes, asthma, stress, anxiety, depression, etc…) had a high risk of low quality of life and this might be because they are vulnerable to COVID-19 with high fear of contamination therefore pushing them to low quality of life. Other factors such as confinement, financial constraints, fear of being contaminated with COVID-19 and having a contaminated family member increased the likelihood of anxiety, stress and depression therefore leading to the low individual quality of life [ 58 ]. The main reason of stress due to confinement is due to financial constraint because a confined person is not allowed to work and generate income to sustain the family during the pandemic. It is surprising that both low and high income countries were affected by COVID-19 reducing their population quality of life. This shows how no country in the world was prepared for any huge health pandemic whether rich or poor. This highlights the low level of preparedness for countries to face similar catastrophic situations. What is lacking? Is it the money or strategies? Developed countries can afford to provide necessary means to fight against pandemics but there is no guaranty to protect the populations from dying before actions are in place. For this purpose, there is a need to strengthen infectious disease predictions and modeling using machine learning or artificial intelligence. There is a need to embrace and exploit artificial intelligence to improve the prediction of future events to prevent populations from diseases and death and maintain their maximum quality of life.

Strengths and weaknesses

First and the foremost, the strength of this review is that, it was conducted according to the international guidelines for systematic reviews after registration of the protocol in international database PROSPERO. Secondly, it was conducted two and half years after the pandemic begun and authors already have published enough papers to allow robust systematic synthesis of results. And the results can be generalized as papers were searched Worldwide with a reasonable sample size (22,967 participants).

There were also some limitations; We searched papers in English only leaving probably out some studies. The fact that we searched only 3 databases and a search engine, some articles might have been missed. The generalizability should be done with caution. Most studies reported the mean QoL during COVID-19 with no baseline to compare, this can weaken our results. All studies were cross-sectional and there were no cohort or case control studies, this can also weaken our conclusions.

This systematic review confirms that the COVID-19 pandemic affected negatively health related quality of life of the general population. Several factors influencing quality of life of general population through COVID-19 have been identified; age, sex, marital status, education, peoples living with chronic diseases, confinement and financial constraints among others, etc…. There was no significant difference between the impact of COVID-19 in general population in high income countries and low and middle income countries. Three quality of life scales were mainly used to assess the quality of life of the general population; WHO-QoL-BREEF, EQ-5D, SF and others. The findings of this review will be useful for policy makers and health managers to facilitate the planning and prevention of quality of life of the general population during future pandemics. We recommend cohort and case control studies on impact of COVID-19 on quality of life to collect more and strong evidence on impact of COVID-19 on different population in the world. We are also recommending studies on prediction and modeling of infectious diseases using machine learning and artificial intelligence to prevent the population from future pandemics to maintain the population quality of life.

Supporting information

S1 checklist. prisma checklist..

https://doi.org/10.1371/journal.pgph.0002137.s001

S1 Table. Summary of included studies.

https://doi.org/10.1371/journal.pgph.0002137.s002

S1 Text. PubMed search string.

https://doi.org/10.1371/journal.pgph.0002137.s003

Acknowledgments

The authors acknowledge the moral support from their families, friends and colleagues.

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• Published: 06 July 2020

COVID and CopMich: comparing and contrasting COVID-19 experiences in the USA and Scandinavia

• Juan J. Andino 1 ,
• James M. Dupree   ORCID: orcid.org/0000-0002-4290-9648 1 ,
• Christian F. S. Jensen 2 ,
• Ganesh S. Palapattu 1 ,
• Jens Sønksen 2 &
• Daniela Wittmann   ORCID: orcid.org/0000-0002-9201-7269 1  

Nature Reviews Urology volume  17 ,  pages 493–498 ( 2020 ) Cite this article

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• Clinical microbiology
• Public health

On 11 March 2020, the World Health Organization declared SARS-CoV-2 and its associated disease, COVID-19, a global pandemic. Across the world, governments took action to slow the spread and hospitals rushed to accommodate an influx of patients with this highly infectious and lethal disease. The urology departments in Ann Arbor, Michigan, USA, and Herlev and Gentofte, Copenhagen, Denmark — which are linked by the pre-existing CopMich Collaborative — had to respond with massive changes to the organization, staffing and workload of their teams. In this Viewpoint, authors from different urological subspecialties and at different career stages reflect on their experiences during the pandemic. Although their countries’ responses to the COVID-19 pandemic differed radically, the similarities between the responses in Copenhagen and Michigan demonstrate the universal characteristics of medicine and the value of teamwork, flexibility and collaboration.

