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Persuasive Essay Guide

Persuasive Essay About Covid19

How to Write a Persuasive Essay About Covid19 | Examples & Tips

11 min read

Steps to Write a Persuasive Essay About Covid-19

Here are the steps to help you write a persuasive essay on this topic, along with an example essay:

Step 1: Choose a Specific Thesis Statement

Your thesis statement should clearly state your position on a specific aspect of COVID-19. It should be debatable and clear. For example:

Step 2: Research and Gather Information

Collect reliable and up-to-date information from reputable sources to support your thesis statement. This may include statistics, expert opinions, and scientific studies. For instance:

COVID-19 vaccination effectiveness data
Information on vaccine mandates in different countries
Expert statements from health organizations like the WHO or CDC

Step 3: Outline Your Essay

Create a clear and organized outline to structure your essay. A persuasive essay typically follows this structure:

Introduction
Background Information
Body Paragraphs (with supporting evidence)
Counterarguments (addressing opposing views)

Step 4: Write the Introduction

In the introduction, grab your reader's attention and present your thesis statement. For example:

Step 5: Provide Background Information

Offer context and background information to help your readers understand the issue better. For instance:

Step 6: Develop Body Paragraphs

Each body paragraph should present a single point or piece of evidence that supports your thesis statement. Use clear topic sentences, evidence, and analysis. Here's an example:

Step 7: Address Counterarguments

Acknowledge opposing viewpoints and refute them with strong counterarguments. This demonstrates that you've considered different perspectives. For example:

Step 8: Write the Conclusion

Summarize your main points and restate your thesis statement in the conclusion. End with a strong call to action or thought-provoking statement. For instance:

Step 9: Revise and Proofread

Edit your essay for clarity, coherence, grammar, and spelling errors. Ensure that your argument flows logically.

Step 10: Cite Your Sources

Include proper citations and a bibliography page to give credit to your sources.

Remember to adjust your approach and arguments based on your target audience and the specific angle you want to take in your persuasive essay about COVID-19.

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Examples of Persuasive Essay About Covid19

When writing a persuasive essay about the Covid-19 pandemic, it’s important to consider how you want to present your argument. To help you get started, here are some example essays for you to read:

Check out some more PDF examples below:

Persuasive Essay About Covid-19 Pandemic

Sample Of Persuasive Essay About Covid-19

Persuasive Essay About Covid-19 In The Philippines - Example

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Examples of Persuasive Essay About Covid-19 Vaccine

Covid19 vaccines are one of the ways to prevent the spread of Covid-19, but they have been a source of controversy. Different sides argue about the benefits or dangers of the new vaccines. Whatever your point of view is, writing a persuasive essay about it is a good way of organizing your thoughts and persuading others.

A persuasive essay about the Covid-19 vaccine could consider the benefits of getting vaccinated as well as the potential side effects.

Below are some examples of persuasive essays on getting vaccinated for Covid-19.

Covid19 Vaccine Persuasive Essay

Persuasive Essay on Covid Vaccines

Interested in thought-provoking discussions on abortion? Read our persuasive essay about abortion blog to eplore arguments!

Examples of Persuasive Essay About Covid-19 Integration

Covid19 has drastically changed the way people interact in schools, markets, and workplaces. In short, it has affected all aspects of life. However, people have started to learn to live with Covid19.

Writing a persuasive essay about it shouldn't be stressful. Read the sample essay below to get idea for your own essay about Covid19 integration.

Persuasive Essay About Working From Home During Covid19

Searching for the topic of Online Education? Our persuasive essay about online education is a must-read.

Examples of Argumentative Essay About Covid 19

Covid-19 has been an ever-evolving issue, with new developments and discoveries being made on a daily basis.

Writing an argumentative essay about such an issue is both interesting and challenging. It allows you to evaluate different aspects of the pandemic, as well as consider potential solutions.

Here are some examples of argumentative essays on Covid19.

Argumentative Essay About Covid19 Sample

Argumentative Essay About Covid19 With Introduction Body and Conclusion

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Examples of Persuasive Speeches About Covid-19

Do you need to prepare a speech about Covid19 and need examples? We have them for you!

Persuasive speeches about Covid-19 can provide the audience with valuable insights on how to best handle the pandemic. They can be used to advocate for specific changes in policies or simply raise awareness about the virus.

Check out some examples of persuasive speeches on Covid-19:

Persuasive Speech About Covid-19 Example

Persuasive Speech About Vaccine For Covid-19

You can also read persuasive essay examples on other topics to master your persuasive techniques!

Tips to Write a Persuasive Essay About Covid-19

Writing a persuasive essay about COVID-19 requires a thoughtful approach to present your arguments effectively.

Here are some tips to help you craft a compelling persuasive essay on this topic:

Choose a Specific Angle

Start by narrowing down your focus. COVID-19 is a broad topic, so selecting a specific aspect or issue related to it will make your essay more persuasive and manageable. For example, you could focus on vaccination, public health measures, the economic impact, or misinformation.

Provide Credible Sources

Support your arguments with credible sources such as scientific studies, government reports, and reputable news outlets. Reliable sources enhance the credibility of your essay.

Use Persuasive Language

Employ persuasive techniques, such as ethos (establishing credibility), pathos (appealing to emotions), and logos (using logic and evidence). Use vivid examples and anecdotes to make your points relatable.

Organize Your Essay

Structure your essay involves creating a persuasive essay outline and establishing a logical flow from one point to the next. Each paragraph should focus on a single point, and transitions between paragraphs should be smooth and logical.

Emphasize Benefits

Highlight the benefits of your proposed actions or viewpoints. Explain how your suggestions can improve public health, safety, or well-being. Make it clear why your audience should support your position.

Use Visuals -H3

Incorporate graphs, charts, and statistics when applicable. Visual aids can reinforce your arguments and make complex data more accessible to your readers.

Call to Action

End your essay with a strong call to action. Encourage your readers to take a specific step or consider your viewpoint. Make it clear what you want them to do or think after reading your essay.

Revise and Edit

Proofread your essay for grammar, spelling, and clarity. Make sure your arguments are well-structured and that your writing flows smoothly.

Seek Feedback

Have someone else read your essay to get feedback. They may offer valuable insights and help you identify areas where your persuasive techniques can be improved.

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Common Topics for a Persuasive Essay on COVID-19

Here are some persuasive essay topics on COVID-19:

The Importance of Vaccination Mandates for COVID-19 Control
Balancing Public Health and Personal Freedom During a Pandemic
The Economic Impact of Lockdowns vs. Public Health Benefits
The Role of Misinformation in Fueling Vaccine Hesitancy
Remote Learning vs. In-Person Education: What's Best for Students?
The Ethics of Vaccine Distribution: Prioritizing Vulnerable Populations
The Mental Health Crisis Amidst the COVID-19 Pandemic
The Long-Term Effects of COVID-19 on Healthcare Systems
Global Cooperation vs. Vaccine Nationalism in Fighting the Pandemic
The Future of Telemedicine: Expanding Healthcare Access Post-COVID-19

In search of more inspiring topics for your next persuasive essay? Our persuasive essay topics blog has plenty of ideas!

To sum it up,

You have read good sample essays and got some helpful tips. You now have the tools you needed to write a persuasive essay about Covid-19. So don't let the doubts stop you, start writing!

If you need professional writing help, don't worry! We've got that for you as well.

MyPerfectWords.com is a professional persuasive essay writing service that can help you craft an excellent persuasive essay on Covid-19. Our experienced essay writer will create a well-structured, insightful paper in no time!

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Frequently Asked Questions

Are there any ethical considerations when writing a persuasive essay about covid-19.

Yes, there are ethical considerations when writing a persuasive essay about COVID-19. It's essential to ensure the information is accurate, not contribute to misinformation, and be sensitive to the pandemic's impact on individuals and communities. Additionally, respecting diverse viewpoints and emphasizing public health benefits can promote ethical communication.

What impact does COVID-19 have on society?

The impact of COVID-19 on society is far-reaching. It has led to job and economic losses, an increase in stress and mental health disorders, and changes in education systems. It has also had a negative effect on social interactions, as people have been asked to limit their contact with others.

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How to Write About Coronavirus in a College Essay

Students can share how they navigated life during the coronavirus pandemic in a full-length essay or an optional supplement.

Writing About COVID-19 in College Essays

Serious disabled woman concentrating on her work she sitting at her workplace and working on computer at office

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Experts say students should be honest and not limit themselves to merely their experiences with the pandemic.

The global impact of COVID-19, the disease caused by the novel coronavirus, means colleges and prospective students alike are in for an admissions cycle like no other. Both face unprecedented challenges and questions as they grapple with their respective futures amid the ongoing fallout of the pandemic.

Colleges must examine applicants without the aid of standardized test scores for many – a factor that prompted many schools to go test-optional for now . Even grades, a significant component of a college application, may be hard to interpret with some high schools adopting pass-fail classes last spring due to the pandemic. Major college admissions factors are suddenly skewed.

"I can't help but think other (admissions) factors are going to matter more," says Ethan Sawyer, founder of the College Essay Guy, a website that offers free and paid essay-writing resources.

College essays and letters of recommendation , Sawyer says, are likely to carry more weight than ever in this admissions cycle. And many essays will likely focus on how the pandemic shaped students' lives throughout an often tumultuous 2020.

But before writing a college essay focused on the coronavirus, students should explore whether it's the best topic for them.

Writing About COVID-19 for a College Application

Much of daily life has been colored by the coronavirus. Virtual learning is the norm at many colleges and high schools, many extracurriculars have vanished and social lives have stalled for students complying with measures to stop the spread of COVID-19.

"For some young people, the pandemic took away what they envisioned as their senior year," says Robert Alexander, dean of admissions, financial aid and enrollment management at the University of Rochester in New York. "Maybe that's a spot on a varsity athletic team or the lead role in the fall play. And it's OK for them to mourn what should have been and what they feel like they lost, but more important is how are they making the most of the opportunities they do have?"

That question, Alexander says, is what colleges want answered if students choose to address COVID-19 in their college essay.

But the question of whether a student should write about the coronavirus is tricky. The answer depends largely on the student.

"In general, I don't think students should write about COVID-19 in their main personal statement for their application," Robin Miller, master college admissions counselor at IvyWise, a college counseling company, wrote in an email.

"Certainly, there may be exceptions to this based on a student's individual experience, but since the personal essay is the main place in the application where the student can really allow their voice to be heard and share insight into who they are as an individual, there are likely many other topics they can choose to write about that are more distinctive and unique than COVID-19," Miller says.

Opinions among admissions experts vary on whether to write about the likely popular topic of the pandemic.

"If your essay communicates something positive, unique, and compelling about you in an interesting and eloquent way, go for it," Carolyn Pippen, principal college admissions counselor at IvyWise, wrote in an email. She adds that students shouldn't be dissuaded from writing about a topic merely because it's common, noting that "topics are bound to repeat, no matter how hard we try to avoid it."

Above all, she urges honesty.

"If your experience within the context of the pandemic has been truly unique, then write about that experience, and the standing out will take care of itself," Pippen says. "If your experience has been generally the same as most other students in your context, then trying to find a unique angle can easily cross the line into exploiting a tragedy, or at least appearing as though you have."

But focusing entirely on the pandemic can limit a student to a single story and narrow who they are in an application, Sawyer says. "There are so many wonderful possibilities for what you can say about yourself outside of your experience within the pandemic."

He notes that passions, strengths, career interests and personal identity are among the multitude of essay topic options available to applicants and encourages them to probe their values to help determine the topic that matters most to them – and write about it.

That doesn't mean the pandemic experience has to be ignored if applicants feel the need to write about it.

Writing About Coronavirus in Main and Supplemental Essays

Students can choose to write a full-length college essay on the coronavirus or summarize their experience in a shorter form.

To help students explain how the pandemic affected them, The Common App has added an optional section to address this topic. Applicants have 250 words to describe their pandemic experience and the personal and academic impact of COVID-19.

"That's not a trick question, and there's no right or wrong answer," Alexander says. Colleges want to know, he adds, how students navigated the pandemic, how they prioritized their time, what responsibilities they took on and what they learned along the way.

If students can distill all of the above information into 250 words, there's likely no need to write about it in a full-length college essay, experts say. And applicants whose lives were not heavily altered by the pandemic may even choose to skip the optional COVID-19 question.

"This space is best used to discuss hardship and/or significant challenges that the student and/or the student's family experienced as a result of COVID-19 and how they have responded to those difficulties," Miller notes. Using the section to acknowledge a lack of impact, she adds, "could be perceived as trite and lacking insight, despite the good intentions of the applicant."

To guard against this lack of awareness, Sawyer encourages students to tap someone they trust to review their writing , whether it's the 250-word Common App response or the full-length essay.

Experts tend to agree that the short-form approach to this as an essay topic works better, but there are exceptions. And if a student does have a coronavirus story that he or she feels must be told, Alexander encourages the writer to be authentic in the essay.

"My advice for an essay about COVID-19 is the same as my advice about an essay for any topic – and that is, don't write what you think we want to read or hear," Alexander says. "Write what really changed you and that story that now is yours and yours alone to tell."

Sawyer urges students to ask themselves, "What's the sentence that only I can write?" He also encourages students to remember that the pandemic is only a chapter of their lives and not the whole book.

Miller, who cautions against writing a full-length essay on the coronavirus, says that if students choose to do so they should have a conversation with their high school counselor about whether that's the right move. And if students choose to proceed with COVID-19 as a topic, she says they need to be clear, detailed and insightful about what they learned and how they adapted along the way.

"Approaching the essay in this manner will provide important balance while demonstrating personal growth and vulnerability," Miller says.

Pippen encourages students to remember that they are in an unprecedented time for college admissions.

"It is important to keep in mind with all of these (admission) factors that no colleges have ever had to consider them this way in the selection process, if at all," Pippen says. "They have had very little time to calibrate their evaluations of different application components within their offices, let alone across institutions. This means that colleges will all be handling the admissions process a little bit differently, and their approaches may even evolve over the course of the admissions cycle."

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EDITORIAL article

Editorial: coronavirus disease (covid-19): the impact and role of mass media during the pandemic.

$\nPatrícia Arriaga$

1 Department of Social and Organizational Psychology, Iscte-University Institute of Lisbon, CIS-IUL, Lisbon, Portugal
2 Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
3 Department of Psychiatry and Psychotherapy, Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany

Editorial on the Research Topic Coronavirus Disease (COVID-19): The Impact and Role of Mass Media During the Pandemic

The outbreak of the coronavirus disease 2019 (COVID-19) has created a global health crisis that had a deep impact on the way we perceive our world and our everyday lives. Not only has the rate of contagion and patterns of transmission threatened our sense of agency, but the safety measures to contain the spread of the virus also required social and physical distancing, preventing us from finding solace in the company of others. Within this context, we launched our Research Topic on March 27th, 2020, and invited researchers to address the Impact and Role of Mass Media During the Pandemic on our lives at individual and social levels.

Despite all the hardships, disruption, and uncertainty brought by the pandemic, we received diverse and insightful manuscript proposals. Frontiers in Psychology published 15 articles, involving 61 authors from 8 countries, which were included in distinct specialized sections, including Health Psychology, Personality and Social Psychology, Emotion Science, and Organizational Psychology. Despite the diversity of this collective endeavor, the contributions fall into four areas of research: (1) the use of media in public health communication; (2) the diffusion of false information; (3) the compliance with the health recommendations; and (4) how media use relates to mental health and well-being.

A first line of research includes contributions examining the use of media in public health communication. Drawing on media messages used in previous health crises, such as Ebola and Zika, Hauer and Sood describe how health organizations use media. They offer a set of recommendations for COVID-19 related media messages, including the importance of message framing, interactive public forums with up-to-date information, and an honest communication about what is known and unknown about the pandemic and the virus. Following a content analysis approach, Parvin et al. studied the representations of COVID-19 in the opinion section of five Asian e-newspapers. The authors identified eight main issues (health and drugs, preparedness and awareness, social welfare and humanity, governance and institutions, the environment and wildlife, politics, innovation and technology, and the economy) and examined how e-newspapers from these countries attributed different weights to these issues and how this relates to the countries' cultural specificity. Raccanello et al. show how the internet can be a platform to disseminate a public campaign devised to inform adults about coping strategies that could help children and teenagers deal with the challenges of the pandemic. The authors examined the dissemination of the program through the analysis of website traffic, showing that in the 40 days following publication, the website reached 6,090 visits.

