How to Write About Coronavirus in a College Essay

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

Writing About COVID-19 in College Essays

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

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

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

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

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

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

Writing About COVID-19 for a College Application

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

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

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

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

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

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

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

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

Above all, she urges honesty.

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

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

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

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

Writing About Coronavirus in Main and Supplemental Essays

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

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

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

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

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

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

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

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

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

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

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

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

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

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Home — Essay Samples — Nursing & Health — Covid 19 — My Experience during the COVID-19 Pandemic

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My Experience During The Covid-19 Pandemic

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Words: 440 |

Published: Jan 30, 2024

Words: 440 | Page: 1 | 3 min read

Table of contents

Introduction, physical impact, mental and emotional impact, social impact.

  • World Health Organization. (2021). Coronavirus (COVID-19) Dashboard. https://covid19.who.int/
  • American Psychiatric Association. (2020). Mental health and COVID-19. https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2020/03/mental-health-and-covid-19
  • The New York Times. (2020). Coping with Coronavirus Anxiety. https://www.nytimes.com/2020/03/11/well/family/coronavirus-anxiety-mental-health.html

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My life experience during the covid-19 pandemic.

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My content explains what my life was like during the last seven months of the Covid-19 pandemic and how it affected my life both positively and negatively. It also explains what it was like when I graduated from High School and how I want the future generations to remember the Class of 2020.

Class assignment, Western Civilization (Dr. Marino).

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Blanco, Melissa, "My Life Experience During the Covid-19 Pandemic" (2020). Community Reflections . 21. https://digitalcommons.sacredheart.edu/covid19-reflections/21

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Read these 12 moving essays about life during coronavirus

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Writing about COVID-19 in a college admission essay

by: Venkates Swaminathan | Updated: September 14, 2020

Print article

Writing about COVID-19 in your college admission essay

For students applying to college using the CommonApp, there are several different places where students and counselors can address the pandemic’s impact. The different sections have differing goals. You must understand how to use each section for its appropriate use.

The CommonApp COVID-19 question

First, the CommonApp this year has an additional question specifically about COVID-19 :

Community disruptions such as COVID-19 and natural disasters can have deep and long-lasting impacts. If you need it, this space is yours to describe those impacts. Colleges care about the effects on your health and well-being, safety, family circumstances, future plans, and education, including access to reliable technology and quiet study spaces. Please use this space to describe how these events have impacted you.

This question seeks to understand the adversity that students may have had to face due to the pandemic, the move to online education, or the shelter-in-place rules. You don’t have to answer this question if the impact on you wasn’t particularly severe. Some examples of things students should discuss include:

  • The student or a family member had COVID-19 or suffered other illnesses due to confinement during the pandemic.
  • The candidate had to deal with personal or family issues, such as abusive living situations or other safety concerns
  • The student suffered from a lack of internet access and other online learning challenges.
  • Students who dealt with problems registering for or taking standardized tests and AP exams.

Jeff Schiffman of the Tulane University admissions office has a blog about this section. He recommends students ask themselves several questions as they go about answering this section:

  • Are my experiences different from others’?
  • Are there noticeable changes on my transcript?
  • Am I aware of my privilege?
  • Am I specific? Am I explaining rather than complaining?
  • Is this information being included elsewhere on my application?

If you do answer this section, be brief and to-the-point.

Counselor recommendations and school profiles

Second, counselors will, in their counselor forms and school profiles on the CommonApp, address how the school handled the pandemic and how it might have affected students, specifically as it relates to:

  • Grading scales and policies
  • Graduation requirements
  • Instructional methods
  • Schedules and course offerings
  • Testing requirements
  • Your academic calendar
  • Other extenuating circumstances

Students don’t have to mention these matters in their application unless something unusual happened.

Writing about COVID-19 in your main essay

Write about your experiences during the pandemic in your main college essay if your experience is personal, relevant, and the most important thing to discuss in your college admission essay. That you had to stay home and study online isn’t sufficient, as millions of other students faced the same situation. But sometimes, it can be appropriate and helpful to write about something related to the pandemic in your essay. For example:

  • One student developed a website for a local comic book store. The store might not have survived without the ability for people to order comic books online. The student had a long-standing relationship with the store, and it was an institution that created a community for students who otherwise felt left out.
  • One student started a YouTube channel to help other students with academic subjects he was very familiar with and began tutoring others.
  • Some students used their extra time that was the result of the stay-at-home orders to take online courses pursuing topics they are genuinely interested in or developing new interests, like a foreign language or music.

Experiences like this can be good topics for the CommonApp essay as long as they reflect something genuinely important about the student. For many students whose lives have been shaped by this pandemic, it can be a critical part of their college application.

Want more? Read 6 ways to improve a college essay , What the &%$! should I write about in my college essay , and Just how important is a college admissions essay? .

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8.4 Annotated Student Sample: "U.S. Response to COVID-19" by Trevor Garcia

Learning outcomes.

By the end of this section, you will be able to:

  • Identify the genre conventions of an informal analytical report.
  • Analyze the organizational structure of a report and how writers develop ideas.
  • Recognize how writers use evidence and objectivity to build credibility.
  • Identify sources of evidence within a text and in source citations.

Introduction

The analytical report that follows was written by a student, Trevor Garcia, for a first-year composition course. Trevor’s assignment was to research and analyze a contemporary issue in terms of its causes or effects. He chose to analyze the causes behind the large numbers of COVID-19 infections and deaths in the United States in 2020. The report is structured as an essay, and its format is informal.

Living by Their Own Words

Successes and failures.

student sample text With more than 83 million cases and 1.8 million deaths at the end of 2020, COVID-19 has turned the world upside down. By the end of 2020, the United States led the world in the number of cases, at more than 20 million infections and nearly 350,000 deaths. In comparison, the second-highest number of cases was in India, which at the end of 2020 had less than half the number of COVID-19 cases despite having a population four times greater than the U.S. (“COVID-19 Coronavirus Pandemic,” 2021). How did the United States come to have the world’s worst record in this pandemic? An examination of the U.S. response shows that a reduction of experts in key positions and programs, inaction that led to equipment shortages, and inconsistent policies were three major causes of the spread of the virus and the resulting deaths. end student sample text

annotated text Introduction. Informal reports follow essay structure and open with an overview. end annotated text

annotated text Statistics as Evidence. The writer gives statistics about infection rates and numbers of deaths; a comparison provides context. end annotated text

annotated text Source Citation in APA Style: No Author. A web page without a named author is cited by the title and the year. end annotated text

annotated text Thesis Statement. The rhetorical question leads to the thesis statement in the last sentence of the introduction. The thesis statement previews the organization and indicates the purpose—to analyze the causes of the U.S. response to the virus. end annotated text

Reductions in Expert Personnel and Preparedness Programs

annotated text Headings. This heading and those that follow mark sections of the report. end annotated text

annotated text Body. The three paragraphs under this heading support the first main point in the thesis statement. end annotated text

student sample text Epidemiologists and public health officials in the United States had long known that a global pandemic was possible. end student sample text

annotated text Topic Sentence. The paragraph opens with a sentence stating the topic. The rest of this paragraph and the two that follow develop the topic chronologically. end annotated text

student sample text In 2016, the National Security Council (NSC) published Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents , a 69-page document on responding to diseases spreading within and outside of the United States. On January 13, 2017, the joint transition teams of outgoing president Barack Obama and then president-elect Donald Trump performed a pandemic preparedness exercise based on the playbook; however, it was never adopted by the incoming administration (Goodman & Schulkin, 2020). A year later, in February 2018, the Trump administration began to cut funding for the Prevention and Public Health Fund at the Centers for Disease Control and Prevention, leaving key positions unfilled. Other individuals who were fired or resigned in 2018 were the homeland security adviser, whose portfolio included global pandemics; the director for medical and biodefense preparedness; and the top official in charge of a pandemic response. None of them were replaced, thus leaving the White House with no senior person who had experience in public health (Goodman & Schulkin, 2020). Experts voiced concerns, among them Luciana Borio, director of medical and biodefense preparedness at the NSC, who spoke at a symposium marking the centennial of the 1918 influenza pandemic in May 2018: “The threat of pandemic flu is the number one health security concern,” she said. “Are we ready to respond? I fear the answer is no” (Sun, 2018, final para.). end student sample text

annotated text Audience. The writer assumes that his readers have a strong grasp of government and agencies within the government. end annotated text

annotated text Synthesis. The paragraph synthesizes factual evidence from two sources and cites them in APA style. end annotated text

annotated text Expert Quotation as Supporting Evidence. The expert’s credentials are given, her exact words are placed in quotation marks, and the source is cited in parentheses. end annotated text

annotated text Source Citation in APA Style: No Page Numbers. Because the source of the quotation has no page numbers, the specific paragraph within the source (“final para.”; alternatively, “para. 18”) is provided in the parenthetical citation. end annotated text

student sample text Cuts continued in 2019, among them a maintenance contract for ventilators in the federal emergency supply and PREDICT, a U.S. agency for international development designed to identify and prevent pandemics (Goodman & Schulkin, 2020). In July 2019, the White House eliminated the position of an American public health official in Beijing, China, who was working with China’s disease control agency to help detect and contain infectious diseases. The first case of COVID-19 emerged in China four months later, on November 17, 2019. end student sample text

annotated text Development of First Main Point. This paragraph continues the chronological development of the first point, using a transitional sentence and evidence to discuss the year 2019. end annotated text

student sample text After the first U.S. coronavirus case was confirmed in 2020, the secretary of the Department of Health and Human Services (HHS) was named to lead a task force on a response, but after several months, he was replaced when then vice president Mike Pence was officially charged with leading the White House Coronavirus Task Force (Ballhaus & Armour, 2020). Experts who remained, including Dr. Deborah Birx and Dr. Anthony Fauci of the National Institutes of Health, were sidelined. Turnover of personnel in related government departments and agencies continued throughout 2020, leaving the country without experts in key positions to lead the pandemic response. end student sample text

annotated text Development of First Main Point. This paragraph continues the chronological development of the first point, using a transitional sentence and evidence to discuss the start of the pandemic in 2020. end annotated text

Inaction and Equipment Shortages

annotated text Body. The three paragraphs under this heading support the second main point in the thesis statement. end annotated text

student sample text In January and February of 2020, the president’s daily brief included more than a dozen detailed warnings, based on wire intercepts, computer intercepts, and satellite images by the U.S. intelligence community (Miller & Nakashima, 2020). Although senior officials began to assemble a task force, no direct action was taken until mid-March. end student sample text

annotated text Topic Sentences. The paragraph opens with two sentences stating the topic that is developed in the following paragraphs. end annotated text

student sample text The stockpile of medical equipment and personal protective equipment was dangerously low before the pandemic began. Although the federal government had paid $9.8 million to manufacturers in 2018 and 2019 to develop and produce protective masks, by April 2020 the government had not yet received a single mask (Swaine, 2020). Despite the low stockpile, a request by the head of the Food and Drug Administration (FDA) in early 2020 to begin contacting companies about possible shortages of necessary medical equipment, including personal protective equipment, was denied. This decision was made to avoid alarming the industry and the public and to avoid giving the impression that the administration was not prepared for the pandemic (Ballhaus & Armour, 2020). end student sample text

annotated text Topic Sentence. The paragraph opens with a sentence stating the topic that is developed in the paragraph. end annotated text

annotated text Objective Stance. The writer presents evidence (facts, statistics, and examples) in mostly neutral, unemotional language, which builds trustworthiness, or ethos , with readers. end annotated text

annotated text Synthesis. The paragraph synthesizes factual evidence from two sources. end annotated text

student sample text When former President Trump declared a national emergency on March 13, federal agencies began placing bulk orders for masks and other medical equipment. These orders led to critical shortages throughout the nation. In addition, states were instructed to acquire their own equipment and found themselves bidding against each other for the limited supplies available, leading one head of a coronavirus team composed of consulting and private equity firms to remark that “the federal stockpile was . . . supposed to be our stockpile. It’s not supposed to be states’ stockpiles that they then use” (Goodman & Schulkin, 2020, April 2, 2020). end student sample text

Policy Decisions

annotated text Body. The paragraph under this heading addresses the third main point in the thesis statement. end annotated text

student sample text Policy decisions, too, hampered the U.S. response to the pandemic. end student sample text

student sample text Although the HHS and NSC recommended stay-at-home directives on February 14, directives and guidelines for social distancing were not announced until March 16, and guidelines for mask wearing were inconsistent and contradictory (Goodman & Schulkin, 2020). Implementing the recommendations was left to the discretion of state governors, resulting in uneven stay-at-home orders, business closures, school closures, and mask mandates from state to state. The lack of a consistent message from the federal government not only delegated responsibility to state and local governments but also encouraged individuals to make their own choices, further hampering containment efforts. Seeing government officials and politicians without masks, for example, led many people to conclude that masks were unnecessary. Seeing large groups of people standing together at political rallies led people to ignore social distancing in their own lives. end student sample text

annotated text Synthesis. The paragraph synthesizes factual evidence from a source and examples drawn from the writer’s observation. end annotated text

student sample text Although the first cases of COVID-19 were detected in the United States in January, genetic researchers later determined that the viral strain responsible for sustained transmission of the disease did not enter the country until around February 13 (Branswell, 2020), providing further evidence that the failed U.S. response to the pandemic could have been prevented. Cuts to public health staff reduced the number of experts in leadership positions. Inaction in the early months of the pandemic led to critical shortages of medical equipment and supplies. Mixed messages and inconsistent policies undermined efforts to control and contain the disease. Unfortunately, the response to the disease in 2020 cannot be changed, but 2021 looks brighter. Most people who want the vaccine—nonexistent at the beginning of the pandemic and unavailable until recently—will have received it by the end of 2021. Americans will have experienced two years of living with the coronavirus, and everyone will have been affected in some way. end student sample text

annotated text Conclusion. The report concludes with a restatement of the main points given in the thesis and points to the future. end annotated text

Ballhaus, R., & Armour, S. (2020, April 22). Health chief’s early missteps set back coronavirus response. Wall Street Journal . https://www.wsj.com/articles/health-chiefs-early-missteps-set-back-coronavirus-response-11587570514

Branswell, H. (2020, May 26). New research rewrites history of when COVID-19 took off in the U.S.—and points to missed chances to stop it . STAT. https://www.statnews.com/2020/05/26/new-research-rewrites-history-of-when-covid-19-arrived-in-u-s-and-points-to-missed-chances-to-stop-it/

COVID-19 coronavirus pandemic . (2021, January 13). Worldometer. https://www.worldometers.info/coronavirus/#countries

Goodman, R., & Schulkin, D. (2020, November 3). Timeline of the coronavirus pandemic and U.S. response . Just Security. https://www.justsecurity.org/69650/timeline-of-the-coronavirus-pandemic-and-u-s-response/

Miller, G., & Nakashima, E. (2020, April 27). President’s intelligence briefing book repeatedly cited virus threat. Washington Post . https://www.washingtonpost.com/national-security/presidents-intelligence-briefing-book-repeatedly-cited-virus-threat/2020/04/27/ca66949a-8885-11ea-ac8a-fe9b8088e101_story.html

Sun, L. H. (2018, May 10). Top White House official in charge of pandemic response exits abruptly. Washington Post . https://www.washingtonpost.com/news/to-your-health/wp/2018/05/10/top-white-house-official-in-charge-of-pandemic-response-exits-abruptly/

Swaine, J. (2020, April 3). Federal government spent millions to ramp up mask readiness, but that isn’t helping now. Washington Post . https://www.washingtonpost.com/investigations/federal-government-spent-millions-to-ramp-up-mask-readiness-but-that-isnt-helping-now/2020/04/03/d62dda5c-74fa-11ea-a9bd-9f8b593300d0_story.html

annotated text References Page in APA Style. All sources cited in the text of the report, and only those sources, are listed in alphabetical order with full publication information. See the Handbook for more on APA documentation style. end annotated text

Discussion Questions

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People also looked at

Original research article, covid issue: visual narratives about covid-19 improve message accessibility, self-efficacy, and health precautions.

www.frontiersin.org

  • 1 LifeOmic, Baton Rouge, LA, United States
  • 2 LSU, College of Science, Communications, Baton Rouge, LA, United States
  • 3 Charles H. Sandage Department of Advertising, University of Illinois at Urbana-Champaign, Champaign, IL, United States
  • 4 Freelance, Taipei City, Taiwan
  • 5 Freelance, Washington, DC, United States

Visual narratives are promising tools for science and health communication, especially for broad audiences in times of public health crisis, such as during the COVID-19 pandemic. In this study, we used the Lifeology illustrated “flashcard” course platform to construct visual narratives about COVID-19, and then assessed their impact on behavioral intentions. We conducted a survey experiment among 1,775 health app users. Participants viewed illustrated (sequential art) courses about: 1) sleep, 2) what COVID-19 is and how to protect oneself, 3) mechanisms of how the virus works in the body and risk factors for severe disease. Each participant viewed one of these courses and then answered questions about their understanding of the course, how much they learned, and their perceptions and behavioral intentions toward COVID-19. Participants generally evaluated “flashcard” courses as easy to understand. Viewing a COVID-19 “flashcard” course was also associated with improved self-efficacy and behavioral intentions toward COVID-19 disease prevention as compared to viewing a “flashcard” course about sleep science. Our findings support the use of visual narratives to improve health literacy and provide individuals with the capacity to act on health information that they may know of but find difficult to process or apply to their daily lives.

Introduction

The COVID-19 (Coronavirus Disease 2019) pandemic is a serious global health threat. COVID-19 has spread quickly and unrelentingly since its emergence in Wuhan, China in December 2019. The pandemic has had devastating impacts on human lives, public health, and the global economy. But it has also unified the scientific community in a mission to educate and engage the public in solutions such as public health precautions, including social distancing, testing, masks, engagement in clinical trials for vaccine candidates, and vaccination with approved vaccines. Educational resources about COVID-19 have subsequently exploded. However, communication efforts have left out large segments of the population with low health literacy skills ( Frieden, 2020 ).

Health information has historically been presented such that it is not accessible to most Americans [“Health Literacy” by CDC (2021) ]. Nearly a third of Americans have low general health literacy ( Paasche-Orlow et al., 2005 ). While in this study we focused on developing and assessing health literate COVID-19 materials in a U.S. context, low health literacy and a lack of health literate materials are also problems globally. Nearly half of all Europeans have inadequate and problematic health literacy skills according to a WHO report ( Kickbusch et al., 2013 ). Further, nine out of 10 adults in the U.S. struggle to understand and use personal and public health information that doesn’t follow health literacy guidelines [“Health Literacy” by CDC (2021) ]. Much of the information about COVID-19 has fallen into this trap and is not accurate, trustworthy, and understandable by most people ( Caballero et al., 2020 ). Many experts have pointed out that health literacy has been underestimated as a public health problem during the COVID-19 pandemic ( Abdel-Latif, 2020 ; Paakkari and Okan, 2020 ).

Health-related educational resources designed for broad audiences, especially for adults with low levels of formal education, adults with mental health issues or disabilities ( Kamalakannan et al., 2021 ), non-English speakers, or children, should follow health literacy best practices ( CDC, 2021 ). They should be accurate, accessible, and actionable ( CDC, 2021 ). They should make effective use of plain language, narrative, and visuals or multimedia to improve accessibility. But COVID-19 educational resources incorporating all of these elements remain rare as of the writing of this manuscript. Caballero and colleagues (2020) found that only 39% of assessed COVID-19 consumer materials from the internet included visual images that would have helped readers understand the information. Most of the materials failed to use plain language. Other experts have pointed out similar problems, including infectious disease specialist Benjamin P. Linas, MD. In late March, Linas observed an “absence of COVID-19 health education materials that could speak across language, literacy levels, and cultural norms” ( Bailey, 2020 ).

Broadly accessible resources increased in availability in the months following the outbreak of COVID-19 and stay-at-home orders in the U.S. People produced simple cartoon-like patient factsheets in multiple languages ( Bailey, 2020 ), kids’ visual storybooks, and other accessible resources 1 . Yet, these resources remained limited and urgently needed in more languages and on more topics, such as updated information on COVID-19, immune system responses, and vaccine candidates.

Early in the outbreak of COVID-19 in the U.S., we observed few educational materials or graphics that were accessible and actionable. We observed few resources that helped people understand how they should prepare, how and when they should self-isolate, what they could expect if they got sick, how their bodies would fight the virus, and who should seek emergency care and when. Such actionable information is critical given the devastating potential impact of COVID-19 for people with any risk factors, and every person’s role in helping limit the spread of COVID-19.

Park and colleagues (2020) found that among more than 1,000 U.S. adults recruited to a survey via Amazon’s Mechanical Turk, many people expressed uncertainty about length of quarantine and social distancing requirements. In another study from Germany, up to 52% of just over 1,000 participants reported difficulty accessing, understanding and applying information about how to recognize infection, when and how to find professional help upon infection, and risk factors of disease ( Okan et al., 2020 ). Although these findings don’t necessarily mean that there weren’t educational materials available on these topics, materials on these topics may not have been accessible, easy to understand or health literate.

In addition, while stories of people’s COVID-19 infection experiences did start to appear in the local news media once COVID-19 began to spread in their communities, we didn’t see these stories within the educational resources of government and healthcare institutions. Most resources (especially visual ones) that we saw focused on the history and science of SARS-CoV-2 and the respiratory disease it causes, or abstract concepts such as “flatten the curve”. Meanwhile, there were mixed messages about mask wearing, risk factors and airborne infection risks. There seemed to be a gap in visual and broadly accessible educational materials covering the COVID-19 experience and how people should navigate the disease from prevention to treatment.

More accessible COVID-19 educational resources on a variety of topics are critical for the one in five U.S. adults with low literacy skills 2 and the nearly one-third with low health literacy. But they are also important for people who may be experiencing isolation-exacerbated feelings of fear, stress, anxiety, and/or depression ( Park et al., 2020 ). Stress and mental health issues can make it more difficult for people to process technical health-related information ( CDC, 2021 ) and adhere to public health recommendations ( Middleton et al., 2013 ; Beutel et al., 2018 ). Stress can lower health literacy or an individual’s capacity to put recommended preventative health behaviors into action.

In this study, we started to evaluate the impact of educational resources designed to address the audience and COVID-19 education gaps highlighted above. To do this, we leveraged a new visual science communication format developed by the science-art platform Lifeology.io. In March 2020, Lifeology published two expert-created illustrated “flashcard” courses about COVID-19 that contained plain language visual narratives suitable for broad audiences and people with low health literacy. The courses featured visuals created by professional artists. They were available in 20 + languages and addressed the topic gaps we identified above. One course (“Prevention Primer”) covered the basics of COVID-19 prevention and care, through the story of a family learning to navigate the pandemic. The other course (“Mechanism”) was more technical and covered the mechanisms of COVID-19 inside the body, risk factors and medical considerations for at-risk individuals.

The goal of this study was to test the impact of these two different “flashcard” courses on people’s self-reported self-efficacy, perceived threat, and behavioral intentions toward COVID-19, based on the Extended Parallel Process Model (EPPM). Another goal was to evaluate the ability of these courses to improve health literacy by helping people understand and use information about COVID-19. We did this through self-reported data of people’s experiences with and takeaways from the course content. We conducted an online survey experiment via Qualtrics. We were particularly interested to see any differences in impact between a course with more basic information about COVID-19, a course with more technical information about the mechanisms and risk factors of SARS-CoV-2 infection, and a control course about the general health benefits of sleep.

