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Asian Journal of Medical Sciences (Jan 2023)

Epidemiological study of COVID-19 in Mizoram, India: Meta-analysis of sociodemographic determinants, risk factors, and outcome

  • Gracy Laldinmawii ,
  • Pachuau Lalmalsawma ,
  • Rebecca Lalngaihzuali ,
  • Swagnik Roy ,
  • Zomuanpuii Colney ,
  • Gabriel Lalchandama,
  • Praseena K ,
  • Jacinta Lalhmunsangi ,
  • Vanlalhmingthanpuii ,
  • Lalrinpari Sailo ,
  • Lalfakzuala Pautu ,
  • Yogesh Malvi ,
  • John Zohmingthanga ,

Affiliations

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Background: The impact of COVID-19 pandemic has shifted the livelihood of the global community including Mizoram which is located in the north-east region of India. Universal preventive measures have been implemented to reduce the spread of the virus. Aims and Objectives: The aim of this study is the epidemiological and clinical characterization of patients infected with SARS-COV-2. The aim of the study was to examine the sociodemographic determinants and risk factors of the disease severity with COVID-19 patients. Materials and Methods: A multicenter and cross-sectional study on patients who have been diagnosed and confirmed of SARS CoV2 infection of the Mizo Community. The data were collected by professionals from April 2020 to May 2022. Sociodemographic determinants, clinical presentation, comorbidities, livelihood, alcohol, and tobacco consumptions were described. All data were analyze using SPSS 22 version. The association of the variables with ct value (≤25 and >25) of COVID-19 was examined using Chi-square and logistic regression model and P<0.05 as statistically significant. Results: A total number of 19,25,885 samples were tested among which 2,27,849 cases were diagnosed with COVID-19 from March 24, 2020, to May 12, 2022, in Mizoram. The mean±SD age of the analytic population was 30.10±19.64 years. Female was more infected and patients between the age of 16–30 years represent the most frequent age group in the population study. About 55.2% were symptomatic patients with mortality rate at 0.30% as of May 12, 2022. Conclusion: In this cross-sectional study, a wide range of sociodemographic risk factors, including socioeconomic status, racial/ethnic minority status, household composition, and environmental factors, was significantly associated with COVID-19 incidence and mortality. To address inequities in the burden of the COVID-19 pandemic, these social vulnerabilities and their root causes must be addressed.

  • sars cov-2; sociodemography; covid-19; risk factors; mizoram

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COVID-19 and Governance in Mizoram: Issues and Challenges

  • August 2021
  • International Journal of Research and Review 8(8):673-681
  • 8(8):673-681
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COVID-19 and Governance in Mizoram: Issues and Challenges

Profile image of International Journal of Research & Review (IJRR)

2021, https://www.ijrrjournal.com/IJRR_Vol.8_Issue.8_Aug2021/IJRR-Abstract089.html

Background: The phenomenon of COVID-19 has remained a mystery to mankind. It is not just about the disease but has also multiple ripple effects on every aspect of life. It has completely changed the course of living in a short period. The entry of Covid-19 has taken a heavy toll on human beings in particular and on every government and institution in general. Hence, for the survival and safeguard of the human race, various governments came up with protocols and measures against the spread of Covid19. Apparently, lockdown is one of the strategies widely adopted by the governments as a means to overcome the Covid-19 issue. Although, being under the same umbrella, there are countries that are worst affected by Covid-19 while some countries do not face as much. No doubt that the virus has reached every nook and corner of the globe, as a matter of fact Mizoram which is situated at the corner of most of North-East India has also been under the distress of Covid-19 Aim: The study examined and understand governance on Covid19 in Mizoram. It stresses how the government and various organizations had given efforts in this situation and how the policy being adopted by them has had an impact on the people so far. It also emphasises the issues and challenges of governance policy on Covid-19 for further references. Methods and Materials: The study was descriptive while data is collected from both primary and secondary sources. Primary sources was based on empirical analysis and questionnaire collected through online survey method while secondary sources include articles, journals, newspapers and internet. Findings are based on an online survey method that was conducted with a sample size of 500 and the universe of the study is Aizawl, Mizoram. Results: Findings of the study have suggested that there is a lack of efficiency in carrying out the governance policy on COVID-19. Although, studies have shown that the setting up of Task Force initiated by the government and their contribution and involvement in the governance is considered remarkable. Conclusion: After all, COVID-19 is assumed to exist long enough along with human beings, therefore, for the survival of an individual, one needs to work and function daily. Thus, by keeping that in mind, Mizoram in particular where the economy is weak and not self-sufficient, the State government and official experts have to adopt new methods and strategies besides “lockdown” for the well-being of the people.

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Research Paper

Year: 2021 | Month: August | Volume: 8 | Issue: 8 | Pages: 673-681

DOI: https://doi.org/10.52403/ijrr.20210889

COVID-19 and Governance in Mizoram: Issues and Challenges

Lalhruaitluangi sailo.

Research Scholar, Department of Political Science, School of Social Sciences, Mizoram University, Aizawl, Mizoram, India.

