tag:theconversation.com,2011:/uk/topics/social-distancing-83596/articlesSocial distancing – The Conversation2023-12-04T22:27:20Ztag:theconversation.com,2011:article/2149162023-12-04T22:27:20Z2023-12-04T22:27:20ZPublic health errors: Why it’s crucial to understand what they are before assessing COVID-19 responses<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/public-health-errors-why-its-crucial-to-understand-what-they-are-before-assessing-covid-19-responses" width="100%" height="400"></iframe>
<p>Joe Vipond, a Canadian emergency room physician who was a strong supporter of masking during the pandemic, <a href="https://www.una.ca/1385/worlds-slow-recognition-of-airborne-transmission-of-covid-was-most-egregious-public-health-error-in-modern-history">said in a speech last year</a> that the slow recognition that COVID-19 is spread by airborne transmission resulted in what is likely “the most egregious public health error in modern history.”</p>
<p>The notion that governments can commit public health errors in response to a public health emergency like the COVID-19 pandemic — and that these errors can negatively impact a large number of people — has begun to receive attention from the <a href="https://www.forbes.com/sites/johndrake/2021/05/30/was-covid-19-a-failure-of-policy-or-a-failure-of-information/?sh=7e78786f457a">scientific community and the popular press</a>. Public health measures such as <a href="https://www.nytimes.com/2022/05/31/briefing/masks-mandates-us-covid.html">mask mandates</a>, <a href="https://www.telegraph.co.uk/news/2021/06/10/lockdowns-single-biggest-public-health-mistake-history-says/">lockdowns</a>, <a href="https://vinayprasadmdmph.substack.com/p/anthony-fauci-still-wont-admit-that">school closures</a> and <a href="https://doi.org/10.1136/bmjgh-2022-008684">vaccine mandates</a> are now widely discussed.</p>
<p>However, how can we investigate why governments err without understanding first what a public health error is, and is not? As a public health errors scholar, it strikes me how little research has been done <a href="https://doi.org/10.1097/PHH.0b013e3181bee698">on this topic</a>, and how much confusion exists around <a href="https://doi.org/10.1097/PHH.0b013e3181e030d3">what constitutes a public health error</a>.</p>
<h2>What is a public health error?</h2>
<p>In <a href="https://doi.org/10.1017/jme.2023.67">a new paper</a>, I clarify these issues, offer a new definition of the concept, and explain why studying errors contributes to our understanding of public health policy.</p>
<p>I suggest that a public health error occurs when, in retrospect, a policy choice worsens public health. This decision must either cause direct and significantly greater harm to the public or fail to effectively prevent harm, compared to other available options. Based on those criteria, there are two broad types of errors:</p>
<ol>
<li><strong>Error of action</strong>. Interventions that directly caused harm to population health and were worse than doing nothing at all.</li>
<li><strong>Error of omission</strong>. Failure to take action when measures were needed to protect the health of the population.</li>
</ol>
<h2>Errors of action</h2>
<p>Examples of the first type include public health interventions and campaigns. For instance, <a href="https://theconversation.com/a-generation-of-canadian-children-was-given-radiation-treatment-and-never-warned-of-the-cancer-risks-116403">public health campaigns in the 1950s</a> using low-dose radiation to treat benign illnesses (that is, not for treating cancer), such as acne and <a href="https://global.oup.com/academic/product/ringworm-and-irradiation-9780197568965?cc=ca&lang=en&">ringworm</a>. Children and young adults treated with radiation showed an alarming tendency to develop <a href="https://doi.org/10.2105/AJPH.2018.304763">brain tumours, thyroid cancer and other ailments</a> as adults.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-generation-of-canadian-children-was-given-radiation-treatment-and-never-warned-of-the-cancer-risks-116403">A generation of Canadian children was given radiation treatment and never warned of the cancer risks</a>
</strong>
</em>
</p>
<hr>
<p>Other examples include the approval of a faulty drug, like the drug <a href="https://doi.org/10.1093/toxsci/kfr088">Thalidomide</a> prescribed to pregnant women in the 1950s and 1960s for the treatment of nausea. The drug caused irreversible fetal damage, <a href="https://thalidomide.ca/en/">resulting in thousands of children being born with severe congenital malformations</a>. The painkiller <a href="https://doi.org/10.1503/cmaj.045206">Vioxx</a> that caused heart attacks and strokes is a more recent example of an error of action.</p>
<p>Erroneous guidelines provide yet another example of this type of error. For example, a recommendation in the United States <a href="https://doi.org/10.1056/NEJMms2206281">to give increased radiation doses to Black people</a> compared to other populations during X-ray procedures (a practice called “<a href="https://doi.org/10.1056/NEJMms2004740">race correction</a>”).</p>
<h2>Errors of omission</h2>
<p>The second category of errors includes instances of inaction or cases when public health officials were not doing enough to protect the public. For example, the failure to act against <a href="https://books.google.ca/books/about/The_Cigarette_Century.html?id=yybaN6j4IpEC&redir_esc=y">the harmful effects of tobacco</a>; the delayed action to reduce <a href="https://doi.org/10.1177/0096144215623954">child poisoning caused by lead paint inside U.S. homes</a>; or the time it took for government officials to respond to the <a href="https://doi.org/10.5942/jawwa.2016.108.0195">elevated levels of lead</a> found in the drinking water of residences in Flint, Mich. </p>
<p><a href="https://doi.org/10.1093/phe/phaa031">Health Canada’s delayed and inadequate response to evidence of addiction and misuse associated with the opioid OxyContin</a> is another example of an error of omission.</p>
<h2>The question of blame</h2>
<p>Naturally, when the public is harmed, people want someone to blame, and culpability (such as acts of negligence or carelessness) often becomes our central focus. While understandable, this approach is misguided. Instead, I strongly suggest focusing on the consequences of public health choices — and the systematic factors leading to these outcomes — rather than on blame.</p>
<p>Doing so (removing blame) better aligns with the <a href="https://doi.org/10.17226/1091">goal of public health</a>, which is to maintain and promote the health of populations. In this sense, public health errors of action or omission are contrary to this aim: causing or failing to prevent harm to the public, whether they are culpable or not.</p>
<p>That brings me to a possible definition of error. I <a href="https://doi.org/10.1017/jme.2023.67">define a public health error</a> as “an action or omission, by public health officials, whose consequences for population health were substantially worse than those of an alternative that could have been chosen, regardless of the causal processes involved in the consequences.”</p>
<h2>Back to COVID</h2>
<p>As the COVID-19 pandemic fades, but remains a prominent public health concern, I welcome the debate about whether public health responses could have been better. I suggest we follow four simple rules, rooted in my public health errors lens to better assess our actions:</p>
<ol>
<li><p>Stop focusing on blame (to err is human). Instead, assess the structural factors leading to negative outcomes, such as how science is interpreted, political pressure and decision-making procedures. After all, the goal is to improve and learn from mistakes rather than pointing out blameworthy actors. Allocating blame leads to unnecessary politicization of the process and findings.</p></li>
<li><p>Fight your biases and acknowledge that both the failure to act when measures were needed and <a href="https://doi.org/10.1136/bmj.m4074">the interventions in response to the virus</a> can either cause harm or fail to prevent harm to the public.</p></li>
<li><p>Be humble when interpreting the evidence. It is often difficult to compare different types of harms and benefits. Our actions (or inactions) can have both short-term and long-term effects on health and beyond.</p></li>
<li><p>Assess the impact of our public health measures on the most vulnerable, such as marginalized communities, the poor, disabled individuals and those struggling with addiction disorders. They might be the most susceptible to the consequences of our decisions.</p></li>
</ol>
<p>Moving forward, it is time to set aside our political and <a href="https://www.scientificamerican.com/article/the-covid-science-wars1/">scientific battles</a> so we can work together to examine our mistakes, preventing their recurrence in the future. This task is not easy and requires a thorough and transparent investigation. However, it is essential for protecting the public’s health and rebuilding trust in the medical profession.</p><img src="https://counter.theconversation.com/content/214916/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Itai Bavli does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As the COVID-19 pandemic fades, we may debate whether public health responses could have been better. But first we need to understand what public health errors are — and are not.Itai Bavli, Postdoctoral research fellow, Applied Ethics, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2024992023-03-28T18:25:23Z2023-03-28T18:25:23ZLow vaccination and immunity rates mean NZ faces a harsh whooping cough winter – what needs to happen<figure><img src="https://images.theconversation.com/files/517522/original/file-20230326-26-35bjxm.jpg?ixlib=rb-1.1.0&rect=0%2C13%2C1167%2C639&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Bastiaan Beentjes/Getty Images</span></span></figcaption></figure><p>Following the <a href="https://www.rnz.co.nz/news/national/486457/baby-whooping-cough-victims-tragic-start-to-epidemic-paediatrician">deaths of two infants</a>, doctors and scientists worry New Zealand’s whooping cough epidemic could be the worst in years. </p>
<p>Known as pertussis or the 100-day cough, whooping cough is a bacterial respiratory infection caused by <em>Bordetella pertussis</em>. It is extremely infectious and endemic in New Zealand.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1633649082811162625"}"></div></p>
<p>Usually, pertussis epidemics occur in three-to-five-year cycles. Community (herd) immunity is thought to account for such cycles, with the end of an epidemic indicating <a href="https://www.sciencedirect.com/science/article/pii/B9781455700905000306">herd immunity has been reached</a>. </p>
<p>Then, over the subsequent three to five years, the pool of susceptible individuals grows until a threshold of susceptibility triggers another epidemic. </p>
<p>But the COVID pandemic, years of <a href="https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-regional-immunisation-data">declining immunisation coverage</a> and some nasty microbes have conspired to create a perfect storm of infectious diseases – including whooping cough, measles, respiratory syncytial virus (<a href="https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/respiratory-syncytial-virus-rsv">RSV</a>) and influenza – for the coming winter. </p>
<p>Infants and young children, particularly Māori, will face the brunt.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/respiratory-infections-like-whooping-cough-and-flu-have-plummeted-amid-covid-but-bounce-back-is-a-worry-176692">Respiratory infections like whooping cough and flu have plummeted amid COVID. But 'bounce back' is a worry</a>
</strong>
</em>
</p>
<hr>
<h2>Symptoms of whooping cough</h2>
<p>Whooping cough symptoms vary depending on many factors, including age, vaccination history and pre-existing conditions. </p>
<p>Initially, symptoms are non-specific, reading from the common cold’s playbook – runny nose, sneezing, occasional cough and maybe a mild temperature. This is the most infectious stage and also when antibiotics are most effective. </p>
<p>Features such as violent coughing, sometimes ending in vomiting or turning blue, and the “whoop” sound on breathing occur one to two weeks after these initial symptoms. At this stage, antibiotics are not expected to help symptoms, and for severe cases, care is only supportive, rendering clinicians and loved ones feeling helpless.</p>
<figure class="align-center ">
<img alt="A women helping a young child with an inhaler" src="https://images.theconversation.com/files/517550/original/file-20230327-20-22hg7t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517550/original/file-20230327-20-22hg7t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517550/original/file-20230327-20-22hg7t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517550/original/file-20230327-20-22hg7t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517550/original/file-20230327-20-22hg7t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517550/original/file-20230327-20-22hg7t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517550/original/file-20230327-20-22hg7t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Antiobiotics are most effective during the early stages of infection.</span>
<span class="attribution"><span class="source">Shutterstock/Alexander_Safonov</span></span>
</figcaption>
</figure>
<h2>Social distancing slowed spread of pertussis</h2>
<p>The youngest infants are <a href="https://www.cdc.gov/pertussis/pregnant/mom/deadly-disease-for-baby.html#:%7E:text=Babies%20are%20at%20risk%20for%20getting%20whooping%20cough&text=Most%20of%20the%20deaths%20each,younger%20than%203%20months%20old">most vulnerable to pertussis</a>. Complications usually arise from violent coughing, and range from facial swelling, broken ribs and lack of oxygen to brain bleeds and swelling. There is also <a href="https://pubmed.ncbi.nlm.nih.gov/21533103/">evidence</a> <em>B. pertussis</em> has immune-suppressing qualities, increasing the risk for co-infections or secondary infections. </p>
<p>Over the past 21 years, <a href="https://surv.esr.cri.nz/surveillance/PertussisRpt.php">at least ten deaths in babies</a> have been caused by pertussis in New Zealand. There have likely been more, with some potentially incorrectly attributed to sudden unexpected death in infancy.</p>
<p>Under normal circumstances, whooping cough epidemics happen in cycles, but the arrival of COVID sparked rigorous and unprecedented social distancing and other infection control measures. This was essentially a global war against infectious diseases.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/future-infectious-diseases-recent-history-shows-we-can-never-again-be-complacent-about-pathogens-177746">Future infectious diseases: Recent history shows we can never again be complacent about pathogens</a>
</strong>
</em>
</p>
<hr>
<p>As its only host, <em>B. pertussis</em> relies on humans in order to spread. It is possible its spread was disrupted by the measures we took to protect ourselves from COVID, particularly in regions with more severe and prolonged social distancing measures such as Auckland. </p>
<p>The effect of social distancing on transmission patterns and epidemics has not yet been investigated specifically for pertussis. But work on <a href="https://www.pnas.org/doi/full/10.1073/pnas.2013182117">other endemic airborne respiratory diseases</a>, including influenza and RSV, warns large future outbreaks could happen following periods of extended social distancing. These findings are plausible for pertussis. </p>
<h2>A third of infants lack protection</h2>
<p>Social distancing measures may have reduced circulation of <em>B. pertussis</em> and a corresponding reduction in immunity may have increased susceptibility to pertussis infection. A disruption to the cyclic pattern of an epidemic disease may alter the timing and severity of the following epidemic. It may delay onset but increase severity.</p>
<p>While our pandemic actions may have an influence, we can be certain the <a href="https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-regional-immunisation-data">alarmingly low immunisation coverage rates</a> will result in some very severe cases among our most vulnerable infants. Around a third of our youngest infants are not appropriately immunised against pertussis. For Māori infants, more than half are at risk. </p>
<p>Prior to the COVID pandemic, New Zealand immunisation coverage had been diving, following a short but glorious period of high and relatively equitable vaccine coverage. This downward trend continued over the past three years, made worse through the diversion of resources that were already strained. The greatest declines in coverage have been among Māori. </p>
<p>This all means that since the last pertussis epidemic, New Zealand has been accruing susceptible individuals, accentuated by the pandemic and the declining immunisation coverage. It is like an all-you-can-eat smorgasbord of hosts for the pertussis bacterium to infect and travel through.</p>
<h2>How to curb the immediate risk</h2>
<p>The first most important action to prevent infant deaths is by vaccinating pregnant women. This provides transient protection to the newborn until old enough to receive their own vaccinations. </p>
<p>Less than half of pregnant women in New Zealand receive a pertussis booster, and for Māori women this is halved again. We need urgent action to raise awareness and improve access to services because this pregnancy boost is around 90% effective in preventing pertussis in infants.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1640121793728872455"}"></div></p>
<p>The second most important task is to ensure infants receive their vaccines on time, every time. Getting these services to where they are most needed is vital and it requires urgent action to improve awareness and support for services to be delivered. This vaccine is about 85-94% effective in preventing pertussis in infants and young children in New Zealand.</p>
<p>While COVID remains an ongoing challenge, the pandemic has left us more vulnerable than we were to many other respiratory infections. There are many other factors that contribute to infectious diseases like pertussis, including poverty. Interventions that reduce risk through social and environmental policies, such as improving housing conditions, are central to infectious disease control. </p>
<p>However, with a burned-out and under-resourced workforce, and a revised health system that has yet to demonstrate its worth, some of the best tools in our kit for this winter are our underutilised vaccines.</p><img src="https://counter.theconversation.com/content/202499/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Petousis-Harris receives research funding for investigator-led research from GSK. She has severed on Advisory Boards for industry. She does not receive industry honoraria. She has received funding from research councils for studies related to vaccine coverage. She also has grants from the US CDC for vaccine safety studies and vaccine confidence workstreams.</span></em></p><p class="fine-print"><em><span>Hannah Chisholm does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>One in three infants is not immunised against pertussis. For Māori babies, more than half are at risk from the potentially deadly infection. But there are relatively simple things we can do.Helen Petousis-Harris, Associate Professor Primary Health, University of Auckland, Waipapa Taumata RauHannah Chisholm, Epidemiologist, University of Auckland, Waipapa Taumata RauLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1984812023-02-08T18:43:39Z2023-02-08T18:43:39ZThe pandemic played into ageist stereotypes, but intergenerational contact and co-operation can overcome them<figure><img src="https://images.theconversation.com/files/508476/original/file-20230206-13-t4itv6.jpg?ixlib=rb-1.1.0&rect=63%2C40%2C3810%2C2532&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Stereotypes about the elderly having more than their fair share can be heightened during times of crisis when resources are seen to be scarce.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>As the COVID-19 pandemic spread around the world, <a href="https://news.ontario.ca/en/statement/56348/enhanced-measures-to-protect-ontarians-from-covid-19">stringent public health regulations</a> were imposed to protect vulnerable individuals, with older people seen as a particularly vulnerable group.</p>
<p>In response, some argued the pandemic was just a problem for older people and that they should be <a href="https://doi.org/10.1093/geronb/gbaa102">locked away</a> so younger people could get on with their lives. Others showed <a href="https://doi.org/10.1037/amp0000699">increased concern</a> for older people, with dedicated shopping hours and food deliveries for seniors organized. </p>
<p>We are a team of researchers in psychology, sociology and political science with expertise in intergroup relations. Our research on ageism during the pandemic shows that the group-based beliefs and values people endorse have an impact on how older people are viewed. </p>
<p>This is important because it tells us what beliefs and values need to be targeted to create a more inclusive society, especially when facing a public health emergency like the COVID-19 pandemic.</p>
<p>In August 2020, we <a href="http://dx.doi.org/10.1111/josi.12554">conducted a survey</a> to gauge the attitudes and opinions of Canadians and Americans who were 18 to 65+ years old. The survey relied on nationally representative samples of 2,110 Canadians and 2,124 Americans. The goal was to assess how North Americans perceived older people during the pandemic and what factors explained these perceptions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A younger woman and an elderly man in a wheelchair place their hands on a glass barrier separating them." src="https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People talk through a plexiglass barrier at Lynn Valley Care Centre in North Vancouver in July 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<h2>Intergenerational tension and its basis</h2>
<p>The survey results showed that younger respondents were especially likely to say that older people were using more than their fair share of societal resources, such as those related to health care. This was the case for both Canadians and Americans, and demonstrates <a href="https://doi.org/10.1037/a0032367">ageist consumption stereotypes</a>. These stereotypes can be heightened when resources seem to be scarce.</p>
<p>The degree of concern younger North Americans felt in terms of their own health and finances did not predict ageist consumption stereotypes. Instead, their beliefs and values about group relations were key.</p>
<p>Younger North Americans who endorsed the statement that some groups of people are simply inferior to other groups were more likely to endorse ageist consumption stereotypes. The same was true for those who held values emphasizing competition. In contrast, younger North Americans who valued collective goals and believed in personal sacrifice for the collective good were less likely to hold ageist consumption stereotypes.</p>
<p>At the time of the survey, social distancing measures were in effect, so we also asked survey respondents about their opinions about social distancing. We found that younger North Americans who believed social distancing carries too many problems were also more likely to endorse ageist consumption stereotypes.</p>
<h2>What can we learn?</h2>
<p>To reduce ageist perceptions of older people, we should encourage collectivist norms and the importance of acting for the common good, while downplaying competition and group-based dominance. This benefits all of us. First, it promotes social cohesion in society. In addition, most of us will be old people someday and would prefer not to experience ageism at that time. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An elderly black woman with grey hair looking out of a window." src="https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">To reduce ageist perceptions of older people, we should encourage collectivist norms and the importance of acting for the common good.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In the context of the pandemic and similar health emergencies, one way to do this is through public health messaging that emphasizes how people of all ages share both the risk of diseases such as COVID-19 and the responsibility for co-operating to overcome it. This way, the emphasis is on society as a whole and less on broad age categories.</p>
<p><a href="https://doi.org/10.1093/geronb/gbaa051">Another strategy</a> to reduce ageism is to encourage intergenerational contact to promote solidarity and relatedness across age groups. This could, for example, include more frequent quality contact between family members of different generations, personal contact with older neighbours and participation in volunteering programs that bring people of different ages together. </p>
<p>There is also <a href="https://doi.org/10.1080/02701960.2020.1737047">evidence</a> that if intergenerational contact is coupled with education on aging, ageism can be successfully reduced. </p>
<p>A <a href="https://doi.org/10.1111/josi.12545">recent study</a> conducted during the pandemic found that exposure to online information that shows positive intergenerational contact and provides education that challenges ageist stereotypes effectively reduced ageism and perceived intergenerational conflict among young adults.</p>
<p>Intergenerational tension exists but it is not inevitable. To overcome it, we must understand where it comes from and implement a variety of strategies that bring together people of all ages in order to promote co-operation in solving common problems, rather than competition and dominance.</p><img src="https://counter.theconversation.com/content/198481/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Victoria Esses receives funding from Immigration, Refugees and Citizenship Canada. She has previously received funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Kate Choi receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Patrick Denice receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Alina Sutter, Joanie Bouchard, and Mamta Vaswani do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To reduce ageist perceptions of older people, we should encourage collectivist norms and the importance of acting for the common good.Victoria Esses, Director, Network for Economic and Social Trends (NEST); Co-Chair, Pathways to Prosperity Partnership, Western UniversityAlina Sutter, Postdoctoral Associate, Network for Economic and Social Trends (NEST), Western UniversityJoanie Bouchard, Assistant Professor in Political Science, Université de Sherbrooke Kate Choi, Associate Professor, Sociology, Western UniversityMamta Vaswani, Postdoctoral Associate, Network for Economic and Social Trends (NEST), Western UniversityPatrick Denice, Assistant Professor of Sociology; Affiliate, Network for Economic and Social Trends (NEST), Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1961792022-12-12T13:37:37Z2022-12-12T13:37:37ZChina’s loosened COVID-19 policies – following years of aggressive lockdowns and quarantines – have left the country vulnerable<figure><img src="https://images.theconversation.com/files/500103/original/file-20221209-29029-7l4vwf.jpg?ixlib=rb-1.1.0&rect=0%2C195%2C5202%2C3392&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Chinese government has loosened restrictions designed to limit the spread of COVID-19.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/epidemic-control-workers-wear-ppe-as-they-walk-to-disinfect-news-photo/1447909402?phrase=china%20zero%20covid%20&adppopup=true">Kevin Frayer/Stringer via Getty Images</a></span></figcaption></figure><p>After nearly three years of aiming to eliminate <a href="https://www.theguardian.com/world/2022/nov/29/china-zero-covid-policy-explained-30-seconds-lockdowns-outbreaks">COVID-19 through</a> mass lockdowns, robust contact tracing programs and international travel bans, the Chinese government has announced it is rolling back the “zero-COVID” policies that helped <a href="https://go.gale.com/ps/i.do?id=GALE%7CA618606601&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=00280836&p=HRCA&sw=w&userGroupName=mlin_oweb">suppress the spread of the coronavirus</a> in the country. The Chinese Communist Party <a href="https://www.nytimes.com/2022/12/07/world/asia/china-zero-covid-protests.html">announced these changes</a> on Dec. 7, 2022, as <a href="https://www.nytimes.com/interactive/2021/world/china-covid-cases.html">rates of COVID-19 are on the rise</a> in major cities, following <a href="https://www.nytimes.com/2022/12/07/world/asia/china-zero-covid-protests.html">protests</a> demanding the end of zero-COVID policies. </p>
<p>The situation in China stands in stark contrast to the trajectory of the pandemic in the U.S. SARS-CoV-2 emerged with a bang, but thanks to a strong vaccination effort and the fact that a large portion of U.S. residents have been infected with the coronavirus, COVID-19 cases seem to be reaching somewhat of a steady state and <a href="https://doi.org/10.1056/NEJMp2004361">normal life has mostly resumed</a>.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=YCsTY4sAAAAJ&hl=en&oi=ao">medical anthropologist</a> who studies <a href="https://www.sup.org/books/title/?id=23706">public health trends in China</a> from an epidemiologic and social perspective. </p>
<p>After largely <a href="https://www.nytimes.com/2020/08/23/world/asia/china-coronavirus-normal-life.html">containing the coronavirus in 2020</a>, China began enforcing a strict <a href="https://www.nytimes.com/2022/01/21/world/asia/china-zero-covid-policy.html">zero-COVID policy</a> leading up to the Beijing Olympics in 2022. The result is that China has not followed the standard path of a pandemic where people slowly gain immunity through exposure or vaccination, allowing society to open up over time. Combined with <a href="https://doi.org/10.1136/bmj.n969">questions about the efficacy of China’s vaccines</a> and comparatively low vaccination rates, many public health experts think that China will be hit hard by the coronavirus as the country rapidly <a href="https://www.nytimes.com/2022/12/02/health/china-covid-lockdowns.html">lifts its zero-COVID policy</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A health worker checking a traveller at a checkpoint." src="https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">After the coronavirus first emerged in late 2019, the Chinese government severely limited travel in the region of Wuhan.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakChina/5fffda0e9b8841e8923776fefe4a693b/photo?Query=china%20lockdowns%20wuhan&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=261&currentItemNo=9">AP Photo/Ng Han Guan</a></span>