The contributors

Juan J. Andino is a third-year urology resident at the University of Michigan. He completed his undergraduate and medical degrees, and an MBA at the University of Michigan. Dr Andino is interested in telehealth and health policy and hopes to work at the intersection of these fields to optimize the delivery of urological care.

James M. Dupree is an Associate Professor of Urology at the University of Michigan. He completed his residency at Northwestern University and his fellowship in Male Reproductive Medicine and Surgery at Baylor College of Medicine. He also completed a Health Policy Fellowship with the American College of Surgeons. Dr Dupree specializes in the advanced treatment of male infertility, and his research focuses on male infertility and reproductive health policy. Dr Dupree is also the Ambulatory Care Clinical Chief for Urology at the University of Michigan.

Christian Fuglesang S. Jensen received his medical degree from the University of Copenhagen in 2015 and is currently enrolled as a PhD trainee working with male infertility at the Department of Urology, Herlev and Gentofte Hospital. Dr Jensen has previously worked at the Department of Urology, University of Michigan, performing research into andrology and male infertility. Dr Jensen serves as chair on the ESSM Scientific Sub-Committee for new technologies and sexual function and is a co-founder and member of the Core Unit of the CopMich Collaborative.

Ganesh S. Palapattu is the George F. and Sandy G. Valassis Professor and Chair of the Department of Urology at the University of Michigan. He attended the University of Texas at Austin where he earned a Bachelor of Arts degree in Humanities and then Baylor College of Medicine in Houston, Texas, where he earned his medical degree. Subsequently, Dr Palapattu completed his surgical internship, urology training and chief residency in urology at the David Geffen School of Medicine at UCLA followed by a laboratory research fellowship in Urologic Oncology at the Johns Hopkins Hospital Brady Urological Institute. His clinical interest is in the evaluation and management of men with prostate and kidney cancer.

Jens Sønksen received his medical degree from the University of Copenhagen in 1988 and earned his PhD and Doctor of Medical Science in 1995 and 2003, respectively. He is currently Professor of Urology at the University of Copenhagen and Head of the Urological Research Center and Section of Andrology, Herlev and Gentofte Hospital, Denmark. Dr Sønksen is currently serving as Adjunct Secretary General of the European Association of Urology and is a co-founder and member of the Core Unit of the CopMich Collaborative.

Daniela Wittmann received her BA Hons at Keele University, Keele, UK, her Master’s in Social Work at Simmons College School of Social Work, Boston, MA and her PhD at Michigan State University. She is an Associate Professor in the Department of Urology and Adjunct Associate Professor at the School of Social Work at the University of Michigan. Dr Wittmann is a leading member of the Brandon Prostate Cancer Survivorship Program at the University of Michigan and serves as the Chair of the Mental Health Committee of the Sexual Medicine Society of North America. She is also a member of the Prostate Health Committee of the Urology Care Foundation.

What were the immediate changes in your institution in response to COVID-19?

Ganesh S. Palapattu. COVID-19 has proven to be a crisis like no other. When it became clear that the pandemic was headed our way, our health system rapidly strategized and deployed a series of measures to monitor and mitigate the oncoming health-care disaster. Almost immediately a command centre was created, composed of a small multidisciplinary group of individuals spanning clinical operations, infectious disease, epidemiology, supply chain, critical care and communications, among others. This group met daily during our peak, often twice a day, to assess the current status, plan for the immediate future and identify and solve problems. This group was also key in providing timely and informative updates to our health system and community. At the same time, a team of Michigan Medicine experts, alongside collaborators from around the country, developed Michigan-specific prediction models and liaised with adjoining health systems and local and state government and public health departments. Furthermore, space allocations were quickly re-arranged in the span of days to create a regional infectious containment unit (RICU) — a negative pressure unit comprising a substantial number of isolation rooms equipped with critical care medical equipment in compliance with CDC guidelines. As many of you know, the Detroit area was hit hard by COVID-19. I am proud to say that our health-care system responded to the call for help and provided critical surge capacity for patients and hospital systems in need. Truthfully, I can’t say enough positive things about how Michigan Medicine responded to the acute crisis. We anticipate having a baseline census of patients with COVID-19 in the hospital for the next 18 months or so, in addition to possible further waves of illness to come.

