effect of covid 19 on education in pakistan essay

The Effects of COVID-19 on Education in Pakistan: Students’ Perspective

• Fouzia Malik Benazir Bhutto Shaheed University
• Fouzia Ajmal IIUI
• Zohran Jumani Iqra University

Due to the wide spread of COVID-19, the educational institutes were closed on 20th March, 2020 and the individuals were advised to isolate themselves at home. This lockdown not only adversely affected the economy but all the educational activities were shut down which created a huge gap in students’ learning and knowledge all over the globe. This quantitative study was designed to explore the impact of COVID-19 on the education of higher level students in the context of Pakistan. The five point Likert Scale questionnaire was provided to the learners enrolled in intermediate, undergraduate, graduate and postgraduate level. 74 respondents respond to the questionnaire. The data were analyzed through SPSS 23. The results of the findings revealed that students have been facing a lot of difficulty to grasp certain concepts during e-classes. The students lacked internet access along with not been given any prior guidance related to the usage of online platform. The challenges regarding online classes at the same time are being faced by the teachers as well along with the students. It was also analyzed that although teachers are providing all the necessary resources and feedback to the students but still students have been going through difficulties in grasping the concept, gaining knowledge and communicating with their teachers online. Due to immense number of online classes teachers have a huge workload on their part.

Author Biographies

M. Phil Student

Assistant Professor, Department of Education

Research Scholar

© By Department of Education (Directorate of Distance Education) International Islamic University Islamabad. IJDEEL by International Islamic University Islamabad is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Based on a work at www.iiu.edu.pk.  All articles published by IJDEEL are licensed under the Creative Commons Attribution- NonCommercial 4.0 International License . This permits anyone to copy, redistribute, transmit and adapt the work provided the original work and source is appropriately cited as specified by the Creative Commons Attribution-NonCommercial 4.0 International License.

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IMPACT OF CORONAVIRUS ON EDUCATION SYSTEM IN PAKISTAN: PROBLEMS AND SOLUTIONS

• Dr. Niaz Muhammad A/P, Drptt: of Education, Islamia College University, Peshawar- Pakistan
• Dr. Nasrullah Khan University of Poonch, Rawalakot, Azad Kashmir
• Dr. Khisro Kaleem Raza PhD, University of Peshawar, Peshawar

Background of the study: The sudden rise of COVID pandemic and its speedy spread around the globe affected almost all walks of life particularly the education system in Pakistan. The lockdown in the entire country and closure of all education institutes put a gape in teaching learning process. It made the teachers and students away from each other, thus physical interaction of students and teacher in classrooms became a dream for both the students as well for the teachers at secondary level. The parents of the students were very worried for the study loss of their children but they were helpless. Therefore, the purpose and focus of this research paper was on the evaluation of literature available internationally to see what the status of covid pandemic in the world is and what type of strategy they have adopted to cope with the problem. Method: The nature of this research is evaluative, as it has been mentioned in the above lines that focus was on the available literature, Online overview was also driven for data collection to evaluate it, analyze it and to see the result of the closure of educational institutes due to Covid pandemic and its impact on secondary education system of Pakistan. Results: Key results extracted from literature were: It affected all walks of life particularly the education system at large. It wasted the precious time of the students by halting physical interactive classrooms. ICT stepped in to replace physical classrooms with online classrooms but this new approach had many other problems like, lack of experience, many of the teaching staff as well as the students in ICT, availability of the electronic gadgets to all the teachers and students. Thus availability of the net facility to all the teachers and students in the country was also a problem. Conclusion: It was concluded that online classes were not as useful as physical interactive classes. It does not facilitate the entire stakeholder equally. Online classes have many flaws for instance, availability of the devices, experience of its usage, and net accessibility. In online class it is difficult for the teachers to have hold on the class like in physical classes.

Author Biographies

Dr. niaz muhammad, a/p, drptt: of education, islamia college university, peshawar- pakistan, dr. nasrullah khan, university of poonch, rawalakot, azad kashmir, dr. khisro kaleem raza, phd, university of peshawar, peshawar.

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THE EFFECTS OF COVID-19 ON EDUCATION IN PAKISTAN

• Babar Ali Department of Physical Therapy, Abasyn University Peshawar
• Haider Ali Department of Neurosurgery, Lady Reading Hospital Peshawar
• Sayed Zulfiqar Ali Shah Tongji Medical College, Tongji Hospital, Huazhong university of Science and Technology China

On December 31st, 2019, some cases of unknown pneumonia were reported by Chinese health authorities to world health organization (WHO) regional office China which were later on diagnosed as cases of a novel coronavirus (2019-nCoV). The novel coronavirus was isolated from samples taken from lower respiratory tracts of affectees, gene sequencing and comparison to the existing coronaviruses revealed that the novel coronavirus named “(2019-nCoV)” is a beta coronavirus. Coronaviruses have caused epidemics in 2012 in the Middle East respiratory syndrome coronavirus (MERS-CoV) and in China in 2002-2003 (SARS-Cov). WHO in January 2020 declared Covid-19 as viral global emergency after spread of virus to many countries. This outbreak of novel coronavirus (COVID-19) was officially announced as global pandemic on March 11, 2020, by WHO. So far it is assumed that COVID-19 strain emerged from wild animals in Wuhan, a city in Hubei province of China. Animals namely Pangolins, snakes and Bats have been referred as potential carriers found on the sequence homology of CoV isolated from these animals. Studies suggest that youngsters under the age of 18 years show that about 8.5% of reported cases, with relatively small number deaths as compared to other age groups and generally mild disease. However, patients with severe illness have been reported. Adults having pre-existing comorbidity have been proposed as a risk factor for developing severe disease and intensive care hospitalization.

 The recent COVID-19 pandemic caused by SARS-CoV-2 persist a significant issue for worldwide health, education, society, economics, transportation and society. Due to lack of unclear and effective treatment of COVID-19 in early stages of pandemic, emphasis has been given on early recognition and diagnosis, treatment and isolation of infected people and quarantining their close contacts. Government agencies of all Countries enforced quarantine, social distancing and hand washing to control the spread of infection. Educational institutes comprising universities, colleges and schools were closed in majority of countries including Pakistan. Pakistan is a developing country and the economic condition is not good as compared to developed countries like America, China, United Kingdom and Russia to tackle with COVID- 19 Pandemic. During pandemic majority of institutes in developed countries have moved to online education to facilitate academics and save waste of time.  Developed countries have well established technology, nonstop internet facility and online learning programs but imposition of online of online learning in developing nation including Pakistan faces many barriers. Government of Pakistan announced 1 st lockdown on March 2020, and closed all educational institutes nationwide. During this period ministry of education started teleschool ambition in partnership with leading EdTech supplier such as Knowledge Platform, Teleemabad Sabaq.pk to transmit free learning materials to class 1-12 students. Medical Colleges, degree awarding institutions and universities offering bachelor, master and doctorate programs shifted their learning process on online web based application learning management system (LMS) which offers an teacher with a way to create and deliver learning content, monitor pupil involvement and assess scholar performance. Universities and medical colleges also adopted another software-based application zoom, a video conferencing application that assents teachers and students in the educational and other institutions to carry out online classes and meetings. All these applications required a good working internet connection but remote cities of Pakistan including tribal districts do not have internet coverage due to which students learning process suffered. Further, students of life sciences, biological sciences, health and medical sciences and research scholars involved in lab-based activities were deprived from practical sessions during closure periods.

It is noteworthy that this pandemic is not distinctive to Pakistan alone. Government sector should ensure strong broadcasting of internet facility in all localities of Pakistan. Policy makers of education sector should give obvious directions at the start of the learning sessions, interacting with the students rather of just talking. Organizations should establish IT divisions and software to upgrade learning standard. Moreover, vaccinated process should be accelerated and awareness sessions should be conducted to tackle myths about Covid-19 vaccination among public. In Pakistan cases of Indian delta variant are raising and according to National Command and Operation Centre (NCOC) positivity percentage are 6.30 as of July 22, 2021 leading to fourth wave

of COVID-19 in Pakistan . If the positivity ratio of COVID-19 increases the Government may announce closure of educational institutions in cities with high positivity but educationists, should make efforts to adapt the nemesis of COVID-19 into an opportunity.

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COVID-19 spurs big changes in Pakistan’s education

Neelam ejaz, neha ravail khaliq, yahya bajwa.

Pakistan's schools are reopening again today after a nearly uninterrupted 11-month hiatus.  In March 2020, the Government of Pakistan closed all schools as part of a nationwide lockdown, prompting the Ministry of Federal Education and Professional Training (MoFE&PT) to seek education alternatives to ensure learning continuity.

During the first phase of school closure, Pakistan launched the TeleSchool initiative in collaboration with leading EdTech providers such as Knowledge Platform , Sabaq.pk , Sabaq Muse , and Taleemabad to broadcast free learning content to grades 1-12 students. After briefly opening for 6 weeks, schools were closed again in November. In December, the government launched its first Radioschool to expand student outreach in response to the second school closure.

Has COVID-19 ushered in a new era for how Pakistan delivers education? 

Evidence points to the fact that the EdTech sector has become a crucial education player.   Through virtual blackboards, online live classes, and Learning Management Systems, animated videos, augmented reality, and gamification, EdTech has brought in innovations that will change the way children in Pakistan learn and access education. 

EdTech startups have reported a 20 to 100 percent growth in users during COVID-19.  The World Bank recently held its second EdTech workshop – EdTech Pakistan 2.0 – to connect startups with development partners, government, and other stakeholders. The virtual workshop focused on distance education, blended learning, and girls' education amid COVID-19 and how to keep the momentum to cater to the large population of out-of-school children.

Boosting girls' education online

Nearly one out of three girls in Pakistan has never been to school. Distance from schools, security, and lower numbers of female teachers are among the main reasons behind girls' low enrollment and high dropout rates, translating later into only 26 percent female labor force participation.

Technology, coupled with community support and parents' involvement, can play a critical role in enabling more girls to access a safer, skills-oriented education. 

For example, Edkasa , a startup, offers virtual, interactive classrooms and reaches beyond major cities to Pakistan's poorest districts. Their primary focus is girls' education in the STEM (science, technology, engineering, and mathematics) subjects, providing online classes beyond traditional activities such as "Silai Karhai" (Sewing and Stitching). Another startup, AzCorp , uses 'Edutainment' as their learning foundation, focusing on embedding civic rights, social justice, and gender equality themes among their viewers.

"With the Coronavirus outbreak, it was very difficult to continue studying, but the launch of TeleSchool by the government has really helped us cope." – Primary School Student, Rawalpindi

Bridging gaps with distance education

By confining them at home, COVID-19 has limited students' access to schools, teachers, and learning materials. Distance learning programs have provided an opportunity to surpass this challenge and enable uninterrupted access to resources. To support this, the MoFE&PT has established a new 'Distance Education Wing' to continue developing alternate modes of education, even after schools reopen. Provincial governments have also used digital tools to ensure learning continuity. In collaboration with Sabaq Muse , Sindh Government rolled-out a learning app in 700 schools offering animated and interactive story-based learning content, focusing on early years and primary education. The app provided free learning materials in Urdu, English, and Sindhi.

Capturing student interest is key to improving learning outcomes both at home and in the classroom. Teach the World Foundation focuses on engaging students through gamification, self-learning, personalization, and real-time data tracking to improve learning outcomes using existing resources. Another startup, Kar Muqabla , infuses play and competition to enhance students' learning experience, linking students from across the country through school competitions and providing a space for non-academic creativity.

"When the COVID-19 situation is handled, and students return to schools, they will have TeleSchool as an additional resource available to them." – EdTech Service Provider

Blended learning and the digital divide

The MoFE&PT is also piloting blended learning in 200 public school classrooms to better understand the implementation challenges of new technologies. Schools closure has further spotlighted the existing digital divide across Pakistan. Only 34 percent of households in Pakistan have internet access, and 14 percent have laptops or computers. Girls tend to have limited access to digital resources compared to boys. Although online learning resources are growing, support infrastructure for EdTech, as well as a cohesive implementation strategy to reach the most vulnerable, is a hurdle. In order to support students, MoFE&PT is working towards subsidized packages for devices and broadband.

According to early World Bank estimates, at least 1 million children in Pakistan are expected to drop out of school owing to COVID-19's socioeconomic impact.  The second round of school closures may result in even more children not returning to schools. Distance learning programs and open educational platforms have enabled schools to limit the disruption caused by COVID-19, but there is much to be done to make sure that these mediums have a broader impact on learning. The growing EdTech sector provides alternatives to sustain learning during the pandemic and can be groundbreaking to improve education access post-pandemic. 

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The Annual Status of Education Report (ASER), Pakistan, conducted by Idara-e-Taleem-o-Aagahi (ITA) is the country’s largest citizen-led household-based survey and aims to provide regular, reliable estimates of education status and learning outcomes of children aged 5 - 16 years in rural districts of Pakistan. After the unprecedented school closures of 2020 and early 2021, the ASER study in 2021 was adapted to measure the impacts of COVID-19. The survey was conducted in 16 rural districts of Pakistan (four each in Balochistan, Khyber Pakhtunkhwa, Punjab and Sindh provinces). This report aims to develop a body of evidence to inform future policy decisions, focusing particularly on learning losses due to school closures and the measures taken to support learning for school-going children. 