Background : The phenomenon of COVID-19 has remained a mystery to mankind. It is not just about the disease but has also multiple ripple effects on every aspect of life. It has completely changed the course of living in a short period. The entry of Covid-19 has taken a heavy toll on human beings in particular and on every government and institution in general. Hence, for the survival and safeguard of the human race, various governments came up with protocols and measures against the spread of Covid19. Apparently, lockdown is one of the strategies widely adopted by the governments as a means to overcome the Covid-19 issue. Although, being under the same umbrella, there are countries that are worst affected by Covid-19 while some countries do not face as much. No doubt that the virus has reached every nook and corner of the globe, as a matter of fact Mizoram which is situated at the corner of most of North-East India has also been under the distress of Covid-19 Aim : The study examined and understand governance on Covid19 in Mizoram. It stresses how the government and various organizations had given efforts in this situation and how the policy being adopted by them has had an impact on the people so far. It also emphasises the issues and challenges of governance policy on Covid-19 for further references. Methods and Materials: The study was descriptive while data is collected from both primary and secondary sources. Primary sources was based on empirical analysis and questionnaire collected through online survey method while secondary sources include articles, journals, newspapers and internet. Findings are based on an online survey method that was conducted with a sample size of 500 and the universe of the study is Aizawl, Mizoram. Results : Findings of the study have suggested that there is a lack of efficiency in carrying out the governance policy on COVID-19. Although, studies have shown that the setting up of Task Force initiated by the government and their contribution and involvement in the governance is considered remarkable. Conclusion : After all, COVID-19 is assumed to exist long enough along with human beings, therefore, for the survival of an individual, one needs to work and function daily. Thus, by keeping that in mind, Mizoram in particular where the economy is weak and not self-sufficient, the State government and official experts have to adopt new methods and strategies besides “lockdown” for the well-being of the people.

Keywords: COVID-19, Lockdown, Government, Civil Society Organisations (CSOs), Task Force, Governance, Standard Operating Procedure (SOP)

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What studies say is behind Mizoram’s high Covid-19 infections

Its close-knit society and lack of covid-19 appropriate behaviour, coupled with strict contact tracing and mass testing, have led to a spike in cases.

Guwahati : Mizoram recorded 1,741 new cases of Covid-19 infections on Thursday — two days after the northeastern state witnessed 1,846 cases, the highest-ever figure recorded to date.  

On Thursday, of the 1,741 total cases, 1,263 were detected through RAT and 420 through RT-PCR. (Yogendra Kumar/HT PHOTO)

These are not aberrations. The small state with just over 1.1 million people (according to the 2011 census) has been recording over 1,000 new cases every day for nearly three weeks, leading to concerns in Aizawl and New Delhi.  

Almost untouched by the first wave last year, it has now recorded a total of 93,660 infections and 307 deaths. There are close to 17,000 active cases at present, and test positivity rates have been hovering around and above 20% for days, putting strain on health care facilities and medical workers.  

“The high number of cases is a concern. Studies done by the state government over the past weeks have found some probable reasons for the increasing trend,” said Dr ZR Thiamsanga, chairman of the medical operation team on Covid-19.  Based on studies, it has been surmised that a lack of Covid-19 appropriate behaviour (CAB) in a close-knit society where visits to each other’s houses are common, coupled with strict contact-tracing and mass testing, are some of the causes that have led to a high number of cases. 

 “Our society is very close-knit, people visit each other for occasions, and there are small gatherings. Plus, CAB is not followed by many. Studies showed these were contributing factors for the high community spread of Covid-19,” Thiamsanga, who is also a ruling Mizo National Front (MNF) Member of Legislative Assembly (MLA) from Champhai North, added.  

Dr Pachuau Lalmalsawma, state nodal officer and spokesperson, agreed with Thiamsanga. He added that strict contact tracing and mass testing have also added to the increase in the number of daily cases.  

“We have been following aggressive contact tracing with help of the police and civil society groups. Once a positive case is detected, all those who came in contact with that person are traced, quarantined and tested. The quality of sample collection in Mizoram is also very good,” said Lalmalsawma.  

“Genome sequencing reports have indicated that besides Alpha and Eta variants of Covid-19, there is also a prevalence of the highly contagious Delta and Delta Plus variants in the state leading to a surge in infections,” he added.  

Both Lalmalsawma and Thiamsanga said that although all these factors have contributed to high numbers, it is difficult to point out the single biggest reason for the surge. Two central teams also visited the state to study the scenario and are yet to release their reports, said Lalmalsawma.  

Experts say that Mizoram’s lack of exposure to Covid-19 during the first wave that swept the rest of the country could be another reason why the state is witnessing high numbers during and after the country’s second wave.  Mizoram recorded its first Covid-19 case in late March last year, and the first death was seven months later. From the first case on March 24, 2020, until March 31, 2021, Mizoram had recorded just 4,473 total cases and 11 deaths. But in the six months from April 2021 to the end of September, the total number of cases skyrocketed to nearly 94,000, with the number of deaths reaching 307.  

“The first wave was not really a wave in Mizoram. Most of our population was not exposed to the virus. Maybe that’s why we lack protective antibodies. This needs to be studied. A sero study conducted locally found hardly any prevalence among residents,” said Lalmalsawma.  Both government servants denied reports that high dependence of Rapid Antigen Tests (RAT) tests instead of RT-PCR in Mizoram could be responsible for false-negative reports, leading to infected, but undetected, patients spreading the disease. 

On Thursday, of the 1,741 total cases, 1,263 were detected through RAT and 420 through RT-PCR. The state has just one RT-PCR machine at Zoram Medical Centre in Aizawl, and 20 TruNat machines in all of the 11 districts. 

“The government’s claims of managing the situation are baseless. While the ICMR [Indian Council of Medical Research] recommends that at least 70% of all tests should be RT-PCR, in Mizoram, nearly 70% of tests are RAT. It is known that negative results in RAT are not always conclusive,” said Lalduhoma, a legislator from the Opposition Zoram People’s Movement (ZPM).  

“Even now the state has only one RT-PCR machine. We had offered to buy RT-PCR machines, but it seems that the government is not interested. There was no mass testing earlier in the state. They have started doing it now, but it’s too late as the infection has spread to all parts,” he added. The high number of cases has put a strain on the state’s health infrastructure. The state has one dedicated Covid-19 hospital in Aizawl, 18 Covid-19 health care centres, and around 500 Covid-19 care centres run by the state government, security forces, and villages.  Mizoram has, so far, administered 1,135,539 vaccine doses. Of them, 696,634 are first doses and 438,905 are second doses.  “To bring down cases, we should strictly follow CAB. We also need to isolate people with co-morbidities. We are hopeful that by mid-October, we will see a downward trend,” said Thiamsanga.  