From a departmental perspective, we also rapidly organized and mobilized with the realization that COVID-19 was about to have an enormous impact in our area. We are fortunate to have nearly 50 full-time clinical faculty in our urology department, so this afforded us some flexibility. Borrowing from the Lombardy model, we created three squads composed of faculty, trainees and advanced practice providers (for example, nurse practitioners) from all major urological disciplines (oncology, endourology, neuropelvic–reconstructive, general and paediatric) and deployed them on a schedule of 1 week in-person care followed by 2 weeks of virtual care. The intention was to limit health-care worker exposure as much as possible and to allow appropriate recovery time while providing all necessary care. We halted all elective cases across all specialties during the peak and performed only emergency and urgent procedures. From a urological perspective, this approach meant performing surgery for symptomatic bladder cancer, large renal tumours with caval involvement and urgent stone cases. Many of our residents and advanced practice providers volunteered for general and intensive care unit care responsibilities and some were deployed in this way. We were lucky that the crisis never reached a point that required all of us to be re-deployed, owing to the positive impact of social distancing in our area as well as the tremendous contributions of our medical, surgical and anaesthesia colleagues at Michigan Medicine. Since mid-May, we have begun the surgical ramping up process in a deliberate and thoughtful manner to optimize patient and provider safety.

Juan J. Andino. Our institution and department responded swiftly. Elective surgeries were cancelled, and leadership across the institution helped the transition from in-person to virtual encounters, reserving clinic space, emergency room and inpatient wards for patients with urgent or emergency issues.

Drs Palapattu, Kraft and Ambani (Urology Chair, Program Director and Assistant Program Director, respectively) immediately worked with the chief residents to design a schedule focused on safety, reducing the risk of potential exposures and minimizing the use of PPE. We were initially divided into three groups — one group would divide up tasks in the hospital whereas the remaining two-thirds of residents worked virtually from home.

Residents absorbed multiple roles, covering consultations and inpatient care across our three main hospitals. Initially, this workload was manageable owing to the drop in volume from cancelled elective surgeries as well as the ability to address many clinical queries with e-consults. Telehealth was adopted for the inpatient hospital setting and when a physical examination was not likely to alter medical decision-making, recommendations were provided after a conversation and review of laboratory results and imaging 1 . However, as additional urgent procedures were being scheduled with increased testing capacity and operating room (OR) safety protocols, a clinically active cohort composed of one-third of the residents was no longer sufficient. We then transitioned to a two-team system — Blue and Maize — to enable more effective coverage of operating rooms, consultations and inpatient wards.

At this time, we are planning how to return to a new normal, in which residents go back to previously scheduled rotations with flexible coverage determined by clinical needs and OR availability. Masks are now required in all patient care areas and anyone entering the hospital is screened at every entrance for symptoms and given a mask if they don’t already have one. More widespread testing is enabling patients to be tested before scheduled surgery. Between this and Governor Gretchen Whitmer’s thoughtful approach and executive orders promoting social distancing, the numbers in the hospital have dropped from a peak of 229 on 16 April 2020 to 8 on 26 June 2020.

James M. Dupree. One of our first changes was to limit the number of patients coming to see us in clinic. We started by postponing clinic appointments for patients who were deemed to be at high risk of developing complications should they contract COVID-19, for example, immunosuppressed or elderly patients. Within about a week, we started postponing more patients, based on the urgency of their medical problems. We performed a similar triage for surgical cases and started postponing all but the most urgent urological surgeries, but we never closed our clinics or operating rooms completely and always cared for patients with urgent or emergency needs.

As we neared the peak of the COVID-19 patient surge, we prepared for the possibility of exceeding our hospital’s inpatient capacity. We planned to create a field hospital in a nearby university athletic facility to care for patients who were COVID-19-positive. The urology faculty were planning to staff this field hospital to provide general medical care for patients who were improving but were not yet ready for discharge home. Thankfully, the community’s social distancing measures prevented the COVID-19 patient volume from ever exceeding our hospital’s capacity and that field hospital never opened.

