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In Their Own Words, Americans Describe the Struggles and Silver Linings of the COVID-19 Pandemic

The outbreak has dramatically changed americans’ lives and relationships over the past year. we asked people to tell us about their experiences – good and bad – in living through this moment in history..

Pew Research Center has been asking survey questions over the past year about Americans’ views and reactions to the COVID-19 pandemic. In August, we gave the public a chance to tell us in their own words how the pandemic has affected them in their personal lives. We wanted to let them tell us how their lives have become more difficult or challenging, and we also asked about any unexpectedly positive events that might have happened during that time.

The vast majority of Americans (89%) mentioned at least one negative change in their own lives, while a smaller share (though still a 73% majority) mentioned at least one unexpected upside. Most have experienced these negative impacts and silver linings simultaneously: Two-thirds (67%) of Americans mentioned at least one negative and at least one positive change since the pandemic began.

For this analysis, we surveyed 9,220 U.S. adults between Aug. 31-Sept. 7, 2020. Everyone who completed the survey is a member of Pew Research Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories.  Read more about the ATP’s methodology . 

Respondents to the survey were asked to describe in their own words how their lives have been difficult or challenging since the beginning of the coronavirus outbreak, and to describe any positive aspects of the situation they have personally experienced as well. Overall, 84% of respondents provided an answer to one or both of the questions. The Center then categorized a random sample of 4,071 of their answers using a combination of in-house human coders, Amazon’s Mechanical Turk service and keyword-based pattern matching. The full methodology  and questions used in this analysis can be found here.

In many ways, the negatives clearly outweigh the positives – an unsurprising reaction to a pandemic that had killed  more than 180,000 Americans  at the time the survey was conducted. Across every major aspect of life mentioned in these responses, a larger share mentioned a negative impact than mentioned an unexpected upside. Americans also described the negative aspects of the pandemic in greater detail: On average, negative responses were longer than positive ones (27 vs. 19 words). But for all the difficulties and challenges of the pandemic, a majority of Americans were able to think of at least one silver lining. 

Both the negative and positive impacts described in these responses cover many aspects of life, none of which were mentioned by a majority of Americans. Instead, the responses reveal a pandemic that has affected Americans’ lives in a variety of ways, of which there is no “typical” experience. Indeed, not all groups seem to have experienced the pandemic equally. For instance, younger and more educated Americans were more likely to mention silver linings, while women were more likely than men to mention challenges or difficulties.

Here are some direct quotes that reveal how Americans are processing the new reality that has upended life across the country.

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The Pandemic's Effects on Everyday Life

Boston College researchers are exploring COVID-19's impact on life as we know it. Here’s a look at just some of the important questions they’re asking—and answering.

Is remote work here to stay?

As many as 60 percent of U.S. employees are estimated to have worked remotely at some point during the pandemic, a shift that could lead to “profound transformations in mindsets around work and life as we know it,” said Assistant Professor of Sociology Wen Fan. In a project funded by the National Science Foundation, Fan is exploring the changing nature of work and remote workers’ experiences and preferences, as well as disparities in remote-working conditions and work-family balance by gender, socioeconomic status, and race/ethnicity, which could inform social policies moving forward. Though the team has just begun analyzing the data, Fan says one respondent’s thoughts—“It’s a fickle thing, sometimes you love it, sometimes you hate it”— captures the overall sentiment so far.

Are kids now spending too much time with screens?

When schools and daycares closed abruptly, kids began spending much more time engaged with cell phones and computers.“Screens are the babysitter of last resort,” said BC psychologist Joshua Hartshorne, coauthor of the study “Screen Time as an Index of Family Distress.” Whereas lower screen-time rates before the pandemic were thought to be a function of well- informed parenting, it’s now clear that they were also due to well-resourced parenting, he said. The next phase of the project, funded by the National Science Foundation, will examine whether screen time is actually problematic for child development.

Can we safely reuse PPE?

The pandemic revealed a severe national shortage of personal protective equipment (PPE). So when the CDC made the unprecedented recommendation to reuse N95 respirators, a team from the Connell School’s new Doctor of Nursing Practice program— Jacqueline Sly, Beth McNutt-Clarke, Nanci Haze, and Allan Thomas—created a three-minute YouTube video and guide illustrating how to don, doff, store, and then redon the masks. Their materials are now part of clinical orientation for nursing students, and the team also shared their guidelines and experiences training their colleagues in them in American Nurse and Nursing Management .

What does science say about masks?

Masks are the most important public-health tool for containing the pandemic, according to BC Law School Associate Professor Dean Hashimoto. His new book,  The Case for Masks , presents situations in which wearing (or not wearing) face coverings directly affected how many people got sick. One case study focuses on the Mass General Brigham healthcare network, where Hashimoto is the chief medical officer for occupational health services. When the network required patients and 78,000 employees at its hospitals to mask up last March, there was a linear decline in COVID-19 cases among healthcare workers.

Has language development been affected?

For kids, the pandemic has meant time away from school and friends. To find out if this would affect language development, BC psychologist Joshua Hartshorne and a University of Maryland colleague created the KidTalk app ( kidtalkscrapbook.org ), a tool that allows parents to record conversations and track their children’s speech development. The data could be used by policymakers to support families after the pandemic. “The more we understand how this affects children,” Hartshorne said, “the better we can plan.”

What happens when the earth goes quiet?

There’s been much less human activity during the pandemic lockdowns—so much so that scientists recorded a drop of up to 50 percent in human-induced seismic vibrations of the earth beneath us in early 2020. Associate Professor of Earth and Environmental Sciences Alan Kafka was one of seventy-six scientists from two dozen countries who reported these results in  Science . “It is culturally quieter, so we can explore the finer details of natural seismic phenomena that might otherwise be hidden,” said Kafka, who shared data from BC’s Weston Observatory, as well as from two seismometers on campus.

For more pandemic-related research from across Boston College, see sites.bc.edu/responding-to-covid-19 .

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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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National Statistical

News and insight from the office for national statistics, exploring the changing impact of covid-19 on our lives.

• September 3, 2021

In March 2020, as the nation was urged to stay at home and only to leave for essential reasons, our lives were turned upside down.  At the ONS, most staff moved to homeworking, and those of us with children found ourselves, in common with millions of others, trying to combine childcare and home-schooling with working in new ways.  Here Tim Vizard looks back over the impact we’ve seen the pandemic having on people’s lives.

The word ‘unprecedented’ has been over-used to describe the past 18 months, but that was the position the ONS found itself in last March when the UK Government tasked us with providing real time statistics to understand how adults in Great Britain were coping as circumstances changed.

In a matter of days, we adapted our Opinions and Lifestyle survey to provide robust weekly estimates of the impacts living with COVID-19 were having on people’s daily lives.  Since March 2020, over 200,000 adults have taken part in our survey across Great Britain and to date, we have published weekly reports reflecting how people were feeling, and the evolving challenges they were facing.

Early priorities were to establish whether people understood how to protect themselves from the virus and if they were taking measures to do so, such as handwashing with soap and water. During these early days, wearing face coverings were not on the agenda in those first surveys of March and April 2020s.

TV and social media were playing important roles in providing information and it was clear that people were taking the coronavirus seriously, with 86% of adults worried that they or someone in their family would be infected. Despite this, many people were rallying round to help each other: 84% of people aged 70+ said someone had offered to organise or deliver food and essential items if they needed to self-isolate.

