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11 questions to ask about covid-19 research, how can you tell if a scientific study about the pandemic is valid and useful we have some tips..

Debates have raged on social media, around dinner tables, on TV, and in Congress about the science of COVID-19. Is it really worse than the flu? How necessary are lockdowns? Do masks work to prevent infection? What kinds of masks work best? Is the new vaccine safe?

You might see friends, relatives, and coworkers offer competing answers, often brandishing studies or citing individual doctors and scientists to support their positions. With so much disagreement—and with such high stakes—how can we use science to make the best decisions?

Here at Greater Good , we cover research into social and emotional well-being, and we try to help people apply findings to their personal and professional lives. We are well aware that our business is a tricky one.

Summarizing scientific studies and distilling the key insights that people can apply to their lives isn’t just difficult for the obvious reasons, like understanding and then explaining formal science terms or rigorous empirical and analytic methods to non-specialists. It’s also the case that context gets lost when we translate findings into stories, tips, and tools, especially when we push it all through the nuance-squashing machine of the Internet. Many people rarely read past the headlines, which intrinsically aim to be relatable and provoke interest in as many people as possible. Because our articles can never be as comprehensive as the original studies, they almost always omit some crucial caveats, such as limitations acknowledged by the researchers. To get those, you need access to the studies themselves.

And it’s very common for findings and scientists to seem to contradict each other. For example, there were many contradictory findings and recommendations about the use of masks, especially at the beginning of the pandemic—though as we’ll discuss, it’s important to understand that a scientific consensus did emerge.

Given the complexities and ambiguities of the scientific endeavor, is it possible for a non-scientist to strike a balance between wholesale dismissal and uncritical belief? Are there red flags to look for when you read about a study on a site like Greater Good or hear about one on a Fox News program? If you do read an original source study, how should you, as a non-scientist, gauge its credibility?

Here are 11 questions you might ask when you read about the latest scientific findings about the pandemic, based on our own work here at Greater Good.

1. Did the study appear in a peer-reviewed journal?

In peer review, submitted articles are sent to other experts for detailed critical input that often must be addressed in a revision prior to being accepted and published. This remains one of the best ways we have for ascertaining the rigor of the study and rationale for its conclusions. Many scientists describe peer review as a truly humbling crucible. If a study didn’t go through this process, for whatever reason, it should be taken with a much bigger grain of salt. 

“When thinking about the coronavirus studies, it is important to note that things were happening so fast that in the beginning people were releasing non-peer reviewed, observational studies,” says Dr. Leif Hass, a family medicine doctor and hospitalist at Sutter Health’s Alta Bates Summit Medical Center in Oakland, California. “This is what we typically do as hypothesis-generating but given the crisis, we started acting on them.”

In a confusing, time-pressed, fluid situation like the one COVID-19 presented, people without medical training have often been forced to simply defer to expertise in making individual and collective decisions, turning to culturally vetted institutions like the Centers for Disease Control (CDC). Is that wise? Read on.

2. Who conducted the study, and where did it appear?

“I try to listen to the opinion of people who are deep in the field being addressed and assess their response to the study at hand,” says Hass. “With the MRNA coronavirus vaccines, I heard Paul Offit from UPenn at a UCSF Grand Rounds talk about it. He literally wrote the book on vaccines. He reviewed what we know and gave the vaccine a big thumbs up. I was sold.”

From a scientific perspective, individual expertise and accomplishment matters—but so does institutional affiliation.

Why? Because institutions provide a framework for individual accountability as well as safety guidelines. At UC Berkeley, for example , research involving human subjects during COVID-19 must submit a Human Subjects Proposal Supplement Form , and follow a standard protocol and rigorous guidelines . Is this process perfect? No. It’s run by humans and humans are imperfect. However, the conclusions are far more reliable than opinions offered by someone’s favorite YouTuber .

Recommendations coming from institutions like the CDC should not be accepted uncritically. At the same time, however, all of us—including individuals sporting a “Ph.D.” or “M.D.” after their names—must be humble in the face of them. The CDC represents a formidable concentration of scientific talent and knowledge that dwarfs the perspective of any one individual. In a crisis like COVID-19, we need to defer to that expertise, at least conditionally.

“If we look at social media, things could look frightening,” says Hass. When hundreds of millions of people are vaccinated, millions of them will be afflicted anyway, in the course of life, by conditions like strokes, anaphylaxis, and Bell’s palsy. “We have to have faith that people collecting the data will let us know if we are seeing those things above the baseline rate.”

3. Who was studied, and where?

Animal experiments tell scientists a lot, but their applicability to our daily human lives will be limited. Similarly, if researchers only studied men, the conclusions might not be relevant to women, and vice versa.

Many psychology studies rely on WEIRD (Western, educated, industrialized, rich and democratic) participants, mainly college students, which creates an in-built bias in the discipline’s conclusions. Historically, biomedical studies also bias toward gathering measures from white male study participants, which again, limits generalizability of findings. Does that mean you should dismiss Western science? Of course not. It’s just the equivalent of a “Caution,” “Yield,” or “Roadwork Ahead” sign on the road to understanding.

This applies to the coronavirus vaccines now being distributed and administered around the world. The vaccines will have side effects; all medicines do. Those side effects will be worse for some people than others, depending on their genetic inheritance, medical status, age, upbringing, current living conditions, and other factors.

For Hass, it amounts to this question: Will those side effects be worse, on balance, than COVID-19, for most people?

“When I hear that four in 100,000 [of people in the vaccine trials] had Bell’s palsy, I know that it would have been a heck of a lot worse if 100,000 people had COVID. Three hundred people would have died and many others been stuck with chronic health problems.”

4. How big was the sample?

In general, the more participants in a study, the more valid its results. That said, a large sample is sometimes impossible or even undesirable for certain kinds of studies. During COVID-19, limited time has constrained the sample sizes.

However, that acknowledged, it’s still the case that some studies have been much larger than others—and the sample sizes of the vaccine trials can still provide us with enough information to make informed decisions. Doctors and nurses on the front lines of COVID-19—who are now the very first people being injected with the vaccine—think in terms of “biological plausibility,” as Hass says.

Did the admittedly rushed FDA approval of the Pfizer-BioNTech vaccine make sense, given what we already know? Tens of thousands of doctors who have been grappling with COVID-19 are voting with their arms, in effect volunteering to be a sample for their patients. If they didn’t think the vaccine was safe, you can bet they’d resist it. When the vaccine becomes available to ordinary people, we’ll know a lot more about its effects than we do today, thanks to health care providers paving the way.

5. Did the researchers control for key differences, and do those differences apply to you?

Diversity or gender balance aren’t necessarily virtues in experimental research, though ideally a study sample is as representative of the overall population as possible. However, many studies use intentionally homogenous groups, because this allows the researchers to limit the number of different factors that might affect the result.

While good researchers try to compare apples to apples, and control for as many differences as possible in their analyses, running a study always involves trade-offs between what can be accomplished as a function of study design, and how generalizable the findings can be.

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You also need to ask if the specific population studied even applies to you. For example, when one study found that cloth masks didn’t work in “high-risk situations,” it was sometimes used as evidence against mask mandates.

However, a look beyond the headlines revealed that the study was of health care workers treating COVID-19 patients, which is a vastly more dangerous situation than, say, going to the grocery store. Doctors who must intubate patients can end up being splattered with saliva. In that circumstance, one cloth mask won’t cut it. They also need an N95, a face shield, two layers of gloves, and two layers of gown. For the rest of us in ordinary life, masks do greatly reduce community spread, if as many people as possible are wearing them.

6. Was there a control group?

One of the first things to look for in methodology is whether the population tested was randomly selected, whether there was a control group, and whether people were randomly assigned to either group without knowing which one they were in. This is especially important if a study aims to suggest that a certain experience or treatment might actually cause a specific outcome, rather than just reporting a correlation between two variables (see next point).

For example, were some people randomly assigned a specific meditation practice while others engaged in a comparable activity or exercise? If the sample is large enough, randomized trials can produce solid conclusions. But, sometimes, a study will not have a control group because it’s ethically impossible. We can’t, for example, let sick people go untreated just to see what would happen. Biomedical research often makes use of standard “treatment as usual” or placebos in control groups. They also follow careful ethical guidelines to protect patients from both maltreatment and being deprived necessary treatment. When you’re reading about studies of masks, social distancing, and treatments during the COVID-19, you can partially gauge the reliability and validity of the study by first checking if it had a control group. If it didn’t, the findings should be taken as preliminary.

7. Did the researchers establish causality, correlation, dependence, or some other kind of relationship?

We often hear “Correlation is not causation” shouted as a kind of battle cry, to try to discredit a study. But correlation—the degree to which two or more measurements seem connected—is important, and can be a step toward eventually finding causation—that is, establishing a change in one variable directly triggers a change in another. Until then, however, there is no way to ascertain the direction of a correlational relationship (does A change B, or does B change A), or to eliminate the possibility that a third, unmeasured factor is behind the pattern of both variables without further analysis.

In the end, the important thing is to accurately identify the relationship. This has been crucial in understanding steps to counter the spread of COVID-19 like shelter-in-place orders. Just showing that greater compliance with shelter-in-place mandates was associated with lower hospitalization rates is not as conclusive as showing that one community that enacted shelter-in-place mandates had lower hospitalization rates than a different community of similar size and population density that elected not to do so.

We are not the first people to face an infection without understanding the relationships between factors that would lead to more of it. During the bubonic plague, cities would order rodents killed to control infection. They were onto something: Fleas that lived on rodents were indeed responsible. But then human cases would skyrocket.

Why? Because the fleas would migrate off the rodent corpses onto humans, which would worsen infection. Rodent control only reduces bubonic plague if it’s done proactively; once the outbreak starts, killing rats can actually make it worse. Similarly, we can’t jump to conclusions during the COVID-19 pandemic when we see correlations.

8. Are journalists and politicians, or even scientists, overstating the result?

Language that suggests a fact is “proven” by one study or which promotes one solution for all people is most likely overstating the case. Sweeping generalizations of any kind often indicate a lack of humility that should be a red flag to readers. A study may very well “suggest” a certain conclusion but it rarely, if ever, “proves” it.

This is why we use a lot of cautious, hedging language in Greater Good , like “might” or “implies.” This applies to COVID-19 as well. In fact, this understanding could save your life.

When President Trump touted the advantages of hydroxychloroquine as a way to prevent and treat COVID-19, he was dramatically overstating the results of one observational study. Later studies with control groups showed that it did not work—and, in fact, it didn’t work as a preventative for President Trump and others in the White House who contracted COVID-19. Most survived that outbreak, but hydroxychloroquine was not one of the treatments that saved their lives. This example demonstrates how misleading and even harmful overstated results can be, in a global pandemic.

9. Is there any conflict of interest suggested by the funding or the researchers’ affiliations?

A 2015 study found that you could drink lots of sugary beverages without fear of getting fat, as long as you exercised. The funder? Coca Cola, which eagerly promoted the results. This doesn’t mean the results are wrong. But it does suggest you should seek a second opinion : Has anyone else studied the effects of sugary drinks on obesity? What did they find?

It’s possible to take this insight too far. Conspiracy theorists have suggested that “Big Pharma” invented COVID-19 for the purpose of selling vaccines. Thus, we should not trust their own trials showing that the vaccine is safe and effective.

But, in addition to the fact that there is no compelling investigative evidence that pharmaceutical companies created the virus, we need to bear in mind that their trials didn’t unfold in a vacuum. Clinical trials were rigorously monitored and independently reviewed by third-party entities like the World Health Organization and government organizations around the world, like the FDA in the United States.

Does that completely eliminate any risk? Absolutely not. It does mean, however, that conflicts of interest are being very closely monitored by many, many expert eyes. This greatly reduces the probability and potential corruptive influence of conflicts of interest.

10. Do the authors reference preceding findings and original sources?

The scientific method is based on iterative progress, and grounded in coordinating discoveries over time. Researchers study what others have done and use prior findings to guide their own study approaches; every study builds on generations of precedent, and every scientist expects their own discoveries to be usurped by more sophisticated future work. In the study you are reading, do the researchers adequately describe and acknowledge earlier findings, or other key contributions from other fields or disciplines that inform aspects of the research, or the way that they interpret their results?

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This was crucial for the debates that have raged around mask mandates and social distancing. We already knew quite a bit about the efficacy of both in preventing infections, informed by centuries of practical experience and research.

When COVID-19 hit American shores, researchers and doctors did not question the necessity of masks in clinical settings. Here’s what we didn’t know: What kinds of masks would work best for the general public, who should wear them, when should we wear them, were there enough masks to go around, and could we get enough people to adopt best mask practices to make a difference in the specific context of COVID-19 ?

Over time, after a period of confusion and contradictory evidence, those questions have been answered . The very few studies that have suggested masks don’t work in stopping COVID-19 have almost all failed to account for other work on preventing the disease, and had results that simply didn’t hold up. Some were even retracted .

So, when someone shares a coronavirus study with you, it’s important to check the date. The implications of studies published early in the pandemic might be more limited and less conclusive than those published later, because the later studies could lean on and learn from previously published work. Which leads us to the next question you should ask in hearing about coronavirus research…

11. Do researchers, journalists, and politicians acknowledge limitations and entertain alternative explanations?

Is the study focused on only one side of the story or one interpretation of the data? Has it failed to consider or refute alternative explanations? Do they demonstrate awareness of which questions are answered and which aren’t by their methods? Do the journalists and politicians communicating the study know and understand these limitations?

When the Annals of Internal Medicine published a Danish study last month on the efficacy of cloth masks, some suggested that it showed masks “make no difference” against COVID-19.

The study was a good one by the standards spelled out in this article. The researchers and the journal were both credible, the study was randomized and controlled, and the sample size (4,862 people) was fairly large. Even better, the scientists went out of their way to acknowledge the limits of their work: “Inconclusive results, missing data, variable adherence, patient-reported findings on home tests, no blinding, and no assessment of whether masks could decrease disease transmission from mask wearers to others.”

Unfortunately, their scientific integrity was not reflected in the ways the study was used by some journalists, politicians, and people on social media. The study did not show that masks were useless. What it did show—and what it was designed to find out—was how much protection masks offered to the wearer under the conditions at the time in Denmark. In fact, the amount of protection for the wearer was not large, but that’s not the whole picture: We don’t wear masks mainly to protect ourselves, but to protect others from infection. Public-health recommendations have stressed that everyone needs to wear a mask to slow the spread of infection.

“We get vaccinated for the greater good, not just to protect ourselves ”

As the authors write in the paper, we need to look to other research to understand the context for their narrow results. In an editorial accompanying the paper in Annals of Internal Medicine , the editors argue that the results, together with existing data in support of masks, “should motivate widespread mask wearing to protect our communities and thereby ourselves.”

Something similar can be said of the new vaccine. “We get vaccinated for the greater good, not just to protect ourselves,” says Hass. “Being vaccinated prevents other people from getting sick. We get vaccinated for the more vulnerable in our community in addition for ourselves.”

Ultimately, the approach we should take to all new studies is a curious but skeptical one. We should take it all seriously and we should take it all with a grain of salt. You can judge a study against your experience, but you need to remember that your experience creates bias. You should try to cultivate humility, doubt, and patience. You might not always succeed; when you fail, try to admit fault and forgive yourself.

Above all, we need to try to remember that science is a process, and that conclusions always raise more questions for us to answer. That doesn’t mean we never have answers; we do. As the pandemic rages and the scientific process unfolds, we as individuals need to make the best decisions we can, with the information we have.

This article was revised and updated from a piece published by Greater Good in 2015, “ 10 Questions to Ask About Scientific Studies .”

About the Authors

Jeremy Adam Smith

Uc berkeley.

Jeremy Adam Smith edits the GGSC’s online magazine, Greater Good . He is also the author or coeditor of five books, including The Daddy Shift , Are We Born Racist? , and (most recently) The Gratitude Project: How the Science of Thankfulness Can Rewire Our Brains for Resilience, Optimism, and the Greater Good . Before joining the GGSC, Jeremy was a John S. Knight Journalism Fellow at Stanford University.

Emiliana R. Simon-Thomas

Emiliana R. Simon-Thomas, Ph.D. , is the science director of the Greater Good Science Center, where she directs the GGSC’s research fellowship program and serves as a co-instructor of its Science of Happiness and Science of Happiness at Work online courses.

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• Research article
• Open access
• Published: 04 June 2021

Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews

• Israel Júnior Borges do Nascimento 1 , 2 ,
• Dónal P. O’Mathúna 3 , 4 ,
• Thilo Caspar von Groote 5 ,
• Hebatullah Mohamed Abdulazeem 6 ,
• Ishanka Weerasekara 7 , 8 ,
• Ana Marusic 9 ,
• Livia Puljak   ORCID: orcid.org/0000-0002-8467-6061 10 ,
• Vinicius Tassoni Civile 11 ,
• Irena Zakarija-Grkovic 9 ,
• Tina Poklepovic Pericic 9 ,
• Alvaro Nagib Atallah 11 ,
• Santino Filoso 12 ,
• Nicola Luigi Bragazzi 13 &
• Milena Soriano Marcolino 1

On behalf of the International Network of Coronavirus Disease 2019 (InterNetCOVID-19)

BMC Infectious Diseases volume  21 , Article number:  525 ( 2021 ) Cite this article

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Navigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging, and ongoing critical appraisal of this output is essential. We aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic.

Nine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO’s Global Research, LILACS, and Epistemonikos) were searched from December 1, 2019, to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory, and radiological findings), and quality assessment (AMSTAR 2). A meta-analysis was performed of the prevalence of clinical outcomes.

Eighteen systematic reviews were included; one was empty (did not identify any relevant study). Using AMSTAR 2, confidence in the results of all 18 reviews was rated as “critically low”. Identified symptoms of COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%) and gastrointestinal complaints (5–9%). Severe symptoms were more common in men. Elevated C-reactive protein and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. A frequent finding on chest imaging was uni- or bilateral multilobar ground-glass opacity. A single review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3 to 13.9%.

Conclusions

In this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic were of questionable usefulness. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards.

Peer Review reports

The spread of the “Severe Acute Respiratory Coronavirus 2” (SARS-CoV-2), the causal agent of COVID-19, was characterized as a pandemic by the World Health Organization (WHO) in March 2020 and has triggered an international public health emergency [ 1 ]. The numbers of confirmed cases and deaths due to COVID-19 are rapidly escalating, counting in millions [ 2 ], causing massive economic strain, and escalating healthcare and public health expenses [ 3 , 4 ].

The research community has responded by publishing an impressive number of scientific reports related to COVID-19. The world was alerted to the new disease at the beginning of 2020 [ 1 ], and by mid-March 2020, more than 2000 articles had been published on COVID-19 in scholarly journals, with 25% of them containing original data [ 5 ]. The living map of COVID-19 evidence, curated by the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), contained more than 40,000 records by February 2021 [ 6 ]. More than 100,000 records on PubMed were labeled as “SARS-CoV-2 literature, sequence, and clinical content” by February 2021 [ 7 ].

Due to publication speed, the research community has voiced concerns regarding the quality and reproducibility of evidence produced during the COVID-19 pandemic, warning of the potential damaging approach of “publish first, retract later” [ 8 ]. It appears that these concerns are not unfounded, as it has been reported that COVID-19 articles were overrepresented in the pool of retracted articles in 2020 [ 9 ]. These concerns about inadequate evidence are of major importance because they can lead to poor clinical practice and inappropriate policies [ 10 ].

Systematic reviews are a cornerstone of today’s evidence-informed decision-making. By synthesizing all relevant evidence regarding a particular topic, systematic reviews reflect the current scientific knowledge. Systematic reviews are considered to be at the highest level in the hierarchy of evidence and should be used to make informed decisions. However, with high numbers of systematic reviews of different scope and methodological quality being published, overviews of multiple systematic reviews that assess their methodological quality are essential [ 11 , 12 , 13 ]. An overview of systematic reviews helps identify and organize the literature and highlights areas of priority in decision-making.

In this overview of systematic reviews, we aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic.

Methodology

Research question.

This overview’s primary objective was to summarize and critically appraise systematic reviews that assessed any type of primary clinical data from patients infected with SARS-CoV-2. Our research question was purposefully broad because we wanted to analyze as many systematic reviews as possible that were available early following the COVID-19 outbreak.

Study design

We conducted an overview of systematic reviews. The idea for this overview originated in a protocol for a systematic review submitted to PROSPERO (CRD42020170623), which indicated a plan to conduct an overview.

Overviews of systematic reviews use explicit and systematic methods for searching and identifying multiple systematic reviews addressing related research questions in the same field to extract and analyze evidence across important outcomes. Overviews of systematic reviews are in principle similar to systematic reviews of interventions, but the unit of analysis is a systematic review [ 14 , 15 , 16 ].

We used the overview methodology instead of other evidence synthesis methods to allow us to collate and appraise multiple systematic reviews on this topic, and to extract and analyze their results across relevant topics [ 17 ]. The overview and meta-analysis of systematic reviews allowed us to investigate the methodological quality of included studies, summarize results, and identify specific areas of available or limited evidence, thereby strengthening the current understanding of this novel disease and guiding future research [ 13 ].

A reporting guideline for overviews of reviews is currently under development, i.e., Preferred Reporting Items for Overviews of Reviews (PRIOR) [ 18 ]. As the PRIOR checklist is still not published, this study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 statement [ 19 ]. The methodology used in this review was adapted from the Cochrane Handbook for Systematic Reviews of Interventions and also followed established methodological considerations for analyzing existing systematic reviews [ 14 ].

Approval of a research ethics committee was not necessary as the study analyzed only publicly available articles.

Eligibility criteria

Systematic reviews were included if they analyzed primary data from patients infected with SARS-CoV-2 as confirmed by RT-PCR or another pre-specified diagnostic technique. Eligible reviews covered all topics related to COVID-19 including, but not limited to, those that reported clinical symptoms, diagnostic methods, therapeutic interventions, laboratory findings, or radiological results. Both full manuscripts and abbreviated versions, such as letters, were eligible.

No restrictions were imposed on the design of the primary studies included within the systematic reviews, the last search date, whether the review included meta-analyses or language. Reviews related to SARS-CoV-2 and other coronaviruses were eligible, but from those reviews, we analyzed only data related to SARS-CoV-2.

No consensus definition exists for a systematic review [ 20 ], and debates continue about the defining characteristics of a systematic review [ 21 ]. Cochrane’s guidance for overviews of reviews recommends setting pre-established criteria for making decisions around inclusion [ 14 ]. That is supported by a recent scoping review about guidance for overviews of systematic reviews [ 22 ].

Thus, for this study, we defined a systematic review as a research report which searched for primary research studies on a specific topic using an explicit search strategy, had a detailed description of the methods with explicit inclusion criteria provided, and provided a summary of the included studies either in narrative or quantitative format (such as a meta-analysis). Cochrane and non-Cochrane systematic reviews were considered eligible for inclusion, with or without meta-analysis, and regardless of the study design, language restriction and methodology of the included primary studies. To be eligible for inclusion, reviews had to be clearly analyzing data related to SARS-CoV-2 (associated or not with other viruses). We excluded narrative reviews without those characteristics as these are less likely to be replicable and are more prone to bias.

Scoping reviews and rapid reviews were eligible for inclusion in this overview if they met our pre-defined inclusion criteria noted above. We included reviews that addressed SARS-CoV-2 and other coronaviruses if they reported separate data regarding SARS-CoV-2.

Information sources

Nine databases were searched for eligible records published between December 1, 2019, and March 24, 2020: Cochrane Database of Systematic Reviews via Cochrane Library, PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Sciences, LILACS (Latin American and Caribbean Health Sciences Literature), PDQ-Evidence, WHO’s Global Research on Coronavirus Disease (COVID-19), and Epistemonikos.

The comprehensive search strategy for each database is provided in Additional file 1 and was designed and conducted in collaboration with an information specialist. All retrieved records were primarily processed in EndNote, where duplicates were removed, and records were then imported into the Covidence platform [ 23 ]. In addition to database searches, we screened reference lists of reviews included after screening records retrieved via databases.

Study selection

All searches, screening of titles and abstracts, and record selection, were performed independently by two investigators using the Covidence platform [ 23 ]. Articles deemed potentially eligible were retrieved for full-text screening carried out independently by two investigators. Discrepancies at all stages were resolved by consensus. During the screening, records published in languages other than English were translated by a native/fluent speaker.

Data collection process

We custom designed a data extraction table for this study, which was piloted by two authors independently. Data extraction was performed independently by two authors. Conflicts were resolved by consensus or by consulting a third researcher.

We extracted the following data: article identification data (authors’ name and journal of publication), search period, number of databases searched, population or settings considered, main results and outcomes observed, and number of participants. From Web of Science (Clarivate Analytics, Philadelphia, PA, USA), we extracted journal rank (quartile) and Journal Impact Factor (JIF).

We categorized the following as primary outcomes: all-cause mortality, need for and length of mechanical ventilation, length of hospitalization (in days), admission to intensive care unit (yes/no), and length of stay in the intensive care unit.

The following outcomes were categorized as exploratory: diagnostic methods used for detection of the virus, male to female ratio, clinical symptoms, pharmacological and non-pharmacological interventions, laboratory findings (full blood count, liver enzymes, C-reactive protein, d-dimer, albumin, lipid profile, serum electrolytes, blood vitamin levels, glucose levels, and any other important biomarkers), and radiological findings (using radiography, computed tomography, magnetic resonance imaging or ultrasound).