Jens Sønksen. The COVID-19 pandemic had immediate and profound consequences for the Danish Health system, including the Department of Urology at Herlev and Gentofte Hospital. Despite a well-functioning health-care system, no plan of action was prepared for a situation like this and the initial phase was filled with a lot of uncertainties and communication deficits between the government, health boards, hospital boards and department administration. Within a few days of Denmark’s lockdown on 11 March 2020, all elective surgery and outpatient clinic visits were cancelled or postponed and, if possible, replaced by telecommunications for diagnosis and follow-up monitoring. From one day to the next, the department was completely restructured, with doctors and nurses sent to COVID-19 test centres and COVID-19 wards and regular urology wards redesignated as isolation wards in preparation for the expected rise in the number of COVID-19 cases in Denmark. Every individual worked hard to ‘flatten the curve’ and enable the health system to cope with increasing COVID-19 cases. On a daily level, doctors could no longer meet at morning conferences, all large meetings (>10 persons) were cancelled and the teaching of medical students during clinical rotation was postponed, although virtual teaching programmes were soon established. We are now slowly opening and have restarted outpatient visits and elective surgery, whereas acute urology and cancer diagnostics and treatment have been ongoing during the entire period.

How did your institution respond to the COVID-19 pandemic?

Daniela Wittmann. There was an immediate move to clear the hospital to accommodate the COVID-19 patient influx. Urological surgeries were cancelled. I am a sex therapist in the prostate cancer survivorship programme and this meant that my sex therapy appointments with patients with prostate cancer post-op would diminish for a while. My clinic and my research office were closed and all work moved to virtual platforms. I have been working from home seeing patients in video visits and doing research online with meetings via Zoom. Both are quite manageable, although doing virtual sex therapy has its challenges. However, owing to the decreased clinical volume, I have had time to start a research project on patients’ and physicians’ responses to the delay in cancer care during the pandemic; I am glad to have a chance to engage with this difficult situation in a meaningful way.

J.M.D. I was impressed with the speed and flexibility of our institution’s response to the COVID-19 pandemic. Several weeks before the first case in Michigan, we created a centralized command centre to oversee institution-wide clinical operations. Once COVID-19 reached our state, we contracted our clinical sites, triaged our surgical cases and doubled our intensive care unit capacity. Many of these changes were enabled by our employment structure: the physicians, nurses, nurse practitioners, physician assistants and all the other members of the clinical workforce are employees of the institution, which helped us to respond in a coordinated fashion.

In addition, our medical group had recently implemented new layers of clinical leadership — including physicians, administrators and nurses — to oversee our clinics. These clinical leaders were instrumental in our response. There were instances of miscommunication or challenges with inconsistent decision-making, but these instances were rare, and the benefits of the clinical leadership triads were immense.

Christian Fugelsang S. Jensen. Denmark closed down on the evening of Wednesday 11 March 2020. Listening to the press briefing from the Prime Minister I realized how big an impact the COVID-19 pandemic would have on clinical research. The next day I could not go to work at the Urological Research Unit at Herlev and Gentofte Hospital and had to cancel all my patients’ visits and elective surgeries. I was in the final months of completing my PhD, a randomized surgical trial on sperm retrieval in men with non-obstructive azoospermia, but had to pause all related clinical activities. As part of my PhD, Professor Dana Ohl from the University of Michigan performs surgery with me on all study patients in Denmark, but the travel ban made this impossible. Currently, the travel ban is still in place, but we are working on possibilities for finishing the study and the PhD.

J.S. As Chair of Urology at the University of Copenhagen it was my responsibility to find alternatives for teaching medical students. We successfully established e-learning platforms with interactive sessions for discussion and we had to restrict clinical teaching at hospitals to limit the possible spread of COVID-19. For students on clinical rotations who normally have a real patient as part of their clinical urology examination, we replaced the patient with a urologist in the role of a patient and could then complete the exams.

What did your institution do, formally and informally, to provide support for faculty and staff during the COVID-19 pandemic?

G.S.P. The COVID-19 crisis revealed the true character of our department: compassionate and selfless. People looked out for one another and sought ways to provide support to those in need. One of our faculty in paediatric urology, Dr Courtney Streur, created the Daily (Uro)Flow, a spontaneous and voluntary daily email from a department member describing how they were coping with the crisis, often with funny anecdotes. Plenty of Zoom calls were had to maintain connectivity and provide updates. I know many faculty and staff who reached out to each other during the peak to lend support and check on each other. Our residency programme director, Dr Kate Kraft, met with all of our residents weekly via Zoom to check in and we maintained our weekly department conference schedule via video conference. As much as possible, we tried to remain connected.