Yet in those early weeks of the first lockdown, half of adults thought life would return to normal within 6 months.  Last week, just 16% felt life would return to normal within 6 months, with “over a year” the view of 28% of adults.

The extent to which we have learned to “live with COVID” is seen in responses over time. Support for, and compliance with, protective measures such as hand-washing and wearing face coverings have remained high throughout.

People’s behaviour in each weekly report has reflected changing circumstances and the regulations in place over the past 18 months, from moves towards outdoor socialising and going to cafes and restaurants last summer to the growing restrictions towards the year’s end and then into early 2021.

Over time, worry about the impact of COVID-19 on our lives has fallen from 86% back in March 2020 to 48% at the end of August 2021.  We’ve been able to track the numbers of adults working from home and travelling to work throughout the pandemic, and provided insights into how many adults who would like to continue some form of hybrid working in the future. As young people are returning to schools and colleges, we’ve seen how concerned parents were about the effect that home-schooling had on their children’s wellbeing and the strain it placed on adults too.

Nevertheless, nearly half of adults are still ‘very or somewhat worried’ about the impacts of COVID-19.  Personal wellbeing across all measures is still worse than pre-pandemic. Seeing the nation’s wellbeing in real time have brought home the impact the pandemic has had on levels of anxiety in the population, particularly at the start of 2021. In the first three months of this year , more than one in five adults were experiencing some form of depression: double the rate found before the pandemic.

At the end of 2020, we also started watched with interest the roll out of COVID-19 vaccinations. We’ve seen people become increasingly positive about the COVID-19 vaccines, with 96% of adults saying they having already had it or would be likely if offered. Most recently, 94% of people who have received two doses of a COVID-19 vaccine said they would be very or fairly likely to have a booster vaccine if offered .

As someone who has worked on this survey since the start of 2020, I have found each week’s results fascinating, often resonating with my own experience and that of my colleagues. Delivering weekly results has required a hugely dedicated team across ONS, working long hours to provide timely estimates to our colleagues across Government.  As we move to a fortnightly survey, with the next results published on 10 September, we will continue to explore the impacts, old and new, that COVID-19 is having on our lives.  The fortnightly survey will give our participants more time to respond, and us more time to reflect on findings and incorporate new issues into the survey as life continues to change.

If you are one of the 200,000 people who have taken part in the survey – or any of the others we are conducting – I’d like to say thank you on behalf of all of us at ONS. Your responses have been hugely important in understanding the wide reaching impacts of COVID-19 has had on our lives.

Tim Vizard, Policy Evidence and Analysis Team at the ONS.

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Open Access

Peer-reviewed

Research Article

Impact of COVID-19 on health-related quality of life in the general population: A systematic review and meta-analysis

Roles Conceptualization, Data curation, Formal analysis, Methodology, Supervision, Writing – original draft

* E-mail: [email protected]

Affiliations Departement of Research & Innovation, Mont Kenya University, Thika, Kenya, Department of Health Systems Management, School of Health Sciences, Nairobi Campus, Kenya Methodist University (KeMU), Meru, Kenya, College of Doctoral Studies, Grand Canyon University, Phoenix, Arizona, United States of America

Roles Conceptualization, Data curation, Methodology, Writing – review & editing

Affiliation Department of Community Health & Behavioral Sciences, School of Medicine, Masinde Muliro University of Science & Technology, Kakamega, Kenya

Roles Data curation, Methodology, Writing – review & editing

Affiliation Departement of Research & Innovation, Mont Kenya University, Thika, Kenya

Roles Formal analysis, Methodology, Writing – review & editing

Roles Methodology, Writing – review & editing

Affiliation Department of Environmental Health, Colleges of Health Sciences, Jumeira University, Dubai, The United Arab Emirates

Affiliation Department of Dermatology, International Hospital Kampala, Kampala, Uganda

• Desire Aime Nshimirimana, 
• Donald Kokonya, 
• Jesse Gitaka, 
• Bernard Wesonga, 
• Japheth Nzioki Mativo, 
• Jean Marie Vianey Rukanikigitero

• Published: October 26, 2023
• https://doi.org/10.1371/journal.pgph.0002137
• Peer Review
• Reader Comments

The World Health Organization declared coronavirus disease of 2019 as an epidemic and public health emergency of international concern on January 30 th , 2020. Different factors during a pandemic can contribute to low quality of life in the general population. Quality of life is considered multidimensional and subjective and is assessed by using patient reported outcome measures. The aim and objective of this review is to assess the impact of coronavirus disease of 2019 and associated factors on the Quality of Life in the general population. This review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A protocol was registered in the international Prospective Register of Systematic Reviews database(CRD42021269897). A comprehensive electronic search in PubMed, EBSCO Host Research Databases, MEDLINE and Google scholar search engine was conducted. A total number of 1,7000,074 articles were identified from electronic search. 25 full text articles were retained for qualitative synthesis and seventeen articles for quantitative analysis. Seven main quality of life scales were used to assess the quality of life of the general population; World Health Organization Quality of Life-bref, EuroQuality of Life-Five dimensions, Short Form, European Quality of Life Survey, coronavirus disease of 2019 Quality of Life, General Health Questionnaire12 and My Life Today Questionnaire. The mean World Health Organization Quality of Life-brief was found to be 53.38% 95% confidence interval [38.50–68.27] and EuroQuality of Life-Five dimensions was 0.89 95% confidence interval [0.69–1.07]. Several factors have been linked to the Coronavirus disease of 2019 such as sociodemographic factors, peoples living with chronic diseases, confinement and financial constraints. This review confirms that the Coronavirus disease of 2019 pandemic affected the quality of life of the general population worldwide. Several factors such as sociodemographic, peoples living with chronic diseases, confinement and financial constraints affected the quality of life.

Citation: Nshimirimana DA, Kokonya D, Gitaka J, Wesonga B, Mativo JN, Rukanikigitero JMV (2023) Impact of COVID-19 on health-related quality of life in the general population: A systematic review and meta-analysis. PLOS Glob Public Health 3(10): e0002137. https://doi.org/10.1371/journal.pgph.0002137

Editor: Anil Gumber, Sheffield Hallam University, UNITED KINGDOM

Received: April 21, 2023; Accepted: October 3, 2023; Published: October 26, 2023

Copyright: © 2023 Nshimirimana et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: A protocol was registered in the international Prospective Register of Systematic Reviews database (PROSPERO) registration number (CRD42021269897).

Funding: The authors received no specific funding for this work.

