healthy lifestyle during pandemic essay

• Fact sheets
• Facts in pictures
• Publications
• Questions and answers
• Tools and toolkits
• Endometriosis
• Excessive heat
• Mental disorders
• Polycystic ovary syndrome
• All countries
• Eastern Mediterranean
• South-East Asia
• Western Pacific
• Data by country
• Country presence 
• Country strengthening 
• Country cooperation strategies 
• News releases
• Feature stories
• Press conferences
• Commentaries
• Photo library
• Afghanistan
• Cholera 
• Coronavirus disease (COVID-19)
• Greater Horn of Africa
• Israel and occupied Palestinian territory
• Disease Outbreak News
• Situation reports
• Weekly Epidemiological Record
• Surveillance
• Health emergency appeal
• International Health Regulations
• Independent Oversight and Advisory Committee
• Classifications
• Data collections
• Global Health Observatory
• Global Health Estimates
• Mortality Database
• Sustainable Development Goals
• Health Inequality Monitor
• Global Progress
• World Health Statistics
• Partnerships
• Committees and advisory groups
• Collaborating centres
• Technical teams
• Organizational structure
• Initiatives
• General Programme of Work
• WHO Academy
• Investment in WHO
• WHO Foundation
• External audit
• Financial statements
• Internal audit and investigations 
• Programme Budget
• Results reports
• Governing bodies
• World Health Assembly
• Executive Board
• Member States Portal

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

Joint statement by ilo, fao, ifad and who.

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

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

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

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

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

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

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

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

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

Media Contacts

Kimberly Chriscaden

Communications Officer World Health Organization

Nutrition and Food Safety (NFS) and COVID-19

If you think you’ve been targeted by a scam, get information and assistance from the AARP Fraud Watch Network Helpline.

AARP daily Crossword Puzzle

Hotels with AARP discounts

Life Insurance

AARP Dental Insurance Plans

LIMITED TIME OFFER: Labor Day Sale!

Join AARP for just $9 per year with a 5-year membership and get a FREE Gift! 

Get instant access to members-only products, hundreds of discounts, a free second membership, and a subscription to AARP the Magazine. 

• right_container

Work & Jobs

Social Security

• AARP en Español

• Membership & Benefits
• Members Edition
• AARP Rewards
• AARP Rewards %{points}%

Conditions & Treatments

Drugs & Supplements

Health Care & Coverage

Health Benefits

AARP Hearing Center

Advice on Tinnitus and Hearing Loss

Your Health

What to Know About Vaccines

Brain Health Resources

Tools and Explainers on Brain Health

25 Ways to Get a Flatter Stomach

Scams & Fraud

Personal Finance

Money Benefits

View and Report Scams in Your Area

AARP Foundation Tax-Aide

Free Tax Preparation Assistance

AARP Money Map

Get Your Finances Back on Track

How to Protect What You Collect

Small Business

Age Discrimination

Flexible Work

Freelance Jobs You Can Do From Home

AARP Skills Builder

Online Courses to Boost Your Career

31 Great Ways to Boost Your Career

ON-DEMAND WEBINARS

Tips to Enhance Your Job Search

Get More out of Your Benefits

When to Start Taking Social Security

10 Top Social Security FAQs

Social Security Benefits Calculator

Medicare Made Easy

Original vs. Medicare Advantage

Enrollment Guide

Step-by-Step Tool for First-Timers

Prescription Drugs

9 Biggest Changes Under New Rx Law

Medicare FAQs

Quick Answers to Your Top Questions

Care at Home

Financial & Legal

Life Balance

LONG-TERM CARE

​Understanding Basics of LTC Insurance​

State Guides

Assistance and Services in Your Area

Prepare to Care Guides

How to Develop a Caregiving Plan

End of Life

How to Cope With Grief, Loss

Recently Played

Word & Trivia

Atari® & Retro

Members Only

Staying Sharp

Mobile Apps

More About Games

Right Again! Trivia

Right Again! Trivia – Sports

Atari® Video Games

Throwback Thursday Crossword

Travel Tips

Vacation Ideas

Destinations

Travel Benefits

Camping and RV Ideas

Fun Camping and RV Journeys

Exploration

25 Great Ways to Explore

Train Travel

How to Find Great Train Deals

AARP National Park Guide

Travel to Pinnacles in California

Entertainment & Style

Family & Relationships

Personal Tech

Home & Living

Celebrities

Beauty & Style

TV for Grownups

Fall TV Preview

Kevin Costner’s Big Bet

Looking Back

Take Our ’80s Music Quiz

Sex & Dating

7 Dating Dos and 7 Don'ts

Get Happier

Creating Social Connections

Friends & Family

Veterinarians May Use AI to Treat Pets

Home Technology

What's Inside Your Smartphone

Virtual Community Center

Join Free Tech Help Events

Creative Ways to Store Your Pets Gear

Meals to Make in the Microwave

Wearing Shoes Inside: Pros vs. Cons

Driver Safety

Maintenance & Safety

Trends & Technology

AARP Smart Guide

How to Clean Your Car

We Need To Talk

Assess Your Loved One's Driving Skills

AARP Smart Driver Course

Building Resilience in Difficult Times

Tips for Finding Your Calm

Weight Loss After 50 Challenge

Cautionary Tales of Today's Biggest Scams

7 Top Podcasts for Armchair Travelers

Jean Chatzky: ‘Closing the Savings Gap’

Quick Digest of Today's Top News

AARP Top Tips for Navigating Life

Get Moving With Our Workout Series

You are now leaving AARP.org and going to a website that is not operated by AARP. A different privacy policy and terms of service will apply.

Healthy Living During the Pandemic and Beyond

Cheryl L. Lampkin, AARP Research

For adults ages 50-plus the impact of the pandemic has been tough, but most are committed to regaining control.

The COVID-19 pandemic has had an adverse effect on many different levels, whether they be economic, social, or emotional. A recent study by AARP goes one step further and focuses on the pandemic's impact on maintaining a healthy lifestyle for adults ages 50-plus. Overall, among adults ages 50-plus, nearly half (45%) say their ability to maintain a healthy lifestyle over the past year was more difficult. This difficulty in maintaining a healthy lifestyle is consistent across younger and older adults.

Regaining Control Through Diet

One key component of maintaining a healthy lifestyle is diet. Across age groups, about half (48%) of adults ages 50-plus say their eating habits have not changed since the start of the pandemic. Further, one-third (32%) of older adults say they eat a little more or more healthy now than before the pandemic. 

Looking at diet more closely, the survey asked respondents to indicate how many daily servings they had of each of the following food groups: vegetables, grain, protein, dairy, and fruit. We find one-fifth of adults ages 50-plus say they are eating less healthily today than at the start of the pandemic, even among those with the highest consumption of the recommended food group servings.

To further evaluate the impact of the pandemic on eating habits, the survey asked how eating habits changed for three less-healthy food groups: sweet snacks, salty snacks, and highly processed foods. Overall, more than a quarter (29%) of adults ages 50-plus say that in the past year they were eating more sweet snacks, while a fifth admitted that their diet had changed by eating more salty snacks (20%) and/or highly processed foods (18%). Top reasons cited for eating more snacks and processed foods were spending more time at home (57%) and watching TV/streaming (55%). 

Regardless of which factors drive increased consumption during the height of the pandemic, more than half (55%) of these adults ages 50-plus are very concerned about their change in diet and want to make adjustments. One key bright spot from the survey is the commitment to new activities aimed at regaining a healthy lifestyle, especially changes in diet, as the vast majority are intent on maintaining these modifications a year from now.

Regaining Control Through Exercise

Another key component of maintaining a healthy lifestyle is exercise. As this research clearly shows, the pandemic has limited most older adults’ access to exercise. Not only is exercise a key way to maintain physical health, but it can also impact the ability to cope with stress. 

For those who have found it more difficult to maintain a healthy lifestyle, a decline in exercise appears to have been a contributing factor. More than a third (37%) of respondents said that they have devoted less time to exercise since the pandemic began. Even among those who say maintaining a healthy lifestyle over the past year has been easier, nearly two in 10 (18%) say they are devoting less time to exercise. These results highlight the challenges the pandemic has created for exercise among adults ages 50-plus and the important role that exercise plays in a healthy lifestyle.

Additionally, more than a third (43%) of adults ages 50-plus report that their stress levels have increased since the pandemic began. However, when asked to look six months ahead, one-third (34%) see their stress levels declining. Although many factors will contribute to the anticipated decline in future stress levels (e.g., increase social contact, vaccination rates, etc.), exercise is a key driver. For example, nearly half (47%) of those who see their stress levels declining in the next six months say better weather and the ability to exercise outside is a factor, and nearly one in five (17%) say being able to go back to the gym will help them reduce stress.

Adults ages 50-plus are optimistic about regaining control over their health, with many predicting an increase in exercise time and a reduction in stress over the next six months. However, at least some of this expectation is based on a COVID-free life. This expectation needs to be balanced with the likely reality that the virus is not going to disappear completely anytime soon and that some barriers to physical activity are likely to remain. In this evolving reality, those who want to engage in physical activity to help maintain a healthy lifestyle will have to keep an open mind and adapt to the limitations imposed by the pandemic. Adults ages 50-plus will benefit by exploring new types of exercise, adopting more flexible routines (e.g., time of day, indoors and outside) and experimenting with online exercise classes. 

Methodology

This survey was conducted by the nonpartisan and objective research organization NORC at the University of Chicago on behalf of AARP. For this national survey, data were collected using the AmeriSpeak Panel. AmeriSpeak, the probability-based panel of NORC, is designed to be representative of the U.S. household population.

A total sample of 1,903 adults with multicultural oversamples of African Americans/Blacks (462 total) and Hispanics/Latinos (446 total) were surveyed online and by telephone between April 27, 2021 and May 4, 2021. A portion of the multicultural samples came from the national survey sample. The survey was conducted in English and Spanish.

For more information, please contact Cheryl Lampkin at [email protected] . For media inquiries, contact External Relations at [email protected] .

Suggested citation:

Lampkin, Cheryl.  2021 Healthy Living During the Pandemic and Beyond: An AARP Healthy Living Survey of Adults Ages 50 and Older.  Washington, DC: AARP Research, August 2021.  https://doi.org/10.26419/res.00487.001

MORE FROM AARP

The Altruism-Clinical Trial Participation Disconnect Illuminates Opportunity

This study of U.S. adults ages 18 and older found that about one-fifth are familiar with clinical trials and about six in ten say they would participate in one.

Few people 50-plus know how much exercise is enough

Adults who exercise 150 minutes weekly tend to rate aspects of their health higher than those who exercise 30 minutes, but few know they need 150 minutes.

AARP Research Insights on Health Care

AARP Research on health care highlights U.S. adults' experiences with Medicare, telehealth, prescription drugs, and healthy living.

African American Men Feel Good About Their Health

Most Black men in the U.S. age 50+ found feel good about their health, but more preventive care and better lifestyle choices could mean even better health.

Who's Getting Long COVID and How It's Showing Up

Many COVID sufferers age 50-plus experienced lingering COVID symptoms beyond the typical one-to-two-week period.

DETAILED FINDINGS

(Report, PDF)

HEALTHY LIFESTYLE

(Infographic, PDF)

• Open access
• Published: 08 June 2020

Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey

• Laura Di Renzo 1   na1 ,
• Paola Gualtieri 1   na1 ,
• Francesca Pivari   ORCID: orcid.org/0000-0002-2277-6833 2 ,
• Laura Soldati 2 ,
• Alda Attinà 3 ,
• Giulia Cinelli 3 , 4 ,
• Claudia Leggeri 3 ,
• Giovanna Caparello 3 ,
• Luigi Barrea 5 ,
• Francesco Scerbo 6 ,
• Ernesto Esposito 7 &
• Antonino De Lorenzo 1  

Journal of Translational Medicine volume  18 , Article number:  229 ( 2020 ) Cite this article

356k Accesses

1272 Citations

151 Altmetric

Metrics details

On December 12th 2019, a new coronavirus (SARS-Cov2) emerged in Wuhan, China, sparking a pandemic of acute respiratory syndrome in humans (COVID-19). On the 24th of April 2020, the number of COVID-19 deaths in the world, according to the COVID-Case Tracker by Johns Hopkins University, was 195,313, and the number of COVID-19 confirmed cases was 2,783,512. The COVID-19 pandemic represents a massive impact on human health, causing sudden lifestyle changes, through social distancing and isolation at home, with social and economic consequences. Optimizing public health during this pandemic requires not only knowledge from the medical and biological sciences, but also of all human sciences related to lifestyle, social and behavioural studies, including dietary habits and lifestyle.

Our study aimed to investigate the immediate impact of the COVID-19 pandemic on eating habits and lifestyle changes among the Italian population aged ≥ 12 years. The study comprised a structured questionnaire packet that inquired demographic information (age, gender, place of residence, current employment); anthropometric data (reported weight and height); dietary habits information (adherence to the Mediterranean diet, daily intake of certain foods, food frequency, and number of meals/day); lifestyle habits information (grocery shopping, habit of smoking, sleep quality and physical activity). The survey was conducted from the 5th to the 24th of April 2020.

A total of 3533 respondents have been included in the study, aged between 12 and 86 years (76.1% females). The perception of weight gain was observed in 48.6% of the population; 3.3% of smokers decided to quit smoking; a slight increased physical activity has been reported, especially for bodyweight training, in 38.3% of respondents; the population group aged 18–30 years resulted in having a higher adherence to the Mediterranean diet when compared to the younger and the elderly population (p < 0.001; p < 0.001, respectively); 15% of respondents turned to farmers or organic, purchasing fruits and vegetables, especially in the North and Center of Italy, where BMI values were lower.

Conclusions

In this study, we have provided for the first time data on the Italian population lifestyle, eating habits and adherence to the Mediterranean Diet pattern during the COVID-19 lockdown. However, as the COVID-19 pandemic is ongoing, our data need to be confirmed and investigated in future more extensive population studies.

The 2019 Coronavirus Disease or, as it is now called, COVID-19, is a severe acute respiratory syndrome caused by SARS coronavirus 2 (SARS-CoV-2). It was supposed that in December 2019, SARS-CoV-2 apparently transit from animals to humans at the Huanan seafood market and rapidly spread from Wuhan City of Hubei, Province of China, to the rest of the world [ 1 ]. Due to the growing case notification rates at Chinese and international locations, on the 30th January 2020, the WHO Emergency Committee declared a global health emergency [ 2 ]. In order to contrast and contain the spread of the new COVID-19, at the beginning of March 2020, the Italian Government decided for more stringent containment measures: the ban on mass gatherings and events, as well as the ban on meeting up for no urgent reasons, were issued on the entire national territory [ 3 ]. In particular, after almost a month of lockdown, as of March 28th, 2020, Italy with 92.472 cases and 10.023, was the second world’s worst-affected country in the COVID-19 pandemic [ 4 ]. In detail, the percentage of the new positive cases in Italy showed an average growth rate of +19.63%, with the highest percentage the on February 27th of +52.73% and a lowest percentage on March 28th of +5.50% [ 4 ]. Due to the #iorestoacasa decree [ 5 ] (translated as #stayathome decree), a sudden and radical change has occurred in the habits and lifestyles of the population, with a drastic reduction of any form of socialisation. Physical distancing and self-isolation strongly impacted citizens’ lives, affecting in particular eating habits and everyday behaviours.

There are two major influences: staying at home (which includes digital-education, smart working, limitation of outdoors and in-gym physical activity) and stockpiling food, due to the restriction in grocery shopping. In addition, the interruption of the work routine caused by the quarantine could result in boredom, which in turn is associated with a greater energy intake [ 6 ]. In addition to boredom, hearing or reading continuously about the COVID-19 from media can be stressful. Stress leads subjects toward overeating, especially ‘comfort foods’ rich in sugar, defined as “food craving” [ 7 , 8 ]. Those foods, mainly rich in simple carbohydrates, can reduce stress as they encourage serotonin production with a positive effect on mood [ 9 ]. However, this food craving effect of carbohydrates is proportional to the glycemic index of foods that is associated with the increased risk of developing obesity and cardiovascular diseases, beyond a chronic state of inflammation, that has been demonstrated to increase the risk for more severe complications of COVID-19 [ 10 , 11 ].

This new condition may compromise maintaining a healthy and varied diet, as well as a regular physical activity. For example, limited access to daily grocery shopping may lead to reduce the consumption of fresh foods, especially fruit, vegetables and fish, in favour of highly processed ones, such as convenience foods, junk foods, snacks, and ready-to-eat cereals, which tend to be high in fats, sugars, and salt. Moreover, psychological and emotional responses to the COVID-19 outbreak [ 12 , 13 ], may increase the risk of developing dysfunctional eating behaviors. It is well known how the experience of negative emotions can lead to overeating, the so-called “emotional eating” [ 14 , 15 ]. In order to contrast and respond to the negative experience of self-isolation, people could be more prone to look for reward and gratification physiologically associated with food consumption, even overriding other signals of satiety and hunger [ 16 ]. In addition, boredom feelings, which may arise from staying home for an extended period, are often related to overeating as a means to escape monotony [ 17 , 18 ]. On the other hand, negative experiences may lead to eating restriction, due to the physiological stress reactions that mimic the internal sensations associated with feeding-induced satiety.

Finally, lifestyle may be substantially changed due to the containment measures, with the consequent risk of sedentary behaviours, modification in smoking and sleeping habits. Of interest, different studies reported an association between sleep disturbances and obesity due to increase the secretion of pro-inflammatory cytokines by the increased visceral adipose that could contribute to alter the sleep–wake rhythm [ 19 , 20 ]. In addition, also diet seems to influence the quality of sleep, in fact very recently in a cross-sectional study included 172 middle-aged adults it has been reported that good sleepers had higher adherence to the Mediterranean diet (MD) and lower body mass index (BMI) compared to poor sleepers [ 21 ].

Considering the smoking, there are a significant association exists between SARS-CoV-2 infection and air pollution, and in this context in smokers, more severe COVID-19 symptoms occur [ 22 ].

Low physical activity levels have been suggested to interact both with body fat and appetite dysregulation [ 23 ].

Eating habits and lifestyle modification may threaten our health. Maintaining a correct nutrition status is crucial, especially in a period when the immune system might need to fight back. In fact, subjects with severe obesity (BMI ≥ 40 kg/m 2 ) are one of the groups with the higher risk for COVID-19 complications [ 24 ]. Obesity is an expansion of the adipose tissue, which produces cytokines and contributes to a proinflammatory milieu [ 25 ]. Moreover, in regards to pulmonary physiology, subjects with obesity have decreased expiratory reserve volume, functional capacity and respiratory system compliance. In patients with high abdominal fat, pulmonary function is further compromised in the supine position by decreased diaphragmatic excursion, making ventilation more difficult [ 26 ]. The inflammatory state is also one of the most important factors of the severity of lung disease in COVID-19, which leads to the famous “ cytokine storm” associated with the acute respiratory distress syndrome and multiple organ failure [ 11 ]. In this complex scenario, the inflammatory state characteristics in individuals with obesity could further exacerbate the inflammation in patients with COVID-19, therefore, exposing them to a higher concentration of proinflammatory cytokines compared to normal-weight individuals [ 11 ].

Further, following a healthy diet is important because gene expression levels of all the cytokines are influenced by food [ 27 ] and are capable of modulating the processes of inflammation and oxidative stress [ 27 ]. Several studies have confirmed an inverse association between the adherence to the MD and the overall cancer-related mortality. The healthy MD [ 28 ] is a proper combination of quality foods, based on macro and micronutrient content, and the absence of contaminating substances. According to current knowledge, the MD is the key factor against immune-mediated inflammatory responses, such as those occurring in cancer. In particular, their potential clinical applications are, on one side, low cholesterol levels and, on the other hand, high levels of antioxidants contained in fruits and vegetables, and monounsaturated fatty acid (MUFA), present in fish, nuts and olive oil [ 29 ]. Notably, it is well known that the MD, one of the healthiest dietetic pattern in the world, is linked to lower mortality and reduction in obesity, type 2 diabetes mellitus, low-grade inflammation, cancer, Alzheimer’s disease, depression, and Crohn’s disease [ 29 , 30 ].

In light of the above, the “Eating Habits and Lifestyle Changes in COVID19 lockdown” (EHLC-COVID19) project began by using a web-survey. The main aim of the project, from a diachronic perspective, is to explore and analyse the changes in eating behavior and adherence to the MD and lifestyle during lockdown among the Italian population, according to the regional distribution of the COVID-19 epidemic and to age. Secondly, it allows to achieve nutritional interventions in supporting the health status of different target groups of the population, according to geographical distribution.

Materials and methods

Survey methodology.

The EHLC-COVID19 project was carried out by the Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention of the University of Rome Tor Vergata, using a web-survey to obtain data, from every Italian region, about people eating habits and lifestyle during the COVID-19 pandemic.

The survey was conducted from the 5th to the 24th of April 2020, among the Italian population, by using an online platform, accessible through any device with an Internet connection. The survey was disseminated through institutional and private social networks (Twitter, Facebook, and Instagram), the “ PATTO in Cucina Magazine” website [ 31 ], and institutional mailing lists. This method of administration provides a statistical collective whose population parameters cannot be controlled as it is the case for probabilistic sampling. However, it was completely effective for the research objectives, because it facilitated the wide dissemination of the survey questionnaire during a period where, due to the pandemic, there are many territorial restrictions. Moreover, the latest data reported by the annual Italian report on the use of the internet shows that Internet penetration stood at 82% in January 2020; in particular, 94% of internet users, aged 16 to 64, use their smartphone to connect and 99% of them visited or used a social network or messaging services [ 32 ].

EHLC-COVID19 questionnaire

The EHLC-COVID19 questionnaire was specifically built by using Google Form by the Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention of the University of Rome Tor Vergata. The questionnaire, included 43 questions divided into four different sections: (1) personal data (4 questions: age, gender, hometown, current employment—especially if they had the possibility to work from home, also called “smart working”); (2) anthropometrics information (2 questions: reported weight and height); (3) dietary habits information: (a) adherence to the MD, using the validated 14-items Mediterranean diet adherence screener (MEDAS), which score ranges from 0 to 14 points [ 33 ], (b) structured questionnaire packet (11 questions: daily consumption of certain foods—for example junk food consumption: packaged sweets and baked products, sweet beverages, salted snacks and dressing sauces; food frequency; number of meals/day); (4) lifestyle habits information (12 questions: grocery shopping, smoke habit, hours of sleep and physical activity). Specific questions about physical activity habits were modified from a survey conducted by Istituto Superiore di Sanità [ 34 ]. The full version of the questionnaire is available as Appendix . The score of the adherence to the MD was assessed using MEDAS questionnaire [ 33 ]. On the basis of the MEDAS values, participants were divided in three classes: (1) low adherence (score 0–5), (2) medium adherence (score 6–9) and (3) high (score ≥ 10) adherence to the MD and differences in the compliance rates for each food were calculated.

The study was conducted in full agreement with the national and international regulations, and the Declaration of Helsinki (2000). All participants were fully informed about the study requirements and were required to accept the data sharing and privacy policy before participating in the study. Participants completed the questionnaire directly connected to the Google platform. Participants’ personal information, including names, were anonymized to maintain and protect confidentiality. The anonymous nature of the web-survey does not allow to trace in any way sensitive personal data. Therefore, the present web-survey study does not require approval by Ethics Committee. Once completed, each questionnaire was transmitted to the Google platform and the final database was downloaded as a Microsoft Excel sheet.

Statistical analyses

Data are represented as number and percentage in parentheses (%) for categorical variables, or median and interquartile range in square brackets [IQR] for continuous variables. The Shapiro–Wilk test was performed in order to evaluate variables distribution. All the variables had skewed distribution. The Spearman correlation coefficient was calculated in order to evaluate the correlation between continuous variables. Chi square test was employed to assess the association between categorical variables while McNeman analysis was used to investigate the difference between categorical variables pre and during the COVID-19 emergency. Instead, Mann–Whitney U and Kruskal–Wallis tests were performed to compare continuous variables among two or more groups, respectively. Finally, binary and multinomial logistic regression analyses were conducted to investigate the association between categorical variables (dependent) and continuous or categorical ones (independent). Results were significant for p value < 0.05. Statistical analysis was performed using SPSS ver. 21.0 (IBM, Chicago, IL, USA).

Participants

On the 24th of April 2020, the web-survey was concluded, and the collected data were analysed. A total of 4500 participants completed the questionnaire, and, after validation of the data, 3533 respondents have been included in the study, aged between 12 and 86 years. The female respondents represent 76.1% of the population.

According to gender and age distribution, the sample reflects the population of Italian Internet users (i.e., 91.4% of people older than 20 years) [ 35 ]. Territorial coverage spreads over all the Italian Regions: 15.5% of respondents live in Northern Italy, 56.9% in Center Italy, and 27.6% in Southern Italy and Islands. General characteristics and anthropometrics of the population are reported in Table  1 . The Kruskal–Wallis test showed a statistically significant difference in BMI among the three Italian areas, and, in particular in the post hoc analysis, South and Islands resulted in having a population with higher BMI when compared to North and Center Italy (p = 0.007, p = 0.008; respectively). In terms of employment status, 1042 (29.5%) participants have a full-time job in smart working, 429 (12.1%) go to the workplace, 674 (19.1%) are students, 289 (8.2%) are unemployed, 940 (26.6%) suspended work and 159 (4.5%) are retired.