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Impact of COVID-19 on people's livelihoods, their health and our food systems

Joint statement by ilo, fao, ifad and who.

The COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems and the world of work. The economic and social disruption caused by the pandemic is devastating: tens of millions of people are at risk of falling into extreme poverty, while the number of undernourished people, currently estimated at nearly 690 million, could increase by up to 132 million by the end of the year.

Millions of enterprises face an existential threat. Nearly half of the world’s 3.3 billion global workforce are at risk of losing their livelihoods. Informal economy workers are particularly vulnerable because the majority lack social protection and access to quality health care and have lost access to productive assets. Without the means to earn an income during lockdowns, many are unable to feed themselves and their families. For most, no income means no food, or, at best, less food and less nutritious food. 

The pandemic has been affecting the entire food system and has laid bare its fragility. Border closures, trade restrictions and confinement measures have been preventing farmers from accessing markets, including for buying inputs and selling their produce, and agricultural workers from harvesting crops, thus disrupting domestic and international food supply chains and reducing access to healthy, safe and diverse diets. The pandemic has decimated jobs and placed millions of livelihoods at risk. As breadwinners lose jobs, fall ill and die, the food security and nutrition of millions of women and men are under threat, with those in low-income countries, particularly the most marginalized populations, which include small-scale farmers and indigenous peoples, being hardest hit.

Millions of agricultural workers – waged and self-employed – while feeding the world, regularly face high levels of working poverty, malnutrition and poor health, and suffer from a lack of safety and labour protection as well as other types of abuse. With low and irregular incomes and a lack of social support, many of them are spurred to continue working, often in unsafe conditions, thus exposing themselves and their families to additional risks. Further, when experiencing income losses, they may resort to negative coping strategies, such as distress sale of assets, predatory loans or child labour. Migrant agricultural workers are particularly vulnerable, because they face risks in their transport, working and living conditions and struggle to access support measures put in place by governments. Guaranteeing the safety and health of all agri-food workers – from primary producers to those involved in food processing, transport and retail, including street food vendors – as well as better incomes and protection, will be critical to saving lives and protecting public health, people’s livelihoods and food security.

In the COVID-19 crisis food security, public health, and employment and labour issues, in particular workers’ health and safety, converge. Adhering to workplace safety and health practices and ensuring access to decent work and the protection of labour rights in all industries will be crucial in addressing the human dimension of the crisis. Immediate and purposeful action to save lives and livelihoods should include extending social protection towards universal health coverage and income support for those most affected. These include workers in the informal economy and in poorly protected and low-paid jobs, including youth, older workers, and migrants. Particular attention must be paid to the situation of women, who are over-represented in low-paid jobs and care roles. Different forms of support are key, including cash transfers, child allowances and healthy school meals, shelter and food relief initiatives, support for employment retention and recovery, and financial relief for businesses, including micro, small and medium-sized enterprises. In designing and implementing such measures it is essential that governments work closely with employers and workers.

Countries dealing with existing humanitarian crises or emergencies are particularly exposed to the effects of COVID-19. Responding swiftly to the pandemic, while ensuring that humanitarian and recovery assistance reaches those most in need, is critical.

Now is the time for global solidarity and support, especially with the most vulnerable in our societies, particularly in the emerging and developing world. Only together can we overcome the intertwined health and social and economic impacts of the pandemic and prevent its escalation into a protracted humanitarian and food security catastrophe, with the potential loss of already achieved development gains.

We must recognize this opportunity to build back better, as noted in the Policy Brief issued by the United Nations Secretary-General. We are committed to pooling our expertise and experience to support countries in their crisis response measures and efforts to achieve the Sustainable Development Goals. We need to develop long-term sustainable strategies to address the challenges facing the health and agri-food sectors. Priority should be given to addressing underlying food security and malnutrition challenges, tackling rural poverty, in particular through more and better jobs in the rural economy, extending social protection to all, facilitating safe migration pathways and promoting the formalization of the informal economy.

We must rethink the future of our environment and tackle climate change and environmental degradation with ambition and urgency. Only then can we protect the health, livelihoods, food security and nutrition of all people, and ensure that our ‘new normal’ is a better one.

Media Contacts

Kimberly Chriscaden

Communications Officer World Health Organization

Nutrition and Food Safety (NFS) and COVID-19

Home — Essay Samples — Nursing & Health — Covid 19 — My Experience during the COVID-19 Pandemic

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My Experience During The Covid-19 Pandemic

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Published: Jan 30, 2024

Words: 440 | Page: 1 | 3 min read

Table of contents

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

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

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

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

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

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

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Introduction

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

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

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

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

Social networks

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

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

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

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

Social support

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

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

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

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

Social and interactional norms

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

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

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

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

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

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

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

Recommendations and conclusions

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

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

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

Recommendation 2: intelligently balance online and offline ways of relating

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

Recommendation 3: build stronger and sustainable localised communities

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

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

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

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

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

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

Read the full text or download the PDF:

Read these 12 moving essays about life during coronavirus

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

by Alissa Wilkinson

A woman wearing a face mask in Miami.

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

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

  • The Vox guide to navigating the coronavirus crisis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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The Impact of COVID-19 Pandemic on Family Well-Being: A Literature Review

Maria gayatri.