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

The World Health Organization (WHO) declared coronavirus disease of 2019 (COVID-19) an epidemic and public health emergency of international concern on January 30 th , 2020. The virus is known to have originated from Wuhan City, Hubei Province, China in December 2019. COVID-19 drew global attention due to rapid increase in the numbers reported both in China and internationally within shortest period [ 1 ]. By February 20 th , 2020, the number of contaminated COVID-19 cases in China reached a cumulative total of 75,465 cases and it had already spread to more than 25 countries among them Germany, Italy, France, Japan, Malaysia, Singapore, South Korea, Spain, Thailand, Vietnam, the United Arab Emirates, the United Kingdom (UK), the United States of America (USA) and Africa [ 2 ]. According to WHO (2021), a total of 190,597,409 confirmed cases of COVID-19, among them 4,093,145 deaths and only 3,430,051,539 vaccine doses have already been administered worldwide by 18 th July 2021. Psychological conditions such as depression, anxiety and stress can contribute to the deterioration of quality of life (QoL) of populations. A Spanish study assessed the impact of COVID-19 on mental health and find that the most prevalent mental disorders were anxiety, sleep and affective disorders as well as depression with a considerable increase in suicidal behavior among women and men over 70 years old [ 3 ]. A national study in France reported a burnout of 55% during COVID-19 pandemic and he also find out that there was a strong link between the severity of the burnout syndrome, QoL and the impact of COVID-19 pandemic [ 2 , 4 ]. Health related quality of life (HRQoL) is considered multidimensional and subjective and is assessed by patients using patient reported outcome measures (PROMs). According to WHO, HRQoL is defined as the general perception of individuals of their position in life (i) considering, the culture and value systems and (ii) in relation to expectations, goals, standards, and concerns [ 4 ]. HRQoL considers a wide-ranging concept influenced in a complex and interconnected manner by the psychological state, physical health, personal beliefs, social relationships and relationship to prominent features of the environment [ 5 ]. A systematic review discussed the impact of COVID-19 on the HRQoL on children and adolescents. Their results showed that lockdown significantly affected QoL, happiness and optimism (p < 0.001), as well as perceived stress. In their findings, the authors reported that only 15.3% (n = 146) of children and adolescents had low QoL before COVID-19 outbreak and during the pandemic, 40.2% of them reported low QoL [ 6 ]. A study conducted in the Kingdom of Saudi Arabia [ 7 ] assessed the QoL during COVID-19 in the general population and reported that being male (OR = 1.96; 95% CI = [1.31–2.94]), aged between 26 to 35 years (OR = 5.1; 95% CI = [1.33–19.37]), non-Saudi participants (OR = 1.69; 95% CI = [1.06–2.57]), individuals with chronic diseases (OR = 2.15; 95% CI = [1.33–3.48]), loss of job (OR = 2.18; 95% CI = [1.04–4.57]) and participants with depression (OR = 5.70; 95% CI = [3.59–9.05]), anxiety (OR = 5.47; 95% CI = [3.38–8.84]) and stress (OR = 6.55; 95% CI = [4.01–10.70]) were at a high risk of having lower levels of QoL during COVID-19 pandemic and lockdown period [ 7 ]. Swedish authors assessed the changes of QoL of the Swedish population using data of February and April 2020 and reported that on visual analogue scale (VAS), the mean QoL reduced from 77.1(SD:17.7) in February to 68.7(SD:68.7) in April 2020, a reduction of 8.4% pre and post pandemic measurements (P<0.000) [ 8 ]. In 2021, authors compared the QoL of Brazilian dietitians before (3.83 ± 0.59) and during COVID-19 pandemic (3.36 ± 0.66) and find that the results were statistically different [ 9 ]. To the best of our knowledge, this is one of the first systematic reviews to assess the impact of COVID-19 on HRQoL in the general population. The aim and objective of this systematic review is to assess the impact of COVID-19 and associated factors to Health Related Quality of Life in the general population.

Design and protocol

This systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)( Fig 1 ) [ 10 ]. A protocol was registered in the international Prospective Register of Systematic Reviews database (PROSPERO) with the registration number CRD42021269897.

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https://doi.org/10.1371/journal.pgph.0002137.g001

Eligibility

Articles were included if they were (i) primary and empirical, quantitative, cross-sectional, cohort, case-control, peer reviewed, assessing effects of COVID-19 on the quality of life during COVID-19 in the general population, utilized validated scales for measurement, published in English language from inception to June 30 th , 2022. Articles were excluded if (ii) focusing on subgroups of populations such as health care workers, population with previous mental health, population with cancer, HIV or any other chronic disease, utilized secondary data and non-empirical, non-peer review, review articles such as scoping, narrative or Systematic reviews, papers on Medrxiv and SSRN server, comments, letters, conference abstracts, books and book chapters, articles not assessing the quality of life, papers on the population with previous mental health or papers not assessing quality of life in the general population during COVID-19 pandemic. There was no limit on the number of papers to synthetize. All articles satisfied the eligibility criteria were included. Grey literature was used only to support the background section of the research ( Table 1 ).

https://doi.org/10.1371/journal.pgph.0002137.t001

Search strategy and selection

A comprehensive electronic search in the PubMed, EBSCO Host Research Databases (Academic Research Complete), MEDLINE (OVID) and Google scholar search engine was conducted from January 5 th , 2022 to February 28 th , 2022 and updated on June 30 th , 2022. The search strategy and data extraction were designed by DAN, DK and JG using Medical Subject Headings (MeSH), field tags and relevant keywords related to quality of life, COVID-19 and general population. Boolean operators, thesaurus, truncation, nesting and quotation marks were used to strengthen the search. The full search strategy was provided in supplementary documents. Additional search of the references from retrieved systematic reviews through snow balling was performed. All retrieved papers were downloaded and saved to Mendeley for intext citations and referencing. The following was used as search string for PubMed; “("Quality of Life"[Mesh] OR “quality of life” [tw] OR “Health-related Quality of Life” [tw] OR HRQoL[tw]) AND ("COVID-19"[Mesh] OR COVID-19[tw] OR “SARS-CoV-2” [tw] OR Sars-cov-2[tw] OR Coronavirus[tw] OR SARS OR “Coronavirus disease 2019” [tw] OR “severe acute respiratory syndrome coronavirus 2” [tw] OR “2019-nCoV Infection” [tw] OR 2019-nCoV[tw] OR “COVID-19 Virus Disease” [tw]) AND (Population[Mesh] OR “general population”[tw] OR “general public”[tw] OR public[tw] OR communit*[tw]).

Data extraction technique

A standardized data collection tool to extract relevant information from papers was designed. The following data was collected; authors, country of publication, study design, sample size, demographic characteristics, HRQoL before COVID-19, HRQoL during COVID-19, QoL measurement tool, statistical tests and risk factors as well as their odds ratios (OR). Data was extracted by two authors (DAN & BW) and verified by the second author (JNM). Discrepancies were resolved by the 3 rd author (JG).

Quality appraisal

Two authors (DAN and JG) independently assessed the quality of the included papers using a modified Newcastle-Ottawa Scale (NOS) modified for cross-sectional studies. The quality criteria used in cross-sectional studies were: sample representation, sample size, response rate and validated measurement tools with appropriate cut-off points and the control of confounding variables or use of multiple regression. The quality score ranged between 0 and 5 and any study scoring > or = 3 was considered as high and any study scoring < 3 was considered to be at low quality.

Main outcome

Health related quality of life (HRQoL).

Measures of effect

Health related quality of life measurements such as means of EQ5D and WHOQoL-BREF and their standard deviations were calculated.