A second related line of research that drew the concern of researchers was the diffusion of false information about COVID-19 through the media. Lobato et al. examined the role of distinct individual differences (political orientation, social dominance orientation, traditionalism, conspiracy ideation, attitudes about science) on the willingness to share misinformation about COVID-19 over social media. The misinformation topics varied between the severity and spread of COVID-19, treatment and prevention, conspiracy theories, and miscellaneous unverifiable claims. Their results from 296 adult participants (Mage = 36.23; 117 women) suggest two different profiles. One indicating that those reporting more liberal positions and lower social dominance were less willing to share conspiracy misinformation. The other profile indicated that participants scoring high on social dominance and low in traditionalism were more willing to share both conspiracy and other miscellaneous claims, but less willing to share misinformation about the severity and spread of COVID-19. Their findings can have relevant contributions for the identification of specific individual profiles related to the widespread of distinct types of misinformation. Dhanani and Franz examined a sample of 1,141 adults (Mage = 44.66; 46.9% female, 74.7% White ethnic identity) living in the United States in March 2020. The authors examined how media consumption and information source were related to knowledge about COVID-19, the endorsement of misinformation about COVID-19, and prejudice toward Asian Americans. Higher levels of trust in informational sources such as public health organizations (e.g., Center for Disease Control) was associated with greater knowledge, lower endorsement of misinformation, and less prejudice toward Asian Americans. Media source was associated with distinct levels of knowledge, willingness to endorsement misinformation and prejudice toward American Asians, with social media use (e.g., Twitter, Facebook) being related with a lower knowledge about COVID-19, higher endorsement of misinformation, and stronger prejudice toward Asian Americans.

A third line of research addressed the factors that could contribute to compliance with the health recommendations to avoid the spread of the disease. Vai et al. studied early pre-lockdown risk perceptions about COVID-19 and the trust in media sources among 2,223 Italians (Mage = 36.4, 69.2% female). They found that the perceived usefulness of the containment measures (e.g., social distancing) was related to threat perception and efficacy beliefs. Lower threat perception was associated with less perception of utility of the containment measures. Although most participants considered themselves and others capable of taking preventive measures, they saw the measures as generally ineffective. Participants acknowledged using the internet as their main source of information and considered health organizations' websites as the most trustworthy source. Albeit frequently used, social media was in general considered an unreliable source of information. Tomczyk et al. studied knowledge about preventive behaviors, risk perception, stigmatizing attitudes (support for discrimination and blame), and sociodemographic data (e.g., age, gender, country of origin, education level, region, persons per household) as predictors of compliance with the behavioral recommendations among 157 Germans, (age range: 18–77 years, 80% female). Low compliance was associated with male gender, younger age, and lower public stigma. Regarding stigmatizing attitudes, the authors only found a relation between support for discrimination (i.e., support for compulsory measures) and higher intention to comply with recommendations. Mahmood et al. studied the relation between social media use, risk perception, preventive behaviors, and self-efficacy in a sample of 310 Pakistani adults (54.2% female). The authors found social media use to be positively related to self-efficacy and perceived threat, which were both positively related to preventive behaviors (e.g., hand hygiene, social distancing). Information credibility was also related to compliance with health recommendations. Lep et al. examined the relationship between information source perceived credibility and trust, and participants' levels of self-protective behavior among 1,718 Slovenians (age range: 18–81 years, 81.7% female). The authors found that scientists, general practitioners (family doctors), and the National Institute of Public Health were perceived as the more credible source of information, while social media and government officials received the lowest ratings. Perceived information credibility was found to be associated with lower levels of negative emotional responses (e.g., nervousness, helplessness) and a higher level of observance of self-protective measures (e.g., hand washing). Siebenhaar et al. also studied the link between compliance, distress by information, and information avoidance. They examined the online survey responses of 1,059 adults living in Germany (Mage = 39.53, 79.4% female). Their results suggested that distress by information could lead to higher compliance with preventive measures. Distress by information was also associated with higher information avoidance, which in turn is related to less compliance. Gantiva et al. studied the effectiveness of different messages regarding the intentions toward self-care behaviors, perceived efficacy to motivate self-care behaviors in others, perceived risk, and perceived message strength, in a sample of 319 Colombians (age range: 18–60 years, 69.9% female). Their experiment included the manipulation of message framing (gain vs. loss) and message content (economy vs. health). Participants judged gain-frame health related messages to be stronger and more effective in changing self-behavior, whereas loss-framed health messages resulted in increased perceived risk. Rahn et al. offer a comparative view of compliance and risk perception, examining three hazard types: COVID-19 pandemic, violent acts, and severe weather. With a sample of 403 Germans (age range: 18–89 years, 72% female), they studied how age, gender, previous hazard experience and different components of risk appraisal (perceived severity, anticipated negative emotions, anticipatory worry, and risk perception) were related to the intention to comply with behavioral recommendations. They found that higher age predicted compliance with health recommendations to prevent COVID-19, anticipatory worry predicted compliance with warning messages regarding violent acts, and women complied more often with severe weather recommendations than men.

A fourth line of research examined media use, mental health and well-being during the COVID-19 pandemic. Gabbiadini et al. addressed the use of digital technology (e.g., voice/video calls, online games, watching movies in party mode) to stay connected with others during lockdown. Participants, 465 Italians (age range: 18–73 years, 348 female), reported more perceived social support associated with the use of these digital technologies, which in turn was associated with fewer feelings of loneliness, boredom, anger, and higher sense of belongingness. Muñiz-Velázquez et al. compared the media habits of 249 Spanish adults (Mage = 42.06, 53.8% female) before and during confinement. They compared the type of media consumed (e.g., watching TV series, listening to radio, watching news) and found the increased consumption of TV and social networking sites during confinement to be negatively associated with reported level of happiness. People who reported higher levels of well-being also reported watching less TV and less use of social networking sites. Majeed et al. , on the other hand, examined the relation between problematic social media use, fear of COVID-19, depression, and mindfulness. Their study, involving 267 Pakistani adults (90 female), suggested trait mindfulness had a buffer effect, reducing the impact of problematic media use and fear of COVID-19 on depression.

Taken together, these findings highlight how using different frames for mass media gives a more expansive view of its positive and negative roles, but also showcase the major concerns in the context of a pandemic crisis. As limitations we highlight the use of cross-sectional designs in most studies, not allowing to establish true inferences of causal relationships. The outcome of some studies may also be limited by the unbalanced number of female and male participants, by the non-probability sampling method used, and by the restricted time frame in which the research occurred. Nevertheless, we are confident that all the selected studies in our Research Topic bring important and enduring contributions to the understanding of how media, individual differences, and social factors intertwine to shape our lives, which can also be useful to guide public policies during these challenging times.

Author Contributions

PA: conceptualization, writing the original draft, funding acquisition, writing—review, and editing. FE: conceptualization, writing—review, and editing. MP: writing—review and editing. NP: conceptualization, writing the original draft, writing—review, and editing. All authors approved the submitted version.

PA and NP received partial support to work on this Research Topic through Fundação para a Ciência e Tecnologia (FCT) with reference to the project PTDC/CCI-INF/29234/2017. MP contribution was supported by the German Research Foundation (DFG, PA847/22-1 and PA847/25-1). The authors are independent of the funders.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

We would like to express our gratitude to all the authors who proposed their work, all the researchers who reviewed the submissions to this Research Topic, and to Rob Richards for proofreading the Editorial manuscript.

Keywords: COVID-19, coronavirus disease, mass media, health communication, prevention, intervention, social behavioral changes

Citation: Arriaga P, Esteves F, Pavlova MA and Piçarra N (2021) Editorial: Coronavirus Disease (COVID-19): The Impact and Role of Mass Media During the Pandemic. Front. Psychol. 12:729238. doi: 10.3389/fpsyg.2021.729238

Received: 22 June 2021; Accepted: 30 July 2021; Published: 23 August 2021.

Edited and reviewed by: Eduard Brandstätter , Johannes Kepler University of Linz, Austria

Copyright © 2021 Arriaga, Esteves, Pavlova and Piçarra. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Patrícia Arriaga, patricia.arriaga@iscte-iul.pt

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

The complexity of managing COVID-19: How important is good governance?

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Alaka m. basu , amb alaka m. basu professor, department of global development - cornell university, senior fellow - united nations foundation kaushik basu , and kaushik basu nonresident senior fellow - global economy and development @kaushikcbasu jose maria u. tapia jmut jose maria u. tapia student - cornell university.

November 17, 2020

13 min read

This essay is part of “ Reimagining the global economy: Building back better in a post-COVID-19 world ,” a collection of 12 essays presenting new ideas to guide policies and shape debates in a post-COVID-19 world.

The COVID-19 pandemic has exposed the inadequacy of public health systems worldwide, casting a shadow that we could not have imagined even a year ago. As the fog of confusion lifts and we begin to understand the rudiments of how the virus behaves, the end of the pandemic is nowhere in sight. The number of cases and the deaths continue to rise. The latter breached the 1 million mark a few weeks ago and it looks likely now that, in terms of severity, this pandemic will surpass the Asian Flu of 1957-58 and the Hong Kong Flu of 1968-69.

Moreover, a parallel problem may well exceed the direct death toll from the virus. We are referring to the growing economic crises globally, and the prospect that these may hit emerging economies especially hard.

The economic fall-out is not entirely the direct outcome of the COVID-19 pandemic but a result of how we have responded to it—what measures governments took and how ordinary people, workers, and firms reacted to the crisis. The government activism to contain the virus that we saw this time exceeds that in previous such crises, which may have dampened the spread of the COVID-19 but has extracted a toll from the economy.

This essay takes stock of the policies adopted by governments in emerging economies, and what effect these governance strategies may have had, and then speculates about what the future is likely to look like and what we may do here on.

Nations that build walls to keep out goods, people and talent will get out-competed by other nations in the product market.

It is becoming clear that the scramble among several emerging economies to imitate and outdo European and North American countries was a mistake. We get a glimpse of this by considering two nations continents apart, the economies of which have been among the hardest hit in the world, namely, Peru and India. During the second quarter of 2020, Peru saw an annual growth of -30.2 percent and India -23.9 percent. From the global Q2 data that have emerged thus far, Peru and India are among the four slowest growing economies in the world. Along with U.K and Tunisia these are the only nations that lost more than 20 percent of their GDP. 1

COVID-19-related mortality statistics, and, in particular, the Crude Mortality Rate (CMR), however imperfect, are the most telling indicator of the comparative scale of the pandemic in different countries. At first glance, from the end of October 2020, Peru, with 1039 COVID-19 deaths per million population looks bad by any standard and much worse than India with 88. Peru’s CMR is currently among the highest reported globally.

However, both Peru and India need to be placed in regional perspective. For reasons that are likely to do with the history of past diseases, there are striking regional differences in the lethality of the virus (Figure 11.1). South America is worse hit than any other world region, and Asia and Africa seem to have got it relatively lightly, in contrast to Europe and America. The stark regional difference cries out for more epidemiological analysis. But even as we await that, these are differences that cannot be ignored.

To understand the effect of policy interventions, it is therefore important to look at how these countries fare within their own regions, which have had similar histories of illnesses and viruses (Figure 11.2). Both Peru and India do much worse than the neighbors with whom they largely share their social, economic, ecological and demographic features. Peru’s COVID-19 mortality rate per million population, or CMR, of 1039 is ahead of the second highest, Brazil at 749, and almost twice that of Argentina at 679.

Similarly, India at 88 compares well with Europe and the U.S., as does virtually all of Asia and Africa, but is doing much worse than its neighbors, with the second worst country in the region, Afghanistan, experiencing less than half the death rate of India.

The official Indian statement that up to 78,000 deaths 2 were averted by the lockdown has been criticized 3 for its assumptions. A more reasonable exercise is to estimate the excess deaths experienced by a country that breaks away from the pattern of its regional neighbors. So, for example, if India had experienced Afghanistan’s COVID-19 mortality rate, it would by now have had 54,112 deaths. And if it had the rate reported by Bangladesh, it would have had 49,950 deaths from COVID-19 today. In other words, more than half its current toll of some 122,099 COVID-19 deaths would have been avoided if it had experienced the same virus hit as its neighbors.

What might explain this outlier experience of COVID-19 CMRs and economic downslide in India and Peru? If the regional background conditions are broadly similar, one is left to ask if it is in fact the policy response that differed markedly and might account for these relatively poor outcomes.

Peru and India have performed poorly in terms of GDP growth rate in Q2 2020 among the countries displayed in Table 2, and given that both these countries are often treated as case studies of strong governance, this draws attention to the fact that there may be a dissonance between strong governance and good governance.

The turnaround for India has been especially surprising, given that until a few years ago it was among the three fastest growing economies in the world. The slowdown began in 2016, though the sharp downturn, sharper than virtually all other countries, occurred after the lockdown.

On the COVID-19 policy front, both India and Peru have become known for what the Oxford University’s COVID Policy Tracker 4 calls the “stringency” of the government’s response to the epidemic. At 8 pm on March 24, 2020, the Indian government announced, with four hours’ notice, a complete nationwide shutdown. Virtually all movement outside the perimeter of one’s home was officially sought to be brought to a standstill. Naturally, as described in several papers, such as that of Ray and Subramanian, 5 this meant that most economic life also came to a sudden standstill, which in turn meant that hundreds of millions of workers in the informal, as well as more marginally formal sectors, lost their livelihoods.

In addition, tens of millions of these workers, being migrant workers in places far-flung from their original homes, also lost their temporary homes and their savings with these lost livelihoods, so that the only safe space that beckoned them was their place of origin in small towns and villages often hundreds of miles away from their places of work.

After a few weeks of precarious living in their migrant destinations, they set off, on foot since trains and buses had been stopped, for these towns and villages, creating a “lockdown and scatter” that spread the virus from the city to the town and the town to the village. Indeed, “lockdown” is a bit of a misnomer for what happened in India, since over 20 million people did exactly the opposite of what one does in a lockdown. Thus India had a strange combination of lockdown some and scatter the rest, like in no other country. They spilled out and scattered in ways they would otherwise not do. It is not surprising that the infection, which was marginally present in rural areas (23 percent in April), now makes up some 54 percent of all cases in India. 6

In Peru too, the lockdown was sudden, nationwide, long drawn out and stringent. 7 Jobs were lost, financial aid was difficult to disburse, migrant workers were forced to return home, and the virus has now spread to all parts of the country with death rates from it surpassing almost every other part of the world.

As an aside, to think about ways of implementing lockdowns that are less stringent and geographically as well as functionally less total, an example from yet another continent is instructive. Ethiopia, with a COVID-19 death rate of 13 per million population seems to have bettered the already relatively low African rate of 31 in Table 1. 8

We hope that human beings will emerge from this crisis more aware of the problems of sustainability.

The way forward

We next move from the immediate crisis to the medium term. Where is the world headed and how should we deal with the new world? Arguably, that two sectors that will emerge larger and stronger in the post-pandemic world are: digital technology and outsourcing, and healthcare and pharmaceuticals.

The last 9 months of the pandemic have been a huge training ground for people in the use of digital technology—Zoom, WebEx, digital finance, and many others. This learning-by-doing exercise is likely to give a big boost to outsourcing, which has the potential to help countries like India, the Philippines, and South Africa.

Globalization may see a short-run retreat but, we believe, it will come back with a vengeance. Nations that build walls to keep out goods, people and talent will get out-competed by other nations in the product market. This realization will make most countries reverse their knee-jerk anti-globalization; and the ones that do not will cease to be important global players. Either way, globalization will be back on track and with a much greater amount of outsourcing.

To return, more critically this time, to our earlier aside on Ethiopia, its historical and contemporary record on tampering with internet connectivity 9 in an attempt to muzzle inter-ethnic tensions and political dissent will not serve it well in such a post-pandemic scenario. This is a useful reminder for all emerging market economies.

We hope that human beings will emerge from this crisis more aware of the problems of sustainability. This could divert some demand from luxury goods to better health, and what is best described as “creative consumption”: art, music, and culture. 10 The former will mean much larger healthcare and pharmaceutical sectors.