Lifestyle changes during COVID-19 emergency

With regards to lifestyle changes during the COVID-19 lockdown, most of the population declares not to have changed its habits (46.1%), while 16.7% and 37.2% feel to have improved them or made them worse, respectively. In particular, smoking habits have been reduced during the lockdown (McNemar value = 101.484, p < 0.001), and sleep hours have increased (McNemar value = 330.851, p < 0.001), as shown in Table  2 , equally considering North, Center, and South of Italy (data not shown).

Concerning physical activity, no significant difference between the percentage of people that did not train before (37.7%) nor during (37.4%) the COVID-19 lockdown was observed (p = 0.430). On the contrary, a higher frequency of training during the emergency was found when compared to the previous period (McNemar value = 259.529, p < 0.001). Data about frequency and type of training are reported in Fig.  1 .

Frequency ( a ) and type of training ( b , c ) before and during the COVID-19 emergency

Eating habits changes during COVID-19 emergency

With regards to eating habits, more than half of the participants feel a change in their hunger/satiety perception: 627 (17.7%) and 1214 (34.4%) of them have less or more appetite, respectively. The multinomial logistic regression showed that changed work habits (suspension or smart working), in comparison to unchanged ones, and female gender are associated to modified appetite, either negatively and positively (job: OR = 1.791, p < 0.001; OR = 1.431, p < 0.001; sex: OR = 1.521, p < 0.001; OR = 1.738, p < 0.001). Moreover, North and Center Italy are both inversely associated to appetite increase when compared to the South and Islands (OR = 0.527, p < 0.001; OR = 0.582, p < 0.001). The Kruskal–Wallis analysis and the post hoc test have also shown a significant difference in age among the three groups (p < 0.001). People who declare an increased appetite are younger than those with unchanged or reduced one. No difference was found for BMI. Notably, 1199 (33.9%) subjects declare to feel hungry before the main meals, 807 (22.8%) in between them and 395 (11.2%) after dinner. As expected, the binary logistic regression showed after-dinner hungry to be associated to the habit of having a break before bedtime (OR = 4.067, p < 0.001). Moreover, BMI and age were found to be positively and inversely associated to the increased appetite and night snacks, respectively (OR = 1.073, p < 0.001; OR = 0.972, p < 0.001). Living in Center and Southern Italy and Islands resulted to be associated to the after dinner snack in comparison to the Northern region (OR = 1.843, p = 0.009; OR = 2.128, p = 0.002). No difference was found for gender. Interestingly, more than half of the subjects has not changed the number of their daily meals (57.8%), while 17.5% and 23.5% declares to skip or introduce a break or a main meal, respectively.

The survey investigated the variation in food intake during the COVID-19 emergency (Fig.  2 ). Data show an increase of homemade recipes (e.g. sweets, pizza and bread), cereals, legumes, white meat and hot beverages consumption, and a decrease of fresh fish, packaging sweets and baked products, delivery food and alcoholics intake.

Variation in food intake during the COVID-19 emergency

During the COVID-19 lockdown, 37.4% and 35.8% of the study population declares to eat more or less healthy food (fruit, vegetables, nuts and legumes), respectively. No difference between the two groups was found. People who decrease the junk food consumption (29.8%) were significantly more representative than those who increase it (25.6%) (r 2  = 9.560, p = 0.002). Binary logistic regression analysis showed that an higher BMI, as well as a lower age, were associated to an increase of junk food consumption (packaged sweets and baked products, sweet beverages, savory snacks and dressing sauces) (OR = 1.025, p = 0.005; OR = 0.979, p < 0.001). An enhanced appetite and after dinner hunger were both associated with an increased risk of junk food intake (OR = 4.044, p < 0.001; OR = 1.558, p < 0.001). In the multivariable model, the association remains significant for all the variables, except for after dinner hunger. On the contrary, no association was found between BMI, age and the increase of healthy food intake (p = 0.381, p = 0.053). Moreover, a reduced appetite was related to a major consumption of healthy foods (OR = 1.718, p < 0.001). The perception of weight gain has been detected to be positively and inversely associated to the increase consumption of junk food or healthy food, respectively (OR = 3.122, p < 0.001; OR = 0.805, p = 0.002), to a higher BMI (OR = 1.073, p < 0.001) and to the female gender (OR = 1.234, p = 0.008). Moreover, people who have suspended their usual job or started smart working have a greater perception of having increased their weight when compared to subjects who did not change their job routine (OR = 1.250, p = 0.037). Finally, people who declare to train during the lockdown, as well as people from North and Center of Italy in comparison to those from the Southern and Islands, resulted to have a minor perception of weight gain (OR = 0.660, p < 0.001; OR = 786, p = 0.024; OR = 0.747, p < 0.001). No association was found with the age of the population (p = 0.340).

Most of the population purchases food at the supermarket (75.8%), 26.0% at the grocery shops, 14.8% at farmers, organic or local markets or using Solidal Purchasing Groups, and 9.0% uses online delivery. Finally, 11.8% of participants declare not to purchase food and to delegate shopping to third parties. More than half of the population (54.0%) declares to use the leftover food more than 30% of times. The binary logistic regression showed that shopping at farmers, organic markets, local markets or using Solidal Purchasing Groups was associated to the habit of recycling the leftover food (OR = 1.468, p < 0.001). Moreover, people from the North and Center of Italy appeared to be more prone to this behavior when compared to Southern and Islands population (OR = 2.109, p < 0.001; OR = 1.735, p < 0.001). No association was found with age and gender.

Adherence to the MD

To assess the compliance to the MD recommendations during the COVID-19 lockdown, the MEDAS questionnaire was included in the survey.

After participants stratification in 3 classes on the basis of the MEDAS values, differences in the compliance rates for each food were calculated and depicted in radar charts which illustrate the gap between the current state (percentage of participants currently adherent to each dietary recommendation) and the ideal situation (100% compliance) (Fig.  2 ). As expected, among the three classes of adherence to the MD, there were significant differences for most of the items. In particular, in the highest adherence to the MD, the intake of fruit, vegetables, nuts, legumes and fish was respectively: 58.7%, 93.7%, 75.9%, 80.9% and 63.3% (Fig.  2 ), underlining the improvement of the consumption of typical components of the dietary pattern in our Mediterranean population. Moreover, the consumption of foods not included in the MD profile seems to be reduced.

In Table  3 , the results of positive answers to MEDAS questionnaire and the adherence to MD are reported. The Kruskal–Wallis test showed a significant difference of MEDAS score among the three Italian areas (p = 0.004), with significant higher scores in Northern and Southern Italy and Islands when compared to Center Italy (post hoc analysis p = 0.011, p = 0.048). Moreover, an inverse correlation was found between MEDAS score, BMI and age (r = 0.096, p < 0.001; r = 0.066, p < 0.001). In particular, the population group aged 18-30 years resulted to have a higher MEDAS score when compared to the younger and the elder population (p < 0.001; p < 0.001, respectively). Moreover, normal-weight people have a significant greater level of adherence to MD in comparison to overweight and obese ones (p < 0.001; p < 0.001). No difference was found among the other classes of BMI. Finally, no difference between gender and employment status groups was found for the MEDAS score. Furthermore, participants were asked to indicate how many daily/weekly servings of food groups not included in MEDAS they consumed. Results are shown in Figs.  3 and   4 .

Compliance with items from MEDAS according to high, medium and low adherence to the Mediterranean diet (MD). The radar chart plots the values of each item of MEDAS score along a separate axis that starts in the centre of the chart (0% compliance) and ends at the outer ring (100% compliance). The values are the percentage of the population adherent to each recommendation

Food and water intake during COVID-19 lockdown. a None, half, 1, 2 and > 2 represent the number of daily servings of cereals, bread, milk and yogurt and dairy products. Pasta, rice or other cereals (spelled, barley, oats, quinoa) daily serving: 1 medium serving = 80 g. Bread daily serving: 1 medium serving = 80 g or 2 slices. Milk or yogurt daily serving: 1 serving = 150 ml in a cup or 125 g a jar. Cheese or dairy products weekly serving: 1 portion of dairy product = 100 g; 1 portion of matured cheese = 50 g. b None, 1, 2, 3, 4 and > 4 represent the number of weekly servings of eggs. c  < 1 L, 1–2 L and > 2 L represent the daily intake of water. The ordinate axis represents the percentage of population. The abscissa axis represents the daily/weekly portions for each category of foods

This population-based study provides a snapshot of the eating habits and lifestyle of Italian residents, who participated in the survey between 5th and 24th of April 2020, after 7 weeks of lockdown.

To our knowledge, this study was among one of the first to investigate the immediate impact of the COVID-19 lockdown on eating habits and lifestyle changes among Italian residents. The web-survey was concluded on 24th of April 2020 as it was the first day in Italy with the same number of newly infected and cured people. To that date, according to National Civil Protection Service data [ 36 ], the total number of assessed cases in Italy was 192,994: 106,527 people have tested positive; 60,498 patients have recovered; 25,969 died as confirmed only upon certification of cause of death by the Istituto Superiore di Sanità (ISS). In detail, there were in the North of Italy: 34,368 positive cases in Lombardy, 12,509 in Emilia-Romagna, 15,391 in Piedmont, 9679 in Veneto, 2920 in Trentino Alto Adige, 1320 in Friuli Venezia Giulia, 3437 in Liguria, 354 in the autonomous province of Aosta Valley. In Central Italy: 6133 in Tuscany, 4492 in Lazio, 3273 in Marche, 322 in Umbria. In South Italy: 2943 in Campania, 2933 in Apulia, 2079 in Abruzzo, 821 in Calabria, 229 in Basilicata and 200 in Molise. In Islands: 2320 in Sicily and 804 in Sardinia (Additional file 1 : Figure S1).

Therefore, we decided to analyse the eligible data by dividing the population according to the regions of Northern Italy (Piedmont, Aosta Valley, Lombardy, Liguria, Emilia-Romagna, Veneto, Friuli Venezia Giulia, Trentino Alto Adige), the Center (Tuscany, Lazio, Marche, Umbria, Abruzzo, Molise and San Marino Republic) the South (Campania, Basilicata, Calabria, Apulia) and the Islands (Sicily and Sardinia), to evaluate the weight of the responses based on the singular emotional state of each individual, but also based on the severity of the epidemic and the number of sick and dead cases. Territorial coverage of our web survey extends to all Italian Regions, and ranges from a minimum of 15.48% (Northern Italy) to a maximum of 56.86% (Center Italy). Female respondents are about triple compared to male respondents. The strategy adopted by many countries, including Italy, to reduce the spread of COVID-19 has been “social distancing”. The lockdown had the positive effect of flattening the epidemic curve, thanks to the maintenance of the social rules imposed. However, the fear of the disease and death, as well as the restrictions of individual freedom, worsened the stress load and produced alteration of habitual behaviors. Accordingly, the lifestyle and eating habits changed during the COVID-19 pandemic period, particularly in 37.3% of respondents, but only 16.7% of them improved their behaviors. A recent review underlines that a balanced nutrition, which can help in maintaining immunity, is essential for prevention and management of viral infections [ 37 ]. Considering that COVID-19 has no effective preventive and pharmacological therapies available, healthy eating habits are crucial and elective micronutrient supplementations (e.g. vitamins, trace elements, nutraceuticals and probiotics) may be beneficial especially for vulnerable populations, such as the elderly [ 37 ].

During the COVID-19 lockdown, the sense of hunger and satiety changed for more than half of the population: 17.8% of responders had less appetite, while 34.4% of responders increased appetite. The increased sense of hunger and the consequent change in eating habits could justify the perception of weight gain observed in 48.6% of the population. In fact, 40.3% thinks they have slightly increased their weight, while 8.3% of the studied population thinks they have highly increased their weight. On the other hand, 3.3% of smokers in this period have quit smoking. It is interesting to notice that the number of those who smoked more than 10 cigarettes per day has decreased by 0.5%. This phenomenon could be explained by the fear induced in smokers of the increased risk of respiratory distress and mortality from COVID-19 [ 38 ]. Those who did not use to play sports before the COVID-19 lockdown did not use this as an opportunity to start. However, the most interesting fact is that among those who already took part in sports, training frequency has increased. Those who previously managed to exercise only occasionally, now have more time to do it at home. The percentage of those who train five or more days a week has gone from 6 to 16%, with an average increase of 9.9%. A slight increased physical activity has been reported, especially for bodyweight training (38.3% of respondents).

Interestingly, more than half of the subjects have not changed the number of their daily meals (57.8%), while 17.5% and 23.5% declare to skip or introduce a break or a main meal, respectively.

15% of those interviewed turned to farmers or organic purchasing groups for fruit and vegetables, whose consumption did not decrease despite the enormous difficulties of the agricultural supply chain. During the lockdown, Italians have more desire to cook, and above all to knead. Accordingly, the consumption of homemade desserts, bread and pizza has increased. On the other hand, the consumption of savory snacks, snacks, processed meat, carbonated and sugary drinks has decreased.

It was expected that during the quarantine there would have been a reduction of the consumption of fresh food, accompanied by vitamins and minerals deficiency, including vitamin C and vitamin E and beta-carotene with antioxidants and anti-inflammatory properties. The deficiency of these micronutrients is associated with both obesity and impaired immune responses, thus making more susceptible to viral infections [ 39 , 40 ]. However, during the lockdown, Italians have paid attention to Mediterranean food, and the nutritional quality has remained high, especially in Northern and Central Italy, areas in which there is also a lower BMI compared to the areas of Southern Italy and the Islands (p < 0.05) [ 41 ]. We suggest that MD could represent one of the best food models to restore innate and adaptive immunity and might be an adjuvant therapeutic choice of COVID-19.

Obesity is a state of chronic low-grade inflammation dependent on the adipokine secretion of the adipose tissue with immunomodulatory effects [ 42 ] that contributes to the onset of several metabolic diseases (including insulin resistance and type 2 diabetes mellitus, dyslipidemia and hypertension). These, due to the downregulation of the innate and adaptive immune responses, make the immune system more vulnerable to infections, resulting in patients being less responsive to vaccinations, antivirals and antimicrobial drugs [ 43 ]. These immunomodulatory effects may contribute to aggravate respiratory viral infections [ 11 ]. Thus, even if to date there is no evident data reporting that individuals with obesity have a higher risk of getting COVID-19, it is known that more severe forms of respiratory failure are present in patients with obesity. Therefore, it could be hypothesized that individuals with obesity could be at higher risk of serious illness if infected.

The survey explored the perception of body weight changes: 37.4% of the study population declares a stable weight, 13.9% believes to have lost weight, 40.3% feels to have a slight weight gain, and 8.3% to have gained a lot of weight. The perception of weight gain resulted to be present in people who started the smart working, especially in the North and Center of Italy, the same zone in which an increase of physical activity was observed. Therefore, it is strongly recommended to reduce the consumption of junk food to decrease “obesogenic environment” which predisposes to weight gain and susceptibility to COVID-19 [ 44 , 45 ].

In the present study, we provided for the first time data on the Italian population adherent to the MD pattern during the COVID-19 lockdown, observing that there has not been a deterioration. According to our previous data obtained from a survey, that was conducted to identify clusters of eating patterns among the Italian population aged 15–64 years, three clusters were identified: “Mediterranean-like”, “Western-like” and “low fruit/vegetables”. Among the 5278 subjects, the “Mediterranean-like” pattern was more common among females and elderly; the other clusters were significantly associated with obesity [ 46 ]. Indeed, with great surprise, we realized that the most careful in eating Mediterranean food were the young people of the 18–30 age group (p < 0.001; p < 0.001, respectively). Results from the MEDAS questionnaire in our population sample, classified according to the degree of adherence to the MD demonstrated that subjects with low, medium and high adherence to the MD, had adequate consumption, more than 50% of some typical MD food such as olive oil (94.7% in Northern Italy, 96.6% in the Center Italy and 95% in Southern Italy and Island), vegetables (68.8% in Northern Italy, 72.2% in the Center Italy and 69.5% in Southern Italy and Island), legumes (51.7% in Northern Italy, and 60.7% in Southern Italy and Island). In all the three zones, there is an adequate use of slightly fried, known as “soffritto”. Nutritional status is an important form of protection against the emergence of new viral pathogens [ 47 ]. Therefore, a correct diet rich in nutrients with antioxidant and anti-inflammatory activities, such as that suitable for MD, helps to reduce virulence of SARS-Cov-2 [ 48 , 49 ].

An inadequate intake of Mediterranean foods exposes the whole population to specific oxidative damage [ 28 ], and, thus, to susceptibility to COVID-19. Our results comfort that the inflammation and oxidative damage, dependent on the consumption of junk and ultra-processed food, in the postprandial period contribute significantly to a greater susceptibility to develop chronic diseases that cannot be communicated, whereas the consumption of seasonal foods and foods rich in antioxidants is highly protective [ 50 ].

The main limitation of the present study is represented by a self-reported questionnaire, which may lead to the actual misreporting of data. However, our web-survey was similar to others that have been frequently employed. A strength of our study was represented by the fact that the survey was conducted quickly in the most critical period of the epidemic in Italy, less than three weeks after the lockdown.

In this study, we have provided for the first time data on the Italian population lifestyle, eating habits and adherence to the Mediterranean diet pattern during the COVID-19 lockdown. The perception of weight gain was observed in 48.6% of the population, whereas a slight increased physical activity has been reported in 38.3% of respondents, especially for bodyweight training. Interestingly, the population group aged 18–30 years resulted to have a higher adherence to the MD when compared to the younger and the elder population. Moreover, 15% of respondents turned to farmers or organic purchasing groups for fruit and vegetables, especially in the North and Center of Italy, where BMI values were lower. Another positive result is the percentage reduction in smokers by 3%. However, as the COVID-19 pandemic is still ongoing, our data need to be confirmed and investigated in future larger population studies.

Availability of data and materials

All data generated or analysed during this study are included in this published article.

Abbreviations

Body mass index

• Mediterranean diet

Monounsaturated fatty acid

Eating habits and lifestyle changes in COVID19 lockdown

Mediterranean diet adherence screener

Istituto Superiore di Sanità

Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;365:470–3.

Article   Google Scholar  

Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Heal. 2020;25:278–80.

Article   CAS   Google Scholar  

FAQ—Covid-19, domande e risposte. http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioFaqNuovoCoronavirus.jsp?lingua=italiano&id=228#11 . Accessed 7 May 2020.

Abenavoli L, Cinaglia P, Luzza F, Gentile I, Boccuto L. Epidemiology of coronavirus disease outbreak: the Italian trends. Rev Recent Clin Trials. 2020. https://doi.org/10.2174/1574887115999200407143449 .

Article   PubMed   Google Scholar  

Gazzetta Ufficiale. https://www.gazzettaufficiale.it/eli/id/2020/03/09/20A01558/sg . Accessed 7 May 2020.

Moynihan AB, van Tilburg WAP, Igou ER, Wisman A, Donnelly AE, Mulcaire JB. Eaten up by boredom: consuming food to escape awareness of the bored self. Front Psychol. 2015;6:369.

Yılmaz C, Gökmen V. Neuroactive compounds in foods: occurrence, mechanism and potential health effects. Food Res. 2020;128:108744.

Rodríguez-Martín BC, Meule A. Food craving: new contributions on its assessment, moderators, and consequences. Front Psychol. 2015;6:21.

PubMed   PubMed Central   Google Scholar  

Ma Y, Ratnasabapathy R, Gardiner J. Carbohydrate craving: not everything is sweet. Curr Opin Clin Nutr Metab Care. 2017;20:261–5.

Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020. https://doi.org/10.1001/jamainternmed.2020.0994 .

Article   PubMed   PubMed Central   Google Scholar  

Muscogiuri G, Pugliese G, Barrea L, Savastano S, Colao A. Obesity: the “Achilles heel” for COVID-19? Metabolism. 2020;108:154251.

Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17:1729.

Montemurro N. The emotional impact of COVID-19: from medical staff to common people. Brain Behav Immun. 2020. https://doi.org/10.1016/j.bbi.2020.03.032 .

van Strien T. Causes of emotional eating and matched treatment of obesity. Rep: Curr Diab; 2018.

Book   Google Scholar  

Evers C, Dingemans A, Junghans AF, Boevé A. Feeling bad or feeling good, does emotion affect your consumption of food? A meta-analysis of the experimental evidence. Rev: Neurosci. Biobehav; 2018.

Singh M. Mood, food and obesity. Front Psychol. 2014;5:1–35.

Havermans RC, Vancleef L, Kalamatianos A, Nederkoorn C. Eating and inflicting pain out of boredom. Appetite. 2015;85:52–7.

Crockett AC, Myhre SK, Rokke PD. Boredom proneness and emotion regulation predict emotional eating. J Health Psychol. 2015;20:670–80.

Muscogiuri G, Barrea L, Annunziata G, Di Somma C, Laudisio D, Colao A, et al. Obesity and sleep disturbance: the chicken or the egg? Crit Rev Food Sci Nutr. 2019;59:2158–65.

Pugliese G, Barrea L, Laudisio D, Salzano C, Aprano S, Colao A, et al. Sleep apnea, obesity, and disturbed glucose homeostasis: epidemiologic evidence, biologic insights, and therapeutic strategies. Curr Obes Rep. 2020;9:30–8.

Muscogiuri G, Barrea L, Aprano S, Framondi L, Di Matteo R, Laudisio D, et al. Sleep quality in obesity: does adherence to the mediterranean diet matter? Nutrients. 2020;12:1364.

Engin AB, Engin ED, Engin A. Two important controversial risk factors in SARS-CoV-2 infection: obesity and smoking. Environ Toxicol Pharmacol. 2020. https://doi.org/10.1016/j.etap.2020.103411 .

Panahi S, Tremblay A. Sedentariness and health: is sedentary behavior more than just physical inactivity? Front Public Heal. 2018;6:258.

People Who Are at Higher Risk for Severe Illness | Coronavirus | COVID-19 | CDC. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html . Accessed 7 May 2020.

Hauner H. Secretory factors from human adipose tissue and their functional role. Proc Nutr Soc. 2005;64:163–9.

Dietz W, Santos-Burgoa C. Obesity and its implications for COVID-19 mortality. Obesity. 2020. https://doi.org/10.1002/oby.22818 .

Di Renzo L, Gualtieri P, Romano L, Marrone G, Noce A, Pujia A, et al. Role of personalized nutrition in chronic-degenerative diseases. Nutrients. 2019;11(8):1707.

De Lorenzo A, Bernardini S, Gualtieri P, Cabibbo A, Perrone MA, Giambini I, et al. Mediterranean meal versus Western meal effects on postprandial ox-LDL, oxidative and inflammatory gene expression in healthy subjects: a randomized controlled trial for nutrigenomic approach in cardiometabolic risk. Acta Diabetol. 2017;54:141–9.

Soldati L, Di Renzo L, Jirillo E, Ascierto PA, Marincola FM, De Lorenzo A. The influence of diet on anti-cancer immune responsiveness. J Transl Med. 2018;16(1):75.

Cani PD, Van Hul M. Mediterranean diet, gut microbiota and health: when age and calories do not add up! Gut. 2020. https://doi.org/10.1136/gutjnl-2020-320781 .

PATTO in cucina Magazine. https://www.pattoincucina.it/ . Accessed 7 May 2020.

We Are Social & Hootsuite. Digital 2020. Data Reportal. 2020.

Schröder H, Fitó M, Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, et al. A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr. 2011;141:1140–5.

http://old.iss.it/binary/ofad/cont/questionariogiovaniinforma.1225957648.pdf . Accessed 26 May 2020.

Istat.it | Multiscopo sulle famiglie: aspetti della vita quotidiana - parte generale. https://www.istat.it/it/archivio/217037 . Accessed 7 May 2020.

COVID-19 ITALIA - Desktop. http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1 . Accessed 7 May 2020.

Jayawardena R, Sooriyaarachchi P, Chourdakis M, Jeewandara C, Ranasinghe P. Enhancing immunity in viral infections, with special emphasis on COVID-19: a review. Diabetes Metab Syndr Clin Res Rev. 2020;14:367–82.

Brake SJ, Barnsley K, Lu W, McAlinden KD, Eapen MS, Sohal SS. Smoking upregulates angiotensin-converting enzyme-2 receptor: a potential adhesion site for novel coronavirus SARS-CoV-2 (Covid-19). J Clin Med. 2020;9:841.

García OP, Long KZ, Rosado JL. Impact of micronutrient deficiencies on obesity. Nutr Rev. 2009;67:559–72.

Childs CE, Calder PC, Miles EA. Diet and immune function. MDPI AG: Nutrients; 2019.