J.M.D. I think everyone on our team felt scared, anxious and/or frustrated at various times during the pandemic. It was an unprecedented time. Our institution advertised counselling services that all faculty or staff could use. I took advantage of these counselling services in the heat of the pandemic and found them invaluable for reinforcing my ability to help to lead our department’s operational response. Living and working through this pandemic were powerful reminders that we need to take care of ourselves so that we can take care of others.

D.W. A number of supportive activities were organized by Michigan Medicine, including counselling for staff and faculty and information websites. Hospital system leadership provided daily updates about hospital census of patients with COVID-19, employee testing and infections. Weekly Town Halls were held for all employees with information about state and hospital statistics, workforce deployment, financial impact of the pandemic on the institution and Q and A opportunities. In the Department of Urology, the Chair provided weekly updates on issues relevant to the faculty, such as plans for potential deployment in the COVID-19 zones, organization of urology services, team organization with health-protective strategies, OR availability and financial impact of the pandemic. The departmental Wellness Committee invited faculty and staff to a Facebook page to share experiences, both triumphs and challenges. The Facebook page also posted resources, such as where to get food deliveries or how to talk to children about COVID-19. A faculty member began an informal All Staff and All Faculty email exchange, “The Daily (Uro) Flow”, in which individual staff or faculty members posted narratives and photos about how they and their families were living and coping during the pandemic. In all these initiatives and activities, emphasis was placed on viewing Michigan Medicine and the Department of Urology as a family that would support each other, get through the pandemic together and become strong as a result.

J.S. On a continuing basis, the hospital administration and our department have sent out frequent COVID-19 email newsletters to all staff members, including a summary of information from health authorities to support the dissemination of important information. Throughout the entire period, everyone has received full salaries, including those who were sent home without the possibility of continuing to work. Finally, all health-care workers have experienced huge support from society in general, with positive news coverage of the efforts of health workers and with examples including occasional free meals and snacks for staff on duty, free car rental for health-care workers in Copenhagen and free isolation stays at hotels for infected individuals.

What will be the long-term effects of COVID-19 in your institution?

J.J.A. The pandemic has expanded the use of telehealth owing to rapid and wide-spread changes in national and state-specific regulatory and licensing policies. Even beyond the pandemic, many more patients will have the option of following up with their doctors through video visits 2 . Ideally, this will keep healthier patients at home and open up capacity for patients with acute issues and complex medical needs. Hopefully, this will also give providers additional flexibility and more control over where and how they care for their patients.

This period will also have a lasting impact on our approach to medical education. We have seen how online sessions can reach a broad audience and that videos can be recorded and stored for review at a later time. In the future, medical schools might not need to continue growing in size if the majority of their content can be distributed electronically. Space can be shared and used for specific, hands-on tasks such as cadaver labs, simulations and selected group activities. Similarly, future medical students will be introduced to telehealth as a part of their curriculum. They will start performing video visits at the same time as learning how to do a physical examination in the clinic. Finally, this pandemic might even change the entire interview process; it is not impossible to imagine a system whereby applications are narrowed down through initial review, then virtual interviews and ending with a more selective pool of applicants interviewing in person. It will be interesting to see what long-term changes will come from COVID-19 that we cannot even foresee.

It is also clear that not everything can be shifted to a virtual medium. A different kind of fatigue comes from being connected to a computer or device for most of the day. I miss the sometimes brief but meaningful interactions that take place in the hospital, conference room and lecture halls. A quick hello, swapping of stories, a pat on the back from a colleague you haven’t seen in a while. These are all lost when people are bouncing online through innumerable Zoom sessions.

D.W. I expect that there will be more video visits in usual clinical care in the future, as long as insurance coverage continues. I also expect that Michigan Medicine will remain very much prepared to handle a possible fall spike in COVID-19 and that fast reorganization might occur again. It is not clear when in-person visits for usual care will return, given the lack of testing and treatment for COVID-19. Some patients are already voicing their preference for virtual care, citing both convenience and fear of becoming infected.

J.M.D. I am confident that the principal long-term effect will be the expanded use of telehealth 3 . We were using some telehealth before the COVID-19 pandemic, but when we had to postpone patients from in-person care, telehealth became essential. Even now, as patients are returning to our clinics, the benefits of telehealth — for doctors and for patients — remain.

I also expect us to restructure our clinical work. When we shut down all but the most urgent urological care, it gave us the opportunity to rebuild our clinical delivery system from the ground up, addressing longstanding barriers and reimagining how we can best provide high-quality, safe and efficient urological care to patients.

