two paragraph essay about covid 19

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Covid 19 Essay in English

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

100 Words Essay on Covid 19

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

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

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

My Experience of COVID-19

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

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

Effects of CoronaVirus on Education

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

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

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

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

Effects of CoronaVirus on Economy

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

Effects of CoronaVirus on Health

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

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Paragraph Writing
Paragraph Writing On Covid 19

Paragraph Writing on Covid 19 - Check Samples for Various Word Limits

The Covid-19 pandemic has been a deadly pandemic that has affected the whole world. It was a viral infection that affected almost everyone in some way or the other. However, the effects have been felt differently depending on various factors. As it is a virus, it will change with time, and different variants might keep coming. The virus has affected the lifestyle of human beings. The pandemic has affected the education system and the economy of the world as well. Many people have lost their lives, jobs, near and dear, etc.

Paragraph writing on covid-19 in 100 words, paragraph writing on covid-19 in 150 words, paragraph writing on covid-19 in 200 words, paragraph writing on covid-19 in 250 words, frequently asked questions on covid-19.

Check the samples provided below before you write a paragraph on Covid-19.

Coronavirus is an infectious disease and is commonly called Covid-19. It affects the human respiratory system causing difficulty in breathing. It is a contagious disease and has been spreading across the world like wildfire. The virus was first identified in 2019 in Wuhan, China. In March, WHO declared Covid-19 as a pandemic that has been affecting the world. The virus was spreading from an infected person through coughing, sneezing, etc. Therefore, the affected people were isolated from everyone. The affected people were even isolated from their own family members and their dear ones. Other symptoms noticed in Covid – 19 patients include weariness, sore throat, muscle soreness, and loss of taste and smell.

Coronavirus, often known as Covid-19, is an infectious disease. It affects the human respiratory system, making breathing difficult. It’s a contagious disease that has been spreading like wildfire over the world. The virus was initially discovered in Wuhan, China, in 2019. Covid-19 was declared a global pandemic by the World Health Organization in March. The virus was transferred by coughing, sneezing, and other means from an infected person. As a result, the people who were affected were isolated from the rest of society. The folks who were afflicted were even separated from their own family members and loved ones. Weariness, sore throat, muscle stiffness, and loss of taste and smell are among the other complaints reported by Covid-19 individuals. Almost every individual has been affected by the virus. A lot of people have lost their lives due to the severity of the infections. The dropping of oxygen levels and the unavailability of oxygen cylinders were the primary concerns during the pandemic.

The Covid-19 pandemic was caused due to a man-made virus called coronavirus. It is an infectious disease that has affected millions of people’s lives. The pandemic has affected the entire world differently. It was initially diagnosed in 2019 in Wuhan, China but later, in March 2020, WHO declared that it was a pandemic that was affecting the whole world like wildfire. Covid-19 is a contagious disease. Since it is a viral disease, the virus spreads rapidly in various forms. The main symptoms of this disease were loss of smell and taste, loss of energy, pale skin, sneezing, coughing, reduction of oxygen level, etc. Therefore, all the affected people were asked to isolate themselves from the unaffected ones. The affected people were isolated from their family members in a separate room. The government has taken significant steps to ensure the safety of the people. The frontline workers were like superheroes who worked selflessly for the safety of the people. A lot of doctors had to stay away from their families and their babies for the safety of their patients and their close ones. The government has taken significant steps, and various protocols were imposed for the safety of the people. The government imposed a lockdown and shut down throughout the country.

The coronavirus was responsible for the Covid-19 pandemic. It is an infectious disease that has affected millions of people’s lives. The pandemic has impacted people all across the world in diverse ways. It was first discovered in Wuhan, China, in 2019. However, the World Health Organization (WHO) proclaimed it a pandemic in March 2020, claiming that it has spread throughout the globe like wildfire. The pandemic has claimed the lives of millions of people. The virus had negative consequences for those who were infected, including the development of a variety of chronic disorders. The main symptoms of this disease were loss of smell and taste, fatigue, pale skin, sneezing, coughing, oxygen deficiency, etc. Because Covid-19 was an infectious disease, all those who were infected were instructed to segregate themselves from those who were not. The folks who were affected were separated from their families and locked in a room. The government has prioritised people’s safety. The frontline personnel were like superheroes, working tirelessly to ensure the public’s safety. For the sake of their patients’ and close relatives’ safety, many doctors had to stay away from their families and babies. The government had also taken significant steps and implemented different protocols for the protection of people.

What is meant by the Covid-19 pandemic?

The Covid-19 pandemic was a deadly pandemic that affected the lives of millions of people. A lot of people lost their lives, and some people lost their jobs and lost their entire families due to the pandemic. Many covid warriors, like doctors, nurses, frontline workers, etc., lost their lives due to the pandemic.

From where did the Covid-19 pandemic start?

The Covid-19 pandemic was initially found in Wuhan, China and later in the whole world.

What are the symptoms of Covid-19?

The symptoms of Covid-19 have been identified as sore throat, loss of smell and taste, cough, sneezing, reduction of oxygen level, etc.

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

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

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Coronavirus Pandemic

8 Lessons We Can Learn From the COVID-19 Pandemic

BY KATHY KATELLA May 14, 2021

Rear view of a family standing on a hill in autumn day, symbolizing hope for the end of the COVID-19 pandemic

Note: Information in this article was accurate at the time of original publication. Because information about COVID-19 changes rapidly, we encourage you to visit the websites of the Centers for Disease Control & Prevention (CDC), World Health Organization (WHO), and your state and local government for the latest information.

The COVID-19 pandemic changed life as we know it—and it may have changed us individually as well, from our morning routines to our life goals and priorities. Many say the world has changed forever. But this coming year, if the vaccines drive down infections and variants are kept at bay, life could return to some form of normal. At that point, what will we glean from the past year? Are there silver linings or lessons learned?

“Humanity's memory is short, and what is not ever-present fades quickly,” says Manisha Juthani, MD , a Yale Medicine infectious diseases specialist. The bubonic plague, for example, ravaged Europe in the Middle Ages—resurfacing again and again—but once it was under control, people started to forget about it, she says. “So, I would say one major lesson from a public health or infectious disease perspective is that it’s important to remember and recognize our history. This is a period we must remember.”

We asked our Yale Medicine experts to weigh in on what they think are lessons worth remembering, including those that might help us survive a future virus or nurture a resilience that could help with life in general.

Lesson 1: Masks are useful tools

What happened: The Centers for Disease Control and Prevention (CDC) relaxed its masking guidance for those who have been fully vaccinated. But when the pandemic began, it necessitated a global effort to ensure that everyone practiced behaviors to keep themselves healthy and safe—and keep others healthy as well. This included the widespread wearing of masks indoors and outside.

What we’ve learned: Not everyone practiced preventive measures such as mask wearing, maintaining a 6-foot distance, and washing hands frequently. But, Dr. Juthani says, “I do think many people have learned a whole lot about respiratory pathogens and viruses, and how they spread from one person to another, and that sort of old-school common sense—you know, if you don’t feel well—whether it’s COVID-19 or not—you don’t go to the party. You stay home.”

Masks are a case in point. They are a key COVID-19 prevention strategy because they provide a barrier that can keep respiratory droplets from spreading. Mask-wearing became more common across East Asia after the 2003 SARS outbreak in that part of the world. “There are many East Asian cultures where the practice is still that if you have a cold or a runny nose, you put on a mask,” Dr. Juthani says.

She hopes attitudes in the U.S. will shift in that direction after COVID-19. “I have heard from a number of people who are amazed that we've had no flu this year—and they know masks are one of the reasons,” she says. “They’ve told me, ‘When the winter comes around, if I'm going out to the grocery store, I may just put on a mask.’”

Lesson 2: Telehealth might become the new normal

What happened: Doctors and patients who have used telehealth (technology that allows them to conduct medical care remotely), found it can work well for certain appointments, ranging from cardiology check-ups to therapy for a mental health condition. Many patients who needed a medical test have also discovered it may be possible to substitute a home version.

What we’ve learned: While there are still problems for which you need to see a doctor in person, the pandemic introduced a new urgency to what had been a gradual switchover to platforms like Zoom for remote patient visits.

More doctors also encouraged patients to track their blood pressure at home , and to use at-home equipment for such purposes as diagnosing sleep apnea and even testing for colon cancer . Doctors also can fine-tune cochlear implants remotely .

“It happened very quickly,” says Sharon Stoll, DO, a neurologist. One group that has benefitted is patients who live far away, sometimes in other parts of the country—or even the world, she says. “I always like to see my patients at least twice a year. Now, we can see each other in person once a year, and if issues come up, we can schedule a telehealth visit in-between,” Dr. Stoll says. “This way I may hear about an issue before it becomes a problem, because my patients have easier access to me, and I have easier access to them.”

Meanwhile, insurers are becoming more likely to cover telehealth, Dr. Stoll adds. “That is a silver lining that will hopefully continue.”

Lesson 3: Vaccines are powerful tools

What happened: Given the recent positive results from vaccine trials, once again vaccines are proving to be powerful for preventing disease.

What we’ve learned: Vaccines really are worth getting, says Dr. Stoll, who had COVID-19 and experienced lingering symptoms, including chronic headaches . “I have lots of conversations—and sometimes arguments—with people about vaccines,” she says. Some don’t like the idea of side effects. “I had vaccine side effects and I’ve had COVID-19 side effects, and I say nothing compares to the actual illness. Unfortunately, I speak from experience.”

Dr. Juthani hopes the COVID-19 vaccine spotlight will motivate people to keep up with all of their vaccines, including childhood and adult vaccines for such diseases as measles , chicken pox, shingles , and other viruses. She says people have told her they got the flu vaccine this year after skipping it in previous years. (The CDC has reported distributing an exceptionally high number of doses this past season.)

But, she cautions that a vaccine is not a magic bullet—and points out that scientists can’t always produce one that works. “As advanced as science is, there have been multiple failed efforts to develop a vaccine against the HIV virus,” she says. “This time, we were lucky that we were able build on the strengths that we've learned from many other vaccine development strategies to develop multiple vaccines for COVID-19 .”

Lesson 4: Everyone is not treated equally, especially in a pandemic

What happened: COVID-19 magnified disparities that have long been an issue for a variety of people.

What we’ve learned: Racial and ethnic minority groups especially have had disproportionately higher rates of hospitalization for COVID-19 than non-Hispanic white people in every age group, and many other groups faced higher levels of risk or stress. These groups ranged from working mothers who also have primary responsibility for children, to people who have essential jobs, to those who live in rural areas where there is less access to health care.

“One thing that has been recognized is that when people were told to work from home, you needed to have a job that you could do in your house on a computer,” says Dr. Juthani. “Many people who were well off were able do that, but they still needed to have food, which requires grocery store workers and truck drivers. Nursing home residents still needed certified nursing assistants coming to work every day to care for them and to bathe them.”

As far as racial inequities, Dr. Juthani cites President Biden’s appointment of Yale Medicine’s Marcella Nunez-Smith, MD, MHS , as inaugural chair of a federal COVID-19 Health Equity Task Force. “Hopefully the new focus is a first step,” Dr. Juthani says.

Lesson 5: We need to take mental health seriously

What happened: There was a rise in reported mental health problems that have been described as “a second pandemic,” highlighting mental health as an issue that needs to be addressed.

What we’ve learned: Arman Fesharaki-Zadeh, MD, PhD , a behavioral neurologist and neuropsychiatrist, believes the number of mental health disorders that were on the rise before the pandemic is surging as people grapple with such matters as juggling work and childcare, job loss, isolation, and losing a loved one to COVID-19.

The CDC reports that the percentage of adults who reported symptoms of anxiety of depression in the past 7 days increased from 36.4 to 41.5 % from August 2020 to February 2021. Other reports show that having COVID-19 may contribute, too, with its lingering or long COVID symptoms, which can include “foggy mind,” anxiety , depression, and post-traumatic stress disorder .

“We’re seeing these problems in our clinical setting very, very often,” Dr. Fesharaki-Zadeh says. “By virtue of necessity, we can no longer ignore this. We're seeing these folks, and we have to take them seriously.”

