essay about life in covid 19

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

Joint statement by ilo, fao, ifad and who.

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

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

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

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

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

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

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

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

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

Media Contacts

Kimberly Chriscaden

Communications Officer World Health Organization

Nutrition and Food Safety (NFS) and COVID-19

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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.

by Alissa Wilkinson

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

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

• The Vox guide to navigating the coronavirus crisis

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

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

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

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

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

• A syllabus for the end of the world

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

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

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

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

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

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

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

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

• What day is it today?

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

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

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

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

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

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

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

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

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

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

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Read More: The Family Time the Pandemic Stole

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Coronavirus: The world has come together to flatten the curve. Can we stay united to tackle other crises?

Watching the world come together gives me hope for the future, writes mira patel, a high school junior..

Mira Patel and her sister Veda. (Courtesy of Dee Patel)

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Before the pandemic, I had often heard adults say that young people would lose the ability to connect in-person with others due to our growing dependence on technology and social media. However, this stay-at-home experience has proven to me that our elders’ worry is unnecessary. Because isolation isn’t in human nature, and no advancement in technology could replace our need to meet in person, especially when it comes to learning.

As the weather gets warmer and we approach summertime, it’s going to be more and more tempting for us teenagers to go out and do what we have always done: hang out and have fun. Even though the decision-makers are adults, everyone has a role to play and we teens can help the world move forward by continuing to self-isolate. It’s incredibly important that in the coming weeks, we respect the government’s effort to contain the spread of the coronavirus.

In the meantime, we can find creative ways to stay connected and continue to do what we love. Personally, I see many 6-feet-apart bike rides and Zoom calls in my future.

If there is anything that this pandemic has made me realize, it’s how connected we all are. At first, the infamous coronavirus seemed to be a problem in China, which is worlds away. But slowly, it steadily made its way through various countries in Europe, and inevitably reached us in America. What was once framed as a foreign virus has now hit home.

Watching the global community come together, gives me hope, as a teenager, that in the future we can use this cooperation to combat climate change and other catastrophes.

As COVID-19 continues to creep its way into each of our communities and impact the way we live and communicate, I find solace in the fact that we face what comes next together, as humanity.

When the day comes that my generation is responsible for dealing with another crisis, I hope we can use this experience to remind us that moving forward requires a joint effort.

Mira Patel is a junior at Strath Haven High School and is an education intern at the Foreign Policy Research Institute in Philadelphia. Follow her on Instagram here.  

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

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

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

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

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

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Introduction

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

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

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

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

Social networks

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

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

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

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

Social support

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

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

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

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

Social and interactional norms

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

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

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

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

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

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

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

Recommendations and conclusions

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

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

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

Recommendation 2: intelligently balance online and offline ways of relating

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

Recommendation 3: build stronger and sustainable localised communities

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

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

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

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

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

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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Life after COVID: most people don’t want a return to normal – they want a fairer, more sustainable future

Chair of Cognitive Psychology, University of Bristol

Professor of Cognitive Psychology and Australian Research Council Future Fellow, The University of Western Australia

Disclosure statement

Stephan Lewandowsky receives funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 964728 (JITSUVAX). He also receives funding from the Australian Research Council via a Discovery Grant to Ullrich Ecker, from Jigsaw (a technology incubator created by Google), from UK Research and Innovation (through the Centre of Excellence, REPHRAIN), and from the Volkswagen Foundation in Germany. He also holds a European Research Council Advanced Grant (no. 101020961, PRODEMINFO) and receives funding from the John Templeton Foundation (via Wake Forest University’s Honesty Project).

Ullrich Ecker receives funding from the Australian Research Council.

University of Western Australia provides funding as a founding partner of The Conversation AU.

University of Bristol provides funding as a founding partner of The Conversation UK.

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We are in a crisis now – and omicron has made it harder to imagine the pandemic ending. But it will not last forever. When the COVID outbreak is over, what do we want the world to look like?

In the early stages of the pandemic – from March to July 2020 – a rapid return to normal was on everyone’s lips, reflecting the hope that the virus might be quickly brought under control. Since then, alternative slogans such as “ build back better ” have also become prominent, promising a brighter, more equitable, more sustainable future based on significant or even radical change.

Returning to how things were, or moving on to something new – these are very different desires. But which is it that people want? In our recent research , we aimed to find out.

Along with Keri Facer of the University of Bristol, we conducted two studies, one in the summer of 2020 and another a year later. In these, we presented participants – a representative sample of 400 people from the UK and 600 from the US – with four possible futures, sketched in the table below. We designed these based on possible outcomes of the pandemic published in early 2020 in The Atlantic and The Conversation .

We were concerned with two aspects of the future: whether it would involve a “return to normal” or a progressive move to “build back better”, and whether it would concentrate power in the hands of government or return power to individuals.

Four possible futures

In both studies and in both countries, we found that people strongly preferred a progressive future over a return to normal. They also tended to prefer individual autonomy over strong government. On balance, across both experiments and both countries, the “grassroots leadership” proposal appeared to be most popular.

People’s political leanings affected preferences – those on the political right preferred a return to normal more than those on the left – yet intriguingly, strong opposition to a progressive future was quite limited, even among people on the right. This is encouraging because it suggests that opposition to “building back better” may be limited.

Our findings are consistent with other recent research , which suggests that even conservative voters want the environment to be at the heart of post-COVID economic reconstruction in the UK.

The misperceptions of the majority

This is what people wanted to happen – but how did they think things actually would end up? In both countries, participants felt that a return to normal was more likely than moving towards a progressive future. They also felt it was more likely that government would retain its power than return it to the people.

In other words, people thought they were unlikely to get the future they wanted. People want a progressive future but fear that they’ll get a return to normal with power vested in the government.

We also asked people to tell us what they thought others wanted. It turned out our participants thought that others wanted a return to normal much more than they actually did. This was observed in both the US and UK in both 2020 and 2021, though to varying extents.

This striking divergence between what people actually want, what they expect to get and what they think others want is what’s known as “ pluralistic ignorance ”.

This describes any situation where people who are in the majority think they are in the minority. Pluralistic ignorance can have problematic consequences because in the long run people often shift their attitudes towards what they perceive to be the prevailing norm. If people misperceive the norm, they may change their attitudes towards a minority opinion, rather than the minority adapting to the majority. This can be a problem if that minority opinion is a negative one – such as being opposed to vaccination , for example.

In our case, a consequence of pluralistic ignorance may be that a return to normal will become more acceptable in future, not because most people ever desired this outcome, but because they felt it was inevitable and that most others wanted it.

Ultimately, this would mean that the actual preferences of the majority never find the political expression that, in a democracy, they deserve.

To counter pluralistic ignorance, we should therefore try to ensure that people know the public’s opinion. This is not merely a necessary countermeasure to pluralistic ignorance and its adverse consequences – people’s motivation also generally increases when they feel their preferences and goals are shared by others. Therefore, simply informing people that there’s a social consensus for a progressive future could be what unleashes the motivation needed to achieve it.

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• Introduction

Horrific history

The early days, health and medicine.

What was the impact of COVID-19?

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• Table Of Contents

On February 25, 2020, a top official at the Centers for Disease Control and Prevention decided it was time to level with the U.S. public about the COVID-19 outbreak. At the time, there were just 57 people in the country confirmed to have the infection, all but 14 having been repatriated from Hubei province in China and the Diamond Princess cruise ship , docked off Yokohama , Japan .

The infected were in quarantine. But Nancy Messonnier, then head of the CDC’s National Center for Immunization and Respiratory Diseases, knew what was coming. “It’s not so much a question of if this will happen anymore but rather more a question of exactly when this will happen and how many people in this country will have severe illness,” Messonnier said at a news briefing.

“I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe,” she continued. “But these are things that people need to start thinking about now.”

Looking back, the COVID-19 pandemic stands as arguably the most disruptive event of the 21st century, surpassing wars, the September 11, 2001, terrorist attacks , the effects of climate change , and the Great Recession . It has killed more than seven million people to date and reshaped the world economy, public health , education, work, social interaction, family life, medicine, and mental health—leaving no corner of the globe untouched in some way. Now endemic in many societies, the consistently mutating virus remains one of the leading annual causes of death, especially among people older than 65 and the immunosuppressed.

“The coronavirus outbreak, historically, beyond a doubt, has been the most devastating pandemic of an infectious disease that global society has experienced in well over 100 years, since the 1918 influenza pandemic ,” Anthony Fauci , who helped lead the U.S. government’s health response to the pandemic under Pres. Donald Trump and became Pres. Joe Biden ’s chief medical adviser, told Encyclopædia Britannica in 2024.

“I think the impact of this outbreak on the world in general, on the United States, is really historic. Fifty years from now, 100 years from now, when they talk about the history of what we’ve been through, this is going to go down equally with the 1918 influenza pandemic , with the stock market crash of 1929 , with World War II —all the things that were profoundly disruptive of the social order.”

What few could imagine in the first days of the pandemic was the extent of the disruption the disease would bring to the everyday lives of just about everyone around the globe.

Within weeks, schools and child-care centers began shuttering, businesses sent their workforces home, public gatherings were canceled, stores and restaurants closed, and cruise ships were barred from sailing. On March 11, actor Tom Hanks announced that he had COVID-19, and the NBA suspended its season. (It was ultimately completed in a closed “bubble” at Walt Disney World .) On March 12, as college basketball players left courts mid-game during conference tournaments, the NCAA announced that it would not hold its wildly popular season-ending national competition, known as March Madness , for the first time since 1939. Three days later, the New York City public school system, the country’s largest, with 1.1 million students, closed. On March 19, all 40 million Californians were placed under a stay-at-home order.

By mid-April, with hospital beds and ventilators in critically short supply, workers were burying the coffins of COVID-19 victims in mass graves on Hart Island, off the Bronx . At first, the public embraced caregivers. New Yorkers applauded them from windows and balconies, and individuals sewed masks for them. But that spirit soon gave way to the crushing long-term reality of the pandemic and the national division that followed.

Around the world, it was worse. On the day Messonnier spoke, the virus had spread from its origin point in Wuhan , China, to at least two dozen countries, sickening thousands and killing dozens. By April 4, more than one million cases had been confirmed worldwide. Some countries, including China and Italy, imposed strict lockdowns on their citizens. Paris restricted movement, with certain exceptions, including an hour a day for exercise, within 1 km (0.62 mile) of home.

In the United States , the threat posed by the virus did not keep large crowds from gathering to protest the May 25 slaying of George Floyd , a 46-year-old Black man, by a white police officer, Derek Chauvin. The murder, taped by a bystander in Minneapolis , Minnesota , sparked raucous and sometimes violent street protests for racial justice around the world that contributed to an overall sense of societal instability.

The official World Health Organization total of more than seven million deaths as of March 2024 is widely considered a serious undercount of the actual toll. In some countries there was limited testing for the virus and difficulty attributing fatalities to it. Others suppressed total counts or were not able to devote resources to compiling their totals. In May 2021, a panel of experts consulted by The New York Times estimated that India ’s actual COVID-19 death toll was likely 1.6 million, more than five times the reported total of 307,231.

An average of 3,100 people—one every 28 seconds—died of COVID-19 every day in the United States in January 2021.

When “ excess mortality”—COVID and non-COVID deaths that likely would not have occurred under normal, pre-outbreak conditions—are included in the worldwide tally, the number of pandemic victims was about 15 million by the end of 2021, WHO estimated.

Not long after the pandemic took hold, the United States, which spends more per capita on medical care than any other country, became the epicenter of COVID-19 fatalities. The country fell victim to a fractured health care system that is inequitable to poor and rural patients and people of color, as well as a deep ideological divide over its political leadership and public health policies, such as wearing protective face masks. By early 2024, the U.S. had recorded nearly 1.2 million COVID-19 deaths.

Life expectancy at birth plunged from 78.8 years in 2019 to 76.4 in 2021, a staggering decline in a barometer of a country’s health that typically changes by only a tenth or two annually. An average of 3,100 people—one every 28 seconds—died of COVID-19 every day in the United States in January 2021, before vaccines for the virus became widely available, The Washington Post reported.

The impact on those caring for the sick and dying was profound. “The second week of December [2020] was probably the worst week of my career,” said Brad Butcher, director of the medical-surgical intensive care unit at UPMC Mercy hospital in Pittsburgh , Pennsylvania. “The first day I was on service, five patients died in a shift. And then I came back the next day, and three patients died. And I came back the next day, and three more patients died. And it was completely defeating,” he told The Washington Post on January 11, 2021.

“We can’t get the graves dug fast enough,” a Maryland funeral home operator told The Washington Post that same day.

As the pandemic surged in waves around the world, country after country was plunged into economic recession , the inevitable damage caused by layoffs, business closures, lockdowns, deaths, reduced trade, debt repayment moratoriums , the cost to governments of responding to the crisis, and other factors. Overall, the virus triggered the greatest economic calamity in more than a century, according to a 2022 report by the World Bank .

“Economic activity contracted in 2020 in about 90 percent of countries, exceeding the number of countries seeing such declines during two world wars, the Great Depression of the 1930s, the emerging economy debt crises of the 1980s, and the 2007–09 global financial crisis,” the report noted. “In 2020, the first year of the COVID-19 pandemic, the global economy shrank by approximately 3 percent, and global poverty increased for the first time in a generation.”

A 2020 study that attempted to aggregate the costs of lost gross domestic product (GDP) estimated that premature deaths and health-related losses in the United States totaled more than $16 trillion, or roughly “90% of the annual GDP of the United States. For a family of 4, the estimated loss would be nearly $200,000.”

In April 2020, the U.S. unemployment rate stood at 14.7 percent, higher than at any point since the Great Depression. There were 23.1 million people out of work. The hospitality, leisure, and health care industries were especially hard hit. Consumer spending, which accounts for about two-thirds of the U.S. economy, plunged.

With workers at home, many businesses turned to telework, a development that would persist beyond the pandemic and radically change working conditions for millions. In 2023, 12.7 percent of full-time U.S. employees worked from home and 28.2 percent worked a hybrid office-home schedule, according to Forbes Advisor . Urban centers accustomed to large daily influxes of workers have suffered. Office vacancies are up, and small businesses have closed. The national office vacancy rate rose to a record 19.6 percent in the fourth quarter of 2023, according to Moody’s Analytics , which has been tracking the statistic since 1979.

Many hospitals were overwhelmed during COVID-19 surges, with too few beds for the flood of patients. But many also demonstrated their resilience and “surge capacity,” dramatically expanding bed counts in very short periods of time and finding other ways to treat patients in swamped medical centers. Triage units and COVID-19 wards were hastily erected in temporary structures on hospital grounds.

Still, U.S. hospitals suffered severe shortages of nurses and found themselves lacking basic necessities such as N95 masks and personal protective garb for the doctors, nurses, and other workers who risked their lives against the new pathogen at the start of the outbreak. Mortuaries and first responders were overwhelmed as well. The dead were kept in refrigerated trucks outside hospitals.