Finally, I expect, for better or worse, that there will be more centralized control of clinical operations in our institution. Centralized control was necessary during the pandemic to have a uniform and coordinated response. It will be hard to unwind some of that centralization. However, I think that individual clinics will need to regain some of their autonomy to help facilitate innovation and adapt to the unique needs of local patient populations.

G.S.P. There likely will be many long-term effects of COVID-19 at Michigan Medicine. Virtual care is one. Additionally, extended clinic hours (7 am–7 pm) and the addition of Saturday morning clinics and routine Saturday scheduled surgeries, staffed on a rotating basis, will also be likely incorporated on a long-term basis. The immediate financial impact has forced us to make some hard decisions regarding programmes and personnel. I suspect that in the future we will be much more cost conscious, which is not necessarily a bad thing. I also firmly believe that we as a department and institution will be better and stronger on the other side of COVID. This crisis has required us to take a hard look at what we do and how we do it and, importantly, made us prioritize and economize. Although hard to envision at the moment, I strongly feel that we will be in a better position 1 year from now than we were 1 year ago to take care of patients, make discoveries and educate the leaders of tomorrow.

C.F.S.J. Aside from constant hand hygiene, physical distance and mandatory SARS-CoV-2 tests for health-care personnel and patients, I foresee less physical interaction in general, including meetings, conferences and travel. Although virtual platforms can replace many of these activities, I fear that valuable aspects of direct interaction will disappear, leading to reduced sharing of information and experiences, as well as decreased input from peers. The lack of direct networking may even lead to a reduction in collaboration between institutions and a decrease in the development of new projects to benefit future patients. This has direct implications for programmes such as CopMich ( The Copenhagen Michigan Urological Collaboration ), which is an example of a collaboration built on direct interaction between Professor Jens Sønksen and Professor Dana A. Ohl (Department of Urology, University of Michigan), both clinical researchers sharing similar research interests. Without the established friendship, CopMich would not have been as successful as it has been, with more than 65 shared publications over 25 years. I am fortunate to be part of this friendship and I truly see the personal and scientific value in the relationships created 4 .

J.S. As a consequence of cancelling and postponing appointments for patients with urological conditions, there is a build-up of patients needing evaluation and treatment, which will require a substantial amount of time and effort to catch up on. This backlog will have implications for the workload of our staff and will limit the possibility for participating in educational and research-related activities, including participation in conferences. In a public-health system, we cannot expect additional financial resources for catching up, especially given the enormous amount of money used on governmental emergency relief plans. As a result, I fear we will lack money and opportunities to continue educational activities as we used to before the COVID-19 pandemic.

What lessons were learned during the response to COVID-19?

D.W. I have learned that I can do a lot of my work remotely. I have also learned that much of the ability to work effectively with others in this way is due to being able to rely on the comfort of pre-existing relationships. Doing new patient assessments or interacting with new research colleagues only virtually misses important human dimensions. I miss my colleagues and in-person patient care. As a health-care provider, I have also felt powerless, not useful, given the overwhelming need for specific expertise that I did not have. I offered to volunteer for blood donation and mental health services. I worried about providers on the front line of the COVID-19 work. I was reminded of how important it is to me to be of service.

J.J.A. I’ve had two main takeaways: first, the importance of your colleagues, co-workers and leaders in the workplace. In the face of an unprecedented pandemic and the anxiety evoked when models predicted that our hospital would be overrun within a matter of weeks, people were flexible and willing to adapt to work as part of a team — taking on tasks that would normally be split between two or three people, covering the on-call pager at night and on weekends that were previously scheduled for someone else. I feel very fortunate to be a part of this group. Residency itself is a shared experience like few others; add a pandemic to the mix and this is something that will connect us for the rest of our lives. Second, we have had the technology to connect with friends and family who live far away and have underused it for a long time. For the first time in years, I’ve had long phone and FaceTime conversations with people all around the country and world. Rather than texting or emailing, I’ve picked up my phone or used my laptop to talk, watch concerts together, and celebrate or mourn together.