This study also represents a collaborative effort to put evidence-based science communication into practice ( Jensen and Gerber, 2020 ) and then to measure some outcomes of that practice. We (the authors of this study) are a team of science communication researchers, health writers, industry science communicators, artists and designers. Evidence in science and health communication research, including literature in the field of health literacy reviewed below, informed the creation of the COVID-19 “flashcard” courses evaluated herein. These courses were viewed by over 24,000 people in 3 months; one course was translated into 20 + languages by community volunteers who wanted to share the courses with audiences in their own languages/countries/communities. While the courses were still highly relevant, we began collecting data via survey experiment to evaluate their impact on people’s self-efficacy and behavioral intentions, plugging practice back into research.

Literature Review

Covid-19 pandemic and educational interventions.

The necessity of clear, actionable, and broadly accessible health education ( CDC, 2021 ) has never been more apparent than during the COVID-19 pandemic. According to the World Health Organization (WHO), risk communication and community engagement “is integral to the success of responses to health emergencies” ( WHO, 2020a ). Risk communication and community engagement “helps prevent “infodemics”; (an excessive amount of information about a problem that makes it difficult to identify a solution), builds trust in the response, and increases the probability that health advice will be followed” ( WHO, 2020b , p. 1). Effective communication around COVID-19 should translate scientific information to improve understanding, make it relatable, and deliver it in an accessible manner to diverse populations and communities.

WHO has also provided specific recommendations for communication materials intended for community engagement during the pandemic. They have recommended that countries translate materials into relevant languages, adapt them to appropriate literacy levels, and create shareable (online) visuals/multimedia pieces that present key information. They have encouraged the creation of materials that “explain the disease etiology, symptoms, transmission, how to protect oneself, and what to do if someone gets sick” ( WHO, 2020a ). The United Nations and WHO even launched an unprecedented global call to creators 3 to help stop the spread of COVID-19 through artwork, encouraging creativity and “empathetic communication” to promote the adoption of public health precautions across age groups, affiliations, geographies, and languages.

But despite these recommendations, there has been a dearth of COVID-19 educational materials in the U.S. that make information accessible to most adults and that are inclusive of different people and cultures. This has been despite the disproportionate impact of COVID-19 and related serious illness among racial and ethnic minority groups who are more likely to experience low health literacy ( Eichler et al., 2009 ), including Hispanic/Latino and Black/African American persons ( CDC, 2020 ).

Health Literacy and Models of Health Behavior Change

Health literacy has been defined as “the degree to which individuals have the capacity to obtain, process, and understand the basic health information and services needed to make appropriate health decisions” (Wagner et al., 2009, p. 860; Institute of Medicine, 2004). Modern definitions also focus on the capacity to process and understand health information and use and apply it. Health literacy “entails people’s knowledge, motivation and competencies to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course” ( Sorensen et al., 2012 ). Low health literacy is associated with poorer health outcomes (Institute of Medicine, 2004). Health literacy can impact health-related knowledge, beliefs, motivations, self-efficacy, and ability to problem-solve with regard to self-care as well as using healthcare services ( Paasche-Orlow and Wolf, 2007 ). Health-related knowledge, beliefs, motivations, and self-efficacy (and fear) are critical in determining health behaviors according to theories of health behavior action and change. These theories include the Health Belief Model and the Extended parallel process model ( Jones et al., 2015 ; Sheeran et al., 2016 ).

Difficult-to-read health information and an overabundance of conflicting media health messages (as seen in the COVID-19 “infodemic”) exacerbate health literacy issues. They also contribute to poor health outcomes ( Paasche-Orlow and Wolf, 2007 ). However, educational materials that are accessible and promote experiential learning, i.e., learning through a transforming experience ( Kolb, 1984 ), can improve health literacy ( Day, 2009 ). Improving health literacy can, in turn, improve beliefs, attitudes, and motivations toward health behaviors (Wagner et al., 2009). Educational materials that improve health literacy and address determinants of health behavior change are most likely to drive better health outcomes. Educational materials about COVID-19 should improve health literacy and help people turn their perceived threat from COVID-19 into action by helping them believe that they can act in ways that make a difference.

Educational materials that follow guidelines for improving health literacy are easier to read, digest, understand, and act upon. Health literacy guidelines focus on plain language, actionable information, resources that include visuals such as pictures and drawings, and an audience-centered approach that includes culturally appropriate messages ( CDC, 2021 ). A growing body of research also focuses on the positive impact of visual narratives or storytelling, as seen in the body of research on Graphic Medicine. Storytelling and visual narratives with relatable human characters provide a fun and experiential way of learning that allows people to reflect on information and relate to it on a personal level ( Day, 2009 ).

With this study, we sought to evaluate the impact of health literate visual narratives (Lifeology “flashcard” courses) on content experiences, attitudes and behavioral intentions toward COVID-19. Below, we review relevant literature on the potential impact of visuals and storytelling on health literacy and determinants of health behavior.

Research Question RQ1 : To what extent do people report visual narratives (about COVID-19 or another health topic) as being easy to understand, informative and engaging?

Role of Visuals in Science and Health Education

People typically enjoy content that is visual or that includes illustrations and sequential art (e.g., comics) more than they do content that is not visual (Z. Dayan, 2018 ). In a recent study, medical and healthcare students indicated enjoying multimedia (a mix of images and text, and sometimes sound) as a practical learning tool ( Vagg et al., 2020 ). Visuals can also aid learning among students with different learning styles and preferences ( Aisami, 2015 ). Visuals can improve people’s motivation to learn ( Aisami, 2015 ), increase their engagement with message content ( Lazard and Atkinson, 2015 ), and improve information processing and retention: “Words are abstract and rather difficult for the brain to retain, whereas visuals are concrete and, as such, more easily remembered” ( Aisami, 2015 , p. 542). Scientific concepts, like words, are also abstract. Visuals can make them more concrete and easier to grasp.

Visuals can also stimulate critical thinking. Visual representations draw more attention than text-only messages. Visuals facilitate information processing and enhance message elaboration ( Cvijikj and Michahelles, 2013 ; Kim et al., 2015 ; Lazard and Atkinson, 2015 ). Townsend et al. (2008) found that text with color photographs increases understanding and learning of a food behavior checklist most when compared with text alone, text with line drawings, and text with grayscale photographs. This highlights the positive potential of colorful artwork in improving people’s engagement with science and health information.

People with limited literacy or language skills in particular “benefit from illustrations, not just words” ( Osborne, 2012 p. 214). Visuals “can help people take in information faster and more accurately, and remember it better” ( Osborne, 2012 , p. 214), improving attention to, comprehension of, and recall of technical and health information ( Houts, et al., 2006 ). People with low literacy skills are especially likely to benefit from visuals accompanying text ( Houts et al., 2006 ).

Healthcare providers are encouraged to use visuals and multimedia resources when communicating with people with low health literacy ( Hart et al., 2015 ) to improve patient knowledge ( Nova et al., 2019 ). Empathetic and positively framed visuals and data visualizations in health education materials may help reduce anxiety ( Demircelik et al., 2016 ) and minimize emotional stress associated with risk communication and getting negative prognostic information ( Kim et al., 2020 ). Visuals may even improve behavioral intentions and behaviors, especially among low literacy audiences ( Houts et al., 2006 ). These impacts are observed when viewers have a positive emotional response to visuals in health education materials ( Delp and Jones, 1996 ).

Visual Storytelling for Science and Health Communication

There is a growing field of research around the use of narrative visual formats, sequential art, or visual storytelling for science and health communication. These formats combine the power of visuals with the power of storytelling ( Green and Brock, 2002 ; Leung et al., 2014 ; Wang X. et al., 2019 ) to aid information processing and recall, enhance understanding, and increase engagement. For example, comics are a form of sequential art that combines visuals and plain language storytelling. Comics are preferred over other types of visual narratives because they often include characters readers can relate to, short text that is easy to read, and a story arc that keeps their attention ( Wang Z. et al., 2019 ).

In school and healthcare settings, comics are effective at increasing knowledge and awareness of health issues/conditions ( Ohyama et al., 2015 ; Tekle-Haimanot et al., 2016 ). In one study, a comic about pediatric anesthesia helped reduce preoperative anxiety in children ( Kassai et al., 2016 ). In another study, Leung and colleagues (2014) found that exposure to relatable characters in a detailed artwork comic can capture imagination and influence health behaviors. A comic combining concise text and detailed artwork that encouraged fruit intake increased self-reported self-efficacy and snack selection in urban minority youth ( n = 57). This happened regardless of changes in knowledge. The youth who read the comic were also more absorbed in the content (they reported paying attention without getting distracted) than youth who read a newsletter. The researchers surmise that greater transportation into the narrative of the comic lead to the observed changes in health-related outcomes: “(N)arratives that transport readers have been shown to change beliefs and motivate behavior change” ( Leung et al., 2014 ).

Most studies have investigated the impact of visual narratives among younger audiences. However, there is early evidence that they can also help people of all ages. Health professionals are being encouraged to apply similar mediums—illustrated stories or comic strips—to communicate with older patients and their caregivers. According to behavioral science expert and RN Sarah Kagan, “(m)uch of what we provide as educational material lacks interest, overshoots reading level, and necessarily includes an enormous level of detail” ( Kagan, 2018 ). Some researchers and science communicators have used visual narratives to engage people in preventing the spread of COVID-19. Igarashi et al. (2020) found that manga comics, as a form of visual storytelling steeped in culture and lived experience, can “provide the public with a deeper understanding of (scientific) messages through … characters and their “real-life” situations” (2020, p. 1).

Visual narratives in health education may be especially appropriate for individuals with low health literacy or limited prior knowledge about the topic being communicated ( Mayer, 1997 ; Schnotz and Bannert, 2003 ). According to comic research expert Matteo Farinella, “the visual language of comics might make information, not only more accessible, but also help to overcome linguistic barriers” ( Farinella and Mbakile-Mahlanza, 2020 ). The cartoon-like visual nature of comics and other visual narratives may also make scientific information less daunting and more approachable for people. When it comes to the communication of sensitive health topics or complex, unfamiliar, or scary topics like vaccines ( Muzumdar and Pantaleo, 2017 ), people often prefer simplified, stylized, conceptual, or interpretational illustrations over photographs and realistic art ( Haragi et al., 2019 ; Farinella and Mbakile-Mahlanza, 2020 ).

Despite the burgeoning research field around comics and other narrative visual formats, visual storytelling remains poorly studied in terms of its efficacy for health and risk communication among broader publics in real-world settings ( Farinella, 2018 ). Lifeology “flashcard” courses provide opportunities for further research in this area. They are similar to graphic novels or comics in combining short text with relevant detailed visuals in cards that tell a story and often include characters. We wanted to see when or for whom the visuals in these courses mattered, which we explored through participants’ self-reported content experiences.

Research Question RQ2 : Which factors are correlated/associated with self-reported attention to the visuals in a visual narrative about COVID-19 or another health topic?

Heuristic-Systematic Model of Information Processing

Developed by Chaiken (1980) , the heuristic-systematic model (HSM) stated that information can be processed via two approaches: systematic and heuristic. Systematic processing often occurs when an information seeker is highly motivated and capable of digesting data; thus, the individual pays more attention to message content ( Metzger et al., 2010 ; Katz et al., 2018 ). Conversely, when an individual lacks motivation or the ability to comprehend information, they may rely on contextual factors such as visual or vocal cues to make judgments ( Wang X. et al., 2019 ; Kim, 2018 ; Lahuerta-Otero et al., 2018 ). Additionally, some researchers have found that heuristic processing is more dominant than systematic processing, because the former requires less cognitive effort ( Chan and Park, 2015 ; Lahuerta-Otero et al., 2018 ).

In this study, we use HSM as a framework to investigate the impacts of visual narratives on health-related perceptions (attitudes and beliefs) and behavioral intentions. For example, individuals with lower health literacy or education (lower education is related to lower health literacy) may rely on and pay greater attention to the visuals in an illustrated flashcard course about COVID-19 to process the message. But even highly educated individuals could rely on and pay greater attention to the visuals in a more technical course about the mechanisms of COVID-19 in the body, because technical science and health information can be difficult for anyone to understand and apply in their own lives. Regardless, we would expect greater attention to visuals to result in improved engagement with the content/message and improved outcomes.

This idea—that greater attention to visuals in educational materials improves engagement and outcomes - is related to the concept of absorption ( Oh et al., 2015 ), immersion, or transportation with content being related to associated outcomes. Absorption is defined as “the degree to which users experience temporal dissociation, focused immersion, heightened enjoyment, curiosity, and control over the computer interaction” ( Agarwal and Karahanna, 2000 ; Oh et al., 2015 , p. 740) when interacting with media. Greater absorption can improve behavioral intentions. Both attention and absorption can be conceptualized as components of content engagement. But in this study, we were particularly interested in attention to visuals as a key component of engagement—consisting of qualities like attention, focus, curiosity, interest ( Webster and Ho, 1997 )—with illustrated flashcard courses.

Research Question RQ3 : Is greater self-reported attention to the visuals in a visual narrative about COVID-19 associated with increased self-efficacy, perceived threat, and protective behavioral intentions toward COVID-19?

Health Communication and the Extended Parallel Process Model

In this study, we also explored whether and how understandable and engaging visual narratives about COVID-19 can drive behavior change, either directly and by activating perceived threat and self-efficacy ( Witte, 1994 ). According to the EPPM, external stimuli that increase perceived efficacy and perceived threat (including severity of the threat and one’s susceptibility to it) along with fear can increase protection motivation, message acceptance, and behavioral intentions. People can respond to risk messages and fear appeals in one of three ways: 1) through danger control, for instance in the form of behavioral intentions in line with the message recommendations; 2) fear control (e.g., denial, avoidance); 3) no response.

It is important to note that during the global spread of SARS-CoV-2, fear and perceived threat from COVID-19 have generally been high, especially among older adults. In May 2020, Pew Research found that in the U.S., 38% of adults total, 43% of adults between the ages of 50 and 64, and 49% of adults over the age of 65 see COVID-19 as a major threat to their personal health ( Schaeffer and Rainie, 2020 ). Younger adults also tended to report high levels of emotional distress. In light of this, we expected that educational content that delivered empowering information about COVID-19 prevention and care would improve protective behavioral intentions through improvements in self-efficacy in particular. While perceived threat is key to motivating behavior change according to the EPPM, self-efficacy is key to a positive response. Some researchers have also proposed that “as perceived threat increases when perceived efficacy is low, people will do the opposite of what is advocated” ( Popova, 2012 , p. 463).

Based on the EPPM, risk messages that increase people’s self-efficacy in the face of a health threat can help to drive positive behaviors that may protect them from that threat. Based on research we’ve reviewed above related to health literacy, highly health literate educational content (which is understandable, visual, engaging, actionable) should be best able to help improve people’s understanding of the health threat, and their self-efficacy or knowledge of how to protect themselves and confidence in their ability to do so. We explore this idea through our final research question and corresponding hypotheses, which we analyze in Means of Self-Efficacy, Perceived Threat and Behavioral Intentions Across Course Conditions and Course Impacts on Behavioral Intentions .

Research Question RQ4 : Can understandable and engaging visual narratives about COVID-19 improve self-efficacy and protective behavioral intentions?

Hypothesis H1 : People who view a visual narrative about COVID-19 will have increased self-efficacy toward protecting themselves from COVID-19 than people who view a control narrative.

Hypothesis H2 : People who view a visual narrative about COVID-19 will have improved protection behavioral intentions toward COVID-19 than people who view a control narrative.

Hypothesis H3 : Self-efficacy and perceived threat will mediate the impact of viewing a visual narrative about COVID-19 on protection behaviors.

For all hypotheses, we planned to look at the impact of two illustrated flashcard courses about COVID-19 separately.

We did not predict that viewing an illustrated flashcard course about COVID-19 would increase viewers’ perceived threat from COVID-19 compared to a control course. We did not predict this because we thought that perceived threat would already be high in general among study participants given the state of the pandemic in the U.S. at the time (late March). However, we did plan to explore whether the more technical “Mechanisms” COVID-19 course would raise perceived threat, as this course discussed risk factors of severe COVID-19 illness.

Educational Platform—Lifeology “Flashcard” Courses

Lifeology’s illustrated flashcard courses are self-contained digital and interactive online card decks, where each card contains a small amount of text (one to three short sentences) along with a custom illustration. The cards contain sequential art that, along with bite-sized text, tells a story. The course viewer allows users to swipe or click through the course flashcards. It also allows users to toggle between different language options, tap/click to see information sources, tap/click to learn more about the course creators, and submit feedback. The course viewer is optimized for mobile devices but is responsive and works in any smart-device or desktop web browser. Courses are free and often published under a CC-BY-SA Creative Commons license.

Each course is the product of a collaboration between one or more technical experts, one or more plain-language writers, and an artist. It is becoming increasingly important to incorporate diverse, creative, and non-technical voices in the creation of science and health educational materials. Diverse perspectives improve the accessibility and relatability of science and health information for broad audiences. Every course also goes through a collaborative creation process 4 that conforms to established health literacy strategies ( Osborne, 2012 ). The process includes collaborative identification of one or a few key messages, card script-writing by a plain-language writer, visual storyboarding, fact-checking by external scientists, and listening to early audience feedback.

The courses evaluated in this study incorporate features that meet modern recommendations of health literacy experts ( Osborne, 2012 ; “Principle: Understandable”; WHO, 2020a ; Simmons et al., 2017 ; Mayer, 2003 ). These include: plain language and succinct sentences; definition of technical terms; conversational and positive tone; actionable information; narrative elements including characters and a story-arc; text in close proximity to related visuals. The visuals also incorporate features important for health literacy including: high detail but not hyper-realistic visuals; informative visuals that show characters/people at their best modeling desired behaviors; illustrations that communicate scale and context, as for cells or virus particles; storytelling.

Study Procedure

We conducted an online survey experiment. Participants were randomly assigned to one of three stimulus (flashcard course) conditions: a course about sleep; a Prevention Primer course about the basics of COVID-19 prevention and self-care; a Mechanism course about how the novel coronavirus impacts our body. The study was approved for IRB exemption by Louisiana State University (IRB# E11953).

Study participants first answered questions about whether their state of residence was under a stay at home order, their perceived knowledge about COVID-19, and attention to news about it. Participants were then instructed to open and swipe/click through “a series of health-related flashcards organized into a mini-course” and answer some questions about it. We used an opened-ended question asking participants what the course was about and what they had learned, to ensure that participants had opened and browsed through the course cards. Finally, participants answered questions related to their perceptions of the course they had viewed, their perceptions of COVID-19 as a threat to their health, their self-efficacy and their behavioral intentions toward COVID-19 protection and care, and demographics.

Stimulus Content

The control flashcard course 5 covered why we sleep, sleep patterns of humans and animals, and sleep hygiene tips for brain health. It was illustrated in a storybook style by artist Ariella Abolaffio.

The COVID-19 Prevention Primer course 6 titled “What do I need to know about the 2019 novel coronavirus?” focused on explaining and clarifying basic information about COVID-19. It introduced and explained the viral cause of COVID-19 and the lifestyle and environmental changes that are recommended to keep people healthy and safe from infection. The content addressed what people could expect during the outbreak and what they might do if a family member were to get sick. The course used a detailed cartoon-like visual style and pictorial/representation visuals ( Haragi et al., 2019 ) to illustrate preventative behaviors and processes people could adopt such as handwashing and social distancing ( Figure 1 ). The course was illustrated by science artist Elfy Chiang.

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FIGURE 1 . Above we’ve reproduced three of the “cards” contained within the COVID-19 Primer Prevention course, as they would be seen on a mobile device. The first is the title card of the course, while the others are example cards to demonstrate the visual style, informational content, and amount of text.

The COVID-19 Mechanism course 7 titled “What does the coronavirus do in my body?” covered how the virus SARS-CoV-2 infects cells, infection mechanisms at the cellular level, how the body fights back, why some people are at risk for more severe illness and when they should seek care. This course followed a character from the Primer course but focused on providing a basic understanding of how viruses cause symptoms, how people recover from infection, and why there are differences in disease severity. This course used more interpretational ( Haragi et al., 2019 ), metaphor-communicating visuals in a hand-drawn but digitized watercolor style to enhance understanding of the technical information about virology and the immune response ( Figure 2 ). The course was illustrated by science artist Elfy Chiang.

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FIGURE 2 . Above we’ve reproduced three of the “cards” contained within the COVID-19 Mechanism course, as they would be seen on a mobile device. The first is the title card of the course, while the others are example cards to demonstrate the visual style, informational content, and amount of text.

We assessed whether the courses were health literate based on validated external tools including the SMOG ( McLaughlin, 1969 ) online calculator, a tool for assessing reading level, and the PEMAT for printable materials ( Shoemaker et al., 2014 ) 8 .

The SMOG index was 9.2 for the Primer course and 9.3 for the Mechanism course, meaning they were both at a sixth grade reading level and “easy to read”.

We evaluated PEMAT understandability and actionability scores for our COVID-19 courses, and we also had an independent reviewer submit scores—the independently derived scores matched our own. We evaluated the Primer course to have a 95% Understandability Score (14 out of 15 points 9 ) and an 80% Actionability Score (4 out of 5 points 10 ). We deducted one point for not providing a “tangible tool” for taking action, although we linked to WHO and CDC guidance and resources on home care and prevention for COVID-19. We evaluated the Mechanism course to have an 87% Understandability Score (13 out of 15 points) and a 60% Actionability Score (3 out of 5 points). We took a point away on Understandability for the Mechanism course for some technical terms like cytokines and antibodies, even though we defined them. We also took a point away on Actionability for “steps to action”—this course was more focused on informing people about COVID-19 risk factors.

Variables and Scales

Following news about covid-19.

We measured (pre-stimulus) how closely participants were following news about COVID-19 on traditional news media outlets in print, on TV, or online, on a 5-point scale from not at all closely to very closely .

Perceived Knowledge About COVID-19

We Asked Participants “ How informed would you say you are about COVID-19? ”, measured (pre-stimulus) on a 5-point scale from not at all to very .

Understanding and Learning

We measured perceived learning or the degree to which people found courses informative (“ I learned a lot ”), and understanding (“ It was easy for me to understand the information ”), as single items on 5-point scales, based on level of agreement. We also explored how relatable the course was to people (“ The mini-course was created with people like me in mind ”) as a single item on a 5-point scale.

We assessed basic COVID-19 knowledge with a 4-item quiz (Sum of items, mean score = 3.87, SD = 0.38). Its usefulness was limited by a low Chronbach’s alpha of 0.21. Although Chronbach’s alpha is not always a useful characteristic of knowledge instruments ( Taber, 2018 ), we’ve only used the sum of knowledge items related to information presented across the two COVID-19 courses as an informal check and context for our self-reported learning measure.

The quiz consisted of true/false statements for the following: Scientists are working on developing potential vaccines for COVID-19 (true); Coronaviruses are found only in humans (false); Some people with COVID-19 have no symptoms (true); When practicing social distancing , 3 feet is the recommended distance (false).

Attention and Absorption

We measured self-reported attention to the visuals and absorption in the content of the course based on items taken from Agarwal Karahanna (2000) and Oh et al. (2015) . Participants were asked to indicate their level of agreement on a 5-point scale ( strongly disagree to strongly agree ) to statements “ I paid close attention to the graphics and visuals in the mini-course ” and “ The mini-course held my attention all the way through to the end ”. These two variables are moderately correlated (Correlation = 0.48, p < 0.001) and used separately.