Costa de Miranda R, Di Renzo L, Cupertino V, Romano L, De Lorenzo A, Salimei C, et al. Secular trend of childhood nutritional status in Calabria (Italy) and the United States: the spread of obesity. Nutr Res. 2019;62:23–31.

De Lorenzo A, Gratteri S, Gualtieri P, Cammarano A, Bertucci P, Di Renzo L. Why primary obesity is a disease? J Transl Med. 2019;17:169.

Dhurandhar NV, Bailey D, Thomas D. Interaction of obesity and infections. Obes Rev. 2015;16:1017–29.

De Lorenzo A, Romano L, Di Renzo L, Di Lorenzo N, Cenname G, Gualtieri P. Obesity: a preventable, treatable, but relapsing disease. Nutrition. 2020;71:110615.

Nappi F, Barrea L, Di Somma C, Savanelli MC, Muscogiuri G, Orio F, et al. Endocrine aspects of environmental “obesogen” pollutants. MDPI AG: Int J Environ Res Public Health; 2016.

Denoth F, Scalese M, Siciliano V, Di Renzo L, De Lorenzo A, Molinaro S. Clustering eating habits: frequent consumption of different dietary patterns among the Italian general population in the association with obesity, physical activity, sociocultural characteristics and psychological factors. Eat Weight Disord. 2016;21:257–68.

Beck MA, Handy J, Levander OA. Host nutritional status: The neglected virulence factor. Trends Microbiol. 2004;12:417–23.

Romano L, Bilotta F, Dauri M, Macheda S, Pujia A, De Santis GL, et al. Short report—medical nutrition therapy for critically ill patients with COVID-19. Sci: Eur Rev Med Pharmacol; 2020.

Google Scholar  

Muscogiuri G, Barrea L, Savastano S, Colao A. Nutritional recommendations for CoVID-19 quarantine. Eur J Clin Nutr. 2020. https://doi.org/10.1038/s41430-020-0635-2 .

Di Renzo L, Merra G, Botta R, Gualtieri P, Manzo A, Perrone MA, et al. Post-prandial effects of hazelnut-enriched high fat meal on LDL oxidative status, oxidative and inflammatory gene expression of healthy subjects: a randomized trial. Eur Rev Med Pharmacol Sci. 2017;21:1610–26.

PubMed   Google Scholar  

Ministero della Sanità Classificazione statistica internazionale delle malattie e dei problemi sanitari correlati DECIMA REVISIONE. http://www.salute.gov.it/imgs/C_17_pubblicazioni_1929_allegato.pdf .

Download references

Acknowledgements

The authors thank Fulvia Mariotti and Oliviero Plazzi Marzotto for the editorial and English language revisions.

This research does not received external funding.

Author information

Laura Di Renzo and Paola Gualtieri contributed equally to this work

Authors and Affiliations

Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133, Rome, Italy

Laura Di Renzo, Paola Gualtieri & Antonino De Lorenzo

Department of Health Sciences, University of Milan, Via A. Di Rudinì, 8, 20142, Milan, Italy

Francesca Pivari & Laura Soldati

School of Specialization in Food Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy

Alda Attinà, Giulia Cinelli, Claudia Leggeri & Giovanna Caparello

Predictive and Preventive Medicine Research Unit, “Bambino Gesù” Children Hospital IRCCS, 00165, Rome, Italy

Giulia Cinelli

Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, 80131, Naples, Italy

Luigi Barrea

Doctoral School in Public Health and Nursing, “Policlinico Tor Vergata” Foundation, Rome, Italy

Francesco Scerbo

General Directorate for the Department of Human Policies, Basilicata Region, Italy

Ernesto Esposito

You can also search for this author in PubMed   Google Scholar

Contributions

LDR, PG draft the manuscript; LDR, conceived and designed the web-survey; AA, GC, CL, GC, designed the web-survey and collected data; LB, FS, EE collected data; GC analyzed the data; FP, LS reviewed the text; ADL had primary responsibility for the final content. All the authors read and approved the final manuscript. All the authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Francesca Pivari .

Ethics declarations

Ethics approval and consent to participate.

The study was conducted in full agreement with the national and international regulations and the Declaration of Helsinki (2000). All participants were fully informed about the study requirements and were required to accept the data sharing and privacy policy before participating in the study. The study was not a clinical trial on drugs, supplements or foods, but a surveillance on population’s habits. All the participants gave their consent to the data treatment at the beginning of the web-survey. If any participant had not given his/her consent, the web-survey automatically stopped. The anonymous nature of the web-survey does not allow to trace in any way sensitive personal data. Therefore, the present web-survey study does not require approval by Ethics Committee.

Consent for publication

Not applicable.

Competing interests

The authors declare no conflict of interest.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Additional file 1. figure s1..

Geographical distribution of COVID-19 total positive cases in Italy on April 24th 2020. Data derived from the Health Ministry of Italy [ 51 ].

Appendix: Questionnaire

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Di Renzo, L., Gualtieri, P., Pivari, F. et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med 18 , 229 (2020). https://doi.org/10.1186/s12967-020-02399-5

Download citation

Received : 12 May 2020

Accepted : 02 June 2020

Published : 08 June 2020

DOI : https://doi.org/10.1186/s12967-020-02399-5

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Coronavirus
• Eating habits

Journal of Translational Medicine

ISSN: 1479-5876

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

We need your support today

Independent journalism is more important than ever. Vox is here to explain this unprecedented election cycle and help you understand the larger stakes. We will break down where the candidates stand on major issues, from economic policy to immigration, foreign policy, criminal justice, and abortion. We’ll answer your biggest questions, and we’ll explain what matters — and why. This timely and essential task, however, is expensive to produce.

We rely on readers like you to fund our journalism. Will you support our work and become a Vox Member today?

Read these 12 moving essays about life during coronavirus

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

by Alissa Wilkinson

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

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

• The Vox guide to navigating the coronavirus crisis

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

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

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

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

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

• A syllabus for the end of the world

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

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

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

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

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

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

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

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

• What day is it today?

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

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

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

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

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

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

• Vox is starting a book club. Come read with us!

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

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

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

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

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

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

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

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

• Recommendations

Most Popular

• The astonishing link between bats and the deaths of human babies
• iPad kids speak up
• The right-wing podcasters turned Russian propaganda dupes, explained
• Conservatives are shocked — shocked! — that Tucker Carlson is soft on Nazis
• Has The Bachelorette finally gone too far?

Today, Explained

Understand the world with a daily explainer plus the most compelling stories of the day.

This is the title for the native ad

More in Culture

The DOJ says Tim Pool, Dave Rubin, Benny Johnson and others were unwitting Russian stooges.

Inside Gen Alpha’s relationship with tech.

The Bachelorette finale was riveting TV — and unfathomably cruel.

How China’s first global gaming blockbuster became a weird rallying point for the right.

Jennifer Lopez’s and Ben Affleck’s reactions to their split are both very on-brand and kind of pointless.

The back-and-forth over a wildly rare appeal is a win for victim’s rights.

• Open access
• Published: 25 June 2021

Lifestyle changes during the first wave of the COVID-19 pandemic: a cross-sectional survey in the Netherlands

• Esther T. van der Werf 1 , 2 ,
• Martine Busch 2 , 3 ,
• Miek C. Jong 4 , 5 &
• H. J. Rogier Hoenders 2 , 6  

BMC Public Health volume  21 , Article number:  1226 ( 2021 ) Cite this article

67k Accesses

68 Citations

68 Altmetric

Metrics details

During the Covid-19 pandemic the Dutch government implemented its so-called ‘intelligent lockdown’ in which people were urged to leave their homes as little as possible and work from home. This life changing event may have caused changes in lifestyle behaviour, an important factor in the onset and course of diseases. The overarching aim of this study is to determine life-style related changes during the first wave of the COVID-19 pandemic among a representative sample of the adult population in the Netherlands.

Life-style related changes were studied among a random representative sample of the adult population in the Netherlands using an online survey conducted from 22 to 27 May 2020. Differences in COVID-19-related lifestyle changes between Complementary and Alternative Medicine (CAM) users and non-CAM users were determined. The survey included a modified version of the I-CAM-Q and 26 questions on lifestyle related measures, anxiety, and need for support to maintain lifestyle changes.

1004 respondents were included in the study, aged between 18 and 88 years (50.7% females). Changes to a healthier lifestyle were observed in 19.3% of the population, mainly due to a change in diet habits, physical activity and relaxation, of whom 56.2% reported to be motivated to maintain this behaviour change in a post-COVID-19 era. Fewer respondents (12.3%) changed into an unhealthier lifestyle. Multivariable logistic regression analyses revealed that changing into a healthier lifestyle was positively associated with the variables ‘Worried/Anxious getting COVID-19’ (OR: 1.56, 95% C.I. 1.26–1.93), ‘CAM use’ (OR: 2.04, 95% C.I. 1.38–3.02) and ‘stress in relation to financial situation’ (OR: 1.89, 95% C.I. 1.30–2.74). ‘Age’ (OR 18–25: 1.00, OR 25–40: 0.55, 95% C.I. 0.31–0.96, OR 40–55:0.50 95% C.I. 0.28–0.87 OR 55+: 0.1095% C.I. 0.10–0.33), ‘stress in relation to health’ (OR: 2.52, 95% C.I. 1.64–3.86) and ‘stress in relation to the balance work and home’ (OR: 1.69, 95% C.I. 1.11–2.57) were found predicting the change into an unhealthier direction.

These findings suggest that the coronavirus crisis resulted in a healthier lifestyle in one part and, to a lesser extent, in an unhealthier lifestyle in another part of the Dutch population. Further studies are warranted to see whether this behavioural change is maintained over time, and how different lifestyle factors can affect the susceptibility for and the course of COVID-19.

Peer Review reports

The rapid spread of COVID-19 to nearly all parts of the world has posed enormous health, economic, environmental and social challenges worldwide. In the absence of effective drugs or vaccines, social distancing, surgical masks, washing hands and other preventive measures are presented as the only ways to fight the (spread of the) virus. Lockdown is among one of the options suggested by WHO to reduce spread of the virus. Although underreported, preventative strategies such as a healthy lifestyle seem important alternative avenues to fight (the spread of) COVID-19. From a public health perspective, these strategies are very important to consider. Between February 2020 and 1st of June 2021 1.651.780 positive cases and 17,632 deaths has been registered in The Netherlands [ 1 ]. As a response to COVID-19, many countries are using a combination of containment and mitigation activities with the intention of delaying major surges of patients and levelling the demand for hospital beds, while protecting the most vulnerable from infection, including elderly people and those with comorbidities [ 2 ]. In the Netherlands, a so-called “intelligent lockdown” was enforced on 15th of March 2020, with easing of restrictions per 1st of July 2020 [ 3 ]. With the intelligent lockdown, the Dutch Government appealed to the responsibility and self-discipline of citizens to practice 1.5 m social distance, and to maintain home isolation when showing COVID-19-related symptoms. Over the course of several weeks in March and April 2020, additional measures were taken to restrict the further spread of the coronavirus in the Netherlands. These measures included closure of schools, restaurants, certain beaches and parks, and prohibition of spontaneous group gatherings in public spaces.

Due to this intelligent lockdown, a sudden and radical change occurred in the lives and habits of the Dutch population. Life experiences that may greatly influence an individual’s daily routine are referred to as life changing events [ 4 ], defined as “those occurrences, including social, psychological and environmental, which require an adjustment or effect a change in an individual’s pattern of living.” Life changing events may influence lifestyle behaviours for better or worse [ 5 , 6 ]. For instance, Engberg et al. showed that transition to university, having a child, remarriage and mass urban disasters were associated with decreased physical activity levels, while retirement was associated with increased physical activity [ 7 ]. Stressful life events have been correlated with excessive alcohol consumption and alcohol dependence and emotional eating [ 8 ].

Maintaining a healthy nutrition status and level of certain exercise is crucial, especially in a period when the immune system might need to fight back. In fact, subjects with (severe) obesity (BMI ≥ 30 kg/m2) are one of the groups with a higher risk for COVID-19 complications [ 9 , 10 ]. Therefore, losing weight may be one of the strategies to lower the risk of severe illness from COVID-19. Worldwide, authorities and healthcare professional’s recommendations on how to stay healthy during the COVID-19 pandemic, besides taking appropriate hygiene measures, are related to healthy life-style measures such as assuring sufficient sleep, eat plenty of fresh fruits and vegetables, reduce stress and social isolation and stay active [ 11 , 12 ].

The COVID-19 pandemic might motivate people to make healthier choices and adopt a healthier lifestyle. Conversely, COVID-19 control measures such as social distancing and compulsory home isolation can be expected to increase sedentary behaviour and might cause an unhealthy eating and sleeping pattern. For example, the interruption of the daily (work) routine caused by the staying at home (which includes digital-education, working from home, and limitation of outdoors and in-gym physical activity) could result in boredom, which in turn is associated with a greater energy intake [ 13 ]. In addition, hearing or reading continuously about the COVID-19 pandemic and its possible impact from media can be stressful. Stress leads individuals toward overeating, especially ‘comfort foods’ or inactivity [ 14 ]. For future actions it is important to determine the lifestyle changes taken during this COVID-19 pandemic, and what support will be needed to (dis) continue this health behaviour in a post-COVID-19 era.

Previous studies show that Complementary and Alternative Medicine (CAM) users have on average a healthier lifestyle behaviour than non-CAM users, and overall a stronger focus on wellness [ 15 , 16 , 17 , 18 ]. In general, CAM is defined as a group of diverse medical and health care symptoms, practices and products that are not generally considered part of conventional medicine [ 19 ]. Nahin et al. found based on a survey among the US population that engaging in leisure-time physical activity, having consumed alcohol in one’s life but not being a current heavy drinker, and being a former smoker are independently associated with the use of CAM [ 16 ]. Interestingly, reported significantly better health status and healthier behaviours overall (higher rates of physical activity and lower rates of obesity) seems more prominent in adults using CAM for health promotion than those who use CAM as treatment [ 15 ]. The relation between CAM use and lifestyle needs further investigation in various populations.

The overarching aim of this reported study is to investigate life-style related changes during the first wave of the COVID-19 pandemic among a representative sample of the adult population in the Netherlands. Within this aim the following objectives has been framed: i) To determine life-style related changes (healtier/unhealthier) during the first wave of the COVID-19 pandemic; (ii) To identify the (sociodemographic) factors independently associated with changes into lifestyle (healthy/unhealthy); (iii) To explore possible differences in COVID-19-related lifestyle changes between CAM users and non-CAM users, and (iv) To determine the intention to continue lifestyle changes and the required support.

An international cross-sectional survey on CAM use and self-care strategies for prevention and treatment of COVID-19 related symptoms was carried out in Norway, Sweden and the Netherlands in spring 2020. The results of this international survey will be published elsewhere. This online survey consisted of a modified version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q) [ 20 ], and a country specific part on lifestyle for The Netherlands (it is the latter on which this paper reports). The modified I-CAM-Q consisted of four parts, and all parts related to CAM use during the past three COVID-19 pandemic months as did the Dutch part on lifestyle.

The modified I-CAM-Q included questions about visits to conventional and unconventional health care providers, self-management strategies such as use of natural remedies and self-help techniques such as mindfulness used within the last three months. The questions regarding specific therapies were adapted to The Netherlands ( supplementary material ).

The country specific part for the Netherlands included 26 questions divided into three sections on 1) current lifestyle related measures (alcohol use, smoking, daily consumption of certain foods, exercise, sleep, stress and meaning and purpose/spirituality), 2) lifestyle related changes since the COVID-19 outbreak and anxiety (section 1 and 2: 20 questions) and 3) intention to continue lifestyle changes and need for support (6 questions). For this study, we included six aspects of lifestyle with established effects on physical and mental health: nutrition, exercise, sleep, addiction, relaxation and meaning and purpose/spirituality.

In the Netherlands, an online survey was performed between May 22 and May 27, 2020 in collaboration with Ipsos Netherlands. An internal Ipsos tool (ISS) has been used to gather the respondents. The respondents registered into the IIS panel have shared their baseline information such as age,gender, region, and more specific information on education, income and work. From the panel of 45,000 Dutch residents, a representative sample (based on the baseline parameters) was invited to complete the questionnaire until 1000 responses were received (limit set due to costs). Individuals who were reached and refused participation ( n  = 3607) were considered non-respondents, leading to a response rate of 22%. The final sample contained 1004 individuals.

Taking into account multiple response biases, the questionnaire was designed as followed: 1) answer options were randomized. Meaning every participant will see the same answer options, but in different order, preventing primacy bias (to decrease the amount of times one answer can be chosen which might lead to survey results being too unfairly weighted towards one option), and 2) questions were formulated in a neutral way when asked about education level, salary, age and gender to prevent prestige/stereotype bias as much as possible. Respondents received a personal link (password/username) to prevent filling in the questionnaire more than one time or any self-selection bias would happen.

Demographic characteristics collected were gender, age, municipality of residence and county, income, and level of education. Income was classified as high (Euro 75,000 >), middle (Euro 25,000 – 74,999) and low income (< Euro 24,999). Education was classified as higher education ((applied) university/ post-doctoral level), secondary education (middle and higher secondary education) and lower education (no school/primary school only/lower secondary education).

All data was anonymously collected and reported. The anonymous nature of the web-survey did not allow to trace in any way sensitive personal data. The study protocol was reviewed by the Medical Ethical Reviewing Committee of Wageningen University. They decided that this study did not fall within the remit of the Dutch Medical Research Involving Human Subjects Act (WMO), and therefore was exempt from further medical ethical review. Informed consent was obtained from all participants and all patients agreed their data to be used for scientific publication. GDPR guidelines were taken into account [ 21 ]. Once completed, each questionnaire was transmitted to the survey platform, and the final database was downloaded.

The current paper reports on the country specific part of the survey using data of the I-CAM-Q, only to categorize users and non-users of CAM. Here, CAM use is defined as all treatments and (self) care strategies that are used in addition or as an alternative to the usual (regular) care of e.g. general practitioner, specialist, dietician, physiotherapist or nurse in the past 3 months.

Statistical analyses

Descriptive statistics like measures of central tendencies, frequencies and proportions were used to evaluate the responses. Data are represented as number and/or percentage for categorical variables or mean and standard deviation for continuous variables. Pearson’s Chi-square test and ANOVA tests were performed to identify differences in socio-demographics (age, education level, household income), as well as to identify differences in lifestyle/lifestyle changes between users and non-users of CAM.

Univariable and multivariable logistic regression was used to identify the (sociodemographic) factors independently associated with changes in lifestyle (healthy/unhealthy). Outcomes on changes in lifestyle questions were dichotomized. Change in lifestyle due to corona crisis: answer categories: Yes, I live healthier, Yes, I live unhealthier and No. Multivariable models were derived through several iterations using backward stepwise logistic regression, including all variables that were statistically significant in the univariable analyses. The authors controlled for age, gender and education in these models.

Statistics were carried out using Statistical Package for Social Sciences (SPSS) v. 26.0. Results were statistically significant for p value < 0.05.

A total of 1013 individuals completed the online questionnaire, and, after validation of the data, 1004 respondents (age 18–88 years) were included in the study. As shown in Table  1 , most respondents were between 50 to 69 years of age (37.5%), and female respondents represented 50.7% of the population sample. Respondents were distributed across the 12 provinces, with 27.3% from the northern regions of the Netherlands, 27.6% from the central regions of the Netherlands and 45.1% from the southern regions of the Netherlands. Of all respondents, 46.5% resided in urban zones, 23.8% in sub-urban zones and 24.9% in rural/sub-rural zones. Married respondents living with or without children accounted for the majority of sample distribution, making up to 63.3% of responses followed by individuals living alone without children (24.8%). Half of the respondents (49.9%) had a higher education status and 49.7% of respondents was categorized to have a middle income.

Lifestyle changes during the COVID-19 pandemic

Although the majority of the surveyed population reported no significant change in their daily habits or intake of food/snacks since the COVID-19 outbreak in the Netherlands, we found substantial lifestyle changes in a considerable part of the population, both for the better and the worse (see Table  2 ). 14.0% of all respondents reported a decrease in sleeping hours, while 13.0% reported an increase. One fifth (20.0%) of the respondents reported to snack more than before the COVID-19 pandemic, and 7.7% snacked less. Intake of vegetables increased in 11.7% whereas it decreased in 1.7%.

Table 2 shows that the majority did not know whether their stress levels had changed in relation to ‘the balance between work and childcare’ and ‘care for their family’, respectively 57.8 and 62.1%. 52.3% of the respondents indicated no change in stress related to their own health, but nearly a quarter (22.2%) did perceive more health-related stress or future perspective related stress (27.7%).

As shown in Tables  3 , 80% of the respondents reported that in general they were happy with their current lifestyle. 12.2% of the total population reported an unhealthier lifestyle since the outbreak of the COVID-19 pandemic, whereas 19.3%, ( n  = 194) indicated that the COVID-19 pandemic positively influenced their lifestyle (Table  3 ). The 194 respondents reported a healthier lifestyle due to a higher intake of fruit and vegetables (54.6%), exercise (63.4%), and relaxation (46.4%). Only a small proportion of the participants reported to live healthier due to a change in meaning of life aspects/spirituality (6.2%) (Table 3 ).

Remarkably, the number of respondents that thought that lifestyle changes can influence the natural history (symptoms) of COVID-19 once infected, was higher than the number of respondents that thought lifestyle changes can influence the risk of getting infected (Table 3 ). Nearly halve of respondents (48.2%) did not think that a change in their lifestyle could decrease their risk of getting infected by the corona virus (Table 3 ).

Factors independently associated with changes into lifestyle (healthy/unhealthy)

Table  4 shows the univariable statistically significant associated variables with a change to healthy- or unhealthy lifestyle that are entered into the multivariable analyses to come to the final models ( P  < 0.05). Based on univariable analyses, no statistically significant associations with a change to a healthy lifestyle were found with regards to age, gender, residential region, smoking, alcohol use, stress in relation to work and stress in relation to future perspectives. With regard to a change to an unhealthy lifestyle no statistically significant associations were found for gender, income level, living region, smoking, alcohol use, use of CAM and anxiety for getting infected their selves with Covid-19.

The final multivariate models (Table 4 ) included 1004/1004 (100%) of the respondents of the survey. Three predictors were strongly associated with changing into a healthy lifestyle: Worried/Anxious getting infected with SARS-coV-2 (OR: 1.56, 95% C.I. 1.26–1.93), CAM use (OR: 2.04, 95% C.I. 1.38–3.02) and stress in relation to financial situation (OR: 1.89, 95% C.I. 1.30–2.74). Together these gave an AUROC of 0.66 (95% CI = 0.63 to 0.71). Similarly, three predictors were strongly associated with changing into an unhealthy lifestyle: Age (OR 18–25: 1.00, OR 25–40: 0.55, 95% C.I. 0.31–0.96, OR 40–55:0.50 95% C.I. 0.28–0.87 OR 55+: 0.1095% C.I. 0.10–0.33), stress in relation to health (OR: 2.52, 95% C.I. 1.64–3.86) and stress in relation to the balance work and home (OR: 1.69, 95% C.I. 1.11–2.57). Together these gave an AUROC of 0.56 (95% C.I. 0.50–0.62)).

Differences in COVID-19-related lifestyle changes between CAM users and non-CAM users

Our multivariable model shows that CAM use is an important predictor of changing to a healthier lifestyle during the first wave of the COVID-19 pandemic and is not statistically significant associated with a change to an unhealthy lifestyle. More than two third (68%) of the respondents indicated use of CAM in the past 3 months. 13.3% of all respondents consulted a CAM practitioner (medical doctor or other (non) healthcare professional specialized in CAM, 59.4% used (CAM) supplements (e.g. vitamins/minerals, herbs, and/or dietary supplements) and 30% indicated to make use of (CAM) self-help techniques ((e.g. breathing exercises, yoga) (Table  5 ).

No statistically significant differences were found between non-CAM and CAM users with regards to mean age, residential region, marital status, education and yearly income. Lifestyle related behaviour measures as smoking, alcohol use and daily exercise were similarly distributed between the two groups. The younger aged (age < 30) and the elderly (age 65+) did make less use of CAM then those aged between 31 and 64 years old, as did men (male non-CAM users: 61.7%).

As shown in Tables  5 , 87.7 and 84.0% of the CAM users and non-CAM users respectively reported that in general they were happy with their current lifestyle. The proportion CAM users that changed into a healthier lifestyle influenced by the COVID-19 pandemic is bigger than the proportion of non-CAM users.

More than one third of the CAM users indicated to think changes in lifestyle could change their risk of getting infected with SARS-coV2 (38.1%), and 46.3% did also think that changing their lifestyle could influence the course of the illness once infected, compared to 40.3% of the non-CAM users and 44.8% of all participants. CAM users were statistically significant less anxious/worried to get infected with COVID-19 than non-CAM users.