1 Directorate for Development of Service Quality of Family Planning, National Population and Family Planning Board (BKKBN), Jakarta, Indonesia

Mardiana Dwi Puspitasari

2 Research Center for Population, National Research and Innovation Agency (BRIN), Jakarta, Indonesia

Background: COVID-19 has changed family life, including employment status, financial security, the mental health of individual family members, children's education, family well-being, and family resilience. The aim of this study is to analyze the previous studies in relation to family well-being during the COVID-19 pandemic. Methods: A literature review was conducted on PubMed, Medline, Web of Science, and Scopus for studies using a cross-sectional or quasi-experimental design published from their inception to October 15, 2020, using the keywords “COVID-19,” “pandemic,” “coronavirus,” “family,” “welfare,” “well-being,” and “resilience.” A manual search on Google Scholar was used to find relevant articles based on the eligibility criteria in this study. The presented conceptual framework is based on the family stress model to link the inherent pandemic hardships and the family well-being. Results: The results show that family income loss/economic difficulties, job loss, worsening mental health, and illness were reported in some families during the COVID-19 pandemic. Family life has been influenced since the early stage of the pandemic by the implementation of physical distancing, quarantine, and staying at home to curb the spread of coronavirus. During the pandemic, it is important to maintain family well-being by staying connected with communication, managing conflict, and making quality time within family. Conclusion: The government should take action to mitigate the social, economic, and health impacts of the pandemic on families, especially those who are vulnerable to losing household income. Promoting family resilience through shared beliefs and close relationships within families is needed during the COVID-19 pandemic.

Introduction

Coronavirus disease 2019 (COVID-19) is a form of pneumonia caused by the severe acute respiratory coronavirus syndrome 2 (SARS-CoV-2) ( Lai et al., 2020 ). The appearance of COVID-19 becomes an outbreak in December 2019 in China. The coronavirus disease can be transmitted through the respiratory tract, digestive system, and also mucosal surface ( Ye et al., 2020 ). Fever, cough, shortness of breath, and diarrhea are the symptoms of COVID-19 infection at the onset. The pandemic of COVID-19 has brought many changes to all the communities, workers, and families to reduce the spread of the coronavirus and limit its impact on health, societal, and economic consequences. This pandemic had a powerful impact on family life. Mental resilience is required for coping strategies during the pandemic ( Barzilay et al., 2020 ).

COVID-19 has changed family life, including employment, financial instability, the mental health of family members, children's education, family well-being, and family resilience. People start to protect themselves from the spread of the coronavirus by physical and social distancing, sheltering-in-place, restricting travel, and implementing health protocols. Some public places are abrupt closures, such as schools, childcare centers, community programs, religious places, and workplaces. This change impacts social life, such as isolation, psychological distress, substantial economic distress, depression, and also domestic violence, including child abuse ( Campbell, 2020 ; Patrick et al., 2020 ). The Internet has become the most important thing to support all activities while staying at home and staying connected with others.

Families are forced to maintain a work–life balance in the same place with all family members during the pandemic ( Fisher et al., 2020 ). Parents are working from home while children are in school. Therefore, parents and children should share the space for their activities at home. On the one hand, parents should focus on their job to maintain their working target in order to avoid losing their job, heighten their financial concerns, sustain their food security, maintain healthy habits, and keep their family members safe from COVID-19. Balancing life during the pandemic is challenging ( Fisher et al., 2020 ). Fathers and mothers should work together not only on the paid job but also on domestic chores, childcare, and teaching their children.

The aim of this literature review is to identify the impact of the COVID-19 pandemic on family well-being based on the previously published articles.

Literature Review

The coronavirus pandemic has become a public health crisis or disaster that has had an impact on family well-being both directly and indirectly. An infectious disease outbreak has spread rapidly, severely disrupted the world, and resulted in morbidity and mortality. This pandemic produced not only a health crisis, but also a social crisis among the population ( Murthy, 2020 ).

The conceptual framework was adapted from McCubbin and Patterson's family stress model. Using McCubbin and Patterson's family stress model, stressful life events (external stressors) had an impact on family life. During the COVID-19 pandemic, there was a profound impact on Indonesian economic growth and labor market, indicating that more people were living in poverty ( Gandasari & Dwidienawati, 2020 ; Olivia et al., 2020 ; Suryahadi et al., 2020 ). Stress-frustration theory indicates that diminished economic resources in the family could add to stress, frustration, and conflict in interpersonal interactions, which might increase the risk of men committing violence against women ( Kaukinen, 2020 ). It means that unemployment and economic instability contributed to the family stress. Furthermore, the underlying pandemic difficulties posed a threat to Indonesian people's mental health ( Abdullah, 2020 ; Megatsari et al., 2020 ). A higher risk of stress could lead to domestic violence. Domestic violence was defined as a coping mechanism for stress induced by social-systemic variables, such as poverty, unemployment, homelessness, loneliness, and ecological characteristics ( Zhang, 2020 ). Individual stress and other factors (such as job loss, lower income, limited resources and support, and hazardous and harmful alcohol use) were associated with domestic violence during the COVID-19 pandemic ( Campbell, 2020 ). Indonesian children were also affected. A recent study found that the financial burden within the family constituted a risk to Indonesian child competency and adjustment ( Riany & Morawska, 2021 ). The well-being of children might be dependent on the well-being of their parents ( Dahl et al., 2014 ). As a result, the inherent pandemic hardships posed a risk to family well-being.

According to the family stress model, the family must engage in an active process to balance external stressors with personal and family resources and a positive outlook on COVID-19 in order to develop and sustain an adaptive coping strategy to face the inherent pandemic hardships and eventually reach a level of family well-being. Mental health and prevention from the risk of mental disorders were required by incorporating individuals, families, communities, and government during and after pandemic events, so that family well-being and resilience could be achieved and improved ( Murthy, 2020 ). Resilience was characterized as a process that encompassed not just successfully adapting and functioning after experiencing adversity or crisis, but also the possibility of personal and relationship transformation and positive growth as a result of adversity ( Walsh, 1996 ). There were three fundamental processes to becoming resilient: shared belief systems, organizational patterns, and communication processes within the family ( Walsh, 1996 ).

A literature review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines ( Moher et al., 2009 ). This study was conducted from the beginning of March 2020, when the first positive case occurred in Indonesia, to October 1, 2020.

