( 71)
Values are mean and standard deviation (SD) for continuous data. a Statistical analyses: general linear models were used to compare eating routines between pre-pandemic and ‘new normal’ groups. Analyses were adjusted for age and gender. p -values were corrected using the Benjamini–Hochberg method, assuming a False Discovery Rate (FDR) of 5%. Significant p -values are shown in bold.
Our results also indicated that BMI and diet quality were similar between the pre-pandemic and ‘new normal’ groups ( Table 2 ). Regarding eating behaviors, the results showed that cognitive restraint was reduced by 0.2 points (95% CI: −0.4, −0.1) in the ‘new normal’, whereas no differences were found in emotional and uncontrolled eating scores. Regarding sleep quality and physical activity, we did not observe any significant difference between groups ( Table 2 ). Likewise, we observed that well-being was similar between the pre-pandemic and ‘new normal’ groups.
Comparison of pre-pandemic and ‘new normal’ conditions in body mass index and health-related variables.
Pre-Pandemic ( 71) | New Normal ( 68) | -Value | |
---|---|---|---|
Body mass index, kg/m | 22.2 (3.2) | 21.3 (2.7) | 0.177 |
Diet quality, score | 8.9 (1.8) | 8.5 (1.9) | 0.366 |
Eating behaviors | |||
Cognitive restraint, score | 2.1 (0.5) | 1.9 (0.3) | |
Emotional eating, score | 1.7 (0.6) | 1.7 (0.6) | 0.893 |
Uncontrolled eating, score | 1.9 (0.5) | 1.9 (0.4) | 0.707 |
Sleep quality, score | 5.1 (2.4) | 5.2 (2.5) | 0.818 |
Physical activity, MET-minutes/day | 2242.8 (1591.1) | 2193.9 (1913.7) | 0.899 |
Well-being, score | 57.8 (16.6) | 55.2 (17.6) | 0.550 |
Values are mean and standard deviation (SD). MET, metabolic equivalent of task. a Statistical analyses: general linear models were used to compare body mass index and health-related variables between pre-pandemic and ‘new normal’ groups. Analyses were adjusted for age and gender. p -values were corrected using the Benjamini–Hochberg method, assuming a False Discovery Rate (FDR) of 5%. Significant p -values are shown in bold.
Our findings revealed that, relative to pre-pandemic conditions, the ‘new normal’ had a positive impact in terms of regularity in daily sleep and eating routines. Therefore, the greater flexibility in social schedules provided by the ‘new normal’ was significantly associated with lower social and eating jet lag (−0.7 h and −0.3 h, respectively). Furthermore, our results suggest that in the ‘new normal’, the sleep routines followed by college students on weekdays were more sustainable. Note that in the ‘new normal’, participants slept 1.8 h more, and sleep debt was reduced by ~1.3 h.
These findings are in line with the conclusions drawn from COVID-19 lockdown studies indicating that greater flexibility in social schedules, possibly due to online learning and the elimination of commute time, had a positive impact on daily sleep routines [ 2 ]. This is supported by the significant decrease in sleep debt and social jet lag found during the ‘new normal’. Furthermore, our results showed that the ‘new normal’ lifestyle could mitigate the misalignment between biological and social clocks [ 2 , 16 , 17 , 18 ]. It should be noted that circadian misalignment has been associated with obesity and metabolic alterations [ 6 , 7 , 10 , 11 ], as well as with unhealthy eating habits [ 6 , 29 ]. Therefore, it is plausible that, in the long term, regularity in daily sleep routines could have a positive impact on body weight and other health-related variables in college students. However, evidence from longitudinal studies needs to be warranted.