We also collected data on reporting guidelines and requirements for the publication of systematic reviews and meta-analyses from journal websites where included reviews were published.

Quality assessment in individual reviews

Two researchers independently assessed the reviews’ quality using the “A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2)”. We acknowledge that the AMSTAR 2 was created as “a critical appraisal tool for systematic reviews that include randomized or non-randomized studies of healthcare interventions, or both” [ 24 ]. However, since AMSTAR 2 was designed for systematic reviews of intervention trials, and we included additional types of systematic reviews, we adjusted some AMSTAR 2 ratings and reported these in Additional file 2 .

Adherence to each item was rated as follows: yes, partial yes, no, or not applicable (such as when a meta-analysis was not conducted). The overall confidence in the results of the review is rated as “critically low”, “low”, “moderate” or “high”, according to the AMSTAR 2 guidance based on seven critical domains, which are items 2, 4, 7, 9, 11, 13, 15 as defined by AMSTAR 2 authors [ 24 ]. We reported our adherence ratings for transparency of our decision with accompanying explanations, for each item, in each included review.

One of the included systematic reviews was conducted by some members of this author team [ 25 ]. This review was initially assessed independently by two authors who were not co-authors of that review to prevent the risk of bias in assessing this study.

Synthesis of results

For data synthesis, we prepared a table summarizing each systematic review. Graphs illustrating the mortality rate and clinical symptoms were created. We then prepared a narrative summary of the methods, findings, study strengths, and limitations.

For analysis of the prevalence of clinical outcomes, we extracted data on the number of events and the total number of patients to perform proportional meta-analysis using RStudio© software, with the “meta” package (version 4.9–6), using the “metaprop” function for reviews that did not perform a meta-analysis, excluding case studies because of the absence of variance. For reviews that did not perform a meta-analysis, we presented pooled results of proportions with their respective confidence intervals (95%) by the inverse variance method with a random-effects model, using the DerSimonian-Laird estimator for τ 2 . We adjusted data using Freeman-Tukey double arcosen transformation. Confidence intervals were calculated using the Clopper-Pearson method for individual studies. We created forest plots using the RStudio© software, with the “metafor” package (version 2.1–0) and “forest” function.

Managing overlapping systematic reviews

Some of the included systematic reviews that address the same or similar research questions may include the same primary studies in overviews. Including such overlapping reviews may introduce bias when outcome data from the same primary study are included in the analyses of an overview multiple times. Thus, in summaries of evidence, multiple-counting of the same outcome data will give data from some primary studies too much influence [ 14 ]. In this overview, we did not exclude overlapping systematic reviews because, according to Cochrane’s guidance, it may be appropriate to include all relevant reviews’ results if the purpose of the overview is to present and describe the current body of evidence on a topic [ 14 ]. To avoid any bias in summary estimates associated with overlapping reviews, we generated forest plots showing data from individual systematic reviews, but the results were not pooled because some primary studies were included in multiple reviews.

Our search retrieved 1063 publications, of which 175 were duplicates. Most publications were excluded after the title and abstract analysis ( n = 860). Among the 28 studies selected for full-text screening, 10 were excluded for the reasons described in Additional file 3 , and 18 were included in the final analysis (Fig. 1 ) [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Reference list screening did not retrieve any additional systematic reviews.

PRISMA flow diagram

Characteristics of included reviews

Summary features of 18 systematic reviews are presented in Table 1 . They were published in 14 different journals. Only four of these journals had specific requirements for systematic reviews (with or without meta-analysis): European Journal of Internal Medicine, Journal of Clinical Medicine, Ultrasound in Obstetrics and Gynecology, and Clinical Research in Cardiology . Two journals reported that they published only invited reviews ( Journal of Medical Virology and Clinica Chimica Acta ). Three systematic reviews in our study were published as letters; one was labeled as a scoping review and another as a rapid review (Table 2 ).

All reviews were published in English, in first quartile (Q1) journals, with JIF ranging from 1.692 to 6.062. One review was empty, meaning that its search did not identify any relevant studies; i.e., no primary studies were included [ 36 ]. The remaining 17 reviews included 269 unique studies; the majority ( N = 211; 78%) were included in only a single review included in our study (range: 1 to 12). Primary studies included in the reviews were published between December 2019 and March 18, 2020, and comprised case reports, case series, cohorts, and other observational studies. We found only one review that included randomized clinical trials [ 38 ]. In the included reviews, systematic literature searches were performed from 2019 (entire year) up to March 9, 2020. Ten systematic reviews included meta-analyses. The list of primary studies found in the included systematic reviews is shown in Additional file 4 , as well as the number of reviews in which each primary study was included.

Population and study designs

Most of the reviews analyzed data from patients with COVID-19 who developed pneumonia, acute respiratory distress syndrome (ARDS), or any other correlated complication. One review aimed to evaluate the effectiveness of using surgical masks on preventing transmission of the virus [ 36 ], one review was focused on pediatric patients [ 34 ], and one review investigated COVID-19 in pregnant women [ 37 ]. Most reviews assessed clinical symptoms, laboratory findings, or radiological results.

Systematic review findings

The summary of findings from individual reviews is shown in Table 2 . Overall, all-cause mortality ranged from 0.3 to 13.9% (Fig. 2 ).

A meta-analysis of the prevalence of mortality

Clinical symptoms

Seven reviews described the main clinical manifestations of COVID-19 [ 26 , 28 , 29 , 34 , 35 , 39 , 41 ]. Three of them provided only a narrative discussion of symptoms [ 26 , 34 , 35 ]. In the reviews that performed a statistical analysis of the incidence of different clinical symptoms, symptoms in patients with COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%), gastrointestinal disorders, such as diarrhea, nausea or vomiting (5.0–9.0%), and others (including, in one study only: dizziness 12.1%) (Figs. 3 , 4 , 5 , 6 , 7 , 8 and 9 ). Three reviews assessed cough with and without sputum together; only one review assessed sputum production itself (28.5%).

A meta-analysis of the prevalence of fever

A meta-analysis of the prevalence of cough

A meta-analysis of the prevalence of dyspnea

A meta-analysis of the prevalence of fatigue or myalgia

A meta-analysis of the prevalence of headache

A meta-analysis of the prevalence of gastrointestinal disorders

A meta-analysis of the prevalence of sore throat

Diagnostic aspects

Three reviews described methodologies, protocols, and tools used for establishing the diagnosis of COVID-19 [ 26 , 34 , 38 ]. The use of respiratory swabs (nasal or pharyngeal) or blood specimens to assess the presence of SARS-CoV-2 nucleic acid using RT-PCR assays was the most commonly used diagnostic method mentioned in the included studies. These diagnostic tests have been widely used, but their precise sensitivity and specificity remain unknown. One review included a Chinese study with clinical diagnosis with no confirmation of SARS-CoV-2 infection (patients were diagnosed with COVID-19 if they presented with at least two symptoms suggestive of COVID-19, together with laboratory and chest radiography abnormalities) [ 34 ].

Therapeutic possibilities

Pharmacological and non-pharmacological interventions (supportive therapies) used in treating patients with COVID-19 were reported in five reviews [ 25 , 27 , 34 , 35 , 38 ]. Antivirals used empirically for COVID-19 treatment were reported in seven reviews [ 25 , 27 , 34 , 35 , 37 , 38 , 41 ]; most commonly used were protease inhibitors (lopinavir, ritonavir, darunavir), nucleoside reverse transcriptase inhibitor (tenofovir), nucleotide analogs (remdesivir, galidesivir, ganciclovir), and neuraminidase inhibitors (oseltamivir). Umifenovir, a membrane fusion inhibitor, was investigated in two studies [ 25 , 35 ]. Possible supportive interventions analyzed were different types of oxygen supplementation and breathing support (invasive or non-invasive ventilation) [ 25 ]. The use of antibiotics, both empirically and to treat secondary pneumonia, was reported in six studies [ 25 , 26 , 27 , 34 , 35 , 38 ]. One review specifically assessed evidence on the efficacy and safety of the anti-malaria drug chloroquine [ 27 ]. It identified 23 ongoing trials investigating the potential of chloroquine as a therapeutic option for COVID-19, but no verifiable clinical outcomes data. The use of mesenchymal stem cells, antifungals, and glucocorticoids were described in four reviews [ 25 , 34 , 35 , 38 ].

Laboratory and radiological findings

Of the 18 reviews included in this overview, eight analyzed laboratory parameters in patients with COVID-19 [ 25 , 29 , 30 , 32 , 33 , 34 , 35 , 39 ]; elevated C-reactive protein levels, associated with lymphocytopenia, elevated lactate dehydrogenase, as well as slightly elevated aspartate and alanine aminotransferase (AST, ALT) were commonly described in those eight reviews. Lippi et al. assessed cardiac troponin I (cTnI) [ 25 ], procalcitonin [ 32 ], and platelet count [ 33 ] in COVID-19 patients. Elevated levels of procalcitonin [ 32 ] and cTnI [ 30 ] were more likely to be associated with a severe disease course (requiring intensive care unit admission and intubation). Furthermore, thrombocytopenia was frequently observed in patients with complicated COVID-19 infections [ 33 ].

Chest imaging (chest radiography and/or computed tomography) features were assessed in six reviews, all of which described a frequent pattern of local or bilateral multilobar ground-glass opacity [ 25 , 34 , 35 , 39 , 40 , 41 ]. Those six reviews showed that septal thickening, bronchiectasis, pleural and cardiac effusions, halo signs, and pneumothorax were observed in patients suffering from COVID-19.

Quality of evidence in individual systematic reviews

Table 3 shows the detailed results of the quality assessment of 18 systematic reviews, including the assessment of individual items and summary assessment. A detailed explanation for each decision in each review is available in Additional file 5 .

Using AMSTAR 2 criteria, confidence in the results of all 18 reviews was rated as “critically low” (Table 3 ). Common methodological drawbacks were: omission of prospective protocol submission or publication; use of inappropriate search strategy: lack of independent and dual literature screening and data-extraction (or methodology unclear); absence of an explanation for heterogeneity among the studies included; lack of reasons for study exclusion (or rationale unclear).

Risk of bias assessment, based on a reported methodological tool, and quality of evidence appraisal, in line with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method, were reported only in one review [ 25 ]. Five reviews presented a table summarizing bias, using various risk of bias tools [ 25 , 29 , 39 , 40 , 41 ]. One review analyzed “study quality” [ 37 ]. One review mentioned the risk of bias assessment in the methodology but did not provide any related analysis [ 28 ].

This overview of systematic reviews analyzed the first 18 systematic reviews published after the onset of the COVID-19 pandemic, up to March 24, 2020, with primary studies involving more than 60,000 patients. Using AMSTAR-2, we judged that our confidence in all those reviews was “critically low”. Ten reviews included meta-analyses. The reviews presented data on clinical manifestations, laboratory and radiological findings, and interventions. We found no systematic reviews on the utility of diagnostic tests.

Symptoms were reported in seven reviews; most of the patients had a fever, cough, dyspnea, myalgia or muscle fatigue, and gastrointestinal disorders such as diarrhea, nausea, or vomiting. Olfactory dysfunction (anosmia or dysosmia) has been described in patients infected with COVID-19 [ 43 ]; however, this was not reported in any of the reviews included in this overview. During the SARS outbreak in 2002, there were reports of impairment of the sense of smell associated with the disease [ 44 , 45 ].

The reported mortality rates ranged from 0.3 to 14% in the included reviews. Mortality estimates are influenced by the transmissibility rate (basic reproduction number), availability of diagnostic tools, notification policies, asymptomatic presentations of the disease, resources for disease prevention and control, and treatment facilities; variability in the mortality rate fits the pattern of emerging infectious diseases [ 46 ]. Furthermore, the reported cases did not consider asymptomatic cases, mild cases where individuals have not sought medical treatment, and the fact that many countries had limited access to diagnostic tests or have implemented testing policies later than the others. Considering the lack of reviews assessing diagnostic testing (sensitivity, specificity, and predictive values of RT-PCT or immunoglobulin tests), and the preponderance of studies that assessed only symptomatic individuals, considerable imprecision around the calculated mortality rates existed in the early stage of the COVID-19 pandemic.

Few reviews included treatment data. Those reviews described studies considered to be at a very low level of evidence: usually small, retrospective studies with very heterogeneous populations. Seven reviews analyzed laboratory parameters; those reviews could have been useful for clinicians who attend patients suspected of COVID-19 in emergency services worldwide, such as assessing which patients need to be reassessed more frequently.

All systematic reviews scored poorly on the AMSTAR 2 critical appraisal tool for systematic reviews. Most of the original studies included in the reviews were case series and case reports, impacting the quality of evidence. Such evidence has major implications for clinical practice and the use of these reviews in evidence-based practice and policy. Clinicians, patients, and policymakers can only have the highest confidence in systematic review findings if high-quality systematic review methodologies are employed. The urgent need for information during a pandemic does not justify poor quality reporting.

We acknowledge that there are numerous challenges associated with analyzing COVID-19 data during a pandemic [ 47 ]. High-quality evidence syntheses are needed for decision-making, but each type of evidence syntheses is associated with its inherent challenges.

The creation of classic systematic reviews requires considerable time and effort; with massive research output, they quickly become outdated, and preparing updated versions also requires considerable time. A recent study showed that updates of non-Cochrane systematic reviews are published a median of 5 years after the publication of the previous version [ 48 ].

Authors may register a review and then abandon it [ 49 ], but the existence of a public record that is not updated may lead other authors to believe that the review is still ongoing. A quarter of Cochrane review protocols remains unpublished as completed systematic reviews 8 years after protocol publication [ 50 ].

Rapid reviews can be used to summarize the evidence, but they involve methodological sacrifices and simplifications to produce information promptly, with inconsistent methodological approaches [ 51 ]. However, rapid reviews are justified in times of public health emergencies, and even Cochrane has resorted to publishing rapid reviews in response to the COVID-19 crisis [ 52 ]. Rapid reviews were eligible for inclusion in this overview, but only one of the 18 reviews included in this study was labeled as a rapid review.

Ideally, COVID-19 evidence would be continually summarized in a series of high-quality living systematic reviews, types of evidence synthesis defined as “ a systematic review which is continually updated, incorporating relevant new evidence as it becomes available ” [ 53 ]. However, conducting living systematic reviews requires considerable resources, calling into question the sustainability of such evidence synthesis over long periods [ 54 ].

Research reports about COVID-19 will contribute to research waste if they are poorly designed, poorly reported, or simply not necessary. In principle, systematic reviews should help reduce research waste as they usually provide recommendations for further research that is needed or may advise that sufficient evidence exists on a particular topic [ 55 ]. However, systematic reviews can also contribute to growing research waste when they are not needed, or poorly conducted and reported. Our present study clearly shows that most of the systematic reviews that were published early on in the COVID-19 pandemic could be categorized as research waste, as our confidence in their results is critically low.

Our study has some limitations. One is that for AMSTAR 2 assessment we relied on information available in publications; we did not attempt to contact study authors for clarifications or additional data. In three reviews, the methodological quality appraisal was challenging because they were published as letters, or labeled as rapid communications. As a result, various details about their review process were not included, leading to AMSTAR 2 questions being answered as “not reported”, resulting in low confidence scores. Full manuscripts might have provided additional information that could have led to higher confidence in the results. In other words, low scores could reflect incomplete reporting, not necessarily low-quality review methods. To make their review available more rapidly and more concisely, the authors may have omitted methodological details. A general issue during a crisis is that speed and completeness must be balanced. However, maintaining high standards requires proper resourcing and commitment to ensure that the users of systematic reviews can have high confidence in the results.

Furthermore, we used adjusted AMSTAR 2 scoring, as the tool was designed for critical appraisal of reviews of interventions. Some reviews may have received lower scores than actually warranted in spite of these adjustments.

Another limitation of our study may be the inclusion of multiple overlapping reviews, as some included reviews included the same primary studies. According to the Cochrane Handbook, including overlapping reviews may be appropriate when the review’s aim is “ to present and describe the current body of systematic review evidence on a topic ” [ 12 ], which was our aim. To avoid bias with summarizing evidence from overlapping reviews, we presented the forest plots without summary estimates. The forest plots serve to inform readers about the effect sizes for outcomes that were reported in each review.

Several authors from this study have contributed to one of the reviews identified [ 25 ]. To reduce the risk of any bias, two authors who did not co-author the review in question initially assessed its quality and limitations.

Finally, we note that the systematic reviews included in our overview may have had issues that our analysis did not identify because we did not analyze their primary studies to verify the accuracy of the data and information they presented. We give two examples to substantiate this possibility. Lovato et al. wrote a commentary on the review of Sun et al. [ 41 ], in which they criticized the authors’ conclusion that sore throat is rare in COVID-19 patients [ 56 ]. Lovato et al. highlighted that multiple studies included in Sun et al. did not accurately describe participants’ clinical presentations, warning that only three studies clearly reported data on sore throat [ 56 ].

In another example, Leung [ 57 ] warned about the review of Li, L.Q. et al. [ 29 ]: “ it is possible that this statistic was computed using overlapped samples, therefore some patients were double counted ”. Li et al. responded to Leung that it is uncertain whether the data overlapped, as they used data from published articles and did not have access to the original data; they also reported that they requested original data and that they plan to re-do their analyses once they receive them; they also urged readers to treat the data with caution [ 58 ]. This points to the evolving nature of evidence during a crisis.

Our study’s strength is that this overview adds to the current knowledge by providing a comprehensive summary of all the evidence synthesis about COVID-19 available early after the onset of the pandemic. This overview followed strict methodological criteria, including a comprehensive and sensitive search strategy and a standard tool for methodological appraisal of systematic reviews.

In conclusion, in this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all the reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic could be categorized as research waste. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards to provide patients, clinicians, and decision-makers trustworthy evidence.

Availability of data and materials

All data collected and analyzed within this study are available from the corresponding author on reasonable request.

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Acknowledgments

We thank Catherine Henderson DPhil from Swanscoe Communications for pro bono medical writing and editing support. We acknowledge support from the Covidence Team, specifically Anneliese Arno. We thank the whole International Network of Coronavirus Disease 2019 (InterNetCOVID-19) for their commitment and involvement. Members of the InterNetCOVID-19 are listed in Additional file 6 . We thank Pavel Cerny and Roger Crosthwaite for guiding the team supervisor (IJBN) on human resources management.

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Israel Júnior Borges do Nascimento

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Dónal P. O’Mathúna

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IJBN conceived the research idea and worked as a project coordinator. DPOM, TCVG, HMA, IW, AM, LP, VTC, IZG, TPP, ANA, SF, NLB and MSM were involved in data curation, formal analysis, investigation, methodology, and initial draft writing. All authors revised the manuscript critically for the content. The author(s) read and approved the final manuscript.

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Supplementary Information

Additional file 1: appendix 1..

Search strategies used in the study.

Additional file 2: Appendix 2.

Adjusted scoring of AMSTAR 2 used in this study for systematic reviews of studies that did not analyze interventions.

Additional file 3: Appendix 3.

List of excluded studies, with reasons.

Additional file 4: Appendix 4.

Table of overlapping studies, containing the list of primary studies included, their visual overlap in individual systematic reviews, and the number in how many reviews each primary study was included.

Additional file 5: Appendix 5.

A detailed explanation of AMSTAR scoring for each item in each review.

Additional file 6: Appendix 6.

List of members and affiliates of International Network of Coronavirus Disease 2019 (InterNetCOVID-19).

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Borges do Nascimento, I.J., O’Mathúna, D.P., von Groote, T.C. et al. Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews. BMC Infect Dis 21 , 525 (2021). https://doi.org/10.1186/s12879-021-06214-4

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• Volume 10, Issue 12
• Impact of the COVID-19 pandemic on mental health and well-being of communities: an exploratory qualitative study protocol
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• http://orcid.org/0000-0003-0180-0213 Anam Shahil Feroz 1 , 2 ,
• Naureen Akber Ali 3 ,
• Noshaba Akber Ali 1 ,
• Ridah Feroz 4 ,
• Salima Nazim Meghani 1 ,
• Sarah Saleem 1
• 1 Community Health Sciences , Aga Khan University , Karachi , Pakistan
• 2 Institute of Health Policy, Management and Evaluation , University of Toronto , Toronto , Ontario , Canada
• 3 School of Nursing and Midwifery , Aga Khan University , Karachi , Pakistan
• 4 Aga Khan University Institute for Educational Development , Karachi , Pakistan
• Correspondence to Ms Anam Shahil Feroz; anam.sahyl{at}gmail.com

Introduction The COVID-19 pandemic has certainly resulted in an increased level of anxiety and fear in communities in terms of disease management and infection spread. Due to fear and social stigma linked with COVID-19, many individuals in the community hide their disease and do not access healthcare facilities in a timely manner. In addition, with the widespread use of social media, rumours, myths and inaccurate information about the virus are spreading rapidly, leading to intensified irritability, fearfulness, insomnia, oppositional behaviours and somatic complaints. Considering the relevance of all these factors, we aim to explore the perceptions and attitudes of community members towards COVID-19 and its impact on their daily lives and mental well-being.

Methods and analysis This formative research will employ an exploratory qualitative research design using semistructured interviews and a purposive sampling approach. The data collection methods for this formative research will include indepth interviews with community members. The study will be conducted in the Karimabad Federal B Area and in the Garden (East and West) community settings in Karachi, Pakistan. The community members of these areas have been selected purposively for the interview. Study data will be analysed thematically using NVivo V.12 Plus software.

Ethics and dissemination Ethical approval for this study has been obtained from the Aga Khan University Ethical Review Committee (2020-4825-10599). The results of the study will be disseminated to the scientific community and to the research subjects participating in the study. The findings will help us explore the perceptions and attitudes of different community members towards the COVID-19 pandemic and its impact on their daily lives and mental well-being.

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Strengths and limitations of this study

The mental health impact of the COVID-19 pandemic is likely to last much longer than the physical health impact, and this study is positioned well to explore the perceptions and attitudes of community members towards the pandemic and its impact on their daily lives and mental well-being.

This study will guide the development of context-specific innovative mental health programmes to support communities in the future.

One limitation is that to minimise the risk of infection all study respondents will be interviewed online over Zoom and hence the authors will not have the opportunity to build rapport with the respondents or obtain non-verbal cues during interviews.

The COVID-19 pandemic has affected almost 180 countries since it was first detected in Wuhan, China in December 2019. 1 2 The COVID-19 outbreak has been declared a public health emergency of international concern by the WHO. 3 The WHO estimates the global mortality to be about 3.4% 4 ; however, death rates vary between countries and across age groups. 5 In Pakistan, a total of 10 880 cases and 228 deaths due to COVID-19 infection have been reported to date. 6

The worldwide COVID-19 pandemic has not only incurred massive challenges to the global supply chains and healthcare systems but also has a detrimental effect on the overall health of individuals. 7 The pandemic has led to lockdowns and has created destructive impact on the societies at large. Most company employees, including daily wage workers, have been prohibited from going to their workplaces or have been asked to work from home, which has caused job-related insecurities and financial crises in the communities. 8 Educational institutions and training centres have also been closed, which resulted in children losing their routine of going to schools, studying and socialising with their peers. Delay in examinations is likewise a huge stressor for students. 8 Alongside this, parents have been struggling with creating a structured milieu for their children. 9 COVID-19 has hindered the normal routine life of every individual, be it children, teenagers, adults or the elderly. The crisis is engendering burden throughout populations and communities, particularly in developing countries such as Pakistan which face major challenges due to fragile healthcare systems and poor economic structures. 10

The COVID-19 pandemic has certainly resulted in an increased level of anxiety and fear in communities in terms of disease management and infection spread. 8 Further, the highly contagious nature of COVID-19 has also escalated confusion, fear and panic among community residents. Moreover, social distancing is often an unpleasant experience for community members and for patients as it adds to mental suffering, particularly in the local setting where get-togethers with friends and families are a major source of entertainment. 9 Recent studies also showed that individuals who are following social distancing rules experience loneliness, causing a substantial level of distress in the form of anxiety, stress, anger, misperception and post-traumatic stress symptoms. 8 11 Separation from family members, loss of autonomy, insecurity over disease status, inadequate supplies, inadequate information, financial loss, frustration, stigma and boredom are all major stressors that can create drastic impact on an individual’s life. 11 Due to fear and social stigma linked with COVID-19, many individuals in the community hide their disease and do not access healthcare facilities in a timely manner. 12 With the widespread use of social media, 13 rumours, myths and inaccurate information about COVID-19 are also spreading rapidly, not only among adults but are also carried on to children, leading to intensified irritability, fearfulness, insomnia, oppositional behaviours and somatic complaints. 9 The psychological symptoms associated with COVID-19 at the community level are also manifested as anxiety-driven panic buying, resulting in exhaustion of resources from the market. 14 Some level of panic also dwells in the community due to the unavailability of essential protective equipment, particularly masks and sanitisers. 15 Similarly, mental health issues, including depression, anxiety, panic attacks, psychotic symptoms and even suicide, were reported during the early severe acute respiratory syndrome outbreak. 16 17 COVID-19 is likely posing a similar risk throughout the world. 12

The fear of transmitting the disease or a family member falling ill is a probable mental function of human nature, but at some point the psychological fear of the disease generates more anxiety than the disease itself. Therefore, mental health problems are likely to increase among community residents during an epidemic situation. Considering the relevance of all these factors, we aim to explore the perceptions and attitudes towards COVID-19 among community residents and the impact of these perceptions and attitude on their daily lives and mental well-being.

Methods and analysis

Study design.