In order to meet the research objective, the authors carried out the literature review by searching various databases. The present study uses an integrative review to summarize the existing evidence to obtain a comprehensive understanding of the impact of the COVID-19 pandemic on family welfare. PubMed, Medline, Web of Science, and Scopus are selected as the main sources of the article's database. A manual search on Google Scholar is also conducted to find relevant articles based on the study’s eligibility criteria. The following keywords are used to perform the search, such as “COVID-19,” “pandemic,” “coronavirus,” “family,” “welfare,” “resilience,” and “mental health.” A total of 67 articles with the matching keywords were primarily retrieved.

Studies were eligible for inclusion if the studies are cross-sectional, experimental designs, or cohort studies describing the impact of the pandemics on family well-being both physical and mental well-being. Studies had to be published from the inception of the pandemic to October 15, 2020, in a journal with impact factors, English-language studies, and related to the COVID-19 pandemic. However, some articles are excluded because they are duplicate articles or studies in non-English language. We also excluded opinions, letters to the editor, and systematic reviews or meta-analyses. Moreover, unpublished articles and reports are also excluded from this study. Finally, based on the inclusion and exclusion criteria, eight articles met the inclusion criteria, and the data were extracted for the next analysis.

Based on eight articles, the data were extracted to include some important information, such as (1) Country/Region, (2) The purpose of the study, (3) Methods of the study, (4) The respondents (sample size and sample characteristics), (5) the main result of the study. The data extraction is done using a form on Microsoft Excel. All articles in this study were evaluated using narrative synthesis and presented data in the table forms.

A total of eight articles were selected for this study, with various subjects consisting of children, adolescents, adults, and parents. The literature review in this study is based on previous studies in the United States, Canada, Brazil, the United Kingdom, Germany, Ireland, Israel, China, Taiwan, Japan, and Bangladesh. Common impacts are physiological stress, anxiety, depression, income loss, fear, economic hardship, food insecurity, and family violence. Higher resilience is associated with fewer COVID-19-related worries, lower anxiety, and lower depression. Greater parental control is associated with lower stress and a lower risk of child abuse. Positive children were infected by the household contact. The results of the review are shown in Table 1 .

Table 1.

Characteristics of the Studies.

ReferenceCountryPurposeMethodRespondentsMain result
)The United StatesTo determine how the pandemic and mitigation efforts affected the physical and emotional well-being of parents and children in the United States through early June 2020Online research panel created by using probability-based address sampling of U.S. households. National survey of parents using the Ipsos Knowledge Panel. Households without Internet at the time of recruitment are provided with an Internet-enabled tablet1,011 parents with at least one child under the age of 18 years old in the household27% of parents reported worsening mental health themselves, and 14% reported worsening behavioral health of their children. The proportion of families with moderate or severe food insecurity increased. Employer-sponsored insurance coverage for children decreased, and parents reported a loss of regular childcare
)BangladeshTo investigate the relationships between human COVID-19 stress with basic demographic, fear of infection, and insecurity-related variables, which can be helpful in facilitating mental health policies and strategies during the COVID-19 crisis periodOnline-based survey340 Bangladeshi adult populations (65.9% male)About 85.60% of the participants are in COVID-19-related stress, which results in sleep shortness, short temper, and chaos in family. Fear of COVID-19 infection (i.e., self and/or family member(s), and/or relatives), hampering scheduled study plans and future career, and financial difficulties are identified as the main causes of human stress Economic hardship and food shortages are linked together and cause stress for millions of people, while hamper of formal education and future plan create stress for job seekers
)IsraelTo investigate the extent to which individual resilience, well-being, and demographic characteristics may predict two indicators of the coronavirus pandemic: distress symptoms and perceived dangerOnline survey: an Internet panel company and an Internet survey through social media by using snowball sampling605 Jewish Israelis from the Internet survey company and 741 respondents from the Internet sampleIndividual resilience and well-being were the strongest predictors of distress symptoms and a sense of danger
)The United States, Israel, and other countries (the United Kingdom, Canada, Brazil, Germany, Ireland, etc.)To measure resilience using self-reported surveys and explore differences in COVID-19-related stress and resilienceOnline survey on a crowdsourcing research website3,042 participants of healthcare providers and non-healthcare providers (engineering, computers, finance, research, legal, government, administration, student, teaching).Respondents were more distressed about family members contracting COVID-19 and unknowingly infecting others than they were about contracting COVID-19 themselves Higher resilience scores were associated with fewer COVID-19-related worries. Increasing resilience score was associated with a reduced rate of anxiety and depression
)United StatesTo examine the impacts of the COVID-19 pandemic in relation to parental perceived stress and child abuse potentialOnline survey via Qualtrics183 parents with a child under the age of 18 years old in the western United StatesGreater COVID-19-related stressors and high anxiety and depressive symptoms are associated with higher parental perceived stress. Receipt of financial assistance and high anxiety and depressive symptoms are associated with higher child abuse potential. Conversely, greater parental support and perceived control during the pandemic are associated with lower perceived stress and child abuse potential. The results also indicate racial and ethnic differences in COVID-19-related stressors
)ChinaTo analyze the different clinical characteristics between children and their families infected with severe acute respiratory syndrome coronavirus 2Retrospective review of the clinical, laboratory, and radiologic tests9 children and their 14 familiesAll the children were diagnosed with positive results after their family's onset, which indicated that they were infected by the household contact. A positive PCR among children may relate to mental health after discharge. The duration of positive PCR among children is longer compared with their adult families
)TaiwanTo explore family members’ concerns for their relatives during the lockdown period, assess their level of acceptance of the visiting restriction policy, and determine the associated factorsTelephone interviews of family members of residents in long-term care facilities comprising 186 beds156 family membersThe most common concerns of the family members for their relatives were psychological stress (such as feelings of loneliness among residents), followed by nursing care, and daily activity. More than 80% of respondents accepted the visiting restriction policy, and a higher satisfaction rating was independently associated with acceptance of the visiting restriction policy
)JapanTo examine the relationship between the presence or absence of a COVID-19 patient in a close setting and psychological distress levelsAdministrative survey using social networking service (SNS): chatbot on LINE16,402 people aged 15 years and olderIn the groups under the age of 60 years old, respondents with COVID-19 patients in a close setting had higher psychological stress