But to take advantage of these new opportunities, nations will need to navigate the current predicament so that they have a viable economy once the pandemic passes. Thus it is important to be able to control the pandemic while keeping the economy open. There is some emerging literature 11 on this, but much more is needed. This is a governance challenge of a kind rarely faced, because the pandemic has disrupted normal markets and there is need, at least in the short run, for governments to step in to fill the caveat.

Emerging economies will have to devise novel governance strategies for doing this double duty of tamping down on new infections without strident controls on economic behavior and without blindly imitating Europe and America.

Here is an example. One interesting opportunity amidst this chaos is to tap into the “resource” of those who have already had COVID-19 and are immune, even if only in the short-term—we still have no definitive evidence on the length of acquired immunity. These people can be offered a high salary to work in sectors that require physical interaction with others. This will help keep supply chains unbroken. Normally, the market would have on its own caused such a salary increase but in this case, the main benefit of marshaling this labor force is on the aggregate economy and GDP and therefore is a classic case of positive externality, which the free market does not adequately reward. It is more a challenge of governance. As with most economic policy, this will need careful research and design before being implemented. We have to be aware that a policy like this will come with its risk of bribery and corruption. There is also the moral hazard challenge of poor people choosing to get COVID-19 in order to qualify for these special jobs. Safeguards will be needed against these risks. But we believe that any government that succeeds in implementing an intelligently-designed intervention to draw on this huge, under-utilized resource can have a big, positive impact on the economy 12 .

This is just one idea. We must innovate in different ways to survive the crisis and then have the ability to navigate the new world that will emerge, hopefully in the not too distant future.

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Arguments in the debate over responses to the coronavirus (covid-19) pandemic, 2020.

State and local government responses to the coronavirus (COVID-19) pandemic have varied widely. Those responses have generated a similar variety of responses from pundits, policy makers, lawmakers, and more. This article highlights the arguments over government responses in several areas:

Universal or mass testing

Mask requirements

School closures, travel restrictions, lockdown/stay-at-home orders.

Expansion of absentee or mail-in voting

Religious service restrictions

This article is a hub for our coverage of arguments within each area of debate. It includes links to policy-specific pages that provide an overview of the arguments within each topic. It also includes links to state-specific pages that dive into the debate that's happening in each state about a variety of policies.

These arguments come from a variety of sources, including public officials, journalists, think tanks, economists, scientists, and other stakeholders. We encourage you to share the debates happening in your local community to [email protected] .

For an overview of federal, state, and local responses around the country, click here .

1.1 Testing
1.2 Mask requirements
1.3 School closures
1.4 Travel restrictions
1.5 Lockdown/stay-at-home orders
1.6 Expansion of absentee/mail-in voting
1.7 Religious service restrictions
2 General resources
4 External links
5 Footnotes

Topics and arguments

The main areas of disagreement about universal or mass testing for COVID-19 before the economy can reopen are:

Universal testing is necessary
Universal testing is effective
Universal testing is possible
Universal testing is not necessary
Universal testing is not possible
Universal testing would divert and waste resources
Universal testing might be dangerous
Massive testing is too expensive
Universal testing results are unreliable
Universal testing is too slow to protect public health

The main areas of disagreement about mask requirements during the coronavirus pandemic are:

Masks reduce airborne spread of coronavirus
Mask requirements are good for the economy
Mask laws are justified to promote public health
Mask mandates should apply statewide
Masks reduce the intensity of COVID-19 infection and sickness
Mask requirements are not necessary to stop the spread of coronavirus
Mask requirements give a false sense of security
Mask requirements restrict freedom
Masks present other health risks
Mask requirements have harmful social consequences
Mask requirements are unenforceable

The main areas of disagreement about school closures during the coronavirus pandemic are:

School closures are necessary to prevent the spread of the virus
Evidence from past pandemics supports the efficacy of school closures
Reopening Universities will increase COVID-19 spread
Reopening schools puts people of color at higher risk
Keep schools closed because COVID-19 outbreaks are inevitable
School closures are ineffective in preventing the spread of the virus
School closures pose significant unintended consequences
School closures and reopening plans have disparate economic effects
School closures and distance learning exacerbate digital divide
Reopen schools to protect the economy
School-aged children have reduced COVID-19 risk

The main areas of disagreement about travel restrictions are:

Travel restrictions prevent the spread of the virus
Travel restrictions promote the state's safety image
Travel restrictions are constitutional
Travel restrictions protect tourism workers
Certain travel restrictions are unconstitutional
Travel restrictions are unfair to tourism businesses
Travel restrictions are difficult to enforce
Travel restrictions are ineffective
Travel restrictions damage local economies

The main areas of disagreement about lockdown/stay-at-home orders are:

Lockdown/stay-at-home orders are necessary
Lockdown/stay-at-home orders are better for the economy long-term
Lockdown/stay-at-home orders are legal
Lockdown/stay-at-home orders are limited
Lockdown/stay-at-home orders are unnecessary
Lockdown/stay-at-home orders are worse than the coronavirus pandemic itself
Lockdown/stay-at-home orders are illegal
Lockdown/stay-at-home orders are unpopular
Lockdown/stay-at-home orders are unenforceable
Lockdown/stay-at-home orders go too far
Lockdown/stay-at-home orders create COVID-19 risks

Expansion of absentee/mail-in voting

The main areas of disagreement about the expansion of absentee/mail-in voting are:

Absentee/mail-in voting reduces the spread of COVID-19
Absentee/mail-in voting expansion is necessary to facilitate access to voting
Expanding absentee/mail-in voting is unlikely to increase fraud
Expanding vote-by-mail is fair to both major parties
States have the capacity and experience to expand absentee/mail-in voting
Absentee/mail-in voting is less reliable than in-person voting
Absentee/mail-in voting systems can fail
Absentee/mail-in voting poses a higher risk for fraud and manipulation
It is unnecessary to change voting systems in response to COVID-19
The expansion of absentee/mail-in voting systems open the door to flawed election policies
Expansion of absentee/mail-in voting systems creates election controversies (“blue shift”)

The main areas of disagreement about religious service restrictions are:

Public safety priorities take precedence over religious interests
Religious services present a higher risk than other social and business activities
Restrictions on physical gatherings do not preclude religious practices
Limiting religious gatherings during a pandemic aligns with most religious values
Skepticism of religious restrictions has harmed religious communities during COVID-19
In-person religious gatherings are not essential services
Religious gathering restrictions do not discriminate against faiths
Religious service restrictions violate the First Amendment and religious freedom
Religious services are essential
Religious service restrictions put church viability at risk
There is insufficient evidence that religious services pose a higher risk than other social and business activities
COVID-19 religious restrictions unfair to some faiths

General resources

Click the links below to explore official resources related to the coronavirus outbreak.

Centers for Disease Control and Prevention (CDC), U.S. Department of Health & Human Services
National Institutes of Health, U.S. Department of Health & Human Services
Occupational Safety and Health Administration, U.S. Department of Labor
U.S. Department of Education
World Health Organization
Trends in Number of COVID-19 Cases and Deaths in the US Reported to CDC, by State/Territory
Coronavirus (COVID-19) Vaccinations, Our World in Data (Number of vaccines administered)
Coronavirus Vaccine Tracker, New York Times (Progress of vaccine trials)
Ballotpedia: Political responses to the coronavirus (COVID-19) pandemic, 2020
State government responses to the coronavirus (COVID-19) pandemic, 2020
Government official, politician, and candidate deaths, diagnoses, and quarantines due to the coronavirus (COVID-19) pandemic, 2020-2021
Changes to ballot measure campaigns, procedures, and policies in response to the coronavirus (COVID-19) pandemic, 2020-2022
Ballotpedia's elections calendar

External links

The external resources listed below are related to the coronavirus pandemic.

Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services
National Institutes of Health, U.S. Department of Health and Human Services
Coronavirus arguments by topic
One-off pages, evergreen

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An Overview of the Vaccine Debate

Looking at Both Sides of the Argument

There is a wealth of research demonstrating the efficacy and safety of vaccines —including how some have virtually eradicated infectious diseases that once killed millions. However, this has done little to sway those who believe that untold harms are being hidden from the American public.

The vaccine debate—including the argument as to whether vaccines are safe, effective, or could cause conditions like autism —has received a lot of attention from the media in recent years. With so much conflicting information being publicized, it can be a challenge to discern what is true and what is not. Therefore, it is important to learn the facts before making health decisions.

Claims and Controversy

Those who are part of the anti-vaccination movement include not only non-medical professionals but several scientists and healthcare providers who hold alternative views about vaccines and vaccination in general.

Some notable examples include:

British healthcare provider Andrew Wakefield, who in 1998 published research linking the MMR vaccine and autism . That study has since been retracted, and he was later removed from the medical registry in the United Kingdom for falsifying scientific data.
Pediatrician Bob Sears, who wrote the bestseller "The Vaccine Book: Making the Right Decision for your Child ," which suggested that many essential childhood vaccines were "optional." However, he was subsequently put on probation by the Medical Review Board of California in 2018 for alleged medical negligence and the inappropriate writing of medical exemptions for vaccinations.
Dr. Jane M. Orient, director of the Association of American Healthcare Providers and Surgeons, who was among the leading opponents of the COVID-19 vaccine and one of the leading proponents of using hydroxychloroquine to treat COVID-19 during the pandemic.

These opposing views and claims, along with other information promoted by the news and social media, have led some people to question whether they know everything they need to know about vaccines.

Common Concerns Regarding Vaccines

The arguments made against vaccines are not new and have been made well before the first vaccine was developed for smallpox back in the 18th century.

The following are some of the common arguments against vaccines:

Vaccines contain "toxic" ingredients that can lead to an assortment of chronic health conditions such as autism.
Vaccines are a tool of "Big Pharma," in which manufacturers are willing to profit off of harm to children.
Governments are "pharma shills," meaning they are bought off by pharmaceutical companies to hide cures or approve drugs that are not safe.
A child’s immune system is too immature to handle vaccines , leading the immune system to become overwhelmed and trigger an array of abnormal health conditions.
Natural immunity is best , suggesting that a natural infection that causes disease is "better" than receiving a vaccine that may cause mild side effects.
Vaccines are not tested properly , suggesting a (highly unethical) approach in which one group of people is given a vaccine, another group is not, and both are intentionally inoculated with the same virus or bacteria.
Infectious diseases have declined due in part to improved hygiene and sanitation , suggesting that hand-washing and other sanitary interventions are all that are needed to prevent epidemics.
Vaccines cause the body to "shed" virus , a claim that is medically true, although the amount of shed virus is rarely enough to cause infection.

The impact of anti-vaccination claims has been profound. For example, it has led to a resurgence of measles in the United States and Europe, despite the fact that the disease was declared eliminated in the U.S. back in 2000.

Studies have suggested that the anti-vaccination movement has cast doubt on the importance of childhood vaccinations among large sectors of the population. The added burden of the COVID-19 pandemic has led to further declines in vaccination rates.

There is also concern that the same repercussions may affect COVID-19 vaccination rates—both domestically and abroad. Ultimately, vaccine rates must be high for herd immunity to be effective.

According to a study from the Centers for Disease Control and Prevention (CDC), the rate of complete recommended vaccination among babies age 5 months has declined from 66.6% in 2016 to 49.7% by May 2020. Declines in vaccination coverage were seen in other age groups as well.

Benefits of Vaccination

Of the vaccines recommended by the CDC, the benefits of immunization are seen to overwhelmingly outweigh the potential risks. While there are some people who may need to avoid certain vaccines due to underlying health conditions, the vast majority can do so safely.

According to the U.S. Department of Health and Human Services, there are five important reasons why your child should get the recommended vaccines:

Immunizations can save your child’s life . Consider that polio once killed up to 30% of those who developed paralytic symptoms. Due to polio vaccination, the disease is no longer a public health concern in the United States.
Vaccination is very safe and effective . Injection site pain and mild, flu-like symptoms may occur with vaccine shots. However, serious side effects , such as a severe allergic reaction, are very rare.
Immunization protects others . Because respiratory viruses can spread easily among children, getting your child vaccinated not only protects your child but prevents the further spread of disease.
Immunizations can save you time and money . According to the non-profit Borgen Project, the average cost of a measles vaccination around the world is roughly $1.76, whereas the average cost of treating measles is $307. In the end, the cost of prevention is invariably smaller than the cost of treatment.
Immunization protects future generations . Smallpox vaccinations have led to the eradication of smallpox . Rubella (German measles) vaccinations have helped eliminate birth defects caused by infection of pregnant mothers in the developed world. With persistence and increased community uptake, measles could one day be declared eliminated (again) as well.

A Word From Verywell

If you have any questions or concerns about vaccinations, do not hesitate to speak with your healthcare provider or your child's pediatrician.

If a vaccine on the immunization schedule has been missed, speak to a healthcare provider before seeking the vaccination on your own (such as at a pharmacy or clinic). In some cases, additional doses may be needed.

Vaccines Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

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Eggerton L. Lancet retracts 12-year-old article linking autism to MMR vaccines . CMAJ . 2010 Mar 9; 182(4):e199-200. doi:10.1503/cmaj.109-3179

Park A. Doctor behind vaccine-autism link loses license . Time .

Offit PA, Moser CA. The problem with Dr Bob's alternative vaccine schedule . Pediatrics. 2009 Jan;123 (1):e164-e169. doi:10.1542/peds.2008-2189

Before the Medical Board of California, Department of Consumer Affairs, State of California. In the Matter of the Accusation Against Robert William Sears, M.D., Case No. 800-2015-012268 .

Stolberg SG. Anti-vaccine doctor has been invited to testify before Senate committee . The New York Times.

Wolfe RM, Sharp LK. Anti-vaccinationists past and present . BMJ. 2002;325(7361):430-2. doi:10.1136/bmj.325.7361.430

Agley J, Xiao Y. Misinformation about COVID-19: Evidence for differential latent profiles and a strong association with trust in science . BMC Public Health. 2021;21:89. doi:10.1186/s12889-020-10103-x

Centers for Disease Control and Prevention. Measles history .

Hussain A, Ali S, Ahmed M, Hussain S. The anti-vaccination movement: a regression in modern medicine . Cureus . 2018;10(7): e2919. doi:10.7759/cureus.2919

Bramer CA, Kimmins LM, Swanson R, et al. Decline in child vaccination coverage during the COVID-19 pandemic — Michigan Care Improvement Registry, May 2016–May 2020 . MMWR. 2020 May;69(20):630-1. doi:10.15585/mmwr.mm6920e1

Centers for Disease Control and Prevention. Why vaccinate .

Centers for Disease Control and Prevention. Poliomyelitis .

Centers for Disease Control and Prevention. Making the vaccine decision .

Borgen Project. What is the cost of measles in the developed world? .

By Vincent Iannelli, MD Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.

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Read these 12 moving essays about life during coronavirus

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Iran J Med Sci
v.45(4); 2020 Jul

A Narrative Review of COVID-19: The New Pandemic Disease

Kiana shirani, md.

1 Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Erfan Sheikhbahaei, MD

2 Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Zahra Torkpour, MD

Mazyar ghadiri nejad, phd.

3 Industrial Engineering Department, Girne American University, Kyrenia, TRNC, Turkey

Bahareh Kamyab Moghadas, PhD

4 Department of Chemical Engineering, Shiraz Branch, Islamic Azad University, Shiraz, Iran

Matina Ghasemi, PhD

5 Faculty of Business and Economics, Business Department, Girne American University, Kyrenia, TRNC, Turkey

Hossein Akbari Aghdam, MD

6 Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Athena Ehsani, PhD

7 Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran

Saeed Saber-Samandari, PhD

8 New Technologies Research Center, Amirkabir University of Technology, Tehran, Iran

Amirsalar Khandan, PhD

9 Department of Electrical Engineering, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

10 0Technology Incubator Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

Nearly every 100 years, humans collectively face a pandemic crisis. After the Spanish flu, now the world is in the grip of coronavirus disease 2019 (COVID-19). First detected in 2019 in the Chinese city of Wuhan, COVID-19 causes severe acute respiratory distress syndrome. Despite the initial evidence indicating a zoonotic origin, the contagion is now known to primarily spread from person to person through respiratory droplets. The precautionary measures recommended by the scientific community to halt the fast transmission of the disease failed to prevent this contagious disease from becoming a pandemic for a whole host of reasons. After an incubation period of about two days to two weeks, a spectrum of clinical manifestations can be seen in individuals afflicted by COVID-19: from an asymptomatic condition that can spread the virus in the environment, to a mild/moderate disease with cold/flu-like symptoms, to deteriorated conditions that need hospitalization and intensive care unit management, and then a fatal respiratory distress syndrome that becomes refractory to oxygenation. Several diagnostic modalities have been advocated and evaluated; however, in some cases, diagnosis is made on the clinical picture in order not to lose time. A consensus on what constitutes special treatment for COVID-19 has yet to emerge. Alongside conservative and supportive care, some potential drugs have been recommended and a considerable number of investigations are ongoing in this regard

What’s Known

Substantial numbers of articles on COVID-19 have been published, yet there is controversy among clinicians and confusion among the general population in this regard. Furthermore, it is unreasonable to expect physicians to read all the available literature on this subject.