Perceived Threat

We evaluated COVID-19 risk perceptions as a 4-item scale (Chronbach’s alpha = 0.67) based on level of agreement on a 5-point scale to statements reflecting participants’ belief that they could get COVID-19, that they could get very sick, and that COVID-19 is serious; personal feelings of risk because of COVID-19; belief that COVID-19 is serious. This measure and items represent threat in the EPPM and were taken from Witte et al. (1996) and Popova (2012) .

Self-Efficacy

We evaluated self-efficacy for COVID-19 prevention and care as a 3-item scale (Cronbach’s Alpha = 0.68) based on level of agreement on a 5-point scale to the following statements: “ I feel confident in my ability to protect myself from getting COVID-19 ”, “ I know how to protect myself from getting COVID-19 ”, “ I know what to do if I get COVID-19 and when to seek emergency care if necessary ”. This measure incorporates both knowledge about COVID prevention and self-care and belief about one’s ability to act on that knowledge. This measure represents self-efficacy in the EPPM.

Behavioral Intentions

We evaluated behavioral intentions as an 8-item scale (Chronbach’s Alpha = 0.87). We measured participants’ likelihood to engage in the following behaviors during the COVID-19 pandemic, on a 5-point scale from extremely unlikely to extremely likely : Stay 6 feet from others in public spaces, wash hands often, limit visits to public places or crowds, wear a face mask/covering in public, avoid visits with people I don’t live with, follow government recommendations, stay at home as much as possible. All behavioral items were derived from official public health recommendations published by the CDC and other official sources.

Demographics

We measured demographic and other personal information including age, gender, formal education level, location (state), and existence of a stay-at-home order in the participant’s state. Participants represented all 50 states and DC.

Data Collection, Cleaning, and Analysis

We collected data via a Qualtrics online questionnaire, which linked participants out to the courses in a new window that automatically closed upon course completion. Participants were recruited from two mobile health tracking apps—the LIFE Fasting Tracker (185k users received a study email) and the LIFE Extend mobile health applications (4,616 received a study email). To avoid recruiting too many participants, we recruited only participants that had 1) used the app at least one time within the previous 30 days, 2) a valid email address linked to their mobile application account, and 3) country of residence was the United States. An invitation to participate was sent to the eligible participant pool using an industry-standard mobile application data and analytics platform (MixPanel). The email outlined the study with a button/link to participate, the estimated time to complete, and a random reward for completion. All participants who clicked to participate received a follow-up “thank you” email and reminder to complete the questionnaire.

By May 22, 2020 (first email sent on May 8), 1,890 users completed and submitted the questionnaire, while 1,670 users had responses in progress. The completion rate was 53%. Based on emails opened ( n = 37,581), the response rate for partial completions was 9.5% (1.8% based on total emails sent), while the rate of study invite emails open to completion was 5% (0.97% based on total emails sent).

We processed and analyzed all anonymous survey responses in SPSS. For data analysis, we only included partial responses where respondents completed more than half of the questionnaire and answered at least some of the post-stimulus dependent variables (starting with risk perceptions) ( n = 65). We also removed responses ( n = 115) where participants didn’t correctly answer an attention filter question correctly or incorrectly answered what the course was about (responded “flu” as opposed to sleep or the novel coronavirus). We ended up with a total of 1,775 responses. The minimum time for questionnaire completion among these was 4.5 min.

To explore our research questions, we used ANOVA or ANCOVA tests to evaluate the impact of stimulus condition (categorical variable) as well as covariates that were not substantially correlated (typically age, gender and level of education) on interval data dependent variables. We assumed linearity, and normal distribution on dependent variables which we confirmed with histogram plots (understanding and behavioral intentions were most left skewed). We used conservative Bonferroni post hoc tests to adjust for multiple pairwise comparisons between stimulus conditions. Because Levene’s test was sometimes significant in our ANOVA tests, we report the Welch F statistic (does not assume equal variances) for these tests.

White test for heteroskedasticity was positive in univariate tests predicting learning, absorption, and quiz scores. However, parameter estimates with robust standard errors (HC3 method) revealed no differences in significant results or differences between standard errors and robust standard errors ( Hayes and Cai, 2007 ). Therefore, we report the standard statistics for ANOVA, ANCOVA and linear regression tests below. For ANCOVA tests, we report effect size as R 2 .

We used linear regression to test our hypotheses with continuous interval outcome variables. In these regression tests, residuals for outcome variables (self-efficacy, threat, behavioral intentions) were normally distributed.

Demographics and Descriptives

Our final data analysis included 1,775 participants: 637 participants (36%) saw the control course about sleep, 546 (31%) saw the COVID-19 Prevention Primer course, and 592 (33%) saw the COVID-19 Mechanism course. Randomization was successful - there were no significant differences in participant age, education level, stay at home order status, self-reported previous knowledge about COVID-19, or attention to COVID-19 in the news across stimulus conditions.

Participants’ age range was 18 to 90 years (Mean = 44.0, SD = 11.7). A majority of participants were female (80%, n = 1,423), reflecting the demographics of LIFE Apps users; 67% ( n = 1,195) identified as White, 9% ( n = 153) identified as Hispanic/Latino, 8% ( n = 135) as Black; 4% ( n = 68) as Asian. Participants were highly educated with 30% ( n = 528) having a graduate degree, 33% ( n = 587) having a Bachelor’s/4-year degree, 27% having some college education ( n = 487) and only 6% ( n = 108) having a high school GED or less. These demographics reflected the self-reported data we had for all LIFE Apps users, suggesting our survey respondents were representative of the eligible study population.

A majority of the participants (81%, n = 1,442) indicated that their state was under a stay at home order at the time of study participation. On 5-point scales, most participants reported feeling quite or very informed about COVID-19 (M = 3.99, SD = 0.91), and that they were following news about COVID-19 on traditional news outlets quite or very closely (M = 3.44, SD = 1.12).

Looking only at participants randomized to the control group ( n = 637) as a baseline (these individuals had no exposure to COVID-19 information within this study), participants generally expressed moderate to high self-efficacy (M = 4.16, SD = 0.63), high behavioral intentions toward COVID-19 (M = 4.41, SD = 0.722), and moderate perceived threat (M = 3.67, SD = 0.81). According to their self-reports, a majority (> 70%) of participants said they were extremely likely to wash their hands often and practice social distancing. Fewer, but still many, were extremely likely to wear a face mask in public (68%) avoid visiting people they don’t live with (46%), clean and disinfect frequently touched surfaces (49%), or follow government recommendations such as stay-at-home orders (59%). (For all but handwashing, the “extremely likely” intentions for these behaviors went up four to five percentage points among participants who saw a COVID-19 course.) While most participants (53%) somewhat agreed that they feel confident in their ability to protect themselves from COVID-19, only 23% strongly agreed; 38% strongly agreed that they know how to protect themselves. (These percentages increased substantially in the Primer course group, where 29% strongly agreed they feel confident in their ability to protect themselves and 53% strongly agreed they know how to protect themselves.) While most participants in the control group strongly agreed that COVID-19 is serious (60%), only 11% strongly agreed and 35% somewhat agreed that they personally feel at risk because of COVID-19.

Content Experiences—Course Understanding, Learning, and Absorption

To address RQ1, we looked at participants’ experiences with the “flashcard” course content. We specifically looked at self-reported understanding of, learning from, and absorption in the courses. Participants generally reported that all the courses were very easy to understand (M = 4.59, SD = 0.67). See Mean results per course in Table 1 . In an ANCOVA, course condition, age, gender, and level of education had no significant impacts on course understanding.

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TABLE 1 . Mean values of courses for Understanding, Learning, and Absorption.

Participants who saw the control or Mechanism courses indicated learning (“ I learned a lot ”) significantly more (Bonferroni post hoc test p < 0.001) than those who saw the Primer course (ANOVA, Welch F(2, 1,154.04) = 83.11, p < 0.001). See Mean results per course in Table 1 . The Primer course was designed and written for broad audiences to learn the basics of COVID-19; it contained information that many participants observed in open-ended post-course reflections that they were already aware of through information sources such as the CDC. The Mechanism course was also written for broad audiences but covered more technical information related to COVID-19 and how it works in the body. However, participants with lower levels of education indicated learning more from both of the COVID-19 courses (ANCOVA for COVID-19 conditions only with covariates age, education and gender; R 2 (effect size) = 0.14; Stimulus F(1, 1,083) = 137.18, p < 0.001; Education covariate F(1, 1,083) = 28.59, p < 0.001).

Although we focused on evaluating self-reported content experiences for RQ1, we did conduct a basic 4-item quiz of basic COVID-19 information following stimulus exposure. The quiz scores were generally very high, with over 90% of participants across all conditions answering correctly for each question. However, participants who viewed the Primer course scored slightly but significantly higher (M = 3.92, SD = 0.31; Bonferonni post hoc test p < 0.05) than did those who viewed the control (M = 2.84, SD = 0.44) or Mechanism (M = 3.87, SD = 0.38) courses (ANCOVA across all conditions with covariates age, education and gender; R 2 (effect size) = 0.02; Stimulus F(2, 1,680) = 6.6; p < 01). This result was largely driven by scores for the question of whether coronaviruses are only found in humans or not (significant differences were found across stimulus conditions for this question alone, which was covered in the Primer course), as well as the question about COVID-19 symptoms. Higher education also predicted higher quiz scores (Education covariate F(1, 1,680) = 24.80, p < 0.001).

Participants indicated significantly (Bonferroni post hoc test p < 0.001) greater absorption in the control and Mechanism courses compared to the Primer course (ANOVA, Welch F (2, 1,154.25) = 17.72, p < 0.001). See Mean results per course in Table 1 . Absorption in the course and perceived learning are significantly and moderately correlated (Pearson Correlation = 0.58, p < 0.001).

We also explored whether participants found the course they viewed to be relatable (“ The mini-course was created with people like me in mind .”) (M = 3.53, SD = 1.21). Most people agreed (55%) or neither agreed nor disagreed (26%) that the course was created with people like them in mind. The Mechanism course was evaluated as more relatable (M = 3.73, SD = 1.17), significantly more so (Bonferroni host hoc test p < 0.001) than the Primer course (M = 3.26, SD = 1.30; ANOVA across all stimulus conditions, Welch F (2, 1,156.51) = 21.40, p < 0.001). However, as with perceived learning, lower levels of education were associated with greater evaluation of relatability (ANCOVA across all conditions with covariates age, education and gender; R 2 (effect size) = 0.06; Education covariate F (1, 1,680) = 28.96, p < 0.001). Perceived relatability was significantly and strongly correlated with perceived learning (Pearson Correlation = 0.65, p < 0.001) and absorption (Pearson Correlation = 0.50, p < 0.001). It was weakly but negatively correlated with level of education (Pearson Correlation = −0.12, p < 0.001). The strongest correlation between relatability and level of education existed for those viewing the Primer course, suggesting that this course was particularly well suited to meet the informational needs of people with lower levels of education.

Based on these findings, the illustrated flashcard course format appears to make information about COVID-19 easy to understand for people with high and low levels of education alike. Individuals with lower levels of education indicated learning more from the course they viewed and perceiving it to be created with people like them in mind to a greater extent.

We relied on self-reported data of learning and absorption in the content, which limits robustness of the results. However, data on the time participants spent on the page that linked out to the Lifeology course can provide some context. Participants spent, on average, 3.3 min on the page linking to the sleep course (36 cards), 4 min on the page linking to the Primer course (49 cards), and 4.3 min on the page linking to the Mechanism course (47 cards). A minority (less than 1 out of 5) of participants spent less than a minute, and few spent more than 13 min. Based on previous user testing, a 30-card Lifeology courses takes around 4–6 min for a reader to read aloud. Most participants who completed the survey were engaged enough to spend a few minutes on the content, but didn’t spend so much time that distracted reading (e.g., browsing off) was likely. Time spent was weakly but positively correlated with absorption (Pearson Correlation = 0.10, p < 0.001).

Attention to Visuals

Participants indicated paying significantly closer attention (Bonferroni post hoc test p < 0.001) to the visuals in the Mechanism course compared to the control or Primer courses (ANOVA, Welch F (2, 1,168.41) = 27.89, p < 0.001).

We were also interested in exploring predictors of attention to visuals (RQ2), so we ran a linear regression test predicting this variable with stimulus condition dummy variables, demographic variables, previous knowledge, and following of COVID-19 news (R 2 (effect size) = 0.06; F (8, 1,677) = 13.53, p < 0.001). See results in Table 2 . People who viewed the Mechanism course, people with lower education levels, and people following COVID-19 news closely on traditional media paid closer attention to the course visuals.

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TABLE 2 . Results of linear regression analysis predicting attention to visuals.

Attention to visuals is significantly correlated with absorption in the course content (Pearson Correlation = 0.48, p < 0.001), perceived learning (Pearson Correlation = 0.38, p < 0.001) and relatability (Pearson Correlation = 0.35, p < 0.001).

Means of Self-Efficacy, Perceived Threat and Behavioral Intentions Across Course Conditions

We conducted a series of simple ANOVA tests with Bonferonni post hoc tests for multiple comparisons, followed by a serial mediation analysis, to explore RQ3 and RQ4, and to test our hypotheses H1, H2, and H3. We hypothesized that people who view an illustrated flashcard course about COVID-19 will have increased self-efficacy and behavioral intentions than people who view a control course, and that self-efficacy and perceived threat will mediate course impacts on behavioral intentions. As a reminder, the self-efficacy measure was based on participants self-reported feelings of confidence in their ability to protect themselves from COVID-19, knowledge of how to do so, knowledge of what to do if they got COVID-19 and knowledge of when to seek emergency care. Perceived threat was based on participants’ belief that they could get COVID-19, that they could get very sick, and that COVID-19 is serious; personal feelings of risk because of COVID-19; belief that COVID-19 is serious.

Participants who saw the Primer course (M = 4.35, SD = 0.56) had significantly (p < 0.001) higher self-efficacy for personal COVID-19 prevention and care than did participants who saw either the Mechanism course (M = 4.21, SD = 0.63) or the control course (M = 4.14, SD = 0.63). The means were significantly different overall: Welch F(2, 1,177.80) = 15.62, p < 0.001.

Perceived threat was slightly lower for the Primer course (M = 3.57, SD = 0.79) than for the Mechanism course (M = 3.68, SD = 0.78) or the control course (M = 3.67, SD = 0.81). But the means were not significantly different overall.

Participants who saw the Primer course reported slightly greater behavioral intentions (M = 4.51, SD = 0.64), followed by those who saw the Mechanism course (M = 4.47, SD = 0.69) and those who saw the control course (M = 4.41, SD = 0.72). But the means were not significantly different overall.

Course Impacts on Behavioral Intentions

Analytical approach.

We used the PROCESS macro add-on ( Hayes and Cai, 2007 ) to conduct a serial mediation analysis 11 to test whether and how course viewing was causally linked ( Hayes, 2012 ) to COVID-19 preventive behavioral intentions, both directly and indirectly through attention to visuals, self-efficacy, and perceived threat. Preventive behavioral intentions was the primary outcome variable, course condition was the primary predictor entered as a multi-categorical variable 12 , and self-efficacy and perceived threat were entered as serial mediators. We also included attention to course visuals as a mediator between course viewing and all other outcomes. Given the large sample size used in the present study, we opted for a more stringent level of significance ( α = 0.01). The results are presented in Table 3 .

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TABLE 3 . The serial mediation model of the effects of course types on preventive behavioral intentions via attention to visuals, self-efficacy, and perceived threat.

Attention to visuals was a significant predictor ( p < 0.01) in a series of regression tests predicting all other mediators and outcomes—self-efficacy (B = 0.037, SE = 0.014), perceived threat (B = 0.078, SE = 0.017) and behavioral intentions (B = 0.064, SE = 0.013). (Effect sizes are generally small; R 2 between 0.5% and 2%.) As we noted previously, people paid significantly closer attention to visuals embedded in the Mechanism course (B = 0.424, SE = 0.061, p < 0.001) compared to the control course (Model R = 0.17, F(2, 1753) = 26.39, p < 0.001). This addresses RQ3 and shows that greater attention to visuals in COVID-19 visual narratives predicts improved outcomes. See arrows connecting attention to visuals and outcomes in Figure 3 .

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FIGURE 3 . Path diagram illustrating the relative direct and indirect effects of illustrated flashcard course viewing on behavioral intentions toward COVID-19. This path diagram visually represents a serial mediation model of the effects of viewing three different courses on behavioral intentions via attention to the course visuals, self-efficacy, and perceived threat. Solid thin arrows represent significant links between variables ( p < 0.01), dashed thin arrows represent marginally significant links ( p < 0.05). B, unstandardized coefficients showing relationship between variables. The larger arrow connecting condition directly to behavioral intentions denotes the path from predictor to outcome controlling for all mediators. See Table 3 for full results of the regression analyses that this path diagram represents.

We hypothesized in H1 that people who saw a course about COVID-19 would have a greater sense of self-efficacy. Course viewing did have a significant relative direct effect on self-efficacy. Specifically, people who saw the Primer (B = 0.184, SE = 0.036, p < 0.001) as compared to a control course about sleep had improved self-efficacy in terms of protecting themselves from COVID-19. We controlled for attention to visuals (Model R = 0.141, F(3, 1752) = 11.87, p < 0.001). Attention to visuals was also a significant predictor in this regression model (B = 0.036, SE = 0.0136, p < 0.01). We found partial support for H1, based on the relative impacts of a COVID-19 Prevention Primer course. See arrows connecting the course stimulus condition to self-efficacy in Figure 3 .

Course viewing did not have a significant relative direct effect on perceived threat. However, attention to the course visuals was a significant predictor (Model R = 0.124, F(3, 1752) = 9.10, p < 0.001; B = 0.078, SE = 0.017, p < 0.001).

As hypothesized in H2, people who saw a COVID-19 course as compared to a control course about sleep had greater behavioral intentions toward COVID-19. There was a significant relative direct effect of Primer course viewing on behavioral intentions, controlling for attention to visuals, self-efficacy, and perceived threat (Model R = 0.51, R 2 (effect size) = 0.26, F(5, 1750) = 120.20, p < 0.001). See the large arrow directly connecting course condition to behavioral intentions in Figure 3 . People who viewed the Primer course had greater behavioral intentions toward protecting themselves from COVID-19 compared to those who viewed a control course (B = 0.126, SE = 0.035, p < 0.001, 99% bootstrap confidence interval: 0.035, 0.217). Attention to visuals (B = 0.064, p < 0.001), self-efficacy (B = 0.063, p < 0.01) and perceived threat (B = 0.427, p < 0.001) were all significant predictors in this regression model. We found partial support for H2, based on the relative impacts of a COVID-19 Prevention Primer course.

There was a significant indirect effect from Primer course → self-efficacy → behavioral intentions (B = 0.011, SE = 0.005, 99% bootstrap confidence interval: 0.000, 0.027). The bootstrap confidence intervals were based on 5,000 bootstrap samples.

There was a significant indirect effect from Mechanism course → attention to visuals → behavioral intentions (B = 0.027, SE = 0.007, 99% bootstrap confidence interval: 0.011, 0.047). The indirect effect from Mechanism course → attention to visuals → perceived threat → behaviors was also significant (B = 0.014, SE = 0.004, 99% bootstrap confidence interval: 0.005, 0.026).

As hypothesized in H3, both self-efficacy and perceived threat mediated the impact of course viewing on behavioral intentions. Self-efficacy was a key mediator of the impact of viewing a COVID-19 Prevention Primer course on behavioral intentions, while perceived threat was a key mediator of the impact of viewing a COVID-19 Mechanism course on behavioral intentions.

Visual narratives are a useful tool for engaging broad audiences in risk messages and public health precautions for COVID-19. We found that illustrated flashcard courses (visual narratives) about COVID-19 were perceived as understandable and engaging for a relatively broad audience, regardless of level of education. The effect sizes for these relationships were typically small but robust, where stimulus condition and other key independent variables often explained 1–6% of the variance in outcome metrics.

We also found that viewing an illustrated flashcard course about COVID-19 resulted in improved perceptions of self-efficacy and behavioral intentions. The stimulus condition, attention to the visuals, self-efficacy and perceived threat explained a substantial amount of the variance in behavioral intentions (over 25%). Visual narratives may improve health literacy, or capacity to understand and act on health information.

Interestingly, the COVID-19 Primer course impacted self-efficacy and behavioral intentions even though, on average, people indicated not necessarily learning anything new from the content. Participants viewing our COVID-19 courses had most likely come across similar information in other formats based on their existing knowledge of COVID-19, but these formats may not have made the information as accessible and relatable to their daily lives. Our results also suggest that visual narratives may improve health outcomes and disease prevention.

While both of the courses about COVID-19 had positive outcomes compared to a control course, they impacted self-efficacy and perceived threat to different extents. The Prevention Primer course was particularly effective in improving self-efficacy and behavioral intentions directly. This course visually told a story of a family’s journey through a COVID-19 outbreak in their city and their experience when a younger family member got sick. The course visuals showed characters expressing concern but ultimately modeling preventative behaviors such as handwashing for at least 20 s, social distancing, and safely caring for a sick family member. It also provided actionable takeaways. All of these features likely contributed to the course’s impact on self-reported self-efficacy and behavioral intentions. On the other hand, the impact of the COVID-19 Mechanism course on behavioral intentions was primarily mediated by greater self-reported attention to the course visuals and perceived threat from COVID-19. This course explained how the coronavirus works in the body and why some people are at greater risk of severe illness, again with actionable takeaways.

Across both COVID-19 courses, greater self-reported attention to the visuals mediated the impacts of course viewing on self-efficacy, perceived threat, and behavioral intentions. We also found support for the idea that people with lower levels of formal education rely to a greater extent on visuals in these educational materials. This seems to be particularly true when the materials contain more technical science and health information. The more technical Mechanism course received slightly lower ease of understanding scores than the Primer and control courses. Participants who saw this course also reported paying significantly greater attention to the course visuals than did participants who saw the Primer course or the control course. Greater self-reported attention to the visuals in the Mechanism course in turn mediated a significant impact on perceived threat, and thus protective behavioral intentions.

Other factors beyond the level of technical content in the Mechanism course could also have contributed to the self-reported attention to the visuals in this course. The course contained more interpretational visuals, defined as representing information associated with as opposed to directly representing the textual referents ( Haragi et al., 2019 ). These types of visuals have previously been found to invite interpretation and elaboration of content, and to improve self-reported understanding, memorability, and interest ( Haragi et al., 2019 ). However, future research is needed to explore whether it was the greater level of difficulty of this course that truly drove greater attention to visuals, or some other aspect of the visuals in this course.

Implications

This study fills a gap in literature looking at the real-world, holistic impact of health education materials that combine text, narrative, and visuals. The lack of research in this area may stem from the lack of health education materials that make effective, data-driven use of stories and visuals. But why are these materials missing from the media landscape? One of the reasons may be a dearth of collaboration between scientific and art communities. There are a growing number but still few resources and spaces that make it easy for scientists, artists, and communication experts to work together on such materials. However, calls for collaboration between scientists and creatives are increasing ( Khoury et al., 2019 ; Botsis et al., 2020 ; Murchie and Diomede, 2020 ). Art-science platforms including Art The Science, Lifeology, the SciArt Initiative, and others are facilitating this collaboration through nascent online spaces that bring people from STEM and art fields together.