Coronavirus diseases put families in uncertain conditions without clarity on how long the pandemic situation will last. The pandemic has caused many challenges that impact on family unit and the functions of the family unit, including distraction in family relationships ( Luttik et al., 2020 ). These challenges will have an influence on family well-being in many aspects, such as loss of community, loss of income, resources, planned activities, and travel due to quarantine. The concern about nuclear family members increased because they did not want their family to become ill from the coronavirus. It is suggested to not visit the older members or those with serious illnesses who are more vulnerable to the virus.

Family life has been influenced since the early stage of the pandemic by the implementation of physical distancing, quarantine, and staying at home to curb the spread of coronavirus. Physical and social distancing are effective mitigations to reduce the spread of the coronavirus during the outbreak. However, distancing requires adaptation among family members to improve family well-being. Sheltering-in-place makes more frequent interactions among family members because they have limited opportunities to have a leisure time into the outside world. This condition, on the one hand, can create a quality time and intimate interactions among family members, but on the other hand, it may lead to long-standing high conflicts, occasionally domestic violence, and divorce ( Lebow, 2020b ). In this condition, a home can be described as a place of warmth, love, and safety or as a place of intimidation, abuse, and fear ( Hitchings & Maclean, 2020 ). Other studies found a positive outlook on the COVID-19 pandemic regarding the necessity of focusing on and enjoying family relationships, especially taking advantage of the pandemic's gift of extended time together ( Evans et al., 2020 ; Holmberg et al., 2021 ). This optimistic attitude could function as a shared belief system within the family, resulting in family resilience. Working life balance at home during the time of COVID-19 provides a new chance for internal conflicts, disagreements, and arguments in which parents try to play their multi-roles with all family members to mitigate some problems such as unemployment and financial instability ( Lebow, 2020b ). Family income loss/economic difficulties, job loss, experienced hardships during the pandemic, worsening mental and behavioral health, stress, high anxiety, distress about family contracting COVID-19, and illness are reported in some families during the COVID-19 pandemic.

Domestic violence related to mental and physical health may happen during the COVID-19 quarantine. Family members lived in complex situations during the pandemic, which increased the risk of overexposure by increasing the levels of stress, anxiety, and instability. The increase in domestic violence during the pandemic is reported in many countries, such as China, Brazil, the United States, and Italy, which may represent as “tip of the iceberg” since many victims do not have the freedom to report the abuse ( Campbell, 2020 ). Domestic violence is reported as physical harm, emotional harm, and abuse. Intimate partner violence is a common form of family violence during the COVID-19 pandemic ( Kaukinen, 2020 ; Zhang, 2020 ). There are three factors of family violence, such as the opportunities of family violence during lockdown and isolation at home, the economic crisis in the households, and insufficient social support for the victims of domestic violence ( Zhang, 2020 ). Individual resilience is a strong predictor of the willingness of people to cope with emergencies and challenges of different kinds, including the COVID-19 pandemic ( Kimhi et al., 2020 ). Individual resilience and well-being are significant factors influencing distress symptoms and a sense of danger ( Kimhi et al., 2020 ). Physical abuse, emotional abuse, and stalking are kinds of intimate partner violence that are experienced by some women during the COVID-19 quarantine ( Mazza et al., 2020 ).

Family violence is one of the causes of divorce. Family violence has become a serious social problem. During the pandemic in China, some couples decide to divorce due to family violence in their spousal relationship ( Zhang, 2020 ). Divorcing partners in the wake of COVID-19 have more complex issues because they should physically and emotionally separate in their households. It is suggested to involve family therapy so they can share their problems that arise readily to prevent anger, contempt, and other problematic conflicts ( Lebow, 2020b ). A good cooperation and communication among divorced parents may help children achieve their goals through this hard time. A recent study found that communication between two single parents discussing the impact of the COVID-19 epidemic on their family life could acquire something considerably more significant than just support and self-discovery ( Abdellatif & Gatto, 2020 ).

Financial distress, economic depression, unemployment, poverty, and added stressors such as the care and homeschooling of children, social distancing, and family isolation have increased the opportunities for family violence ( Kaukinen, 2020 ; Zhang, 2020 ). Family members with lower financial income, lower education status, and lower occupational status are more likely to experience family violence, including family conflicts, economic distress, high tension, lower mental well-being, and insufficient support during physical distancing or lockdown ( Zhang, 2020 ). Families have been dealing with threats from COVID-19 pandemics, both direct and indirect effects ( Lebow, 2020a ). The direct effects are the loss of family members, anxiety feelings related to family loss, increased unemployment, limited physical and social contact, family stress, conflict, and financial vulnerability. During the pandemic, families may have a virtual connection to maintain their communication. Therefore, geographic challenges are becoming less important due to virtual interconnection. Furthermore, a recent study found that virtual communication during the COVID-19 pandemic could improve family well-being and happiness ( Gong et al., 2021 ). At this time, digital technology, which needs digital literacy, becomes essential ( Hitchings & Maclean, 2020 ).

