essay on impact of covid

• History & Society
• Science & Tech
• Biographies
• Animals & Nature
• Geography & Travel
• Arts & Culture
• Games & Quizzes
• On This Day
• One Good Fact
• New Articles
• Lifestyles & Social Issues
• Philosophy & Religion
• Politics, Law & Government
• World History
• Health & Medicine
• Browse Biographies
• Birds, Reptiles & Other Vertebrates
• Bugs, Mollusks & Other Invertebrates
• Environment
• Fossils & Geologic Time
• Entertainment & Pop Culture
• Sports & Recreation
• Visual Arts
• Demystified
• Image Galleries
• Infographics
• Top Questions
• Britannica Kids
• Saving Earth
• Space Next 50
• Student Center
• Introduction

Horrific history

The early days, health and medicine.

What was the impact of COVID-19?

Our editors will review what you’ve submitted and determine whether to revise the article.

• 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.

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• Current issue
• BMJ Journals

You are here

• Volume 76, Issue 2
• COVID-19 pandemic and its impact on social relationships and health
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• 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

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

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.

Ethics statements

Patient consent for publication.

Not required.

• Office for National Statistics (ONS)
• Ford T , et al
• Riordan R ,
• Ford J , et al
• Glonti K , et al
• McPherson JM ,
• Smith-Lovin L
• Granovetter MS
• Fancourt D et al
• Stadtfeld C
• Office for Civil Society
• Cook J et al
• Rodriguez-Llanes JM ,
• Guha-Sapir D
• Patulny R et al
• Granovetter M
• Winkeler M ,
• Filipp S-H ,
• Kaniasty K ,
• de Terte I ,
• Guilaran J , et al
• Wright KB ,
• Martin J et al
• Gabbiadini A ,
• Baldissarri C ,
• Durante F , et al
• Sommerlad A ,
• Marston L ,
• Huntley J , et al
• Turner RJ ,
• Bicchieri C
• Brennan G et al
• Watson-Jones RE ,
• Amichai-Hamburger Y ,
• McKenna KYA
• Page-Gould E ,
• Aron A , et al
• Pietromonaco PR ,
• Timmerman GM
• Bradbury-Jones C ,
• Mikocka-Walus A ,
• Klas A , et al
• Marshall L ,
• Steptoe A ,
• Stanley SM ,
• Campbell AM
• ↵ (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
• Rosenberg M ,
• Hensel D , et al
• Banerjee D ,
• Bruner DW , et al
• Bavel JJV ,
• Baicker K ,
• Boggio PS , et al
• van Barneveld K ,
• Quinlan M ,
• Kriesler P , et al
• Mitchell R ,
• de Vries S , et al

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.

Read the full text or download the PDF:

• Fact sheets
• Facts in pictures
• Publications
• Questions and answers
• Tools and toolkits
• Endometriosis
• Excessive heat
• Mental disorders
• Polycystic ovary syndrome
• All countries
• Eastern Mediterranean
• South-East Asia
• Western Pacific
• Data by country
• Country presence 
• Country strengthening 
• Country cooperation strategies 
• News releases
• Feature stories
• Press conferences
• Commentaries
• Photo library
• Afghanistan
• Cholera 
• Coronavirus disease (COVID-19)
• Greater Horn of Africa
• Israel and occupied Palestinian territory
• Disease Outbreak News
• Situation reports
• Weekly Epidemiological Record
• Surveillance
• Health emergency appeal
• International Health Regulations
• Independent Oversight and Advisory Committee
• Classifications
• Data collections
• Global Health Observatory
• Global Health Estimates
• Mortality Database
• Sustainable Development Goals
• Health Inequality Monitor
• Global Progress
• World Health Statistics
• Partnerships
• Committees and advisory groups
• Collaborating centres
• Technical teams
• Organizational structure
• Initiatives
• General Programme of Work
• WHO Academy
• Investment in WHO
• WHO Foundation
• External audit
• Financial statements
• Internal audit and investigations 
• Programme Budget
• Results reports
• Governing bodies
• World Health Assembly
• Executive Board
• Member States Portal

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

Joint statement by ilo, fao, ifad and who.

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

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

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

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

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

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

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

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

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

Media Contacts

Kimberly Chriscaden

Communications Officer World Health Organization

Nutrition and Food Safety (NFS) and COVID-19

We need your support today

Independent journalism is more important than ever. Vox is here to explain this unprecedented election cycle and help you understand the larger stakes. We will break down where the candidates stand on major issues, from economic policy to immigration, foreign policy, criminal justice, and abortion. We’ll answer your biggest questions, and we’ll explain what matters — and why. This timely and essential task, however, is expensive to produce.

We rely on readers like you to fund our journalism. Will you support our work and become a Vox Member today?

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.

• Recommendations

Most Popular

• What the polls show about Harris’s chances against Trump
• The state of the 2024 race, explained in 7 charts
• America isn’t ready for another war — because it doesn’t have the troops
• Trump’s biggest fans aren’t who you think
• Take a mental break with the newest Vox crossword

Today, Explained

Understand the world with a daily explainer plus the most compelling stories of the day.

This is the title for the native ad

More in Culture

Jennifer Lopez’s and Ben Affleck’s reactions to their split are both very on-brand and kind of pointless.

The back-and-forth over a wildly rare appeal is a win for victim’s rights.

Why everyone suddenly cares about Brittany Mahomes’s politics.

The second season of the series has huge news for fans of Tom Bombadil.

A newsletter about kids, for everyone.

How the once-maligned retailer quietly became a closet staple — and a stock market giant — once again.

The pandemic has had devastating impacts on learning. What will it take to help students catch up?

Subscribe to the brown center on education policy newsletter, megan kuhfeld , megan kuhfeld senior research scientist - nwea jim soland , jim soland assistant professor, school of education and human development - university of virginia, affiliated research fellow - nwea karyn lewis , and karyn lewis director, center for school and student progress - nwea emily morton emily morton research scientist - nwea.

March 3, 2022

As we reach the two-year mark of the initial wave of pandemic-induced school shutdowns, academic normalcy remains out of reach for many students, educators, and parents. In addition to surging COVID-19 cases at the end of 2021, schools have faced severe staff shortages , high rates of absenteeism and quarantines , and rolling school closures . Furthermore, students and educators continue to struggle with mental health challenges , higher rates of violence and misbehavior , and concerns about lost instructional time .

As we outline in our new research study released in January, the cumulative impact of the COVID-19 pandemic on students’ academic achievement has been large. We tracked changes in math and reading test scores across the first two years of the pandemic using data from 5.4 million U.S. students in grades 3-8. We focused on test scores from immediately before the pandemic (fall 2019), following the initial onset (fall 2020), and more than one year into pandemic disruptions (fall 2021).

Average fall 2021 math test scores in grades 3-8 were 0.20-0.27 standard deviations (SDs) lower relative to same-grade peers in fall 2019, while reading test scores were 0.09-0.18 SDs lower. This is a sizable drop. For context, the math drops are significantly larger than estimated impacts from other large-scale school disruptions, such as after Hurricane Katrina—math scores dropped 0.17 SDs in one year for New Orleans evacuees .

Even more concerning, test-score gaps between students in low-poverty and high-poverty elementary schools grew by approximately 20% in math (corresponding to 0.20 SDs) and 15% in reading (0.13 SDs), primarily during the 2020-21 school year. Further, achievement tended to drop more between fall 2020 and 2021 than between fall 2019 and 2020 (both overall and differentially by school poverty), indicating that disruptions to learning have continued to negatively impact students well past the initial hits following the spring 2020 school closures.

These numbers are alarming and potentially demoralizing, especially given the heroic efforts of students to learn and educators to teach in incredibly trying times. From our perspective, these test-score drops in no way indicate that these students represent a “ lost generation ” or that we should give up hope. Most of us have never lived through a pandemic, and there is so much we don’t know about students’ capacity for resiliency in these circumstances and what a timeline for recovery will look like. Nor are we suggesting that teachers are somehow at fault given the achievement drops that occurred between 2020 and 2021; rather, educators had difficult jobs before the pandemic, and now are contending with huge new challenges, many outside their control.

Clearly, however, there’s work to do. School districts and states are currently making important decisions about which interventions and strategies to implement to mitigate the learning declines during the last two years. Elementary and Secondary School Emergency Relief (ESSER) investments from the American Rescue Plan provided nearly $200 billion to public schools to spend on COVID-19-related needs. Of that sum, $22 billion is dedicated specifically to addressing learning loss using “evidence-based interventions” focused on the “ disproportionate impact of COVID-19 on underrepresented student subgroups. ” Reviews of district and state spending plans (see Future Ed , EduRecoveryHub , and RAND’s American School District Panel for more details) indicate that districts are spending their ESSER dollars designated for academic recovery on a wide variety of strategies, with summer learning, tutoring, after-school programs, and extended school-day and school-year initiatives rising to the top.

Comparing the negative impacts from learning disruptions to the positive impacts from interventions

To help contextualize the magnitude of the impacts of COVID-19, we situate test-score drops during the pandemic relative to the test-score gains associated with common interventions being employed by districts as part of pandemic recovery efforts. If we assume that such interventions will continue to be as successful in a COVID-19 school environment, can we expect that these strategies will be effective enough to help students catch up? To answer this question, we draw from recent reviews of research on high-dosage tutoring , summer learning programs , reductions in class size , and extending the school day (specifically for literacy instruction) . We report effect sizes for each intervention specific to a grade span and subject wherever possible (e.g., tutoring has been found to have larger effects in elementary math than in reading).

Figure 1 shows the standardized drops in math test scores between students testing in fall 2019 and fall 2021 (separately by elementary and middle school grades) relative to the average effect size of various educational interventions. The average effect size for math tutoring matches or exceeds the average COVID-19 score drop in math. Research on tutoring indicates that it often works best in younger grades, and when provided by a teacher rather than, say, a parent. Further, some of the tutoring programs that produce the biggest effects can be quite intensive (and likely expensive), including having full-time tutors supporting all students (not just those needing remediation) in one-on-one settings during the school day. Meanwhile, the average effect of reducing class size is negative but not significant, with high variability in the impact across different studies. Summer programs in math have been found to be effective (average effect size of .10 SDs), though these programs in isolation likely would not eliminate the COVID-19 test-score drops.

Figure 1: Math COVID-19 test-score drops compared to the effect sizes of various educational interventions

Source: COVID-19 score drops are pulled from Kuhfeld et al. (2022) Table 5; reduction-in-class-size results are from pg. 10 of Figles et al. (2018) Table 2; summer program results are pulled from Lynch et al (2021) Table 2; and tutoring estimates are pulled from Nictow et al (2020) Table 3B. Ninety-five percent confidence intervals are shown with vertical lines on each bar.

Notes: Kuhfeld et al. and Nictow et al. reported effect sizes separately by grade span; Figles et al. and Lynch et al. report an overall effect size across elementary and middle grades. We were unable to find a rigorous study that reported effect sizes for extending the school day/year on math performance. Nictow et al. and Kraft & Falken (2021) also note large variations in tutoring effects depending on the type of tutor, with larger effects for teacher and paraprofessional tutoring programs than for nonprofessional and parent tutoring. Class-size reductions included in the Figles meta-analysis ranged from a minimum of one to minimum of eight students per class.

Figure 2 displays a similar comparison using effect sizes from reading interventions. The average effect of tutoring programs on reading achievement is larger than the effects found for the other interventions, though summer reading programs and class size reduction both produced average effect sizes in the ballpark of the COVID-19 reading score drops.

Figure 2: Reading COVID-19 test-score drops compared to the effect sizes of various educational interventions

Source: COVID-19 score drops are pulled from Kuhfeld et al. (2022) Table 5; extended-school-day results are from Figlio et al. (2018) Table 2; reduction-in-class-size results are from pg. 10 of Figles et al. (2018) ; summer program results are pulled from Kim & Quinn (2013) Table 3; and tutoring estimates are pulled from Nictow et al (2020) Table 3B. Ninety-five percent confidence intervals are shown with vertical lines on each bar.

Notes: While Kuhfeld et al. and Nictow et al. reported effect sizes separately by grade span, Figlio et al. and Kim & Quinn report an overall effect size across elementary and middle grades. Class-size reductions included in the Figles meta-analysis ranged from a minimum of one to minimum of eight students per class.

There are some limitations of drawing on research conducted prior to the pandemic to understand our ability to address the COVID-19 test-score drops. First, these studies were conducted under conditions that are very different from what schools currently face, and it is an open question whether the effectiveness of these interventions during the pandemic will be as consistent as they were before the pandemic. Second, we have little evidence and guidance about the efficacy of these interventions at the unprecedented scale that they are now being considered. For example, many school districts are expanding summer learning programs, but school districts have struggled to find staff interested in teaching summer school to meet the increased demand. Finally, given the widening test-score gaps between low- and high-poverty schools, it’s uncertain whether these interventions can actually combat the range of new challenges educators are facing in order to narrow these gaps. That is, students could catch up overall, yet the pandemic might still have lasting, negative effects on educational equality in this country.

Given that the current initiatives are unlikely to be implemented consistently across (and sometimes within) districts, timely feedback on the effects of initiatives and any needed adjustments will be crucial to districts’ success. The Road to COVID Recovery project and the National Student Support Accelerator are two such large-scale evaluation studies that aim to produce this type of evidence while providing resources for districts to track and evaluate their own programming. Additionally, a growing number of resources have been produced with recommendations on how to best implement recovery programs, including scaling up tutoring , summer learning programs , and expanded learning time .

Ultimately, there is much work to be done, and the challenges for students, educators, and parents are considerable. But this may be a moment when decades of educational reform, intervention, and research pay off. Relying on what we have learned could show the way forward.

Related Content

Megan Kuhfeld, Jim Soland, Beth Tarasawa, Angela Johnson, Erik Ruzek, Karyn Lewis

December 3, 2020

Lindsay Dworkin, Karyn Lewis

October 13, 2021

Early Childhood Education Education Access & Equity Education Policy K-12 Education

Governance Studies

U.S. States and Territories

Brown Center on Education Policy

Phillip Levine

September 3, 2024

Lydia Wilbard

August 29, 2024

Zachary Billot, Annie Vong, Nicole Dias Del Valle, Emily Markovich Morris

August 26, 2024

45,000+ students realised their study abroad dream with us. Take the first step today

Meet top uk universities from the comfort of your home, here’s your new year gift, one app for all your, study abroad needs, start your journey, track your progress, grow with the community and so much more.

Verification Code

An OTP has been sent to your registered mobile no. Please verify

Thanks for your comment !

Our team will review it before it's shown to our readers.

• School Education /

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

• Updated on  
• Apr 30, 2024

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

Table of Contents

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

Essay On COVID-19 in English 100 Words

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

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

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

Also Read: National Safe Motherhood Day 2023

Essay On COVID-19 in 200 Words

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

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

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

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

Also Read : Essay on My Best Friend

Essay On COVID-19 in 300 Words

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

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

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

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

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

Also Read: Essay on Abortion in English in 650 Words

Short Essay on Covid-19

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

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

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

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

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

Related Reads

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

Simran Popli

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

Leave a Reply Cancel reply

Save my name, email, and website in this browser for the next time I comment.

Contact no. *

Connect With Us

45,000+ students realised their study abroad dream with us. take the first step today..

Resend OTP in

Need help with?

Study abroad.