This study will employ an exploratory qualitative research design using semistructured interviews and a purposive sampling approach. The data collection methods for this formative research will include indepth interviews (IDIs) with community members. The IDIs aim to explore perceptions of community members towards COVID-19 and its impact on their mental well-being.

Study setting and study participants

The study will be conducted in two communities in Karachi City: Karimabad Federal B Area Block 3 Gulberg Town, and Garden East and Garden West. Karimabad is a neighbourhood in the Karachi Central District of Karachi, Pakistan, situated in the south of Gulberg Town bordering Liaquatabad, Gharibabad and Federal B Area. The population of this neighbourhood is predominantly Ismailis. People living here belong mostly to the middle class to the lower middle class. It is also known for its wholesale market of sports goods and stationery. Garden is an upmarket neighbourhood in the Karachi South District of Karachi, Pakistan, subdivided into two neighbourhoods: Garden East and Garden West. It is the residential area around the Karachi Zoological Gardens; hence, it is popularly known as the ‘Garden’ area. The population of Garden used to be primarily Ismailis and Goan Catholics but has seen an increasing number of Memons, Pashtuns and Baloch. These areas have been selected purposively because the few members of these communities are already known to one of the coinvestigators. The coinvestigator will serve as a gatekeeper for providing entrance to the community for the purpose of this study. Adult community members of different ages and both genders will be interviewed from both sites, as mentioned in table 1 . Interview participants will be selected following the eligibility criteria.

• View inline

Study participants for indepth interviews

IDIs with community members

We will conduct IDIs with community members to explore the perceptions and attitudes of community members towards COVID-19 and its effects on their daily lives and mental well-being. IDI participants will be identified via the community WhatsApp group, and will be invited for an interview via a WhatsApp message or email. Consent will be taken over email or WhatsApp before the interview begins, where they will agree that the interview can be audio-recorded and that written notes can be taken. The interviews will be conducted either in Urdu or in English language, and each interview will last around 40–50 min. Study participants will be assured that their information will remain confidential and that no identifying features will be mentioned on the transcript. The major themes will include a general discussion about participants’ knowledge and perceptions about the COVID-19 pandemic, perceptions on safety measures, and perceived challenges in the current situation and its impact on their mental well-being. We anticipate that 24–30 interviews will be conducted, but we will cease interviews once data saturation has been achieved. Data saturation is the point when no new themes emerge from the additional interviews. Data collection will occur concurrently with data analysis to determine data saturation point. The audio recordings will be transcribed by a transcriptionist within 24 hours of the interviews.

An interview guide for IDIs is shown in online supplemental annex 1 .

Supplemental material

Eligibility criteria.

The following are the criteria for inclusion and exclusion of study participants:

Inclusion criteria

Residents of Garden (East and West) and Karimabad Federal B Area of Karachi who have not contracted the disease.

Exclusion criteria

Those who refuse to participate in the study.

Those who have experienced COVID-19 and are undergoing treatment.

Those who are suspected for COVID-19 and have been isolated/quarantined.

Family members of COVID-19-positive cases.

Data collection procedure

A semistructured interview guide has been developed for community members. The initial questions on the guide will help to explore participants’ perceptions and attitudes towards COVID-19. Additional questions on the guide will assess the impact of these perceptions and attitude on the daily lives and mental health and well-being of community residents. All semistructured interviews will be conducted online via Zoom or WhatsApp. Interviews will be scheduled at the participant’s convenient day and time. Interviews are anticipated to begin on 1 December 2020.

Patient and public involvement

No patients were involved.

Data analysis

We will transcribe and translate collected data into English language by listening to the audio recordings in order to conduct a thematic analysis. NVivo V.12 Plus software will be used to import, organise and explore data for analysis. Two independent researchers will read the transcripts at various times to develop familiarity and clarification with the data. We will employ an iterative process which will help us to label data and generate new categories to identify emergent themes. The recorded text will be divided into shortened units and labelled as a ‘code’ without losing the main essence of the research study. Subsequently, codes will be analysed and merged into comparable categories. Lastly, the same categories will be grouped into subthemes and final themes. To ensure inter-rater reliability, two independent investigators will perform the coding, category creation and thematic analyses. Discrepancies between the two investigators will be resolved through consensus meetings to reduce researcher bias.

Ethics and dissemination

Study participants will be asked to provide informed, written consent prior to participation in the study. The informed consent form can be submitted by the participant via WhatsApp or email. Participants who are unable to write their names will be asked to provide a thumbprint to symbolise their consent to participate. Ethical approval for this study has been obtained from the Aga Khan University Ethical Review Committee (2020-4825-10599). The study results will be disseminated to the scientific community and to the research subjects participating in the study. The findings will help us explore the perceptions and attitudes of different community members towards the COVID-19 pandemic and its impact on their daily lives and mental well-being.

The findings of this study will help us to explore the perceptions and attitudes towards the COVID-19 pandemic and its impact on the daily lives and mental well-being of individuals in the community. Besides, an indepth understanding of the needs of the community will be identified, which will help us develop context-specific innovative mental health programmes to support communities in the future. The study will provide insights into how communities are managing their lives under such a difficult situation.

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1

ASF and NAA are joint first authors.

Contributors ASF and NAA conceived the study. ASF, NAA, RF, NA, SNM and SS contributed to the development of the study design and final protocols for sample selection and interviews. ASF and NAA contributed to writing the manuscript. All authors reviewed and approved the final version of the paper.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Open Access

Peer-reviewed

Research Article

The challenges arising from the COVID-19 pandemic and the way people deal with them. A qualitative longitudinal study

Contributed equally to this work with: Dominika Maison, Diana Jaworska, Dominika Adamczyk, Daria Affeltowicz

Roles Conceptualization, Funding acquisition, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing

Affiliation Faculty of Psychology, University of Warsaw, Warsaw, Poland

Roles Formal analysis, Investigation, Writing – original draft, Writing – review & editing

Roles Conceptualization, Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Roles Conceptualization, Formal analysis, Investigation, Methodology

• Dominika Maison, 
• Diana Jaworska, 
• Dominika Adamczyk, 
• Daria Affeltowicz

• Published: October 11, 2021
• https://doi.org/10.1371/journal.pone.0258133
• Peer Review
• Reader Comments

The conducted qualitative research was aimed at capturing the biggest challenges related to the beginning of the COVID-19 pandemic. The interviews were carried out in March-June (five stages of the research) and in October (the 6 th stage of the research). A total of 115 in-depth individual interviews were conducted online with 20 respondents, in 6 stages. The results of the analysis showed that for all respondents the greatest challenges and the source of the greatest suffering were: a) limitation of direct contact with people; b) restrictions on movement and travel; c) necessary changes in active lifestyle; d) boredom and monotony; and e) uncertainty about the future.

Citation: Maison D, Jaworska D, Adamczyk D, Affeltowicz D (2021) The challenges arising from the COVID-19 pandemic and the way people deal with them. A qualitative longitudinal study. PLoS ONE 16(10): e0258133. https://doi.org/10.1371/journal.pone.0258133

Editor: Shah Md Atiqul Haq, Shahjalal University of Science and Technology, BANGLADESH

Received: April 6, 2021; Accepted: September 18, 2021; Published: October 11, 2021

Copyright: © 2021 Maison et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files ( S1 Dataset ).

Funding: This work was supported by the Faculty of Psychology, University of Warsaw, Poland from the funds awarded by the Ministry of Science and Higher Education in the form of a subsidy for the maintenance and development of research potential in 2020 (501-D125-01-1250000). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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

Introduction

The coronavirus disease (COVID-19), discovered in December 2019 in China, has reached the level of a pandemic and, till June 2021, it has affected more than 171 million people worldwide and caused more than 3.5 million deaths all over the world [ 1 ]. The COVID-19 pandemic as a major health crisis has caught the attention of many researchers, which has led to the creation of a broad quantitative picture of human behavior during the coronavirus outbreak [ 2 – 4 ]. What has been established so far is, among others, the psychological symptoms that can occur as a result of lockdown [ 2 ], and the most common coping strategies [ 5 ]. However, what we still miss is an in-depth understanding of the changes in the ways of coping with challenges over different stages of the pandemic. In the following study, we used a longitudinal qualitative method to investigate the challenges during the different waves of the coronavirus pandemic as well as the coping mechanisms accompanying them.

In Poland, the first patient was diagnosed with COVID-19 on the 4 th March 2020. Since then, the number of confirmed cases has grown to more than 2.8 million and the number of deaths to more than 73,000 (June 2021) [ 1 ]. From mid-March 2020, the Polish government, similarly to many other countries, began to introduce a number of restrictions to limit the spread of the virus. These restrictions had been changing from week to week, causing diverse reactions in people [ 6 ]. It needs to be noted that the reactions to such a dynamic situation cannot be covered by a single study. Therefore, in our study we used qualitative longitudinal research in order to monitor changes in people’s emotions, attitudes, and behavior. So far, few longitudinal studies have been carried out that investigated the various issues related to the COVID-19 pandemic; however, all of them were quantitative [ 7 – 10 ]. The qualitative approach (and especially the use of enabling and projective techniques) allows for an in-depth exploration of respondents’ reactions that goes beyond respondents’ declarations and captures what they are less aware of or even unconscious of. This study consisted of six stages of interviews that were conducted at key moments for the development of the pandemic situation in Poland. The first stage of the study was carried out at the moment of the most severe lockdown and the biggest restrictions (March 2020) and was focused on exploration how did people react to the new uncertain situation. The second stage of the study was conducted at the time when restrictions were extended and the obligation to cover the mouth and nose everywhere outside the household were introduced (middle of April 2020) and was focused at the way how did people deal with the lack of family gatherings over Easter. The third stage of the study was conducted at the moment of announcing the four stages of lifting the restrictions (April 2020) and was focused on people’s reaction to an emerging vision of getting back to normalcy. The fourth stage of the study was carried out, after the introduction of the second stage of lifting the restrictions: shopping malls, hotels, and cultural institutions were gradually being opened (May 2020). The fifth stage of the study was conducted after all four stages of restriction lifting were in place (June 2020). Only the obligation to cover the mouth and nose in public spaces, an order to maintain social distance, as well as the functioning of public places under a sanitary regime were still in effect. During those 5 stages coping strategies with the changes in restrictions were explored. The sixth and last stage of the study was a return to the respondents after a longer break, at the turn of October and November 2020, when the number of coronavirus cases in Poland began to increase rapidly and the media declared “the second wave of the pandemic”. It was the moment when the restrictions were gradually being reintroduced. A full description of the changes occurring in Poland at the time of the study can be found in S1 Table .

The following study is the first qualitative longitudinal study investigating how people cope with the challenges arising from the COVID-19 pandemic at its different stages. The study, although conducted in Poland, shows the universal psychological relations between the challenges posed by the pandemic (and, even more, the restrictions resulting from the pandemic, which were very similar across different countries, not only European) and the ways of dealing with them.

Literature review

The COVID-19 pandemic has led to a global health crisis with severe economic [ 11 ], social [ 3 ], and psychological consequences [ 4 ]. Despite the fact that there were multiple crises in recent years, such as natural disasters, economic crises, and even epidemics, the coronavirus pandemic is the first in 100 years to severely affect the entire world. The economic effects of the COVID-19 pandemic concern an impending global recession caused by the lockdown of non-essential industries and the disruption of production and supply chains [ 11 ]. Social consequences may be visible in many areas, such as the rise in family violence [ 3 ], the ineffectiveness of remote education, and increased food insecurity among impoverished families due to school closures [ 12 ]. According to some experts, the psychological consequences of COVID-19 are the ones that may persist for the longest and lead to a global mental health crisis [ 13 ]. The coronavirus outbreak is generating increased depressive symptoms, stress, anxiety, insomnia, denial, fear, and anger all over the world [ 2 , 14 ]. The economic, social, and psychological problems that people are currently facing are the consequences of novel challenges that have been posed by the pandemic.

The coronavirus outbreak is a novel, uncharted situation that has shaken the world and completely changed the everyday lives of many individuals. Due to the social distancing policy, many people have switched to remote work—in Poland, almost 75% of white-collar workers were fully or partially working from home from mid-March until the end of May 2020 [ 15 ]. School closures and remote learning imposed a new obligation on parents of supervising education, especially with younger children [ 16 ]. What is more, the government order of self-isolation forced people to spend almost all their time at home and limit or completely abandon human encounters. In addition, the deteriorating economic situation was the cause of financial hardship for many people. All these difficulties and challenges arose in the aura of a new, contagious disease with unexplored, long-lasting health effects and not fully known infectivity and lethality [ 17 ]. Dealing with the situation was not facilitated by the phenomenon of global misinformation, called by some experts as the “infodemic”, which may be defined as an overabundance of information that makes it difficult for people to find trustworthy sources and reliable guidance [ 18 ]. Studies have shown that people have multiple ways of reacting to a crisis: from radical and even violent practices, towards individual solutions and depression [ 19 ]. Not only the challenges arising from the COVID-19 pandemic but also the ways of reacting to it and coping with it are issues of paramount importance that are worth investigating.

The reactions to unusual crisis situations may be dependent on dispositional factors, such as trait anxiety or perceived control [ 20 , 21 ]. A study on reactions to Hurricane Hugo has shown that people with higher trait anxiety are more likely to develop posttraumatic symptoms following a natural disaster [ 20 ]. Moreover, lack of perceived control was shown to be positively related to the level of distress during an earthquake in Turkey [ 21 ]. According to some researchers, the COVID-19 crisis and natural disasters have much in common, as the emotions and behavior they cause are based on the same primal human emotion—fear [ 22 ]. Both pandemics and natural disasters disrupt people’s everyday lives and may have severe economic, social and psychological consequences [ 23 ]. However, despite many similarities to natural disasters, COVID-19 is a unique situation—only in 2020, the current pandemic has taken more lives than the world’s combined natural disasters in any of the past twenty years [ 24 ]. It needs to be noted that natural disasters may pose different challenges than health crises and for this reason, they may provoke disparate reactions [ 25 ]. Research on the reactions to former epidemics has shown that avoidance and safety behaviors, such as avoiding going out, visiting crowded places, and visiting hospitals, are widespread at such times [ 26 ]. When it comes to the ways of dealing with the current COVID-19 pandemic, a substantial part of the quantitative research on this issue focuses on coping mechanisms. Studies have shown that the most prevalent coping strategies are highly problem-focused [ 5 ]. Most people tend to listen to expert advice and behave calmly and appropriately in the face of the coronavirus outbreak [ 5 ]. Problem-focused coping is particularly characteristic of healthcare professionals. A study on Chinese nurses has shown that the closer the problem is to the person and the more fear it evokes, the more problem-focused coping strategy is used to deal with it [ 27 ]. On the other hand, a negative coping style that entails risky or aggressive behaviors, such as drug or alcohol use, is also used to deal with the challenges arising from the COVID-19 pandemic [ 28 ]. The factors that are correlated with negative coping include coronavirus anxiety, impairment, and suicidal ideation [ 28 ]. It is worth emphasizing that social support is a very important component of dealing with crises [ 29 ].

Scientists have attempted to systematize the reactions to difficult and unusual situations. One such concept is the “3 Cs” model created by Reich [ 30 ]. It accounts for the general rules of resilience in situations of stress caused by crises, such as natural disasters. The 3 Cs stand for: control (a belief that personal resources can be accessed to achieve valued goals), coherence (the human desire to make meaning of the world), and connectedness (the need for human contact and support) [ 30 ]. Polizzi and colleagues [ 22 ] reviewed this model from the perspective of the current COVID-19 pandemic. The authors claim that natural disasters and COVID-19 pandemic have much in common and therefore, the principles of resilience in natural disaster situations can also be used in the situation of the current pandemic [ 22 ]. They propose a set of coping behaviors that could be useful in times of the coronavirus outbreak, which include control (e.g., planning activities for each day, getting adequate sleep, limiting exposure to the news, and helping others), coherence (e.g., mindfulness and developing a coherent narrative on the event), and connectedness (e.g., establishing new relationships and caring for existing social bonds) [ 22 ].

Current study

The issue of the challenges arising from the current COVID-19 pandemic and the ways of coping with them is complex and many feelings accompanying these experiences may be unconscious and difficult to verbalize. Therefore, in order to explore and understand it deeply, qualitative methodology was applied. Although there were few qualitative studies on the reaction to the pandemic [e.g., 31 – 33 ], they did not capture the perception of the challenges and their changes that arise as the pandemic develops. Since the situation with the COVID-19 pandemic is very dynamic, the reactions to the various restrictions, orders or bans are evolving. Therefore, it was decided to conduct a qualitative longitudinal study with multiple interviews with the same respondents [ 34 ].

The study investigates the challenges arising from the current pandemic and the way people deal with them. The main aim of the project was to capture people’s reactions to the unusual and unexpected situation of the COVID-19 pandemic. Therefore, the project was largely exploratory in nature. Interviews with the participants at different stages of the epidemic allowed us to see a wide spectrum of problems and ways of dealing with them. The conducted study had three main research questions:

• What are the biggest challenges connected to the COVID-19 pandemic and the resulting restrictions?
• How are people dealing with the pandemic challenges?
• What are the ways of coping with the restrictions resulting from a pandemic change as it continues and develops (perspective of first 6 months)?

The study was approved by the institutional review board of the Faculty of Psychology University of Warsaw, Poland. All participants were provided written and oral information about the study, which included that participation was voluntary, that it was possible to withdraw without any consequences at any time, and the precautions that would be taken to protect data confidentiality. Informed consent was obtained from all participants. To ensure confidentiality, quotes are presented only with gender, age, and family status.

The study was based on qualitative methodology: individual in-depth interviews, s which are the appropriate to approach a new and unknown and multithreaded topic which, at the beginning of 2020, was the COVID-19 pandemic. Due to the need to observe respondents’ reactions to the dynamically changing situation of the COVID-19 pandemic, longitudinal study was used where the moderator met on-line with the same respondent several times, at specific time intervals. A longitudinal study was used to capture the changes in opinions, emotions, and behaviors of the respondents resulting from the changes in the external circumstances (qualitative in-depth interview tracking–[ 34 ]).

The study took place from the end of March to October 2020. Due to the epidemiological situation in the country interviews took place online, using the Google Meets online video platform. The audio was recorded and then transcribed. Before taking part in the project, the respondents were informed about the purpose of the study, its course, and the fact that participation in the project is voluntary, and that they will be able to withdraw from participation at any time. The respondents were not paid for taking part in the project.

Participants.

In total, 115 interviews were conducted with 20 participants (6 interviews with the majority of respondents). Two participants (number 11 and 19, S2 Table ) dropped out of the last two interviews, and one (number 6) dropped out of the last interview. The study was based on a purposive sample and the respondents differed in gender, age, education, family status, and work situation (see S2 Table ). In addition to demographic criteria intended to ensure that the sample was as diverse as possible, an additional criterion was to have a permanent Internet connection and a computer capable of online video interviewing. Study participants were recruited using the snowball method. They were distant acquaintances of acquaintances of individuals involved in the study. None of the moderators knew their interviewees personally.

A total of 10 men and 10 women participated in the study; their age range was: 25–55; the majority had higher education (17 respondents), they were people with different professions and work status, and different family status (singles, couples without children, and families with children). Such diversity of respondents allowed us to obtain information from different life perspectives. A full description of characteristics of study participants can be found in S2 Table .

Each interview took 2 hours on average, which gives around 240 hours of interviews. Subsequent interviews with the same respondents conducted at different intervals resulted from the dynamics of the development of the pandemic and the restrictions introduced in Poland by the government.

The interviews scenario took a semi-structured form. This allowed interviewers freely modify the questions and topics depending on the dynamics of the conversation and adapt the subject matter of the interviews not only to the research purposes but also to the needs of a given respondent. The interview guides were modified from week to week, taking into account the development of the epidemiological situation, while at the same time maintaining certain constant parts that were repeated in each interview. The main parts of the interview topic guide consisted of: (a) experiences from the time of previous interviews: thoughts, feeling, fears, and hopes; (b) everyday life—organization of the day, work, free time, shopping, and eating, etc.; (c) changes—what had changed in the life of the respondent from the time of the last interview; (d) ways of coping with the situation; and (e) media—reception of information appearing in the media. Additionally, in each interview there were specific parts, such as the reactions to the beginning of the pandemic in the first interview or the reaction to the specific restrictions that were introduced.

The interviews were conducted by 5 female interviewers with experience in moderating qualitative interviews, all with a psychological background. After each series of interviews, all the members of the research teams took part in debriefing sessions, which consisted of discussing the information obtained from each respondent, exchanging general conclusions, deciding about the topics for the following interview stage, and adjusting them to the pandemic situation in the country.

Data analysis.

All the interviews were transcribed in Polish by the moderators and then double-checked (each moderator transcribed the interviews of another moderator, and then the interviewer checked the accuracy of the transcription). The whole process of analysis was conducted on the material in Polish (the native language of the authors of the study and respondents). The final page count of the transcript is approximately 1800 pages of text. The results presented below are only a portion of the total data collected during the interviews. While there are about 250 pages of the transcription directly related to the topic of the article, due to the fact that the interview was partly free-form, some themes merge with others and it is not possible to determine the exact number of pages devoted exclusively to analysis related to the topic of the article. Full dataset can be found in S1 Dataset .

Data was then processed into thematic analysis, which is defined as a method of developing qualitative data consisting of the identification, analysis, and description of the thematic areas [ 35 ]. In this type of analysis, a thematic unit is treated as an element related to the research problem that includes an important aspect of data. An important advantage of thematic analysis is its flexibility, which allows for the adoption of the most appropriate research strategy to the phenomenon under analysis. An inductive approach was used to avoid conceptual tunnel vision. Extracting themes from the raw data using an inductive approach precludes the researcher from imposing a predetermined outcome.

As a first step, each moderator reviewed the transcripts of the interviews they had conducted. Each transcript was thematically coded individually from this point during the second and the third reading. In the next step, one of the researchers reviewed the codes extracted by the other members of the research team. Then she made initial interpretations by generating themes that captured the essence of the previously identified codes. The researcher created a list of common themes present in all of the interviews. In the next step, the extracted themes were discussed again with all the moderators conducting the coding in order to achieve consistency. This collaborative process was repeated several times during the analysis. Here, further superordinate (challenges of COVID-19 pandemic) and subordinate (ways of dealing with challenges) themes were created, often by collapsing others together, and each theme listed under a superordinate and subordinate category was checked to ensure they were accurately represented. Through this process of repeated analysis and discussion of emerging themes, it was possible to agree on the final themes that are described below.

Main challenges of the COVID-19 pandemic.

Challenge 1 –limitation of direct contact with people . The first major challenge of the pandemic was that direct contact with other people was significantly reduced. The lockdown forced many people to work from home and limit contact not only with friends but also with close family (parents, children, and siblings). Limiting contact with other people was a big challenge for most of our respondents, especially those who were living alone and for those who previously led an active social life. Depending on their earlier lifestyle profile, for some, the bigger problem was the limitation of contact with the family, for others with friends, and for still others with co-workers.

I think that because I can’t meet up with anyone and that I’m not in a relationship , I miss having sex , and I think it will become even more difficult because it will be increasingly hard to meet anyone . (5 . 3_ M_39_single) . The number In the brackets at the end of the quotes marks the respondent’s number (according to Table 1 ) and the stage of the interview (after the dash), further is information about gender (F/M), age of the respondent and family status. Linguistic errors in the quotes reflect the spoken language of the respondents.

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https://doi.org/10.1371/journal.pone.0258133.t001

Changes over time . Over the course of the 6 months of the study, an evolution in the attitudes to the restriction of face-to-face contact could be seen: from full acceptance, to later questioning its rationale. Initially (March and April), almost all the respondents understood the reasons for the isolation and were compliant. At the beginning, people were afraid of the unknown COVID-19. They were concerned that the tragic situation from Italy, which was intensively covered in the media, could repeat itself in Poland (stage 1–2 of the study). However, with time, the isolation started to bother them more and more, and they started to look for solutions to bypass the isolation guidelines (stage 3–4), both real (simply meeting each other) and mental (treating isolation only as a guideline and not as an order, perceiving the family as being less threatening than acquaintances or strangers in a store). The turning point was the long May weekend that, due to two public holidays (1 st and 3 rd May), has for many years been used as an opportunity to go away with family or friends. Many people broke their voluntary isolation during that time encouraged by information about the coming loosening of restrictions.

During the summer (stage 5 of the survey), practically no one was fully compliant with the isolation recommendations anymore. At that time, a growing familiarity could be observed with COVID-19 and an increasing tendency to talk about it as “one of many diseases”, and to convince oneself that one is not at risk and that COVID-19 is no more threatening than other viruses. Only a small group of people consciously failed to comply with the restrictions of contact with others from the very beginning of the pandemic. This behavior was mostly observed among people who were generally less anxious and less afraid of COVID-19.

I’ve had enough. I’ve had it with sitting at home. Okay, there’s some kind of virus, it’s as though it’s out there somewhere; it’s like I know 2 people who were infected but they’re still alive, nothing bad has happened to anyone. It’s just a tiny portion of people who are dying. And is it really such a tragedy that we have to be locked up at home? Surely there’s an alternative agenda there? (17.4_F_35_Adult and child)

Ways of dealing . In the initial phase, when almost everyone accepted this restriction and submitted to it, the use of communication platforms for social meetings increased (see Ways of dealing with challenges in Table 1 ) . Meetings on communication platforms were seen as an equivalent of the previous face-to-face contact and were often even accompanied by eating or drinking alcohol together. However, over time (at around stage 4–5 of the study) people began to feel that such contact was an insufficient substitute for face-to-face meetings and interest in online meetings began to wane. During this time, however, an interesting phenomenon could be seen, namely, that for many people the family was seen as a safer environment than friends, and definitely safer than strangers. The belief was that family members would be honest about being sick, while strangers not necessarily, and—on an unconscious level—the feeling was that the “family is safe”, and the “family can’t hurt them”.