It is difficult today to assess visual quality or exactly how “good” illustrations improve information processing ( McGrath and Brown, 2005 ). Different people have different tastes in the aesthetics of artwork that may stem from their cultural or social background. For this reason, it is important that the public have diverse options in terms of illustrated educational content available to them, created by diverse artists in diverse styles and cultural contexts.

Limitations

Participants in this study represented U.S. users of popular health tracking apps (the LIFE Apps). These apps have a broad user base with over 2.5 million users. Users of these apps are likely to be motivated to improve their health and adopt positive health behaviors; however, many join the app because they are struggling to achieve their health and weight loss goals. Most of the participants were highly educated. This does not necessarily mean that they had high health literacy levels, as even highly educated people can struggle to understand and apply technical health information. However, the results of our study are limited by this sample and the fact that we did not directly assess the health literacy level of our participants. While we did confirm that our courses were broadly understandable and had positive outcomes for a subset of our participants who had less than a high school education, outcomes could be different for people facing more substantial language, reading level, and internet access barriers.

Creators of visual narrative educational materials for science and health communication should always design their messages and content with target audiences in mind and evaluate their materials early among those target audiences. Future studies could target evaluation of visual narratives and illustrated flashcard courses in different languages within low-literacy populations, non-English-speaking populations, rural populations, racial and ethnic minorities, etc.

This study is also limited by not comparing the flashcard courses to the same messages presented in non-visual and/or non-narrative formats. We don’t know how much the narrative elements of the courses (story, characters, emotions, etc.) distinctly contributed to the outcomes, separately from the visual elements and factual information presented. However, this would have been difficult to test in practice, as both the visuals and the text of the courses contained narrative as well as informational elements.

Another important limitation of this study is self-reported data. To measure learning outcomes, we would have needed to assess knowledge before and after viewing the courses ( Jensen, 2014 ). However, we note that the COVID-19 courses had positive outcomes even though participants generally reported being quite informed beforehand. Self-reported behavioral intentions also do not fully predict behaviors ( Sheeran and Webb, 2016 ). However, the self-reported data can still tell us a lot about people’s experiences of the content and how prepared and motivated it helped them feel to protect themselves and others from COVID-19. Measures of enjoyment and absorption in content often rely on self-reports related to how much people enjoyed the content, whether it held their attention or if they were distracted by other things while viewing the content. However, real-world measured data for these variables would provide greater insight.

There was the possibility of bias in people’s responses to experiences of the content. To try to prevent this, we assured survey respondents that their responses were anonymous, and we asked for honest evaluation to help us create better content for others. None of the content was branded by LifeOmic or LIFE Apps to avoid eliciting any identity with or loyalty to the LIFE Apps brand. LIFE Apps users also do not pay to use their apps and are often invited to join various other health research projects where strict privacy and HIPAA regulations apply. The risk that they joined this study because of any social pressure or experienced pressure to “like” the educational content displayed is no more likely than in other survey experiments, in our opinion.

Finally, we also acknowledge that we did not fully test or directly manipulate all factors of the EPPM in this study, particularly fear. We leveraged materials that had already been created and designed survey questions around the messages contained in these materials, with a focus on practical takeaways. While this approach has its strengths in terms of evaluating new educational resources at a high level in a real-world setting, it is limited when it comes to pinpointing effect mechanisms.

Takeaways and Recommendations

New visual narrative formats have the potential to substantially improve engagement on issues of pressing public health concern. These formats are also ripe for future research.

In the process of conducting this study, starting with the collaborative creation the “flashcard” courses evaluated herein, we learned a lot about how to create effective visual educational materials science and health. We’ve curated some of what we learned into actionable tips below. (We are also leveraging lessons learned into a series of Lifeology SciComm “flashcard” courses 13 that help scientists and communicators learn evidence-based science and health communication practices.) This advice is based on our own process for and experiences in creating the materials evaluated in this study. It is based on factors that we think may have contributed to the impact of our materials. Future research should pin-point the role of these different strategies in making health education materials more effective.

1) Use plain language and non-clinical, narrative illustrations to improve understanding and relatability of science and health messages.

2) Assemble interdisciplinary teams in the creation of visual narrative materials. Collaborate with local professional artists and storytellers.

3) Use visuals that complement text. Avoid decorative visuals or ones that are either exact visual representations or conversely are unrelated to the text. Visuals might communicate helpful metaphors or help the viewer interpret or create accurate mental models of abstract concepts or hidden processes.

4) Include empowering stories of characters who face struggles, express relatable emotions, and achieve ultimately positive outcomes or a change in perspective through desired behaviors. Be compassionate when visualizing characters.

5) Be inclusive and illustrate a diversity of characters to engage a diverse audience.

Data Availability Statement

The raw data supporting the conclusion of this article will be made available by the authors, without undue reservation.

Ethics Statement

The studies involving human participants were reviewed and approved by the Alex Cohen, Louisiana State University. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.

Author Contributions

All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.

Conflict of Interest

PJ, DA, and MF are full-time employees of LifeOmic, a private health software company that owns and operates Lifeology, the platform being used and evaluated in this study. PJ, DA, and MF have received management incentive units (a form of equity compensation) in LifeOmic. Survey participants were recruited from the LifeOmic LIFE health tracking apps and incentives (e.g., free LifeOmic t-shirts) were randomly provided for 5 participants.

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

Publisher’s Note

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

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fcomm.2021.712658/full#supplementary-material

1 https://education.gsu.edu/research-outreach/alrc/adult-literacy-coronavirus-resource-links/

2 https://www.oecd.org/skills/piaac/ ; https://nces.ed.gov/datapoints/2019179.asp

3 https://www.talenthouse.com/i/united-nations-global-call-out-to-creatives-help-stop-the-spread-of-covid-19 . The call has been controversial among artists on account of asking for free labor in exchange for “exposure”.

4 https://app.us.lifeology.io/viewer/lifeology/default/how-is-a-lifeology-course-created

5 https://app.us.lifeology.io/viewer/lifeology/default/why-do-we-sleep

6 https://app.us.lifeology.io/viewer/lifeology/default/2019-novel-coronavirus

7 https://app.us.lifeology.io/viewer/lifeology/default/what-does-the-coronavirus-do-in-my-body

8 https://www.ahrq.gov/health-literacy/patient-education/pemat-p.html

9 N/A scores given to items on headers and narration

10 N/A scores given to calculations and charts

11 The sample size for the PROCESS analysis was 1765, the custom seed was 20200617

12 Entered as dummy variables relative to the control group

13 https://lifeology.io/lifeology-univ-scicomm/

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Keywords: COVID-19, visual narratives, public engagement, visual communication, storytelling

Citation: Jarreau PB, Su LY-F, Chiang EC-L, Bennett SM, Zhang JS, Ferguson M and Algarra D (2021) COVID ISSUE: Visual Narratives About COVID-19 Improve Message Accessibility, Self-Efficacy, and Health Precautions. Front. Commun. 6:712658. doi: 10.3389/fcomm.2021.712658

Received: 20 May 2021; Accepted: 26 July 2021; Published: 18 August 2021.

Reviewed by:

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

*Correspondence: Paige Brown Jarreau, [email protected]

This article is part of the Research Topic

Evidence-Based Science Communication in the COVID-19 Era

Sandro Galea M.D.

COVID-19 Was a Turning Point for Health

Our new book focuses on the lessons of the pandemic..

Posted February 15, 2024 | Reviewed by Michelle Quirk

  • To think comprehensively about COVID-19 is to think not just about the past but also about the future.
  • The narratives we accept about the pandemic will do much to shape our ability to create a healthier world.
  • Understanding the pandemic, and learning from it, means coming to terms with the emotions of that time.

In 2021, the United States was at a turning point. We had just lived through the acute phase of a global pandemic. During that time, the country had experienced an economic crisis, civil unrest, a deeply divisive federal election, and a technological revolution in how we live, work, and congregate. The emergence of COVID-19 vaccines allowed us, finally, to look ahead to a post-pandemic world, but what would that world be like? Would it be a return to the pre-COVID-19 status quo, or would it be something radically new?

It was with these questions in mind that, in 2021, I partnered with my colleague Michael Stein to write a series of essays reflecting on the COVID-19 pandemic. Our aim was to engage with the COVID moment through the lens of cutting -edge public health science. By exploring the pandemic’s intersection with topics like digital surveillance, vaccine distribution, big data, and the link between science and political decision-making , we tried to sketch what the moment meant while it unfolded and what its implications might be for the future. If journalism is “the first rough draft of history,” these essays were, in a way, our effort to produce just such a draft, from the perspective of a forward-looking public health. I am delighted to announce that a book based on this series of essays has just been published by Oxford University Press: The Turning Point: Reflections on a Pandemic .

The book includes a series of short chapters, structured in five sections that address the following themes:

This section looks at the COVID-19 moment through the lens of what we might learn from it, toward better addressing future pandemics. It tackles challenges we faced in our approach to testing, our successes and shortcomings in implementing contact tracing, the intersection of the pandemic and mass incarceration, and more. Many of these lessons emerged organically from the day-to-day experience of the pandemic, reflecting “unknown unknowns”—areas where we encountered unexpected deficits in our knowledge, which were revealed by the circumstances of the pandemic. Chapter 8, for example, explores the necessity of public health officials speaking with care, mindful that our words may be used to justify authoritarian approaches in the name of health, a challenge we saw in the actions of the Chinese government during the pandemic.

Our understanding of large-scale health challenges like pandemics depends on more than collections of data and a timeline of events. It depends on our stories. The narratives we accept about the pandemic will do much to shape our ability to create a healthier world before the next contagion strikes. This section explores the stories we told during COVID-19 about what was happening to us and looks ahead to the narratives that will likely define our recollections of the pandemic moment. It addresses narratives around the virtues and limits of expertise, the role of the media as both a shaper of stories and a character in them, the hotly contested narrative around vaccines, and the role scientists, physicians, and epidemiologists played in shaping the story of the pandemic as it unfolded.

This section explores how our values informed what we did during COVID-19 through the ethical considerations that shaped our engagement with the moment. These include the ethical tradeoffs involved in questions of digital surveillance, scientific bias, vaccine mandates, balancing individual autonomy and collective responsibility, and the role of the profit motive in creating critical treatments. At times, these reflections reach back into history, grappling with past moments when we failed in our ethical obligations to support the health of all, as in a chapter discussing how the legacy of medical racism shaped our engagement with communities of color during the pandemic. Such soul-searching is core to our ability to evaluate our performance during COVID-19 and face the future grounded in the values that support effective, ethical public health action.

As human beings, we do not process events through reason alone. We are deeply swayed by emotion . This is particularly true in times of tragedy like COVID-19. Understanding the pandemic, and learning from it, means coming to terms with the emotions of that time, the feelings that attended all we did. Grief and loss, humility and hope, trust and mistrust , compassion and fear —both individual and collective—were all core to the experience of the pandemic. The simple act of recognizing our collective grief, as several chapters in this section try to do, can help us move forward, acknowledging the emotions that attend tragedy as we work toward a better world.

To think comprehensively about COVID-19 is to think not just about the past but about the future. We seek to understand the pandemic to prevent something like it from ever happening again. This means creating a world that is fundamentally healthier than the one that existed in 2019. This final section looks to the future from the perspective of the COVID-19 moment, with an eye toward using the lessons of that time to create a healthier world, as in Chapter 50, which addresses the challenge of rebuilding trust in public health institutions after it was tested during the pandemic. The section also touches on leadership and decision-making, shaping a better health system, shoring up our investment in health, the future of remote work, and next steps in our efforts to support health in the years to come.

I end with a note of gratitude to Michael Stein, who led on the development of this book. It is, as always, a privilege to work with him and learn from him. I look forward to continued collaborations in the months and years to come, and to hearing from readers of The Turning Point as we engage in our collective task of building a healthier world, informed by what we have lived through and looking to the future.

A version of this essay appeared on Substack.

Sandro Galea M.D.

Sandro Galea, M.D., is the Robert A. Knox professor and dean of the Boston University School of Public Health

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  • Published: 01 November 2023

Historical narratives about the COVID-19 pandemic are motivationally biased

  • Philipp Sprengholz   ORCID: orcid.org/0000-0002-9925-1920 1 , 2 , 3   na1 ,
  • Luca Henkel 4 , 5   na1 ,
  • Robert Böhm   ORCID: orcid.org/0000-0001-6806-0374 6 , 7 , 8   na2 &
  • Cornelia Betsch   ORCID: orcid.org/0000-0002-2856-7303 2 , 3   na2  

Nature volume  623 ,  pages 588–593 ( 2023 ) Cite this article

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How people recall the SARS-CoV-2 pandemic is likely to prove crucial in future societal debates on pandemic preparedness and appropriate political action. Beyond simple forgetting, previous research suggests that recall may be distorted by strong motivations and anchoring perceptions on the current situation 1 , 2 , 3 , 4 , 5 , 6 . Here, using 4 studies across 11 countries (total n  = 10,776), we show that recall of perceived risk, trust in institutions and protective behaviours depended strongly on current evaluations. Although both vaccinated and unvaccinated individuals were affected by this bias, people who identified strongly with their vaccination status—whether vaccinated or unvaccinated—tended to exhibit greater and, notably, opposite distortions of recall. Biased recall was not reduced by providing information about common recall errors or small monetary incentives for accurate recall, but was partially reduced by high incentives. Thus, it seems that motivation and identity influence the direction in which the recall of the past is distorted. Biased recall was further related to the evaluation of past political action and future behavioural intent, including adhering to regulations during a future pandemic or punishing politicians and scientists. Together, the findings indicate that historical narratives about the COVID-19 pandemic are motivationally biased, sustain societal polarization and affect preparation for future pandemics. Consequently, future measures must look beyond immediate public-health implications to the longer-term consequences for societal cohesion and trust.

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Data are available at https://doi.org/10.17605/OSF.IO/BXG7V . Study 2 ( https://aspredicted.org/uw47f.pdf ) and study 3 ( https://aspredicted.org/kk33k.pdf ) were preregistered.

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Acknowledgements

We thank J. Simmank and J. Schneider for discussions about the ex-post evaluation of the pandemic and for input for the items to assess the appropriateness of political action; S. Columbus, M. Müller and F. Zimmermann for comments and suggestions; and the COSMO teams at the University of Erfurt and the Bernhard Nocht Institute for Tropical Medicine for their continuous work, on which this paper builds. Financial support by the following institutions is acknowledged: Federal Centre for Health Education, Robert Koch Institute, Leibniz Institute of Psychology, Bernhard Nocht Institute for Tropical Medicine, Klaus Tschira Foundation, Thüringer Ministerium für Wirtschaft, Wissenschaft und digitale Gesellschaft, Thüringer Staatskanzlei, University of Erfurt and Deutsche Forschungsgemeinschaft (DFG; German Research Foundation). The project was partly funded by the DFG under Germany’s Excellence Strategy: EXC 2126/1–390838866. Support from the DFG through CRC TR 224 (project A01) is also acknowledged. C.B. was partly funded by the DFG (BE3970/12-1) and the Leibniz Foundation (P106/2020). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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These authors contributed equally: Philipp Sprengholz, Luca Henkel

These authors jointly supervised this work: Robert Böhm, Cornelia Betsch

Authors and Affiliations

Institute of Psychology, University of Bamberg, Bamberg, Germany

Philipp Sprengholz

Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany

Philipp Sprengholz & Cornelia Betsch

Implementation Science, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany

Kenneth C. Griffin Department of Economics, University of Chicago, Chicago, IL, USA

Luca Henkel

Department of Economics, University of CEMA, Buenos Aires, Argentina

Faculty of Psychology, University of Vienna, Vienna, Austria

Robert Böhm

Department of Psychology, University of Copenhagen, Copenhagen, Denmark

Copenhagen Center for Social Data Science, University of Copenhagen, Copenhagen, Denmark

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All authors designed and performed the research. P.S. and L.H. performed the data analyses. All authors wrote and revised the manuscript.

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Extended data figures and tables

Extended data fig. 1 predictors of appropriateness of political action in study 1..

Results of a multiple linear regression with vaccination status and vaccination status identification predicting perceived appropriateness of political measures to contain the COVID-19 pandemic. Ribbons visualize 95% confidence intervals; R 2  = 0.482.

Extended Data Fig. 2 Effects of interventions to reduce recall bias in study 2.

a – f , Linear regression predicting individual recall on the basis of past (December 2021) and present (January 2023) ratings and their interactions with vaccination status and experimental condition for infection probability ( a ), infection severity ( b ), trust in government ( c ), trust in science ( d ), mask wearing ( e ) and avoiding contacts ( f ) ( n  = 3,105). Each line visualizes directional bias and how past and present perceptions affect recall (at recall = 4) for a given vaccination status and experimental condition (see the Fig. 1 legend for details on how to read the figure).

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Sprengholz, P., Henkel, L., Böhm, R. et al. Historical narratives about the COVID-19 pandemic are motivationally biased. Nature 623 , 588–593 (2023). https://doi.org/10.1038/s41586-023-06674-5

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The essay outlines the ways in which narrative approaches to COVID-19 can draw on imaginative literature and critical oral history to resist the ‘closure’ often offered by cultural representations of epidemics. To support this goal, it analyses science and speculative fiction by Alejandro Morales and Tananarive Due in terms of how these works create alternative temporalities, which undermine colonial and racist medical discourse. The essay then examines a new archive of emerging autobiographical illness narratives, namely online Facebook posts and oral history samples by 'long COVID' survivors, for their alternate temporalities of illness.

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At the time of writing (July 2020), the current COVID-19 pandemic has infected more than thirteen million people and claimed more than 580 000 lives worldwide.

At the time of revision (May 2021), the COVID-19 pandemic has infected more than one hundred sixty-five million people and claimed more than 3.42 million lives worldwide.

At the time of second revision (October 2021), the COVID-19 pandemic has infected more than 242 million people and has claimed more than 4.93 million lives worldwide.

Due to the timescale of academic publication, over a year separates my writing and second revision of this article. I have chosen to include the three versions of my first sentence, because it shows that, while I have been working on this piece, 4.35 million human beings have died. I want to begin this article by acknowledging that there is no narrative, whether epidemiological, sociological, or literary, that can adequately emplot the three versions of my first sentence. There is no story that can make sense of this progression. Instead, current Health Humanities scholarship is created in the breach between three versions of one sentence—in the suffering, and in the becoming.

While the three versions of this first sentence are desperately inadequate, they are also, inescapably, a form of representation. The sentence harkens back to the early beginnings of the essay as genre: a written meditation on a subject, which shows its own process of thought. In terms of content, the sentence presents my own time of writing, embedding me in a historical moment; it names the disease and it documents that disease’s spread by stating in stark terms the growing fatalities from COVID-19. During the first review, this manuscript was sent back with the comment to remove the strike-throughs, which the editorial team understandably assumed were a typographical error. With the use of typography, the strike-throughs try to make legible our necessary re-evaluations and revisions throughout the pandemic. These revisions also reflect the temporal ‘layering’ of COVID-19 narratives. Each declarative statement has within it its own future overwriting. Nothing feels stable. By the time you are reading this article, holding either the print copy of the journal or scrolling online, the numbers will have shifted, inevitably higher. Your moment overwrites my most recent revision. Finally, the last version makes us circle back to the first, continually trying and failing to make sense of the progression. The reader is trapped in a recursive time.

The most obvious gap, which the sentences do not address, is the human impact of the pandemic. The repetition of the sentence shows the impossibility of capturing loss with these facts. Visual and written art forms can creatively reframe medical and historical data to show how human experience is ‘layered’ with facts and figures. For example, the image below is a reproduction of artist Anatol Bologan’s painting ‘Viral 01’. It is the first in a series of multimedia works dealing with the human cost of COVID-19. The painting is a visual meditation on loss, as a patient with COVID-19 reaches to embrace a loved one who has died ( figure 1 , Bologan 2020 ). Furthermore, by digitally layering pandemic data visualisations behind and on top of the central couple, the artist illustrates the human pain that is not fully captured by discussions of disease ‘rates’ and ‘curves.' The medical image of the patient’s lungs, taken from a computer rendering of a CT scan, shows an active COVID-19 infection with an uncertain outcome. The viewer assumes that the central figure may become part of one of the bars on the graph, and that his body may continue to fragment and dissolve, as it does on the left edge of the artwork. The red line across the bottom third of the image provides the base for the graph, and could represent a flatlining heart monitor ( figure 1 , Bologan 2020 ).

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Anatol Bologan, ‘Viral 01’ ( Bologan 2020 ).

The painting is a vivid portrayal of what I call the layered temporalities of the COVID-19 pandemic. While epidemiology offers one model for how to trace the spread of COVID-19 (geographically, spreading outwards from one or multiple epicentres) and public health offers another (as with the graphs of infection and mortality), these models do not capture the multiply unfolding temporalities of people’s lived experience of the pandemic. Each of us is a distinct nodal point in terms of the timing of this disease outbreak. Our stories of growing awareness about the disease, travel, work, social distancing and perhaps illness, healing and loss, all unfold on different patterns. These temporalities may be anchored by some shared news cycles and social media conversations, or may echo one another in terms of the how infection and symptoms manifest on the body. However, they are also distinct. By placing the human figures in the centre of these graphs and charts, overlaid but not determined by them, the painting demonstrates that artistic and creative works can engage the distinctiveness of the lived experience of this time.

The painting also invokes the people permanently missing from our lives and communities, and makes one wonder about their stories. Jay Baruch and his coauthors, in their article about art and patients’ stories, recount an exercise with medical students where the students are asked to contemplate Cy Twombly’s Untitled (1968). The leaders ask the students to look for negative space in the abstract artwork, relating this negative space to understanding patient experience: “When you’re listening to stories, are you sensitive to the gaps, mindful of what was unsaid—perhaps even unsayable?” ( Baruch et al 2020, 430 ). Though representational and not abstract, the painting ‘Viral 01’ uses negative space—the around and between—to show loss that defies full comprehension.

Currently, the Centers for Disease Control (CDC) has rescinded the mask order. In spite of surges in Delta-variant hospitalisations and deaths, schools and universities have opened to in-person instruction. More Americans flew home to see their families for Memorial Day, 2021, than have flown since the beginning of the pandemic. Understandably, the public is focusing on new ‘firsts’, new beginnings and reunions. However, when public discourse focuses on the ending to disease outbreaks it can also conveniently overlook ongoing health inequities.

In this article, I focus on stories that represent the lived experience of epidemic disease, specifically those that defy the temporal closure offered by popular disease rhetoric. Specifically, I suggest that the affective engagement or embodied reading practices encouraged by Health Humanities allows us to remain sensitised to the COVID-19 stories that might be otherwise unnoticed. I propose a narrative investigation that takes up the layered temporalities of COVID-19 stories, specifically focusing on chronicity, erasure, fragmentation, revision, and repetition. This article first demonstrates how postcolonial speculative and science fiction, such as works by Tananarive Due and Alberto Morales, nuance our understanding of the lived experience of epidemics. These works highlight injustices perpetrated on those blamed for the outbreak and offer different imaginative possibilities for how we could relate to one another during a time of crisis.