UK, Canada, US & More

IELTS, GRE, GMAT & More

Scholarship, Loans & Forex

Country Preference

New Zealand

Which English test are you planning to take?

Which academic test are you planning to take.

Not Sure yet

When are you planning to take the exam?

Already booked my exam slot

Within 2 Months

Want to learn about the test

Which Degree do you wish to pursue?

When do you want to start studying abroad.

January 2024

September 2024

What is your budget to study abroad?

How would you describe this article ?

Please rate this article

We would like to hear more.

Have something on your mind?

Make your study abroad dream a reality in January 2022 with

India's Biggest Virtual University Fair

Essex Direct Admission Day

Why attend .

Don't Miss Out

• Share full article

Advertisement

Supported by

‘When Normal Life Stopped’: College Essays Reflect a Turbulent Year

This year’s admissions essays became a platform for high school seniors to reflect on the pandemic, race and loss.

By Anemona Hartocollis

This year perhaps more than ever before, the college essay has served as a canvas for high school seniors to reflect on a turbulent and, for many, sorrowful year. It has been a psychiatrist’s couch, a road map to a more hopeful future, a chance to pour out intimate feelings about loneliness and injustice.

In response to a request from The New York Times, more than 900 seniors submitted the personal essays they wrote for their college applications. Reading them is like a trip through two of the biggest news events of recent decades: the devastation wrought by the coronavirus, and the rise of a new civil rights movement.

In the wake of the high-profile deaths of Black people like George Floyd and Breonna Taylor at the hands of police officers, students shared how they had wrestled with racism in their own lives. Many dipped their feet into the politics of protest, finding themselves strengthened by their activism, yet sometimes conflicted.

And in the midst of the most far-reaching pandemic in a century, they described the isolation and loss that have pervaded every aspect of their lives since schools suddenly shut down a year ago. They sought to articulate how they have managed while cut off from friends and activities they had cultivated for years.

To some degree, the students were responding to prompts on the applications, with their essays taking on even more weight in a year when many colleges waived standardized test scores and when extracurricular activities were wiped out.

We are having trouble retrieving the article content.

Please enable JavaScript in your browser settings.

Thank you for your patience while we verify access. If you are in Reader mode please exit and  log into  your Times account, or  subscribe  for all of The Times.

Thank you for your patience while we verify access.

Already a subscriber?  Log in .

Want all of The Times?  Subscribe .

Writing about COVID-19 in a college admission essay

by: Venkates Swaminathan | Updated: September 14, 2020

Print article

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? .

Homes Nearby

Homes for rent and sale near schools

How our schools are (and aren't) addressing race

The truth about homework in America

What should I write my college essay about?

What the #%@!& should I write about in my college essay?

Yes! Sign me up for updates relevant to my child's grade.

Please enter a valid email address

Thank you for signing up!

Server Issue: Please try again later. Sorry for the inconvenience

Long COVID: Lasting effects of COVID-19

Some people continue to experience health problems long after having COVID-19. Understand the possible symptoms and risk factors for post-COVID-19 syndrome.

After any coronavirus disease 2019 (COVID-19) illness, no matter how serious, some people report that symptoms stay for months. This lingering illness has often been called long COVID or post-COVID-19 syndrome. You might hear it called long-haul COVID or post-acute sequelae of SARS-CoV-2 (PASC).

There is no universal definition of long COVID right now.

In the U.S., some experts have defined long COVID as a long-lasting, called chronic, condition triggered by the virus that causes COVID-19. The medical term for this is an infection-associated chronic condition.

As researchers learn more about long COVID, this definition may change.

What are the most common symptoms of long COVID?

In research studies, more than 200 symptoms have been linked to long COVID. Symptoms may stay the same over time, get worse, or go away and come back.

Common symptoms of long COVID include:

• Extreme tiredness, especially after activity.
• Problems with memory, often called brain fog.
• A feeling of being lightheaded or dizzy.
• Problems with taste or smell.

Other symptoms of long COVID include:

• Sleep problems.
• Shortness of breath.
• Fast or irregular heartbeat.
• Digestion problems, such as loose stools, constipation or bloating.

Some people with long COVID may have other illnesses. Diseases caused or made worse by long COVID include migraine, lung disease, autoimmune disease and chronic kidney disease.

Diseases that people may be diagnosed with due to long COVID include:

• Heart disease.
• Mood disorders.
• Stroke or blood clots.
• Postural orthostatic tachycardia syndrome, also called POTS.
• Myalgic encephalomyelitis-chronic fatigue syndrome, also called ME-CFS.
• Mast cell activation syndrome.
• Fibromyalgia.
• Hyperlipidemia.

People can get long COVID symptoms after catching the COVID-19 virus even if they never had COVID-19 symptoms. Also, long COVID symptoms can show up weeks or months after a person seems to have recovered.

And while the COVID-19 virus spreads from person to person, long COVID is not contagious and doesn't spread between people.

Why does COVID-19 cause ongoing health problems?

Current research has found that long COVID is a chronic condition triggered by the virus that causes COVID-19. The medical term for this is an infection-associated chronic condition.

Researchers don't know exactly how COVID-19 causes long-term illness, but they have some ideas. Theories include:

• The virus that causes COVID-19 upsets immune system communication. This could lead immune cells to mistake the body's own cells as a threat and react to them, called an autoimmune reaction.
• Having COVID-19 awakens viruses that haven't been cleared out of the body.
• The coronavirus infection upsets the gut's ecosystem.
• The virus may be able to survive in the gut and spread from there.
• The virus affects the cells that line blood vessels.
• The virus damages communication in the brain stem or a nerve that controls automatic functions in the body, called the vagus nerve.

Because the virus that causes COVID-19 continues to change, researchers can't say how many people have been affected by long COVID. Some researchers have estimated that 10% to 35% of people who have had COVID-19 went on to have long COVID.

What are the risk factors for long COVID?

Risk factors for long COVID are just starting to be known. In general, most research finds that long COVID is diagnosed more often in females of any age than in males. The long COVID risk also may be higher for people who have cardiovascular disease before getting sick.

Some research also shows that getting a COVID-19 vaccine may help prevent long COVID.

Many other factors may raise or lower your risk of long COVID, but research is still ongoing.

What should I do if I have long COVID symptoms?

See a healthcare professional if you have long COVID symptoms. Part of long COVID's definition is symptoms that last for three months.

But at this time, no test can say whether you have long COVID. Since you may not have symptoms if you have an infection with the COVID-19 virus, you may not know you had it. Some people have mild symptoms and don't take a COVID-19 test. Others may have had COVID-19 before testing was common.

Long COVID symptoms may come and go or be constant. They also can start any time after you had COVID-19. But symptoms still need to be documented for at least three months in order for a health care professional to diagnose long COVID.

Healthcare professionals may treat your symptoms or conditions before a long COVID-19 diagnosis. And they may work to rule out other conditions over the time you start having symptoms.

Your healthcare team might do lab tests, such as a complete blood count or liver function test. You might have other tests or procedures, such as chest X-rays, based on your symptoms.

The information you give and any test results can help your healthcare professional come up with a treatment plan.

Care for long COVID

It can be hard to get care for long COVID. Treatment may be delayed while you work with healthcare professionals. And people with long COVID may have their health problems dismissed by others, including healthcare professionals, family members or employers.

For people with cultural or language barriers, getting a long COVID diagnosis can be even harder. Pulling together information about symptoms and timing can be a challenge too. This is especially true when medical history is fragmented or when someone is managing symptoms related to memory or that affect the thought process.

Underdiagnosis may be more common among people who have less access to healthcare or who have limited financial resources.

If you're having long COVID symptoms, talk with your healthcare professional. It can help to have your medical records available before the appointment if you are starting to get care at a new medical office.

To prepare for your appointment, write down:

• When your symptoms started and if they come and go.
• What makes your symptoms worse.
• How your symptoms affect your activities.
• Questions you have about your illness.

List medicines and anything else you take, including nutrition supplements and pain medicine that you can get without a prescription. Some people find it helpful to bring a trusted person to the appointment to take notes.

Keep visit summaries and your notes in one place. That can help you track what actions you need to take or what you've already tried to treat your symptoms.

Also, you might find it helpful to connect with others in a support group and share resources.

How long can long COVID last?

The conditions linked as part of long COVID may get better over months or may last for years.

What treatment is available for long COVID?

Healthcare professionals treat long COVID based on the symptoms. For tiredness, your healthcare professional may suggest that you be active only as long as your symptoms stay stable. If you start to feel worse, rest and don't push through your tiredness.

For symptoms of pain, breathlessness or brain fog, work with your healthcare professional to find a treatment plan that works for you. That may include medicine you can get without a prescription for pain, prescription medicine, supplements and referrals to other healthcare team members.

For loss of taste or smell, a process to retrain the nerves involved in those processes may help some people. The process is called olfactory training. For people with POTS or a fast heartbeat, the healthcare professional may suggest prescription medicine as well as a plan to stay hydrated.

Treatment for other long COVID symptoms may be available so contact your healthcare professional for options.

Next steps for Long COVID

Long COVID makes life more difficult for many people. To provide better options for care, research is going on to better understand this illness. In the meantime, adults or children with long COVID may be able to get support for daily activities affected by the illness.

• National Academies of Sciences, Engineering, and Medicine. A Long COVID Definition: A Chronic, Systemic Disease State with Profound Consequences. National Academies Press; 2024. https://nap.nationalacademies.org/catalog/27768/a-long-covid-definition-a-chronic-systemic-disease-state-with. Accessed Aug. 7, 2024.
• Oelsner EC, et al. Epidemiologic features of recovery from SARS-CoV-2 infection. JAMA Network Open. 2024; doi:10.1001/jamanetworkopen.2024.17440
• Long COVID basics. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html. Accessed June 19, 2024.
• Living with long COVID. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/care-post-covid.html. Accessed June 19, 2024.
• Post-COVID syndrome. AskMayoExpert. 2023.

Products and Services

• A Book: Endemic - A Post-Pandemic Playbook
• Begin Exploring Women's Health Solutions at Mayo Clinic Store
• A Book: Future Care
• Antibiotics: Are you misusing them?
• COVID-19 and vitamin D
• Convalescent plasma therapy
• Coronavirus disease 2019 (COVID-19)
• COVID-19: How can I protect myself?
• Herd immunity and respiratory illness
• COVID-19 and pets
• COVID-19 and your mental health
• COVID-19 antibody testing
• COVID-19, cold, allergies and the flu
• COVID-19 tests
• COVID-19 drugs: Are there any that work?
• COVID-19 in babies and children
• Coronavirus infection by race
• COVID-19 travel advice
• COVID-19 vaccine: Should I reschedule my mammogram?
• COVID-19 vaccines for kids: What you need to know
• COVID-19 vaccines
• COVID-19 variant
• COVID-19 vs. flu: Similarities and differences
• COVID-19: Who's at higher risk of serious symptoms?
• Debunking coronavirus myths
• Different COVID-19 vaccines
• Extracorporeal membrane oxygenation (ECMO)
• Fever: First aid
• Fever treatment: Quick guide to treating a fever
• Fight coronavirus (COVID-19) transmission at home
• Honey: An effective cough remedy?
• How do COVID-19 antibody tests differ from diagnostic tests?
• How to measure your respiratory rate
• How to take your pulse
• How to take your temperature
• How well do face masks protect against COVID-19?
• Is hydroxychloroquine a treatment for COVID-19?
• Loss of smell
• Mayo Clinic Minute: You're washing your hands all wrong
• Mayo Clinic Minute: How dirty are common surfaces?
• Multisystem inflammatory syndrome in children (MIS-C)
• Nausea and vomiting
• Pregnancy and COVID-19
• Safe outdoor activities during the COVID-19 pandemic
• Safety tips for attending school during COVID-19
• Sex and COVID-19
• Shortness of breath
• Thermometers: Understand the options
• Treating COVID-19 at home
• Unusual symptoms of coronavirus
• Vaccine guidance from Mayo Clinic
• Watery eyes

Related information

• Post-COVID Recovery & COVID-19 Support Group - Related information Post-COVID Recovery & COVID-19 Support Group
• Coronavirus disease 2019 COVID-19 - Related information Coronavirus disease 2019 COVID-19
• COVID-19 vaccines: Get the facts - Related information COVID-19 vaccines: Get the facts
• Long COVID Lasting effects of COVID-19

5X Challenge

Thanks to generous benefactors, your gift today can have 5X the impact to advance AI innovation at Mayo Clinic.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Has Covid-19 left an imprint on our levels of life satisfaction? Empirical evidence from the Netherlands

Affiliation.

• 1 University Rey Juan Carlos, Madrid, Spain.
• PMID: 39170413
• PMCID: PMC11336748
• DOI: 10.1016/j.heliyon.2024.e35494

Many papers have investigated the effects of Covid-19 on people's well-being shortly after the epidemic's outbreak. In this article, we use the joint World Values Survey (WVS) and European Value Study (EVS) 2017-2022 dataset and employ OLS (Ordinary Least Squares) regressions and Coarsened Exact Matching, to evaluate the possible existence of a persistent effect on life satisfaction, two years after the start of the pandemic. We have chosen to focus on the Netherlands -a country which appears among the happiest in the world and for which we have available data- to assess the impact of the Covid-19 pandemic at this later stage. The results of our analysis seem to indicate that the pandemic has contributed to reducing the levels of life satisfaction significantly, particularly among the younger generation. These findings show that specific intervention programmes should be created focusing on different age groups.

© 2024 The Authors.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Progress of national average of…

Progress of national average of life evaluation in the Netherlands, 2005–2021.

Average life evaluation in the…

Average life evaluation in the Netherlands and in 28 European countries- 2012–2021.

Distribution of individuals by treatment…

Distribution of individuals by treatment or control group membership.

• Mofijur M., Fattah I.M.R., Alam A., Islam S., Ong H.C., Rhaman A., Najafi G., Ahmed S.F., Uddin A., Mahlia T.M.I. Impact of Covid-19 on the social, economic, environmental and energy domains: lessons learnt from a global pandemic. Sustain. Prod. Consum. 2021;26:343–359. doi: 10.1016/j.spc.2020.10.016. - DOI - PMC - PubMed
• Naseer S., Khalid S., Parveen S., Abbass K., Song H., Achim M.V. COVID-19 outbreak: impact on global economy. Front. Public Health. 2023;10 doi: 10.3389/fpubh.2022.1009393. - DOI - PMC - PubMed
• Sharma A., Borah S.B. Covid-19 and Domestic Violence: an indirect path to social and economic crisis. J. Fam. Violence. 2022;37:759–765. doi: 10.1007/s10896-020-00188-8. - DOI - PMC - PubMed
• Mallah S., Ghorab O., Al-Salmi S., Abdellatif O., Tharmaratnam T., Iskandar M.A., Sefen J., Sidhu P., Allatah B., El-Lababidi R., Al-Qahtani M. COVID-19: breaking down a global health crisis. Ann. Clin. Microbiol. Antimicrob. 2021;20:35. doi: 10.1186/s12941-021-00438-7. - DOI - PMC - PubMed
• Galanti T., Guidetti G., Mazzei E., Zappalá S., Toscano F. Work from home during the COVID-19 Outbreak: the impact on employees'remote work productivity, engagement and stress. Occup. Environ. Med. 2021;63(7):426–432. doi: 10.1097/jom.0000000000002236. - DOI - PMC - PubMed

Related information

Linkout - more resources, full text sources.