The coronavirus pandemic has increased the risk of mental health problems (such as mood disorders, fear, anxiety, depression, alcohol and smoking abuse) as well as physical health problems (such as sleep disturbance, gastrointestinal problems, poorer health condition) ( Mazza et al., 2020 ). The mental problems are caused by work stress, financial stress, and changes in the social life. The coronavirus pandemic has increased the risk of mental disorders (such as mood disorders, anger, anxiety, depression, alcohol and smoking abuse) as well as physical disorders (such as sleep disturbance, gastrointestinal problems, poorer health condition). Children’s health and well-being are also in danger during the pandemic, because most of the children may get the transmission of the virus from their adult family members who were previously infected ( Su et al., 2020 ). Therefore, individual resilience and well-being as a part of family resilience and well-being should be maintained to cope with the threat of the coronavirus pandemic.

Homeschooling during the pandemic makes parental responsibilities extended to include being teachers, coaches, trainers, and mentors for their children's school from home and other extracurricular activities ( Lebow, 2020b ). The condition of staying at home may increase parental stressors, particularly for working parents who are responsible for their multi-task dealing with other stressful conditions as paid workers and also doing domestic tasks. Moreover, violence may increase among children during homeschooling. During this time, parents and children are similarly living with stress, fear, and many challenges because they share their activities in the same place for uncertain time. Some factors influence the home learning as a distance learning, such as poverty, the educational levels of parents, mental health, the availability of gadget, and Internet access. During the pandemic, however, parental involvement in their children's activities provided an opportunity to develop and preserve family well-being ( Evans et al., 2020 ).

During the pandemic, it should be more widely focused on helping family members generate their individual space. A good and intensive family communication is needed to deal with the uncertainty of the COVID-19 pandemic. Some interventions are needed to improve maternal and child health and nutrition, such as strengthening the food supply chain, reducing food insecurity, building a net social security program, and a cash support program for the disadvantaged families during the COVID-19 pandemic. Based on the literature review, it is recommended to increase public awareness to staying connected and reporting if they find any family violence. Improving the readiness and knowledge of healthcare providers and counselors is needed to provide counseling services to help families who have physical and mental health problems. Fulfilling parents with updated information and guidance is important to deal with pandemic especially how to have working life balance and quality of life between working, guiding children in their homeschooling and other activities. Providing parenting resources during COVID-19 including conflict management is needed to have positive relationship and manage parenting stress. The government should take action to mitigate the social, economic, and health impacts of the pandemic on families, especially those who are vulnerable to losing household income. During the pandemic, it is important to maintain family well-being by staying connected with communication, managing conflict, and making quality time within family. Promoting family resilience through shared beliefs and close relationships within families is needed during the COVID-19 pandemic.

This study has some limitations. The limitation of this article is the possibility of omission of the potential article related to the family welfare during the COVID-19 pandemic. Moreover, the exclusion of unpublished articles will become another limitation. The findings of this literature review were mostly conducted in higher-income countries, which limits the generalization of the findings to low- and middle-income countries. The future research is required regarding family welfare as responses to women’s empowerment during the COVID-19 pandemic with homogenous family’s samples or with a large sample size with heterogeneity of welfare's status. The future research can be conducted by mixed methods between qualitative and quantitative methods.

COVID-19 outbreak around the world has become a public health concern. The coronavirus pandemic has had a substantial impact on the family's life. Physical and mental health problems, economic instability, and family violence are social issues during the pandemic that should be dealt with. The government should take action to mitigate the social, economic, and health impacts of the pandemic on families especially those who are vulnerable to losing household income. Promoting family welfare and resilience through shared beliefs and close relationships within families is needed during the COVID-19 pandemic.

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs: Maria Gayatri https://orcid.org/0000-0002-2792-5586

Mardiana Dwi Puspitasari https://orcid.org/0000-0002-6827-3350

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IMAGES

  1. COVID-19 spreads in Mizoram despite high vaccination rate

    covid 19 effect in mizoram essay

  2. Mizoram's COVID-19 tally crosses 800-mark

    covid 19 effect in mizoram essay

  3. Behind Mizoram’s Covid numbers: Aggressive testing & long, strict curbs

    covid 19 effect in mizoram essay

  4. 88 children among 440 new COVID-19 patients in Mizoram

    covid 19 effect in mizoram essay

  5. Mizoram's COVID-19 tally rises to 1,786

    covid 19 effect in mizoram essay

  6. 5 fresh COVID-19 cases in Mizoram; count rises to 117

    covid 19 effect in mizoram essay

COMMENTS

  1. Epidemiological study of COVID-19 in Mizoram, India: Meta-analysis of

    The association of the variables with ct value (≤25 and >25) of COVID-19 was examined using Chi-square and logistic regression model and P<0.05 as statistically significant. Results: A total number of 19,25,885 samples were tested among which 2,27,849 cases were diagnosed with COVID-19 from March 24, 2020, to May 12, 2022, in Mizoram.

  2. PDF Effectiveness of Online Learning during the COVID -19 Pandemic in Mizoram

    (1.1 million) and the literacy rate was around 91%. The outbreak of Covid-19 pandemic has been a major problem in Mizoram. To minimize the spread of Covid-19, the education institutions in Mizoram made the transition to online teaching and learning soon after the first Covid-19 pandemic lockdown. The online education affected the

  3. PDF COVID-19 and Governance in Mizoram: Issues and Challenges

    Background: The phenomenon of COVID-19 has remained a mystery to mankind. It is not just about the disease but has also multiple ripple effects on every aspect of life. It has completely changed the course of living in a short period. The entry of Covid-19 has taken a heavy toll on human beings in particular and on every

  4. Mitigating infectious diseases in Mizoram

    Abstract. COVID-19 pandemic has created huge havoc in public health in India and across the world. One among the small states of India, Mizoram lies between Bangladesh and Myanmar compelling a ...

  5. COVID-19 and Governance in Mizoram: Issues and Challenges

    Background: The phenomenon of COVID-19 has remained a mystery to mankind. It is not just about the disease but has also multiple ripple effects on every aspect of life.