Regarding eating routines, we noticed a slight advance in dinner timing on weekdays (~0.24 h). Note that advancing dinner time would allow postprandial blood glucose to return to fasting values before the rise in endogenous melatonin levels [ 30 ]. In fact, having dinner closer to bedtime is associated with obesity and metabolic alterations [ 4 , 30 , 31 ]. Furthermore, this subtle shift in dinner timing plus the regularity in daily sleep routines seen in the ‘new normal’ are related to a lower eating jet lag. Regularity in daily eating routines is crucial to maintaining optimal nutrient utilization [ 32 , 33 ]. Note that, when eating occurs at an expected (or regular) time, the circadian system ensures that the proper pathways that help to assimilate the nutrients begin to increase in anticipation of food intake [ 32 ]. However, when food intake occurs at an unexpected (or irregular) time, nutrient sensing pathways act on the peripheral clocks so that food is anticipated at the new mealtime in the following days [ 32 ]. Thus, eating can independently activate nutrient-sensing pathways, compromising the way food is processed during the postprandial period. Not surprisingly, the irregularity in daily eating routines (given by a greater eating jet lag) has been associated with obesity [ 9 , 15 ].
It is worth noting that regularity in daily sleep and eating routines might explain why BMI was similar between the ‘new normal’ and the pre-pandemic groups. We cannot ignore that the COVID-19 lockdown was a stressful time that, among others, had a negative impact on what we ate, how well we slept, and how much exercise we practiced [ 17 , 34 , 35 , 36 ]. Unsurprisingly, during the COVID-19 lockdown, people were more likely to gain weight. In fact, a recent systematic review and meta-analysis found that body weight and BMI increased significantly (~1.57 kg and ~0.31 kg/m 2 , respectively) during the lockdown period compared with pre-pandemic conditions [ 37 ]. Thus, our results suggest that the measures that characterized the ‘new-normal’ (such as prioritizing online classes, allowing individual exercise, and letting people have some sort of social life) may have helped college students to maintain and/or recover their weight once they returned to ‘normal’ life.
In line with the above, we observed that diet quality was similar between the ‘new normal’ and pre-pandemic groups. Our hypothesis was that schedule flexibility could play a role in maintaining diet quality, as having online classes could give college students more time to do other activities, such as cooking. This trend was also observed in young Spanish adults during the COVID-19 lockdown [ 34 ]. The authors reported that 57% of the population studied increased their home cooking practices [ 34 ], which could favor the consumption of healthier homemade foods [ 38 ]. It is worth mentioning that meals prepared and eaten at home are associated with higher-quality diets and better health outcomes [ 39 , 40 , 41 ]. Specifically, Larson et al. [ 39 ] showed that young adults who frequently bought their own food and prepared meals at home had a better diet quality. Interestingly, adherence to a healthy diet could play a significant role in the prevention and predisposition to viral infections, such as COVID-19 [ 42 , 43 ]. According to recent reviews, special attention should be paid to nutrients that play a role in regulating the immune response [ 43 ]. For example, Messina et al. [ 42 ] hypothesized that omega-3 polyunsaturated fatty acids could be used to reduce inflammation, as well as to ameliorate lung damage that occurs after coronavirus infection.
It is also worth noting that in the ‘new normal’, college students were more relaxed in terms of their diet, without compromising diet quality. It is noteworthy that our results showed that cognitive restraint was significantly lower in the ‘new normal’ compared with the pre-pandemic group. Importantly, less cognitive restraint does not necessarily imply that the subjects are prone to increase their body weight, but quite the opposite [ 44 , 45 ]. In fact, previous research performed by our group showed that a greater dietary restraint is associated with a higher BMI among college students [ 45 ].
Along these lines, we observed that the flexibility provided by the ‘new normal’ could have helped to maintain sleep quality, despite the stressful pandemic context. This would also be in line with the findings of Blume et al. [ 17 ] during COVID-19 lockdown. According to the authors, the reduction in sleep debt and social jet lag limited the decline in sleep quality during lockdown. Furthermore, Pilz et al. [ 46 ] suggested that it is not the delay in sleep timing that affects sleep quality, but rather the social jet lag. The authors explained that the combination of late sleep schedules with the time constrains of the social clock could explain why subjects who had a preference for late sleep schedules usually showed the worst sleep quality.