When it became clear that online communication is an insufficient substitute for face-to-face contacts, people started to meet up in real life. However, a change in many behaviors associated with meeting people is clearly visible, e.g.: refraining from shaking hands, refraining from cheek kissing to greet one another, and keeping a distance during a conversation.

I can’t really say that I could ‘feel’ Good Friday or Holy Saturday. On Sunday, we had breakfast together with my husband’s family and his sister. We were in three different places but we connected over Skype. Later, at noon, we had some coffee with my parents, also over Skype. It’s obvious though that this doesn’t replace face-to-face contact but it’s always some form of conversation. (9.3_F_25_Couple, no children)

Challenge 2 –restrictions on movement and travel . In contrast to the restrictions on contact with other people, the restrictions on movement and the closing of borders were perceived more negatively and posed bigger challenges for some people (especially those who used to do a lot of travelling). In this case, it was less clear why these regulations were introduced (especially travel restrictions within the country). Moreover, travel restrictions, particularly in the case of international travels, were associated with a limitation of civil liberties. The limitation (or complete ban) on travelling abroad in the Polish situation evoked additional connotations with the communist times, that is, with the fact that there was no freedom of movement for Polish citizens (associations with totalitarianism and dictatorship). Interestingly, the lack of acceptance of this restriction was also manifested by people who did not travel much. Thus, it was not just a question of restricting travelling abroad but more of restricting the potential opportunity (“even if I’m not planning on going anywhere, I know I still can”).

Limitations on travelling around the country were particularly negatively felt by families with children, where parents believe that regular exercise and outings are necessary for the proper development of their children. For parents, it was problematic to accept the prohibition of leaving the house and going to the playground (which remained closed until mid-May). Being outdoors was perceived as important for maintaining immunity (exercise as part of a healthy lifestyle), therefore, people could not understand the reason underlying this restriction and, as a consequence, often did not accept it.

I was really bothered by the very awareness that I can’t just jump in my car or get on a plane whenever I want and go wherever I want. It’s not something that I have to do on a daily basis but freedom of movement and travelling are very important for me. (14.2_M_55_Two adults and children)

Changes over time . The travel and movement limitations, although objectively less severe for most people, aroused much greater anger than the restrictions on social contact. This was probably due to a greater sense of misunderstanding as to why these rules were being introduced in the first place. Moreover, they were often communicated inconsistently and chaotically (e.g., a ban on entering forests was introduced while, at the same time, shopping malls remained open and masses were allowed to attend church services). This anger grew over time—from interview to interview, the respondents’ irritation and lack of acceptance of this was evident (culminating in the 3 rd -4 th stage of the study). The limitation of mobility was also often associated with negative consequences for both health and the economy. Many people are convinced that being in the open air (especially accompanied by physical activity) strengthens immunity, therefore, limiting such activity may have negative health consequences. Some respondents pointed out that restricting travelling, the use of hotels and restaurants, especially during the holiday season, will have serious consequences for the existence of the tourism industry.

I can’t say I completely agree with these limitations because it’s treating everything selectively. It’s like the shopping mall is closed, I can’t buy any shoes but I can go to a home improvement store and buy some wallpaper for myself. So I don’t see the difference between encountering people in a home improvement store and a shopping mall. (18.2_F_48_Two adults and children)

Ways of dealing . Since the restriction of movement and travel was more often associated with pleasure-related behaviors than with activities necessary for living, the compensations for these restrictions were usually also from the area of hedonistic behaviors. In the statements of our respondents, terms such as “indulging” or “rewarding oneself” appeared, and behaviors such as throwing small parties at home, buying better alcohol, sweets, and new clothes were observed. There were also increased shopping behaviors related to hobbies (sometimes hobbies that could not be pursued at the given time)–a kind of “post-pandemic” shopping spree (e.g., a new bike or new skis).

Again, the reaction to this restriction also depended on the level of fear of the COVID-19 disease. People who were more afraid of being infected accepted these restrictions more easily as it gave them the feeling that they were doing something constructive to protect themselves from the infection. Conversely, people with less fears and concerns were more likely to rebel and break these bans and guidelines.

Another way of dealing with this challenge was making plans for interesting travel destinations for the post-pandemic period. This was especially salient in respondents with an active lifestyle in the past and especially visible during the 5 th stage of the study.

Today was the first day when I went to the store (due to being in quarantine after returning from abroad). I spent loads of money but I normally would have never spent so much on myself. I bought sweets and confectionery for Easter time, some Easter chocolates, too. I thought I’d do some more baking so I also bought some ingredients to do this. (1.2_ F_25_single)

Challenge 3 –necessary change in active lifestyle . Many of the limitations related to COVID-19 were a challenge for people with an active lifestyle who would regularly go to the cinema, theater, and gym, use restaurants, and do a lot of travelling. For those people, the time of the COVID constraints has brought about huge changes in their lifestyle. Most of their activities were drastically restricted overnight and they suddenly became domesticated by force, especially when it was additionally accompanied by a transition to remote work.

Compulsory spending time at home also had serious consequences for people with school-aged children who had to confront themselves with the distance learning situation of their children. The second challenge for families with children was also finding (or helping find) activities for their children to do in their free time without leaving the house.

I would love to go to a restaurant somewhere. We order food from the restaurant at least once a week, but I’d love to go to the restaurant. Spending time there is a different way of functioning. It is enjoyable and that is what I miss. I would also go to the cinema, to the theater. (13.3_M_46_Two adults and child.)

Changes over time . The nuisance of restrictions connected to an active lifestyle depended on the level of restrictions in place at a given time and the extent to which a given activity could be replaced by an alternative. Moreover, the response to these restrictions depended more on the individual differences in lifestyle rather than on the stage of the interview (except for the very beginning, when the changes in lifestyle and everyday activities were very sudden).

I miss that these restaurants are not open . And it’s not even that I would like to eat something specific . It is in all of this that I miss such freedom the most . It bothers me that I have no freedom . And I am able to get used to it , I can cook at home , I can order from home . But I just wish I had a choice . (2 . 6_F_27_single ).

Ways of dealing . In the initial phase of the pandemic (March-April—stage 1–3 of the study), when most people were afraid of the coronavirus, the acceptance of the restrictions was high. At the same time, efforts were made to find activities that could replace existing ones. Going to the gym was replaced by online exercise, and going to the cinema or theater by intensive use of streaming platforms. In the subsequent stages of the study, however, the respondents’ fatigue with these “substitutes” was noticeable. It was then that more irritation and greater non-acceptance of certain restrictions began to appear. On the other hand, the changes or restrictions introduced during the later stages of the pandemic were less sudden than the initial ones, so they were often easier to get used to.

I bought a small bike and even before that we ordered some resistance bands to work out at home, which replace certain gym equipment and devices. […] I’m considering learning a language. From the other online things, my girlfriend is having yoga classes, for instance. (7.2_M_28_Couple, no children)

Challenge 4 –boredom , monotony . As has already been shown, for many people, the beginning of the pandemic was a huge change in lifestyle, an absence of activities, and a resulting slowdown. It was sometimes associated with a feeling of weariness, monotony, and even of boredom, especially for people who worked remotely, whose days began to be similar to each other and whose working time merged with free time, weekdays with the weekends, and free time could not be filled with previous activities.

In some way, boredom. I can’t concentrate on what I’m reading. I’m trying to motivate myself to do such things as learning a language because I have so much time on my hands, or to do exercises. I don’t have this balance that I’m actually doing something for myself, like reading, working out, but also that I’m meeting up with friends. This balance has gone, so I’ve started to get bored with many things. Yesterday I felt that I was bored and something should start happening. (…) After some time, this lack of events and meetings leads to such immense boredom. (1.5_F_25_single)

Changes over time . The feeling of monotony and boredom was especially visible in stage 1 and 2 of the study when the lockdown was most restrictive and people were knocked out of their daily routines. As the pandemic continued, boredom was often replaced by irritation in some, and by stagnation in others (visible in stages 3 and 4 of the study) while, at the same time, enthusiasm for taking up new activities was waning. As most people were realizing that the pandemic was not going to end any time soon, a gradual adaptation to the new lifestyle (slower and less active) and the special pandemic demands (especially seen in stage 5 and 6 of the study) could be observed.

But I see that people around me , in fact , both family and friends , are slowly beginning to prepare themselves for more frequent stays at home . So actually more remote work , maybe everything will not be closed and we will not be locked in four walls , but this tendency towards isolation or self-isolation , such a deliberate one , appears . I guess we are used to the fact that it has to be this way . (15 . 6_M_43_Two adults and child) .

Ways of dealing . The answer to the monotony of everyday life and to finding different ways of separating work from free time was to stick to certain rituals, such as “getting dressed for work”, even when work was only by a computer at home or, if possible, setting a fixed meal time when the whole family would gather together. For some, the time of the beginning of the pandemic was treated as an extra vacation. This was especially true of people who could not carry out their work during the time of the most severe restrictions (e.g., hairdressers and doctors). For them, provided that they believed that everything would return to normal and that they would soon go back to work, a “vacation mode” was activated wherein they would sleep longer, watch a lot of movies, read books, and generally do pleasant things for which they previously had no time and which they could now enjoy without feeling guilty. Another way of dealing with the monotony and transition to a slower lifestyle was taking up various activities for which there was no time before, such as baking bread at home and cooking fancy dishes.

I generally do have a set schedule. I begin work at eight. Well, and what’s changed is that I can get up last minute, switch the computer on and be practically making my breakfast and coffee during this time. I do some work and then print out some materials for my younger daughter. You know, I have work till four, I keep on going up to the computer and checking my emails. (19.1_F_39_Two adults and children)

Challenge 5 –uncertainty about the future . Despite the difficulties arising from the circumstances and limitations described above, it seems that psychologically, the greatest challenge during a pandemic is the uncertainty of what will happen next. There was a lot of contradictory information in the media that caused a sense of confusion and heightened the feeling of anxiety.

I’m less bothered about the changes that were put in place and more about this concern about what will happen in the future. Right now, it’s like there’s these mood swings. […] Based on what’s going on, this will somehow affect every one of us. And that’s what I’m afraid of. The fact that someone will not survive and I have no way of knowing who this could be—whether it will be me or anyone else, or my dad, if somehow the coronavirus will sneak its way into our home. I simply don’t know. I’m simply afraid of this. (10.1_F_55_Couple, no children)

Changes over time . In the first phase of the pandemic (interviews 1–3), most people felt a strong sense of not being in control of the situation and of their own lives. Not only did the consequences of the pandemic include a change in lifestyle but also, very often, the suspension of plans altogether. In addition, many people felt a strong fear of the future, about what would happen, and even a sense of threat to their own or their loved ones’ lives. Gradually (interview 4), alongside anxiety, anger began to emerge about not knowing what would happen next. At the beginning of the summer (stage 5 of the study), most people had a hope of the pandemic soon ending. It was a period of easing restrictions and of opening up the economy. Life was starting to look more and more like it did before the pandemic, fleetingly giving an illusion that the end of the pandemic was “in sight” and the vision of a return to normal life. Unfortunately, autumn showed that more waves of the pandemic were approaching. In the interviews of the 6 th stage of the study, we could see more and more confusion and uncertainty, a loss of hope, and often a manifestation of disagreement with the restrictions that were introduced.

This is making me sad and angry. More angry, in fact. […] I don’t know what I should do. Up until now, there was nothing like this. Up until now, I was pretty certain of what I was doing in all the decisions I was making. (14.4_M_55_Two adults and children)

Ways of dealing . People reacted differently to the described feeling of insecurity. In order to reduce the emerging fears, some people searched (sometimes even compulsively) for any information that could help them “take control” of the situation. These people searched various sources, for example, information on the number of infected persons and the number of deaths. This knowledge gave them the illusion of control and helped them to somewhat reduce the anxiety evoked by the pandemic. The behavior of this group was often accompanied by very strict adherence to all guidelines and restrictions (e.g., frequent hand sanitization, wearing a face mask, and avoiding contact with others). This behavior increased the sense of control over the situation in these people.

A completely opposite strategy to reducing the feeling of uncertainty which we also observed in some respondents was cutting off information in the media about the scale of the disease and the resulting restrictions. These people, unable to keep up with the changing information and often inconsistent messages, in order to maintain cognitive coherence tried to cut off the media as much as possible, assuming that even if something really significant had happened, they would still find out.

I want to keep up to date with the current affairs. Even if it is an hour a day. How is the pandemic situation developing—is it increasing or decreasing. There’s a bit of propaganda there because I know that when they’re saying that they have the situation under control, they can’t control it anyway. Anyhow, it still has a somewhat calming effect that it’s dying down over here and that things aren’t that bad. And, apart from this, I listen to the news concerning restrictions, what we can and can’t do. (3.1_F_54_single)

Discussion and conclusions

The results of our study showed that the five greatest challenges resulting from the COVID-19 pandemic are: limitations of direct contact with people, restrictions on movement and travel, change in active lifestyle, boredom and monotony, and finally uncertainty about the future. As we can see the spectrum of problems resulting from the pandemic is very wide and some of them have an impact on everyday functioning and lifestyle, some other influence psychological functioning and well-being. Moreover, different people deal with these problems differently and different changes in everyday life are challenging for them. The first challenge of the pandemic COVID-19 problem is the consequence of the limitation of direct contact with others. This regulation has very strong psychological consequences in the sense of loneliness and lack of closeness. Initially, people tried to deal with this limitation through the use of internet communicators. It turned out, however, that this form of contact for the majority of people was definitely insufficient and feelings of deprivation quickly increased. As much data from psychological literature shows, contact with others can have great psychological healing properties [e.g., 29 ]. The need for closeness is a natural need in times of crisis and catastrophes [ 30 ]. Unfortunately, during the COVID-19 pandemic, the ability to meet this need was severely limited by regulations. This led to many people having serious problems with maintaining a good psychological condition.

Another troubling limitation found in our study were the restrictions on movement and travel, and the associated restrictions of most activities, which caused a huge change in lifestyle for many people. As shown in previous studies, travel and diverse leisure activities are important predictors of greater well-being [ 36 ]. Moreover, COVID-19 pandemic movement restrictions may be perceived by some people as a threat to human rights [ 37 ], which can contribute to people’s reluctance to accept lockdown rules.

The problem with accepting these restrictions was also related to the lack of understanding of the reasons behind them. Just as the limitation in contact with other people seemed understandable, the limitations related to physical activity and mobility were less so. Because of these limitations many people lost a sense of understanding of the rules and restrictions being imposed. Inconsistent communication in the media—called by some researchers the ‘infodemic’ [ 18 ], as well as discordant recommendations in different countries, causing an increasing sense of confusion in people.

Another huge challenge posed by the current pandemic is the feeling of uncertainty about the future. This feeling is caused by constant changes in the rules concerning daily functioning during the pandemic and what is prohibited and what is allowed. People lose their sense of being in control of the situation. From the psychological point of view, a long-lasting experience of lack of control can cause so-called learned helplessness, a permanent feeling of having no influence over the situation and no possibility of changing it [ 38 ], which can even result in depression and lower mental and physical wellbeing [ 39 ]. Control over live and the feeling that people have an influence on what happens in their lives is one of the basic rules of crisis situation resilience [ 30 ]. Unfortunately, also in this area, people have huge deficits caused by the pandemic. The obtained results are coherent with previous studies regarding the strategies harnessed to cope with the pandemic [e.g., 5 , 10 , 28 , 33 ]. For example, some studies showed that seeking social support is one of the most common strategies used to deal with the coronavirus pandemic [ 33 , 40 ]. Other ways to deal with this situation include distraction, active coping, and a positive appraisal of the situation [ 41 ]. Furthermore, research has shown that simple coping behaviors such as a healthy diet, not reading too much COVID-19 news, following a daily routine, and spending time outdoors may be protective factors against anxiety and depressive symptoms in times of the coronavirus pandemic [ 41 ].

This study showed that the acceptance of various limitations, and especially the feeling of discomfort associated with them, depended on the person’s earlier lifestyle. The more active and socializing a person was, the more restrictions were burdensome for him/her. The second factor, more of a psychological nature, was the fear of developing COVID-19. In this case, people who were more afraid of getting sick were more likely to submit to the imposed restrictions that, paradoxically, did not reduce their anxiety, and sometimes even heightened it.

Limitations of the study.

While the study shows interesting results, it also has some limitations. The purpose of the study was primarily to capture the first response to problems resulting from a pandemic, and as such its design is not ideal. First, the study participants are not diverse as much as would be desirable. They are mostly college-educated and relatively well off, which may influence how they perceive the pandemic situation. Furthermore, the recruitment was done by searching among the further acquaintances of the people involved in the study, so there is a risk that all the people interviewed come from a similar background. It would be necessary to conduct a study that also describes the reaction of people who are already in a more difficult life situation before the pandemic starts.

Moreover, it would also be worthwhile to pay attention to the interviewers themselves. All of the moderators were female, and although gender effects on the quality of the interviews and differences between the establishment of relationships between women and men were not observed during the debriefing process, the topic of gender effects on the results of qualitative research is frequently addressed in the literature [ 42 , 43 ]. Although the researchers approached the process with reflexivity and self-criticism at all stages, it would have seemed important to involve male moderators in the study to capture any differences in relationship dynamics.

Practical implications.

The study presented has many practical implications. Decision-makers in the state can analyze the COVID-19 pandemic crisis in a way that avoids a critical situation involving other infectious diseases in the future. The results of our study showing the most disruptive effects of the pandemic on people can serve as a basis for developing strategies to deal with the effects of the crisis so that it does not translate into a deterioration of the public’s mental health in the future.

The results of our study can also provide guidance on how to communicate information about restrictions in the future so that they are accepted and respected (for example by giving rational explanations of the reasons for introducing particular restrictions). In addition, the results of our study can also be a source of guidance on how to deal with the limitations that may arise in a recurrent COVID-19 pandemic, as well as other emergencies that could come.

The analysis of the results showed that the COVID-19 pandemic, and especially the lockdown periods, are a particular challenge for many people due to reduced social contact. On the other hand, it is social contacts that are at the same time a way of a smoother transition of crises. This knowledge should prompt decision-makers to devise ways to ensure pandemic safety without drastically limiting social contacts and to create solutions that give people a sense of control (instead of depriving it of). Providing such solutions can reduce the psychological problems associated with a pandemic and help people to cope better with it.

Conclusions

As more and more is said about the fact that the COVID-19 pandemic may not end soon and that we are likely to face more waves of this disease and related lockdowns, it is very important to understand how the different restrictions are perceived, what difficulties they cause and what are the biggest challenges resulting from them. For example, an important element of accepting the restrictions is understanding their sources, i.e., what they result from, what they are supposed to prevent, and what consequences they have for the fight against the pandemic. Moreover, we observed that the more incomprehensible the order was, the more it provoked to break it. This means that not only medical treatment is extremely important in an effective fight against a pandemic, but also appropriate communication.

The results of our study showed also that certain restrictions cause emotional deficits (e.g., loneliness, loss of sense of control) and, consequently, may cause serious problems with psychological functioning. From this perspective, it seems extremely important to understand which restrictions are causing emotional problems and how they can be dealt with in order to reduce the psychological discomfort associated with them.

Supporting information

S1 table. a full description of the changes occurring in poland at the time of the study..

https://doi.org/10.1371/journal.pone.0258133.s001

S2 Table. Characteristics of study participants.

https://doi.org/10.1371/journal.pone.0258133.s002

S1 Dataset. Transcriptions from the interviews.

https://doi.org/10.1371/journal.pone.0258133.s003

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• Published: 03 December 2022

Impacts of the COVID-19 pandemic on scientists’ productivity in science, technology, engineering, mathematics (STEM), and medicine fields

• Seulkee Heo   ORCID: orcid.org/0000-0002-0786-5002 1 ,
• Alisha Yee Chan 1 , 2 ,
• Pedro Diaz Peralta 1 , 3 ,
• Lan Jin 4 ,
• Claudia Ribeiro Pereira Nunes 1 , 5 &
• Michelle L. Bell   ORCID: orcid.org/0000-0002-3965-1359 1  

Humanities and Social Sciences Communications volume  9 , Article number:  434 ( 2022 ) Cite this article

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While studies suggested adverse impacts of COVID-19 on scientific outputs and work routines for scientists, more evidence is required to understand detailed obstacles challenging scientists’ work and productivity during the pandemic, including how different people are affected (e.g., by gender). This online survey-based thematic analysis investigated how the pandemic affected scientists’ perception of scientific and academic productivity in the science, technology, engineering, and mathematics (STEM) and medicine fields. The analysis examined if inequitable changes in duties and responsibilities for caregiving for children, family, and/or households exist between scientists who are mothers compared to scientists who are fathers or non-parents. The survey collected data from 2548 survey responses in six languages across 132 countries. Results indicate that many scientists suffered from delays and restrictions on research activities and administrations due to the lockdown of institutions, as well as increased workloads from adapting to online teaching environment. Caregiving responsibility for children and family increased, which compromised time for academic efforts, especially due to the temporary shutdown of social supports. Higher percentages of female parent participants than male parent participants expressed such increased burdens indicating unequal divisions of caregiving between women and men. A range of physical and mental health issues was identified mainly due to overworking and isolation. Despite numerous obstacles, some participants reported advantages during the pandemic including the efficiency of online teaching, increased funding for COVID-related research, application of alternative research methodologies, and fluidity of the workday from not commuting. Findings imply the need for rapid institutional support to aid various academic activities and diminish gender inequity in career development among academicians, highlighting how crisis can exacerbate existing inequalities.

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Introduction

Even though there is not definitive start date of the pandemic and the pandemic began at different times throughout the world, the COVID-19 pandemic, announced by the World Health Organization (WHO) on March 11, 2020 (WHO, 2020 ), resulted in global mitigation measures such as physical/social distancing and stay-at-home interventions intending to reduce virus transmission. Many research institutions and universities partially shutdown and severely reduced onsite academic activities in many countries (Omary et al., 2020 ). This significantly changed teaching and research environments for scientists. As universities quickly canceled in-person classes and training programs and instituted online teaching (Tarkar, 2020 ), substantial challenges were created for students and teachers (Coyne et al., 2020 ).

The COVID-19 pandemic affected scientists in different fields unevenly (Myers et al., 2020 ) and the changes in work routines have been especially significant in the science and engineering fields for which research and teaching activities include physical laboratory resources, living animals, and time-sensitive experiments (Mehta et al., 2022 ). For example, research involving animal subjects was impacted by halts in new animal orders and experiments. Ongoing or new projects requiring human samples or field work were not permitted unless they were relevant to COVID-19 research, and “dry” research that does not require “wet” laboratories was shifted to remote work (Omary et al., 2020 ). The COVID-19 pandemic has adversely affected clinical trials in the medicine, health care, and public health fields with most trials being delayed or deferred. Ethical issues raised during the pandemic led to the debates in these fields between utilizing the best opportunity to conduct COVID-19 clinical research and drawing efforts toward the new mission of providing clinical care to patients affected by the pandemic (Hashem et al., 2020 ). Thus, it is anticipated that the institutional-level actions to address COVID-19 brought significant changes in work routines and productivity in these fields that may be different from other research or educational fields.

Several studies explored changes in productivity in academic fields during the pandemic by focusing on publications and the number of hours worked. A survey study for faculty and principal investigators found that total working hours declined for over half of the survey participants by April 2020 in US and European countries, whereas 18% of participants reported increased working hours (Myers et al., 2020 ). The decreased time devoted to work was largest for scientists in fields involving physical laboratory activities. Although the number of research articles on COVID-19 increased during the early phase of the pandemic (Älgå et al., 2020 ), the numbers of publications and work hours cannot fully reflect quality or outputs of other scientific work including teaching, grant writing, mentorship, or academic service. Furthermore, although these results provide empirical findings for output of academic work during the pandemic, more information is needed on the various situations that hinder academic activities and scientific productivity. Therefore, more understanding is needed regarding challenges caused by the pandemic both onsite and offsite and how such challenges affect scientists’ productivity and well-being.

Numerous studies focused on disproportionate changes in publications between men and women during the pandemic. The number of COVID-19 articles in medical journals with a female first author was 19% lower than those with a male first author in March–April 2020 (Andersen et al., 2020 ). Submissions of articles in public health increased overall during January–May 2020 compared to the pre-pandemic period in the US, by 23.8% for men and 7.9% for women (Bell and Fong, 2021 ). Studies suggest that the pandemic exacerbated existing gender disparities for publications and career progress (Staniscuaski et al., 2021 ; Breuning et al., 2021 ). Many studies found that women usually carry a greater burden of domestic responsibilities and childcare (Zamarro and Prados, 2021 ). The misconception that women do not have time for collaboration due to other duties including childcare (Clancy, 2020 ) is another obstacle faced by female scientists. Pursuing academic careers while being a mother can be more challenging in male-dominated areas such as science, technology, engineering, and mathematics (STEM)-related fields (Staniscuaski et al., 2021 ). During the pandemic, increased caregiving responsibility for small children was aggravated due to the closure of childcare facilities and affected gender differences in publications and work hours (Collins et al., 2021 ; Krukowski et al., 2021 ). These studies shed light on the need for understanding inequities of productivity by gender and status as a parent for scientists during times of crisis, such as the pandemic. Further, more evidence is needed about how the pandemic affected gender differences in the division of childcare as almost all parents needed to spend more time at home and work remotely during the pandemic (Zamarro and Prados, 2021 ).