The country’s fragmented public health system proved inadequate to the task of coping with the outbreak, sparking calls for major reform of the CDC and other agencies. The CDC botched its initial attempt to create tests for the virus, leaving the United States almost blind to its spread during the early stages of the pandemic.

Beyond the physical dangers, mental health became a serious issue for overburdened health care personnel, other “essential” workers who continued to labor in crucial jobs, and many millions of isolated, stressed, fearful, locked-down people in the United States and elsewhere. Parents struggled to care for children kept at home by the pandemic while also attending to their jobs.

In a June 2020 survey, the CDC found that 41 percent of respondents said they were struggling with mental health and 11 percent had seriously considered suicide recently. Essential workers, unpaid caregivers , young adults, and members of racial and ethnic minority groups were found to be at a higher risk for experiencing mental health struggles, with 31 percent of unpaid caregivers reporting that they were considering suicide. WHO reported two years later that the pandemic had caused a 25 percent increase in anxiety and depression worldwide, young people and women being at the highest risk.

The rate of homicides by firearm in the United States rose by 35 percent during the pandemic to the highest rate in more than a quarter century.

A silver lining in the chaos of the pandemic’s opening year was the development in just 11 months of highly effective vaccines for the virus, a process that normally had taken 7–10 years. The U.S. government’s bet on unproven messenger RNA technology under the Trump administration’s Operation Warp Speed paid off, and the result validated the billions of dollars that the government pours into basic research every year.

On December 14, 2020, New York nurse Sandra Lindsay capped the tumultuous year by receiving the first shot of the vaccine that eventually would help end the public health crisis caused by COVID-19 pandemic.

Greater Good Science Center • Magazine • In Action • In Education

How Life Could Get Better (or Worse) After COVID

How do pandemics change our societies? It is tempting to believe that there will not be a single sector of society untouched by the COVID-19 pandemic . However, a quick look at previous pandemics in the 20th century reveals that such negative forecasts may be vastly exaggerated.

Prior pandemics have corresponded to changes in architecture and urban planning, and a greater awareness of public health . Yet the psychological and societal effects of the Spanish flu, the worst pandemic of the 20th century, were later perceived as less dramatic than anticipated, perhaps because it originated in the shadow of WWI. Austrian psychoanalyst Sigmund Freud described Spanish flu as a “ Nebenschauplatz ”—a sideshow in his life of that time, even though he eventually lost one of his daughters to the disease. Neither do we recall much more recent pandemics: the Asian flu of 1957 and the Hong Kong flu from 1968.

Imagining and planning for the future can be a powerful coping mechanism to gain some sense of control in an increasingly unpredictable pandemic life. Over the past year, some experts proclaimed that the world after COVID would be a completely different place , with changed values and a new map of international relations. The opinions of oracles who were not downplaying the virus were mostly negative . Societal unrest and the rise of totalitarian regimes, stunted child social development, mental health crises, exacerbated inequality, and the worst economic recession since the Great Depression were just a few worries discussed by pundits and on the news.

Other predictions were brighter—the disruptive force of the pandemic would provide an opportunity to reshape the world for the better, some said. To complement the voices of journalists, pundits, and policymakers, one of us (Igor Grossmann) embarked on a quest to gather opinions from the world’s leading scholars on behavioral and social science, founding the World after COVID project.

The World after COVID project is a multimedia collection of expert visions for the post-pandemic world, including scientists’ hopes, worries, and recommendations. In a series of 57 interviews, we invited scientists, along with futurists, to reflect on the positive and negative societal or psychological change that might occur after the pandemic, and the type of wisdom we need right now. Our team used a range of methodological techniques to quantify general sentiment, along with common and unique themes in scientists’ responses.

The results of this interview series were surprising, both in terms of the variability and ambivalence in expert predictions. Though the pandemic has and will continue to create adverse effects for many aspects of our society, the experts observed, there are also opportunities for positive change, if we are deliberate about learning from this experience.

Three opportunities after COVID-19

Scientists’ opinions about positive consequences were highly diverse. As the graph shows, we identified 20 distinct themes in their predictions. These predictions ranged from better care for elders, to improved critical thinking about misinformation, to greater appreciation of nature. But the three most common categories concerned social and societal issues.

1. Solidarity. Experts predicted that the shared struggles and experiences that we face due to the pandemic could foster solidarity and bring us closer together, both within our communities and globally. As clinical psychologist Katie A. McLaughlin from Harvard University pointed out, the pandemic could be “an opportunity for us to become more committed to supporting and helping one another.”

Similarly, sociologist Monika Ardelt from the University of Florida noted the possibility that “we realize these kinds of global events can only be solved if we work together as a world community.” Social identities—such as group memberships, nationality, or those that form in response to significant events such as pandemics or natural disasters—play an important role in fostering collective action. The shared experience of the pandemic could help foster a more global, inclusive identity that could promote international solidarity.

2. Structural and political changes. Early in the pandemic, experts also believed that we might also see proactive efforts and societal will to bring about structural and political changes toward a more just and diversity-inclusive society. Experts observed that the pandemic had exposed inequalities and injustices in our societies and hoped that their visibility might encourage societies to address them.

Philosopher Valerie Tiberius from the University of Minnesota suggested that the pandemic might bring about an “increased awareness of our vulnerability and mutual dependence.”

Fellow of the Royal Institute for International Affairs in the U.K. Anand Menon proposed that the pandemic might lead to growing awareness of economic inequality, which could lead to “greater sustained public and political attention paid to that issue.” Cultural psychologist Ayse Uskul from Kent University in the U.K. shared this sentiment and predicted that this awareness “will motivate us to pick up a stronger fight against the unfair distribution of resources and rights not just where we live, but much more globally.”

3. Renewed social connections. Finally, the most common positive consequence discussed was that we might see an increased awareness of the importance of our social connections. The pandemic has limited our ability to connect face to face with friends and families, and it has highlighted just how vulnerable some of our family members and neighbors might be. Greater Good Science Center founding director and UC Berkeley professor Dacher Keltner suggested that the pandemic might teach us “how absolutely sacred our best relationships are” and that the value of these relationships would be much higher in the post-pandemic world. Past president of the Society of Evolution and Human Behavior Douglas Kenrick echoed this sentiment by predicting that “tighter family relationships would be the most positive outcome of this [pandemic].”

Similarly, Jennifer Lerner—professor of decision-making from Harvard University—discussed how the pandemic had led people to “learn who their neighbors are, even though they didn’t know their neighbors before, because we’ve discovered that we need them.” These kinds of social relationships have been tied to a range of benefits, such as increased well-being and health , and could provide lasting benefits to individuals.

Post-pandemic risks

How about predictions for negative consequences of the pandemic? Again, opinions were variable, with more than half of the themes were mentioned by less than 10% of our interviewees. Only two predictions were mentioned by at least ten experts: the potential for political unrest and increased prejudice or racism. These predictions highlight a tension in expert predictions: Whereas some scholars viewed the future bright and “diversity-inclusive,” others fear the rise in racism and prejudice. Before we discuss this tension, let us examine what exactly scholars meant by these two worries.

1. Increased prejudice or racism. Many experts discussed how the conditions brought about by the pandemic could lead us to focus on our in-group and become more dismissive of those outside our circles. Incheol Choi, professor of cultural and positive psychology from Seoul National University, discussed that his main area of concern was that “stereotypes, prejudices against other group members might arise.” Lisa Feldman Barrett, fellow of the American Academy of Arts & Sciences and the Royal Society of Canada, echoed this sentiment, noting that previous epidemics saw “people become more entrenched in their in-group and out-group beliefs.”

2. Political unrest. Similarly, many experts discussed how a greater focus on our in-groups might also exacerbate existing political divisions. Past president of the Society for Philosophy and Psychology Paul Bloom discussed how a greater dismissiveness toward out-groups was visible both within countries and internationally, where “countries are blaming other countries and not working together enough.” Dilip Jeste, past president of the American Psychiatric Association, discussed his concerns that the tendency to view both candidates and supporters as winners and losers in elections could mean that the “political polarization that we are observing today in the U.S. and the world will only increase.”

These predictions were not surprising— pundits and other public figures have been discussing these topics, too. However, as we analyzed and compared predictions for positive and negative consequences, we found something unexpected.

The yin and yang of COVID’s effects

Almost half of the interviewees spontaneously mentioned that the same change could be a force for good and for bad . In other words, they were dialectical , recognizing the multidetermined nature of predictions and acknowledging that context matters—context that determines who may be the winners and losers in the years to come. For example, experts predicted that we may see greater acceptance of digital technologies at home and at work. But besides the benefits of this—flexible work schedules, reduced commutes—they also mentioned likely costs, such as missing social information in virtual communication and disadvantages for people who cannot afford high-speed internet or digital devices.

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Amid this complexity, experts weighed in on what type of wisdom we need to help bring about more positive changes ahead. Not only do we need the will to sustain political and structural change, many argued, but also a certain set of psychological strategies promoting sound judgment: perspective taking, critical thinking, recognizing the limits of our knowledge, and sympathy and compassion.

In other words, experts’ recommended wisdom focuses on meta-cognition, which underlies successful emotion regulation, mindfulness, and wiser judgment about complex social issues. The good news is that these psychological strategies are malleable and trainable ; one way we can cultivate wisdom and perspective, for example, is by adopting a third-person, observer perspective on our challenges.

On the surface, the “it depends” attitude of many experts about the world after COVID may be dissatisfying. However, as research on forecasting shows, such a dialectical attitude is exactly what distinguishes more accurate forecasters from the rest of the population. Forecasting is hard and predictions are often uncertain and likely wrong. In fact, despite some hopes for the future, it is equally possible that the change after the pandemic will not even be noticeable. Not because changes will not happen, but because people quickly adjust to their immediate circumstances.

The future will tell whether and how the current pandemic has altered our societies. In the meantime, the World after COVID project provides a time-stamped window into experts’ apartments and their minds. As we embrace another pandemic spring, these insights can serve as a reminder that the pandemic may lead not only to worries but also to hopes for the years ahead.

About the Authors

Igor Grossmann

Igor Grossmann, Ph.D. , studies people and cultures, sometimes together, and often across time. He is an associate professor of psychology at the University of Waterloo, where he directs the Wisdom and Culture Lab.

Oliver Twardus

Oliver Twardus is the lab manager for the Wisdom and Culture lab and an aspiring researcher. He will be starting his master’s in neuroscience and applied cognitive science in September 2021.

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Life after COVID-19: Making space for growth

In this time of grief, the theory of post-traumatic growth suggests people can emerge from trauma even stronger

Vol. 51, No. 4

In the traditional Japanese art of kintsugi, artisans fill the cracks in broken pottery with gold or silver, transforming damaged pieces into something more beautiful than they were when new. Post-traumatic growth is like kintsugi for the mind.

Developed in the 1990s by psychologists Richard Tedeschi, PhD, and Lawrence Calhoun, PhD, the theory of post-traumatic growth suggests that people can emerge from trauma or adversity having achieved positive personal growth. It’s a comforting idea in the best of times. But it holds particular appeal as we live through a pandemic that’s upending lives for people around the globe.

Growing from trauma isn’t unusual, says Tedeschi, now a professor emeritus at the University of North Carolina Charlotte and chair of the Boulder Crest Institute for Posttraumatic Growth in Bluemont, Virginia. “Studies support the notion that post-traumatic growth is common and universal across cultures,” he says. “We’re talking about a transformation—a challenge to people’s core beliefs that causes them to become different than they were before.”

And the COVID-19 pandemic may have the ingredients to foster such growth. “We’re still in the middle of this situation, and we don’t know yet what might happen—but there will be serious challenges to people’s lives,” Tedeschi says. While those effects may be devastating, it’s possible to emerge from such adversity for the better, he adds. “For some people, this event may be a shock to their core belief system. When that’s the case, it has the potential to result in s­ignificant positive changes.”

Resilience vs. post-traumatic growth

Research across a variety of disasters has shown that there are different trajectories for recovery, says Erika Felix, PhD, a psychologist at the University of California, Santa Barbara, who treats and studies trauma survivors. Some people need time to recover from a trauma before returning to normal functioning. A portion of people experience negative mental health impacts that become chronic, but the majority of people bounce back from a trauma pretty quickly, she says. “Most people will be resilient and return to their previous level of functioning.”

Resilience and post-­traumatic growth are not the same thing, however. In fact, people who bounce back quickly from a setback aren’t the ones likely to experience positive growth, Tedeschi explains. Rather, people who experience post-traumatic growth are those who endure some cognitive and emotional struggle and then emerge changed on the other side.

This experience is measured by Tedeschi and Calhoun’s Post­traumatic Growth Inventory (PTGI) ( Journal of Traumatic Stress , Vol. 9, No. 3, 1996), which evaluates growth in five areas: appreciation of life, relating to others, personal strength, recognizing new possibilities and spiritual change. It’s not necessary or even typical to show change in all five areas, Tedeschi says. But growth in even one or two of those realms “can have a profound effect on a person’s life,” he says.

Some psychologists say the evidence for post-traumatic growth isn’t yet as robust as it could be. For example, Patricia Frazier, PhD, at the University of Minnesota, and colleagues followed undergraduates before and after a trauma. They found that participants’ self-reported perceived growth didn’t align with actual growth as measured by the PTGI. And while actual growth was related to positive coping, perceived growth was not, suggesting the construct may not fully reflect the way people are transformed by trauma ( Psychological Science , Vol. 20, No. 7, 2009).

But other evidence suggests that people do grow from trauma. A 2018 book by Tedeschi and colleagues summarizes more than 700 studies related to post-traumatic growth, including Tedeschi’s own research and work from other scientists (“ Posttraumatic Growth: Theory, Research, and Applications ,” Routledge, 2018). “When you look at how people respond to traumatic events, post-traumatic growth seems to be fairly common,” he says.

Planting the seeds for positive change

Post-traumatic growth isn’t something psychologists can prescribe or create, Tedeschi says. But they can facilitate it. “We see it as a natural tendency that we can watch for and encourage, without trying to make people feel pressured or that they’re failures if they don’t achieve this growth,” Tedeschi explains.

Most evidence-based trauma treatments provide a “manualized approach” to alleviating stress and symptoms such as anxiety, Tedeschi says. The post-traumatic growth framework he uses is an integrated approach that includes elements of cognitive-behavioral therapy, along with other aspects that emphasize personal growth. “It has elements of narrative and existential aspects, too, because traumas often present people with existential questions about what’s important in life.”

One way to help clients see the possibilities for growth is to be an “expert companion” during their struggle, he says. “That’s someone who accompanies their trauma, listens carefully to their story and learns from them about what has happened in their lives. By being that kind of expert, people start to open up and look at the possibilities in their lives more thoroughly.”

Yet post-traumatic growth isn’t something that can be rushed, and it often takes a long time to come to fruition. “As a clinician, you can plant the seeds that may germinate later,” Tedeschi says.

As we emerge from the COVID-19 crisis, clinicians and their clients may have opportunities to help those seeds begin to sprout. “This situation presents a challenge to people’s lives, and some people will be able to emerge from this for the better,” Tedeschi says.