Regarding other health-related variables, our results revealed that physical activity was similar between the ‘new normal’ and pre-pandemic groups (~2242.8 vs. ~2193.9 MET-minutes/day, respectively). This can be attributed to the fact that, despite the restrictions, in the ‘new normal’, exercise was allowed. Importantly, Zhang et al. [ 47 ] observed that during COVID-19 lockdown, performing 2500 METs/week of physical activity (equivalent to a moderate level of physical activity [ 48 ]) alleviated negative emotions in college students, which could also be in line with our results regarding well-being. It is worth noting that despite social restrictions and the curfew issued in the ‘new normal’, well-being remained similar between the ‘new normal’ and pre-pandemic groups. It is also plausible that the consistency of daily sleep routines could also be associated with the maintenance of well-being in the ‘new normal’ [ 2 , 49 ].
Our study has certain limitations, starting with the observational nature of the study, that prevent us from claiming causation. Additionally, we acknowledge as a limitation that our sample consisted mostly of women and undergraduate students of the Bachelor’s Degree in Human Nutrition and Dietetics, which is not representative of the entire population. Furthermore, the representativeness of our results is limited to students living in an urban area. We also acknowledge our results are based upon a cohort of healthy young adults, who may not be representative of the entire population in terms of sleep and meal timing. Nonetheless, the strength of our study is that this is the first research to study the effects of the ‘new normal’ on daily sleep and eating routines, BMI, and health-related variables in college students.
In summary, our findings indicate that the ‘new normal’ was associated with greater regularity in daily sleeping and eating routines. Additionally, we observed that BMI, diet and sleep quality, the level of physical activity, and well-being were similar between the ‘new normal’ and pre-pandemic groups. Although, we did observe that college students were less restrictive in terms of their diet, without compromising diet quality. It is also worth noting that the ‘new normal’ offered college students a more sustainable lifestyle, which was reflected in longer sleep duration on weekdays, as well as with less social and eating jet lag. These findings point to the need to rethink the possibility of combining face-to-face activities with remote work and online education, which could be associated with more hours of sleep during weekdays, and the regularity of daily sleep and eating routines. However, more studies are needed to investigate the long-term potential benefits of regular sleep and eating routines on BMI and other health-related variables. Finally, our findings could help formulate public health recommendations for future pandemics where social distancing measures are needed to halt the spread of a virus.
Conceptualization and methodology, M.I.-P. and M.F.Z.-R.; investigation, formal analysis, data curation, and writing—original draft preparation, C.R.-C. and M.F.Z.-R.; writing—review and editing, M.I.-P.; supervision, project administration, and funding acquisition, M.I.-P. All authors have read and agreed to the published version of the manuscript.
CRC was supported by the National Agency for Research and Development (ANID)/Scholarship Program/DOCTORADO BECAS CHILE/2019–72200134.
The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the University of Barcelona (IRB00003099, 20 May 2020).
Informed consent was obtained from all subjects involved in the study.
The authors declare no conflict of interest.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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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.
At the New York Review of Books, Ali Bhutto writes that in Karachi, Pakistan, the government-imposed curfew due to the virus is “eerily reminiscent of past military clampdowns”:
Beneath the quiet calm lies a sense that society has been unhinged and that the usual rules no longer apply. Small groups of pedestrians look on from the shadows, like an audience watching a spectacle slowly unfolding. People pause on street corners and in the shade of trees, under the watchful gaze of the paramilitary forces and the police.
His essay concludes with the sobering note that “in the minds of many, Covid-19 is just another life-threatening hazard in a city that stumbles from one crisis to another.”
Writing from Chattanooga, novelist Jamie Quatro documents the mixed ways her neighbors have been responding to the threat, and the frustration of conflicting direction, or no direction at all, from local, state, and federal leaders:
Whiplash, trying to keep up with who’s ordering what. We’re already experiencing enough chaos without this back-and-forth. Why didn’t the federal government issue a nationwide shelter-in-place at the get-go, the way other countries did? What happens when one state’s shelter-in-place ends, while others continue? Do states still under quarantine close their borders? We are still one nation, not fifty individual countries. Right?
Award-winning photojournalist Alessio Mamo, quarantined with his partner Marta in Sicily after she tested positive for the virus, accompanies his photographs in the Guardian of their confinement with a reflection on being confined :
The doctors asked me to take a second test, but again I tested negative. Perhaps I’m immune? The days dragged on in my apartment, in black and white, like my photos. Sometimes we tried to smile, imagining that I was asymptomatic, because I was the virus. Our smiles seemed to bring good news. My mother left hospital, but I won’t be able to see her for weeks. Marta started breathing well again, and so did I. I would have liked to photograph my country in the midst of this emergency, the battles that the doctors wage on the frontline, the hospitals pushed to their limits, Italy on its knees fighting an invisible enemy. That enemy, a day in March, knocked on my door instead.