In general, CAM users perceived more often an increase in stress than non-CAM users. Rather large differences were found between more stress in the previous three months in relation to work (CAM users: 23.1%, Non-CAM users: 12.3%, P  < 0.001), health (CAM users: 25.9%, Non-CAM users: 10.7%, P  < 0.001), balance work/childcare (CAM users: 12.0%, Non-CAM users: 7.0%, P  = 0.012)), financial situation (CAM users: 21.2%, Non-CAM users:10.7%, P  < 0.001)) and future perspective (CAM users: 33.8, Non-CAM users:16.9%, P  < 0.001)).

In the 3 months ahead of the survey, CAM users were more aware of their own diet habits than non-CAM users (CAM users: 18.8%, Non-CAM users: 9.1%, P  < 0.05).

Intention to continue lifestyle changes and the required support

This study provides information that may be relevant to policy makers, health insurances and research funding organizations to guide future decisions on lifestyle and COVID-19.

Table  6 shows that in general, more than halve of the 194 respondents who reported a positive change in their lifestyle since the start of the COVID-19 pandemic indicated the wish to continue their changes through healthy food (56.2%) and exercise (54.6%). Of the pre-defined options: 1) healthy choices at work/school (food, drinks, exercise during breaks e.g., yoga, tai chi, mindfulness) 2) free choice and reimbursement of any treatment in relation to CAM and Lifestyle; 3) support from GP/Health centre/Community care; 4) online advice and support, and 5) affordable and easilyaccessible healthy food, 55.8% of respondents declared needing none of these.

However, affordable and easily accessible healthy food was perceived as helpful by one third of the respondents (34.7%), followed by healthy choices at work/school and free choice and reimbursement of CAM and lifestyle treatments with respectively 17.2 and 16.0%.

Statistically significant more CAM users reported a desire to continue more activities regarding meaning of life/ spirituality/ (CAM users: 27.4%, Non-CAM users: 10.8%, P  = 0.03) in a post Covid-19 era.

This population-based study is a snapshot of the health related lifestyle changes of Dutch residents during the first wave of the COVID-19 pandemic which included nine weeks of Intelligent lockdown as declared by the Dutch Government. Our study seems to indicate that one fifth of the Dutch residents changed their lifestyle into a healthier one and that this was mainly due to healthier food habits, more exercise and more relaxation. More than half of these respondents reported to be motivated to maintain this behaviour change in a post-COVID-19 era. Around 10% of the total study population, on the other hand, admitted to have started living unhealthier due to the corona crisis. 35% of respondents thought that a lifestyle change could change their risk of getting infected by the corona virus and nearly half of the total group thought this change could influence the course of the illness once infected.” Our study also shows that CAM use is an important predictor of changing to a healthier lifestyle during the first wave of the COVID-19 pandemic. The use of CAM and healthy lifestyle has been associated previously [ 15 , 16 , 17 , 18 ], and our results confirm this positive association.

Regardless of the time and context within one decides to eat better, exercise more, or be less stressed, it can be hard to make a lifestyle change, and even harder to make it a habit [ 22 ]. Life changing events might provide a unique opportunity to live healthier and to continue these changes [ 23 ]. Since the outbreak of the novel coronavirus disease (COVID-19) in China, the world is in the grip of a coronavirus pandemic, a unique crisis with disastrous health, societal and economic effects worldwide [ 24 ]. The Corona crisis is said to be the biggest crises since World War III in the Netherlands and is expected to change the way we think and live at individual and societal levels.

A large part of non-communicable diseases is caused by unhealthy behaviour [ 20 , 25 , 26 ]. Addressing modifiable risks such as tobacco use, physical inactivity, unhealthy diet and harmful use of alcohol are among most effective interventions to keep people healthy and productive, reducing the individual, societal and economic impact and suffering caused by non-communicable diseases [ 20 , 25 , 26 ]. Nearly 20% of our respondents indicated that the COVID-19 pandemic positively influenced their lifestyle. This is a positive finding from a public health perspective, in which the importance of a healthier lifestyle to prevent chronic and non-communicable diseases is emphasized. A comparable percentage among a representative sample of the general population of Italy surveyed in the first months of 2020 was found to change to a healthier lifestyle. The survey in Italy further revealed that most of the Italian respondents declared not to have changed its habits (46.1%) (compared to 68% of our respondents), while 37.2% (compared to 12% of our respondents) felt to have made them worse [ 27 ]. This latter difference might be due to the difference in lockdown, with a stricter one in Italy.

Although healthy lifestyles offer a number of health benefits, non- adherence to recommended lifestyle changes remains a frequent and difficult obstacle to realizing these benefits [ 28 , 29 ]. It is therefore promising that of this representative sample of the Dutch population, more than half who changed into a healthier lifestyle indicates to be willing to maintain to these new habits. A US poll has found that as many as 80% of American adults will try to practice self-care more regularly once the COVID-19 pandemic is over [ 30 ]. The prospect of improving health and reducing illness through changes in living habits rather than through curative healthcare, is attractive from the perspective of public health and on economic grounds.

Our final multivariable model for changing into a healthy lifestyle showed positive associations with: (i) anxiety to get infected with SARs-coV-2; (ii) the use of CAM; and (iii) stress with regards to financial situation. Taylor et al. (2020) recently developed the COVID stress Scales (CSS) and identified five factors of stress and anxiety symptoms relating to the coronavirus in two large samples in Canada and the United States including ‘danger and contamination’ and ‘fears about economic consequences’. Two predictive factors (anxiety to get infected with SARs-coV-2 and stress with regards to financial situation) we found to be positively associated with a change into a healthy lifestyle. Previously, Anderson et al. showed that occurrence of life events and subsequent effects, can contribute to health promoted behaviour despite the potential worries, poor health and diseases which may also be associated with them [ 23 ].

Analyses of data from the National Health Interview Study (NHIS) found that CAM users were more likely to use exercise and less likely to be obese than those who did not use CAM [ 15 , 16 ]. Associations of CAM with exercise [ 15 , 16 , 31 , 32 ], higher vegetable intake [ 31 , 32 , 33 ], lower fat or lipid intake [ 31 , 32 , 33 ], and smoking cessation or decreased smoking [ 16 , 31 , 34 ] have been reported previously. These studies, like ours, show a commitment to overall wellbeing that spans both lifestyle and CAM use and hypothesise that CAM therapies may even be used as a gateway to healthy lifestyle. Concurrent use of the two modalities should be investigated further in various populations. Moreover, CAM users in our study indicated to favour support of policy driven decisions related to a healthy lifestyle, consequently, a focus on the Dutch CAM users could work as a gateway to a healthier lifestyle for the general population.

On the other hand, younger age and stress regarding health and the balance between work and family life were found to be positively associated (final multivariable model) with a change into an unhealthy lifestyle. Our data shows that especially younger age was a risk factor for a change into an unhealthier direction. The fact that the young generation seems to be more prone might be due to fact that the restrictions as home confinement during the pandemic has especially impacted their lives by home schooling, working from home and balancing work and childcare (parents) causing a long period of stress resulting into an unhealthier lifestyle. Heightened life stress has been linked to unhealthy eating [ 35 , 36 ] and stressed people are more likely to crave food high in energy, fats, and sugars [ 37 ]. Moreover, parenting is found to be stressful under normative circumstances but pandemic-related data indicate that COVID-19 has led to significant increases in the population’s general stress, a change felt even more acutely for parents than their non-parent counterparts [ 38 ]. The results obtained by our study are relevant if we consider that people with stress in relation to balancing work and family care have a 1.7 higher chance of changing into an unhealthy lifestyle than people not perceiving this specific stress.

Some strengths and limitations of this study need to be noted.

Our study has been strengthened by the fact that the survey was conducted during the first critical period of the epidemic in the Netherlands. Responses from over 1000 individuals were rapidly collected within a period of five days from a representative sample of the population. Another strength is that our sample size was sufficiently large for detecting correlations. A limitation of this study is the rather low response rate of 22% to the survey, increasing the risk of non-response bias. Furthermore, because of the urgency to rapidly assess lifestyle changes in a very critical period of the pandemic, the questionnaire was not first piloted among a smaller sample. Although the research team carefully developed and selected life-style related questions and thoroughly discussed comprehensiveness, flow and clarity of the survey, it is not known whether the questionnaire was fully understandable and acceptable for the target population. Another limitation includes the fact that the results are limited by a self-reported questionnaire. The assessment of lifestyle changes was based on individual recall methods, and not by direct measurement of dietary and sleeping pattern, smoking and alcohol consumption. Respondents may thus have either overestimated or underestimated their changes in behaviour. An obvious other limitation of a cross-sectional study design is that it does not allow causal inferences about relationships and thus limits any claim about the directionality of the results. Last, no data on comorbidities (e.g. diabetes, hypertension and obesity) were gathered for the purpose of this study, which might limit the results. Linking with GP data on comorbidities would strengthen future research [ 15 , 16 , 31 , 32 ].

The COVID-19 pandemic and following Intelligent lockdown provides an unique window of opportunity to improve lifestyle habits on a population level. This is not only important to combat COVID-19 but also the other pandemic; of obesity and other non-communicable lifestyle-related disease. For a part of the Dutch population, the Corona crisis has already brought a shift in thinking, working and lifestyle behaviour, another large part is now motivated to make such changes. From a public health perspective, it is important to use this unique situation optimally and immediately as this increased motivation is crucial to obtain sustainable lifestyle changes, but may disappear quickly once COVID-19 wanes off. Strategies may include investing in prevention and education (e.g. smoking, drugs, alcohol), health campaigns, lowering taxes on healthy foods and sponsorship of sport facilities. Further studies are warranted to see whether this behavioural change is maintained over time, and how (changing) lifestyle behaviour can affect the susceptibility for and the course of COVID-19. Finally, the results of this study are in line with others showing the potential synergistic relationship between CAM use and healthy lifestyle behaviours [ 15 , 16 , 31 , 32 ]. This relation could be targeted in future interventions to increase general wellbeing, symptom control, and clinical outcomes in at-risk populations and might be used as a potential translatable strategy to increase healthy lifestyle behaviours in general populations.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Complementary and Alternative Medicine

Confidence interval

https://www.rivm.nl/coronavirus-covid-19/actueel .

Bedford J, Enria D, Giesecke J, Heymann DL, Ihekweazu C, Kobinger G, et al. COVID-19: towards controlling of a pandemic. Lancet. 2020;395(10229):1015–8. https://doi.org/10.1016/S0140-6736(20)30673-5 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Kuiper M, de Bruijn A, Folmer C, Olthuis E, Brownlee M, Kooistra E, et al. The intelligent lockdown: compliance with COVID-19 mitigation measures in the Netherlands. 2020.

Holmes TH, Rahe RH. The social readjustment rating scale. J Psychosom Res. 1967;11(2):213–8. https://doi.org/10.1016/0022-3999(67)90010-4 .

Article   CAS   PubMed   Google Scholar  

Trabelsi K, Ammar A, Masmoudi L, Boukhris O, Chtourou H, Bouaziz B, et al. Globally altered sleep patterns and physical activity levels by confinement in 5056 individuals: ECLB COVID-19 international online survey. Biol Sport. 2021;38(4):495–506.

Google Scholar  

Trabelsi K, Ammar A, Masmoudi L, Boukhris O, Chtourou H, Bouaziz B, et al. Sleep quality and physical activity as predictors of mental wellbeing variance in older adults during COVID-19 lockdown: ECLB COVID-19 international online survey. Int J Environ Res Public Health. 2021;18(8):4329. https://doi.org/10.3390/ijerph18084329 .

Article   PubMed   PubMed Central   Google Scholar  

Engberg E, Alen M, Kukkonen-Harjula K, Peltonen JE, Tikkanen HO, Pekkarinen H. Life events and change in leisure time physical activity: a systematic review. Sports Med. 2012;42(5):433–47. https://doi.org/10.2165/11597610-000000000-00000 .

Article   PubMed   Google Scholar  

Torres SJ, Nowson CA. Relationship between stress, eating behavior, and obesity. Nutrition. 2007;23(11–12):887–94. https://doi.org/10.1016/j.nut.2007.08.008 .

www.cdc.gov . https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html; People Who Are at Higher Risk for Severe Illness | Coronavirus | COVID-19 Accessed 7 May 2020.

Molema H, Erk Mv. Wetenschappelijke notitie over de relaties tussen COVID-19, metabole ontregeling, weerstand en leefstijlinterventies. mei 2020.

https://www.eufic.org/en/healthy-living/article/7-tips-to-keep-healthy-while-in-i-solation-or-quarantine-covid-19 .

https://www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome .

Moynihan AB, van Tilburg WA, Igou ER, Wisman A, Donnelly AE, Mulcaire JB. Eaten up by boredom: consuming food to escape awareness of the bored self. Front Psychol. 2015;6:369.

Article   Google Scholar  

Rodriguez-Martin BC, Meule A. Food craving: new contributions on its assessment, moderators, and consequences. Front Psychol. 2015;6:21.

PubMed   PubMed Central   Google Scholar  

Davis MA, West AN, Weeks WB, Sirovich BE. Health behaviors and utilization among users of complementary and alternative medicine for treatment versus health promotion. Health Serv Res. 2011;46(5):1402–16. https://doi.org/10.1111/j.1475-6773.2011.01270.x .

Nahin RL, Dahlhamer JM, Taylor BL, Barnes PM, Stussman BJ, Simile CM, et al. Health behaviors and risk factors in those who use complementary and alternative medicine. BMC Public Health. 2007;7(1):217. https://doi.org/10.1186/1471-2458-7-217 .

Schuster TL, Dobson M, Jauregui M, Blanks RH. Wellness lifestyles I: a theoretical framework linking wellness, health lifestyles, and complementary and alternative medicine. J Altern Complement Med. 2004;10(2):349–56. https://doi.org/10.1089/107555304323062347 .

Schuster TL, Dobson M, Jauregui M, Blanks RH. Wellness lifestyles II: modeling the dynamic of wellness, health lifestyle practices, and network spinal analysis. J Altern Complement Med. 2004;10(2):357–67. https://doi.org/10.1089/107555304323062356 .

Medicine NCfCaA. What is complementary and alternative medicine? https://www.aamc.org/research/adhocgp/pdfs/nccam.pdf .

Quandt SA, Verhoef MJ, Arcury TA, Lewith GT, Steinsbekk A, Kristoffersen AE, et al. Development of an international questionnaire to measure use of complementary and alternative medicine (I-CAM-Q). J Altern Complement Med. 2009;15(4):331–9. https://doi.org/10.1089/acm.2008.0521 .

https://gdpr-info.eu/ .

Hoenders HJR, Steffek E, Eendebak M, Castelein S. Handboek Leefstijl geneeskunde. Vries Iris DE editor2020.

Andersson L, Stanich J. Life events and their impact on health attitudes and health behavior. Arch Gerontol Geriatr. 1996;23(2):163–77. https://doi.org/10.1016/0167-4943(96)00716-9 .

Varma A, Dergaa I, Ashkanani M, Musa S, Zidan M. Analysis of Qatar’s successful public health policy in dealing with the Covid-19 pandemic. Int J Med Rev Case Rep. 2021;5(2):6–11.

Arena R, Guazzi M, Lianov L, Whitsel L, Berra K, Lavie CJ, et al. Healthy lifestyle interventions to combat noncommunicable disease-a novel nonhierarchical connectivity model for key stakeholders: a policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine. Eur Heart J. 2015;36(31):2097–109. https://doi.org/10.1093/eurheartj/ehv207 .

Nugent R, Bertram MY, Jan S, Niessen LW, Sassi F, Jamison DT, et al. Investing in non-communicable disease prevention and management to advance the sustainable development goals. Lancet. 2018;391(10134):2029–35. https://doi.org/10.1016/S0140-6736(18)30667-6 .

Di Renzo L, Gualtieri P, Pivari F, Soldati L, Attina A, Cinelli G, et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med. 2020;18(1):229. https://doi.org/10.1186/s12967-020-02399-5 .

Arena R, Harrington RA, Despres JP. A message from modern-day healthcare to physical activity and fitness: welcome home! Prog Cardiovasc Dis. 2015;57(4):293–5. https://doi.org/10.1016/j.pcad.2014.11.001 .

Pratt M, Perez LG, Goenka S, Brownson RC, Bauman A, Sarmiento OL, et al. Can population levels of physical activity be increased? Global evidence and experience. Prog Cardiovasc Dis. 2015;57(4):356–67. https://doi.org/10.1016/j.pcad.2014.09.002 .

Foundation S. 2020. Self-Care in a Post Pandemic World: Americans'perceptions of health &wellbeing during covid-19.

Cheung CK, Wyman JF, Halcon LL. Use of complementary and alternative therapies in community-dwelling older adults. J Altern Complement Med. 2007;13(9):997–1006. https://doi.org/10.1089/acm.2007.0527 .

Gray CM, Tan AW, Pronk NP, O'Connor PJ. Complementary and alternative medicine use among health plan members. A cross-sectional survey. Eff Clin Pract. 2002;5(1):17–22.

PubMed   Google Scholar  

Palasuwan A, Margaritis I, Soogarun S, Rousseau AS. Dietary intakes and antioxidant s tatus in mind-body exercising pre- and postmenopausal women. J Nutr Health Aging. 2011;15(7):577–84. https://doi.org/10.1007/s12603-011-0060-2 .

Bair YA, Gold EB, Greendale GA, Sternfeld B, Adler SR, Azari R, et al. Ethnic differences in use of complementary and alternative medicine at midlife: longitudinal results from SWAN participants. Am J Public Health. 2002;92(11):1832–40. https://doi.org/10.2105/AJPH.92.11.1832 .

Greeno CG, Wing RR. Stress-induced eating. Psychol Bull. 1994;115(3):444–64. https://doi.org/10.1037/0033-2909.115.3.444 .

Ball K, Lee C. Relationships between psychological stress, coping and disordered e ating: a review. Psychol Health. 2000;14(6):1007–35. https://doi.org/10.1080/08870440008407364 .

Wardle J, Steptoe A, Oliver G, Lipsey Z. Stress, dietary restraint and food intake. J Psychosom Res. 2000;48(2):195–202. https://doi.org/10.1016/S0022-3999(00)00076-3 .

Brown SM, Doom JR, Lechuga-Pena S, Watamura SE, Koppels T. Stress and parenting during the global COVID-19 pandemic. Child Abuse Negl. 2020;110:104699.

Download references

Acknowledgements

We would like to thank Barbara Wider Vellinga for her assistance with survey development.

This study was funded by co-funding of Triodos Foundation, Fred Foundation, Association of Homeopathy, Iona Foundation and the Artsen Vereniging Integrale Geneeskunde (AVIG)).

Author information

Authors and affiliations.

Louis Bolk Institute, Bunnik, The Netherlands

Esther T. van der Werf

Dutch Consortium for Integrative Medicine and Health (CIZG), Utrecht, The Netherlands

Esther T. van der Werf, Martine Busch & H. J. Rogier Hoenders

Van Praag Institute, Utrecht, The Netherlands

Martine Busch

National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway

Miek C. Jong

Mid Sweden University, Department of Health Sciences, Sundsvall, Sweden

Center for Integrative Psychiatry (CIP), Lentis Mental Health Institution, Groningen, the Netherlands

H. J. Rogier Hoenders

You can also search for this author in PubMed   Google Scholar

Contributions

EvdW and MB designed the study. EvdW analysed the data and drafted the manuscript. RH,MB and MJ provided critical feedback for revisions. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Esther T. van der Werf .

Ethics declarations

Ethics approval and consent to participate.

This study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act and therefore does not require ethical approval. All participants participated on a voluntary basis.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1., rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

van der Werf, E.T., Busch, M., Jong, M.C. et al. Lifestyle changes during the first wave of the COVID-19 pandemic: a cross-sectional survey in the Netherlands. BMC Public Health 21 , 1226 (2021). https://doi.org/10.1186/s12889-021-11264-z

Download citation

Received : 26 November 2020

Accepted : 10 June 2021

Published : 25 June 2021

DOI : https://doi.org/10.1186/s12889-021-11264-z

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

BMC Public Health

ISSN: 1471-2458

• General enquiries: [email protected]

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

[Healthy lifestyles in times of pandemic]

Affiliations.

• 1 Departamento de Psiquiatría y Salud Mental Norte, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
• 2 Unidad de Medicina Integrativa, Hospital Clínico, Universidad de Chile, Santiago, Chile.
• PMID: 33399785
• DOI: 10.4067/S0034-98872020000801189

SARS-CoV-2 pandemic generated a profound impact on people's health, emphasizing the relevance of healthy lifestyles. Recommendations on how to maintain adequate physical activity, diet, sleep and social connection have been issued. However, it is worth expanding our look to other possible elements related to lifestyles such as the relationship with technology, nature, pets and music. These areas should be included in the assessment and intervention from this perspective. To achieve changes, the values, beliefs, intentions, motivations, risk/benefit balances, capacity for self-regulation, previous history of changes and the person's sense of competence in relation to the possible changes that are being suggested, should be assessed. Individualized and contextualized suggestions that increase the intention of change should be made, avoiding confrontation and generalizations. Although there are still areas of uncertainty in this approach, particularly in relation to dosage and mechanisms of action, its development should be encouraged, given its great potential in terms of cost-effectiveness.

PubMed Disclaimer

• [Balanced Diet as a Healthy Lifestyle Habit in Times of Pandemic by SARS-CoV-2]. Tolentino KGG. Tolentino KGG. Rev Med Chil. 2021 Feb;149(2):313. doi: 10.4067/s0034-98872021000200313. Rev Med Chil. 2021. PMID: 34479284 Spanish. No abstract available.

Similar articles

• Motivations for Social Distancing and App Use as Complementary Measures to Combat the COVID-19 Pandemic: Quantitative Survey Study. Kaspar K. Kaspar K. J Med Internet Res. 2020 Aug 27;22(8):e21613. doi: 10.2196/21613. J Med Internet Res. 2020. PMID: 32759100 Free PMC article.
• Did social isolation during the SARS-CoV-2 epidemic have an impact on the lifestyles of citizens? Ferrante G, Camussi E, Piccinelli C, Senore C, Armaroli P, Ortale A, Garena F, Giordano L. Ferrante G, et al. Epidemiol Prev. 2020 Sep-Dec;44(5-6 Suppl 2):353-362. doi: 10.19191/EP20.5-6.S2.137. Epidemiol Prev. 2020. PMID: 33412829 English.
• Adherence to a Lifestyle Exercise and Nutrition Intervention in University Employees during the COVID-19 Pandemic: A Randomized Controlled Trial. García Pérez de Sevilla G, Barceló Guido O, De la Cruz MP, Blanco Fernández A, Alejo LB, Montero Martínez M, Pérez-Ruiz M. García Pérez de Sevilla G, et al. Int J Environ Res Public Health. 2021 Jul 14;18(14):7510. doi: 10.3390/ijerph18147510. Int J Environ Res Public Health. 2021. PMID: 34299960 Free PMC article. Clinical Trial.
• Promoting healthy lifestyles using information technology during the COVID-19 pandemic. Dixit S, Nandakumar G. Dixit S, et al. Rev Cardiovasc Med. 2021 Mar 30;22(1):115-125. doi: 10.31083/j.rcm.2021.01.187. Rev Cardiovasc Med. 2021. PMID: 33792253 Review.
• Mental Health of Children and Adolescents Amidst COVID-19 and Past Pandemics: A Rapid Systematic Review. Meherali S, Punjani N, Louie-Poon S, Abdul Rahim K, Das JK, Salam RA, Lassi ZS. Meherali S, et al. Int J Environ Res Public Health. 2021 Mar 26;18(7):3432. doi: 10.3390/ijerph18073432. Int J Environ Res Public Health. 2021. PMID: 33810225 Free PMC article. Review.
• Search in MeSH

LinkOut - more resources

Full text sources.

• Scientific Electronic Library Online
• MedlinePlus Health Information

Miscellaneous

• NCI CPTAC Assay Portal
• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

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

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

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

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

More from TIME

Read More: The Family Time the Pandemic Stole

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

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

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

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

Read More: A Tool for Staying Grounded in This Era of Constant Uncertainty

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

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

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

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

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

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

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

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

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

More Must-Reads from TIME

• The 100 Most Influential People in AI 2024
• Inside the Rise of Bitcoin-Powered Pools and Bathhouses
• How Nayib Bukele’s ‘Iron Fist’ Has Transformed El Salvador
• What Makes a Friendship Last Forever?
• Long COVID Looks Different in Kids
• Your Questions About Early Voting , Answered
• Column: Your Cynicism Isn’t Helping Anybody
• The 32 Most Anticipated Books of Fall 2024

Contact us at [email protected]

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Review Article
• Open access
• Published: 06 January 2024

How did you perceive the lifestyle changes caused by the COVID-19 pandemic?