</figcaption>
</figure>
<h2>China’s initial reaction to COVID-19</h2>
<p>Public health campaigns and control of emerging disease in China are entirely reliant on and directed by the government, which promotes health both for the <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0486-6">good of the people and the nation</a>. When COVID-19 emerged, the Chinese government was quick to institute mask-wearing policies and testing regimens, and it <a href="https://www.cnbc.com/2020/04/08/coronavirus-china-ends-lockdown-of-wuhan-city-where-outbreak-started.html">locked down the city of Wuhan and the surrounding region</a> where the coronavirus originated. With only the aid of these <a href="https://doi.org/10.1016/S0140-6736(20)31278-2">nonpharmaceutical interventions</a>, the Chinese government was very successful in containing the spread of COVID-19 after the initial wave hit Wuhan. </p>
<p>From the time China started recording cases in late December 2019, until the government ended its initial period of lockdown in April 2020, <a href="https://www.cnbc.com/2020/04/08/coronavirus-china-ends-lockdown-of-wuhan-city-where-outbreak-started.html">the government documented </a> 82,000 cases of COVID-19 and just over 3,300 deaths. Though not officially called a zero-COVID policy at the time, the control measures were born out of a goal of <a href="https://doi.org/10.2471%2FBLT.20.254045">eliminating COVID-19</a> from the country. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A line of people waiting to be swabbed for COVID-19." src="https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In the months leading up to the 2022 Beijing Olympics, China began ramping up zero-COVID measures, including mandatory testing requirements.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakChina/f24fab8b8eae4ee4a90c714caadbf960/photo?Query=china%20zero%20covid&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=796&currentItemNo=230">AP Photo/Mark Schiefelbein</a></span>
</figcaption>
</figure>
<h2>Ramping up zero-COVID</h2>
<p>Life returned to normal in China after the initial wave of COVID-19 ravaged Wuhan. For most of 2020 and the first half of 2021, Chinese people were <a href="https://www.theguardian.com/world/2022/nov/29/china-zero-covid-policy-explained-30-seconds-lockdowns-outbreaks">out and about</a> in shopping malls, restaurants and bars. </p>
<p>During this same period, the coronavirus was rampaging across the U.S, Europe and other regions of the world, leading many health experts to say that the lockdowns in China, though brutal, were <a href="https://go.gale.com/ps/i.do?id=GALE%7CA618606601&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=00280836&p=HRCA&sw=w&userGroupName=mlin_oweb">successful</a>. Between May 2020 and August 2021, people in China saw COVID-19 as a <a href="https://www.newyorker.com/news/news-desk/what-chinese-people-think-of-their-governments-zero-covid-policy">distant threat</a> and supported the government’s actions. </p>
<p>The situation changed in August 2021 when the Chinese government officially adopted what it calls the “<a href="https://www.ijbs.com/v18p5314.htm">Dynamic zero-COVID</a>” strategy to combat the new delta variant. This strict prevention policy included provisions for mass lockdowns <a href="https://doi.org/10.1016/S2213-2600(22)00142-4">aimed at eliminating</a> the disease in a particular region, even if just a small number of cases were found. </p>
<p>China <a href="https://www.newsweek.com/omicron-march-beijing-strains-china-zero-covid-policy-before-2022-olympics-1667828">ramped up enforcement of the policy</a> as the 2022 Winter Olympics approached. A <a href="https://www.theguardian.com/world/2021/nov/02/china-locks-down-shanghai-disneyland-and-tests-34000-visitors-after-single-covid-case">single case</a> could trigger a massive lockdown where the government would severely limit people’s movement and enforce quarantines, as occurred several times in Shanghai Disney. In some instances, people were held in stores or office buildings for <a href="https://www.nytimes.com/2022/01/21/world/asia/china-zero-covid-policy.html">several days</a> after exposure to an infected person. </p>
<p>Summer and fall 2022 were relatively quiet, with only around 1,000 confirmed infections per day. But since early November 2022, COVID-19 cases in China <a href="https://www.nytimes.com/interactive/2021/world/china-covid-cases.html">have climbed steadily</a>, with more than <a href="https://www.nytimes.com/interactive/2021/world/china-covid-cases.html">35,000 new cases detected per day</a> in the first week of December. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Chinese president Xi Jinping with people in masks behind him." src="https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Following a wave of protests in late November and early December, the Chinese Communist Party announced that it would roll back some of the strictest travel limitations and quarantine requirements.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakChina/1ca47c62c5f94606bc1a2586088c1d71/photo?Query=xi%20jinping%20zero%20covid%20&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=76&currentItemNo=47">Jack Taylor/Pool Photo via AP</a></span>
</figcaption>
</figure>
<h2>What happens next?</h2>
<p>As of early December, COVID-19 rates in China were still relatively <a href="https://www.nytimes.com/interactive/2021/us/covid-cases.html">low compared to many places, including the U.S.</a>. But China faces some unique challenges thanks to low levels of immunity in the population and a disease control strategy that prioritized nonpharmaceutical interventions like mask-wearing, social distancing and <a href="https://www.nytimes.com/2022/06/14/business/china-covid-testing.html">frequent testing over vaccine administration</a>.</p>
<p>To date, 90% of the population in China <a href="https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html">has been vaccinated</a>. Older people have been more reluctant, though, and only <a href="https://www.cnbc.com/2022/11/29/china-says-covid-vaccination-rates-for-seniors-has-climbed-over-the-last-two-weeks.html">66% of those over 80</a> have received two doses of a vaccine. A further concern arises from studies indicating that China’s vaccines may <a href="https://doi.org/10.1136/bmj.n969">not be as effective as the mRNA vaccines</a> used in the West. So far, China has <a href="https://www.cnn.com/2021/12/13/china/china-western-mrna-vaccine-mic-intl-hnk/index.html">not been willing to import</a> and administer Western mRNA vaccines. </p>
<p>In addition to concerns over vaccination, the zero-COVID policy has, to a large extent, successfully suppressed the coronavirus in China. The result is that since most people have not been exposed to the virus, they have not had a chance to develop immunity. This has likely <a href="https://www.theatlantic.com/health/archive/2022/12/china-zero-covid-wave-immunity-vaccines/672375/?utm_source=substack&utm_medium=email">left the country very susceptible</a> to a large outbreak. </p>
<p>There is also a social dimension to the problems facing China today. <a href="https://www.cbsnews.com/news/china-lockdowns-zero-covid-policy/">Recurring lockdowns</a> over the past year have damaged the economy and lessened <a href="https://www.nytimes.com/2022/12/03/opinion/china-covid-protests.html?smid=nytcore-ios-share&referringSource=articleShare">peoples’ patience</a> with restrictive policies. Despite government efforts to <a href="https://www.theguardian.com/world/2022/nov/28/china-censors-maskless-crowd-footage-in-world-cup-broadcasts">limit access to outside information</a>, people in China are learning that most other countries are functioning normally. Maintaining stringent zero-COVID policies has become increasingly difficult, as they <a href="https://www.nytimes.com/2022/12/01/opinion/china-covid-protests.html">wear on a populace</a> that wants life to return to normal.</p>
<p>The Dec. 7 announcement to ease COVID-19 restrictions is a continuation of a trend a few weeks in the making, but has been seen by many as a <a href="https://www.nytimes.com/2022/12/07/world/asia/china-zero-covid-protests.html">response to the widespread protests</a>. Testing centers <a href="https://www.nytimes.com/2022/12/01/world/asia/china-covid-protests-restrictions.html?utm_source=substack&utm_medium=email">are closing</a> and infected people are now allowed to <a href="https://www.reuters.com/world/china/china-allow-some-positive-covid-19-cases-quarantine-home-sources-2022-12-01/?mc_cid=b8f3c7dbfb&mc_eid=d60d414cea&utm_source=substack&utm_medium=email">quarantine at home</a> for the first time since the pandemic began. The digital health passes, issued to people who tested negative through daily PCR tests, are <a href="https://www.washingtonpost.com/world/2022/12/07/china-covid-easing-restrictions/">also no longer required</a> to enter public places. </p>
<p>In much of the world, COVID-19 has followed that <a href="https://www.jstor.org/stable/20025233">natural trajectory</a> of a pandemic. The story is different in China. The relaxation of zero-COVID policies may bring China more in line with the rest of the world in terms of what the people there can do, but the virus also gets a chance to run its natural course now that government actions will not suppress the spread. It is likely that in the coming months, the Chinese people will face the pain and suffering that many other places experienced in 2020 and 2021.</p><img src="https://counter.theconversation.com/content/196179/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elanah Uretsky does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Strict lockdowns, quarantines and testing have prevented many people in China from catching COVID-19. With concerns over Chinese vaccine efficacy and uptake, China may be facing a looming COVID-19 surge.Elanah Uretsky, Associate Professor of International and Global Studies, Brandeis UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1875562022-08-03T15:27:52Z2022-08-03T15:27:52ZCOVID: how careful do I still need to be around older and vulnerable family members?<figure><img src="https://images.theconversation.com/files/476712/original/file-20220729-23-rs10ea.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7360%2C4891&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cheerful-old-woman-wheelchair-her-young-467172827">JP WALLET/Shutterstock</a></span></figcaption></figure><p>We are all pretty fed up with COVID, and perhaps keen for a summer of <a href="https://theconversation.com/should-i-still-go-on-holiday-if-i-have-covid-186185">holidays</a>, social outings and family get togethers. But while the threat posed by COVID has certainly decreased the virus can still be dangerous, especially <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html">for older people</a>.</p>
<p>Meanwhile, young people are generally <a href="https://www.local.gov.uk/age-and-gender-impact-covid-19">at lower risk from COVID</a>. So if you are younger and healthy, how should you balance attempts to return to normal social activities with a moral responsibility to care for people who may still be vulnerable?</p>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/i-have-covid-symptoms-should-i-do-a-test-186368?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">I have COVID symptoms. Should I do a test?</a></em></p>
<p><em><a href="https://theconversation.com/should-i-still-go-on-holiday-if-i-have-covid-186185?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Should I still go on holiday if I have COVID?</a></em></p>
<p><em><a href="https://theconversation.com/five-tips-for-young-people-dealing-with-long-covid-from-a-gp-180464?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Five tips for young people dealing with long COVID – from a GP</a></em></p>
<hr>
<p>Although there have been significantly <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19latestinsights/deaths">fewer deaths</a> since the introduction of COVID vaccines, it’s important to realise that vaccines are less effective at <a href="https://www.nature.com/articles/d41586-022-00775-3">preventing infections and reinfections</a>, particularly as time increases since the most recent dose.</p>
<p>This isn’t necessarily a big concern for most people, who will experience mild symptoms, especially if they’ve been vaccinated. But there are still some people, mostly <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html">older</a> or with a range of health conditions, who remain at a higher risk of severe outcomes from COVID.</p>
<p>Although antiviral and <a href="https://www.nhs.uk/conditions/coronavirus-covid-19/self-care-and-treatments-for-coronavirus/treatments-for-coronavirus/#medical-treatments">other treatments</a> for COVID are significantly better than they were a couple of years ago, it’s far safer not to need to rely on them in the first place. It’s also important to acknowledge that every COVID case carries a risk of potentially life-changing <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/7july2022">long COVID</a> complications following the initial infection.</p>
<p>So while we can now rely on vaccines and medications to a certain extent, we still face significant challenges working out what a proportionate response should be as COVID infections <a href="https://coronavirus.data.gov.uk/">continue to fluctuate</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/caught-covid-heres-what-you-should-and-shouldnt-do-when-self-isolation-isnt-mandatory-179441">Caught COVID? Here’s what you should and shouldn't do when self-isolation isn’t mandatory</a>
</strong>
</em>
</p>
<hr>
<h2>A balancing act</h2>
<p>As an example, we know that another way to reduce the impact of COVID is through public health interventions. But while some, such as the wearing of face masks, <a href="https://theconversation.com/does-your-face-mask-protect-you-or-other-people-142612">are effective and fairly benign</a>, more intrusive restrictions must be balanced against their negative effects, especially among certain parts of the population. </p>
<p>Younger adults, for instance, are disproportionately affected by enforced behavioural changes including lockdowns, social distancing and working from home. An increasing number of studies now show <a href="https://www.gov.uk/government/publications/covid-19-mental-health-and-wellbeing-surveillance-spotlights/covid-19-mental-health-and-wellbeing-surveillance-report-spotlight-age-groups">poorer mental health and wellbeing</a> during the pandemic among people in the 18 to 29 age group in particular. </p>
<p>At the other end of the spectrum we know social restrictions lead to <a href="https://www.elder.org/the-elder/survey-on-elderly-loneliness/">increased loneliness</a> among older people.</p>
<figure class="align-center ">
<img alt="A young man sitting on a couch." src="https://images.theconversation.com/files/476726/original/file-20220729-13348-t3rcsj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476726/original/file-20220729-13348-t3rcsj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476726/original/file-20220729-13348-t3rcsj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476726/original/file-20220729-13348-t3rcsj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476726/original/file-20220729-13348-t3rcsj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476726/original/file-20220729-13348-t3rcsj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476726/original/file-20220729-13348-t3rcsj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID restrictions took a significant toll on younger people.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-serious-man-emotion-panic-attacks-1734481565">panitanphoto/Shutterstock</a></span>
</figcaption>
</figure>
<p>To address this balancing act, perhaps the most proportionate thing any of us can do is to simply remain aware of COVID. This could take the form of wearing a face mask in public spaces, washing our hands more often, and avoiding mixing with others if we are feeling unwell. A lesson we should all have learned from COVID is that it’s not OK to “push on” when we are ill.</p>
<p>Similarly, we should try to be more aware of other people. Just because you may not be concerned about catching COVID (again), this does not mean that everyone else is equally unconcerned. Realising that others have legitimate reasons to worry is important.</p>
<p>In relation to older and vulnerable family members, it’s worth having conversations about what they feel comfortable with. They may want to be very cautious, or they may decide that spending time with family and friends is more important to them.</p>
<p>If you do decide to socialise, it’s relatively cheap and easy to take a COVID test prior to visiting someone who may be at higher risk, and consider postponing a visit or activity if necessary. It should also go without saying that we should all keep our COVID vaccinations and boosters up to date.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/long-social-distancing-how-young-adults-habits-have-changed-since-covid-183837">Long social distancing: how young adults' habits have changed since COVID</a>
</strong>
</em>
</p>
<hr>
<h2>The pandemic isn’t over</h2>
<p>None of this is new or should be surprising, yet the strong desire to move on from COVID seems to mean that many are rapidly forgetting the lessons and precautions learned over the past couple of years. </p>
<p>Vaccines and other medical advances have been game changers, but while they mean it is unlikely that we will ever return to the draconian restrictions of 2020, we still need to <a href="https://theconversation.com/caught-covid-heres-what-you-should-and-shouldnt-do-when-self-isolation-isnt-mandatory-179441">take some precautions</a>. COVID may be less lethal than it was at the outset of the pandemic, but it’s still a serious disease that demands our respect.</p><img src="https://counter.theconversation.com/content/187556/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Kolstoe is chair of the UKHSA's Research Ethics and Goverance Group. </span></em></p>The advent of COVID vaccines has radically changed things for the better, but doesn’t mean we can fully return to our pre-pandemic lives.Simon Kolstoe, Reader in Bioethics and University Ethics Advisor, University of PortsmouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1838372022-05-30T12:46:41Z2022-05-30T12:46:41ZLong social distancing: how young adults’ habits have changed since COVID<figure><img src="https://images.theconversation.com/files/465732/original/file-20220527-23-7d3pzb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5176%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/friends-sitting-on-grass-eating-music-298773782">Monkey Business Images/Shutterstock</a></span></figcaption></figure><p>After two long, difficult years of the pandemic, life has started to return to normal – or at least something resembling normal – for many people. </p>
<p>With all major COVID restrictions now removed in the UK, <a href="https://coronavirus.data.gov.uk/details/cases?areaType=nation&areaName=England">recorded cases</a> at their lowest rate in about a year, and vaccines and booster coverage <a href="https://coronavirus.data.gov.uk/details/vaccinations">relatively high</a>, many people are keenly settling back into <a href="https://theconversation.com/two-years-into-the-pandemic-which-of-our-newly-formed-habits-are-here-to-stay-178204">old habits</a>. Mobility <a href="https://www.google.com/covid19/mobility/">data suggests that</a> – with the exception of travel on public transport and travel to workplaces, which are still below average – we are starting to get out and about as much as we did before the pandemic.</p>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-tips-for-young-people-dealing-with-long-covid-from-a-gp-180464?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Five tips for young people dealing with long COVID – from a GP</a></em></p>
<p><em><a href="https://theconversation.com/covid-vaccines-why-second-boosters-are-being-offered-to-vulnerable-people-in-the-uk-but-not-young-and-healthy-people-yet-180215?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">COVID vaccines: why second boosters are being offered to vulnerable people in the UK – but not young and healthy people yet</a></em></p>
<p><em><a href="https://theconversation.com/goblin-mode-a-gothic-expert-explains-the-trends-mythical-origins-and-why-we-should-all-go-vampire-mode-instead-180282?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Goblin mode: a gothic expert explains the trend’s mythical origins, and why we should all go ‘vampire mode’ instead</a></em></p>
<hr>
<p>But for a significant number of people, the habits that were picked up during the pandemic are still very much a part of life. For example, recent data suggests that just under one-third of people in the UK are continuing to <a href="https://yougov.co.uk/topics/international/articles-reports/2020/03/17/personal-measures-taken-avoid-covid-19">avoid crowded places</a>, while about one-third say they’re maintaining social distancing when meeting up with people from <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/datasets/publicopinionsandsocialtrendsgreatbritaincoronaviruscovid19andotherillnesses">outside their household</a>. More than half of people (54%) report still wearing face masks at least sometimes.</p>
<p>This phenomenon – which has been called “<a href="https://www.nytimes.com/2022/03/19/world/researchers-find-an-ongoing-commitment-to-pandemic-behaviors-they-call-it-long-social-distancing.html">long social distancing</a>” – is not unique to the UK. For example, in many countries, including France, Spain, Italy and Germany, <a href="https://yougov.co.uk/topics/international/articles-reports/2020/03/17/personal-measures-taken-avoid-covid-19">more than four in ten people</a> have reported they’re still avoiding crowds.</p>
<p>Meanwhile, <a href="https://wfhresearch.com/wp-content/uploads/2022/04/LongSocialDistance_v11_forwebsite.pdf">US research</a> has found that 13% of Americans say they plan to continue to socially distance after the pandemic is over, with another 46% saying they plan on only a partial return to normal activities.</p>
<p>But who is practising long social distancing, and why? And where do young people fit in? </p>
<h2>Let’s take a look</h2>
<p>One obvious group is those who are clinically vulnerable. For example, people with disabilities – many of whom, depending on the nature of their disability, might be at higher risk of serious outcomes from COVID – are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/coronaviruscovid19disabledpeoplearemorelikelytofeellifewillneverreturntonormal/2022-03-16">more likely</a> to believe that their lives will never return to normal. Similarly, adults aged over 70, also at higher risk of serious illness from COVID, are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/datasets/publicopinionsandsocialtrendsgreatbritaincoronaviruscovid19andotherillnesses">more likely</a> to still be wearing face masks.</p>
<p>There are certainly differences in behaviour by age. Data from the UK finds that younger adults are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/bulletins/publicopinionsandsocialtrendsgreatbritain/latest">less likely</a> than older adults to either be still socially distancing or wearing face masks. Research <a href="https://wfhresearch.com/wp-content/uploads/2022/04/LongSocialDistance_v11_forwebsite.pdf">from the US</a> meanwhile finds that younger people are less likely to continue socially distancing after the pandemic is over.</p>
<p>Younger people may have been quicker to return to social activities, compared to older adults. Recent <a href="https://www.covidsocialstudy.org/_files/ugd/064c8b_c525505ffa6b432f96dc41d6b6a985ea.pdf">UK data</a> suggests that over the first few months of 2022, during and just after the initial omicron wave, more than 80% of 18 to 29-year-olds said they had met up with friends during the previous week, compared to around 60% to 70% of people in older age groups.</p>
<p>Even so, <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/datasets/publicopinionsandsocialtrendsgreatbritaincoronaviruscovid19andotherillnesses">data shows that</a> 16% of those aged 16-29 are still socially distancing, and 40% are still wearing masks outside of their homes at least sometimes.</p>
<figure class="align-center ">
<img alt="A young woman on a bus wearing a mask." src="https://images.theconversation.com/files/465739/original/file-20220527-19-7bdndc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465739/original/file-20220527-19-7bdndc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465739/original/file-20220527-19-7bdndc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465739/original/file-20220527-19-7bdndc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465739/original/file-20220527-19-7bdndc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465739/original/file-20220527-19-7bdndc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465739/original/file-20220527-19-7bdndc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some young people are continuing to wear masks when they go out.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-medical-mask-bus-period-mandatory-1796776639">wasilisa/Shutterstock</a></span>
</figcaption>
</figure>
<h2>The pandemic has been hard on young adults</h2>
<p>Young adults have tended to get a bad rap during the pandemic, often unfairly. Although some surveys have suggested that rule-breaking was <a href="https://www.ipsos.com/en-uk/young-britons-most-likely-break-coronavirus-rules-pursuit-romance-0">higher among younger adults</a>, others have found that compliance in this group was as high, or at certain points <a href="https://www.sciencedirect.com/science/article/pii/S0016328721001920?via%3Dihub">even higher</a>, than it was among older adults.</p>
<p>Notably, young adults have been one of the groups who have found the pandemic, and the policies designed to contain COVID, most difficult. General life satisfaction has been <a href="https://www.covidsocialstudy.org/_files/ugd/064c8b_c525505ffa6b432f96dc41d6b6a985ea.pdf">significantly lower</a> among younger compared to older adults throughout the past two years. It’s possible that the “<a href="https://bmjopen.bmj.com/content/10/7/e039334">social losses</a>” experienced during the pandemic have been more challenging for younger adults, for whom we know socialising <a href="https://pubmed.ncbi.nlm.nih.gov/10842426/">is crucial</a> for development and wellbeing.</p>
<p>Young adults have been among the most likely to experience <a href="https://pubmed.ncbi.nlm.nih.gov/33308420/">mental health problems</a>, and not to look after their <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11140-w">physical health</a> – for example having a poor diet, drinking a lot of alcohol, or not doing enough exercise. As we continue to emerge from the pandemic, problems such as anxiety and depression tend to remain <a href="https://www.covidsocialstudy.org/_files/ugd/064c8b_c525505ffa6b432f96dc41d6b6a985ea.pdf">higher among younger adults</a>.</p>
<h2>Why a return to ‘normal’ won’t be uniform</h2>
<p>Behaviour is complex and often if not always the result of many factors. Research has invariably shown how everything from <a href="https://www.sciencedirect.com/science/article/pii/S0033350620303772">political affiliation</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259055/#bb0265">personality traits</a> affects how people have been behaving during the pandemic. <a href="https://iaap-journals.onlinelibrary.wiley.com/doi/full/10.1111/aphw.12284">Conscientiousness</a> and <a href="https://doi.apa.org/fulltext/2020-76208-001.html">neuroticism</a>, for example, have both been associated with greater adherence to infection-reducing behaviour. </p>
<p>Similarly, these sorts of factors are likely to affect the extent to which different people return to their <a href="https://theconversation.com/two-years-into-the-pandemic-which-of-our-newly-formed-habits-are-here-to-stay-178204">pre-pandemic social habits</a>. Certainly there’s a significant minority of the population who remain at least somewhat worried about the effect of COVID on their lives – <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/bulletins/publicopinionsandsocialtrendsgreatbritain/latest">four in ten</a> according to recent UK data. </p>
<p>Interestingly, <a href="https://wfhresearch.com/wp-content/uploads/2022/04/LongSocialDistance_v11_forwebsite.pdf">US data</a> suggests people on lower incomes, and with less formal education, are the least likely to feel as though they will return to normal pre-pandemic activities.</p>
<p>Further research is needed to explore why this is the case. One possible explanation is that people from <a href="https://jech.bmj.com/content/75/11/1050">more deprived communities</a> have been at greater risk of more serious outcomes from COVID. They have also been most affected by the economic and social impacts of pandemic policies. So for them it’s perhaps unsurprising that getting back to “normal” seems like a distant, if not impossible, goal.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/two-years-into-the-pandemic-which-of-our-newly-formed-habits-are-here-to-stay-178204">Two years into the pandemic, which of our newly formed habits are here to stay?</a>
</strong>
</em>
</p>
<hr>
<p>In our <a href="https://www.swansea.ac.uk/research/research-highlights/health-innovation/public-during-pandemic/">Public Views During the COVID Pandemic</a> project, we have been following people using a combination of focus groups and surveys since March 2020. One of our aims is to continue to explore some of the reasons behind why, and for how long, social distancing might be a part of some people’s lives.</p><img src="https://counter.theconversation.com/content/183837/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Nicholas Williams has received funding from Swansea University, the University of Manchester, Senedd Cymru and Public Health Wales for research on COVID-19. However, this opinion article reflects the views of the author only and no funding bodies were involved in the writing or content of this article.</span></em></p>Some young adults are hanging onto COVID habits – but less so than older people.Simon Nicholas Williams, Senior Lecturer in People and Organisation, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1828142022-05-11T12:05:04Z2022-05-11T12:05:04ZBeyond honey: 4 essential reads about bees<figure><img src="https://images.theconversation.com/files/462307/original/file-20220510-12-bnz0cm.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2330%2C1681&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bumblebees at work, dotted with pollen.</span> <span class="attribution"><a class="source" href="https://flic.kr/p/cFk2Cm">Crabchick/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>As spring gardening kicks into high gear, bees emerge from hibernation and start moving from flower to flower. These hardworking insects play an essential role <a href="https://www.fs.fed.us/wildflowers/pollinators/animals/bees.shtml">pollinating plants</a>, but they’re also interesting for many other reasons. Scientists study bees to learn about their intricate social networks, learning patterns and adaptive behaviors. These four stories from The Conversation’s archive offer diverse views of life in the hive.</p>