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Here’s How COVID-19 Has Impacted Everyone in Pakistan

Coronavirus (2019-nCoV) allegedly started from the Wuhan animal market in China on 16 November 2019 according to South China Morning Post. Then it quickly spread all over the world. At present, USA, Brazil, China and India are the most affected countries by COVID-19. No doubt, China has technically and scientifically fought this pandemic in a much better way than other countries of the world. Even though COVID vaccines, especially by American multinational pharmaceutical company (Pfizer) and many others are nearing mass production, the pandemic has created many challenges for South Asian countries. Here is how the pandemic has impacted Pakistan.

COVID-19 has severely affected Pakistan’s economy. Since the arrival of Covid-19, economic growth has taken a turn for the worse, pushing economies into a global recession . Micro and medium-sized enterprises are the major victims of this pandemic in Pakistan. Various businesses are facing different issues with varying degrees of loss.

Particularly, enterprises are facing a variety of problems such as a decrease in demand, supply chain disruptions, cancelation of export orders, raw material shortage, and transportation disruptions, among others. Nevertheless, it is quite clear that enterprises around the globe are experiencing the significant impact of the COVID-19 outbreak on their businesses.

Micro-level businesses are the backbone of many economies worldwide, providing income and employment to a large number of people around the globe. Similarly, in the case of Pakistan, these businesses are crucial for the economy. About 3.2 million such businesses are contributing 40% to GDP and 40% to exports. On 2 April 2020, the Federal Government shared the initial assessment that total losses to the economy could be as high as Rs 2.5 trillion, reported  The News .  

COVID-19 also became the major cause of unemployment in Pakistan. Most of the informal sector, which accommodates about 27.3 million employees, is now suffering a sudden increase in unemployment. Firms that are continuously facing a loss are now nearing closure forced to fire their employees. 

Moreover, livelihood opportunities for daily wage workers have been squeezed. Not only have small and medium enterprises and traders been badly hit but the closure of large industries, ports, airports, and transportation services has also compressed and jammed the wheel of Pakistan’s economy.

Additionally, this cut down in economic activity has scaled down the consumption of petroleum products thus resulting in the closure of refineries globally due to which Pakistan’s petroleum trade is immensely impacted.

Pakistan is suffering a great loss in its education sector since the pandemic began. While access to education was already a problem in Pakistan –  22.8 million of Pakistan’s over 70 million children are out of school – the coronavirus outbreak has exposed its intense technological inequities. Over 50 million school and university-going Pakistanis now risk falling behind, says Umbreen Arif, a top education advisor for Pakistan’s central government.

In Pakistan, about 300,000 schools have been closed since March due to the coronavirus outbreak. Following Govt’s orders, school administrations have shifted classes to an online mode of learning. Teachers who are living in urban cities and towns have the facilities of internet and smartphones. Similarly, students of these areas can access the internet and continue their studies through digital platforms and applications.

On the other hand, this e-learning hurts the students and teachers of rural areas. Wi-Fi issues, resource allocation, lack of electronics, are all problems affecting rural students with little or no access to the necessities that go along with online school and college courses. For example, students of Govt. schools are major victims of the pandemic. Another example is students living in exurban areas of Sindh, as well as of hilly areas of KP, GB, and Balochistan, where there is no mobile phone service, are waiting for a miracle which will make it easy for them to study online. Due to tensions on the LOC between India and Pakistan, students of AJK do not have internet. Online mode of learning has put a financial burden on parents as well as they have to arrange gadgets for all of their children.

All this has adverse impacts on the psychology of people and they are getting depressed.

Religious activities in Pakistan are badly affected by COVID-19. At the start of this pandemic, the govt. imposed lockdown on Mosques and Sunday Schools.

The Govt. banned all kinds of religious and social gatherings. Madrassas got closed and when mosques were reopened, the govt. strictly ordered to maintain a social distance of 6 feet during congregations.

Due to COVID-19 , all sports activities were banned in Pakistan. When the pandemic hit, Pakistan Super League season 5 was going on, but it was postponed. The last few matches were rescheduled to November with no crowd attendance. Similarly, Pakistan Premier League (PPL) 2020 was canceled and not organized by Pakistan Football Federation due to COVID-19.

Pakistani city Sialkot is famous for producing finest quality sports goods. Markets of Sialkot are littered with millions of footballs, hockey sticks, bats and other sports-related goods. Pakistan annually earns $1 billion from exports of sports goods, which includes $350-$500 million from footballs alone. Its famous “thermos-bonded” soccer balls were used in the 2018 World Cup in Russia. The country’s sports industry, according to exporters, has seen a 70% decline in new orders over the past three months. Hundreds of orders from Europe, South America and far Asia were canceled due to the COVID-19 lockdown across the globe. It is observed that the country’s exports of sports goods reduced to $700-$800 million due to lockdown restrictions. According to Husnain Cheema, a former president of the Pakistan Sports Goods Association, around 25% of workers in the sports industry have lost their jobs during the lockdown period.

Pakistan’s domestic tourism industry is another victim of this pandemic. After an extensive battle against terrorism, the domestic tourism industry was restored. The majority of countries that declared Pakistan as a terrorist state started declaring it as a peaceful and best holiday destination. Pakistan topped Forbes and Conde Nast Traveler’s list of best holiday destinations for 2020. Even Balochistan and Waziristan received special attention from the tourists and famous vloggers.

Unfortunately, by the end of Jan 2020, when the pandemic changed the whole world, the World Tourism Organization (UNWTO) has alerted that “the COVID-19 pandemic could lead to a loss of $300-500 billion in tourism receipts globally”.

Due to COVID-19, public transport in Pakistan got banned. Domestic as well as international flights were disallowed. Closure of markets, public places, parks, big bazaars, and shopping malls added fuel to fire. In major cities, many hotels were transformed into quarantine centers. Dine-in was banned and only home delivery and take away were allowed.

In Pakistan, most of the people living in Northern areas earn from tourism and rely only on tourist spending. But this pandemic left those areas desolated and they are suffering.

It was all about COVID-19’s first wave and Pakistan suffered a lot. While the public and the Govt. are struggling to recover from the initial wave, the second spell of COVID-19 cases is expected that this wave will be even more lethal. May Allah protect us all from this disease.   

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Explained: Impact of COVID-19 on Pakistan's education system

Students have experienced several school closures, and experts speculate that such a loss could have long-term impacts..

Published : Sep 23, 2021 13:18 IST

The pandemic has impacted the learning of nearly 40 million students.

Last week, Pakistan opened both public and private schools in various districts of Punjab and Khyber Pakhtunkhwa, with Sindh province opening its schools in August. Schools are now operating with a 50 per cent attendance policy on alternating days due to the COVID regulations set forth by the National Command and Operation Center (NCOC). Vaccinations were also made mandatory for all staff and students over the age of 15.

Schools in Pakistan were closed for around seven months during the first COVID wave. However, they reopened in September 2020 and were closed again shortly thereafter the following November. The government announced another phased opening of educational institutions in January of this year. However, this reopening was also short-lived, as schools closed again in April 2021 due to the third wave.

"The school year for 2021-22 has been extended to June 2022. Final examinations will be conducted in June 2022,” Murad Raas, Punjab's Education Minister, tweeted last week. Officials have introduced digital learning methods to compensate for the repeated closures. Recently, the minister of education also decided to promote some students who had failed by awarding them 33 per cent concessional marks. However, the effectiveness of these measures remains in doubt.

Millions of students lose out

In a country already scarred by stark differences in the quality of education between public and private schools, as well as low literacy rates, the pandemic has affected the learning of approximately 40 million students across Pakistan. The World Bank has claimed that "even the most optimistic scenario suggests an overall loss of learning for every child enrolled."

According to a study by UNICEF, students learned significantly less from home, compared with classroom learning before the pandemic. Their learning was harmed by a lack of access to technology, network connectivity issues, and low levels of motivation. "Keeping the children interested and motivated in online classes is the biggest challenge, as children do not have any interest in them and their screen time is increased," Alia Malik, a mother of three, told DW . Arranging separate places and gadgets for all the children in the house presented a further challenge.

While talking to DW about the contrast between online and face-to-face learning, Shahram Ahmad, a private university student, said: "It's the same difference as between a call and meeting someone in person. It's a lot easier to understand difficult concepts when an instructor can use all tools at their disposal."

Muhammad Qadeer, a secondary school teacher, told DW that since students are passing through a critical stage of their mental and biological development, the lack of regular coaching and extracurricular activities will have a huge impact on their learning. "This generation will always be remembered as the COVID generation,” he said.

'A matter of privilege'

As reported by UNICEF, remote learning was not possible for 23 per cent of young children due to a lack of access to digital devices. The pandemic has hit poor and disadvantaged families the hardest, as they are unable to purchase even a single device.

Geographical barriers have also had an impact. Around 26 per cent of urban youth had no access to technology whereas, in the countryside, that figure rose to 36 per cent. Remote learning is also challenging for children with disabilities and girls. "I did really well in my in-person classes but during lockdown, I had some domestic duties that couldn't be ignored. This severely affected my performance in university and my GPA hit rock-bottom," said Wyena Qureshi, a private university student.

Students also had to drop out due to financial losses during the pandemic. Pakistan's economy was hit hard by the pandemic. Back in 2020, the World Bank predicted 930,000 children would drop out of primary and secondary education. "Pakistan is globally the country where we expect the highest [number of] dropouts due to the COVID crisis," the bank said.

Two sides of the same coin?

"It's been a challenging experience for all of us but we have also learned to function and stay connected from a distance," Yasmeen Hameed, an educator, told DW . "New learning techniques were adapted and gradually children have become familiar with them,” she said.

Pakistan’s teleschool program for students in Punjab initially had a high number of viewers due to the support of stakeholders and a phase-by-phase rollout. However, the market research firm, IPSOS, found that usage decreased after six months.

Zulfiqar Samin, deputy secretary for policy at the Ministry of Federal Education, told DW that the ministry has tried to overcome challenges with education through the digital programs. "We tried to reach all radio and TV channels that we possibly could and kept the language of communication as Urdu at the federal level to overcome any linguistic barriers. Parents have also cooperated very well with us," he said.

He also stressed that developed countries like China, the United States, and Germany have also been affected similarly. He added that, while the government of Pakistan is pushing its vaccination campaign until the majority of people get vaccinated, they remain at risk.

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• DOI: 10.61173/0bfxz117
• Corpus ID: 270317018

A Study on the Effect of Foreign Language Learning Anxiety on Language Learning Effectiveness

• Zhixuan Xiang
• Published in Arts, Culture and Language 6 June 2024
• Education, Linguistics
• Arts, Culture and Language

4 References

Detecting perceived barriers in flsa: the socio-psycholinguistic study of efl university learners, online foreign language learning in higher education and its correlates during the covid-19 pandemic, related papers.

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• Open access
• Published: 01 December 2022

The psychological impact, risk factors and coping strategies to COVID-19 pandemic on healthcare workers in the sub-Saharan Africa: a narrative review of existing literature

• Freddy Wathum Drinkwater Oyat 1 ,
• Johnson Nyeko Oloya 1 , 2 ,
• Pamela Atim 1 , 3 ,
• Eric Nzirakaindi Ikoona 4 ,
• Judith Aloyo 1 , 5 &
• David Lagoro Kitara   ORCID: orcid.org/0000-0001-7282-5026 1 , 6 , 7  

BMC Psychology volume  10 , Article number:  284 ( 2022 ) Cite this article

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The ongoing COVID-19 pandemic has significantly impacted the physical and mental health of the general population worldwide, with healthcare workers at particular risk. The pandemic's effect on healthcare workers' mental well-being has been characterized by depression, anxiety, work-related stress, sleep disturbances, and post-traumatic stress disorder. Hence, protecting the mental well-being of healthcare workers (HCWs) is a considerable priority. This review aimed to determine risk factors for adverse mental health outcomes and protective or coping measures to mitigate the harmful effects of the COVID-19 crisis among HCWs in sub-Saharan Africa.

We performed a literature search using PubMed, Google Scholar, Cochrane Library, and Embase for relevant materials. We obtained all articles published between March 2020 and April 2022 relevant to the subject of review and met pre-defined eligibility criteria. We selected 23 articles for initial screening and included 12 in the final review.