• Tetsuya Tamaki   ORCID: orcid.org/0000-0001-6217-7731 1 ,
• Wataru Nozawa   ORCID: orcid.org/0000-0001-8075-4248 2 &
• Akinori Kitsuki 3  

Humanities and Social Sciences Communications volume  11 , Article number:  70 ( 2024 ) Cite this article

1215 Accesses

1 Altmetric

Metrics details

• Health humanities

This study did five surveys between April 2020 and March 2021 to look at how lifestyle changes during the pandemic affected well-being. These surveys covered all of Japan and were done both before and after the state of emergency was lifted. Applying the fixed-effects method to the panel data acquired in this manner, the analysis focused on subjective well-being and behavior during the COVID-19 pandemic. The results showed that teleworking during the pandemic may have increased life satisfaction, especially among young people. Although self-restraint behavior reduced well-being among young people, it tended to increase well-being among elderly individuals. On the other hand, self-restraint behavior by partners was found to lead to a decline in well-being among elderly individuals. In addition, it was observed that both the declaration of a state of emergency and the infection status had minimal impact on life satisfaction and happiness across all generational groups. Thus, the results show that lifestyle changes during the pandemic did not necessarily harm well-being, suggesting that the positive or negative impacts of factors differ from generation to generation.

Similar content being viewed by others

A 2-year longitudinal study examining the change in psychosocial factors under the COVID-19 pandemic in Japan

The evolution of the subjective well-being of the general population during the COVID-19 pandemic period: the case of Belgium

Lifestyle and mental health 1 year into COVID-19

Introduction.

After a case of COVID-19 was reported in Wuhan, China in December 2019, COVID-19 quickly spread worldwide. The World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC) on January 30, 2020, indicating a particular need for an international response; this was followed by an assessment on March 11 that determined that COVID-19 could be characterized as a pandemic (World Health Organization, 2020a , b ). Many countries implemented travel restrictions, curfews, and other measures to control infections, requiring drastic changes in people’s daily lives. These movement restrictions included not only cross-border movement but also movement between cities within a country.

On April 7, 2020, a state of emergency was declared in certain prefectures in Japan, and on April 16, the state of emergency was extended to all the prefectures of Japan (Ministry of Health Labour and Welfare, Japan, 2021 ). Unlike many other countries, the state of emergency declaration in Japan was not legally binding on the public; instead, people were urged to refrain from going out ‘voluntarily.’ This weak stay-at-home order sparked some critical opinions about its effectiveness (e.g., Ookita, 2022 ). However, Mizuno ( 2020 ) estimated that the ‘self-restraint rate,’ indicating the extent to which people refrained from going out, reached 40-50% in most prefectures after the issuance of the state of emergency declaration. This suggests that the declaration was sufficiently effective, even without legal binding force. Then, what effect did this unenforced stay-at-home order have on subjective well-being? Our study aims to investigate the impact of the state of emergency declaration on people’s subjective well-being, taking into account these characteristics. In particular, it is not fully clear whether they are caused solely by the stay-at-home order or by changes in one’s life due to actual voluntary refraining from going out Footnote 1 . Therefore, this study seeks to answer these questions by investigating how people’s subjective well-being changed based on their actions under the declared state of emergency.

Addressing this issue involves an initial focus on the factors of subjective well-being. Many studies have shown that subjective well-being is related to various factors other than individual attributes (e.g., gender, age, marriage, and income). For example, The Gallup Organization proposes five components of well-being: the career, social, financial, physical, and community aspects (Helliwell et al. 2021 ). The OECD has proposed a well-being index called the Better Life Index, which includes 11 indices: housing, income, jobs, community, education, environment, civic engagement, health, life satisfaction, safety, and work-life balance (OECD, 2022 ). However, the way in which subjective well-being is perceived is not always consistent across countries and regions, which makes it difficult to conduct a unified evaluation. For example, cultural differences have been shown to influence subjective well-being. In Asia, people’s happiness level has been shown to increase with other factors, such as appreciation toward others and harmony with nature, whereas the satisfaction of a person’s own ego has been shown to enhance well-being in the West (Uchida and Kitayama, 2009 ; Uchida et al., 2004 ).

In addition, in contrast to other countries, it has been reported in Japan that the level of a person’s well-being does not increase much even in his or her old age (Commission on Measuring Well-being, 2011 ). The Japanese government has also shown interest in subjective well-being in recent years, and the Cabinet Office of the Government of Japan has been leading discussions on this topic since 2010 (Commission on Measuring Well-being, 2011 ). A report proposed three domains of well-being in Japan: socioeconomic conditions, health, and relatedness. As these three factors were significantly impacted by the COVID-19 pandemic, they are indispensable in examining the subjective well-being during this unprecedented disaster.

While public health measures such as ensuring social distancing and self-isolation are considered essential to contain a virus and thus control the spread of infection (Anderson et al., 2020 ), it has been pointed out that such measures may have negative impacts on mental health. For example, in China, it has been pointed out that measures such as self-isolation cause various psychological problems, although the degree of impact differs depending on gender, age, and social status (Qiu et al., 2020 ; Zhang et al., 2020 ). Several studies have also reported on the psychological effects of the COVID-19 pandemic, including effects on the relationship between self-isolation requests and health anxiety, financial worry, and loneliness (Brooks et al., 2020 ; Clair et al., 2021 ; Reger et al., 2020 ; Tull et al., 2020 ). Even if a person is not actually infected, these psychological effects may be closely related to his or her satisfaction and happiness with his or her daily life. Trzebiński et al. ( 2020 ) found in their mediation analysis that basic hope supports meaning in life and life satisfaction, and increases in the latter two factors result in decreased anxiety and COVID-19 stress.

Zacher and Rudolph ( 2021 ) also conducted a subjective well-being survey in Germany from December 2019 to May 2020 and analyzed it using a latent growth curve model. They found that although individual differences in life satisfaction are related to controllable stress in oneself and others, the effects of stress appraisals on individual changes in life satisfaction were shown to be small and nonsignificant. Although many researchers are investigating the relationship between the COVID-19 pandemic and subjective well-being, the results of these studies have been reported to vary by region and survey method (Prati and Mancini, 2021 ). As pointed out by Zacher and Rudolph ( 2021 ), additional research will be essential in the future.

The COVID-19 pandemic not only directly affects mental health and subjective well-being, but also indirectly through factors such as relationships and socioeconomic status (Arenas-Arroyo et al., 2021 ; Reger et al., 2020 ; Schokkenbroek et al., 2021 ). While there have been reports on people’s increased loneliness and troubles with intimate partners due to a reduction in opportunities to go out as a result of the pandemic, Galdiolo et al. ( 2022 ) investigated couples’ satisfaction during the COVID-19 lockdowns and found that partners perceived the influence of these lockdowns on couples and family functioning to be increasingly positive over time. Randall et al. ( 2022 ) also suggest the possibility that perceived partner positive dyadic coping buffers the negative association between post-COVID-19 psychological distress and relationship quality. In addition, Zacher and Rudolph ( 2021 ) found from multiple surveys that not only life satisfaction and positive affect but also negative affect declined after March 2020, and they cited a decrease in affective experiences themselves as a possible explanation. In other words, it is clear that the unprecedented crisis of COVID-19 has had a negative impact on subjective well-being, but it is also suggested that the successful adaptation to the new situation may have had a positive impact as well.

Beck and Hensher ( 2020 ) mentioned reduced commuting time as an important positive effect of teleworking during the COVID-19 pandemic. Subsequent studies have indicated that the time gained from reduced commuting is spent on leisure and family time rather than paid work (Hensher and Beck, 2023 ; Hensher et al., 2022 ). It has also been pointed out that there is considerable heterogeneity across studies (Prati and Mancini, 2021 ), and cultural variation is considered to be a factor (Randall et al., 2022 ). The results of studies that focus on specific regions, such as the present study, are important in terms of examining the impact of the COVID-19 pandemic in an integrated manner.

Note that survey-based research is subject to certain limitations related to survey implementation. Even when data from multiple surveys are used, the effects of various events that occur between the surveys may be considered as if they were the effects of a single representative event. For this reason, few studies have been able to separate the impact of the government’s stay-at-home order from the impact of actual behaviors. There are many possible reasons why people may have followed the government’s request to refrain from going out. In addition to an avoidance of the risk of infection, external factors such as the shortened opening hours of restaurants may also be cited. Another possible reason, for instance, is the perceived stigma of going out. Under the state of emergency, going out was regarded as an antisocial behavior, as it was the social norm to refrain from going out. It has been pointed out that a fear of being recognized as having been outside the house was a concern under the state of emergency declaration (Katafuchi et al., 2021 ). These effects were caused by the declaration of the state of emergency and are different from the effects of actual self-restraint behaviors. In addition, although many related studies have been conducted, only a few have utilized longitudinal data during the COVID-19 pandemic. Therefore, while various factors have been identified, few studies have been able to address causal relationships. To overcome these shortcomings, some studies have analyzed the impact of lockdowns based on data such as those on Google trends or the number of counseling sessions conducted (Armbruster and Klotzbücher, 2020 ; Brodeur et al., 2021 ; Foa et al., 2022 ). In these studies, mental effects are inferred from actual behaviors (e.g., performing a search, or making a phone call). However, it is difficult to directly relate an individual’s behavior to general indicators such as his or her life satisfaction (Banks et al., 2021 ).

Building upon the aforementioned, this study aims to address three issues: (1) How did teleworking and self-restraint behaviors impact subjective well-being? (2) How was subjective well-being influenced by partner behavior? and (3) Did the declaration of a state of emergency in Japan affect subjective well-being? To achieve this objective, a total of five surveys were conducted across Japan over approximately one year starting in April 2020 when COVID-19 began spreading rapidly. The paper is structured as follows: “Methodology” provides details on the data and methodologies used in the analysis, ”Results” presents the analysis results, followed by a discussion in “Discussion”, and the paper concludes in “Conclusion”.

Methodology

Dataset and variables.

Figure 1 shows the number of newly infected patients and the periods of state of emergency declarations in Japan from the early stages of the spread of COVID-19 infection to April 2021. The number of newly infected patients increased rapidly around late March 2020, especially in Tokyo and other urban areas. Although the spread of the disease was milder than it was in Europe, a state of emergency was declared on April 7 due to a shortage of medical care. The measures implemented in accordance with this declaration covered the seven prefectures of Tokyo, Kanagawa, Saitama, Chiba, Osaka, Hyogo, and Fukuoka and were expanded to cover the entire country on April 16, 2020 Footnote 2 . Subsequently, the government reduced the number of target areas based on the infection situation and other factors, and the state of emergency was lifted nationwide on May 25, 2020 (Ministry of Health Labour and Welfare, Japan, 2021 ).

This figure shows the number of new infections in Japan and the timing of emergency declarations issued and lifted in each prefecture.

After the spread of COVID-19 appeared to be under control, the number of infected people began to gradually increase again in late June of the same year, and voluntary self-restraint was again recommended. However, during this so-called second wave, the number of new infections peaked in early August and gradually declined, although a state of emergency was not declared Footnote 3 . Although it was hoped that the disease would be eradicated, it was not, and the number of newly infected people began to increase again around November of the same year. This third wave coincided with the year-end and New Year holidays, which is when travel increases, and infection spread rapidly in the Tokyo metropolitan area as well as the Kansai and Chukyo areas. The number of newly infected people was extremely high compared to the previous cases; thus, the government declared a state of emergency for the second time on January 7, 2021 for the Tokyo, Saitama, Chiba, and Kanagawa prefectures, and one week later, on January 14, 2021, Tochigi, Gifu, Aichi, Osaka, Hyogo, Kyoto, and Fukuoka were added to the coverage area. The scope of the declaration was subsequently reduced as the number of newly infected cases decreased, and the emergency measures implemented for the third wave were finally lifted on March 21 of the same year.

This study conducted a questionnaire survey on life during the COVID-19 pandemic, covering factors such as life satisfaction. The survey encompassed targeted all of Japan during the period between the first and third waves of COVID-19. The survey was conducted online by a professional survey company Footnote 4 . As shown in Fig. 1 , the first survey was conducted on April 26, 2020, and the next four surveys were conducted on May 19, 2020; June 30, 2020; February 24, 2021; and March 31, 2021. The survey dates corresponded to the periods when the emergency measures were put into place and after they were lifted to account for the infection situation and the implementation of the emergency measures. In particular, the first, second, and fourth surveys were conducted when emergency measures were being put into place and the number of new patients was decreasing after the declaration of the state of emergency was issued. The first survey was conducted when the entire country was under the declaration, and the second survey was conducted when only some areas were under it. The third and fifth surveys were conducted after the declarations were lifted and when the number of newly infected patients had begun to increase.

This survey targeted men and women over the age of 18 who were registered with a professional survey company. They provided the survey company with demographic information such as age, gender, occupation, and annual income in advance, and this information was also used in this analysis. Initially, 1149 respondents completed the first survey, and the second and subsequent questionnaires were administered to individuals who had responded to the previous survey. Therefore, the numbers of respondents corresponding to the second survey and the surveys thereafter were 992, 912, 762, and 728, respectively. In other words, 728 respondents responded to all five surveys, and 421 respondents abandoned their responses midway through the survey. The aim is to assess the subjective well-being of the entire population of 100 million people excluding those under 17 years old in Japan. With a confidence level of 99% and a margin of error of 5%, this sample size is deemed acceptable.

The attributes of the respondents are described in Table 1 . In addition to providing the aggregate results regarding all the respondent attributes, Table 1 includes the aggregate results regarding the attributes of individuals with complete and incomplete responses (hereafter, the complete and incomplete respondents, respectively). Focusing first on age, the average age of all the respondents was 52.4 years, while the average age of the complete respondents was slightly higher at 53.5 years. The complete respondents were somewhat older than the incomplete respondents ( p  < 0.01). On the other hand, the results of a χ 2 test of gender, marital status, and the presence of children did not reveal any significant differences between the complete and incomplete respondents. The sample was roughly evenly split between men and women; moreover, over 60% of the respondents were married and almost 50% had children. The results regarding annual income were significant, and the annual income of the complete respondents was slightly higher than that of the incomplete respondents ( p  = 0.063). Approximately 40% of the respondents had annual income in the range of 2 to 6 million yen. In this analysis, the average value of the selected category (e.g., 1.5 million for the range of 1 million-1.99 million) was used as each respondent’s annual household income. The respondents’ education was categorized as follows: junior high school graduate or lower, high school graduate, junior college/technical school graduate, university graduate, graduate school graduate or higher, and others. The “others” category included those who answered “not educated” or “do not know.” Respondents who had graduated from high school, junior college/technical school, or university accounted for approximately 90% of the total. There was a significant difference between the complete and incomplete respondents at the 5% level in the χ 2 test ( p  = 0.044).

From these respondents, responses on happiness, life satisfaction, health, community, and income change were obtained in all five surveys. In the fourth and fifth surveys, responses on teleworking status and staying at home were also obtained to complement the series of surveys. The other variables used in this analysis were a variable denoting the state of emergency declarations and a variable denoting the number of new cases.

Happiness: Happiness was rated on a five-point scale, namely, 1-completely unhappy, 2-slightly unhappy, 3-neither, 4-slightly happy, and 5-completely happy, in response to the question, “All in all, how happy are you?"

Life satisfaction: Life satisfaction was rated on a five-point scale, namely, 1-completely dissatisfied, 2-slightly dissatisfied, 3-neither, 4-slightly satisfied, and 5-completely satisfied, in response to the question, “All in all, how satisfied are you with your life?"

These were done to give positive situations a higher score.

Health: This indicator was used only to determine the respondents’ health status at the time of the survey, and the respondents were asked, “How is your overall health?" Therefore, COVID-19 was not mentioned in this question. Responses were given on a 5-point scale as follows: 1 - very bad, 2 - a little bad, 3 - undecided, 4 - a little good, and 5 - very good.

Community: To measure their level of attachment to the communities in which they lived, the respondents were asked, “How attached are you to the community in which you live?" A 5-point scale was used: 1-no attachment at all, 2-not much attachment, 3-neither, 4-somewhat attached, 5-very attached.

Change in income: In the second and subsequent surveys, the respondents were asked about any changes in household income during the previous two months (Fig. 2 ). The following eight options were offered in response to the question, “Was there any difference in your household income during X (e.g., March) compared to your income before the coronavirus began to spread? “: decreased by ~50–100%, decreased by ~10–50%, decreased by a few percent to ~10%, no change, increased by a few percent to ~10%, increased by ~10–50%, increased by ~50–100%, increased by more than 100%. The second survey (initiated on May 19, 2020) covered March and April 2020, the third survey (initiated on June 30, 2020) covered May and June 2020, and the fourth survey (initiated on February 24, 2021) covered December 2020 and January 2021. Because all the surveys, including the first one, were conducted at the end of the respective month, this study used the responses corresponding to the month in which the survey began to construct the variable for income change in each survey. In addition, since 60–70% of the respondents indicated that their income was no different from their income before the COVID-19 pandemic, the data were tabulated into three groups: those whose household income had decreased ( inc_decrease ), those whose income had remained approximately the same, and those whose income had increased ( inc_increase ). A corresponding dummy variable was created.

This figure shows the extent to which respondents’ monthly income has changed over the five survey periods compared to the pre-pandemic period.

Although there are many factors that influence happiness and life satisfaction, the Commission on Measuring Well-being ( 2011 ) identified “socioeconomic conditions," “health," and “relatedness" as the three main axes in the Japanese subjective well-being survey. Since it has been pointed out that perceptions of happiness are highly dependent on national characteristics (Uchida and Kitayama, 2009 ; Ura et al., 2012 ) and since this survey was conducted in Japan, changes in health, community, and income were used as the three key variables of this study.

Working from home and self-restraint: Questions on teleworking and self-restraint were included in the fourth and fifth surveys. The respondents were asked to report on their teleworking and self-restraint status, as well as that of their partners, for each month of the past year. Since it was necessary to go back about one year, to make it as easy as possible for respondents to answer, the survey asked them to “Select all the months since last year in which more than half of your or your partner’s work has been transferred to teleworking. Additionally, please select all the months in which you think you were more cautious about going out than you were before the COVID-19 pandemic." In the fifth survey, a similar question was asked about March 2021. As with the “change in income" question, for these items, the responses corresponding to the month in which the survey was conducted were coded as dummy variables (1 if selected and 0 otherwise). Figure 3 shows the changes in the respondents’ teleworking and self-restraint status. The vertical axis shows the percentage of respondents who answered “yes" to the above question; those who answered “no" include the respondents who indicated that they did not have a partner.

This figure shows the teleworking and self-restraint status of respondents and respondents’ partners by month.

The percentages of respondents teleworking and practicing self-restraint increased around March and April 2020 but then declined slightly, and these percentages increased again around November 2020. These results are generally consistent with the number of people infected and the state of emergency declarations.

State of emergency: As shown in Fig. 1 , the periods during which a state of emergency was declared differed by prefecture. Therefore, a dummy variable was used; this variable equaled 1 for prefectures that had declared a state of emergency at the time the focal survey was initiated and 0 for prefectures that had not.

Infection status: Two variables were prepared to denote infection status using relevant data at the prefecture level provided by Sapporo Medical University Footnote 5 . The first variable was the number of new infections in the week immediately prior to the start of the survey ( num_patients [1000 people]); the second was a dummy variable denoting the trend of increasing infections, and it was set to 1 if the number of new infections in the week immediately prior to the survey exceeded the number of new infections two weeks prior to the survey and 0 otherwise ( dmy_patients ).

Other variables: This study also controlled for personal attributes that are associated with happiness, life satisfaction, and stress in our analysis. Several previous studies have pointed out the impacts of demographics (Banks et al., 2021 ; Bruine de Bruin, 2021 ; Dowd et al., 2020 ; Klaiber et al., 2021 ; Qiu et al., 2020 ; Schokkenbroek et al., 2021 ; Wenham et al., 2020 ). In particular, the relationship between age and happiness is said to be a U-shaped curve. Although the increase in happiness observed in old age is lower in Japan than in other countries, the analysis attempted to incorporate the square of the age term, in line with existing studies (Commission on Measuring Well-being, 2011 ; Tsurumi et al., 2019 ). In addition, the respondents were categorized into five family composition groups, namely, one person, couple, two generations, three or more generations, and other (dormitory, shared house, etc.), and these were added as dummy variables (one person was used as the standard). This item was added as a variable because of concerns that it might reflect the effects of the COVID-19 disaster. The increase in time spent at home during the pandemic increased the amount of time spent sharing the same space with family members or roommates. Therefore, control for family composition was necessary in the analysis of the effects of teleworking and self-restraint. In addition, we controlled for the respondents’ prefectures of residence and occupation types. There were many regional differences in the status of COVID-19 infections; for example, explosive increases in the number of infections were accelerated in large cities such as Tokyo and tourist destinations such as Okinawa (Abiko, 2021 ). With regard to occupation, it is easy to imagine that people’s risk of infection and changes in work patterns during the pandemic differed depending on their type of occupation. The respondents were classified into 47 prefecture groups according to their place of residence and into 11 occupation categories: full-time employees, contract employees, managers, civil servants, self-employed individuals, freelance workers, medical professionals, homemakers, students, part-time employees, and unemployed individuals.

Figure 4 depicts life satisfaction and happiness by prefecture in the first survey. The x -axis represents the population size of each prefecture, with larger prefectures (such as Tokyo, Osaka, Aichi, and Kanagawa) located towards the right. Smaller prefectures show greater variation in life satisfaction and happiness, while no significant regional differences are observed in prefectures with more than 2 million people, where there are more than several dozen samples available. Figure 5 displays trends in life satisfaction and happiness based on occupation. While many occupations remained unchanged throughout the survey period, medical professionals’ life satisfaction and happiness exhibited at downward trend, possibly due to the prolonged duration of the pandemic increasing their burden. Additionally, the figure indicates that students experience relatively high levels of subjective well-being.

This figure shows the relationship between the size of the respondent’s place of residence and subjective well-being.

This figure shows how the subjective well-being of respondents by occupation changed over the course of the five surveys.

Using the data described above, this study constructs a panel data regression analysis model with subjective well-being as the explained variable. First, as a base model, the consideration involves the following ordinary least squares (OLS) model consisting of a minimum number of variables:

where i  = 1, 2, …,  N and t  = 1, 2, …,  T . Here, N denotes the total number of respondents, and T represents the total number of survey rounds. The error term, ε i t , accounts for the residual variations in the model. The explained variable, S W B i t , is an index of subjective well-being, specifically, happiness or life satisfaction. Z i is a vector of individual socio-demographic variables, including logarithmic income, presence of children, marital status, age, sex, education level, family composition, occupation, and residential area (prefectures). The variable θ t represents time effects, capturing any time-specific influences on subjective well-being.

Next, a model is considered in which variables related to the economic changes that occurred during the COVID-19 pandemic( inc_decrease and inc_increase ) and the actions taken at that time (self-restraint ( SR ) and the working-from-home ( WFH ) are added to equation ( 1 ).

The model includes changes in factors that, although self-reported, would have affected subjective well-being, which is precisely what was greatly affected by the pandemic.

Finally, a fixed-effects (FE) model is suggested.

While previous models relied on socio-demographic variables to capture differences among respondents, they may not fully account for all the factors influencing individual responses. For example, psychological traits can significantly vary among respondents, leading them to perceive and respond differently to the same phenomenon. These traits are not adequately reflected in the previous models, as they are treated as part of the error term in the OLS model. This can introduce bias in the estimated coefficients, as the error term may be correlated with the independent variables. In contrast, the fixed effects model introduces dummy variables, α i , to represent the time-invariant characteristics of each respondent. By doing so, it effectively controls for the unobservable heterogeneity among respondents that remains constant over time. This separation of unobservable respondent characteristics from the error term reduces bias in the coefficient estimates and enhances the model’s reliability for identifying causal relationships between the independent and dependent variables (Let ϵ i t be the error term from which the time-invariant respondent characteristics are separated).

This study employs fixed effects methods to account for unobserved time-invariant confounding factors. For unveiling more intricate causal relationships, G-estimation methods would be necessary.

Baseline estimation

Table 2 shows the results of the analysis when life satisfaction (Columns 1–3) and happiness (Columns 4–6) are the explained variables for the respondents as a whole. Only the variables of interest are highlighted in the tables. (Detailed estimation results are in Tables A and B of the Online Appendix in the separate supplemental material file).

Table 2 shows the results regarding the notable variables. The effects of the stay-at-home order and the infection status were considered here by adding as variables the state of emergency declaration status at the time of each survey, the number of new patients in the previous week, a dummy denoting whether the number of new patients had increased over that of the previous two weeks, and their cross terms, which were not significant and had small estimates in most estimations Footnote 6 . In Models (a1) and (a4), the only variable related to the stay-at-home order was the state of emergency declaration, and self-restraint behaviors and teleworking were not taken into account separately. However, significant effects of the state of emergency declaration itself or the infection situation were not observed. Similarly, in Models (a2) and (a5), which were estimated by OLS, the variables denoting changes in income since the beginning of the pandemic and the self-restraint and teleworking of the respondents and their partners were added, but the estimated coefficients of the state of emergency declaration and the infection situation were small and not significant. The same was true of Models (a3) and (a6), which were the fixed effects models. In other words, neither the declaration of a state of emergency nor familiar infection conditions changed life satisfaction or happiness much, and causal relationships could not be identified.