What’s New

This article reviews high-quality articles on COVID-19 and effectively summarizes them for healthcare providers and the general population.

Introduction

A pathogen from a human-animal virus family, the coronavirus (CoV), which was identified as the main cause of respiratory tract infections, evolved to a novel and wild kind in Wuhan, a city in Hubei Province of China, and spread throughout the world, such that it created a pandemic crisis according to the World Health Organization (WHO). CoV is a large family of viruses that were first discovered in 1960. These viruses cause such diseases as common colds in humans and animals. Sometimes they attack the respiratory system, and sometimes their signs appear in the gastrointestinal tract. There have been different types of human CoV including CoV-229E, CoV-OC43, CoV-NL63, and CoV-HKU1, with the latter two having been discovered in 2004 and 2005, respectively. These types of CoV regularly cause respiratory infections in children and adults. 1 There are also other types of these viruses that are associated with more severe symptoms. The new CoV, scientifically known as “SARS-CoV-2”, causes severe acute respiratory syndrome (SARS). 2 A newer type of the virus was discovered in September 2012 in a 60-year-old man in Saudi Arabia who died of the disease; the man had traveled to Dubai a few days earlier. The second case was a 49-year-old man in Qatar who also passed away. The discovery was first confirmed at the Health Protection Agency’s Laboratory in Colindale, London. The outbreak of this CoV is known as the Middle East Respiratory Syndrome (MERS), commonly referred to as “MERS-CoV”. The virus has infected 2260 people and has killed 912, most of them in the Middle East. 3 - 5 Finally, in December 2019, for the first time in Wuhan, in Hubei Province of China, a new type of CoV was identified that caused pneumonia in humans. 6 SARS-CoV-2 has affected 5404512 people and killed more than 343514 around the world according to the WHO situation report-127 (May 26, 2020). 3 , 7 - 10 The WHO has officially termed the disease “COVID-19”, which refers to corona, the virus, the disease, the year 2019, and its etiology (SARS-CoV-2). This type of CoV had never been seen in humans before. The initial estimates showed a mortality rate ranging from between 1% and 3% in most countries to 5% in the worst-hit areas ( Figure 1 ). 9 Some Chinese researchers succeeded in determining how SARS-CoV-2 affects human cells, which could help to develop techniques of viral detection and had antiviral therapy potential. Via a process termed “cryogenic electron microscopy (cryo-EM)”, these scientists discovered that CoV enters human cells utilizing a kind of cell membrane glycoprotein: angiotensin-converting enzyme 2 (ACE2). Then, the S protein is split into two sub-units: S1 and S2. S1 keeps a receptor-binding domain (RBD); accordingly, SARS-CoV-2 can bind to the peptidase domain of ACE2 directly. It appears that S2 subsequently plays a role in cellular fusion. Chinese researchers used the cryo-EM technique to provide ACE2 when it is linked to an amino acid transporter called “B0AT1”. They also discovered how to connect SARS-CoV-2 to ACE2-B0AT1, which is another complex structure. Given that none of these molecular structures was previously known, the researchers hoped that these studies would lead to the development of an antiviral or vaccine that would help to prevent CoV. Along the way, scientists found that ACE2 has to undergo a molecular process in which it binds to another molecule to be activated. The resulting molecule can bind two SARS-CoV-2 protein molecules simultaneously. The scientists also studied different SARS-CoV-2 RBD binding methods compared with other SARS-CoV-RBDs, which showed how subtle changes in the molecular binding sequence make the coronal structure of the virus stronger.

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Most cases with SARS-CoV-2 are asymptomatic or have mild clinical pictures such as influenza and colds. This group of patients should be detected and isolated in their homes to break the transmission chain of the disease and adhere to the precautionary recommendations in order not to infect other people. The screening process will help this group and suppress the outbreak in the community. Patients with the confirmed disease who are admitted to hospitals can contaminate this environment, which should be borne in mind by healthcare providers and policymakers.

Transmission

While the first mode of the transmission of COVID-19 to humans is still unknown, a seafood market where live animals were sold was identified as a potential source at the beginning of the outbreak in the epidemiologic investigations that found some infected patients who had visited or worked in that place. The other viruses in this family, namely MERS and SARS, were both confirmed to be zoonotic viruses. Afterward, the person-to-person spread was established as the main mode of transmission and the reason for the progression of the outbreak. 11 Similar to the influenza virus, SARS-CoV-2 spreads through the population via respiratory droplets. When an infected person coughs, sneezes, or talks, the respiratory secretions, which contain the virus, enter the environment as droplets. These droplets can reach the mucous membranes of individuals directly or indirectly when they touch an infected surface or any other source; the virus, thereafter, finds its ways to the eyes, nose, or mouth as the first incubation places. 11 - 15 It has been reported that droplets cannot travel more than two meters in the air, nor can they remain in the air owing to their high density. Nonetheless, given the other hitherto unknown modes of transmission, routine airborne transmission precautions should be considered in high-risk countries and during high-risk procedures such as manual ventilation with bags and masks, endotracheal intubation, open endotracheal suctioning, bronchoscopy, cardiopulmonary resuscitation, sputum induction, lung surgery, nebulizer therapy, noninvasive positive pressure ventilation (eg, bilevel positive airway pressure and continuous positive airway pressure ), and lung autopsy. In the early stages of the disease, the chances of the spread of the virus to other persons are high because the viral load in the body may be high despite the absence of any symptoms ( Figure 2 ). 11 - 13 The person-to-person transmission rates can be different depending on the location and the infection control intervention; still, according to the latest reports, the secondary COVID-19 infection rate ranges from 1% to 5%. 13 - 23 Although the RNA of the virus has been detected in blood and stool, fecal-oral and blood-borne transmissions are not regarded as significant modes of transmission yet. 19 - 26 There have been no reports of mother-to-fetus transmission in pregnant women. 27

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SARS-CoV-2 mode of transmission and clinical manifestations are illustrated in this figure. The potential source of this outbreak was identified to be from animals, similar to MERS and SARS, in epidemiologic studies; nonetheless, person-to-person transmission through droplets is currently the important mode. After reaching mucous membranes by direct or indirect close contact, the virus replicates in the cells and the immune system attacks the body due to its nature. Afterward, the clinical pictures appear, which are much more similar to influenza. However, different patients will have a spectrum of signs and symptoms.

Source Investigation

Recently, the appearance of SARS-CoV-2 in society shocked the healthcare system. 28 - 32 Veterinary corona virologists reported that COVID-19 was isolated from wildlife. Several studies have shown that bats are receptors of the CoV new version in 2019 with variants and changes in the environment featuring various biological characteristics. 33 - 36 The aforementioned mammals are a major source of CoV, which causes mild-to-severe respiratory illness and can even be deadly. In recent years, the virus has killed several thousands of people of all ages. 37 - 39 The mutated alternative of the virus can be transmitted to humans and cause acute respiratory distress. 40 , 41 One of the main causes of the spread of the virus is the exotic and unusual Chinese food in Wuhan: CoV is a direct result of the Chinese food cycle. The virus is found in the body of animals such as bats, 42 and snake or bat soup is a favorite Chinese food. Therefore, this sequence is replicated continuously. Almost everyone who was infected for the first time was directly in the local Wuhan market or had indirectly tried snake or bat soup in a Chinese restaurant. An investigation stated that the Malayan pangolin (Manis javanica) was a possible host for SARS-CoV-2 and recommended that it be removed from the wet market to prevent zoonotic transmissions in the future. 43 , 44

Pathogenesis

The important mechanisms of the severe pathogenesis of SARS-CoV-2 are not fully understood. Extensive lung injury in SARS-CoV-2 has been related to increased virus titers; monocyte, macrophage, and neutrophil infiltrations into the lungs; and elevated levels of pro-inflammatory cytokines and chemokines. Thus, the clinical exacerbation of SARS-CoV-2 infection may be in consequence of a combination of direct virus-induced cytopathic and immunopathological effects due to excessive cytokinesis. Changes in the cytokine/chemokine profile during SARS infection showed increased levels of circulating cytokines such as tumor necrosis factor-α (TNF-α), C–X–C motif chemokine 10 (CXCL10), interleukin (IL)-6, and IL-8 levels, in conjunction with elevated levels of serum pro-inflammatory cytokines such as IL-1, IL-6, IL-12, interferon-gamma (IFN-γ), and transforming growth factor-β (TGF-β). Nevertheless, constant stimulation by the virus creates a cytokine storm that has been related to acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndromes (MODS) in patients with COVID-19, which may ultimately lead to diminished immunity by lowering the number of CD4+ and CD8+ T cells and natural killer cells (crucial in antiviral immunity) and decreasing cytokine production and functional ability (exhaustion). It has been shown that IL-10, an inhibitory cytokine, is a major player and a potential target for therapeutic aims. 45 - 51 Severe cases of COVID-19 have respiratory distress and failure, which has been linked to the altered metabolism of heme by SARS-CoV-2. Some virus proteins can dissociate iron from porphyrins by attacking the 1-β chain of hemoglobin, which decreases the oxygen-transferring ability of hemoglobin. Research has also indicated that chloroquine and favipiravir might inhibit this process. 52

Clinical Manifestations

SARS-CoV-2, which attacks the respiratory system, has a spectrum of manifestations; nonetheless, it has three main primary symptoms after an incubation period of about two days to two weeks: fever and its associated symptoms such as malaise/fatigue/weakness; cough, which is nonproductive in most of the cases but can be productive indeed; and shortness of breath (dyspnea) due to low blood oxygenation. Although these symptoms appear in the body of the affected person over two to 14 days, patients may refer to the clinic with gastrointestinal symptoms (nausea/vomiting-diarrhea) or decreased sense of smell and/or taste. More devastatingly, however, patients may refer to the emergency room with such coagulopathies as pulmonary thromboembolism, cerebral venous thrombosis, and other related manifestations. The WHO has stated that dry throat and dry cough are other symptoms detected in the early stages of the infection. 53 , 54 The estimations of the severity of the disease are as follows: mild (no or mild pneumonia) in 81%, severe (eg, with dyspnea, hypoxia, or >50% lung involvement on imaging within 24 to 48 hours) in 14%, and critical (eg, with respiratory failure, shock, or multiorgan dysfunction) in 5%. In the early stages, the overall mortality rate was 2.3% and no deaths were observed in non-severe patients. Patients with advanced age or underlying medical comorbidities have more mortality and morbidity. 55 Although adults of middle age and older are most commonly affected by SARS-CoV-2, individuals at any age can be infected. A few studies have reported symptomatic infection in children; still, when it occurs, it has mild symptoms. The vast majority of cases have the infection with no signs and symptoms or mild clinical pictures; they are called “the asymptomatic group”. These patients do not seek medical care and if they come into close contact with others, they can spread the virus. Therefore, quarantine in their home is the best option for the population to break the transmission of the virus. It should be considered that some of these asymptomatic patients have clinical signs such as chest computed tomography scan (CT-Scan) infiltrations. Similar to bacterial pneumonia, lower respiratory signs and symptoms are the most frequent manifestations in serious cases of COVID-19, characterized by fever, cough, dyspnea, and bilateral infiltrates on chest imaging. In a study describing pneumonia in Wuhan, the most common clinical signs and symptoms at the onset of the illness were fever in 99% (although fever might not be a universal finding), fatigue in 70%, dry cough in 59%, anorexia in 40%, myalgia in 35%, dyspnea in 31%, and sputum production in 27%. Headache, sore throat, and rhinorrhea are less common, and gastrointestinal symptoms (eg, nausea and diarrhea) are relatively rare. 7 , 42 , 43 , 45 - 48 , 56 , 57 According to our clinical experience in Iran, anosmia, atypical chest pain, diarrhea, nausea/vomiting, and hemoptysis are other presenting symptoms in the clinic. It should be noted that COVID-19 has some unexplained potential complications such as secondary bacterial infections, myocarditis, central nervous system injury, cerebral edema, MODS, acute demyelinating encephalomyelitis (ADEM), kidney injury, liver injury, new-onset seizure, coagulopathy, and arrhythmias.

Laboratory data : Complete blood counts, which constitute a routine laboratory test, have shown different results in terms of the white blood cell count: from leukopenia and lymphopenia to leukocytosis, although lymphopenia appears to be the most common. Fatal cases have exhibited severe lymphopenia accompanied by an increased level of D-dimer. Liver function enzymes can be increased; however, it is not sufficient to diagnose a disease. The serum procalcitonin level is a marker of infection, especially in bacterial diseases. Patients with COVID-19 who require intensive care unit (ICU) management may have elevated procalcitonin. Increased urea and creatinine, creatinine-phosphokinase, lactate dehydrogenase, and C-reactive protein are other findings in some cases. 7 , 56 , 57

Imaging studies : Routine chest X-ray (CXR) is widely deemed the first-step management to evaluate any respiratory involvement. Although negative findings in CXR do not rule out the viral disease, patients without common findings do not have severe disease and can, consequently, be managed in the outpatient setting. 58 , 59 Another modality is chest CT-Scan. It can be ordered in suspected cases with typical symptoms at the first step, or it can be performed after the detection of any abnormalities in CXR. The most common demonstrations in CT-Scan images are ground-glass opacification, round opacities, and crazy paving with or without bilateral consolidative abnormalities (multilobar involvement) in contrast to most cases of bacterial pneumonia, which have locally limited involvement. Pleural thickening, pleural effusion, and lymphadenopathy are less common. 58 - 61 Tree-in-bud, peribronchial distribution, nodules, and cavity are not in favor of common COVID-19 findings. Although reverse transcriptase-polymerase chain reaction (RT-PCR) is used to confirm the diagnosis, it is a time-consuming procedure and has high false-negative/false-positive findings; hence, in the emergency clinical setting, CT-Scan findings can be a good approach to make the diagnosis. It is deserving of note, however, that false-positive/false-negative cases were reported by one study to be high and other differential diagnoses should be in mind in order not to miss any other cases such as acute pulmonary edema in patients with heart disease.