In the New York Times Magazine, deputy editor Jessica Lustig writes with devastating clarity about her family’s life in Brooklyn while her husband battled the virus, weeks before most people began taking the threat seriously:
At the door of the clinic, we stand looking out at two older women chatting outside the doorway, oblivious. Do I wave them away? Call out that they should get far away, go home, wash their hands, stay inside? Instead we just stand there, awkwardly, until they move on. Only then do we step outside to begin the long three-block walk home. I point out the early magnolia, the forsythia. T says he is cold. The untrimmed hairs on his neck, under his beard, are white. The few people walking past us on the sidewalk don’t know that we are visitors from the future. A vision, a premonition, a walking visitation. This will be them: Either T, in the mask, or — if they’re lucky — me, tending to him.
Essayist Leslie Jamison writes in the New York Review of Books about being shut away alone in her New York City apartment with her 2-year-old daughter since she became sick:
The virus. Its sinewy, intimate name. What does it feel like in my body today? Shivering under blankets. A hot itch behind the eyes. Three sweatshirts in the middle of the day. My daughter trying to pull another blanket over my body with her tiny arms. An ache in the muscles that somehow makes it hard to lie still. This loss of taste has become a kind of sensory quarantine. It’s as if the quarantine keeps inching closer and closer to my insides. First I lost the touch of other bodies; then I lost the air; now I’ve lost the taste of bananas. Nothing about any of these losses is particularly unique. I’ve made a schedule so I won’t go insane with the toddler. Five days ago, I wrote Walk/Adventure! on it, next to a cut-out illustration of a tiger—as if we’d see tigers on our walks. It was good to keep possibility alive.
At Literary Hub, novelist Heidi Pitlor writes about the elastic nature of time during her family’s quarantine in Massachusetts:
During a shutdown, the things that mark our days—commuting to work, sending our kids to school, having a drink with friends—vanish and time takes on a flat, seamless quality. Without some self-imposed structure, it’s easy to feel a little untethered. A friend recently posted on Facebook: “For those who have lost track, today is Blursday the fortyteenth of Maprilay.” ... Giving shape to time is especially important now, when the future is so shapeless. We do not know whether the virus will continue to rage for weeks or months or, lord help us, on and off for years. We do not know when we will feel safe again. And so many of us, minus those who are gifted at compartmentalization or denial, remain largely captive to fear. We may stay this way if we do not create at least the illusion of movement in our lives, our long days spent with ourselves or partners or families.
Novelist Lauren Groff writes at the New York Review of Books about trying to escape the prison of her fears while sequestered at home in Gainesville, Florida:
Some people have imaginations sparked only by what they can see; I blame this blinkered empiricism for the parks overwhelmed with people, the bars, until a few nights ago, thickly thronged. My imagination is the opposite. I fear everything invisible to me. From the enclosure of my house, I am afraid of the suffering that isn’t present before me, the people running out of money and food or drowning in the fluid in their lungs, the deaths of health-care workers now growing ill while performing their duties. I fear the federal government, which the right wing has so—intentionally—weakened that not only is it insufficient to help its people, it is actively standing in help’s way. I fear we won’t sufficiently punish the right. I fear leaving the house and spreading the disease. I fear what this time of fear is doing to my children, their imaginations, and their souls.
At ArtForum , Berlin-based critic and writer Kristian Vistrup Madsen reflects on martinis, melancholia, and Finnish artist Jaakko Pallasvuo’s 2018 graphic novel Retreat , in which three young people exile themselves in the woods:
In melancholia, the shape of what is ending, and its temporality, is sprawling and incomprehensible. The ambivalence makes it hard to bear. The world of Retreat is rendered in lush pink and purple watercolors, which dissolve into wild and messy abstractions. In apocalypse, the divisions established in genesis bleed back out. My own Corona-retreat is similarly soft, color-field like, each day a blurred succession of quarantinis, YouTube–yoga, and televized press conferences. As restrictions mount, so does abstraction. For now, I’m still rooting for love to save the world.