Heterogeneity and risk of bias assessment of included studies

Qualitative synthesis and quantitative analysis

Data was summarized following the “Institute of Medicine committee on the standards for systematic reviews of comparative effectiveness research: Finding out what works in health care; standards for systematic reviews: recommended standards for qualitative synthesis” [ 19 ] and the key characteristics of included studies if similar were grouped, synthetized qualitatively and discussed in order to draw conclusions. The mean effect size was performed and pooled for both EQ5D and WHOQoL_BREF using Random effect model. In meta-analysis, they are two classes of models; fixed and random effect models. For fixed-effect model, all studies are assumed that population effect sizes are the same and are appropriate for drawing inferences on the studies included in the meta-analysis whereas random-effect model attempt to generalize the findings beyond included studies and assume that the selected studies are random samples from a larger population. According to Dettori et al. (2022), the observed effect size is a combination of the study-specific effect and the sampling error [ 20 ]. The model is: Yi = B random+Ui+ei, where B random is the average of the true effect sizes, Ui addition of random effect, ei = error. Homogeneity of effect sizes, that is τ2 = 0 can be tested by chi-square statistic which is Q statistic. The τ2 can be used to estimate the degree of heterogeneity. τ2 also depends on the type of effect size used and the common one is I2. I2 is interpreted as the proportion of between-study heterogeneity to the total variation (between–study heterogeneity plus sampling error). When I2 is negative, it is truncated to zero. I2 of 25, 50 and 75% is considered low, moderate and high heterogeneity respectively as a rule of thumb [ 21 ]. When conducting a random effect model, it is required to estimate the amount of heterogeneity. The most widely used heterogeneity estimator in medical science is DerSimonian and Laid. Other estimators such as maximum likelihood and restricted maximum likelihood may also be used.

A total number of 1,700,074 articles were identified from electronic databases on PubMed (1,334,241), Medline (OVID) (365,401), EBSCO (Host Research Databases (Academic Research Complete)) (425) and manual search with Google scholar search engine (5). 121,211 duplicates and 1,578,317 papers not related to quality of life were removed and 546 papers were retained. 461 full text papers and abstracts were removed to retain 85 full articles for screening. Finally, 25 full text articles were included for quality synthesis. 8 full articles were excluded because there were no papers with similar instruments to compare and 17 studies were included for quantitative analysis (PRISMA) ( Fig 1 ).

Characteristics of included studies

The total sample size of included studies was N = 22,967 participants and ranges from 225 to 3,002 participants per study. The majority (64.85%) were female (n = 14,894). 3 studies were done in China [ 22 – 24 ], 2 Morocco [ 25 , 26 ], 2 Vietnam [ 27 , 28 ], 2 Italy [ 29 , 30 ], 1 Saudi Arabia [ 7 ], 1 Malaysia [ 31 , 32 ], 1 Jordan [ 33 ], 1 Philippines [ 34 ], 1 Hong Kong [ 35 ], 1 Portugal [ 36 ], 1 Israel [ 37 ], 1 Spain [ 38 ], 1 Brazil [ 39 ], 1 Scotland [ 40 ], 1 USA [ 41 ], 1 Egypt [ 42 ], 1 study done in two countries Belgium and Netherlands [ 43 ] and one in Africa, North America, Asia, Australia, Europe, South America [ 44 ]. Nine articles used the WHOQoL-BREF tool to measure the quality of life in their respective countries [ 7 , 30 – 33 , 35 , 37 , 39 , 41 ], six papers utilized the EQ-5D [ 22 , 25 , 27 , 28 , 36 , 43 ], three used SF12/SF-8/ SF36 [ 24 , 26 , 38 ], one utilized EQLS [ 40 ], one used GH12 [ 29 ], one utilized the COVID-19 QoL questionnaire [ 44 ], on used the COVID-19 (COV19- Impact on the quality of life (COV19-QoL) scale) [ 42 ] and one utilized MLT [ 34 ]. The majority of the studies (n = 23) were of cross-sectional design and only one [ 40 ] was of a mixed method. Nine studies utilized the WHOQoL-BREF [ 7 , 30 – 33 , 35 , 37 , 39 , 41 ], nine utilized the EQ-5D [ 22 , 25 , 27 , 28 , 36 , 40 , 43 ] among them two studies compared and reported QoL scores before and during COVID-19 [ 25 , 36 ], three articles utilized the SF12/SF-8/SF36 [ 24 , 26 , 38 ] one article utilized EQLS [ 40 ], one paper used GH12 [ 29 ]. Another one assessed the HRQoL using COVID-19 QoL questionnaire [ 44 ] and one article used MLT [ 34 ] to assess HRQoL in general population ( Table 2 ).

https://doi.org/10.1371/journal.pgph.0002137.t002

Measurement tools

The most used instruments in this study (WHOoQoL and EQ5D) are explained below and a brief description of their normal values for unaffected populations are given at the beginning of each reported instrument. Eight (n = 8) scales have been used to assess health related quality of life on the general population worldwide during COVID-19. EQ-5D: Euro_QoL-Five dimensions; is a preference and generic quality of life instrument to valuate and describe health related quality of life; the higher the index, the better the health. It describes health in terms of five dimensions; mobility, self-care, usual activities, pain/discomfort and anxiety/depression [ 45 ]. A utility score can be generated from the five dimensions based on a published algorithm with a value of 0 for death and 1 for perfect health. WHO_OoL-BREF: the WHO_BREF is a 26-item instrument with four domains: physical health (7 items), psychological health (6 items), social relationships (3 items), and environmental health (8 items) [ 46 ]. It is scored from 1 to 5 on a response scale but transformed linearly to a 0 to 100 scale. 0 point represent the worse possible health state while 100 points represent the best possible health state. SF12: Short form are generic health survey short-forms (don’t use preference based approach) to assess quality of life which are used in research and clinical practice, health policy and general surveys [ 47 ]. EQLS: European Quality of Life Survey is a 2012 scale which considers the following dimensions; employment and work-life balance, family and social life, health and public services, home and local environment, quality of society, social exclusion and community involvement, standard of living and deprivation, subjective well-being which is designed for the general population[ 48 ]. GHQ: General Health Questionnaire is a measure of current mental health and since its development by Goldberg in the 1970s it has been extensively used in different settings and different cultures [ 49 ]. COV19-QoL is a 6-item scale covering main areas of quality of life in relation to mental health. The first item covers patients’ feelings about the impact of the current pandemic on their quality of life in general population. The second and third include the participants’ perceptions of possible mental and physical health deterioration. COV19-QoL scale is a recently developed specific reliable and valid tool assessing perceptions of deterioration in QoL as a result of the COVID-19 pandemic [ 42 ]. MLT: My Life Today the 9-tem (4) scale was used to measure the participants’ perceptions of various life domains, including the assessment of life in general population [ 34 ].

Quality of life before and during COVID-19

Among 25 articles reporting changes in QoL, 23 reported the mean QoL only during COVID-19 and did not report the QoL before COVID-19. Nine papers [ 22 , 25 , 27 , 28 , 36 , 40 , 43 ] utilized EQ5D among them only two reported both QoL before COVID-19 as compared to that of during COVID-19 [ 25 , 36 ] using EQ5D instrument. Azizi et al. (2020) in Morocco reported an EQ5D mean score before COVID-19 of 0.91(SD: NR) and 0.86 (SD: NR) during the pandemic. This makes a drop of 0.05 on QoL. Ferreira et al. (2021) in Portugal also reported an EQ5D mean score before COVID-19 of 0.887 (SD: NR) and 0.861 (SD: NR) during COVID-19 making a drop of 0.026 of QoL. Using EQ5D, the minimum score reported during COVID-19 was 0.79 (SD: 0.17–1.41) and a maximum of 0.95 (SD:.14–1.76) with a mean score 0.89 (SD: 0.66–1.13). Among papers reporting QoL using WHOQoL, no study reported both scores (before and after) and the WHOQoL minimum score reported during COVID-19 was 13.20 (SD: 9.85, 16.55) with a maximum of 73.50 (SD:66.14, 80.86). The mean reported was 53.38 (SD:38.50, 68.27). The lower the score, the lower the QoL. The rest of quality of life instruments were used at least once making it not practical to report their means for a comparison.