The article then turns to excerpts from oral histories and life-writing by COVID-19 survivors. Studying the ‘unknowingness’ in postcolonial science fiction can inform the way in which one engages COVID-19 narratives and how they resist temporal closure. Especially for those struggling with long COVID, or for those mourning the loss of loved ones to COVID-19, triumphalist, chronological narratives of ‘flattening the curve’ or putting the pandemic behind us ring false. These first-hand stories follow different narrative arcs than crisis to cure, or pandemic’s start to pandemic’s end. In fact, more possibilities may be offered from narratives of endemicity and chronic illness than the structure of climax and resolution of traditional plague narratives. Understanding COVID-19 as both epidemic and endemic allows different critical approaches to emerge, such as allowing us to address systemic health inequities as ongoing 1 . In addition, as I have shown elsewhere, those living in an environment with endemic disease can also use this status to gain authority and make demands on medical systems ( Howell 2014 ). Furthermore, Health Humanities scholarship that engages with chronic pain acknowledges that ‘reading less in search of narrative coherence or self-authorship’ allows a heightened appreciation for the ‘value of textual fragments, episodes and moments’ ( Wasson 2018 , 106). By examining COVID-19 narratives using the methods of postcolonial studies and critical oral history, Health Humanities scholars can resist the stories’ instrumentalisation within national and medical discourses.

Defying closure and cure: postcolonial and speculative fiction

We have never lived through this pandemic. However, we have talked about epidemics before. Written and visual narratives of epidemics may consolidate a chaotic series of events, give a sense of purpose and directionality and also to attempt to capture for the reader the experience of the disease. Such methods are a way to engage our attention and to create or direct readers’ anxiety about future epidemics, or, conversely, to comfort us that the epidemic is safely over. However, to write and to read a story set during an epidemic is to work within a set of expectations and constraints. Our cultural values, scientific knowledge base and previously established disease discourse all play a role in how we discuss the current moment. For example, Patricia Wald identifies a certain ‘vocabulary of disease outbreaks’ as beginning during the AIDS crisis in the 1980s and being reinterpreted within the outbreak films and science writing of the 90s ( Wald 2008, 2 ). In this case, the vocabulary of ‘emerging infections’ which many of us now use in fact originated within a particular set of political, biological and cultural circumstances (heteronormative, middle-class, 1980s white America and its imagined others).

Within the realm of illness narrative in particular, critical medical humanities scholarship has begun to examine why certain stories of pain and healing are validated while others are not. Within the edited volume by Angela Whitehead et al. (2016) , scholars examine why certain subjects’ experiences are more often discounted: the ‘obese’ (Evans and Cooper), black Americans (Andrews and Metzl), disabled individuals (Tilley and Olsén) and the neurodivergent (Herman). These studies assume that our idea of what constitutes a coherent narrative, and thus our receptivity towards what we read, is influenced by our own cultural and political values. This holds true with our reading of epidemic narratives as well, the structures of which are deeply intertwined with the history of colonialism. We may assume that one writes a story to consolidate a sense of self. However, the concept of ‘self’ which narrative supposedly consolidates, as Sylvia Wynter and others have shown, is at base a colonial construct: the ‘(Western bourgeois) conception of the human’ ‘over-represents itself as if it were the human itself’ ( Wynter 2003, 260 ). In other words, the ways in which certain subjects’ narratives are recognised as human experience while others are not, are influenced by histories of colonial exploitation and racism. 2

One key subject of analysis for Global Health Humanities scholarship is how the legacies of colonial medicine influence which stories of illness are read and in what manner. Colonial medical politics de-authorised the illness experience of indigenous populations, privileging instead white subjects’ perceptions of the health threats posed by foreign lands. For example, as Megan Vaughn (1991) has demonstrated in Curing Their Ills , medical discourse in late 19th and early 20th century Africa worked to undermine indigenous knowledge formations and to construct the ‘African’ as a subject in need of health intervention. Publications as diverse as cartoons, medical journals and public health posters worked to stereotype local health practices and depict the colonial doctor as heroic. John and Jean Comaroff engage the ‘ideology of colonial healing’ that depicted colonialism as driven by humanitarianism ( Comaroff and Comaroff 1992 ). This ideology does not acknowledge whether or not a health intervention is desired by local populations.

Colonialist narratives of cure rest on specific conventions: an exoticised location is pathologised, its inhabitants blamed for their current state of ill health. Western-trained doctors and nurses are depicted as providing a heroic intervention, benefitting local populations and inspiring their gratitude. If the health crisis is not eradicated by the end of the narrative, at the least the worst is averted. Contemporary global health organisations currently draw on similar rhetoric when they depict local populations as suffering from abject poverty and ill health and in need of top-down interventions. As Nicholas King explains, both former colonial medical and contemporary global public health discourses justify the control of disease for protection of western economic growth ( King 2002, 776 ). Postcolonial science fiction or speculative fiction disrupts specific colonialist underpinnings of medical narrative: geographies are interdependent rather than separable; Western forms of medical knowledge are fallible. Most important for my purposes, postcolonial fiction de-stabilises the very assumptions about disease outbreaks as following a specific chronology or temporal progression through presenting instead alternate or recursive temporalities. 3

Works such as Tananarive Due’s ‘Patient Zero’ and Alejandro Morales’s The Rag Doll Plagues both use the structures of science fiction to question the traditional temporal unfolding of an outbreak. Historically, scientists such as Ronald Ross tested indigenous bodies as the ‘source’ of disease. 4 Both Due and Morales craft characters who are subject to experimentation, ostensibly in the name of solving the epidemic. These postcolonial science/speculative fictions draw on these histories by using the affective response of the reader to engage the colonial and settler colonial medical practice of experimenting on bodies of colour during a time of disease outbreak.

Postcolonial fiction disrupts or nuances certain Western assumptions about the relationship between temporality and narrative. Paul Ricœur has claimed that narrative and time are inextricable, and that narrative reflects a ‘temporal experience’ ( Ricœur 1984, 3 ) . The work by Patricia Tobin highlights the gendered nature of this narrative structure. She argues that the ‘genealogical imperative’ in Western narrative structures—the way in which language is structured to show cause and effect and seriality—is influenced by its cultural context, namely patriarchal structures of lineage ( Tobin 1978, 8 ) . Subsequent generations of critics have shown that such 20th-century theories of narrative and time were greatly influenced by the structures of 19th-century writing, which manifested a ‘belief in progress’ ( Gomel 2010, 8 ), or ‘linear industrial time’ ( Henrikson and Kullberg 2021, 12 ). Medical Humanities scholars such as Laura Salisbury show that ‘linear narratives that stress deep psychological continuities across time’ might ‘privilege and render problematically universal modes of subjectivity and self-expression that are, in fact, culturally and historically contingent’ ( Salisbury 2016, 444 ).

Critics Elana Gomel, Randall Stevenson and Russell West-Pavlov have suggested that these earlier theoretical assumptions about time and narrative be revised to acknowledge their capitalist-colonialist underpinnings. 5 West-Pavlov claims, ‘Time’s attributes of linearity (“what’s past is past”), universality, quantifiability and commodifiability (“time is money”), and finally contemporaneity and modernity (“newer is better”) all work to structure human existence according to the restrictive but profitable mechanisms of late capitalism’ ( West-Pavlov 2012, 5 ). Rather, he suggests that one cultivate an awareness of reading as ‘digressive’ and an understanding of literature as a ‘playful re-working of the putatively factual givens of reality’, which gestures towards a ‘plethora of temporalities subsisting under the threshold of an all-embracing and coercive time’ (9).

One example of the ‘coercive time’ that West-Pavlov discusses is temporality ‘inculcated’ by colonial education, which embodied a ‘forward vector of progress and incremental acquisition of civilization’ (159). What would happen, he asks, if one were to ‘abandon the sequence’ this time ‘relies on altogether’, taking up instead ‘a notion of overlapping, non-segmented temporal planes’ with ‘many actants with agency’ (166)—what Dipesh Chakrabarty calls ‘ interlocking of presents, pasts and futures’ ( Chakrabarty 2000 )? Postcolonial authors experiment with temporality in their works to unmoor narrative from its colonialist associations with progress. In speaking about Salman Rushdie’s Midnight’s Children (1981), Randall Stevenson (2019, 211 ) demonstrates that the literary text ‘illustrates a range of tensions between imperially imposed temporality and influences indigenous to countries colonialism sought to subjugate’. Time is ‘an unsteady affair’ (citing Rushdie, 1981, 79), whereby postcolonial fiction ‘magnifies and valorises unsteady, divergent temporalities’.

For the purposes of the current analysis, the most important aspect of narrative structure and time is its inter-relationship with science. Tobin observes that science follows an ‘arrow of time’ similar to that of traditional chronological narration in stressing causation and effect, hypothesis and proof (8). I would add that this assumption about science is similarly influenced by colonial and national consolidation of the scientific process—recent scholarship has shown that there are narrative multiplicities possible in indigenous scientific knowledge as well. If colonial science ‘instrumentalises nature’, then critics like Masood Raja, Jason Ellis and Swaralipi Nandi suggest that postcolonial science fiction can, by stressing incomprehensibility, ‘magic’ and the unknowable, call into question these scientific logics underpinning narrative ( Raja, Ellis, and Nandi 2011, 5 ). This is not just a theoretical practice, but an embodied one. As Michel Foucault has shown, biopower inscribes control of the life course through social expectations. Arne de Boever, following Edward Said, claims that ‘historically, the rise of the novel coincides with the rise of what Foucault calls governmentality and biopower’ ( De Boever 2013, 9 ). By changing the colonial-scientific temporal logic of narrative, one can attempt to redefine the stakes of one’s own life course. Elizabeth Freeman argues that ‘temporality is a mode of implantation through which institutional forces come to seem like somatic facts’ ( Freeman 2007 ), cited in ( West-Pavlov 2012, 5 ). In the case of an epidemic, the ‘somatic facts’ of infection, illness and healing, on both a national and personal level, are quickly identified according to a normative timeline, which may or may not align with an individual’s lived experience. Instead, as Paula Henrikson and Christina Kullberg observe, ‘lived time is contextually dependent’ (citing Hartog 2003 , 14).

Questioning the narrative patterns of science, and particularly colonial science, does not lead one to an antiscience or antimedicine stance. To argue that disease treatment is not equally available to all, and that this inequality both reflects pre-existing colonial priorities as well as reinforces existing racial and national disparities, is not to argue against medical research or treatment. Medical research and treatment are needed. Rather, the critique focuses on two aspects of medical narrative logic: one which claims that Western medical science is the apex of modernity, and that this modernity is offered or given to others, and the other that depicts disease eradication in a chronological and definitive arc. By understanding these logical assumptions as constructed rather than inherently ‘true’, one may approach stories of chronic illness, or stories of repeated or ongoing outbreaks, not as unusual but as endemic to a global system of medical inequality.

Furthermore, reading literary descriptions of physical symptoms and suffering causes an embodied reaction in the reader specific to the disease being invoked. In Postcolonial Poetics , Elleke Boehmer claims that reading “sets off a cascading set of inferences, which the reader processes at different simultaneously unfolding cognitive (semantic, sensory, kinaesthetic) levels, their responses modifying and adjusting as the communication develops” ( Boehmer 2018, 8 ) . When considering the multisensorial experience of reading about illness, one must assume that in specific scenes of suffering, and throughout the work, we are plunged into the space-time of disease particular to that disease itself. The structure of illness from disease (acute vs chronic) is also embedded in the chronology and structure of literary texts (for more, see Howell 2018 ). By creating this affective response in relationship to a fictional disease, these following literary works invite the reader to reflect on how we behave towards one another during times of health crisis, without the specific anchor of a named plague. I suggest that critical engagement with specific literary works about epidemics allows us to practice the radical, speculative exercise of imagining a more equitable present as well as future. These works subvert the Patient Zero myth and disease stigmatisation; encourage us to consider what a decolonised medical praxis would look like and allow us to be aware of our own experiences of embodied reading.

The Rag Doll Plagues by Alejandro Morales (1992) explicitly critiques colonial medicine’s exploitation of Mexican bodies during a fictional, mysterious illness called La Mona in 1788 Mexico City. The book directly engages the colonial value systems that are embedded with the treatment of epidemic disease. The novel self-consciously invokes the tradition of colonial judgmentalism towards ‘uncivilised’ populations, in order to turn this stereotype on its head. Morales’s narrator, Don Gregorio, the First Professor of Medicine, Anatomy and Surgery in his Majesty’s Empire, is a Spaniard who visits colonial Mexico to ‘implement these new [medical] procedures’. In addition to improving sanitation, the ‘new procedures’ he introduces ‘to the native population’ includes a great deal of cauterisation, surgery and amputation, as if seeking to quite literally cut out all that is rotten and diseased in the colonies, including the ‘hedonistic carnal acts’ he witnesses (28).

Each section of this tripartite novel shifts locations and times, thus disrupting colonial narratives of progress. This ‘collapsing of linear time’ is emphasised by the ‘phantasmic atemporal characters Gregory and Papa Damian, who appear in each of the three books of the novel’ ( Joyce and Garay 2013, 141 ). Morales’s novel follows a tradition, as with the work of Gabriel García Márquez (1988) , which undermines colonial assumptions of medical progress. When García Márquez’s character Juvenal Urbino returns to his Caribbean home from medical training in Europe, he brings back all the disparaging assumptions about indigenous subjects’ inadequate hygiene and backwardness with him. The novel describes Urbino as arriving home with ‘the beard of a young Pasteur’ (106).

The clearest articulation of The Rag Doll Plagues’ critique of colonial medical legacies can be found in its last section. Don Gregorio’s descendants discover that residents of Mexico City, who are called ‘Mexico City Mexicans’, have a uniquely healing property to their blood that perhaps has been caused by their survival of La Mona in the 18th century. These Mexican citizens become valued and commodified, their blood used for infusions to cure people during a ‘major plague’ (183). Through reverse-colonisation via transfusion, ‘Mexican blood would gain control of the land it lost almost two hundred and fifty years ago’ (195). Morales’s novel points towards the double-edged sword of biological essentialism: whether being decimated or valued for their blood, disparaged or fetishised for their relationship to place, the colonised subject’s body is commodified by the dominant political power. Finally, as Joyce and Garay demonstrate, the The Rag Doll Plagues ’ focus on the male doctor/scientist, on a quest for self-improvement and discovery, is not unproblematic in its gender politics, as could be said of other famous pandemic fiction such as Michael Crichton’s Andromeda Strain .

By showing the breakdown in social relationships, pandemic fiction can inspire the readers to imagine a different world, where we choose to relate to one another during a time of crisis with more humanity. Tananarive Due’s short story ‘Patient Zero’ (2010) engages the harvesting of immune groups’ blood or body parts for study or the development of antibodies, with or without their consent. ‘Patient Zero’ is narrated by a 10-year-old boy, Jay, who is the subject of study in a research facility during a future pandemic. Jay has recovered from ‘Virus-J’, while everyone else around him dies. He is thus labelled the ‘Patient Zero’, and made both the subject of study as well as the recipient of hostility and misunderstanding.

Due uses the innocent voice of a child narrator to undermine the stigmatisation that occurs during a pandemic. The Patient Zero is a mythic figure who reassures us that pandemics have a traceable beginning. Jay questions his label at the first patient: “that was when I first learned how people tell lies, because that wasn’t true. Somebody on my dad’s oil rig caught it first, and then he gave it to my dad. And my dad gave it to me, my mom and my brother” ( Due 2001, 9 ). His sense of injustice highlights the uncertain timeframe and geography of pandemics. Jay’s own temporality is different from the official timeline. This official timeline has the goal of certainty rather than truth.

This work of speculative fiction also plunges the reader into the experience of being experimented on. Jay recounts that the doctors and nurses at the containment facility “take so much blood from me all the time, until they make purple bruises on my arms and I feel dizzy” (12). He continues,

“I think they have even taken out parts of me, but I’m not really sure. …I had surgery on my belly a year ago, and sometimes when I’m climbing the play-rope hanging from the ceiling in my room, I feel like it hasn’t healed right, like I’m still cut open. … I don’t hate anything like I hate operations” (12).

Jay’s physical symptoms are not from the virus but from his doctors’ search for the virus’s cause. These are described in visceral detail, so that the reader can imagine being dizzy from multiple blood draws, or aching from multiple surgeries. The story invites us to balance the cost of specific individuals’ pain against the larger goals of scientific discovery, especially during times of uncertain and emerging knowledge when that pain may or may not lead to a cure.

The text is important in terms of Health Humanities’ critical engagement with scale—if one is the only person who suffers from an undiagnosed illness, does that make one’s suffering less legitimate? If someone recovers from an illness that kills many, which community will welcome them? As a story by a black American author about one boy being blamed for a pandemic, ‘Patient Zero’ also invites us to read within the framework of America’s historical and present medical abuse of bodies of colour. From Tuskegee to COVID-19, black Americans have received inadequate or abusive medical treatment. The erroneous creation of race as a biologic category has been used to justify medical experimentation on groups of black people since the times of slavery (see Roberts 1997 , 2011 ; Hogarth 2017 ).

It is outside the scope of this article to fully address the continuities and divergences between colonial medicine practised by Britain in India, for example, with colonial medicine in Mexico, alongside medical exploitation of black Americans. 6 Narrative experimentations also will reflect authors’ distinctive cultural and historical associations with time and the body. However, while different national literatures invoke distinctive histories of medical treatment, reading these works in conjunction offers specific insights. One becomes more aware of the political stakes of aggrandising medical ‘modernity’, and one can see more clearly the power differentials that relate to who lives and who dies during a pandemic (see discussion of biopolitics and the right to ‘make live and let die’, in Society Must be Defended by Michel Foucault 1976; 2003 ). This practice encourages reading disease, not as an inherent manifestation of biological and historical circumstances, but also as a symptom of longstanding injustice.

These conversations are unfortunately timely due to the racial disparities exemplified by COVID-19 illness and death rates ( Chowkwanyun and Reed 2020 ). In a recent article, authors Yoshiko Iwai, Zahra Khan and Sayantani DasGupta exhort medical professionals to practice what they term ‘abolition medicine’: ‘imagining… ourselves into a more racially just future invested in enriching communities’ and (thereby) working ‘toward a future of health and social justice’ ( Iwai, Khan, and DasGupta 2020, 158 ). As of 12 June 2020, the Centers for Disease Control (2020) showed that ‘age-adjusted hospitalisation rates’ for ‘American Indian or Alaska Native’ as well as black people are approximately five times, and Hispanic or Latino people four times, that of non-Hispanic white people. According to the CDC, this is due to factors such as dense population, caused by housing segregation; proportionately higher risk of living in a food desert and depending on public transport or being an essential worker and having no sick leave. The devastating effects of COVID-19 on communities of colour are exacerbated because ‘racism, stigma and systemic inequities undermine prevention efforts, increase levels of chronic and toxic stress and ultimately sustain health and healthcare inequities’ ( Centers for Disease Control 2021 ). This moment is revealing the faultlines within our systems and making clear the impact of ongoing stress and violence on the bodies of people of colour. Health Humanities research is engaging the overlapping categories of systemic violence that have caused unnecessary and avoidable human suffering.

Examining postcolonial pandemic fiction is relevant to our current moment. The ‘Patient Zero’ is a temporal trope used to exoticise and blame racialised subjects, whether in a formerly colonised country such as Guinea or in an American context. This individual is often identified with marginalised groups, an easy scapegoat to protect normative group identity. One observes the Patient Zero myth uncritically reproduced within contemporary scholarship. For example, in a preface to the newest edition of Epidemics and Society: From the Black Death to the Present , seminal medical historian Frank Snowden (2020) connects COVID-19 with Ebola through the image of human-non-human transmission in an ‘exotic’ locale: in 2013, “a small child played in the hollow of a tree near the garden of his home in Guinea…The misfortune of the four year-old boy was to inhale viruses shed in the dejecta of the displaced bats” (ix). Guinea in 2013 becomes Wuhan in 2019: ‘this sequence of events, transposed to an urban context, probably recurred at a bushmeat “wet market” in Wuhan, China’, where ‘unhygienic passageways’ become a ‘giant petri dish’ (ix–x).

This new preface to Epidemics and Society risks invoking the same colonialist judgmentalism critiqued by García Márquez and Morales, and risks ‘othering’ the Patient Zero as in Due’s short story. In fact, as Kelly, Keck, and Lynteris (2020, 1 ) demonstrate in Anthropology of Epidemics, ‘While the viruses that spill over from wild animals to remote village populations occupy pride of place in these end-of-the-world fantasies, today the pathogens that could spark global pandemics might as easily evolve in antimicrobial-rich hospital environments in Europe and the United States’. Both histories and works of fiction about pandemics ask us to project ourselves into a disease’s beginnings; however, popular disease rhetoric is often based on the assumption of the self as inviolate, threatened by external forces. ‘Patient Zero’ invites us to enter into the experience of vulnerability, not only of the uninfected but of the ‘carrier’ by employing the voice of a child. Therefore, even as our physical bodies are in quarantine from pandemic illness, or to avoid pandemic illness, we can recognise the ways in which our stories are embedded in embodied experience, and how affective reading practice connects our own bodies to others’.

Plague has its own vocabulary. The texts by Due and Morales use a haemorrhagic framework of metaphors and images to describe the effects of disease on the body. The images are drawn from bacterial infections causing acute and immediate suffering. When reading COVID-19 narratives, whether first-person accounts written by sufferers, health practitioners, family members or fictionalised accounts, Health Humanities scholars must engage with this disease’s unique descriptive lexicon. Patients’ narratives offer experiences of respiratory distress and isolation; technologically-mediated communication; neurological and cognitive aftereffects. Healthcare practitioners find themselves cast in roles they did not audition for. 7 The study of postcolonial science fiction and speculative fiction suggests that one keep in mind the ways in which authors can portray health injustice by subverting the linear temporality offered by medical discourses.

Furthermore, postcolonial and social justice scholars stress the importance of oral history as a critical methodology that can complicate official narratives. Historian Indira Chowdhury argues for the practice of oral history to understand science in the postcolonial context, specifically the ways ‘scientific practice has adapted to local and contingent factors’ ( Chowdhury 2013 ). Quoting writer Chimamanda Adichie, Christine Lemley argues that critical oral history can subvert the ‘danger of a single story’: in the case of Adichie’s experience, the dominance of a Western-centric, stereotypical viewpoint of her upbringing in Nigeria. According to Lemley, critical oral history ‘exists to contextualise story and create spaces through which people who are underrepresented in dominant systems use agency to identify and act on struggles to build new possibilities’ ( Lemley 2013, 7 ). In the context of a pandemic, critical oral history offers diversity in terms of venue, perspective, and positionality to stories of illness and healing. Genres of study include interviews, as well as drawings, documentaries and material objects. In the section that follows, I draw on social media postings, emails and interviews in order to demonstrate how critical oral history about COVID-19 can contribute to postcolonial Health Humanities scholarship.