Suspected cases should be diagnosed as soon as possible to isolate and control the infection immediately. COVID-19 should be considered in any patient with fever and/or lower respiratory tract symptoms with any of the following risk factors in the previous 2 weeks: close contact with confirmed or suspected cases in any environment, especially at work in healthcare places without sufficient protective equipment or long-time standing in those places, and living in or traveling from well-known places where the disease is an epidemic. 61 - 66 Patients with severe lower respiratory tract disease without alternative etiologies and a clear history of exposure should be considered having COVID-19 unless confirmed otherwise. According to the Centers for Disease Control and Prevention (CDC), sending tests to check SARS-CoV-2 in suspected cases is based on physicians’ clinical judgment. Although there are some positive cases without clinical manifestations (ie, fever and/or symptoms of acute respiratory illness such as cough and dyspnea), infectious disease and control centers should take action in society to limit the exposure of such patients to other healthy individuals. The CDC prioritizes the use of the specific test for hospitalized patients, symptomatic patients who are at risk of fatal conditions (eg, age ≥65 y, chronic medical conditions, and immunocompromising conditions) and those who have exposure risks (recent travel, contact with patients with COVID-19, and healthcare workers). 61 - 66 Although treatment should be started after the confirmation of the disease, RT-PCR for highly suspected cases is a time-consuming test; accordingly, a considerable number of clinicians favor the use of a combination of clinical manifestations with imaging modalities (eg, CT-Scan findings) and their clinical judgment regarding the probability of the disease in order not to lose more time. 61 - 66

Treatment of COVID-19

There is no confirmed recommended treatment or vaccine for SARS-CoV-2; prevention is, therefore, better than treatment. Nevertheless, the high contagiousness of COVID-19, combined with the fact that some individuals fail to adhere to precautionary measures or they have significant risk factors, means that this infectious disease is inevitable in some people. Beside supportive treatments, many types of medications have been introduced. These medications come from previous experimental studies on SARS, MERS, influenza, or human immunodeficiency virus (HIV); hence, their efficacy needs further experimental and clinical approval. Patients with mild symptoms who do not have significant risk factors should be managed in their home like a self-made quarantine (in an isolated room); still, prompt hospital admission is required if patients exhibit signs of disease deterioration. 25 , 67 , 68 Isolation from other family members is an important prevention tip. Patients should wear face masks, eat healthy and warm foods similar to when struggling with influenza or colds, do the handwashing process, dispose of the contaminated materials cautiously, and disinfect suspicious surfaces with standard disinfectants. 69 Patients with severe symptoms or admission criteria should be hospitalized with other patients who have the same disease in an isolated department. When the disease is progressed, ICU care is mandatory. 25 , 67 , 68 SARS-CoV-2 attacks the respiratory system, diminishing the oxygenation process and forcing patients with low blood oxygen saturation to take extra oxygen from different modalities. Nasal cannulae, face masks with or without a reservoir, intubation in severe cases, and then extracorporeal membrane oxygenation in refractory hypoxia have been used; however, the safety and efficacy of these measures should be evaluated. As was mentioned above, impaired coagulation is one of the major complications of the disease; consequently, alongside all recommended supportive care and drugs, anticoagulants such as heparin should be administered prophylactically ( Table 1 ). Although it is said that all the clinical signs and symptoms of COVID-19 are induced by the immune system, as other research on influenza and MERS has revealed, glucocorticoids are not recommended in COVID-19 pneumonia unless other indications are present (eg, exacerbation of chronic obstructive pulmonary disease and refractory septic shock) due to the high risk of mortality and delayed viral clearance. Earlier in the national and international guidelines, nonsteroidal anti-inflammatory drugs such as naproxen were recommended on the strength of their antipyretic and anti-inflammatory components; however, the guideline has been revised recently and acetaminophen with or without codeine is currently the favored drug in patients with COVID-19. 25 , 67 , 68 According to the pathogenesis of the disease, whereby cytokine storm and immune-cell exhaustion can be seen in severe cases, selective antibodies against harmful interleukins such as IL-6 and IL-10 or other possible agents can be therapeutic for fatal complications. Tocilizumab, an IL-6 inhibitor, albeit with limited clinical efficacy, has been introduced in China’s National Health Commission treatment guideline for severe infection with profound pulmonary involvement (ie, white lung). 70 , 87

Summary of possible anti-COVID-19 drugs

mg, Milligrams; BD, Every 12 hours; RdRP, RNA-dependent RNA polymerase; TDS, Every 8 hours; IV, Intravenous; IL, Interleukin; μg, Micrograms

RNA synthesis inhibitors (eg, tenofovir disoproxil fumarate and 2’-deoxy-3’-thiacytidine [3TC]), neuraminidase inhibitors (NAIs), nucleoside analogs, lopinavir/ritonavir, atazanavir, remdesivir, favipiravir, INF-β, and Chinese traditional medicine (eg, Shufeng Jiedu and Lianhuaqingwen capsules) are the major candidates for COVID-19. 26 , 70 , 85 , 88 - 96 Antiviral drugs have been investigated for various diseases, but their efficacy in the treatment of COVID-19 is under investigation and several randomized clinical trials are ongoing to release a consensus result on the treatment of this infectious disease. Moderate-to-severe SARS-CoV-2 disease needs drug therapy. Favipiravir, a previously validated drug for influenza, is a drug that has shown promising results for COVID-19 in experimental and clinical studies, but it is under further evaluation. 70 , 79 , 80 Remdesivir, which was developed for Ebola, is an antiviral drug that is under evaluation for moderate-to-severe COVID-19 owing to its promising results in in vitro investigations. 70 , 73 - 75 , 81 Remdesivir was shown to have reduced the virus titer in infected mice with MERS-CoV and improved lung tissue damage with more efficiency compared with a group treated with lopinavir/ritonavir/INF-β. 67 , 70 Another investigation studied the potential efficacy of INF-β-1 in the early stages of COVID-19 as a potential antiviral drug. 86 Although there is some hope, an evidence-based consensus requires further clinical trials. 70 , 77 A combined protease inhibitor, lopinavir/ritonavir, is used for HIV infection and has shown interesting results for SARS and MERS in in vitro studies. 73 - 75 The clinical effectiveness of lopinavir/ritonavir for SARS-CoV-2 was also reported in a case report. 70 , 71 , 74 , 76 Atazanavir, another protease inhibitor, with or without ritonavir is another possible anti-COVID-19 treatment. 77 , 78 NAIs, including oseltamivir, zanamivir, and peramivir, are recommended as antiviral treatment in influenza. 68 Oral oseltamivir was tried for COVID-19 in China and was first recommended in the Iranian guideline for COVID-19 treatment; nevertheless, because of the absence of strong evidence indicating its efficacy for SARS-CoV-2, it was eliminated from the subsequent updates of the guideline. 85 RNA-dependent RNA polymerase inhibitors with anti-hepatitis C effects such as ribavirin have shown satisfactory results against SARS-CoV-2 RNA polymerase; however, they have limited clinical approval. 82 - 84 The well-known drugs for rheumatoid arthritis, systemic lupus erythematosus, and an antimalarial drug, chloroquine 71 and hydroxychloroquine 21 are other potential drugs for moderate-to-severe COVID-19 but with limited or no clinical appraisal. Hydroxychloroquine has exhibited better safety and fewer side effects than chloroquine, which makes it the preferred choice. 70 Furthermore, the immunomodulatory effects of hydroxychloroquine can be used to control the cytokine precipitation in the late phases of SARS-CoV-2 infections. There are numerous mechanisms for the antiviral activity of hydroxychloroquine. A weak base drug, hydroxychloroquine concentrates on such intracellular sections as endosomes and lysosomes, thereby halting viral replication in the phase of fusion and uncoating. Additionally, this immunosuppressive and antiparasitic drug is capable of altering the glycosylation of ACE2 and inhibiting both S-protein binding and phagocytosis. 72 A recent multicenter study showed that regarding the risks of cardiovascular adverse effects and mortality rates, hydroxychloroquine or chloroquine with or without a macrolide (eg, azithromycin) was not beneficial for hospitalized patients, although further research is needed to end such controversies. 97

Disease Duration

It is not easy to quarantine the patients who have fully recovered because there is evidence that they are highly infectious. 81 The recovery time for confirmed cases based on the National Health Commission reports of China’s government was estimated to range between 18 and 22 days. 73 As indicated by the WHO, the healing time seems to be around two weeks for moderate infections and 3 to 6 weeks for the severe/ serious disease. 75 Pan Feng and others studied 21 confirmed cases with COVID-19 pneumonia with about 82 CT-Scan images with a mean interval of four days. Lung abnormalities on chest CT showed the highest severity approximately 10 days after the initial onset of symptoms. All patients became clear after 11 to 26 days of hospitalization. From day zero to day 26, four stages of lung CT were defined as follows: Stage 1 (first 4 days): ground-glass opacities; Stage 2 (second 4 days): crazy-paving patterns; Stage 3 (days 9–13): maximum total CT scores in the consolidations; and Stage 4 (≥14 d): steady improvements in the consolidations with a reduction in the total CT score without any crazy-paving pattern. 74 Nevertheless, there are also rare cases reported from some studies that show the recurrence of COVID-19 after negative preliminary RT-PCR results. For example, Lan and othersstudied one hospitalized and three home-quarantined patients with COVID-19 and evaluated them with RT-PCR tests of the nucleic acid. All the patients with positive RT-PCR test results had CT imaging with ground-glass opacification or mixed ground-glass opacification and consolidation with mild-to-moderate disease. After antiviral treatments, all four patients had two consecutive negative RT-PCR test results within 12 to 32 days. Five to 13 days after hospital discharge or the discontinuation of the quarantine, RT-PCR tests were repeated, and all were positive. An additional RT-PCR test was performed using a kit from a different manufacturer, and the results were also positive. Their findings propose that a minimum percentage of recovered patients may still be infection carriers. 76

Supplements for COVID-19

Since the appearance of SARS-CoV-2 in Wuhan, China, there have been reports of the unreliable and unpredictable use of mysterious therapies. Some recommendations such as the use of certain herbs and extracts including oregano oil, mulberry leaf, garlic, and black sesame may be safe as long as people do not utilize their hands for instance. 98 According to data released by the CDC, vitamin C (VitC) supplements can decrease the risk of colds in people besides preventing CoV from spreading. The aforementioned organization states that frequent consumption of VitC supplements can also decrease the duration of the cold; however, if used only after the cold has risen, its consumption does not influence the disease course. VitC also plays an important role in the body. One of the main reasons for taking VitC is to strengthen the immune system because this vitamin plays a significant part in the immune system. Firstly, VitC can increase the production of white blood cells (lymphocytes and phagocytes) in the bone marrow, which can support and protect the body against infections. Secondly, VitC helps immune cells to function better while preserving white blood cells from damaging molecules such as free oxidative radicals and ions. Thirdly, VitC is an essential part of the skin’s immune system. This vitamin is actively transported to the skin surface, where it serves as an antioxidant and helps to strengthen the skin barrier by optimizing the collagen synthesis process. Patients with pneumonia have lower levels of VitC and have been revealed to have a longer recovery time. 69 , 99 In a randomized investigation, 200 mg/d of VitC was applied to older patients and resulted in improvements in the respiratory symptoms. Another investigation reported 80% fewer mortalities in a controlled group of VitC takers. 73 However, for effective immune system improvement, VitC should be consumed alongside adequate doses of several other supplements. Although VitC plays an important role in the body, often a balanced diet and the consumption of fresh fruits and vegetables can quickly fill the blanks. While taking high amounts of VitC is less risky because it is water-soluble and its waste is eliminated in the urine, it can induce diarrhea, nausea, and abdominal spasms at higher concentrations. Too much VitC may cause calcium-oxalate kidney stones. People with genetic hemochromatosis, an iron deficiency disorder, should consult a physician before taking any VitC supplements as high levels of VitC can lead to tissue damage. Some studies have evaluated the different doses of oral or intravenous VitC for patients admitted to the hospital for COVID-19. Although they used different regimens, all of them demonstrated satisfactory results regarding the resolution of the compilations of the disease, decreased mortality, and shortened lengths of stay in the ICU and/or the hospital. 100 , 101 Immunologists have also recommended 6 000 units of vitamin A (VitA) per day for two weeks, more than twice the recommended limit for VitA, which can create a poisoning environment over time. According to the guidance of the National Institutes of Health (NIH), middle-aged men and women should take 1 and 2 mg of VitA every day, respectively. The safe upper limit of this vitamin is 6000 mg or 5000 units, and overdose can have serious outcomes such as dizziness, nausea, headache, coma, and even death. Extreme consumption of VitA throughout pregnancy can lead to birth anomalies.

Similar to VitC, vitamin D (VitD) has antioxidant, anti-inflammatory, and immune-modulatory effects in our body such as reducing pro-inflammatory cytokines and inhibiting viral replication according to experimental studies. 83 The VitD state of our body is checked through 25 (OH) VitD in the serum. VitD deficiency is pandemic around the world due to multifactorial reasons. It has been shown that VitD deficient patients are prone to SARS-CoV-2 and, accordingly, treating VitD deficiency is not without benefits. Grant and others recommended 10 000 units per day for two weeks and then 5 000 units per day as the maintenance dose to keep the level between 40 and 100 ng/mL. 102 VitD toxicity causes gastrointestinal discomfort (dyspepsia), congestion, hypercalcemia, confusion, positional disorders, dysrhythmia, and kidney dysfunction.

James Robb, 103 a researcher who detected CoV for the first time as a consultant pathologist with the National Cancer Institute of America, suggested the influence of zinc consumption. Oral zinc supplements can be dissolved in the nback of the throat. Short-term therapy with oral zinc can decrease the duration of viral colds in adults. Zinc intake is also associated with the faster resolution of nasal congestion, nasal drainage, sore throats, and coughs. Researchers 104 , 105 have warned that the consumption of more than 1 mg of zinc a day can lead to zinc poisoning and have side effects such as lowered immune function. Children and old people with zinc insufficiency in developing nations are extremely vulnerable to pneumonia and other viral infections. It has also been determined that zinc has a major role in the production and activation of T-cell lymphocytes. 106 , 107

And finally, for high-risk people or those who work in high-risk places such as healthcare providers, hydroxychloroquine has been mentioned to be effective as a prophylactic regimen ( Table 2 ). Although different doses have been investigated so far, Pourdowlat and others recommended 200 mg daily before exposure, and for the post-exposure scenario, a loading dose of 600-800 mg followed by a maintenance dose of 200 mg daily. 74

Possible prophylactic regimens against SARS-CoV-2 infection

IU, International unit; mg, Milligrams; kg, Kilograms; ICU, Intensive care unit; g, Grams; IV, Intravenous; Vit, Vitamin; ng, Nanograms; mL, Milliliter

COVID-19 Kits and Deep Learning

COVID-19 has threatened public health, and its fast global spread has caught the scientific community by surprise. 108 Hence, developing a technique capable of swiftly and reliably detecting the virus in patients is vital to prevent the spreading of the virus. 109 , 110 One of the ways to diagnose this new virus is through RT-PCR, a test that has previously demonstrated its efficacy in detecting such CoV infections as MERS-CoV and SARS-CoV. Consequently, increasing the availability of RT-PCR kits is a worldwide concern. The timing of the RT-PCR test and the type of strain collected are of vital importance in the diagnosis of COVID-19. One of the characteristics of this new virus is that the serum is negative in the early stage, while respiratory specimens are positive. The level of the virus at the early stage of the illness is also high, even though the infected individual experiences mild symptoms. 111 For the management of the emerging situation of COVID-19 in Wuhan, various effective diagnostic kits were urgently made available to markets. While a few different diagnostics kits are used merely for research endeavors, only a single kit developed by the Beijing Genome Institute (BGI) called “Real-Time Fluorescent PCR” has been authenticated for clinical diagnostics. Fluorescent RT-PCR is reliable and able to offer fast results probably within a few hours (usually within two hours). Besides RT-PCR, China has successfully developed a metagenomic-sequencing kit based on combinatorial probe-anchor synthesis that can identify virus-related bacteria, allowing observation and evaluation during the transmission of the virus. Furthermore, the metagenomic-sequencing kit based on combinatorial probe-anchor synthesis is far faster than the abovementioned fluorescent RT-PCR kit. Apart from China, a Singapore-based laboratory, Veredus, developed a virus detection kit (Vere-CoV) in late January. It is a portable Lab-On-Chip used to detect MERS-CoV, SARS-CoV, and SARS-CoV-2, in a single examination. This kit works based on the VereChip™ technology, the lines of code (LOC) program incorporating two different influential molecular biological functions (microarray and PCR) precisely. Several studies have focused on SARS-CoV diagnostic testing. These papers have presented investigative approaches to the identification of the virus using molecular testing (ie, RT-PCR). Researchers probed into the use of a nested PCR technique that contains a pre-amplification step or integrating the N gene as an extra subtle molecular marker to improve on the sensitivity. 112 - 115 CT-Scan is very useful for diagnosing, evaluating, and screening infections caused by COVID-19. One recommendation for scanning the disease is to take a scan every three to five days. According to researchers, most CT-Scan images from patients with COVID-19 are bilateral or peripheral ground-glass opacification, with or without stabilization. Nowadays, because of a paucity of computerized quantification tools, only qualitative reports and sometimes inaccurate analyses of contaminated areas are drawn upon in radiology reports. A categorization system based on the deep learning approach was proposed by a study to automatically measure infected parts and their volumetric ratios in the lung. The functionality of this system was evaluated by making some comparisons between the infected portions and the manually-delineated ones on the CT-Scan images of 300 patients with COVID-19. To increase the manual drawing of training samples and the non-interference in the automated results, researchers adopted a human-based approach in collaboration with radiologists so as to segment the infected region. This approach shortens the time to about four minutes after 3-time updating. The mean Dice similarity coefficient illustrated that the automatically detected infected parts were 91.6% similar to the manually detected ones, and the average of the percentage estimated error was 0.3% for the whole lung. 116 , 117