Lesson 6: We have the capacity for resilience

What happened: While everyone’s situation is different (and some people have experienced tremendous difficulties), many have seen that it’s possible to be resilient in a crisis.

What we’ve learned: People have practiced self-care in a multitude of ways during the pandemic as they were forced to adjust to new work schedules, change their gym routines, and cut back on socializing. Many started seeking out new strategies to counter the stress.

“I absolutely believe in the concept of resilience, because we have this effective reservoir inherent in all of us—be it the product of evolution, or our ancestors going through catastrophes, including wars, famines, and plagues,” Dr. Fesharaki-Zadeh says. “I think inherently, we have the means to deal with crisis. The fact that you and I are speaking right now is the result of our ancestors surviving hardship. I think resilience is part of our psyche. It's part of our DNA, essentially.”

Dr. Fesharaki-Zadeh believes that even small changes are highly effective tools for creating resilience. The changes he suggests may sound like the same old advice: exercise more, eat healthy food, cut back on alcohol, start a meditation practice, keep up with friends and family. “But this is evidence-based advice—there has been research behind every one of these measures,” he says.

But we have to also be practical, he notes. “If you feel overwhelmed by doing too many things, you can set a modest goal with one new habit—it could be getting organized around your sleep. Once you’ve succeeded, move on to another one. Then you’re building momentum.”

Lesson 7: Community is essential—and technology is too

What happened: People who were part of a community during the pandemic realized the importance of human connection, and those who didn’t have that kind of support realized they need it.

What we’ve learned: Many of us have become aware of how much we need other people—many have managed to maintain their social connections, even if they had to use technology to keep in touch, Dr. Juthani says. “There's no doubt that it's not enough, but even that type of community has helped people.”

Even people who aren’t necessarily friends or family are important. Dr. Juthani recalled how she encouraged her mail carrier to sign up for the vaccine, soon learning that the woman’s mother and husband hadn’t gotten it either. “They are all vaccinated now,” Dr. Juthani says. “So, even by word of mouth, community is a way to make things happen.”

It’s important to note that some people are naturally introverted and may have enjoyed having more solitude when they were forced to stay at home—and they should feel comfortable with that, Dr. Fesharaki-Zadeh says. “I think one has to keep temperamental tendencies like this in mind.”

But loneliness has been found to suppress the immune system and be a precursor to some diseases, he adds. “Even for introverted folks, the smallest circle is preferable to no circle at all,” he says.

Lesson 8: Sometimes you need a dose of humility

What happened: Scientists and nonscientists alike learned that a virus can be more powerful than they are. This was evident in the way knowledge about the virus changed over time in the past year as scientific investigation of it evolved.

What we’ve learned: “As infectious disease doctors, we were resident experts at the beginning of the pandemic because we understand pathogens in general, and based on what we’ve seen in the past, we might say there are certain things that are likely to be true,” Dr. Juthani says. “But we’ve seen that we have to take these pathogens seriously. We know that COVID-19 is not the flu. All these strokes and clots, and the loss of smell and taste that have gone on for months are things that we could have never known or predicted. So, you have to have respect for the unknown and respect science, but also try to give scientists the benefit of the doubt,” she says.

“We have been doing the best we can with the knowledge we have, in the time that we have it,” Dr. Juthani says. “I think most of us have had to have the humility to sometimes say, ‘I don't know. We're learning as we go.’"

Information provided in Yale Medicine articles is for general informational purposes only. No content in the articles should ever be used as a substitute for medical advice from your doctor or other qualified clinician. Always seek the individual advice of your health care provider with any questions you have regarding a medical condition.

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Woman with face protective mask standing on the street, possibly with post-COVID-19 symptoms

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

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

November 17, 2020

13 min read

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The way forward

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Writing about COVID-19 in a college admission essay

by: Venkates Swaminathan | Updated: September 14, 2020

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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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Read these 12 moving essays about life during coronavirus

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

by Alissa Wilkinson

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

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

The Vox guide to navigating the coronavirus crisis

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

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

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

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

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

A syllabus for the end of the world

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

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

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

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

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

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

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

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

What day is it today?

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

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

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

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

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

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

Vox is starting a book club. Come read with us!

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

Joint statement by ilo, fao, ifad and who.

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

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

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

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

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

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

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

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

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

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

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

inequalities

Data availability statement

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

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

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

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Introduction

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

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

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

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

Social networks

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

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

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

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

Social support

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

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

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

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

Social and interactional norms

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

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

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

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

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

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

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

Recommendations and conclusions

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

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

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

Recommendation 2: intelligently balance online and offline ways of relating

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

Recommendation 3: build stronger and sustainable localised communities

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

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

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↵ (ONS), O.f.N.S., Domestic abuse during the coronavirus (COVID-19) pandemic, England and Wales . Available: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/domesticabuseduringthecoronaviruscovid19pandemicenglandandwales/november2020
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Twitter @karenmaxSPHSU, @Mark_McCann, @Rwilsonlowe, @KMitchinGlasgow

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

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

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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Introduction

Horrific history

The early days, health and medicine.

What was the impact of COVID-19?

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Table Of Contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What is COVID-19 and how is it spread?

With nearly 550,000 people infected, almost 25,000 dead, and hundreds of millions in lockdown across the globe, the coronavirus pandemic has brought the world to a standstill. But what do we know about COVID-19 and what can we do to fight this pandemic?

27 March 2020
by Priya Joi

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COVID-19 is a serious global infectious disease outbreak with nearly 550,000 cases and around 25,000 deaths worldwide. It is part of a family of viruses called coronaviruses that infect both animals and people. This particular one originated in China at the end of 2019, in the city of Wuhan, which has 11 million residents. In the past two decades coronavirus outbreaks have caused global concern, including one in 2003 with the Severe Acute Respiratory Syndrome (SARS) and more recently in 2012 with the Middle East Respiratory Syndrome (MERS).

COVID-19 can cause symptoms very similar to the flu – fever and a dry cough (the two most common symptoms) , fatigue, aches and pains, and nasal congestion. As the pandemic spread around the world, other symptoms such as a loss of sense of smell or taste have emerged – these are not yet conclusive evidence of infection with the new coronavirus, and the World Health Organization is investigating this.

Severe cases can lead to serious respiratory disease, and even pneumonia. Those most at risk are the elderly, or people with underlying medical issues, such as heart problems or diabetes. According to the most recent global numbers (27 March 2020), 14.8% of people over 80 years old, infected with the virus, have died from it, compared with 0.4% in people aged 40-49% and none in children under 9 years. The situation across countries is rapidly changing and these numbers will continue to change as the pandemic shifts.

Despite most deaths still being in older people, it is clear that many young people with the virus can still develop serious infection that requires hospitalisation.

The evidence so far indicates that the virus is spread from person to person through small respiratory droplets. When a person coughs or sneezes, these droplets can also land on nearby surfaces. There is also evidence that the COVID-19 virus can last on surfaces – especially plastic or metal – for up to 3 days. This is why advice to avoid catching COVID-19 has focused on handwashing with soap, the use of alcohol-based hand sanitising gels and keeping a distance from people who are symptomatic.

While many people can be seen to wear masks, especially on public transport, the World Health Organization (WHO) says that you only need to wear a mask if you are unwell or looking after someone who is sick and is in addition to the important measures above

IS THERE A TREATMENT OR VACCINE?

Right now, there are no antivirals or vaccines to treat or prevent COVID-19, although there are at least 44 potential coronavirus vaccines in development. Several antivirals, including those against flu and HIV are being tested to see if they could be used against the new coronavirus, as is chloroquine, a common antimalarial.

Even in an emergency, vaccines can take a long time to develop – no matter how quickly researchers race through the initial phase of identifying candidate vaccines and getting their vaccines into clinical testing. This is because taking the vaccine through the rigorous stages of testing for safety and efficacy can normally take several years. And it is still unclear whether the COVID-19 outbreak will have peaked before a vaccine can be rolled-out.

HOW BAD IS THIS PANDEMIC?

COVID-19 is a new coronavirus, which means that it is likely no-one has natural immunity to it. Coronaviruses such as MERS-CoV and SARS are on watchlists of infections with pandemic potential, along with Ebola and influenza . Since it began, COVID-19 has spread worldwide, leading the WHO to label it a pandemic and a “public health emergency of international concern.”

Based on available evidence, COVID-19 appears to have a fatality rate of 4.4%, much lower than 10% for SARS and around 30% for MERS-CoV. Yet this is not a reason to relax containment and control measures.

COVID-19 is more contagious than either SARS or MERS-CoV, and crucially, can be spread undetected. This is because many people with COVID-19 are either asymptomatic or have very mild symptoms, so they may not be adequately isolating themselves, and spreading the infection. Most countries around the world are now on lockdown to avoid spreading the virus any further, and allowing “a flattening of the curve” meaning avoiding cases from spiking and overwhelming health systems.

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How Is the Coronavirus Outbreak Affecting Your Life?

How are you staying connected and sane in a time of social distancing?

By Jeremy Engle

Find all our Student Opinion questions here.

Note: The Times Opinion section is working on an article about how the coronavirus outbreak has disrupted the lives of high school students. To share your story, fill out this form .

The coronavirus has changed how we work , play and learn : Schools are closing, sports leagues have been canceled, and many people have been asked to work from home.

On March 16, the Trump administration released new guidelines to slow the spread of the coronavirus, including closing schools and avoiding groups of more than 10 people, discretionary travel, bars, restaurants and food courts.

How are you dealing with these sudden and dramatic changes to how we live? Are you practicing social distancing — and are you even sure what that really means?

In “ Wondering About Social Distancing? ” Apoorva Mandavilli explains the term and offers practical guidance from experts:

What is social distancing? Put simply, the idea is to maintain a distance between you and other people — in this case, at least six feet. That also means minimizing contact with people. Avoid public transportation whenever possible, limit nonessential travel, work from home and skip social gatherings — and definitely do not go to crowded bars and sporting arenas. “Every single reduction in the number of contacts you have per day with relatives, with friends, co-workers, in school will have a significant impact on the ability of the virus to spread in the population,” said Dr. Gerardo Chowell, chair of population health sciences at Georgia State University. This strategy saved thousands of lives both during the Spanish flu pandemic of 1918 and, more recently, in Mexico City during the 2009 flu pandemic.

The article continues with expert responses to some common questions about social distancing. Here are excerpts from three:

I’m young and don’t have any risk factors. Can I continue to socialize? Please don’t. There is no question that older people and those with underlying health conditions are most vulnerable to the virus, but young people are by no means immune. And there is a greater public health imperative. Even people who show only mild symptoms may pass the virus to many, many others — particularly in the early course of the infection, before they even realize they are sick. So you might keep the chain of infection going right to your own older or high-risk relatives. You may also contribute to the number of people infected, causing the pandemic to grow rapidly and overwhelm the health care system. If you ignore the guidance on social distancing, you will essentially put yourself and everyone else at much higher risk. Experts acknowledged that social distancing is tough, especially for young people who are used to gathering in groups. But even cutting down the number of gatherings, and the number of people in any group, will help. Can I leave my house? Absolutely. The experts were unanimous in their answer to this question. It’s O.K. to go outdoors for fresh air and exercise — to walk your dog, go for a hike or ride your bicycle, for example. The point is not to remain indoors, but to avoid being in close contact with people. You may also need to leave the house for medicines or other essential resources. But there are things you can do to keep yourself and others safe during and after these excursions. When you do leave your home, wipe down any surfaces you come into contact with, disinfect your hands with an alcohol-based sanitizer and avoid touching your face. Above all, frequently wash your hands — especially whenever you come in from outside, before you eat or before you’re in contact with the very old or very young. How long will we need to practice social distancing? That is a big unknown, experts said. A lot will depend on how well the social distancing measures in place work and how much we can slow the pandemic down. But prepare to hunker down for at least a month, and possibly much longer. In Seattle, the recommendations on social distancing have continued to escalate with the number of infections and deaths, and as the health system has become increasingly strained. “For now, it’s probably indefinite,” Dr. Marrazzo said. “We’re in uncharted territory.”