A total of 5,323 participants in twelve studies, predominantly from Ethiopia (eight studies), one from Uganda, Cameroon, Mali, and Togo, fulfilled the eligibility criteria. Investigators found 16.3–71.9% of HCWs with depressive symptoms, 21.9–73.5% with anxiety symptoms, 15.5–63.7% experienced work-related stress symptoms, 12.4–77% experienced sleep disturbances, and 51.6–56.8% reported PTSD symptoms. Healthcare workers, working in emergency, intensive care units, pharmacies, and laboratories were at higher risk of adverse mental health impacts. HCWs had deep fear, anxious and stressed with the high transmission rate of the virus, high death rates, and lived in fear of infecting themselves and families. Other sources of fear and work-related stress were the lack of PPEs, availability of treatment and vaccines to protect themselves against the virus. HCWs faced stigma, abuse, financial problems, and lack of support from employers and communities.

The prevalence of depression, anxiety, insomnia, and PTSD in HCWs in sub-Saharan Africa during the COVID-19 pandemic has been high. Several organizational, community, and work-related challenges and interventions were identified, including improvement of workplace infrastructures, adoption of correct and shared infection control measures, provision of PPEs, social support, and implementation of resilience training programs. Setting up permanent multidisciplinary mental health teams at regional and national levels to deal with mental health and providing psychological support to HCWs, supported with long-term surveillance, are recommended.

Peer Review reports

Introduction

When coronavirus disease 2019 (COVID-19) was declared a pandemic in March 2020, healthcare workers (HCWs) globally and in sub-Saharan Africa (SSA) were unprepared for the scale of the physical and mental health devastation that was to follow [ 1 ]. The impact of the COVID-19 pandemic on healthcare workers has been profound, characterized by death, disability, and untenable burden on mental health and well-being [ 2 ]. Factors impacting their mental health include high risks of exposure and infection, financial insecurity, separation from loved ones, stigma, difficult triage decisions, stressful work environment, scarcity of supplies including personal protective equipment (PPEs), exhaustion, traumatic experiences due to regular witnessing of deaths among patients and colleagues [ 2 , 3 ]. Greenberg et al. [ 4 ] observed that the COVID-19 pandemic put healthcare professionals worldwide in an unprecedented situation, making difficult decisions to provide care for many severely ill patients with constrained or inadequate resources.

In almost all WHO regions, data indicates that infection rates among healthcare workers are higher than in the general population [ 5 ]. Scholars suggest that the end of the COVID-19 pandemic is not yet in sight. Neither are they sure about the virulence of the following variant when it appears as caseloads are still rising, with more than 621 million infections and 6.5 million deaths reported worldwide by 19th October 2022 [ 6 ]; mainly driven by the newer omicron variants. However, recently in October 2022, we received with gratitude a reassuring message from US President Biden declaring the end of the COVID-19 pandemic in the United States of America.

Meanwhile, previous studies found high levels of depression, anxiety, and PTSD in survivors among the general population and healthcare workers (HCWs) one-to-three years after the control of the SARS epidemic [ 7 ] and the 2014–2016 Ebola epidemic in West Africa [ 8 ]. In addition, recent surveys [ 9 , 10 , 11 , 12 , 13 , 14 ], reviews, and meta-analyses [ 15 , 16 , 17 , 18 ] are pointing to early evidence that a considerable proportion of healthcare workers have experienced stress, anxiety, depression, and sleep disturbances during the COVID-19 pandemic, raising concerns about risks to their long-term mental health.

Studies from the global north countries [ 19 , 20 ], UK [ 21 ], USA [ 22 ], and in India [ 23 ], and China [ 24 , 25 ] have shed light on the vulnerability that characterizes frontline healthcare workers during this pandemic, especially regarding their mental health and well-being. However, evidence in sub-Saharan Africa is scanty, and the pattern and prevalence of psychological disorders are not well understood.

Evidence from a systematic review by Pappa S et al. on 33,062 Chinese HCWs in April 2020 found a pooled prevalence rate of mental health problems among respondents; anxiety 23.2%, depression 22.8%, and insomnia 38.9% [ 26 ]. Similarly, Singapore study, Tan et al . [ 27 ], Li et al . [ 28 ], BMA [ 29 ] and in China [ 31 ] found high levels of psychological disorders among health workers.

Since the beginning of the pandemic, we found one systematic review involving 919 frontline HCWs, 3928 general HCWs, and 2979 medical students conducted in Africa from December 2019 to April 2020 [ 31 ]. The study by Chen J et al . reported a high prevalence of depression, anxiety, and insomnia among frontline HCWs in sub-Saharan Africa (SSA) at 45%, 51%, and 28%, respectively. In comparison, the prevalence of depression, anxiety, and insomnia among the general population was much lower at 30%, 31%, and 24%, respectively [ 31 ]. Furthermore, we found that only a few studies investigated protective and coping measures, given the many uncertainties surrounding the evolution of the COVID-19 pandemic [ 32 ]. Adequate data are needed to equip frontline HCWs and healthcare managers in sub-Saharan Africa to mitigate the medium and long-term adverse effects of the COVID-19 pandemic [ 33 ].

This review aimed to answer three questions (1) What is the psychological impact of the COVID-19 pandemic on HCWs in Sub-Saharan Africa?

(2) What are the associated risk factors during the COVID-19 pandemic?

(3) What interventions (mitigating and coping strategies) protect and support the mental health and well-being of HCWs during the ongoing crises and after the pandemic?

Methodology

Search methodology and article selection.

This current article is a mixed-method narrative review of existing literature on mental health disorders, risk factors, and interventions relevant to the COVID-19 pandemic on HCWs in sub-Saharan. A search on the PubMed electronic database was undertaken using the search terms "novel coronavirus", "COVID-19", "nCoV", "mental health", "psychiatry", "psychology", "anxiety", "depression" and "stress" in various permutations and combinations.

Search processes

We conducted a comprehensive literature search on original articles published from March 2020 to 30 April 2022 in electronic databases of Embase, PubMed, Google Scholar, and the daily updated WHO COVID-19 database. Our search terms included but were not limited to ('COVID-19'/exp OR COVID-19 OR 'coronavirus'/exp OR coronavirus) AND ('psychological'/exp OR psychological OR 'mental'/exp OR mental OR 'stress'/exp OR stress OR 'anxiety' OR anxiety OR 'depression' OR depression OR 'post-traumatic' OR 'post-traumatic'/exp OR 'trauma' OR 'trauma'/exp) OR Health care workers, medical workers of health care professionals, sub-Saharan Africa, for Embase. ("COVID-19" [All Fields] OR "coronavirus" [All Fields]) AND ("Stress, Psychological" [Mesh] OR "mental" OR "anxiety" OR "depression" OR "stress" OR "post-traumatic" OR "trauma") for PubMed, for the WHO COVID-19 database, and ("COVID-19" OR "coronavirus") AND ("Psychological" OR "mental" OR "anxiety" OR "depression" OR "stress" OR "post-traumatic" OR "trauma") for Google Scholar. On reviewing the above citations, twelve articles met the inclusion criteria relevant for this review and are in Table 1 . All twelve articles were cross-sectional, with one qualitative and the others quantitative observational studies.

Eligibility criteria

We included original qualitative and quantitative studies examining the risk factors, psychological impact of COVID-19 and coping strategies of healthcare workers (HCWs) in sub-Saharan Africa during the COVID-19 pandemic. We excluded studies if they were.

1. Not reported in the English language 2. Studies which were not primary research 3. Studies that had not been published in a peer-reviewed journal 4. Studies that did not include data on HCWs’ mental health or psychological well-being 5. Duplicate studies 6. not using validated instruments to measure the risks and psychological impact.

FWDO performed the search of articles. DLK reviewed the articles involving screening of titles, followed by examination of abstracts. The potential articles identified were further reviewed in full text to examine their eligibility. In addition, four of the authors independently reviewed the full articles to abstract the relevant data required for the review. Thereafter, a meeting to harmonise findings were done and presented in a report.

Data extraction and appraisal of the study

We extracted information from each study, including author, study population, year of publication, country, socio-demographic characteristics, sample size, response rate, gender proportion, age, and study time, areas assessed, the validated instrument used and the prevalence. The appraisal involved assessing the research design, recruitment of respondents, inclusion and exclusion criteria, reliability of outcome determination, statistical analyses, ethical compliance, strengths, limitations, and clinical implications of the articles.

Our review protocol was not registered on PROSPERO because of the significant variation in the methodologies of the articles used in the review. The results precluded using a meta-analytic approach and made a narrative review the most suitable for this work. In addition, we did not use the Cochrane Collaboration GRADE method to assess the quality of evidence of outcomes included in this narrative review. Instead, we used the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) 22 items checklist to gauge the quality of the twelve articles included in this review. We qualitatively validated the articles based on additional considerations namely study design, sample sizes, sampling procedures, response rates, statistical methods used, measures taken by the authors to deal with bias and confounding factors and ethical consideration.

Definition of healthcare worker (HCW)

For this narrative review, we adhered to the Centres for Disease Control and Prevention (CDC) definition of HCWs, which includes physicians, nurses, emergency medical personnel, dental professionals and students, medical and nursing students, laboratory technicians, pharmacists, hospital volunteers, and administrative staff [ 34 ].

Search results

The search found twenty-three studies of interest. Full texts of potentially relevant studies underwent eligibility assessment, and twelve articles met the inclusion criteria for this narrative review.

Study characteristics

The twelve articles comprised eleven quantitative and one qualitative study. The common mental health conditions assessed were depression, anxiety, perceived stress, and post-traumatic stress disorder (PTSD). The coping strategy, perceived health status, health distress (including burnout), insomnia, and perceived stigma were also assessed [ 35 , 36 ]. The total number of respondents in these studies was 5,323. The qualitative study had fifty respondents [ 35 ], while the most significant number of participants, 420 was recorded in one of the quantitative studies from Ethiopia [ 37 ]. The questionnaire response rates varied between 90%-100%, with most studies dominated by male respondents at 51.9%-69.2% [ 38 ]. Nurses were the commonest study population, followed by doctors, pharmacists, and laboratory technicians, and no study involved non-HCWs of facilities. Most papers utilized probability sampling procedures, and four quantitative studies used non-random sampling procedures limiting generalizability of their findings and increasing the risk of selection bias. Eight studies were from Ethiopia, and one was from Cameroon, Uganda, Mali, and Togo, respectively (Table 1 ). Most studies were conducted in urban tertiary public hospitals, university teaching hospitals, and rural and urban general hospitals, including primary care facilities operated by Non-Governmental Organizations (NGOs) for example in Mali [ 39 ]. Several validated tools assessed depression, anxiety, insomnia, stress, and PTSD (Table 1 ).

Table 1 provides an overview of the studies selected and validated instruments used to measure psychological disorders.

Table 2 provides comparisons with studies conducted outside of sub-Saharan Africa.

Table 3 provides information on studies showing the classification of psychological outcomes.

Table 4 are studies showing risk factors associated with psychological disorders.

Table 5 are studies that identified protective factors for psychological disorders.

Risks of bias and confounding factors

Most articles selected were cross-sectional studies that employed probability sampling procedures (Table 1 ). Cross-sectional study design minimized selection biases, but many used structured questionnaires, including online self-administered questionnaires, which increased bias due to social desirability. It was not clear how confounding variables were controlled in five papers reviewed [ 38 , 39 , 40 , 43 , 45 ] leading to excessive and perhaps inappropriate determination of associations.

Socio-demographic factors

In this review, the mean age of the respondents ranged between 23 and 35 years, and predominantly males. Age was associated with anxiety, and stress symptoms in 6(50%) of all the studies reviewed [ 35 , 37 , 40 , 41 , 42 , 44 ]. An age of over 40 years was associated with moderate to severe symptoms of PTSD. Two studies concluded that respondents aged over 40 years were more likely to develop PTSD symptoms than their younger counterparts [ 37 , 41 ].

Female gender was significantly associated with depression, anxiety, and stress symptoms among HCWs in seven studies reviewed [ 36 , 37 , 38 , 41 , 42 , 43 ]. Many studies found that being female, married, and a nurse were independent predictors of stress symptoms. Moreover, sex, age, marital status, type of profession, and working environment were significant factors for PTSD symptoms [ 37 , 41 ]. However, one study in Ethiopia found that the odds of depression were twice higher among male healthcare providers than among female healthcare providers [ 35 ].

Psychological impact on healthcare workers

Most studies reviewed directly assessed the prevalence of depression, anxiety, stress, insomnia, and PTSD in HCWs. Common causes of anxiety, fear, or psychological distress that health professionals reported were: lack of access to PPEs and other equipment, being exposed to COVID-19 at work and taking the infection home to their families, uncertainties that their organization will support/take care of their personal and family needs if they got infection, long working hours, death of colleagues, lack of social support, stigmatization, high rates of transmission and poor income [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. However, the prevalence of mental health symptoms exhibited great variations for example depressive symptoms were examined in nine studies [ 35 , 36 , 37 , 39 , 43 , 44 , 45 , 46 ], and varied between 16.3% and 71.9% among HCWs [ 38 , 39 ].