<h2>1. Females are the future</h2>
<p>The survival of bee colonies <a href="https://theconversation.com/spring-signals-female-bees-to-lay-the-next-generation-of-pollinators-134852">depends on female bees</a>, although they play different roles depending on their species. In social bee species, females find nesting spots to establish new colonies and lay hundreds of eggs there. </p>
<p>Other species are solitary, meaning that each bee lives alone. Females create segmented nests, lay an egg in each segment, deposit a ball of pollen to feed the larva, and then die off. </p>
<p>Female bees need support, especially early in the year when foraging options are few, doctoral student <a href="https://www.researchgate.net/profile/Lila-Westreich">Lila Westreich</a> notes. “It’s best to provide female bees with many early spring flowers – they rely on nectar from flowers to fuel their search for a nesting spot. Planting early-flowering plants such as willow, poplar, cherry trees and other spring blooms provides nectar for queen bees,” she writes. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/spring-signals-female-bees-to-lay-the-next-generation-of-pollinators-134852">Spring signals female bees to lay the next generation of pollinators</a>
</strong>
</em>
</p>
<hr>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/vf8QyIF3eoY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In solitary bee species, females play the roles of queen and worker.</span></figcaption>
</figure>
<h2>2. Some bees are curious, others are focused</h2>
<p>All bees forage, but they do it in different ways. Some become very focused on the smell, colors and locations of known food sources and return to those flowers over and over. Others are more willing to explore and will change their behavior when they learn about new food sources. </p>
<p>As part of an experiment, Marquette University biologist <a href="https://scholar.google.com/citations?user=lGDvqJ8AAAAJ&hl=en">Chelsea Cook</a> and her colleagues bred populations of bees that were genetically programmed to be <a href="https://theconversation.com/some-bees-are-born-curious-while-others-are-more-single-minded-new-research-hints-at-how-the-hive-picks-which-flowers-to-feast-on-144900">either curious or focused</a>, and a colony that mixed these two styles together. Then they offered the bees a familiar food source and novel sources. Sure enough, the focused colony concentrated on the familiar source and the curious colony visited both known and novel sources. </p>
<p>In the mixed colony, bees came to concentrate more on the familiar source than the new ones over time. Why? The researchers observed how the bees communicated through their “waggle dance,” which tells nestmates where to find food, and saw that the focused bees were dancing faster. This conveyed their message more intensely than signals from slower dancers.</p>
<p>“Because curious bees are interested in everything, including new information about possible food locations, they are perfect listeners and are easily convinced to visit the chosen feeder of their enthusiastic nestmates,” Cook observes.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/some-bees-are-born-curious-while-others-are-more-single-minded-new-research-hints-at-how-the-hive-picks-which-flowers-to-feast-on-144900">Some bees are born curious while others are more single-minded – new research hints at how the hive picks which flowers to feast on</a>
</strong>
</em>
</p>
<hr>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/12Q8FfyLLso?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A scientist breaks down bees’ waggle dance.</span></figcaption>
</figure>
<h2>3. It takes a colony</h2>
<p>Bees communicate with one another about <a href="https://theconversation.com/honey-bees-cant-practice-social-distancing-so-they-stay-healthy-in-close-quarters-by-working-together-141106">many things besides food</a>. For example, bees use dancing to persuade their colony to move to a new nest site, write Providence College biologist <a href="https://scholar.google.com/citations?user=B6WmgvLL8vMC&hl=en">Rachael Bonoan</a> and Tufts University biologist <a href="https://scholar.google.com/citations?user=KF4sBDIAAAAJ&hl=en">Phil Starks</a>.</p>
<p>And bees work together to defend their colonies against external threats. Bonoan and Starks analyzed how honeybee colonies of varying sizes protected themselves against a fungus that causes a bee disease called chalkbrood. To do this, the researchers infected the colonies with the fungus and tracked the bees’ responses with thermal imaging.</p>
<p>The pathogen needs cool temperatures to infect bees, so the bees respond with heat. “When this pathogen is detected, worker bees protect the vulnerable young by contracting their large flight muscles to generate heat. This raises the temperature in the brood comb area of the hive just enough to kill the pathogen,” the biologists explain. Worker bees also remove diseased and dead young from the colony, which reduces the chance of infection spreading.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/honey-bees-cant-practice-social-distancing-so-they-stay-healthy-in-close-quarters-by-working-together-141106">Honey bees can't practice social distancing, so they stay healthy in close quarters by working together</a>
</strong>
</em>
</p>
<hr>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1395430362315067396"}"></div></p>
<h2>4. Straining for the good of the swarm</h2>
<p>Computer scientist <a href="https://scholar.google.com/citations?user=xH5Ryy4AAAAJ&hl=en">Orit Peleg</a> at the University of Colorado Boulder studied yet another way in which bees work together for the good of the group. Peleg and her colleagues analyzed swarms that European honeybees form when a colony becomes so large that it’s about to split into two new groups. The relocating group forms a swarm that can hang from objects such as tree branches, and can change its shape, with each bee essentially holding hands with others next to it.</p>
<p>The scientists used a motor to shake a wooden board with a swarm of 10,000 honeybees hanging from the underside. By seeing how the swarm <a href="https://theconversation.com/what-a-bundle-of-buzzing-bees-can-teach-engineers-about-robotic-materials-125194">responded to shaking in various directions</a>, they hoped to gain insights that could inform the creation of adaptive structures made up of robots linked together. </p>
<p>“Using a computational model, we showed that bonds between bees located closer to where the swarm attaches to the board stretch more than bonds between bees at the far tip of the swarm,” Peleg recounts. “Bees could sense these different amounts of stretching, and use them as a directional signal to move upwards and make the swarm spread.”</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/462309/original/file-20220510-16-hqlk80.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A football-shaped cluster of bees hangs from a branch." src="https://images.theconversation.com/files/462309/original/file-20220510-16-hqlk80.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/462309/original/file-20220510-16-hqlk80.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=806&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462309/original/file-20220510-16-hqlk80.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=806&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462309/original/file-20220510-16-hqlk80.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=806&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462309/original/file-20220510-16-hqlk80.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1013&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462309/original/file-20220510-16-hqlk80.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1013&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462309/original/file-20220510-16-hqlk80.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1013&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Bee swarm on a tree branch in Arkansas.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Swarming_(honey_bee)#/media/File:Bee_Swarm.JPG">Mark Osgathard/Wikipedia</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Put another way, the bees moved from locations where bonds stretched less to locations where they stretched more. “This behavioral response improves the collective stability of the swarm as a whole at the expense of increasing the average burden experienced by the individual bee,” Peleg concludes. </p>
<p>They found that when they shook the board horizontally, the swarm spread out into a wider, more stable cone. But it was less able to react to vertical shaking and eventually broke apart. That’s because vertical shaking didn’t disrupt the bonds between individual bees as much as horizontal shaking, so the swarm didn’t respond to vertical shaking by changing its shape.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-a-bundle-of-buzzing-bees-can-teach-engineers-about-robotic-materials-125194">What a bundle of buzzing bees can teach engineers about robotic materials</a>
</strong>
</em>
</p>
<hr>
<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archive.</em></p><img src="https://counter.theconversation.com/content/182814/count.gif" alt="The Conversation" width="1" height="1" />
Bees offer insights into many scientific questions, from cooperating in close quarters to strategies for finding food.Jennifer Weeks, Senior Environment + Cities Editor, The ConversationLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772382022-03-10T20:57:37Z2022-03-10T20:57:37ZShould public health measures like masking continue beyond the pandemic? Data on viral infections shows their benefits<figure><img src="https://images.theconversation.com/files/450321/original/file-20220307-84100-jira1v.jpg?ixlib=rb-1.1.0&rect=166%2C98%2C2717%2C1675&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A woman wears a face mask as she walks by the sculpture ‘The Illuminated Crowd’ on a street in Montréal. Vulnerable people may benefit from measures like face masks even after the COVID-19 pandemic.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span></figcaption></figure><p>Public health measures, such as masking and physical distancing, that have been a high-profile part of the COVID-19 response for the past two years <a href="https://www.cbc.ca/news/canada/edmonton/jason-kenney-copping-alta-covid-restrictions-lift-1.6368297">are now</a> <a href="https://www.cbc.ca/news/canada/toronto/covid19-ontario-march-9-mask-mandates-1.6378148">beginning to lift</a>. However, surprisingly little attention has been paid to the remarkable effects of these measures on other respiratory illnesses that are caused or exacerbated by viral infections.</p>
<p>These effects are a valuable research discovery from the pandemic. It’s a discovery that suggests that selective, non-mandated use of public health measures like masking, physical distancing and hand-washing may have a continued role as we enter the endemic phase of COVID-19. Collectively, these measures are known as non-pharmacologic public health interventions (NPIs).</p>
<h2>Decreases in acute care</h2>
<p>Following the onset of the pandemic in March 2020, many regions around the world reported a dramatic decrease in demand for <a href="https://doi.org/10.1371/journal.pone.0252441">acute health-care services</a>, including urgent care visits to emergency departments and inpatient hospital stays.</p>
<p>Early on, this was likely driven by stringent lockdown measures, patients avoiding health-care settings due to fears of contracting COVID-19 or the perception that hospitals were overwhelmed and unable to accommodate non-emergency cases. </p>
<p>However, as public health measures were relaxed over the following months, there was a rapid rebound in health-care services for conditions such as heart disease and appendicitis. Meanwhile, the decrease persisted for respiratory illnesses attributed to <a href="http://doi.org/10.1007/s11739-022-02932-y">non-COVID-19 viruses</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sign above a row of sinks shows an image of a man washing his hands with the message 'Clean hands keep you healthy. Wash your hands with soap and water for at least 20 seconds. Life is better with clean hands.'" src="https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Public health measures such as masking, hand-washing and physical distancing are collectively known as non-pharmacologic public health interventions (NPIs).</span>
<span class="attribution"><span class="source">(AP Photo/David Zalubowski)</span></span>
</figcaption>
</figure>
<p>In Canada, the usual annual surge in influenza infections has not occurred during the <a href="https://doi.org/10.1016/j.lana.2021.100015">two winters since the beginning of the pandemic</a>. </p>
<p>Our research group — all front-line health-care workers — analyzed nationwide admissions data. Our analysis revealed that hospital admissions for major respiratory illnesses dropped sharply in the year following the start of the first lockdown. </p>
<p>Specifically, flare-ups of chronic obstructive pulmonary disease (COPD), a severe lung disease related to long-term smoking, and community-acquired non-COVID-19 pneumonia decreased by nearly 40 per cent across Canada <a href="http://doi.org/10.1007/s11739-022-02932-y">following the implementation of NPIs like masking and physical distancing</a>. </p>
<p>These findings were supported by another study of 15,677 patients from nine countries. That study reported a 50 per cent reduction in the hospital admissions for COPD <a href="https://doi.org/10.1371/journal.pone.0255659">following the onset of the pandemic</a>. This is not entirely surprising as <a href="https://doi.org/10.1111/resp.12780">both COPD and non-COVID-19 pneumonia</a> are often triggered by <a href="https://doi.org/10.1007/s10741-017-9614-7">common cold viruses</a>. If you are like most Canadians, you have not caught a cold in nearly two years. </p>
<h2>Impact on vulnerable patients</h2>
<p>So, what’s the big fuss about a few runny noses and colds? While a viral infection such as the common cold or influenza is unlikely to significantly harm a healthy individual, it can be <a href="https://doi.org/10.1503/cmaj.201748">debilitating and sometimes deadly</a> for someone who is <a href="https://dx.doi.org/10.1016%2FS2213-2600(18)30496-X">elderly, immunocompromised or suffering from a lung disease</a>. It can result in the need for acute care in the hospital, or even the ICU in severe cases, and some patients do not survive. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people in masks sitting on a park bench." src="https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A viral infection, such as the common cold or influenza, is unlikely to significantly harm a healthy individual, but it can be debilitating and sometimes deadly for someone who is elderly, immunocompromised or living with a lung disease.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<p>In Canada, acute and chronic respiratory diseases are the third greatest cause of death, trailing behind only <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/201126/t001b-eng.htm">cancer and heart disease</a>. This also means virally linked respiratory illnesses place a substantial burden on limited health-care resources. </p>
<p>There were several periods during the pandemic when our <a href="https://cmajnews.com/2022/01/11/covid-update-beds-duong-1095984/">health-care systems</a> were <a href="https://www.cbc.ca/news/health/tam-omicron-more-restrictions-better-masks-1.6293347">over capacity</a>, and there was a fear that hospitals would need to <a href="https://www.theglobeandmail.com/canada/article-alberta-preps-critical-care-triage-plan-amid-surge-in-covid-19-cases/">triage resources</a> and deny ICU care to some critically ill patients. </p>
<p>Thankfully, this did not come to pass, and it seems that the likely reason was the significant additional capacity that became available due to hospitalizations avoided for other <a href="http://doi.org/10.1007/s11739-022-02932-y">virally linked respiratory illnesses</a>.</p>
<h2>Ending COVID-19 prevention measures</h2>
<p>As the pandemic drags on, people have become fatigued with ongoing public health restrictions. With <a href="https://ourworldindata.org/covid-vaccinations">vaccination rates in Canada among the highest in the world</a> and expected to reach even higher with the <a href="https://www.canada.ca/en/public-health/services/vaccination-children/making-decisions-5-11-years-age.html">approval of vaccinations for pediatric populations</a>, many are looking forward to a time when NPIs may no longer be needed. </p>
<p>However, before dispensing with the measures entirely, it is important to consider whether their demonstrated benefits warrant continued use. The fact that hospitalizations for non-COVID-19 respiratory illnesses have remained low, despite the relaxation of stringent lockdown measures, suggests that these benefits may be sustained with the use of masking and practices such as frequent hand-washing. </p>
<figure class="align-center ">
<img alt="Close-up image of a red social distancing circle on asphalt, with two shoe-prints and the message 'Please keep 2M distance'" src="https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is no consensus on which specific NPIs may be most effective in preventing disease spread.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jonathan Hayward</span></span>
</figcaption>
</figure>
<p>Even prior to the pandemic, <a href="https://www.asiapacific.ca/publication/great-mask-divide-lessons-asia">public masking was a common practice</a> in many Asian countries. With this now being the norm in Canada as well, continuing these practices may have significant merit and offer protection to the most vulnerable demographics of our society. </p>
<p>This will certainly be challenging given <a href="https://www.reuters.com/world/americas/canadian-cities-brace-more-anti-vaccine-mandate-protests-2022-02-05/">opposition from a vocal minority</a> and the lack of awareness among the general public about the benefits of continuing use of NPIs. Currently, most available evidence is largely observational, as no randomized trials have yet evaluated the efficacy of NPIs for reducing non-COVID-19 viral respiratory illnesses at a population level. </p>
<p>Additionally, there is no consensus on which specific NPIs may be most effective in preventing disease spread. It’s also unknown whether reductions in acute care use have translated into a reduction in mortality rates for specific conditions. </p>
<h2>Future prevention</h2>
<p>These limitations are currently being addressed in a large-scale Albertan study of over 500,000 patients. The preliminary results — which will be published in the proceedings of the 2022 American Thoracic Society International Conference — show that NPIs are an effective strategy for preventing both acute care visits and mortality related to respiratory illnesses. </p>
<p>However, in the interim, public policy-makers should consider this compelling evidence and weigh in on whether the continued use of masking and other NPI measures is warranted, especially for individuals at high-risk for serious illness from viral respiratory infections and those close to them. </p>
<p>Recommendations, policies or, if deemed necessary, mandates can be amended in the future as new evidence emerges. Until then, NPI use, even on an interim basis, may reduce the strain on our health-care system and help protect the most vulnerable members of our society.</p><img src="https://counter.theconversation.com/content/177238/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Decreases in respiratory infections during the pandemic suggest there may be a continued role for the selective, non-mandated use of measures like masks and social distancing even post-COVID-19.Rutvij A. Khanolkar, Medical Student, University of CalgaryEddy S. Lang, Professor, Cumming School of Medicine, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1774262022-03-04T13:20:14Z2022-03-04T13:20:14ZClarifying the CDC’s COVID-19 quarantine and isolation guidelines – an infectious disease doc looks at the latest research<figure><img src="https://images.theconversation.com/files/448147/original/file-20220223-19-100j9b3.jpg?ixlib=rb-1.1.0&rect=85%2C0%2C5090%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The CDC's new recommendations have caused consternation among the public, the media and even among doctors.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-woman-with-mask-looking-through-window-royalty-free-image/1215755299?adppopup=true">Justin Paget/DigitalVision via Getty Images</a></span></figcaption></figure><p>In December 2021, the U.S. Centers for Disease Control and Prevention updated its guidelines for <a href="https://www.cdc.gov/media/releases/2021/s1227-isolation-quarantine-guidance.html">how long people should isolate</a> following a COVID-19 infection. The agency shortened the isolation from 10 days to five, followed by five days of wearing a mask for those no longer symptomatic. </p>
<p>The change came during the height of the <a href="https://theconversation.com/will-omicron-the-new-coronavirus-variant-of-concern-be-more-contagious-than-delta-a-virus-evolution-expert-explains-what-researchers-know-and-what-they-dont-169020">omicron variant’s surge</a> and <a href="https://www.cnn.com/2022/01/03/us/omicron-variant-covid-local-impacts/index.html">related staffing shortages</a> at hospitals, schools and businesses. Some critics suspected that the move was <a href="https://www.pbs.org/newshour/health/new-cdc-isolation-quarantine-guidelines-confuses-some-and-raises-questions">more practically motivated than science-based</a> to allow workers, especially health care and other essential personnel, to return to their jobs quicker.</p>
<p>As a result, I thought it useful to review the data behind the latest recommendations to help people think through best practices.</p>
<p><a href="https://med.virginia.edu/pathology/contact/william-a-petri-jr-m-d-ph-d/">I’m an infectious diseases specialist</a> at the University of Virginia. I take care of patients hospitalized with COVID-19 and conduct research on how the immune system responds to infection. </p>
<h2>The CDC’s current strategy</h2>
<p>First, <a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html?">let’s make a distinction</a> between <a href="https://www.hhs.gov/answers/public-health-and-safety/what-is-the-difference-between-isolation-and-quarantine/index.html">the terms “isolation” and “quarantine.”</a> During the pandemic, people have often used them interchangeably. But isolation is meant to separate infected people from those who aren’t, whereas quarantine separates those who were exposed to COVID-19 but have not yet tested positive or are not symptomatic. </p>
<p>That said: If you are infected with COVID-19, the CDC’s latest guidelines have cut your isolation period by half, to five days from the onset of symptoms, or the first positive test if you do not have symptoms. After five days, as long as you are getting better, the CDC says you no longer need to isolate but should mask around others for five more days. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/xFIN6ckZWnI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Why the CDC changed its COVID-19 quarantine restrictions.</span></figcaption>
</figure>
<p>If you are exposed to COVID-19 and have not had your booster shot, the CDC recommends that you quarantine for five days following exposure. Between days five to seven, you should be tested, and if the test is negative, you can end the quarantine. Consider yourself exposed if you are within 6 feet of an infected person for 15 minutes or more over a 24-hour period. And the CDC says if you are vaccinated and boosted, you don’t need to quarantine at all after an exposure to COVID-19 – though you should get tested five days later and mask for at least 10 days after exposure.</p>
<p>Regardless of vaccination status, the CDC recommends that you take a <a href="https://theconversation.com/over-the-counter-rapid-antigen-tests-can-help-slow-the-spread-of-covid-19-heres-how-to-use-them-effectively-166869">rapid antigen test</a> or a <a href="https://theconversation.com/whats-the-difference-between-a-pcr-and-antigen-covid-19-test-a-molecular-biologist-explains-170917">PCR test</a> five to seven days after exposure to confirm that you did not acquire COVID-19 prior to leaving quarantine.</p>
<h2>New studies support these CDC recommendations</h2>
<p>What is the evidence behind these recommendations? Although researchers are still learning about omicron – as the CDC says, “<a href="https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine-isolation-background.html">the science is evolving</a>” – some reports suggest its symptoms appear more rapidly after exposure when compared with the <a href="https://theconversation.com/delta-variant-makes-it-even-more-important-to-get-a-covid-19-vaccine-even-if-youve-already-had-the-coronavirus-164203">delta variant</a>. That includes the results of four small studies from Nebraska, Norway, Japan and the National Basketball Association in the U.S. </p>
<p>In Nebraska, a family of six was exposed at the same time to the omicron variant of SARS-CoV-2, the virus that causes COVID-19. Symptoms of infection appeared within <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm705152e3.htm">one to three days of exposure</a>, which is one to two days faster than the delta variant. This finding supports the CDC recommendations. In Norway, approximately 100 guests were exposed to omicron at a Christmas party; most got COVID-19, with symptoms appearing and <a href="https://doi.org/10.2807/1560-7917.ES.2021.26.50.2101147">infections detected within two to five days</a> after exposure, again earlier than would have been expected for delta. </p>
<p>In Japan, a study of 21 people infected with omicron found that the amount of virus was highest three to six days <a href="https://www.niid.go.jp/niid/en/2019-ncov-e/10884-covid19-66-en.html">after diagnosis or symptom onset</a>. And a study from the NBA COVID-19 surveillance system discovered that a person with omicron was <a href="https://dash.harvard.edu/handle/1/37370587">typically no longer infectious by day five</a>. </p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-youresmart">You can read us daily by subscribing to our newsletter</a>.]</p>
<p>Taken together, these studies suggest that most people who were infected with the omicron variant or who had an exposure no longer transmitted the virus by day five.</p>
<p>These four studies illustrate the reasoning behind the CDC’s shortening of its isolation and quarantine recommendations to five days. By that point post-infection, the vast majority of people aren’t going to spread the virus to others, so it makes sense that they can get back to their normal routines.</p>
<h2>The follow-up test is critical if you were exposed and in quarantine</h2>
<p>But remember the caveat: Without a rapid antigen or PCR test five to seven days after the beginning of quarantine, transmission rates of COVID-19 <a href="https://doi.org/10.1101/2022.01.13.22269257">might only be reduced by half</a>.</p>
<p>That’s why both the CDC and the World Health Organization <a href="https://www.who.int/publications/i/item/WHO-2019-nCoV-Contact-tracing-and-quarantine-Omicron-variant-2022.1">are recommending the follow-up tests</a> within five to seven days of the start of quarantine.</p>
<p>Mathematical models demonstrate that <a href="http://dx.doi.org/10.1136/bmjopen-2021-050473">either rapid antigen or PCR testing</a> allows for <a href="http://dx.doi.org/10.1136/bmjopen-2021-050473">shortening of quarantine time</a> without compromising public safety.</p>
<p>And one footnote: As of early March 2022, nearly 57% of Americans who are fully vaccinated <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total">have not received the booster</a>. That means tens of millions of Americans have yet to take this extra step to more fully protect themselves from this virus.</p><img src="https://counter.theconversation.com/content/177426/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>William Petri receives funding from the NIH and the Gates Foundation.</span></em></p>The CDC’s controversial recommendation changes are based on new studies showing that most omicron transmission takes place within five days of the onset of illness.William Petri, Professor of Medicine, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772142022-02-23T13:36:44Z2022-02-23T13:36:44ZCOVID-19 cases on campus could surge after spring break unless students take certain precautions<figure><img src="https://images.theconversation.com/files/447836/original/file-20220222-17-1cm3x89.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4187%2C2917&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What college students do during and after spring break can affect the number of COVID-19 cases on campus. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-enjoy-themselves-while-walking-along-the-daytona-news-photo/1231920082?adppopup=true">Paul Hennessy/SOPA Images/LightRocket via Getty Images</a></span></figcaption></figure><p><em>In a <a href="https://doi.org/10.1038/s41598-022-06260-1">new study</a> published in Scientific Reports, researchers found that breaking up spring break into small breaks instead of the traditional nine-day vacation can help reduce COVID-19 cases on campus by 2% to 37% when students return. To learn more, The Conversation reached out to <a href="https://scholar.google.com/citations?user=w7mMcLoAAAAJ&hl=en">Naveen K. Vaidya</a>, a co-author of the study and an expert in mathematical modeling, to predict how infectious diseases spread and to get his take on whether a traditional spring break this year will be safe.</em> </p>
<h2>What happened in 2021 at colleges that offered a regular spring break?</h2>
<p>Many of them had surges after spring break, but the levels varied.</p>
<p>The size of the surge depended on several variables. One of the most important factors was how many students from campus traveled and, if so, whether they went to a destination with a high prevalence of COVID-19 cases.</p>