Abdullah Shihipar writes in an Opinion essay, “ Coronavirus and the Isolation Paradox ,” that while social distancing is required to prevent infection, loneliness can make us sick:

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COVID-19 pandemic crisis—a complete outline of SARS-CoV-2

Sana saffiruddin shaikh.

1 Y. B. Chavan College of Pharmacy, Dr. Rafiq Zakaria Campus, Aurangabad, 431001 India

Anooja P. Jose

2 Government College of Pharmacy, Aurangabad, 431001 India

Disha Anil Nerkar

Midhuna vijaykumar kv, saquib khaleel shaikh, associated data.

The data and material are available upon request. The graphs and figures used in the manuscript were generated and analyzed and are not used anywhere else before.

Coronavirus (SARS-CoV-2), the cause of COVID-19, a fatal disease emerged from Wuhan, a large city in the Chinese province of Hubei in December 2019.

Main body of abstract

The World Health Organization declared COVID-19 as a pandemic due to its spread to other countries inside and outside Asia. Initial confirmation of the pandemic shows patient exposure to the Huanan seafood market. Bats might be a significant host for the spread of coronaviruses via an unknown intermediate host. The human-to-human transfer has become a significant concern due to one of the significant reasons that is asymptomatic carriers or silent spreaders. No data is obtained regarding prophylactic treatment for COVID-19, although many clinical trials are underway.

The most effective weapon is prevention and precaution to avoid the spread of the pandemic. In this current review, we outline pathogenesis, diagnosis, treatment, ongoing clinical trials, prevention, and precautions. We have also highlighted the impact of pandemic worldwide and challenges that can help to overcome the fatal disease in the future.

Coronaviruses (CoVs) are a large family of RNA viruses; they show discrete point-like projections over their surface. They show the presence of an unusually large RNA genome and a distinctive replication strategy. The term “coronavirus” is acquired from the “crown”-like morphology. Coronaviruses show potential fatal human respiratory infections and cause a variety of diseases in animals and birds [ 1 ]. Coronavirus primarily targets the human respiratory system [ 2 ]. The World Health Organization (WHO) named the latest virus as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on 12 January 2020 [ 3 ]. The COVID-19 or the SARS-CoV-2 is rapidly unfurling from Wuhan in Hubei Province of China to worldwide [ 4 ].

Initial confirmation of the pandemic was carried out by conducting studies on 99 patients with COVID-19 pneumonia, from which 49% of patients exhibited a history of subjection to the Huanan seafood market. The patient examined had a clinical manifestation of fever, cough, shortness of breath, muscle ache, and sore throat-like symptoms [ 5 ]. COVID-19 has infected several hundreds of humans and has caused many fatal cases [ 6 ]. Worldwide, there have been 3,925,815 confirmed cases, including 274,488 deaths of COVID-19 as of 6:37 pm CEST 10 May 2020 reported to WHO [ 7 ].

This article outlines and gives a complete overview of SARS-CoV-2, including its pathogenesis, diagnosis, treatment, prevention, and precautions. This article also provides the current scenario of the pandemic worldwide, since new findings are rapidly evolving and can help the readers in upgrading their knowledge about the COVID-19. It also emphasizes the challenges faced by giving an idea about future strategies in fighting and preventing recurrence.

History and origin

Coronaviruses were not expected to be highly infectious to humans, but the outburst of a severe acute respiratory syndrome (SARS) in Guangdong province China in the years 2002 and 2003 proved to be devastating. SARS-CoV is the contributory agent of the SARS, also known as “atypical pneumonia”. The coronaviruses that spread before that time in humans mostly caused mild infections in immune-competent people. But after the emergence of SARS, another highly infectious coronavirus, MERS-CoV, appeared in Middle Eastern countries [ 8 , 9 ]. Research has shown that SARS-CoV-2 shows similarities with SARS-CoV and MERS-CoV. (Table (Table1) 1 ) depicts a comparison of SARS-CoV-2 with SARS-CoV and MERS-CoV [ 10 – 16 ]. Several disseminating strains of coronaviruses were identified and were considered harmless pathogens, causing common cold and mild upper respiratory illness [ 17 ]. HCoV-229E [ 18 ] strain was isolated in 1966. HCoV-NL63 was first isolated from the Netherlands during late 2004. In 2012, MERS-CoV was first identified from the lung of a 60-year-old patient who was suffering from acute pneumonia and renal failure in Saudi Arabia [ 19 ]. About 8000 cases and 800 deaths worldwide were observed due to the outbreak of SARS first human pandemic in the dawn of the twenty-first century [ 20 ].

Comparison of coronaviruses

Parameters	SARS-COV2	SARS-COV	MERS-COV
Epidemiology	Dec 2019, Wuhan, China	Nov 2002, Guangdong, China	April 2012, Saudi Arabia
Animal reservoir	Bats	Bats	Bats
Intermediate host	Pangolins/minks (yet to be confirmed)	Palm civets	Camels
Receptor target	ACE2	ACE2	DPP4
Fatality rate	2.3%	9.5%	34.4%
Genetic similarity with the other	79.5% SARS-CoV 50% MERS-CoV	79.5% SARS-CoV-2	50% SARS-CoV-2
Virus type	SS-RNA	RNA	RNA
Total RNA sequence length of pathogen	29,903 bp	29,751 bp	30,108 bp
M:F ratio	2.70:1	1:1.25	2:1
Transmission route	Droplets; faeco-oral transmission; contact with infected individual or things Human-to-human	Droplets; contact with infected individual or things; bat-civets-human Human-to-human	Touching infected camel or consumption of meat or milk Limited human-to-human transmission
Clinical symptoms	Fever, fatigue, dry cough	Fever, cough, myalgia, dyspnea, diarrhea	Fever, cough, respiratory distress, vomiting, diarrhea
Incubation	7–14 days, 24 days	2–7 days	5–6 days
R	2.68	2.5	> 1
Diagnostic methods	RRT-PCR, RT-PCR, RT-lamp, RRT-lamp, coronavirus detection kit	RRT-PCR, RT-PCR, RT-lamp, RRT-lamp, coronavirus detection kit	RRT-PCR, ELISA, micro neutralization assay, MERS-CoV serology test
Chest X-ray	Bilateral multi-lobular ground glass opacities	Ground glass opacities	Ground glass opacities; consolidation
Chest CT scan	No nodular opacities	Lobar consolidation; nodular opacities	Single or multiple opacities; bilateral glass opacities; sub-pleural and lower lobe predominance; septal thickness
Prevention	Hand hygiene; cough etiquette; avoiding unnecessary touching of the eyes or face.	Hand hygiene; cough etiquette; avoiding unnecessary touching of the eyes or face.	Hand hygiene; cough etiquette; avoiding unnecessary touching of the eyes or face; avoiding raw milk and meat consumption.
Treatment	Ritonavir; lopinavir (in testing)	Glucocorticoids; interferon	Ribavirin; interferon; analgesics (treatment not yet determined)

Note: despite the lower case fatality rate observed in COVID-19, the overall number of death far outweighs that from SARS and MERS

The α-CoVs HCoV-229E and HCoV-NL63 and β-CoVs HCoV-HKU1 and HCoV-OC43 are identified as a human susceptible virus with low pathogenicity and cause mild respiratory symptoms similar to common cold [ 21 ]. SARS-CoV and MERS-CoV result in severe respiratory tract infections [ 22 , 23 ]. COVID-19 was recently reported from Wuhan (China), which has cases in Thailand, Japan, South Korea, and the USA, which has been confirmed as a new coronavirus [ 24 ].

The coronavirus genera, which mostly infect mammals, are alpha-coronavirus and beta-coronavirus. Out of 15 presently assigned viral species, seven were isolated from bats. The research proposed that bats are significant hosts for alpha-coronaviruses and beta-coronaviruses and play an essential role as the gene source in the evolution of these two coronavirus genera SARS and MERS [ 25 ]. The genome sequence was found to be 96.2% identical to a bat CoV RaTG13, whereas it shares 79.5% identity to SARS-CoV. The virus genome sequencing outcomes and evolutionary analysis show that bat can be a natural host from virus source, and SARS-CoV-2 might be transferred from bats through unspecified intermediate hosts to infect humans [ 26 ]. It is found that SARS-CoV-2 affects males more than females [ 27 ]. The spread of SARS-CoV-2 emerged like a wild forest fire in many countries worldwide. Table ( (2) 2 ) [ 28 ] gives a brief of the first identified cases of COVID-19 in different countries.

First confirmed case

Country	First confirmed case (dates)
China, East Asia	31 December 2019
Thailand	13 January 2020
Japan	15 January 2020
Korea	20 January 2020
USA	23 January 2020
Vietnam	24 January 2020
Singapore	24 January 2020
Australia, Nepal, and French Republic	25 January 2020
Malaysia	26 January 2020
Canada	27 January 2020
Cambodia, Germany, Sri Lanka	28 January 2020
United Arab Emirates	29 January 2020
Philippines, India, Finland	30 January 2020
Italy	31 January 2020
Russian Federation, Spain, Sweden, UK	1 February 2020
Belgium	5 February 2020
Japan	6 February 2020
Egypt	15 February 2020

The first confirmed case was reported in China, and since then, there was a widespread of coronavirus in other countries worldwide. Table Table1 1 shows the first confirmed case with dates

Coronaviruses are spherical to pleomorphic enveloped particles [ 29 ]. The size ranges from 80 to 120 nm in diameter. The maximum size is as small as 50 nm and as large as 200 nm are also seen [ 30 ]. There are four types of main structural proteins observed in the coronaviruses: the spike (S), membrane (M), envelope (E), and nucleocapsid (N) proteins, which are encoded within the viral genome (Table (Table3). 3 ). In thin sections, the virion envelope may be visualized as inner and outer shells separated by a translucent space [ 31 ]. The virion envelope contains phospholipids, glycolipids, cholesterol, di- and triglycerides, and free fatty acids in proportions. The complexed genome RNA is with the basic nucleocapsid (N) protein, which forms a helical capsid established within the viral membrane. The enclosed glycoproteins are responsible for attachment to the host cells [ 32 ].

Structural proteins of coronavirus and their functions

Structural proteins	Functions of proteins
Spike protein (S)	Virus and host cell fusion by binding
Membrane protein (M)	Nutrient transport, determines shape, and formation of envelope
Envelope protein (E)	Interferes with host immune response
Nucleocapsid protein (N)	Binds with RNA genome and makes up nucleocapsid
Hemagglutinin-esterase (HE)	Binds sialic acids on surface glycoprotein

According to the recent studies, it is observed that coronavirus which lacks envelope protein (E) serves as a good candidate in vaccine designing

The coronavirus genomes are among the most massive mature RNA molecules as compared to other eukaryotic RNAs (Fig. (Fig.1) 1 ) [ 33 ]. The genome of these viruses contains multiple ORFS. A typical CoV consists of at least 6 ORFs in its genome. Several studies have confirmed the genetic resemblance between SARS-CoV-2 and a bat CoV.

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Structure of novel coronavirus

A study conducted to compare the genetic mutations of COVID showed genomic mutations among viruses from different countries, wherein a sequence obtained from Nepal showed minimum to no variations. In contrast, the maximum number of modifications was obtained from one derived from the Indian series located in ORF1-ab nsp2 nsp3 helicase ORF8 and spike surface glycoprotein. Also, host antiviral mRNAs play a critical part in the regulation of immune response to virus infection, depending upon the viral agent. The unique host mRNAs could be explored in the development of novel antiviral therapies. The club-like surface projections or peplomers of coronaviruses are about 17–20 nm from the virion surface. It has a subtle base that swells to a width of about 10 nm at the distal extremity. Some coronaviruses that exhibit the second set of projections about 5–10-nm long are present beneath the significant projections. These shorter spikes are now known as hemagglutinin-esterase (HE) protein, an additional membrane protein found in a subset of group 2 coronaviruses. The primary role of this non-essential protein is to aid in viral entry and pathogenesis in vivo. It configures short projections that bind to N-acetyl-9-O-acetlyneuramic acid or N-glycolylneuraminic acid and have esterase [ 34 – 39 ]. Figure Figure2 2 shows the primary classification of coronavirus.