G.S.P. I think there are several lessons we have learned from COVID-19 thus far. First, we are at our best when we work together. The collaborative spirit shown by our team during this time of crisis is inspiring. Second, we have seen the importance of communication. Frequent and clear communication from leadership about the status of the epidemic and our response to it, as well as the consequences of the crisis (such as financial issues), engendered better understanding of what was happening and built trust. Third, virtual care really does work! Our department had been using various methods of virtual care before the pandemic, but over the past 2 months our usage went up dramatically. For the most part, patients and providers have found virtual care convenient and I anticipate that it will play a major role in how we care for patients moving forward 1 .

J.M.D. I believe we will be realizing lessons from the COVID-19 pandemic for years to come. My most important lesson was a reminder about the importance of institutional culture. As I described above, our institution completely reorganized our clinical care operations within a few days. Everyone’s schedule changed, which, as you can imagine, was very disruptive. Thankfully, our urology department has a culture that values collaboration, teamwork and a shared sense of responsibility for our patients. These qualities shone as we responded to the daily changes in our lives.

Personally, I also learned several lessons about leadership. First, communication is a cornerstone of leadership, especially in a crisis. We used regular, clear and frank communication to reorganize our workforce and adapt to the changing epidemiology of the pandemic. Second, I learned the importance of being vulnerable and admitting when I do not know what is going to happen next. However, I also learned that it is valuable to pair that vulnerability with a clearly articulated belief in our ability to get through the pandemic together. Third, I was reminded about the benefits of feedback. It is tempting for leaders to make their own plans, assuming they know what is best. However, each time I asked for feedback on my plans, especially feedback from those on the front lines such as nurses, medical assistants and administrators, their responses made the plans better. There truly is wisdom in the crowd. Finally, I was reminded to give others the benefit of the doubt. In stressful times, there will inevitably be interpersonal conflict. Believing that everyone is trying their best given the circumstances was helpful as I navigated those conflicts.

C.F.S.J. I have learned to appreciate going to work as I quickly realized that working from home had several downsides and limitations and completely lacked the social aspect and daily input from colleagues. On the other hand, I learned that many activities, including meetings, do not necessarily have to be physical but can often be replaced by virtual meetings. However, this approach requires discipline and is a skill that needs to be learned 2 .

J.S. Many lessons can be learned from this unforeseeable situation. The most important thing is to have a plan for such situations. This was seemingly neglected, as Denmark has not been in a real emergency since World War 2. Furthermore, a clear structure for communication should be in place to avoid misinformation and misinterpretation.

Gadzinski, A. J. et al. Telemedicine and eConsults for hospitalized patients during COVID-19. Urology https://doi.org/10.1016/j.urology.2020.04.061 (2020).

Article   PubMed   PubMed Central   Google Scholar  

Gadzinski, A. J. & Ellimoottil, C. Telehealth in urology after the COVID-19 pandemic. Nat. Rev. Urol. https://doi.org/10.1038/s41585-020-0336-6 (2020).

Ellimoottil, C. What will urology look like in 2035? Nat. Rev. Urol. 16 , 635–636 (2019).

Article   Google Scholar  

[No authors listed] 15 years of urology at Nature : a celebration of collaboration. Nat. Rev. Urol . 16 , 631 (2019).

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Acknowledgements

This work was carried out on behalf of the CopMich Collaborative group. The authors from the University of Michigan and Herlev and Gentofte Hospital wish to acknowledge and thank all the nurses, physicians, nurse practitioners, physician assistants, medical assistants, students, schedulers, call centre agents, office staff and clinical staff who rose to the occasion and cared for our patients. More than any other time, responding to the COVID-19 pandemic was a team effort.

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Department of Urology, University of Michigan, Ann Arbor, MI, USA

Juan J. Andino, James M. Dupree, Ganesh S. Palapattu & Daniela Wittmann

Department of Urology, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen, Denmark

Christian F. S. Jensen & Jens Sønksen

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Correspondence to Juan J. Andino , James M. Dupree , Christian F. S. Jensen , Ganesh S. Palapattu , Jens Sønksen or Daniela Wittmann .

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J.M.D. declares grant funding from Blue Cross Blue Shield of Michigan for quality improvement activities. The other authors declare no competing interests.

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Andino, J.J., Dupree, J.M., Jensen, C.F.S. et al. COVID and CopMich: comparing and contrasting COVID-19 experiences in the USA and Scandinavia. Nat Rev Urol 17 , 493–498 (2020). https://doi.org/10.1038/s41585-020-0352-6

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Accepted : 12 June 2020

Published : 06 July 2020

Issue Date : September 2020

DOI : https://doi.org/10.1038/s41585-020-0352-6

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