<p>But data from spring 2021 only offers limited insight because <a href="https://edscoop.com/universities-prepare-another-largely-virtual-semester-spring-2021/">most universities offered online or hybrid classes at the time</a>, so not all colleges had students returning from spring break to campus. Plus, many implemented post spring-break protocols, such as two-week quarantines and mandatory regular testing.</p>
<p>The <a href="https://calmatters.org/education/higher-education/college-beat-higher-education/2021/02/california-colleges-vaccines">first dose of the COVID-19 vaccine</a> had <a href="https://www.ajmc.com/view/a-timeline-of-covid-19-vaccine-developments-in-2021">begun to be administered before spring break</a> last year. Also, the delta variant, which <a href="https://newsnetwork.mayoclinic.org/discussion/how-covid-19-delta-variant-is-impacting-younger-people/">significantly affected</a> <a href="https://www.infectioncontroltoday.com/view/younger-people-in-us-getting-hit-hard-by-delta-variant">younger people</a>, was already <a href="https://www.newsweek.com/first-us-covid-delta-variant-cases-how-did-it-mutate-1617871">circulating in other places in the world</a> and was about to surface in the U.S. </p>
<p>Some schools canceled the traditional spring breaks, and some attempted to <a href="https://www.newsweek.com/expected-spring-breakrelated-covid-19-surge-reported-some-college-campuses-1579178">curb the expected bump</a> in COVID-19 cases when students returned to campus. For example, the University of California at Berkeley <a href="https://www.dailycal.org/2021/04/13/uc-berkeley-avoids-covid-19-surge-after-spring-break/">required students who lived on campus to quarantine for 10 days after spring break</a>. The University of California, Davis reduced student travel by offering a $75 gift card to students to have a <a href="https://www.ucdavis.edu/news/students-enjoy-their-staycations">“staycation” on campus</a> during spring break. About <a href="https://www.ucdavis.edu/news/students-enjoy-their-staycations">2,500 students</a> took the university up on its offer.</p>
<p>Post-spring break surges were reported on college campuses in states such as <a href="https://www.connectradio.fm/2021/05/09/florida-reports-more-than-10000-covid-19-variant-cases-surge-after-spring-break/">Florida</a>, <a href="https://www.indystar.com/story/news/health/2021/04/22/indianapolis-covid-cases-rise-after-ncaa-tourney-spring-break/7337360002/">Indiana</a>, <a href="https://www.clickondetroit.com/news/local/2021/04/06/hospitals-across-metro-detroit-say-theyre-ready-for-possible-covid-surge-after-spring-break/">Michigan</a> and <a href="https://buffalonews.com/news/local/education/schools-see-post-spring-break-covid-19-surge/article_e32d6790-9d5d-11eb-89f3-4b7a893e4be5.html">New York</a>.</p>
<h2>Is spring break safe for this year?</h2>
<p>We don’t know. Spring break itself is not the problem, but it can become problematic based on other variables, such as how many students travel and whether they go places where there is a relatively high prevalence of COVID-19 cases.</p>
<p>Based on those variables and our <a href="https://doi.org/10.1038/s41598-022-06260-1">model simulations</a>, breaking up spring break into shorter breaks instead of the regular nine-day break could reduce COVID-19 cases between 2% and 37%. However, the actual percentage will likely be influenced by the presence of the more transmissible omicron variant and by the fact that many more people are vaccinated than at this time last year.</p>
<h2>What kinds of destinations should students avoid?</h2>
<p>If students travel, they should consider going to places where the prevalence of COVID-19 cases is relatively low and the portion of people who are vaccinated is relatively high. People can check with government websites or other sources, such as the <a href="https://coronavirus.jhu.edu/map.html">Johns Hopkins University & Medicine’s Coronavirus Resource Center</a>, to see the status of vaccination rates in a particular place.</p>
<p>A vacation plan with more outdoor activities will be beneficial because the virus is <a href="https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/safe-activities-during-covid19/art-20489385">less likely to be transmitted outdoors</a>. Coming into contact with fewer people and wearing masks during travel can also help reduce exposure to COVID-19. </p>
<h2>Do you expect COVID-19 cases to spike at campuses when students return?</h2>
<p>Yes, that is what is predicted by our model and what many universities experienced last year. However, it should be noted that students might have already been vaccinated, probably even with a booster, as <a href="https://www.bestcolleges.com/news/2021/10/11/list-of-colleges-that-require-covid-19-vaccine/">mandated by many universities</a>, which can also lessen the spread of the coronavirus.</p>
<p>Also, two years of the pandemic, to some extent, might have taught people to observe safer practices when they are in a crowd, such as keeping their distance from people, wearing a mask properly and washing their hands frequently.</p>
<p>While some spikes of COVID-19 are expected following spring break, policy changes by colleges, such as incentives for students who avoid travel, sending frequent emails reminding students to wear a mask and reduce contacts, and a few days of quarantine with frequent testing upon return, may help curtail potential surges.</p><img src="https://counter.theconversation.com/content/177214/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Naveen K. Vaidya does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An expert weighs in on how colleges can lower their chances of being hit by surges of COVID-19 cases after spring break 2022.Naveen K. Vaidya, Associate Professor of Mathematics, San Diego State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1742872022-02-16T13:16:55Z2022-02-16T13:16:55ZDoes scaring people work when it comes to health messaging? A communication researcher explains how it’s gone wrong during the COVID-19 pandemic<figure><img src="https://images.theconversation.com/files/440339/original/file-20220111-25-1wkr62m.jpg?ixlib=rb-1.1.0&rect=46%2C0%2C5220%2C3422&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The film 'Don't Look Up' warns of the dangers of ignoring the findings of science.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/an-artists-depiction-of-an-inhabited-earth-royalty-free-illustration/532101243">Marc Ward/Stocktrek Images via Getty Images</a></span></figcaption></figure><p>In the recent film “<a href="https://www.netflix.com/title/81252357">Don’t Look Up</a>,” two astronomers learn that a comet is on track to collide with Earth and destroy human civilization. When they try to sound the alarm, <a href="https://theconversation.com/dont-look-up-hollywoods-primer-on-climate-denial-illustrates-5-myths-that-fuel-rejection-of-science-174266">all manner of obstacles</a> get in their way. In the end, well, you’ll have to watch the movie to find out. </p>
<p>The film is fiction, of course, but the situation illuminates one facet of reality: When people try to warn others of impending danger, success is not guaranteed. </p>
<p>Warning messages travel under a variety of names, including fear appeals, threat appeals and risk communication. <a href="https://scholar.google.com/citations?user=vGp8WKMAAAAJ&hl=en">As a communication scientist</a> who has studied warning messages for 40 years, I’ve thought a lot about the question of when fear appeals are heeded and when they are not – a consideration that has undoubtedly been on the minds of many public health officials throughout the COVID-19 pandemic.</p>
<h2>COVID-19: A ‘biological comet’</h2>
<p>Fear appeals obviously aren’t limited to comets. Warnings about the unwanted consequences of smoking, texting while driving and drinking while pregnant can be considered fear appeals. So can food recalls, evacuation warnings and messages that encourage vaccination for the flu, polio and COVID-19.</p>
<p>Broad research literature reviews, called meta-analyses, find that <a href="https://doi.org/10.1080/23808985.1984.11678581">fear appeals do work</a> for most people most of the time. </p>
<p>And yet, consider where society finds itself today. For the past two years, people the world over have been told that they are in danger of contracting a potentially deadly disease – a sort of biological comet – and that a variety of health protective behaviors, such as social distancing, masking and vaccination, can save lives. Still, many people forgo social distancing, reject masking recommendations and continue to refuse a vaccine that will protect them. Why?</p>
<figure class="align-center ">
<img alt="Adults and children hold protest signs while demonstrating against COVID-19 vaccine mandates." src="https://images.theconversation.com/files/440346/original/file-20220111-22323-jy4n0k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440346/original/file-20220111-22323-jy4n0k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440346/original/file-20220111-22323-jy4n0k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440346/original/file-20220111-22323-jy4n0k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440346/original/file-20220111-22323-jy4n0k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440346/original/file-20220111-22323-jy4n0k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440346/original/file-20220111-22323-jy4n0k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In Huntington Beach, Calif., adults and children alike demonstrated against COVID-19 vaccine mandates for students.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-demonstrate-against-covid-19-vaccine-mandates-for-news-photo/1237524823?adppopup=true">Robyn Beck/AFP via Getty Images</a></span>
</figcaption>
</figure>
<h2>How fear appeals fail – at times</h2>
<p>Understanding when fear appeals work and when they don’t requires some knowledge of what they are and how they function. Fear appeals <a href="https://psycnet.apa.org/record/2013-39243-012">have two distinct parts</a>. The first part describes the danger. The second describes how to mitigate the danger.</p>
<p>If they are well crafted, the first part scares the people receiving the message and the second calms them down. As a person hears or reads a fear appeal from beginning to end, fear looks like an inverted U: It rises and then it falls. </p>
<p>Research I have conducted with my colleagues at Penn State shows that both the escalation and de-escalation of fear must occur <a href="https://doi.org/10.1080/03637751.2016.1158412">for the message to be effective</a>. Without the rise and the fall of fear, the message will fail. So what might interfere with this process?</p>
<p>A great deal hinges on what people believe about the supposed threat. If the problem is not seen as serious, there is no reason to be afraid, no need to pay attention to the recommended solution and no need to protect oneself.</p>
<p>From the earliest days of the COVID-19 pandemic, some message sources downplayed the threat. President Trump, for instance, <a href="https://www.forbes.com/sites/tommybeer/2020/09/10/all-the-times-trump-compared-covid-19-to-the-flu-even-after-he-knew-covid-19-was-far-more-deadly/?sh=652ec757f9d2">compared the novel coronavirus</a> to another disease that society has learned to cope with. “This is a flu. This is like a flu,” Trump said. Statements of this sort compromised efforts to convey the true risks of COVID-19. </p>
<p>And even a serious threat must be seen as relevant or it is unlikely to evoke strong emotion. Early in the pandemic, <a href="https://doi.org/10.1001/jama.2020.25381">some areas</a> were hit hard by the virus while others experienced relatively low infection rates. People living in those low-caseload areas often had only indirect information about the pandemic, often through social media. And social media contained a great deal of misinformation. </p>
<p>Strikingly, just 12 people were responsible for <a href="https://www.npr.org/2021/05/13/996570855/disinformation-dozen-test-facebooks-twitters-ability-to-curb-vaccine-hoaxes">two-thirds of the misinformation</a> about vaccines on social media platforms such as Twitter and Facebook. Joseph Mercola, an osteopathic physician with 3.6 million followers, <a href="https://www.counterhate.com/disinformationdozen">notoriously and erroneously stated</a>: “The same number of people died in 2020 that, on average, have died in previous years. This simply wouldn’t be the case if we had a lethal pandemic.” This blanket denial of the virus’s true impact allowed a great many people to conclude that the pandemic wasn’t a problem for them or for anyone else. </p>
<p>Then there’s the question of what can be done about the threat. </p>
<p>Health experts maintain – based on a vast amount of data and scientific evidence – that COVID-19 vaccines <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness/index.html">are highly effective</a>. When individuals believe the remedy is effective, fear is diminished and the likelihood of action is enhanced. But beliefs about the vaccines’ effectiveness <a href="https://doi.org/10.1016/j.vaccine.2021.07.056">have been weakened</a> by claims that the vaccine is too new and unproven or that its production was rushed. </p>
<p>Last, a key consideration is whether people can actually achieve the solution. Social distancing required pivoting to remote work and school, placing a huge burden on families that <a href="https://www.mckinsey.com/featured-insights/future-of-work/covid-19-and-gender-equality-countering-the-regressive-effects">fell disproportionately on women</a>. Meanwhile, high-quality masks were initially expensive and challenging to locate <a href="https://www.nytimes.com/2021/11/30/health/covid-masks-counterfeit-fake.html">in a sea of counterfeits</a>. </p>
<p>Just a year ago, in early 2021, <a href="https://www.npr.org/2021/02/08/965515631/why-is-it-so-hard-to-figure-out-where-to-get-vaccinated-for-covid-19">vaccines were unavailable</a> in many locations. And now, after navigating nearly two years of challenges in adapting recommended solutions, there is a real danger that <a href="https://apps.who.int/iris/bitstream/handle/10665/335820/WHO-EURO-2020-1160-40906-55390-eng.pdf">pandemic fatigue</a> will reduce motivation to adhere to safety guidelines.</p>
<h2>Undermining the messenger</h2>
<p>Fear appeals can also be thwarted in more general ways. For instance, by attributing nefarious motives to the government and public health officials, those who <a href="https://252f2edd-1c8b-49f5-9bb2-cb57bb47e4ba.filesusr.com/ugd/f4d9b9_b7cedc0553604720b7137f8663366ee5.pdf">spread misinformation</a> and conspiracy theories can cause others to discount any and all information coming from those sources.</p>
<p>As I noted above, research shows that fear appeals are persuasive for most of the people most of the time. However, the studies underlying that conclusion are primarily experiments in which <a href="https://doi.org/10.1037/a0039729">fear appeals are compared</a> with either some weak message or no message at all. In other words, these comparisons do not at all resemble the reality surrounding COVID-19. </p>
<p>Pro-vaccine messaging is taking place in a highly competitive message environment – one that involves active efforts to <a href="https://252f2edd-1c8b-49f5-9bb2-cb57bb47e4ba.filesusr.com/ugd/f4d9b9_b7cedc0553604720b7137f8663366ee5.pdf">undermine public health advocacy</a>. The <a href="https://www.washingtonpost.com/health/2022/01/07/walensky-cdc-confusing-messaging/">inconsistent and contradictory messaging</a> produced by health agencies such as the Centers for Disease Control and Prevention has damaged the effectiveness of fear appeals. The fact that scientific knowledge evolves and always possesses a degree of uncertainty explains why health agencies changed – and continue to change – their messaging. Regrettably, this inconsistency also undercuts the impact of health messaging in a public that wants simple, consistent answers.</p>
<p>And just as in “Don’t Look Up,” various groups and individuals have prioritized their own short-term gains over a genuine global danger. Those collective efforts have left large swaths of the population unconcerned or demotivated about a genuine global threat. This helps to explain why the U.S. has many more deaths from COVID-19 than do <a href="https://www.nytimes.com/interactive/2022/02/01/science/covid-deaths-united-states.html">other wealthy nations</a>. The parallels between cinema and reality are more than a little frightening.</p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-likethis">Sign up for The Conversation’s daily newsletter</a>.]</p><img src="https://counter.theconversation.com/content/174287/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Dillard does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Whether about a comet hitting the Earth or a virus infecting the world, fear-based messages often do not succeed at changing people’s behaviors.James Dillard, Professor of Communication Arts and Sciences, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1745912022-01-31T21:21:22Z2022-01-31T21:21:22ZMasks and other pandemic measures are necessary at school, but can make it harder to hear in classrooms<figure><img src="https://images.theconversation.com/files/443232/original/file-20220128-14047-no7ina.jpg?ixlib=rb-1.1.0&rect=0%2C24%2C5070%2C3260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Classroom noise and students' inability to hear can be a barrier to teaching and learing. </span> <span class="attribution"><span class="source">(Shutterstock) </span></span></figcaption></figure><p><a href="https://theconversation.com/back-to-school-faqs-on-childrens-health-and-covid-19-delta-variant-preventing-infection-testing-and-international-examples-164684">Masks, social distancing and increased ventilation</a> are all necessary pandemic measures in classrooms, but they <a href="https://www.charlotteobserver.com/news/coronavirus/article257776773.html">can make for a difficult listening and hearing environment</a> for students and teachers. </p>
<p>While this is true for <a href="https://www.naceweb.org/diversity-equity-and-inclusion/best-practices/addressing-challenges-students-with-hearing-loss-may-face-during-pandemic/">students with hearing loss</a>, the capacity for COVID-19 measures to affect all students’ ability to hear clearly should also be considered.</p>
<p>Before COVID-19, <a href="https://www.asha.org/public/hearing/classroom-acoustics/#:%7E:text=Two%20things%20cause%20poor%20classroom,many%20places%2C%20including%20the%20following%3A&text=Sounds%20from%20inside%20the%20building%2C%20such%20as%20students%20talking%20in%20the%20hallway">classrooms already</a> represented <a href="https://www.pressreader.com/canada/windsor-star/20090117/281728380398088">less-than-optimal-acoustic environments</a>. It’s also true that <a href="https://doi.org/10.4103/1463-1741.70506">young children</a>, children who are <a href="https://doi.org/10.1044/1059-0889.0503.47">learning a new language</a>, children with <a href="https://doi.org/10.1073/pnas.0504446102">language difficulties</a> and children with <a href="https://doi.org/10.1159/000162664">recurrent ear infections</a> have particular difficulty understanding speech in noisy situations.</p>
<p>The <a href="https://etfohealthandsafety.ca/site/wp-content/uploads/2019/06/Noise-Lobby-Booklet.pdf">Elementary Teachers’ Federation of Ontario</a> recognizes classroom noise as a barrier to teaching and learning.</p>
<p>COVID-19 measures potentially degrade the listening situation further because of <a href="https://www.asha.org/public/communicating-effectively-while-wearing-masks-and-physical-distancing">masks, which remove visual cues for speech-reading and muffle the speaker’s voice</a>, social distancing, <a href="https://www.sac-oac.ca/sites/default/files/resources/General_Public_Voice_Impact_Info_Sheet_EN.pdf">plexiglass barriers</a> or ventilation systems, which can <a href="https://www.tes.com/magazine/analysis/general/covid-schools-ventilation-10-step-guide-using-air-cleaning-units">add significant noise into the room</a>.</p>
<h2>Masks and hearing</h2>
<p>All masks reduce the transmission of speech and reduce visual cues, such as how lips are moving and a person’s facial expression. Researchers from the University of Illinois Augmented Listening Laboratory measured <a href="https://publish.illinois.edu/augmentedlistening/face-masks/">the effect of a wide variety of different masks on speech transmission</a> and found that surgical <a href="https://theconversation.com/what-is-the-best-mask-for-covid-19-a-mechanical-engineer-explains-the-science-after-2-years-of-testing-masks-in-his-lab-175481">and KN95 masks</a> provided the least degradation of speech. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/4bUp2TosgzE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>All masks reduce high-frequency <a href="https://www.healthyhearing.com/report/52448-Understanding-high-frequency-hearing-loss">(high pitched)</a> speech sounds such as those that allow us to hear consonants clearly. For example, hearing the difference between “cap,” “cat” and “cash”. The laboratory researchers found surgical and KN95 masks preserved these high frequencies best. </p>
<p>N95 masks, which have <a href="https://www.healthing.ca/diseases-and-conditions/coronavirus/masks/ontario-teachers-union-n95/">now been provided for teachers in Ontario schools</a>, reduced high-frequency speech sounds more than surgical masks or KN95 masks. For people with normal hearing, listening to someone speak with a mask had only a small effect on understanding of speech when it was quiet, but when there was noise, there was a <a href="https://doi.org/10.1186/s41235-021-00314-0">significant detrimental effect on understanding and people had to work harder to listen</a>. And <a href="https://asa.scitation.org/doi/abs/10.1121/1.1635837?casa_token=A4M5rSumk_QAAAAA:qfivomlpBUTcrX7gtORnE4ZZhWF9zNjCbLcflMlleLPNfjOm2aL1qQImG1PuehARkFsjJsp8mjU">classrooms almost always have noise</a>. </p>
<p>There are masks available that have a clear plastic insert, so that the speaker’s mouth can be seen. The University of Illinois researchers found that these masks were the worst for understanding speech, as clear masks “strongly degrade high-frequency sounds.”</p>
<h2>Ventilation systems</h2>
<p>As of August 2021, <a href="https://efis.fma.csc.gov.on.ca/faab/Memos/B2021/B14_EN.pdf">the Ontario Ministry of Education invested over $550 million in improving and optimizing ventilation and air filtration in schools</a> in the 2020-21 school year. However, ventilation systems potentially add another noise source. According to an August memo to directors of education from the ministry detailing best practices for upgrading ventilation, the “noise rating of a unit should be considered.” But the memo offers no guidance about how to assess noise levels or how much noise is a barrier.</p>
<p>A 2007 study of <a href="https://www.ahrinet.org/App_Content/ahri/files/standards%20pdfs/Classroom%20Acoustical%20Study.pdf">noise levels in HVAC systems</a> in Minnesota and Arizona classrooms indicated that most systems had noise levels that exceeded acoustical standards. Policies on ventilation, such as the recent May 2021 <a href="https://www.centerforhealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2021/20210526-school-ventilation.pdf">report from the John Hopkins Bloomberg School of Public Health Center for Health Security</a>, are of course focused on air quality. However, the report touches on noise, noting: “Louder units are cheaper and some jurisdictions may opt for the cheaper units, especially if the quiet ones are sold out, but the additional noise may disrupt learning, which would generate hard-to-quantify costs.”</p>
<p>All of this may add up to students having difficulty hearing the teacher and their classmates. For teachers, having to raise one’s voice <a href="https://doi.org/10.1016/j.jvoice.2021.04.001">to counteract the effects of masks, distance and noise is hard on teachers’ voices</a> as well. </p>
<p>Anecdotally, through my work as an educational audiologist I have heard of some teachers <a href="https://www.etsu.edu/etsu-news/2020/09-september/voice-tips-for-teachers.php">experiencing voice problems due to the necessity to raise their voices for students to hear them</a>, and of some purchasing their own portable speaker systems. Given that we cannot eliminate masks, social distancing and changes to ventilation systems in classrooms, is there another option to help students hear better during in-person learning?</p>
<h2>Sound field system technology can help</h2>
<p>There is a technology available since the 1980s that was already being used in Canadian classrooms pre-pandemic, with research demonstrating benefits in <a href="https://cjslpa.ca/files/2010_CJSLPA_Vol_34/CJSLPA_2010_Vol_34_No_01_Spring.pdf#page=18">improved reading skills</a>, <a href="http://www.edaud.org/journal/2017-2018/Journal-2017-2018.pdf#page=36">student engagement</a> and <a href="https://doi.org/10.1044/0161-1461.3104.324">student attention</a>.</p>
<p>Use of this technology could be expanded to all classrooms. Many students with hearing loss use technology known as FM systems (or <a href="https://www.hearingloss.org/hat-help/">Hearing Assistance Technology, HAT</a>) that involve the teacher wearing a wireless transmitter or microphone. The teacher’s voice is transmitted either directly into an individual student’s hearing aids or to a speaker in the classroom. </p>
<figure class="align-center ">
<img alt="Teacher wears a COVID-19 mask and a headset microphone." src="https://images.theconversation.com/files/443233/original/file-20220128-13-xuxhdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/443233/original/file-20220128-13-xuxhdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443233/original/file-20220128-13-xuxhdx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443233/original/file-20220128-13-xuxhdx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443233/original/file-20220128-13-xuxhdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443233/original/file-20220128-13-xuxhdx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443233/original/file-20220128-13-xuxhdx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One solution to better hearing in the classroom involves the teacher wearing a wireless transmitter or microphone.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The version with the teacher’s voice transmitted for everyone to hear is called a sound field system. These systems provide better access to the teacher’s voice under difficult listening conditions and have been shown to benefit <a href="https://doi.org/10.1179/136132807805297503">students with and without hearing loss</a>.</p>
<p>Sound field systems are a way to use <a href="https://www.hearandlearn.com.au/wp-content/uploads/pdf/Hear-and-Learn-Proof-Page-Universal-Design-Soundfield.pdf">a universal design approach to the problem of hearing in the classroom</a> and some school systems are installing these systems <a href="https://www.govtech.com/education/k-12/bluetooth-audio-amplification-helps-teachers-be-heard">as a response to the pandemic</a>. </p>
<h2>Using a sound field system with masks</h2>
<p>The University of Illinois researchers studied whether a sound field system
could be used in conjunction with masks and found that placing a microphone below the chin <a href="http://publish.illinois.edu/augmentedlistening/files/2020/08/masks_lapel.png">effectively preserved of the speech signal</a>. They noted this improvement for all masks — surgical as well as transparent. Sound field systems have the additional benefit of allowing teachers to <a href="https://doi.org/10.1016/S0892-1997(99)80042-3">speak in a regular voice</a>, reducing vocal strain and fatigue.</p>
<p>The COVID-19 pandemic has introduced <a href="https://www.weforum.org/agenda/2020/04/coronavirus-education-global-covid19-online-digital-learning/">profound challenges to student learning</a>. We need to do everything we can to support our students in classrooms until COVID-19 measures such as masks and social distancing are no longer needed. Installing sound field amplification technology in all classrooms is one way to ensure that students are able to hear and learn effectively.</p><img src="https://counter.theconversation.com/content/174591/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Pam Millett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Teachers wearing wireless microphones that amplify their voices could be one solution to ensuring children can hear — and saving teachers’ voices from strain, particularly in the pandemic.Pam Millett, Associate professor, Faculty of Education, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1751432022-01-19T18:59:51Z2022-01-19T18:59:51Z‘Welcome to our world’: families of children with cancer say the pandemic has helped them feel seen, while putting them in peril<figure><img src="https://images.theconversation.com/files/441415/original/file-20220118-3715-10acrhg.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5184%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>For billions of people across the world, life as we knew it stopped in 2020. </p>
<p>Families and friends were separated. Masks mandated. Hand washing essential. Every trip outside became risky.</p>
<p>As news of deaths, variants and long-term effects of COVID trickled in daily, we were forced to adjust to a new normal marked by constant anxiety and fear, which has only worsened with the recent surge in Omicron cases in Australia.</p>
<p>But for a particular group of Australians, this lifestyle is all too familiar.</p>
<p>As both the mother of a childhood cancer survivor and a Curtin University PhD student exploring families’ experiences of childhood cancer, I embarked on a study to understand the pandemic’s effects on kids going through cancer treatment, and their families. </p>
<p>In mid-2020 I interviewed 34 parents of children with cancer across Australia about their experiences during the pandemic. </p>
<p>The answer I received was a resounding: “welcome to our world”. The pandemic lifestyle we are all adjusting to is the life families of children with cancer have already been living.</p>
<p>The parents in our study, <a href="https://academic.oup.com/jpepsy/advance-article/doi/10.1093/jpepsy/jsab125/6448612?login=true">published in December</a> with a team of Curtin University researchers, painted a picture of both benefits and devastating costs. </p>
<h2>Even a cold can lead to hospitalisation</h2>
<p>Every year, almost <a href="https://www.ccia.org.au/about-childhood-cancer">1,000 Australian kids</a> are diagnosed with cancer.</p>