  6. COVID-19 and Governance in Mizoram: Issues and Challenges

    The effects of Covid-19 and lockdown have heavily impacted the socioeconomic aspects of the people more likely to daily wage seekers in particular. ... Online survey response on Governance and COVID-19 in Mizoram Governance Policy Good Poor Others Total Respondents Govt. efforts in response to Covid19 issues 304 49 147 500 60.8% 9.8% 29.4% ...

  7. PDF Mitigating infectious diseases in Mizoram

    ies could make it a possible route of spreading communicable diseases. The first case of COVID-19 in Mizoram was diagnosed on 24 March 2020. There were 418 active cases with five mortality from 3765 infected patients as of 26 November 2020.22 The government of Mizoram along with non-governmental organizations ha.

  8. COVID-19 and Governance in Mizoram: Issues and Challenges

    Research Scholar, Department of Political Science, School of Social Sciences, Mizoram University, Aizawl, Mizoram, India. ABSTRACT. Background: The phenomenon of COVID-19 has remained a mystery to mankind. It is not just about the disease but has also multiple ripple effects on every aspect of life.

  9. COVID-19 pandemic in Mizoram

    As of 4 May 2020, a 74-year-old man from Mizoram, who had tested positive for COVID-19 died on 3 May 2020 in Kolkata. He is the first person from Mizoram to die of COVID-19. As of 9 May 2020, Mizoram becomes COVID-19 free as lone patient recovers. June 2020. As of 2 June 2020, the total number of cases in Mizoram was 12.

  10. What studies say is behind Mizoram's high Covid-19 infections

    Mizoram recorded its first Covid-19 case in late March last year, and the first death was seven months later. From the first case on March 24, 2020, until March 31, 2021, Mizoram had recorded just ...

  11. PDF STUDY ON COVID-19 LOCKDOWN AND ITS ECONOMIC CONSEQUENCES FOR ...

    2 Foreword The 'Study on Covid-19 Lockdown and its Economic Consequences for the State of Mizoram' is an attempt to analyse the economic implications of the ongoing COVID-19 pandemic on the State's economy and to highlights possible policy measures for various sectors to cushion economic shock during the pandemic and to revive / recover the

  12. Insights into the impact on daily life of the COVID-19 pandemic and

    1. Introduction. The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented changes in people's daily lives, with implications for mental health and well-being [1-4], both at the level of a given country's population, and when considering specific vulnerable groups [5-7].In order to mitigate the untoward impact of the pandemic (including lockdown) and support mental health ...

  13. COVID-19 pandemic and its impact on social relationships and health

    Abstract. This essay examines key aspects of social relationships that were disrupted by the COVID-19 pandemic. It focuses explicitly on relational mechanisms of health and brings together theory and emerging evidence on the effects of the COVID-19 pandemic to make recommendations for future public health policy and recovery.

  14. COVID-19 and Its Impact on the Indian Economy

    This windfall gain can, to some extent, offset the direct losses due to COVID-19. At the same time, dreams like a $5 trillion economy no longer look even a remote possibility. This article takes stock of the likely impact of COVID-19 on the Indian economy in the short term and the long term.

  15. Impact of COVID-19 on the social, economic, environmental and energy

    Fig. 15 a shows the effect of COVID-19 on the GDP of different countries around the globe. On the other hand, economies of emerging market and developing economies, excluding China, are projected to contract by only 1.0% in 2020. The economic recovery in 2021 will depend on the gradual rolling back of containment efforts in the latter part of ...

  16. Covid-19 Lockdown and its Consequences on Mizoram

    Budget Analysis Budget in Brief 2018-2019 Covid-19 Lockdown and its Consequences on Mizoram 2020 Comparison of Retail Prices within AMC Area 2021 Economic cum-Purpose Classification of Budget 2013-2014

  17. Impact of COVID-19 on people's livelihoods, their health and our food

    Reading time: 3 min (864 words) The COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems and the world of work. The economic and social disruption caused by the pandemic is devastating: tens of millions of people are at risk of falling into extreme poverty ...

  18. How COVID-19 shaped mental health: from infection to pandemic effects

    On a global scale and based on imputations and modeling from survey data of self-reported mental health problems, the Global Burden of Disease (GBD) study 29 estimated that the COVID-19 pandemic has led to a 28% (95% uncertainty interval (UI): 25-30) increase in major depressive disorders and a 26% (95% UI: 23-28) increase in anxiety disorders.

  19. My Experience During The Covid-19 Pandemic

    Conclusion. In conclusion, the COVID-19 pandemic has had a profound impact on my life. It affected me physically, mentally, and emotionally and challenged my ability to cope with adversity. However, it also taught me valuable lessons and allowed me to grow as an individual. This is only a sample.

  20. COVID-19 pandemic and its impact on social relationships and health

    This essay examines key aspects of social relationships that were disrupted by the COVID-19 pandemic. It focuses explicitly on relational mechanisms of health and brings together theory and emerging evidence on the effects of the COVID-19 pandemic to make recommendations for future public health policy and recovery. We first provide an overview of the pandemic in the UK context, outlining the ...

  21. 12 moving essays about life during coronavirus

    Read these 12 moving essays about life during coronavirus. Artists, novelists, critics, and essayists are writing the first draft of history. A woman wearing a face mask in Miami. Alissa Wilkinson ...

  22. The Impact of COVID-19 Pandemic on Family Well-Being: A Literature

    Background: COVID-19 has changed family life, including employment status, financial security, the mental health of individual family members, children's education, family well-being, and family resilience. The aim of this study is to analyze the previous studies in relation to family well-being during the COVID-19 pandemic. Methods: A literature review was conducted on PubMed, Medline, Web of ...

  23. Here's How the Coronavirus Pandemic Has Changed Our Lives

    From lifestyle changes to better eating habits, people are using this time to get healthier in many areas. Since the pandemic started, nearly two-thirds of the survey's participants (62%) say ...