Forest plot WHO_BREF

Study1 [ 7 ], study2 [ 31 ], Study3 [ 33 ], Study4 [ 35 ], Study5 [ 7 ], Study6 [ 37 ], Study 7 [ 32 ], Study8 [ 41 ], study 9 [ 50 ]. The mean health related quality of life using WHOQoL_BREF is estimated at 53.38.

https://doi.org/10.1371/journal.pgph.0002137.g002

Forest plot EQ5D

Study 1 [ 25 ], Study2 [ 43 ], Study3 [ 43 ], Study4 [ 22 ], Study5 [ 36 ], Study6 [ 23 ], Study7 [ 27 ], Study8 [ 28 ].

https://doi.org/10.1371/journal.pgph.0002137.g003

Heterogeneity and risk of bias of WHO-BREF studies

A funnel plot of the estimates is shown in ( Fig 4 ). The regression test indicated funnel plot asymmetry ( p = 0.0019) but not the rank correlation test ( p = 0.1194) ( Fig 4 ).

Study1 [ 7 ], study2 [ 31 ], Study3 [ 33 ], Study4 [ 35 ], Study5 [ 7 ], Study6 [ 37 ], Study 7 [ 32 ], Study8 [ 41 ], study 9 [ 50 ].

https://doi.org/10.1371/journal.pgph.0002137.g004

Heterogeneity and risk of bias of EQ5D studies

https://doi.org/10.1371/journal.pgph.0002137.g005

Quality assessment

We used the Modified Newcastle-Ottawa quality assessment scale tool to assess the quality of included papers and only 3 papers scored five out five (5/5) [ 29 , 36 , 39 ]. Ten papers scored four out of five (4/5) [ 7 , 22 , 23 , 30 , 31 , 33 , 35 , 38 , 42 , 44 ]. Eight studies scored three out five (3/5) [ 24 , 27 , 28 , 32 , 34 , 38 , 43 ]. Only three papers [ 25 , 26 , 40 ] scored 2 out five making it the lowest score and therefore low quality. We included the three low quality articles in the qualitative synthesis however only one low quality paper [ 25 ] was included in the quantitative analysis (meta-analysis) because it was lying within two standard deviations of the mean therefore it was not affecting the results ( Table 3 ).

https://doi.org/10.1371/journal.pgph.0002137.t003

Quality of life and factors associated to the low HRQoL

Eight studies [ 22 , 25 , 27 , 28 , 36 , 40 , 43 ] have used the EQ-5D to assess the quality of life for the general population during COVID-19 pandemic. The mean score using EQ-5D estimated at 0.89 [95% CI 0.66–1.13]. By using EQ-5D, authors [ 25 ] reported the results (before and during confinement) that the quality of life was affected in the five health dimensions; mobility 87%(87%), self-care 97%(93%), usual activities 82%(89%), pain/discomfort 70%(78%) and anxiety/depression 44%(66%). His comparison on the two samples showed that during confinement, peoples had lower scores of HRQoL at 0.86 (p<0.001) as compared to before confinement whose score was 0.91 [ 25 ]. Female gender was affected with lower scores of HRQoL than their counterpart male on both utility (0.85; P = <0.0001 and VAS (78.49; P = 0.004) and (utility = 0.89 and VAS = 83.78) respectively. Marital status was significantly associated to EQ-5D utility (P = 0.002) and VAS (P = 0.005) scores, widowed had the worst HRQoL (utility = 0.43 and VAS = 48.75) compared to single (utility = 0.87 and VAS = 80.09), married (utility = 0.86 and VAS = 81.43), and separated (utility = 0.89 and VAS = 80.15) participants. Participants with university education had the higher EQ-5D utility score (0.88; p<0.001) and age did not have a significant impact. A study done in Belgium and Netherlands also evaluated the quality of life using EQ5D as well, a minority in both countries felt stressed with 27% and 14% respectively [ 43 ]. The majority reported concerns about their personal current and future financial situation (59 and 48% respectively) and the national economies (88 and 86%). Specifically, in Belgium, the EQ-5D before COVID-19 measured 0.82 (95% CI; 0.80–0.84) and during COVID-19 measures 0.79 (95% CI; 0.77–0.81). In Netherlands, before COVID-19, 0.85 (95% CI; 0.83–87) and during COVID-19 outbreak, it was 0.84 (95% CI; 0.82–0.86). Chen et al. (2021), using EQ5D concluded that the mean EQ-5D score and VAS were 0.99 and 93.5. Their multiple linear regression showed that the quality of life measure was related to physical activities (β = 0.006) and keeping home ventilation (β = 0.063) in Daqing, and were related to wearing a mask when going out (β = 0.014), keeping home ventilation (β = 0.061), other marital status (β = − 0.011), worry about the epidemic (β = − 0.005) and having a centralized or home quarantine (β = − 0.005) in Taizhou [ 22 ]. Using EQ5D, authors concluded that those quarantined at home experienced higher levels of anxiety and a lower HRQoL compared with the pre-COVID-19 pandemic population. Females and elderly individuals experienced the highest levels of anxiety and poorest HRQoL (OR not reported) [ 36 ]. Other authors [ 23 ] using the same instrument EQ5D reported that the risk of pain/discomfort and anxiety/depression in general population in China raised significantly with aging, with chronic disease, lower income, epidemic effects, worried about get COVID-19 during the COVID-19 pandemic (OR not reported) [ 23 ]. Tran et al. (2020) With the same instrument EQ5D (n = 341) reported that 66.9% of household income loss was due to the impact of COVID-19. The mean score of EQ-5D and EQ-VAS was 0.95 (SD ± 0.07) and 88.2 (SD ± 11.0) respectively. The domain of Anxiety/Depression had the highest proportion of reporting any problems among 5 dimensions of EQ-5D (38.7%). Being female, having chronic conditions and living in the family with 3–5 members were associated with lower HRQOL score (OR not reported) [ 27 ]. Vu et al. (2020) using EQ5D reported the highest mean EQ-VAS at 90.5 (SD: 7.98) among people in government quarantine facilities, followed by 88.54 (SD: 12.24) among general population and 86.54 (SD 13.69) among people in self-isolation group [ 28 ]. The EQ-5D value was reported as the highest among general population at 0.95 (SD: 0.07), followed by 0.94 (SD: 0.12) among people in government quarantine facilities, and 0.93 (SD: 0.13) among people who put themselves in self-isolation. Overall, most people, at any level, reported having problems with anxiety and/or depression in all groups.

WHOQoL-BREF.

The WHOQoL average scores was estimated at 50.55% 95% CI [32.19–68.90]. Authors by using WHOQoL-BREF reported a quality of life affected with a score of 39% (CI not reported) and according to authors, males were more affected with OR = 1.96 (95% CI = 1.31–2.94); participants aged 26 to 35 years OR = 5.1; (95% CI = 1.33–19.37); non-Saudi participants OR = 1.69 (95% CI = 1.06–2.57); individuals with chronic diseases OR = 2.15 (95% CI = 1.33–3.48); those who lost their job OR = 2.18 (95% CI = 1.04–4.57) and those with depression OR = 5.70 (95% CI = 3.59–9.05), anxiety OR = 5.47; (95% CI = 3.38–8.84), and stress OR = 6.55 (95% CI = 4.01–10.70) [ 7 ].