<p>With advances in treatment, survival rates have increased and <a href="https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/cancer-incidence-and-survival">84% of children</a> now survive to five years after diagnosis. But this comes at the cost of long, gruelling and complex treatments involving a combination of chemotherapy, surgery and radiotherapy. </p>
<p>Chemotherapy leaves children profoundly vulnerable to infection. Even a simple cold can leave a child in hospital struggling for their life.</p>
<p>For the families in this study, wearing masks, washing hands, isolating and missing social events was already a way of life during treatment. Some even placed hand sanitiser outside their front door.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1250257538723000320"}"></div></p>
<h2>COVID silver linings</h2>
<p>For this reason, many of the parents welcomed the increased infection control which came with COVID.</p>
<p>“When COVID happened, [people] started taking care […] social distancing, wiping everything, covering their mouths,” said one father. Another added: “it’s actually positively impacted us […] she wasn’t getting colds and flus she’d normally get”. </p>
<p>Previous research has found parents of children with cancer often struggle trying to care for siblings and <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/pbc.28345">keep up an income</a> while being in hospital with the child with cancer. The shift to online work and school helped reduce some of this burden.</p>
<p>“One of the good things is that COVID allows me to work remotely […] it’s a big weight off my shoulders […] allows for income to keep coming in,” commented one dad, adding “if it had happened in 2019 it would have been a different approach.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-need-better-treatments-for-childhood-cancer-with-fewer-side-effects-67310">We need better treatments for childhood cancer, with fewer side effects</a>
</strong>
</em>
</p>
<hr>
<p>For both the child with cancer, and their siblings, it’s a lonely road. These kids are forced to miss out on having a normal childhood, missing birthday parties, school and time spent with friends. This is an isolating experience, leaving kids feeling like the “odd one out”, and leaving parents feeling profoundly guilty for the impact on their children. </p>
<p>But parents in our study noticed a silver lining to COVID: their kids no longer felt like the only one missing out. “Either way she didn’t miss out on anything, because everybody missed out,” said one parent.</p>
<h2>A lonely road</h2>
<p>Despite some silver linings of COVID for the families in our study, they also told a story of devastating isolation and fear.</p>
<p>Because of restrictions which allowed only one parent with a child in hospital, several of the parents in our study recalled being alone when they were told of their child’s diagnosis. </p>
<blockquote>
<p>“The very first moment we discovered their diagnosis, I was sitting alone, and my husband was in the ED waiting room. I then stayed with my child and it meant we were left to process this news solo and not together […] the last thing I wanted was to sit with my own thoughts.”</p>
</blockquote>
<p>As treatment progressed, hospital visitor restrictions kept families apart for months: “I couldn’t see my partner for three months […] five minutes at the door of the hospital […] a little kiss and good night, that was horrible.”</p>
<figure class="align-center ">
<img alt="Mother cuddling child with cancer in hospital bed" src="https://images.theconversation.com/files/441416/original/file-20220118-19-wbxuud.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441416/original/file-20220118-19-wbxuud.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441416/original/file-20220118-19-wbxuud.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441416/original/file-20220118-19-wbxuud.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441416/original/file-20220118-19-wbxuud.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441416/original/file-20220118-19-wbxuud.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441416/original/file-20220118-19-wbxuud.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID restrictions have made for a lonely pandemic for many parents of kids with cancer.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>One mother described the gruelling experience as restrictions kept friends and family from visiting hospital: “For the whole year I was on my own […] it was the loneliest year”. </p>
<p>Travel restrictions also meant overseas parents and relatives couldn’t visit to provide support. One parent said: “we definitely felt like we were in the trenches, just the three of us”. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/immunocompromised-people-make-up-nearly-half-of-covid-19-breakthrough-hospitalizations-an-extra-vaccine-dose-may-help-166241">Immunocompromised people make up nearly half of COVID-19 breakthrough hospitalizations – an extra vaccine dose may help</a>
</strong>
</em>
</p>
<hr>
<p>Even though our study was conducted before the recent wave of Omicron cases, it can still teach us some valuable lessons going forward.</p>
<p>Despite the hardships of COVID, the virus has allowed us to develop new ways of connecting online, and increased flexibility for those unable to be there in person.</p>
<p>As we renegotiate what life with COVID looks like, we can use these lessons to protect and support the most vulnerable among us.</p><img src="https://counter.theconversation.com/content/175143/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jenny Davies receives funding from a Commonwealth PhD research scholarship.</span></em></p>The pandemic lifestyle we are all adjusting to is the life families of children with cancer have already been living. But there have been positives, too.Jenny Davies, PhD researcher, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1741952022-01-09T13:14:44Z2022-01-09T13:14:44ZOmicron: Vaccines remain the best defence against this COVID-19 variant and others<figure><img src="https://images.theconversation.com/files/439616/original/file-20220106-13-ngc07h.jpg?ixlib=rb-1.1.0&rect=125%2C26%2C5622%2C4136&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The best way to stop new variants from arising is to increase the proportion of vaccinated individuals while maintaining infection prevention measures like wearing masks and social distancing.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/omicron--vaccines-remain-the-best-defence-against-this-covid-19-variant-and-others" width="100%" height="400"></iframe>
<p>We have made it through another pandemic winter holiday. Fortunately, COVID-19 fatalities have decreased since the year before, however, the numbers still weren’t ideal. Using Dec. 25 as a reference date, <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Align+outbreaks=false&country=USA%7ECAN">the death rate from COVID-19</a> in the United States was 4.27 per million in 2021, compared to 7.48 per million in 2020. In Canada, it was 0.42 per million in 2021, compared to 2.95 per million the previous year — a much more significant decrease. </p>
<p>The difference that vaccination is making becomes clear when comparing the <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=People+fully+vaccinated&Interval=7-day+rolling+average&Relative+to+Population=true&Align+outbreaks=false&country=USA%7ECAN">corresponding rates of fully vaccinated people: 61.4 per cent in the U.S. compared to 77.1 per cent in Canada</a>. The higher vaccination rate in Canada corresponds to the more sharply reduced death rate.</p>
<p>As a medical doctor and researcher of COVID-19, I am optimistic about the power of increased vaccination rates in combination with infection prevention practices to fight the pandemic. </p>
<p>Waiting for <a href="https://theconversation.com/5-failings-of-the-great-barrington-declarations-dangerous-plan-for-covid-19-natural-herd-immunity-148975">natural herd immunity</a> will not fix this or save lives. In the U.S., the <a href="https://www.nytimes.com/interactive/2021/us/covid-cases.html">55 million people who have tested positive for COVID-19</a> since the pandemic began represent only about 17 per cent of the roughly 330 million population — nowhere near the <a href="https://theconversation.com/covid-19-may-never-go-away-but-practical-herd-immunity-is-within-reach-162406">level needed for herd immunity</a>. The only ethical means of achieving herd immunity is vaccination.</p>
<h2>Omicron</h2>
<p>Unfortunately, the Omicron variant may have <a href="https://pubmed.ncbi.nlm.nih.gov/34873578/">greater potential to infect people than past variants</a>, and may be more able to infect fully vaccinated and boosted individuals, according to research awaiting peer review. This new form of the virus is a product of its natural evolution. The longer a pandemic lasts, the more changes occur with a virus. </p>
<p>The best way to stop new variants from arising is to increase the proportion of vaccinated individuals while maintaining infection prevention measures, like following recommendations for face masks and social distancing. <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html#:%7E:text=Evidence%20suggests%20the%20US%20COVID,interrupting%20chains%20of%20transmission.">Vaccinated individuals are less likely to pass on the virus if they do become infected</a>.</p>
<p>Most cases and deaths <a href="https://covid.cdc.gov/covid-data-tracker/#rates-by-vaccine-status">continue to affect unvaccinated individuals</a>. Further sickness and death are largely preventable, just as most of the illness and death in recent months were. Vaccine refusal, in the absence of valid medical reasons, and not adhering to infection prevention measures are largely responsible for the continued hardship of the pandemic. </p>
<h2>Vaccines and variants</h2>
<p>Vaccines remain an effective tool towards ending the pandemic, particularly against Omicron. This is despite research awaiting peer review indicating the new variant may have <a href="https://pubmed.ncbi.nlm.nih.gov/34873578/">greater potential to infect people than past variants</a>, and may be more able to infect fully vaccinated and boosted individuals. </p>
<p>More data is needed to establish how much more or less infectious the Omicron variant is compared to others, but <a href="https://asm.org/Articles/2021/December/How-Ominous-is-the-Omicron-Variant-B-1-1-529">Omicron’s ability to infect vaccinated individuals (albeit less so than unvaccinated individuals) is concerning</a>. That means infection prevention activities, like wearing a mask and social distancing regardless of vaccination status, are still essential. <a href="https://doi.org/10.1038/d41586-021-03614-z">Poor adherence to these measures can be enough to increase cases in a community</a>, even with many vaccinated folks. </p>
<figure class="align-center ">
<img alt="Illustration of a row of coronaviruses in a gradient of colours" src="https://images.theconversation.com/files/439629/original/file-20220106-19-173dcvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439629/original/file-20220106-19-173dcvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=217&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439629/original/file-20220106-19-173dcvj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=217&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439629/original/file-20220106-19-173dcvj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=217&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439629/original/file-20220106-19-173dcvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=272&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439629/original/file-20220106-19-173dcvj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=272&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439629/original/file-20220106-19-173dcvj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=272&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The longer a pandemic lasts, the more changes occur with a virus.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>While vaccines are less protective against becoming infected with Omicron than other variants, <a href="https://directorsblog.nih.gov/2021/12/14/the-latest-on-the-omicron-variant-and-vaccine-protection/">they offer significant protection against developing an infection</a> and <a href="http://doi.org/10.1056/NEJMc2119270">severe illness</a>. </p>
<p>For those who have already had COVID-19 but have not been vaccinated, the evidence available so far suggests that they should still get vaccinated <a href="https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-49-Omicron/">because past infection did not protect against Omicron</a>. While there are claims that Omicron produces milder illness, one cannot rely on this when infected individuals still face a significant chance of severe disease.</p>
<p>Several months of winter remain, and COVID-19 <a href="https://globalnews.ca/news/8479373/covid-canada-omicron-christmas/">cases are ballooning again</a>. There is reason to believe that the pandemic will get worse before it gets better. </p>
<h2>Pandemic toolkit</h2>
<p>Booster shots are readily available in the U.S. and are increasingly available in Canada. <a href="https://directorsblog.nih.gov/2021/12/14/the-latest-on-the-omicron-variant-and-vaccine-protection/">Boosters have been shown to confer increased protection against the Omicron variant</a>. </p>
<p>It is everyone’s social responsibility to get the booster, with the exception of the very few people who are allergic to vaccine components. Research showed that <a href="http://doi.org/10.1001/jamanetworkopen.2021.22255">being highly allergic to something that is not vaccine-related rarely equates with an expected severe allergic reaction to the vaccine</a>. </p>
<figure class="align-center ">
<img alt="Illustration of a hand holding a syringe pointed at a coronavirus against a background of stopwatches" src="https://images.theconversation.com/files/439630/original/file-20220106-27-1yqmm7w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439630/original/file-20220106-27-1yqmm7w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=209&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439630/original/file-20220106-27-1yqmm7w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=209&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439630/original/file-20220106-27-1yqmm7w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=209&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439630/original/file-20220106-27-1yqmm7w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=263&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439630/original/file-20220106-27-1yqmm7w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=263&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439630/original/file-20220106-27-1yqmm7w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=263&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaccines remain an effective tool towards ending the pandemic, particularly against Omicron.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>I have an allergy to shellfish that has placed me in the hospital when I inadvertently consumed it. Nothing happened to me when receiving any of my three shots of COVID-19 vaccines, and the above research suggests that this would be the case for most people with non-vaccine allergies. </p>
<p>The risks of COVID-19 far outweigh the very small risk of having an allergic reaction to the vaccine. In the unlikely event that you did have an allergic reaction to the vaccine, such reactions are typically mild and readily treated.</p>
<p>The pandemic will get better if we work together. While news of Omicron and implications on vaccine effectiveness are disheartening, more systems are in place to respond to this change and future changes in the pandemic. Pfizer, one of the drug makers of the effective COVID-19 vaccines, <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-provide-update-omicron-variant">has already announced a readiness to produce vaccines adapted to the changing virus</a>. We can expect other manufacturers to follow suit, ensuring that the therapies needed to meet this challenge are available. </p>
<p>This leaves it up to consumers — us — to do our part in ending the pandemic.</p><img src="https://counter.theconversation.com/content/174195/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Daniel Sunday Willett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even with a variant like Omicron that may be more transmissible than earlier variants, vaccines remain the most effective tool for protection against COVID-19 and for ending the pandemic.Julian Daniel Sunday Willett, PhD Candidate, Quantitative Life Sciences, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1727472021-12-22T13:13:33Z2021-12-22T13:13:33ZDuring a COVID-19 surge, ‘crisis standards of care’ involve excruciating choices and impossible ethical decisions for hospital staff<figure><img src="https://images.theconversation.com/files/438078/original/file-20211216-17-16i6mbg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Amid the latest surge of COVID-19 cases, health care workers yet again are having to make difficult triage decisions in caring for patients. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/healthcare-coworkers-working-in-icu-during-covid-19-royalty-free-image/1265188155?adppopup=true">Morsa Images/E+ via Getty Images</a></span></figcaption></figure><p><em>The Conversation is running a series of dispatches from clinicians and researchers operating on the front lines of the coronavirus pandemic. You can <a href="https://theconversation.com/us/topics/covid-19-front-lines-84846">find all of the stories here</a>.</em></p>
<p>As the <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/omicron-variant.html">omicron variant</a> brings a <a href="https://www.npr.org/sections/coronavirus-live-updates/2021/12/20/1066083896/omicron-is-now-the-dominant-covid-strain-in-the-u-s-making-up-73-of-cases">new wave of uncertainty and fear</a>, I can’t help reflecting back to March 2020, when people in health care across the U.S. watched in horror as COVID-19 <a href="https://www.vox.com/2020/3/27/21197400/new-york-covid-19-hospitals-coronavirus">swamped New York City</a>. </p>
<p>Hospitals were <a href="https://www.adn.com/nation-world/2020/03/31/hospitals-overflow-with-bodies-in-new-york-the-us-epicenter-of-the-virus/">overflowing</a> with sick and dying patients, while ventilators and personal protective equipment were in short supply. Patients sat for hours or days in ambulances and hallways, waiting for a hospital bed to open up. <a href="https://www.nytimes.com/2020/03/25/nyregion/nyc-coronavirus-hospitals.html">Some never made it</a> to the intensive care unit bed they needed. </p>
<p>I’m an infectious disease specialist and bioethicist at the University of Colorado’s Anschutz Medical Campus. I worked with a team nonstop from March into June 2020, helping <a href="https://www.cuanschutz.edu/docs/librariesprovider139/covid-19-resources/uchealth_csc-triage-decision-criteria-and-process_v4_10_20-final.pdf?sfvrsn=a3afd5b9_0">my hospital</a> and <a href="https://cdphe.colorado.gov/colorado-crisis-standards-care">state</a> get ready for the massive influx of COVID-19 cases we expected might inundate our health care system.</p>
<p>When health systems are moving toward crisis conditions, the first steps we take are to do all we can to conserve and reallocate scarce resources. Hoping to keep delivering quality care – despite shortages of space, staff and stuff – we do things like canceling elective surgeries, moving surgical staff to inpatient units to provide care and holding patients in the emergency department when the hospital is full. These are called “contingency” measures. Though they can be inconvenient for patients, we hope patients won’t be harmed by them. </p>
<p>But when a crisis escalates to the point that we simply can’t provide necessary services to everyone who needs them, we are forced to perform crisis triage. At that point, the care provided to some patients is admittedly less than high quality – sometimes much less.</p>
<p>The care provided under such extreme levels of resource shortages is called “<a href="https://www.ama-assn.org/delivering-care/ethics/crisis-standards-care-guidance-ama-code-medical-ethics">crisis standards of care</a>.” Crisis standards can impact the use of any type of resource that is in extremely short supply, from staff (like nurses or respiratory therapists) to stuff (like ventilators or N95 masks) to space (like ICU beds). </p>
<p>And because the care we can provide during crisis standards is much lower than normal quality for some patients, the process is supposed to be fully transparent and <a href="https://cdphe.colorado.gov/colorado-crisis-standards-care">formally allowed by the state</a>. </p>
<h2>What triage looks like in practice</h2>
<p>In the spring of 2020, our plans assumed the worst – that we <a href="https://www.nytimes.com/2020/03/21/us/coronavirus-medical-rationing.html">wouldn’t have enough ventilators</a> for all the people who would surely die without one. So we focused on how to make ethical determinations about who should get the last ventilator, as though any decision like that could be ethical. </p>
<p>But one key fact about triage is that it’s not something you decide to do or not. If you don’t do it, then you are deciding to behave as if things are normal, and when you run out of ventilators, the next person to come along doesn’t get one. That’s still a form of triage. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/438371/original/file-20211220-13-e5kd8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two doctors leaning over a patient while intubating, or placing the patient on a ventilator." src="https://images.theconversation.com/files/438371/original/file-20211220-13-e5kd8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438371/original/file-20211220-13-e5kd8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438371/original/file-20211220-13-e5kd8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438371/original/file-20211220-13-e5kd8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438371/original/file-20211220-13-e5kd8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438371/original/file-20211220-13-e5kd8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438371/original/file-20211220-13-e5kd8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In the early months of the pandemic, the U.S. faced a shortage of ventilators. In some regions, hospitals were forced to make difficult decisions about which patients received them.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/healthcare-workers-intubating-a-covid-patient-royalty-free-image/1255594215?adppopup=true">Tempura/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>Now imagine that all the ventilators are taken and the next person who needs one is a young woman with a complication delivering her baby. </p>
<p>That’s what we had to talk about in early 2020. My colleagues and I didn’t sleep much. </p>
<p>To avoid that scenario, our hospital <a href="https://doi.org/10.7326/M20-1738">and many others</a> proposed using a scoring system that counts up how many of a patient’s organs are failing and how badly. That’s because people with multiple organs failing <a href="https://doi.org/10.1001/jama.286.14.1754">aren’t as likely to survive</a>, which means they shouldn’t be given the last ventilator if someone with better odds also needs it. </p>
<p>Fortunately, before we had to use this triage system that spring, we got a reprieve. Mask-wearing, social distancing and <a href="https://coloradosun.com/2020/03/16/colorado-governor-restaurants-bars-closed/">business closures went into effect</a>, and they worked. We bent the curve. In April 2020, Colorado had some days with <a href="https://covid19.colorado.gov/data">almost 1,000 COVID-19 cases per day</a>. But by early June, our daily case rates were in the low 100s. COVID-19 cases would surge back in August as those measures were relaxed, of course. And <a href="https://www.thedenverchannel.com/news/coronavirus/coronavirus-in-colorado-covid-19-updates-for-dec-14-dec-20-2020">Colorado’s surge in December 2020</a> was especially severe, but we subdued these subsequent waves with the same basic public health measures. </p>
<figure class="align-center ">
<img alt="A chart depicting the number of COVID-19 patients hospitalized from Feb. 2020 to Dec. 2021." src="https://images.theconversation.com/files/438727/original/file-20211221-49721-nhkoat.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438727/original/file-20211221-49721-nhkoat.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438727/original/file-20211221-49721-nhkoat.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438727/original/file-20211221-49721-nhkoat.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438727/original/file-20211221-49721-nhkoat.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438727/original/file-20211221-49721-nhkoat.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438727/original/file-20211221-49721-nhkoat.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Number of COVID-19 patients hospitalized from Feb. 24, 2020 to Dec. 20, 2021.</span>
<span class="attribution"><a class="source" href="https://ourworldindata.org/covid-hospitalizations">Our World in Data.org</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>And then what at the time felt like a miracle happened: A safe and effective <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7008e3.htm">vaccine became available</a>. First it was just for people at highest risk, but then it became available <a href="https://www.webmd.com/vaccines/covid-19-vaccine/news/20210420/all-us-adults-eligible-covid-vaccines">for all adults</a> by later in the spring of 2021. We were just over one year into the pandemic, and people felt like the end was in sight. So <a href="https://www.nature.com/articles/d41586-021-01394-0">masks went by the wayside</a>.</p>
<p>Too soon, it turned out.</p>
<h2>A haunting reminder of 2020</h2>
<p>Now, in December 2021 here in Colorado, hospitals are filled to the brim again. Some have even been over 100% capacity recently, and <a href="https://covid19.colorado.gov/data">a third of the hospitals</a> expect ICU bed shortages during the last weeks of 2021. The best estimate is that by the end of the month we’ll be overflowing and <a href="https://www.cpr.org/2021/11/17/colorado-covid-hospitalizations-icu-beds/">ICU beds will run out statewide</a>. </p>
<p>But today, some members of the public have little patience for wearing masks or avoiding big crowds. People who’ve been vaccinated don’t think it’s fair they should be forced to cancel holiday plans, when <a href="https://www.uchealth.org/today/covid-19-coronavirus-recent-updates/">over 80% of the people hospitalized for COVID-19 are the unvaccinated</a>. And those who aren’t vaccinated … well, many seem to believe they just aren’t at risk, which <a href="https://www.washingtonpost.com/nation/2021/12/16/covid-omicron-variant-live-updates/">couldn’t be further from the truth</a>. </p>
<p>So, hospitals around our state are yet again facing triage-like decisions on a daily basis.</p>
<p>In a few important ways, the situation has changed. Today, our hospitals have plenty of ventilators, but <a href="https://www.nytimes.com/2020/11/22/health/Covid-ventilators-stockpile.html">not enough staff to run them</a>. Stress and burnout are <a href="https://doi.org/10.1016/j.eclinm.2021.100879">taking their toll</a>. </p>
<p>So, those of us in the health care system are hitting our breaking point again. And when hospitals are full, we are forced into making triage decisions.</p>
<h2>Ethical dilemmas and painful conversations</h2>
<p>Our health system in Colorado is now assuming that by the end of December, we could be 10% over capacity across all our hospitals, in both intensive care units and regular floors. In early 2020, we were looking for the patients who would die with or without a ventilator in order to preserve the ventilator; today, our planning team is looking for people who might survive outside of the ICU. And because those patients will need a bed on the main floors, we are also forced to find people on hospital floor beds who could be sent home early, even though that might not be as safe as we’d like.</p>
<p>For instance, take a patient who has diabetic ketoacidosis, or DKA – extremely high blood sugar with fluid and electrolyte disturbances. DKA is dangerous and typically requires admission to an ICU for a continuous infusion of insulin. But patients with DKA only rarely end up requiring mechanical ventilation. So, under crisis triage circumstances, we might move them to hospital floor beds to free up some ICU beds for very sick COVID-19 patients. </p>
<p>But where are we going to get regular hospital rooms for these patients with DKA, since those are full too? Here’s what we might do: People with serious infections due to IV drug use are regularly kept in the hospital while they receive long courses of IV antibiotics. This is because if they were to use an IV catheter to inject drugs at home, it could be very dangerous, even deadly. But under triage conditions, we might let them go home if they promise not to use their IV line to inject drugs. </p>
<p>Obviously, that’s not completely safe. It’s clearly not the usual standard of care – but it is a crisis standard of care.</p>
<p>Worse than all of this is anticipating the conversations with patients and their families. These are what I dread the most, and in the last few weeks of 2021, we’ve had to start practicing them again. How should we break the news to patients that the care they are getting isn’t what we’d like because we are overwhelmed? Here’s what we might have to say:</p>
<p>“… there are just too many sick people coming to our hospital all at once, and we don’t have enough of what is needed to take care of all the patients the way we would like to … </p>
<p>… at this point, it is reasonable to do a trial of treatment on the ventilator for 48 hours, to see how your dad’s lungs respond, but then we’ll need to reevaluate …</p>
<p>… I’m sorry, your dad is sicker than others in the hospital, and the treatments haven’t been working in the way we had hoped.” </p>
<p>Back when vaccines came on the horizon a year ago, we hoped we’d never need to have these conversations. It’s hard to accept that they are needed again now.</p><img src="https://counter.theconversation.com/content/172747/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Wynia receives funding from the National Academies of Sciences, Engineering and Medicine; the U.S. Health and Human Services Assistant Secretary for Planning and Response; and the National Center for Advancing Translational Sciences.