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Classification of coronavirus

Lifecycle of coronavirus

The life cycle of the virus with the host consists of the following four steps: attachment, penetration, biosynthesis, maturation, and release (Fig. (Fig.3). 3 ). Once the virus binds to the host receptor, they enter host cells through endocytosis or membrane fusion. Once the viral contents are released inside the host cells, viral RNA enters the nucleus for replication. Viral mRNA is used to make viral proteins and is further proceeded by maturation and release [ 40 , 41 ].

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Attachment and entry

The virion attachment with the host cell is initiated by interaction between S protein and its receptors, which is also a primary determinant for coronavirus infection. The S protein undergoes acid-dependent proteolytic cleavage, which results in exposure of fusion peptide. This fusion is followed by the formation of a six-helix bundle (bundle formation helps in combining viral and cellular membrane) and release of the viral genome into the cytoplasm.

Replicase protein expression

The process of translation of replicase gene ORFs1a and ORFs1b and translation of polyprotein pp1a and pp1ab takes place. Assembly of nsps into replicase-transcriptase complex (RTC) leads to viral RNA synthesis (replication and transcription of subgenomic RNAs).

Replication and transcription

In the replication process, the viral RNA synthesis is followed by the production of genomic and sub-genomic RNAs (sub-genomic mRNAs), which further leads to recombination of the virus.

Assembly and release

The insertion and translation of viral structure protein S, E, and M takes place into the endoplasmic reticulum (ER), which is followed by the movement of proteins along the secretory pathway into ERGIC (endoplasmic reticulum Golgi intermediate compartment). The viral genome is encapsidated by N protein into the membrane of ERGIC. M and E protein expression give rise to the formation of virus-like particles (VLPs). After the assembly of the virion and its transportation to cell surface vesicles, exocytosis takes place. Finally, it results in viral release (E protein helps by altering the host secretory pathway).

The incubation period is the period between the entry of the virus into the host and appearance of signs and symptoms in the host or the period between the earliest date of contact of the transmission source and the most initial time of symptom onset (i.e., cough, fever, fatigue, or myalgia) [ 42 ]. The incubation period of COVID-19 is vital as the disease could be transmitted during this phase through asymptomatic as well as symptomatic carriers (Table (Table4). 4 ). The inhaled virus SARS-CoV-2 binds to the epithelial cells present in the nasal cavity and starts replicating.

Incubation period of coronaviruses

Coronavirus strain	Incubation period	Death period	Symptoms
SARS-CoV	4–10 days	20–25 days	Fever, dry cough, myalgia, dyspnea, headache, sore throat, sputum production, rhinorrhea, watery diarrhea, confusion, poor appetite.
MERS-CoV	5–6 days	11–13 days	Myalgia, fever, chills, malaise associated with confusion, cough, shortness of breath, dyspnea, pneumonia
COVID-19	3–7 days	17–24 days	Fever, cough, dyspnea, muscle ache, confusion, headache, sore throat, rhinorrhea, chest pain, diarrhea, nausea, vomiting, anosmia, dysgeusia

On the basis of studies conducted and data findings, virologists points out that incubation period extends to 14 days, with a median time of 4–5 days from exposure to symptom onset. One study reported that 97.5% of persons with COVID-19 who develop symptoms will do so within 11.5 days of SARS-CoV-2 infection

ACE2 is the primary receptor for both SARS-CoV-2 and SARS-CoV, which is an asymptomatic state (initial 1–2 days of infection). Upper airway and conducting airway response are seen the next few days. The disease is mild and mostly restricted only to the upper conducting airways for about 80% of the infected patients [ 43 ].

The incubation period is required to create more productive quarantine systems for people infected with the virus. The incubation period for the COVID-19 is between 2 and 14 days after exposure. A newly infected person shows symptoms in the about 5 days after contact with a sick patient. In most patients, symptoms appeared after 12–14 days of infection

The average incubation period was approximated to be 5.1 days, and 97.5% of those who develop symptoms will do so within 11.5 days of infection. In Wuhan’s return patients, the average incubation period is found to be 6.4 days. In a case reported by Hubei province, local government on 22 February showed an incubation period of 27 days. In another case, an incubation period of 19 days was observed. Therefore a 24-day observation period is considered in suspected cases by the Chinese government and also by WHO [ 44 – 51 ]. The frequency of cases is increasing day by day, and it is essential to keep a check over it. Figure Figure4 4 gives a glance of confirmed cases cumulative and death overtime cumulative from 10 January onwards up to 25 May.

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a Graph of confirmed (cumulative) cases overtime in various countries . b Graph of death (cumulative) overtime in various countries

Pathogenesis

Like other CoVs, the SARS-CoV-2 is transmitted primarily via respiratory droplets and possible faeco-oral transmission routes [ 52 ]. Figure Figure5 5 gives a complete outline of the pathogenesis of coronavirus. On infection, primary viral replication is expected to occur in the mucosal epithelium of the upper respiratory tract with further multiplication into the lower respiratory tract and GI mucosa, giving rise to mild viremia. The virus enters the host cells through two methods either:

I. Direct entry
II. Endocytosis

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Complete pathogenesis of coronavirus

These are positive sense ss-RNA viruses that can cause respiratory, enteric, hepatic, and neurologic diseases. High binding capacity with SARS-CoV-2 was observed by molecular biological analysis [ 53 ]. The ACE2 gene encodes the angiotensin-converting enzyme-2 receptor for both the SARS-CoV and the human respiratory coronavirus NL63. Recent studies show that ACE2 could be the host receptor for the novel coronavirus 2019-nCoV/SARS-CoV-2 [ 54 ].

Human angiotensin-converting enzyme 2 (hACE2), which was the binding receptor of SARS-CoV, is analogous to SARS-CoV-2. These hACE2 are type 1 membrane proteins expressed in various cells of the nasal mucosa, lung, bronchus, heart, kidney, intestines, bladder, stomach, esophagus, and ileum. It functions as an enzyme in the RAS and is, therefore, mainly associated with cardiovascular diseases [ 55 ].

The zinc peptidase ACE2 has also expressed in the alveolar type 2 pneumocytes, which explains its role in lung damage due to SARS-CoV. The SARS-CoV-2 shows 10–12-fold more affinity towards the proteins than the other SARS-CoV. Pathophysiology and virulence of the virus link to the function of its nsps and structural proteins. The nsp can block the host’s innate mechanism response while the virus envelope increases the pathogenicity as it assists the assembly and release of the virus [ 56 ].

The CoV spike glycoproteins comprise of three segments—a large ectodomain, a single-pass transmembrane anchor, and a small intracellular tail. The ectodomain is composed of the receptor-binding domain (RBD)—the S1 and the membrane fusion subunit S2. The two significant areas in s1, N-terminal domain (NTD) and the c-terminal domain (CTD), have been identified. The S1 NTDs are essential for binding to the sugar receptors, and the s1 CTDs are responsible for binding receptors ACE2, SPN, and DPP4 [ 57 ]. The S proteins undergo a considerable structural rearrangement to fuse with the viral membrane of the host cell membrane. The s1 subunit shedding and the s2 subunit transition to a highly stable conformation is the initial step in the fusion process [ 58 ]. The ACE2 consists of the N-terminal peptidase domain (NPD) and the C-terminal collectrin-like domain (CCTD) that ends with a single transmembrane helix and a 40 residue intracellular segment. It provides a direct binding site for S protein of CoVs.

The enzymes which assist this virus attachment include the serine protease enzymes TMPRSS2. These enzymes, which are cell-surface proteases, facilitate entry. In endosomes, the S1 of s proteins is cleaved, and the fusion peptides S2 are exposed. This exposed S2 unit brings the HR1 and HR2 together, resulting in membrane fusion and thereby release of viral package into the host membrane [ 59 ].

The viral RNA enters the nucleus for replication after the viral contents are released. Viral mRNA is used to make viral proteins. Decreased expression of ACE2 in a host cell results in an attack on the airway epithelium by the virus. These lead to acute lung injury that triggers immune responses. The release of various pro-inflammatory and chemokines like IL-6, IFN- gamma, MCPI 1, and IL-10 leads to capillary permeability in alveolar sacs. Due to local inflammation in the lungs, the secretion of pro-inflammatory cytokines and chemokines increases into the blood circulation of the patient. It results in fluid filling and increased difficulty in the exchange of gases across the membrane. Viral replication and infection in airway epithelial cells could cause high levels of virus-linked pyroptosis with associated vascular leakage. IL-beta cytokine released during pyroptosis is a highly inflammatory form of programmed cell death, which is the trigger subsequent inflammatory response. The IgG antibodies against SARS-CoV-2 N protein can be detected in the serum in the early stages at the onset of the disease. The non-neutralizing antibodies result in ADE (antibody-dependent enhancement), which leads to an increased systematic inflammatory response.

The pro-inflammatory cytokines and chemokines are an indicator of T H cells. Secretions from such cytokines and chemokines attract immune cell monocytes and T lymphocytes. High levels of pro-inflammatory cytokines, including IL-2, IL-7, IL-10, IP-10, G-CSF, MCP-1, MIP-1A, and TNF alpha, were detected in the severe infection called cytokine storm or cytokine release syndrome as a crucial factor in the pathogenesis of COVID-19.

The cytokine storm increases the inflammatory response resulting in increased blood plasma levels of neutrophils IL-6, IL-10, granulocytes, MCP1, TNF, and decreased organ perfusion, which results in multiple organ failure. Cytokine storm and pulmonary edema due to ACE2 dysregulation result in acute respiratory distress syndrome. SARS-CoV-2 can also affect the CNS [ 60 ]. Myocardial damage increases the difficulty and complexity of patient treatment [ 61 ]. Clinical investigations have shown that patients with cardiac diseases, hypertension, or diabetes, who are treated with ACE2-increasing drugs, including inhibitors and blockers, are at higher risk of getting infected with SARS-CoV2 [ 62 ]. Death results due to ARDS and multiple organ failure.

People with COVID-19 infection show symptoms ranging from mild to severe illness. Figure Figure6 6 shows a brief outline of various symptoms related to COVID-19. The warning signs and symptoms such as trouble breathing, constant pain or pressure in the chest, inability to wake or stay awake, and bluish lips or face are observed in patients [ 63 ]. Older people (65 years and older) are at higher risk of developing the disease.

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Symptoms for coronavirus

According to a study, people of all ages having asthma, diabetes, HIV, liver diseases, severe heart conditions, severe obesity (body mass index [BMI] of 40 or higher), and chronic kidney diseases undergoing dialysis show a higher mortality rate. The other populations with people showing disabilities, pregnancy, and breastfeeding and people experiencing homelessness, racial, and minority groups are at elevated risk of transmission of disease [ 64 ]. The crucial fact to know about coronavirus on surfaces is that they can easily be cleaned with ordinary household disinfectants that will kill the virus [ 65 ]. Studies have shown (Fig. (Fig.7) 7 ) that the COVID-19 virus can survive for up to 72 h on plastic and stainless steel, about 4 h on copper, and less than 24 h on cardboard [ 66 ].

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Survival of virus on various objects

Diagnosis: COVID-19

There are two categories of tests available for COVID-19:

Viral tests: a viral analysis indicates whether a person has a current infection.
Antibody tests: an antibody indicates whether a person had an infection.

The protection of getting infected again in a person showing the presence of antibodies to the virus is still unexplained [ 67 ].

Tests for current infection

A swab sample is collected (from the nose) to conclude that a person is currently infected with SARS-CoV-2. Some tests are called as point-of-care tests, which means their results may be available in less than an hour. Other test takes 1–2 days for analyzing after being received by the laboratory [ 68 ].