This survey-based qualitative analysis had two specific goals. The first is to identify scientists’ perceptions and experiences regarding their scientific/academic productivity during the COVID-19 pandemic. We focus on work productivity for scientists in terms of research, teaching, and mentoring/supervising, although productivity in academic and scientific fields can be defined more broadly including clinical work, administrative work, outreach, public service, and leadership. While many changes for work environment and conditions were experienced along with competing responsibilities, we aimed to identify and summarize both positive and negative experiences of scientists regarding productivity during the pandemic. Second, we aimed to examine our hypothesis of inequitable changes in duties and responsibilities for caregiving for children, family, and/or households between scientists who are mothers compared to scientists who are fathers or non-parents.

Survey recruitment

This study was approved by the Yale University Institutional Review Board. We conducted a study using an online survey questionnaire and summaries of this survey are presented elsewhere with quantitative analyses related to the mental health and well-being of scientists in STEM, medicine, public health, or other areas of science/engineering (Heo et al., 2022 ). This paper utilizes participants’ responses to an open-ended question in the questionnaire. The survey study was designed to investigate how the COVID-19 pandemic affects scientists’ work productivity and mental health. This survey targeted scientists working in research and/or educational institutions, government agencies, industry, or other institutions for STEM, medicine, public health, or other areas of science/engineering (hereafter referred to as ‘STEMM fields’). Three screening questions were used to identify participants who satisfied the following criteria and were given the remainder of the survey: (1) age >18 years, (2) scientists in STEMM fields, and (3) not a student.

We recruited participants in two ways. We advertised on social media (Facebook, Instagram), with a brief description and link that directed persons to our questionnaire, starting with the online consent form. We also manually distributed this link to email addresses registered at citation databases such as Scopus and PubMed for articles published 2017–2021 in SCI-level journals of various categories of STEMM fields, using an approach applied in previous research (Deryugina et al., 2021 ). Persons who received our email were asked to click the survey link for their preferred language and were directed to the survey, starting with the online consent form. The questionnaire was available in some of the world’s most frequently spoken languages (Lane, 2021 ): English, Mandarin, Spanish, Portuguese, Japanese, and Korean. The survey was open from October 5 through December 31, 2021. Thus, responses represent perceptions of a 2-year period (2020–2021) since the spread of COVID-19, although we recognize that there is not definitive start date for the pandemic and that the pandemic took place at different times throughout the world. We included an open-ended, optional question, “How has COVID-19 affected your overall productivity?”, with a 300 maximum word count. Open-ended responses are widely used to explore participants’ experiences and perspectives in a variety of fields (Feng and Behar-Horenstein, 2019 ).

Thematic analysis

Thematic analysis was used to identify patterns of themes in the open-ended survey data to understand scientists’ experiences regarding productivity and work during the pandemic. A thematic analysis approach was chosen as it allows interpretation of large datasets by sorting them into broad themes, which can capture and summarize core points of coherent and meaningful patterns in the responses (Braun and Clarke, 2006 ; Kiger and Varpio, 2020 ). These themes recur across participants or datasets and cluster around a central organizing concept (Braun and Clarke, 2006 ). Themes within the survey responses were identified in an inductive (“bottom-up”) approach because an open-ended question was used rather than structured multiple questions with primarily defined themes. Thus, identified themes were data-driven. We followed the Standards for Reporting Qualitative Research (SRQR) in conducting and reporting the thematic analysis (Supplementary Table S1 ) (O’Brien et al., 2014 ).

Responses from the five non-English questionnaires were translated into English using a certified, professional translation service (CQ Fluency). Only non-English responses to the open-ended question were shared with translators, and no other information from the survey data was provided. English and translated non-English responses were combined in a single file. In total, the study included responses from 2548 participants. We iteratively read the raw responses noting initial ideas to draw a combination of inductive themes driven from the data.

After a re-reading process to become familiar with the data, we identified emerging and meaningful patterns (“code”) relevant for changes/difficulties/challenges for work and productivity during the pandemic. We developed and modified the codes as we read through participants’ responses. After finding the meaningful codes, we categorized them into potential themes to build the structure of primary code and lower-area codes. Researcher’s judgment was required to determine what proportion of the data needs to display evidence of the theme for it to be considered a reoccurring theme (Braun and Clarke, 2006 ). The initially identified codes were regrouped, edited, or removed as the reading progressed. The structured groups of codes were verified by two investigators who performed the iteration of reading through the responses.

After defining the potential codes, we examined how the codes relate to each other. In this stage, researchers re-read survey responses to ascertain whether identified themes and thematic maps represent the dataset. These potential codes became sub-themes and were grouped into several meaningful themes. The developmental process of potential themes and sub-themes are shown in Supplementary Figs. S1 – S2 . After finalizing relationships between identified themes and sub-themes, we assessed whether the impact of each sub-theme was positive or negative for productivity based on participants’ assessments and responses related to each sub-theme that repeatedly appeared in their responses. A sub-theme could have positive or negative impacts on productivity, or both.

We generated word clouds analyzing the most frequently mentioned 1000 words using Nvivo Ver 12 software. Stacking words in cloud form ensures that the most found words are assigned the largest font size. The visualization using word clouds provides an intuitive way to find major themes and is often used for text documents (Lohmann et al., 2015 ). This analysis assumes that important and significant words appear in responses more frequently (Carley, 1993 ). Nvivo’s queries extracted responses mentioning words of five or more letters.

We applied text search analysis to analyze and compare experiences regarding caregiving for children, family, and domestic work between female and male scientists who are also parents. While we recognize the critical importance of studying non-binary genders and the difference between sex and gender (Torgrimson and Minson, 2005 ; Reisner et al., 2016 ; Peters and Norton, 2018 ; Spizzirri et al., 2021 ), our text search analysis focused on self-identified female and male genders as the percentage of non-binary gender participants was low (0.9%) and previous evidence mainly focused on gender inequality of caregiving between female and male scientists (Zamarro and Prados, 2021 ). Using the text search query of Nvivo, we compared the number of participants mentioning search words between female and male participants and parent and non-parent participants. Stemmed variants were considered as the same word (i.e., “research” and “researcher”). We searched the following select words relevant for caregiving for children, family, and households: child, childcare, children, son, daughter, baby, kid, elder, daycare, school*, parent*, mother, father, dad, mom, household, chore, and domestic. The asterisk indicates any combination of letters, reflecting stemmed variants as the same word.

Characteristics of participants

Our study participants were diverse in terms of position, major, career stage, age, and region. Supplementary Table S2 summarizes participants’ characteristics. About 86% of responses were collected in English. Respondents were 55.8% male and 43.3% female. Approximately 56% were assistant professors, associate professors, or professors. About 41.5% were parents of children age <18 years living with them. About 17.3% of mothers and 15.3% of fathers were the primary caregiver for their young children. About 9.7% of mothers and 19.9% of fathers reported that their spouse/partner was the primary caregiver. The percentage of participants who had help for childcare from other family members, in-house paid childcare providers, or childcare facilities was 7.1% for mothers and 6.8% for fathers. The fraction of responses from North America and European countries were similar (34% each). The region with the next highest percent of responses was Asia, with 16.9%. The field with the highest responses was medicine/public health, accounting for 39.0%, followed by 22.7% for biology. A large portion of participants was in medicine and health care fields, possibly because these fields were particularly affected by the pandemic and such researchers may have been more inclined to complete this survey. About 68.5% percent of the participants were age 35–59 years.

Results for thematic analysis

We identified sub-themes regarding the productivity of scientific work under five major themes (Table 1 ). Initial versions (versions 1 and 2) of potential themes and sub-themes are shown in Supplementary Figs. S1 and S2 , and the final version is in Fig. 1 . In the following sections, we describe the identified themes and demonstrate the themes by highlighting relevant quotes from participants. Many participants reported both “positive” and “negative” changes during the pandemic regarding their work and productivity. For example, one participant wrote: “In some ways, the productivity declined due to homeschooling kids and having to abandon some data collection. However, I found working from home more balanced in terms of my energy and more focused for writing tasks (participant ID2517).” We note that statements from participants highlighted in the following sections represent many themes that simultaneously influenced to increase or decrease the productivity.

The size of words visualized the frequency of the words found in the survey.

The same changes in work environment, culture, and conditions brought different “voices” regarding productivity and mental health. A notable example is working at home. Some participants described working at home as “distracting” and note “lack of materials for work”, whereas others were “more comfortable”, “efficient”, “more balanced”, or “fluid”, and were “being able to better focus”. Statements regarding the extra workload of online meetings during the pandemic contrasted with other statements referring to flexibility and efficiency of online meetings. The positive aspect of remote working (e.g., fluidity) was contrasted by the negative aspects of lack of face-to-face interactions.

Increases in the number of hours worked did not always mean increased productivity. Work productivity may remain the same or decrease despite increased working hours due to factors including lack of assistance and resources, changing COVID-19 policies, and mental stress of the pandemic. In the quotes, we found it important to distinguish between language about changes in the number of work hours and perception of work productivity. Supplementary Table S3 presents selected de-identified supporting quotes from participants as evidence to support each theme.

Theme 1: Delays and restrictions

Changing COVID-19 regulations: The first sub-theme was the delay or shutdown of the work due to newly established and constantly changing COVID-19 policies at institutions. Many participants noted that time spent discussing or establishing COVID-19 policies at institutions consumed much of their time that could have been used for other academic labors.

Example response

“Most of the reduction in scientific productivity went into ever-changing administrative means, regulations, communications, etc. to adopt to new pandemic measures (ID1616, Austria).”

Lack of staff and support

Lack of efficient administrative assistance contributed to delays in scientific work. Many participants noted lack of staff and support in their institutions during the pandemic. Lack of efficient administrative assistance caused challenges such as decreased time for research, delays in recruitment of researchers/staff, less support for grant applications, decreased information technology (IT) support, and approval of budgets. The identified reasons for the lack of staff included institutional financial challenges and illness of staff and their family, which sometimes resulted in permanent leave of the staff. Many participants mentioned that administrative support significantly decreased or slowed as staff worked from home and were less responsive. Also, staff had more duties for addressing COVID-19-related policies, leaving less time for other work.

“ The university eliminated many positions so much of administrative work now falls on me (ID519, USA).”

Banned access to laboratories/office/travels and recruitment

The ban on access to laboratories, offices, and work travel caused a severe loss of activities and outputs for research and education. Many participants, especially those in bench sciences, noted delays in research for long periods over several months due to limited access to laboratories and offices. Inability to conduct experiments was a major factor reducing research productivity, which also affected generating teaching materials based on research results. Participants encountered canceled or halted field trips for data collection due to COVID-19 regulations including lockdown and ban of domestic/international travel. Recruitment of new staff in laboratories and human participants for research was limited to reduce risk of disease spread during the pandemic. Many participants expressed that delayed recruitment interrupted original research plans. For example, a respondent working with human participants noted that the complete shutdown of their research led to establishing an entirely new project and slowed their productivity (ID274, USA). Participants expressed suffering from canceled or postponed international research training. The reduction in the number of researchers in research facilities led to perceptions that workload increased for the remaining personnel who had access to laboratories and had to perform the research.

“As an experimental scientist and P.I., the limited accessibility of lab resources and recruitment of talented personnel reduced the scientific productivity significantly (ID266, USA).”

Shortage of research equipment

Among participants engaged in research, significant delays in research products (e.g., plasticware, personal protective equipment, reagents) slowed research, especially for those involving bench experiments.

“We have had to halt some experiments because we do not have necessary materials and I am a year behind intended publication schedule (ID1115, Australia).”

Canceled grants and delayed publication

Grants and funding for research were canceled or decreased during the pandemic leading to significantly reduced research outputs. Some participants perceived decreased success rate for new funding during the pandemic. Some also reported slower review processes for scientific journals affecting their publications. Participants expressed that finding reviewers for some journals took longer and the review process was extended. Some noted that some journals received a significantly increased number of articles and their papers that could have been published in the past have been rejected and the level of the journals they can publish in has lowered.

“The most noticeable effect was the time required to find reviewers in some journals, the review process was extended (ID1041, Finland).”

Theme 2: Changes in responsibilities

Teaching burdens and online supervision.

Time for teaching increased for many participants during the pandemic as teaching transitioned to online. Restructuring online courses and adapting to online systems required significant time for many participants. A few participants mentioned that no or little support and guidance were provided by their institutions despite the increased responsibility for organizing new course timetables and online teaching. Some participants were given additional (online) courses to teach. Some described changes in scheduling and distorted timelines due to increased teaching responsibilities as “abrupt” (participant number ID383, Poland) and “brutal” (ID1169, USA). Many expressed difficulties in teaching and supervising.

Online teaching was less effective and more time-consuming for many participants, and teaching quality was negatively affected. A participant expressed that remote training was more difficult while the needs for training and emotional support for students and staff increased during the pandemic (ID1635, USA). Other major challenges for teaching and supervision included time differences for students in different countries, unstable internet connection, lack of direct interactions, and distractions. On the contrary, some participants found that transitioning to online teaching increased productivity. One participant mentioned that the increased teaching efforts to generate new educational materials for remote teaching in the first year of the pandemic improved teaching in 2021 (ID 2209, South Korea).

“Professors had to organize new course timetables and online teaching with little or no help from administrative personnel and very poor guidelines (ID1235, Spain).”

No or little time for research

As duties and time for teaching, mentoring, or administrative work increased, time for research decreased for many participants. Some expressed that their university still expected all academic staff to have publications while access to laboratories was restricted.

“Grant applications were delayed due to lack of time but also due to reduced contact with colleagues as we are all working at home (ID354, USA).”

Increased burden for child/eldercare and domestic work

Childcare and housework became intertwined with work during the pandemic. This was described as a “juggle” between work and caregiving by some participants. A participant described the effect on productivity as devastating (ID1291, Italy). Another reported that having to work from home and supervise school-age children hindered her from working efficiently (ID934, Greece). The identified reasons for increased childcare included difficulties in hiring childcare workers, closure of daycare facilities, and homeschooling due to school closures. Parents noted markedly increased stress from balancing work and childcare simultaneously at home. While some participants mentioned difficulties of juggling work and childcare, others described aspects of productivity that were affected by changed caregiving responsibilities. For example, one mentioned that her publication outputs were lower than normal (ID1260, Australia) due to leading children’s homeschooling and working from home in conjunction with increased household duties. Another mentioned that working from home with kids at home reduced his productivity (ID1167, USA).

We found that the number of work hours increased for some participants with children at home, but decreased for others. Some participants worked at night to compensate for lost productivity caused by the increased time for childcare, which deteriorated psychological and physical health. Others had decreased work hours due to struggles with mental and emotional capacity to focus on work and stress from caregiving.

Relatively more female parents than male parents mentioned increased childcare burdens (Table 2 ), but we did not find significant differences in the content or degrees of expression of hardships for childcare between these groups. A few participants wrote that they had equal distributions of childcare with their partner/spouse during the pandemic.

Increases in domestic work and caregiving for family other than children were identified as factors that made work difficult during the pandemic. There were a few single participants that reported a higher workload due to performing the work of their co-workers with children and families.

“The most demanding was the online learning of children, me (and my wife and both parents) had to partly substitute the teachers (ID1561, Czech Republic).”

Increased number of online meetings

The significant increase in the number and time of online meetings reduced the time that could be spent on other tasks. Some participants described the increased burden of online meetings as depressing, exhausting, and stressful. A few participants also mentioned that the duration of online meetings was very long (e.g., in one instance, over 6 h) and sometimes took a place at night. On the contrary, a few participants favored the increase in online meetings as it kept meeting times concise and efficient and increased work efficiency and opportunities for collaboration.

“ Several meetings have more online making it easier to collaborate with cross-border teams (ID2381, Nigeria).”

Theme 3: Deteriorated health

Deterioration of physical health.

Working from home, which was isolating, and working long hours at home were associated with various health issues including office syndrome, lack of sleep and breaks, and fatigue for many participants. Some participants also experienced disruption of work after COVID-19 infection. A few participants noted that working in masks made them feel fatigued quicker. Some participants who mentioned physical health issues also expressed that their productivity was affected as they were exhausted or fatigued.

“Decreased overall work productivity, I lost days when I was sick. I couldn’t keep up with emails, notes, etc. I’m still not fully caught up months later (ID773, USA).”

Deterioration of mental health

Mental health issues at work and home during the pandemic were found to be harmful to scientific productivity for many participants. Many experienced burnout from working overtime despite their increased productivity. Slowed research, fewer interactions, high work demand, altered priorities of tasks, and minimal administrative support affected motivation. The lockdown and confinement at home were associated with a lack of motivation and decreased productivity for some participants. A participant expressed that stress and depression decreased her scientific creativity and focusing power (ID2534, Romania). Another mentioned that a decline in enthusiasm and work mood slightly reduced his productivity (ID2507, Germany).

While many participants said that they were affected mentally (e.g., depression, anxiety, stress, worries) due to work-related challenges during the pandemic, some expressed that anxiety and fear directly related to COVID-19 interfered with work productivity. Uncertainty about COVID-19 and job security also caused stress and anxiety among some participants.

“Overall, the lack of job security and increased workload has led to increased anxiety and loss of motivation (ID18, Bangladesh).”

Theme 4: Insufficient at-home work environment

Blurred boundary between work and life.

Many participants working from home noted difficulties in dividing time between work and life and often worked overtime. Many participants reported working more hours by working from home and expressed their fatigue and burnout from working overtime (see Theme 3). The increased time for work did not always increase productivity due to distractions affecting concentration, more administrative processes, or interruptions of work routines by priority tasks due to the pandemic. Some participants noted that this situation made it hard to concentrate on work and affected focus and performance.

While some participants expressed fatigue and frustration caused by the high demand for “being always available at home for work”, a few viewed this situation as positive leading to increased productivity because colleagues and collaborators are more available with remote working. For example, one wrote, “Increased productivity as colleagues and collaborators are more available online (ID526, Switzerland).”

“Since I work at home, my superiors expect me to be always available, and I end up having trouble keeping regular working hours. I feel tired often (ID1159, Bulgaria).”

Insufficient workspace and/or set-up

Some participants encountered challenging situations including unsatisfactory home workspace or unstable internet connection. Not having office supplies at home was also mentioned as a reason for inefficient homework environment by a few participants.

“Working from home without having a proper workspace resulted in inefficiency (ID2448, Canada).”

Lack of in-person interactions

Insufficient communication due to remote working during the lockdown was found as a sub-theme negatively affecting scientific productivity. Participants responded that communicating remotely was less efficient and more time-consuming than face-to-face interactions. In terms of staffing and support, some participants expressed that communication slowed as most staff were working from home and conversation over emails took longer than in-person interactions. Some participants noted that opportunities for open and creative discussion for work and sharing research outputs decreased due to remote working and a lack of formal events such as conferences and seminars. They mentioned that planned research projects were delayed due to decreased in-person collaborations. Some participants mentioned difficulties in supervising remotely. Physical disconnection from colleagues and having less or no face-to-face interactions affected productivity with feelings of isolation and reduced motivation for some participants. Some early-career scientists expressed hardships in socializing and getting to know new colleagues through remote working environments, which slowed their adaptation to new work and positions.

“E-mail-based supervision is time-consuming (ID922, Estonia).”

Theme 5: Increased flexibility and other positive aspects

Teaching environment.

Participants also identified positive impacts on work during the pandemic. A few participants favored transitioning to online teaching. Some stated that remote teaching was more efficient than in-person classes for some activities involving computer science. Also, a participant mentioned that utilizing online teaching techniques and not having to book classrooms added flexibility.

“I have more flexibility in teaching and teaching methods as I don’t need to book lecture halls and can experiment with different techniques (ID561, Sweden).”

Grants for COVID-19 research

A few respondents in fields directly relevant to COVID-19 topics reported that they have been “more productive in terms of publications and grants (ID1721, USA)” with “Fantastic increase in productivity - covid research (ID1471, USA).” Some mentioned that having more funds and grants for COVID-19 research led to valuable research experience and publications.

“Actually (the pandemic) increased scholarly activities as they expanded to include SARS-CoV-2 and COVID work. They are directly related to our clinical and public health research interests (ID1157, Canada).”

Alternative methods

While the previous sub-theme was about new research opportunities related to COVID-19, this sub-theme is about efforts to change the way research is conducted. Many participants suffering from limited access to laboratories reported switching to different study methodologies or activities. The time used for conducting laboratory experiments was instead spent writing scientific papers and grant applications. Applying study designs such as online surveys that do not require face-to-face contact, re-analyzing old experimental data, and writing review articles were reported as alternative research activities during the pandemic to maintain productivity. These altered approaches resulted in increased number of publications for some participants but not for all.

Some participants who had applied alternative research methods and maintained publication productivity were worried about their future research productivity, such as the inability to collect new data.

“Due to the lack of experimental studies my work has primarily focused on surveys and other types of research that does not require direct contact with participants (ID1562, Netherlands).”

Fluidity of workday

This sub-theme summarizes the preference of many participants for the flexibility of working from home without commuting or traveling. Increases in the number of work hours were described as positive changes for work during the pandemic for these participants. The flexibility of working from home was described as “excellent (ID1011, Australia)” and “a positive game changer (ID1338, Germany)” for saving time and increasing productivity. Many participants reported that their time increased for writing and publishing papers, focusing, and conducting research due to flexible schedules. Some participants described the working environment at home as “distraction-free (ID387, Germany)” and “quieter (ID1626, USA).”

Some participants mentioned that the reduction of unnecessary meetings or chats provided additional time for research and other work. Furthermore, a few participants commented that they could select when to interact with staff or students via emails or interact with collaborators in different time zones via online meetings while working from home. A few participants responded that they saved time due to the prohibition of after-work dinner parties. This positive voice for eliminating “unnecessary” gathering after work, an extension of work, contrasted with colleagues who experienced isolation (see Theme 3).

“The COVID-19 pandemic has increased work productivity. It has saved time from transportation; provided flexibility for interaction through internet platforms at my convenience; enabled watching a number of webinars and interact with various communities that would not be possible through face-to-face interaction (ID87, Greece).”

Results of word cloud analysis

Results of work cloud analysis are shown in Fig. 1 . The most frequently mentioned word was “work” followed by “time”, “research”, “productivity”, “home”, “increased”, and “pandemic”. The participants often mentioned “working”, “teaching”, “online”, and “students”, which are relevant for teaching, mentoring, and supervision. Our participants also frequently mentioned “lab”, “meetings”, “colleagues”, “access”, “restrictions”, “travel”, and “remote”. Terms relevant for caregiving responsibility including “care”, “childcare”, “child”, “children”, “kids”, and “family” were also identified and so were terms for health and life such as “mental”, “stress”, “health”, and “life”.

Results of text search analysis

Word search analysis examined how female and male participants expressed their experiences regarding caregiving for children, family, and domestic work during the pandemic. Results found that the burden from increased duties for childcare and domestic work during the COVID-19 pandemic and their negative effects on scientific productivity may be higher in mothers than fathers given that mothers mentioned select keywords related to children and domestic work more frequently than fathers (Table 2 ).

Although research is needed on the impacts of the COVID-19 pandemic on scientific productivity (Biswakarma et al., 2021 ), studies remained limited. Studies on the impacts of COVID-19 on scientific productivity often did not examine gender disparities and inequitable changes in caregiving by gender and status as a parent (Staniscuaski et al., 2021 ). A number of studies quantitatively compared scientific publications and authorship by gender, with inconsistent findings (See Supplementary Table S5 ). Some studies compared the changes in the number of work hours between men and women scientists. These studies did not examine the contributing factors from the work routines and environment on gender differences. Some studies focused on the experiences of scientists during the pandemic, with a focus on only one type of scientific activity such as teaching and research. Evidence of the affected work environment for administrative activities among scientists during the pandemic is scarce.

Given these characteristics of previous studies, this current study contributes to identifying in-depth challenges in various work activities among scientists during the COVID-19 pandemic, including gender differences, using information collected from over 132 countries using a six-language survey with an open-ended question. Moreover, by comprehensively summarizing and categorizing the impacts of COVID-19 on scientific labors in addition to changes in work and daily life, this research contributed to understanding of the inequality in the burden of household labor during the pandemic, which is gender inequality in scientific performance during the pandemic.

Our findings indicate conflicting impacts across participants. Some scientists may have increased time for research due to decreased teaching burden, whereas others may have had less time for research due to increased burdens for teaching, administration, or grant applications. Many participants experienced conflicting demands for teaching, research, and administration due to COVID-19. The varying situations and challenges in scientific fields (e.g., some participants expressing frustration with remote work while others found it helpful) indicate that support and policies for scientists during times of crisis should be flexibly applied and recognize the different impacts rather than being applied strictly and uniformly.

A previous study discussed that many faculty were unfamiliar with online teaching software prior to the pandemic and that many universities were unprepared to provide proper guidance and training for transitioning to remote learning (Coyne et al., 2020 ). Similarly, many of our participants noted that time for teaching increased during the pandemic as teaching transitioned to online. Faculty experienced a remarkable loss of in-person interactions with students and colleagues while teaching remotely (Colclasure et al., 2021 ). For some scientists involved in research and teaching, the time to pursue research was modified due to the increased demands for teaching and service during the pandemic (Malisch et al., 2020 ). However, a few participants in our study found online teaching to be more efficient to reach students and perform computer assignments. It is likely that demand for teaching would take priority when educational facilities are restricted and in-person learning becomes infeasible in future crises. Thus, educational institutions should establish rapid action guidelines for teaching transitions. Another challenge during pandemics is altered quality of teaching, which can affect faculty’s promotion. Institutions should find appropriate measures of teaching quality and effectiveness that account for these unique challenges (Sotto-Santiago et al., 2021 ).