He serves as an unpaid advisor to the National Academies of Sciences, Engineering and Medicine, the Hastings Center, and the Defense Advanced Research Projects Agency. He is on the Fellows Council for The Hastings Center and the Advisory Council for Physicians for Human Rights.</span></em></p>A physician-bioethicist reflects on how health professionals are yet again facing painful reminders of the early months of the pandemic.Matthew Wynia, Director of the Center for Bioethics and Humanities, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1731802021-12-19T11:14:55Z2021-12-19T11:14:55ZDo the math when measuring social distancing: two metres is not the same as six feet<iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/do-the-math-when-measuring-social-distancing--two-metres-is-not-the-same-as-six-feet" width="100%" height="400"></iframe>
<p>The COVID-19 pandemic has changed the world we live in. Informative signs, designed to limit the virus’s spread are everywhere these days, reminding us: <a href="https://www.toronto.ca/home/covid-19/covid-19-spread-the-word/">Wear a mask, wash your hands, cover your mouth when you cough or sneeze</a>, <a href="https://www.cdc.gov/coronavirus/2019-ncov/downloads/communication/print-resources/CDC_school_vaccine_clinic_student_athlete2_card.pdf">get vaccinated</a> and of course, maintain social distancing. </p>
<p>Public health awareness resources are helping all of us get through these difficult times. Unfortunately, many social distancing signs are also helping spread an entirely different scourge across our country: Innumeracy. The term was coined by mathematician John Allen Paulos 30 years ago when he wrote <a href="https://www.math.temple.edu/%7Epaulos/innumeracy.html"><em>Innumeracy: Mathematical Illiteracy and its Consequences</em></a>. As the title suggests, innumeracy is the mathematical analog of illiteracy: <a href="https://www.macmillandictionary.com/dictionary/british/innumeracy">a lack of the ability to do basic math</a>.</p>
<p>What I’m referring to is common signage in different parts of the country that suggest two meters is the equivalent of six feet. For the record, two metres is not six feet. Two metres is about 6.56168 feet. This matters for several reasons.</p>
<h2>Metric confusion</h2>
<p>Canada switched to using the metric system from using <a href="https://www.thecanadianencyclopedia.ca/en/article/weights-and-measures">mainly the imperial system</a> for measurement <a href="https://www.thecanadianencyclopedia.ca/en/article/metric-conversion">between 1970 and the early ‘80s</a>. As a result, our social distancing signage should first present the metric measurement (two metres) and then convert it to the imperial system (about 6.5 feet). But I’ve even seen signs that present the imperial system before the metric system, and tell us that six feet is two metres. (To be clear, six feet is not two metres. It’s less than two metres. It’s about 1.8288 metres.) </p>
<p>Instead, I continually see <a href="https://doi.org/10.1007/s42330-021-00176-0">flippant, dismissive conversion from the imperial to the metric system of measurement</a> presented on social distancing signs everywhere I go. </p>
<p>Don’t even get me started on the signs that completely ignore the metric system, using only the imperial system.</p>
<h2>Innumeracy: socially acceptable?</h2>
<p>About two years into the pandemic, I’m still surprised that nobody cares about the social distancing signage. I haven’t seen any kind of public outcries similar to those we see from grammar enthusiasts who practically fall into fever dreams when they come across <a href="https://www.theguardian.com/books/booksblog/gallery/2014/may/13/bad-grammar-rogue-apostrophes-and-bizarre-spelling-in-pictures">a sign showing the possessive form of the pronoun it (its) incorrectly presented</a> as a contraction of “it is.” </p>
<p>Does this mean many believe being innumerate is fine? </p>
<p>As a teacher of future math teachers, on the first day of class each semester, I ask the class: “Who here can’t read?” To date, not a single hand has been raised. The future math teachers look at me with a dusting of disgust. I then ask: “Who here can’t do math?” Unfortunately, every year, a sea of hands, most with a sense of pride, are raised. </p>
<p>The next question I ask future Canadian math teachers is the same question I’ve raised here: “Why do you think it’s OK to be innumerate?”</p>
<h2>Social consequences of a culture of innumeracy</h2>
<p>Students’ answers, which might even be your answer are often: “I don’t see the big deal here.” You might even agree and think it silly to worry about signs that display casual indifference to the metric system. </p>
<p>Yet as Paulos noted, mathematical illiteracy has consequences like belief in pseudoscience, poor risk assessment and much, much more. Move over, Nostradamus. </p>
<p>Metric conversion misinformation points to larger issues with innumeracy: There can be consequences for our health (<a href="https://www.bbc.com/news/magazine-28166019">such as when doctors can’t read test results</a>) and finances <a href="https://freakonomics.com/podcast/payday-loans">when people don’t understand the effects of high-interest loans</a>. Statistican Jeffrey Rosenthal explores <a href="http://probability.ca/jeff/ftpdir/probjustice.pdf">how probabilities, whether accurately or inaccurately grasped</a>, inform legal decisions in our justice systems.</p>
<p>If you start looking, you will notice little signs of innumeracy everywhere. For example, many people now carry little super computers in their pockets. I’ve learned to live with people peering through their phones, so they do not have to calculate unit prices, discounts or taxes while shopping.</p>
<p>Should the current COVID-19 social distancing signage be accepted, I am declaring an official moratorium on the phrase, “Damn kids these days, they can’t even make change without a calculator.” We can’t have it both ways.</p>
<h2>Alternative metrics</h2>
<p>Students today also learn <a href="https://www.edu.gov.mb.ca/k12/cur/math/framework_k-8/full_doc.pdf">about non-standard units of measurement</a>, and many alternative metrics appear on social distancing signage. I’ve seen hockey sticks, hiking poles and yoga mats, drawn from the world of sports. From the animal world, signs tell us to <a href="https://www.cbc.ca/news/canada/north/yukon-one-caribou-apart-campaign-1.5551587">stay a caribou</a>, grizzly bear, elk antlers and a moose apart. </p>
<p>Whether it’s <a href="https://www.narcity.com/tim-hortons-timbits-are-a-way-to-measure-physical-distance-and-someone-tested-it-on-tiktok">Timbits (46 of them)</a>, a bathtub, buckets or shopping carts, alternative metrics are doing their part to help us stay apart. </p>
<h2>A simple fix</h2>
<p>Navigating the world two metres apart is no easy task. Just ask the man from Toronto <a href="https://toronto.ctvnews.ca/toronto-man-creates-social-distancing-machine-to-highlight-pedestrian-woes-1.4893751">who built and wore a social distancing machine</a>. </p>
<p>But keeping a safe distance from each other isn’t made simpler when units of measurement are being butchered. </p>
<p>During these trying times, we should not be fostering innumeracy. The fix isn’t difficult. Any sign that doesn’t embrace alternative metrics should simply read: “Please maintain social distancing: two metres or about six and a half feet. Thank you.” </p>
<p>I’ll take a sign with a moose, a grizzly bear or a bunch of jugs of maple syrup over a sign incorrectly indicating that two metres equals six feet or six feet equals two metres. I’m Canadian, after all.</p><img src="https://counter.theconversation.com/content/173180/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Egan J Chernoff receives (and has received) funding from Social Sciences and Humanities Research Council. </span></em></p>Why haven’t people gotten upset about how our social distancing signs are fostering innumeracy?Egan J Chernoff, Professor of Mathematics Education, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1734822021-12-17T13:26:46Z2021-12-17T13:26:46ZSold-out supplies, serving a public need and other adventures of doing science during a pandemic – 4 researchers share their experiences<figure><img src="https://images.theconversation.com/files/437889/original/file-20211215-27-1wvi6x6.jpg?ixlib=rb-1.1.0&rect=50%2C361%2C4834%2C3362&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Like much else, scientific labs have been shut down by the pandemic.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/lab-coats-on-hanger-royalty-free-image/960990096?adppopup=true">Cavan Images/Cavan via Getty Images</a></span></figcaption></figure><p><em>Closures, remote work, supply chain issues and changing priorities have affected almost everyone’s lives at some point during the nearly two years of the coronavirus pandemic. The process of science itself was no exception. The many people who do the lab work, experiments and human studies that further scientific knowledge all faced challenges – many of which were unexpected.</em></p>
<p><em>To understand how the pandemic changed the process of science, we asked four researchers about their experiences over the past two years.</em> </p>
<p></p><hr><p></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/437891/original/file-20211215-13-1wcqgz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two health care workers wearing masks." src="https://images.theconversation.com/files/437891/original/file-20211215-13-1wcqgz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/437891/original/file-20211215-13-1wcqgz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437891/original/file-20211215-13-1wcqgz3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437891/original/file-20211215-13-1wcqgz3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437891/original/file-20211215-13-1wcqgz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437891/original/file-20211215-13-1wcqgz3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437891/original/file-20211215-13-1wcqgz3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Early in the pandemic, a lot of scientific testing needed to be done to understand how masks could protect health care workers.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakSouthCarolina/bf5486900fdf4e89bf064a3e09809ebc/photo?Query=healthcare%20mask%20virus&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=163&currentItemNo=31">AP Photo/Mic Smith</a></span>
</figcaption>
</figure>
<h2>Balancing public needs with science and mentorship</h2>
<p><strong>Christian L'Orange, Assistant Research Professor of Mechanical Engineering, Colorado State University</strong></p>
<p>I am an <a href="https://scholar.google.com/citations?user=MaEhNkQAAAAJ&hl=en&oi=ao">engineer and aerosol scientist</a>. People used to return a look of confusion when I said that, and prospective engineering students rarely had any idea that aerosol science was even an area of research. That all changed with COVID-19.</p>
<p>In March 2020, as the world was being told to stay home in the first weeks of the lockdown, the university and my lab were asked by the Colorado governor’s office to test masks being purchased for front-line workers.</p>
<p>In a matter of days, we pivoted all of our time to testing masks. This came at the cost of our research: Everything was put on hold. Nevertheless, we were proud to do it. I have had few experiences more gratifying than knowing I was making a difference in a time of need – however bittersweet.</p>
<p>A big reason I do the job I do is my love for research and the opportunity to mentor students. COVID-19 took both of those away for nearly two years. Research has begun again, and students are returning to the lab, but we won’t get that time back.</p>
<p>My colleagues and I were able to respond to the governor’s request for mask testing only because of the skills and experience that come from years of being in the lab – but what could those skills have led to if we hadn’t lost the past two years? What more could my students have achieved if they hadn’t lost that time?</p>
<p>Despite the good we have done, those questions still bother me. </p>
<p>However, I am optimistic that the pandemic might end up being good for aerosol research. I no longer get blank stares when I mention airborne particles, and maybe this pandemic will attract new bright students to a field about which I am so passionate.</p>
<p></p><hr><p></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/437892/original/file-20211215-17-s16abl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Thousands of shipping containers stacked on a dock." src="https://images.theconversation.com/files/437892/original/file-20211215-17-s16abl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/437892/original/file-20211215-17-s16abl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437892/original/file-20211215-17-s16abl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437892/original/file-20211215-17-s16abl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437892/original/file-20211215-17-s16abl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437892/original/file-20211215-17-s16abl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437892/original/file-20211215-17-s16abl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Scientific supplies – from chemicals to plastic containers – were all affected by supply chain issues.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/SupplyChainShipping/ad81987130834374ab54ea850e417ce7/photo?Query=supply%20chain&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=1736&currentItemNo=25">AP Photo/Noah Berger</a></span>
</figcaption>
</figure>
<h2>Resource sharing to overcome supply chain issues</h2>
<p><strong>Erin Lavik, Professor of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County</strong></p>
<p>My lab – where my colleagues and I <a href="https://scholar.google.com/citations?user=vptJat0AAAAJ&hl=en&oi=ao">study biomaterials to control bleeding, deliver drugs and build tissues</a> – was shut down in March 2020 because of the coronavirus. When labs on campus began to reopen that June, we worked with a skeleton crew to restart our projects.</p>
<p>We expected there to be challenges getting certain supplies and <a href="https://asm.org/Articles/2020/September/Laboratory-Supply-Shortages-Are-Impacting-COVID-19">chemicals</a> that were necessary for vaccine production, but I was utterly surprised by <a href="https://theconversation.com/why-you-should-expect-more-suez-like-supply-chain-disruptions-and-shortages-at-your-local-grocery-store-158266">how hard it was to get everything</a>. Plasticware that we use in experiments became impossible to find. Many <a href="https://www.the-scientist.com/news-opinion/supply-shortages-hit-life-science-labs-hard-68695">chemicals were back-ordered for months, if not years</a>.</p>
<p>To keep scientific projects moving forward, my lab and many others on campus have banded together and have been sharing supplies and looking after one another’s projects. Because of unexpected sudden quarantines, we cannot afford to just do our work – we need to know what others are doing and be willing and able to step in at a moment’s notice to complete a chemical reaction, take care of some cells in a petri dish or record important data. </p>
<p>The challenges of limited supplies and quarantines are not over and may even be getting worse. But through the collaborative systems my colleagues and I have built, we have been able to keep research moving forward, albeit at a slower pace. And like everyone, we have all gotten better at the process of collaborating remotely, too.</p>
<p></p><hr><p></p>
<h2>Teaching the public directly</h2>
<p><strong>Tony Schmitz, Professor of Mechanical, Aerospace and Biomedical Engineering, University of Tennessee, Knoxville</strong></p>
<p>The challenges of the pandemic are significant and continuing, but my personal experience at the intersection of COVID-19 and science has been unexpectedly positive.</p>
<p>I run the Machine Tool Research Center and <a href="https://scholar.google.com/citations?user=FLWGrZYAAAAJ&hl=en&oi=ao">study ways to improve and speed up the process of manufacturing parts</a>. Machining is important because it remains a critical process for manufactured products, but the U.S. workforce is in <a href="https://www.wbur.org/hereandnow/2021/05/27/manufacturing-open-jobs-us">sharp decline</a>. When the University of Tennessee transitioned from in-person to online instruction, this new time away from the office gave me the opportunity to produce video and written content that explains the science and modern skills of machining to a lay audience. </p>
<p>The <a href="https://mtrc.utk.edu/ace/">online training</a> I developed is like a flight simulator for machining. No prior experience is necessary, and it provides step-by-step instructions for computer-aided manufacturing skills. It explains the geometry and physics of machining and simulates the real-world vibrations and sounds of making parts. </p>
<p>I was not alone in having time on my hands though. Disruptions to education and the supply chain provided time for both students and manufacturing professionals to explore the online training I made. In one sense, the two factors created the perfect storm for nontraditional learning in machining, and the response has been fantastic. Since its launch in December 2021, 1,756 people have registered for the class, and 676 people completed it. These participants comprised 36% industry workers and 64% students and represented 47 states. </p>
<p>It has been fantastic to have an opportunity to teach machining in a unique way to a broader audience, and I will continue to do so. The Department of Defense is funding the effort, and in the future I plan to grow the network and add in-person training locations that complement the online instruction. Despite the many hardships the shutdowns caused, this would not have been possible in a normal year.</p>
<p></p><hr><p></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/437895/original/file-20211215-27-fx2lcp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman wearing virtual reality goggles." src="https://images.theconversation.com/files/437895/original/file-20211215-27-fx2lcp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/437895/original/file-20211215-27-fx2lcp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437895/original/file-20211215-27-fx2lcp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437895/original/file-20211215-27-fx2lcp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437895/original/file-20211215-27-fx2lcp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437895/original/file-20211215-27-fx2lcp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437895/original/file-20211215-27-fx2lcp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Virtual reality can mimic many in-person experiences.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/businesswoman-wearing-virtual-reality-simulator-royalty-free-image/1322226152?adppopup=true">Westend61 via Getty Images</a></span>
</figcaption>
</figure>
<h2>Using tech when you can’t meet in person</h2>
<p><strong>Nilanjan Banerjee, Professor of Computer Science and Electrical Engineering, University of Maryland, Baltimore County</strong></p>
<p>At the Mobile Pervasive and Sensor Systems Lab, my colleagues and I seek to understand how people’s physical states – like stress, for example – <a href="https://scholar.google.com/citations?user=mzSAFhQAAAAJ&hl=en&oi=ao">affect the performance of a group</a>. To study this, we need to collect physiological data like heart rate and heart rate variability from subjects while they play group games in person. </p>
<p>Unfortunately, having people meet in person to play games has been impossible for much of the past two years, thanks to the coronavirus. For many situations, remote conference tools can get the job done even if they are <a href="https://theconversation.com/got-zoom-fatigue-out-of-sync-brainwaves-could-be-another-reason-videoconferencing-is-such-a-drag-172380">a bit more tiring than meeting in person</a>. But a Zoom call simply can’t emulate the immersive environment required for group games and the physical responses that I study.</p>
<p>If my colleagues and I wanted to continue our research, we needed an immersive but safe way for our study participants to interact. So, we developed virtual reality games. Over the months that we relied on virtual reality, my colleagues and I realized that not only did these games work, in fact, they turned out to be better than in-person games because the virtual environment is completely free of distractions. </p>
<p>[<em>Over 140,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-140ksignup">Sign up today</a>.]</p>
<p>Developing virtual reality games and making them as realistic as possible is not cheap. But compared with a normal in-person study, this is a simple, inexpensive and effective platform to study how people in groups perform under different conditions. Since it allows our team to study these things without the need for subjects to be in the same room all at once, we plan to continue using this platform for future large-scale studies even post-pandemic.</p><img src="https://counter.theconversation.com/content/173482/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christian L'Orange has received funding from NIOSH and WHO.</span></em></p><p class="fine-print"><em><span>Tony Schmitz receives funding from DoD IBAS.</span></em></p><p class="fine-print"><em><span>Erin Lavik and Nilanjan Banerjee do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Supply chain issues, emergency science, social distancing requirements and a lot more free time offered both challenges and opportunities for research scientists.Christian L'Orange, Assistant Research Professor of Mechanical Engineering, Colorado State UniversityErin Lavik, Professor of Chemical, Biochemical, and Environmental Engineering, University of Maryland, Baltimore CountyNilanjan Banerjee, Associate Professor of Computer Science and Electrical Engineering, University of Maryland, Baltimore CountyTony Schmitz, Professor of Mechanical, Aerospace and Biomedical Engineering, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1694622021-10-25T01:02:53Z2021-10-25T01:02:53ZHow to support a person with dementia as lockdowns ease<figure><img src="https://images.theconversation.com/files/427718/original/file-20211021-19-i7n81o.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-home-carer-supporting-old-woman-1815235466">Shutterstock</a></span></figcaption></figure><p>Lockdowns lasting months in some states have seen tight restrictions on visitors to nursing homes. So as lockdowns ease, and if you’re vaccinated, you might be planning a happy reunion with your friend or family.</p>
<p>If your loved one has dementia, you might be wondering if their symptoms have worsened in lockdown, or if they remember who you are.</p>
<p>Here’s what to look out for on your first visit after lockdowns end, and how to support your loved one after that.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-people-with-dementia-dont-all-behave-the-same-100960">Why people with dementia don't all behave the same</a>
</strong>
</em>
</p>
<hr>
<h2>Expect some decline</h2>
<p>Lockdowns can result in decline in people with dementia, particularly those living in nursing homes.</p>
<p><a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00327-8/fulltext">Research</a> from lockdowns in 2020 showed people with dementia had more trouble thinking and problem solving. Their behaviour and mood worsened. Some studies showed people were less able to do things around the home or look after themselves. </p>
<p>Keeping mentally, physically and socially active helps people with dementia maintain their brain and thinking. But in lockdown, when people with dementia did less, they exercised their brains and bodies less.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-best-to-celebrate-christmas-with-a-person-with-dementia-21110">How best to celebrate Christmas with a person with dementia</a>
</strong>
</em>
</p>
<hr>
<p>Lockdowns not only meant a ban on visitors to nursing homes, but limited stimulation from group activities, such as concerts, visits from schools and bus outings.</p>
<p>During lockdowns, nursing home residents (<a href="https://www.aihw.gov.au/reports/australias-health/dementia">more than half</a> have dementia) also got worse in terms of their <a href="https://ltccovid.org/2021/01/19/safe-visiting-at-care-homes-during-covid-19-a-review-of-international-guidelines-and-emerging-practices-during-the-covid-19-pandemic/">thinking and well-being</a>. </p>
<p>Residents sometimes didn’t understand why they couldn’t move freely around the nursing home, and why their loved ones had stopped visiting. This led to increases in behaviours, such as agitation.</p>
<p>After lockdowns began, there has been <a href="https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30370-7/fulltext">an increase</a> <a href="https://www.medrxiv.org/content/10.1101/2020.11.26.20239525v1.full-text">in prescriptions</a> of psychotropic medications reported internationally. These medications are used in nursing homes to manage behaviours such as aggression and agitation.</p>
<h2>The first visit can be difficult</h2>
<p>Some families might be worried about their first visit in several months to a person living with dementia. </p>
<p>They might be concerned their loved one has gotten worse, or scared they won’t recognise them. </p>
<p>But it may help to think of visits as providing really important mental stimulation and human connection for your loved one, even though visits might be difficult emotionally for you. </p>
<p>Introduce yourself: “Hi Dad, it’s Ali”, if it looks like your loved one can’t quite place who you are or your name. </p>
<p>Read their reactions to you. If they need time to warm up to you (which might be disappointing if you are close), chat with someone else who is there. The person might enjoy your company even if they aren’t actively participating in the conversation at first.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427719/original/file-20211021-14-bal18c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Elderly lady doing crafts with a carer, outside at a table" src="https://images.theconversation.com/files/427719/original/file-20211021-14-bal18c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427719/original/file-20211021-14-bal18c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=358&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427719/original/file-20211021-14-bal18c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=358&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427719/original/file-20211021-14-bal18c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=358&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427719/original/file-20211021-14-bal18c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=449&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427719/original/file-20211021-14-bal18c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=449&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427719/original/file-20211021-14-bal18c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=449&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Prepare an activity to do together, based on their interests.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/elderly-woman-caregiver-needle-crafts-occupational-1770495194">Shutterstock</a></span>
</figcaption>
</figure>
<p>Then invite them to participate in the conversation by asking them their opinion: “How is the dog going?” or “I’m looking forward to going to the hairdresser, how about you?”.</p>
<p>Prepare an activity to do together based on their interests. You could walk in the garden, browse a magazine about the royal family, sing along to a favourite album.</p>
<p>If it’s a noisy gathering, find a quiet spot for one-on-one conversation, as the person may have trouble focusing when there are several people talking at once.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-tips-on-how-to-talk-to-kids-about-dementia-46924">Five tips on how to talk to kids about dementia</a>
</strong>
</em>
</p>
<hr>
<h2>Let them know when you’ll be back</h2>
<p>Because of your long separation, your loved one might be quite emotional or clingy when you are leaving. </p>
<p>Let them know when you’ll be coming again. You can write this down in their calendar, or on a card to give them. You can also tell the nursing home staff so they can remind them. </p>
<p>You can also leave a visual reminder of your visit. This could be a card or photograph, or some flowers with a note.</p>
<p>If possible, get back into a visiting routine.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427721/original/file-20211021-18-4ruhtz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Elderly woman with bunch of flowers hugging child" src="https://images.theconversation.com/files/427721/original/file-20211021-18-4ruhtz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427721/original/file-20211021-18-4ruhtz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427721/original/file-20211021-18-4ruhtz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427721/original/file-20211021-18-4ruhtz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427721/original/file-20211021-18-4ruhtz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427721/original/file-20211021-18-4ruhtz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427721/original/file-20211021-18-4ruhtz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You could leave some flowers and card as a physical reminder of your visit.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/thank-you-my-dear-excited-aged-1822626431">Shutterstock</a></span>
</figcaption>
</figure>
<h2>If you notice a decline</h2>
<p>Families are more likely to notice small or marked changes in their loved one’s abilities if they have not seen them for several months. That might mean noticing early signs of dementia or worsening symptoms if they’ve already been diagnosed with it.</p>
<p>So this can be a <a href="https://www.health.qld.gov.au/news-events/news/dementia-signs-symptoms-recognise-what-to-do">delicate conversation</a> to have with your loved one.</p>
<p>Many people can be defensive or in denial about changes, put it down to “old age”, and are afraid about having dementia. </p>
<p>You might need to have the conversation several times to get them to see the doctor. Call the <a href="https://www.dementia.org.au/helpline">National Dementia Helpline</a> on 1800 100 500 for advice.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-check-if-your-mum-or-dads-nursing-home-is-up-to-scratch-123449">How to check if your mum or dad's nursing home is up to scratch</a>
</strong>
</em>
</p>
<hr>
<h2>In the longer term, consider rehab</h2>
<p>Rehabilitation <a href="https://www.elsevier.com/books/dementia-rehabilitation/low/978-0-12-818685-5">helps people</a> with dementia. So it’s worth looking into what support services your loved one might need.</p>
<p>A psychologist can help with strategies to manage <a href="https://www.forwardwithdementia.org/au/article/therapies-to-help-memory-and-thinking/">memory and thinking</a>; an occupational therapist can help with doing <a href="https://www.forwardwithdementia.org/au/article/speech-and-occupational-therapy/">day-to-day things around the house</a>; an exercise physiologist or physiotherapist can help with mobility; and a speech pathologist can help with <a href="https://www.forwardwithdementia.org/au/article/speech-and-occupational-therapy/">communication</a>. </p>
<p>Family carers can talk to their loved one’s dementia specialist, or ask their GP for a <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-chronicdisease-pdf-infosheet">Chronic Disease Management Plan</a> for some subsidised rehabilitation sessions.</p>
<h2>If you’re not the main carer</h2>
<p>If you’re not the main family carer, make sure that person has some support. Ask how they are feeling and what support you can offer. </p>
<p>Carers have been <a href="https://academic.oup.com/ageing/advance-article/doi/10.1093/ageing/afab156/6315067">providing more help</a> during lockdowns to people with dementia living in the community. That’s because there have been fewer services on offer, and as people with dementia needed help to comply with restrictions. </p>