One doesn’t necessarily need to experience trauma and existential struggle to learn from this crisis, however. For many people, the pandemic is shining a light on the things that are most important. “We might be making more time for things we find meaningful, simplifying our lives and making time for being connected in our relationships,” Felix says. “A stressor like this makes all of us think: What does this slowdown mean for our lives? We might be fundamentally changed in some ways that are beneficial.”

The Posttraumatic Growth Workbook Tedeschi, R.G., & Moore, B.A. New Harbinger Publications, 2016

The Posttraumatic Growth Inventory: A Revision Integrating Existential and Spiritual Change Tedeschi R.G., et al., Journal of Traumatic Stress , 2017

Do Levels of Posttraumatic Growth Vary by Type of Traumatic Event Experienced? An Analysis of the Nurses’ Health Study II Lowe, S.R., et al., Psychological Trauma , 2020

Resiliency and Posttraumatic Growth Despotes, A.M., et al. In Wilson, L.C. (Ed.)The Wiley Handbook of the Psychology of Mass Shootings, John Wiley & Sons, 2017

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A National Strategy for the “New Normal” of Life With COVID

• 1 Perelman School of Medicine and The Wharton School, University of Pennsylvania, Philadelphia
• 2 Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis
• 3 Grossman School of Medicine, New York University, New York, New York
• Viewpoint The First 2 Years of COVID-19—Lessons to Improve Preparedness for the Next Pandemic Jennifer B. Nuzzo, DrPH, SM; Lawrence O. Gostin, JD JAMA
• Viewpoint A National Strategy for COVID-19—Testing, Surveillance, and Mitigation Strategies David Michaels, PhD, MPH; Ezekiel J. Emanuel, MD, PhD; Rick A. Bright, PhD JAMA
• Viewpoint A National Strategy for COVID-19 Medical Countermeasures Luciana L. Borio, MD; Rick A. Bright, PhD; Ezekiel J. Emanuel, MD, PhD JAMA
• Viewpoint The Pandemic Preparedness Program Eli Y. Adashi, MD, MS; I. Glenn Cohen, JD JAMA
• Medical News & Perspectives Former Biden-Harris Transition Advisors Propose a New National Strategy for COVID-19 Jennifer Abbasi JAMA
• Comment & Response Strategy for the “New Normal” of Life With COVID—Reply Ezekiel J. Emanuel, MD, PhD; Michael Osterholm, PhD, MPH; Céline R. Gounder, MD, ScM JAMA
• Comment & Response Strategy for the “New Normal” of Life With COVID Afschin Gandjour, MD, PhD, MA JAMA
• Viewpoint COVID-19 Vaccination—Becoming Part of the New Normal Peter Marks, MD, PhD; Janet Woodcock, MD; Robert Califf, MD JAMA

As the Omicron variant of SARS-CoV-2 demonstrates, COVID-19 is here to stay. In January 2021, President Biden issued the “National Strategy for the COVID-19 Response and Pandemic Preparedness.” As the US moves from crisis to control, this national strategy needs to be updated. Policy makers need to specify the goals and strategies for the “new normal” of life with COVID-19 and communicate them clearly to the public.

SARS-CoV-2 continues to persist, evolve, and surprise. In July 2021, with vaccinations apace and infection rates plummeting, Biden proclaimed that “we’ve gained the upper hand against this virus,” and the Centers for Disease Control and Prevention (CDC) relaxed its guidance for mask wearing and socializing. 1 By September 2021, the Delta variant proved these steps to be premature, and by late November, the Omicron variant created concern about a perpetual state of emergency.

In delineating a national strategy, humility is essential. The precise duration of immunity to SARS-CoV-2 from vaccination or prior infection is unknown. Also unknown is whether SARS-CoV-2 will become a seasonal infection; whether antiviral therapies will prevent long COVID; or whether even more transmissible, immune-evading, or virulent variants will arise after Omicron.

Another part of this humility is recognizing that predictions are necessary but educated guesses, not mathematical certainty. The virus, host response, and data will evolve. Biomedical and public health tools will expand, along with better understanding of their limitations. The incidence of SARS-CoV-2, vaccination rates, hospital capacity, tolerance for risk, and willingness to implement different interventions will vary geographically, and national recommendations will need to be adapted locally.

It is imperative for public health, economic, and social functioning that US leaders establish and communicate specific goals for COVID-19 management, benchmarks for the imposition or relaxation of public health restrictions, investments and reforms needed to prepare for future SARS-CoV-2 variants and other novel viruses, and clear strategies to accomplish all of this.

Redefining the Appropriate National Risk Level

The goal for the “new normal” with COVID-19 does not include eradication or elimination, eg, the “zero COVID” strategy. 2 Neither COVID-19 vaccination nor infection appear to confer lifelong immunity. Current vaccines do not offer sterilizing immunity against SARS-CoV-2 infection. Infectious diseases cannot be eradicated when there is limited long-term immunity following infection or vaccination or nonhuman reservoirs of infection. The majority of SARS-CoV-2 infections are asymptomatic or mildly symptomatic, and the SARS-CoV-2 incubation period is short, preventing the use of targeted strategies like “ring vaccination.” Even “fully” vaccinated individuals are at risk for breakthrough SARS-CoV-2 infection. Consequently, a “new normal with COVID” in January 2022 is not living without COVID-19.

The “new normal” requires recognizing that SARS-CoV-2 is but one of several circulating respiratory viruses that include influenza, respiratory syncytial virus (RSV), and more. COVID-19 must now be considered among the risks posed by all respiratory viral illnesses combined. Many of the measures to reduce transmission of SARS-CoV-2 (eg, ventilation) will also reduce transmission of other respiratory viruses. Thus, policy makers should retire previous public health categorizations, including deaths from pneumonia and influenza or pneumonia, influenza, and COVID-19, and focus on a new category: the aggregate risk of all respiratory virus infections.

What should be the peak risk level for cumulative viral respiratory illnesses for a “normal” week? Even though seasonal influenza, RSV, and other respiratory viruses circulating before SARS-CoV-2 were harmful, the US has not considered them a sufficient threat to impose emergency measures in over a century. People have lived normally with the threats of these viruses, even though more could have been done to reduce their risks.

The appropriate risk threshold should reflect peak weekly deaths, hospitalizations, and community prevalence of viral respiratory illnesses during high-severity years, such as 2017-2018. 3 That year had approximately 41 million symptomatic cases of influenza, 710 000 hospitalizations and 52 000 deaths. 4 In addition, the CDC estimates that each year RSV leads to more than 235 000 hospitalizations and 15 000 deaths in the US. 3 This would translate into a risk threshold of approximately 35 000 hospitalizations and 3000 deaths (<1 death/100 000 population) in the worst week.

Today, the US is far from these thresholds. For the week of December 13, 2021, the CDC reported the US experienced more than 900 000 COVID-19 cases, more than 50 000 new hospitalizations for COVID-19, and more than 7000 deaths. 5 , 6 The tolerance for disease, hospitalization, and death varies widely among individuals and communities. What constitutes appropriate thresholds for hospitalizations and death, at what cost, and with what trade-offs remains undetermined.

This peak week risk threshold serves at least 2 fundamental functions. This risk threshold triggers policy recommendations for emergency implementation of mitigation and other measures. In addition, health systems could rely on this threshold for planning on the bed and workforce capacity they need normally, and when to institute surge measures.

Rebuilding Public Health

To cope with pandemic, and eventually, endemic SARS-CoV-2 and to respond to future public health threats requires deploying real-time information systems, a public health implementation workforce, flexible health systems, trust in government and public health institutions, and belief in the value of collective action for public good. 7 , 8

First, the US needs a comprehensive, digital, real-time, integrated data infrastructure for public health. As Omicron has reemphasized, the US is operating with imprecise estimates of disease spread, limited genomic surveillance, projections based on select reporting sites, and data from other countries that may not be generalizable. These shortcomings are threatening lives and societal function.

The US must establish a modern data infrastructure that includes real-time electronic collection of comprehensive information on respiratory viral infections, hospitalizations, deaths, disease-specific outcomes, and immunizations merged with sociodemographic and other relevant variables. The public health data infrastructure should integrate data from local, state, and national public health units, health care systems, public and commercial laboratories, and academic and research institutions. Using modern technology and analytics, it is also essential to merge nontraditional environmental (air, wastewater) surveillance data, including genomic data, with traditional clinical and epidemiological data to track outbreaks and target containment.

Second, the US needs a permanent public health implementation workforce that has the flexibility and surge capacity to manage persistent problems while simultaneously responding to emergencies. Data collection, analysis, and technical support are necessary, but it takes people to respond to crises. This implementation workforce should include a public health agency–based community health worker system and expanded school nurse system.

A system of community public health workers could augment the health care system by testing and vaccinating for SARS-CoV-2 and other respiratory infections; ensuring adherence to ongoing treatment for tuberculosis, HIV, diabetes, and other chronic conditions; providing health screening and support to pregnant individuals and new parents and their newborns; and delivering various other public health services to vulnerable or homebound populations.

School nurses need to be empowered to address the large unmet public health needs of children and adolescents. As polio vaccination campaigns showed, school health programs are an efficient and effective way to care for children, including preventing and treating mild asthma exacerbations (often caused by viral respiratory infections), ensuring vaccination as a condition for attendance, and addressing adolescents’ mental and sexual health needs. School clinics must be adequately staffed and funded as an essential component of the nation’s public health infrastructure.

Third, because respiratory infections ebb and flow, institutionalizing telemedicine waivers, licensure to practice and enable billing across state lines, and other measures that allow the flow of medical services to severely affected regions should be a priority.

Fourth, it is essential to rebuild trust in public health institutions and a belief in collective action in service of public health. 7 Communities with higher levels of trust and reciprocity, such as Denmark, have experienced lower rates of hospitalization and death from COVID-19. 7 Improving public health data systems and delivering a diverse public health workforce that can respond in real time in communities will be important steps toward building that trust more widely.

Conclusions

After previous infectious disease threats, the US quickly forgot and failed to institute necessary reforms. That pattern must change with the COVID-19 pandemic. Without a strategic plan for the “new normal” with endemic COVID-19, more people in the US will unnecessarily experience morbidity and mortality, health inequities will widen, and trillions will be lost from the US economy. This time, the nation must learn and prepare effectively for the future.

The resources necessary to build and sustain an effective public health infrastructure will be substantial. Policy makers should weigh not only the costs but also the benefits, including fewer deaths and lost productivity from COVID-19 and all viral respiratory illnesses. Indeed, after more than 800 000 deaths from COVID-19, and a projected loss of $8 trillion in gross domestic product through 2030, 8 these interventions will be immensely valuable.

Corresponding Author: Ezekiel J. Emanuel, MD, PhD, Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Blockley Hall, Philadelphia, PA 19104 ( [email protected] ).

Published Online: January 6, 2022. doi:10.1001/jama.2021.24282

Conflict of Interest Disclosures: Dr Emanuel reported personal fees, nonfinancial support, or both from companies, organizations, and professional health care meetings and being a venture partner at Oak HC/FT; a partner at Embedded Healthcare LLC, ReCovery Partners LLC, and COVID-19 Recovery Consulting; and an unpaid board member of Village MD and Oncology Analytics. Dr Emanuel owns no stock in pharmaceutical, medical device companies, or health insurers. No other disclosures were reported.

Additional Information: Drs Emanuel, Osterholm, and Gounder were members of the Biden-Harris Transition COVID-19 Advisory Board from November 2020 to January 2021.

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Emanuel EJ , Osterholm M , Gounder CR. A National Strategy for the “New Normal” of Life With COVID. JAMA. 2022;327(3):211–212. doi:10.1001/jama.2021.24282

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When Computer Bugs Were Actual Insects

Extreme natural phenomena, openmind books, scientific anniversaries, a loop towards the extinction of species,the other ‘butterfly effect’, featured author, latest book, a changing world: life after covid-19, understanding as a way to reinvent ourselves following a lethally smart virus.

It happened in the blink of an eye, to put it metaphorically.  Suddenly, the virus had made its home in the body of more than hundreds, if not thousands, of people in different countries around the world. The coronavirus that started in the city of Wuhan, China, according to official sources , on December 31, 2019, which is where it got the name COVID-19, followed its natural course, ignoring borders, customs and tariffs.  

The part about following its natural course refers to a Chinese proverb that has become something like the slogan of the so-called chaos theory , developed by the mathematician and meteorologist Edward Lorenz in the 1960s, together with other scientists, which tries to answer the following question: Is it possible for a butterfly flapping its wings in Sri Lanka to cause a hurricane in the United States? If we interpret and adapt the chaos theory and butterfly effect to the current situation we are globally experiencing, this new outbreak of coronavirus, it could lead us to give the answer that an event, regardless of how unlikely it may seem, does not mean it is impossible for it to occur.

Proof of this is that the disaster is already upon us, shaking our political, social and economic gears as never before. So how can an invisible virus be defeated when it does not seem to produce symptoms in the people who carry, or carried, it the most? Furthermore, even though some insist with all their might on denying the obvious, the truth is that the virus does not care about social class, race, gender or other labels that divide us. COVID-19 has once again put Darwin’s hypothesis of “survival of the fittest” in style, which does not necessarily have to correspond to the strongest. In fact, it is Trump’s America that is the country that has been hit the hardest by COVID-19, and Italy and Spain have the highest number of deaths in Europe.

Going back in time to take stock of the situation

Media coverage of disasters or health crises is no simple task when right in the middle of them. However, it is important to analyze and clear up certain unknowns to the extent possible . That’s why, one of the key questions in this global pandemic is whether it could have been avoided. If it could not have been avoided, it could fall under the category of what the Lebanese-American philosopher and researcher Nassim Nicholas Taleb calls a black swan. 

This concept is a metaphor that  Taleb developed in his 2007 book entitled The Black Swan: The Impact of the Highly Improbable. A black swan is a surprising event (for the observer) that has a great socioeconomic impact and after it happens it is rationalized retrospectively (making it seem predictable or explainable and giving the impression that it was expected to occur). In addition, these types of incidents considered extremely atypical, collectively play much bigger roles that regular events. 

For Taleb, examples of “black swans” throughout the history of humankind have included: the start of World War I, the Spanish flu , or the September 11, 2001 terrorist attacks. That said, what do you think Taleb said about whether COVID-19 is another black swan? The answer, which is in this video published on March 31st, is no, as the author feels that the pandemic could have been prevented.

However, although COVID-19 does not meet all the requirements for Taleb’s theory to be considered a real black swan, we cannot deny the evidence that we are facing an event that is disruptive on a planetary scale, whose future consequences we are not currently able to make out.  If there are documented facts, who in the past could have warned about the possibility of a pandemic outbreak of this magnitude?