While our focus was to find a broad spectrum of the COVID-19 impacts on scientific work productivity, the impacts of COVID-19 and institutional solutions constantly change overtime based on the severity of the disease transmission trend. Thus, we note that the themes found in our research and the obstacles from them perceived among scientists can considerably vary by the time of pandemic and the level of institutional reactions to the pandemic. This indicates the need of continuous efforts to recognize scientists’ difficulties during and after the pandemic by the institutions and leaders.

We found that time for research, teaching, mentoring, and administrative work was diverted to other obligations at home during the pandemic, more so for some participants than others. Participants with pre-school or school-age children noted struggles to find time and space for work while performing increased caregiving for their children during the pandemic. Especially, mothers expressed such struggles more than fathers. Many previous studies showed that school closures and stay-at-home orders amplified gender differences in productivity by disrupting both work and life for many researchers (Andersen et al., 2020 ; Malisch et al., 2020 ; Breuning et al., 2021 ). The blurred boundaries between work and responsibilities at home led to significant mental health issues such as stress and burnout among many participants. Institutional supports are critically needed, especially to diminish gender differences of academic productivity caused by unequitable division of responsibilities at work and home. Some policies for reducing gender inequity include creating an infrastructure for identifying and providing childcare resources, accommodating flexible working arrangements, increasing funding for opportunities for certain groups, monitoring sex breakdown in promotion and tenure, and monitoring teaching load and service (Cardel et al., 2020 ; Minello et al., 2021 ).

Our results found that many scientists suffered from health issues including lack of sleep and exercise, burnout, fatigue, and deterioration of mental health. Increased work burdens, uncertainty regarding the pandemic, and lack of interactions with others were associated with mental health issues for many participants, as also shown in previous studies (Camerlink et al., 2021 ; Colclasure et al., 2021 ). Some participants were worried and fearful about long-term effects of the pandemic on their productivity and career progress, similarly observed in previous studies (Minello et al., 2021 ). A previous study using surveys and interviews found that a lack of face-to-face interactions with students increased personal stress and anxiety among faculty at institutions primarily for undergraduate students (Colclasure et al., 2021 ). These results suggest that university and research institutions should find formats to maintain connections during lockdowns with technical infrastructure and supports for mental health (Sahu, 2020 ).

Some positive aspects of the changed work environment during the pandemic were favored by some scientists. A recent study in the UK presented several benefits in the early stages of the pandemic including working from home thereby avoiding commuting time and increasing productivity and work-life balance (Jackman et al., 2021 ). Similarly, some of our participants mentioned that time saved from not commuting can be used for mental and physical health. These findings may help identify key intervention points; accommodating flexible work arrangements (Cardel et al., 2020 ) and providing technical support for effective supervision and communication for remote working may positively impact scientists’ productivity during a pandemic.

Scientists may engage in more creative scientific works when away from laboratories during a pandemic by spending time to read the latest literature, carefully plan experiments, and write grant proposals and manuscripts (Buchanan et al., 2021 ). However, over longer periods of restrictions, some scientists would suffer from a lack of new data and access to key resources. Our results imply that even scientists who managed to effectively publish and conduct research during the pandemic were worried about long-term effects on their productivity.

This study has several limitations. As we targeted scientists in STEMM fields, our findings may not be generalizable for other disciplines. As the survey introduction and consent form stated our goal to investigate gender differences in scientific productivity and mental health during the pandemic, those who were interested in these topics may have been more likely to participate, affecting the findings. Also, our survey participants are more likely to have research-related positions than government scientists or instructors due to our recruitment process using scientific articles from publication databases. Second, due to the limitation of a thematic analysis, we were not able to compare the findings of this research among subgroups of geographical region, position, employment status (e.g., full-time, part-time), or tenure status, which may be a factor of different impacts of the COVID-19 pandemic on productivity.

The thematic analysis of this research is an effective and established method (Braun and Clarke, 2006 ; Kiger and Varpio, 2020 ) to provide a summary of the themes among the recruited study participants. Additional results on other aspects of the survey include a quantitative analysis, which we have previously provided elsewhere (Heo et al., 2022 ). Here, we focus on a qualitative, thematic analysis, and also report a summary table of the percentage of our study participants reporting each of the found themes among different geographical regions in supplementary materials (Supplementary Table S4 ). This type of analysis can indicate the need for future studies with quantitative analyses for further understanding of disparities of the COVID-19 impacts on productivity by regions, but our results should be interpreted cautiously. In addition, qualitative analyses can be criticized as they can be more subjective than quantitative studies and there is a degree of subjectivity in all states of the analysis, which may lead to opportunities for bias (Chapman et al., 2015 ; Roberts et al., 2019 ). To minimize such potential bias, two investigators independently drafted potential codes and then performed inter-rater comparisons and discussions iteratively reviewing and moving them until an agreement between the two investigators as to what determined sufficient demonstration of a true theme became evident. Despite our efforts for the reproducibility of analyses, we note that it is important to recognize the nature of the thematic analysis with regard to the characteristics of the respondent group and organizational and geographical context (Chapman et al., 2015 ).

Moreover, we recognize that the distinction between sex and gender is critically important and that there are multiple genders (Torgrimson and Minson, 2005 ; Reisner et al., 2016 ; Peters and Norton, 2018 ; Spizzirri et al., 2021 ). However, the words “sex” and “gender” are commonly used interchangeably in countries where there are currently no separate words for sex and gender. Thus, we were challenged to address these concepts across six languages and the cultures of 132 countries where these concepts vary considerably compared to Western usage (Riley, 1997 ; Abbey et al., 2004 ; Clayton and Tannenbaum, 2016 ; Schiebinger and Stefanick, 2016 ; Peters and Norton, 2018 ; Morgenroth et al., 2021 ). The term “sex” used in this paper likely represented sex for some participants and gender for others, but the impacts of COVID-19 on the academic fields may differ between sex and genders. Therefore, substantial future studies are required with more detailed subgroups for sex and gender, with language specific to the culture.

Although we used a published method and received IRB approval, our survey recruitment process raised concerns for a few email recipients regarding privacy issues as they had not initiated contact with us before receiving an unsolicited email. Thus, we recommend different survey recruitment processes in future studies. Our study design was cross-sectional, which is limited for validating temporal relationships. The word cloud analysis included some words and phrases translated from other languages, which may have affected findings. Although we provided a definition of academic activities including research, teaching, mentoring, and administrative service in our questionnaire, the definition of productivity could vary among participants. Therefore, the answers in our survey were based on academic productivity self-defined by our participants and their perceptions of their productivity.

This study has several strengths. Our survey reached various populations using six languages. As a result, we had a variety of study participants in terms of position, rank, career stage, tenure status, major, and characteristics of work (e.g., “wet” and “dry” science), with participants from 132 countries. Previous results are limited to the quantitative analysis using publications as a measure for productivity changes during the pandemic, which is likely insufficient to reflect the productivity of other scientific work other than publishing articles. These previous studies often lacked consideration of disparities by gender and parental status of the impact of the pandemic on performance (Staniscuaski et al., 2021 ). Furthermore, in most previous studies, results for changes in scientific performance were based on responses from the US- and European institutions and were scarce for other regions (Webber, 2012 ). A contribution of our research is that it summarized the intersecting vulnerabilities by gender and status as a parent in scientific fields and better insight into the systematic changes of scientific institutions during a global crisis. Second, we investigated the perceived effect of the pandemic on scientific productivity and self-reported mental health status for faculty in STEMM fields; the body of scientific literature for pandemic-related obstacles and mental health effects was relatively smaller for faculty compared to students (Breuning et al., 2021 ). Through an open-ended question and systematic thematic analysis, we allowed participants’ to share their experiences of how the pandemic affected their scientific endeavors.

In summary, this study provides important insights into the struggles and opportunities scientists can face during a global health crisis, showing that the impacts varied widely, even for the same change in work (e.g., remote working increased productivity for some and lowered productivity for others). The adverse impacts of the COVID-19 pandemic on academic productivity are likely to last long after the pandemic. Our findings suggest that academic communities need to recognize the different impacts of the pandemic on scientists and ensure flexibility in policies for promotion and job security. Leaders of universities and research institutions should explore the obstacles for scientists and review their crisis management plans to best support scientists for productivity and career, recognizing that scientists will experience these challenges differently. Institutional efforts are imperative to avoid widening gender gaps in academia during and after the pandemic.

Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available as the data contain potentially sensitive information that could compromise research participant privacy and the study participants did not consent to share any data publicly.

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Acknowledgements

The authors appreciate Yale Internal Women Faculty Forum (WFF) Seed Grant for supporting this research. We thank all participants in this online survey study. We would like to also thank all members of Prof. Michelle L. Bell’s research group for their contribution to the early drafts of the survey questionnaire in this research.

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Seulkee Heo, Alisha Yee Chan, Pedro Diaz Peralta, Claudia Ribeiro Pereira Nunes & Michelle L. Bell

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Pedro Diaz Peralta

School of Public Health, Yale University, New Haven, CT, USA

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A full review of this research was deemed exempt by the Yale University Human Subjects Committee because all participants had to agree with the informed online consent form before participating in the online anonymous survey. The questionnaire and methodology for this study were approved by the Human Subjects Committee of Yale University (Protocol number: 2000031343). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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An online written consent form was provided on the first page of the anonymous survey questionnaire to potential participants of this study. The rest pages of the survey only continued for and collected responses from the participants who had signed the consent form. The survey only targeted adults and no participants needed legal guardians to participate in this study. The online consent form informed the participants of the purpose of the research, potential risks, and benefits to participants. Verbal consent forms were not obtained from the participants as this survey was anonymous (no collection of personal information), there were no direct contacts between the participants and authors, and the survey was conducted entirely online.

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Heo, S., Chan, A.Y., Diaz Peralta, P. et al. Impacts of the COVID-19 pandemic on scientists’ productivity in science, technology, engineering, mathematics (STEM), and medicine fields. Humanit Soc Sci Commun 9 , 434 (2022). https://doi.org/10.1057/s41599-022-01466-0

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Learning about COVID-19: a qualitative interview study of Australians’ use of information sources

• Deborah Lupton 1 &
• Sophie Lewis 2  

BMC Public Health volume  21 , Article number:  662 ( 2021 ) Cite this article

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A multitude of information sources are available to publics when novel infectious diseases first emerge. In this paper, we adopt a qualitative approach to investigate how Australians learnt about the novel coronavirus and COVID-19 and what sources of information they had found most useful and valuable during the early months of the pandemic.

In-depth semi-structured telephone interviews were conducted with a diverse group of 40 Australian adults in mid-2020 about their experiences of the COVID-19 crisis. Participants were recruited through Facebook advertising. Detailed case studies were created for each participant, providing the basis of a thematic analysis which focused on the participants’ responses to the questions about COVID-19-related information sources.

Diverse sources of COVID-19-related information, including traditional media, online media and in-person interactions, were actively accessed, appraised and engaged with by participants. There was a high level of interest in COVID-19 information as people grappled with uncertainty, anxiety and feeling overwhelmed. Certain key events or experiences made people become aware that the outbreak was threatening Australia and potentially themselves. Most people demonstrated keen awareness that misinformation was rife in news outlets and social media sites and that they were taking steps to determine the accuracy of information. High trust was placed in health experts, scientists and government sources to provide reliable information. Also important to participants were informal discussions with friends and family members who were experts or working in relevant fields, as well as engaging in-person in interactions and hearing from friends and family who lived overseas about what COVID-19 conditions were like there.

A constantly changing news environment raises challenges for effective communication of risk and containment advice. People can become confused, distressed and overwhelmed by the plethora of information sources and fast-changing news environment. On the other hand, seeking out information can provide reassurance and comfort in response to anxiety and uncertainty. Clarity and consistency in risk messaging is important, as is responding quickly to changes in information and misinformation. Further research should seek to identify any changes in use of and trust in information sources as time goes by.

Peer Review reports

News and social media can play an important role in providing information to publics in cases of new or emerging diseases. It is vital to reach people quickly and share details in a situation in which medical and public health authorities are grappling with how the disease spreads and can best be controlled [ 1 , 2 , 3 , 4 , 5 ]. Major infectious disease outbreaks are highly newsworthy, typically attracting dramatic statements concerning risk [ 6 , 7 , 8 ]. News media coverage is often a starting point at which people start to reflect on the seriousness of pandemic risk and its implications for their own lives [ 2 , 9 ]. However, news reports can also become hyperbolic or convey misinformation, leading to scepticism and lack of trust in official sources, unfounded complacency or alternatively, generating heightened feelings of fear, uncertainty, depression and anxiety [ 2 , 10 , 11 ].

The COVID-19 outbreak began to receive public attention in early January 2020, following reports by Wuhan health officials of a cluster of viral pneumonia cases of unknown cause affecting people in that large Chinese city in Hubei province [ 12 ]. The news and public health communication environment responding to the COVID-19 crisis has been fraught, frequently characterised by conflicting or rapidly changing information as health authorities and governments struggled to make sense of this new outbreak and identify the best way to control its spread [ 13 , 14 , 15 ]. COVID-19 news reporters and creators and sharers of social media content have been subjected to continual criticism for disseminating misleading or false information. The term ‘infodemic’ has been used in some popular media outlets and academic analyses to describe the wealth of ‘fake news’ and conspiracy theories circulating, particularly in online news sites and social media platforms [ 16 , 17 , 18 , 19 , 20 ].

Analyses of how news reporting and social media content have framed COVID-19 issues across different countries have identified marked variances. Ageism in social media content has been identified, with older people positioned as both more vulnerable and more expendable than other age groups [ 21 ]. Racism has also featured in some countries’ news reporting, particularly against Chinese people, who have been frequently positioned as to blame for the emergence of the novel coronavirus in Wuhan [ 22 ]. Politicisation and polarisation of opinion has characterised COVID-19 news in US television networks and newspapers [ 23 ], whereas strong support for government measures was evident in South Korean newspaper reporting [ 24 ]. A focus on prevention and control measures, medical treatment and research, and global or local socioeconomic influences was identified in an analysis of Chinese news articles [ 25 ].

Information provided in news coverage of COVID-19 in Australia has included reporting of the first cases and deaths and the subsequent rapid spread of the novel coronavirus around the world, accounts of statements, decisions and press conferences held by political leaders and health authorities, strategies to avoid infection, medical controversies and debates and progress towards treatments for COVID-19 and vaccines [ 5 , 26 , 27 ]. In Australia, very early news reporting (January 2020) focused on the ‘mystery Chinese virus’ and made continual comparisons to SARS [ 26 ]. A study of two major Australian newspapers’ COVID-19 coverage found that they were quite slow to begin covering the emerging outbreak, suggesting an initial lack of awareness that it might pose a threat to Australians. Subsequent news reporting largely focused on the social and economic impacts of the crisis. There was little blame or judgement directed at any social or national groups, although panic buyers did receive some criticism [ 27 ].

Quantitative surveys to determine how publics were responding to coverage of the COVID-19 crisis in news and social media have identified an association between COVID-19-related news and social media consumption and heightened anxiety and distress in Russia [ 28 ], China [ 29 , 30 ] and USA [ 31 ]. Malaysian research found that respondents mainly used television and internet news portals to access COVID-19 information. Those who preferred government sources of information were more confident about the control of COVID-19 and believed their government was handling the crisis well [ 32 ]. Research in the UK found that people’s news consumption surged in the early months of the crisis but gradually returned to pre-crisis levels, with evidence of a growing avoidance of news. A decline in respondents’ trust in key sources of COVID-19-related news and information was also noted: particularly in relation to social media sites and government sources [ 33 ].

A comparative international online survey included nationally representative samples from Australia, New Zealand, UK, USA, Italy and South Korea [ 34 ]. For respondents in most of these countries, government and friends and family were the most trusted sources of COVID-19 information, ranked above the news media and social media. Together with New Zealanders (89%), Australians evidenced the highest levels of trust in their government (78%) to give clear and accurate advice on COVID-19. While 58% of Australians said they trusted the news media in general for COVID-19 advice, only 30% trusted information found or shared on social media more specifically.

Another online survey conducted early in the Australian nation-wide lockdown (April 2020) [ 35 ] found that Australians were consuming news media more than usual due to their interest in and concern about the pandemic. More than two-thirds said that they had been accessing news more than once a day since the outbreak. Half of the respondents were using television reporting as their main COVD news source, while 22% were accessing online news coverage and 18% news on social media. The respondents reported high levels of satisfaction with news coverage of COVID-19 (73%), but it was contributing to people’s feelings of anxiety, particularly for women and younger people. Most respondents said that they trusted health experts and scientists (85%) and to a lesser degree, government (66%) to provide information about COVID-19. Just over half said that they trusted news organisations but less than a quarter of respondents reported that they had encountered high levels of misinformation in the news or social media about COVID-19. Australians agreed that the federal government had done a good job of informing them about the pandemic (75%) and how they should respond (81%).

The surveys reviewed above are valuable in identifying trends across large populations in attitudes and practices related to COVID-19 information sources. To complement and extend such findings, qualitative social research methods provide a way of investigating people’s engagements with personal sources of information about emerging health risks such as family members and healthcare providers as well as with government sources and news and social media reporting in greater depth. This approach provides for explorations of lived experiences in sociocultural contexts [ 1 , 2 , 11 , 36 ]. Thus far, few qualitative analyses of Australians’ responses to news and social media coverage of COVID-19 have been published. Among other issues, the ‘Australians’ Experiences of COVID-19′ study investigated people’s use and appraisal of information about COVID-19. We wanted to surface the full range of information sources upon which participants relied and those they most trusted: including but beyond media or government sources.

The study took place during the first 6 months of the COVID-19 crisis in Australia, following the identification of the first Australian COVID-19 cases on 25 January 2020 and the implementation of a nation-wide lockdown from mid-March 2020 [ 37 ]. Forty indepth, semi-structured interviews with adults living in Australia were conducted by the second author between late May and late July 2020. In addition to the closing of international borders and some national state borders, the national lockdown included directives for people to work at home where possible, limits on household visitors, bans on public gatherings, the closing of non-essential services and schools, and physical distancing rules. The spread of COVID-19 began to be slowed by April 2020. Restrictions were progressively eased from mid-May 2020 onwards but fluctuated in response to the incidence of COVID-19 community case numbers. Restrictions were re-introduced in the state of Victoria from July until November 2020, following a significant second wave of infection in that state [ 37 ].

Due to physical distancing restrictions, the interviews for this study were conducted by telephone. This method also ensured that people living across the nation, including in regional and remote areas, had the opportunity to participate in the study. Interested potential participants responded to an advertisement about the study on Facebook. Participants were offered a gift card to compensate them for their time. Sub-quotas were set and achieved in recruitment to ensure a heterogeneous interviewee group with a spread of participants across gender, age group, and place of residence (metropolitan, regional and rural/remote areas). Facebook was chosen to advertise for recruitment because of its popularity among Australian adults. At the time this study was carried out, figures on Australian Facebook use show that 60% of all Australians (of any age) were regular Facebook users, with 50% of the Australian population logging on at least once a day [ 38 ]. Using this method of recruitment therefore proved to be fast and effective, and we easily met our sub-quotas. Table  1 shows the sociodemographic characteristics of the participants.

The study adopted a qualitative approach that was focused on a wide-ranging interview about the participants’ experiences of the novel coronavirus/COVID-19 during the 6 month period following identification of the first Australian cases. All interviews were audio-recorded and professionally transcribed in full. A narrative case study approach was adopted in compiling and analysing the interview materials. This approach sees the indepth interview as a form of shared storytelling, in which participants recount narratives in response to interview questions and researchers formulate their accounts into narratives [ 39 , 40 ]. The second author wrote fieldnotes for each participant soon after she conducted each interview. These fieldnotes were presented in narrative form, drawing on the author’s impressions and recollections of how the participants responded to the questions. Once each interview was transcribed by a professional service and returned to the authors, both authors then used the transcripts to augment these notes, inserting illustrative direct quotations from them to configure a detailed narrative case study for each interviewee. These case studies, together with the full transcripts, comprise our research materials for analysis.

Some of our findings are reported thematically across the case studies, while in other analyses we present case studies to provide a detailed biographical narrative. For the purposes of the present paper, the set of detailed case studies formed the basis of a topical thematic analysis which focused on the participants’ responses to the questions about sources of information about COVID-19. These themes were derived as an iterative analytical process involving both authors working with the research materials of case studies we had developed together with the interview transcripts. This approach to social inquiry is directed at identifying ‘making the mundane, taken-for-granted, everyday world visible’ through interpretative and narrative practices ( [ 41 ] , p. 723). As Denzin ( [ 41 ] , p. 722) puts it, human experience (and by extension, social inquiry) ‘is a process. It is messy, open-ended, inconclusive, tangled up’. Hence our focus on interpretation and narrative as modes of analysis: the interviewees interpreted our questions in formulating their responses, and we in turn interpreted their responses in configuring the case studies, identifying themes across the cases and presenting our findings.

The first question in the interview prompted participants to think back to how and when they had first heard about COVID-19 and to provide narratives of how they felt about it at that time. This question was followed up by asking participants ‘Since that first time of hearing about the coronavirus/COVID-19, what has been the most helpful or useful sources of information for you to learn about the virus?’ and ‘What has made these sources so helpful or useful for you?’. It is on their responses to these three opening questions that we focus in this article.

Initial reactions to COVID-19-related information

Given that initial news reports in Australian outlets focused on China and SARS [ 26 ], it is not surprising that most participants had first heard about the new infectious disease outbreak through news media sources reporting on the ‘mystery SARS-like’ cluster of cases in China. The location of the outbreak in first news reports and the comparison with SARS in this early news coverage led people to think that it was a faraway problem that would not directly affect them. Several people drew on their memories of previous outbreaks of novel infectious diseases such as SARS, MERS and Ebola in their responses. For example, Michael (aged 56) initially heard about the virus in Wuhan through television news reporting. He recalls hearing about coronavirus as it was being compared with SARS. He remembered that the SARS epidemic had not affected Australia, so did not think COVID-19 would either.

SARS seemed to affect other countries around the world but not Australia. So, I didn’t think that it would be as severe as what it ended up, so widespread across the world. So no, I didn’t really worry at the time.

Greg (aged 69) was even less concerned about the threat of COVID-19 at first, as his initial exposure to news about the coronavirus was via jokes that circulated on Facebook. He remembered that Facebook friends at first tended to make light of the threat of the outbreak: ‘I wasn’t too sure what to make of it, and enjoyed a couple of jokes when people said “I’m having a corona attack!” and put a photo of a [Corona brand] beer up on Facebook’. It was when Greg heard projections of the number of people that might be hospitalised with the virus in Australia on television news reporting in early March that he began to realise that it was a serious problem. The initial joking on Facebook was countered by the dramatic television news reports of the growing threat posed by COVID-19 to Australians.

I had listened to all the news broadcasts: listened with some trepidation to the forecasts of 'the hospitals are going to need thousands of beds', and concerned about that … By early March, I started to pay attention.

The initial sheer volume of news reporting and other public messaging about the spread of the coronavirus and measures needed to contain it could be overwhelming for some people. Because of the novel nature of the COVID-19 pandemic and the fast-changing news about it and its potential impacts on Australia, it was common for the participants to observe that they found themselves not being able to look away from news reporting about the crisis once the serious nature and rapid spread of the pandemic worldwide began to be reported in Australian news outlets. Participants commented on the importance of judicious consumption of news and information about the virus to avoid becoming overly obsessed and anxious after realising the risks to Australians of COVID-19. Several participants commented that they began to feel that there was saturation of ‘bad news’ and fear-inducing announcements from government officials in press conferences and health communication campaigns.

Some participants noted the tendency for sensationalism in news reporting and social media activity and the deleterious effects on their feelings of wellbeing. They often talked about ‘switching off’ from or limiting their exposure to news about the virus as time went on as a way of managing their distress and supporting their mental wellbeing. As Joe (aged 41) commented:

when I have looked at the international news and looking at what’s happening in America and that sort of stuff, it gets me really worked up and I get very upset about it. I find that quite challenging, and at the same time, I find it very difficult not to look. So, I found it really hard, particularly in the early days, in terms of just not constantly having the news on and constantly hearing about what was going on. It’s only probably been in the last two weeks that I’ve managed to sort of cut that down to maybe two or three times a week, whereas it was two or three times a day. It was just, I had to know what was going on all the time.

Several others reported difficulty in keeping up with all the new information being issued from these sources: some of which could be contradictory. For example, Emma (aged 29) described the government-provided information in press conferences or public health campaigns concerning restrictions as often ‘confusing’. She noted that some of the restrictions imposed by the government were ‘arbitrary’ or hard to make sense of. Emma gave the example of the number of people allowed at a wedding or a funeral, a rule which she remembered was constantly changed during the early months of the pandemic: ‘It’s, like, bizarre and kind of hard to understand’.