<p>Offer to spend some time with the person with dementia so the carer can have a break. Or take the carer out for a meal and some social time now restrictions have eased.</p><img src="https://counter.theconversation.com/content/169462/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lee-Fay Low receives or has received funding from the NHMRC, Federal Department of Health, NSW Government, aged care providers such as HammondCare and The Whiddon Group, and not-for-profit organisations such as Dementia Australia and The Benevolent Society. </span></em></p>Keeping mentally, physically and socially active helps people with dementia maintain their brain and thinking. But in lockdown, when people with dementia did less, this can lead to a decline.Lee-Fay Low, Professor in Ageing and Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1669432021-09-02T20:07:36Z2021-09-02T20:07:36ZVital Signs. Introducing OzSAGE, a source of practical expert advice for how to reopen Australia from COVID safely<figure><img src="https://images.theconversation.com/files/419028/original/file-20210902-15-1lofiax.jpg?ixlib=rb-1.1.0&rect=384%2C301%2C2575%2C1338&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source"> superjoseph/Shutterstock</span></span></figcaption></figure><p>Australia is in the middle of its worst COVID-19 outbreak. Our hospital system is under strain. Vulnerable communities are being hit hard. And more than half the nation is locked down.</p>
<p>There is an understandable desire to know when we can reopen. But there is also an even more important need to know <em>how</em> we can reopen.</p>
<p>The <a href="https://www.pm.gov.au/sites/default/files/media/national-plan-to-transition-australias-national-covid-19-response-30-july-2021.pdf">national plan</a> endorsed by the prime minister and state and territory leaders goes part of the way to answering this question. </p>
<p>It sets thresholds for the proportion of the 16-plus population vaccinated beyond which it says certain restrictions can be less common.</p>
<p>But it doesn’t talk much about the other things we will have to do.</p>
<h2>How we reopen is as important as when</h2>
<p>It’s the big gap in the national approach. And it needs to be filled. Now.</p>
<p>That is what <a href="https://www.ozsage.org">OzSAGE</a> aims to do. OzSAGE is an additional expert resource for governments and business, health, education, community and non-government agencies in Australia.</p>
<p>Inspired by the <a href="https://www.independentsage.org/">UK Independent SAGE</a> (Independent Scientific Advisory Group for Emergencies), OzSAGE members have expertise in public health, infectious diseases, epidemiology, Aboriginal health, engineering, the built environment, occupational hygiene, behavioural and social science, multicultural engagement, communications, law, data science, public policy and economics.</p>
<h2>Ventilation will become a priority</h2>
<p>Our first piece of advice on how to best live with occasional outbreaks centres on ventilation and what we are calling vaccines-plus.</p>
<p><strong>Ventilation</strong> (and filtration) is about providing safe air and limiting transmission in shared spaces. These include workplaces, health and aged care, schools, prisons, social venues and homes, especially where overcrowding is present. COVID is airborne, meaning prevention requires safe air.</p>
<p><strong>Vaccines</strong> are essential to our pandemic exit strategy, but overseas experience shows current vaccines alone are not sufficient to fight the Delta variant. </p>
<p><strong>“Plus”</strong> refers to testing, contact tracing, masks and other non-pharmaceutical strategies that will continue to be required in the medium term to fight Delta, and may need to be scaled up or down depending on severity of the epidemic.</p>
<p>Our first recommendations have been with politicians for a week.</p>
<p>They are released publicly <a href="https://www.ozsage.org/media_releases/september-2/">this morning</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/nWnOR3O-ZF0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">QUT’s Distinguished Professor Lidia Morawska, OzSAGE.</span></figcaption>
</figure>
<p>One of the things that made Australia’s 2020 pandemic response world-leading was that we acted early to keep the virus under control. This gave us options other countries did not have. </p>
<p>As we reopen we should ensure we do so safely enough to retain what economists call “option value” — the ability to adapt to changing circumstances.</p>
<p>Our approach should entail the following elements.</p>
<p><strong>1. Living with occasional outbreaks rather than widespread disease</strong></p>
<p>COVID-19 is here to stay, but we don’t have to resign ourselves to losing all the gains won in 2020. We should aim to control COVID-19 in the same way we control measles, which is even more contagious. </p>
<p>Right now that requires ventilation and “vaccines-plus” to manage outbreaks. But the level of innovation in vaccines is extraordinary. </p>
<p>When boosters or vaccines matched to variants are available, herd immunity ought to be possible using a smart and agile vaccine strategy.</p>
<p><strong>2. Leaving no-one behind</strong></p>
<p>Vaccine targets should be met for all, not only for the population as a whole but also for subgroups, recognising structural and social disadvantage.</p>
<p>These include all Aboriginal and Torres Strait Islander people, residents of remote and regional Australia, and other vulnerable high-risk and disadvantaged groups. </p>
<p>While vaccination is not available yet for all children, we recommend additional steps to protect them and make schools safe.</p>
<p><strong>3. Protecting the health system</strong></p>
<p>Australia has one of the best healthcare systems in the world. Despite this, urgent non-COVID care is already suffering in NSW. </p>
<p>We plan to outline a range of strategies essential to preventing the loss of health workers and protecting hospitals and their patients in cities and in regional areas.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-vaccination-to-ventilation-5-ways-to-keep-kids-safe-from-covid-when-schools-reopen-166734">From vaccination to ventilation: 5 ways to keep kids safe from COVID when schools reopen</a>
</strong>
</em>
</p>
<hr>
<p>The best-laid plans to reopen will be disrupted if the capacity of the health system to deal with COVID and non-COVID care is exceeded by a surge.</p>
<p>I am proud to be part of an expert group that will provide independent, cross-disciplinary advice on how to open up safely.</p>
<h2>What’s next?</h2>
<p>Our advice will be informed by the best evidence, but will be practical. It will provide government, business, and community organisations with a series of tangible measures that can be taken to ensure we can reopen safely.</p>
<p>Nobody knows what 2022 will hold. But we need to ensure Australia is in a position to consolidate its successes and avoid repeating its recent mistakes.</p>
<p>Proper ventilation is a start. We will have more to say in coming weeks.</p><img src="https://counter.theconversation.com/content/166943/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Holden is President-elect of the Academy of the Social Sciences in Australia and an executive member of OzSAGE, the Australian Scientific Advisory Group for Emergencies.</span></em></p>OzSAGE brings together infectious disease and public heath experts, engineers, architects, economists and social scientists. Its first recommendations deal with ventilation and the measures that will have to accompany widespread vaccination.Richard Holden, Professor of Economics, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1647412021-08-18T12:12:25Z2021-08-18T12:12:25ZCorrectional officers are driving the pandemic in prisons<figure><img src="https://images.theconversation.com/files/415045/original/file-20210806-90838-180utg2.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2995%2C1994&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While prison may isolate people from the larger community, it does not isolate them from COVID-19.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-wearing-protective-masks-leave-the-cook-county-jail-news-photo/1217875901">Scott Olson/Staff/Getty Images News</a></span></figcaption></figure><p>Prisons and jails have hosted some of the <a href="https://www.nytimes.com/interactive/2021/us/covid-cases.html">largest COVID-19 outbreaks in the U.S.</a>, with <a href="https://www.nytimes.com/interactive/2021/us/covid-cases.html">some facilities approaching 4,000 cases</a>. In the U.S., which has some of the highest COVID-19 infection rates in the world, 9 in 100 people have had the virus; in U.S. prisons, <a href="https://www.nytimes.com/interactive/2021/04/10/us/covid-prison-outbreak.html">the rate is 34 out of 100</a>.</p>
<p><a href="https://scholar.google.com/citations?hl=en&user=l3emkpsAAAAJ">I study public health issues around prisons</a>. My colleagues and I set out to <a href="https://doi.org/10.3390/ijerph18136873">understand why COVID-19 infection rates were so high</a> among incarcerated individuals. </p>
<p>Using data from the Federal Bureau of Prisons, we discovered the infection rate among correctional officers drove the infection rate among incarcerated individuals. We also found a three-way relationship between the infection rate of officers, incarcerated individuals and the communities around prisons.</p>
<h2>No stranger to outbreaks</h2>
<p>Prisons, jails and other correctional facilities routinely deal with infectious diseases. <a href="https://doi.org/10.1086/521910">Hepatitis B</a> <a href="https://doi.org/10.1016/j.idc.2018.02.014">and C</a> as well as <a href="https://doi.org/10.2105/AJPH.2016.303423">tuberculosis</a> are all incredibly common in prison populations.</p>
<p>Because of that, prisons have established policies and procedures for handling infectious diseases. Many of those policies are the same as those for preventing the spread of COVID-19 – such as medical isolation of individuals with active infections, increased cleaning and surveillance of the disease. </p>
<p>Public health experts have <a href="https://doi.org/10.1086/521910">encouraged prisons to think about the role of correctional officers in infection spread</a> for years and more recently have warned that <a href="http://dx.doi.org/10.15585/mmwr.mm6919e1">correctional officers are a weak link for COVID-19</a> infections in prisons.</p>
<p>Even though prisons have policies for disease control, many of which include guidelines for correctional officers, <a href="https://doi.org/10.1086/521910">prisons are at a disadvantage</a> in stopping the spread of COVID-19. Current prison conditions – including <a href="https://doi.org/10.1016/j.amepre.2021.01.018">poor ventilation</a>, <a href="https://www.prisonpolicy.org/blog/2020/12/21/overcrowding/">overcrowding</a> and a <a href="https://doi.org/10.1007/s11606-020-05968-y">lack of space for social distancing and isolation</a> – make respiratory diseases like COVID-19 very difficult to control. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415054/original/file-20210806-17-19y86fs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Prisoners populate a yard surrounded by razor wire." src="https://images.theconversation.com/files/415054/original/file-20210806-17-19y86fs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415054/original/file-20210806-17-19y86fs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415054/original/file-20210806-17-19y86fs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415054/original/file-20210806-17-19y86fs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415054/original/file-20210806-17-19y86fs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415054/original/file-20210806-17-19y86fs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415054/original/file-20210806-17-19y86fs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Nebraska Department of Correctional Services was forced to declare an overcrowding emergency on July 1, 2020. Capacity in the state’s 10 prisons was at 151%, exceeding the 2015 mandated 140% threshold.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/PrisonCrowdingNebraska/581139315b654cf786085fa5d02693bb">AP Photo/Nati Harnik</a></span>
</figcaption>
</figure>
<p>For instance, before the start of the pandemic, the Federal Bureau of Prisons, along with nine state prison systems, has been <a href="https://www.prisonpolicy.org/blog/2020/12/21/overcrowding/">operating at over 100% capacity</a>. During the pandemic, even with massive early release and home confinement programs, <a href="https://www.prisonpolicy.org/blog/2020/12/21/overcrowding/">many states remain at 100% prisoner capacity – or more</a>. </p>
<p>Additionally, U.S. <a href="https://nij.ojp.gov/topics/articles/workforce-issues-corrections">prisons have been facing chronic staffing shortages</a>. In the federal system, the issue is so severe that staff not trained as prison guards – including nurses – <a href="https://www.nbcnews.com/news/us-news/federal-prisons-forced-use-cooks-nurses-guard-inmates-due-staff-n1268138">are being reassigned to guard the prison population</a>. Short staffing makes the daily business of running a prison difficult during the best of times, not to mention during a pandemic. </p>
<p><a href="https://www.bop.gov/coronavirus/overview.jsp#bop_emergency_response">As early as March 2020</a>, many prisons attempted to mitigate these conditions by granting early release and home confinement. Some also blocked all visitors and outside contractors. While <a href="https://madison.com/ct/news/local/govt-and-politics/early-research-shows-fewer-inmates-flattened-covid-19-curve-at-dane-county-jail/article_7fd4ebb9-59fa-56c2-8952-3668f5d61ad2.html">helpful in some cases</a>, ultimately these actions did little to stop outbreaks. </p>
<h2>Responding to COVID-19</h2>
<p>Initially, public health organizations such as the Centers for Disease Control and Prevention <a href="https://www.latimes.com/science/story/2021-07-27/timeline-cdc-mask-guidance-during-covid-19-pandemic">went back and forth on the need for masks</a>. Then mask mandates became a partisan issue. By midsummer 2020, <a href="https://www.prisonpolicy.org/blog/2020/08/14/masks-in-prisons/">30 states mandated masking for correctional officers, prisoners or both</a>. The Bureau of Prisons <a href="https://www.bop.gov/foia/docs//Mandatory_Use_Face_Coverings_for_Staff_08242020.pdf">adopted a masking policy in late August</a>, requiring correctional officers to mask when social distancing was not possible.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415894/original/file-20210812-20-1ixq4w5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Wearing a protective mask and gloves, a correctional officer sanitizes an inmate transport van." src="https://images.theconversation.com/files/415894/original/file-20210812-20-1ixq4w5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415894/original/file-20210812-20-1ixq4w5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=447&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415894/original/file-20210812-20-1ixq4w5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=447&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415894/original/file-20210812-20-1ixq4w5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=447&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415894/original/file-20210812-20-1ixq4w5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=561&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415894/original/file-20210812-20-1ixq4w5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=561&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415894/original/file-20210812-20-1ixq4w5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=561&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Masking seems to slow the spread in prisons but not halt it.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/wearing-a-protective-mask-and-gloves-elijah-johnson-a-news-photo/1209294310">David L. Ryan/The Boston Globe via Getty Images</a></span>
</figcaption>
</figure>
<p>As the second and third waves of COVID-19 swept through the nation and the federal prison system, the <a href="https://doi.org/10.3390/ijerph18136873">mask mandate made only a small dent</a> in slowing the uptick of infections among prisoners. </p>
<p>Additionally, <a href="https://www.prisonpolicy.org/blog/2021/04/22/vaccinerefusal/">vaccine adoption rates among correctional officers</a> and <a href="https://www.nytimes.com/2021/05/22/us/covid-prison-vaccine.html">incarcerated people</a> are low, weakening this line of defense. Across all states, <a href="https://doi.org/10.1371/journal.pone.0253208">incarcerated people have not been prioritized for the vaccine</a>. Even when the vaccines are available, many incarcerated people are <a href="https://www.nytimes.com/2021/05/22/us/covid-prison-vaccine.html">skeptical about receiving them due to mistrust</a> of prison officials. </p>
<h2>Two-way vectors</h2>
<p>We found the relationship between COVID-19 infections among correctional staff and incarcerated individuals is also shaped by the <a href="https://doi.org/10.3390/ijerph18136873">incidence of COVID-19 in the community</a> surrounding the prison. Because correctional officers move between the prison and the community at the beginning and end of each shift, they can carry COVID-19 between these two spaces. </p>
<p>Even when correctional officers test negative for COVID-19, they can still drive COVID-19 rates both inside and outside the prison via asymptomatic or pre-symptomatic spread. <a href="https://doi.org/10.3390/ijerph18136873">Our data shows</a> that when COVID-19 rates in the outside community get worse, so too do rates among the incarcerated population.</p>
<p>Prison policies aimed at stopping the spread of COVID-19 should be designed with an eye toward controlling the disease in the prison population, among correctional officers and in the community around the prison. </p>
<p>For example, prison systems should be just as concerned with vaccination rates in the communities around prisons as they are with vaccination rates among correctional officers. Both rates will have an impact on the spread of COVID-19 within a prison.</p>
<p>[<em>Over 110,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p><img src="https://counter.theconversation.com/content/164741/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danielle Wallace received funding from the National Science Foundation, surrounding this work, specifically, Award #2032747, “Estimating the Reciprocal Relationship between COVID-19 Infections of Prisoners and Staff and Infections in the Surrounding Communities.”</span></em></p>New research shows correctional officers are vectors of infection, driving COVID-19 rates both inside prisons and in their communities.Danielle Wallace, Associate Professor of Criminology and Criminal Justice, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1657792021-08-16T12:10:21Z2021-08-16T12:10:21ZWhy we missed hugs<figure><img src="https://images.theconversation.com/files/415922/original/file-20210812-25200-1rcoxvk.jpg?ixlib=rb-1.1.0&rect=52%2C26%2C3426%2C2294&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not being able to hold and hug loved ones has been one of the more difficult parts of the pandemic.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/woman-hugs-her-friend-as-she-departs-at-hong-kong-news-photo/1234052378?adppopup=true">Alex Chan Tsz Yuk/SOPA Images/LightRocket via Getty Images</a></span></figcaption></figure><p><a href="https://www.cbsnews.com/news/great-grandmother-gets-to-hug-family-thanks-to-granddaughters-hug-time-invention/">Rose Gagnon</a> could not hug her grandchildren for several months.</p>
<p>Not being able to see and touch her loved ones every day because of COVID-19’s social distancing protocols was taking a toll on the mental health of the 85-year-old. Like many, she was feeling lonely and yearning for an emotional connection that had been hampered by the inability to embrace those most important to her.</p>
<p>That’s when Gagnon’s granddaughter Carly Marinaro devised an innovative solution in the form of a “hug time” device. Inside a frame made of PVC piping, Marinaro fashioned a see-through plastic barrier with two arm attachments, so that grandmother and granddaughter could share a hug while minimizing the risk of exposure to the coronavirus.</p>
<p>Like Gagnon, many Americans have missed the warmth of an embrace, the intimacy of a kiss or the calming feeling of holding someone’s hand. When the Centers for Disease Control and Prevention issued its advice to stay 6 feet apart from others back in March 2020, that suddenly made affectionate touch a scarcity. </p>
<p>As a social scientist, I have been studying the communication of affection for over two decades. <a href="https://www.cambridge.org/core/books/affectionate-communication-in-close-relationships/11E2FEBA4692A64EEBBEFFE8DD99C489">Affectionate communication</a> comes in many forms, and not all of them have been curtailed by the pandemic. Even with social distancing, people can still say “I love you.” They can also share affectionate text messages and social media posts – and thanks to platforms such as Zoom and Skype, they can see each other’s faces and hear each other’s voices. The one experience it has not been able to facilitate, however, is touch. Individuals cannot hug their grandchildren, kiss their friends, or hold the hand of a dying loved one via Microsoft Teams or Google Hangout.</p>
<p>What people have suffered during the pandemic is “<a href="https://doi.org/10.1177/0020764021997485">touch hunger</a>,” a colloquial term for what social scientists call “<a href="https://doi.org/10.1080/01463373.2016.1176942">affection deprivation</a>”, a state in which individuals want or need more affection than they receive. And here’s why that matters. </p>
<h2>Touch hunger impairs well-being</h2>
<p>Similar to regular hunger, touch hunger serves as an alert that something important is missing – in this case, the sense of security, intimacy, and care that comes with tactile contact. As people have taken pains to socially distance, many have discovered the sense of deprivation that can accompany the <a href="https://www.tandfonline.com/doi/full/10.1080/10570314.2014.927071?casa_token=6ocREO8_tQkAAAAA%3AP8VgNx6VBV2f4yvIEVpjYjNJWhvNdHMgPt6t-wCih7KqideOtgbpxkVNdTrAjnegJ7ElVMo73c7q">lack of affectionate touch</a>.</p>
<p>Touch hunger is essential to well-being throughout our life span. Psychologist <a href="https://ruthfeldmanlab.com/">Ruth Feldman</a> has demonstrated that <a href="https://psycnet.apa.org/record/2011-14742-015">touch is instrumental</a> for healthy physical and cognitive development beginning in infancy. During adulthood, affectionate touch contributes to both psychological health and the body’s ability to <a href="https://doi.org/10.1177/1088868316650307">manage stress</a> and <a href="https://doi.org/10.1080/10570314.2020.1850851">reduce inflammation</a>. </p>
<p>And among the elderly, affectionate touch can <a href="https://doi.org/10.1080/01488376.2019.1626320">enhance calmness and responsiveness</a> for those suffering from dementia. Touch is so powerful, in fact, that even <a href="https://doi.org/10.1016/j.jesp.2016.04.001">imagining touch</a> can reduce stress and pain, according to psychologists <a href="https://thecollege.syr.edu/people/faculty/jakubiak-phd-brittany-k/">Brittany Jakubiak</a> and <a href="https://www.cmu.edu/dietrich/psychology/people/core-training-faculty/feeney-brooke.html">Brooke Feeney</a>.</p>
<p>When people feel deprived of touch, therefore, it is understandable that their well-being can suffer. Even in normal times, touch hunger is associated with <a href="https://doi.org/10.1080/10570314.2014.927071">greater stress, anxiety and loneliness</a>; <a href="https://doi.org/10.1080/10510974.2016.1205641">lower-quality sleep</a>; and <a href="https://doi.org/10.1080/01463373.2016.1176942">reduced satisfaction and closeness</a> in romantic relationships. Add to that the restrictions on touch introduced by COVID-19 and it makes sense why so many are suffering. In fact, research has demonstrated that the benefits of affectionate interaction – including touch – are heightened during experiences of distress. </p>
<p>Biological psychologist <a href="https://www.med.unc.edu/psych/directory/karen-grewen/">Karen Grewen</a> and her colleagues have shown that hugging a romantic partner reduces the extent to which stressful situations <a href="https://doi.org/10.1080/08964280309596065">elevate blood pressure and heart rate</a>, whereas psychologist <a href="https://www.cmu.edu/dietrich/psychology/people/core-training-faculty/cohen-sheldon.html">Sheldon Cohen</a> and colleagues found that hugging protects the body against the <a href="https://doi.org/10.1177/0956797614559284">stress of a viral exposure</a>.</p>
<h2>Responding to a lack of affectionate touch</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/416082/original/file-20210813-24-loctu0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man shaking a dog's paw on World Animal Day in Kyiv, Ukraine, in 2017." src="https://images.theconversation.com/files/416082/original/file-20210813-24-loctu0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/416082/original/file-20210813-24-loctu0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/416082/original/file-20210813-24-loctu0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/416082/original/file-20210813-24-loctu0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/416082/original/file-20210813-24-loctu0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/416082/original/file-20210813-24-loctu0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/416082/original/file-20210813-24-loctu0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">For those missing human touch, sharing affection with pets can help.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/dog-festival-and-competition-dedicated-to-world-animal-day-news-photo/870748348?adppopup=true">Oleksandr Rupeta/NurPhoto via Getty Images</a></span>
</figcaption>
</figure>
<p>Not everyone needs the same amount of affectionate touch, of course, any more than everyone needs the same amount of food or sleep. Like many characteristics, <a href="https://doi.org/10.1007/BF02170075">the need for touch</a> varies from person to person, according to communication scholars <a href="https://isearch.asu.edu/profile/39762">Laura Guerrero</a> and <a href="https://communication.sdsu.edu/faculty_and_staff/profile/peter-a.-andersen">Peter Andersen</a>. Some people are even what Andersen calls “<a href="https://doi.org/10.1007/BF00990960">touch avoidant</a>,” meaning they often find interpersonal touch stressful instead of pleasurable.</p>
<p>Receiving touch can be uncomfortable for those with physical conditions such as <a href="https://www.healthline.com/health/what-does-rheuamtoid-arthritis-feel">rheumatoid arthritis</a>, or mental health conditions such as <a href="https://doi.org/10.1016/j.rasd.2013.09.010">autism spectrum disorder</a>. People who have been <a href="https://doi.org/10.1176/appi.ajp.2019.19020212">traumatized</a> or sexually abused may also find touch to be triggering.</p>
<p>It is also worth noting that not all forms of touch are equally beneficial. Some perfunctory touches, such as a handshake, may be largely benign, whereas <a href="https://doi.org/10.1016/j.chiabu.2007.01.003">aggressive or abusive touch</a> often precipitates long-term health detriments. </p>
<p>[<em>Over 100,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>For those who are missing touch, however, research suggests some substitutes. <a href="https://doi.org/10.1163/15685306-12341374">Sharing affection with a pet</a> has stress-alleviating benefits. <a href="https://doi.org/10.1016/j.cobeha.2021.06.012">Self-massage</a>, such as of the hands or neck, can have calming and pain-reducing effects. Even <a href="https://doi.org/10.1109/EMBC44109.2020.9175900">hugging a pillow</a> reduces the brain’s experience of stress. These are all imperfect substitutes, to be sure, but until COVID-19 is a memory, they may be useful for those suffering from touch hunger.</p><img src="https://counter.theconversation.com/content/165779/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kory Floyd receives funding from the National Institutes of Health. </span></em></p>Lack of human touch can lead to greater stress, anxiety and loneliness – and that is what made the social distancing during the pandemic so hard for many.Kory Floyd, Professor of Communication, University of ArizonaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1627502021-08-09T17:55:35Z2021-08-09T17:55:35ZChild and youth mental health problems have doubled during COVID-19<figure><img src="https://images.theconversation.com/files/412969/original/file-20210724-19-ojjyym.jpg?ixlib=rb-1.1.0&rect=393%2C48%2C4568%2C3516&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not only did youth mental health difficulties increase during COVID-19, but they became more prevalent as the pandemic persisted.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>For most children and adolescents, the past year has been a shadow of a typical childhood. Instead, there have been strict stay-at-home orders, repeated opening and closures of schools, social distancing from peers and other supports, limited or no access to sport and extracurricular activities, and many missed milestones such as graduation. </p>
<p>During this time, the family unit has been in crisis as well, with financial instability as well as <a href="https://doi.org/10.1016/S2215-0366(21)00074-2">increased psychological stress for caregivers</a>. Independently and collectively, these events can catalyze mental health difficulties in children and youth. </p>
<p>At the beginning of the pandemic, children and adolescents were the <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html">lowest-risk group with regards to medical concerns and complications</a> from COVID-19. Now, over a year into the pandemic, they have emerged as the invisible casualties of this global crisis. </p>
<h2>Sounding the alarm to a youth mental health crisis</h2>
<p>Many clinicians and child-health practitioners are calling attention to a youth <a href="https://ottawacitizen.com/news/local-news/kids-are-not-doing-well-pediatricians-raise-alarm-bells-about-impact-of-pandemic-on-children">mental health crisis</a>. Recently, national children’s charity Children First Canada declared a <a href="https://childrenfirstcanada.org/campaign/code-pink/">#codePINK</a>, a term commonly used in health-care settings to indicate a pediatric emergency.</p>
<p>Many pediatric hospitals have <a href="https://childrenfirstcanada.org/code-pink/kids-are-in-crisis-canadas-top-advocates-and-experts-unite-to-declare-codepink/">reported a 100-per-cent increase in admissions for mental health problems</a>, upwards of a 200-per-cent increase in admissions for substance use and suicide attempts, and report that <a href="https://doi.org/10.1007/s00787-021-01744-3">70 per cent of children and youth</a> have indicated that the pandemic has affected their mental health. </p>
<p>Our child psychology research team sought to better understand the current state of children’s mental health globally, one year into the pandemic. This <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2782796">research summary, published in <em>JAMA Pediatrics</em></a>, shows that globally, one in four young people is experiencing clinically elevated depressive symptoms, while one in five is experiencing clinically elevated anxiety symptoms. </p>
<p>These rates are all the more alarming when compared to pre-pandemic estimates, which were closer to one in 10 youth having clinically elevated anxiety and depression. This indicates that youth mental health difficulties have likely doubled during COVID-19. </p>
<h2>Child and youth mental health distress may be sustained long term</h2>
<p>When we looked deeper into which youth were struggling the most globally, we found that — consistent with <a href="https://doi.org/10.1016/j.yfrne.2014.05.004">pre-pandemic data</a> — females and older youth were at greater risk for both depression and anxiety difficulties. </p>
<p>We also found that mental health difficulties were more prevalent as the pandemic persisted. This suggests that as the length of the pandemic continued, along with <a href="https://theconversation.com/with-covid-19s-third-wave-were-far-from-all-in-this-together-159178">public health safety measures such as school closures and social distancing</a>, clinically significant anxiety and depression symptoms also increased. This indicates that children and youth globally are struggling with mental health difficulties, and their symptoms are worsening as the pandemic continues. </p>
<h2>What can be done to help children and youth?</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Long rows of lockers in an empty school hallway" src="https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The pandemic and measures such as school closures and social distancing from friends can catalyze mental health difficulties in children and youth.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jonathan Hayward</span></span>
</figcaption>
</figure>
<p>As researchers and psychologists, we are left wondering whether mental health difficulties in youth will continue to persist for years to come. Will their mental health deterioration be one of the most profound impacts of the COVID-19 pandemic? We think so. </p>