Prevention Considerations

In the healthcare setting, any individual with the manifestations of COVID-19 (eg, fever, cough, and dyspnea) should wear a face mask, have a separate waiting area, and keep the distance of at least two meters. Symptomatic patients should be asked about recent travel or close contact with a patient in the preceding two weeks to find other possible infected patients. The CDC and WHO have announced special precautions for healthcare providers in the hospital and during different procedures. Wearing tight-fitting face masks with special filters and impermeable face shields is necessary for all of them. 11 , 18 , 65 , 66 , 76 , 118 - 124 Other people should pay attention to the CDC and WHO preventive strategies, which recommend that individuals not touch their eyes, mouth, and nose before washing or disinfecting their hands; wash their hands regularly according to the standard protocol; use effective disinfection solutions (ie, containing at least 60% ethylic alcohol) for contaminated surfaces; cover their mouth when coughing and sneezing; avoid waiting or walking in crowded areas, and observe isolation protocols in their home. Postponing elective work and decreasing non-urgent visits and traveling to areas in the grip of COVID-19 may be useful to lessen the risk of exposure. If suspected individuals with mild symptoms are managed in outpatient settings, an isolated room with minimal exposure to others should be designed. Patients and their caregivers should wear tight-fitting face masks. 11 , 18 , 65 , 66 , 76 , 118 - 124 Substantial numbers of individuals with COVID-19 are asymptomatic with potential exposure; accordingly, a screening tool should be employed to evaluate these cases. In addition to passport checks, corona checks have been incorporated into the protocols in airports and other crowded places. The use of a remote thermometer to measure body temperature leads to an increase in the number of false-negative cases. It is, thus, essential that everyone pay sufficient heed to the WHO and CDC recommendations in their daily life. Traveling is not prohibited, but it should be restricted and passengers from any country should be monitored. 11 , 18 , 65 , 66 , 76 , 118 - 124

SARS-CoV-2 is the new highly contagious CoV, which was first reported in China. While it had a zoonotic origin in the beginning, it subsequently spread throughout the world by human contact. COVID-19 has a spectrum of manifestations, which is not lethal most of the time. To diagnose this condition, physicians can avail themselves of laboratory and imaging findings besides signs and symptoms. RT-PCR is the gold standard, but it lacks sufficient sensitivity and specificity. Although there are some potential drugs for COVID-19 and some vitamins or minerals for prophylaxis, the best preventive strategies are quarantine (staying at home) and the use of personal protective equipment and disinfectants.

Acknowledgement

The authors express their gratitude toward the Supporting Organizations for Foreign Iranian Students, Islamic Azad University Isfahan (Khorasgan) Branch, and Isfahan University of Medical Sciences.

Conflict of Interest: None declared.

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Published: 01 February 2022

Persuasive narrative during the COVID-19 pandemic: Norwegian Prime Minister Erna Solberg’s posts on Facebook

Sanjana Arora ORCID: orcid.org/0000-0003-0107-7061 1 ,
Jonas Debesay 2 &
Hande Eslen-Ziya ORCID: orcid.org/0000-0001-7113-6771 1

Humanities and Social Sciences Communications volume 9 , Article number: 35 ( 2022 ) Cite this article

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Cultural and media studies
Politics and international relations

This article explores the Facebook posts of Norway’s Prime Minister Erna Solberg to highlight the key features of her crisis communication during the COVID-19 pandemic. It draws on data from Solberg’s Facebook posts from February 27, 2020 to February 9, 2021 (i.e., starting from the day when the first case of COVID-19 was recorded in Norway until the time of data collection for this study). Out of her 271 posts, 157 of them were about COVID-19 and were chosen for analysis. The analyses identified five major themes: (1) Promoting responsibility and togetherness (2) Coping (3) Being in control amidst uncertainty (4) Fostering hope and (5) Relating with the followers. Drawing inspiration from Boin, Stern and Sundelius’, work on persuasive narratives, this study shows the ways that Solberg’s posts about COVID-19 exhibit all five identified frame functions. In addition, the findings add contextual nuances to the frame functions through the theme of ‘Responsibilization and togetherness’, which are reflected through references to Norwegianness and the cultural concept and practice of dugnad . This study adds to our knowledge about how persuasive narratives are incorporated into the social media communication strategies of leaders and highlights the usefulness of this framework for studying ongoing and future crises.

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Michele Avalle, Niccolò Di Marco, … Walter Quattrociocchi

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Eleanor Knott, Aliya Hamid Rao, … Chana Teeger

Introduction

The economic and social disruption caused by the COVID-19 pandemic is having major impacts on people’s livelihoods and their health. As of 18 April 2021, there have been 140,322,903 confirmed cases of SARS-CoV-2 infections and 3,003,794 deaths (WHO, 2021 ), making the COVID-19 pandemic an unprecedented global health crisis of the century. As countries across the world grapple with mitigating the risks associated with the pandemic, communication—an essential component of planning, response, and recovery during crisis (Houston et al., 2014 )—has been one of the integral parts of the crisis management (Reddy and Gupta, 2020 ). Crisis communication highlights legitimation strategies, but also indicates how government institutions themselves make sense of crises (Brandt and Wörlein, 2020 ). Moreover, crises such as the COVID-19 pandemic can disrupt the socio-political order of societies, leaving a cognitive void in the minds of the public that can be filled with fear and uncertainty (Boin et al., 2016 ). In Norway, COVID-19 has been called a fear-driven pandemic that is based on alarming information of long-term illness and disability that is out of politicians control (Vogt and Pahle, 2020 ). Having control over the dramaturgy of political communication is thus central to effective leadership and crisis management (Boin et al., 2016 ). Effective communication can help societies handle uncertainty and promote adherence to behaviour change while fostering hope among the citizens (Finset et al., 2020 ).

The COVID-19 pandemic continues to rapidly evolve, and social media plays a pivotal role in meeting the communication needs of the public during such crisis (Van Dijck, 2013 ). As social media use increases during crises, leaders and public officials may utilise this platform to communicate, which in return helps reduce public panic and builds trust (Kavanaugh et al., 2012 ). As a result of the cultural and symbolic value of social media in contemporary times (Jenzen et al., 2021 ), the communication of public leaders in the midst of uncertainty and fear facilitates interpersonal and group interaction. Research has shown that, when compared to the traditional media platforms, social media platforms are used by leaders and elected officials to communicate, inform, and engage with their citizens (Golbeck et al., 2010 ). They use social media to spread messages farther and faster than it would be possible with traditional media (Sutton et al., 2013 ). What leaders post on social media can give insights into their communication and leadership strategies during crises. Understanding how leaders communicate with the public during crises will not only provide us with the knowledge about their governance styles but will also guide us to their meaning-making in times of uncertainty. Based on this assumption we will be studying the Facebook posts of Norwegian Prime Minister Erna Solberg, with the aim to highlight the key features of her communication. In doing so, we will take an exploratory rather than confirmatory perspective (Boudreau et al., 2001 ).

Solberg, member of the Conservative Party and in power since 2013, was defeated by the centre-left as this paper was being revised. Solberg has had a long career in politics, becoming a deputy representative to the Bergen City Council in 1979 when she was 18 years old. She was elected to the Parliament in 1989 where she was the youngest member of her party group (Notaker and Tvedt, 2021 ). Solberg’s tough stance on issues such as immigration earned her the nickname of ‘Jern-Erna’ [Iron Erna] (Reuters, 2013 ). However, upon her appointment as Prime Minister, Solberg displayed a ‘softer side’ by caring about voters’ jobs, health, and schools (Notaker and Tvedt, 2021 ).

The first Norwegian COVID-19 patient was diagnosed on February 26, 2020. While the initial spread of infection was relatively slow, cases increased quickly by March 12 th , after winter break for schools ended and many Norwegians returned from skiing holidays in Northern Italy (Dagsavisen, 2020 ). On March 12, the Norwegian Directorate of Health (NDH) adopted comprehensive measures to prevent the spread, which included closing day care centres, schools, and educational institutions. The measures also included a ban on cultural events, closed swimming gyms and pools, a halt to all service provisions that involved being less than one meter away from another person, and prohibiting visits to recreational cabins Footnote 1 , among others. Behavioural measures such as recommendations to keep physical distance, encourage handwashing, quarantine, stay home when ill, work from home, and avoid public transportation were also included. Following the lockdown, Norway became the first European country to announce that the situation was under control due to low levels of hospitalizations and mortalities (Christensen and Lægreid, 2020 ). In Norway, as of March 22, 2021, there have been over eighty thousand confirmed cases of coronavirus infection and more than six hundred deaths due to COVID-19. Norway has had far fewer COVID-19 cases, deaths, and hospitalizations per capita than most other countries in Western Europe or the United States (Christensen and Lægreid, 2020 ). Compared to its Scandinavian neighbours Denmark and Sweden, the proportion of cases of infections and deaths have been much lower (WHO, 2021 ), despite the three countries sharing similar social welfare and healthcare systems. Recently, a report submitted by the Corona Committee in Norway also concluded that the overall handling of the crisis by the government has been good. Not only has the number of infections and deaths in Norway been much lower than most countries in Europe, but the healthcare services have also remained stable, and society has remained relatively open (Lund, 2021 ). It is probable that good governance and responsible leadership demonstrated by the Norwegian cabinet and Prime Minister Erna Solberg contributed to this success.

In Norway, there is considerably less focus on individualization of candidates in political parties as compared to for instance the US, since the electoral system in Norway is based on proportional representation (Karlsen and Enjolras, 2016 ). Despite this, with the presence of digital and social media, there has been increasing focus on the individual candidates, leading to ‘decentralising personalisation’ (Karlsen and Enjolras, 2016 ; Balmas et al., 2014 ). Given this context, Erna Solberg’s Facebook account during the COVID-19 pandemic serves as an intermediary platform between the government’s role and her own personal profile as the Prime Minister who has been handling the COVID-19 crisis. Solberg has used Facebook more actively than other outlets like Twitter and has more followers on Facebook than any other platform. The proportion of Facebook users in Norway vis-a-vis other social media platform is also the highest (for example, 84% of people use Facebook compared to 22% who use Twitter who use Twitter) (Werliin and Kokholm, 2016 ). Facebook thus serves as an important platform for public leaders in Norway during crises, and therefore, by analysing Solberg’s Facebook posts, we aim to demonstrate the key features of her communication strategy during the COVID-19 crisis.

Background on crisis and crisis communication

Crisis is defined as a rare, and significant public situation creating undesirable consequences (Coombs, 2015 ; Gruber et al., 2015 ). In most cases it is ‘an unpredictable event that threatens important expectancies of stakeholders and can seriously impact an organization’s performance and generate negative outcomes’ (Coombs, 2015 : p. 3). Crisis communication on the other hand is referred as the strategies used to lessen the uncertainties during crisis via the dissemination and exchange of information (Collins et al., 2016 ). Effective crisis communication establishes reliability and maintains public trust. It should be frequent, consistent and involve compassionate messages conveyed in an inspired and transformational communication style. It is essential that public officials and leaders when communicating crisis relevant information be efficient and informative. Past research has shown the importance of repetition of the consistent interaction to help the message reach the recipients clearly and increase compliance behaviour in cases of crisis (Stephens et al., 2013 ). Inconsistent messages on the other hand were found to cause misperception and confusion, leading to a non-compliant behaviour by the recipients. The content of the message as well as its tone is also an important indicator of whether the recipients will comply or not (Sutton et al., 2013 ). Sources of crisis communication, such as leaders and public health officials, are perceived to be reliable and trustworthy when they exhibit concern and care (Heath and O’ Hair, 2010 ). In addition, they can be more effective in building relationship with the public, if they consider the cultural factors that play a role in their communicating about risks (Aldoory, 2010 ).

Boin et al. ( 2016 ) argue that crisis communication is one of the key challenges, which leaders face during a crisis situation. During crisis communication, leaders are required to frame ‘meaning’ of the crisis in order to shape how public perceives the risks, consequences and how they respond to the measures being taken. Developing a persuasive narrative in communication is thus integral to succesful framing of the crisis and for a strategic leadership. The construction of a successful persuasive narrative requires five frame functions: namely that the narrative will offer a credible explanation of what happened, it will provide guidance, instil hope, show empathy, and suggest that leaders are in control (Boin et al., 2016 ). In doing so, leaders aid the public’s understanding of the facts associated with crisis while sumltaneously acknolwedging and appealing to collective emotions. In incorporating these frame functions, leaders are posed with various choices and decision-making such as how they choose to or not choose to dramatise the situation, the language that they use and how they appeal to the colleactive emotions and stress.

As digital media technologies became popular resources for getting and spreading information, public officials and leaders also increasingly started using them as domains during the crises. In fact, for some scholars the use of social media while enabling mutual interaction between the leaders and recipients has altered the field of crisis communication altogether. For instance, it was found that as social media enables constant and effective communication, it was used more regularly than traditional media outlets during crisis (Kim and Liu, 2012 ). Similarly, Utz et al. ( 2013 ) discussed how for effective crisis communication strategy, the use of media channels, social media—Twitter, and Facebook—versus traditional— newspapers—was more critical than the type of the crisis. Moreover, Schultz et al. ( 2011 ) concluded that when compared to traditional media networks, crisis communication received less negative response when social media was used. Hence, it is not to our surprise that public officials nowadays are turning to social media platforms for communicating with the masses during crisis. They not only use these tools to communicate about crisis but also request information from the public. This was the case during the COVID-19 pandemic crisis where social media was employed by political leaders across the globe to mediate the communication of information about the pandemic as well as for reaching out to their citizens. This paper by focusing on the Norwegian case and more specifically on the Norwegian Prime Minister’s Facebook use during the time of COVID-19 pandemic aims to explore the use of social media platforms by political leaders during crisis. Our goal is to better understand how political leaders adapt social media technologies in their communication strategies during crises.

Our data that covers Erna Solberg’s Facebook posts between February 27, 2020, and February 10, 2021 (a total of 271 posts) were extracted from Footnote 2 into an Excel sheet. A total of 114 posts were removed as they were not related to COVID-19 leaving us 157 posts for further analysis. To aid the coding process, we noted the variables presented in Table 1 . These are: date, number of interactions, number, and type of reactions (e.g., angry, sad, like, etc.), URLs of links shared, and a description of the content of the posts that was later used in the qualitative analysis. We also noted if the posts were made during any particularly critical period (e.g., before, during or after new restrictive measures were introduced). The content of the posts and the number of likes and other reactions derived from this data should be considered a ‘snapshot’ of Solberg’s posts as they appeared at the time of data collection (Brügger, 2013 ), as it is possible that some posts have been subsequently removed, or that the numbers and types of reactions to the posts have changed by the publication date

The data was analysed through thematic analysis (Braun and Clarke, 2006 ): in the first step, we read all posts and generated the first set of codes. Next, we combined all the similar codes while labelling them in clusters and organised them into analytical themes/categories (see Fig. 1 ). The authors then discussed and reviewed these analytical themes and merged them into aggregate/conceptual themes. Lastly, we reviewed the aggregate themes through the lens of the five frame functions of persuasive narrative and identified commonalities and differences. We have included some posts under each theme to illustrate our analytical process and illuminate the themes (Sandelowski, 1994 ). All posts presented here were translated from Norwegian to English by the authors.

Schematic formulation of a theme from the categories captured in posts.

Our analysis resulted in five themes: (1) Promoting responsibility and togetherness (2) Coping (3) Being in control amidst uncertainty (4) Fostering hope and (5) Relating with the followers. In reviewing our findings from the framework of Boin et al. ( 2016 ), we found that all five frame functions of persuasive narrative were embedded in Solberg’s posts and aligned with our themes. Below we discuss our themes with reference to frame functions of Boin et al. ( 2016 ) for a persuasive narrative and in doing so, add contextual nuances to each theme.