Test for past infection

Antibody tests analyze a blood sample for the presence of antibodies, which show if one had a previous infection with the virus. Antibody tests cannot be used to diagnose someone as being currently infected with COVID-19. Antibody tests are accessible through healthcare providers and laboratories [ 69 ]. In severe cases, clinical diagnosis is done based on the clinical manifestations of respiratory failure syndrome, increased liver function tests, blood tests indicating leukopenia, and high levels of ferritin. For such, a test for soluble CD-163 (sCD-163), showing the activation of macrophages, was suggested [ 70 ]. Laboratory diagnosis included genomic sequencing, reverse-transcription polymerase chain reaction (RT-PCR), and serological methods (such as enzyme-linked immunoassay [ELISA]). Because of the rapidly changing diversity found in the expression of the novel coronavirus, pneumonia became diverse and quickly changed. Other methods used are radiographic images for early observations and evaluation of disease severity [ 71 ].

Reverse-transcription polymerase chain reaction (RT-PCR) shows high sensitivity for new SARS cases. The suspected cases must be confirmed by using RT-PCR and other methods (slower methods) of detection such as serology or viral culture, isolation, and identification by electron microscopy, thereby causing a significant increase in the time required for an accurate diagnosis [ 72 ]. The samples are collected from upper and lower respiratory tracts through expectorated sputum, bronchoalveolar lavage, or endotracheal aspirate, which are then assessed by conducting polymerase chain reaction for viral RNA. It is recommended to repeat the test for reevaluation purposes in case of a positive result, and if the test is negative, a strong clinical impression also permits repeat testing [ 73 ].

An alternative diagnostic test to detect the SARS-CoV is mass spectroscopic identification of microbial nucleic acid signatures. Computed tomography images of the lungs showed 100% multiple patchy with fine mesh and consolidated shade distributed under the pleura. Nucleic acid tests were conducted in 187 patients, and all were positive to SARS-CoV-2. In the pulmonary CT images, 8% of them (15 cases) showed diffused lesions in either lungs or white lung. In the absorptive period, 98.9% showed fibrogenesis and diminished lesions. The CT imaging features differed from each follow-up showing different clinical symptoms [ 74 ]. The improvement in the detection of COVID-19 was found by the ELISA method. It is based on SARS r-CoV Rp3 nucleocapsid protein, which helps to detect the IgM and IgG against SARS-CoV-2. ELISA is a highly recommended method as the sampling blood is less stringent, and antibodies allow longer windows than oropharyngeal swabs for detecting viruses [ 75 ].

There is no particular treatment recommended for COVID-19. There is no data obtained regarding prophylactic treatment for COVID-19, only we can prevent from coming in contact with the pathogen. Confirmed cases are hospitalized and admitted in the same ward. Patients with mild symptoms may not require hospitalization [ 76 ]. They are isolated or self-isolated at home by following the doctor’s advice. Critically ill patients (respiratory shock, respiratory failure, septic shock, or other organ failures) should be admitted to ICU as soon as possible [ 77 ].

General treatment

The general treatment includes bed rest and supportive measures ensuring sufficient intake of calories, fluid, and electrolytes, and maintenance of acid-base homeostasis. Monitoring oxygen saturation and vital signs, keeping the respiratory tract unobstructed and inhaling oxygen, measuring C-reactive protein, hematology and biochemistry laboratory testing and ECG, blood gas analysis, and examining of chest images as when required and monitoring for any complications [ 78 ]. Patients having high body temperature above 38.5°C Celsius are administered with ibuprofen and acetaminophen orally.

Oxygen therapy

Patients with conditions of obstructed breathing, respiratory distress, shock, coma, and convulsions must receive oxygen therapy and airway management, targeting SpO2 more significant than 94%. Initiate O 2 treatment at 5 L/min and titrated to reach the target or use a face mask with a reservoir bag (10–15 L/min) if the patients are in critical condition.

Once stable, the target is 90% SpO2 in non-pregnant adults and 95% in pregnant adults. The use of nasal prongs or nasal cannula is preferred in young children, as they may be better tolerated. When oxygen therapy fails, mechanical ventilation is necessary. In a meta-analysis, the use of additional oxygen therapy (38.9%), non-invasive (7.1%) and invasive ventilation (28.7%), and even ECMO (0.9%) was surprisingly high among the 1876 patients in which any kind of pharmacological and supportive intervention was reported [ 79 ].

Antiviral agents

Remdesivir inhibits virus infection at the micromolar level (0.77–1.13 μM) and with high selectivity [ 80 ]. Remdesivir gets incorporated into viral RNA due to its adenosine analog nature and results in premature chain termination [ 81 ]. Remdesivir is not approved by the Food and Drug Administration (FDA). It is only recommended for mild or moderate COVID-19 conditions and the treatment of hospitalized adults and children in emergencies.

Chloroquine/hydroxychloroquine

Chloroquine increases endosomal pH, making the environment unfavorable for viral cell fusion. It also affects the glycosylation process of ACE-2. On administering chloroquine after 1 h of infection, gradual loss of antiviral activity was seen, though it affects the endosome fusion when administered shortly after the infection. When administered after 3–5 h after the infection, chloroquine was significantly effective against HCoV strain OC43 [ 82 ]. There is an excessive risk of toxicities due to high chloroquine doses; the recommended dose for chloroquine is 600 mg twice daily for 10 days for the treatment of COVID-19.

Interferon–alpha

Interferon-α is used in treating bronchiolitis; viral pneumonia; acute upper respiratory tract infection; hand, foot, and mouth disease; SARS; and other viral infections in children. According to the clinical research and experiences, the following usage is recommended for COVID-19

Interferon-α nebulization: interferon-α 200,000–400,000 IU/kg or 2–4 μg/kg in 2 mL sterile water, nebulization two times per day for 5–7 days
Interferon-α2b spray: applied for high-risk populations with close contact with suspected COVID-19 infected patients or those in the early phase with only upper respiratory tract symptoms.

Lopinavir/ritonavir

In a clinical trial among adult patients of or less than 18 years, it was observed that a combination of lopinavir/ritonavir, ribavirin, and interferon beta-1b would speed up the recovery, suppress the viral load, shorten hospitalization, and reduce mortality compared with lopinavir/ritonavir [ 83 ].

Immune-based therapy

Patients who show an inadequate response to initial therapy can get benefit from immunoglobulin [ 84 ]. Non-SARS-CoV-2-specific IVIG should not be used for COVID-19 except in case of clinical trials.

Corticosteroids

Corticosteroids are widely used in the symptomatic treatment of severe pneumonia. According to a detailed review and analysis, the result indicates that patients with severe conditions required corticosteroid therapy [ 85 ]. According to a systematic review of literature, daily use of corticosteroids in a COVID-19 patient is not encouraged; however, some studies suggest that methylprednisolone can reduce the mortality rate in more severe conditions, such as in ARDS [ 86 ].

Antimicrobial therapy

Patients with a mild type of bacterial infection can take oral antibiotics, such as cephalosporin or fluoroquinolones. Although a patient may be a suspect for COVID-19, appropriate antimicrobial agent should be administered within an hour of recognition of sepsis. Antibiotic therapy should be based on the clinical diagnosis of community-acquired pneumonia, healthcare-associated pneumonia, local epidemiology, susceptibility data, and national treatment guidelines. When there is the ongoing local circulation of seasonal influenza, this therapy with a neuraminidase inhibitor should be considered for the treatment for patients [ 87 ].

Tocilizumab

According to a review, 25 patients with laboratory-confirmed severe COVID-19 who received tocilizumab and completed 14 days of follow-up, 36% were discharged alive from the intensive care unit, and 12% died [ 88 ]. The biopsy specimen analysis suggested that increased alveolar exudates resulted from an immune response against an inflammatory cytokine storm. Probably an obstruction in alveolar gas exchange contributed to the high mortality rate of severe COVID-19 patients. A study identified that pathogenic T cells and inflammatory monocytes arouse an inflammatory storm with a large amount of interleukin 6. Tocilizumab blocks IL-6 receptors, which shows encouraging clinical results, including controlling temperature quickly and improved respiratory functions. Henceforth, tocilizumab is useful in the treatment of severe COVID-19 patients to calm the inflammatory storm and reduce mortality [ 89 ].

FDA-approved drug ivermectin for parasitic infection has a possibility for reprocessing and acts as an inhibitor of SARS-CoV-2 in vitro. A single therapy can affect approximately 500-fold reduction and effectual loss of substantially all viral material by 48 h [ 90 ]. A single of ivermectin, in combination with doxycycline, yielded the near-miraculous result in curing the patients with COVID-19 virtually.

Azithromycin

Azithromycin is used for patients with viral pneumonia from COVID-19. It can also work synergistically and coactively with other antiviral treatments. It has also shown antiviral activity against the Zika virus and rhinoviruses, which cause the common cold. Viral infection was significantly reduced in patients receiving hydroxychloroquine than those who did not. The virus elimination was efficient in patients who received both azithromycin and hydroxychloroquine [ 91 ]. (Table (Table5) 5 ) lists other supporting agents used in treatment [ 92 ].

Supporting agents used in treatment

Antiviral agents	Supporting agents	Others
• Baloxavir • Chloroquine phosphate • Favipiravir • HIV protease inhibitors • Hydroxychloroquine • Neuraminidase inhibitor • Remdesivir • Umifenovir	• Anakinra • Azithromycin • Baricitinib (Olumiant®) • Colchicine • Corticosteroids (general) • COVID-19 • Convalescent plasma • Epoprostenol (inhaled) • Methylprednisolone (DEPO-Medrol®, SOLU-Medrol®) • Nitric oxide (inhaled) • Ruxolitinib (Jakafi®) • Sarilumab (Kefzara®) • Siltuximab (Sylvant®) • Sirolimus (Rapamune®) • Tocilizumab (Actemra®)	• ACE inhibitors, angiotensin II receptor blockers (ARBs) • Anticoagulants (low molecular weight heparin [LMWH], unfractionated heparin [UFH]) • Famotidine • HMG-CoA reductase inhibitors (statins) • Immune globulin (IGIV, IVIG, γ-globulin) • Ivermectin • Nebulized drugs • Niclosamide • Nitazoxanide • Nonsteroidal anti-inflammatory agents (NSAIDs) • Tissue plasminogen activator (t-PA; alteplase)

Antiviral agents

Supporting agents

Others

• Baloxavir

• Chloroquine phosphate

• Favipiravir

• HIV protease inhibitors

• Hydroxychloroquine

• Neuraminidase inhibitor

• Remdesivir

• Umifenovir

• Anakinra

• Azithromycin

• Baricitinib (Olumiant®)

• Colchicine

• Corticosteroids (general)

• COVID-19

• Convalescent plasma

• Epoprostenol (inhaled)

• Methylprednisolone (DEPO-Medrol®, SOLU-Medrol®)

• Nitric oxide (inhaled)

• Ruxolitinib (Jakafi®)

• Sarilumab (Kefzara®)

• Siltuximab (Sylvant®)

• Sirolimus (Rapamune®)

• Tocilizumab (Actemra®)

• ACE inhibitors, angiotensin II receptor blockers (ARBs)

• Anticoagulants (low molecular weight heparin [LMWH], unfractionated heparin [UFH])

• Famotidine

• HMG-CoA reductase inhibitors (statins)

• Immune globulin (IGIV, IVIG, γ-globulin)

• Ivermectin

• Nebulized drugs

• Niclosamide

• Nitazoxanide

• Nonsteroidal anti-inflammatory agents (NSAIDs)

• Tissue plasminogen activator (t-PA; alteplase)

The repurposing of available therapeutic drugs is being used as supporting agents in the treatment of COVID-19; however, the efficacy of these treatments should be verified by using designed clinical trials

Precautions and preventions

WHO declared the COVID-19 outbreak as a public health emergency of international concern on 30 January 2020. Unfortunately, no medication until now is approved by the FDA, and various trials are going on. Still, the most effective weapon the community has in hand is the prevention of spread. The following are some of the COVID-19 prevention measures.

Quarantine: self-quarantine, mandatory quarantine (private residence, hospital, public institution, etc.)
Other measures: avoiding crowding, hand hygiene, isolation, personal protective equipment, school/workplace measures/closures, social distancing [ 93 ].