• Elsevier Science
• PubMed Central

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Why has COVID been so much worse this summer? The health belief model has the answer

Associate Professor of Interdisciplinary Studies, Royal Roads University

Disclosure statement

Jaigris Hodson receives funding from the Social Sciences and Humanities Research Council. She is a resident fellow with the Cascade Institute and an advisor to the Clarity Foundation.

Royal Roads University provides funding as a member of The Conversation CA.

Royal Roads University provides funding as a member of The Conversation CA-FR.

View all partners

If you think COVID-19 was suddenly in the news a lot over the summer, you’re probably right.

Throughout August, outlets in both Canada and the United States ran headlines about high COVID levels , the summer surge of cases , timing of booster shots and reviving the use of face masks .

As numerous athletes tested positive for COVID at the Olympics in Paris , news outlets reminded Canadians that COVID is still a threat , and that summer cold symptoms might in fact be COVID .

The list of COVID news stories could go on and on, but what many experts seem to agree on is that this surge is a pretty big deal. In fact, Ashish Jha, dean of the Brown University School of Public Health predicts this wave might be the biggest summer surge since the virus started , according to an article in CNN.

Why COVID is surging now?

But why is the biggest surge occurring now, after health experts declared the end of the global health emergency over a year ago ?

My research team at Royal Roads University studied how to share evidence-based health information during the COVID-19 pandemic, collecting interview, survey and experimental data between 2020 and 2023. We developed a framework that employed the health belief model for understanding why people may choose to act on health promoting behaviours — like adopting masks and vaccines during a pandemic .

Looking at the news about this latest surge, I think the health belief model can help people understand why our biggest summer surge has specifically occurred after the pandemic stage of the virus has been declared long over.

The health belief model

The health belief model helps public health practitioners and doctors understand what motivates people to adopt a positive health action (like quitting smoking or exercising), or act to reduce exposure to a negative health event (like getting a flu vaccine or practising safer sex).

This model tells us that the likelihood of a person taking action towards a particular health outcome depends on the person’s perception of the risk of the negative health outcome to themselves personally, and also their perception of the benefit of the risk reducing behaviour. People also need to feel like they have the ability to take the necessary action, and that the action will be effective.

A summary of the health belief model can be seen in a diagram .

Adopting the health belief model in practice means that public health communicators and the media need to illuminate both the risk of the negative health outcome, and the benefits and effectiveness of the risk reducing behaviours that will help people avoid the health danger. Both of these elements have been lacking since the end of the global emergency declaration for COVID-19.

Health belief and the summer of COVID

The reason I think we’re seeing such a surge now is because people don’t believe COVID is a risk, and they also don’t understand how getting vaccinations beyond the initial vaccine series from a few years ago would protect them now.

When public health officials communicated the end to the global emergency stage of COVID, they unwittingly gave the public the impression that the danger was over. This decreased perceived risk and, with it, the likelihood that people would engage in regular vaccination, mask wearing and hand washing.

Furthermore, Health Canada no longer keeps or reports the latest COVID numbers , which means that many people have no real idea of the relative risk to themselves for gathering in public spaces, making them less likely to take precautions and more likely to pass on the virus.

Reporting on COVID in the media has not helped matters. While the dangers of new variants began to be reported as early as May of this year , the reporting on the spread of the virus didn’t really start to pick up until Olympians started collapsing after events .

This is the biggest summer wave because people are under-vaccinated and have stopped taking other precautions like distancing or wearing masks. And the reasons why we’re not taking these important risk-reduction behaviours is because many of us believe that COVID is over, or, if not over, that it’s not a big deal.

Read more: Making visible the invisible: Supporting long COVID patients and the people caring for them

But long COVID is still a risk and as of mid-August, the Public Health Agency of Canada reported over four million COVID cases in Canada . It’s not “just the flu” either, as with this summer surge, the World Health Organization also reports increases in hospitalizations .

COVID is not the emergency it once was, but it’s still a health threat, and we’d be wise to reduce our risk of getting it. That’s why public health communicators should re-integrate strategies that employ the health belief model to remind people that they are at risk, they can do something to reduce that risk and they will be better off for it.

• Public health
• Infectious diseases
• Olympic Games Paris 2024

Admissions Officer

Director of STEM

Community member - Training Delivery and Development Committee (Volunteer part-time)

Chief Executive Officer

Head of Evidence to Action

The Effects of Remote Learning and Broadband Accessibility on Academic Performance During the Covid-19

20 Pages Posted: 30 Aug 2024

Sungjin Lee

Ohio State University (OSU), John Glenn School of Public Affairs, Students

Joonhong Ahn

National Pension Research Institute

COVID-19 disrupted education unprecedently starting in March 2020. Schools, educators, and policymakers have been made much efforts to improve student outcomes after the pandemic. Using variations in the use of online education across school districts during the pandemic, this study examines the impact of the transition to online education on student performance. This study also explores the role of broadband accessibility or the ‘digital divide’ in explaining the different effects of online learning on academic performance across school districts. The results of our OLS model imply that increases in in-person classes and internet accessibility are associated with better academic performance. Findings of a saturation model, however, imply heterogenous effects depending on subjects. Internet accessibility increases the average math test score for districts employing a high portion of online classes during the pandemic However, we do not find the same effect on the average Reading Language Arts (RLA) test score.

Keywords: online learning, internet accessibility, digital divide, COVID-19, academic achievement

Suggested Citation: Suggested Citation

Ohio State University (OSU), John Glenn School of Public Affairs, Students ( email )

110 Page Hall 1810 College Road Columbus, OH 43210 United States

Joonhong Ahn (Contact Author)

National pension research institute ( email ).

Seoul Korea, Republic of (South Korea)

Do you have a job opening that you would like to promote on SSRN?

Paper statistics, related ejournals, pedagogy ejournal.

Subscribe to this fee journal for more curated articles on this topic

Educational & Instructional Communication eJournal

COVID-19 Effects on the Global Economy: An Overview

• First Online: 28 August 2024

Cite this chapter

• Ashraf Mishrif 3  

Part of the book series: The Political Economy of the Middle East ((PEME))

24 Accesses

The scope and magnitude of the COVID-19 pandemic has made a lasting impact on the global economy, with the US, European and Asian emerging markets being the most affected. The pandemic that originated in China in late 2019 caused huge economic, financial, and human losses, with hundreds of millions of people lost their lives, hospitalized, lost their jobs and sources of income. Although the pandemic has officially ended, the repercussions of the public health crisis have left the global economy in turmoil, with global recession reaching a record high, unemployment reaching a peak, and disrupted global value chains negatively affecting the flow of factors of production, including goods, services, and capital worldwide. While providing an overview of the effects of the pandemic on the global economy, the analysis paves the way towards greater understanding of the economic consequences of the public health crisis on national economies and markets.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save.

• Get 10 units per month
• Download Article/Chapter or eBook
• 1 Unit = 1 Article or 1 Chapter
• Cancel anytime
• Available as PDF
• Read on any device
• Instant download
• Own it forever
• Available as EPUB and PDF
• Durable hardcover edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abuzayed, B., & Al-Fayoumi, N. (2021). Risk spillover from crude oil prices to GCC stock market returns: New evidence during the COVID-19 outbreak. The North American Journal of Economics and Finance, 58 , 101476.

Article   Google Scholar  

Al Samman, H., & AKKAŞ, E. (2022). How do the crises of falling oil prices and COVID-19 affect economic sectors in the rentier economies? Evidence from the GCC countries.  Journal of Economy Culture and Society .

Google Scholar  

Asare, P., & Barfi, R. (2021). The impact of Covid-19 pandemic on the global economy: Emphasis on poverty alleviation and economic growth. Economics, 8 (1), 32–43.

Barlow, P., van Schalkwyk, M. C., McKee, M., Labonté, R., & Stuckler, D. (2021). COVID-19 and the collapse of global trade: Building an effective public health response. The Lancet Planetary Health, 5 (2), e102–e107.

Barua, S. (2020). Understanding coronanomics: The economic implications of the coronavirus (COVID-19) pandemic. Available at SSRN 3566477.

Barua, S. (2021). Understanding coronanomics: The economic implications of the covid-19 pandemic. The Journal of Developing Areas, 55 (3), 435–450. https://doi.org/10.1353/jda.2021.0073

Boubaker, S., Goodell, J. W., Kumar, S., & Sureka, R. (2023). COVID-19 and finance scholarship: A systematic and bibliometric analysis. International Review of Financial Analysis, 85 , 102458.

Brodeur, A., Gray, D., Islam, A., & Bhuiyan, S. (2021). A literature review of the economics of COVID-19. Journal of Economic Surveys, 35 (4), 1007–1044.

EIA expects lower crude oil prices for the second half of 2023 and for 2024 . (n.d.). Independent Statistics and Analysis, Energy Information Administration. Retrieved August 22, 2023, from https://www.eia.gov/todayinenergy/detail.php?id=56560

Hanieh, A. (2021). COVID-19 and global oil markets. Canadian Journal of Development Studies/revue Canadienne D’études Du Développement, 42 (1–2), 101–108.

Henseler, M., Maisonnave, H., & Maskaeva, A. (2022). Economic impacts of COVID-19 on the tourism sector in Tanzania. Annals of Tourism Research Empirical Insights, 3 (1), 100042. https://doi.org/10.1016/j.annale.2022.100042

IEA (2021). World Energy Outlook 2021, International Energy Agency. https://www.iea.org/reports/world-energy-outlook-2021/executive-summary

IMF. (2020). Five charts that illustrate COVID-19’s impact on the Middle East and Central Asia. International Monetary Fund. https://www.imf.org/en/News/Articles/2020/07/14/na071420-five-charts-that-illustrate-covid19s-impact-on-the-middle-east-and-central-asia

IMF. (2023a). Real GDP growth . International Monetary Fund. https://www.imf.org/external/datamapper/NGDP_RPCH@WEO/WEOWORLD/JPN/AFQ/EU/CHN/ARE

IMF. (2023b).  Real GDP growth . International Monetary Fund. https://www.imf.org/external/datamapper/NGDP_RPCH@WEO/WEOWORLD/JPN/AFQ/EU/CHN/ARE

Jackson, C. (2023). Revisiting covid scarring in emerging markets. IMF Working Papers , 2023 (162), 1. https://doi.org/10.5089/9798400252136.001

OECD. (2023a). GDP growth . Organization for Economic Co-operation and Development. https://www.oecd.org/economic-outlook/june-2023/

OPEC. (2022). Annual report 2022 . Organization of the Petroleum Exporting Countries. https://www.opec.org/opec_web/static_files_project/media/downloads/AR%202022.pdf

OPEC. (2023b). OPEC basket price . Organization of the Petroleum Exporting Countries. https://www.opec.org/opec_web/en/data_graphs/40.htm

Rodrigues, M. V. G., Duarte, T. E., Dos Santos, M., & Gomes, C. F. S. (2021). Prospective scenarios analysis Impact on demand for oil and its derivatives after the COVID-19 pandemic.  Brazilian Journal of Operations & Production Management ,  18 (2), 1–15. https://doi.org/10.14488/bjopm.2021.039

Roy, S. (2020). Economic impact of Covid-19 pandemic. A Preprint, 1 , 29.

Shamsudheen, S. V., Khattak, M. A., Muneeza, A., & Huda, M. (2022). COVID-19 and GCC stock market performance: An analysis of the boon (financial stimulus package) and curse (oil price plunge) effects. International Journal of Islamic and Middle Eastern Finance and Management, 15 (2), 223–235.

The World Bank. (2023). GDP growth (annual %). https://data.worldbank.org/indicator/NY.GDP.MKTP.KD.ZG?end=2022&start=2019&view=chart

UNWTO. (2020a). Covid-19 and tourism, a year in review. World Tourism Organization. https://www.unwto.org/covid-19-and-tourism-2020

UNWTO. (2020b, October). UNWTO world tourism barometer and statistical annex. World Tourism Organization. https://www.e-unwto.org/doi/abs/10.18111/wtobarometereng.2020.18.1.6

UNWTO. (2021a, May). UNWTO world tourism barometer and statistical annex. World Tourism Organization. https://www.e-unwto.org/loi/wtobarometereng

UNWTO. (2021b). World tourism barometer, 2023 . World Tourism Organization. https://www.e-unwto.org/doi/abs/10.18111/wtobarometereng.2023.21.1.1

UNWTO. (2021c). Tourism investments trends and challenges during COVID-19 . The World Trade Organization. https://www.unwto.org/events/tourism-investments-trends-and-challenges-during-covid-19

UNCTAD. (2022a). Global trade update 2022 . United Nations Conference on Trade and Development. https://unctad.org/system/files/official-document/ditcinf2022d4_en.pdf

UNCTAD. (2022b). Global trade hits record high of $28.5 trillion in 2021, but likely to be subdued in 2022 . United Nations Conference on Trade and Development. https://unctad.org/news/global-trade-hits-record-high-285-trillion-2021-likely-be-subdued-2022

UNWTO (2023). Global and regional tourism performance . World Tourism Organization. https://www.unwto.org/tourism-data/global-and-regional-tourism-performance

Wei, P., Jin, C., & Xu, C. (2021). The influence of the COVID-19 pandemic on the imports and exports in China, Japan, and South Korea. Frontiers in Public Health, 9 , 682693.

WEO. (2022). World Economic Outlook. https://www.imf.org/en/Publications/WEO/Issues/2022/10/11/world-economic-outlook-october-2022

WEO. (2023). World Economic Outlook. https://www.imf.org/en/Publications/WEO/Issues/2023/07/10/world-economic-outlook-update-july-2023

World Economic Outlook. (2019). World Economic Outlook, April 2019 growth slowdown, precarious recovery. https://www.imf.org/en/Publications/WEO/Issues/2019/03/28/world-economic-outlook-april-2019

World Health Organization. (2023). https://covid19.who.int/

WTO. (2021a). World trade statistical review 2021 . World Trade Organization. https://www.wto.org/english/res_e/statis_e/wts2021_e/wts2021_e.pdf

WTO. (2021b). Information note on trade in intermediate goods: Second quarter 2021 . World Trade Organization. https://www.wto.org/english/news_e/news21_e/stat_03nov21_e.pdf

WTO. (2021c). Spotlight COVID-19 and world trade . World Trade Organization. https://www.wto.org/english/res_e/booksp_e/anrep_e/anrep21_spotlight_covid_e.pdf

WTO. (2022). World trade statistical review 2022. World Trade Organization. https://www.wto.org/english/res_e/publications_e/wtsr_2022_e.htm

WTO. (2023). World trade statistical review 2023 . World Trade Organization. https://www.wto.org/english/res_e/publications_e/wtsr_2023_e.htm

Wu, D. C., Cao, C., Liu, W., & Chen, J. L. (2022). Impact of domestic tourism on economy under COVID-19: The perspective of tourism satellite accounts. Annals of Tourism Research Empirical Insights, 3 (2), 100055. https://doi.org/10.1016/j.annale.2022.100055

Viana-Lora, A., & Nel-lo-Andreu, M. G. (2022). Bibliometric analysis of trends in COVID-19 and tourism.  Humanities and Social Sciences Communications ,  9 (1).

Zhang, W. W., Dawei, W., Majeed, M. T., & Sohail, S. (2022). COVID-19 and international trade: Insights and policy challenges in China and USA. Economic Research-Ekonomska Istraživanja, 35 (1), 1991–2002.