Blame, misinformation and conspiracy theories

Many participants were highly aware of the potential for news reporting or social media content to be misleading or inaccurate: problems which themselves have received attention from the news media itself as well as public health authorities in Australia [ 5 , 15 ]. Some people expressed feelings such as frustration, distress or anger around the kinds of information (conspiracies, misinformation, concerns about bias or fake news) circulating social media platforms. One example is Sarah (aged 54), whose husband is an essential worker in health services. She was concerned that the misinformation about COVID-19 in the news media and social media could reinforce or sanction careless or negligent behaviours that would place her husband and other frontline healthcare workers at increased risk of infection. She knew from her husband’s first-hand experience that the threat of COVID-19 was not exaggerated.

My husband was dealing with those patients who are highly contagious, and he was told not to wear full protection and that was frightening. So when people were saying ‘It’s a hoax, don’t worry about it,’ I’m like, ‘Well, you’re putting my husband’s life in danger’. So it was really distressing.

Other participants demonstrated a high level of scepticism towards the accuracy of information they encountered in the news media. They said that they were careful to try to evaluate the level of risk as it was reported in news outlets, given the news media’s tendency towards hyperbole to attract viewers. As James (aged 26) commented:

[The media] are going to catastrophise everything and anything, all the information. So, whatever I’m reading, I’ve got to make sure that I don’t just believe it straight away and look into it a bit more and ask some more questions, rather than just saying, yep, okay, I believe that.

For Greg (aged 69), the main source of information to learn about the novel coronavirus and COVID-19 has been television news reporting. He talked about the importance of ‘reading between the lines’ and being mindful of the polarisation and ‘bias of the media’ in reporting about the coronavirus. Greg was also concerned about some of the conspiracy theories that were circulating initially, and that the outbreak was not being taken seriously by a section of the community. He was even more vigilant in appraising the validity of news and commentary on Facebook: his second main source of information.

I must admit I’ve become quite careful about reading conspiracy-type theories on Facebook. Yeah, it’s a platform for everyone to have their say, but I’ve discovered that in my own opinion, some theories are quite farfetched. People can be sincerely wrong.

Joe (aged 41) said he is surprised by how many people he knows have ‘bought into’ the conspiracy theories, including his own elderly mother. He perceives these theories as expressed by people who need someone to blame. Joe said that he does his best to counter these claims where he has seen them expressed: which includes in face-to-face interactions or telephone conversations with close family members as well as in social media outlets such as Facebook.

There has been some discussion that I’ve had with family that has been just ridiculous. My mother, who’s a bit older and just, I don’t know, a bit susceptible to bad information, says all sorts of conspiracy-type things to me, which I’ve just told her is ridiculous. At one point, I think she was saying that China’s done this deliberately, and this was to break the world economy. I mean, the worst one I’ve seen and heard of, which was from an associate on Facebook, was the 5G theory, which – I just think – I don’t know … it seems to – a lot of people were buying into that, which surprised me. I think they were desperate to have a cause of something they could point at.

Most trustworthy information sources

Given their caution about news reporting and social media content, many participants talked about being judicious around what sources of information they used to learn about the COVID-19 crisis. They placed an emphasis on trusted, unbiased, reliable sources of information that they assumed were founded on expert medical and scientific advice and research, or on personal experience of the pandemic.

Natalia (aged 67) was born overseas and keeps in close contact with friends and family there: including viewing content about COVID-19 they have shared on Facebook. She said that she is careful to check that any news items she sees her friends or family members sharing comes from ‘a well-known news source’ such as the ABC (Australian Broadcasting Corporation) or the Washington Post (USA) news outlet or quoting a scientific study: ‘I try to do that, because well, I know how fake news creates fear or hopes for nothing’. Ruth (aged 70) also referred to the ABC as well as the BBC (British Broadcasting Corporation) as trustworthy, noting that she uses her smartphone to access their news reporting.

I just keep reading on my phone and some articles I discount because I think they’re crap, and other articles I think, well, yeah, this seems to make sense … I take the ABC and the BBC as being okay.

For most participants, government sources such as the federal government health minister and state premiers and health authorities such as Chief Medical Officers were also viewed as credible. Greg (aged 69) said that he finds information from these sources to be the most helpful, mainly because he believes that ultimately, they have the country’s and its citizens’ best interests at heart. He positioned himself and other Australians as responsible for following government advice for the collective good of the community and as a way of demonstrating good citizenship.

Well that was pretty much the bottom line for me. That, okay, if the government says you’ve got to socially isolate, well that’s what I’ll do. I’ll take precautions, I’ll wear a mask, I’ll wear gloves when I go shopping. I did all of that in the early stages.

Max (aged 52) spoke about the value he placed on the federal government response communicated in regular news conferences that were closely covered by the news media. He liked keeping up to date with reporting of these news conferences because he thought that they provided the most current and local information about the pandemic and the current restrictions in a situation in which these details could change from day to day. Max found it reassuring and informative that these news conferences and announcements were predictable and appreciated being able to readily access these details using digital news outlets.

Even though those news conferences became a bit tedious and repetitive, it was good to know that they were regular conferences … and that you knew that a couple of times a day we were being updated as to what’s going on.

High value and trust were also placed on the information provided by people known personally to the participants who were considered to have expert knowledge or personal experience of the pandemic. Such sources included friends or family members who work in healthcare, government or science domains. They were viewed as unbiased and therefore more credible than some of the news media reporting. For example, Ruth (age 70) said that she trusts both her doctor and her brother, who is a scientist, to give her authoritative and fact-based advice about COVID-19.

I actually discussed it with my doctor, probably three or four weeks ago, because I see him frequently … He said in our particular district there hasn’t been any coronavirus cases for three or four weeks and he thought it was quite safe. So, I talked to him about it … I talk to my brother about it – he’s a scientist. I think it’s factual information and people with scientific backgrounds that provide the information.

Sarah (aged 54) noted that with her husband working in a hospital, their family had received a proliferation of COVID-19-related information from his workplace even before the national lockdown took place. She knew from her husband’s work experiences that hospitals were engaged in rushed preparations for a predicted surge of patients needing care for COVID-19: ‘Yeah that was the word of mouth we were getting. So that was, yeah, it was good in some respects and terrifying in others’.

Participants who had family members or friends living overseas also often nominated these people as important sources of details about what life was like in countries such as the USA, UK, Spain and Italy where the COVID-19 crisis was much further advanced than in Australia. Riley (aged 29), who was born in the USA and still has family and friends living there, observed that: ‘certainly once it hit New York, then I was getting inundated with messages from my parents, because it was affecting them very directly obviously’.

A small number of participants mentioned faith-based communities or teachings as contributing to their sense-making around COVID-19. For Greg (aged 69), it was his fundamentalist Christian teachings that contributed to his growing awareness that the COVID-19 outbreak in China could be serious globally, resulting in the ‘end times’ he believes is forecast in the Bible. For Riley (aged 29), the personal risk of infection was really brought home by new measures introduced into the synagogue that Riley regularly attends.

I was involved in a lot of stuff in the synagogue and about early to mid-March, early March, they were starting to say we can’t shake hands anymore and we can’t come close to each other anymore. When they started talking about that in the synagogue, I was starting to really pay attention, I was like ‘They’re telling me this for a reason!’. I started to take it a bit more seriously, so I’m glad that the people in my religious community were taking it seriously before I started to.

Bringing sources together

As is evident from the participants’ accounts outlined above, many used a range of information sources about COVID-19. The relative influence of these sources in some cases changed as the pandemic gathered momentum or as key details about COVID-19 changed over the first 6 months when medical and public health experts were still learning about the ways the novel coronavirus spread, the effects of COVID-19 and how best to contain the pandemic and governments and health officials were struggling to find the most effective and least harmful policy settings.

Several people explained the complex processes by which they appraised and made sense of COVID-19 information through a range of sources. For example, Georgia (aged 24) commented that she likes the immediacy of sources of information like Twitter and television news reports but considers them not always trustworthy or reliable. Typically, she will supplement this information through her own online research using government websites and through word of mouth from friends who live overseas and have been more seriously affected or exposed to the COVID-19 crisis. Georgia explained that the government-sourced information is the most helpful for her because it is ‘verifiable’. She knows that the government draws on health expertise in formulating its COVID-19 advice and policy. In particular, she finds localised information most useful: for instance when and where it is safe to go outside in her local area, and what actions she should be taking to reduce her own risk of COVID-19 as well as risks to others. It is less important for her to learn about the ‘bigger picture’ of the pandemic. These practices also help Georgia deal with the plethora of information available about COVID-19: ‘Anything where the information is bite sized and verifiable, I appreciate, so I guess in that sense, Twitter is good as long as I then go fact check’.

Emma (aged 29) also receives a lot of news through Twitter, preferring to read a range of different sources on that platform so that she is then able to formulate her own views about the issue. She also recounted hearing in the news and social media about people’s real-life experiences of becoming ill with COVID-19 and how that was particularly powerful for her. Emma described herself as already living with anxiety pre-COVID-19. She noted that accessing more information and gaining knowledge about COVID-19 made her feel less worried: in part, because it gave her the knowledge to take precautions to avoid contracting the novel coronavirus. Emma was also keen to be aware of what the government was doing to handle the crisis, including how she as an individual could help the collective response.

Personally, I find it really helpful to have as much information as possible on things. I think that helps me relax a bit more. I know certain people, it’s the opposite, where the more you know about something, reading about something a lot, will make you more agitated. But it was the opposite for me – where I was like, I would like to know as much as possible about this so I can avoid it and knowing what the governments are doing and knowing what you can do personally to help and so on and so forth.

Another example of bringing different information sources together is provided by Darren (aged 64). He said that he has relied on government-related information in finding out and learning more about the coronavirus and COVID-19. He accesses this information via online government health websites. Darren commented that he finds this kind of information more truthful than the news media ‘spin’ that is imposed on government-based information.

I saw the media reports where health ministers and health advisors were giving information out, but to be quite honest I didn’t pay too much attention to it, because attached to all that was the media spin afterwards. So I left it alone to a great extent and just relied on the government website and blogs that were from medical personnel.

Darren noted that he is cautious about the circulation of ‘false information’ and ‘fake news’ on social media. However, he is willing to use social media to access websites and ‘serious’ bloggers which he accesses as more truthful and trustworthy: ‘They are either scientific or they are reliable blogs, if you know what I mean. They are ones that I have read for many, many years’.

The description of his evaluation of COVID-19 information sources provided by Mark (aged 48) highlights the importance of the advice offered both by international bodies that can provide general advice and local sources of information, as well as demonstrating that social media sites can be vital platforms for disseminating these details. Mark said that he has ‘never trusted the media for reporting anything’. He preferred the World Health Organization’s (WHO) regular media briefings hosted on social media outlets as his chief source of information about the novel coronavirus and COVID-19. Mark said that he used Australian government sources of information as a secondary source to the WHO, to provide more localised information and advice: for instance about guidelines and directives for daily living and how to prevent against contracting or spreading the coronavirus.

Similar to previous qualitative research on publics’ responses to information sources about new disease outbreaks [ 1 , 2 , 11 , 36 ], our findings show that participants were active users of information sources rather than passively accepting news accounts, government spokespeople or social media content as authoritative. The participants demonstrated awareness that misinformation was rife in news outlets – and especially social media sites – and that they were taking steps to determine the accuracy of information. Their accounts also highlight the interactions of different forms of information sources, and the sophistication with which participants engage with these different kinds of information. Diverse sources of COVID-19-related information, both international and local, were actively accessed, appraised and engaged with by participants.

As was found in survey findings in Australia [ 35 ] and other countries [ 32 ], traditional media (television and radio news reports) were important sources for participants, as were government sources such as press conferences, health campaigns and websites [ 34 , 35 ] and friends and family [ 34 ]. Despite contentions that Australian publics have lost confidence in the advice of public health authorities and governments due to conflicting and rapidly changing information provided [ 13 ], our participants demonstrated willingness to trust these sources for information and advice about how to respond to the crisis. Indeed, other research conducted around the same time as our study showed that Australians’ trust in government had increased dramatically since the outbreak of COVID-19: largely because they assess government interventions to manage COVID-19 as appropriate and effective [ 42 ]. Regular press conferences with government and health officials were important in gaining people’s trust and reassuring them that the federal and state governments were working hard to control the crisis. People wanted both very localised information that was directly relevant to them and general information from trusted global health organisations such as the WHO.

Healthcare professionals personally known to people, such as their regular general practitioner, were also trusted sources of information. Illustrative of the importance placed on experiential knowledge, the participants referred to the value of having informal discussions with friends and family members who were experts or working in relevant fields, such as healthcare or science, as well as engaging in-person in interactions with groups such as faith-based communities and simply hearing from friends and family who lived overseas about what COVID-19 conditions were like there.

Our findings support and extend other research that has highlighted the affective dimensions of engaging with information sources in relation to major health crisis such as outbreaks of new infectious diseases [ 2 , 9 , 10 , 11 ]. Similar to survey-based research in Australia [ 35 ] and internationally [ 28 , 29 , 30 , 31 , 33 ], our study’s participants reported a high interest in COVID-19 news reports in the initial stages of the pandemic. Some people described feelings of anxiety or distress in response to the plethora of information continually published in news reports and on social media. Others were angry and frustrated about the extent of misinformation that was circulating in the community and online and the potential for it to contribute to the spread of the coronavirus and pose a risk to others. However for many people, keeping up to date with changes in information and news in the rapidly changing environment of the COVID-19 crisis was a form of reassurance and helpful in ensuring they were conforming to best-practice risk avoidance and management.

The findings also show how certain key events or experiences made people become aware that the outbreak was threatening Australia and potentially themselves. For some people, this was hearing in the news media about the growing number of cases in their region, drastic government interventions imposed to contain the spread or the identification of infected people in their immediate locale. For others, it was face-to-face encounters or telephone conversations with trusted people or viewing content from friends and family members overseas on social media about how they were experiencing the pandemic in their countries that really brought home the dire threats posed by COVID-19 and what could happen to Australia if the outbreak were not contained.

A limitation of our study is that it did not involve a representative sample of Australian adults and therefore the findings are not generalisable to the population as a whole. However, a diverse group of participants was included, and the findings support and provide further detail about the trends identified in large-scale surveys of Australians’ news consumption and trust in information sources during the initial months of the COVID-19 crisis [ 34 , 35 ].

Conclusions

Our findings provide further contextual insights into the complexities and social contexts of these practices and sense-making responses, including how people bring together information from different sources in understanding the threat of COVID-19 and the interactions of digital with non-digital sources. A constantly changing news environment, as was the case during the first 6 months of the COVID-19 crisis, raises challenges for effective communication of risk and containment advice. People can become confused, distressed and overwhelmed by the plethora of information sources and fast-changing news environment. On the other hand, seeking out information can provide reassurance and comfort in response to anxiety and uncertainty. Clarity and consistency in risk messaging is important, as is responding quickly to changes in information and misinformation.

Our interview study took place at a certain point in the Australian experience of the COVID-19 crisis (towards the end of the national lockdown). Given the rapidly changing nature of the spread of COVID-19 in Australia since then, including a major outbreak in the state of Victoria and an extended second lockdown in that state, continuing and follow-up research is recommended to better understand how Australians have made sense of and protected themselves against the COVID-19 crisis and which sources have been most helpful for them in doing so.

Availability of data and materials

No data or materials are publicly available as the participants did not consent to open sharing of their interview transcripts or other personal information. Anonymised interview transcripts may be made available from the corresponding author on reasonable request.

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Acknowledgements

We thank the participants for giving their time to be interviewed for this study.

The study was funded by personal research support awarded to DL by UNSW Sydney as part of her SHARP Professorship.

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DL conceived the project, conducted the literature review, contributed to the analysis, interpretation and discussion of the research materials and wrote the manuscript. SL conducted the interviews, wrote the case studies, contributed to the analysis, interpretation and discussion of the materials and reviewed and commented on the manuscript draft. Both authors read and approved the final manuscript.

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The study was conducted according to the guidelines of the National Research and Medical Council of Australia. It was approved by the UNSW human research ethics committee (approval number HC200292). All participants provided informed consent prior to the interview. To maintain confidentiality, participants were assigned a pseudonym and all contextual identifiers were removed from the transcripts. To further preserve anonymity, the participants’ specific location of residence is not disclosed in the findings.

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Evaluating Survey Questions in the Age of COVID-19

HOST: The quality of data in any health survey depends on the quality of the questions being asked, as well as the interpretation of those questions by the survey participants.  NCHS has a team in place that directly deals with those issues, the Collaborating Center for Question Design and Evaluation Research, or “CCQDER.”  CCQDER uses cognitive interviewing, a popular method for evaluating survey questions, by offering a detailed depiction of meanings and processes used by respondents to answer questions, which ultimately impact the survey data.  The sample of respondents in these studies is usually small, between 20 and 50 respondents.

This week, the CCQDER team hosted a webinar in which they discussed the design of survey questions about COVID-19, and the administration of those questions during the pandemic.  In addition to cognitive interviewing, the webinar also covered topics such as the Research and Development Survey, or “RANDS.”

As part of the Q and A segment of the webinar, Kristen Miller, the CCQDER Director, was asked whether standardized COVID questions had been developed by NCHS for outside researchers to use in their own studies:

KRISTEN MILLER: So traditionally it hasn’t been in our job scope to come up with standardized questions.  What we have done is – and maybe we want to rethink this for the future – but what we do do is we test these questions…  in these reports you will see specifically what each individual question captures. So what we would like to see people do is to get on, read these reports, see if this question – is this question capturing what I need it to capture – and then you making the decision, “Yes, I’m going to go with this question.”  So again, not anything standardized, but information provided to you so that you can choose the question that is best going to fit your research question.

HOST: The team was also asked what they would recommend in a rapid deployment situation in which there is not enough time to conduct a full evaluation of questions:

KRISTEN MILLER: I fully appreciate the problem.  And at the same time, I think that whenever we’re writing questions we need to have a concerted effort to have a plan how we’re going to go about question evaluation.  So it’s keeping track of the questions that go into the field, having mixed method or having these follow up pro questions that we had on RANDS to be able to see, “OK, this is going to be, there’s going to be error in this question, it’s going to be more error for less educated people, let’s keep that in mind as we interpret the data that’s coming in.”  But then, again, keeping track of what we’re asking so that we can improve our questions.  I mean, we’re so far into this pandemic I’d like to think our questions that we’re asking are much more improved from the questions that we began with when it first started.  So again, it’s just really having a question evaluation plan going forward.

HOST: The reaction to any survey question is highly personal and subjective, and the CCQDER team was asked about whether respondents have been impacted by their fear of COVID-19 when answering the questions.  Dr. Stephanie Willson of the CCQDER team described some of the challenges:

STEPHANIE WILLSON: Right, actually that’s a very astute observation because again the experience that people had – you had people who thought it was a hoax over here to people who were super-afraid of getting it, right?  So that absolutely was filtered through.  One example I didn’t get a chance to talk about was this need — there were questions about, “Did you need medical care for something but not get it because of the pandemic?”  So that kind of fear, the idea of need, was filtered through people’s experience with the pandemic and how afraid they were of catching it.  So certain things were missed, because suddenly now, “I don’t need to get a check-up, I don’t need a well-woman visit, I don’t need a cancer screening because of the pandemic.”  Where in non-pandemic times:  “Yes, I feel like I need those things.”  So that is an element of fear that absolutely did factor into interpretations.

HOST: Dr. Willson also discussed the differences between “remote interviewing” and traditional face-to-face interviews, and whether remote interviewing will continue into the post-pandemic era:

STEPHANIE WILLSON: The interesting thing was, even though I’ve been doing this for a long time, I had never done a virtual interview prior to the pandemic so I went into it kind of skeptical.  But I have to tell you, I’m a convert.  I really feel as though Zoom interviews really gave the same kind of quality cognitive interview data that face-to-face, in-person face-to-face interviews gave, so I think we should continue to use this.  I think that in certain situations, there’s a downside maybe in terms of socioeconomic status, but the upside to this would be geographical diversity that we can now explore that you can’t do… It takes so much more money to, let’s say, go regionally throughout the United States, for example.  And we did have actually geographic diversity in our sample here – not enough to make it count because we were trying to do it quickly but, yeah, I think it should continue to be used.

HOST: All CCQDER studies feature a final report that document the study findings, and are housed on a searchable, publicly accessible database called Q-Bank .

MUSICAL BRIDGE

HOST: Urgent care centers and health clinics located within grocery or retail stores are able to provide acute health care services for non-emergency visits, and they also can provide preventive care services, such as routine vaccinations. The availability and utilization of urgent care has risen dramatically in recent years.

A new report released this week examines urgent care center and retail health clinic visits among adults in the past year by sex and selected characteristics.  The report uses data from the 2019 National Health Interview Survey, and reveal that 1/3 of women and slightly over ¼ of men made one or more visit to an urgent care center or retail health clinic in the past year.

Older adults are less likely to use urgent care centers or retail health clinics than younger adults, and non-Hispanic white adults are more likely to have visited an urgent care center or retail health clinic at least once in the past year compared to Hispanic, non-Hispanic black or NH Asian adults.  In addition, adults with higher education levels are more likely to use urgent care centers or retail health clinics.

A second report came out this week which compares provisional or preliminary 2020 data with final 2019 and 2018 data on changes in the number of births in the United States by month and by state.  The report also includes data on the race and Hispanic origin of the mother, and sheds some light on the impact of the COVID-19 pandemic on fertility in the country.

From 2019 to 2020, the number of births declined for each month.  In comparison, from 2018 to 2019, the number of births declined for only 9 months of the year.  The largest declines in 2020 occurred in December, followed by August, and then October and November.  The number of births in the U.S. declined 8% more in December 2020 than it did the previous year.

In other words, the decline in births between 2019 and 2020 was larger in the second half of the year than in the first half of the year – 6% in the second half of the year vs. only 2% in the first half.   Between 2018 and 2019, the number declined 2% in the first half of the year and 1% in the second half.

Ultimately, more information on fertility during the pandemic won’t be known until 2021 data are available. The first provisional data for 2021 should be available by early Fall.

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Quantitative analysis reveals unequal impact of COVID-19

Neil Sheth, a graduate student in the Interdisciplinary Scientist Training Program, examined the unequal impact of COVID-19 on different communities within large cities.  “A quantitative analysis reveals that the Covid-19 pandemic has had a greater impact on [Chicago and New York] communities with a lower Human Development Index," which is a composite of income, education and life expectancy at birth for a community, explained Sheth. Sheth's research mentor is Dr. Luis Bettencourt , Profossor of Ecology and Evolution and Director of the  Mansueto Institute for Urban Innovation . Their findings were featured on ABC-7 and in several national news outlets. You can read more about their analysis here .

The Impact of COVID-19 on the Careers of Women in Academic Sciences, Engineering, and Medicine (2021)

Chapter: 8 major findings and research questions, 8 major findings and research questions, introduction.

The COVID-19 pandemic, which began in late 2019, created unprecedented global disruption and infused a significant level of uncertainty into the lives of individuals, both personally and professionally, around the world throughout 2020. The significant effect on vulnerable populations, such as essential workers and the elderly, is well documented, as is the devastating effect the COVID-19 pandemic had on the economy, particularly brick-and-mortar retail and hospitality and food services. Concurrently, the deaths of unarmed Black people at the hands of law enforcement officers created a heightened awareness of the persistence of structural injustices in U.S. society.

Against the backdrop of this public health crisis, economic upheaval, and amplified social consciousness, an ad hoc committee was appointed to review the potential effects of the COVID-19 pandemic on women in academic science, technology, engineering, mathematics, and medicine (STEMM) during 2020. The committee’s work built on the National Academies of Sciences, Engineering, and Medicine report Promising Practices for Addressing the Underrepresentation of Women in Science, Engineering, and Medicine: Opening Doors (the Promising Practices report), which presents evidence-based recommendations to address the well-established structural barriers that impede the advancement of women in STEMM. However, the committee recognized that none of the actions identified in the Promising Practices report were conceived within the context of a pandemic, an economic downturn, or the emergence of national protests against structural racism. The representation and vitality of academic women in STEMM had already warranted national attention prior to these events, and the COVID-19

pandemic appeared to represent an additional risk to the fragile progress that women had made in some STEMM disciplines. Furthermore, the future will almost certainly hold additional, unforeseen disruptions, which underscores the importance of the committee’s work.

In times of stress, there is a risk that the divide will deepen between those who already have advantages and those who do not. In academia, senior and tenured academics are more likely to have an established reputation, a stable salary commitment, and power within the academic system. They are more likely, before the COVID-19 pandemic began, to have established professional networks, generated data that can be used to write papers, and achieved financial and job security. While those who have these advantages may benefit from a level of stability relative to others during stressful times, those who were previously systemically disadvantaged are more likely to experience additional strain and instability.

As this report has documented, during 2020 the COVID-19 pandemic had overall negative effects on women in academic STEMM in areas such productivity, boundary setting and boundary control, networking and community building, burnout rates, and mental well-being. The excessive expectations of caregiving that often fall on the shoulders of women cut across career timeline and rank (e.g., graduate student, postdoctoral scholar, non-tenure-track and other contingent faculty, tenure-track faculty), institution type, and scientific discipline. Although there have been opportunities for innovation and some potential shifts in expectations, increased caregiving demands associated with the COVID-19 pandemic in 2020, such as remote working, school closures, and childcare and eldercare, had disproportionately negative outcomes for women.

The effects of the COVID-19 pandemic on women in STEMM during 2020 are understood better through an intentionally intersectional lens. Productivity, career, boundary setting, mental well-being, and health are all influenced by the ways in which social identities are defined and cultivated within social and power structures. Race and ethnicity, sexual orientation, gender identity, academic career stage, appointment type, institution type, age, and disability status, among many other factors, can amplify or diminish the effects of the COVID-19 pandemic for a given person. For example, non-cisgender women may be forced to return to home environments where their gender identity is not accepted, increasing their stress and isolation, and decreasing their well-being. Women of Color had a higher likelihood of facing a COVID-19–related death in their family compared with their white, non-Hispanic colleagues. The full extent of the effects of the COVID-19 pandemic for women of various social identities was not fully understood at the end of 2020.