Asymptomatic carriers as the “silent spreaders” are of great concern for the elimination of disease and its control. So, more attention should be given to them [ 94 ]. Hand hygiene with alcohol-based hand-rub is globally recommended as productive and economical procedures against SARS-CoV-2 cross-transmission [ 95 ]. The economic implications of hand hygiene have been established. It has been found that this cost under 1% of total HAI-related economics. It is better to invest not only in the materials needed but also in the people working there. This investment will lead to an increase in the health outcome [ 96 ]. The clinical presentation of COVID-19 is non-specific, so it needs a robust and accurate diagnosis. It has been suggested that before stopping the infection control measures, we have to be sure to exclude the diagnosis [ 97 ]. Prevention plays a vital role in treating and defeating the COVID-19 disaster.

The Centers for Disease Control and Prevention gives standard precautions (Fig. (Fig.8) 8 ) and recommends measures to prevent COVID-19. Wear personnel protective equipment (face shield, mask, gown, gloves, and closed-toed shoes) when evaluating persons at risk. N-95 masks are known to prevent up to 95% of small particles, including viruses [ 98 ]. Cover all coughs/sneezes with a tissue and then throw the tissue away. Regularly clean/disinfect frequently touched objects and surfaces with household cleaning spray and use a tissue when handling (e.g., doorknobs, sink taps, water fountain handles, elevator buttons, cross-walk buttons, and shopping carts). Avoid contact with infected people (recommended > 6 ft) and maintain an appropriate distance as much as possible and refrain from touching nose eyes and mouth [ 99 ]. Avoid well persons when you are ill. Wear a mask continuously if taking care of persons with respiratory illness. To turn on the tap, use a paper towel and then wash hands with soap and water for at least 30 s after going to the bathroom. Use hand sanitizer and carry whenever at a public venue. Activate community-based interventions (e.g., cancel sporting events, dismiss, termination of universities and schools, practice social distancing, create employee plans to work remotely) [ 100 ]. Create a household-ready plan. Cancel any non-essential travel [ 101 ]. Frequent disinfection and cleaning are advised for groups that are at risk of contracting the virus [ 102 ].

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Prevention and precaution

In an Indian study mathematical approach was used to address some questions related to intervention strategies to control the COVID-19 transmission in India. Some hypothetical epidemic curves helped to illustrate the critical findings [ 103 ]. Predication of spread and implications of prevention and control using the Maximum-Hasting (MH) parameter assessment method and the modified Susceptible Exposed Infectious Recovered (SEIR) model was done. Suppression, mitigation, and mildness were the three predicted outlines for the spread of infection in some African countries [ 104 ].

Infection control strategies that can be acquired in hospitals were accomplished in a Taiwanese hospital to tackle the COVID-19 pandemic. These included emergency vigilance and responses from the hospital administration, education, surveillance, patient flow arrangement, the partition of hospital zones, and the prevention of a systemic shutdown by using the “divided cabin, divided flow” strategy. These measures may not be universally appropriate [ 105 ]. The preventive measures implemented in China included countrywide health education campaigns. The Examine and Approve Policy on the continuation of work, working and living quarters, a health Quick Response code system, community screening, and social distancing policies were some of the preventive measures [ 106 ].

Based on the analysis of immigration population data, the Epidemic Risk Time Series Model was outlined to estimate the effectiveness of COVID-19 epidemic control and prevention among different regions in China. Compared to other methods, this model was able to issue early recognition more instantaneously. For the prevention and control of COVID-19, this model can be generalized and applied to other countries [ 107 ]. The majority of clinical trials involving COVID-19 vaccines or treatment are showing encouraging results. (Tables (Tables6 6 and and7) 7 ) show ongoing phase 3 and 4 clinical trials [ 108 ].

Ongoing clinical trials phase 3 studies

Study title	Conditions	Interventions	Locations
Randomized evaluation of COVID-19 therapy	Severe acute respiratory syndrome	Drugs: hydroxychloroquine, lopinavir/ritonavir, corticosteroid, azithromycin, tocilizumab	Nuffield Department of Population Health, University of Oxford, Oxford, UK
Hydroxychloroquine and zinc with either azithromycin or doxycycline for treatment of COVID-19 in outpatient setting	COVID-19	Drugs: hydroxychloroquine, azithromycin, zinc sulfate, doxycycline	St. Francis Hospital, Roslyn, NY, USA
Favipiravir in hospitalized COVID-19 patients	COVID-19	Drugs: favipiravir, hydroxychloroquine	Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran
Baricitinib therapy in COVID-19	COVID-19 pneumonia	Drug: baricitinib 4 mg oral tablet	Fabrizio Cantini, Prato, Tuscany, Italy
Treatment for COVID-19 in high-risk adult outpatients	COVID-19 SARS-CoV-2	Drugs: ascorbic acid, hydroxychloroquine sulfate, azithromycin, folic acid	• Boston University, Boston, MA, USA • University of Washington Coordinating Center, Seattle, Washington, USA • UW Virology Research Clinic, Seattle, WA, USA and 4 more
Convalescent plasma for hospitalized adults with COVID-19 respiratory illness (CONCOR-1)	COVID-19	Other: convalescent plasma	• Vancouver General Hospital, Vancouver, British Columbia, Canada • Victoria General Hospital, Victoria, British Columbia, Canada • London Health Sciences Centre—University Hospital, London, Ontario, Canada and 25 more
BCG vaccine for health care workers as defense against COVID-19	Coronavirus infection, Coronavirus as the cause of diseases classified elsewhere	Biologicals: BCG vaccine, placebo vaccine	• Harvard T.H. Chan School of Public Health, Boston, MA, USA • Baylor College of Medicine, Houston, TX, USA • MD Anderson Cancer Center, Houston, TX, USA and 4 more
Outcomes related to COVID-19 treated with hydroxychloroquine among in-patients with symptomatic disease	Coronavirus acute respiratory infection -SARS-CoV infection	• Drugs: hydroxychloroquine, placebo	• Stanford University, Stanford, CA, USA • University of Colorado Hospital, Aurora, CO, USA • Denver Health Medical Center, Denver, CO, USA and 40 more
Treatment of COVID-19 patients with anti-interleukin drugs	COVID-19	• Other: usual care • Drugs: anakinra, siltuximab, tocilizumab	• University Hospital Saint-Pierre, Brussels, Belgium • University Hospital Antwerp, Edegem, Belgium • University Hospital Brussels, Jette, Belgium 13 more
Study to evaluate the safety and antiviral activity of remdesivir (GS-5734™) in participants with severe coronavirus disease (COVID-19)	COVID-19	Drug: remdesivir	• Kaiser Permanente Los Angeles Medical Center, 3340 E. La Palma Avenue, Anaheim, CA, USA • Alta Bates Summit Medical Center, Berkeley, CA, USA • Mills-Peninsula Medical Center, Burlingame, CA, USA and180 more

Ongoing clinical trials, phase 4 studies

Study title	Conditions	Interventions	Locations
Evaluation of Ganovo (danoprevir) combined with ritonavir in the treatment of SARS-CoV-2 infection	COVID-19	Drug: Ganovo + ritonavir/interferon nebulization	• The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
The use of tocilizumab in the management of patients who have severe COVID-19 with suspected pulmonary hyper inflammation	COVID-19 pneumonia	Drug: tocilizumab	• Hadassah Medical Orginisation, Jerusalem, Israel • Barzilai Medical Center, Ashkelon, Israel • Wolfson Medical Center, Holon, Israel • Sheba Medical Center, Ramat Gan, Israel
Fluoxetine to reduce intubation and death after COVID19 infection	COVID-19 cytokine storm	Drug: fluoxetine	University of Toledo, Toledo, OH, USA
Hydroxychloroquine and zinc with either azithromycin or doxycycline for treatment of COVID-19 in outpatient setting	COVID-19	Drug: hydroxychloroquine, azithromycin, zinc sulfate, doxycycline	St Francis Hospital, Roslyn, NY, USA
Favipiravir in hospitalized COVID-19 patients	COVID-19	Drug: favipiravir, hydroxychloroquine	Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran
Azithromycin in hospitalized COVID-19 patients	COVID-19	Drug: hydroxychloroquine, azithromycin	Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran, Islamic Republic of
Prophylaxis of exposed COVID-19 individuals with mild symptoms using chloroquine compounds	• SARS-CoV2 • Symptomatic condition • COVID-19	• Drug: hydroxychloroquine sulfate regular dose, hydroxychloroquine sulfate loading dose, chloroquine, placebo	• Expo COVID Isolation Center/Mayo Hospital Field Hospital, Lahore, Punjab, Pakistan • Mayo Hospital/King Edward Medical University, Lahore, Punjab, Pakistan • Pakistan Kidney and Liver Institute, Lahore, Punjab, Pakistan
BCG vaccine for health care workers as defense against COVID 19	• Coronavirus • Coronavirus infection • Coronavirus as the cause of diseases classified elsewhere	• Biological: BCG vaccine • Biological: placebo vaccine	• Cedars-Sinai Medical Center, Los Angeles, CA, USA • Harvard T.H. Chan School of Public Health, Boston, MA, USA • Texas A&M Family Care Clinic, Bryan, TX, USA and 4 more
Hydroxychloroquine in patients with newly diagnosed COVID-19 compared to standard of care	• COVID-19 • Coronavirus Infection • SARS-CoV-2 • 2019-nCoV • 2019 novel coronavirus	• Drug: hydroxychloroquine • Dietary supplement: vitamin C	Portland Providence Medical Center, Portland, OR, USA
Efficacy of dexamethasone treatment for patients with ARDS caused by COVID-19	Acute respiratory distress syndrome caused by COVID-19	• Drug: dexamethasone	• ICU, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain • Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Las Palmas, Spain • Department of Anesthesia, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain and 21 more

Impact of COVID-19 on overall health of the people worldwide

The international response to COVID-19 has been more transparent and efficient when compared to the SARS outbreak [ 109 ].

The pandemic COVID-19, being a most severe strainer, is affecting the overall health system worldwide. There is a continuously increasing demand for healthcare facilities and associated workers, which is overstretching the ability to operate efficiently [ 110 ]. Some pieces of evidence are showing a destructive effect on maternal and child health. Some financial, educational, sanitation, and even clinical constraints are threatening the overall population of the children [ 111 ]. As coronavirus is sweeping across the world, the primary psychological impact is elevated in terms of stress and anxiety. The quarantine period is expected to raise cases involving suicidal behavior, substance abuse, self-harm, depression, and loneliness. WHO Department of Mental Health and Substance use has given some messages to overcome psychological impacts [ 112 ]. There is a relationship between human development and infectious diseases. Whichever changes (new technology, constructions of dams, deforestations, migration, increasing populations, the emergence of urban ghettoes, globalization of food, and increasing international travel) brought about by the development, are stretching the word into the mouth of such pandemics indirectly. This pandemic is having a significant impact on the global economy as the erosion of capacity and rise in poverty [ 113 , 114 ].

COVID-19 has affected the population differently based on gender. Significantly, this crisis is affecting the reproductive and sexual health of women. Another point is that there should be an equal contribution to both the genders in any healthcare body. There should be more distribution of decision-making power among them [ 115 ]. Protective measures can effectively prevent COVID-19 infection, including improving personal hygiene, wearing N95 masks, adequate rest, and proper ventilation [ 116 ].

Have to learn to live with COVID-19

The Health Ministry has said that we have to learn to survive with COVID-19. We cannot step ahead by carrying the burden of COVID-19 that could recur annually and kill so many people [ 117 ]. Governments are learning to strike a balance between controlling COVID-19 spread and allowing individual freedoms and economic activity. Measures such as lockdowns, arbitrary travel bans, widespread quarantines, intrusive screening of people crossing boundaries can be adopted for prevention. Virtual work will become much more common. Supplier close-downs, sudden employee truancy, and demand collapse caused by disease outbreaks will make the businesses able to withstand disruptions.