COVID-19 stories and layered temporality: healthcare workers and long COVID survivors

Text message, 11 February 2021: Why did you come [to the home] when you knew you had a known COVID-19 exposure and no negative test? Reply: It had been 10 days. Email sent to all faculty and students, from Texas A&M University, received 6 September 2021: Close contact is defined as being within six feet for a cumulative 15 minutes over 24 hours with someone who tested positive for COVID-19. Vaccinated individuals do not have to quarantine, while unvaccinated must quarantine. Oral history excerpt, ‘B’: I said, I am going to be walking and I’m going to leave (the hospital) at the date in which you [the doctors] prescribe, which I believe was the 21st of January. If I remember correctly. […] All these difficult, very difficult things but I wasn’t going to take any other sort of answer and I left on January 21st. ( B, interview 2021 )

During a pandemic, official time and personal lived time diverge. COVID-19 is morphic, variable, emerging; both respiratory and neurological in its effects; both acute and chronic in manifestation. However, the guidance set by public health entities such as the CDC must by necessity be standardised, in order to provide individuals guidance on how to behave to curb the spread of disease. Our success as a nation is then measured by how well we have followed official time and its interlocking health guidelines; our individual success is measured by how well we have avoided illness or progressed towards healing on a specific timeline. We exercise bodily autonomy in the individual interpretation of that time, and our body’s relationship to it. We create space for alternate temporalities through narrative and art, as well as through other means.

In the first excerpt above, the speaker reminds someone of his individual responsibility and how he had broken a social contract by not heeding that responsibility. In the official email, Texas A&M University leadership places responsibility on the teacher or student for calculating the minutes they have been exposed to someone who is COVID-19 positive within 24 hours, in order to determine if they should quarantine. In the third excerpt, oral history participant ‘B’ sets his own goal for his discharge date after 3 months in the hospital with acute COVID-19, as a motivation to get well. The very length of his hospitalisation belies the CDC’s implied average timeline of illness: even ‘severely ill’ people can expect to re-enter society after 20 days, the website reads ( https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html ).

One may form an appreciation for alternate and divergent illness temporalities through studying narratives of COVID-19. By so doing, one may also bear witness to the ongoing human impact of the pandemic. This analysis in no way undermines quarantine, masking or self-monitoring practices. Rather, it stresses that individual lived time is very different from official guidance, and official guidance insistently overlooks systemic inequalities. For example, 2 weeks’ quarantine (during the pre-vaccine era of COVID-19) for someone who is self-employed might be a hardship that pushes that person closer to financial precarity. Racism and xenophobia can make the time one waits for equitable and humane medical treatment interminable. Time spent away from one’s small children due to an exposure; time spent away from one’s beloved in hospital; time spent asking one’s body to perform tasks that used to come easily; time spent waiting for a referral to a specialist to study a little-known symptom: these minutes, hours and days are agonisingly slow. Trauma and post-traumatic stress disorder can cause someone to revisit the same time again and again, compounded by lack of widespread understanding and acknowledgement of one’s illness.

Our temporalities are acutely distinct, and also shared; fractured, and also continuous. Historically important, but not yet historical. The disease is both personally isolating, and creates global interconnection, as patients read others’ narratives from Italy, China or New York online, predicting what might be their future symptoms. Stories from the COVID-19 pandemic reflect this unique temporality: they capture something of the world in which they occurred, emerging as photo essays, texts, vlogs, Facebook posts, Tweets, scraps of paper slid under the door within a shared household, or notes written by practitioners on the glass separating a hospitalised patient from the hallway.

Some of the first overtures at narrating hospitalised patients with COVID-19 suffering were performed by their healthcare practitioners. Rafael Campo, a poet and medical internist, has spoken about the challenge of communicating with and hearing the stories of severely sick patients with COVID-19. He says “some patients living with this disease are literally silenced. When that tube goes in someone’s throat to support their breathing, it physically takes away the voice” ( Gibson 2020 ). In response, he has turned to writing poetry as “a kind of a channel for some of the experiences that I’m having and that we’re having”. He says that healthcare practitioners’ writing can “shed light on what people are actually experiencing who have this illness and who are dying from it and who don’t have that voice, which is so necessary for us to hear”.

In his poem-in-draft ‘The Doctor’s Song’, Campo incorporates some of the foregoing imagery in the first few lines: ‘The ventilator’s rise and fall/The yellow gown’s swish down the hall’. These are markers of embodied time: one imagines oneself in the setting of the hospital, seeing the rhythm of the ventilator and hearing the sound of the gowns. It is implied that these are repeated, ongoing sounds. Even while an individual’s case comes to a crisis, leading to discharge or death, the healthcare practitioner’s experience is of inexorable time, where case after case succeeds the other. Campo captures the doctor’s own frustration:

The stethoscope won’t be an instrument of hope: It merely amplifies the gallop, makes audible the broken heart.

The space that a poem creates between each line emphasises the gaps in the doctor’s knowledge. The speaker’s stethoscope amplifies the patient’s ‘broken heart’, but also, by implication, the doctor’s own, facing that which cannot be controlled.

In a poem about cardiac and respiratory symptoms, the poem as a form also makes us mindful of these symptoms through our embodied reading. We breathe in the pauses between lines, or feel the scansion’s echo in the rhythm of our own heartbeats. Finally, with the line ‘The Doctor’s Song is not heroic’, Campo undercuts the expectation that doctors’ heroism in the face of a pandemic should be the focus of COVID-19 narration. From the comment in Campo’s interview that his patients are ‘silenced’, one assumes he agrees that it is important to hear more stories by patients themselves.

Therefore, in addition to literary works like poetry, first-person narratives of COVID-19 illness are necessary to understand the ongoing and debilitating temporality of the disease. The following narratives were collected under a grant-funded, cross-disciplinary oral history project titled ‘Global Health and the Humanities’ (IRB2018-1513M). My collaborators included Violet Showers Johnson and Laura Dague, as well as graduate researcher Michelle Yeoman and undergraduate assistant Trinity Buchanan. We are following the Oral History Association ethical guidelines, including gathering informed consent, performing advance training for interviewers, including diverse voices, using open-ended questioning methods within interviews, recording and transcribing the oral histories, identifying an open-access repository for anonymised transcripts, and making research publications available to interviewees ( https://www.oralhistory.org/oha-statement-on-ethics/ ). Oral histories were conducted from 2018 to 2019 with participants in Sierra Leone and Sierra Leonean diasporic communities in Dallas, Texas. These interviewees were asked questions about their experiences with the 2014–2016 Ebola outbreak in West Africa and with endemic malaria.

The follow-on project included COVID-19 oral histories collected via an online video conferencing platform, with subjects based across the USA. Future research outputs will engage from a comparative perspective the role of oral histories in illuminating global health crises. However, for the purpose of this article, only the COVID-19 oral histories are excerpted and analysed. Participants for these interviews were recruited using social media networks and posting boards related to COVID-19, and selected to represent diversity of perspectives. All excerpts used in publication are anonymised to the level that the participant should not be identifiable. Readers who have certain first-hand experiences of COVID-19 may find the following descriptions difficult to read. If a reader were to wish to avoid this section, the conclusion to this article’s argument appears with the paragraph beginning ‘Often, psychology’.

First, SurvivorCorps Facebook Group Posts (2020) provide a platform for patient advocacy and social justice work. They also provide an opportunity to study how illness narratives of chronic debility can be used as a form of protest against those who might suggest that falling numbers marks a tapering off of the pandemic’s human impact ( SurviviorCorps ). As ‘a grassroots solution-based movement’, the online support group SurvivorCorps seeks ‘to mobilise the sharply increasing number of people affected by COVID-19 to come together, support and participate in the medical and scientific research community efforts’. The Facebook group is open membership, which means that anyone can join and post. It provides a venue for those who have never received formal medical treatment to commiserate, and for those who have received medical treatment to compare diagnoses and interventions. Members post pictures and ask questions about their own symptoms, drawing on the shared knowledge of the group; they post one-line or two-line obituaries of loved ones who have died. The moderator publicises survivors’ interviews in news outlets and opportunities for members to participate in academic research studies. As the public group grows and gains more recognition, the experiences shared by this group are also driving science and social science policy and research. Punctuation and spelling have been kept verbatim in the examples that follow.

‘Long COVID’ sufferers use the forum to validate each-others’ experiences, using a form of collective as well as individual story-telling. They are co-constituting a narrative of chronic illness within a sociohistorical context that instead encourages closure and healing. One of the methods through which they do this is by stating how long their symptoms have persisted at the beginning of their narratives. One poster writes, “I was a firefighter/paramedic at the time of infection. I am on day 130. I have a collapsed lung—was never hospitalised, and have experienced about 70 symptoms” ( SurvivorCorps Facebook Group Posts 2020 ).

Many posters document their difficulty receiving proper treatment. One poster received a false negative test, and spent months suffering without adequate medical support: “after 4 lung x-rays 3 EKGs and 3 C Scans, and one new primary Doctor later… visit to a lung specialist…it was determined that the negative COVID-19 test administered was a false negative…next step for me a scheduled Bronchoscopy which allows doctor to visualize scar tissue and nodules that have formed in my lungs” ( SurvivorCorps Facebook Group Posts 2020 ). Another says that when she started feeling ill she “called my doctor’s office and they said I should be given a test because of my asthma and to call the walk in. I called, was asked a bunch of questions, and told i didn’t qualify”. A final poster shares, “I have not been able to receive any medical care due to lack of belief and insurance and workers comp issues”. For some of these individuals, a timeline of COVID-19 illness never officially ‘began’ on their medical records. Their stories are only available in private diaries and through social media. In order to provide ongoing treatment, their future practitioners will need to piece together a health history invisible to digital patient charts and laboratory results. This process of recreation will be a narrative one, whereby patients craft their own timeline and causality in reporting the long-term impact of their illness. Finally, the number of long COVID-19 survivors who are uninsured or underinsured needs further investigation—oftentimes these sufferers may have avoided hospitalisation and tried to cope at home. This economic inequality directly impacts how the data about their suffering, whether medical or narrative, will be accessed and analysed in the future.

Common descriptions emerge across narratives, which capture the cyclical and inexorable temporality of illness with COVID-19. Specifically, many call the illness a rollercoaster, with the associations of a frightening and unexpected ride that ends up where one began. On a roller coaster, emotions are intensified, but movement is circular. A further example reads, “107 days later I still continue to fight off this horrific rollercoaster of a virus. This virus is relentless…” ( SurvivorCorps Facebook Group Posts 2020 ). Many keep a log or journal of exactly how many days they have been sick. Another poster is still suffering after 4 months: “It was a roller coaster for about 2 weeks in isolation of my room”. A final poster says, “Hi, I am ___ and I have been riding the Coranacoaster for 16 straight weeks”.

Taken together, the ‘long haulers’’ experiences are being studied as emerging medical knowledge. Neurological and psychiatric symptoms, less well understood by the medical community, are being documented by symptom surveys based on members’ experiences ( Lambert, Natalie and SurvivorCorps 2020 ). Some symptoms, like hair loss and sadness, were not previously represented on the CDC list. These posts are also developing a new lexicon for illness narratives. Metaphors such as ‘coronacoaster’, as well as precise physical descriptions, offer their fellow sufferers, as well as interested readers, a new way to understand the lived experience of the disease.

Although this creation of new knowledge and community is a mobilising and unifying experience for many members, some are also experiencing mental distress from not feeling supported adequately medically or not understood within wider discussions of the disease. They express a drastic shift in physical ability and sometimes feeling alienated from their pre-COVID identity. One poster says, “I feel like I’ll never be the same again” and another says, “I’m praying that we all eventually make it back to who we were before this”. Notable is the language of identification—not I’ll never feel the same again but I’ll never be the same again; not we can make it back to where we were (in terms of lifestyle) before this but to who we were.

This demonstrates what chronic illness scholars have pointed out is a risk in terms of a balance between one’s ambition for one’s life and one’s daily ability: ‘The tension within the experience of chronic conditions lies in the uncertainty whether this separation or alienation [with the world one inhabited before] can be reduced’ ( Barnard 1995, 42 ). Added to the uncertainty inherent in all chronic illnesses is the extra uncertainty for COVID-19 survivors because they are infected with or recovering from a disease about which much is still unknown. However, scholars of chronic illness and literature also have pointed towards the creative potential offered when authors create a ‘chronic poetics’. Hillary Gravendyk claims that chronic poetics provides a mode through which the reader co-constitutes meaning with the text. She defines chronic poetics as the ‘perception and artistic practice that allows the shared conditions of embodiment to emerge from the text’ (cited in Day 2017, 95 ), especially the work’s focus on ‘simultaneity, chronicity, duration and other forms of embodied perception’ ( Day 2017, 95 ).

Online forums and groups provide a particularly promising avenue to study COVID-19 narratives, because the real-time and communal nature of the storytelling that occurs in these settings can capture the temporality of pain in new and multifaceted ways. Social media can make pain visible, by incorporating photos, screen shots and condensed stories; it also creates ‘networks of voices engaging and reinterpreting pain’ through ‘multimodal communications’ ( Gonzalez-Polledo and Tarr 2014, 1467 ). In the process of ‘sharing pain experiences and meanings’, participants create new kinds of storytelling, where the ‘teller and audience’ meet within the story. Thus, ‘new forms of patient expertise emerge through communicating about chronic illness online’. As the SurvivorCorps community demonstrates, patients can use storytelling (and information sharing, and grassroots campaigning) to exercise ‘transformative agency’ to affect “not only their own health care, but also the quality of health care for others” ( Hinson and Sword 2019, 106 ).

This article began by introducing, and then intentionally revising, a ‘global’, or ‘public health’ chronology of the SARS-CoV-2 pandemic, to show the constant changes in our current temporality. It then created a framework for analysis of temporal innovations in pandemic literature by analysing examples from late-20th-century-postcolonial and speculative fiction. This final section has examined online COVID-19 narratives from 2020, and now turns to very recently gathered and transcribed oral histories from October 2021. Articles have their own internal chrono-logic. By ending with these recent oral histories, I am both introducing emerging original Health Humanities research, as well as illustrating the ongoingness of COVID-19 survivors’ own stories. Specifically, the genre of recorded and transcribed oral history offers unique opportunities to understand the stories of COVID-19 as full of nuance and multiplicity. Oral histories are digressive and capacious narratives, originating before editing and streamlining have imposed a chronology of illness. Interviewees return to a specific moment of significance multiple times; their stories wind through and around difficult experiences. Audio recordings include the patter of conversation that one engages in to feel at ease. They also show the mundane temporality of chronic illness as it impacts daily life.

The extracts that follow are from an interview with a middle-aged father and former army medic, who was working in a prison when he contracted COVID-19. He was hospitalised from October 2020 through January 2021, and is seeking medical retirement due to the ongoing physical effects of his illness. When asked if he could think of one moment that illustrates living during the time of COVID-19, ‘B’ (alias) responds with a historically significant mortality marker before turning to a brief encapsulation of his own illness. The interviewee first says, “we just surpassed the deaths for the Spanish flu, which is just crazy” ("B. Interview," Global Health and the Humanities project, 2021). Both this marker, as well as his narrative of symptoms that follows, stresses the ongoing nature of the pandemic, in both its national and personal impact. B explains,

So for the rest of my life, I’m going to be dealing with permanent issues, including pulmonary fibrosis, scar[s] on my heart. I had a heart attack during my period when I was in my medication-induced coma. I have vision loss. I have to wear glasses now, prior to COVID, I had 20/15, 20/20 vision. So I have to wear actually prism glasses because my balance was affected. Also, I have significant memory loss, short- and long-term memory loss. ("B. Interview," Global Health and the Humanities project, 2021)

This list is matter-of-fact and declarative. However, timing shifts between past crises (“I had a heart attack”), present condition (“I have vision loss”) and future predictions (“for the rest of my life”). The final sentence, regarding B’s memory loss, implies what an effort it may be to deal with the physical symptoms, and to recall and organise these symptoms into a recognisable order. The embodied effort of telling a story—the mental exhaustion, thirst and sadness that come with the telling—are integral to the texture of this recording. Temporal layering and fragmentation are part of the unique quality of COVID-19 storytelling.

B’s story is interrupted at one point when the sensory memory and trauma of his extended hospitalisation causes him to be overcome with emotion. His story is a necessary companion to Rafael Campo’s poem. While the doctors treating patients with COVID-19 may be wrestling with uncertainty and loss as they see the rhythmic rise and fall of the ventilator, it becomes apparent that for at least some of their patients, the sensory memories of the hospital’s temporal rhythm (especially procedures done repeatedly) are not rhythmic but intrusive and traumatic. B says,

I have a lot of problems with … I recently had to go into the emergency room for chest pain…When I got there, there were many triggers that occurred when I was there. So be it the smell of the deodorizer disinfectant cleaner that they use on the floor to the fluorescent lights, to the Hoyer lift that was above me, that they used to have to transfer me when I couldn’t move, when I was bedridden. All those things came back to me and I’m sorry, I… Interviewer: No, please. Yeah. Take your time and I understand, this is difficult. BB: It still affects me emotionally.

This transcript shows a dialogue that unfolded as a lived conversation via Zoom. Therefore, in reading it, one is immersed in the temporality of the interview: not the same temporality as the recording, but an individual reading of that temporality as reflected in text. When B breaks off, it is a temporal as well as spatial break for the reader. However, one does not know if the pause was 3 seconds or 3 minutes. Therefore, one does not know how long to hold one’s breath out of concern for the speaker’s well-being. Perhaps our eyes need to leave the page for a moment. Perhaps our heartbeats quicken. The next line, “it still affects me emotionally,” registers as a thunderclap through its very understatement. These are just some possible embodied responses to reading—however, they are meant to suggest that it will be important to reproduce first-person narratives of COVID-19 illness in their original form. One must be attuned to the way the genre influences how one reads, and to how one’s own embeddedness in this moment influences interpretation.

Often, psychology and brain sciences presuppose that trauma disrupts the teller’s access to ‘natural’ narrative ordering: ‘an essential dimension of psychological trauma is the breaking up of the unifying thread of temporality’ ( Stolorow 2003, 158 ). However, postmodern and postcolonial criticism, as previously demonstrated, offer us the possibility that time is co-constituted between physical and cultural realities. Narrative shows us, not the ‘reality’ of a universal time, but how disparate one person’s experience of lived time can be to another’s. That is to say, the same chronological time of hospital staff, organised by shift changes, regular cleaning of the floors and daily functions performed for the patient’s body, are registered by the patient’s subjectivity as acutely traumatic and recursive time.

More work needs to be done understanding COVID-19 survivors’ experiences from a disability studies perspective. Rebecca Garden argues that ‘narrative, particularly first-person accounts, provide a critical resource by representing the point of view of people with disabilities and by offering a means of examining the social context and social determinants of disability’ ( Garden 2010, 70 ). One goal of disability studies is increased accessibility for disabled persons. Accommodating disabled and chronically ill ‘long haulers’ may mean reconfiguring our understanding of the pervasiveness of chronic COVID-19, and encouraging communities to understand these long-term effects.

One of the challenges of oral history and auto/biographical scholarship is discussing the import of others’ experiences in terms they have not used themselves. Not all posters or interviewees cited herein associate themselves with antiracist or disability rights activism. Instead, this article means to use critical oral history in order open up analytical frameworks useful to analyse the emerging stories of COVID-19, making space for the multiplicity of these speakers’ own experiences. This is an important intervention, as many of the patient stories thus far have been curated by the organisation publishing them—whether this is a public health organisation using the story for educational purposes, or a hospital advertising the quality of its care. For example, a story titled ‘Grateful to be Alive’ represents the experience of Ernesto Castro, a patient at UC Health, Greeley, Colorado. Castro’s experience is framed using illness narrative clichés such as “he fought for his life”. The article stresses the heroic nature of the hospital workers (“Health workers greeted him and jumped into action”). His interviewer encouraged a specific kind of testimonial storytelling, so that when he is directly quoted it is to commend his practitioners: “If it wasn’t for the UC Health staff, I don’t think I’d be here” ( UC Health 2020 ).

Postcolonial and disability studies can help one to focus on the lack of health access and health inequity during a time of pandemic, and to help us to envision radical new ways of storytelling that do not impose closure on narratives of illness with COVID-19. Health Humanities scholarship regarding chronic pain and chronic illness narratives demonstrates the importance of cultivating an aesthetic appreciation for non-linear or fragmented narrative structures. In uniting these approaches, the project is to create discursive space, and interpretive flexibility, around these narratives. By so doing, one may help resist their instrumentalisation within medical or nationalist discourse.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

Texas A&M University IRB2018-1513M. Participants gave informed consent to participate in the study before taking part.

Acknowledgments

The author acknowledges the contribution of the Global Health and the Humanities oral history project collaborators and interviewees for collecting the oral histories. Thanks to Violet Showers Johnson, Laura Dague, Michelle Yeoman, Trinity Buchanan, Lise Saffran and the oral history interviewees who shared their stories.

1. For more on the cultural values of endemic and epidemic disease in narrative, see The Endemic Pandemic by Larsen (2020) and Endemic: Essays in Contagion Theory by Nixon and Servitje (2016) . Specifically, Nixon and Servitje claim that “Epidemic discourse so thoroughly structures our world that it is endemic to our processes of social construction” (2).

2. We may assume, based on Western norms of storytelling, that human subjects seek to unify their sense of self through narrative. However, as Angela Woods has demonstrated, some of us do not have ‘the propensity or orientation towards narrativity: the feeling of deep psychological continuity with one’s past self, married with the desire to frame experience, tell stories and revise the past’ ( Woods 2011, 73 ).

3. Rosemary Jolly has pointed towards the importance of self-questioning in memoirs by Western subjects: the doctor-writer’s misunderstanding, she suggests, demonstrates the ‘limits of colonial diagnostic knowledge’ and ‘works against the narrator-as-doctor enacting the colonialist fantasy of remedying, or ministering to, the chronically ill indigenous subject’ ( Jolly 2016, 528 ). These works make visible in a specific way how colonialist medical practices do harm.

4. For more on medical experimentation in colonial settings, see Africa as Living Laboratory by Tilley (2011) and Bacteriology in British India: Laboratory Medicine and the Tropics by Chakravarty (2012) .

5. Recently, Elaine Freedgood also questions our assumptions about 19th century realism. Freedgood suggests that our perceptions of this literary past rests on post-1970s aesthetic valuation and that we thereby overlook 19th century novels’ ‘oddness’. She also questions the ‘aesthetic racism’ that has valued realism in the novel ( Freedgood 2019 ).

6. ‘The logics of dispossession and elimination, which are key tenets of a settler colonial model, were not isolated to British imperialism; they were also central to Spanish and Portuguese imperial projects’ ( Castellanos 2017, 778 ).

7. Rishi Goyal’s recent work stresses how the label of healthcare workers as ‘heroes’ serves to distract from the ‘deep institutional betrayal’ they were subjected (inadequate supplies, protections and support) during the pandemic ( Goyal 2020 ).

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Contributors JH is the sole author.

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

Competing interests None declared.

Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the 'Methods' section for further details.

Provenance and peer review Not commissioned; externally peer reviewed.

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Together Again: Personal Narratives of COVID-19 Uniting the Seton Hall Community

Together Again: Personal Narratives of COVID-19 Uniting the Seton Hall Community

The COVID-19 pandemic has disrupted life at Seton Hall as it has for millions of others around the country and the world. In the name of saving lives, the social distancing needed to slow the spread of the virus has scattered us into our homes around the region and the country. Although we are now physically distant from one another, we remain united as Setonians through our connection to Seton Hall.

To reconnect as a community, we seek your stories of what this time has been like for you. How has it changed your experience at Seton Hall, as a student, faculty, staff member, or alum? We hope that sharing these stories with one another will bring us back together in a new way, through sharing our personal experiences of this moment. When we move forward, because there will be a time when we move forward, we plan to listen to these stories together as a community, reflect on what we have learned, and let them guide us into the future.