<p>Children and adolescents who endured the various disruptions and emotional and physical consequences of the pandemic are the future of our society. To help foster their well-being and our prosperity as a society, now is the time to act to protect the next generation. We have identified three primary objectives for pandemic recovery efforts aimed at improving child and youth mental health. </p>
<h2>1. Take action now</h2>
<p>We can’t wait to make services available to children who are suffering emotionally. We must act now to address a near doubling in mental health difficulties for children and youth during the pandemic. There is a need for government to develop urgent and strategic plans to address the mental health of youth and ensure the provision of accessible and equitable resources to support this initiative. </p>
<h2>2. Return to routine</h2>
<p>Decades of research on child development has shown that <a href="https://depts.washington.edu/isei/iyc/20.4_spagnola.pdf">children thrive in the context of clear and consistent routines and structure</a>. Many of the strategies used to reduce the spread of COVID-19 have forced children and adolescents to stay indoors, resulting in disrupted routines, increased <a href="https://doi.org/10.1111/apa.15966">sedentary time</a> (for example, more screen time, less physical activity) and a reduction in structured activities such as sports, camps and extracurriculars. </p>
<p>Keeping schools open and <a href="https://doi.org/10.1016/j.ynstr.2020.100291">maintaining family routines</a> during the pandemic can protect children’s mental health. It will also be critical to support families by ensuring they have the material and psychological resources needed to help their children. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19-stress-toll-is-a-family-affair-4-ways-to-support-mothers-mental-health-155862">COVID-19 stress toll is a family affair: 4 ways to support mothers' mental health</a>
</strong>
</em>
</p>
<hr>
<h2>3. Mental health supports for children</h2>
<p>To address this ongoing crisis, there is a need for equitable mental health services that are accessible to all children and youth. Investing in new models of care that can be adapted to increase scalability should be prioritized. This includes group and individual <a href="http://dx.doi.org/10.1037/cap0000259">telemental health services</a> (mental health services delivered by phone, texting or videoconference) and brief intervention approaches. Emerging research awaiting peer review suggests that single-session interventions for adolescent depression during COVID-19 <a href="https://doi.org/10.31234/osf.io/ved4p">can effectively reduce feelings of depression and hopelessness among youth</a>. Increased access to, and availability of, mental health resources are critical. </p>
<p>Children and youth represent our largest investment in the future. The mental health implications of COVID-19 have been particularly dire. Although there have been some COVID-19 recovery initiatives <a href="https://pm.gc.ca/en/news/news-releases/2021/04/28/investing-young-canadians">targeted at this group</a>, we need clear and actionable items to move forward with a mental health recovery plan that will address the increased severity of mental illness in children and adolescents and the rising need for services. </p>
<p>Ultimately, the policy choices we make now will have long-lasting effects on the prosperity of the next generation of youth. There is an urgent and rising demand for child and youth mental health services in Canada. Parents, practitioners, allies and policy-makers need to come together to develop methods of mental health service delivery with widespread impact to meet this demand.</p><img src="https://counter.theconversation.com/content/162750/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brae Anne McArthur receives funding from Alberta Children's Hospital Research Institute, the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, and the Children and Screens Institute of Social Media and Child Development. She is affiliated with the Family Psychology Place. </span></em></p><p class="fine-print"><em><span>Nicole Racine receives funding from the Social Sciences and Humanities Research Council, Alberta Innovates, the Canadian Institutes of Health Research, and the Children and Screens Institute of Social Media and Child development. She is affiliated with the Family Psychology Place and Strong Minds, Strong Kids.</span></em></p><p class="fine-print"><em><span>Sheri Madigan receives funding from the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, the Alberta Children's Hospital Foundation, the Canada Research Chairs program, and Children and Screens: Institute of Digital Media and Child Development.</span></em></p>New research shows the dire effects of the pandemic on the mental health of children and youth, with as many as 25 per cent of young people affected. Immediate action can help address this distress.Brae Anne McArthur, Postdoctoral Research Fellow, Determinants of Child Development Lab, University of CalgaryNicole Racine, Postdoctoral Research Fellow, Psychology, University of CalgarySheri Madigan, Associate Professor, Canada Research Chair in Determinants of Child Development, Owerko Centre at the Alberta Children’s Hospital Research Institute, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1652562021-08-09T08:48:12Z2021-08-09T08:48:12ZLockdowns make people lonely. Here are 3 steps we can take now to help each other<figure><img src="https://images.theconversation.com/files/415125/original/file-20210809-23-1pdqx8j.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5982%2C3988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Millions of Australians are currently living under lockdowns in an effort to curb the rapid spread of the Delta variant of COVID-19.</p>
<p>While lockdowns and other social distancing restrictions are important strategies to protect Australians’ physical health during the pandemic, it’s no secret they take a significant toll on mental health.</p>
<p>As well as financial stressors, including the loss of work, prolonged or frequent lockdowns can affect mental health by disrupting social routines. This puts people in lockdown at risk of loneliness.</p>
<p>So with lockdowns and social restrictions likely to be a part of life in Australia until a significant majority of us are fully vaccinated, it’s timely to think about what we can do to look out for people who may be vulnerable.</p>
<h2>Lockdowns and loneliness</h2>
<p>Lockdowns reduce our opportunities to connect with loved ones in person, and slow our ability to develop or foster new connections. Many families are also divided across borders — both domestic and international — with little certainty as to when they’ll be able to reunite.</p>
<p>We collected data from the United Kingdom, the United States and Australia, examining loneliness levels in relation to the severity of social restrictions during the first six months of the pandemic. </p>
<p>Although our research is yet to be published, we found, somewhat unsurprisingly, that as social restrictions eased, loneliness levels also dropped significantly. </p>
<figure class="align-center ">
<img alt="A man rests his head on his hands." src="https://images.theconversation.com/files/415163/original/file-20210809-15-6fh20y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415163/original/file-20210809-15-6fh20y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415163/original/file-20210809-15-6fh20y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415163/original/file-20210809-15-6fh20y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415163/original/file-20210809-15-6fh20y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415163/original/file-20210809-15-6fh20y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415163/original/file-20210809-15-6fh20y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">During lockdowns, the social contact we can have with others face-to-face is limited. This can take a toll on well-being.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-man-covering-his-face-hands-701935606">Shutterstock</a></span>
</figcaption>
</figure>
<p>While it’s normal to feel lonely from time to time, some people are <a href="https://pubmed.ncbi.nlm.nih.gov/32524169/">at higher risk</a> of problematic levels of loneliness. We found being aged 18-25, being unemployed, and living alone were among the factors that predicted higher levels of loneliness.</p>
<h2>Why should we care about loneliness?</h2>
<p>For some people, experiencing persistent or distressing levels of loneliness can lead to poor health. In part, this may be because loneliness creates a physiological <a href="https://www.sciencedirect.com/science/article/abs/pii/S0889159102000739?via%3Dihub">stress</a> response. </p>
<p>Researchers from <a href="https://academic.oup.com/abm/advance-article-abstract/doi/10.1093/abm/kaaa044/5899648?redirectedFrom=fulltext">Denmark</a> found loneliness increases a person’s chance of developing heart disease by 20%, and type 2 diabetes by 90% within a five-year period. </p>
<p>While people with <a href="https://pubmed.ncbi.nlm.nih.gov/22570258/">a mental health disorder</a> are more likely to report being lonely, it goes the other way too. Loneliness predicts <a href="https://pubmed.ncbi.nlm.nih.gov/27124713/">more severe depression</a>, social anxiety and paranoia. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-hard-to-admit-were-lonely-even-to-ourselves-here-are-the-signs-and-how-to-manage-them-143987">It's hard to admit we're lonely, even to ourselves. Here are the signs and how to manage them</a>
</strong>
</em>
</p>
<hr>
<p>There’s increasing recognition that feeling lonely also costs businesses. Loneliness has been estimated <a href="https://www.campaigntoendloneliness.org/wp-content/uploads/cost-of-loneliness-2017.pdf">to set UK employers back</a> up to £2.53 billion per year, owing to factors such as higher staff turnover, lower job satisfaction and lower productivity. </p>
<p>The adoption of remote working practices beyond the immediate crisis of the COVID-19 pandemic will further limit our ability to form or keep those small, informal but important moments to connect with colleagues. </p>
<h2>How can we help those who may be at risk?</h2>
<p>Loneliness is a personal and distressing experience that can be complex to resolve.</p>
<p>But for people who are lonely, feeling meaningfully connected to others can help. Here are three steps we can all take to help people who may be experiencing loneliness.</p>
<p><strong>1. Listen out</strong></p>
<p>People who are lonely may not readily or explicitly complain about their loneliness due to fear of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0191886920306735?via%3Dihub#bb0170">judgement or stigma</a>. </p>
<p>If they do reach out, a person who is lonely may ask to connect in an indirect or non-urgent way. This can be because people who feel lonely <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/scs.12869">don’t want to burden</a> others. For example, “when you have time, let’s catch up” may appear non-urgent, but it’s important to respond to these requests.</p>
<figure class="align-center ">
<img alt="A hand holds up a smartphone on a video call." src="https://images.theconversation.com/files/415164/original/file-20210809-19-1d8rjsl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415164/original/file-20210809-19-1d8rjsl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415164/original/file-20210809-19-1d8rjsl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415164/original/file-20210809-19-1d8rjsl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415164/original/file-20210809-19-1d8rjsl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415164/original/file-20210809-19-1d8rjsl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415164/original/file-20210809-19-1d8rjsl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We’re lucky to have digital means to communicate during the pandemic. But loneliness remains a significant health problem.</span>
<span class="attribution"><span class="source">Ben Collins/Unsplash</span></span>
</figcaption>
</figure>
<p><strong>2. Check in and share</strong></p>
<p>Living in a lockdown is stressful, but it’s a shared experience. It presents us with <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11489-y">opportunities to show kindness</a> to people we may not know well. A simple “hello” can go a long way for many. </p>
<p>Asking others how they are can become part and parcel of our conversations with each other. Indeed, checking in — even with people who we may not know well, such as co-workers, neighbours, or the barista at the local coffee shop — is becoming the new normal.</p>
<p>Where appropriate, more often than not, sharing our lockdown experiences can create an opportunity to bond with and support each other.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-the-kids-alright-social-isolation-can-take-a-toll-but-play-can-help-146023">Are the kids alright? Social isolation can take a toll, but play can help</a>
</strong>
</em>
</p>
<hr>
<p><strong>3. Ask the right questions</strong></p>
<p>If someone shares they are feeling lonely, asking “is there anything I can do to help?” facilitates the conversation and lets others know you are there without judgement. </p>
<p>Don’t assume what works for you will work for someone else. Ask them “what do you think could help you?”</p>
<h2>Being proactive</h2>
<p>Since the pandemic began, many Australians have discovered different ways to keep in touch beyond the zoom call. These include things like writing stories and letters, leaving care packages, and exercising with a friend (while socially distanced and with masks). </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1422748158363267082"}"></div></p>
<p>Millions of Australians are living with multiple sources of stress right now. But it’s not impossible to show emotional support and care to people around us while still sticking to social distancing rules.</p>
<p>Employers must also take proactive steps to keep workers engaged with each other and to the organisation.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lonely-in-lockdown-youre-not-alone-1-in-2-australians-feel-more-lonely-since-coronavirus-142724">Lonely in lockdown? You're not alone. 1 in 2 Australians feel more lonely since coronavirus</a>
</strong>
</em>
</p>
<hr>
<p>So long as lockdowns are used as a strategy against the virus, there will be a social cost to our well-being. But that only makes it more important than ever that we make the effort to stay meaningfully connected to others.</p><img src="https://counter.theconversation.com/content/165256/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle H Lim is the Chairperson and Scientific Chair of Ending Loneliness Together, a not-for-profit national organisation. She is also the Co-Director of the Global Initiative on Loneliness and Connection. She has received research funding from Barbara Dicker Brain Sciences Foundation and Nextdoor Inc.
</span></em></p>With lockdowns likely to be a part of life in Australia until a significant majority of us are vaccinated, it’s timely to think about what we can do to look out for people who may be vulnerable.Michelle H Lim, Senior Lecturer and Clinical Psychologist, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1631202021-07-22T17:42:10Z2021-07-22T17:42:10ZPandemic has teens feeling worried, unmotivated and disconnected from school<figure><img src="https://images.theconversation.com/files/407480/original/file-20210621-14-10blweu.jpg?ixlib=rb-1.1.0&rect=11%2C0%2C3982%2C2616&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Students nearing the end of high school worried about their schoolwork and education more than younger students.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/senior-student-ariana-diaz-with-a-plexiglass-barrier-in-the-news-photo/1231929484">Al Seib / Los Angeles Times via Getty Images</a></span></figcaption></figure><p>When the COVID-19 pandemic started, many U.S. teens were more worried about the disruption to their education than the possibility of getting sick. A May 2020 survey of high school students found that they reported <a href="https://doi.org/10.1016/j.jadohealth.2020.11.010">academics and work habits</a> to be among their biggest challenges, ahead of mental and physical health. Nearly three-quarters (72%) indicated they were <a href="https://psycnet.apa.org/fulltext/2020-50562-001.pdf">“very much” concerned</a> with how COVID-19 would impact their school year.</p>
<p>As a <a href="https://scholar.google.com/citations?user=jB3jAv8AAAAJ&hl=en">researcher who studies adolescent development</a>, I was interested in whether and how teens’ school stress changed as the pandemic dragged on. So during the fall of 2020, <a href="https://hdfs.uconn.edu/person/rebecca-puhl/">my colleague</a> and I surveyed adolescents about their academic concerns and the changes they noticed in school social dynamics.</p>
<p>Our study, published in <a href="https://doi.org/10.1037/spq0000443">School Psychology</a>, revealed that some school challenges increased, while others stayed about the same. </p>
<h2>Education concerns</h2>
<p>The 452 adolescents, aged 11-17, that we surveyed reported that they still worried about how COVID-19 would impact their schoolwork. And concerns about academic motivation were most common. Teens most frequently worried about not being able to motivate themselves to do, or focus on, schoolwork. </p>
<p>These academic worries were elevated among older students who were further along in secondary school, for whom graduation and college planning are more imminent.</p>
<p>While our study did not collect academic achievement data, links between school stress and <a href="https://doi.org/10.1007/s40688-014-0044-4">poorer academic outcomes</a> highlight the importance of alleviating students’ academic worries in order to reduce potential pandemic-related <a href="https://www.pnas.org/content/118/17/e2022376118">learning loss</a>.</p>
<h2>Less support from teachers</h2>
<p>In the early months of the pandemic, nearly <a href="https://www.surveymonkey.com/curiosity/common-sense-media-coronavirus/">one in four teens</a> said they connected with teachers less than once a week after in-person school activities were canceled. We found this limited communication with teachers persisted into the 2020-2021 school year. </p>
<p>In fact, nearly 70% of the teens in our sample reported communicating less frequently with teachers since the start of the COVID-19 pandemic. Many also perceived a decline in academic and emotional support from teachers, reported by 61% and 48% of the sample, respectively.</p>
<p>Of course, it is critical to recognize how teachers’ lives have also been upended by the pandemic. Having to navigate family obligations, <a href="https://www.ijopr.com/download/teachers-experiences-of-stress-and-their-coping-strategies-during-covid-19-induced-distance-teaching-8475.pdf">technology challenges</a>, <a href="https://internal-journal.frontiersin.org/articles/10.3389/fpsyg.2020.620718/full#B8">psychological strain</a> and COVID-19 health concerns, for example, may contribute to <a href="https://doi.org/10.1016/j.ijedro.2020.100016">teacher burnout</a> and <a href="https://doi.org/10.1080/2372966X.2020.1855473">mental health declines</a>.</p>
<h2>Cyberbullying</h2>
<p>Although school is a <a href="https://doi.org/10.1146/annurev-psych-010213-115030">common setting for bullying</a>, we found that distance learning did not necessarily give students a reprieve from being mistreated by peers. Teens in our sample reported that cyberbullying remained relatively consistent since the COVID-19 pandemic began. </p>
<p>In fact a notable proportion – one in three students – reported that cyberbullying “increased” and was “more of a problem” during this time period.</p>
<p>It is possible that these increases reflect <a href="https://doi.org/10.1037/cbs0000215">increases in social media</a> use during the pandemic, given potential links between social media use and <a href="http://www.sciencedirect.com/science/article/pii/S1054139X20301075">cyberbullying</a>. </p>
<p>It is important to note that our study assessed only experiences of general cyberbullying. We believe attention toward teens’ online experiences of bias-based bullying is much needed. One study, conducted in the spring of 2020, found that <a href="https://doi.org/10.1542/peds.2020-021816">nearly half</a> of Chinese American youth were targets of COVID-19-related racial discrimination online.</p>
<h2>Back-to-school tips</h2>
<p>To alleviate teens’ academic worries, schools can cultivate <a href="https://doi.org/10.1016/j.jadohealth.2020.09.026">structure and routine for students</a> as they resume some normalcy. </p>
<p>Social connection and communication between students and teachers should be prioritized, including opportunities for students to express their worries early on. Meeting with guidance counselors for support at the outset of the upcoming school year may help students cope with the transition out of the pandemic. </p>
<p>With the switch back to classroom instruction, schools should also ensure that teachers have the resources they need, including clear administrative guidance, to support students and avoid burnout during this reintegration period.</p>
<p>To get teens excited about the upcoming school year, parents might encourage them to reconnect over the summer with classmates they may have lost touch with during the pandemic. <a href="https://doi.org/10.1177/0265407521998459">Video chatting</a> with friends may help students reestablish social bonds and increase enjoyment of school once the academic year begins. After all, teens often report that they go to school <a href="https://doi.org/10.1002/cd.121">to be with their friends</a>, and such friendships can help them navigate academic demands and other school-related challenges.</p><img src="https://counter.theconversation.com/content/163120/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leah Lessard has received funding from the Society for Research in Child Development and the Society for the Psychological Study of Social Issues.</span></em></p>Students’ academic worries persisted through the pandemic. A developmental scientist offers tips to support young people heading back to school.Leah M. Lessard, Postdoctoral Fellow at the Rudd Center for Food Policy & Obesity, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1634172021-07-22T12:11:04Z2021-07-22T12:11:04ZOur analysis of 7 months of polling data shows friendships, the economy and firsthand experience shaped and reshaped views on COVID-19 risks<figure><img src="https://images.theconversation.com/files/412158/original/file-20210720-23-pkmeor.jpg?ixlib=rb-1.1.0&rect=0%2C20%2C6735%2C3952&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Political leanings and community features predicted support of COVID-19 mitigation measures.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mask-war-royalty-free-image/1257147451">wildpixel/iStock via Getty Images Plus</a></span></figcaption></figure><p>Even though Americans shared the experience of living through a global pandemic, their individual attitudes towards it differed and evolved – sometimes dramatically. </p>
<p><a href="https://scholar.google.com/citations?hl=en&user=Hw_l57UAAAAJ">We</a> <a href="https://scholar.google.com/citations?user=UP31kb4AAAAJ&hl=en">study</a> risk perception. Using public opinion polls and state-level data, we conducted an in-depth analysis of how American attitudes and behaviors changed over the course of the pandemic.</p>
<p>Since the first confirmed COVID-19 case in the U.S., over 33 million Americans have been diagnosed with SARS-CoV-2 and <a href="https://coronavirus.jhu.edu/region/united-states">more than 600,000 have died</a>. We set out to see how attitudes and beliefs correlated with Americans’ risk perceptions, mask wearing and support for other COVID-19 mitigation measures. </p>
<p>Here’s what we discovered.</p>
<h2>Public health and politics are intertwined</h2>
<p>Using statistical modeling, we dug into data from public opinion polls conducted by Pew Research Center, National Opinion Research Center, Democracy Fund and UCLA – as well as our own survey combined with state-level data from the Centers for Disease Control and Prevention and Moody’s Analytics and National Conference of State Legislatures. </p>
<p>In a presidential election year <a href="https://www.pewresearch.org/2021/03/05/a-year-of-u-s-public-opinion-on-the-coronavirus-pandemic/">characterized by intensifying polarization</a>, public health got caught up in politics. </p>
<p>In March 2020, with uncertainty surrounding COVID-19, contrasting cues from political leaders undoubtedly played a crucial role in shaping risk perception of the virus.</p>
<p>Conservatives who had more confidence in President Trump and his team’s handling of COVID-19, <a href="https://doi.org/10.1016/j.socscimed.2020.113235">perceived less risk from the virus</a> compared to conservatives with less confidence in Trump. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/410197/original/file-20210707-15-vew72g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three middle-aged women at a rally wearing Trump hats." src="https://images.theconversation.com/files/410197/original/file-20210707-15-vew72g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/410197/original/file-20210707-15-vew72g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410197/original/file-20210707-15-vew72g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410197/original/file-20210707-15-vew72g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410197/original/file-20210707-15-vew72g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410197/original/file-20210707-15-vew72g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410197/original/file-20210707-15-vew72g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Political leaders shaped risk perception.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/with-few-face-masks-and-no-social-distancing-to-reduce-the-news-photo/1282732670">Chip Somodevilla via Getty Images News</a></span>
</figcaption>
</figure>
<p>The powerful influence of political cues persisted. Based on our <a href="https://www.voterstudygroup.org/publication/nationscape-data-set">analysis of a poll conducted in June 2020</a>, Republicans who were in favor of Trump were less supportive of mitigation measures – like canceling gatherings, closing businesses and schools, restricting non-essential travel and fever testing before entering public buildings – <a href="https://doi.org/10.3389/ijph.2021.1604037">compared to Republicans who were less supportive of Trump</a>. </p>
<p>Symmetrically, Democrats who were in favor of then candidate Joe Biden were more supportive of mitigation measures, <a href="https://doi.org/10.3389/ijph.2021.1604037">compared to Democrats who were less supportive of Biden</a>. </p>
<p>By May 2020, national political influence began to be mirrored at the state level. Americans who lived in states with both Democratic governors and legislatures were <a href="https://doi.org/10.1177/08901171211017286">more likely to perceive COVID-19 as a threat</a> and adjust their behaviors and support policy measures to mitigate transmission of the virus. </p>
<h2>Connected communities more likely to slow the spread</h2>
<p>When the pandemic was rapidly spreading in early summer of 2020, the CDC <a href="https://www.cdc.gov/coronavirus/2019-ncov/php/mask-evaluation.html">recommended wearing masks</a>. Americans with more extensive social connections and stronger trust in others were <a href="https://doi.org/10.1016/j.healthplace.2021.102537">more likely to engage in mitigation behaviors</a> such as mask wearing. </p>
<p>Individual behavior is <a href="https://doi.org/10.1016/j.healthplace.2021.102537">influenced by one’s community</a> – such as family, friends and neighbors. As information on the pandemic spread, counties where residents had stronger and closer connections with others started to show a <a href="https://doi.org/10.1371/journal.pone.0245135">slower increase in COVID-19 cases</a>, as people adopted more infection mitigation measures. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/410198/original/file-20210707-19-vyzcxg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Masked riders on the subway" src="https://images.theconversation.com/files/410198/original/file-20210707-19-vyzcxg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/410198/original/file-20210707-19-vyzcxg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410198/original/file-20210707-19-vyzcxg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410198/original/file-20210707-19-vyzcxg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410198/original/file-20210707-19-vyzcxg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410198/original/file-20210707-19-vyzcxg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410198/original/file-20210707-19-vyzcxg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People in areas with greater social connection were more likely to change their behaviors.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/passengers-wear-face-masks-while-traveling-through-the-news-photo/1267735676">Robert Nickelsberg via Getty Images News</a></span>
</figcaption>
</figure>
<p>Also, people with stronger and closer connections with others were <a href="https://doi.org/10.1016/j.healthplace.2021.102537">more likely to act for the common good</a> with the expectation that others would do the same. Trust promoted social coordination, which provided incentive for people to take similar actions such as wearing masks in response to COVID–19. </p>
<h2>COVID-19 survivors less likely to support distancing</h2>
<p>In summer 2020, when COVID-19 continued to infect thousands of Americans a day, the <a href="https://www.cdc.gov/coronavirus/2019-ncov/php/mask-evaluation.html">CDC recommended mitigation measures</a> such as canceling gatherings, closing schools and restricting non-essential travel.</p>
<p>Americans who contracted COVID-19 – or whose family members had been sick with the coronavirus – <a href="https://doi.org/10.3389/ijph.2021.1604037">didn’t necessarily support mitigation measures</a> after their illness. Perhaps acquiring some measure of immunity by surviving COVID-19 lessened their perceived threat. As philosopher Friedrich Nietzsche once said, “<a href="https://en.wikipedia.org/wiki/What_does_not_kill_me_makes_me_stronger">What does not kill me makes me stronger</a>.”</p>
<p>Interestingly, Americans who had coworkers and others in their social circle get COVID-19 were <a href="https://doi.org/10.3389/ijph.2021.1604037">more likely than others to support mitigation measures</a>. It may be those with indirect experience became more anxious about contracting the virus themselves by hearing “horror stories” from others.</p>
<h2>Economic recovery falsely signaled safety</h2>
<p>In late August to early September 2020, Americans from states whose economies had recovered close to pre-pandemic levels <a href="https://doi.org/10.1177/08901171211017286">became less concerned about the pandemic</a> and were more likely to forgo mitigation behaviors. We suspect economic recovery provided people with the impression that a return to normal was around the corner, which helped form a false sense of safety. </p>
<h2>Risk mitigation closely linked to cases and deaths</h2>
<p>COVID-19 case numbers and death rates influenced whether or not people adopted risk mitigation behaviors. Generally speaking, <a href="https://doi.org/10.1177/08901171211017286">more cases</a> and <a href="https://doi.org/10.1016/j.healthplace.2021.102537">deaths</a> influenced people to see the virus as a more urgent threat, which resulted in active mitigation behaviors. </p>
<p>Meanwhile, in places with a low number of confirmed cases or deaths, <a href="https://doi.org/10.1177/08901171211017286">residents were likely to perceive the risk as abstract and distant</a>. Consequently, their motivation to control the transmission of the virus was weak.</p>
<p>Overall, our research shows the combination of timely information with trusting, well-connected communities, is most likely to result in collective risk mitigation behavior. Perhaps these insights can help the U.S. prepare better for the next pandemic.</p>
<p>[<em>Research into coronavirus and other news from science</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-corona-research">Subscribe to The Conversation’s new science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/163417/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Multiple factors determined whether or not individual Americans adopted COVID-19 safety measures, according to statistical analysis of public opinion data.Wanyun Shao, Assistant Professor of Geography, University of AlabamaFeng Hao, Assistant Professor of Sociology, University of South FloridaLicensed as Creative Commons – attribution, no derivatives.