In addition, nine other studies reported high prevalence of anxiety symptoms among HCWs [ 35 , 36 , 37 , 40 , 43 , 44 , 45 , 46 , 47 ] which varied between 21.9% and 73.5% [ 36 , 39 ]. Five studies investigated HCWs' perceived stress during the pandemic; 15.5%-63.7% of HCWs reported high levels of work-related stress [ 35 , 36 , 37 , 43 , 45 ]. Three studies reported 12.4–77% of HCWs experienced sleep disturbances during the COVID-19 pandemic [ 37 , 39 , 40 ].

Post-traumatic stress disorder (PTSD) was in three studies [ 38 , 41 , 42 ], and the prevalence of PTSD-like symptoms varied between 51.6 and 56.8% in HCWs [ 38 , 41 ]. A qualitative study from Uganda reported high symptoms of depression, anxiety, and PTSD among HCWs [ 35 ]. Additionally, factors that increased the risk of PTSD symptoms were for example, working in emergency units and being frontline workers. Furthermore, many studies found that frontline HCWs had increased symptoms of mental disorders and being a frontline worker was an independent risk factor for depression, anxiety, and PTSD [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ].

Risk factors associated with adverse mental health outcomes

The qualitative study from Uganda reported the factors associated with mental disorder symptoms among HCWs. These were long working hours, lack of equipment (PPEs, testing kits), lack of sleep, exhaustion, high death rates, death of colleagues, and a high COVID-19 transmission rate among HCWs [ 35 ]. Lack of equipment (PPEs, ventilators, and testing kits), overworking, and lack of logistic support were in Ethiopian studies [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 45 ]. Most studies identified several risk factors for adverse mental health outcomes among respondents for example those with medical and mental illnesses, contacts with confirmed COVID-19 patients, and poor social support which were significantly associated with depression [ 42 , 43 ]. Other factors were females, nurses, married, frontline workers, ICU, emergency units, living alone, and lack of social support [ 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Too, participants’ families with chronic illnesses, had contacts with confirmed COVID-19 cases, and poor social support were significantly associated with anxiety. Other risk factors associated with anxiety include exhaustion, long working hours, frontline workers, emergencies, nurses, pharmacists, laboratory technicians, married, older, younger, living alone, being female, working at general and referral hospitals, and perceived stigma. In addition, participants’ families with chronic illnesses, those who had contacts with confirmed COVID-19 cases, and those with poor social support were predictors of stress during the COVID-19 pandemic [ 37 , 38 , 40 , 41 , 42 , 43 , 45 ]. Other stress symptoms include having a medical illness, a mental illness, being a frontline worker, married, nurse, female, pharmacist, laboratory technician, physician, older age, lack of standardized PPE supply, low incomes, and living with a family [ 36 , 37 , 40 , 41 , 42 , 43 , 44 , 45 ]. Healthcare providers with low monthly incomes were significantly more likely to develop stress than those with high monthly incomes [ 38 ]. In addition, participants living alone, living with a family, and being married were associated with symptoms of psychological disorders among HCWs [ 36 , 37 , 38 , 45 ]. Overall, the risk factors for adverse psychological impacts are categorized in three thematic areas (i) occupational, (ii) psychosocial, and (iii) environmental aspects.

Occupational factors

Most studies showed that frontline HCWs, nurses, doctors, pharmacists, and laboratory technicians had significantly higher levels of mental health risks compared to non-frontline HCWs [ 35 , 36 , 37 , 38 , 40 , 42 , 43 , 45 ]. They experienced higher frequency of insomnia, anxiety, depression, and somatization than non-frontline medical HCWs. In contrast, Mali [ 39 ] and Cameroon [ 46 ] studies found a higher prevalence of depression, anxiety, and PTSD in non-frontline HCWs [ 39 , 46 ]. However, among HCWs, physicians were 20% less likely to develop mental health disorders than nurses, pharmacists, and laboratory technicians [ 39 ]. In addition, healthcare workers with low monthly incomes had higher symptoms of depression, anxiety, stress, and insomnia [ 37 ].

Healthcare groups

Five studies found that being a nurse was associated with worse mental disorders than doctors [ 36 , 37 , 40 , 44 , 45 ].

Frontline staff with direct contact with COVID-19

Most papers in the review found that being in a “frontline” position or having direct contact with COVID-19 patients was associated with higher level of psychological distress [ 35 , 36 , 37 , 38 , 40 , 42 , 43 , 45 ]. In addition, studies found that contact with COVID-19 patients was independently associated with an increased risk of sleep disturbances [ 40 , 46 ]. Moreover, HCWs who had contact with confirmed COVID-19 cases were more likely to develop depression, anxiety, and stress symptoms than those who had no contact with COVID-19 patients [ 36 , 37 , 38 , 43 , 45 ].

Lack of personal protective equipment (PPEs)

Most studies reported that the lack of PPEs was associated with higher symptoms of depression, anxiety, stress, and insomnia, while its availability was associated with fewer mental disorder symptoms [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ]. In Mali, workers from centres that provided facemasks were 51% less likely to suffer from depression, 62% less likely to develop anxiety, and 45% less likely to develop insomnia [ 39 ]. In Ethiopia, the odds of developing post-traumatic stress disorder were much higher among HCWs who did not receive standardized PPEs supplies than those who had [ 38 , 41 , 42 ]. In Uganda, the lack of PPEs was associated with depression, anxiety, and PTSD [ 35 ].

Heavy workload

Longer working hours, increased work intensity, increased patient load, and exhaustion were risk factors in Ugandan [ 35 ] and Ethiopian studies [ 36 ].

Psychosocial factors: perceived stigma and fear of infection

The fear of infection was in the qualitative study from Uganda [ 35 ], one quantitative study from Cameroon [ 47 ] and seven cross-sectional studies from Ethiopia [ 36 , 37 , 38 , 41 , 42 , 43 , 44 ]. Poor social support was associated with PTSD symptoms, depression, anxiety, and stress [ 35 , 36 , 37 , 38 , 42 , 43 ]. Two studies reported that HCWs with perceived stigmatization were more likely to suffer from depression, anxiety, stress, and PTSD [ 37 , 42 ].

family concerns

This came up as one of the main risk factors of stress in almost all studies, especially among those HCWs in direct contact with confirmed COVID-19 cases [ 35 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 45 ]. A family member suffering from COVID-19 was associated with poor mental health outcomes in HCWs [ 36 , 37 ].

Protective psychosocial factors

Two studies suggest a reduction of perceived stigma can be achieved by sensitization of communities about COVID-19 [ 37 , 42 ], and four studies recommend solid social support [ 36 , 37 , 42 , 43 ].

Safety of family

Family safety had the most significant impact in reducing stress. Safety from COVID-19 infection and financial protection of families were essential coping strategies for HCWs [ 35 , 36 ].

Underlying illnesses

We found three studies that reported an underlying medical and mental illness as an independent risk factor for poor psychological outcomes [ 42 , 43 , 45 ].

Protective factors against adverse mental health outcomes

The review identified protective factors to adverse mental health outcomes during COVID-19. The qualitative study from Uganda and four quantitative cross-sectional studies from Ethiopia identified some protective factors [ 35 , 38 , 41 , 42 , 45 ]. The protective factors are grouped under three thematic areas (i) occupational, (ii) psychosocial, and (iii) environmental aspects.

The qualitative study identified many social coping strategies among respondents, including family networks, community networks, help from family, responsibility to society, assistance from community members, availability of assistance from strangers, and the symbiotic nature of assistance in the community [ 35 ].

Protective occupational factors

Studies suggest that physicians suffered fewer mental health disorders partly because of their experience with previous epidemics [ 37 , 42 , 45 ].

Some necessary coping measures include good hospital guidance and ongoing training of frontline HCWs [ 37 , 42 , 45 ].

Adequate supply of PPEs

As mentioned above, PPE was a protective factor when adequate and a risk factor for poor mental health outcomes when deemed inadequate [ 35 , 36 , 37 , 42 , 43 ].

The COVID-19 pandemic has been an ongoing global public health emergency that has burdened healthcare workers' physical and mental well-being (HCWs) [ 1 , 5 ]. Our review confirms the enormous magnitude of mental health impact of COVID-19 on healthcare workers in sub-Saharan Africa, and it is widespread, with significant levels of depression, anxiety, distress, and insomnia; especially those working directly with COVID-19 patients at particular risk [ 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Out of the twelve articles reviewed, eight studies (66%) came from Ethiopia, and this has implications on the results (Table 1 ). This finding indicates few research published to date on the psychological impact of the pandemic on the mental health of HCWs in sub-Saharan Africa; a subregion that the COVID-19 pandemic has severely impacted.

Overview of the study sites

Studies in this review were conducted predominantly in hospital settings. We found only one study relating to primary healthcare workers or facilities [ 38 ]. This finding is of concern, as there is increasing evidence that many non-frontline HCWs continue to suffer psychological symptoms long after the conclusion of infectious disease epidemics [ 7 , 8 ]. In addition, a significant mortality due to COVID-19 was due to excess morbidity, some of which were from primary care facilities. Given that this study is the first narrative review in sub-Saharan Africa, it would be helpful to briefly compare our findings with some published reviews and surveys from other regions (Table 2 ).

High prevalence of psychological disorders among participants

Investigators in this review found 16.3–71.9% HCWs with depressive symptoms, 21.9–73.5% had anxiety symptoms, 15.5–63.7% experienced work-related stress symptoms, 12.4–77% experienced sleep disturbances, and 51.6–56.8% PTSD symptoms [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. This high prevalence of mental health symptoms among HCWs in our review is consistent with previous reviews conducted early in the pandemic in sub-Saharan Africa [ 31 ], Asia [ 17 , 18 , 26 , 28 ], USA & Europe [ 15 , 16 ], and supported by a batch of cross-sectional studies globally [ 11 , 12 , 13 , 14 , 19 , 27 , 30 ]. We found mixed results with significant variations within and among regions and countries, as depicted in Tables 1 and 2 .

Risk factors of psychological disorders among participants

Studies established that HCWs responding to the COVID-19 pandemic in sub-Saharan Africa were exposed to long working hours, overworking, exhaustion, high risk of infection, and shortage of personal protective equipment (Tables 3 and 4 ). In addition, HCWs had deep fear, were anxious and stressed with the high transmission rate of the virus among themselves, high death rates among themselves and their patients, and lived under constant fear of infecting themselves and their families with obvious consequences [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Some HCWs were deeply worried about the lack of standardized PPEs, known treatments and vaccines to protect against the virus. Many health workers had financial problems, lacked support from families and employers if they contracted the virus [ 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 44 ]. An additional source of fear and anxiety was the perceived stigma attached to being infected with COVID-19 by the public [ 36 , 41 ]. Studies found that HCWs, especially those working in emergency, intensive care units, infectious disease wards, pharmacies, and laboratories, were at higher risk of developing adverse mental health impacts compared to others [ 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 ]. This is supported by previous reviews [ 15 , 16 , 17 , 18 , 26 , 28 ] and cross-sectional studies [ 10 , 11 , 12 , 13 , 14 , 20 , 21 , 23 , 25 , 30 ]. However, findings were inconsistent on the impact of COVID-19 on frontline health workers, with ten studies [ 35 , 36 , 37 , 39 , 40 , 41 , 42 , 44 , 45 ] suggesting they are at higher risk than peers and two studies showing no significant difference in psychological disorders relating to the departments [ 38 , 43 ].

The Mali’s study was conducted exclusively in primary care facilities among HCWs not involved in treating COVID-19 cases but still registered a very high prevalence of depression 71.9%, anxiety 73.6%, and insomnia 77.0% [ 39 ]. In contrast, two studies conducted among HCWs at COVID-19 treatment facilities in Ethiopia [ 36 , 38 ] registered much lower prevalence of depression 20.2%, anxiety 21.0%, and insomnia12.4% [ 36 ], and 16.3%, 30.7% and 15.9% respectively, in the second study [ 38 ]. These findings show that not only frontline HCWs experienced mental health disorders during this pandemic but highlight the need for direct interventions for all HCWs regardless of occupation or workstation during this and future pandemics. The significant disparity in the studies could be due to structural, occupational, and environmental issues for example challenges faced by Mali's healthcare systems, characterized by acute equipment shortages, lack of PPEs, human resources, lack of trained and experienced HCWs, ongoing nationwide insecurity, and terrorism compared to Ethiopia. Therefore, local context needs to be considered as contributing factor to mental health disorders among HCWs.

Regional variations of psychological disorders

Tan et al . found a higher prevalence of anxiety among non-medical HCWs in Singapore [ 27 ]. As previously noted, the prevalence of poor psychological outcomes varied between countries. Compared to sub-Saharan Africa and China, data from India [ 23 ] and Singapore [ 27 ] revealed an overall lower prevalence of anxiety and depression than similar cross-sectional data from sub-Saharan Africa [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ] and China [ 9 , 25 , 30 ]. This finding suggests that different contexts and cultures may reveal different psychological findings and that, it is possible that being at different countries’ outbreak curve may play a part, as there is evidence that it is influential.

Tan et al . suggests that medical HCWs in Singapore had experienced a SARS outbreak and thus were well prepared for COVID-19 psychologically and infection control measures [ 27 ]. What can be deduced is that context and cultural factors play a role, not just the cadre or role of healthcare workers [ 16 ]. It also highlights the importance of reviewing evidence regularly as more data emerge from other countries.