Questions to guide your response:

● What is your day to day life like? What would you want people the future to know about what life is like for us now?

● What has been most challenging about this time? What do you miss about your life before COVID-19? Are there specific places or things on campus that you miss?

● Essential is a word we are hearing a lot right now. What does essential mean to you? Who is essential? What are we learning about what is essential?

● What is COVID-19 making possible that never existed before? What good do you see coming out of this moment? How can we re-frame this moment as an opportunity?

● What is it you want to remember about this time? What have you learned?

● After this pandemic ends, will things go back to the way they were? What kinds of changes would you like to see? How will you contribute to rebuilding the world? What will you do differently?

Please submit your 1-3 minute audio or video recording to our portal. Please view submission instructions.

Need an Accessible transcript of this submission? Please email [email protected] to request.

With thanks to the scholars and librarians who came together to create this project: Professors Angela Kariotis Kotsonis, Sharon Ince, Marta Deyrup, Lisa DeLuca, and Alan Delozier, Technical Services Archivist Sheridan Sayles and Assistant Deans Elizabeth Leonard and Sarah Ponichtera.

COVID19: How it Has Changed Our Lives by Anirudh Ramesh

COVID19: How it Has Changed Our Lives

Anirudh Ramesh

sentiments during the pandemic by Amanda DeJesus

sentiments during the pandemic

Amanda DeJesus

Covid-19 experience by Cole Corregano

Covid-19 experience

Cole Corregano

George's Quarantine Experience by George K. Waweru

George's Quarantine Experience

George K. Waweru

Personal COVID-19 submission by Tyler Abline

Personal COVID-19 submission

Tyler Abline

COVID-19 Personal Narrative-Andrew by Andrew Tiess

COVID-19 Personal Narrative-Andrew

Andrew Tiess

Time Capsule by Eric Sweeney

Time Capsule

Eric Sweeney

COVID-19 by Samuel Perez

Samuel Perez

View from the front door by Nicholas Shraga

View from the front door

Nicholas Shraga

Nick's COVID experience by Nicholas DeMizio

Nick's COVID experience

Nicholas DeMizio

Redefining the Essential by Blake Harrsch

Redefining the Essential

Blake Harrsch

COVID-19 Experience by Samantha Vail

COVID-19 Experience

Samantha Vail

My COVID-19 Experience by Stephanie Wickman

My COVID-19 Experience

Stephanie Wickman

covid-19 reconnection video by Robert Caola

covid-19 reconnection video

Robert Caola

Liem Pham's COVID-19 Audio Message by Liem Pham

Liem Pham's COVID-19 Audio Message

Solidarity by Michael Turiansky

Michael Turiansky

Pandemic Update: Extra Credit, Peer Upload for Gennarino Conzemius by Arianna Braccio

Pandemic Update: Extra Credit, Peer Upload for Gennarino Conzemius

Arianna Braccio

COVID-19 by Shawnessy Earle

Shawnessy Earle

Covid-19 by Abigail Graham

Abigail Graham

COVID-19 by Aurelio Licata

Aurelio Licata

Missing Life Before the Pandemic by Victoria Saniko

Missing Life Before the Pandemic

Victoria Saniko

The collective cannot be ignored by Kaitlynn Chaljub

The collective cannot be ignored

Kaitlynn Chaljub

Life with Covid 19 by Viktoria Olowski

Life with Covid 19

Viktoria Olowski

Alex's Corona Lifestyle by Alexandra H. Dittmar

Alex's Corona Lifestyle

Alexandra H. Dittmar

Choosing Selflessness in Times of Crisis by Jacob M. Barnoski

Choosing Selflessness in Times of Crisis

Jacob M. Barnoski

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Persuasive Essay Guide

Persuasive Essay About Covid19

Caleb S.

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

11 min read

Persuasive Essay About Covid19

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Are you looking to write a persuasive essay about the Covid-19 pandemic?

Writing a compelling and informative essay about this global crisis can be challenging. It requires researching the latest information, understanding the facts, and presenting your argument persuasively.

But don’t worry! with some guidance from experts, you’ll be able to write an effective and persuasive essay about Covid-19.

In this blog post, we’ll outline the basics of writing a persuasive essay . We’ll provide clear examples, helpful tips, and essential information for crafting your own persuasive piece on Covid-19.

Read on to get started on your essay.

Arrow Down

  • 1. Steps to Write a Persuasive Essay About Covid-19
  • 2. Examples of Persuasive Essay About Covid19
  • 3. Examples of Persuasive Essay About Covid-19 Vaccine
  • 4. Examples of Persuasive Essay About Covid-19 Integration
  • 5. Examples of Argumentative Essay About Covid 19
  • 6. Examples of Persuasive Speeches About Covid-19
  • 7. Tips to Write a Persuasive Essay About Covid-19
  • 8. Common Topics for a Persuasive Essay on COVID-19 

Steps to Write a Persuasive Essay About Covid-19

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

Step 1: Choose a Specific Thesis Statement

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

Step 2: Research and Gather Information

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

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

Step 3: Outline Your Essay

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

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

Step 4: Write the Introduction

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

Step 5: Provide Background Information

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

Step 6: Develop Body Paragraphs

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

Step 7: Address Counterarguments

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

Step 8: Write the Conclusion

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

Step 9: Revise and Proofread

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

Step 10: Cite Your Sources

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

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

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Examples of Persuasive Essay About Covid19

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

Check out some more PDF examples below:

Persuasive Essay About Covid-19 Pandemic

Sample Of Persuasive Essay About Covid-19

Persuasive Essay About Covid-19 In The Philippines - Example

If you're in search of a compelling persuasive essay on business, don't miss out on our “ persuasive essay about business ” blog!

Examples of Persuasive Essay About Covid-19 Vaccine

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

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

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

Covid19 Vaccine Persuasive Essay

Persuasive Essay on Covid Vaccines

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

Examples of Persuasive Essay About Covid-19 Integration

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

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

Persuasive Essay About Working From Home During Covid19

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

Examples of Argumentative Essay About Covid 19

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

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

Here are some examples of argumentative essays on Covid19.

Argumentative Essay About Covid19 Sample

Argumentative Essay About Covid19 With Introduction Body and Conclusion

Looking for a persuasive take on the topic of smoking? You'll find it all related arguments in out Persuasive Essay About Smoking blog!

Examples of Persuasive Speeches About Covid-19

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

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

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

Persuasive Speech About Covid-19 Example

Persuasive Speech About Vaccine For Covid-19

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

Tips to Write a Persuasive Essay About Covid-19

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

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

Choose a Specific Angle

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

Provide Credible Sources 

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

Use Persuasive Language

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

Organize Your Essay

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

Emphasize Benefits

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

Use Visuals -H3

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

Call to Action

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

Revise and Edit

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

Seek Feedback 

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

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Common Topics for a Persuasive Essay on COVID-19 

Here are some persuasive essay topics on COVID-19:

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

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

To sum it up,

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

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

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

So don't hesitate and get in touch with our persuasive essay writing service today!

Frequently Asked Questions

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

FAQ Icon

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

What impact does COVID-19 have on society?

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

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Keep reading

Persuasive Essay

COVID-19 narratives and layered temporality

Affiliation.

  • 1 English, Texas A&M University, College Station, Texas, USA [email protected].
  • PMID: 35584895
  • DOI: 10.1136/medhum-2021-012258

The essay outlines the ways in which narrative approaches to COVID-19 can draw on imaginative literature and critical oral history to resist the 'closure' often offered by cultural representations of epidemics. To support this goal, it analyses science and speculative fiction by Alejandro Morales and Tananarive Due in terms of how these works create alternative temporalities, which undermine colonial and racist medical discourse. The essay then examines a new archive of emerging autobiographical illness narratives, namely online Facebook posts and oral history samples by 'long COVID' survivors, for their alternate temporalities of illness.

Keywords: COVID-19; history; literature and medicine; medical humanities; patient narratives.

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

  • COVID-19* / complications
  • Post-Acute COVID-19 Syndrome

NPR suspends senior editor Uri Berliner after essay accusing outlet of liberal bias

Npr suspended senior editor uri berliner a week after he authored an online essay accusing the outlet of allowing liberal bias in its coverage..

narrative essay topic on covid 19

NPR has suspended a senior editor who authored an essay published last week on an online news site in which he argued that the network had "lost America's trust" because of a liberal bias in its coverage, the outlet reported.

Uri Berliner was suspended Friday for five days without pay, NPR reported Tuesday . The revelation came exactly a week after Berliner publicly claimed in an essay for The Free Press, an online news publication, that NPR had allowed a "liberal bent" to influence its coverage, causing the outlet to steadily lose credibility with audiences.

The essay reignited the criticism that many prominent conservatives have long leveled against NPR and prompted newsroom leadership to implement monthly internal reviews of the network's coverage, NPR reported. Berliner's essay also angered many of his colleagues and exposed NPR's new chief executive Katherine Maher to a string of attacks from conservatives over her past social media posts.

In a statement Monday to NPR, Maher refuted Berliner's claims by underscoring NPR's commitment to objective coverage of national issues.

"In America everyone is entitled to free speech as a private citizen," Maher said. "What matters is NPR's work and my commitment as its CEO: public service, editorial independence, and the mission to serve all of the American public. NPR is independent, beholden to no party, and without commercial interests."

Heat exposure law: Florida joins Texas in banning local heat protections for outdoor workers

Berliner rails against NPR's coverage of COVID-19, diversity efforts

Berliner, a senior business editor who has worked at NPR for 25 years, argued in the Free Press essay that “people at every level of NPR have comfortably coalesced around the progressive worldview.”

While he claimed that NPR has always had a "liberal bent" ever since he was hired at the outlet, he wrote that it has since lost its "open-minded spirit," and, hence, "an audience that reflects America."

The Peabody Award-winning journalist highlighted what he viewed as examples of the network's partisan coverage of several major news events, including the origins of COVID-19 and the war in Gaza . Berliner also lambasted NPR's diversity, equity and inclusion (DEI) policies – as reflected both within its newsroom and in its coverage – as making race and identity "paramount in nearly every aspect of the workplace.”

"All this reflected a broader movement in the culture of people clustering together based on ideology or a characteristic of birth," he wrote.

Uri Berliner's essay fuels conservative attacks on NPR

In response to the essay, many prominent conservatives and Republicans, including former President Donald Trump, launched renewed attacks at NPR for what they perceive as partisan coverage.

Conservative activist Christopher Rufo in particular targeted Maher for messages she posted to social media years before joining the network – her  first at a news organization . Among the posts singled out were  a 2020 tweet that called Trump racist .

Trump reiterated on his social media platform, Truth Social, his longstanding argument that NPR’s government funding should be rescinded.

NPR issues formal rebuke to Berliner

Berliner provided an NPR reporter with a copy of the formal rebuke for review in which the organization told the editor he had not been approved to write for other news outlets, as is required of NPR journalists.

NPR also said he publicly released confidential proprietary information about audience demographics, the outlet reported.

Leadership said the letter was a "final warning" for Berliner, who would be fired for future violations of NPR's policies, according to NPR's reporting. Berliner, who is a dues-paying member of NPR's newsroom union, told the NPR reporter that he is not appealing the punishment.

A spokeswoman for NPR said the outlet declined to comment on Berliner's essay or the news of his suspension when reached Tuesday by USA TODAY.

"NPR does not comment on individual personnel matters, including discipline," according to the statement. "We expect all of our employees to comply with NPR policies and procedures, which for our editorial staff includes the NPR Ethics Handbook ."

NPR staffer express dismay; leadership puts coverage reviews in place

According to the NPR article, Berliner's essay also invoked the ire of many of his colleagues and the reporters whose stories he would be responsible for editing.

"Newsrooms run on trust," NPR political correspondent Danielle Kurtzleben said in a post last week on social media site X, though he didn't mention Berliner by name. "If you violate everyone's trust by going to another outlet and [expletive] on your colleagues (while doing a bad job journalistically, for that matter), I don't know how you do your job now."

Amid the fallout, NPR reported that NPR's chief news executive Edith Chapin announced to the newsroom late Monday afternoon that Executive Editor Eva Rodriguez would lead monthly meetings to review coverage.

Berliner expressed no regrets about publishing the essay in an interview with NPR, adding that he tried repeatedly to make his concerns over NPR's coverage known to news leaders.

"I love NPR and feel it's a national trust," Berliner says. "We have great journalists here. If they shed their opinions and did the great journalism they're capable of, this would be a much more interesting and fulfilling organization for our listeners."

Eric Lagatta covers breaking and trending news for USA TODAY. Reach him at [email protected]

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Effects of Narrative Messages on Key COVID-19 Protective Responses: Findings From a Randomized Online Experiment

Irina a. iles.

1 National Cancer Institute, Rockville, MD, USA

Anna Gaysynsky

Wen-ying sylvia chou.

2 ICF International Office

We investigated the effectiveness of narrative vs non-narrative messages in changing COVID-19-related perceptions and intentions.

Design/Setting

The study employed a between-subjects two-group (narratives vs non-narratives) experimental design and was administered online.

Subjects/Intervention

1804 U.S. adults recruited via Amazon MTurk in September 2020 were randomly assigned to one of two experimental conditions and read either three narrative or three non-narrative messages about social distancing, vaccination, and unproven treatments.

Perceptions and intentions were assessed before and after message exposure (7-point scales).

Using multivariable regression, we assessed main effects of the experimental condition (controlling for baseline measures) and interactions between the condition and pre-exposure perceptions/intentions in predicting post-exposure outcomes.

Compared to non-narratives, narratives led to (1) less positive perceptions about the benefits of unproven treatments ( M narrative = 3.60, M non-narrative = 3.77, P = .007); and (2) less willingness to receive an unproven drug ( M narrative = 3.46, M non-narrative = 3.77, P < .001); this effect was stronger among individuals with higher baseline willingness to receive unproven drugs (baseline willingness = 2.09: b = −.06, P = .461; baseline willingness = 3.90: b = −.30, P < .001; baseline willingness = 5.71: b = −.55, P < .001). Narratives also led to more positive perceptions of vaccine safety/effectiveness, but only among individuals with lower baseline vaccine perceptions (baseline perceptions = 4.51: b = .10, P = .008; baseline perceptions = 5.89: b = .04, P = .167; baseline perceptions = 7: b = −.01, P = .688).

Narratives are a promising communication strategy, particularly for topics where views are not entrenched and among individuals who are more resistant to recommendations.

From the outset, the course of the COVID-19 pandemic has depended on large-scale behavior change at the population level 1 : slowing the spread of COVID-19 requires individuals to engage in behaviors like mask wearing and social distancing, while bringing the pandemic fully under control depends on individuals receiving vaccines. However, certain segments of the public have been resistant to following recommended protective behaviors. 2 Insufficient adoption of evidence-based behaviors has been aggravated by unprecedented misinformation and politicization surrounding the coronavirus. 3 , 4 Therefore, there is an urgent need for more effective public health communication that encourages individuals to adopt protective health behaviors and prevents them from taking potentially harmful actions. We designed a study to examine the ability of narrative messages (or short personal stories) to improve perceptions and intentions related to recommended health behaviors in the context of COVID-19.

The COVID-19 pandemic poses many unique challenges to public health that necessitate a re-evaluation of existing health communication approaches. The pandemic is occurring at a time when many people report eroding trust in social institutions and experts, 5 , 6 which may increase resistance toward following public health recommendations from sources of authority. 7 Resistance to health messages is not new, but it has been heightened in the context of COVID-19, with some groups arguing that public health directives adopted during the pandemic, like those requiring social distancing or mask wearing, violate their rights. 8 , 9 Another key challenge in communicating about COVID-19 is that rumors and falsehoods about this pandemic, from the severity of the disease to potential treatments, have circulated on social media since COVID-19 emerged. 10 Although misinformation is not a novel phenomenon, the speed and scale at which it spreads in the digital era clearly poses a new challenge to public health response, and strategies to counter its effects are needed.

While unique in some ways, the COVID-19 pandemic also shares features with other public health crises that create communication challenges. Specifically, crises are often characterized by high uncertainty and strong negative emotions, 11 which can impact risk perceptions and attitudes toward recommended behaviors. 12 Further, when people feel threatened, they may experience “mental noise” that can impair information-processing, decision-making, and other key cognitive processes, rendering traditional communication approaches ineffective. 11 Therefore, communication efforts that solely focus on relaying facts and data based on the assumption that people will make rational decisions in response to this information may fall short. 12

Narrative-based messages conveying personal experience could be a potentially effective alternative approach. A narrative is a “representation of connected events and characters that has an identifiable structure, is bounded in space and time, and contains implicit or explicit messages about the topic being addressed”. 13 (p. 222) Research across a variety of health topics suggests that conveying health information through personal experience narratives is a more effective way to motivate and support behavior change than communicating facts and statistics. 14 - 16

Narratives may also be particularly well-suited to relaying information about the COVID-19 pandemic for several reasons. First, narratives inhibit reactance because they are less likely to be recognized as a persuasive attempt 17 , 18 , which may make narratives particularly effective in the context of a pandemic characterized by unusual resistance to public health guidance. Second, studies have found that information provided in narrative form is better retrieved than information provided in other formats, 19 which suggests that narrative messages could help individuals process and retain information during a crisis. Finally, narratives may also be effective in correcting misinformation by replacing misbeliefs about COVID-19. Individuals need mental coherence and causal explanations for events. When such coherence is lacking (such as when scientific knowledge about an emerging disease is limited), individuals tend to adopt what information is available, regardless of its accuracy, to complete their mental models of events. 20 These models are difficult to update via simple provision of facts, 21 partially because people are resistant to being told what to do or how to think. 22 Thus, it is possible that by reducing overall resistance to the information in a message, narratives may be distinctly effective at helping individuals update inaccurate mental models.

To date, limited research has examined the effectiveness of narratives in the context of pandemics, and existing studies have shown mixed results. 23 - 25 Bekalu et al 23 found a narrative video clip to be less effective than a non-narrative video in increasing knowledge and perceived response efficacy related to the prevention of pandemic influenza. Similarly, Kuru et al 24 compared the effectiveness of pro-MMR vaccine narratives to expert pro-vaccine science messages containing statistical information and found that the informational message outperformed the narrative one. However, narratives may prove more effective in the context of COVID-19 due to potentially greater resistance to COVID-19 messages, and the novelty of the COVID-19 vaccine compared to MMR/flu vaccines. For example, a recent study found that viewing a visual narrative course on the disease and how to protect oneself was associated with improved self-efficacy and behavioral intentions toward COVID-19 disease prevention (compared to a control course about sleep). 25

To test the effectiveness of narratives in promoting protective behaviors, we conducted an online experimental study to compare participants’ responses (relevant perceptions and intentions) to congruent COVID-19 behavior messages presented in two different formats: personal experience narrative vs non-narrative (didactic) information. We chose three distinct topics—namely, social distancing practices, vaccination, and the use of unproven treatments—to test the robustness of narratives as a messaging strategy across very different behaviors. It is important to note that at the time of the study, no vaccine had yet been authorized for use in the U.S. (although several were under development), and social distancing constituted a top priority for public health messaging and was mandated in several parts of the country. Further, discussion about use of treatments not authorized for COVID-19 (such as hydroxychloroquine) became more salient as the number of COVID-19 infections and deaths continued to rise and prominent public figures endorsed these unproven therapeutics.

We hypothesized that exposure to a narrative (versus non-narrative message) would lead to more positive perceptions of the behavior promoted in the message (H1a) and greater intention to engage in the behavior (H1b). Because the presumed advantage of narratives lies in their ability to reduce resistance to information, we also expected participants who initially held more negative perceptions/intentions toward a given COVID-19-related protective behavior to benefit more from exposure to a narrative. Stated formally, we hypothesized that the positive effect of a narrative vs non-narrative message on post-message exposure perceptions and intentions would be moderated by individuals’ initial perceptions and intentions levels, such that: (a) the effect on post-message exposure perceptions would be stronger for those with more negative initial perceptions of the behavior advocated in the message (H2a); and (b) the effect on post-message exposure intentions would be stronger for those with lower initial intentions to engage in that behavior (H2b).

Participants

A total of 1830 U.S. adults responded to the study invitation posted on Amazon’s Mechanical Turk (MTurk) platform. 26 , 27 MTurk is an opt-in online crowdsourcing platform that has been used to facilitate recruitment of participants for scientific studies. Individuals who are at least 18 years old and have access to a computer with an internet connection are eligible to join MTurk. Users can then browse available research studies and are remunerated for their participation upon completion of a particular study. Remuneration is set by the study administrator (i.e., the researcher) based on study length. Participants can choose to redeem their earnings as cash or Amazon.com gift cards. 28 Further, MTurk users are vetted by the platform using patented technology that assesses data quality via measures of participant attention and engagement, among others. 29 In addition, our study also included an English proficiency check to ensure participants’ understanding of study materials; data from 26 participants were excluded because they failed this check, resulting in a final sample size of 1804. An overall response rate could not be calculated because the number of potential respondents who see the study invitation but choose not to participate is not recorded by MTurk.

Design and Setting

The online experiment employed a between-subjects two-group (type of message: narrative vs non-narrative) design and was administered via Qualtrics. After consenting to participate in the study, participants answered questions about personal experience with COVID-19 and how closely they followed COVID-19-related news, and responded to pre-exposure measures of perceptions and behavioral intentions relevant to the study topics. They were then randomly assigned to one of two experimental conditions: either personal experience narrative messages or non-narrative (didactic) messages with congruent topical content.

In each experimental condition, participants read three messages in randomized order. The survey software required participants to spend a minimum amount of time reading each message (215 milliseconds per word) before they could advance, to help ensure careful reading. After reviewing each message, participants reported their perceptions of, and intentions to engage in, the behavior discussed in the message. Participants then answered a series of socio-demographic questions. The study was fielded between September 16 and 23, 2020 and received approval from the internal review board of the institution where the study was conducted. Informed consent was obtained from all participants and they were remunerated $2 for completing the study.

Intervention

Participants assigned to the narrative condition read three first-person stories adapted from real news stories (see Appendix A ). The social distancing message described the story of a woman whose husband contracted COVID-19 after ignoring social distancing recommendations and subsequently became an advocate of such measures. The vaccine message was about an individual who initially had negative views regarding vaccines but changed their mind after seeing the harm inflicted by COVID-19 and reading about the rigorousness of the vaccine development and review process. In the unproven treatment message , participants read about a COVID-19 patient’s request to take hydroxychloroquine and their subsequent discussion with their provider about potential side effects, which ends with the patient regretting their haste to take an unproven treatment and reiterating the importance of clinical trials. Participants in the non-narrative information condition read three messages on social distancing, vaccines, and unproven treatments that mirrored the information presented in the narrative messages, without the presence of a central character.

Perceptions

We assessed relevant perceptions (adapted from 30 , 31 ) both at baseline and after exposure to the message. Participants reported their perceptions of (1) social distancing effectiveness (1 item: “ Social distancing is an effective measure against the spread of the coronavirus ” (1-strongly disagree to 7-strongly agree)); (2) vaccine safety and effectiveness (3 items: “ Overall, vaccines are safe / effective / important to protect the health of others ” (1-strongly disagree to 7-strongly agree; 8-don’t know, coded as missing); baseline Cronbach’s α = .94; post-exposure Cronbach’s α = .94); and (3) the benefits of unproven medical treatment (1 item: “ What is your view about allowing more people access to experimental drugs for COVID-19 before clinical trials have been completed?” (1-the risks outweigh the benefits to 7-the benefits outweigh the risks)); and the importance of clinical trials (1 item: “ How important do you think it is to go through the process of conducting clinical trials, even if it will lengthen the time it takes to make new treatments available to the public? ” (1-not at all important to 7-very important)) 1 . These measures of perceptions were chosen because we considered them important drivers of the behaviors addressed in the messages and our messages were designed to influence these perceptions.