In 2021, a study [ 31 ] concluded that higher psychological QoL reduced the odds of depressive symptoms OR = 0.83 (95% CI = 0.69–0.99, p = 0.032) and depressive with comorbid anxiety symptoms OR = 0.82, (95% CI = 0.68–0.98, p = 0.041), whereas higher physical health QoL OR = 0.85, (95% CI = 0.75–0.97, p = 0.021) and social relationship QoL OR = 0.70 (95% CI = 0.55–0.90, p = 0.009) reduced the odds of anxiety symptoms [ 31 ]. In 2020, a study [ 33 ] had reported a mean for total QoL score of 73.21 (SD ¼ 16.17). The mean general QoL and health scores were 3.15 (SD ¼ 0.94) and 3.40 (SD ¼ 0.95). As for the four QoL subscales, the mean scores in each domain were as follows: 18.04 (SD ¼ 4.39) for physical health, 17.65 (SD ¼ 3.77) for psychological health, 8.69 (SD ¼ 2.67) for social relationships, and 22.29 (SD ¼ 5.84) for environment(29). Choi et al (2021), using the same QoL scale reported that 69.6% of participants were worried about contracting COVID-19, and 41.4% frequently suspected themselves of being infected whereas 29.0% were concerned by the lack of disinfectants. All of these findings were associated with poorer HRQoL in the physical and psychological health, social relationships, and environment domains (OR not reported). 47.4% of participants were concerned that they may lose their job because of the pandemic and 39.4% were bothered by the insufficient supply of surgical masks [ 35 ]. The results of a study [ 30 ] showed statistically significant difference in QoL depending on a number of variables, including sex, area of residence in Italy, and being diagnosed with a medical/psychiatric condition (OR: NR). The overall average score at the WHOQoL-BREF was 54.48 (SD = 7.77). The item with the lowest scores was 14 (about the use of spare time), given that 932 (41.4%) participants reported to have little or no time for leisure at the time of data collection. Regarding the other three domains of the WHOQoL, items with lowest scores were: item 15 for the physical domain, as 1019 (45.3%) participants reported little or no possibility to do physical activity; item 5 for the psychological domain, with 712 (31.6%) respondents reporting that they were not enjoying their lives at the time of data collection, and item 21 for social relationships, as 843 (37.4%) respondents reported that they were little or not at all satisfied with their sexual life [ 30 ]. A research in 2021 [ 37 ] reported that COVID-19 has had a wide impact on the general population, with the potential for negative secondary impacts. Women, young adults, and the unemployed are at high risk for secondary effects (ORs:NR). Another study [ 39 ] scores on the social relationships QoL domain were lower among participants who had a family member or friend with COVID-19 and among those who engaged in negative forms of spiritual religious coping (SRC). The quarantine during the COVID-19 pandemic has limited personal contact with family and friends, adversely affected sexual activity, and has restricted other activities that are assessed in the social relationships QoL domain. Positive forms of spiritual religious coping (SRC) were associated with better scores on this domain, as reported in other studies [ 37 ]. In 2020, a study [ 32 ] highlighted that approximately one in three individual experienced mild-to-severe depressions during the nationwide movement control order (MCO). The results of a study [ 41 ] reported that most would expect quality of life to be challenged during a global pandemic; however, when behavioral health assessed as a component of overall quality of life, longer term outcomes became concerning [ 41 ].

SF12/SF-8/ SF36.

Samlani et al. (2020) by using SF 12/8 (Chinese) scale, all participants obtained a total average score of 70.60 (±13.1) with a mental health score (MCS) of 34.49 (±6.44) and a physical health score (PCS) of 36.10 (± 5.82). The physical (PCS) and mental (MCS) scores of participants with chronic diseases were 32.51 (±7.14) and 29.28 (±1.23), respectively. Overall, the participants’ PCS and MCS scores suffered from chronic diseases and the elderly participants were lower than those of young participants without comorbidities(23). López et al (2021) reported the following results using SF-36; the presence of pain in subjects undergoing confinement was persistent, with varying intensity and frequency based on age, gender, physical activity, and work status (OR:NR). In any of these conditions, the quality of life of the subjects in confinement has been severely affected [ 38 ]. Qi et al. 2020 using–SF8 (Chinese), participants’ average physical component summary score (PCS) and mental component summary score (MCS) for HRQoL were 75.3 (SD = 16.6) and 66.6 (SD = 19.3), respectively. More than half of participants (53.0%) reported moderate levels of stress. Significant correlations between physical activity participation, QoL, and levels of perceived stress were observed (p < 0.05). Prolonged sitting time was also found to have a negative effect on QoL (p < 0.05) [ 24 ].

Campbell & Davison (2022) by using EQLS found that there are strong relationships between QoL and income, disability and living arrangement as well as social isolation and Disability and living arrangement [ 40 ]. Correlation and multiple regression analyses showed a strong relationship between social isolation, gratitude, uncertainty and QoL with social isolation being a significant predictor (OR not reported).

Bonichini & Tremolada (2021) reported that the mean GH12 score in participants amounted to 17.86 (SD = 5.85), reflecting a contingent moderate stressful impact on QoL. GH12 identified 39% of respondents as having subclinical QoL scores (score ≥ 15). 24.5% of such respondents as having very problematic scores (score ≥ 19), and 36.5% of such respondents as having normal scores (score < 15). Analysis of variance (ANOVA) showed there was a significant difference (F(2, 1.836) = 5.50, p = 0.004, η 2 = 0.01) in mean GH12 scores [ 29 ].

COVID-19 QoL questionnaire.

The results of Khodami et al. (2022) showed that Quality of life is significantly decreased over time, perceived stress level raised significantly and an increased level of difficulty in emotion regulation has happened. Younger peoples and individuals who had a worsening quality of life response tended to show more stress and emotion regulation problems [ 44 ]. Mohsen et al. (2022) using COVID-19 on Quality of life scale reported that the total COV19-QoL scale score was 2.3±0.6. Two items show the highest mean with 2.6±0.7 (quality of life in general and perception of danger on their personal safety) indicating the poorest quality of life regarding these 2 items. However, the lowest mean score was related to the perception of mental health deterioration (1.9±0.8). Significant variables in the bivariate analysis revealed that sex (regression coefficient = 0.1 (95% CI(0.02 to 0.2), p value = 0.02), monthly income (regression coefficient (95% CI) = 0.1 (0.004 to 0.2), p value = 0.04), knowing someone infected with COVID19 (regression coefficient (95% CI) = 0.15 (0.08 to 0.3), p value = 0.001), and data collection time (regression coefficient (95% CI) = 0.1 (0.006 to 0.2), p value = 0.04) were the independent predictors for overall QoL scale score [ 42 ].