Promoting responsibility and togetherness: we are in this together

Analysis of Solberg’s posts revealed a strong message of responsibility and togetherness. In almost all shares, she not only emphasized solidarity but also called for courage and responsibility. This Facebook post, shared soon after comprehensive shut-down measures were introduced, shows how important, for Solberg, was Norwegian solidarity expressed as ‘we’ (March 12, 2020):

Dear everyone. In times of crisis, we understand how dependent we are on each other. What unites us is more important than what separates us. This is not the time for ‘I’. This is the time for ‘we’.

Lunn et al. ( 2020 ) note that citizens are isolated during government induced or self-imposed quarantines: appeals to collective action and a spirit of ‘we-are-in-it-together’ are important ways to ensure compliance with quarantine and hence curb the rate of infection. Leaders in countries such New Zealand, UK, Brazil have also been found to have used a similar narrative emphasizing patriotic duty, love of country, and coming together as one, to mobilise community action (Dada et al., 2021 ).

Her posts were also imbued with appreciation and expression of gratitude towards healthcare workers and those who follow rules. For example, after introduction of the ban to travel to cabins and after the government’s decision to extend regulations until after Easter, Solberg posted the following on April 4, 2020, receiving a high number of likes:

I feel proud when I see how we handle this together. Many thanks to everyone who follows the advice from the health authorities. Many thanks to everyone in the health service who works hard and perseveres. Many thanks to all Norwegians for the patience, love and solidarity we now show each other

The use of the word ‘I’ and how it was being used in reference to ‘feel[ing] proud’, we argue, highlights the ‘positioning of self’ by Solberg. Davies and Harré ( 1990 ) claim that development of the notion of ‘positioning’ is a contribution to the understanding of personhood, and how speakers choose to position their personal identity vis-a-vis their discontinuous personal diversity (such as being the Prime Minister, politician, Norwegian citizen, etc.). In such posts, whether intentionally or unintentionally, we also see the discursive practices through which Solberg allocates meaning to her position as a Prime Minister by emphasising that she feels proud upon seeing those who follow advice. At the same time, her emphasis on ‘we’, as in how ‘ we handle this together’, places her as a member of the Norwegian masses.

Moreover, such references to togetherness and solidarity also reflect attempts to utilise the existing nationalistic cultural repertoire of the Norwegian concept of dugnad . For example, on New Year’s Day following the Gjerdrum community disaster (a sudden and unexpected mudslide that destroyed several residential houses) and rise in the number of infections during the holiday period (2125 reported cases on December 29, 2020), Solberg posted the following post:

[…] During the year we have put behind us, Norway has lined up for the big dugnad . People have put their interests and dreams on hold to protect the elderly and the risk groups. It has saved lives. I am deeply grateful, proud and touched, for the way the Norwegian people have handled the biggest challenge for our society since World War II. We lined up for each other when it mattered most…

Dugnad in Norwegian is voluntary work that is performed as a collective effort (Moss and Sandbakken, 2021 ). Nilsen and Skarpenes ( 2020 ) discuss how the concept of dugnad is embedded in a moral repertoire of the socially responsible citizen that is indicative of a specifically Norwegian welfare mentality and conclude that dugnad is imperative for the sustainability and resilience of the Norwegian welfare model. Before the pandemic, Simon and Mobekk ( 2019 ) argued that the concept of dugnad is central to Norwegian culture, inculcating prosocial and cooperative behaviour, and thereby plays a role in Norway being one of the most egalitarian democracies and having high levels of equality and reciprocity. In the context of COVID-19, social anthropologist Thomas Hylland Eriksen ( 2020 ) pointed out that one reason for the success of the Norwegian approach was the mobilisation of broader society to fight COVID-19, driven by the notion of dugnad . Similarly, Moss and Sandbakken ( 2021 ) analysed data from press conferences and interviews with members of the public and found that many participants mentioned liking how the government talked of ‘a spirit of dugnad ’ ( dugnadsånd ), appealing to shared voluntary work rather than strict rules. The authors posit that in a pandemic it is crucial to create and use meta-narratives that are a good fit with the context in order to aid meaning-making and increase compliance. The use of dugnad as a cultural repertoire has, however, met with criticism from some scholars, who argue that ‘a word associated with solidarity, unity, and voluntary work obscures the forced nature of the measures’ (Tjora, 2020 ) and shifts the onus for finding solutions onto individual citizens or groups (Nilsen and Skarpenes, 2020 ; Hungnes, 2016 ).

Despite the criticism of imbibing such cultural repertoire, the alignment of the key values of Norwegian society with the core message of encouraging collective action is essential for a crisis narrative to be politically effective (Boin et al., 2016 ). Furthermore, the theme of ‘Promoting responsibility and togetherness’ shows the context specific nature of crisis communication narrative in the case of COVID-19 in Norway and therefore adds to the components for a persuasive narrative.

Coping: everything will be fine

Solberg’s Footnote 3 posts also carried messages that address the consequences of coping with COVID-19, namely self-isolation, and loneliness. For instance, her posts guided followers in dealing with loneliness and maintaining general physical and mental health. The Norwegian government, like that of many other countries, had introduced measures such as mandatory quarantine and social distancing rules to manage the spread of the virus. Studies have shown that home confinement during COVID-19 has negatively affected the emotional state of individuals due to depression and anxiety and has led to or increased a sedentary lifestyle (Sang et al., 2020 ). Thus, emphasis on the well-being of the population during COVID-19 is important for effective crisis management (WHO, 2020a ) because increased well-being would reinforce its coping abilities during illness and hardships. As these are not the direct effects of the COVID-19 infection, but a result of the contagion containment measures imposed on citizens by the government, we observe Solberg taking responsibility and providing solutions to help. In doing so, she appears sensitive and caring towards the public.

Christensen and Lægreid ( 2020 ) attribute the ‘high-performing’ handling of the pandemic in Norway to the initial focus on suppression, followed by a control strategy. The authors further examine the ideas that having successful communication with the public, a collaborative and pragmatic decision-making style, the country’s resourcefulness, and high trust of government all contributed to the relative success in Norway. Adopting the correct and effective strategy indeed heavily influences the outcomes of crises. However, to fill the ‘cognitive void’ that the public might be experiencing, leaders need to manage the meaning-making process and ensure legitimacy of their actions (Boin et al., 2016 ). Solberg and the other ministers played an important role in communicating with citizens and the media through daily media briefings together with the NDH (Norwegian Directorate of Health) and NIPH (Norwegian Institute of Public Health) (Christensen and Lægreid, 2020 )

Solberg emphasized the impact of loneliness, for example, during one of the first holiday periods during the pandemic when comprehensive shut-down measures were introduced, she wrote:

Many people may feel lonely during holidays such as Easter, and the corona crisis exacerbates this. Therefore, I would like to encourage everyone to call someone you know is alone at Easter. The little things can mean a lot. Happy Easter!

A study by Blix et al. ( 2021 ) on the topic of mental health in the Norwegian population during the COVID-19 pandemic found that a substantial proportion of the population experienced significant psychological distress in the early phases. More than one out of four reported ongoing psychological distress over the threshold for clinically significant symptoms. Two other categories of individuals (those recently exposed to violence and those with pre-existing mental health problems) were found to be at special risk but worrying about the consequences of the pandemic was also found to contribute negatively to mental health. In this regard, Shah et al. ( 2020 ) argued that several nations have failed to address the mental health aspect among the public, as far more effort is being focused on understanding the epidemiology, clinical features, transmission patterns, and management of COVID-19. Solberg’s open discussion about mental health during the pandemic implies a situation-specific and data-driven strategy of managing the less visible effects of the pandemic and show insight in anticipating future needs (Han et al., 2020 ).

Moreover, Solberg’s posts also subtly utilised the Norwegian concept of friluftsliv , which translates as ‘free air life,’ a philosophy of outdoor living and connection with nature (Henderson and Vikander 2007 ). Friluftsliv is associated with grand narratives of Norwegian national identity depicting outdoor adventures, foraging, and a deep connection to nature (Jørgensen-Vittersø, 2021 ). For example, with the re-opening of DNT [Den Norske Turistforening] cabins in mid-2020, Solberg in her post on June 11 emphasized the importance of being outdoors in fresh air:

We need to use our bodies and get out into the light and fresh air. It is important for both physical and mental health! I hope many have a good and active Norwegian holiday this year!

In these posts, Solberg also shared pictures of herself being outdoors. In such ways, Solberg appeared to be offering not only guidance for coping with the challenges and consequences of living during the pandemic, but also emphasizing one characteristic of the Norwegian culture, which they are proud of—spending time in nature. Be it advice to spend time in nature, or to keep social distance or self-isolation, we consider that Solberg’s approach to coping aligns with the frame function of ‘offering guidance’. During a crisis, leaders have a window of opportunity during which they can communicate a frame to not only make sense of the crisis but also to provide guidance and to portray themselves as attentive and concerned about the challenging circumstances faced by the public (Boin et al., 2016 ). By depicting herself as attuned to the emotions experienced by her followers during the pandemic and by utilising the moment to suggest ways of coping, Solberg’s communication encapsulates the frame function of offering guidance for a persuasive narrative.

Being in control amidst uncertainty

In her posts, Solberg presented a narrative of being in control amidst uncertainty, which aligns with two of the frame functions of Boin et al. ( 2016 ), namely offering a credible explanation and suggesting that leaders are in control. In times of a crisis, it is important that leaders do not downplay the gravity of the situation or claim unrealistically optimistic scenarios (Boin et al., 2016 ). We see that Solberg maintained a balance by providing a detailed explanation of her actions and the reasons behind the restrictive measures taken. At the same time, she acknowledged the uncertainty inherent in the ever-changing crisis and demonstrated her concern. According to Lunn et al. ( 2020 ), in situations characterised by uncertainty and fear, responsible leaders need to signal that they are in control of the situation, which can be demonstrated by making decisions with confidence and honesty. Moreover, it is also essential that leaders do not make promises that are impossible or unrealistic, because doing that can impede the persuasiveness of their narrative by affecting their credibility later (Boin et al., 2016 ). In Solberg’s posts, we see that she displays confidence but also the reality of uncertainty and concern, which is a sign of effective leadership and shows ‘bounded optimism’ (Brassey and Kruyt, 2020 ). The following post where she writes about her worries and concerns followed by advice is a good example of credibility and control:

I am worried. Right now, we have ongoing outbreaks in Bergen, Oslo, Trondheim and Hammerfest… We know that vigorous work is being done intensively in these municipalities with infection detection and other measures. Although Norway has relatively low infection rates, we also register here at home that the number of hospital admissions and the number of infected have increased recently. We now have the highest number of hospitalized patients with COVID-19 since May… We also see that the infection has begun to spread to older age groups. And there is a significant risk that the numbers will continue to rise as we see in Europe. That is why we have today announced new national austerity measures next week. We can still reverse the trend here at home…

A demonstration of concern from role models has been shown to have a role in persuading the public to adhere to recommendations (Simon and Mobekk, 2019 ). Tannenbaum et al. ( 2015 ) note that fear is easier to handle when it is acknowledged, which relates to the idea of ‘citizens being anxious enough to take the advice from the authorities to heart and optimistic enough as to feel that their actions make a difference’ (Petersen, 2020 ). Inculcating ‘optimistic anxiety’ (Tannenbaum et al., 2015 ) is therefore an important feature of crisis communication narratives.

Another important nuance that emerges from Solberg’s posts is her comparisons to other countries to draw attention to the seriousness of the situation. For example, on November 5, 2020, Solberg made the following post announcing new national measures, which received over 5000 likes:

My message to the Norwegian people is: Stay at home as much as possible. Have the least possible social contact with others. It is absolutely necessary to avoid a new shutdown. Norway is at the beginning of the second wave of infection… The virus is spreading rapidly and all counties now have outbreaks. The government is therefore introducing new national infection control measures… If the current rate of infection continues, the number of inpatients in intensive care units will increase sharply in the coming weeks. This will lead to less intensive capacity for other seriously ill people. We are now where the Netherlands was at the beginning of September. A very rapid increase in infection in the Netherlands quickly led to more patients in the intensive care unit… Other European countries have similar experiences. There is therefore a heavy seriousness about the situation. And we must take responsibility together

By giving detailed reasoning behind measures being taken amidst uncertainty, Solberg exhibits both confidence and honesty in her narratives (Lunn et al., 2020 ). Another key feature that emerges from the post above is the emphasis on the risks of an increase in infection, and the possibility of a new lockdown and overburdening of intensive care capacity, thereby reflecting a more strongly persuasive intent. Such emphasis on the risks is different from other posts where Solberg exhibits control and optimism much more strongly. This adaption from a communicative stance to a more persuasive one could result from not only the perceived severity of the situation, but also the perceived risks of pandemic fatigue. Pandemic fatigue has been defined by the WHO as a lack of motivation to adhere to recommended protective behaviours (WHO, 2020b ). According to surveys conducted in different countries, most people have been shown to possess adequate knowledge of COVID-19 and the precautions required to keep safe, yet factors like emotions and context have been found to have greater impact on behaviours than knowledge (Gavi the Vaccine Alliance, 2020 ). A study of different ways of communicating healthcare messages suggested that believability of the messages and the recipients’ reactions to them can be influenced by the persuasive intent (Wang and Shen, 2019 ). Koh et al. ( 2020 ) also discuss the importance of devising effective and successful communications for a sustained period without message fatigue setting in, which includes concern for the way the communication is framed. Overall, we see that Solberg’s posts provide a rationale with portrayal of the government being in control of managing the crisis.

Fostering hope and return to normalcy

Solberg’s posts also emphasized the hopeful aspects of the crisis by appealing to followers to look forward to a return to everyday life, and new educational and economic prospects, despite the difficult current circumstances. This theme aligns with the frame of ‘instilling hope’ as per frame functions for a persuasive narrative by Boin et al. ( 2016 ). During a crisis, more than ever, effective leaders embody the hopes and fears of the society under threat, and therefore they should strive to inculcate optimism of a better future (Boin et al., 2016 ). Previous research has documented that in times of turmoil, followers especially look up to leadership that serves as a beacon of hope for and faith in a positive future, more than they do in times of prosperity (Stam et al., 2018 ; Shamir et al., 1993 ). According to Boin et al., leadership during crisis always has a moral dimension. On January 10, 2021, by which time Norway had witnessed over 50000 cases of infection and over 400 deaths as well as the Gjerdrum disaster, Solberg made the following post:

Dear everyone. This year I hope we can take our dreams back. After a year of pandemic and fear. Then I look forward to seeing creativity unleashed…

Another post that emphasized the optimism for educational prospects was made on April 15, 2020, and drew over 5000 likes:

Today is the last deadline to apply to a vocational school, college or university. I understand that it can feel strange to apply for an education this autumn while the educational institutions keep their campuses closed. Maybe someone also thinks the idea of moving from home to a new city seems extra scary these days. To you I want to say that everyday life will return. Therefore, my appeal to you who want to study: do not put your life on hold, but apply for education this year!

Lessons from previous crises tell us that leaders need to pay attention to the fear of the ongoing threat, as well as sadness and grief, and to provide hope to mitigate social disruption (Maak et al., 2021 ). Here, we see that Solberg’s is attempting to convey hope while also acknowledging the challenges and impact of COVID-19. In doing so, the messages also emphasise self-efficacy and trust in the government. Hope and resilience are closely aligned constructs, as they both include a tendency towards maintaining an optimistic outlook in the face of adversity (Duggal et al., 2016 ). Thus, fostering hope during crisis can help the community cope with the consequences of the crisis. Moreover, by using emotional appeals, leaders can influence attitudes and behaviours as well as induce compassion (Ghio et al., 2020 ).

The theme of fostering hope in Solberg’s posts was found to be particularly emphasized during and before national holidays or important events. Her posts often utilised humour to foster positivity, particularly during critical periods such as during or after implementation of stricter COVID-19 measures. For example, a day after it was announced that infection-reduction measures would continue throughout Christmas, Solberg shared a snipped of her response to a question asked in a press conference and posted:

Can Santa actually come to visit this year?

Creating human moments and hope is a sign of compassionate leadership and helps to establish the relational foundation for widespread support for pandemic control measures (Maak et al., 2021 ). Also, by utilising humour, Solberg adapts the tone of her messages, a tactic that has been found to significantly affect audiences’ attitudes and behaviours, help people manage their emotions, and strengthen support for pandemic measures (Lee and Basnyat, 2013 )

Relating with followers

The last theme is about the posts in which Solberg relates to the public by providing personal information, acknowledging, and relating with the difficult circumstances, and using humour or a private tone in her posts. For example, the post below was made just before Easter and it received more than 13000 likes, making it to be the third-most liked post of Solberg related to COVID-19 during this period.