Behavioral Intentions

Behavioral intentions were also measured pre- and post-message exposure (adapted from 30 ). Participants reported: (1) intention to engage in social distancing in the next 7 days (1-strongly disagree to 7-strongly agree); (2) intention to take a vaccine to prevent COVID-19 if one were available (1-definitely NOT get the vaccine to 7-definitely get the vaccine); and (3) willingness to take a drug that is being tested in clinical trials and has not yet been approved for the treatment of COVID-19 (1-strongly disagree to 7-strongly agree).

Participants reported their personal experience with COVID-19, how closely they had been following news about the virus, employment status, political views, geographic location, whether they had been diagnosed with certain health conditions that put them at risk for COVID-19 complications, whether people in their community wore masks, and basic demographics (age, gender, race, Hispanic ethnicity, and education).

Statistical Analysis

Data were analyzed with Stata 15.1. All potential covariates were significantly correlated with most outcomes ( P-values <.10) and were included in the final models 2 . 32 We first ran seven multivariable regression models to assess the main effects of the experimental condition (0-non-narrative; 1-narrative) on each post-exposure outcome, controlling for baseline measures on that particular outcome (in addition to covariates). We then ran another seven multivariable regression models to assess the interaction between the experimental condition and the pre-exposure measure in predicting the post-exposure outcome (perceptions or behavioral intentions). De-identified participant data are available by request.

Table 1 presents descriptive statistics for all covariates included in the analyses and Table 2 presents perception and behavioral intention unadjusted means and standard deviations.

Descriptive Statistics of Covariates Included in the Models.

Unadjusted Means (Standard Deviations) by Experimental Condition.

Intervention Effects (H1a and H1b)

The experimental condition participants were assigned to had no effect on perceptions of social distancing effectiveness (P = .778); intentions to engage in social distancing in the next 7 days (P = .563); perceptions of vaccine safety and effectiveness (P = .174); intentions to receive a COVID-19 vaccine if one were available (P = .199); or perceptions of the importance of clinical trials (P = .289). In contrast, an effect was observed for the unproven drug outcomes. Participants who read the narrative vs non-narrative message expressed less positive perceptions about the benefits of unproven drugs ( b = −.18, P = .007; η p 2 = .005). Further, participants in the narrative vs non-narrative condition reported lower willingness to receive an unproven drug ( b = −.30, P < .001; η p 2 = .016). See Appendix B for regression models. Table 3 presents adjusted means by experimental condition.

Adjusted Means (Standard Errors) by Experimental Condition.

Moderation of Intervention Effects by Baseline Measures (H2a and H2b)

The experimental condition did not interact with the corresponding baseline measure of perception and behavioral intention in predicting post-exposure perceived social distancing effectiveness (P = .251), intentions to engage in social distancing in the next 7 days (P = .838), intentions to receive a COVID-19 vaccine if one were available (P = .170), perceived benefits of unproven drugs (P = .268), or perceived importance of clinical trials (P = .756).

However, the experimental condition interacted with baseline perceptions of vaccine safety and effectiveness in predicting post-exposure vaccine perceptions ( b = −.05, P = .018, 95% CI = [−.09; −.01]; η p 2 = .004). Exposure to a narrative (vs non-narrative) message about vaccines led to more positive vaccine safety and effectiveness perceptions, but only for participants who reported the least positive vaccine perceptions at baseline (baseline perceptions = 4.51 (1 SD below the mean): b = .10, P = .008, 95% CI = [.03; 0.18]; baseline perceptions = 5.89 (mean): b = .04, P = .167, 95% CI = [.02; 0.09]; baseline perceptions = 7: b = −.01, P = .688, 95% CI = [−.08; 0.06] 3 ). This interaction is plotted in Figure 1 .

An external file that holds a picture, illustration, etc.
Object name is 10.1177_08901171221075612-fig1.jpg

Experimental condition and baseline perceptions of vaccine safety and effectiveness interact in predicting post-exposure perceptions of vaccine safety and effectiveness.

The experimental condition also interacted with baseline willingness to receive an unproven drug in predicting post-exposure willingness to receive such a drug ( b = −.13, P < .001; 95% CI = [−.20; −.07]; η p 2 = .01). Exposure to the narrative (vs non-narrative) message led to lower willingness to receive an unproven drug, but only among individuals with average and above average baseline willingness (baseline willingness = 2.09 (1 SD below the mean): b = −.06, P = .461, 95% CI = [−.23; 0.10]; baseline willingness = 3.90 (mean): b = −.30, P < .001, 95% CI = [−.42; −.19]; baseline willingness = 5.71 (1 SD above the mean): b = −.55, P < .001, 95% CI = [−.71; −.38]). This interaction is plotted in Figure 2 .

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Object name is 10.1177_08901171221075612-fig2.jpg

Experimental condition and baseline intentions to receive an unproven drug interact in predicting post-exposure intentions to receive an unproven drug.

COVID-19 communication to date has been fraught with challenges. 33 Effective messaging must not only contend with the usual challenges associated with crisis communication, but also the high levels of polarization, politicization of the pandemic, and the spread of misinformation, which have generated resistance to public health guidance. We explored the utility of narratives in promoting protective COVID-19 health behaviors. The effect of narratives was not uniformly observed across the three topics under study. Specifically, narratives (vs non-narrative messages) led to: (1) more negative perceptions about the benefits of unproven drugs; (2) less willingness to receive an unproven treatment for COVID-19 (especially among individuals with higher baseline willingness to receive an unproven drug); and (3) more positive perceptions of vaccine safety and effectiveness, but only among individuals with lower baseline vaccine perceptions. There were no significant differences between conditions for perceived social distancing effectiveness, intentions to practice social distancing, or intentions to vaccinate.

These findings offer several insights about the use of narratives as a communication strategy, both in the current pandemic and for future public health challenges. First, our results suggest that narratives may be more effective for topics where views are less entrenched. We suspect that narrative messages were effective in dissuading people from wanting to use unproven drugs, but did not have a substantial impact on vaccination or social distancing intentions, because the public had less crystalized views on unproven drugs, which allowed for change to occur via a one-time exposure to a narrative message. This premise is supported by the fact that overall baseline perceptions about the benefits of unproven drugs were closer to the mid-point of the scale (as opposed to vaccination and social distancing perceptions, which were closer to the extremes of the scales). Bode and Vraga 34 similarly found that corrections delivered via news stories were more successful at changing views toward a more novel topic for which public opinion was less established (i.e., health consequences of GMOs), than for the link between vaccines and autism, suggesting our findings could apply beyond the COVID-19 pandemic context.

When views about a health topic are more established, the persuasive advantage of narratives over non-narratives may only manifest for individuals who disagree with the recommendation being promoted because it reduces their scrutiny of the message content. That narratives led to more positive perceptions of vaccine safety and effectiveness, but only among those with the least positive perceptions at baseline, aligns with prior work finding that narratives perform better than statistical evidence when information in a message is value-discrepant. 35

In contrast, we did not observe a similar effect of narratives for intentions to receive a COVID-19 vaccine. Intentions to receive a vaccine may be much harder to change with a one-time exposure to a message, particularly given that no COVID-19 vaccine had been approved at the time of the study. Therefore, it may have been difficult for participants to form and express an intention to accept such a vaccine prior to its approval. Yet, the positive effect on perceptions of safety and effectiveness among those most hesitant about vaccines in our sample is still notable, particularly when considering the large volume of vaccine misinformation in circulation. 36 , 37

The beneficial effects of narratives on vaccine perceptions and willingness to try an unproven drug among participants who at baseline had views that were most divergent with public health recommendations also suggest that narratives may be effective in countering misinformation about the coronavirus. Some participants’ negative views of vaccines and positive views toward trying unproven drugs for COVID-19 at baseline could have been, at least in part, influenced by rampant misinformation about these topics. Then, the observed revision in perceptions/intentions after exposure to narratives would indicate that narratives may have facilitated an update of such inaccurate beliefs. 22

The lack of main effects on social distancing-related perceptions and intentions may be explained by participants’ overall strongly positive baseline perceptions and intentions. This baseline alignment with public health recommendations may have limited both the persuasive advantage of narratives to reduce psychological resistance (since there was likely very little of it, similar to findings observed by Bekalu et al in the context of pandemic influenza 23 ) and the overall ability of a message to induce additional change. When the study was conducted, social distancing was being enforced in many places (e.g., stores, public transit, and restaurants), which may have created a perception of social distancing as normative, in which case participants in the study provided responses that aligned with those perceived norms. 38

The pandemic situation has evolved in important ways since this study was conducted, and our findings should be considered in light of these changes. Notable differences include the actual availability of vaccines today, further politicization of preventive measures, and exacerbated pandemic fatigue. Whereas these changes do not necessarily negate the effectiveness of narratives as a public health messaging strategy, they do have implications for how narrative content should be constructed. For example, the availability of vaccines, coupled with their politicization, means views on vaccination today are both more crystalized and more divided along partisan lines. 39 To successfully address these issues, narrative messages may need to be modified to focus on current concerns (e.g., fertility or myocarditis risk) 40 and highlight values relevant to either side of the political spectrum. 41 , 42 Additionally, the use of unauthorized treatments (e.g., ivermectin) has become an increasingly pressing concern, 43 suggesting that there is an urgent need to effectively communicate about the risks of taking unproven treatments without generating reactance. Narratives, then, could be particularly effective in this context. Finally, pandemic fatigue is higher today than it was when this study was conducted, which may mean that text-based narratives may garner less engagement than they would have earlier in the pandemic and may need to be visually enhanced to be effective (e.g., through videos, cartoons, and virtual reality). 44

Conducted at the height of the COVID-19 pandemic, this study contributes to our understanding of the utility of narrative persuasion in health communication during public health emergencies. Findings show that using narratives to communicate critical information is a promising strategy for novel topics where views are still developing and among individuals who are most likely to be resistant to public health recommendations. We also find evidence that narratives may be persuasive even when a topic is the target of significant misinformation (e.g., vaccination). Whether narratives indeed help update misperceptions about such topics should be further studied using more detailed measures. Although more work is needed, this study adds to our developing understanding of how we can best relay evidence-based recommendations to the public.

Limitations

This study has several limitations. The lack of effects observed on some outcomes may be because the experiment involved a single exposure to each message—findings might have been different if participants were exposed to the messages repeatedly over time, as would occur with a public health campaign. Non-significant findings may also be explained by the pre-post design, where post-measures were administered immediately after message exposure. Others have found a sleeper effect associated with narrative persuasion, such that the magnitude of effects increases over time. 45 Further, the control messages were very detailed and informative, which also could have contributed to the limited intervention effect; however, keeping information congruent across conditions enabled us to hone in on the effect of the narrative format. Moreover, the effects that were observed were small, but this is not unusual in narrative persuasion research 23 and does not mean the findings are not consequential. Small effects for one-time message exposures can have cumulatively large effects via repeated exposure in the context of a long-term public health communication campaign 46 and can have meaningful population-level impact due to their substantial reach. 47

Another limitation concerns the fact that we relied on an online convenience sample which reduces the generalizability of our findings. Specifically, MTurk users tend to be younger, more liberal, and better educated, compared to the U.S. population; further, users may have previously participated in similar studies, affecting their sensitivity to study materials and/or measurements, 48 thus, potentially reducing the effects observed. Finally, the study was conducted in September 2020 and since then perceptions and intentions regarding the topics under study have likely shifted (as explained above). These limitations aside, narrative as a format for COVID-19 communication remains promising, as long as message content is up-to-date and responsive to current concerns and conditions.

What is already known on this topic?

Narratives have been shown to be an effective communication strategy across a wide range of health topics.

What does this article add?

In a pandemic context, narratives are more effective than non-narratives (1) when communicating about emerging topics on which views may be less entrenched, and (2) when targeting individuals inclined to be resistant to behavioral recommendations.

What are the implications for health promotion practice or research?

Narratives can be effective in certain situations and can be an important tool for public health practitioners. To optimize this communication approach, more research is needed in the context of pandemics to investigate when narratives are most effective and why.

Appendix A. Study messages

Social Distancing

Vaccination.

Unproven Treatment.

Appendix B. Regression model results for each of the outcomes.

1. Participants were provided with a definition of “clinical trials”.

2. The pattern of results did not change in models without covariates.

3. We probed this interaction at the maximum value on the scale as opposed to the conventional value of one standard deviation above the mean because the latter was outside the scale range (7.27).

Author Contributions: Iles: Conceptualization; Formal analysis; Methodology; Writing – Original Draft Preparation; Writing – Review & Editing; Gaysynsky: Conceptualization; Methodology; Writing – Original Draft Preparation; Writing – Review & Editing; Chou: Conceptualization; Methodology; Writing – Original Draft Preparation; Writing – Review & Editing

Data Availability: De-identified participant data are available to individual investigators by request from the authors.

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

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the National Cancer Institute under contract number HHSN261201800002 B issued to Westat. The funder had no role in the study design; collection, analysis and interpretation of data; writing of the report; or the decision to submit the article for publication.

Disclaimer: The opinions expressed by the authors are their own and the research presented in this paper should not be interpreted as representing the official viewpoint of the U.S. Department of Health and Human Services, the National Institutes of Health or the National Cancer Institute.

ORCID iDs: Irina A. Iles https://orcid.org/0000-0002-9348-1012

Anna Gaysynsky https://orcid.org/0000-0001-5612-5572

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Call for Submissions: 2024 Tobin Siebers Prize

blue banner with the text "Call for Submissions"

About the 2024 Tobin Siebers Prize

Submissions are now open for the 2024 Tobin Siebers Prize for Disability Studies in the Humanities. The prize is awarded in memory of disability studies pioneer Tobin Siebers, Professor of English at the University of Michigan and author of many influential books and articles in the field of Disability Studies. The prize is awarded yearly for the best proposed book-length manuscript on a topic of pressing urgency in the field (with the exception of 2020, due to the challenges presented by COVID-19). Reflecting on the work of the scholar the prize commemorates, the competition invites submissions on a wide range of topics, from literary and cultural studies, to trans-historical research, to contributions to disability theory such as work in crip/queer studies. The deadline is August 1, 2024; the winner will be announced in January 2025. Winners receive a cash prize of $1000, and a book contract from the University of Michigan Press to be published in the Corporealities: Discourses of Disability series.

Previous winners:

  • 2023 Aly Patsavas’s Pain in Relation: On Cripistemologies, Chronicity, and Crip Evidence
  • 2022 Anastasia Todd, Cripping Girlhood
  • 2021 Susan Antebi, Embodied Archive: Disability in Post-Revolutionary Mexican Cultural Production
  • 2019 Kateřina Kolářová, Rehabilitative Post-Socialism: Disability, Race, Gender, and Sexuality and the Limits of National Belonging
  • 2018 Stephen Knadler, Vitality Politics: Health, Debility, and the Limits of Black Emancipation
  • 2017 Elizabeth B. Bearden, Monstrous Kinds: Body, Space, and Narrative in Renaissance Representations of Disability
  • 2016 Shelley L. Tremain, Foucault and Feminist Philosophy of Disability
  • 2015 Anne McGuire, War on Autism: On the Cultural Logic of Normative Violence

Guidelines for Submissions

Eligible submissions include a book proposal and two sample chapters not under consideration by another publisher. Unrevised dissertations, fiction, poetry, and memoirs will not be considered. Manuscripts and supporting documents should be in digital format and must be sent via email to [email protected] and Associate Editor Haley Winkle [email protected] , no later than August 1, 2024.

In addition to the proposal and sample chapters, please send the following materials:

  • A description of the manuscript
  • A brief statement regarding its relative contribution to the field of Disability Studies
  • The word count and illustration count
  • A current curriculum vitae

For assistance with the submission process, please contact  [email protected]

About Tobin Siebers

The work of the late University of Michigan faculty member, Tobin Siebers, has influenced Disability Studies in field-shifting ways since the publication of his prize-winning essay “My Withered Limb” in 1998. His subsequent scholarly publications, including the books Disability Theory (2008) and Disability Aesthetics (2010) as well as essays such as “A Sexual Culture for Disabled People” (2012), quickly became pivotal works in the field. Siebers’s work has galvanized new scholarship in relation to questions of representation, subjectivity, and the entry of non-normative bodies into public space, and made the study of disability a central component (alongside gender, race, sexuality, and class) in analyses of the culture wars and identity studies.

To honor this remarkable legacy, the University of Michigan Press and the University of Michigan Department of English Language and Literature established The Tobin Siebers Prize for Disability Studies in the Humanities. Reflecting the scholar’s work the prize commemorates, the competition invites submissions on a wide range of topics, from literary and cultural studies, to trans-historical research, to contributions to disability theory such as work in crip/queer studies.

Books Mentioned In This Post

narrative essay topic on covid 19

Cripping Girlhood

narrative essay topic on covid 19

Foucault and Feminist Philosophy of Disability

narrative essay topic on covid 19

Vitality Politics

narrative essay topic on covid 19

Embodied Archive

narrative essay topic on covid 19

Monstrous Kinds

narrative essay topic on covid 19

Disability Theory

narrative essay topic on covid 19

War on Autism

narrative essay topic on covid 19

Disability Aesthetics

narrative essay topic on covid 19

Millions of Suns Writing Contest Winners

This vivid novel of mental illness captures the power of living on

‘what kingdom,’ by fine grabol, is set at a residential facility meant to transition residents out into the world.

The mad have long haunted the borderlands of our fiction. Consider the attic-bound wife in “Jane Eyre,” the deluded ranters of Dostoevsky and Gogol, or all of Kleist’s lunatics, driven crazy by their dogged adherence to absurd principles. These figures can be comic or tragic, jesters or men who have fooled themselves into believing they’re the kings. All destabilize the reality of a narrative, injecting a dangerous dose of irrationality into circumstances otherwise defined by decorum and rigorous self-interest.

As madness became mental illness, the unwell and their institutions have taken on a more central role in their own stories. Memoirs and autobiographical novels such as “The Eden Express” and “The Bell Jar” foregrounded mental breakdowns, from delusions and hallucinations to hospitalization and treatment. These institutions then became subjects in themselves, their straitjackets and barred windows standing in for social repression at large. Books like “One Flew Over the Cuckoo’s Nest ” present illness and treatment through a metaphorical lens, as symptoms of something else, and not as subjects in and of themselves.

These precisely are the concerns of “What Kingdom,” the Danish poet Fine Grabol’s prizewinning debut novel. Grabol’s unnamed narrator lives on the fifth floor of a psychiatric housing facility, in the temporary accommodations for young people (the book’s Danish title translates to “Youth Unit ” ) transitioning back into society following periods of hospitalization. With her schizotypal personality disorder and bipolar disorder diagnoses, the narrator has already experienced her share of institutionalization, and has come to “the residential facility” to learn skills and routines that might allow her to live on her own again. “Those of us with no place to live and no place to die end up in this trial home,” she writes in Martin Aitken’s vivid translation, “this impermanent halfway house.”

Grabol’s narrator cannot sleep, hallucinates that the building is breathing, and experiences memory loss in the aftermath of electroconvulsive therapy and her pharmaceutical regimen. She longs to devour neon tubes, then vomits up her food. Violent episodes are followed by recessed ones, as hyper-attunement to minute details — the fingerprints left on a computer screen, the thud of a fellow resident’s unique gait — gives way to numbness. “I sometimes wake up,” she observes, “and realize that what’s going to happen has no name.”

This results in “a self-narrative with gaps,” told in an episodic present tense that directly plugs you into each moment — from floor meetings and outings to the grocery store to insomniac periods and manic episodes — even as it elides her self-harming and occasional suicide attempts. A single period can separate the preparation of a razor blade from the staff bandaging her arms. These gaps reveal the novel’s fundamental instability. However close we feel to Grabol’s narrator, there is much more she won’t or can’t convey to us.

Her floor of the residential facility is meant to transition residents out into the world, teaching them routines that will place guardrails around their instability. They shop and cook for one another, sing karaoke, go on outings, play in a band. After periods of confinement, they need to learn to be comfortable in their own rooms, with their own things, managing, for the most part, their own time.

It is an environment of deliberate limits, providing its residents the safety of their “incomplete individuality.” The staff are not authoritarians, but custodians, aides who “see the two poles ill and well as an acknowledgment of the individual’s pain.” They want to keep their charges out of the hospital, and to ease their way back into society. We are a long ways from the sadism of Nurse Ratched. Yet this security and support come with real trade-offs: The narrator’s room might be hers to design and keep up, but the staff will always have an extra key. Her home there will always be provisional, temporary, subject to changes in the law and her own situation.

When she was a teenager, Grabol was institutionalized in a series of psychiatric hospitals, and much of “What Kingdom” appears to be autobiographical. Her descriptions can be both beautiful and queasily intimate, a record of treatment’s effects on both mind and body. In the hospital, the narrator takes “something that would make me disappear.” The staff make her drink activated charcoal, turning her excrement into “thin, oily jets of liquid,” which only adds to her distress.

This period is now in Grabol’s past, and even though the novel is written in an insistent present tense, her narrator conveys the experiences at hand in a variety of registers. She discusses the gendered qualities of diagnosis — “boys are schizotypal, girls are borderline or obsessive-compulsive” — relays how various laws affect their housing, and questions how mental illness is theorized and treated. These digressions can be aphoristic, and sometimes they extend to become minor essays on how we conceive of the ill and the well. “Psychiatry exists on the premise of internally directed treatment forms,” she writes. “Could we not imagine treatments that are instead externally directed, involving the outside world gearing itself towards a wider and more comprehensive emotional spectrum?” Yet her conclusions are unresolved and ambivalent: “I don’t know.”

The result is a novel deeply versed in the experience and terminology of psychiatric treatment, without taking on the tenor of therapy. In “What Kingdom,” a diagnosis is only one part of the explanation, and it certainly is not a cure. Grabol’s narrator cannot escape or resolve her illness, and there is no third-act revelation of buried trauma that might yet be resolved. Instead, the poet tries to place us within her experience, conveying through an accumulation of acute details the alternately mundane and hallucinatory qualities of deep mental illness. From one page to the next, a description of sluggish summer boredom will give way to a dream in which the narrator transforms into a massive esophagus and swallows the entire facility, with only a chapter heading to separate them. And by fracturing the narrative, Grabol effectively scrambles all sense of progress, highlighting the stop-start, backsliding reality of treatment. Hers is not a novel of overcoming or repudiating. “What Kingdom ” is about the living-through and the living-with, about the hard-won routines of survival, and the remarkable persistence of a life from one day to the next.

Robert Rubsam is a writer and critic whose work has been published in the New York Times Magazine, the Atlantic, the Baffler and the Nation.

What Kingdom

By Fine Grabol, translated from Danish by Martin Aitken

Archipelago. 146 pp. $18, paperback

An earlier version of this review misidentified the husband of Bertha Antoinetta Rochester in “Jane Eyre.” It was Edward Rochester, not Heathcliff. This version has been corrected.

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