Coronavirus pandemic: an overlooked reality

In October 2007, the academic journal Clinical Microbiology Reviews published that it is specializing in analysis of the most innovative developments in the areas of clinical microbiology and immunology in an article called: Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection . In its introduction, it says: “The rapid economic growth in southern China has led to an increasing demand for animal proteins including those from exotic game food animals such as civets. Large numbers and varieties of these wild game mammals in overcrowded cages and the lack of biosecurity measures in wet markets allowed the jumping of this novel virus from animals to human. Its capacity for human-to-human transmission, the lack of awareness in hospital infection control, and international air travel facilitated the rapid global dissemination of this agent.” The conclusion of the same article says: “The possibility of the reemergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored.”

In the year 2013, German authorities published the 2012 Report on risk analysis in civil protection ( Bericht zur Risikoanalyse im Bevölkerungsschutz 2012 ). One of the sections of this official document described a simulation of a hypothetical outbreak of coronavirus around the world. The researchers who carried out this “simulation game” were a group or researchers led by the Robert Koch Institute . This is Germany’s public health agency, as well as the research center in charge of controlling and preventing diseases. On April 7th, the German magazine Der Spiegel published an article in which the author asked the following question, which is exactly what many people are thinking, and which can be extrapolated beyond Germany: “Why wasn’t Germany better prepared if it knew that this kind of scenario could occur? And therefore, what was the purpose of the report?” 

Meanwhile, Luis Enrique Martín Otero , colonel veterinarian and coordinator of VISVET at the Network of Biological Alert Laboratories (RE-LAB), who at the same time was Technical Director on a national level of the 2001 anthrax crisis, wrote the following article near the end of March: Covid19: silent biological threat . The first paragraph of this article has the following: 

In this fragment, Martín Otero also makes it clear that this pandemic was not a black swan. He argues the following: “ As long as nothing happens, politicians do not value the importance of constantly researching these biological threats. Those of us working on them know that they will occur, but we don’t know when.” 

However, humans are not the only ones who have been making forecasts about a possible global pandemic from coronavirus. So have some  AI based computer programs , as described by Ramón López de Mántaras Badia , Director of the CSIC Institute for Artificial Intelligence , which anticipated the outbreak, but the use of these data was not completely smart and effective. It was missing a human mind, as Ramón clarifies, or more precisely, a group of them spaced out over the world in order to interpret and manage the data or conclusions obtained from the machines. 

On a sinking ship, focus on what is important 

Apparently, for some unknown reason, deciphering the future continues to be humans’ great dream. So far, we have been chasing this goal, and continue to do do, still drunk on a sort of blind hope. 

Some of the hypothetical causes that could have led to this scenario could stem from: the very limits of human understanding of reality and human nature, which have led us to not have appropriate mechanisms to manage these kinds of incidents; perhaps out of some kind of ignorance or arrogance; together with an implemented technology that is even baptized with the name artificial intelligence, which is not yet as intelligent as previously believed, as it has not been adapted to the basic needs of a globalized, constantly evolving world. This could be due once again to the knowledge, understanding or more precisely, the design of artificial intelligence itself, as more than betting on implementing technology that lowers the weaknesses we face as a species, we have attempted, and continue to attempt, to only simulate some aspects of our human intelligence, playing some sort of Homo Deus. 

If the famous cult of reason and the systematization of science, which is so important to the method and for scientific progress is combined with the impetus to continue deciphering the role that human emotions play to a greater extent, as well as the nature of our fear of uncertain events, the origin of power struggles, our systems of beliefs and values, of our decision-making and therefore of our identity, we will have managed to make a qualitative evolutionary leap. 

However, these more profound causes will be better analyzed and studied after the fact, when we are able to take stock of this historic period with more perspective, understood as from a distance, with the calmness and tranquility that no one currently possesses as we are completely immersed in the fight for survival. However, if we don’t do it, our eternal great enemy will have won the battle: oblivion. 

Rosae Martín Peña

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Essay On Covid-19: 100, 200 and 300 Words

• Updated on  
• Apr 30, 2024

COVID-19, also known as the Coronavirus, is a global pandemic that has affected people all around the world. It first emerged in a lab in Wuhan, China, in late 2019 and quickly spread to countries around the world. This virus was reportedly caused by SARS-CoV-2. Since then, it has spread rapidly to many countries, causing widespread illness and impacting our lives in numerous ways. This blog talks about the details of this virus and also drafts an essay on COVID-19 in 100, 200 and 300 words for students and professionals. 

Table of Contents

• 1 Essay On COVID-19 in English 100 Words
• 2 Essay On COVID-19 in 200 Words
• 3 Essay On COVID-19 in 300 Words
• 4 Short Essay on Covid-19

Essay On COVID-19 in English 100 Words

COVID-19, also known as the coronavirus, is a global pandemic. It started in late 2019 and has affected people all around the world. The virus spreads very quickly through someone’s sneeze and respiratory issues.

COVID-19 has had a significant impact on our lives, with lockdowns, travel restrictions, and changes in daily routines. To prevent the spread of COVID-19, we should wear masks, practice social distancing, and wash our hands frequently. 

People should follow social distancing and other safety guidelines and also learn the tricks to be safe stay healthy and work the whole challenging time. 

Also Read: National Safe Motherhood Day 2023

Essay On COVID-19 in 200 Words

COVID-19 also known as coronavirus, became a global health crisis in early 2020 and impacted mankind around the world. This virus is said to have originated in Wuhan, China in late 2019. It belongs to the coronavirus family and causes flu-like symptoms. It impacted the healthcare systems, economies and the daily lives of people all over the world. 

The most crucial aspect of COVID-19 is its highly spreadable nature. It is a communicable disease that spreads through various means such as coughs from infected persons, sneezes and communication. Due to its easy transmission leading to its outbreaks, there were many measures taken by the government from all over the world such as Lockdowns, Social Distancing, and wearing masks. 

There are many changes throughout the economic systems, and also in daily routines. Other measures such as schools opting for Online schooling, Remote work options available and restrictions on travel throughout the country and internationally. Subsequently, to cure and top its outbreak, the government started its vaccine campaigns, and other preventive measures. 

In conclusion, COVID-19 tested the patience and resilience of the mankind. This pandemic has taught people the importance of patience, effort and humbleness. 

Also Read : Essay on My Best Friend

Essay On COVID-19 in 300 Words

COVID-19, also known as the coronavirus, is a serious and contagious disease that has affected people worldwide. It was first discovered in late 2019 in Cina and then got spread in the whole world. It had a major impact on people’s life, their school, work and daily lives. 

COVID-19 is primarily transmitted from person to person through respiratory droplets produced and through sneezes, and coughs of an infected person. It can spread to thousands of people because of its highly contagious nature. To cure the widespread of this virus, there are thousands of steps taken by the people and the government. 

Wearing masks is one of the essential precautions to prevent the virus from spreading. Social distancing is another vital practice, which involves maintaining a safe distance from others to minimize close contact.

Very frequent handwashing is also very important to stop the spread of this virus. Proper hand hygiene can help remove any potential virus particles from our hands, reducing the risk of infection. 

In conclusion, the Coronavirus has changed people’s perspective on living. It has also changed people’s way of interacting and how to live. To deal with this virus, it is very important to follow the important guidelines such as masks, social distancing and techniques to wash your hands. Getting vaccinated is also very important to go back to normal life and cure this virus completely.

Also Read: Essay on Abortion in English in 650 Words

Short Essay on Covid-19

Please find below a sample of a short essay on Covid-19 for school students:

Also Read: Essay on Women’s Day in 200 and 500 words

to write an essay on COVID-19, understand your word limit and make sure to cover all the stages and symptoms of this disease. You need to highlight all the challenges and impacts of COVID-19. Do not forget to conclude your essay with positive precautionary measures.

Writing an essay on COVID-19 in 200 words requires you to cover all the challenges, impacts and precautions of this disease. You don’t need to describe all of these factors in brief, but make sure to add as many options as your word limit allows.

The full form for COVID-19 is Corona Virus Disease of 2019.

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Hence, we hope that this blog has assisted you in comprehending with an essay on COVID-19. For more information on such interesting topics, visit our essay writing page and follow Leverage Edu.

Simran Popli

An avid writer and a creative person. With an experience of 1.5 years content writing, Simran has worked with different areas. From medical to working in a marketing agency with different clients to Ed-tech company, the journey has been diverse. Creative, vivacious and patient are the words that describe her personality.

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• Pandemic Stories from New Orleans-Area Service and Hospitality Workers In 2023, Dr. Sara T. Bernstein, Dr. Elise Chatelain, and Zach Golden, of Dismantle Culture and Media Alliance, LLC, received funding to interview service and hospitality professionals who worked during the height of the COVID-19 pandemic in the New Orleans, LA-area. The researchers sought to understand how COVID-19 impacted the lives of hospitality workers and how the workers adapted to the changes created by…

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Beyond the pandemic: The truth of life after COVID-19

This study focused on how to deal with the psychological trauma from the perspective of a doctor on the front line of the fight against COVID-19. As the pandemic continues to ravage our world, post-pandemic psychological counseling urgently needs to be addressed. Based on the experience of fighting the epidemic, this study discusses the psychological changes since the COVID-19 outbreak in 2020. Taking a 19-year-old with breast cancer as an example, this study considered how to find spiritual comfort, and examined how to find meaning in today's complicated world and lives, as well as turning the crisis into an opportunity for spiritual renewal and adding meaning to our lives. It is hoped that this study will inspire readers to overcome the difficulties of the epidemic, find strength and see it as a life-changing opportunity.

Introduction

The Covid-19 pandemic is in its third year. China has been battling the outbreak since early 2020. 1 To date, we are still fighting SARS-Cov-2 and the Omicron variants on multiple fronts. 2 The dramatic changes brought about by COVID-19 have affected every aspect of people's lives. Some of the measures to control the epidemic, including isolation, access restrictions and economic shutdowns, radically changed psychosocial behavior, and induced psychological trauma, especially China's strict prevention and control policies have affected large numbers of people. Nevertheless, there is a lack of timely research on post-pandemic trauma and psychological counseling. 3 Here, I would like to share some thoughts about the trauma under the epidemic from the viewpoint of an infectious disease specialist. It is hoped this will inspire readers and help them overcome psychological trauma and bring a new perspective on life in the post-pandemic era.

Trauma haunts many people and psychological counseling is urgent

Before COVID-19, like everyone else around me, I had made plans, looked forward to the future, and expected things to go according to my wishes. We live so uneventfully for so long that we become desensitized to major events. Even in the hospital, faced with life, death, and severe diseases, we do things according to procedure and remain unperturbed. However, when COVID-19 hit, things changed.

In the early days of fighting COVID-19, the knowledge of the Novel Coronavirus was limited. We risked our lives in the fight against an unknown enemy. From public officials to medical staff, even ordinary Chinese citizens, people paid a high price for the first victory against COVID-19. In the most difficult times, I held multiple roles: a doctor in a fever clinic, a comforter of anxious patients, a collector of throat swabs for SARS-Cov-2 tests, and a member of staff collating patients’ data. Initially, I was lost, terrified, overwhelmed, and had never felt so close to death. I lived alone, apart from my family. What I could do was immerse myself in various roles, held on through psychological trauma, dedicated to the fight against the epidemic, and looked forward to overcoming it as soon as possible. People around me, including colleagues, friends, were also suffering from trauma; some even struggled with feelings of powerlessness and desperation. We pulled through the hard times and made hard-won progress.

Unfortunately, COVID-19 became a global pandemic. 4 , 5 At this moment, we are still experiencing waves of the Omicron variants. I often wonder, what does COVID-19 bring after we have suffered so much? How do we define ourselves in a medical career under such conditions? It could be said without exaggeration that human destiny and behavior have been forced to undergo momentous changes, including lives, work, study, and entertainment, among others. Many people experienced psychological distress, even to the brink of collapse. Personally, I have experienced a range of emotions and situations. Facing life, death, illness, science, religion, mission, work, family, solitude, incomprehension from others, pressure, and so on, which are intertwined as diversely as cytokine signaling pathways.

How do we respond to these huge changes? What is the most essential change that COVID-19 has brought? What are the key factors in the chaos and how do we make the right choices? We may complain that the epidemic and the competitive society have caused a seismic shift in our day to day lives, increased social inequities and adversities; however, complaining leads nowhere. The real difficulty is how to embrace life according to inner ideas and think independently. I cannot help but think, the most important thing I can do under the pandemic is to find things that touch our soul truly live our lives.

Turning crisis into opportunity

Whenever I think about things in life that touch our souls, I miss a friend named Xiao Yue, who was once one of my patients. At that time, I was a medical intern and studied thoracic surgery. Xiao Yue was a 19-year-old girl with advanced breast cancer. She had no choice but to have one breast removed, leaving thick stitches on her chest. She said to me: “I want to be a doctor in the future, specializing in breast reconstruction, so that many patients like me can get their lost breasts back. I hope to be able to stand out with my proud chest.”

Xiao Yue was gone a few years later, leaving no legacy. However, her words had a lasting impact on my life. As I look back, how should I use my friend's words to guide me in difficult situations like the pandemic? Do I “go with the flow”, or follow my mission, even in hard times? I do not want to be a mindless and insensitive man, but look forward to a colorful life, although there will be a lot of difficulties. How then do we find the truth about life? As a doctor, I will do everything I can to help patients, and guide them to understand the disease, life, and death. As a thinker, I would like to devote myself to the integration of medical science, my mission as a doctor, passion for the unknown, and real-life, give meaning to life, not only to the individual and families but also to devotion to society and medicine.

Reality and dreams, just like the double helix of DNA, are closely intertwined and create beautiful lives. Maybe this is where the truth of life is hidden. Life and death are nothing more than a dreamlike gathering of particles that constantly assemble and disintegrate. We should face reality and try to make the best of our lives and make them as fulfilling as possible.

Acknowledgment

I would like to express my deep gratitude to my wife, Yun Liu, for her continuous support. This work was supported by the research start-up fund of the Second Affiliated Hospital of Nanchang University (B2117).

The summer COVID-19 surge may be dipping — just like life expectancy

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Early signs California’s COVID-19 surge is peaking

As we approach the end of summer (someone please tell that to this heat wave ), let’s check back on the state of COVID-19 in the Golden State.

After months of rising cases, hospitalizations and wastewater levels, there are some early signs the coronavirus surge has peaked and is starting to recede.

“Although it’ll take a few more weeks of measurement to confirm the trajectory, health officials hope the release of updated vaccines will help further dent the wave,” Times reporter Rong-Gong Lin II wrote this week .

Many Californians can now get the new 2024-25 COVID vaccine at retail pharmacies, Kaiser Permanente and other health facilities. Health officials are advising people to get their shot soon so it reaches peak protection in time for late fall through early winter, when infections tend to ramp up again.

What does the data show?

The U.S. Centers for Disease Control and Prevention categorized viral activity in California’s wastewater as “high” for the last week of August , down from the “very high” status held since July. CDC officials note that the virus is “ likely declining ” in the state.

But Lin noted that “not all metrics are moving in the rosy direction.”