Download references

Author information

Authors and affiliations.

Humanities Research Centre, Sultan Qaboos University, Muscat, Sultanate of Oman

Ashraf Mishrif

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Ashraf Mishrif .

Editor information

Editors and affiliations.

Humanities Research Centre, Sultan Qaboos University, Khaudh, Oman

Rights and permissions

Reprints and permissions

Copyright information

© 2024 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Mishrif, A. (2024). COVID-19 Effects on the Global Economy: An Overview. In: Mishrif, A. (eds) Economic Effects of the Pandemic. The Political Economy of the Middle East. Palgrave Macmillan, Singapore. https://doi.org/10.1007/978-981-97-4367-4_1

Download citation

DOI : https://doi.org/10.1007/978-981-97-4367-4_1

Published : 28 August 2024

Publisher Name : Palgrave Macmillan, Singapore

Print ISBN : 978-981-97-4366-7

Online ISBN : 978-981-97-4367-4

eBook Packages : Economics and Finance Economics and Finance (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Elsevier - PMC COVID-19 Collection

Effects of COVID-19 pandemic in daily life

Dear Editor,

COVID-19 (Coronavirus) has affected day to day life and is slowing down the global economy. This pandemic has affected thousands of peoples, who are either sick or are being killed due to the spread of this disease. The most common symptoms of this viral infection are fever, cold, cough, bone pain and breathing problems, and ultimately leading to pneumonia. This, being a new viral disease affecting humans for the first time, vaccines are not yet available. Thus, the emphasis is on taking extensive precautions such as extensive hygiene protocol (e.g., regularly washing of hands, avoidance of face to face interaction etc.), social distancing, and wearing of masks, and so on. This virus is spreading exponentially region wise. Countries are banning gatherings of people to the spread and break the exponential curve. 1 , 2 Many countries are locking their population and enforcing strict quarantine to control the spread of the havoc of this highly communicable disease.

COVID-19 has rapidly affected our day to day life, businesses, disrupted the world trade and movements. Identification of the disease at an early stage is vital to control the spread of the virus because it very rapidly spreads from person to person. Most of the countries have slowed down their manufacturing of the products. 3 , 4 The various industries and sectors are affected by the cause of this disease; these include the pharmaceuticals industry, solar power sector, tourism, Information and electronics industry. This virus creates significant knock-on effects on the daily life of citizens, as well as about the global economy.

Presently the impacts of COVID-19 in daily life are extensive and have far reaching consequences. These can be divided into various categories:

• • Challenges in the diagnosis, quarantine and treatment of suspected or confirmed cases
• • High burden of the functioning of the existing medical system
• • Patients with other disease and health problems are getting neglected
• • Overload on doctors and other healthcare professionals, who are at a very high risk
• • Overloading of medical shops
• • Requirement for high protection
• • Disruption of medical supply chain
• • Slowing of the manufacturing of essential goods
• • Disrupt the supply chain of products
• • Losses in national and international business
• • Poor cash flow in the market
• • Significant slowing down in the revenue growth
• • Service sector is not being able to provide their proper service
• • Cancellation or postponement of large-scale sports and tournaments
• • Avoiding the national and international travelling and cancellation of services
• • Disruption of celebration of cultural, religious and festive events
• • Undue stress among the population
• • Social distancing with our peers and family members
• • Closure of the hotels, restaurants and religious places
• • Closure of places for entertainment such as movie and play theatres, sports clubs, gymnasiums, swimming pools, and so on.
• • Postponement of examinations

This COVID-19 has affected the sources of supply and effects the global economy. There are restrictions of travelling from one country to another country. During travelling, numbers of cases are identified positive when tested, especially when they are taking international visits. 5 All governments, health organisations and other authorities are continuously focussing on identifying the cases affected by the COVID-19. Healthcare professional face lot of difficulties in maintaining the quality of healthcare in these days.

Declaration of competing interest

None declared.

• Open access
• Published: 29 August 2024

The causal relationship model of factors influencing COVID-19 preventive behaviors during the post-pandemic era and implications for health prevention strategies: a case of Bangkok City, Thailand

• Piyapong Janmaimool 1 ,
• Jaruwan Chontanawat 2 ,
• Siriphan Nunsunanon 3 &
• Surapong Chudech 3  

BMC Infectious Diseases volume  24 , Article number:  887 ( 2024 ) Cite this article

1 Altmetric

Metrics details

Though, many countries are currently in the COVID post-pandemic era, people’s health protective behaviours are still essential to protect their health and well-being. This study aims to evaluate people’s understanding and perceptions of COVID-19 risk characteristics (i.e. threat occurrence, threat severity, perceived susceptibility and exposure), the health risk perception towards COVID-19, and health protective behaviours. The study also aims to estimate the associations among these factors by the analysis of structural equation modelling (SEM).

From 15 October to 9 November 2022, questionnaire surveys were administrated to 521 people living in Bangkok of Thailand by using the convenience sampling technique. The analyses were carried out in three phases including descriptive statistical analyses, a measurement model assessment using a confirmatory factor analysis (CFA), and structural equation modelling (SEM) analysis.

The results of descriptive analyses demonstrated that the majority of respondents, 39.9%, had the age between 20 and 30 years old, and 61.4% of them were female. Approximately 52.1% of them had a bachelor’s degree. Upon analysing individuals’ understanding and perceptions of all risk characteristics, individuals’ understanding of COVID-19 severity did not statistically affect health risk perception towards COVID-19, whereas perceived exposure had the strongest effect and in turn influenced health protective behaviours. Perceived susceptibility and understanding of the threat occurrence also significantly affected health risk perception, and indirectly affected health protective behaviours.

Conclusions

This study implies that though the potential health impact of COVID-19 is perceived as less severe, people can still construct a perception of its risk particularly based on their perceived exposure and susceptibility. Thus, communicating people about exposure conditions and susceptibility can greatly contribute to people’ construction of risk perception towards COVID-19 which subsequently leads to the decision to perform health protective behaviours.

This study investigated whether people still construct a perception of COVID-19 related risk during the post-pandemic era.

Though the potential health impact of COVID-19 is perceived as less severe, people still constructed a perception of its risk particularly based on their perceived exposure and susceptibility.

Risk perceptions of COVID-19 during the post-pandemic era could explain only 10–23% of variances in heath protective behaviours.

Upon analysing individuals’ perceptions of all risk characteristics, perceived severity of COVID-19 did not statistically affect risk perception, whereas perceived exposure had the strongest effect.

Perceived susceptibility and occurrence of COVID-19 spreading also significantly affected risk perceptions, and indirectly affected health protective behaviours.

Thus, communicating people about exposure conditions and susceptibility is effective to promote heath protective bahaviours during the post-pandemic era.

Peer Review reports

Introduction

Since the first emergence of SARS-CoV-2 (COVID-19) pandemic in early December 2019, massive efforts to control and manage the virus transmissions have been implemented. Healthcare workers as well as individuals have been encouraged to perform health protective behaviours against the virus. Though, the COVID-19 situations have been improving in several countries, the COVID-19 is still a public health threat which requires individuals’ health protective actions and effective health systems. The health impact of COVID-19 can be very devastating as the virus potentially causes severe respiratory illness [ 1 , 2 ], and subsequently leads to death [ 3 , 4 ]. The physical symptoms of COVID-19 are such as fever, cough, difficulty breathing, sore throat, headache, loss of smell or taste, and conjunctivitis [ 5 , 6 ]. Several studies reported sever health impacts of COVID-19. Jiménez-Zarazúa et al. [ 7 ] reported that many COVID-19 patients developed acute respiratory distress syndrome, a pathology which can potentially cause chronic lung damage. Pereckaitė et al. [ 6 ] added that COVID-19 patients could develop organ damage including myocarditis and pericarditis.

By mid-October 2022, it was reported by World Health Organization (WHO) that approximately 621 million people had contracted the virus, and 6.5 million people died [ 8 ]. Since, the COVID-19 pandemic had been declared by WHO as a global health emergency in March 2020, the WHO and the governments of each country recommended both medical staff and the general population use COVID-19 Personal Protective Equipment (PPE), such as medical and non-medical face masks (e.g. self-made masks of cloth, cotton or other textiles), face shields, aprons and gloves [ 9 ]. The current COVID-19 situation has become better than the situation in the last three years, and the WHO decided to declare an end of global emergency status for COVID-19 in May 2023 [ 10 ]. However, health impacts of COVID-19 still exist. Many people, particularly vulnerable groups (e.g., elderly people with age over 60 years, people with underlying health conditions such as diabetes, heart disease, and respiratory illnesses, and pregnant women) [ 11 ], can be killed by this virus, and there is a high chance that new variants will occur and consequently cause new cases and deaths. WHO [ 12 ] states that it is still necessary to continue protecting people, particularly the most vulnerable group against the virus. WHO also recommends that people should continue to take the preventive actions needed to protect their health. The continuous use of personal protective equipment (PPE) by healthcare workers and individuals is recommended by WHO [ 8 ]. Essential PPE includes gloves, medical masks, goggles or a face shield, and gowns, as well as for specific procedures, respirators, and aprons.

Since the first occurrence of COVID-19 in Thailand, the Thai population has been encouraged to perform health protective behaviours. Many Thai population were active to wear face masks during the pandemic era (2020–2021) [ 13 ]. However, the Thai government by the Ministry of Public Health has announced that Thailand entered to the post-pandemic era since June 2022, and the cancellation of the state of emergency declaration was also announced in September 2022, due to a decrease in death rate, and a high percentage of vaccination coverage [ 14 ]. As of 15th November 2022, 54 provinces out of 77 provinces achieved 2-dose vaccination coverage of more than 70% [ 14 ], and the Case Fatality Rate (CFR) was reduced from 1.89% in January 2022 to 0.01% at the end of October 2022. Though, COVID-19 pandemic is improving in Thailand, it is still important to maintain health protective behaviours.

It becomes challenging to encourage people to continue preforming health protective behaviours against COVID-19, as they have become familiar with the situation, and have tended to forget to perform such protective behaviours against COVID-19. The focus of this research is thus examining factors influencing people’s health protective behaviours against COVID-19. Several scholars have stated that individuals’ health protective behaviours are greatly influenced by their risk perception of the pandemic, thus leading to these behaviours. For instance, Wismans et al. [ 15 ] revealed that the perceived health risk of COVID-19 positively affects face mask use. According to the Health Belief Model (HBM) [ 16 ] and Protection Motivation Theory (PMT) [ 17 ], health protective behaviours are influenced by individuals’ risk perceptions (described in PMT as individuals’ threat appraisal). Understanding risk perception, its determinants and its association with health protective behaviours can reveal how to develop communication strategies which can enhance people’s motivation to perform the protective behaviours. Bruine de Bruin and Bennett [ 18 ] confirmed that individuals with a greater risk perception are more likely to perform health protective behaviours. Similarly, many studies conducted during the COVID-19 outbreak have confirmed that risk perception is related to the implementation of COVID-19 prevention behaviours [ 19 , 20 , 21 ]. However, what should be elaborated are determinants of risk perception which can be diverse. Understanding determinants of risk perception can provide basic understanding on how to maintain people’s constructed risks associated with COVID-19 which consequently influence their health protective behaviours.

In this way, how people judge and perceive the risks associated with COVID-19 can affect their performance of health protective behaviours. Based on the psychometric paradigm developed by Slovic [ 22 ], risk perception can be constructed based on individuals’ rational thinking process by considering a combination of (perceived) risk characteristics, such as perceived severity of the risk, perceived exposure to the risk, controllability, familiarity and observability. Fischhoff et al.’s [ 23 ] research in the modern day implies that individuals’ perceived risks of the COVID-19 can be amplified or attenuated due to differences in individuals’ understanding or judgement of risk characteristics. Regarding risk perception towards COVID-19 pandemic, Lohiniva at al. [ 24 ] indicated that individuals’ interpretation, comprehension, understanding and perceptions of the virus characteristics could have a significant impact on individuals’ health risk perception. The virus characteristics are such as the scope of pandemic, the severity of the symptoms caused by infection, the risk of virus transmission, virus exposure environments, and vulnerable health conditions. Cardona et al. [ 25 ] classified risk characteristics into three aspects.

The first one is hazard, which refers to the possible, future occurrence of undesirable events that may have adverse effects on vulnerable and exposed elements [ 26 , 27 ]. The second aspect is exposure, or the inventory of elements in an area in which hazardous events may occur [ 28 ]. In the event that people are not living in potentially dangerous settings, no problem of disaster risk would exist. The last aspect is vulnerability, which refers to the propensity of exposed elements such as human beings, their livelihoods and assets suffering adverse effects when impacted by hazard events [ 27 ]. Vulnerability relates to susceptibilities, fragilities, weaknesses, deficiencies or insufficient capacities that cause adverse effects for exposed elements. COVID-19 can be considered a type of disaster event. Therefore, the ways individuals understand and perceive characteristics of this pandemic risk, including hazard, exposure and vulnerability, may shape their health risk perceptions, which consequently leads to participation in health protective behaviours.

Understanding what is driving the health risk perception can allow risk communicators to communicate with the public about risks, subsequently promote behavioural change [ 24 ]. Based on the psychometric paradigm [ 22 ], this study assumes that individuals use their rational thinking to judge risk of COVID-19, and thus are motivated to perform health protective behaviours. Through rational thinking, individuals’ health risk perceptions can be determined by how they understand and judge risk characteristics [ 22 , 23 ]. This study divides risk characteristics into three aspects: perceived exposure, vulnerability and hazard, which includes threat occurrence and severity [ 25 ]. Differences in individual judgements of these risk characteristics may affect health risk perception, thus leading to a difference in health protective behaviours. Currently, the COVID-19 outbreak situation is changing over time due to the consecutive emergence of new coronavirus variants and vaccination types. This change may influence the way people construct risks and health responses.

Accordingly, this study aims to examine people’s risk perception towards COVID-19 during the post-pandemic era, and examine how the risk perception towards COVID-19 have been influenced by the understanding and perceptions of risk characteristics (i.e. threat occurrence, threat severity, individual susceptibility and exposure). Finally, the effect of risk perception on health protective behaviours will be examined. The casual relationship of factors influencing health protective behaviours against COVID-19 will be evaluated by the analysis of structural equation modelling (SEM). Bangkok city of Thailand was selected as a case study because it is a highly populated area and individuals’ heath protective behaviours against COVID-19 should be strongly promoted. By understanding the association among factors influencing individuals’ health protective behaviours could help provide significant implications for the development of communication strategies to promote protective behaviours against COVID-19 during the post-pandemic era.

Literature review and hypotheses

• Health protective behaviours

Several studies revealed effectiveness of health protective behaviours in reducing risks of infection [ 29 , 30 , 31 , 32 ]. For instance, the study of Lio et l. [ 30 ] revealed that outdoor mask wearing could reduce COVID-19 risk by 69.3% after adjusting for other confounders such as contact history, hygiene practice, and being in crowded activities. The study of Hajmohammadi et al. [ 31 ] reported that the application of PPE or facial mask use was significantly associated with a decrease in risk of COVID-19 infections. In Thailand, people are especially encouraged to participate in COVID-19 self-preventive measures. First, since ATKs were approved for home use by the Ministry of Public Health Thailand’s Food and Drug Administration, people have been encouraged to use them to test for COVID-19 infection when they have suspicious symptoms, or when they must be in a crowded and inadequately ventilated space. Though they have low sensitivity, immunochromatographic assay rapid antigen test (RAT) and ATK kits are affordable and accessible to the general public. RAT kits require minimal training and equipment, and are very useful for the identification of infected people [ 33 ]. The purpose of RAT kits is to detect the nucleocapsid protein of COVID-19 in nasal swab specimens [ 34 ]. RATs can detect the presence of a specific viral antigen, which implies COVID-19 infection. Currently authorized methods may include point-of-care tests and at-home self-tests, and are applicable to people of any age [ 35 ].