In contrast, focusing on Models (a2) and (a3), which used life satisfaction as the explained variable, the respondents’ own teleworking was positively significant, with coefficients estimated at 0.0929 (s.e. 0.0532) and 0.1297 (s.e. 0.0647), respectively. Additionally, the respondents’ self-restraint behavior was negatively significant in only Model (a3), and the coefficient was −0.1039 (s.e. 0.0504). These results indicate that teleworking generally increases life satisfaction, whereas self-restraint decreases life satisfaction. In addition, it is estimated that the behavior of an individual’s partner also affects his or her life satisfaction. The estimated values for partners’ teleworking were small and not significant, but those for partners’ self-restraint behavior were equal to 0.1974 (s.e. 0.0563) for (a2) and 0.1075 (s.e. 0.0618) for (a3), both of which were found to be significant. The results suggest that people’s life satisfaction increased when their partners refrained from going out. In terms of income, the coefficient of the income decrease dummy was −0.2605 (s.e. 0.0327) and −0.0670 (s.e. 0.0331) in Models (a2) and (a3), and these were both negative and significant results. The income increase dummy was nonsignificant in relation to life satisfaction.

Next, focusing on the model with happiness as the explained variable, we find that neither the respondent’s own self-restraint behavior (teleworking and self-restraint) nor that of his or her partner is significant for happiness. Model (a5) was the only model in which partner self-restraint was positively significant (0.1424; s.e. 0.0529), indicating that the respondents whose partners refrained from going out were slightly happier than those whose partners did not. Regarding changes in income, Model (a6) reveals a trend in which happiness increases with an increase in income, albeit at the 10% level of significance (0.0800; s.e. 0.0455).

Generational differences

Next, an attempt was made to analyze the differences in effects across generations by creating subgroups for each generation. In the previous analysis, the inclusion of age and its square term as variables was done to account for age differences. However, previous studies have pointed out that perceptions of the effects of the pandemic vary greatly depending on age. Klaiber et al. ( 2021 ) also found that during the pandemic, young and middle-aged people faced more interpersonal conflicts and work- and family-related daily stressors. On the other hand, older adults were less concerned about the threat of COVID-19 and had better affective well-being. Bruine de Bruin ( 2021 ) also reported that elderly people have a more optimistic outlook on COVID-19. Therefore, the data was divided into three groups according to the respondents’ ages to examine these differences in the studied effects. Here, the respondents were categorized into three groups (young, middle-aged, and elderly), namely, under 40 years old, between 40 and 59 years old, and over 60 years old, with sample sizes of 545 (222 respondents), 1901 (544 respondents), and 1296 (383 respondents), respectively.

Graphs depicting the average life satisfaction and happiness of each group are shown in Fig. 6 . These figures clearly show that the scores of the elderly group were higher than those of the other groups. In addition, the youngest group showed greater variation across the surveys than the other groups. Helliwell et al. ( 2021 ) also surveyed people’s level of well-being during the pandemic by generation, and similar to the present study, a high level of well-being was observed among elderly individuals. However, the survey showed that the youngest group exhibited little variation over the survey period, while the middle-aged and elderly groups showed similar levels of variation. This may be due to the influence of the survey area and the timing of the survey, but there are commonly large differences across generations; moreover, the relatively similar patterns of variation of the middle-aged and elderly groups may be a common feature of the two groups.

This figure shows how respondents’ subjective well-being by generation changed over the course of the five surveys.

Subsequently, OLS and FE analyses were conducted for each of the subgroups. The life satisfaction and happiness estimates are shown in Table 3 . These results show that the estimated values and their significance differ considerably by generation. As was the case with our analysis of all the data, both the declaration of a state of emergency and the infection status had little effect on life satisfaction and happiness across all the generation groups. Models (b1) through (b6) use life satisfaction as the explained variable. When focusing on the respondents’ teleworking in these models, the estimated values are the highest in the young group (0.3923, s.e. 0.1691) analyzed with FE, and the estimated values decrease as age increases. Significance was found in only the model for the young group. Conversely, the estimated value of the respondents’ self-restraint was −0.2575 (s.e. 0.1224) for the youngest group and −0.0931 (s.e. 0.0673) and 0.0237 (s.e. 0.1072) for the middle-aged and elderly groups, respectively; this result indicates a gradually decreasing effect. As was the case with teleworking, significance was confirmed for only the young group. The variables related to partner behavior were not significant according to our FE analysis. However, in the OLS models, partner self-restraint behavior was significant for all generations. In the young group, those whose partners exhibited self-restraint tended to be more satisfied with their lives, but this trend reversed with increasing age. Particularly in the older age groups, life satisfaction tended to be low not only among those whose partners were not going out but also among those whose partners were teleworking. The effect of changes in income observed in the overall analysis was not found to be significant in the FE analysis of the subgroups.

Next, turning to Models (b7) to (b12), happiness serves as the explained variable. In the OLS analysis, the coefficients of the self-restraint behavior of the respondents were −0.4470 (s.e. 0.1247), 0.0009 (s.e. 0.0572), and 0.3993 (s.e. 0.0911) for the young (b7), middle-aged (b9), and elderly groups (b11), respectively, while an effect of teleworking on the level of happiness was not observed. In other words, the level of happiness of the self-restraint group tends to be lower than that of the young group, but this difference disappears almost completely in the middle-aged group; moreover, in the elderly group, self-restraining individuals have a higher level of happiness. In contrast, the coefficients of the partners’ self-restraint behavior were estimated to be 0.6373 (s.e., 0.1995), 0.1655 (s.e., 0.0712), and −0.2440 (s.e., 0.0994), indicating that the happiness level of those whose partners practice self-restraint is higher in the young group; however, this tendency is reversed in the elderly group. These results are consistent with those of the analysis of life satisfaction. In the FE analysis, significant differences were found in only the elderly group (b12), with the coefficient of self-restraint behavior estimated at 0.2051 (s.e. 0.0918) and that of partner self-restraint behavior at −0.1956 (s.e. 0.0953). With regard to the impact of the pandemic on income, in contrast to the results of the overall analysis, there was no increase in happiness due to increased income. The OLS analysis estimated a negative value for the effect of the decrease in income, and this effect was significant for the middle-aged and elderly groups. The young group was the only group where a negative causality was observed in the FE analysis.

The above results suggest the following effects on well-being brought about by the COVID-19 pandemic in Japan. First, the state of emergency declaration itself had little effect on well-being, and the recent infection situation in the immediate area and the increase or decrease in the number of infected people are not considered to be factors that affect well-being. This lack of significance was observed across different generations, similar to the overall estimates. In Models (a1) and (a4), other factors related to the declaration of a state of emergency were not included among the variables. Therefore, the effect was estimated as the total impact of the emergency declaration rather than the impact of the emergency declaration itself. One possibility is that the positive and negative factors related to the declaration of a state of emergency could have canceled each other out. Our observation of both positive and negative factors in Models (a2) and (a5) supports the validity of this hypothesis. Banks et al. ( 2021 ) pointed out that mental health may have deteriorated before the lockdown and the stay-at-home order and that it may have stabilized after the lockdown. The results of this study are considered consistent with this opinion. In addition, there may be some effects unique to Japan. Although a state of emergency was declared, it was not legally binding. Additionally, surveys of private companies at the time showed a high percentage of support for the declaration of a state of emergency, suggesting that the public wanted a state of emergency to be declared Footnote 7 . However, although this study focused on teleworking, self-restraint behavior, and partner relationships, it cannot be said that the state of the emergency declaration itself had no effect since some factors could not be separated from the effects of the state of emergency declaration, such as exercise.

In terms of actual behavior, it could be suggested that subjective well-being may be affected by individuals’ behavior and that of their partners. In particular, both an individual’s behaviors and those of his or her partner are factors that affect life satisfaction, and their effects are not necessarily negative. The results of the overall estimates show that teleworking independently leads to an increase in life satisfaction. Although expectations regarding the potential benefits of teleworking were high before the pandemic, there were concerns about the physical and mental health effects (Buomprisco et al., 2021 ; Mann and Holdsworth, 2003 ; Song and Gao, 2020 ). In addition to the benefits of reduced commute time and increased free time, a benefit that may cause many people to consider working from home is the ability to reduce the risk of infection, which is an advantage in a pandemic. However, while teleworking improved life satisfaction in the overall estimation, positive significance was observed in only the young group in the generational analysis. According to the Cabinet Office ( 2020 ), 21.5% of people in Japan were teleworking as of December 2020, and more than half of them hoped that more than 50% of their work would consist of teleworking in the future. In addition, the results showed that a large percentage of young people changed their attitudes toward work-life balance, placing greater importance on their lives rather than on their jobs; indeed, compared to the period before the spread of the infectious disease, such attitudes tended to be stronger among young people. Moreover, the top two advantages of teleworking were shown to be the elimination of the need to commute and the effective use of spare time, which suggests that teleworking is favored by young people who wish to focus on their daily lives. The fact that young people are more likely to adapt to new approaches and situations may also be a factor in this causal relationship among young people. Another possible factor behind these results is their position in the business. Bloom et al. ( 2022 ) found significant differences in the evaluation of hybrid working from home between managers and non-managers. Non-managers viewed the introduction of hybrid WFH positively, while managers viewed it negatively. The consistent finding of the positive impact of WFH on subjective well-being among the younger generation, who are more likely to be in non-managerial positions, supports this notion.

Relationships with close partners may also be involved; Galdiolo et al. ( 2022 ) pointed out that opportunities for communication that arise during lockdown increase couples’ well-being. Teleworking increases these opportunities by causing people to be at home. While self-restraint was shown to have a negative impact on life satisfaction, the results regarding partners’ self-restraint were favorable, suggesting that the increase in time spent together at home during the pandemic was viewed positively by the respondents to this survey.

The characteristics of self-restraint behavior also varied significantly across generations. While self-restraint behavior tended to be associated with lower life satisfaction and happiness in the young group, the correlation was reversed as the respondents’ ages increased. Causality was observed in only the young group in relation to life satisfaction and in the elderly group in relation to happiness. Klaiber et al. ( 2021 ) found that elderly individuals report more positive events in their daily diary data. These results suggest that elderly individuals may have been able to enjoy their self-restrained situation more, such as by finding new pleasure in their situations. In contrast, the opposite trend was observed in relation to partner self-restraint behavior. In the young group, life satisfaction and happiness were higher for those whose partners practiced self-restraint, whereas these factors were lower for the older group whose partners did so. Various possible explanations come to mind for this result. In a survey by the Cabinet Office ( 2020 ), more than 80% of the respondents who reported increased time spent with their families during the pandemic indicated that they would like to maintain this time with their families in the future. In addition, more than 40% of those who reported an increase in the husband’s role in child-rearing and household chores and of those who reported an increase in both roles reported an improvement in their marital relationship, while less than 20% of those who reported an increase in the wife’s role reported an improvement in their marital relationship. In the young group, the division of household chores and child-rearing was altered by the pandemic, which may have resulted in the improvement of relationships. Many of the couples in the elderly group had already finished child-rearing, and the burden of household chores may have been placed on only one of the spouses, but this study cannot indicate the reason for this.

In this study, a series of surveys was conducted covering ~1 year, starting in April 2020, when COVID-19 infections began to spread. By separating the teleworking and self-restraint behavior of the survey respondents and their partners during the pandemic from the effects of the state of emergency declaration, it was revealed that the lifestyle changes that arose during the pandemic did not necessarily harm well-being. It also became clear that the effects of these actions during the pandemic varied greatly across generations. For example, a causal relationship emerged in which teleworking increased life satisfaction in the young group of respondents; however, this effect was small, and causality was not observed in the middle-aged and elderly groups. In addition, while in the young group, there was a negative correlation between subjective well-being and self-restraint behavior and a positive correlation with the self-restraint behavior of partners, the opposite was true in the elderly group. The reason for these results is thought to stem from differences in how different generations perceive various behaviors adopted under the state of emergency declaration. The government’s stay-at-home order may have been perceived by young people as a constraint. On the other hand, elderly people may have viewed it more optimistically, choosing to use their time in a meaningful way, as shown by Klaiber et al. ( 2021 ) and Bruine de Bruin ( 2021 ). Conversely, the effect of the self-restraint behavior of partners is presumably a reflection of relationships with family members or close partners and of factors such as life-work balance.

In addition, this study suggests that pandemic-induced lifestyle changes have both positive and negative effects on subjective well-being. Therefore, considering the impact of lockdowns or stay-at-home orders as a single overall impact would lead to variation across studies, as Prati and Mancini ( 2021 ) point out. In this study, the results show that the impact of the state of emergency declaration is almost negligible through a separation of the impact of teleworking and self-restraint behavior. This may be due in part to the fact that there has been a high level of support for the state of emergency declaration in Japan, but the limitation of this study should also be understood. Although the behavior of the respondents and their partners was considered in addition to the state of emergency declaration and the daily changes in the number of infected persons, not all the behavioral changes stemming from stay-at-home orders could be captured as variables. For example, the frequencys of exercise and shopping for daily necessities are possible factors, but they were not taken into account in this study. Since the timing of the emergency declaration and its lifting differ from prefecture to prefecture, the variables in our analysis represent simply whether a state of emergency had been declared in the focal area. Therefore, it is difficult to conduct a more detailed analysis focused on factors such as changes within the period when the state of emergency was in place. To better clarify such factors, a more advanced analysis, such as one that combines different approaches in addition to the questionnaire survey, is necessary.

Several years have passed since the pandemic occurred, but its aftermath is still ongoing. Continued investigation and the accumulation of knowledge are needed not only on the short-term effects of the pandemic on well-being but also on its long-term effects. In addition to differences in gender and age, differences in the government response, national character, and culture have significant impacts. The accumulation of these findings will provide effective countermeasures against similar risks in the future.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

In this study, “self-restraint” is defined as voluntary refraining from going out, while ‘self-isolation’ is defined as refraining from going out, regardless of voluntariness.

The Cabinet Secretariat has published an archive of reports on its website, detailing the timing of emergency declarations and the corresponding covered areas: https://corona.go.jp/emergency/ Accessed 19 Jul 2022.

Although a state of emergency was not declared, some point out that the government’s call for restaurants to shorten their hours and for people to refrain from going out was effective (The Asahi Shimbun, 2020 ).

A service called Freeasy from iBridge Corporation was utilized. This company owns a pool of 13 million potential respondents in Japan, from whom a random sample was selected. The selected respondents were required to be at least 18 years old.

These data can be downloaded from the following URL: https://web.sapmed.ac.jp/canmol/coronavirus/japan.html Accessed 19 Jul 2022.

We also analyzed models in which these variables were added independently but did not find significant changes in the estimation results.

For example, the following articles are available. Eighty-four percent of the respondents to a certain survey were in favor of the nationwide expansion of the first declaration of a state of emergency (The Chunichi Shimbun, 2020 ). A total of 72.5% were in favor of the second state of emergency declaration (NEXER inc., 2021b ). A total of 43.3% of the respondents (27.1% in favor) were against the lifting of the second state of emergency declaration on March 21 (NEXER inc., 2021a ).

Abiko Y (2020) Shingata korona kannsennsha no todoufukenbetusaino keizaitekihaikei (in japanese). Ikoma J Econ. 19:17–32

Google Scholar  

Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD (2020) How will country-based mitigation measures influence the course of the Covid-19 epidemic? Lancet 395:931–934

Article   PubMed   PubMed Central   CAS   Google Scholar  

Arenas-Arroyo E, Fernandez-Kranz D, Nollenberger N (2021) Intimate partner violence under forced cohabitation and economic stress: evidence from the Covid-19 pandemic. J Public Econ 194:104350

Article   PubMed   Google Scholar  

Armbruster S, Klotzbücher V (2020) Lost in lockdown? Covid-19, social distancing, and mental health in Germany. Technical report, Diskussionsbeiträge

Banks J, Fancourt D, and Xu X (2021) Mental health and the Covid-19 pandemic. World Happiness Report 2021 , 24

Beck MJ, Hensher DA (2020) Insights into the impact of Covid-19 on household travel and activities in Australia—the early days of easing restrictions. Transport Policy 99:95–119

Article   PubMed   PubMed Central   Google Scholar  

Bloom N, Han R, and Liang J (2022) How hybrid working from home works out. Technical report, National Bureau of Economic Research

Brodeur A, Clark AE, Fleche S, Powdthavee N (2021) Covid-19, lockdowns and well-being: evidence from Google trends. J Public Economics 193:104346

Article   Google Scholar  

Brooks SK (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 395:912–920

Bruine de Bruin W (2021) Age differences in Covid-19 risk perceptions and mental health: evidence from a national us survey conducted in March 2020. J Gerontol: Ser B 76:e24–e29

Buomprisco G, Ricci S, Perri R, De Sio S (2021) Health and telework: new challenges after covid-19 pandemic. Eur J Environ Public Health 5:em0073

Cabinet Office (2020) Survey on changes in lifestyle awareness and behavior under the influence of Covid-19 infection (in Japanese). https://www5.cao.go.jp/keizai2/wellbeing/covid/index.html Accessed 19 Jul 2022

Clair R, Gordon M, Kroon M, Reilly C (2021) The effects of social isolation on well-being and life satisfaction during pandemic. Hum Soc Sci Commun 8:1–6

Commission on Measuring Well-being, J (2011) Measuring national well-being:-proposed well-being indicators

Dowd JB (2020) Demographic science aids in understanding the spread and fatality rates of COVID-19. Proc Natl Acad Sci 117:9696–9698

Article   ADS   PubMed   PubMed Central   CAS   Google Scholar  

Foa RS, Fabian M, Gilbert S (2022) Subjective well-being during the 2020–21 global coronavirus pandemic: evidence from high-frequency time series data. PloS One 17:e0263570

Galdiolo S, Culot S, Delannoy P, Mauroy A, Laforgue F, Gaugue J (2022) Harmful stress-related couple processes during the COVID-19 pandemic and lockdown: a longitudinal dyadic perspective. Front Psychol 13:819874

Helliwell JF, Layard R, Sachs JD, and Neve J-ED (2021) World Happiness Report 2021

Hensher DA, Beck MJ (2023) Exploring how worthwhile the things that you do in life are during covid-19 and links to well-being and working from home. Transport Res Part A: Policy Pract 168:103579

Hensher DA, Beck MJ, Balbontin C (2022) Time allocation of reduced commuting time during COVID-19 under working from home. J Transport Econ Policy 56:399–428

Katafuchi Y, Kurita K, Managi S (2021) Covid-19 with stigma: theory and evidence from mobility data. Econ Disasters Clim Change 5:71–95

Klaiber P, Wen JH, DeLongis A, Sin NL (2021) The ups and downs of daily life during COVID-19: age differences in affect, stress, and positive events. J Gerontol: Ser B 76:e30–e37

Mann S, Holdsworth L (2003) The psychological impact of teleworking: stress, emotions and health. New Technol Work Employ 18:196–211

Ministry of Health Labour and Welfare, Japan (2021) Annual health labour and welfare report 2021 (in Japanese)

Mizuno T (2020) Visualizing social and behaviour. http://research.nii.ac.jp/~mizuno/ Accessed 19 Jul 2022

NEXER Inc (2021a) 43.4% of respondents were “opposed" to the lifting of the state of emergency declaration by Tokyo and three other prefectures (in japanese). https://trend-research.jp/7679/ Accessed 19 Jul 2022

NEXER Inc. (2021b) Second declaration of a state of emergency: 72.5% of respondents “agree", some say it is “too late" (in Japanese). https://trend-research.jp/6455/ Accessed 19 Jul 2022

OECD (2022) Better life index. https://www.oecdbetterlifeindex.org/ Accessed 19 Jul 2022

Ookita T (2022) Nihon no covid-19 taisaku ni tsuite: houtekikihan no kentou (in Japanese). Rinrigakukenkyu 52(14)

Prati G, Mancini AD (2021) The psychological impact of COVID-19 pandemic lockdowns: a review and meta-analysis of longitudinal studies and natural experiments. Psychol Med. 51:201–211

Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y (2020) A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatry 33(2)

Randall AK (2022) Coping with global uncertainty: perceptions of COVID-19 psychological distress, relationship quality, and dyadic coping for romantic partners across 27 countries. J Soc Person Relationsh 39:3–33

Reger MA, Stanley IH, Joiner TE (2020) Suicide mortality and coronavirus disease 2019–a perfect storm? JAMA Psychiatry 77:1093–1094

Schokkenbroek JM, Hardyns W, Anrijs S, Ponnet K (2021) Partners in lockdown: relationship stress in men and women during the Covid-19 pandemic. Couple Fam Psychol: Res Practice 10(3):149

Song Y, Gao J (2020) Does telework stress employees out? A study on working at home and subjective well-being for wage/salary workers. J Happiness Stud 21:2649–2668

The Asahi Shimbun (2020) Why did the second wave of Covid-19 decay? (in Japanese). https://www.asahi.com/articles/ASN995GMKN98ULZU01H.html Accessed 19 Jul 2022

The Chunichi Shimbun (2020) Readers’ survey on “declaration of state of emergency to be expanded nationwide" 84% in favor (in Japanese). https://www.chunichi.co.jp/article/42877 Accessed 19 Jul 2022

Trzebiński J, Cabański M, Czarnecka JZ (2020) Reaction to the COVID-19 pandemic: the influence of meaning in life, life satisfaction, and assumptions on world orderliness and positivity. J Loss Trauma 25:544–557

Tsurumi T, Imauji A, Managi S (2019) Relative income, community attachment and subjective well-being: evidence from Japan. Kyklos 72:152–182

Tull MT (2020) Psychological outcomes associated with stay-at-home orders and the perceived impact of COVID-19 on daily life. Psychiatry Res 289:113098

Uchida Y, Kitayama S (2009) Happiness and unhappiness in East and West: themes and variations. Emotion 9:441

Uchida Y, Norasakkunkit V, Kitayama S (2004) Cultural constructions of happiness: theory and empirical evidence. J Happiness Stud 5:223–239

Ura K, Alkire S, Zangmo T, and Wangdi K (2012) A short guide to gross national happiness index . The Centre for Bhutan Studies

Wenham C, Smith J, Morgan R (2020) Covid-19: the gendered impacts of the outbreak. Lancet 395:846–848

World Health Organization (2020a) Statement on the second meeting of the International Health Regulations (2005) emergency committee regarding the outbreak of novel coronavirus (2019-ncov). https://www.who.int/news/item/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov) Accessed 19 Jul 2022

World Health Organization (2020b) Who director-general’s opening remarks at the media briefing on COVID-19 11 March 2020. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 Accessed 19 Jul 2022

Zacher H, Rudolph CW (2021) Individual differences and changes in subjective wellbeing during the early stages of the covid-19 pandemic. Am Psychol 76:50

Zhang J (2020) The differential psychological distress of populations affected by the Covid-19 pandemic. Brain Behav Immunity 87:49

Article   CAS   Google Scholar  

Download references

Acknowledgements

This work was supported by JSPS KAKENHI Grant Numbers 19K15114, 23K04077.

Author information

Authors and affiliations.

Faculty of Engineering and Design, Kagawa University, 2217-20 Hayashi-cho, Takamatsu, Kagawa, 761-0396, Japan

Tetsuya Tamaki

Department of Economics, Fukuoka University, 8-19-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan

Wataru Nozawa

Faculty of Arts and Science, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan

Akinori Kitsuki

You can also search for this author in PubMed   Google Scholar

Contributions

T.T. designed the study, the main conceptual ideas, and the proof outline. T.T., W.N., and A.K. designed the survey and collected the data. T.T., W.N., and A.K. aided in interpreting the results and worked on the manuscript. T.T. wrote the manuscript. T.T., W.N., and A.K. discussed the results and commented on the manuscript.

Corresponding author

Correspondence to Tetsuya Tamaki .

Ethics declarations

Competing interests.

The authors declare no competing interests.

Ethical approval

The research related to human use has been complied with all the relevant national regulations, institutional policies and in accordance the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

Informed consent

Informed consent has been obtained from all individuals included in this study.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Supplemental material, rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Tamaki, T., Nozawa, W. & Kitsuki, A. How did you perceive the lifestyle changes caused by the COVID-19 pandemic?. Humanit Soc Sci Commun 11 , 70 (2024). https://doi.org/10.1057/s41599-023-02530-z

Download citation

Received : 01 June 2023

Accepted : 11 December 2023

Published : 06 January 2024

DOI : https://doi.org/10.1057/s41599-023-02530-z

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

• Tuition & Fees
• Admissions Requirements
• Academic Calendar
• Transcripts

How to Stay Healthy During a Pandemic

Touro pharmacy professor shares the truth about supplements and how to keep your immune system in top shape.

Vitamins. Exercise. Sunlight. As the COVID-19 pandemic continues, many people are desperate to boost their immune system in hopes of avoiding the illness or lessen its devastating impact. But supplements aren’t always safe and can have adverse side effects. Before you pop another Vitamin D, Touro College of Pharmacy professor Roman Fazylov, Pharm.D., BCPS, explains what you need to know about the immune system and how to keep yourself healthy.

Everyone is talking about the need to boost the immune system during the pandemic. How exactly does that work?