For example, 13% of statewide coronavirus tests with an officially recorded result came back positive last week (ending Sept. 2), which exceeds the peaks set last winter and summer.

COVID-19 deaths have also increased in the state and nation — up from earlier this summer, though not as sharply as 2023’s midyear peak.

And health officials are weary that the Labor Day holiday distorted reporting data and may spark a rebound. It’s unclear how many people actually have COVID-19 since many are not bothering to test anymore (because people simply don’t care like they used to ).

COVID’s lasting effects are continuing to be studied.

While the chance of contracting long COVID has decreased slightly since the introduction of vaccines, it still poses a significant risk .

The CDC’s list of symptoms ranges from respiratory issues to digestive troubles to neurological effects, including:

• significant fatigue in daily life
• heart palpitations
• trouble sleeping
• difficulty breathing
• changes in smell and/or taste

COVID-19 has also reduced life expectancy in California and across much of the nation. Babies born in the state in 2021 are expected to live 78.3 years on average, according to CDC data . That’s down two years and six months from Californians’ life expectancy in 2019 .

The decline was sharper for men than women. CDC researchers put the average female life expectancy in California at 81.4 years, while males get 75.3 years.

Compare that to the respective averages in 2019: 83.3 for females and 78.4 for males.

The reason for the decline is “mostly due to the COVID-19 pandemic and increases in unintentional injuries (mainly drug overdose deaths),” according to the CDC.

Still, people in the Golden State live longer on average than the majority of U.S. residents, ranking 10th last year out of the 50 states plus Washington, D.C. And preliminary data for 2022 show the national average life expectancy increased from 2021 .

The CDC also calculated remaining life expectancy by state for those who were 65 in 2021. For Californians, the overall average is 19.3 years, with 17.8 years for males and 20.7 for females. California ranked 8th overall by that metric.

Today’s top stories

Harris and Trump will face off tonight at a high-stakes debate in Philadelphia

• The live debate, which begins 6 p.m. PT and will be hosted by ABC News, comes as Vice President Kamala Harris and former President Trump are neck and neck in the 2024 presidential contest.
• Harris’ foreign policy has yet to be revealed, but some aspects could become clearer during tonight’s debate.
• Columnist Doyle McManus provides questions the debate’s moderators should have on their list .
• Meanwhile, former Rep. Adam Kinzinger, an Illinois Republican who voted to impeach Trump, said he would be open to serving in Harris’ Cabinet .

Firefighting crews in Southern California continued to battle out-of-control wildfires

• Two fires — the Line fire in San Bernardino County and the Bridge fire in L.A. County — have scorched thousands of acres and forced residents to flee their homes amid record-breaking heat.
• Meanwhile, a fast-moving brush fire erupted in Orange County on Monday afternoon, injuring three people and prompting evacuations in Trabuco Canyon.
• In Northern California and Nevada, two wildfires that ignited over the weekend have damaged scores of structures and forced thousands of residents to flee.

The Dodgers have been hit especially hard by a pitching injury epidemic in MLB

• The Dodgers have had 98 injured list stints for pitchers since 2021 — the most in Major League Baseball .
• Among the culprits behind the crisis is the rapid escalations in pitching velocity that increase the risk of injuries , medical experts say.

More big stories

• UC Berkeley will launch one of the nation’s few Palestinian-Arab studies programs amid demand.
• A baby’s risk for SIDS could one day be predicted by a blood screening .
• A California death row inmate who received support from Oprah lost an effort to overturn his conviction.
• Apple’s newest generation of iPhones will include artificial intelligence tools that can help users write emails and find old photos, among other things.
• Univision news anchor Jorge Ramos will exit the network at the end of the year.

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Commentary and opinions

• Here is the problem with former Republican Rep. Liz Cheney’s endorsement of Harris , columnist Jonah Goldberg writes.
• A debate tip for the candidates — there’s a correct answer on weapons to Israel , writes Sarah Yager, the Washington director at Human Rights Watch, in a guest opinion.
• Here’s how L.A. can finally fix its terrible, dangerous sidewalks , writes Donald Shoup , a distinguished research professor in urban planning at UCLA.
• And Susan McWilliams Barndt , a politics professor at Pomona College, asks, Do you remember what politics were like without Donald Trump? My students don’t .

Today’s great reads

Hotter, drier and all-around different: How climate change will alter your life in L.A. Will we be living in a fiery landscape with sizzling sidewalks, or will our penchant for innovation be our salvation?

Other great reads

• Children are stuck inside, glued to screens. Are “forest schools” the antidote ?
• For these California kids, the fight against climate change is personal .
• Given the crush of bad news on our changing climate, choosing a “green” career just might be a matter of survival .

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• 🌹 “ The Golden Bachelorette ” hopes Joan Vassos, a 61-year-old grandmother, will help restore luster to Bachelor Nation.
• 🍌 Here’s a look at what happened to one of the stars of “ Chimp Crazy ” after the finale of the HBO series.
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• Review Article
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• Published: 10 September 2024

From crisis to opportunity: advancements in emergency language services

• Xingrong Guo   ORCID: orcid.org/0000-0001-8672-2108 1 ,
• Di Xiao 1 &
• Yiming Guo 2  

Humanities and Social Sciences Communications volume  11 , Article number:  1170 ( 2024 ) Cite this article

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• Language and linguistics

Emergency language services play a critical role in emergency management and language services, facilitating effective information transmission, timely life-saving efforts, accurate public opinion guidance, and the maintenance of social stability during public emergencies. This study aims to comprehensively assess the current state of emergency language research, exploring recent advancements and future trends in emergency language services. Using bibliometric and content analysis, 3814 academic papers on emergency language services were systematically reviewed. Recent publications reveal a burgeoning interest in this field, particularly in the United States, Canada, the United Kingdom, and Australia. Research areas reflect a multidisciplinary approach to addressing the complex challenges of emergency language services. Keyword co-occurrence analysis unveils the pivotal research trajectories across various temporal phases. In the initial stage, emphasis was placed on unraveling communication and language hurdles within the emergency department. Transitioning into a phase of stable development, attention primarily gravitated toward natural language processing technology and the complexities of language barriers. Subsequently, during a period of rapid advancement, the spotlight shifted towards the pragmatic application of emergency language services amid the COVID-19 pandemic. This encompassed diverse domains such as distance education, telemedicine services, and exploratory investigations into social media dynamics. This evolution highlights an increasing interest in leveraging emerging technologies to enhance emergency response times and service quality. Future research should prioritize addressing key issues within the research framework and fostering interdisciplinary development.

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Introduction.

Every year, nations and regions globally are faced with many natural disasters and public health emergencies, which have a profound impact on human health (Berchtold et al., 2020 ; Goode et al., 2021 ). According to statistics, around 2 billion people globally were affected by natural disasters between 2008 and 2018 (Almukhlifi et al., 2021 ), and in 2019, the COVID-19 pandemic further captured global attention. In the process of emergency response and rescue, language barriers are one of the significant factors that affect rescue operations. In such situations, emergency language services become crucial for post-disaster relief efforts (Shao et al., 2018 ; Wang, 2021 ). Emergency language services refer to the provision of rapid language products, language technologies, or participation in language rescue operations for the prevention, monitoring, rapid response, and recovery of major natural disasters or public crisis events. These services include emergency translation of foreign languages, minority languages, dialects, and sign language for individuals with disabilities, the development of disaster language software, the dissemination of disaster information, and the management of disaster language resources for relief services. Additionally, they encompass the development of emergency language standards, emergency language training, language therapy, and rehabilitation, as well as language counseling and crisis intervention (Wang et al., 2020 ). In the context of disasters and other crises, emergency language services enable individuals to comprehend and communicate information about emergency preparedness and response systems, thereby enhancing personal safety and collectively mitigating risks faced by affected individuals (Markakis et al., 2017 ). Therefore, emergency language services are crucial in emergency situations.

At present, in terms of emergency language services, a comprehensive and clear representation of the scientific review literature is lacking. Traditional reviews in this area have mostly focused on enhancing the capabilities of emergency language services, such as the development of emergency language service systems and the training of personnel for emergency preparedness services. However, these studies have not sufficiently considered the complexity of communication during emergency response and rescue processes, and reliance solely on traditional on-site human translation proves inadequate to meet the efficiency requirements of emergency language services. Specifically, there is a scarcity of review studies that employ quantitative analysis methods to examine the complexities of emergency language services.

To address this gap, this paper employs bibliometric analysis and content analysis methods to analyze the collected effective literature related to the study of emergency language services. The analysis methods help to identify the development trends, research hotspots, and future directions of the field (Cheng, Zhang ( 2023 )). This approach advances the research on emergency language services, providing guidance for its further development and for scholars conducting research in this field.

Specifically, the study mainly addresses the following key research questions.

RQ 1. What is the current state of emergency language services research, and what progress has been made in recent years?

RQ 2. What is the distribution of core authors, journals, and institutions involved in emergency language services research?

RQ 3. What are the hotspots of emergency language services research, and what are the prospects for the field in the future?

This paper makes a comprehensive analysis of the current research situation in the field of emergency language services, that is, a comprehensive review of the literature on emergency language services in recent decades, including bibliometric analysis and quantitative visualization research. Particularly, these research results provide guidance for constructing a framework combining the latest literature and highly cited content of emergency language services, and it promotes rapid and long-term development of emergency language services research.

The remaining sections of this paper are organized as follows. Section “Methods” explains the research design, including data sources, the screening process, and the main analysis methods (bibliometric analysis and content analysis). Section “Results” presents the results of trend analysis, impact analysis, and content analysis. Firstly, it analyzes the annual publication trends of the 3814 selected literature and identifies the key influential journals of publication. Then, it introduces the analysis of author influence, country and institution analysis, disciplinary analysis, keyword co-occurrence analysis, and keyword clustering analysis using bibliometric analysis and content analysis methods. The results of the bibliometric and content analysis are further discussed in Section “Discussion”. Finally, Section “Conclusions” presents the conclusions and outlines the limitations of this paper. The overall research design framework of this study is illustrated in Fig. 1 . The process consists of three main steps: the first involves data collection and screening; the second applies bibliometric and content analysis; and the final step includes discussion and conclusions.

The framework consists of three main research steps: data collection, bibliometric analysis, and discussion and conclusion. *n=number.

Data source

In this paper, the literature used for the analysis of emergency language services research was retrieved from the core dataset of the Web of Science (WoS). WoS is one of the world’s leading science citation index databases and is widely recognized and used in academia (Wang et al., 2016 ). WoS includes high-quality articles on international research (Ciavolino et al., 2022 ), including journal articles related to emergency language services, and provides journal and article citations.

Data screening

To ensure the accuracy and representativeness of the selected literature, the inclusion criteria of the literature were established: (1) the literature source was the core dataset of WoS; (2) The publication period of the literature is from January 1, 1988–December 31, 2023; (3) The literature sources were SCI-EXPANDED, SSCI, ESCI, and A&HCI; (4) The language type of the document is English. Exclusion criteria: (1) The topic unrelated to emergency language services but only containing the keywords “emergency” and “language”; (2) Conference minutes, editorial materials and other non-academic articles. Finally, 3814 articles were obtained that were highly consistent with the research theme of this paper.

The data retrieval and cleaning process in the bibliometric analysis section is described as follows:

Using the advanced search method with the search condition “(Topic = emergency)” and “(Topic = language)”, a total of 5592 records were retrieved.

The literature retrieval type was set as “Article” or “Review article”, with the language filter set to English. The literature source categories included SCI-EXPANDED, SSCI, ESCI, and A&HCI. The retrieval period spanned from January 1, 1988, to December 31, 2023. Subsequently, book reviews, book chapters, conference proceedings, and other irrelevant materials were excluded, resulting in a final set of 4662 articles.

Further exclusions were made by reviewing and analyzing abstracts to eliminate articles unrelated to emergency language services. This included articles that only had keywords in the abstract without addressing research in the field, research papers not involving emergency language services in their descriptive topics, and data that was insufficient or findings that were unclear. In the end, a total of 848 papers were excluded, leaving 3814 papers for analysis.

Bibliometric analysis

In recent years, bibliometric research has witnessed rapid development, with its methods and tools increasingly applied in various scientific fields (Broitman and Davis, 2013 ). This study mainly focuses on bibliometric analysis, supplemented by content analysis. A total of 3814 literature articles on emergency language services published between January 1, 1988, and December 31, 2023, were analyzed from different perspectives. The first article retrieved from the WoS database on emergency language services was titled “Language Concordance as a Determinant of Compliance and Emergency Room Use in Patients with Asthma” (Manson, 1988 ). Therefore, it served as the starting point for data collection in this study.

Author influence analysis and national institution analysis were carried out after topic search and screening. This was done to identify authors with high influence and contributions in the research field of emergency language services, to pinpoint the hot research frontiers in this field, and to understand the situation of international cooperation. This analysis promotes cooperation and exchange between different national institutions and supports the international development of emergency language services research.

Various bibliometric cartographic analysis methods were applied to obtain answers to the research questions described in section “Introduction”. Each method of bibliometric cartographic analysis is designed for specific research purposes (Li et al., 2022 ). In this study, the following bibliometric network maps were created: keyword co-occurrence graph, cluster graph, and other types of tables and graphs to answer the research questions.

Content analysis

By employing content analysis, a more systematic and in-depth analysis was conducted on the disciplinary distribution, keywords co-occurrence, and clustering results related to emergency language services research. This helped identify different aspects and focal points of research in the field, providing guidance and direction for further research and practice. Content analysis and bibliometric analysis worked in tandem: bibliometric analysis identified pivotal articles and areas of focus, while content analysis delivered a detailed and objective portrayal of the research landscape of emergency language services.

Publications output distribution

The distribution of publication output is a key indicator that provides insights into research activities related to a particular set of documents (Li et al., 2020 ). In this section, the main analysis is the trend in the number of publications and journal distribution of the 3814 articles.

Analysis of annual publication volume

Figure 2 illustrates the trend in the annual publication volume since 1988. It is evident that, although the overall trend indicates growth, the annual publication volume does not consistently increase. There were some temporary declines in certain years, such as 2001, 2007, and 2009. However, the number of articles has progressively increased in the field of emergency language services research, from only 1 article in 1988 to 488 articles in 2023. This indicates that in recent decades, there has been increasing attention from researchers in the field of emergency language services, and the prominence of emergency language services has been continually rising.

Annual publication growth of research literature on emergency language services (1988-2023). Data points are represented by black diamonds ( ◆ ), with the number of publications per year indicated by blue numbers next to each data point. The three phases are demarcated by red dashed lines and labeled accordingly.

It can be observed that the average annual publication counts for research on emergency language services from 1988 to 2023 is 109 articles, with a simple average annual growth rate of 30.92%, and a compound annual growth rate (CAGR) of approximately 14.64%. Based on the annual growth rate of the articles, this indicates a continuous upward trend: an initial exploratory period (1988–2003), a stable growth period (2004–2014), and a rapid growth period (2015–2023).