One hospital in Ethiopia found that the thought of resignation was associated with higher chances of mental health disorders and that pharmacists and laboratory technicians who did not receive prior training exhibited higher symptoms of mental health disorders compared to others [ 36 ]. Work shift arrangement, considering a dangerous atmosphere presented by working in COVID-19 wards, was one which exacerbated or relieved mental health symptoms among HCWs, with shorter exposure periods being most beneficial [ 36 ]. Meanwhile, studies found that financial worries caused by severe lockdowns and erratic payment of salaries and allowances were also major stressors [ 35 ]. This finding is like studies in Pakistan [ 13 ] and China [ 30 , 32 ].

In this review, HCWs who had contact with confirmed COVID-19 patients were more affected by depression, anxiety, and stress than their counterparts who had not [ 35 , 36 , 37 , 40 , 41 , 43 , 45 ]. This finding is like previous reviews [ 15 , 16 , 17 , 18 , 26 , 28 , 31 ] and cross-sectional studies [ 9 , 10 , 11 , 12 , 13 , 14 , 21 , 23 , 24 , 25 , 27 , 30 ], which reported higher depression, anxiety, and psychological symptoms of distress in HCWs who were in direct contact with confirmed or suspected COVID-19 patients.

A study in Pakistan showed that 80% of participants expected the provision of PPE from authority [ 13 ], and 86% were anxious. Some respondents alluded to forced deployment, while in Mali, 73.3% were anxious, with the majority worrying about the shortage of nurses [ 39 ]. Therefore, prospects of being deployed at a workstation where one had not been trained or oriented contributed to fear among health workers. In the sub-Saharan African context, this scenario can best be represented in HCWs involved in internship who must endure hard work during their training. Tan et al . found that junior doctors were more stressed than nurses in Singapore [ 27 ].

Socio-demographic characteristics

Nearly all studies in our review suggest that socio-demographic variables for example age, gender, marital status, and living alone or with families contribute to the high mental disorder symptoms [ 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 ]. We, the authors suggest that these observations are handled cautiously as several investigators of these reviewed articles did not entirely control the influence of confounding variables. An alternative explanation for this study's findings may be the more significant risks of frontline exposure amongst women and junior HCWs, predominantly employed in lower-status roles, many of whom lacked experience and appropriate training within healthcare system globally. It is also important to note that respondents to all studies, when disaggregated by gender, and age, were predominantly younger or female, which may have impacted the outcomes of these findings [ 16 ]. In addition, the consistently higher mortality rates, and risk of severe COVID-19 disease amongst men would suggest that the complete picture regarding gender and mental health during this pandemic is still incomplete [ 16 ]. Moreover, in several studies, both younger and older age groups were equally affected by mental health symptoms but for different reasons. Cai et al . [ 32 ] in a Chinese study on HCWs for example observed that irrespective of age, colleagues' safety, self and families' safety, the lack of treatment for COVID-19 was a factor that induced stress in HCWs. Similarly, in our review, the lack of PPEs, high infection transmission rates, high death rates among HCWs, and the fear of infecting their families were the factors that induced stress in all HCWs [ 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].

We, the authors propose that paying close attention to concerns of HCWs by employers would greatly relieve some stressors and contribute to increased mental well-being of participants. Compared with physicians, our review showed that nurses were more likely to suffer from depression, anxiety, insomnia, PTSD, and stress [ 35 , 37 , 39 , 40 , 41 , 44 , 45 ]. Workloads and night shifts in healthcare facilities, as well as contacts with risky patients, enhanced nurses' mental distress risks [ 15 , 16 , 17 , 18 , 26 , 27 , 28 ]. In addition, nursing staff have more extended physical contacts and closer interactions with patients than other professionals, providing round-the-clock care required by patients with COVID-19 and thus the increased risk [ 15 ]. On the one hand, we posit that most senior physicians are experienced and always keep well-informed with emerging medical emergencies. The majority become aware of emerging epidemic early and actively protect themselves from infections through regular scientific literature updates compared to their junior counterparts. Senior physicians also spend less time in emergency wards unless there is a need to conduct specific procedures which cannot be undertaken by senior housemen or general medical officers. Cai et al . [ 32 ] concluded that it is essential to have a high level of training and professional experience for healthcare workers engaging in public health emergencies, especially for the new staff. As a result, these findings highlight the importance of focusing on all the frontline HCWs sacrificing to contain the COVID-19 pandemic.

Regular monitoring of high-risk groups

There is a need to continue monitoring the high-at-risk groups, including nursing staff, interns, support staff, and all deployed in emergency wards. These high-at-risk groups should be encouraged to undertake screening, treatment, and vaccination to avoid the medium and long-term consequences of such epidemics [ 15 , 16 , 35 , 37 , 40 , 44 ].

Social support and coping mechanisms

The effect of social support and coping measures is in the qualitative study [ 34 ] and three other quantitative studies [ 36 , 41 , 42 ] which concluded that respondents with good social support were less likely to suffer from severe depression, anxiety, work-related stress, and PTSD. The qualitative study identified several coping measures, including community and organizational support, family, and community networks, help from family, responsibility to society, and assistance from community members and strangers, including the symbiotic nature of assistance in the community [ 35 ]. Other measures include providing accommodation and food to employees [ 35 ].

Interestingly, no study examined the association of resilience and self-efficacy with sleep quality, degrees of anxiety, depression, PTSD, and stress. However, a Chinese study by Cai et al. [ 32 ] suggests that the social support given to HCWs causes a reduction in anxiety and stress levels and increases their self-efficacy. In divergence, Xiao et al . [ 46 ] found no relationship between social support and sleep quality.

Only two studies in our review examined the effects of stigma on the mental health of HCWs [ 36 , 41 ] and found that HCWs with perceived stigma were more likely to be depressed, anxious, stressed, and prone to poor sleep quality [ 36 , 41 ]. We, the authors suggest that better community sensitization by creating public awareness involving appropriate local community structures and networks are essential. The broader community in sub-Saharan Africa may have suffered severely from infodemics with severe consequences on their mental health, especially during the difficult lockdowns. In addition, removing discrimination/inequalities at the workplace based on race and other social standings have a powerful influence on the mental health outcomes of HCWs. Also, because emotional exhaustion is long associated with depression, anxiety, and sleep disturbances, none of the studies in our review examined burnout as an essential component of mental health disorders in HCWs in sub-Saharan Africa.

Protective and coping measures

In this review we have provided evidence about personal, occupational, and environmental factors that were important protective and coping measures against psychological disorders. Based on these factors we suggest some protective and coping measures which can help to reduce the negative effects of the pandemic on mental health of HCWs in sub-Saharan Africa. Organizations and healthcare managers need to be aware that primary prevention is key to any successful interventions to contain and control any epidemic. This should take the form of planned regular training, orientation and continuing medical education grounded on proven infection control measures. These measures need to be backed up by timely provision of protective equipment, drugs, testing facilities, vaccines, isolation facilities, clinical and mental health support, and personal welfare of HCWs [ 35 , 36 , 37 , 42 , 45 ]. The effect of community and organizational support and coping measures was shown by the qualitative study [ 35 ] and five other quantitative studies [ 36 , 37 , 41 , 42 , 43 ] indicating that respondents who had good social and organizational support were less likely to suffer from severe depression, anxiety, work related stress and PTSD. Prior experience with comparable pandemics and training are suggested as beneficial coping strategies for healthcare workers during this pandemic but also local social structural and geopolitical conditions appear to determine the pattern and evolution of mental health symptoms among HCWs [ 14 , 15 , 31 , 32 , 47 ]. In our case the high prevalence of all mental health symptoms in non-frontline primary health care facilities in Mali [ 39 ] which was already plagued with instability and weak healthcare systems prior to the pandemic is a case in point. Results are particularly consistent in showing that provision of PPEs, testing kits, orientation training of workers, work shift arrangements, provision of online counselling, provision of food and accommodation and prompt payment of allowances by employers were important protective measures [ 35 , 36 , 37 , 38 , 39 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. The feeling of being protected is associated with higher work motivation with implication for staff turnover [ 35 , 38 , 43 , 45 ]. Hence, physical protective materials [ 14 ], together with frequent provision of information, should be the cornerstone of any interventions to prevent deterioration in mental health of HCWs (Table 5 ). Finally, provision of rest rooms, online consultation with psychologists/psychiatrists, protection from financial hardships, access to social amenities and religious activities are some important coping measures [ 35 , 36 , 38 , 42 , 45 ]. In this era of digital health care with plentiful internet and smartphones, organization can conduct online trainings, online mental health education, online psychological counselling services, and online psychological self-help intervention tailored to the needs of their HCWs [ 35 , 37 , 42 ]. In addition, it is essential to understand and address the sources of anxiety among healthcare professionals during this COVID-19 pandemic, as this has been one of the most experienced mental health symptoms [ 48 ]. Adequate protective equipment provided by health facilities is one of the most important motivational factors for encouraging continuation of work in future outbreaks. Furthermore, availability of strict infection control guidelines, specialized equipment, recognition of their efforts by facility management, government, and reduction in reported cases of COVID-19 provide psychological benefits [ 15 , 32 ]. Finally, we call upon Governments (the largest employers of HCWs) in sub-Saharan Africa to do what it takes to improve investments in the mental health of HCWs and plan proactively in anticipation of managing infectious disease epidemics, including other expected and unexpected disasters.

Future research direction

There was no study that examined the association of resilience and self-efficacy with sleep quality, degrees of anxiety, depression, PTSD, and stress. Although emotional exhaustion has long been associated with depression, anxiety, and sleep disturbances, no study in our review examined burnout as an important component of mental health disorders in HCWs in sub-Saharan Africa. The impacts of infodemics, stringent lockdown measures, discrimination/inequalities at workplaces based on race, and other social standings on mental health outcomes of HCWs need to be investigated.

Future studies are needed on the above including other critical areas like suicidality, suicidal ideations, and substance abuse during the COVID-19 pandemic. In addition, there is a significant variation of related literature calling for more rigorous research in future. More systematic studies will be required to clarify the full impact of the pandemic so that meaningful interventions can be planned and executed at institutional and national levels in the Sub-Saharan Africa.

Limitations of this study

There are some limitations to this study. First, most of the studies are from one country, limiting the generalizability of the results to the whole African continent. Second, all the studies were cross-sectional and only looked at associations and correlations. There is a need for prospective or retrospective cohort or case–control studies on this subject matter. Longitudinal research studies on the prevalence of mental disorders in the COVID-19 pandemic in the sub-Saharan Africa are urgently required. Third, most studies reviewed did not adequately examine protective factors or coping measures of the health workers in their settings. In addition, most studies did not pay strict attention to confounding variables which could have led to inappropriate results and conclusions. Fourth, most sample sizes were small and unlikely representative of the population and yet larger sample sizes would better identify the extent of mental health problems among health workers in the region. Fifth, depression, anxiety, and stress were assessed solely through self-administered questionnaires rather than face-to-face psychiatric interviews. Sixth, these studies employed various instruments and different cut-off thresholds to assess severity. Notably, the magnitude and severity of reported mental health outcomes may vary based on the validity and sensitivity of the measurement tools. Seventh, there was no mention of mental baseline information among the studied population and therefore it was unknown if the studied population had pre-existing mental health illnesses that decompensated during the pandemic crisis. Eight, investigators did not give much attention to stigma, burnout, resilience, and self-efficacy among study participants.

Furthermore, our review did not employ systematic reviews or meta-analyses methods for the information generated. This narrative review paper precluded deeper insight into the quality of reviewed articles for this paper. Still, our observation was that investigators did not consider the strict lockdown measures, quarantine, and isolation imposed by many countries in sub-Saharan Africa as possible risk factors for mental health disorders among HCWs.

Based on the articles reviewed, the prevalence of depression, anxiety, insomnia, and PTSD in HCWs in the sub-Saharan Africa during the COVID-19 pandemic is high. We implore health authorities to consider setting up permanent multidisciplinary mental health teams at regional and national levels to deal with mental health issues and provide psychological support to patients and HCWs, always supported with sufficient budgetary allocations.

Long-term surveillance is essential to keep track of insidiously rising mental health crises among community members. There is a significant variation of related literature thus calling for more rigorous research in the future. More systematic studies will be needed to clarify the full impact of the pandemic so that meaningful interventions can be planned better and executed at institutional and national levels in sub-Saharan Africa.

Availability of data and materials

Datasets analysed in the current study are available from the corresponding author at a reasonable request.

Abbreviations

Coronavirus disease 2019

Healthcare workers.

Mental health

Public health emergency

Personal protective equipment

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Acknowledgements

We thank Uganda Medical Association Acholi-branch members for the financial assistance which enabled the team to conduct this study successfully.