At the Paris Review , Matt Levin writes about reading Virginia Woolf’s novel The Waves during quarantine:
A retreat, a quarantine, a sickness—they simultaneously distort and clarify, curtail and expand. It is an ideal state in which to read literature with a reputation for difficulty and inaccessibility, those hermetic books shorn of the handholds of conventional plot or characterization or description. A novel like Virginia Woolf’s The Waves is perfect for the state of interiority induced by quarantine—a story of three men and three women, meeting after the death of a mutual friend, told entirely in the overlapping internal monologues of the six, interspersed only with sections of pure, achingly beautiful descriptions of the natural world, a day’s procession and recession of light and waves. The novel is, in my mind’s eye, a perfectly spherical object. It is translucent and shimmering and infinitely fragile, prone to shatter at the slightest disturbance. It is not a book that can be read in snatches on the subway—it demands total absorption. Though it revels in a stark emotional nakedness, the book remains aloof, remote in its own deep self-absorption.
In an essay for the Financial Times, novelist Arundhati Roy writes with anger about Indian Prime Minister Narendra Modi’s anemic response to the threat, but also offers a glimmer of hope for the future:
Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next. We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it.
From Boston, Nora Caplan-Bricker writes in The Point about the strange contraction of space under quarantine, in which a friend in Beirut is as close as the one around the corner in the same city:
It’s a nice illusion—nice to feel like we’re in it together, even if my real world has shrunk to one person, my husband, who sits with his laptop in the other room. It’s nice in the same way as reading those essays that reframe social distancing as solidarity. “We must begin to see the negative space as clearly as the positive, to know what we don’t do is also brilliant and full of love,” the poet Anne Boyer wrote on March 10th, the day that Massachusetts declared a state of emergency. If you squint, you could almost make sense of this quarantine as an effort to flatten, along with the curve, the distinctions we make between our bonds with others. Right now, I care for my neighbor in the same way I demonstrate love for my mother: in all instances, I stay away. And in moments this month, I have loved strangers with an intensity that is new to me. On March 14th, the Saturday night after the end of life as we knew it, I went out with my dog and found the street silent: no lines for restaurants, no children on bicycles, no couples strolling with little cups of ice cream. It had taken the combined will of thousands of people to deliver such a sudden and complete emptiness. I felt so grateful, and so bereft.
And on his own website, musician and artist David Byrne writes about rediscovering the value of working for collective good , saying that “what is happening now is an opportunity to learn how to change our behavior”:
In emergencies, citizens can suddenly cooperate and collaborate. Change can happen. We’re going to need to work together as the effects of climate change ramp up. In order for capitalism to survive in any form, we will have to be a little more socialist. Here is an opportunity for us to see things differently — to see that we really are all connected — and adjust our behavior accordingly. Are we willing to do this? Is this moment an opportunity to see how truly interdependent we all are? To live in a world that is different and better than the one we live in now? We might be too far down the road to test every asymptomatic person, but a change in our mindsets, in how we view our neighbors, could lay the groundwork for the collective action we’ll need to deal with other global crises. The time to see how connected we all are is now.
The portrait these writers paint of a world under quarantine is multifaceted. Our worlds have contracted to the confines of our homes, and yet in some ways we’re more connected than ever to one another. We feel fear and boredom, anger and gratitude, frustration and strange peace. Uncertainty drives us to find metaphors and images that will let us wrap our minds around what is happening.
Yet there’s no single “what” that is happening. Everyone is contending with the pandemic and its effects from different places and in different ways. Reading others’ experiences — even the most frightening ones — can help alleviate the loneliness and dread, a little, and remind us that what we’re going through is both unique and shared by all.
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Six months into a new decade, 2020 has already been earmarked as ‘the worst’ year in the 21st century. The novel coronavirus has given rise to a global pandemic that has destabilized most institutional settings. While we live in times when humankind possesses the most advanced science and technology, a virus invisible to the naked eye has massively disrupted economies, healthcare, and education systems worldwide. This should serve as a reminder that as we keep making progress in science and research, humanity will continue to face challenges in the future, and it is upon us to prioritize those issues that are most relevant in the 21st century.