During the initial exploratory period from 1988 to 2003, an average of 15 articles related to emergency language services were published each year. Among them, the highest number of articles was published in 2002, with a total of 36 articles. In the stable growth period from 2004 to 2014, the publication count showed a steady increase with minor fluctuations, averaging 74 articles per year. After 2014, there was a significant increase in the number of publications, with a total of 2779 articles published in the following nine years, averaging 309 articles per year. This is approximately eight times the number of articles published during the initial exploratory period and the stable growth period. In 2022, there were 541 published articles, accounting for 14.18% of the total, reaching its peak.

Journal distribution

Figure 3 shows the top 20 journals in terms of publication quantity related to emergency language services. It can be seen that “Academic Emergency Medicine” leads the list with a total of 80 articles. Notably, “Academic Emergency Medicine” has published significantly more papers on emergency language services ( n  = 80) than other journals, such as “Pediatric Emergency Care” ( n  = 51), “Annals of Emergency Medicine” ( n  = 48), “BMJ Open” ( n  = 47), “American Journal of Emergency Medicine” ( n  = 44), “PLoS One” ( n  = 40), “International Journal of Environmental Research and Public Health” ( n  = 36), and “Journal of General Internal Medicine” ( n  = 34). Despite the relatively small overall number of publications, the number of papers published in “Academic Emergency Medicine” is nearly double that of any other journal. This indicates that, in terms of publication quantity, the journals ranking higher are more likely to attract the attention of researchers.

The top 20 journals in terms of publication quantity related to emergency language services are listed from top to bottom in descending order.

Research power results

Author influence analysis.

Research authors play a crucial role in reflecting the research capacity of an academic field and evaluating its development (Guo et al., 2021 ). Among the 3814 analyzed articles, there were a total of 17,026 authors, with an average of 4.46 authors per article. Given the large number of core authors, this study ranked the top 20 most prolific authors in descending order based on the number of publications, as shown in Table 1 .

Table 1 reveals that, in terms of publication output, Lion, K. Casey from the University of Florida, and Topaz, Maxim from Columbia University in the United States have the highest number of publications on emergency language services research, with 13 articles each, which is significantly more than other scholars. Following closely is Camargo, Carlos A. from Massachusetts General Hospital in the United States, with 12 articles, maintaining a considerable lead over other contributors. Notably, 16 of the top 20 authors in this field are affiliated with American institutions, highlighting the significant emphasis placed by the United States and underscoring its influence in the global research landscape.

Country and institutional analysis

Analyzing the distribution of research on emergency language services across countries and institutions unveils the geographical landscape of such research, offering insights into its focus, strengths, and challenges globally. This information aids decision-makers in resource allocation and serves as a reference for international collaboration and knowledge sharing.

Table 2 presents the number and proportion of publications in the field of emergency language services research for the top 20 countries by publication count. At present, a total of 3814 articles were retrieved from 12,302 institutions studying emergency language services, covering 931 countries or regions. In terms of the number of publications and proportion, the top three countries are the United States, Canada, and the United Kingdom. Among them, the number of articles published in the United States is significantly higher than in other countries, accounting for 45.65%, which is 5.49 times and 5.58 times of Canada and the United Kingdom, ranking second and third, respectively. Therefore, the United States represents a major research force and a leading contributor to the development of the field of emergency language services research worldwide.

Figure 4 shows the collaboration institutions in emergency language services research. The size of the circle in Fig. 4 represents the number of publications by each institution in the field. The larger the circle, the more publications the institution has. Institutions such as the University of Washington, Harvard Medical School, and the University of California, San Francisco, are represented by the larger circles, signifying their significant contribution to research and publications in the field of emergency language services. These institutions demonstrate a high level of activity and influence. The top 20 institutions in the field of emergency language services, ranked by the number of publications, are listed in Table 3 .

The collaboration network of institutions is visualized using CiteSpace, with nodes representing institutions.

Table 3 provides basic information on the top 20 institutions in the field of emergency language services, ranked by the number of publications. It can be seen from this that the University of Washington, Harvard Medical School, and the University of California, San Francisco, have published the most papers. Additionally, centrality measures the importance of institutions in academic networks. Centrality was measured using a value between 0 and 1, with higher values indicating higher centrality in the academic network. The University of Washington and the University of California, San Francisco, are institutions with high centrality. These institutions hold significant research influence and occupy important positions in this field. These data reveal that institutions from the United States dominate in terms of article output and centrality in the field of emergency language services research.

Discipline analysis

In the WoS core database, each publication is classified into at least one thematic category, along with its research direction content, to indicate its research domain. This section analyzes the disciplinary knowledge and directional characteristics of 3814 retrieved literature to determine the main disciplinary directions involved in the research field of emergency language services. Considering the interdisciplinary nature, this article also explores the core disciplines in this field. Table 4 describes the Top 20 disciplinary direction rankings in emergency language services.

The 3814 literature articles retrieved so far encompass a total of 194 disciplines related to emergency language services. The top 20 disciplinary directions reveal a broad range of disciplines that contribute to this interdisciplinary field (Table 4 ). Emergency Medicine leads the list with a significant frequency of 524, followed by Public Environmental Occupational Health, Medicine General Internal, and Health Care Sciences Services.

Highly cited topics, such as Nursing and Healthcare Policy, highlight the importance of these themes in the emergency language services domain. Themes like Trauma & Emergency Surgery, Health Literacy & Telemedicine, Knowledge Engineering and Representation, Language and Linguistics, and Education Educational Research, highlight the need for effective communication and technology integration in emergency settings.

The research directions show a similar trend, with Emergency Medicine, General Internal Medicine, and Public Environmental Occupational Health leading the way. Additionally, disciplines like Computer Science and Education Educational Research indicate the increasing relevance of technological solutions and training programs in enhancing emergency response capabilities.

In summary, based on the analysis of disciplinary categories, highly cited topics, and research directions, the disciplinary theoretical foundation of emergency language services mainly concentrates on emergency medicine, environmental science, public health and preventive medicine, computer science, educational science, and language and linguistics. This interdisciplinary approach underscores the complexity of providing effective language services in emergency scenarios and the need for collaboration across multiple fields. Besides, special attention should be given to theories that integrate computer science with other fields, as these theories play a crucial role in understanding emergency language services research.

Core keywords and co-occurrence analysis

Keywords provide information about the core content of an article (Liu et al., 2015 ). When two or more keywords appear together in the same paper, it is referred to as keyword co-occurrence (Fang et al., 2017 ). Keyword co-occurrence analysis can identify research hotspots and emerging frontiers in scientific knowledge domains (Liu et al., 2015 ). In a keyword co-occurrence graph, the size of the circles represents the total frequency of occurrence of keywords in the field of emergency language services research. The larger the circle, the more representative it is of research hotspots and directions in the field (Yang et al., 2020 ; Yu et al., 2020 ). Using CiteSpace software, keyword co-occurrence analysis was conducted on the text of the retrieved 3814 literature articles. The keyword co-occurrence network is shown in Fig. 5 . The parameter settings are as follows:

year (s) per slice: 1 year;

Selection criteria: g-index (k = 10), LRF = 3.0, L/N = 10, LBY = 5, e = 1.0;

Pruning: Pathfinder;

Nodes Labeled: 1.0%.

Co-occurrence network of keywords in the field of emergency language services (1988-2023). The network is visualized using CiteSpace. Each node represents a keyword, with the size of the node indicating the frequency of the keyword’s appearance.

From Fig. 5 , it can be observed that the circles containing the keywords “emergency department”, “natural language processing”, and “COVID-19 pandemic” are the largest, indicating their high frequency of occurrence. Therefore, the research hotspots in the field of emergency language services may be related to increased research in emergency medicine, natural language processing, and emergency services resulting from public health events like the COVID-19 pandemic.

To understand the co-occurrence of the keywords in Fig. 5 , the core keywords were classified according to the three stages of emergency language service development. The top 20 keywords in each stage were listed in Table 5 .

In the initial exploration stage from 1988 to 2003, “emergency department”, “communication”, “language”, “emergency medical services”, and “interpreters” were the top five keywords in terms of frequency. Among them, the “emergency department” has the highest frequency of occurrence, indicating that the emergency department was the core focus of research during this period. In addition, during this period, research on emergency language services also focused on communication issues in emergency situations, language barriers or cross-cultural communication barriers that may be encountered during communication, emergency pharmaceutical services, interpretation services, emergency management, and other aspects during emergency rescue.

During the steady growth period from 2004 to 2014, the keywords with high frequency were: “natural language processing”, “emergency medicine”, “systematic review”, “language barriers”, and “limited English proficiency”. During this period, researchers began to pay attention to the application of natural language processing technology to solve the problem of emergency language services. For example, Starlander et al. ( 2005 ) described the evaluation of an open-source medical speech translation system (MedSLT) for safety-critical applications with a view to eliminating the language barrier in emergency situations. St-Maurice, Kuo ( 2012 ) used natural language processing to analyze primary care data extracted from identification to identify inappropriate emergency room use. On the other hand, researchers are also working to overcome language barriers, focusing on public health and the harm caused by natural disasters and public health events to children or migrants with limited language skills.

During the period of rapid development from 2015 to 2023, high-frequency keywords such as “COVID-19 pandemic”, “machine learning”, “social media”, “emergency remote teaching” and “artificial intelligence” emerged. The keywords during this period covered multiple aspects of emergency language services research. Keywords such as “COVID-19 pandemic”, “emergency remote teaching”, “online learning”, “triage”, and “telemedicine” are highly likely to be related to the COVID-19 pandemic in public health in 2020. The COVID-19 pandemic has had a significant impact on research on emergency language services, and researchers have begun to pay attention to the evaluation and response of the COVID-19 pandemic to language service needs, language barriers, multilingual transmission, and cross-cultural communication.

In the field of education, emergency remote teaching and online learning have been conducted. For example, Jiang et al. ( 2023 ) conducted a case study using a renowned Chinese language university to explore how Chinese university scholars responded to the challenges of emergency remote teaching during the pandemic. In the medical field, triage and prioritization are carried out during emergency situations, considering how to provide appropriate language support during the triage process to ensure the fair allocation of resources and timely provision of language services. For instance, a natural language processing system using nursing triage records was used to predict the quantity of emergency resources needed in the future (Sterling et al., 2020 ). Analysis of spoken expressions during simulated emergency call triage processes was also conducted (Morimura et al., 2005 ). Additionally, remote medical services are provided through technologies like video conferencing to offer cross-lingual medical consultations and support, addressing language barriers and promoting healthcare accessibility. For example, the usage of remote medical services by non-elderly patients with limited English proficiency during the COVID-19 pandemic was evaluated, along with its relationship to emergency department visits and hospital encounters (Chang et al., 2023 ). Remote medical methods under low bit-rate communication conditions have also been explored (Ruminski, 2008 ).

The keywords “social media” and “Twitter” may be related to the role of social media in the field of language services. Social media platforms and Twitter can be used to disseminate emergency information, provide multilingual support, promote community participation and communication. Keywords such as “refugees”, “pediatrics”, and “accident & emergency medicine” may be related to language service needs and practices specific to refugees, pediatric patients, and emergency medical settings. Through co-occurrence analysis of keywords, the focus of emergency language services research has changed in different periods. From a focus on emergency departments, communication, and language barriers during the exploration period, to a focus on natural language processing and language barriers in emergency medicine during the stable development period, and systematic reviews of previous research, to research on emergency language services, remote education and medical services, and the application of social media during the rapidly developing COVID-19 pandemic. This reflects the development trend and evolution of research focus in the field of emergency language services, while also revealing future research directions and challenges.

Literature co-word cluster analysis

This study employed co-occurrence cluster analysis to unveil intricate relationships between words in the literature, shedding light on the research content and patterns within current emergency language services research. By applying the co-occurrence clustering analysis method, many articles were successfully classified and organized based on their content, characteristics, and word co-occurrence. This approach has the potential to reveal nuanced topics and highlight potential connections within related literature, thus facilitating the identification of interdisciplinary research opportunities (Wang et al., 2016 ). By conducting an in-depth analysis of keyword frequencies, this paper successfully constructed multiple keyword co-occurrence networks. These networks vividly outlined the diverse landscape of emergency language services research. Figure 6 shows the co-word cluster network of emergency language services, generated using CiteSpace software. Notably, the analysis produced 10 distinct clusters, each offering valuable insights into specific facets of the emergency language services domain. The parameters are set as follows:

Slice Length = 1;

Selection criteria: g-index (k = 10), LRF = 3.0, L/N = 10, LBY = −1, e = 1.0;

Network: N = 429, E = 645 (Density= 0.007);

Nodes labeled: 1.0%.

Nine large clusters of co-word in the field of emergency language services were generated by CiteSpace software. Each cluster is represented by a different color.

Based on the parameters used, 15 clusters were identified. Figure 6 displays the top 10 of these clusters. From Fig. 6 , it can be clearly observed that the symbiosis is visualized as a knowledge domain graph composed of ten keyword co-occurrence networks. Each of these networks is represented by a different color. To provide a clearer and more intuitive presentation of each cluster, Table 6 was created, which includes the labels, the number of keywords in each cluster, and some of the keywords contained in each cluster.

Cluster #0: emergency-medicine resident

This initial keyword cluster delves into the myriad challenges and complexities encountered by emergency medicine residents, specifically focusing on communication hurdles, language comprehension, and interactions with immigrant patients. The research within this cluster centers on resident physicians within the emergency medicine field, addressing various critical aspects:

Exploring communication challenges in emergency settings is urgent. This facet involves a thorough examination of the challenges and barriers that emergency medicine residents face in effectively communicating with patients. Noteworthy studies, such as those exploring emergency physicians’ awareness of language barriers within the emergency department environment (Hendry et al., 2012 ), contribute valuable insights into fostering improved communication strategies.

The exploration of health literacy levels is an important topic. Researchers within this cluster delve into how emergency medicine residents navigate patients’ health literacy levels. This includes investigating how emergency medicine residents address patients’ health literacy levels and potential obstacles in providing medical care, including issues related to patients’ understanding of diagnoses, treatment, and self-management abilities (Doty et al., 2022 ).

Addressing the unique challenges faced by emergency medicine residents when dealing with immigrant patients, including language barriers, cultural differences, and legal and policy-related issues, is necessary. For instance, assessing residents’ attitudes towards culturally competent care, their preparedness to provide quality care to diverse patient populations, as well as their experiences and educational environment regarding cross-cultural training (Betancourt et al., 2007 ). Additionally, exploring the approaches taken by emergency department physicians when facing unique barriers to accessing healthcare for undocumented residents (Samra et al., 2019 ).

The primary goal of these studies is to improve the communication skills of emergency medicine residents. Furthermore, they aim to foster a deeper understanding and trust between healthcare providers and patients, ultimately contributing to the delivery of enhanced medical services within emergency medicine settings.