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Freddy Wathum Drinkwater Oyat, Johnson Nyeko Oloya, Pamela Atim, Judith Aloyo & David Lagoro Kitara

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Oyat, F.W.D., Oloya, J.N., Atim, P. et al. The psychological impact, risk factors and coping strategies to COVID-19 pandemic on healthcare workers in the sub-Saharan Africa: a narrative review of existing literature. BMC Psychol 10 , 284 (2022). https://doi.org/10.1186/s40359-022-00998-z

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The future of work after COVID-19

The COVID-19 pandemic disrupted labor markets globally during 2020. The short-term consequences were sudden and often severe: Millions of people were furloughed or lost jobs, and others rapidly adjusted to working from home as offices closed. Many other workers were deemed essential and continued to work in hospitals and grocery stores, on garbage trucks and in warehouses, yet under new protocols to reduce the spread of the novel coronavirus.

This report on the future of work after COVID-19 is the first of three MGI reports that examine aspects of the postpandemic economy. The others look at the pandemic’s long-term influence on consumption and the potential for a broad recovery led by enhanced productivity and innovation. Here, we assess the lasting impact of the pandemic on labor demand, the mix of occupations, and the workforce skills required in eight countries with diverse economic and labor market models: China, France, Germany, India, Japan, Spain, the United Kingdom, and the United States. Together, these eight countries account for almost half the global population and 62 percent of GDP.

Jobs with the highest physical proximity are likely to be most disrupted

Before COVID-19, the largest disruptions to work involved new technologies and growing trade links. COVID-19 has, for the first time, elevated the importance of the physical dimension of work. In this research, we develop a novel way to quantify the proximity required in more than 800 occupations by grouping them into ten work arenas according to their proximity to coworkers and customers, the number of interpersonal interactions involved, and their on-site and indoor nature.

This offers a different view of work than traditional sector definitions. For instance, our medical care arena includes only caregiving roles requiring close interaction with patients, such as doctors and nurses. Hospital and medical office administrative staff fall into the computer-based office work arena, where more work can be done remotely. Lab technicians and pharmacists work in the indoor production work arena because those jobs require use of specialized equipment on-site but have little exposure to other people (Exhibit 1).

We find that jobs in work arenas with higher levels of physical proximity are likely to see greater transformation after the pandemic, triggering knock-on effects in other work arenas as business models shift in response.

The short- and potential long-term disruptions to these arenas from COVID-19 vary. During the pandemic, the virus most severely disturbed arenas with the highest overall physical proximity scores: medical care, personal care, on-site customer service, and leisure and travel. In the longer term, work arenas with higher physical proximity scores are also likely to be more unsettled, although proximity is not the only explanation. For example:

• The on-site customer interaction arena includes frontline workers who interact with customers in retail stores, banks, and post offices, among other places. Work in this arena is defined by frequent interaction with strangers and requires on-site presence. Some work in this arena migrated to e-commerce and other digital transactions, a behavioral change that is likely to stick.
• The leisure and travel arena is home to customer-facing workers in hotels, restaurants, airports, and entertainment venues. Workers in this arena interact daily with crowds of new people. COVID-19 forced most leisure venues to close in 2020 and airports and airlines to operate on a severely limited basis. In the longer term, the shift to remote work  and related reduction in business travel, as well as automation of some occupations, such as food service roles, may curtail labor demand in this arena.
• The computer-based office work arena includes offices of all sizes and administrative workspaces in hospitals, courts, and factories. Work in this arena requires only moderate physical proximity to others and a moderate number of human interactions. This is the largest arena in advanced economies, accounting for roughly one-third of employment. Nearly all potential remote work is within this arena.
• The outdoor production and maintenance arena includes construction sites, farms, residential and commercial grounds, and other outdoor spaces. COVID-19 had little impact here as work in this arena requires low proximity and few interactions with others and takes place fully outdoors. This is the largest arena in China and India, accounting for 35 to 55 percent of their workforces.

COVID-19 has accelerated three broad trends that may reshape work after the pandemic recedes

The pandemic pushed companies and consumers to rapidly adopt new behaviors that are likely to stick, changing the trajectory of three groups of trends. We consequently see sharp discontinuity between their impact on labor markets before and after the pandemic.

Remote work and virtual meetings are likely to continue, albeit less intensely than at the pandemic’s peak

Perhaps the most obvious impact of COVID-19 on the labor force is the dramatic increase in employees working remotely. To determine how extensively remote work might persist after the pandemic, we analyzed its potential  across more than 2,000 tasks used in some 800 occupations in the eight focus countries. Considering only remote work that can be done without a loss of productivity, we find that about 20 to 25 percent of the workforces in advanced economies could work from home between three and five days a week. This represents four to five times more remote work than before the pandemic and could prompt a large change in the geography of work, as individuals and companies shift out of large cities into suburbs and small cities. We found that some work that technically can be done remotely is best done in person. Negotiations, critical business decisions, brainstorming sessions, providing sensitive feedback, and onboarding new employees are examples of activities that may lose some effectiveness when done remotely.

Some companies are already planning to shift to flexible workspaces after positive experiences with remote work during the pandemic, a move that will reduce the overall space they need and bring fewer workers into offices each day. A survey of 278 executives by McKinsey in August 2020 found that on average, they planned to reduce office space by 30 percent. Demand for restaurants and retail in downtown areas and for public transportation may decline as a result.

Remote work may also put a dent in business travel as its extensive use of videoconferencing during the pandemic has ushered in a new acceptance of virtual meetings and other aspects of work. While leisure travel and tourism are likely to rebound after the crisis, McKinsey’s travel practice estimates that about 20 percent of business travel, the most lucrative segment for airlines, may not return. This would have significant knock-on effects on employment in commercial aerospace, airports, hospitality, and food service. E-commerce and other virtual transactions are booming.

Many consumers discovered the convenience of e-commerce and other online activities during the pandemic. In 2020, the share of e-commerce grew at two to five times the rate before COVID-19 (Exhibit 2). Roughly three-quarters of people using digital channels for the first time during the pandemic say they will continue using them when things return to “normal,” according to McKinsey Consumer Pulse  surveys conducted around the world.

Other kinds of virtual transactions such as telemedicine, online banking, and streaming entertainment have also taken off. Online doctor consultations through Practo, a telehealth company in India, grew more than tenfold between April and November 2020 . These virtual practices may decline somewhat as economies reopen but are likely to continue well above levels seen before the pandemic.

This shift to digital transactions has propelled growth in delivery, transportation, and warehouse jobs. In China, e-commerce, delivery, and social media jobs grew by more than 5.1 million during the first half of 2020.

COVID-19 may propel faster adoption of automation and AI, especially in work arenas with high physical proximity

Two ways businesses historically have controlled cost and mitigated uncertainty during recessions are by adopting automation and redesigning work processes, which reduce the share of jobs involving mainly routine tasks. In our global survey of 800 senior executives  in July 2020, two-thirds said they were stepping up investment in automation and AI either somewhat or significantly. Production figures for robotics in China exceeded prepandemic levels by June 2020.

Many companies deployed automation and AI in warehouses, grocery stores, call centers, and manufacturing plants to reduce workplace density and cope with surges in demand. The common feature of these automation use cases is their correlation with high scores on physical proximity, and our research finds the work arenas with high levels of human interaction are likely to see the greatest acceleration in adoption of automation and AI.

The mix of occupations may shift, with little job growth in low-wage occupations

The trends accelerated by COVID-19 may spur greater changes in the mix of jobs within economies than we estimated before the pandemic.

We find that a markedly different mix of occupations may emerge after the pandemic across the eight economies. Compared to our pre-COVID-19 estimates, we expect the largest negative impact of the pandemic to fall on workers in food service and customer sales and service roles, as well as less-skilled office support roles. Jobs in warehousing and transportation may increase as a result of the growth in e-commerce and the delivery economy, but those increases are unlikely to offset the disruption of many low-wage jobs. In the United States, for instance, customer service and food service jobs could fall by 4.3 million, while transportation jobs could grow by nearly 800,000. Demand for workers in the healthcare and STEM occupations may grow more than before the pandemic, reflecting increased attention to health as populations age and incomes rise as well as the growing need for people who can create, deploy, and maintain new technologies (Exhibit 3).

Before the pandemic, net job losses were concentrated in middle-wage occupations in manufacturing and some office work, reflecting automation, and low- and high-wage jobs continued to grow. Nearly all low-wage workers who lost jobs could move into other low-wage occupations—for instance, a data entry worker could move into retail or home healthcare. Because of the pandemic’s impact on low-wage jobs, we now estimate that almost all growth in labor demand will occur in high-wage jobs. Going forward, more than half of displaced low-wage workers may need to shift to occupations in higher wage brackets and requiring different skills to remain employed.

As many as 25 percent more workers may need to switch occupations than before the pandemic

Given the expected concentration of job growth in high-wage occupations and declines in low-wage occupations, the scale and nature of workforce transitions required in the years ahead will be challenging, according to our research. Across the eight focus countries, more than 100 million workers, or 1 in 16, will need to find a different occupation by 2030 in our post-COVID-19 scenario, as shown in Exhibit 4. This is 12 percent more than we estimated before the pandemic, and up to 25 percent more in advanced economies (Exhibit 4).

Before the pandemic, we estimated that just 6 percent of workers would need to find jobs in higher wage occupations. In our post-COVID-19 research, we find not only that a larger share of workers will likely need to transition out of the bottom two wage brackets but also that roughly half of them overall will need new, more advanced skills to move to occupations one or even two wage brackets higher.

The skill mix required among workers who need to shift occupations has changed. The share of time German workers spend using basic cognitive skills, for example, may shrink by 3.4 percentage points, while time spend using social and emotional skills will increase by 3.2 percentage points. In India, the share of total work hours expended using physical and manual skills will decline by 2.2 percentage points, while time devoted to technological skills will rise 3.3 percentage points. Workers in occupations in the lowest wage bracket use basic cognitive skills and physical and manual skills 68 percent of the time, while in the middle wage bracket, use of these skills occupies 48 percent of time spent. In the highest two brackets, those skills account for less than 20 percent of time spent. The most disadvantaged workers may have the biggest job transitions ahead, in part because of their disproportionate employment in the arenas most affected by COVID-19. In Europe and the United States, workers with less than a college degree, members of ethnic minority groups, and women are more likely to need to change occupations after COVID-19 than before. In the United States, people without a college degree are 1.3 times more likely to need to make transitions compared to those with a college degree, and Black and Hispanic workers are 1.1 times more likely to have to transition between occupations than white workers. In France, Germany, and Spain, the increase in job transitions required due to trends influenced by COVID-19 is 3.9 times higher for women than for men. Similarly, the need for occupational changes will hit younger workers more than older workers, and individuals not born in the European Union more than native-born workers.

Companies and policymakers can help facilitate workforce transitions

The scale of workforce transitions set off by COVID-19’s influence on labor trends increases the urgency for businesses and policymakers to take steps to support additional training and education programs for workers. Companies and governments exhibited extraordinary flexibility and adaptability in responding to the pandemic with purpose and innovation that they might also harness to retool the workforce in ways that point to a brighter future of work.

Businesses can start with a granular analysis of what work can be done remotely by focusing on the tasks involved rather than whole jobs. They can also play a larger role in retraining workers, as Walmart, Amazon, and IBM have done. Others have facilitated occupational shifts by focusing on the skills they need, rather than on academic degrees. Remote work also offers companies the opportunity to enrich their diversity by tapping workers who, for family and other reasons, were unable to relocate to the superstar cities where talent, capital, and opportunities concentrated before the pandemic.

Policymakers could support businesses by expanding and enhancing the digital infrastructure. Even in advanced economies, almost 20 percent of workers in rural households lack access to the internet. Governments could also consider extending benefits and protections to independent workers and to workers working to build their skills and knowledge mid-career.

Both businesses and policymakers could collaborate to support workers migrating between occupations. Under the Pact for Skills established in the European Union during the pandemic, companies and public authorities have dedicated €7 billion to enhancing the skills of some 700,000 automotive workers, while in the United States, Merck and other large companies have put up more than $100 million to burnish the skills of Black workers without a college education and create jobs that they can fill.

The reward of such efforts would be a more resilient, more talented, and better-paid workforce—and a more robust and equitable society.

Go behind the scenes and get more insights with “ Where the jobs are: An inside look at our new Future of Work research ” from our New at McKinsey blog.

Susan Lund and Anu Madgavkar are partners of the McKinsey Global Institute, where James Manyika and Sven Smit are co-chairs and directors. Kweilin Ellingrud is a senior partner in McKinsey’s Minneapolis office. Mary Meaney is a senior partner in the Paris office. Olivia Robinson is a consultant in the London office.

This report was edited by Stephanie Strom, a senior editor with the McKinsey Global Institute, and Peter Gumbel, MGI editorial director.

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Pakistan’s Response to COVID-19: Overcoming National and International Hypes to Fight the Pandemic

Hashaam akhtar.

1 Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Islamabad, Pakistan

Maham Afridi

2 Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan

Samar Akhtar

Hamaad ahmad, sabahat ali.