Aruta et al. (2022) by using MLT questionnaire, the results of the path analysis indicated a good data‐model fit: (χ 2 = 4.97, df = 2, p = 0.08; CFI = 0.99, TLI = 0.96, SRMR = 0.02, RMSEA [90% CI] = 0.06 [0.000 − 0.13]). The direct effects of safety at home (B = −0.27, β = −0.21, SE = 0.05, p ≤ 0.001), TPIs (B = −0.19, β = −0.27, SE = 0.05, p ≤ 0.001), and financial difficulties (B = 0.15, β = 0.18, SE = 0.05, p ≤ 0.001) on psychological distress were found to be significant. Direct effects of safety at home (B = 0.19, β = 0.22, SE = 0.05, p ≤ 0.001), TPIs (B = 0.18, β = 0.27, SE = 0.04, p ≤ 0.001), financial difficulties (B = −0.15, β = −0.21, SE = 0.05, p ≤ 0.001), and psychological distress (B = −0.29, β = −0.34, SE = 0.04, p ≤ 0.001) on quality of life were found to be significant. Results indicated that psychological distress partially mediated the positive influence of safety at home (B = 0.06, β = 0.07, SE = 0.02, p ≤ 0.001) and TPIs (B = 0.06, β = 0.09, SE = 0.02, p ≤ 0.001) on quality of life [ 34 ]. These findings indicate that psychological distress is a mechanism that can partly explain why socio‐ ecological factors (i.e., safety at home, financial difficulties, and trust in institutions) impact the quality of life of Filipino adults during COVID‐19.

Findings of included studies demonstrated how COVID-19 pandemic reduced the QoL of the general population. Different factors influenced directly or indirectly the change of QoL. Researchers utilized different quality of life measurement scales among them EQ-5D leading the pool of measurement scales followed by WHOQoL-BREF then SF12/SF-8/ SF36 as 3 rd scale and the rest. For studies that used EQ-5D to assess the impact of quality of life, all five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) were affected significantly with a mean EQ-5D score of 0.89 with 95% CI [-1.865–2.048] with the lowest score of 0.79 at 95% CI (NR) and upper score of 0.99 at 95% CI (NR) [ 25 ]. The mean WHOQoL-BREF score was estimated at 50.55 with a 95% CI [32.19, 68.90]. Other instruments such as SF12 scored 70.60 with 95% CI [57.5, 83.7], SF8 scored QoL at 75.3 with 95% CI [58.7, 91.9] and SF36 (score NR). In low and middle income countries (LMICs) such as Morocco [ 25 ] using EQ-5D reported low QoL during confinement as compared to before in the 5 health dimensions respectively; mobility 87%(87%), self-care 97%(93%), usual activities 82%(89%), pain/discomfort 70%(78%) and anxiety/depression 44%(66%) with average QoL at 0.91 (p<0.001) before and 0.86 (0.001) after confinement. Whereas in high income countries (HICs), Belgium for example using EQ-5D before COVID-19 QoL measured 0.82 (95% CI; 0.80–0.84) and during COVID-19 measures 0.79 (95% CI; 0.77–0.81), the same with Netherlands, before COVID-19 EQ-5D measured 0.85 (95% CI; 0.83–0.87) before and during COVID-19 0.84 (95% CI; 0.82–0.86). A research in China, using EQ5D concluded that the mean EQ-5D score and VAS were 0.99 before COVID-19 and 93.5 during COVID-19. When compared HICs and LMICs, both countries were affected significantly by COVID-19 and this was exacerbated by confinement [ 51 ]. These results are in line with those of a Chinese study with an average score EQ-5D of 0.949 and VAS score 85.52 [ 22 ]. Nine published papers assessed QoL using WHOQoL [ 7 , 30 – 33 , 35 , 37 , 39 , 41 ] and their mean score was 50.55% with 95% CI [32.19–68.90]. The lower the score, the lower the quality of life. On the other hand, using EQ-5D, the mean score was estimated at 0.89 with 95% CI [0.66–1.13] with the same trend, the lower the score, the lower the quality of life. Our study findings are different from those published in Vietnam that reported EQ5D score 0.95 (SD = NR.) during the national social distancing, against our results (mean EQ5D = 0.89) [ 27 ]. This might be because it is an empirical study while our study summarizes results from a variety of studies making our mean score low. Our main findings rely most on EQ5D and WHOQoL instrument reports. Although, we assessed QoL of the general population during COVID-19 (Mean EQ5D = 0.89), some authors assessed the impact of some chronic diseases on QoL of the general population such as type 2 diabetes [ 52 ] (EQ5D = 0.8 SD = 0.20), human immunodeficiency virus (HIV) [ 53 ] (EQ5D = 0.8 SD = 0.2), skin disease [ 54 ] (EQ5D = 0.73 SD = 0.19), respiratory diseases (EQ5D = 0.66 SD = 0.31), dengue fever (EQ5D = 0.66 SD = 0.24), frail elderly in Vietnam [ 55 ] (EQ5D = 0.58 SD = 0.20), elderly after fall injury and facture injuries (EQ5D = 0.46 SD = NR). QoL in general population during COVID-19 was comparable to that of type2 diabetes and HIV. This may be because Type2 diabetes and HIV are chronic conditions, patients are stable on medication if the management and compliance to medications is respected. QoL of skin disease patients, respiratory diseases, dengue fever, frail elderly, elderly after fall and fracture injuries were low as compared to COVID-19 general population. This may be due to the high score of pain involved in these conditions. Different factors that contributed to low quality of life have been identified; age, gender, education level, marital status, financial constraints, confinement, fear of being contaminated and individual with other chronic conditions. The two measurement scales were the most utilized instruments as compared to the other scales and their results show a considerable reduced quality of life. Using WHOQoL-BREF [ 7 ] reported a quality of life affected with a score of 39% (CI = NR) and according to authors, males were more affected probably because in developing countries, males are responsible of financial support to the family and because of that, they may fear either confinement that affects job market or else being contaminated and not able to work for their families. Concerning age, participants aged 26-35years were more affected and the reason may be because most peoples of this age bracket are the young couples or single mothers therefore the young fathers were worried about their families and finances if they are quarantined. Females were more affected than their counterparts according to [ 25 ] this may be due to the fact that females naturally are the nuclear parts of a family and their emotions towards the family therefore become much worried than males. Widowers had the worst quality of life and this may be due to their worries about their life and that of their children with less psychological support [ 56 , 57 ] from their spouses. Individuals with chronic diseases (hypertension, Type2 diabetes, asthma, stress, anxiety, depression, etc…) had a high risk of low quality of life and this might be because they are vulnerable to COVID-19 with high fear of contamination therefore pushing them to low quality of life. Other factors such as confinement, financial constraints, fear of being contaminated with COVID-19 and having a contaminated family member increased the likelihood of anxiety, stress and depression therefore leading to the low individual quality of life [ 58 ]. The main reason of stress due to confinement is due to financial constraint because a confined person is not allowed to work and generate income to sustain the family during the pandemic. It is surprising that both low and high income countries were affected by COVID-19 reducing their population quality of life. This shows how no country in the world was prepared for any huge health pandemic whether rich or poor. This highlights the low level of preparedness for countries to face similar catastrophic situations. What is lacking? Is it the money or strategies? Developed countries can afford to provide necessary means to fight against pandemics but there is no guaranty to protect the populations from dying before actions are in place. For this purpose, there is a need to strengthen infectious disease predictions and modeling using machine learning or artificial intelligence. There is a need to embrace and exploit artificial intelligence to improve the prediction of future events to prevent populations from diseases and death and maintain their maximum quality of life.

Strengths and weaknesses

First and the foremost, the strength of this review is that, it was conducted according to the international guidelines for systematic reviews after registration of the protocol in international database PROSPERO. Secondly, it was conducted two and half years after the pandemic begun and authors already have published enough papers to allow robust systematic synthesis of results. And the results can be generalized as papers were searched Worldwide with a reasonable sample size (22,967 participants).