Even amidst the pandemic, Space X, an American aerospace manufacturer, managed to become the first private company to send humans to space. While this is a tremendous achievement and prepares humanity for a sustainable future, I feel there is a need to introspect the challenges that we are already facing. On the one hand, we seem to be preparing beyond the 21st century. On the other hand, heightened nationalism, increasing violence against marginalized communities and multidimensional inequalities across all sectors continue to act as barriers to growth for most individuals across the globe. COVID-19 has reinforced these multifaceted economic, social and cultural inequalities wherein those in situations of vulnerability have found it increasingly difficult to get quality medical attention, access to quality education, and have witnessed increased domestic violence while being confined to their homes.
Given the coronavirus’s current situation, some households have also had time to introspect on gender roles and stereotypes. For instance, women are expected to carry out unpaid care work like cooking, cleaning, and looking after the family. There is no valid reason to believe that women ought to carry out these activities, and men have no role in contributing to household chores. With men having shared household chores during the lockdown period, it gives hope that they will realize the burden that women have been bearing for past decades and will continue sharing responsibilities. However, it would be naïve to believe that gender discrimination could be tackled so easily, and men would give up on their decades' old habits within a couple of months. Thus, during and after the pandemic, there is an urgent need to sensitize households on the importance of gender equality and social cohesion.
Moving forward, developing quality healthcare systems that are affordable and accessible to all should be the primary objective for all governments. This can be done by increasing expenditure towards health and education and simultaneously reducing expenditure on defence equipment where the latter mainly gives rise to an idea that countries need to be prepared for violence. There is substantial evidence that increased investment in health and education is beneficial in the long-term and can potentially build the basic foundation of a country.
If it can be established that usage of nuclear weapons, violence and war are not solutions to any problem, governments (like, for example, Costa Rica) could move towards disarmament of weapons and do their part in building a more peaceful planet that is sustainable for the future. This would further promote global citizenship wherein nationality, race, gender, caste, and other categories, are just mere variables and they do not become identities of individuals that restrict their thought process. The aim should be to build responsible citizens who play an active role in their society and work collectively in helping develop a planet that is well-governed, inclusive, and environmentally sustainable.
‘A year after Coronavirus’ is still an unknown, so I think that our immediate focus should be to tackle the complex problems that have emerged from the pandemic so that we make the year after coronavirus one which highlights recovery and acts as a pathway to fresh beginnings. While there is little to gain from such a fatal cause, it is vital that we also use it to make the ‘new normal’ in favour of the environment and ensure that no one is left behind.
This article is related to the United Nation’s Sustainable Development Goals .
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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
COVID-19 is significantly impacting the lives of all people on the globe. Strict quarantine measures changed the attitude towards such simple things as walking in the park, talking to strangers, working, and studying in a team. What is more, people started to value the work of medics as keen as never before. Unfortunately, many nurses become victims of this virus. The current paper discusses the impact of COVID-19 on the loss of nurses on personal and professional levels.
The loss of nurses caused by the death from the coronavirus leads to the shortage of labor in health institutions. Someday, the pandemic will come to an end, and people will return to the usual lifestyle; however, the losses of nurses are irretrievable. During the pandemic situation, some countries such as China, Russia, Japan, the US send their medics to foreign countries. This help is relevant during these hard times. Nevertheless, after the pandemic, other states will hardly share their nurses, medical equipment, and medicines. The shortage of nurses will cause a higher workload on the doctors to whom they usually assist. It would be harder to take care of inpatients since nurses do a great job helping doctors to monitor them.
On a personal level, I admire medical staffers who work with people infected with the virus. They wear special costumes that minimize the probability of getting infected. Notwithstanding this fact, the statistics indicate how significant are the losses among the nurses. Grace Oghiehor-Enoma, a nurse from New York, compared physicians with fighters on the battlefield. She says: “You see the fire, and you are running into the fire, not thinking about yourself. That is the selflessness that you can see in nursing today” (World Health Organization, 2020). People used to underestimate the importance of nurses while now see who the saviors of humanity are.