3 Department of Gynecology and Obstetrics, Paf Hospital, Islamabad, Pakistan

Sundas Khalid

4 School of Chemical and Materials Engineering, National University of Science and Technology, Islamabad, Pakistan

Sajid Mahmood Awan

Shahzaib jahangiri, yousef saleh khader.

5 Medical Education and Biostatistics, Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan

The COVID-19 outbreak started as pneumonia in December 2019 in Wuhan, China. The subsequent pandemic was declared as the sixth public health emergency of international concern on January 30, 2020, by the World Health Organization. Pakistan could be a potential hotspot for COVID-19 owing to its high population of 204.65 million and its struggling health care and economic systems. Pakistan was able to tackle the challenge with relatively mild repercussions. The present analysis has been conducted to highlight the situation of the disease in Pakistan in 2020 and the measures taken by various stakeholders coupled with support from the community to abate the risk of catastrophic spread of the virus.

Introduction

COVID-19 started as an outbreak of a series of unusual pneumonia cases in Wuhan, China, with the earliest cases reported to the World Health Organization’s country office in China on December 31, 2019. By January 12, 2020, the causative agent was identified as a novel coronavirus, initially termed “2019-nCoV,” and up to 41 cases had been preliminarily diagnosed [ 1 , 2 ]. The virus has since been renamed as SARS-CoV-2 and spread drastically, and COVID-19 was declared as pandemic by the World Health Organization (WHO) on March 11, 2020 [ 3 ]. Having currently affected more than 210 countries and territories, with 19,550,650 active cases and a mortality rate of 2.85% as of December 31, 2020, the COVID-19 pandemic continues to be a major global public health concern [ 4 ].

Pakistan: Epidemiologic Profile

COVID-19 cases were reported from Islamabad and Karachi on February 26, 2020 [ 5 ]. Pakistan being one of the most densely populated countries in Asia, with a population of 204.65 million, and Karachi being the largest metropolitan city in Pakistan, has been greatly vulnerable to this outbreak [ 6 ]. Owing to its present economic condition, health care resources, and the occurrence of previous outbreaks, the Centers for Disease Control and Prevention had already issued a level 3 warning for international travelers to Pakistan [ 7 ]. The administration had a huge responsibility to constrain the spread through a timely response and the adoption of appropriate measures to avoid any major catastrophe. The disease was initially difficult to contain, especially because of noncompliance of the general population to the necessary measures and timely reporting of symptoms. Within 45 days, on April 10, 2020, Pakistan reported 4601 confirmed cases with a death toll approaching 66 individuals [ 8 ].

Public and Community Response to the COVID-19 Pandemic

There was a mixed response from the community. Few people paid attention to the news and some even considered it fake. News of the virus being a hoax or propaganda spread greatly worldwide and countered the efforts of governments and other agencies that made marked efforts to tackle the spread of the pandemic [ 9 , 10 ]. Common rumors on COVID-19 emergence and treatment through the media and social media resources are presented in Table 1 .

Rumors related to COVID-19 emergence and treatment.

Government’s Initiatives to Tackle the Pandemic

The government of Pakistan has been lauded by international organizations including the WHO (and rightly so) for taking the necessary precautions and measures against the COVID-19 pandemic to guarantee not only the containment of disease spread but also to fulfill its responsibility as a state toward its people and their safety [ 14 ].

Immediate Response to Contain Disease Spread

One of the first steps taken by the government was to develop functional emergency operations centers and to detect the route of disease spread in Pakistan. The origin of the virus was the first question; hence, detailed history-taking of patients was crucial not only in understanding the outbreak but also in determining the contacts of patients with other people in the community [ 15 ]. This helped in cordoning off areas or home-bounding people who came in close contact with a patient with COVID-19. In addition to this, patients with a recent international travel history were monitored closely. This made sense because many cases and massive spread was reported in the countries neighboring Pakistan [ 15 - 17 ].

Containment Measures

Once primary and secondary contact-tracing was delineated, the foremost step taken by the government was to control the borders [ 18 ]. This was a crucial decision, owing to the consideration of a large number of Pakistani students and pilgrims studying in and travelling from China, Iran, and Europe. The government gained the confidence of the affected individuals and their families. It was almost unfeasible to restrict such individuals outside the country because of the strong public response; nonetheless, it was necessary if the spread of the virus was to be controlled quickly. To tackle this problem, the government took the initiative of designating quarantine houses near borders and airports to isolate people entering Pakistan for a short period to make sure they were not infected before they moved out in the community [ 19 , 20 ].

Border Control

The WHO reported that the number of new cases increased by the minute, and disease spread was now not only limited to people who had a recent travel history in the regions highly affected by the pandemic. Disease spread within the community was alarming and called for drastic steps to be taken not only by local governments but also by countries and states at large. All necessary services and measures are still being used in maximum capacity till date to ensure the safety of people’s lives in the country. Since all cases initially had a history of recent travel, it was speculated that transmissions were imported from outside of the country. Therefore, travel restrictions were imposed to limit the spread of virus from other countries to Pakistan [ 21 ].

Quarantine Houses

After the borders were contained, it was important for the government to provide a solution to all individuals stuck at the borders to enter the country without imposing a threat to the rest of the community [ 20 ]. It was crucial to quarantine the people at a specific location and either have them tested or wait for at least 2 weeks to ensure that they were not infected with SARS-CoV-2 before they travelled to their hometowns. People who did not show any symptoms after being quarantined for a certain duration could go to their cities and notify the authorities in case of any signs and symptoms after leaving the quarantine homes [ 19 , 20 ]. The development of these shelters was an economically and strategically massive task for the government. More than 3000 pilgrims arrived from Iran in the first week of March 2020 alone and were housed at quarantine shelters in Taftan and Chaman [ 22 , 23 ].

Toward the end of March 2020, the government decided to relocate the pilgrims to their respective provinces where quarantine centers were set up. Most news outlets and social media users condemned this step taken by the government. Many problems were faced by the pilgrims and other people who were quarantined at these centers, including included small, cramped spaces for people to live in, unhygienic conditions, shortage of food, water, medication, and unavailability of physicians [ 23 ].

Country-Wide Lockdown

Many other steps were taken by the government to tackle disease spread and to minimize the damage caused by the pandemic in Pakistan [ 24 , 25 ].

One of the first steps that the government of Pakistan took to limit the spread of the virus within the community was to impose well-planned lockdowns in all major cities [ 20 , 26 ]. Lockdowns were imposed during different hours in different regions, and most of the public spaces were closed off except for grocery stores, pharmacies, and vegetable and fruit shops. All the eateries, parks, wedding halls, schools, and offices were closed until further notice by the federal government [ 27 ]. This led to retaliation from the provincial governments and opposition as it posed a great economic threat to the country’s daily-wage workers and to the low-income population; however, this was a necessary measure to curtail disease spread. Another step that the government took, and faced major opposition, was the closure of prayers at mosques, including Friday prayers [ 26 , 28 , 29 ].

Cordoning Off Areas

When reports of virus transmission started emerging, especially in the federal capital of Islamabad, the government took the initiative of sealing off areas that reported infections. According to a notification issued by the District Magistrate Islamabad, the city administration decided to cordon off areas to ensure public safety after the number of infections increased [ 30 ]. Samples were tested by the National Institute of Health, Islamabad, and analyzed by epidemiologists of the deputy commissioner of the COVID-19 Nerve Centre after which the notification was issued. This helped in not only curbing the spread of the infection but also in contact-tracing and further testing of the public.

Testing and Contact Tracing

The country’s testing capacity was limited during the early months of the pandemic, and while high-income countries were conducting large-scale randomized tests to estimate the actual number of confirmed cases, Pakistan was forced to carry out priority-based testing and rely on the enforcement of strict quarantine and isolation strategies to contain the pandemic [ 31 ]. Contact-tracing, however, was an effective strategy that not only helped limit the spread of the virus but also helped predict its route through different regions of the country and across different age groups. Nevertheless, since large-scale testing was crucial to assess the severity of the pandemic, the testing capacity of laboratories and the availability of testing kits was gradually increased by the government, and in June 2020 up to 30,000 tests were conducted daily to ascertain the pace of spread and to formulate future strategies accordingly [ 32 ]. Both these strategies provided valuable insights on the differences in the clinical manifestation of COVID-19 in people with different demographic and health backgrounds.

Field Epidemiology Laboratory Training Program

The Training Programs in Epidemiology and Public Health Interventions Network is a network of 75 field epidemiology training programs, which operate in >100 countries including Pakistan. After the WHO declared COVID-19 a public health emergency of international concern, alumni from the Field Epidemiology Training Program implemented standard operating procedures (SOPs) for COVID-19 screening at international airports in Pakistan. They also designed and implemented a real-time data entry system to screen travelers from high-risk countries [ 33 ].

Implementation of SOPs: Masks, Sanitization, and Social Distancing

SOPs were devised for the public and were meant to be strictly followed in public areas. These included guidelines on social distancing; that is, avoiding crowded areas, maintaining a physical distance of 3 feet, wearing masks, maintaining hand hygiene, sanitizing frequently touched surfaces and areas, and following general hygiene rules such as avoiding touching the face, nose, or eyes, and coughing, or sneezing in the elbow or a paper napkin instead of the hands. The authorities started taking disciplinary action against those who violated the SOPs at public places in various parts of the country in accordance with the recommendations of the National Command and Control Centre of Pakistan. The focus of the National Command and Control Centre was on SOPs, compliance, strict administrative actions being implemented, and enforcement of various strands of the track, trace, and quarantine strategy [ 34 ].

Initiation of Awareness Campaigns: Role of Community Health workers

Many campaigns were initiated by both local and federal governments in the interest of the general population to spread awareness about the risks, signs, and symptoms of COVID-19 [ 35 ]. Pakistan’s extensive polio vaccination program, consisting of more than 265,000 community health workers and vaccinators, was mobilized with the help of the WHO [ 36 ]. This not only helped provide infrastructure to track and trace cases early during the epidemic but also helped spread awareness in the remote, underdeveloped rural regions of Pakistan. Another vital step was taken to spread awareness to the masses, where text messages were sent by the government of Pakistan on all mobile networks [ 37 ]. The daily reminders on following SOPs helped tackle those who did not take the necessary precautions and were unaware of the aforementioned information, and the imposition of fines and charges for noncompliance made risk and awareness campaigns a nationwide success [ 35 , 37 ].

Recorded voice messages in various local languages including Urdu, Pashto, and Sindhi, which warned against the risks of COVID-19, its spread, and its complications, and general awareness regarding the SOPs to help control its spread, were used as caller tunes before every phone call. The recorded messages were changed in accordance with the situation and ranged from guidelines on SOPs, warning noncompliers, and even congratulating efforts after successfully controlling disease spread during August 2020 [ 37 ].

Economic Measures

On the emergence of COVID-19 in Pakistan, the entire system faced various problems owing to the limitations of the health care system, poor infrastructure, uneven access to health care, resistance from various social, political, cultural, and religious groups, political instability, economic fragilities, and mistrust among the public. Data of a web-based survey conducted by the Small and Medium Enterprises Development Authority from April 3-14, 2020, among 920 businesses revealed insufficient revenue generation, losses, and difficulty in survival among businesses [ 38 ]. Pakistan launched various schemes to tackle the economic crisis faced by many individuals during the pandemic. On May 2, 2020, Prime Minister Imran Khan launched a relief scheme for people who lost their jobs or whose source of income has been compromised owing to the lockdown. He launched a cash assistance program through the Ehsaas Cash Programme to support unemployed individuals [ 39 ].

After lifting the lockdown in some sectors, the government allowed construction and daily-wage workers to resume working while dutifully following the SOPs and taking necessary precautions. This helped ease some of the economic burdens of the government, especially in providing rations and relief packages for the daily-wage workers [ 40 ].

Furthermore, the government also requested people who had been diagnosed with mild or asymptomatic COVID-19 to quarantine at home as some of them did not required hospital care; this helped curb the patient influx in hospitals and at diagnostic centers, thus easing the burden on health workers and medical practitioners [ 41 ].

Production of Ventilators

One of the largest concerns for the ministry of health and health departments in Pakistan and worldwide is coping with the continuously increasing demand of ventilators as the virus spreads and the number of cases increases. The shortage of ventilators is a major issue faced by Pakistan, especially because all the major medical equipment are imported and not produced locally. To tackle this problem, the National Radio and Telecommunication Corporation produced its first ventilator locally within a few months of the onset of the pandemic [ 42 ]. The National Radio and Telecommunications Corporation initially offered cost-free repairs for almost 109 ventilators throughout the country and later designed and produced its own ventilators. Initially, 8 ventilators were produced and handed over to the National Disaster Management Authority after which the prime minister formally inaugurated a facility for large-scale production of ventilators within Pakistan [ 43 ].