The government, industry, or specialist certification for disease control processes and standards similar to ISO 9001 or USFDA certificate will be a crucial part of many businesses. The cost of traveling will expand more due to the risk of infection and lockdown. At the same time, the responsibility of work airlines, hotels, and restaurants will be added to minimize infection risk. Delivery businesses will perform well, and “Contactless delivery” is already a thing.

The industries that provide products to help circumvent, control, diminish, or treat COVID-19 will flourish. The requirement for hospital rooms will increase tremendously, with an increasing need for reserves of equipment, supplies, and drugs. In the upcoming time, businesses are likely to face demand crisis as the world comes to terms with living in a state of medical beleaguerment [ 118 ]. It is just a prediction, but we can still aspire for the best [ 119 ]. The most destructive effects would be in countries with weak health systems, on-going disputes, or existing infectious disease epidemics.

In contrast, the health systems in high-income countries would be stretched out by the outbreak [ 120 ]. It has been seen that resources are limited in countries with poor scientific infrastructure, such as Nepal, where there was only one laboratory equipped to test for coronavirus infection. Fear and stigma is an evident feature of the COVID-19; it has affected the economic and social development of many countries worldwide [ 121 ].

The insufficiency of the trained workforce capable of performing experiments required to test for SARS-CoV-2 and interpret the results is another major limitation in the testing and confinement of COVID-19 in developing countries [ 122 ]. The virus has the potential to adapt and get through the different environmental conditions, which makes it quite difficult to identify its mode of survival [ 123 ]. Another crucial impediment in a research project is a suitable model to investigate in vivo mechanism associated with the pathogenesis of SARS-CoV-2 [ 124 – 126 ].

Current screening approaches for COVID-19 are likely to miss approximately 50% of the infected cases, even in countries with sound health systems and available diagnostic capacities. Many symptoms correlated with COVID-19 are similar to malaria, such as fever, difficulty in breathing, fatigue, and headaches of acute onset. If symptoms alone are used to specify a case during the emergency period then, a malaria case may be misinterpreted as COVID-19. The symptoms for malaria are seen within 10–15 days after an infective bite; multi-organ failure is common in severe cases among adults, while respiratory distress is also expected in children [ 127 ].

COVID-19 has emerged as the most terrified and enormous viral infection. According to WHO, the coronavirus might become an endemic disease. Originating from China as a global pandemic, it has influenced people on a large scale. There is no clear end that can be seen for this contagious disease. The only possible cure for this pandemic is prevention. We have to face it as a global community and support each other. The amplification of positivity will have a tremendous impact on the whole society. It is the duty of each individual for self-supervision and to report COVID-19 status, and challenging for those who appear to be ill. The other measure which can be followed to tackle this pandemic is healthy nourishment, sanitation, and hygiene practices robust connection and communication among children, and counseling to face the situation. Special care should be given to older people and pregnant ladies. It is better to get information only from the trusted sources; it is vital to get the facts and not the misinformation or rumors. Healthcare servants should have excellent and accurate communication with the public and must provide emotional and practical support. The ongoing pandemic of COVID-19 has caused not only notable morbidity and mortality in the world but also revealed significant systematic problems in the control and prevention of infectious diseases.

Acknowledgements

The authors express their sincere thanks to Ms. Fatma Rafiq Zakaria, Chairman of Maulana Azad Educational Trust Aurangabad Maharashtra, for her endless encouragement and support and for providing necessary facilities to carry out the above research work.

Abbreviations

ACE-2	Angiotensin-converting enzyme-2
ARDS	Acute respiratory distress syndrome
CoV	Coronavirus
COVID-19	Novel coronavirus infectious disease 2019
MERS-CoV	Middle East respiratory syndrome coronavirus
Nsps	non-structural proteins
ORF	Open reading frame
RBD	Receptor-binding domain
RTC	Replicase-transcriptase complex
SARS-CoV	Severe acute respiratory syndrome coronavirus
WHO	World Health Organization

Authors’ contributions

All authors participated in the work substantively and have approved the manuscript as submitted. The authors have no conflict of interest in the study. Drafting the article and critical revision of the article was carried out by SSS. Data collection for the formation of graphical abstract and various figures and tables was also contributed from her end. Conception or design of the work was carried out by SKS. He also contributed to the data collection for lifecycle, history, and origin. Data collection for pathogenesis and comparison of CoVs study was carried out by APJ. Data collection for diagnosis and treatment was carried out by MVKV. Data collection for clinical trials was carried out by DAN. Final approval of the version to be published was done by all the authors’ SSS, APJ, DAN, MVKV, and SKS. All the authors have read and approved the manuscript. Each author has agreed with the publication of the manuscript.

No funding was received for this work

Availability of data and materials

Ethics approval and consent to participate.

Not applicable

Consent for publication

Competing interests.

I, on behalf of all the authors, hereby declare that there is no significant financial, professional, or personal competing interest that might have influenced the performance or presentation of the work described in this manuscript.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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> Understanding Coronavirus
> Introduction

Book contents

Understanding Coronavirus
Series page
Copyright page
Preface to the Revised and Updated Edition
Preface to the First Edition
Abbreviations
1 Introduction
2 How Is the Coronavirus Spreading?
3 What Is a Coronavirus?
4 How Is the Coronavirus Changing?
5 How Did the COVID-19 Outbreak Start and Evolve?
6 How Does the COVID-19 Outbreak Compare to the SARS Outbreak in 2003?
7 How Does the COVID-19 Outbreak Compare to Seasonal and Pandemic Influenza?
8 How Can We Treat the Virus and Prevent Infections?
Conclusions
Summary of Common Misunderstandings
Suggested Further Reading
Figure and Quotation Credits

1 - Introduction

Published online by Cambridge University Press: 29 September 2021

At the end of December 2019, an outbreak of pneumonia cases of unknown origin was reported in Wuhan, Hubei province, China. The patients presented with high fever and had difficulty breathing. Some, but not all, of these cases were in people who visited the Huanan Seafood Wholesale Market, where, in addition to seafood, a variety of live animals were also sold. Other infections occurred in people staying at a nearby hotel on December 23–27. All tests carried out by the Chinese Center for Disease Control and Prevention for known viruses and bacteria were negative, indicating the presence of a previously unreported agent. A new virus was isolated and its genome sequenced, revealing a similarity with SARS-like coronaviruses found in bats. Although very similar to the virus causing severe acute respiratory syndrome (SARS) in 2003, it was different enough to be considered a new human-infecting coronavirus. Clusters of infected families, together with transmission in medical settings, indicated that the virus had the ability to undergo human-to-human transmission. A month later, by the beginning of February 2020, the virus was found in several countries across the globe, and on March 11, 2020, the World Health Organization (WHO) declared it a global pandemic. The disease caused by the new coronavirus was called coronavirus disease 19, or COVID-19.

The single biggest threat to man’s continued dominance on the planet is the virus.

Viruses populate the world between the living and the non-living, the molecules that can duplicate themselves and the ones that cannot. Inherent in the organization and properties of viruses are many of the secrets of life …

The rapid pace of these events led to significant confusion. Attitudes and perceptions in the population varied dramatically, from denial to serious concern and panic, mimicking the disparate comments and actions taken by public authorities and the media. After the declaration of the pandemic and the first serious outbreaks in Wuhan, Northern Italy, Spain, and Iran, it became clear that the emergence of this virus was a serious threat, and could lead to a significant overloading of healthcare systems. By the end of March 2020, the USA, the UK, India, and most countries in Europe had reported an escalating number of cases and deaths, and had implemented extensive public health measures, including lockdowns. The associated effects on the economy were daunting, including foreclosure of many businesses, escalating unemployment, international travel bans, market uncertainty, and significant reduction of demand for and production of goods and services, among many others.

Unfortunately, the confusion of the first few months of the pandemic led to a profusion of myths, large amounts of inconsequential information, and conspiracy theories that infected the Internet faster than the virus spread around the world. In trying to make sense of the situation, and to create a coherent narrative that incorporates the overwhelming data, many questions have arisen: questions about the nature of the virus and the disease it causes, about its changes, and about the future. This book addresses some of these questions. I have decided to structure the book in the form of a dialogue, of simple questions and answers. Most of these questions came from family, friends, and colleagues.

This book is aimed at the lay reader, one who has minimal knowledge of biology, virology, epidemiology, or medicine in general. I have tried to make the chapters self-contained, and they can be read in any order, although I recommend reading the first four chapters first, in order to get a clearer understanding of the biological and epidemiological concepts that are discussed in the chapters about specific viruses and outbreaks. Because this book is a short introduction to the topic, there are some important details that are overlooked. To compensate for the superficiality in how some themes have been treated, I have included at the end of the book a list of recommended reading material that will guide the interested reader to more in-depth treatment of specific topics. This material has been selected from among recent scientific journal papers of broader scope, and from textbooks. I would encourage the enthusiastic reader to follow up with these references. I apologize to some of the researchers whose work I have not been able to discuss or mention due to the introductory nature of this book.

Viruses are fascinating entities that awaken our deepest fears. The history of humankind is literally plagued with the narration of the devastating effects of infectious diseases, in which viruses have been major players. Smallpox killed one in every three people it infected, with an estimated 300 million deaths in the past century. The infamous Spanish Influenza of 1918 shocked the world with its rapid spread, completely overwhelming healthcare systems, and with its vicious attack on the young adult population. The human immunodeficiency virus (HIV) in the 1980s marked a then-young generation and challenged a rapidly evolving society. Rotavirus infection, a vaccine-preventable disease, is one of the most common causes of diarrhea in young children, and kills more than 100,000 children every year. Many other examples, recent and historical, easily come to mind.

Once an infectious pathogen appears, we would like to understand and quantify how it is spreading, what its effects are in the population, and how the efficacy of different public health measures can be evaluated. In the rapid expansion of the COVID-19 virus around the world, we have observed and experienced the role of drastic public health policies that have changed our social lives dramatically, and we have witnessed the rapid growth of cases and deaths associated with the disease. Chapter 2 deals with basic concepts in epidemiology – the science of evaluating the distribution of diseases and different control measures.

What do we know about the virus that causes COVID-19? The coronavirus disease, or COVID-19, is caused by the SARS coronavirus 2, or SARS-CoV-2. Chapter 3 explores viruses, and coronaviruses in particular. Viruses are the most common biological entity on Earth and are present in every realm of the surface of this planet. Only a very small fraction of them interact with humans, and only a small fraction of those are pathogenic. The pathogenic viruses, however, have captured most of the attention of the scientific community. Coronaviruses constitute a particular type of virus that can be found in mammals and birds. Some coronaviruses cause disease in humans, but most of them infect other species, such as bats, without apparent disease. Four coronavirus types are found commonly in humans and induce typical cold symptoms. Others can cause severe disease, like bronchitis in chickens or diarrhea in pigs. Some, as we have seen with the virus causing COVID-19, can cause severe disease in humans. Many questions come to mind. Is this a new virus? Where is it coming from? How does it relate to other coronaviruses? In the third chapter of this book I provide some basic notions of what viruses are, and describe coronaviruses in particular. I explain the different types of coronaviruses and where they can be found. All coronaviruses share a common but highly distinctive structure. I also briefly explain how they enter and leave infected cells.

How was the coronavirus that causes COVID-19 able to infect and spread in humans? To answer this question, we need to understand how viruses evolve. Viruses are the tiniest and most rapidly evolving biological entities known. Changes in viral genomes happen almost continually. All changes in viruses can be read in their tiny genomes, which keep all the information on the virus and its history. Reading genomes is like reading a history book, where the main characters are viruses. This record not only portrays the history, but also allows one to infer the rules of the processes that dictate the changes. Through the recent developments in genomic technologies, viral genomes can be sequenced rapidly and their changes can be observed almost in real time. As the COVID-19-causing virus spreads across the globe, we will be able to follow a parallel history by reading the genomes of the viruses collected in different parts of the world.