The immune system is complex and not yet fully understood by modern day science. It functions on a variety of levels to accomplish the ultimate function of protecting our body from physical foreign objects. The term “boost immune system” being used widely in the wake of the COVID-19 pandemic is misleading and not based in science. In general, the best way to support your immune system is to live a healthy lifestyle, which provides your immune cells with the proper nutrients and environment for optimal function. Healthy ways to strengthen your immune system include:

• Limited alcohol
• Lots of fruits and vegetables
• Avoid saturated fats and starchy carbohydrates
• Exercise regularly
• Maintain a healthy weight
• Get adequate sleep (8 hours/night)
• Minimize stress
• Talk to your physician to ensure adequate levels of vitamin D, electrolytes and trace metals

Which vitamins/supplements would you recommend and at what dosage?

Unfortunately, there are no vitamins or supplements that can be recommended for the purposes of “boosting immune” function. In general, people should take vitamins only if they have a deficiency through their diet or other sources. Specifically, Vitamins A, E, D or K should be taken if patients have a proven deficiency or are preventing a deficiency from recurring. The reason being is that these vitamins have a risk of overdose with serious adverse effects; therefore, their levels should be monitored via blood level testing at pre-determined intervals and dosing should be patient-specific. On the other hand, B-Complex, Vitamin C or Omega-3 fatty acids can be taken if there is a deficiency from dietary sources. Patients can consult their specific case with a nutritionist, physician or pharmacist for solutions tailored to them with the goal of maintaining adequate amounts of necessary vitamins/minerals and trace elements for optimal immune function.

Do these vitamins help prevent COVID? Are they useful for people suffering from COVID? Can they prevent a secondary infection?

There are no vitamins or supplements that can prevent COVID-19. The best prevention methods are those that have been outlined by the CDC. Maintain social distancing; wash your hands frequently with soap and water; and cover your mouth and nose with a mask when around others. Some experts suggest taking Vitamin C 200 mg daily to prevent COVID-19 and other respiratory tract infections, or 1-2 grams daily at the onset of symptoms to improve recovery. These doses are likely safe in most adults, but there is no strong evidence to support the effectiveness of Vitamin C for COVID-19. There is also no strong evidence supporting other herbs and supplements for COVID-19 such as elderberry, echinacea or zinc.

Can supplements have adverse effects? Please explain.

Supplements are most definitely associated with adverse effects. Many herbs and supplements have potentially significant drug-drug or drug-food interactions that may cause harm to patients. To get specific information on herbs or supplements, be sure to seek counsel with a trained professional such as a physician or pharmacist or you can seek guidance from a reference known as the Natural Medicines Comprehensive Database.

• COVID-19 and your mental health

Worries and anxiety about COVID-19 can be overwhelming. Learn ways to cope as COVID-19 spreads.

At the start of the COVID-19 pandemic, life for many people changed very quickly. Worry and concern were natural partners of all that change — getting used to new routines, loneliness and financial pressure, among other issues. Information overload, rumor and misinformation didn't help.

Worldwide surveys done in 2020 and 2021 found higher than typical levels of stress, insomnia, anxiety and depression. By 2022, levels had lowered but were still higher than before 2020.

Though feelings of distress about COVID-19 may come and go, they are still an issue for many people. You aren't alone if you feel distress due to COVID-19. And you're not alone if you've coped with the stress in less than healthy ways, such as substance use.

But healthier self-care choices can help you cope with COVID-19 or any other challenge you may face.

And knowing when to get help can be the most essential self-care action of all.

Recognize what's typical and what's not

Stress and worry are common during a crisis. But something like the COVID-19 pandemic can push people beyond their ability to cope.

In surveys, the most common symptoms reported were trouble sleeping and feeling anxiety or nervous. The number of people noting those symptoms went up and down in surveys given over time. Depression and loneliness were less common than nervousness or sleep problems, but more consistent across surveys given over time. Among adults, use of drugs, alcohol and other intoxicating substances has increased over time as well.

The first step is to notice how often you feel helpless, sad, angry, irritable, hopeless, anxious or afraid. Some people may feel numb.

Keep track of how often you have trouble focusing on daily tasks or doing routine chores. Are there things that you used to enjoy doing that you stopped doing because of how you feel? Note any big changes in appetite, any substance use, body aches and pains, and problems with sleep.

These feelings may come and go over time. But if these feelings don't go away or make it hard to do your daily tasks, it's time to ask for help.

Get help when you need it

If you're feeling suicidal or thinking of hurting yourself, seek help.

• Contact your healthcare professional or a mental health professional.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline , available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential.

If you are worried about yourself or someone else, contact your healthcare professional or mental health professional. Some may be able to see you in person or talk over the phone or online.

You also can reach out to a friend or loved one. Someone in your faith community also could help.

And you may be able to get counseling or a mental health appointment through an employer's employee assistance program.

Another option is information and treatment options from groups such as:

• National Alliance on Mental Illness (NAMI).
• Substance Abuse and Mental Health Services Administration (SAMHSA).
• Anxiety and Depression Association of America.

Self-care tips

Some people may use unhealthy ways to cope with anxiety around COVID-19. These unhealthy choices may include things such as misuse of medicines or legal drugs and use of illegal drugs. Unhealthy coping choices also can be things such as sleeping too much or too little, or overeating. It also can include avoiding other people and focusing on only one soothing thing, such as work, television or gaming.

Unhealthy coping methods can worsen mental and physical health. And that is particularly true if you're trying to manage or recover from COVID-19.

Self-care actions can help you restore a healthy balance in your life. They can lessen everyday stress or significant anxiety linked to events such as the COVID-19 pandemic. Self-care actions give your body and mind a chance to heal from the problems long-term stress can cause.

Take care of your body

Healthy self-care tips start with the basics. Give your body what it needs and avoid what it doesn't need. Some tips are:

• Get the right amount of sleep for you. A regular sleep schedule, when you go to bed and get up at similar times each day, can help avoid sleep problems.
• Move your body. Regular physical activity and exercise can help reduce anxiety and improve mood. Any activity you can do regularly is a good choice. That may be a scheduled workout, a walk or even dancing to your favorite music.
• Choose healthy food and drinks. Foods that are high in nutrients, such as protein, vitamins and minerals are healthy choices. Avoid food or drink with added sugar, fat or salt.
• Avoid tobacco, alcohol and drugs. If you smoke tobacco or if you vape, you're already at higher risk of lung disease. Because COVID-19 affects the lungs, your risk increases even more. Using alcohol to manage how you feel can make matters worse and reduce your coping skills. Avoid taking illegal drugs or misusing prescriptions to manage your feelings.

Take care of your mind

Healthy coping actions for your brain start with deciding how much news and social media is right for you. Staying informed, especially during a pandemic, helps you make the best choices but do it carefully.

Set aside a specific amount of time to find information in the news or on social media, stay limited to that time, and choose reliable sources. For example, give yourself up to 20 or 30 minutes a day of news and social media. That amount keeps people informed but not overwhelmed.

For COVID-19, consider reliable health sources. Examples are the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).

Other healthy self-care tips are:

• Relax and recharge. Many people benefit from relaxation exercises such as mindfulness, deep breathing, meditation and yoga. Find an activity that helps you relax and try to do it every day at least for a short time. Fitting time in for hobbies or activities you enjoy can help manage feelings of stress too.
• Stick to your health routine. If you see a healthcare professional for mental health services, keep up with your appointments. And stay up to date with all your wellness tests and screenings.
• Stay in touch and connect with others. Family, friends and your community are part of a healthy mental outlook. Together, you form a healthy support network for concerns or challenges. Social interactions, over time, are linked to a healthier and longer life.

Avoid stigma and discrimination

Stigma can make people feel isolated and even abandoned. They may feel sad, hurt and angry when people in their community avoid them for fear of getting COVID-19. People who have experienced stigma related to COVID-19 include people of Asian descent, health care workers and people with COVID-19.

Treating people differently because of their medical condition, called medical discrimination, isn't new to the COVID-19 pandemic. Stigma has long been a problem for people with various conditions such as Hansen's disease (leprosy), HIV, diabetes and many mental illnesses.

People who experience stigma may be left out or shunned, treated differently, or denied job and school options. They also may be targets of verbal, emotional and physical abuse.

Communication can help end stigma or discrimination. You can address stigma when you:

• Get to know people as more than just an illness. Using respectful language can go a long way toward making people comfortable talking about a health issue.
• Get the facts about COVID-19 or other medical issues from reputable sources such as the CDC and WHO.
• Speak up if you hear or see myths about an illness or people with an illness.

COVID-19 and health

The virus that causes COVID-19 is still a concern for many people. By recognizing when to get help and taking time for your health, life challenges such as COVID-19 can be managed.

• Mental health during the COVID-19 pandemic. National Institutes of Health. https://covid19.nih.gov/covid-19-topics/mental-health. Accessed March 12, 2024.
• Mental Health and COVID-19: Early evidence of the pandemic's impact: Scientific brief, 2 March 2022. World Health Organization. https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1. Accessed March 12, 2024.
• Mental health and the pandemic: What U.S. surveys have found. Pew Research Center. https://www.pewresearch.org/short-reads/2023/03/02/mental-health-and-the-pandemic-what-u-s-surveys-have-found/. Accessed March 12, 2024.
• Taking care of your emotional health. Centers for Disease Control and Prevention. https://emergency.cdc.gov/coping/selfcare.asp. Accessed March 12, 2024.
• #HealthyAtHome—Mental health. World Health Organization. www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome---mental-health. Accessed March 12, 2024.
• Coping with stress. Centers for Disease Control and Prevention. www.cdc.gov/mentalhealth/stress-coping/cope-with-stress/. Accessed March 12, 2024.
• Manage stress. U.S. Department of Health and Human Services. https://health.gov/myhealthfinder/topics/health-conditions/heart-health/manage-stress. Accessed March 20, 2020.
• COVID-19 and substance abuse. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/covid-19-substance-use#health-outcomes. Accessed March 12, 2024.
• COVID-19 resource and information guide. National Alliance on Mental Illness. https://www.nami.org/Support-Education/NAMI-HelpLine/COVID-19-Information-and-Resources/COVID-19-Resource-and-Information-Guide. Accessed March 15, 2024.
• Negative coping and PTSD. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/gethelp/negative_coping.asp. Accessed March 15, 2024.
• Health effects of cigarette smoking. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm#respiratory. Accessed March 15, 2024.
• People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed March 15, 2024.
• Your healthiest self: Emotional wellness toolkit. National Institutes of Health. https://www.nih.gov/health-information/emotional-wellness-toolkit. Accessed March 15, 2024.
• World leprosy day: Bust the myths, learn the facts. Centers for Disease Control and Prevention. https://www.cdc.gov/leprosy/world-leprosy-day/. Accessed March 15, 2024.
• HIV stigma and discrimination. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/basics/hiv-stigma/. Accessed March 15, 2024.
• Diabetes stigma: Learn about it, recognize it, reduce it. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/features/diabetes_stigma.html. Accessed March 15, 2024.
• Phelan SM, et al. Patient and health care professional perspectives on stigma in integrated behavioral health: Barriers and recommendations. Annals of Family Medicine. 2023; doi:10.1370/afm.2924.
• Stigma reduction. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/od2a/case-studies/stigma-reduction.html. Accessed March 15, 2024.
• Nyblade L, et al. Stigma in health facilities: Why it matters and how we can change it. BMC Medicine. 2019; doi:10.1186/s12916-019-1256-2.
• Combating bias and stigma related to COVID-19. American Psychological Association. https://www.apa.org/topics/covid-19-bias. Accessed March 15, 2024.
• Yashadhana A, et al. Pandemic-related racial discrimination and its health impact among non-Indigenous racially minoritized peoples in high-income contexts: A systematic review. Health Promotion International. 2021; doi:10.1093/heapro/daab144.
• Sawchuk CN (expert opinion). Mayo Clinic. March 25, 2024.

Products and Services

• A Book: Endemic - A Post-Pandemic Playbook
• Begin Exploring Women's Health Solutions at Mayo Clinic Store
• A Book: Future Care
• Antibiotics: Are you misusing them?
• COVID-19 and vitamin D
• Convalescent plasma therapy
• Coronavirus disease 2019 (COVID-19)
• COVID-19: How can I protect myself?
• Herd immunity and respiratory illness
• COVID-19 and pets
• COVID-19 antibody testing
• COVID-19, cold, allergies and the flu
• COVID-19 tests
• COVID-19 drugs: Are there any that work?
• COVID-19 in babies and children
• Coronavirus infection by race
• COVID-19 travel advice
• COVID-19 vaccine: Should I reschedule my mammogram?
• COVID-19 vaccines for kids: What you need to know
• COVID-19 vaccines
• COVID-19 variant
• COVID-19 vs. flu: Similarities and differences
• COVID-19: Who's at higher risk of serious symptoms?
• Debunking coronavirus myths
• Different COVID-19 vaccines
• Extracorporeal membrane oxygenation (ECMO)
• Fever: First aid
• Fever treatment: Quick guide to treating a fever
• Fight coronavirus (COVID-19) transmission at home
• Honey: An effective cough remedy?
• How do COVID-19 antibody tests differ from diagnostic tests?
• How to measure your respiratory rate
• How to take your pulse
• How to take your temperature
• How well do face masks protect against COVID-19?
• Is hydroxychloroquine a treatment for COVID-19?
• Long-term effects of COVID-19
• Loss of smell
• Mayo Clinic Minute: You're washing your hands all wrong
• Mayo Clinic Minute: How dirty are common surfaces?
• Multisystem inflammatory syndrome in children (MIS-C)
• Nausea and vomiting
• Pregnancy and COVID-19
• Safe outdoor activities during the COVID-19 pandemic
• Safety tips for attending school during COVID-19
• Sex and COVID-19
• Shortness of breath
• Thermometers: Understand the options
• Treating COVID-19 at home
• Unusual symptoms of coronavirus
• Vaccine guidance from Mayo Clinic
• Watery eyes

Related information

• Mental health: What's normal, what's not - Related information Mental health: What's normal, what's not
• Mental illness - Related information Mental illness

5X Challenge

Thanks to generous benefactors, your gift today can have 5X the impact to advance AI innovation at Mayo Clinic.

Seven short essays about life during the pandemic

The boston book festival's at home community writing project invites area residents to describe their experiences during this unprecedented time..

My alarm sounds at 8:15 a.m. I open my eyes and take a deep breath. I wiggle my toes and move my legs. I do this religiously every morning. Today, marks day 74 of staying at home.

My mornings are filled with reading biblical scripture, meditation, breathing in the scents of a hanging eucalyptus branch in the shower, and making tea before I log into my computer to work. After an hour-and-a-half Zoom meeting, I decided to take a long walk to the post office and grab a fresh bouquet of burnt orange ranunculus flowers. I embrace the warm sun beaming on my face. I feel joy. I feel at peace.

I enter my apartment and excessively wash my hands and face. I pour a glass of iced kombucha. I sit at my table and look at the text message on my phone. My coworker writes that she is thinking of me during this difficult time. She must be referring to the Amy Cooper incident. I learn shortly that she is not.

Advertisement

I Google Minneapolis and see his name: George Floyd. And just like that a simple and beautiful day transitions into a day of sorrow.

Nakia Hill, Boston

It was a wobbly, yet solemn little procession: three masked mourners and a canine. Beginning in Kenmore Square, at David and Sue Horner’s condo, it proceeded up Commonwealth Avenue Mall.

S. Sue Horner died on Good Friday, April 10, in the Year of the Virus. Sue did not die of the virus but her parting was hemmed by it: no gatherings to mark the passing of this splendid human being.

David devised a send-off nevertheless. On April 23rd, accompanied by his daughter and son-in-law, he set out for Old South Church. David led, bearing the urn. His daughter came next, holding her phone aloft, speaker on, through which her brother in Illinois played the bagpipes for the length of the procession, its soaring thrum infusing the Mall. Her husband came last with Melon, their golden retriever.

I unlocked the empty church and led the procession into the columbarium. David drew the urn from its velvet cover, revealing a golden vessel inset with incandescent tiles. We lifted the urn into the niche, prayed, recited Psalm 23, and shared some words.

It was far too small for the luminous “Dr. Sue”, but what we could manage in the Year of the Virus.

Nancy S. Taylor, Boston

On April 26, 2020, our household was a bustling home for four people. Our two sons, ages 18 and 22, have a lot of energy. We are among the lucky ones. I can work remotely. Our food and shelter are not at risk.

As I write this a week later, it is much quieter here.

On April 27, our older son, an EMT, transported a COVID-19 patient to the ER. He left home to protect my delicate health and became ill with the virus a week later.

On April 29, my husband’s 95-year-old father had a stroke. My husband left immediately to be with his 90-year-old mother near New York City and is now preparing for his father’s discharge from the hospital. Rehab people will come to the house; going to a facility would be too dangerous.

My husband just called me to describe today’s hospital visit. The doctors had warned that although his father had regained the ability to speak, he could only repeat what was said to him.

“It’s me,” said my husband.

“It’s me,” said my father-in-law.

“I love you,” said my husband.

“I love you,” said my father-in-law.

“Sooooooooo much,” said my father-in-law.

Lucia Thompson, Wayland

Would racism exist if we were blind?

I felt his eyes bore into me as I walked through the grocery store. At first, I thought nothing of it. With the angst in the air attributable to COVID, I understood the anxiety-provoking nature of feeling as though your 6-foot bubble had burst. So, I ignored him and maintained my distance. But he persisted, glaring at my face, squinting to see who I was underneath the mask. This time I looked back, when he yelled, in my mother tongue, for me to go back to my country.

In shock, I just laughed. How could he tell what I was under my mask? Or see anything through the sunglasses he was wearing inside? It baffled me. I laughed at the irony that he would use my own language against me, that he knew enough to guess where I was from in some version of culturally competent racism. I laughed because dealing with the truth behind that comment generated a sadness in me that was too much to handle. If not now, then when will we be together?

So I ask again, would racism exist if we were blind?

Faizah Shareef, Boston

My Family is “Out” There

But I am “in” here. Life is different now “in” Assisted Living since the deadly COVID-19 arrived. Now the staff, employees, and all 100 residents have our temperatures taken daily. Everyone else, including my family, is “out” there. People like the hairdresser are really missed — with long straight hair and masks, we don’t even recognize ourselves.

Since mid-March we are in quarantine “in” our rooms with meals served. Activities are practically non-existent. We can sit on the back patio 6 feet apart, wearing masks, do exercises there, chat, and walk nearby. Nothing inside. Hopefully June will improve.

My family is “out” there — somewhere! Most are working from home (or Montana). Hopefully an August wedding will happen, but unfortunately, I may still be “in” here.

From my window I wave to my son “out” there. Recently, when my daughter visited, I opened the window “in” my second-floor room and could see and hear her perfectly “out” there. Next time she will bring a chair so we can have an “in” and “out” conversation all day, or until we run out of words.

Barbara Anderson, Raynham

My boyfriend Marcial lives in Boston, and I live in New York City. We had been doing the long-distance thing pretty successfully until coronavirus hit. In mid-March, I was furloughed from my temp job, Marcial began working remotely, and New York started shutting down. I went to Boston to stay with Marcial.

We are opposites in many ways, but we share a love of food. The kitchen has been the center of quarantine life —and also quarantine problems.

Marcial and I have gone from eating out and cooking/grocery shopping for each other during our periodic visits to cooking/grocery shopping with each other all the time. We’ve argued over things like the proper way to make rice and what greens to buy for salad. Our habits are deeply rooted in our upbringing and individual cultures (Filipino immigrant and American-born Chinese, hence the strong rice opinions).

On top of the mundane issues, we’ve also dealt with a flooded kitchen (resulting in cockroaches) and a mandoline accident leading to an ER visit. Marcial and I have spent quarantine navigating how to handle the unexpected and how to integrate our lifestyles. We’ve been eating well along the way.

Melissa Lee, Waltham

It’s 3 a.m. and my dog Rikki just gave me a worried look. Up again?

“I can’t sleep,” I say. I flick the light, pick up “Non-Zero Probabilities.” But the words lay pinned to the page like swatted flies. I watch new “Killing Eve” episodes, play old Nathaniel Rateliff and The Night Sweats songs. Still night.

We are — what? — 12 agitated weeks into lockdown, and now this. The thing that got me was Chauvin’s sunglasses. Perched nonchalantly on his head, undisturbed, as if he were at a backyard BBQ. Or anywhere other than kneeling on George Floyd’s neck, on his life. And Floyd was a father, as we all now know, having seen his daughter Gianna on Stephen Jackson’s shoulders saying “Daddy changed the world.”

Precious child. I pray, safeguard her.

Rikki has her own bed. But she won’t leave me. A Goddess of Protection. She does that thing dogs do, hovers increasingly closely the more agitated I get. “I’m losing it,” I say. I know. And like those weighted gravity blankets meant to encourage sleep, she drapes her 70 pounds over me, covering my restless heart with safety.

As if daybreak, or a prayer, could bring peace today.

Kirstan Barnett, Watertown

Until June 30, send your essay (200 words or less) about life during COVID-19 via bostonbookfest.org . Some essays will be published on the festival’s blog and some will appear in The Boston Globe.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Int J Environ Res Public Health

Eating Behaviour Changes during the COVID-19 Pandemic: A Systematic Review of Longitudinal Studies

Associated data.

Not aplicable.

Eating behaviour is a complex construct that is liable to be modified by external factors. Due to the outbreak of coronavirus disease 2019 (COVID-19), many restrictive measures were carried out with the aim of reducing the impact of this disease. As a result, lifestyles were disrupted, which could affect eating behaviours. The aim of this systematic review of longitudinal studies was to assess changes in eating behaviour during the COVID-19 pandemic by establishing a comparison of eating behaviours before and after the outbreak of the pandemic. This study followed the PRISMA guidelines (PROSPERO: CRD42020203246), whereas to assess the quality of the studies, the Newcastle-Ottawa Quality Assessment Scale (NOS) was applied. Out of a set of 826 studies, 23 were included in this systematic review. The main findings provided information about a shift towards modified eating behaviours, characterized by an increased snack frequency and a preference for sweets and ultra-processed food rather than fruits, vegetables, and fresh food. Additionally, an increased alcohol consumption was found among different countries. Consequently, adherence to healthy diets decreased. These findings are relevant to future policies and strategies to assess nutrition in cases of alarming situations such as the current COVID-19 pandemic.

1. Introduction

The appearance of coronavirus disease 2019 (COVID-19), an infectious disease caused by a coronavirus [ 1 ], has led to serious changes worldwide from late 2019 to the present day. Not only relationship patterns but also lifestyle habits have changed due to lockdown conditions, social distancing, reduced capacity in enclosed spaces and curfews proposed by governments. Although the aim of this measure was to fight the spread of the pandemic, the impact on daily life has been immense [ 2 , 3 ]. Since the first wave of the COVID-19 pandemic, many governments have ordered their population to stay at home while following security measures. As a result, people from many countries had to eat all of their meals at home while adapting their physical activity indoors due to not being allowed to go to public places or even to the gym [ 4 , 5 ]. In other cases, lifestyle habits suffered abrupt changes due to a lack of social services such as school cantines [ 6 ], and food insecurity [ 7 ]. As a result, eating behaviours could change across age groups [ 8 , 9 , 10 ].

Eating behaviours may be defined as food choices that are moderated by consumption trends, personal preferences, specific diets and calorie counting [ 11 , 12 ]. Regarding this definition, some cross-sectional studies have been carried out since the outbreak of the pandemic with the aim of achieving this objective [ 8 , 9 , 10 , 13 , 14 , 15 , 16 , 17 ]. However, as cross-sectional studies cannot identify differences in eating behaviour in comparison to previous baselines before the pandemic, bias can appear when trying to interpret the results [ 18 , 19 , 20 , 21 , 22 ]. This limitation appears to have been solved by summarizing the information in a few systematic reviews that have been carried out with the aim of exploring the impact of the pandemic on weight-related behaviours that include not only eating behaviours but also politics affecting the food supply and the health consequences in terms of nutritional status [ 18 , 19 , 20 , 21 , 22 ]. In this sense, a wide range of eating patterns that include both food restriction and loss of control over eating have been found, especially when analysing unhealthy food consumption [ 19 , 20 ]. This information remains relevant for people without comorbidities but also for vulnerable groups such as the older population and people with obesity that have experienced more acute changes in their eating behaviour [ 21 , 22 ].

Specifically, it has been found that the COVID-19 pandemic has had a global impact on daily diet among adults [ 19 ]. Although it has not been possible to establish a correlation between weight gain and changes on eating behaviour, an increased appetite accompanied by a higher consumption of snacks and a greater number of daily meals have been found. In the case of children, results appear to point at similar conclusions as the closure of school canteens has affected many families [ 6 ]. This situation has worsened the quality of diet in families with little resources as well as in families in which all members were workers. Finally, regarding dependent persons such as the elderly, people with morbid obesity and people with other type of disabilities, scientific evidence has linked preventive measures of physical contact restriction to changes in eating behaviour. Those changes have been associated to a significant decline in health nutrition [ 20 ].