Cluster #1: trial study design

This cluster primarily focuses on the application of experimental research designs in the field of emergency medicine. The research may involve evaluating health disparities among different populations (Cegala, Post ( 2006 )) and understanding differences in health status, healthcare accessibility, or health outcomes among diverse populations to promote health equity and improve healthcare strategies targeting specific groups. It may also involve assessing the effectiveness of different medications, interventions, or acute asthma management approaches to study treatment methods and strategies for acute asthma (Press et al., 2012 ). Additionally, it may explore emergency department situations related to alcohol use (Vaca et al., 2020 ), such as examining the impact of alcohol-related incidents on emergency department visits, evaluating alcohol-related emergency interventions, or studying the health consequences of acute alcohol poisoning.

The main goal of this cluster is to advance the understanding of emergency medicine through robust experimental research designs. By assessing health disparities, differences in health status, and the efficacy of interventions, researchers contribute to the ongoing efforts to refine emergency medical practices and strategies. This cluster plays a pivotal role in shaping evidence-based approaches for diverse populations within emergency medicine contexts.

Cluster #2: review article

Cluster 2 is related to literature reviews, indicating that researchers at a certain stage focused on reviewing articles in the field of emergency language services. These reviews aimed to extract lessons learned and explore new research directions. The research within this cluster can be summarized into the following two aspects:

Clinical practices, diagnostic and treatment methods in the field of emergency medicine, and emergency medical systems and processes, are important research topics. For example, improving the analytical utility of clinical trial content by integrating data innovations to provide information for health disparity research (Cohen, Unangst ( 2018 )). Systematically reviewing the differences in the usage of patient portals among vulnerable populations, with the aim of increasing the impact of interventions that promote portal use or predict factors associated with usage disparities (Grossman et al., 2019 ).

Emergency management in disaster situations, along with psychological well-being in emergency situations, deserves investigation. For example, Almukhlifi et al. ( 2021 ) conducted a comprehensive review of the literature on the perceived preparedness of emergency healthcare personnel for disaster management. The review revealed that most emergency healthcare workers appear to lack sufficient disaster preparedness, and past experiences and training have improved preparedness efforts. Future research should focus on interventions to enhance the preparedness of emergency healthcare workers for disasters. North, Pfefferbaum ( 2013 ) reviewed and summarized the evidence on how to best identify individuals in need of disaster mental health services and classify them into appropriate care. The aim is to provide a comprehensive understanding of the field of emergency medicine by synthesizing existing research and provide evidence for emergency medicine practice and policy-making.

This cluster, characterized by literature reviews, plays a crucial role in consolidating existing knowledge in emergency language services. By delving into clinical practices, diagnostics, treatment methods, and the broader spectrum of emergency management, researchers contribute to the synthesis of evidence. The outcomes of these reviews aid in informing and shaping the landscape of emergency medicine practices, paving the way for improved policies and strategic interventions.

Cluster #3: emergency call

Cluster 3 labeled “emergency call” is highly relevant to the field of emergency telephone services. The research on emergency language services within this cluster can include the following three points:

Analysis of emergency call data is a crucial theme. This involves examining the content and patterns of emergency calls to identify common issues, improve response protocols, and enhance emergency communication strategies. Researchers may investigate the relationship between emergency telephone services and patient mortality rates. For example, Cabrita et al., ( 2004 ) conducted a study on the impact of emergency medical service calls on the management of acute myocardial infarction. The study concluded that patients with symptoms of myocardial infarction underutilized emergency medical service calls and documented the beneficial effects of emergency medical service calls in reducing prehospital delays and increasing early reperfusion therapy.

Emergency telephone services provide medical support for non-healthy patients, such as those with dementia and heart failure. Research in this area includes Voss et al., ( 2018 ) qualitatively exploring the nursing experience of emergency medical services (EMS) nursing staff in dementia patients through focus groups and interviews, evaluating EMS staff’s views on dementia management. Jung et al. ( 2022 ) employed a descriptive qualitative approach to investigate 911 calls for EMS in cases of heart failure. Their findings suggest that interventions are needed to assist heart failure patients and their families in communicating more effectively during emergencies.

Emergency call response and quality assurance deserve significant attention. This includes investigating the effectiveness and efficiency of emergency call response systems, evaluating the quality of emergency services provided over the phone, and identifying areas for improvement in terms of language support and cultural sensitivity. For example, Penverne et al. ( 2019 ) reported on a strategy to reduce waiting time for emergency calls at dispatch centers. Through their research, they found that connecting dispatch centers can improve their performance, especially during periods of overload. This enables the prompt handling of emergency calls and appropriate dispatching of emergency medical services.

This cluster serves as a focal point for enriching the understanding of emergency language services within the realm of emergency telephone services. By dissecting emergency call data, addressing the medical support needs of non-healthy patients, and scrutinizing the efficiency of emergency call response systems, researchers contribute to the enhancement of emergency services, ultimately ensuring more effective and culturally sensitive outcomes.

Cluster #4: COVID-19 crisis

Cluster 4, denoted as the “COVID-19 Crisis”, is inherently tied to the challenges posed by the COVID-19 pandemic. During the COVID-19 crisis, researchers have explored the application of qualitative research methods in addressing the COVID-19 crisis. Qualitative research techniques mainly encompass the gathering and examination of data that is not expressed in numerical form, such as observations, interviews, and textual analysis. These methods aim to provide valuable insights into comprehending the COVID-19 crisis and evaluating response measures. Qualitative research in emergency language services can provide insights into various aspects of pandemic prevention and response measures (Wang et al., 2022 ), the involvement of social media in public health (Han et al., 2020 ), emergency online teaching (Adedoyin, Soykan ( 2023 )), and remote medical services (Reza Safdari et al., 2021 ).

Furthermore, qualitative research provides researchers with an opportunity to gain an in-depth understanding of emergency language services. This includes exploring the experiences of participants such as translators, staff of translation service agencies, and service users, as well as examining service quality and effectiveness, the roles and practices of service providers, cultural and cross-cultural communication, and other aspects. Such research contributes to the improvement and optimization of emergency language service practices and policies to meet diverse language needs during emergency situations. When conducting qualitative research on emergency language services, methods such as focus group interviews and text analysis are commonly employed. For instance, the use of focus group interviews can facilitate discussions within a community to understand the importance of their surrounding environment, existing resources, and assistance. This engagement of the public helps in building resilient communities to minimize the impact of disasters (Nirupama, Maula ( 2013 )). Regression text analysis, on the other hand, can be utilized to evaluate the quality and reliability of emergency language services and eliminate ambiguities in emergency response plans (Guo et al., 2020 ). These methods play a pivotal role in comprehending the diverse needs and challenges associated with emergency language services, ensuring accuracy, timeliness, and reliability in emergency situations. The insights garnered contribute not only to research advancements but also to the refinement of practices and policies in the broader landscape of emergency language services.

Cluster #5: pharmaceutical service

Cluster 5 is labeled “pharmaceutical service” and is highly relevant to pharmacy services in disaster and emergency situations. Additionally, researchers have also focused on the provision of pharmaceutical services within hospitals and issues related to healthcare inequalities. This may include studying the organization and management of pharmacy services within hospitals, the safety and efficiency of the pharmaceutical supply chain, and inequalities in accessing and utilizing pharmacy services among different populations. However, it is worth noting that the average year of research within this cluster is 1996, indicating that the studies related to pharmaceutical services in emergency language services are relatively earlier compared to other clusters.

Cluster #6: ethnic disparities

Cluster 6 is labeled “ethnic disparities”, and researchers focus on the differences among various ethnic groups in emergency language services, including variations in language needs, service access, and outcomes. Based on other keywords within the cluster, researchers also examine disparities among different ethnic groups in emergency language services related to stroke prevention, treatment, and rehabilitation, particularly in children. The aim is to improve the efficiency of treatment and rescue efforts and reduce the impact of diseases or disasters on physical health. For example, Flores, Ngui ( 2007 ) conducted a literature review to uncover several racial/ethnic disparities in pediatric patient safety and proposed a new conceptual model for understanding racial/ethnic disparities in patient safety. Lim et al. ( 2019 ) studied racial/ethnic disparities in the utilization of mental health services among Medicaid adults aged 21–64 in Hawaii. Hartford et al. ( 2022 ) explored differences in the treatment of pediatric migraines among different racial, ethnic, and language preference groups in the emergency department, highlighting another area where equity in emergency department patients must be improved.

Cluster #7: remote teaching

Cluster 7, denoted as “remote teaching”, primarily focuses on the realm of remote teaching in emergency situations, especially during the COVID-19 pandemic. Researchers within this cluster may concentrate on strategies for emergency remote teaching, online learning tools, teaching effectiveness, and the experiences of both students and teachers. For instance, Latif, Alhamad ( 2023 ) conducted a study by surveying 112 Arabic and English as a foreign language teachers and conducting semi-structured interviews with 14 teachers. The research investigated the experiences and reflective beliefs of Saudi university language teachers in emergency remote teaching, with specific attention to: a) the general educational challenges faced by teachers and how they overcome these challenges, b) the perceived difficulties of remote teaching and assessing the foreign language domain and their coping strategies, and c) a reflective evaluation of remote language teaching after three semesters. Wang et al. ( 2022 ) explored the positive emotions and language enjoyment of Chinese language learners in the context of emergency remote teaching (ERT) during the COVID-19 pandemic, adopting a positive psychology perspective. Knežević et al. ( 2022 ) surveyed the teaching practices and experiences of foreign language teachers during the “lockdown period” in 2020, as well as their self-assessment of their digital technology application skills in teaching. The results indicated a lack of pedagogical knowledge and skills among foreign language teachers in utilizing the mentioned tools in teaching. Consequently, the authors called for more attention to digital technology teaching issues in foreign language methodology courses.

Cluster #8: emergency department visit

Cluster 8 “emergency department visit”, combined with other keywords in the cluster, indicates that this cluster may focus on applying techniques such as natural language processing, machine learning, deep learning, and nursing informatics to process and analyze data related to emergency department visits. For example, Doan et al. ( 2016 ) attempted to create and test the performance of the Natural Language Processing (NLP) tool KD-NLP to identify emergency department (ED) patients who should be considered for diagnosis as Kawasaki disease Lee et al. ( 2019 ) provide an overview of machine learning related to clinical and operational scenarios in emergency medicine.

Cluster #9: systematic review

Cluster 9 centers on research involving systematic reviews and meta-analyses of specific topics or issues. Systematic review is a research method designed to systematically collect, evaluate, and synthesize existing literature to answer specific research questions. Meta-analysis, on the other hand, is a statistical analysis method within systematic reviews that involves the reanalysis and synthesis of existing statistical data from studies on a particular topic.

Through systematic review and meta-analysis, researchers can synthesize and analyze a large amount of research evidence on emergency language services, thereby obtaining more comprehensive and reliable conclusions and providing support for decision-making, policy formulation, and further research. For example, Iqbal et al. ( 2021 ) evaluate the evidence of clinical outcomes of digital alert systems in remote monitoring through system reviews and meta-analyses and call for trials of different alert protocols to understand the best alerts to guide future widespread implementation. This will further promote the development of emergency language services.

This study conducted bibliometric and content analysis on 3814 items of literature retrieved from 1988 to 2023. Furthermore, it proposed several crucial research indicators, encompassing basic analyses of publication time and quantity, notable journals, primary research contributors (authors, countries, and institutions), disciplinary direction analysis, and co-occurrence clustering of keywords. Overall, the literature in the field of emergency language services research is constantly increasing, indicating that researchers’ interest in the field of emergency language services is gradually increasing.

Research trend

In addressing RQ 1: What is the current status of emergency language services research, and what progress has been made in recent years? Section “Publications output distribution” analyzes the current status and latest progress of research on emergency language services. The examination of published literature suggests a progressive rise in the number of research journals dedicated to emergency language services, indicating a growing trend toward diversification within the field. This phenomenon can be attributed to the fact that natural disasters and public health events impact countries worldwide to different extents, such as the Lushan earthquake in China in 2013 (Lu et al., 2014 ), the East Japan earthquake in 2011 (Onuma et al., 2017 ), the Christchurch earthquake in New Zealand and the Bangkok flood in Thailand (Noy, 2015 ), the novel coronavirus pandemic in 2019 (Wang et al., 2020 ) and the Ebola epidemic in West Africa in 2014–2016 (Agnihotri et al., 2021 ), Hurricane Katrina along the Gulf of Mexico in the United States (Kahn, Barondess ( 2008 )), etc. Faced with numerous natural disasters and sudden public health emergencies, scholars from various countries have gradually enhanced the significance of research on emergency language services. Nevertheless, the multidisciplinary nature of emergency language services and the wide range of disciplines involved have contributed to a diverse trajectory of development. This emphasis on the advancement of emergency language services from various fields has fostered a diversified overall direction of progress.

Research power

Section “Research power results” analyzes the distribution of core authors and national institutions in emergency language service research, addressing RQ 2: What is the distribution of core authors, journals, and institutions involved in emergency language services research? An examination of research influence reveals that countries such as the United States, Canada, the United Kingdom, and Australia hold significant positions in publishing papers on emergency language services. Notably, the United States stands out with its dominant presence in terms of article output and centrality within the field. Institutions such as the University of Washington, Harvard Medical School, and the University of California, San Francisco, have a high research impact in the field of emergency language services. First, these countries have large populations, vast lands, and high rates of natural disasters and public health events. In this case, fast and accurate information transmission is crucial to ensure the safety of people’s lives and property. Modern technology provides a more powerful guarantee for emergency communication, effectively improves the efficiency of post-disaster emergency rescue work, and achieves good disaster reduction effects. These countries, owing to their robust economic and technological capabilities, as well as well-developed communication and information technology infrastructure, have shown a heightened focus on emergency management and response. Their ability to efficiently collect, process, and disseminate vast quantities of real-time emergency information enables them to effectively meet public demands and facilitate advancements in emergency language service research.

Research content

Section “Content analysis” mainly addresses RQ 3: What are the hotspots of emergency language services research, and what are the prospects for the field in the future? This part examines the multidisciplinary nature of emergency language services and explores the current research trends and focal areas within the field. By examining disciplinary categories, highly cited topics, and research directions, the disciplinary, theoretical bases of emergency language services mainly concentrate on emergency medicine, environmental science, public health and preventive medicine, computer science, educational science, and language and linguistics. However, the research focus varies across each field. The field of emergency medicine is more focused on optimizing the collaboration in emergency medicine research (Perry et al., 2021 ), language support in emergency medical facilities, medical translation, and interpretation services in emergency situations, etc. For example, it explores the application of mobile technology in medical interpretation (Ji, 2019 ). Environmental science mainly focuses on the language exchange of environmental information and risk communication in emergency events, language support for emergency environmental monitoring and data processing, etc. For example, in order to improve the efficiency of emergency rescue, the coal mine emergency rescue communication system based on a wireless mesh network and environmental monitoring subsystem is tested (Zhao, Yang ( 2018 )). The research focuses on the field of public health and preventive healthcare science may include health information dissemination and education in emergency situations, multilingual emergency warning systems, and cross-cultural adaptation of emergency medical resources. The field of computer science primarily focuses on researching machine translation, such as evaluating two specific automatic translation techniques to assess their potential impact on improving communication in emergency situations (Turner et al., 2019 ), applying natural language processing, speech recognition, and intelligent language services. For example, the development of speech recognition technology in emergency calls (Valizada et al., 2021 ) provides online language support and emergency language services for medical translation services. The field of educational science focuses on training medical translators and interpreters, conducting cross-cultural communication, and education in emergency situations.