Chapter 4 explains the two main mutational mechanisms that drive the evolution of coronaviruses. The first one is what is known as the “sloppiness” of the replication machinery. Once a virus infects a cell, it makes tens of thousands of copies of itself. But these copies are sometimes (often) imperfect, with small variations on the main theme. Many times, these changes lead to a faulty copy. But sometimes, the new virus can acquire new abilities that become useful to the virus, such as the ability to enter a new type of cell or to evade recognition by the immune system of the organism it is infecting. But an even more dramatic mechanism is pervasive in coronaviruses: recombination. In a recombination event, two different viruses can swap genomic material rapidly, quickly acquiring new abilities. The combination of these two processes – sloppiness and recombination – shapes the evolution of coronaviruses. We will talk about these two mechanisms and how they can be read from viral genomes. Understanding how viruses evolve is far from an academic exercise: it will be fundamental to understanding the situation we are living in and what we have to do to be prepared.

Chapters 2 – 4 provide a background to contextualize the emergence of the virus that causes COVID-19, which is discussed in Chapter 5 . Using genomic information, we relate the genome of the new virus, SARS-CoV-2, to other known viruses and where they were found. The new virus is related to SARS-CoV, the agent that caused the 2002–2003 SARS outbreak, and to many other viruses found in other species, mostly bats. I narrate the first known events in the history of this outbreak, how it was first identified, and how it has been evolving. I then discuss the disease caused by the virus – COVID-19 – its symptoms, and how it causes disease and death. I also devote some time to the demographics of the populations at risk, how it is affecting more men than women, and the effects on children.

Chapter 6 is devoted to the outbreak that occurred in 2002 and 2003 due to one of the closest relatives of the virus that causes COVID-19. That outbreak was SARS, and the virus was the SARS coronavirus, a close relative of SARS-CoV-2. These are the only two viruses in the same virus species that are known to have caused outbreaks in humans. There are remarkable similarities between the SARS outbreak of 2002–2003 and the COVID-19 outbreak in 2019–2020. The two viruses have many similarities in their genes, in the type of cells they infect, in how they enter cells, and in how they interact with the cell machinery and immune system. It is not surprising that the diseases caused by these two viruses share certain similarities. More interestingly, we can learn many things about the new virus causing COVID-19 from the work that scientists have carried out with the virus causing SARS. The basic biology and the clinically acquired knowledge from related viruses can help to accelerate the discovery of potential treatments for COVID-19.

Chapter 7 is a scientific misfit. It is about a virus, but not a coronavirus. Rather, it is about a virus that has been used widely as a comparison: influenza. The elements for comparison are obvious. Influenza causes respiratory diseases; it spreads through surfaces and air droplets in coughs and sneezes; and it causes severe disease in the elderly. These are all elements that are shared with COVID-19. But, in many other aspects, the SARS-CoV-2 and the influenza viruses are very different, and the diseases caused by them, and the severity of those diseases, are very different. Most importantly, for seasonal influenza, there is at least partial immunity in the population, and we have vaccines and specific drugs for treatment. None of this is true for COVID-19. The lack of immunity to the COVID-19-causing virus has taken an immunologically unprotected population by surprise, leading to a dramatic surge in cases that has pushed healthcare systems to the verge of collapse. This rapid surprise attack has occurred in the past in the context of pandemic influenza, most notably in the infamous Spanish Influenza of 1918. In 1918, it was not known that the disease was caused by a virus, and part of the world was still embroiled in a devastating war. That virus, however, was not a coronavirus, and the diseases, the populations most affected, and healthcare systems were very different. It is, however, instructive to compare some of the historical events of the Spanish Influenza of 1918 to the COVID-19 pandemic of 2020, such as how different places dealt with the unmanageable surge in the number of cases.

The last chapter of this book is about testing, our immune system, and how our immune system recognizes the virus. I will also be talking about vaccines, how they work, how long they last, and how mutations can hinder the immune response, among other things. We have now witnessed the most rapid development and widespread deployment of vaccines in human history. Within a few months of the initial outbreak in Wuhan, several vaccines were being tested in humans, and a year later the population was being vaccinated at an unprecedented rate. This astonishing enterprise, together with the societal awareness of the dangers of emerging infectious diseases, left us wondering if we will be better prepared for potential future pandemics.

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Introduction
Raul Rabadan , Columbia University, New York
Book: Understanding Coronavirus
Online publication: 29 September 2021
Chapter DOI: https://doi.org/10.1017/9781009090063.004

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A Searing Reminder That Trump Is Unwell

His bizarre diatribe at the RNC shows why the pro-democracy coalition is so worried about beating him.

This is an edition of The Atlantic Daily, a newsletter that guides you through the biggest stories of the day, helps you discover new ideas, and recommends the best in culture. Sign up for it here.

Donald Trump’s bizarre diatribe at the Republican National Convention shows why the prodemocracy coalition is so worried about beating the GOP nominee—even if it means that Joe Biden must step down.

But first, here are three new stories from The Atlantic .

It’s official: The Supreme Court ignores its own precedent.
What the Microsoft outage reveals
“Hillbilly” women will get no help from J. D. Vance.

Not Comparable

It’s been quite a year in politics, what with President Biden facing calls to drop out of the race and Trump having a meltdown in public after an assassination attempt and …

I’m sorry, did I say a year ? I meant a week .

So much has happened, and political events have become so freakish, that we can all be forgiven for losing our bearings a bit. For the past few days, I’ve felt like Homer Simpson after he accidentally turned a toaster into a time machine and came back to find that Ned Flanders was the unchallenged dictator of the world.

But in the midst of all this, two things remain clear:

Joe Biden is showing significant signs of frailty and faces real opposition within his party to continuing his campaign.
Donald Trump is emotionally unwell.

These are not comparable problems.

Nor did Biden and Trump have equally bad weeks. Biden is facing a revolt in his own party and is now recovering from COVID. Trump was nearly killed by a young loner .

Biden claims to still be in the race, an answer many elected Democrats have refused to accept. My colleague Russell Berman wrote yesterday afternoon that Senator Peter Welch of Vermont believes that the Biden campaign may be at an end; more telling is that Russell described Welch as the only member of the upper chamber making that argument, but from the time that Russell wrote that article to this afternoon, three more sitting Democratic U.S. senators— Sherrod Brown of Ohio, Jon Tester of Montana, and Martin Heinrich of New Mexico—called for Biden to step down.

The case for Biden leaving the race is evident to anyone who’s watched him over the past month. He seems to be no better in his public outings than he was during the debate, and has sometimes seemed worse. As I’ve said here , I don’t think that means he can’t run the country for the remainder of his term, but Trump is going to be fired up and on the road, and I doubt that Biden can match that level of engagement, which could be decisive in a race that will be won on slim margins in a handful of states. I suspect that the people voting to save democracy would vote for Biden if he were governing from a cryostatic tube, but the Democrats calling on him to wrap it up have perfectly valid fears that he could lose and take the down-ballot races with him.

Meanwhile, the Republican National Convention was a searing reminder that Trump is a vengeful autocrat with obvious mental deficits who has surrounded himself with a crew of vicious goons.

I approached Trump’s speech with genuine curiosity. I was for most of my life a working political scientist, and I have written speeches for politicians; I think I know a good one when I see one. So I watched last night to see if Trump, tamed by a brush with death, would strike a new tone or, at the very least, try to make peace with one of his most hated enemies: the teleprompter.

No chance. To be fair, some people who watched the speech thought that the first 10 minutes or so, in which Trump recounted being injured, were good, even thoughtful. I thought they were terrible; although Trump and his people have emphasized Trump’s defiance in the moment after he was hurt, his blow-by-blow account of the incident came across to me as creepy and solipsistic rather than brave.

Contrast that with Ronald Reagan, the previous president injured in an attempt on his life. Karen Tumulty of The Washington Post reminded us today that Reagan appeared before Congress a month after he was nearly killed. (His injuries were severe and life-threatening.) Reagan was on the Hill to talk about the economy, but he started by thanking the country for its prayers and good wishes, noting a cute letter he got from a child while he was in the hospital, and paying tribute to the people injured alongside him. This digression took all of four paragraphs, a matter of a few minutes. “Now, let’s talk about getting spending and inflation under control and cutting your tax rates,” he then said. Trump, however, droned on about how much the human ear can bleed, while the screens behind him showed huge pictures of blood on his face. He then went over to the equipment owned by Corey Comperatore, the volunteer firefighter killed in the attack, and kissed the helmet. Some in the crowd may have loved it, but I prefer a bit more stoicism in national leaders; I’ve always thought that Trump’s penchant for hugging and kissing flags was weird, and planting a kiss on the headgear of a dead man was even weirder.

And then things really went off the rails. If you didn’t sit through it, I can’t blame you; it was the longest presidential-nomination-acceptance speech on record. Basking in the friendliest audience he will ever find on this planet, Trump couldn’t help himself. He was supposed to be like a band at a concert doing a tight set, playing some favorites for the loyal fans, introducing a little new material, and gaining a wider audience. Instead, he blew the chance and ran overtime as he noodled, improvised, and even mangled some of his classics.

The speech wasn’t written that way, of course, but Trump can’t stick to a script. You can always tell when Trump is trying to read the teleprompter: His shoulders tense up, he cocks his head and squints, and he rushes through words he has clearly never seen before. It doesn’t help that Trump’s writers stuff his speeches with baroque constructions that are supposed to be soaring and majestic but that always end up sounding more like dollar-store Churchill imitations. Trump struggles with these complex sentences, and then he abandons them—and that is when the real Trump comes out, in all his whiny and aggrieved glory.

I do not have the space (or the endurance) to relive those moments with you, but they were the ramblings of a man who has serious psychological problems . All of it was on display last night: rage, paranoia, pettiness, desolating selfishness.

I’m always sorry to leave readers with these sorts of observations just before a weekend, but much of the media response to Biden’s troubles and Trump’s madness has been mired in equivalences that obscure what’s happening to both men, and what’s at stake for the nation. (As I was writing this, for example, a Washington Post newsletter arrived in my inbox and told me that the GOP had just wrapped up “an energized, focused convention.” That’s an interesting description of a Republican gathering that featured a sex worker, Hulk Hogan, and a spaced-out Trump.)

Yes, Biden is old, and he’s having trouble communicating. The people expressing serious concerns about him have good reason to worry about both his health and his ability to defeat Trump. He might be out of the race by next week. But Trump is mentally and emotionally unwell. He and his valet, J. D. Vance, are not going anywhere. The real tragedy is that, in a serious country, Biden might step down without incident, and a normal race would continue, because decent people would have banished Trump from the public square long ago.

David Frum: This crew is totally beatable.
The new Trump is always the old Trump.

Today’s News

A software update from the cybersecurity company CrowdStrike caused a digital outage that disrupted airlines, health care, shipping, and many other services on Friday.
A federal appeals court temporarily blocked a Biden-administration student-loan-repayment plan, leading the Department of Education to pause payments for 8 million borrowers.
Depending on his recovery from COVID-19, Biden expects to meet Israeli Prime Minister Benjamin Netanyahu when the latter is in Washington next week to address a joint session of Congress.
The Books Briefing : Emma Sarappo explores the books that keep readers awake at night .
Atlantic Intelligence : Damon Beres asks: What happens when a bot gets too good at its job ?

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Evening Read

A collage of photos of John Fogerty, and the author of this piece performing as John Fogerty

How I Faked My Way to Rock Stardom

By J. R. Patterson

Before John Fogerty’s life became mine, there was cold. In November 2012, I was 22 and had left the family farm in Manitoba to find work in the oil fields of Alberta. I arrived during a bust and, because work was not immediate, spent the days driving my Ford F-150 around the country surrounding Calgary, listening to AM radio and my small collection of CDs—a few Rolling Stones albums, some outlaw-country records, and the complete discography of Creedence Clearwater Revival. The Ford was what they call a SuperCab, with a rear backward-opening half door and a narrow bench for a back seat. At night, lacking the money for a hotel, I would find a quiet place to park, crawl into the back seat, and stretch out on the bench, my clothes wrapped around my boots for a pillow. I kept my guitars—an acoustic Martin and an electric Epiphone Les Paul—beside me to warm them, lest they crack in the cold. The nights weren’t kind to me either, and I often woke up shivering, the world outside covered with frost or snow. To allay myself, I’d run the engine for a while and put on Creedence.

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