This panorama has been worse in developing countries, where the outbreak of the COVID-19 pandemic has enhanced the need of proper define ‘food security’. Although apparently there was ‘availability’ and ‘accessibility’ to food supplies, many developing countries had no adequate supply chains. Consequently, families were not properly supplied with food, so they had to change their eating behaviours, which, in turn, contributed to a decline in health nutrition [ 7 ]. It is important to establish this dichotomy when talking about ‘eating behaviour changes during the COVID-19 pandemic’ because decision making about food may be motivated by different reasons, although the outbreak of the COVID-19 pandemic primarily triggered those changes.

In light of the above, the results suggest the need to properly understand the changes in eating behaviour that occurred during the development of the COVID-19 pandemic by focusing on longitudinal studies that can address changes by establishing comparisons before and after the outbreak of the pandemic. Therefore, the main objective of this study was to undertake a systematic review from September 2019 to July 2021 to evaluate eating behaviour changes, taking into account the following research question: which changes have occurred in eating behaviour during the COVID-19 pandemic? It is expected to produce an accurate description of those changes to better understand their consequences. These findings remain relevant to future policies and strategies to assess nutrition in cases of alarming situations such as the current COVID-19 pandemic.

2. Materials and Methods

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 23 ]. Additionally, it was registered in the International Prospective Register of Systematic Reviews database (PROSPERO) (registration number CRD42020203246).

2.1. Search Strategy

The search strategy was defined by establishing the research question as well as the inclusion and exclusion criteria according to the PICO (Population/Participants, Intervention, Comparison and Outcomes) model [ 24 ], as shown in Table 1 .

Inclusion and Exclusion Criteria.

The search was first piloted in the PubMed database on 27 July 2021 (as shown in Table 2 ) and filtered since 31 December 2019. Then, it was replicated in three other databases: Cochrane Library, PsycInfo and Web of Science. Then, two clusters of search terms were designed. The first included terms related to COVID-19, while the second was related to eating behaviour changes. To develop a representative advanced search, the selected words were chosen from the Medical Subject Headings (MeSH) thesaurus. Additionally, lists of references from previous studies that were selected as representative of this review were examined.

Search Strategy in PubMed.

2.2. Study Selection Process

This systematic review comprised 3 main steps. First, duplicated content was identified and deleted. Second, by following the inclusion/exclusion criteria, the studies were reviewed by title/abstract. Finally, those that passed the screening were reviewed by a full-text reading. All of these steps were conducted independently by two reviewers, and in cases of disagreement, a third reviewer was assigned to resolve any discrepancies. The inter-agreement of the total selection between reviewers was almost perfect [ 25 ] (Cohen Kappa Index = 0.85; 95% CI, 0.49 to 1.00).

3.1. Study Selection

The search strategy led to a set of 816 studies. In addition, 10 studies were identified after examining the lists of references from the representative studies. Consequently, the first stage of the revision gathered 826 studies. Of those, 106 studies met the inclusion criteria under the title/abstract review. After a full-text reading, 83 studies were removed due to not meeting the inclusion criteria. Thus, 23 studies passed the screening process, which led to the next phase. The screening process is summarized in Figure 1 .

PRISMA flow diagram of the included and excluded studies throughout the systematic review protocol.

3.2. Study Characteristics

The characteristics of the selected studies are summarized in Table 3 . The variables are taken for in-depth analysis from the paragraphs below.

Characteristics of the included studies.

Note. Design: PS: Prospective Study; RS: Retrospective Study. Sample Size at Baseline (Total n/Female (%)): * Other: Non-binary/ Transgender participants.

3.2.1. Country and Design of the Studies

The twenty-three longitudinal studies included the following countries: India [ 26 ], Australia [ 27 , 28 ], Spain [ 29 , 30 ], Italy [ 31 , 32 , 33 , 34 , 35 ], Brazil [ 36 ], France [ 37 ], China [ 38 , 39 , 40 , 41 ], the United States [ 42 ], Canada [ 43 ], Poland [ 44 ], the United Kingdom [ 45 , 46 ] and Japan [ 47 , 48 ].

Twelve [ 26 , 27 , 28 , 29 , 30 , 36 , 37 , 42 , 43 , 45 , 46 , 48 ] (50%) were prospective studies, and eleven [ 31 , 32 , 33 , 34 , 35 , 38 , 39 , 40 , 41 , 44 , 47 ] (42.86%) were retrospective studies. Additionally, the length of follow-ups varied between 2 [ 32 , 35 , 47 ] and 54 weeks [ 28 , 42 ].

3.2.2. Target Population

Although studies mainly focused on adult populations over 18 years old with no comorbidities [ 28 , 35 , 36 , 37 , 38 , 42 , 43 , 44 , 46 , 48 ], specific subgroups that might be taken into account were found: people diagnosed with diabetes mellitus [ 26 , 32 , 47 ], young people [ 27 , 29 , 30 , 31 , 34 , 39 , 40 , 41 ], people with obesity [ 33 ] and people in vulnerable situations [ 45 ]. The average of mean ages for twenty-three longitudinal studies was 24.19 years (SD = 15.3).

3.2.3. Sample Size

Due to the differences among the studies, sample sizes varied between 34 [ 47 ] and 37,252 [ 37 ] participants (media n = 4918; IQR 112 to 10,082). However, the experimental mortality was not significant except for one study [ 27 ], which lost almost 44.84% of the participants. In addition, the ratio between males and females was relatively equal, with the exception of five studies in which samples were comprised mainly of females [ 27 , 33 , 36 , 41 , 43 ]. This systematic review evaluated a total of 116,952 participants.

3.2.4. Assessment Tools

All the studies used different recording measures to assess target eating behaviour changes. In this sense, many of them were standardized validated scales, such as the NSW Centre for Public Health Nutrition [ 27 ], The Mediterranean Diet Quality Index for children and teenagers (KIDMED) [ 29 ], the 12-items lifestyle questionnaire [ 31 ], the House hold Dietary Diversity Score (HDDS) [ 38 ], the COVID-19 Impact on Lifestyle Change Survey (COINLICS) [ 39 ], the Diet Screener Questionnaire, the Dietary Questionnaire for Epidemiological Studies (DQUES and diet v3.2; Cancer Council Victoria) [ 28 ], the Food and Beverages Diet frequency questionnaire [ 40 ], the Modified Food frequency Questionnaire (FFQ-6) [ 44 ], and the Mediterranean diet (Med-Diet) questionnaire [ 30 ]; whereas the others used scales that were created for the specific purpose of their research [ 26 , 32 , 33 , 34 , 35 , 36 , 41 , 47 ]. Additionally, self-reports [ 37 , 43 , 45 , 46 ] were used in order to follow eating changes among participants. One study used ecological momentary assessment through the CALO mama health app for this purpose [ 48 ].

3.3. Objectives, Outcomes, and Results

Table 4 summarizes the objectives, outcomes, and results of the studies, as shown below.

Objective, outcomes and results of the included studies.

3.3.1. Objectives

All of the studies had a common objective, assessing eating behaviour changes caused by the COVID-19 pandemic. In this sense, sixteen studies focused on eating behaviour changes during lockdown conditions [ 26 , 29 , 31 , 32 , 33 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 45 , 46 ], while seven studies focused their research into the entire spectrum of the pandemic [ 27 , 28 , 30 , 36 , 44 , 47 , 48 ].

3.3.2. Outcomes

Out of twenty-three studies, eighteen studies pursued eating behaviour as a primary or main outcome [ 27 , 28 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ], while five studies included it as a secondary outcome [ 26 , 29 , 30 , 31 , 41 ].

3.3.3. Results

All of the studies recorded eating behaviour changes during the COVID-19 pandemic in comparison to previous baselines before the pandemic, concluding that there were changes in the type of diet. Two studies found that there were changes in mealtimes [ 26 , 37 ], whereas three reported a more frequent food intake [ 26 , 35 , 39 ] and four an increased amount of food eaten [ 26 , 31 , 46 , 47 ]. In particular, six studies highlighted a greater consumption of snacks [ 33 , 34 , 35 , 41 , 44 , 47 ]. In this sense, five studies established that there was a preference for sweets [ 32 , 33 , 34 , 35 , 44 ] while two concluded that wheat products were more frequently consume after the COVID-19 pandemic [ 39 , 40 ]. In the case of beverages, two studies found a higher daily intake [ 35 , 40 ] while another one reported a decreased intake [ 39 ]. Specifically, for alcohol, six studies reported an increased consumption [ 28 , 38 , 41 , 44 , 45 , 48 ].

Otherwise, four studies reported a decreased consumption of fruit and vegetables [ 39 , 40 , 45 , 48 ], two that there were no substantial changes [ 27 , 31 ], and two that the daily intake got increased [ 30 , 36 ]. Regarding this, three studies found a decreased consumption of fresh food [ 37 , 39 , 40 ] and four other studies reported a higher intake of ultra-processed food [ 35 , 36 , 37 , 47 ]. Meat consumption got decreased according to two studies [ 40 , 42 ], but also got increased regarding three studies [ 30 , 31 , 48 ].

Finally, three studies resolved that negative changes in eating behaviour were found due to a lower adherence to healthy diets [ 29 , 35 , 46 ], meanwhile two reported adherence to healthy diet [ 30 , 43 ] and one study declared no changes in dietary habits just except for a reduction in the amount of meat eaten [ 42 ].

3.4. Quality of Studies

To assess the quality of the studies, the Newcastle-Ottawa Quality Assessment Scale (NOS) [ 49 ] was used. This tool was developed with the aim of being helpful for systematic reviews so that quality criteria can be reached while ensuring a low risk of bias. NOS uses three main categories: selection, comparability and outcome. Each category contains several items about the characteristics of observational studies, each of which includes several answers. Among those answers, at least one is accompanied by a star (☆). As stars symbolize a low risk of bias, once the scale is completed, it is necessary to sum them. If the result is less than 7 stars, there might be a high risk of bias. Additionally, in the case of reviewers selecting answers that do not include a star, it is important to check the possible biases of the study. Therefore, NOS scores might be categorized into three groups: very high risk of bias (0–3 stars), high risk of bias (4–6 stars) and low risk of bias (7–9 stars) [ 50 ].

The quality of each study was evaluated independently by two reviewers. A third reviewer was assigned in case of disagreement. The final consensus is shown in Table 5 .

Quality appraisal studies.

Note. The following items could gather up to 2 stars (☆ ☆): ‘Representativeness of the exposed cohort’; ‘Ascertainment of exposure’; ‘Comparability of cohorts on the basis of the design or analysis’; ‘Assessment of outcome’; ‘Adequacy of follow-up’.

To quantify the degree of agreement between reviewers regarding overall quality assessment, the Cohen Kappa Index was calculated. The results showed that there was a good agreement level (Cohen Kappa Index = 0.74; 95% CI, 0.60 to 0.89) regarding the specific score of each study. By considering this, it was possible to conclude that there was a low risk of bias in all twenty-three studies.

4. Discussion

The current systematic review, which included twenty-three studies, provides a comprehensive overview of eating behaviour characteristics associated with the COVID-19 pandemic. Consistent with previous reviews, several outcomes, such as overeating [ 26 , 31 , 46 , 47 ] and the influence of personal preferences on food choices [ 32 , 33 , 34 , 35 , 44 ], have been observed. However, this systematic review also found that the frequency of meals is not associated with the amount of food eaten [ 32 , 36 , 40 ]. Additionally, variables, such as gender and age, that did not show a correlation with specific eating behaviours [ 29 ], need to be considered, as well as the influence of mental health [ 41 , 45 , 46 ]. In the case of work status, one study found that people who spend more time at home consumed a greater amount of self-made food [ 48 ] something that appears to be correlated with the availability of food delivery services [ 51 ], which are a faster option for people who is in a rush.

However, when referring to population with no comorbidities, results may generate controversy. Three studies reported patterns of stability on eating behaviour despite the outbreak of the pandemic [ 27 , 28 , 42 ], while two studies even reported improvements in the adherence to healthy diets [ 38 , 43 ]. In spite of that, results showed a more frequent intake of food, an increased consumption of ultra-processed food and a higher caloric intake due to a more frequent alcohol consumption [ 35 , 37 , 44 , 46 , 48 ].

Regarding specific subgroups, people with diabetes appeared to increase the daily amount of food eaten. In this sense, unhealthy food products such as sweets and starchy food were common among this population [ 26 , 32 , 47 ]. People with obesity showed similar trends by reporting a significant increase in the amount and frequency of unhealthy food products [ 33 ]. In the case of young people, a lower adherence to healthy diets such as the Mediterranean Diet [ 29 ] was found due to an increased intake of food, a preference for snacks and a lack of fruit and vegetables intake [ 27 , 29 , 30 , 31 , 34 , 39 , 40 , 41 ]. On the contrary, vulnerable population showed a reduced intake of food, contrasting with an increased alcohol consumption [ 45 ]. In all these cases, results did not show changes towards a healthier diet, what may emphasize the need to protect vulnerable population from risk situations that might affect health or, in this case, nutritional status.

By considering all this information, it is possible to confirm the existence of changes in eating behaviour during the COVID-19 pandemic. To the best of our knowledge, this is the first systematic review that examined these trends by considering longitudinal studies. With this design, it is possible to analyse the changes of eating behaviour in comparison with previous baselines before the pandemic, which made it possible to establish the level of significance of this phenomenon. Additionally, the screening process that was applied ensured the quality of this review, as shown in the NOS results of each study. Therefore, it might be possible to accept the relevance of this review on this topic.

Even so, several limitations should be considered when interpreting these results. First, due to the heterogeneity of the designs as well as the small set of papers used, it is important to consider this review as a first approach to eating behaviour changes during the COVID-19 pandemic. Its results may be useful to consider when undertaking future directions of reviews when more studies become available. Second, and according to the above, due to the novelty of this phenomenon, there were no comparators apart from within-subject comparability (prospective and retrospective), which is a limitation when trying to distinguish between the influence of the pandemic (lockdowns, social distance, isolation, uncertainty about the future, etc.) and any other external factor. Longitudinal between-subject studies may be necessary to dismiss possible bias caused by external factors. Third, this systematic review included both clinical and non-clinical population what may disturb results due to additional variables that has not been measured. Consequently, any interpretation should be made carefully, as the effect size might not represent society-wide eating behaviour, although previous studies have established common eating behaviour changes among clinical and non-clinical populations [ 21 , 22 ]. Finally, although one of the strengths of this review is that different countries have been included, it might be important to consider that restrictive measures have been different among countries so that the COVID-19 pandemic might have had a greater or lesser impact depending on the policies of each country [ 36 ].

Keeping all of this in mind, a deep understanding beyond the results is still possible. Therefore, this review is useful as a benchmark that contributes to the current body of knowledge about the impact of the COVID-19 pandemic on daily lifestyles. In addition to confirming the appearance of changes in eating behaviour since the outbreak of the COVID-19 pandemic, this is the first systematic review that has achieved an accurate description of those changes by considering different countries. The results of this study will provide a reference to guide future research directions among those interested not only in this topic but also in specific eating patterns as well as in the differences between ‘amount of food’ and ‘snack frequency’. All of these approaches will lead to a better understanding of eating behaviour during the COVID-19 pandemic as well as contribute to future guidelines about health promotion.

Implications for Government Policies in Nutrition

Due to the importance of eating behaviour as criteria on health and safety, it is important for governments to ensure healthy eating patterns among population through health education programmes and suitable access to food supply [ 52 ]. In this sense, nutrition-sensitive policies might seek participation from different social and economic sectors with the aim of reaching a proper change in eating behaviour [ 53 ]. Some examples of these policies would include: (a) access to education, (b) the promotion of healthy local food environments as well as social protection programmes, (c) the regulation of working conditions, (d) the improvement of menus at school cantines and (e) the regulation of advertising through a gender-based perspective that rejects beauty standards and encourages a healthy lifestyle [ 54 ].

This initiative would address the Sustainable Development Goals (SDGs), in particular, the SDG 2 which aims to ‘End hunger, achieve food security and improved nutrition and promote sustainable agriculture’ [ 55 ]. Nutrition plays an important role within international cooperation as hunger elimination together with the development of sustainable food systems might improve several environmental aspects of strategic relevance and interest [ 56 ]. This systematic review provides important information about food choices in case of worldwide alarming situations such as the COVID-19 pandemic that might be responsible for a lack of food supply and negative emotions [ 4 , 9 ]. By considering that, future programmes aimed at mindful eating and healthy habits might include guidelines towards resources of interest during state alarms, examples of balanced diets and their budgets, area-based lists of soup kitchens, and allowances. Not only that but also, educational programmes might be extended beyond health and politic fields by applying multi-strategy campaigns concerned with sustained public awareness on healthy eating [ 53 ]. This kind of approach might be suitable for developed and developing countries as its objective would be ensuring a proper use of resources as well as healthier choices. Evidence-based interventions have demonstrated the efficacy of nutritional education programmes into adaptative eating behaviour [ 57 ], what might involve an urgent call to action for governments and social sectors focused on health promotion. Some implications of this initiative would include a lower demand of healthcare resources [ 58 ], a greater productivity in the workplace [ 59 ], and a better quality of life among countries due to the access to basic needs [ 60 ].

5. Conclusions

The COVID-19 outbreak led to changes in eating behaviour, which may have become less healthy during the pandemic. Although these changes could be a result of uncertainty and discomfort, adverse effects on health, especially for vulnerable population, would emphasize the need to promote healthy habits through preventive interventions and social actions supported by governments. Additionally, with the aim of assessing a more accurate framework of the stages through which eating behaviour changes evolved during this period, further research should be carried out. In this context, it would be important to focus on food intake but also on alcohol consumption and its consequences. By this, not only may a progression of ‘eating behaviour during a state of alarm’ be developed but also a benchmark for future directions can be established that will help improve guidelines for achieving proper nutrition aimed at the new normality.

Author Contributions

Conceptualization, C.G.-M., C.M.O.-S. and E.M.; methodology, C.G.-M., E.M. and I.G.-G.; formal analysis, C.G.-M., C.M.O.-S., I.G.-G. and E.M.; investigation, C.G.-M. and E.M.; writing—original draft preparation, C.G.-M.; writing—review and editing, C.G.-M. and E.M.; supervision, I.G.-G. and C.M.O.-S. All authors have read and agreed to the published version of the manuscript.

Emma Motrico and Irene Gómez-Gómez have received funding from Instituto de Salud Carlos III (PI19/01264) and Junta de Andalucia (PY20 RE 025 LOYOLA).

Institutional Review Board Statement

Informed consent statement, data availability statement, conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• Current issue
• BMJ Journals

You are here

• Volume 76, Issue 2
• COVID-19 pandemic and its impact on social relationships and health
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

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

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

• inequalities

Data availability statement

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

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

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

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Introduction

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

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

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

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

Social networks

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

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

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

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

Social support

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

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

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

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

Social and interactional norms

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

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

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

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

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

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

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

Recommendations and conclusions

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

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

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

Recommendation 2: intelligently balance online and offline ways of relating

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

Recommendation 3: build stronger and sustainable localised communities

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

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

Ethics statements

Patient consent for publication.

Not required.

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

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

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

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

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

Read the full text or download the PDF:

One Student's Perspective on Life During a Pandemic

• Markkula Center for Applied Ethics
• Ethics Resources
• Ethics Spotlight
• COVID-19: Ethics, Health and Moving Forward

The pandemic and resulting shelter-in-place restrictions are affecting everyone in different ways. Tiana Nguyen, shares both the pros and cons of her experience as a student at Santa Clara University.

person sitting at table with open laptop, notebook and pen

Tiana Nguyen ‘21 is a Hackworth Fellow at the Markkula Center for Applied Ethics. She is majoring in Computer Science, and is the vice president of Santa Clara University’s Association for Computing Machinery (ACM) chapter .

The world has slowed down, but stress has begun to ramp up.

In the beginning of quarantine, as the world slowed down, I could finally take some time to relax, watch some shows, learn to be a better cook and baker, and be more active in my extracurriculars. I have a lot of things to be thankful for. I especially appreciate that I’m able to live in a comfortable house and have gotten the opportunity to spend more time with my family. This has actually been the first time in years in which we’re all able to even eat meals together every single day. Even when my brother and I were young, my parents would be at work and sometimes come home late, so we didn’t always eat meals together. In the beginning of the quarantine I remember my family talking about how nice it was to finally have meals together, and my brother joking, “it only took a pandemic to bring us all together,” which I laughed about at the time (but it’s the truth).

Soon enough, we’ll all be back to going to different places and we’ll be separated once again. So I’m thankful for my living situation right now. As for my friends, even though we’re apart, I do still feel like I can be in touch with them through video chat—maybe sometimes even more in touch than before. I think a lot of people just have a little more time for others right now.

Although there are still a lot of things to be thankful for, stress has slowly taken over, and work has been overwhelming. I’ve always been a person who usually enjoys going to classes, taking on more work than I have to, and being active in general. But lately I’ve felt swamped with the amount of work given, to the point that my days have blurred into online assignments, Zoom classes, and countless meetings, with a touch of baking sweets and aimless searching on Youtube.

The pass/no pass option for classes continues to stare at me, but I look past it every time to use this quarter as an opportunity to boost my grades. I've tried to make sense of this type of overwhelming feeling that I’ve never really felt before. Is it because I’m working harder and putting in more effort into my schoolwork with all the spare time I now have? Is it because I’m not having as much interaction with other people as I do at school? Or is it because my classes this quarter are just supposed to be this much harder? I honestly don’t know; it might not even be any of those. What I do know though, is that I have to continue work and push through this feeling.

This quarter I have two synchronous and two asynchronous classes, which each have pros and cons. Originally, I thought I wanted all my classes to be synchronous, since that everyday interaction with my professor and classmates is valuable to me. However, as I experienced these asynchronous classes, I’ve realized that it can be nice to watch a lecture on my own time because it even allows me to pause the video to give me extra time for taking notes. This has made me pay more attention during lectures and take note of small details that I might have missed otherwise. Furthermore, I do realize that synchronous classes can also be a burden for those abroad who have to wake up in the middle of the night just to attend a class. I feel that it’s especially unfortunate when professors want students to attend but don’t make attendance mandatory for this reason; I find that most abroad students attend anyway, driven by the worry they’ll be missing out on something.

I do still find synchronous classes amazing though, especially for discussion-based courses. I feel in touch with other students from my classes whom I wouldn’t otherwise talk to or regularly reach out to. Since Santa Clara University is a small school, it is especially easy to interact with one another during classes on Zoom, and I even sometimes find it less intimidating to participate during class through Zoom than in person. I’m honestly not the type to participate in class, but this quarter I found myself participating in some classes more than usual. The breakout rooms also create more interaction, since we’re assigned to random classmates, instead of whomever we’re sitting closest to in an in-person class—though I admit breakout rooms can sometimes be awkward.

Something that I find beneficial in both synchronous and asynchronous classes is that professors post a lecture recording that I can always refer to whenever I want. I found this especially helpful when I studied for my midterms this quarter; it’s nice to have a recording to look back upon in case I missed something during a lecture.

Overall, life during these times is substantially different from anything most of us have ever experienced, and at times it can be extremely overwhelming and stressful—especially in terms of school for me. Online classes don’t provide the same environment and interactions as in-person classes and are by far not as enjoyable. But at the end of the day, I know that in every circumstance there is always something to be thankful for, and I’m appreciative for my situation right now. While the world has slowed down and my stress has ramped up, I’m slowly beginning to adjust to it.

• Share full article

Advertisement

Supported by

current events

12 Ideas for Writing Through the Pandemic With The New York Times

A dozen writing projects — including journals, poems, comics and more — for students to try at home.

By Natalie Proulx

The coronavirus has transformed life as we know it. Schools are closed, we’re confined to our homes and the future feels very uncertain. Why write at a time like this?

For one, we are living through history. Future historians may look back on the journals, essays and art that ordinary people are creating now to tell the story of life during the coronavirus.

But writing can also be deeply therapeutic. It can be a way to express our fears, hopes and joys. It can help us make sense of the world and our place in it.

Plus, even though school buildings are shuttered, that doesn’t mean learning has stopped. Writing can help us reflect on what’s happening in our lives and form new ideas.

We want to help inspire your writing about the coronavirus while you learn from home. Below, we offer 12 projects for students, all based on pieces from The New York Times, including personal narrative essays, editorials, comic strips and podcasts. Each project features a Times text and prompts to inspire your writing, as well as related resources from The Learning Network to help you develop your craft. Some also offer opportunities to get your work published in The Times, on The Learning Network or elsewhere.

We know this list isn’t nearly complete. If you have ideas for other pandemic-related writing projects, please suggest them in the comments.

We are having trouble retrieving the article content.

Please enable JavaScript in your browser settings.

Thank you for your patience while we verify access. If you are in Reader mode please exit and  log into  your Times account, or  subscribe  for all of The Times.

Thank you for your patience while we verify access.

Already a subscriber?  Log in .

Want all of The Times?  Subscribe .