Second, people in Thailand are encouraged to use face masks. According to the WHO’s COVID-19 advice for the public [ 36 ], people are encouraged to wear a mask as a normal part of being around others if COVID-19 is spreading in their community. Several studies have revealed the effectiveness of wearing a face mask in preventing the spread of COVID-19 [ 37 ]. Chua et al. [ 38 ] and Pullangott & Kannan [ 39 ] demonstrated that droplets containing the virus can be filtered by face masks. Face masks have been utilized as a public and personal health control measure, and have been widely implemented to control the spread of COVID-19 [ 40 ]. Moreover, several studies have shown that wearing two masks creates more filtration efficiency than just one, and can substantially reduce individuals’ exposure to the virus [ 41 , 42 ]. In Thailand, according to an order published in the Royal Gazette in June 2021, people were required to wear a face mask in public places [ 43 ]. However, on 23 June 2022, the wearing of face masks became voluntary, though many parties still encourage people to do so [ 44 ].

Risk perception towards COVID-19 and health protective behaviours

Risk perception refers to a subjective assessment of a potential threat to individuals’ lives or psychological well-being [ 41 ]. Lohiniva at al. [ 24 ] explain risk perception as one’s subjective assessment of the actual or potential threat to one’s life or one’s psychological well-being. Slovic [ 45 ] defines risk perception as the assessment of the severity and probability of negative outcomes. Regarding risk perception towards COVID-19, risk perception consists of two aspects including the probability of being infected by the virus (i.e., infection probability) and the perceived severity of the symptoms after actual infection (i.e., outcome severity) [ 46 , 47 ]. For instance, Adachi et al. [ 48 ] measured risk perception of COVID-19 based on individuals’ perceived possibility of being infected with the COVID-19 and severity of severe illness caused by the infection. Risk perception can be estimated with respect to one’s personal situation or general population at large.

The Protection Motivation Theory (PMT) [ 17 ] explains risk perception (threat appraisal) as individuals’ estimation of the level of threat to themselves and their valued things which relatively influence behavioural responses against their facing threat. Based on PMT, risk perception contains two aspects: individuals’ perceived severity of the threat and their perceived probability of facing adverse impacts from the threat. PMT has been widely and successfully applied in the context of health threats to explain how people’s feelings of fear affect their health response or health behaviours [ 49 ]. To measure health risk perception based on PMT, researchers examine individuals’ beliefs in the severity of the threat to their valued things (perceived severity) and their estimation of the chance of being affected by the health risk (perceived vulnerability) [ 50 , 51 ]. Like PMT, Becker’s [ 52 ] Health Belief Model (HBM) also explains risk perception, particularly in the context of health, as individuals’ feelings of the seriousness or harmfulness of contracting a disease, and individuals’ perceived possibility of contracting an illness or disease. Both theories assume that health risk perceptions affect health preventive behaviours.

These theories have been applied in many studies to explore determinants of health behaviours. For instance, Becker [ 52 ] utilized the HBM to find that health behaviours are driven by individuals’ risk perceptions of disease susceptibility and severity. Regarding the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, many studies revealed that higher perceptions of SARS infection were significantly related to engagement in more preventive behaviours and compliance with disease control strategies [ 49 , 53 ]. Further, Siegrist and Bearth [ 54 ] concluded that perceived threat to individuals’ environment influences their compliance with protective measures. With COVID-19, several studies have also demonstrated COVID-19’s perceived social risk to be associated with engagement in protective measures [ 55 , 56 ]. Asri et al. [ 57 ] revealed that among younger age groups, the perceived threat of COVID-19 to other people beyond themselves was more influential in affecting their decision to wear masks; in contrast, older people were motivated to wear a mask based on their perceived threat to themselves. Wise et al. [ 58 ] found that individuals’ health risk perceptions affect their compliance with COVID-19 measures. In general, both self- and other-related risk perceptions are assumed to have a positive effect on individuals’ decision to wear a mask.

The Ministry of Public Health of Thailand has promoted three types of COVID-19 self-preventive measures, which are considered effective to reduce risks of COVID-19 infections [ 59 ]. These measures are wearing a face mask outside the home or double face masks in highly crowded or poorly ventilated places, and using RAT kits for COVID-19 detection, as widely encouraged by many parties (e.g. educational institutes, companies and government offices). This study accordingly assumes that individuals’ practice of COVID-19 preventive measures can be predicted by health risk perception. Beyond exploring the effect of risk perception on decisions to perform health preventive behaviours, as widely reported in many relevant studies [ 55 , 59 ], this study intends to reveal the effect of health risk perception on the intensity of health preventive practices, as reflected by the degree of PPE use. Namely, when individuals perceive a high health risk, they tend to perform intensive practice of health preventive behaviours, such as wearing a face mask and using ATKs for COVID-19 detection.

Understanding and perceptions of risk characteristics as factors influencing risk perception and Health Protective behaviours

Based on the psychometric paradigm [ 22 ], individuals’ risk perception is based on their rational thinking process, itself based on their interpretation, comprehension and understanding of risk characteristics. Cardona et al. [ 25 ] classified risk characteristics into three dimensions: hazard, vulnerability and exposure to a harmful event. In the psychometric paradigm, risk perception can be generated from the evaluation of these risk characteristics, which fall under “unknown risk” or “dread risk” [ 22 ]. Dread risk refers to individuals’ perception of catastrophic consequences of a threat or harmful event, and perception of their control over exposure to that risk. These perceptions can affect individuals’ feelings of fear and drive their motivation to perform response behaviours. The more fear that individuals construct when being exposed to a risk, the more they tend to perceive the risk as higher [ 60 , 61 ]. In turn, unknown risk refers to the characteristics of a harmful event, particularly if it is familiar, predictable, observable and understood [ 62 , 63 ]. Risks can be perceived as high if individuals are not familiar with the harm; risks might also have delayed effects.

For this study, individuals’ understanding, and perceptions of all risk characteristics (hazard, susceptibility and exposure) are deliberatively explored to determine whether and how they affect risk perception. The first risk characteristic is hazard. Each hazard has two particular features that individuals perceive differently according to their understanding, comprehension, and interpretation: threat occurrence and threat severity. With threat occurrence, individuals who recognize the possibility of threat occurrence start assessing the risk that they may face, and consequently construct risk perception. Meanwhile, threat severity refers to the threat’s catastrophic consequence(s). According to the psychometric paradigm [ 22 ], individuals who are aware of a threat’s catastrophic consequences are more likely to construct risks. Saito et al. [ 64 ] revealed that threat occurrence (e.g. earthquakes) significantly affects risk perception. Regarding COVID-19, Lohiniva et al. [ 24 ] found that individuals’ understanding of the nature of the virus, such as its potential health impacts, affect their health risk perception.

The second risk characteristic that can influence risk perception is risk susceptibility – in this case, specifically disease susceptibility. Disease susceptibility refers to conditions in which individuals can be easily affected by a harmful medical event, such as having poor health conditions, a chronic disease or limited capacity to cope with a disease. For instance, Ritz et al. [ 65 ] noted that health status, particularly respiratory or allergen-based illnesses, is relatively associated with air pollution perception. McCormack et al. [ 66 ] told that obesity makes individuals with chronic obstructive pulmonary disease (COPD) susceptible to indoor particulate matter. Socio-economic characteristics can also be associated with personal susceptibility. For example, younger people construct a lower risk perception of COVID-19 than older people [ 67 ], because the young population generally has better health. Ding et al. [ 68 ] revealed that female and non-medical students construct a higher level of perceived risk to COVID-19 than male and medical students. Many previous studies revealed that individuals’ perceived susceptibility to disease can increase their health risk perception. For instance, in the context of the COVID-19 pandemic, individuals with different degrees of perceived susceptibility show significant differences in their risk perception of the virus [ 69 ]. Makhanova and Shepherd [ 70 ] indicated that individuals’ perceived vulnerability to disease contributes to stronger reactions to the COVID-19 threat, including an increased degree of anxiety, demand for behavioural change and higher importance granted to proactive behaviour. The study of Adachi et al. [ 48 ] found that perceived poor health conditions were significantly associated with high-risk perception towards COVID-19 infection and illness. Several studies have explored how perceived susceptibility directly affects health protective behaviours as well [ 71 ]. For instance, Tang and Wong [ 72 ] found that Chinese citizens who constructed a low level of perceived susceptibility to the 2003 SARS epidemic tended to participate less in health protective behaviours, such as wearing face masks and sanitizing hands.

The last type of risk characteristic is exposure. Individuals’ exposure to a threat can determine their perceived risk as feeling exposed to a threat, which in turn can make them aware of the possibility of its negative impacts. Orru et al. [ 73 ], for instance, found that individuals’ perceived exposure to PM 10 determines their health risk perception, which consequently influences health symptoms due to stress and anxiety. Lee et al. [ 74 ] revealed that when exposed to an individual sneezing in public, individuals’ perceived risks to potential threats relatively increase. Similarly, Koh et al. [ 75 ] found that an increase in health risk perception was determined by individuals’ perceived exposure to the electromagnetic waves emitted from 5G network base stations. In terms of COVID-19 transmission, the virus can travel on droplets that might be larger or smaller than 5 μm. Exhaled droplets over 5 μm will fall to the ground within some distance from the exhaling person [ 76 ], whereas droplets smaller than 5 μm (called aerosols) originate directly from exhalation and can stay in the air for a long time [ 77 ]. Aerosols can then provide ambient virus exposure. Individuals’ exposure to viral transmission can therefore be attributed to moving between places [ 78 ], participating in face-to-face activities [ 79 ], being in crowded environments [ 80 ] and being in poorly or non-ventilated spaces [ 80 , 81 ]. Hong et al. [ 82 ] notably found that areas with higher population flows have more COVID-19 infection rates. People have also been widely educated about the nature of virus transmission, and can therefore construct a perception of their exposure which might consequently influence their health risk perceptions, and their decision to perform protective behaviours.

Currently, the COVID-19 situation is ever-changing due to the consecutive emergence of new coronavirus variants, vaccination developments and changes in the mitigation and prevention of measures such as lock-downs. This study assumes that these changes affect people’s understating, interpretation and perceptions of risk characteristics related to COVID-19, which in turn, affect their risk perception. As discussed above, risk perception of COVID-19 is the sum of two aspects including individuals’ perceived infection probability and perceived outcome severity or perceived severity of the symptoms after actual infection [ 46 , 47 , 83 ]. Based on theoretical discussion, these two components of risk perception can be evaluated and perceived differently by individuals based on the understanding and perceptions of risk characteristics including (1) understanding of threat occurrence (e.g., virus transmission, locations of virus transmission, and an occurrence of pandemic) (2) understanding of threat severity (e.g., possibility of death, the severity of the symptoms associated with the virus, or possible sever illness), (3) perceived exposure to COVID-19 transmission (e.g., exposure conditions) and (4) perceived susceptibility to COVID-19 (e.g., sensitiveness to the impacts). Once risks of COVID-19 are perceived in some level, it is likely that individuals will perform behavioural responses or recommended health protective behaviours against COVID-19. Risk perceptions can play an important role in driving motivation to perform actions to eliminate risks. In another word, risk perceptions of COVID-19 can provide a legitimate reason for individuals to endorse the significance of recommended health protective behaviours. For instance, the study of Schmitz et al. [ 84 ] revealed that individuals with a high perception of severe illness after COVID-19 infection reported higher motivation to uptake vaccination, which in turn affected an effective uptake of the COVID-19 vaccine. Based on this discussion, the following research hypotheses can thus be proposed (see Fig.  1 ):

Conceptual framework of this study

People’s understanding of threat occurrence can affect health protective behaviours against COVID-19 via their risk perception towards COVID-19.

People’s understanding of threat severity can affect health protective behaviours against COVID-19 via their risk perception towards COVID-19.

People’s perceived exposure to COVID-19 transmission can affect health protective behaviours against COVID-19 via their risk perception towards COVID-19.

People’s perceived susceptibility to COVID-19 can affect health protective behaviours against COVID-19 via their risk perception towards COVID-19.

Study design and study area

This study adopted a cross-sectional study design by using questionnaire surveys. Both online and face-to-face questionnaire surveys were conducted from 15 October to 9 November 2022 in Bangkok city of Thailand. Bangkok, the capital of Thailand, forms the country’s highest populated area, with approximately 5.5 million people living in an area of 1,568 km 2 [ 85 ]. Bangkok contains 50 administrative districts. For this study, 5 districts with the largest population as of 2021 [ 86 ] were selected for questionnaire surveys (see Fig.  2 ). Those districts include Sai Mai having a population of 206,831 people, Khlong Sam Wa having a population of 206,437 people, Bang Khae having a population of 192,431 people, Bang Khen having a population of 186,200 people and Bang Khun Thian having 184,944 people.

Participants and data collection

The population of this research is people in Bangkok city of Thailand. The sample size was calculated based on the formula of Cochran et al. [ 87 ]. The confidence level was set at 95%, and margin of error was set at 5%. A proportion of people who perform health protective behaviors against COVID-19 was set at 0.5 for calculating the max sample size (n). Accordingly, the result showed the appropriate sample size of 385 participants. However, to enhance reliability of data analysis, and to avoid insufficient datasets caused by a great number of incomplete survey responses and low response rate, this research recruited more participants. The estimated response rate was set as 70%, thus, approximately 550 participants were recommended. In total, questionnaire sheets were distributed to 550 research participants with a convenient sampling technique during the period of 15 October − 9 November 2022.

The questionnaire surveys were conducted in 5 selected administrative districts of Bangkok city. Approximately 110 residents in each target district were invited to participate in the data collection, and both face-to-face (F2F) and online questionnaire surveys were employed to collect data. The inclusion criteria were such as aged over 18 years, Thai citizens, and living in the survey area for more than 6 months. The exclusion criteria were healthcare workers such as medical staff and nurses; those who were having COVID-19 at the time of survey; or those who were caring for COVID-19-infected people at the time of survey. Because these groups of people were basically required to practice health protective measures against COVID-19. After the data collection, due to some incompletely responded questionnaire sheets, 29 samples were excluded, and 521 samples were suitable for data analysis.

Ethical consideration

Before participants were requested to complete a questionnaire, the participants’ consent was received, and they were informed that their participation in the data collection was voluntary and had no negative impacts. In addition, participants were informed that they could deny answering sensitive questions (i.e., income, gender), if they feel discomfort. Ethical consideration for this research was evaluated and approved by the ethical research committee of King Mongkut’s University of Technology Thonburi (KMUTT). The date of approval is October 4th, 2022, and the approval number is KMUTT-IRB 2022/0928/252.