It will be a different Easter this year. Let’s make the best of it. We can play fun board games with our loved ones, read the book we never have time to read, listen to an audiobook or explore the local area. The last few weeks have been challenging for all of us, but we want to get through this… Sindre and I have recharged with board games and wish you all a very happy Easter!

Empathy is an important component of the persuasive narrative, especially during crises when the decisions made by authorities to mitigate, and control can also have consequences for people’s lives. For crisis communication to be effective, the information provided to the public should not be too factual or portray leaders as distant from the citizens (Shen, 2010 ; Lunn et al., 2020 ). By demonstrating concern and acknowledging the impact of crises, leaders can empathise with the public (Shen, 2010 ; Lunn et al., 2020 ). We see Solberg personifying the challenges of COVID-19 by referring to how the times have been challenging for ‘all of us’. According to Boin et al. ( 2016 ), a leader’s personification of suffering is instrumental in showing empathy because the public is then able to relate to them.

Further, previously in a study by Larsson ( 2015 ) about Norwegian party leaders on Facebook during the 2013 ‘short campaign’, it was found that personal content referencing private life is increasingly employed by Norwegian party leaders. Enli and Rosenberg ( 2018 ) investigated voters’ evaluations of politicians as authentic or ‘real,’ and Solberg was found to be one of the most perceived authentic politicians. Enli ( 2014 ) had earlier suggested that Erna Solberg’s public profile as predictable, anti-elitist and imperfect constructs her authenticity.

A similar example of relatability with followers during the pandemic was the instance when she forgot the rule of not shaking hands during public meetups and press conferences. After the event, she wrote:

It is important that we can have some humour in a difficult time Even a prime minister can forget, but now it is important that we all remember to follow the advice of the health authorities…

She also used an engaging communicative style when interacting with her followers:

Then the holiday is over… a different summer, a little cold, weekly meetings in the Government’s Corona Committee on video, beautiful nature experiences from Norway and a lot of rain. Let me share a wonderful little meeting with a lynx on the lawn on Varaldsøy… Have you had a nice summer?

Thus, Solberg embeds references to her private life, which also helps to personify the messages in her posts and thus relate with the public. In addition, by relating with the public on an everyday basis and through the acknowledgment of shared challenges during crisis, Solberg’s narrative also appears empathetic. Our theme of ‘Relating to the public’ thus encapsulates frame function of ‘showing empathy’ for developing a persuasive narrative, as per Boin et al. ( 2016 ).

Concluding remarks

This paper was an attempt to explore the Facebook posts of Norway’s Prime Minister Erna Solberg to highlight the key features of her crisis communication during the COVID-19 pandemic. By drawing on data from Solberg’s Facebook posts during the pandemic our analyses identified five major themes, (1) Promoting responsibility and togetherness (2) Coping (3) Being in control amidst uncertainty (4) Fostering hope and (5) Relating with the followers, where we went in detail explanation by using frame functions of a persuasive narrative by Boin et al. ( 2016 ). We furthermore discussed the specific Norwegian contextual nuances to the frame functions. These were the theme ‘Responsibilization and togetherness’, presented via the references to Norwegianness and the cultural concept and practice of dugnad . Hence, our paper showed how during crisis persuasive narratives are incorporated into the social media communication strategies of political leaders.

The paper also showed how persuasive narratives are delivered through praising the public’s efforts, promoting togetherness, caring about the public’s well-being, displaying optimism and confidence in the government’s measures. It elaborated on how crisis management on social media was done via the use of humour and personal information. Humour was used as a tool to engage with the public and help them relate and comply to the COVID-19 restrictions. Hence, Solberg used Facebook to capitalise on a wide-reaching social medium (Hallahan, 2010 ). While the communication of leaders during crises helps to fill the cognitive void, the use of social media helps build societal resilience by improving awareness and encouraging preparedness (Boin et al., 2016 )

Even so, the success of a persuasive narrative is to a great extent dependant on the credibility of its proponents (Boin et al., 2016 ). The reputation of the leader and the organisation that they represent plays a key role in framing a successful persuasive narrative. In general, Norwegians have more trust in each other and their institutions than most other countries (Skirbekk and Grimen, 2012 ). A survey conducted by the Norwegian Citizen’s Panel [Norsk Medborgerpanel] in March 2020 found that trust in government, in the health authorities, in parliament, and in national and local politicians had increased, as did trust in the Prime Minister during the pandemic (Dahl, 2020 ). Clearly, Solberg seems to have benefitted from the trust capital in Norwegian society with her Facebook communications during a crisis. More recently, Erna Solberg has received heavy criticism for breach of COVID-19 restrictions during a family trip to Geilo for her 60th birthday (The Guardian, 2021a ). Following which, Erna Solberg, has been investigated by police and fined (The Guardian, 2021b ). Thus, while her Facebook posts exhibiting components of a persuasive narrative received popularity, her actions have nevertheless been subjected to scrutiny and criticisms in mainstream media (Larsen, 2021 ). According to Boin et al. ( 2016 : p. 72), the retainment of confidence of the public is essential for the communication strategies to be effective. Therefore, such media criticism might undermine the credibility of Solberg and her cabinet, leading to less credible and politically ineffective narratives. On the other hand, past performances, and reputation also play an important role in increasing leaders’ personal credibility in the face of crisis (Boin et al., 2016 ). Consequently, Solberg’s long career in politics and her reputation of caring about the citizens as previously discussed, could buffer the recent impact on her credibility. Moreover, communication during and after a crisis affects long-term impressions (Coombs, 2007 ). With the personification of politics in Norway or ‘decentralising personalization’ (Balmas et al., 2014 ), the criticisms paved at Erna, however, reflect more of a personal crisis than a national crisis. And while we do not analyse Solberg’s posts beyond 9 th Feb. 2021 i.e., after Solberg spoke about the Geilo trip incident on her Facebook account, we see that she follows similar strategy in handling this personal crisis as the national crisis of COVID-19, through use of a persuasive narrative. Future studies can therefore focus on how Solberg and other political leaders utilise the strategy of persuasive narrative in management of personal crisis in nexus with national crisis such as that of COVID-19.

Further, we concur with Christensen and Lægreid ( 2020 ) who write that the ‘political leadership has succeeded well in connecting governance capacity and legitimacy using the argument that Norway had sufficient resources to deal with the crisis. While the health resource capacity and preparedness of Norway inarguably contributes to the outcomes of the crisis, communicating a successful persuasive narrative with credibility is integral to gaining legitimacy and filling the cognitive void (Boin et al., 2016 ). Erna Solberg’s use of persuasive narrative in Facebook posts, seems therefore to have been effective in the management of the COVID-19 pandemic, but her latest unfortunate incident goes to show how politicians’ management of crises is tenuous and highly dependent on public trust.

Our study adds to the significance and knowledge of how persuasive narratives are incorporated into the communication strategy of leaders on a social media platform and highlights the usefulness of this framework for studies about ongoing and future crises. By using data from social media, our findings also add to the understanding of the increased personification of politics and how leaders utilise this personification to communicate government measures and engage with the public during a crisis. Future research can further explore how public leaders and health authorities’ frame crises situations, actions, issues, and responsibility to dramatise and reinforce key ideas (Hallahan, 1999 ). Such insights can pave way for understanding public’s shaping of risk perceptions and compliance to behavioural measures during crises such as the COVID-19 pandemic.

Data availability

The dataset analysed during the current study is available through the public profile of Erna Solberg on Facebook: https://www.facebook.com/ernasolberg/ . This dataset was derived from Crowd Tangle which can be accessed through request at https://www.crowdtangle.com/ .

Known as ‘hyttetur’, cabin trips are deeply rooted in Norwegian culture and way of life

Crowdtangle extracts both historical and current data of post contents and metadata such as the date the post was made, number of likes, other reactions and shares. Information about how to access raw material included in this study can be found in the data availability statement at the end of the article.

‘Everything will be fine’ [ Alt blir bra ] was one of the campaigns that spread because of the COVID-19 crisis in Norway depicting pictures of a rainbow.

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This article is published as part of the research project ‘Fighting Pandemics with Enhanced Risk Communication: Messages, Compliance and Vulnerability During the COVID-19 Outbreak (PAN-FIGHT)’, which is financed by the Norwegian Research Council (Project number: 312767).

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Arora, S., Debesay, J. & Eslen-Ziya, H. Persuasive narrative during the COVID-19 pandemic: Norwegian Prime Minister Erna Solberg’s posts on Facebook. Humanit Soc Sci Commun 9 , 35 (2022). https://doi.org/10.1057/s41599-022-01051-5

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Guest Essay

The Fantasy of Reviving Nuclear Energy

A photo of two cooling towers at a decommissioned nuclear plant in California, surrounded by vineyards.

By Stephanie Cooke

Ms. Cooke is a former editor of Nuclear Intelligence Weekly and the author of “In Mortal Hands: A Cautionary History of the Nuclear Age.”

World leaders are not unaware of the nuclear industry’s long history of failing to deliver on its promises or of its weakening vital signs. Yet many continue to act as if a nuclear renaissance could be around the corner, even though nuclear energy’s share of global electricity generation has fallen by almost half from its high of roughly 17 percent in 1996.

In search of that revival, representatives from more than 30 countries gathered in Brussels in March at a nuclear summit hosted by the International Atomic Energy Agency and the Belgian government. Thirty-four nations, including the United States and China, agreed “to work to fully unlock the potential of nuclear energy,” including extending the lifetimes of existing reactors, building nuclear power plants and deploying advanced reactors.

Yet even as they did so, there was an acknowledgment of the difficulty of their undertaking. “Nuclear technology can play an important role in the clean energy transition,” Ursula von der Leyen, the president of the European Commission, told summit attendees. But she added that “the reality today, in most markets, is a reality of a slow but steady decline in market share” for nuclear power.

The numbers underscore that downturn. Solar and wind power together began outperforming nuclear power globally in 2021, and that trend continues as nuclear staggers along. Solar alone added more than 400 gigawatts of capacity worldwide last year, two-thirds more than the previous year. That’s more than the roughly 375 gigawatts of combined capacity of the world’s 415 nuclear reactors, which remained relatively unchanged last year. At the same time, investment in energy storage technology is rapidly accelerating. In 2023, BloombergNEF reported that investors for the first time put more money into stationary energy storage than they did into nuclear.

Still, the drumbeat for nuclear power has become pronounced. At the United Nations climate conference in Dubai in December, the Biden administration persuaded two dozen countries to pledge to triple their nuclear energy capacity by 2050. Those countries included allies of the United States with troubled nuclear programs, most notably France , Britain , Japan and South Korea , whose nuclear bureaucracies will be propped up by the declaration as well as the domestic nuclear industries they are trying to save.

“We are not making the argument to anybody that this is absolutely going to be a sweeping alternative to every other energy source,” John Kerry, the Biden administration climate envoy at the time, said. “But we know because the science and the reality of facts and evidence tell us that you can’t get to net zero 2050 without some nuclear.”

That view has gained traction with energy planners in Eastern Europe who see nuclear as a means of replacing coal, and several countries — including Canada, Sweden, Britain and France — are pushing to extend the operating lifetimes of existing nuclear plants or build additional ones. Some see smaller or more advanced reactors as a means of providing electricity in remote areas or as a means of decarbonizing sectors such as heat, industry and transportation.

So far, most of this remains in early stages, with only three nuclear reactors under construction in Western Europe, two in Britain and one in France, each more than a decade behind schedule. Of the approximately 54 other reactors under construction worldwide as of March, 23 are in China, seven are in India, and three are in Russia, according to the International Atomic Energy Agency. The total is less than a quarter of the 234 reactors under construction in the peak year of 1979, although 48 of those were later suspended or abandoned.

Even if you agree with Mr. Kerry’s argument, and many energy experts do not, pledging to triple nuclear capacity by 2050 is a little like promising to win the lottery. For the United States, it would mean adding 200 gigawatts of nuclear operating capacity (almost double what the country has ever built) to the current 100 gigawatts or so, generated by more than 90 commercial reactors that have been running an average of 42 years. Globally it would mean tripling the existing capacity built over the past 70 years in less than half that time, in addition to replacing reactors that will shut down before 2050.

The Energy Department estimates the total cost of such an effort in the United States at roughly $700 billion. But David Schlissel , a director at the Institute for Energy Economics and Financial Analysis , has calculated that the two new reactors at the Vogtle plant in Georgia — the only new reactors built in the United States in a generation — on average, cost $21.2 billion per gigawatt in today’s dollars. Using that figure as a yardstick, the cost of building 200 gigawatts of new capacity would be far higher: at least $4 trillion, or $6 trillion if you count the additional cost of replacing existing reactors as they age out.

For much less money and in less time, the world could reduce greenhouse gas emissions through the use of renewables like solar, wind, hydropower and geothermal power and by transmitting, storing and using electricity more efficiently. A recent analysis by the German Environment Agency examined multiple global climate scenarios in which Paris climate agreement targets are met, and it found that renewable energy “is the crucial and primary driver.”

The logic of this approach was attested to at the climate meeting in Dubai, where more than 120 countries signed a more realistic commitment to triple renewable energy capacity by 2030.

There’s a certain inevitability about the U.S. Energy Department’s latest push for more nuclear energy. An agency predecessor, the Atomic Energy Commission, brought us Atoms for Peace under President Dwight Eisenhower in the 1950s in a bid to develop the peaceful side of the atom, hoping it would gain public acceptance of an expanding arsenal of nuclear weapons while supplying electricity too cheap to meter.

Fast-forward 70 years, and you hear a variation on the same theme. Most notably, Ernest Moniz, the energy secretary under President Barack Obama, argues that a vibrant commercial nuclear sector is necessary to sustain U.S. influence in nuclear weapons nonproliferation efforts and global strategic stability. As a policy driver, this argument might explain in part why the government continues to push nuclear power as a climate solution, despite its enormous cost and lengthy delivery time.

China and Russia are conspicuously absent from the list of signatories to the Dubai pledge to triple nuclear power, although China signed the declaration in Brussels. China’s nuclear program is growing faster than that of any other country, and Russia dominates the global export market for reactors with projects in countries new to commercial nuclear energy, such as Turkey, Egypt and Bangladesh, as well as Iran.

Pledges and declarations on a global stage allow world leaders a platform to be seen to be doing something to address climate change, even if, as is the case with nuclear, they lack the financing and infrastructure to succeed. But their support most likely means that substantial sums of money — much of it from taxpayers and ratepayers — will be wasted on perpetuating the fantasy that nuclear energy will make a difference in a meaningful time frame to slow global warming.

The U.S. government is already poised to spend billions of dollars building small modular and advanced reactors and keeping aging large ones running. But two such small reactor projects based on conventional technologies have already failed. Which raises the question: Will future projects based on far more complex technologies be more viable? Money for such projects — provided mainly under the Infrastructure Investment and Jobs Act and the Inflation Reduction Act — could be redirected in ways that do more for the climate and do it faster, particularly if planned new nuclear projects fail to materialize.

There is already enough potential generation capacity in the United States seeking access to the grid to come close to achieving President Biden’s 2035 goal of a zero-carbon electricity sector, and 95 percent of it is solar, battery storage and wind. But these projects face a hugely constrained transmission system, regulatory and financial roadblocks and entrenched utility interests, enough to prevent many of them from ever providing electricity, according to a report released last year by the Lawrence Berkeley National Laboratory.

Even so, existing transmission capacity can be doubled by retrofitting transmission lines with advanced conductors, which would offer at least a partial way out of the gridlock for renewables, in addition to storage, localized distribution and improved management of supply and demand.

What’s missing are leaders willing to buck their own powerful nuclear bureaucracies and choose paths that are far cheaper, less dangerous and quicker to deploy. Without them, we are doomed to more promises and wasteful spending by nuclear proponents who have repeatedly shown that they can talk but can’t deliver.

Stephanie Cooke is a former editor of Nuclear Intelligence Weekly and the author of “In Mortal Hands: A Cautionary History of the Nuclear Age.”

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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