To sum up, the work of nurses is an excellent feat. They are an example of people whom we must take an example. From the very beginning of the pandemic, it was apparent that the losses among nurses are inevitable. Nevertheless, no one could expect that these losses will be that big. Still, all of us could help them just staying home and minimizing the probability of getting infected.
World Health Organization. (2020). Support Nurses and Midwives through COVID-19 and beyond . Web.
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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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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 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, 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.
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.
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.
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.
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.
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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Not required.
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.
Intended for healthcare professionals
The UK’s new government should commit to public health, starting with better data collection on the prevalence of covid in the community, writes Janet Gunter
A few weeks ago, my partner tested positive for covid-19 for the first time. I’ve never recovered after being infected by covid during the first wave of the pandemic, so this is a big deal for us. The prospect of reinfection and a worsening of my symptoms is deeply troubling, and I spent weeks quarantining and apprehensively waiting to see if I would catch covid again. It’s maddening to know that all of this, including my partner’s infection, could have been avoided if we'd only had access to better data on the prevalence of covid.
We already lead a very covid-cautious life because I do not want to get worse with another infection. I’ve had debilitating long covid symptoms since I first became ill in 2020: extreme fatigue, frequent crashes that leave me bed-bound, pain, cognitive impairment, and disrupted sleep are everyday experiences for me. I live a shadow of my former life, unable to travel much, socialise, or work more than part time.
My partner goes to the office one or two days a week, masking in common spaces, and using a personal air filter at her desk. We mask indoors in public and avoid crowded spaces. Previously, we’ve used data to help us make decisions about how to go about our lives: when we knew the prevalence of covid was high, we’d avoid any extra activity that might expose us to infection.
We got caught out this summer because of a vacuum of information about covid prevalence in England. Before, we could count on data from the Office for National Statistics (ONS) and crowdsourced data by the ZOE app. Both were defunded by the previous government. 1 2
The ONS Covid Infection Survey was one of the few “world-beating” initiatives of the government during covid. 3 4 Experts praised it for setting the gold standard, by going out into the community and testing. Currently, the government shares infection data collected almost exclusively at hospitals, and this does not tell us much about covid's spread in the community. Unlike many countries, England doesn't even collect wastewater data. 5
Now my partner and I rely on Christina Pagel's Substack and Scottish wastewater data to judge how much of a risk covid poses. 6 7 But it simply isn't enough. We had believed that summer infections had peaked in early July, but, anecdotally, it seemed to be everywhere in August, including Olympic changing rooms. 8
My partner and I took risks that we absolutely would not have taken with better prevalence data, and the consequence was bringing covid into our house.
The ability to quarantine is a privilege, but that didn’t stop it being extremely difficult for us and very stressful for me, as I wanted to avoid reinfection at all costs. I did manage to avoid it, but all of our efforts to avoid each other and masking took a toll on my physical and mental health.
My partner had to take a week off work; multiplying that at a national scale, and with multiple infections, can give us an idea of how covid is still damaging productivity. The Economist ’s Economist Impact estimated that long covid will cost the UK economy roughly 0.5% of GDP in 2024. 9 With better prevalence data, employers could prevent covid’s spread by encouraging people to work from home during waves of infection, redoubling efforts to ventilate workplaces, and postponing crowded events.
But beyond productivity, covid continues to kill and disable people. Our new parliamentary undersecretary of state for public health and prevention, MP Andrew Gwynne, knows this firsthand. He has long covid and said in May in Parliament “I have managed to control my long covid for the best part of two years, but this week has been a very bad week for me; I was in bed for all of today, and I have only come in to give this speech.” 10 His words are a reminder of the ongoing, but often invisible, burden of the disease.
The free circulation of a virus that leaves people with these debilitating symptoms, and the failure to monitor it with surveillance systems, is an ongoing public health disaster. The previous government placed all responsibility for preventing covid on the individual but refused to give us the tools to limit our own personal risk. We need this government to bring back a commitment to public health, starting with better data collection on covid prevalence in the community so that we can save lives, prevent disability, and maintain economic productivity. The moment demands courage and care.
Competing interests: JG is a volunteer for Long Covid SOS.
Provenance and peer review: Not commissioned; not peer reviewed.
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