Research tool

To collect the data, a questionnaire was developed based on a review of relevant literature. The questionnaire items used for measuring studied variables are presented in Table  1 . The structure of questionnaire, explanation of the studied variables, types of questions and scales for the survey, are described in Table  1 . The questionnaire’s validity was first evaluated by three experts. The Item-Objective Congruence (IOC) method was used to test content validity, and the questions having an IOC score lower than 0.50 were revised based on experts’ suggestion [ 88 ]. A pilot study was then conducted with 30 people to test the questionnaire’s reliability, which showed an acceptable Cronbach’s alpha (α) value of 0.87, exceeding the minimum requirement of 0.70 [ 89 ]. In addition, the scales for measuring risk perception towards COVID-19 (e.g., perceived probability of being infected by COVID-19 and perceived harmfulness of consequences caused by COVID-19 infection), and individuals’ understanding and perceptions of risk characteristics (e.g., understanding of threat severity, understanding of threat occurrence, perceived individual exposure, and perceived individual susceptibility) showed acceptable reliability with Cronbach’s alpha (α) values ranging from 0.74 to 0.89. All validated questionnaire items are shown in Table  1 .

Data analysis

Before the data analysis, all collected data were screened for completion, with any questionnaire sheets that were not completed excluded. The data analysis itself was divided into three steps. First, analyses of each variable’s descriptive statistics were performed. Then, a measurement model was estimated to test whether the questionnaire items had internal consistency when measuring each variable, as well as the scales’ construct and discriminant validity [ 93 ]. In the assessment of measurement model, the confirmatory factor analysis (CFA) was conducted to verify the construct validity of the scales used for measuring latent constructs [ 94 ]. The validity of measurement model was confirmed by fit indices (e.g., Root Mean Square Error of Approximation (RMSEA), Goodness of Fit Index (GFI), and Comparative Fit Index (CFI), and Chi-square(χ 2 )) [ 95 , 96 ]. Based on this step, some questionnaire items with a low factor loading (< 0.60) were removed to enhance the internal consistency of each construct [ 97 ]. Additionally, to verify the measurement reliability and validity of each latent construct, Cronbach’s alpha (α) coefficients, average variance extracted (AVE) and combined reliability (CR) were calculated. Finally, the relationships outlined in the structural model were assessed by analysing the structural equal model (SEM) using IBM AMOS 2.5 and IBM SPSS statistics 22. The proposed relationship among the variables influencing health protective behaviours against COVID-19 is shown in Fig.  1 . The model fit was tested via the chi-squared test (χ 2 ), root mean square error of approximation (RMSEA), comparative fit index (CFI) and goodness of fit indices (GFIs) [ 96 , 97 ]. Lastly, the risk characteristic constructs’ ability to predict infectious waste generation behaviours was derived.

Characteristics of participants

The participant characteristics are shown in the Table  2 . The proportion of female participants was 61.4% ( n  = 320) of the sample, while the proportion of male participants was 34.7% ( n  = 181). Approximately 3.8% of the sample did not want to identify their gender. Regarding age, most participants ( n  = 208, 39.9%) had the age between 20 and 30 years old. The participants younger than 20 years old was the minority ( n  = 21, 4.0%). The proportion of participants who had a bachelor’s degree was the majority ( n  = 272, 52.21%), while r participants who had an education level below a bachelor’s degree accounted for 12.48% ( n  = 65). Considering an average income, the proportion of participants who had an income lower than 15,000 baht or 420 USD was almost equivalent to the proportion of participants with an income more than 35,000 baht or 975 USD, 37% and 37.6% respectively. Additionally, most participants ( n  = 313, 60.1%) lived in their house, and approximately 58.4% ( n  = 304) had 1–3 family members.

The survey results revealed that most of the research participants (38%) tested for COVID-19 infection by using ATKs approximately 1–2 times per month. Participants who tested for COVID-19 less than 1 time per month accounted for 31% of the study population. Approximately 2% reported using ATKs more than 3 times per week. Regarding the number of face masks used to prevent COVID-19, the results showed that most participants (52.2%) used 5–7 masks per week. Approximately 20% reported using 8–10 face masks per week, and about 7% reported using more than 13 per week. Regarding the use of double masks for COVID-19 prevention, the results revealed that most participants (approximately 38%) reported sometimes wearing double masks, while approximately 28% reported never wearing double masks. Participants who reported regularly wearing double masks accounted for 8.6% (see Table  3 ).

Descriptive statistics and measurement Model

Health risk perceptions.

After screening the data for completion, mean and standard deviation were calculated of study variables (see Table  4 ). A second order confirmatory factor analysis (CFA) was also performed to test the interactions between each health risk perception construct and its observed indicators. It was assumed that health risk perception was a general latent variable which could in turn be explained by two first-order factors, specifically perceived probability of contracting COVID-19 (PP) and perceived harmfulness of the virus’s impacts (PH). After excluding three observed indicators of PH (PH5–7) with low loading estimates (< 0.05) [ 87 , 88 ], the model was determined to have an acceptable fit with the data (Brown [ 98 ]; chi-square (χ 2 ) = 6.815; degree of freedom (df) = 6; p  = 0.338; ratio of chi-square/degree of freedom (χ 2 /df) = 1.136; GFI = 0.996; Tucker–Lewis Index (TLI) = 0.998; CFI = 1.000; AGFI = 0.983; RMSEA = 0.016). The two latent variables of the second-order CFA model explained the second-order latent “health risk perception” variable. The standardized beta coefficients obtained from the PP and PH latent variables were β = 0.799, p  < 0.01 and β = 0.75, p  < 0.01, respectively. Based on these results, an indicator of health risk perception was created by calculating an average score from the 7 items in the two first-order latent variables (M = 3.187, SD = 0.750).

Considering the loadings of the observed indicators shown in Table  4 , the loadings were acceptable, as all items were significantly loaded on their designated latent variables ( p  < 0.001), and had a standardized factor loading > 0.60 that indicated convergent validity [ 99 ]. Two latent variables (PP and PH) were also significantly loaded on health risk perception. Moreover, the reliability and validity of the latent variables was examined via three indicators: composite reliability (CR), average variance extracted (AVE) and Cronbach’s α. AVE reflects the average amount of variance that a construct can explain in its indicators, with an AVE of ≥ 0.5 indicating suitable convergent validity [ 99 ]. This study’s data yielded AVE scores of 0.536 and 0.644, greater than the generally accepted minimum of 0.5 [ 100 ]. CR, meanwhile, is calculated to test the reliability of a latent variable [ 101 ], and implies how each indicator is consistent in what it intends to measure. The model assessment showed CR values of 0.822 and 0.855, which were greater than the acceptable threshold of 0.70, indicating that the latent variable measurement model had good reliability [ 100 ]. For Cronbach’s α, which is calculated to assess the internal reliability of the given measures, the values of the two latent variables were greater than the threshold of 0.70, indicating internal reliability [ 100 ]. Based on the calculations of these three indicators, the model was internally consistent, while the observed indicators substantially measured the constructs of health risk perception.

Determinates of health risk perception

CFA was performed to test the measurement reliability and validity of the factors that potentially affect health risk perception. CFA indicates the factor loading for each item in each variable. This study had four variables that were assumed to have an effect on health risk perception: understanding of threat occurrence (T), understanding of threat severity (S), perceived exposure (PE) and perceived susceptibility to COVID-19 (PSC). Statistical analysis again indicated the model’s acceptable fit with the data (Brown, [ 98 ]; χ 2  = 36.373; df = 34; p  = 0.359; χ 2 /df = 1.170; GFI = 0.982; TLI = 0.996; CFI = 0.998; AGFI = 0.963; RMSEA = 0.018). As seen in Table  5 , the factor loadings of all items were above the standard value of 0.60 [ 99 ], indicating convergent validity. To verify the convergent validity of the model’s latent variables, AVE and CR were also calculated, yielding AVE values ranging from 0.640 to 0.779, which were greater than acceptable minimum of 0.5 [ 100 ], and CR values ranging from 0.842 to 0.891, which also met the acceptable threshold of 0.7 [ 100 ]. In addition, Cronbach’s α was calculated to evaluate the measures’ internal reliability. The Cronbach’s α coefficients for the scales ranged from 0.864 to 0.892, which were above the threshold of 0.7 [ 100 ]. The measurement model was thus internally consistent, and all items could be used to measure factors that affect health risk perception.

Additionally, the correlation analyses were performed to verify discriminant validity. According to Pearson’s correlation analysis, the correlations between the study variables (T, S, PE, PSC, PP, PH, ATK, MM and DMM) were statistically significant ( p  < 0.05; Fornell & Larcker, [ 100 ]), confirming discriminant validity. The coefficient values were not greater than 0.60, indicating that there was no problem with multicollinearity [ 102 ]. In this way, the structural equation model (SEM) analysis could be carried out to test the developed conceptual model presented in Fig.  1 .

Structural model assessment

A SEM analysis was performed to test the association among study variables, that is, risk characteristic constructs, health risk perception and health protective behaviours. The study first checked the overall fit of the model with the data, with the results indicating that the model did not fit with the observed data, and the latent variable “S” (understanding of threat severity) did not significantly affect health risk perception. Therefore, to improve the model’s fit, “S” was removed. The proposed model then fit perfectly with the data, as the χ 2 value was not statistically significant (χ 2  = 105.166; df = 97; p  = 0.268), and χ2/df was 1.084, which is not greater than 5.0 [ 99 ]. Other statistical indices also implied the acceptance of the structural model. The GFI value was 0.979, which was greater than 0.90, indicating a close fit between the observed data and the structural model [ 99 ]. The RMSEA value was 0.013, less than 0.08 and thus indicating a reasonable approximation of the data [ 103 ]. The CFI value was then calculated to explain the discrepancy function adjusted for sample size; this value was acceptable at 0.998, which is greater than 0.90 [ 104 ]. The analysis also yielded an incremental fit index (IFI) value of 0.998, which is greater than 0.900 and thus indicates the proposed model’s acceptability [ 105 ]. The normed fit index (NFI) and TLI values also met the standard value of 0.9, exhibiting that the structural model perfectly fit the observed data [ 105 ]. Overall, the proposed structural model was statistically acceptable (see Fig.  3 ).

The study’s structural equation modelling (SEM; ** p  < 0.001)

Effect of risk characteristic constructs on health risk perception, and the effect of health risk perception on health protective behaviours

The path coefficients among the study variables were examined next. The hypothesized paths from risk characteristic constructs (e.g., understanding of threat occurrence (T), perceived exposure (PE) and perceived susceptibility to COVID-19 (PSC)) to the latent variable of risk perception were statistically significant. Namely, T (β = 0.292; t = 5.289; p  < 0.001), PE (β = 0.388; t = 5.525; p  < 0.001) and PSC (β = 0.336; t = 3.727; p  < 0.001) significantly affected risk perception. In this way, H2 was rejected, as it was excluded from the model.

Considering standardized beta values, perceived exposure to COVID-19 transmission (PE) had the greatest impact on risk perception, and understanding of threat occurrence (T) had the lowest impact. The predicted paths from risk perception also significantly affected three types of health protective behaviours: frequency of COVID-19 ATK use (β = 0.478; t = 8.467; p  < 0.001), quantity of medical face masks used in a week (β = 0.465; t = 8.313; p  < 0.001) and frequency of wearing double medical face masks (β = 0.320; t = 5.833; p  < 0.001). When considering the standardized beta values, the impact of health risk perception on frequency of COVID-19 ATK use (ATK) was the greatest (see Table  6 ).

Mediation effect of risk perception on the relationship between risk characteristic constructs and health protective behaviours

To test the mediating effect of risk perception on the relationship between risk characteristic constructs and health protective behaviours, bootstrapping analysis was performed. The results revealed that risk perception mediated the effect of risk characteristic constructs T, PE and PSC on each type of health protective behaviour (see Table  7 ). Namely, understanding of threat occurrence (T), perceived exposure to COVID-19 transmission (PE) and perceived susceptibility to COVID-19 (PSC) had a significant indirect effect on health protective behaviours via risk perception. In this way, H1, H3 and H4 were accepted. The study then compared the indirect effects of T on each type of health protective behaviour. The bootstrapping analysis revealed that the indirect effect of T on frequency of COVID-19 ATK use (ATK) via risk perception was the greatest (0.205), and its indirect effect on the quantity of medical face masks used in a week (MM) was the lowest (0.185). For perceived exposure, the indirect effect of PE on the frequency of wearing double medical face masks (DMM) was the greatest (0.194), whereas its indirect effect on MM was the lowest (0.163). Perceived susceptibility to COVID-19 (PSC) had the greatest indirect effect on ATK (0.105) and the lowest indirect effect on DMM (0.095).

The COVID-19 situation is changing over time. This change could affect the way people perceive the risks associated with COVID-19, thus affecting their health protective behaviours (e.g. face mask wearing and ATK testing). Practising health protective behaviours to prevent and control COVID-19 consequently contributes to good health outcomes. This study was based on the assumption that how people perceive risks affects their health protective behaviours, and how people’s understanding and perceptions of risk characteristics related to COVID-19 could shape the way people construct their health risk perception. These characteristics are hazard (threat occurrence and threat severity), individual susceptibility and exposure to the virus.

This study first revealed that individuals’ health risk perceptions were significantly determined, in order, by their perceived exposure to the virus, perceived susceptibility and understanding of the possibility of threat occurrence. In contrast, understanding of threat severity was not a significant predictor of health risk perception. The combination of individuals’ understanding and perceptions of these three risk characteristics could explain 62% of variance in overall health risk perceptions. This finding supports the notion of Slovic et al. [ 106 ], who proposed that individuals’ risk perception is constructed based on their understanding of risk characteristics and affective responses (e.g. dread, worry) to a particular health threat. However, in assessing all risk characteristics, this study demonstrated that individuals’ understanding of a threat severity (COVID-19) is not a significant factor that affects individuals’ risk perception. This implies that though the virus itself is perceived as less dangerous due to people’s increased self-immunity (i.e. vaccination), individuals can still construct health risks to such a degree that they perceive the virus as harmful to human health. This is because individuals evaluate the degree of facing health risks mainly based on their perceived exposure (e.g. being in a crowded environment, travelling, living with people who always do outside activities) and individual susceptibility (e.g. poor health conditions or having a chronic disease). The results of this study thus contradict many previous studies that have reported the significant effect of perceived severity of a threat (or its catastrophic consequences) on individuals’ health risk perception [ 107 , 108 ].

This study does, however, strengthen the psychometric paradigm proposed by Slovic [ 22 ] by providing evidence that individuals’ perceived control over their exposure plays an important role in shaping risk perceptions of COVID-19. Feeling lack of control over their exposure can cause fear in individuals, thus leading to the development of a greater risk perception. In turn, individuals’ perceived catastrophic consequences of a threat might not be important, particularly in situations where people are familiar with the threat. As this study was conducted from October to November 2022, when the COVID-19 outbreak had been present for almost 3 years, the participants were quite familiar with the virus.