In terms of keyword clustering analysis, this paper elaborates on the three stages of emergency language service development to better understand its research progress. Firstly, during the exploration period, focus on emergency departments, communication, and language barriers. How should medical staff effectively communicate with patients in the emergency department when facing situations such as non-native language communication, hearing or speaking difficulties, or cultural differences between doctors and patients.

Secondly, during the stable development period, attention should be paid to natural language processing, language barriers in emergency medicine, and a systematic review of previous research. By conducting a systematic review of previous research, researchers can gain a comprehensive understanding of the current situation and development trends in the field of emergency language services, identify knowledge gaps and research challenges, and propose new research questions and directions to promote further development in the field of emergency language services. Moreover, with the continuous development of artificial intelligence (AI) technology, researchers have begun to combine some AI technologies, such as natural language processing technology, with emergency language services, to apply in emergency rescue and emergency medical care, to improve the efficiency and accuracy of language barrier handling, and make up for the shortcomings of human translation and interpretation.

Finally, during the rapid development period, attention should be paid to research on emergency language services, remote education, and medical services, as well as the application of social media during the COVID-19 pandemic. The outbreak of the COVID-19 epidemic has had a significant impact on the world. During COVID-19, emergency services such as distance learning and telemedicine developed rapidly. At the same time, social media plays an important role in information dissemination and crisis notification, multilingual support and translation services, and strengthening community cooperation. For example, Twitter is widely used in emergency situations to issue real-time emergency notifications and alerts. Many government agencies and emergency management departments use Twitter to release key information to the public, including disaster alerts, evacuation guidelines, safety tips, etc. This rapid and extensive dissemination of information helps people to promptly understand emergency situations and take appropriate action.

Emergency language services domain research shortcomings

To facilitate the disciplinary development of emergency language services research, this article presents a comprehensive synthesis of research findings and methodologies, with the goal of identifying the current limitations and shortcomings within the field.

Firstly, the analysis conducted in this paper highlights the interdisciplinary nature of emergency language services as a research field. Given the interdisciplinary nature of the subject matter, it is crucial to emphasize the comprehensive development process within this field. In the face of interdisciplinary content, it is needed to pay attention to its comprehensive development process. Currently, due to variations in disciplinary nature, there is often a tendency to overlook the holistic management of emergency information resources or the cross-disciplinary sharing of practical cases. For example, computer science can apply natural language processing technology to medical education (Chary et al., 2019 ), which can advance potential future work in the field of emergency medical education. However, the applicability of research results of these interdisciplinary theories in innovation still needs to be further increased.

Secondly, natural disasters and public health incidents often occur suddenly, and emergency rescue is extremely urgent. Therefore, the provision of emergency language services is also very urgent. Although current emergency translation technology and interpreters have made significant contributions to emergency language services, there are also significant limitations. For example, in remote areas lacking professional interpreters and basic communication facilities, hiring nonnonprofessional interpreters such as hospital employees and family members may bring great risks and cause serious medical accidents (Kletečka-Pulker et al., 2021 ). Therefore, it is necessary to further study the technological progress and practical application of emergency language services, and cultivate more professional interpreters.

Finally, the article focuses on the research focus of the three stages of emergency language services. At present, there are many applications of intelligent technologies related to emergency language services, such as natural language processing technology in emergency departments, the use of video interpretation systems during emergency rescue, and AI translation software. However, further exploration is needed to explore the differences, advantages, and disadvantages of various AI technologies in different application scenarios, and there is a lack of relevant literature. Besides, given the increasing use of AI in emergency language services, it is essential to consider the ethical implications of these technologies. Moral considerations arise, such as whether to use AI over live interpreters when cost-saving could compromise the quality of communication and patient care. The disparity in access to interpreters based on language prevalence raises equity concerns, particularly for less common languages like Karen. Rigorous testing is needed to validate the effectiveness of AI solutions for rare languages in real-world emergency scenarios to ensure they do not perpetuate disparities and meet ethical standards. Despite the challenges, the ongoing advancement of knowledge and technology will give rise to novel theories and technologies that can effectively address practical applications.

Prospects for emergency language services

To address the identified shortcomings, three targeted recommendations are proposed:

Firstly, emergency language services have interdisciplinary nature, therefore, it is necessary to strengthen cooperation and knowledge sharing between different disciplinary fields. Encourage experts in computer science, medicine, linguistics, and other fields to conduct collaborative research, promote the cross-application of technology and theory, and promote the comprehensive development of emergency language services.

Secondly, cultivate more professional interpreters and translation experts to meet the emergency needs of various situations. In addition, the efficiency and accuracy of emergency translation technology should be further improved to address translation errors caused by equipment issues.

Finally, it is necessary to explore the advantages and limitations of intelligent technology in different application scenarios, evaluate the applicability of different intelligent technologies in emergency language services, and select the most suitable technical solution based on specific circumstances. Simultaneously, active development of emergency language service technologies should be pursued, exploring the applications of technologies such as speech recognition, machine translation, and real-time video communication in emergency response.

Potential areas for future research on emergency language services

In outlining future research directions for emergency language services, this study identifies three key potential areas.

Firstly, the frequent occurrence of natural disasters has highlighted the increasing demand for emergency language services. At present, there are existing deficiencies in emergency rescue auxiliary equipment, and emerging technologies have the potential to provide essential assistance in addressing various challenges encountered during emergency rescue operations. As an example, within the healthcare domain, the application of AI algorithms and natural language processing techniques can play a critical role in identifying syncope patients within medical records of emergency departments (Dipaola et al., 2019 ). Further exploration by researchers is needed to determine how to effectively apply these state-of-the-art technologies to the field of emergency language services.

Secondly, it has been proven that social media platforms are effective in collecting information during emergencies caused by natural or man-made disasters (Khatoon et al., 2021 ). In the event of an emergency, emergency response managers need to respond quickly and handle the victim’s request for help. Citizens will use Internet social media to quickly disseminate information about the development of events, but for emergency response managers, it is difficult to select the most relevant information from a large number of data (Overbey et al., 2015 ). Therefore, it is crucial to study the application of straightforward natural language processing techniques to extract location information from social media networks and search for event-related messages. This research can greatly assist emergency response managers in making timely and accurate decisions (Nieuwenhuijse et al., 2016 ). For instance, by studying and comparing various machine learning models for the correlation classification of flood-related tweets, it becomes clear which machine learning-based method is most suitable for the correlation classification of flood-related tweets. This can assist emergency rescue personnel in identifying more effective disaster management information (Blomeier et al., 2024 ). In addition, text analysis techniques, machine learning (ML), and deep learning (DL) techniques can also be applied to automatically filter and analyze social media data in order to extract real-time information about key events and promote emergency response in crises (Khatoon et al., 2021 ).

Lastly, language models are assuming a progressively significant role in the domain of emergency language services. The current language models include acoustic and language models for automatic speech recognition, neural network language models, and multilingual speech recognition systems, which are widely used in medical emergencies and emergency rescue. For example, because of its advanced natural language processing capabilities, ChatGPT has become a tool that continues to evolve and advance in the ability to assist healthcare information. The study evaluated the accuracy of ChatGPT-3.5 and ChatGPT-4 models in solving queries related to CRRT alarm troubleshooting (Sheikh et al., 2024 ). Ungureanu et al. ( 2023 ) explore the use of automatic speech recognition models to enhance Romanian emergency services and reduce their response times. Future speech models will also have more breakthroughs and developments in the field of emergency language services.

Conclusions

This article conducts a comprehensive analysis of 3814 papers published between 1988 and 2023 on emergency language services using CiteSpace. The analysis aims to shed light on the research progress and future directions in this field. Analysis shows that there is an increasing number of published literature on emergency language services, and researchers are increasingly interested in researching emergency language services. The sources of disciplinary theory for emergency language services mainly concentrate on emergency medicine, environmental science, public health and preventive medicine, computer science, educational science, and language and linguistics. The findings of keyword clustering analysis demonstrate that current research in emergency language services leverages emerging technologies, such as natural language processing, language modeling, and machine learning. These technologies are utilized to expedite emergency response time and improve the quality of emergency services. In addition, there are also methods such as telemedicine and remote teaching to address emergency situations. Other cutting-edge areas include the adaptation and development of interdisciplinary methods for emergency language services, as well as the analysis of the important role of social media in the field of emergency language services.

Future research in emergency language services should focus on addressing pivotal issues related to research frameworks, fostering interdisciplinary and comprehensive development, and comprehending significant advancements in emerging technologies within the field. Of particular importance is the vast potential offered by social media and AI in supporting emergency language services.

This study provides a comprehensive analysis of the scope of emergency language services for research purposes. Nonetheless, it is important to acknowledge certain limitations. Specifically, this paper predominantly relies on the WoS core database and does not encompass other significant databases like Scopus and PubMed. In addition, this study is limited to the analysis of English papers and does not cover literature in other languages. Due to language limitations, this study may not be able to obtain or analyze relevant research results in other language contexts. Future research can consider expanding the language scope to include literature in more languages, to gain a more comprehensive understanding of the development and trends in the field of emergency language services.

Data availability

Data sharing is not applicable to this article, as no datasets were generated during the current study, which is based on bibliometric information from published articles in the Web of Science.

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Guo, X., Xiao, D. & Guo, Y. From crisis to opportunity: advancements in emergency language services. Humanit Soc Sci Commun 11 , 1170 (2024). https://doi.org/10.1057/s41599-024-03698-8

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NHS workers forced to make harrowing end-of-life decisions at height of Covid, inquiry hears

The Covid-19 Inquiry reveals distressing details from patients and medics on how life and death decisions were made after the NHS was left unprepared for the pandemic

• 15:50, 9 Sep 2024

Harrowing stories from the Covid-19 pandemic have been published from thousands of NHS workers and patients.

The Covid-19 Inquiry launched its latest module and heard how exhausted hospital staff were “surrounded by people dying” and stayed with patients to comfort them in their final moments when their loved ones could not.

Publication of the experiences of 32,000 people, including 604 in-depth interviews, revealed patients were told they were going to die over the phone because operations could not be carried out due to pandemic rules.

UK Covid-19 Inquiry secretary Ben Connah said: "In this, our first published record, we draw together thousands of experiences that demonstrate the impact of the pandemic on patients, their loved ones, healthcare systems and settings, and the people working within them. It is a tough read in places - but it really brings to life how people experienced our healthcare systems during those pandemic years.”

Some contributors to the record said senior medics made end-of-life decisions for patients, partly to spare their junior colleagues having to do it.

One said of young doctors: "They were surrounded by people dying, more than one patient in a day, and often uncomfortable and looking distressed when they died. If you don't have that confidence, that certainty and it's all a bit new to you and you're surrounded by chaos and suffering and death then I think it's much more stressful."

End-of-life care also frequently involved hospital staff being with dying patients when their loved ones could not. One hospital nurse said: "Nobody wants anybody to die on their own, and as nurses you try really hard to make sure that that doesn't happen. If family members can't be there, you're there. You just are. You just do it."

One healthcare assistant said they held a dying patient's hands as their family watched through a window. Another worker said: "We're trying to get quality for families, and so, even if, you know, I can wake a patient up for two hours so they can have a chance to have a coherent conversation with their loved ones, that's a win, because that's precious.

"And, you know, if they're going to die, if we can make that passing as dignified and as not horrible as it can be, knowing it's going to be horrible, and if we can take just some of the edges off it, it's still going to be bad."

A hospital doctor spoke of having to tell a patient with a bowel perforation over the phone that they were going to die because they could not be offered an operation. This was because the operation was moderately high risk and was assessed as riskier due to Covid-19.

The said: "At the time the evidence was suggesting that doing operations on people wasn't particularly safe, particularly if they had Covid. It meant that people who in any other time would be offered an operation, an emergency operation to fix something catastrophically wrong with them such as bowel perforation, which normally we would go ahead with without thinking twice about, we offered far fewer of those operations. And, in doing so, knew that people were going to die as a result, and that was obviously very hard."

The document also showed how some medics believed the Nightingale hospitals set up to treat patients was a misuse of resources. One said: "We set up huge Nightingale hospitals with ICU (intensive care) capabilities which were under-used, likely due to lack of highly trained staff or ICU need. A bit of lateral thinking could have meant these being used for less intensive care such as care of the elderly, rehab beds or Covid+ intermediate care beds, freeing up hospital beds for patients that needed them."

Some NHS staff also told the inquiry how stressful it was to be redeployed from their usual role. One physiotherapist said: "When it came to being redeployed, we were actually redeployed as ICU nurses - this had not been communicated to us prior to starting our shifts - and all the jobs that that entails. We had no training - as there were too many patients - and were asked to do 12.5-hour shifts."

The Every Story Matters record, which is designed to assist UK Covid-19 Inquiry chairwoman Baroness Heather Hallett in reaching conclusions and making recommendations on how to handle future pandemics. Monday marks the publication of the document, which is the result of the largest public engagement exercise ever undertaken by a UK public inquiry.

Over the coming weeks module three will look at the governmental and societal response to Covid-19 by assessing the impact of the pandemic on how NHS services were delivered.

Nicola Brook, solicitor at Broudie Jackson Canter, which represents more than 7,000 families from the Covid-19 Bereaved Families for Justice UK group, said: "This module of the inquiry is one of the most important in understanding the true horrors of the pandemic. It will reveal some of the most shocking details, distressing stories and outrageous scandals that took place.

"Despite the narrative pedalled by those in charge that the UK coped, the sad fact is people died unnecessarily. Groups like the disabled and the elderly were written off because it was considered that their lives were not worth saving."

Every Story Matters is still open for submissions. Visit everystorymatters.co.uk to contribute.

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'America's Got Talent' alum Jay Jay Phillips dies after battle with COVID-19, band says

"America's Got Talent" alum Jay Jay Phillips died after becoming ill with COVID-19, his band said in an Instagram statement Friday.

"It is with great sadness we inform you all of the loss of our bandmate/brother/and friend @jayjayrocks. It still doesn’t feel real and we would give anything to change it," the message from Mettal Maffia read.

"Please respect the family, as well as our wishes as we take our time to grieve and process this detrimental loss. We miss you brother, every second of every minute, of every day. Thank you for teaching us all to laugh a little more. Rock in Paradise."

Deadline and other outlets have reported that the heavy-metal keyboardist was not vaccinated against COVID-19.

https://www.instagram.com/p/CW5k6nuLH-u

Phillips appeared on season four in 2009 of the television competition series, which airs on NBC. He was eliminated and then came back for season 12 in 2017 but was cut before the quarterfinals.

This story first appeared on NBCNews.com .