There were also some limitations; We searched papers in English only leaving probably out some studies. The fact that we searched only 3 databases and a search engine, some articles might have been missed. The generalizability should be done with caution. Most studies reported the mean QoL during COVID-19 with no baseline to compare, this can weaken our results. All studies were cross-sectional and there were no cohort or case control studies, this can also weaken our conclusions.

This systematic review confirms that the COVID-19 pandemic affected negatively health related quality of life of the general population. Several factors influencing quality of life of general population through COVID-19 have been identified; age, sex, marital status, education, peoples living with chronic diseases, confinement and financial constraints among others, etc…. There was no significant difference between the impact of COVID-19 in general population in high income countries and low and middle income countries. Three quality of life scales were mainly used to assess the quality of life of the general population; WHO-QoL-BREEF, EQ-5D, SF and others. The findings of this review will be useful for policy makers and health managers to facilitate the planning and prevention of quality of life of the general population during future pandemics. We recommend cohort and case control studies on impact of COVID-19 on quality of life to collect more and strong evidence on impact of COVID-19 on different population in the world. We are also recommending studies on prediction and modeling of infectious diseases using machine learning and artificial intelligence to prevent the population from future pandemics to maintain the population quality of life.

Supporting information

S1 checklist. prisma checklist..

https://doi.org/10.1371/journal.pgph.0002137.s001

S1 Table. Summary of included studies.

https://doi.org/10.1371/journal.pgph.0002137.s002

S1 Text. PubMed search string.

https://doi.org/10.1371/journal.pgph.0002137.s003

Acknowledgments

The authors acknowledge the moral support from their families, friends and colleagues.

• View Article
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• PubMed/NCBI
• 19. Institute of Medicine (US) Committee on Standards for Systematic Reviews of Comparative Effectiveness Research. Finding What Works in Health Care: Standards for Systematic Reviews. Eden J, Levit L, Berg A, Morton S, editors. Washington (DC): National Academies Press (US); 2011. https://doi.org/10.17226/13059

COVID-19 and its impact on education, social life and mental health of students: A survey

Affiliation.

• 1 Biometric Research Laboratory, Department of Information Technology, Delhi Technological University, Bawana Road, Delhi 110042, India.
• PMID: 33390636
• PMCID: PMC7762625
• DOI: 10.1016/j.childyouth.2020.105866

The outbreak of COVID-19 affected the lives of all sections of society as people were asked to self-quarantine in their homes to prevent the spread of the virus. The lockdown had serious implications on mental health, resulting in psychological problems including frustration, stress, and depression. In order to explore the impacts of this pandemic on the lives of students, we conducted a survey of a total of 1182 individuals of different age groups from various educational institutes in Delhi - National Capital Region (NCR), India. The article identified the following as the impact of COVID-19 on the students of different age groups: time spent on online classes and self-study, medium used for learning, sleeping habits, daily fitness routine, and the subsequent effects on weight, social life, and mental health. Moreover, our research found that in order to deal with stress and anxiety, participants adopted different coping mechanisms and also sought help from their near ones. Further, the research examined the student's engagement on social media platforms among different age categories. This study suggests that public authorities should take all the necessary measures to enhance the learning experience by mitigating the negative impacts caused due to the COVID-19 outbreak.

Keywords: Children and Youth; Covid-19; Impact; Mental health; Online education; Students.

© 2020 Elsevier Ltd. All rights reserved.

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Covid 19 Essay in English

Essay on Covid -19: In a very short amount of time, coronavirus has spread globally. It has had an enormous impact on people's lives, economy, and societies all around the world, affecting every country. Governments have had to take severe measures to try and contain the pandemic. The virus has altered our way of life in many ways, including its effects on our health and our economy. Here are a few sample essays on ‘CoronaVirus’.

100 Words Essay on Covid 19

200 words essay on covid 19, 500 words essay on covid 19.

COVID-19 or Corona Virus is a novel coronavirus that was first identified in 2019. It is similar to other coronaviruses, such as SARS-CoV and MERS-CoV, but it is more contagious and has caused more severe respiratory illness in people who have been infected. The novel coronavirus became a global pandemic in a very short period of time. It has affected lives, economies and societies across the world, leaving no country untouched. The virus has caused governments to take drastic measures to try and contain it. From health implications to economic and social ramifications, COVID-19 impacted every part of our lives. It has been more than 2 years since the pandemic hit and the world is still recovering from its effects.

Since the outbreak of COVID-19, the world has been impacted in a number of ways. For one, the global economy has taken a hit as businesses have been forced to close their doors. This has led to widespread job losses and an increase in poverty levels around the world. Additionally, countries have had to impose strict travel restrictions in an attempt to contain the virus, which has resulted in a decrease in tourism and international trade. Furthermore, the pandemic has put immense pressure on healthcare systems globally, as hospitals have been overwhelmed with patients suffering from the virus. Lastly, the outbreak has led to a general feeling of anxiety and uncertainty, as people are fearful of contracting the disease.

My Experience of COVID-19

I still remember how abruptly colleges and schools shut down in March 2020. I was a college student at that time and I was under the impression that everything would go back to normal in a few weeks. I could not have been more wrong. The situation only got worse every week and the government had to impose a lockdown. There were so many restrictions in place. For example, we had to wear face masks whenever we left the house, and we could only go out for essential errands. Restaurants and shops were only allowed to operate at take-out capacity, and many businesses were shut down.

In the current scenario, coronavirus is dominating all aspects of our lives. The coronavirus pandemic has wreaked havoc upon people’s lives, altering the way we live and work in a very short amount of time. It has revolutionised how we think about health care, education, and even social interaction. This virus has had long-term implications on our society, including its impact on mental health, economic stability, and global politics. But we as individuals can help to mitigate these effects by taking personal responsibility to protect themselves and those around them from infection.

Effects of CoronaVirus on Education

The outbreak of coronavirus has had a significant impact on education systems around the world. In China, where the virus originated, all schools and universities were closed for several weeks in an effort to contain the spread of the disease. Many other countries have followed suit, either closing schools altogether or suspending classes for a period of time.

This has resulted in a major disruption to the education of millions of students. Some have been able to continue their studies online, but many have not had access to the internet or have not been able to afford the costs associated with it. This has led to a widening of the digital divide between those who can afford to continue their education online and those who cannot.

The closure of schools has also had a negative impact on the mental health of many students. With no face-to-face contact with friends and teachers, some students have felt isolated and anxious. This has been compounded by the worry and uncertainty surrounding the virus itself.

The situation with coronavirus has improved and schools have been reopened but students are still catching up with the gap of 2 years that the pandemic created. In the meantime, governments and educational institutions are working together to find ways to support students and ensure that they are able to continue their education despite these difficult circumstances.

Effects of CoronaVirus on Economy

The outbreak of the coronavirus has had a significant impact on the global economy. The virus, which originated in China, has spread to over two hundred countries, resulting in widespread panic and a decrease in global trade. As a result of the outbreak, many businesses have been forced to close their doors, leading to a rise in unemployment. In addition, the stock market has taken a severe hit.

Effects of CoronaVirus on Health

The effects that coronavirus has on one's health are still being studied and researched as the virus continues to spread throughout the world. However, some of the potential effects on health that have been observed thus far include respiratory problems, fever, and coughing. In severe cases, pneumonia, kidney failure, and death can occur. It is important for people who think they may have been exposed to the virus to seek medical attention immediately so that they can be treated properly and avoid any serious complications. There is no specific cure or treatment for coronavirus at this time, but there are ways to help ease symptoms and prevent the virus from spreading.

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