Individuals’ perceived susceptibility or weakness to a health threat was found to be a significant determinant of COVID-19 risk perception. Namely, the participants who had a higher perception of their own weakness to COVID-19 (e.g. having a chronic disease) tended to construct a higher health risk perception. Many studies have also reported the significant effect of individuals’ perceived susceptibility to a disease on health risk perception [ 22 , 48 , 104 ]. People with vulnerable conditions might feel that they are sensitive to a disease threat; consequently, they construct a feeling of fear or worry that leads to health risk perception [ 22 ]. For instance, the study of Adachi, et al. [ 48 ] revealed that participants who reported poorer health conditions were more likely to report a significant higher level of risk perception towards COVID-19. Furthermore, this study showed that individuals’ understanding of threat occurrence (existence or occurrence of COVID-19 spreading) significantly influenced a degree of health risk perception in the participants. However, its power to predict health risk perception was weaker than perceived exposure and perceived susceptibility. This is attributable to people still needing to know about a hazard’s possibility of occurrence to initiate evaluations of their risk, and thus decide whether to take preventive measures.

Additionally, this study revealed that health risk perception mediated the effect of individuals’ perceptions of risk characteristics on health protective behaviours. Health risk perception significantly directly affected health preventive behaviours. The direct effect of risk perception on health protective behaviours can be supported by the HBM [ 52 ], as well as many previous studies that confirm that health risk perception contributes to the practice of health protective measures [ 109 , 110 , 111 ]. For instance, Bruine de Bruin and Bennett [ 19 ] found that people were more likely to comply with health protective measures if they had a high level of perceived risk related to COVID-19, as based on their perceived possibility of infection and infection fatality. Similarly, Tang and Wong [ 112 ] reported that health risk perception based on the perceived probability of being infected or the perceived harmfulness of illness among adult Chinese individuals in Hong Kong encouraged them to comply with health-related guidelines. Leppin and Aro [ 113 ] also found that risk perception only predicts individuals’ protective behaviours when people possess self-efficacy or response efficacy.

Recommendations and conclusion

This study can provide practical implications for the development of communication strategies which can motivate people to participate in health protective behaviours against COVID-19. Even though, the findings may need further explorations to be generalized to the public at large due to the limitations related to the sample size and unique characteristics of the samples who were urban populations in Bangkok city of Thailand, the results could provide evident-based risk communication efforts based on the results generated from the scientific and analytical method. Risk communicators (e.g., health professionals, healthcare staff, community leaders, and the government) could gain the deep understanding of how people constructed the risk perception of COVID-19 infection and illness during the post-pandemic era, and how the risk perception could influence the performance of health protective behaviours against COVID-19. Types of risk messages which can enhance or reduce people’s risk perception are identified.

The study revealed that perceived exposure had the strongest impact on individuals’ risk perception, and risk perception in turn significantly affected all three types of health protective behaviours (frequency of COVID-19 ATK use, quantity of medical face masks used in a week and frequency of wearing double medical face masks). In addition, the study revealed that people’s risk perception was constructed based on their perceived susceptibility (i.e., poor health conditions, having chronic disease) and their understanding of threat occurrence. Thus, vulnerable groups, such as people with chronic diseases or poor health conditions, are likely to be active to act against COVID-19. Based on the current COVID-19 situation, even though, the pandemic is better than before, and the virus is perceived as less harmful to human health, people can construct risk perceptions as long as COVID-19 endures and people feel susceptible to the virus. These constructed risk perceptions are essential in promoting the performance of health protective behaviours against COVID-19.

To promote the construction of risk perception towards COVID-19, communicating the public with these three types of risk message can be effective. The first type of risk message is information related threat occurrence such as the possibility of virus transmission, characteristics of transmission, possibility of virus mutations and the exist of COVID-19 pandemic. If people perceive that the pandemic still exists, and the virus is contagious, people will start to think about their possibility to be inflected. The second type of risk message is information about exposure to COVID-19 such as the risk of virus transmission in particular environments (i.e., crowed and narrow places and areas with poor ventilation) and in particular groups of people (i.e., careless people and people having a social lifestyle associated with many people such as parties, events, and travel). If people could understand COVID-19 exposure conditions, they could judge their possibility to be infected with the virus based on their living contexts and lifestyles. The third type of risk message is information about vulnerable conditions to COVID-19 (e.g., elderly people and people with chronic diseases such as hypertension, cardiovascular diseases, diabetes, obesity, and cancer). This type of information can help people judge the seriousness of illness if they are infected. If the health impacts caused by infection are perceived high, people are likely to construct a high risk perception. The result of this study showed that three types of perceptions and understanding of these risk characteristics could explain 62% of variances in health risk perception which in turn influenced health protective behaviours. Furthermore, it should be highlighted that during the post-pandemic era, communicating with the public about severity of COVID-19 inflections (e.g., number of deaths, mortality rate, possible severe symptoms) as always performed during the pandemic period, might not be successful in promoting self-protective behaviours. Because people become familiar with the nature of virus transmission and severity of infections. This finding could provide the theoretical perspective on health risk perception. Namely, when people are familiar with a threat, people’s understanding and perceptions of threat severity (e.g., the severity of symptoms caused by the virus, the probability of death) might not be influential to the construction of health risk perception.

Study limitations

First of all, it is important to note that the findings of this research are based on self-reported data from a specific urban population (Bangkok city of Thailand). Thus, the study has limited capacity to generalize the results to the populations at large. Second, this study contains some limitations related to uncontrolled or unmeasured variables that could have influenced the results of the study. Those uncontrolled variables are such as socio-demographic factors, social influence, and governmental policies. Third, health risk perception, together with its significant determinants, predicted 23% of the variance in the frequency of COVID-19 ATK use, 22% of the variance in quantity of medical face masks used in a week but only 10% of the variance in frequency of wearing double medical face masks. The leftover total variance might be explained by social factors (i.e., peer influence, social norms), the impact of governmental policies, perceived self-efficacy and response efficacy, as recommended by Rogers’s [ 17 ] PMT and Leppin and Aro [ 113 ]. Further research may therefore include an efficacy variable, socio-demographic factors, and social influence to enhance the model’s ability to predict individuals’ health protective behaviours.

Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Rivera-Torres J, Girón N, José S, E. COVID-19: a Comprehensive Review on Cardiovascular alterations, immunity, and therapeutics in older adults. J Clin Med. 2023;12:488.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Huber D, Freidl J, Pichler C, Bischof M, Kiem M, Weisböck-Erdheim R, Squarra G, De Nigris V, Resnyak S, Neberich M, et al. Long-Term effects of Mountain Hiking vs. Forest Therapy on Physical and Mental Health of couples: a Randomized Controlled Trial. Int J Environ Res Public Health. 2023;20:1469.

Article   PubMed   PubMed Central   Google Scholar  

Oboza P, Ogarek N, Olszanecka-Glinianowicz M, Kocelak P. The main causes of death in patients with COVID-19. Eur Rev Med Pharmacol Sci. 2023;27(5):2165–72.

CAS   PubMed   Google Scholar  

Lindahl BIB. COVID-19 and the selection problem in national cause-of-death statistics. Hist Philos Life Sci. 2021;43:72.

Cheng A, Caruso D, McDougall C. Outpatient Management of COVID-19: Rapid evidence review. Am Fam Physician. 2020;102:478–86.

PubMed   Google Scholar  

Pereckaitė L, Dambrauskienė A, Urbonienė D, Sadauskas S, Petrikonis K, Naudžiūnas A, Vitkauskienė A. SARS-CoV-2 Seroprevalence in Healthcare Workers of Kaunas Hospitals during the First Wave of the COVID-19 pandemic. Medicina. 2021;57:148.

Jiménez-Zarazúa O, Vélez-Ramírez LN, Hernández-Ramírez A, Arévalo-Rivas BI, Galván-Casas MA, García-Zavala GU, Mondragón JD. Tomographic findings and mortality in patients with severe and critical pneumonia with COVID-19 diagnosis. Respir Med Case Rep. 2022;40:101752.

PubMed   PubMed Central   Google Scholar  

World Health Organisation (WHO). (2022). Weekly epidemiological update on COVID-19–19 October 2022. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---19-october-2022 (accessed on 20 October 2022).

World Health Organisation (WHO). (2020). Rational Use of Personal Protective Equipment (PPE) For Coronavirus Disease (COVID-19). https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf (accessed on 20 August 2022).

World Health Organisation (WHO). (2023). Statement on the fifteenth meeting of the International Health Regulations (2005) emergency committee regarding the coronavirus disease (COVID-19) pandemic. (accessed 21 August 2023).

World Health Organisation (WHO). (2020). COVID-19: vulnerable and high risk groups. https://www.who.int/westernpacific/emergencies/covid-19/information/high-risk-groups (accessed 29 July 2024).

World Health Organisation (WHO), the International Health Regulations. (2022). Statement on the thirteenth meeting of (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic. (accessed 21 August 2022).

Rojpaisarnkit K, Kaewpan W, Pengpid S, Peltzer K. COVID-19 preventive behaviors and influencing factors in the Thai population: a web-based survey. Front Public Health. 2022;10:816464.

Ministry of Public Health, Thailand. (2023). Managing the new wave of the Covid-19 Epidemic. https://www.moph.go.th/ (accessed 15 January 2023).

Wismans A, van der Zwan P, Wennberg K, et al. Face mask use during the COVID-19 pandemic: how risk perception, experience with COVID-19, and attitude towards government interact with country-wide policy stringency. BMC Public Health. 2022;22:1622.

Becker MH. A. The health belief model and sick role behavior. Health Educ Monogr. 1974;2:409–19.

Article   Google Scholar  

Rogers RW. A Protection Motivation Theory of fear appeals and attitude change. J Psychol. 1975;91:93–114.

Article   PubMed   Google Scholar  

de Bruine W, Bennett D. Relationships between initial COVID-19 risk perceptions and protective health behaviors: a national survey. Am J Prev Med. 2020;59(2):157–67.

Al-Rasheed M. Protective behavior against COVID-19 among the public in Kuwait: an examination of the Protection Motivation Theory, trust in government, and sociodemographic factors. Soc Work Public Health. 2020;35:546–56.

Mortada EM, Elhessewi GMS. Assessment of perceived risk and precautionary behavior toward COVID-19 pandemic using the health belief model, Saudi Arabia. J Egypt Public Health Assoc. 2022;97(1):16.

Šuriņa S, Martinsone K, Perepjolkina V, Kolesnikova J, Vainik U, Ruža A, Vrublevska J, Smirnova D, Fountoulakis KN, Rancans E. Factors related to COVID-19 preventive behaviors: a structural equation model. Front Psychol. 2021;12:76521.

Slovic P. Perception of risk. In: Slovic P, editor. The perception of risk. Sterling, VA: Earthscan; 2000. pp. 220–31. (Original work published in 1987.).

Google Scholar  

Fischhoff B, Slovic P, Lichtenstein S, Read S, Combs B. How safe is safe enough? A psychometric study of attitudes towards technological risks and benefits. Policy Sci. 1978;9:127–52.

Lohiniva AL, Pensola A, Hyökki S, et al. COVID-19 risk perception framework of the public: an infodemic tool for future pandemics and epidemics. BMC Public Health. 2022;22:2124.

Cardona OD, van Aalst MK, Birkmann J, Fordham M, McGregor G, Perez R, Pulwarty RS, Schipper ELF, Sinh BT. Determinants of risk: exposure and vulnerability. Managing the risks of Extreme events and disasters to Advance Climate Change Adaptation. A Special Report of Working groups I and II of the Intergovernmental Panel on Climate Change (IPCC). Cambridge, UK, and New York, NY, USA: Cambridge University Press; 2012. pp. 65–108.

UNDHA. Internationally agreed glossary of basic terms relating to disaster management. Geneva, Switzerland: UNDHA; 1992.

UNDRO. Natural disasters and vulnerability analysis. Report of experts Group Meeting of 9–12 July 1979. Geneva, Switzerland: UNDRO; 1980.

UNISDR. Terminology on disaster risk reduction. Geneva, Switzerland: United Nations International Strategy for Disaster Reduction; 2009.

Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020;395(10242):1973–87.

Lio CF, Cheong HH, Lei CI, Lo IL, Yao L, Lam C, Leong IH. Effectiveness of personal protective health behaviour against COVID-19. BMC Public Health. 2021;21(1):827.

Hajmohammadi M, Saki Malehi A, Maraghi E. Effectiveness of using Face masks and Personal Protective Equipment to reducing the spread of COVID-19: a systematic review and Meta-analysis of case-control studies. Adv Biomed Res. 2023;12:36.

Denpetkul T, Pumkaew M, Sittipunsakda O, Leaungwutiwong P, Mongkolsuk S, Sirikanchana K. Effects of face masks and ventilation on the risk of SARS-CoV-2 respiratory transmission in public toilets: a quantitative microbial risk assessment. J Water Health. 2022;20(2):300–13.

Pray IW. Performance of an antigen-based test for asymptomatic and symptomatic SARS-CoV-2 testing at two university campuses—Wisconsin, September–October 2020. MMWR Morb Mortal Wkly Rep. 2021;69:1642–7.

Embrett M, Sim M. (2021). At-Home COVID-19 Testing: A Rapid Scoping Review. https://sporevidencealliance.ca/wp-content/uploads/2021/05/At-home-COVID-19-testing_Full-Report_2021.02.12.pdf (accessed on 8 May 2021).

Centers for Disease Control and Prevention (CDCP). (2022). Coronavirus (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html (accessed June 2, 2022).

World Health Organisation (WHO). (2021). Coronavirus disease (COVID-19) advice for the public: When and how to use masks. Available online: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks (accessed on 20 August 2022).

Haischer MH, Beilfuss R, Hart MR, Opielinski L, Wrucke D, Zirgaitis G et al. (2020). Who is wearing a mask? Gender-, age-, and location-related differences during the COVID-19 pandemic. PLoS ONE 15, e0240785.

Chua MH, Cheng W, Goh SS, Kong J, Li B, Lim JYC, et al. Face masks in the new COVID-19 normal: materials, testing, and perspectives. Research. 2020;2020:1–40.

Pullangott G, Kannan U. A comprehensive review on antimicrobial face masks: an emerging weapon in fighting pandemics. RSC Adv. 2021;11:6544–76.

Ganczak M, Pasek O, Duda-Duma Ł, Swistara D, Korzeń M. Use of masks in public places in Poland during SARS-CoV-2 epidemic: a covert observational study. BMC Public Health. 2021;21:393.

Brooks JT, Beezhold DH, Noti JD, et al. Maximizing fit for Cloth and Medical Procedure masks to improve performance and reduce SARS-CoV-2 transmission and exposure, 2021. MMWR Morb Mortal Wkly Rep. 2021;70:254–7.

Htwe YZN, Mamat H, Osman B et al. (2022). Performance Comparison of Single and Double Masks: Filtration Efficiencies, Breathing Resistance and CO2 Content. Arab J Sci Eng (2022). https://doi.org/10.1007/s13369-022-06801-w

Royal Thai Gernment Gazette. (2021). Regulation. Issued under Sect. 9 of the Emergency Decree on Public Administration in Emergency Situations B.E. 2548 (2005) (Number 46). Issued on June B.E. 2564 (2021). (In Thai).

Office of the Prime Minister. (2022). Cancel the Emergency Situation Declaration in All Areas throughout the Kingom of Thailand. Available online: https://ratchakitcha.soc.go.th/documents/17227032.pdf (accessed on 27 May 2023). (In Thai).

Slovic P. (2016). Do adolescent smokers know the risk? P. Slovic, editor, The perception of risk, Routledge (2016), pp. 364–371.