Considering the relative paucity of women in many STEMM fields prior to the COVID-19 pandemic, women are more likely to experience academic isolation, including limited access to mentors, sponsors, and role models that share gender, racial, or ethnic identities. Combining this reality with the physical isolation stipulated by public health responses to the COVID-19 pandemic,

women in STEMM were subject to increasing isolation within their fields, networks, and communities. Explicit attention to the early indicators of how the COVID-19 pandemic affected women in academic STEMM careers during 2020, as well as attention to crisis responses throughout history, may provide opportunities to mitigate some of the long-term effects and potentially develop a more resilient and equitable academic STEMM system.

MAJOR FINDINGS

Given the ongoing nature of the COVID-19 pandemic, it was not possible to fully understand the entirety of the short- or long-term implications of this global disruption on the careers of women in academic STEMM. Having gathered preliminary data and evidence available in 2020, the committee found that significant changes to women’s work-life boundaries and divisions of labor, careers, productivity, advancement, mentoring and networking relationships, and mental health and well-being have been observed. The following findings represent those aspects that the committee agreed have been substantiated by the preliminary data, evidence, and information gathered by the end of 2020. They are presented either as Established Research and Experiences from Previous Events or Impacts of the COVID-19 Pandemic during 2020 that parallel the topics as presented in the report.

Established Research and Experiences from Previous Events

___________________

1 This finding is primarily based on research on cisgender women and men.

Impacts of the COVID-19 Pandemic during 2020

Research questions.

While this report compiled much of the research, data, and evidence available in 2020 on the effects of the COVID-19 pandemic, future research is still needed to understand all the potential effects, especially any long-term implications. The research questions represent areas the committee identified for future research, rather than specific recommendations. They are presented in six categories that parallel the chapters of the report: Cross-Cutting Themes; Academic Productivity and Institutional Responses; Work-Life Boundaries and Gendered Divisions of Labor; Collaboration, Networking, and Professional Societies; Academic Leadership and Decision-Making; and Mental Health and Well-being. The committee hopes the report will be used as a basis for continued understanding of the impact of the COVID-19 pandemic in its entirety and as a reference for mitigating impacts of future disruptions that affect women in academic STEMM. The committee also hopes that these research questions may enable academic STEMM to emerge from the pandemic era a stronger, more equitable place for women. Therefore, the committee identifies two types of research questions in each category; listed first are those questions aimed at understanding the impacts of the disruptions from the COVID-19 pandemic, followed by those questions exploring the opportunities to help support the full participation of women in the future.

Cross-Cutting Themes

• What are the short- and long-term effects of the COVID-19 pandemic on the career trajectories, job stability, and leadership roles of women, particularly of Black women and other Women of Color? How do these effects vary across institutional characteristics, 2 discipline, and career stage?

2 Institutional characteristics include different institutional types (e.g., research university, liberal arts college, community college), locales (e.g., urban, rural), missions (e.g., Historically Black Colleges and Universities, Hispanic-Serving Institutions, Asian American/Native American/Pacific Islander-Serving Institutions, Tribal Colleges and Universities), and levels of resources.

• How did the confluence of structural racism, economic hardships, and environmental disruptions affect Women of Color during the COVID-19 pandemic? Specifically, how did the murder of George Floyd, Breonna Taylor, and other Black citizens impact Black women academics’ safety, ability to be productive, and mental health?
• How has the inclusion of women in leadership and other roles in the academy influenced the ability of institutions to respond to the confluence of major social crises during the COVID-19 pandemic?
• How can institutions build on the involvement women had across STEMM disciplines during the COVID-19 pandemic to increase the participation of women in STEMM and/or elevate and support women in their current STEMM-related positions?
• How can institutions adapt, leverage, and learn from approaches developed during 2020 to attend to challenges experienced by Women of Color in STEMM in the future?

Academic Productivity and Institutional Responses

• How did the institutional responses (e.g., policies, practices) that were outlined in the Major Findings impact women faculty across institutional characteristics and disciplines?
• What are the short- and long-term effects of faculty evaluation practices and extension policies implemented during the COVID-19 pandemic on the productivity and career trajectories of members of the academic STEMM workforce by gender?
• What adaptations did women use during the transition to online and hybrid teaching modes? How did these techniques and adaptations vary as a function of career stage and institutional characteristics?
• What are examples of institutional changes implemented in response to the COVID-19 pandemic that have the potential to reduce systemic barriers to participation and advancement that have historically been faced by academic women in STEMM, specifically Women of Color and other marginalized women in STEMM? How might positive institutional responses be leveraged to create a more resilient and responsive higher education ecosystem?
• How can or should funding arrangements be altered (e.g., changes in funding for research and/or mentorship programs) to support new ways of interaction for women in STEMM during times of disruption, such as the COVID-19 pandemic?

Work-Life Boundaries and Gendered Divisions of Labor

• How do different social identities (e.g., racial; socioeconomic status; culturally, ethnically, sexually, or gender diverse; immigration status; parents of young children and other caregivers; women without partners) influence the management of work-nonwork boundaries? How did this change during the COVID-19 pandemic?
• How have COVID-19 pandemic-related disruptions affected progress toward reducing the gender gap in academic STEMM labor-force participation? How does this differ for Women of Color or women with caregiving responsibilities?
• How can institutions account for the unique challenges of women faculty with parenthood and caregiving responsibilities when developing effective and equitable policies, practices, or programs?
• How might insights gained about work-life boundaries during the COVID-19 pandemic inform how institutions develop and implement supportive resources (e.g., reductions in workload, on-site childcare, flexible working options)?

Collaboration, Networking, and Professional Societies

• What were the short- and long-term effects of the COVID-19 pandemic-prompted switch from in-person conferences to virtual conferences on conference culture and climate, especially for women in STEMM?
• How will the increase in virtual conferences specifically affect women’s advancement and career trajectories? How will it affect women’s collaborations?
• How has the shift away from attending conferences and in-person networking changed longer-term mentoring and sponsoring relationships, particularly in terms of gender dynamics?
• How can institutions maximize the benefits of digitization and the increased use of technology observed during the COVID-19 pandemic to continue supporting women, especially marginalized women, by increasing accessibility, collaborations, mentorship, and learning?
• How can organizations that support, host, or facilitate online and virtual conferences and networking events (1) ensure open and fair access to participants who face different funding and time constraints; (2) foster virtual connections among peers, mentors, and sponsors; and (3) maintain an inclusive environment to scientists of all backgrounds?
• What policies, practices, or programs can be developed to help women in STEMM maintain a sense of support, structure, and stability during and after periods of disruption?

Academic Leadership and Decision-Making

• What specific interventions did colleges and universities initiate or prioritize to ensure that women were included in decision-making processes during responses to the COVID-19 pandemic?
• How effective were colleges and universities that prioritized equity-minded leadership, shared leadership, and crisis leadership styles at mitigating emerging and potential negative effects of the COVID-19 pandemic on women in their communities?
• What specific aspects of different leadership models translated to more effective strategies to advance women in STEMM, particularly during the COVID-19 pandemic?
• How can examples of intentional inclusion of women in decision-making processes during the COVID-19 pandemic be leveraged to develop the engagement of women as leaders at all levels of academic institutions?
• What are potential “top-down” structural changes in academia that can be implemented to mitigate the adverse effects of the COVID-19 pandemic or other disruptions?
• How can academic leadership, at all levels, more effectively support the mental health needs of women in STEMM?

Mental Health and Well-being

• What is the impact of the COVID-19 pandemic and institutional responses on the mental health and well-being of members of the academic STEMM workforce as a function of gender, race, and career stage?
• How are tools and diagnostic tests to measure aspects of wellbeing, including burnout and insomnia, used in academic settings? How does this change during times of increased stress, such as the COVID-19 pandemic?
• How might insights gained about mental health during the COVID-19 pandemic be used to inform preparedness for future disruptions?
• How can programs that focus on changes in biomarkers of stress and mood dysregulation, such as levels of sleep, activity, and texting patterns, be developed and implemented to better engage women in addressing their mental health?
• What are effective interventions to address the health of women academics in STEMM that specifically account for the effects of stress on women? What are effective interventions to mitigate the excessive levels of stress for Women of Color?

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The spring of 2020 marked a change in how almost everyone conducted their personal and professional lives, both within science, technology, engineering, mathematics, and medicine (STEMM) and beyond. The COVID-19 pandemic disrupted global scientific conferences and individual laboratories and required people to find space in their homes from which to work. It blurred the boundaries between work and non-work, infusing ambiguity into everyday activities. While adaptations that allowed people to connect became more common, the evidence available at the end of 2020 suggests that the disruptions caused by the COVID-19 pandemic endangered the engagement, experience, and retention of women in academic STEMM, and may roll back some of the achievement gains made by women in the academy to date.

The Impact of COVID-19 on the Careers of Women in Academic Sciences, Engineering, and Medicine identifies, names, and documents how the COVID-19 pandemic disrupted the careers of women in academic STEMM during the initial 9-month period since March 2020 and considers how these disruptions - both positive and negative - might shape future progress for women. This publication builds on the 2020 report Promising Practices for Addressing the Underrepresentation of Women in Science, Engineering, and Medicine to develop a comprehensive understanding of the nuanced ways these disruptions have manifested. The Impact of COVID-19 on the Careers of Women in Academic Sciences, Engineering, and Medicine will inform the academic community as it emerges from the pandemic to mitigate any long-term negative consequences for the continued advancement of women in the academic STEMM workforce and build on the adaptations and opportunities that have emerged.

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Practical Considerations in Qualitative Health Research During the COVID-19 Pandemic

Deepthi s. varma.

1 Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA

Mary E. Young

2 Department of Occupational Therapy, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA

Consuelo M. Kreider

Katherine williams.

3 Department of Counselor Education, College of Education, University of Florida, Gainesville, FL, USA

Krishna Vaddiparti

Christina parisi, luz m. semeah.

4 Veterans Rural Health Resource Center- Gainesville (VRHRC) within the North Florida/South Georgia Veterans Health System, Gainesville, FL, USA

The COVID-19 pandemic has forced both quantitative and qualitative health researchers to adapt and strategize data collection strategies without causing any harm to the participants or researchers. This has resulted in utilizing various types of strategies such as online surveys and synchronous virtual platforms such as Zoom and Webex. This transition from face-to-face to synchronous online platforms has helped in increasing coverage as well as reaching participants who are otherwise unreachable. While quantitative health researchers seem to have made a seamless transition to synchronous online platforms, qualitative health researchers who rely on studying participants in their “real-world-settings” are facing unique challenges with online data collection strategies. This article critically examines the benefits and challenges of implementing qualitative health research studies via synchronous online platforms and provides several practical considerations that can inform qualitative health researchers. It can also assist Institutional Review Board members in reviewing and implementing qualitative health research study protocols in a manner that preserves the integrity, richness, and iterative nature of qualitative research methodology.

Qualitative research is a process of understanding and discovery based on distinct methodological traditions of inquiry that explore social or human experiences. The researcher analyzes words and text, reports detailed views of informants, builds a complex, holistic picture of a phenomenon, and conducts the study in a natural setting ( Miles et al., 2020 ). The researcher has greater control over the “instrument” for data collection since he or she will modify the questions based on participants’ verbal responses and non-verbal behaviors ( Agee, 2009 ; Cresswell, 2007 ). Qualitative health research (QHR) is a specialized form of qualitative research that focuses on peoples’ experiences with health, illness, healthcare system, and healthcare practice, whereby patients’ particular needs regarding privacy and emotionality are taken into account within the research methodology ( Morse, 2011 ).

As pragmatists ( Patton, 2002 ) and “bricoleurs” ( Denzin, 2010 ), health researchers have always risen to the challenge of continuing timely and critical studies to impact the health of individuals and communities. An extensive literature review of published articles showed that qualitative health researchers have long been utilizing synchronous and asynchronous online methods to conduct qualitative research. These methods included telephone interviews, e-mails, online chat rooms, Skype interviews, and online meeting rooms ( Cater, 2011 ; Janghorban et al., 2014 ; Kenny, 2005 ; Murray, 1995 , 1997 ; Sah et al., 2020 ; Turney & Pocknee, 2005 ; Tuttas, 2015 ). Several of these researchers have also reported on the challenges and benefits of these online platforms. However, the COVID-19 pandemic has forced qualitative health researchers to rapidly adapt their tried and true in-person methods and to explore, innovate, and quickly overcome challenges posed by use of the various available video-conferencing technologies in conducting QHR via synchronous online platforms.

During the last year, to accommodate the pandemic-posed social distancing and other restrictions, researchers began migrating to fully online data collection methods such as virtual focus groups, remote interviews, and online self-report measures and surveys. These strategies seem to be working effectively for quantitative researchers. In the case of survey research, the now commonplace use of online platforms has reduced the burden of traditional barriers to research participation such as travel to the research site, finding childcare, and working around work and/or school schedules.

The use of online technologies has increased anonymity and provided participants the opportunity of responding to a survey at their own leisure and convenience. However, qualitative researchers have found it more difficult to effectively transition methods to an online platform. These researchers agree with the quantitative researchers on the benefits of an online or a remote interface platform; however, qualitative researchers are struggling to adapt and apply the core principles of qualitative research such as integrity and richness in the virtual world. Previous reports on online qualitative health research strategies such as online focus group discussions via synchronous and asynchronous interviewing have reported benefits such as increased coverage of otherwise hard-to-reach populations, opportunity for participants to participate from the comfort of their homes, decreased peer pressure in providing socially desirable responses, and increased flexibility. These reports have also highlighted several challenges such as difficulty observing and recording non-verbal cues from participants, controlling respondent’s environment to reduce noise, eliminating distractions, ensuring privacy, and limitations due to the degree of digital literacy of participants during synchronous qualitative data collection ( Cater, 2011 ; Janghorban et al., 2014 ; Kenny, 2005 ; Sah et al., 2020 ; Turney & Pocknee, 2005 ; Tuttas, 2015 ).

At present, in the era of the COVID-19 pandemic and required social distancing, there is an absence of any clear guidelines and practical tips for conducting online QHR. This article is the product of a reflective process and ongoing discussions among the authors, a group of interdisciplinary qualitative health researchers who are members of a regularly scheduled Qualitative Research Colloquium at the Health Science Center of a large public university in the United States.

The methodological decisions described in this article were made in the context of permission from the Institutional Review Board (IRB) to make rapid changes so long as researchers protected the integrity of the research process and maintained the safety and informed consent of participants. The authors, based on their own experiences and extensive literature review, have engaged in ongoing reflective and critical examination of the benefits and challenges of conducting QHR via remote, online environments. This article presents practical considerations that can inform both qualitative researchers and IRB members to review and implement qualitative research protocols in a manner that will preserve the integrity, richness, and iterative nature of qualitative research methodology. We will start by examining the benefits and challenges of implementing a QHR study via an online environment.

As noted in several previous studies, online interviews and focus groups reduce the burden on the participants by allowing them to participate from the comfort of their own homes in a safe environment ( Sah et al., 2020 ; Turney & Pocknee, 2005 ; Tuttas, 2015 ). They need not worry about transportation to the research site and/or securing childcare during the time that they spend with the researchers ( Kenny, 2005 ). Another advantage from the participants’ perspective is their ability to control their anonymity by turning off the video camera, if available, during online interviews or focus group discussions, and/or by using a pseudonym for their on-screen name. This anonymity may provide increased confidence to discuss or disclose information without the fear of being judged by researchers or other participants ( Kenny, 2005 ). Previous online qualitative studies also have described a lesser degree of “social loafing,” or a “synergistic bandwagon effect” compared to a face-to-face focus group discussion ( Kenny, 2005 ; Tuttas, 2015 ). This is especially important while researching areas such as HIV/AIDS, substance use, sexual abuse, mental health, or health behaviors. In addition to providing a virus-safe distancing environment, online focus groups may also assist the researchers by increasing the geographical coverage of their participants ( Sah et al., 2020 ). It helps the researchers to include rural populations and those who live in communities with internet and technology access but are geographically distant from the research site or culturally and linguistically different from the research institutions’ culture and language. Expanding abilities to capture diverse perspectives and experiences serves to make the sample more inclusive and the findings more transferable, thus potentially increasing the impact of the studies on social justice.

Finally, online formats may provide a clearer flow of information during focus group discussions, with less cross-talk and participants talking over each other. While we have observed fewer interruptions, arguments, or counter arguments in the online focus group environment, as in previous studies there does appear to be a greater opportunity for participants to provide well-thought-out responses ( Kenny, 2005 ; Turney & Pocknee, 2005 ; Tuttas, 2015 ). It is as if participants’ familiarity with remote conferencing technology and accompanying netiquette (e.g., muted microphones and use of chat function to prompt topical shifts) is translated to a perceptively more orderly nature of the online focus groups. However, the mute function also works to mute out participants’ immediate agreements, rebuttals, and social conventions for indicating the listener’s engagement (e.g., the “uh hum”s). This requires the researcher to be especially attentive to visual cues such as head nods and facial grimaces in response to the dialog.

We have observed that many focus group participants use the long pauses between their own verbal contributions to listen while simultaneously formulating their own response to the original prompt—which, when finally articulated are often notably well thought out. While the online format seems to elicit richer verbal responses than in face-to-face discussions, there is a notably dampened pace and emotional tone to the focus group discussions that, for some participants, can actually foster better “following along.” The more orderly nature of the online focus groups requires a slightly different skill set from the facilitator—one that seems more akin to skills required of a panel moderator who must direct or set ground rules for when it is a panelist’s turn to speak. Due to the reduction or absence of non-verbal cues and different responsiveness as described above, more attention and concentration may be required from facilitators and co-facilitators during data collection for these focus groups.

Privacy and confidentiality of the information shared by participants from their home with the researcher is a significant challenge for qualitative health researchers whose area of research include HIV/AIDS, sexual abuse, substance use, mental health, stigma, and other sensitive topics. While the presence of other family members in the same room or in close proximity may be discouraged, ultimately, such privacy is—for the most part—out of the researcher’s control. Breach of confidentiality may be a higher risk when participants are in the comfort of their home environment, as participants might disclose—or others might overhear—what is being discussed. These issues should be addressed in the informed consent process. Other types of distractions, such as children or family members requiring attention, pets appearing and interrupting, phones ringing, delivery persons or visitors coming to the door, or a myriad of other diversions that are less frequent during a face-to-face setting but commonplace at home, will not be able to be controlled by the researchers when remoting into the participant’s environment. These distractions could not only interrupt the flow of discussions, but also could prolong the duration of the interview or discussions.

Moreover, several social and personal elements of the interviews are lost in the absence of face-to-face interactions with the participant during the interviewing process. A qualitative researcher gains meaningful insights from the appearance of the participants, and by observing and recording the non-verbal cues and non-verbal behaviors of individual participants and between the participants ( Denham & Onwuegbuzie, 2013 ; Morgan, 1993 ). Online or telephone research without a video camera prevents the researcher from making these observations and capturing cues of their behaviors. Even when a video camera is used, the viewing range is restricted and does not provide the researcher the full context. Though taken for granted, such cues provide important insights into understanding the problem that is being researched ( Denham & Onwuegbuzie, 2013 ). Additionally, an online interview also sometimes limits reciprocal discussions amongst participants. Several of these shortcomings could be significantly improved by encouraging participants to speak with and respond to all members in the group. However, this will require a skilled qualitative researcher who is cognizant of the limitations of an online focus group discussion and can provide clear guidance on rules of interaction and the order and manner of contributing to the discussions.

Last, when conducting online focus groups or interviews, technological challenges such as availability of equipment, internet service limitations, and hesitation in using new platforms may arise; this might be particularly, but not exclusively, the case with participants from rural or low resource communities. The potential for technology barriers must be prepared for in any online exchanges. Researchers must solve problems on the fly, and monitor the chats for participants with bandwidth, cellular connection, or internet stability problems. Researchers must facilitate the use of textual contributions or call-in functions by participants who do not have adequate bandwidth to use the video function. At times, without the availability of additional research personnel, the focus group facilitator becomes responsible for moderating the discussion while simultaneously monitoring for and eliciting contributions via textual chat as well as providing technical support to participants. Having a co-facilitator or research staff available to manage the logistics of problems with signing in, audio/video problems, accompanying demographic questionnaires, and compensation distribution, can be most helpful. Additionally, exclusive dependence in an online format could result in the systematic elimination of certain groups of people such as older adults, those less educated, and those who reside in rural areas from research studies. As such, researchers must be careful to mitigate as best as possible such a “ digital divide, ” which could exacerbate already existing health disparities.

Practical Considerations for Researchers and IRB Members

Based on the novel and varied experiences obtained while conducting virtual qualitative research studies by the diverse group of authors of this article, below are some pointers that need to be considered by the researchers and the IRB members who review and approve QHR study protocols.

• The responsibility of researchers to “do no harm” has long been a tenet of ethical research ( Kostovicova & Knott, 2020 ). Therefore, the qualitative health researcher should ensure privacy and confidentiality by emphasizing that the online interview or focus group be conducted in a private room, to reduce distraction and minimize the chances of others overhearing the conversation with the researcher. Participants could also be provided with a list of best practices, ahead of the research interview, that would minimize distractions and increase privacy. This is especially important in health research studies that collect protected health information and discuss sensitive topics.
• A welcome page, as recommended by previous studies ( Fox et al., 2007 ), or at least the creation of a presentation slide, is strongly encouraged where the participants are provided the title and a brief abstract explaining the goals of the study. This could assist the participants to have a clearer understanding of the study as they are waiting for other participants to join the forum.
• Whenever possible, the researchers must encourage the participants to turn on the camera during the research study. This would help the researchers observe and record the respondent’s facial expressions and verbal behaviors as they normally do in an in-person group discussion or interview.
• The qualitative research study design must explicitly state how the researchers will ensure recruiting people who may not have access or the technical know-how to participate in an online research study. This is important for ensuring representativeness and to avoid increasing the already existing “ digital divide” resulting from the disparities in infrastructure, skills, and usage patterns in the communities being studied ( Hargittai & Hinnant, 2008 ). Lack of attention to these details could also contribute to increasing the health disparity that currently impacts many communities.
• Researchers should ensure trustworthiness, especially during the time of COVID-19, since many community members are more reluctant to share personal information online with a researcher than during a face-to-face interaction. Privacy and confidentiality can be ensured by conducting interviews by sending a link with a passcode to the participant to sign in and establishing a strong rapport by explaining the safeguards before starting the discussions.
• Researchers must be flexible in their approach since the interview or the data collection session could be interrupted by several technological issues such as poor internet connection, or loss of audio or video. The researcher should be prepared to employ strategies, such as slowing the cadence of their speech or directing participants to communicate via the “chat” function, or utilize the call-in function to ensure preservation of the verbal communications during times when bandwidth is insufficient to support smooth and synchronized audio and visual communications. This is especially important if the researcher is recording the interviews for later transcription and analysis.
• Most importantly, online interactions do not necessarily allow development of a strong rapport—as is easier to foster with in-person face-to-face interactions—during the brief duration of the synchronous remote interactions. Previous studies have shown that even with extensive preparation before the interviews, each interview is unique and unpredictable; we cannot foresee how the researcher-participant relationship will develop and how this will impact the knowledge we generate ( Swauger, 2011 ; Tuttas, 2015 ). Therefore, it is important for all researchers to scale down their expectations regarding what can and cannot be achieved through an online platform. Research protocols and data collection plans need to be developed in consideration of this reality.
• The circumstances of the COVID-19 pandemic reinforce the need for establishing and maintaining a constant back and forth dialog with the IRB who can serve as an important resource to help ensure the procedures being considered continue to uphold the integrity of the research process and maintain the safety and informed consent of participants.
• Finally, the researchers should be aware of limitations to providing adequate emotional support to online participants if they strongly experience emotions such as fear, sadness, or anger ( Corbin & Morse, 2003 ). Researchers should be extra vigilant in detecting any type of distress among the participants and should have a plan of addressing any observed distress articulated in the research protocol. Delving deeply into certain sensitive topics such as deviant or illegal activities that expose the vested interests of powerful persons or persons engaged in coercive, violent, or domineering behaviors, abusive behaviors, and certain religious rituals and practices could arouse powerful emotions among participants. Lack or reduction of reciprocity in an online format could leave the participant uncomfortable and unsupported during or after the interview. These limitations need to be highlighted and addressed in the research protocol, informed consent document, and IRB approval process.

This article aims to highlight several key points to be considered while planning and conducting QHR studies on an online or virtual platform. Health research studies cannot be paused or postponed during a pandemic without important mortality and morbidity implications for the community—implications that stem from interruptions or a lack of new findings regarding health care and interventions. Many qualitative research methods such as focus group discussions and in-depth interviews are frequently conducted as part of pilot studies by quantitative researchers. As such, pausing these research efforts can hinder the start and completion of many types of studies. The COVID-19 pandemic has made us aware of the unpredictability of world events which can force us to think out of the box. As researchers, while we can prepare for several uncertainties, it is important for qualitative health researchers to be prepared to improvise or re-strategize the research process according to the context so that we can continue doing timely, effective, and impactful health research.

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

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

Deepthi S. Varma https://orcid.org/0000-0003-1163-0377

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