As a result of all the efforts made by the government of Pakistan, 6 months after reporting its first case, active cases in Pakistan are continuing to steadily decrease, with the number of deaths recorded in a day now often down to single-digit numbers. The country has had 312,263 confirmed cases of as on October 1, 2020, with 6479 COVID-19–related deaths, according to the official data [ 44 ]. Save for single-day glitches, active cases have been progressively declining since peaking in June 2020, currently standing at 8903, their lowest level since late April 2020.

Success Stories: Pakistan’s Population Coming Together to Combat COVID-19

Pakistan is currently faced with one of its toughest challenges since its establishment as an independent nation, and while COVID-19 has severely disrupted routines and led to intense fear among the public, efforts are still being made to bring together the expertise and knowledge of individuals from various fields to ensure combating this pandemic together. In addition to the government’s efforts, many other organizations and individuals came forward to help against the pandemic in various capacities. From using social media to campaign for blood donations for patients with thalassemia nationwide to arranging food supplies and relief packages for those severely affected by the pandemic, the local people of Pakistan came forward and helped fellow citizens.

The Human Development Foundation Pakistan is one of the oldest nonprofit organizations in the country, and it estimated the provision and distribution of more than 14,000 ration packages containing food and medical supplies to the people of Karachi [ 45 ].

Al-Khidmat Foundation Pakistan

Al-Khidmat Foundation Pakistan is one of the leading nonprofit foundations operating in Pakistan for the past 30 years. During the onset of the pandemic, it played a vital role in charity work including awareness campaigns, providing preventive equipment such as soap, sanitizers, masks, and relevant reading material to the general public, providing its services to government institutions including hospitals, Aghosh homes, ambulances, and trained volunteers. Moreover, it carried out food drives, provided COVID-19 test facilities and antibody tests, and arranged for protective equipment to distribute among physicians and medical staff on the frontline [ 46 ]. Al-Khidmat Foundation Pakistan also played a vital role in arranging free plasma for patients with COVID-19 [ 47 ].

Corona Recovered Warriors

The Facebook page titled “Corona Recovered Warriors” provided hope during the grim period of disease spread in Pakistan. Created by musician Zoraiz Riaz with the aim to help coordinate convalescent plasma donations for people with COVID-19 in Pakistan, this group quickly gained popularity and had 320,000 members in just 1 month, needing a team of 33 volunteers to manage the posts. People looking for plasma donors, medical supplies, oxygen cylinders, ventilators, injection drugs or other drugs, and leads on hospitals accepting new admittees posted all their queries on this group, and thousands of people came forward and offered help in all capacities to those in need [ 48 ]. The group then started organizing donation and food drives, providing personal protective equipment (PPE) to health care workers and delivering medical supplies to desperate families of patients with COVID-19 [ 49 ].

Plasma Trials by Medical Professionals

In desperate times when everyone is seeking any cure to tackle the virus, many unapproved and untested remedies were used even by health care professionals to treat individuals with COVID-19. The most popular one was the use of plasma of a recovered patient to treat patients with COVID-19. Dr Shahid Junejo, a senior superintendent at a civil hospital, tested plasma therapy on a patient in Hyderabad. According to him, the decision for the trial was taken after consultation with the vice chancellor of the Liaquat University of Medical and Health Sciences Jamshoro, Prof Bikha Ram Devrajani [ 50 ]. Passive immunization is an old procedure used in the absence of a vaccine to treat infectious diseases; hence, the treatment was administered to many patients throughout the country without any strong evidence of its ability to neutralize the virus [ 51 ]. Even though the Ministry of National Health Services declared that plasma therapy is not a cure for COVID-19 as it is still undergoing a clinical trial on a global scale, there is still a high demand of plasma donors, and as of July 2020 approximately 750 donors were connected with critical patients through the Corona Recovered Warriors Facebook page alone.

Availability of Scholars Against COVID-19 Pakistan

Scholars Against COVID-19 is a platform of over 3000 young scholars and researchers nationwide coming together as volunteers to assist the government and people through donations of equipment from laboratories and universities to scale up testing and experimentation related to the diagnosis and treatment of COVID-19 [ 52 ]. Their aim is to bridge the disconnect among various sectors in Pakistan, which makes executing such ideas challenging.

Student Taskforce Against COVID-19

Student Taskforce Against COVID-19 is a group of final-year medical students from Aga Khan University Hospital who conceived the idea of creating a helpline for families and patients affected by COVID-19 who have been looking for guidelines and help [ 53 ]. The taskforce is not only managing the helpline but also assisting the Aga Khan University Hospital and the Sindh government in contact-tracing and helping the Pakistan Medical Association in identifying and providing volunteers to help at Karachi's Expo Centre isolation ward for patients with COVID-19 [ 54 ].

First Response Initiative of Pakistan

Over 400 medical students have come together through the Combat Corona campaign and are aiming to collect and provide PPE to health care workers. They have targeted hospitals in Karachi needing PPE and have collected hundreds of equipment for distribution through donations in all major hospitals of the city [ 54 ].

Pakistan Against COVID-19 Volunteers Group

Pakistan Against COVID-19 Volunteers is a group of physicians and other professionals who have collaborated and aim to enable connections between manufacturers and suppliers of PPE, carry out innovation and experimentation for designing and manufacturing ventilators through 3D printing technology, and develop noncontact thermometers locally [ 55 , 56 ].

Kwickdoctor.com

Kwickdoctor.com has been developed by 40-year-old information technology expert Salman Khan. He aims to connect the public to consultants, physicians, pharmacies, and laboratories and even delivers prescriptions at the doorstep. With the pandemic spreading, the need to avoid contact has increased and digital care is the need of the hour [ 57 ].

Principal Findings

COVID-19, after being first reported in December 2019, is still swiftly spreading worldwide. Within 10 months, the mortality and morbidity rates have approached unexpected levels. Scientists, researchers, and clinicians have worked together with engineers to develop treatments, diagnostic kits, and vaccines to prevent this infection from spreading further; however, a third wave of COVID-19 is currently underway worldwide with numerous mutant strains. These mutations have rendered this virus either more virulent or resistant to previously used medications [ 58 ]. The second wave has been feared as the situation was reverting to normalcy and businesses, offices, and schools were reopening in late September or early October of 2020. The government of Pakistan started tackling COVID-19 on the basis of the experience of other countries as the disease approached Pakistan after having affected many other countries. Starting from preparing special wards, using all resources including polio and dengue teams and wards, respectively, preparing appropriate SOPs, conveying awareness messages to everyone through the television or mobile phones, updating everyone through special mobile apps and websites, showing hotspots, sharing the economic burden with the weak, and ending with smart lockdowns were some of the most impressive measures to handle the pandemic. The people of Pakistan also supported the government during this time, which is one of the most prominent reasons Pakistan overcame the first 2 waves with minimal morbidities compared to other countries.

Conclusions

Immunization and treatment of COVID-19 may still be questionable, but precautions and SOPs have undoubtedly been set by many. Technology has played its part in spreading awareness, but Pakistan is currently undergoing a third wave of infections. However, if precautions are taken and all SOPs are followed, the entire community can be rescued and the risk of reinfection and further waves would decline immediately. This is a situation where everyone has a responsibility toward the community and must take steps to minimize the risk of further disease spread. Pakistan has shown tremendous potential in public health, and different government and nongovernment organizations can collaborate to address the challenges through the engagement of society and the community along with the introduction of new policies.

Abbreviations

Conflicts of Interest: None declared.

Masks Strongly Recommended but Not Required in Maryland, Starting Immediately

Due to the downward trend in respiratory viruses in Maryland, masking is no longer required but remains strongly recommended in Johns Hopkins Medicine clinical locations in Maryland. Read more .

• Vaccines  
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COVID-19 Vaccine: What You Need to Know

The COVID-19 vaccine is very good at preventing serious illness, hospitalization and death. Because the virus that causes COVID-19 continues to change, vaccines are updated to help fight the disease. It is important to check the Centers for Disease Control and Prevention (CDC) COVID-19 vaccine information for the latest details. (Posted 11/22/23)

What is the COVID-19 vaccine?

The COVID-19 vaccine lessens the severity of COVID-19 by teaching the immune system to recognize and fight the virus that causes the disease.

For fall/winter 2023–2024, the updated COVID-19 vaccine is based on the XBB.1.5 variant. The updated vaccine is made by Pfizer-BioNTech, Moderna and Novavax. This season, only one shot of the vaccine is needed for most people, and there are no boosters. (People who are immunocompromised or ages 6 months to 4 years may need more than one 2023–2024 vaccine.)

How is the 2023–2024 COVID-19 vaccine different from previous COVID-19 vaccines?

The 2023–2024 COVID-19 vaccine targets XBB.1.5, a subvariant of Omicron. While none of the variants currently circulating are exact matches to the vaccine, they are all closely related to the XBB.1.5 strain. Studies show that the updated vaccine is effective against the  variants currently causing the majority of COVID-19 cases  in the U.S.

Who should get a COVID-19 vaccine?

Because the 2023–2024 vaccine is effective for recent strains of COVID-19, it is recommended that everyone stay up to date with this vaccine. Previous vaccines or boosters were not developed to target the more recent strains. For 2023–2024, the CDC recommends:

• Everyone age 5 and older receive one shot of the updated vaccine.
• Children ages 6 months to 4 years may need more than one shot to be up to date.
• People who are moderately or severely immunocompromised may need more than one shot.

You can review the full recommendations on the CDC’s Stay Up to Date with COVID-19 Vaccines webpage . Be sure to talk to your primary care doctor or pediatrician if you are unsure about vaccine recommendations.

What are the side effects of the COVID-19 vaccine?

Side effects vary and may last one to three days. Common side effects are:

• Soreness at the injection site

COVID-19 Vaccine and Pregnancy

COVID-19 vaccines approved by the Food and Drug Administration (FDA) are safe and recommended for people who are pregnant or lactating, as well as for those r intending to become pregnant.

People who are pregnant or were recently pregnant are at a greater risk for severe COVID-19. Having a severe case of COVID-19 while pregnant is linked to a higher risk of pre-term birth and stillbirth and might increase the risk of other pregnancy complications.

What should parents know about the COVID-19 vaccine and children?

The CDC recommends the 2023–2024 vaccine for adolescents and teenagers ages 12 and older, and for children ages 6 months through 11 years.

• Children age 5 and older need one shot of the updated vaccine.

Children are less likely to become seriously ill from COVID-19 than adults, although serious illness can happen. Speak with your pediatrician if you have questions about having your child vaccinated.

If I recently had COVID-19, do I need a 2023–2024 vaccine?

If you recently had COVID-19, the CDC recommends waiting about three months before getting this updated vaccine. If you encounter the virus again, having the updated vaccine will:

• Lessen your risk of severe disease that could require hospitalization
• Reduce the chance that you infect someone else with COVID-19
• Help keep you protected from currently circulating COVID-19 variants

How long should I wait to get this vaccine if I recently had an earlier version of a COVID-19 vaccine or booster?

People age 5 years and older should wait at least two months after getting the last dose of any COVID-19 vaccine before receiving the 2023–2024 vaccine,  according to CDC guidance .

Is natural immunity better than a vaccine?

Natural immunity is the antibody protection your body creates against a germ once you’ve been infected with it. Natural immunity to the virus that causes COVID-19 is no better than vaccine-acquired immunity, and it comes with far greater risks. Studies show that natural immunity to the virus weakens over time and does so faster than immunity provided by COVID-19 vaccination.

Do I need a COVID-19 booster?

The 2023–2024 vaccine is a one-shot vaccine for most people, and there is no booster this season. (People who are immunocompromised or ages 6 months to 4 years may need more than one 2023–2024 vaccine.)

The FDA calls this an updated vaccine (not a “booster” like previous shots) because it builds a new immune response to variants that are currently circulating. This change reflects the current approach of treating COVID-19 similarly to the flu, with preventive measures such as an annual vaccination.

When should I get a COVID-19 vaccine?

Like the flu and other respiratory diseases, COVID-19 tends to be more active in the fall and winter, so getting a vaccine in the fall is recommended.

How quickly does the COVID-19 vaccine become effective?

It usually takes about two weeks for the vaccine to become effective. The CDC website provides more information on how the COVID-19 vaccines work .

How long does the COVID-19 vaccine last?

Studies suggest that COVID-19 vaccines are most effective during the first three months after vaccination.

Is it safe to get a flu and COVID-19 vaccine at the same time?

Yes, it safe to get both shots at the same time. Keep in mind that each has similar side effects and you may experience side effects from both.

Is the COVID-19 vaccine safe?

Yes. COVID-19 vaccines approved by the FDA meet rigorous testing criteria and are safe and effective at preventing serious illness, hospitalization and death. Millions of people have received the vaccines, and the CDC continues to monitor their safety and effectiveness as well as rare adverse events.

Where can I get a COVID-19 vaccine?

The COVID-19 vaccine is available at pharmacies. See vaccines.gov to find a convenient location.

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Far-right advances in EU election, France calls snap national vote

Far-right parties in France, Germany, the Netherlands, Austria and elsewhere performed strongly in a vote that will see the balance of power shift rightwards in the 720-seat parliament that helps shape and approve legislation across the bloc.