Chen YL, Lin YJ, Chang YP, Chou WJ, Yen CF. Differences in sources of information, risk perception, and cognitive appraisals between people with various latent classes of motivation to get vaccinated against COVID-19 and previous seasonal influenza vaccination: Facebook survey study with latent profile analysis in Taiwan. Vaccines. 2021;9(10):1203.

Waterschoot J, Vansteenkiste M, Yzerbyt V, et al. Risk perception as a motivational resource during the COVID-19 pandemic: the role of vaccination status and emerging variants. BMC Public Health. 2024;24:731.

Adachi M, Murakami M, Yoneoka D, et al. Factors associated with the risk perception of COVID-19 infection and severe illness: a cross-sectional study in Japan. SSM - Popul Health. 2022;18:101105.

Floyd DL, Prentice-Dunn S, Rogers RW. A meta-analysis of research on protection motivation theory. J Appl Soc Psychol. 2000;30:407–29.

Ezati Rad R, Mohseni S, Takhti K, H., et al. Application of the protection motivation theory for predicting COVID-19 preventive behaviors in Hormozgan, Iran: a cross-sectional study. BMC Public Health. 2021;21:466.

Krok D, Zarzycka B. Risk perception of COVID-19, meaning-based resources and Psychological Well-being amongst Healthcare Personnel: the mediating role of coping. J Clin Med. 2020;9(10):3225.

Becker MH. (1974)b. The Health Belief Model and personal health behavior. Health Education Monographs, 2, 324–508.

Szkody E, McKinney C. (2020). Appraisal and social support as moderators between stress and physical and psychological quality of life. Stress Health, 1–10.

Siegrist M, Bearth A. (2021). Worldviews, trust, and risk perceptions shape public acceptance of COVID-19 public health measures. Proc Natl Acad Sci. 118.

Franzen A, Wöhner F. (2021). Coronavirus risk perception and compliance with social distancing measures in a sample of young adults: evidence from Switzerland. PLoS One.,16.

Pfattheicher S, Nockur L, Böhm R, Sassenrath C, Petersen MB. The emotional path to action: Empathy promotes physical distancing and wearing of face masks during the COVID-19 pandemic. Psychol Sci. 2020;31:1363–73.

Asri A, Asri V, Renerte B, Föllmi-Heusi F, Leuppi JD, Muser J et al. (2021). Wearing a mask—For yourself or for others? Behavioral correlates of mask wearing among COVID-19 frontline workers. PLoS One. 2021;16:e0253621.

Wise T, Zbozinek TD, Michelini G, Hagan CC, Mobbs D. Changes in risk perception and self-reported protective behaviour during the first week of the COVID-19 pandemic in the United States. R Soc Open Sci. 2020;7:200742.

Lüdecke D, Knesebeck O. Protective behavior in Course of the COVID-19 outbreak—survey results from Germany. Front Public Health. 2020;8:572561.

Marris C, Langford I, Saunderson T, O’Riordan T. Exploring the psychometric paradigm: comparisons between aggregate and individual analyses. Risk Anal. 1997;17:303–12.

Article   CAS   PubMed   Google Scholar  

Siegrist M, Keller C, Kiers HAL. A new look at the psychometric paradigm of perception of hazards. Risk Anal. 2005;25:211–22.

Slovic P, Fischoff B, Lichtenstein S. Characterizing perceived risk. In: Kates RW, Hohenemser C, Kasperson JX, editors. Perilous progress: managing the hazards of technology Boulder., CO: Westview; 1985. pp. 91–125.

Steg L, de Groot JIM. (2018). Environmental psychology. An introduction. Second edition. Hoboken, NJ: Wiley-Blackwell; John Wiley & Sons Inc.

Saito S, Yasumoto S, Sekiya N. Earthquake probability in the National Seismic Hazard maps for Japan and people’s risk perceptions: the search for more effective expression. Earth Planet Space. 2022;74:82.

Ritz T, Kullowatz A, Kanniess F, Dahme B, Magnussen H. Perceived triggers of asthma: evaluation of a German version of the asthma trigger inventory. Respir Med. 2008;102:390–8.

McCormack MC, Belli AJ, Kaji DA, Matsui EC, Brigham EP et al. (2015). Obesity as a susceptibility factor to indoor particulate matter health effects in COPD, European Respiratory Journal Jan 2015, ERJ-00814-2014.

IPSOS. (2020). Responding to COVID-19 in African Countries: Analysis and Report of Survery Findings. https://www.ipsos.com/en/responding-covid-19-africa-key-findings-from-surveys-in-20-countries (accessed on 8 May 2021).

Ding Y, Du X, Li Q, Zhang M, Zhang Q, Tan X et al. (2020). Risk perception of coronavirus disease 2019 (COVID-19) and its related factors among college students in China during quarantine. PLoS ONE, 15, e0237626.

Yang Y, Wei W, Wang T. The Relationship between Perceived vulnerability to disease and anxiety during the COVID-19 pandemic: serial mediation by fear of COVID-19 and Trust in the government. Psychol Res Behav Manag. 2023;16:989–96.

Makhanova A, Shepherd M. Behavioral immune system linked to response to the threat of COVID-19. Pers Individ Differ. 2020;167:110221.

Savadori L, Lauriola M. Risk perception and protective behaviors during the rise of the COVID-19 outbreak in Italy. Front Psychol. 2020;11:577331.

Tang CS, Wong CY. An outbreak of the severe acute respiratory syndrome: predictors of health behaviors and effect of community prevention measures in Hong Kong, China. Am J Public Health. 2003;93(11):1887–8.

Orru K, Nordin S, Harzia H, et al. The role of perceived air pollution and health risk perception in health symptoms and disease: a population-based study combined with modelled levels of PM10. Int Arch Occup Environ Health. 2018;91:581–9.

Lee SWS, Schwarz N, Taubman D, Hou M. Sneezing in times of a flu pandemic: Public sneezing increases perception of unrelated risks and shifts preferences for federal spending. Psychol Sci. 2010;21(3):375–7.

Koh TH, Choi JW, Seo M, Choi HD, Kim KH. Factors affecting risk perception of electromagnetic waves from 5G network base stations. Bioelectromagnetics. 2020;41(7):491–9.

Morawska L, Cao J. Airborne transmission of SARS-CoV-2: the world should face the reality. Environ Int. 2020. https://doi.org/10.1016/jenvint.2020.105730 .

Setti L, Passarini F, De Gennnaro G, Barbieri P, Perrone MG, Borelli M, Palmisani J, Di Gilio A, Piscitelli P, Miani A. Airborne transmission route of Covid-19: why 2 meters/6 feet of interpersonal distance could not be enough. Int J Environ Res Public Health. 2020;17(8):2932.

Freeman S, Eykelbosh A. (2020). COVID-19 and outdoor safety: Considerations for use of outdoor recreational spaces. National collaborating centre for environmental health. https://ncceh.ca/documents/guide/covid-19-and-outdoor-safety-considerations-use-outdoor-recreational-spaces (accessed 20 October 2022).

Svenson O. Perceived Corona virus exposure as a function of interpersonal distance and time of a conversation. Discov Soc Sci Health. 2022;2:24.

World Health Organisation (WHO)b. Water, sanitation, hygiene, and waste management for the COVID-19 virus: interim guidance. World Health Organization; 2020. p. 9. https://www.who.int/publications-detail/water-sanitation-hygiene-and-waste-management-for-covid-19 .

Walker JS, Archer J, Gregson FK, Michel SE, Bzdek BR, Reid JP. Accurate representations of the microphysical processes occurring during the transport of exhaled aerosols and droplets. ACS Cent Sci. 2021;7(1):200–9.

Hong B, Bonczak BJ, Gupta A, Thorpe LE, Kontokosta CE. (2021). Exposure density and neighborhood disparities in COVID-19 infection risk. Proceedings of the National Academy of Sciences, 118(13).

Le TH, Arcodia C. Risk perceptions on cruise ships among young people: concepts, approaches and directions. Int J Hospitality Manage. 2018;69:102–12.

Schmitz M, Luminet O, Klein O, Morbée S, Van den Bergh O, Van Oost P, Vansteenkiste M. Predicting vaccine uptake during COVID-19 crisis: a motivational approach. Vaccine 40(2), 288–97.

Department of Provincial Administration (DOPA). (2022), Ministry of Interior, Thailand. https://stat.bora.dopa.go.th/stat/statnew/statMONTH/statmonth/#/mainpage (accessed 15 September 2022).

Bangkok Administrative Strategy Division. (2022). https://webportal.bangkok.go.th/pipd (assessed on 3 March, 2022).

Cochran WG, Mosteller F, Tukey JW. Statistical problems of the Kinsey report. J Am Stat Assoc. 1953;48(264):673–716.

Wangkawan T, Lai C, Munkhetvit P, Yung T, Chinchai S. The development and psychometric properties of the visuospatial working memory assessment (VWMA) for children. Occupational Therapy International; 2020. p. 8736308.

Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334.

Shahnazi H, Ahmadi-Livani M, Pahlavanzadeh B, Rajabi A, Hamrah MS, Charkazi A. Assessing preventive health behaviors from COVID-19 based on the Health Belief Model (HBM) among people in Golestan province: a cross-sectional study in Northern Iran. Infect Dis Poverty. 2020;9(1):157.

Costa MF. Health belief model for coronavirus infection risk determinants. Rev Saude Publica. 2020;54:47.

Magallares A, Jauregui-Lobera I, Carbonero-Carreño R, Ruiz-Prieto I, Bolaños-Ríos P, Cano-Escoriaza A. Perceive vulnerability to disease and antifat attitudes in a sample of children and teenagers. Eat Weight Disord. 2015;20(4):483–9.

Devellis RF. Scale Development: theory and applications. Thousand Oaks, CA, USA: Sage; 2003.

Gagné P, Hancock GR. Measurement model quality, sample size, and Solution Propriety in Confirmatory factor models. Multivar Behav Res. 2006;41(1):65–83.

Hair JF. (2014). Multivariate Data Analysis; Pearson Education Limited: Harlow, UK.

Kline RB. Principles and practice of structural equation modeling. New York, NY, USA: Guilford Press; 2011.

Byrne BM. Structural equation modeling with AMOS Basic Concept, Applications and Programming. 2nd ed. London, UK: Taylor and Francis group; 2010.

Brown MW, Cudeck R. Alternative ways of assessing Model Fit. In: Bollen KA, Long JS, editors. Testing structural equation models. Newbury Park, CA, USA: Sage; 1994. pp. 136–62.

Hair J, Black W, Babin B, Anderson R. Multivariate Data Analysis: A Global Perspective. London: Pearson; 2010.

Fornell C, Larcker DF. Evaluating Structural equation models with unobservable variables and measurement error. J Mark Res. 1981;18:39–50.

Hair JF, Hult GTM, Ringle CM, Sarstedt M. A primer on partial least squares structural equation modeling. Second ed. Thousand Oaks: Sage; 2017.

Gao L, Wang S, Li H. Application of the extended theory of planned behavior to understand individual’s energy saving behavior in workplaces. Conserv Recycl. 2017;127:107–13.

Brown TA. Confirmatory factor analysis for applied research. New York, NY: Guilford Press; 2006.

Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model Multidiscip J. 1999;6:1–55.

Meyers LS, Gamst G, Guarino AJ. (2006). Applied Multivariate Research: Design and Interpretation; Sage: London, UK, 2006.

Slovic P, Peters E, Finucane ML, MacGregor DG. Affect, risk, and decision making. Health Psychol. 2005;24:S35–40.

Ayegbusi T, Jegede SA, Aminu K, Oluwayelu DO. Perception and prevention practices against Ebola virus disease by bush meat handlers in Ibadan, Nigeria. Afr J Biomed Res. 2016;19(2):117–24.

Blum LS, Dentz H, Chingoli F, Chilima B, Warne T, Lee C, et al. Formative investigation of acceptability of typhoid vaccine during a typhoid fever outbreak in Neno District, Malawi. Am J Trop Med Hyg. 2014;91(4):729–37.

Bish A, Michie S. Demographic and attitudinal determinants of protective behaviours during a pandemic: a review. Br J Health Psychol. 2010;15(4):797–824.

Girma S, Agenagnew L, Beressa G, Tesfaye Y, Alenko A. (2020). Risk perception and precautionary health behavior toward COVID-19 among health professionals working in selected public university hospitals in Ethiopia. PLoS ONE 15(10), e0241101.

Rubin GJ, Amlôt R, Page L, Wessely S. Public perceptions, anxiety, and behavior change in relation to the swine flu outbreak: cross sectional telephone survey. BMJ. 2009;339:b2651.

Tang CSK, Wong CY. Factors influencing the wearing of facemasks to prevent the severe acute respiratory syndrome among adult Chinese in Hong Kong. Prev Med. 2004;39(6):1187–93.

Leppin A, Aro AR. Risk perceptions related to SARS and avian influenza: theoretical foundations of current empirical research. Int J Behav Med. 2009;16(1):7–29.

Download references

Acknowledgements

Authors would like to thank all participants who provided information for this study. Authors also thank Mahidol University for providing publication fund and School of Liberal Arts, King Mongkut’s University of Technology Thonburi for providing a scholarship to conduct this research, grant number: 2566201.

This research project was funded by School of Liberal Arts, King Mongkut’s University of Technology Thonburi, and grant number is 2566201.

Open access funding provided by Mahidol University

Author information

Authors and affiliations.

ASEAN Institute for Health Development, Mahidol University, Salaya, Phuttamonthon 4 Road, 999, 73170, Nakorn Pathom Province, Thailand

Piyapong Janmaimool

The Joint Graduate School of Energy and Environment (JGSEE), King Mongkut’s University of Technology Thonburi, 126 Pracha-Uthit Rd., Thungkru, Bangkok, 10140, Thailand

Jaruwan Chontanawat

Department of Social Sciences and Humanities, School of Liberal Arts, King Mongkut’s University of Technology Thonburi, 126 Pracha-Uthit Rd., Thungkru, Bangkok, 10140, Thailand

Siriphan Nunsunanon & Surapong Chudech

You can also search for this author in PubMed   Google Scholar

Contributions

JP: study design, conceptualization, data collection, data analysis, data interpretation, and writing the original draft; CS and NS: data collection, data interpretation, and writing the original draft; CJ: data interpretation and writing the original draft and editing; All authors reviewed the manuscript.

Corresponding author

Correspondence to Piyapong Janmaimool .

Ethics declarations

Ethics approval and consent to participate.

All data were collected following ethical principles for dealing with human subjects. Ethical consideration for this research was evaluated and approved by the ethical research committee of King Mongkut’s University of Technology Thonburi (KMUTT). The date of approval is October 4th, 2022, and the approval number is KMUTT-IRB 2022/0928/252.

Consent for publication

Not applicable.

Clinical trial number

Competing interests.

The authors declare no competing interests.

Additional information

Publisher’s note.

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

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Janmaimool, P., Chontanawat, J., Nunsunanon, S. et al. The causal relationship model of factors influencing COVID-19 preventive behaviors during the post-pandemic era and implications for health prevention strategies: a case of Bangkok City, Thailand. BMC Infect Dis 24 , 887 (2024). https://doi.org/10.1186/s12879-024-09818-8

Download citation

Received : 04 July 2024

Accepted : 27 August 2024

Published : 29 August 2024

DOI : https://doi.org/10.1186/s12879-024-09818-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Risk perception
• Health communication
• Risk characteristics

BMC Infectious Diseases

ISSN: 1471-2334

• General enquiries: [email protected]